text:
); 89-96
10.25259/IJMSR_62_2020
Artificial Intelligence in Musculoskeletal Radiology: Past, Present, and Future
Mayur Pankhania
Sahyog Imaging Centre, Department of Radiodiagnosis, PDU Medical College and Government Hospital, Rajkot, Gujarat, India
*Corresponding author: Mayur Pankhania, Sahyog Imaging Centre, Department of Radiodiagnosis, PDU Medical College andGovernment Hospital, Rajkot, Gujarat, India. mayurpankhania@gmail.com
© 2019 Published by Scientific Scholar on behalf of Indian Journal of Musculoskeletal Radiology
How to cite this article: Pankhania M. Artificial intelligence in musculoskeletal radiology: Past, present, and future. Indian J Musculoskelet Radiol 2020;2(2):89-96.
Musculoskeletal radiology is an important tool for the diagnosis of muscle damage, bone fractures, bone tumors, musculoskeletal infection, and other diseases. However, all currently used radiological techniques, including radiography, ultrasonography, computed tomography, and magnetic resonance imaging are associated with their own challenges. With its ability to address these challenges, artificial intelligence (AI) holds the promise to transform a musculoskeletal radiologist's job in several areas. In the past, AI-based approaches in musculoskeletal radiology were primarily used for measuring bone mineral density or identifying bone tumors. However, recent studies have expanded the application of AI in several other areas, such as image segmentation, resolution enhancement, and fracture identification as well automatic diagnosis of other forms of musculoskeletal damage. This review article discusses numerous older as well as more recent studies to highlight how the development and application of AI-based approaches have evolved in the field of musculoskeletal radiology and how the applicability of these approaches may be improved in the future.
Musculoskeletal diseases and damage conditions present a plethora of complex possibilities for radiologists and orthopedics alike. In the clinic, radiology is a crucial tool used for the diagnosis (that is, identification) of musculoskeletal damage, fractures, bone tumors, musculoskeletal infection, and other diseases.[1-3] Several techniques are available at the clinician's disposal through the radiology department including X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound. While these techniques have their own strengths, they are not without their weaknesses. For example, MRI sections or slices with high thickness (2.5 mm–4 mm) are associated with partial volume effects which can lead to missed subtle lesions.[4] Moreover, thick slices in MRI imaging can lead to difficulties in assessing the images of tissues that do not strictly lie in a planar orientation including cartilage and ligament tissues.[4] At the same time, radiologists also face challenges when X-ray images have an overlap of anatomical structures.[1] Further, X-rays taken across different radiology visits by a patient may be inconsistent.[1] Similarly, it is difficult to achieve segmentation (or identification of sets of pixels that correspond to curves, lines, or other feature boundaries) of different muscles in CT images.[5] Meanwhile, diagnostic variability from one clinician or radiologist to another is one of the major issues with using ultrasound for diagnosing musculoskeletal problems.[6] These challenges make the diagnoses of musculoskeletal damage, such as bone fractures, difficult. In recent times, numerous studies have focused on addressing the above-mentioned challenges with the help of artificial intelligence (AI) and machine learning (ML).
AI represents an evolving class of computer algorithms and methods that emulate various aspects of human intelligence.[7] Within AI, ML refers to a method that trains computer algorithms to perform a variety of tasks and improves the efficacy and accuracy of these tasks through statistical approaches [Figure 1].[7] One of the most commonly used ML approaches is deep learning (DL), which uses deep neural networks (DNNs) to process large sets of data.[7] Indeed, the fast-paced advancements in AI and ML have accelerated the evolution of health care not only in orthopedics but also in many other fields.[8,9] DL as well as other ML approaches have been found to be useful in musculoskeletal radiology. This review summarizes the state of the art of AI-based approaches in musculoskeletal radiology. Particular focus has been placed on how the use of AI in musculoskeletal radiology has evolved overtime. Further, the need and application of AI in various musculoskeletal radiological approaches, including X-ray, CT, MRI, and ultrasonography, have been discussed. The limitations of these techniques and the manner in which AIand ML-based are being used to overcome those limitations have also been discussed in detail.
Figure 1:: A Venn diagrammatic representation of the hierarchy of artificial intelligence approaches.
Over the past decade, AI has been developed to improve the interpretation of a wide variety of musculoskeletal radiological tests. However, before that, AI-based models had primarily been developed for applications such as the identification of bone tumors, assessment of bone mineral density, and segregation of femoral and tibial features, among other similar tasks.[10-14]
As early as 1963, Lodwick et al. developed a program which had a greater than 80% accuracy for predicting five types of bone tumors through X-ray images, namely, chondroblastoma (87.5%), Ewing's sarcoma (81.8%), fibrosarcoma (81.8%), giant cell tumor (100%), and parosteal sarcoma (100.3%).[11] Later, Mundinger et al. used AI to analyze the texture of bone CT images for the diagnosis of osteoporosis.[14] Similarly, Geraets et al. used AI to predict bone mineral density from X-ray images.[13]
Artificial neural networks applied to musculoskeletal radiology
Today, the importance of adapting AI and ML into day-to-day use in musculoskeletal radiology is being noted by more and more scholars.[9] Recent studies have tried to use AI and ML to transform the field of musculoskeletal radiology by enhancing the quality of assessment that can be derived from radiological techniques. DNNs, radial basis function neural networks, and generative adversarial ML are among the most commonly used AI-related approaches in musculoskeletal radiology. DNNs, such as convolutional neural networks (CNNs), constitute a specific form of DL AI algorithms that allow the compilation of data from multiple characteristics of the same input dataset provided to them.[9] A subset of the available data is used to train the AI algorithms, which can then generalize the information and use it to analyze and interpret the information contained in other similar data sets.[15] CNNs are best suited for working with imaging data as they are designed to preserve spatial relationships. A grid-based input image is provided to a CNN, within which a filter is applied to all locations, giving rise to a convolutional layer of "artificial neurons" [Figures 2 and 3]. Features identified through the filter are pooled and further inputted into a new convolutional layer and so on. Each new layer focuses on a subset of the area in the previous layer. In the end, a fully connected layer is formed, which connects all neurons of the most recent layer to all neurons of the previous layer. Finally, the predicted output(s) are presented based on the prior training of the algorithm, along with the probability of each predicted output.[15]
Figure 2:: A simplistic representation of a convolutional neural network. Data from an input image are transferred through a convolutional layer followed by pooling of features. Data from the pool are further inputted into another convolutional layer and so on. In the end, a fully connected layer maps all features between the final convolutional layer and the previous layer. The final output provides probabilistic predictions, highlighting which output is more likely based on how the algorithm was trained.
Figure 3:: Diagrammatic representation of an artificial neuron and biologic neuron. Input of data is received through the dendrites, which are usually termed weights in the artificial neuron. Each input is multiplied by its corresponding weight, and all the multiplications are summed. A non-linear mathematical formula, rectified linear unit function is performed on the result. The output of the neuron serves as an input in the next layer of neurons.
Meanwhile, another class of neural networks called the radial basis function neural networks has been found to be better in performance and faster in training compared to many other neural networks.[16] Another commonly used AI approach is generative adversarial learning. Generative adversarial networks (GANs) represent a class of DL methods that generate new data instead of processing existing information. GANs combine a generative network and a discriminative network to enhance the performance of a DL model.[17] Neural networks such as DNNs may be used as discriminative networks to train GANs.[17] In the field of musculoskeletal imaging, the use of GANs is still very limited. However, some studies have utilized GANs to analyze musculoskeletal MRI scans and radiographs. Using the above-mentioned AI and ML techniques, numerous studies have improved on the pre-processing, acquisition and analysis of radiographs, CT scans, MRI scans, and ultrasonographs [Figure 4 and Table 1]. Some of these studies have been discussed below.
Figure 4:: Steps involved and basic differences in the processing of data in artificial intelligence, machine learning, and deep learning.
Table 1:: Some recent AI-based approaches in musculoskeletal radiology.
S. No.
Imaging modality
Musculoskeletal tissue
AI-based approach used
Size of imaging data set used
1. Ultrasonography Muscle, tendon CNN 4 images from 1 cadaver 75% sensitivity, 81% specificity Jabbar et al.[22]
2. Ultrasonography Supraspinatus (rotator cuff) tendon Semiautomatic CAD program 99 images from 93 adult patients (43 men, 50 women) Accuracy of diagnosing rotator cuff inflammation – 88.4%, tears – 92.3%, calcific tendonitis – 83.3% Chang et al.[6]
3. X-ray Bone LBF-SVM 36,770 images (MURA) 35% sensitivity, 62% accuracy Mall et al.[18]
4. X-ray Bone Stacked Random Forest Classifier 145 images, with 1900 healthy patches and 100 fractured patches per image 81.2% accuracy, 24.7% precision Cao et al.[1]
5. CT Hip and thigh muscles CNN and Bayesian U-Net 20 CT volumes in the training dataset, 18 CT volumes in the testing dataset X Hiasa et al.[5]
6. MRI Lumbar spine GANs X Galbusera
et al.[20]
7. Ultrasonography Supraspinatus tendon Curvelet-based automatic segmentation 116 images in the testing dataset For full thickness tears:95.6% sensitivity, 95.0% specificity; for partial thickness tears: 94.0% sensitivity, 93.6% specificity Gupta et al.[28]
8. X-ray Arm skeletal muscles Dilated DenseNet 40,895 radiographs from 12,251 patients Accuracy for fingers: 41.7%, forearm: 80.2%, hand: 92.7%, wrist: 93.1%, shoulder: 86.4% Li et al.[17]
9. X-ray Arm skeletal muscles CNN (Keras Deep Learning Framework) 36,808 samples for training, 3197 samples for validation 73% accuracy Wang[23]
10. MRI Knee 3D CNN (DeepResolve) Training dataset of 124 patients, testing dataset of 17 patients Achieved "diagnostic quality" super-resolution images Chaudhari
et al.[4]
Image pre-processing
Many recent studies have used the musculoskeletal radiographs dataset (MURA) to train and test different AI models to improve on image pre-processing.[18] MURA is an open-source X-ray image dataset that makes both normal and abnormal musculoskeletal images available to researchers and radiologists for studies.[19] Mall et al. used ML algorithms to classify bone radiographs from MURA as fractured or intact.[18] The four ML algorithms used in this study performed image pre-processing tasks such as color transformation and contrast enhancement before extracting as many as 12 relevant gray level cooccurrence matrix features, including autocorrelation, contrast, dissimilarity, and energy from each image. These textural features were subsequently used to classify the images into "fracture" and "non-fracture" groups. About 67% of the data was used to train the algorithm while the rest was used for testing. The radial basis function support vector machine (LBF SVM) algorithm achieved the highest accuracy (62%) among the four ML algorithms tested.[18]
Galbusera et al. conducted a study on applying GANs to preprocess spine MR images.[20] They evaluated the efficacy of GANs in detecting defects such as herniation, degenerative disc diseases, and end-plate changes from MRI data. Moreover, radiographs of the lumbar spine were used to identify abnormal numbering of the vertebra and vertebral body compression fractures. Ultimately, the GANs used in the study were able to make low-resolution images sharper and more informative, highlighting the importance of AI-based approaches in aiding musculoskeletal radiologists in their evaluation of spine imaging data.
MRI is preferred when the application necessitates superior soft-tissue contrast.[21] Superresolution musculoskeletal MRI can help generate thin, high-resolution image slices from thicker slices of complex body regions such as the knee.[21] This can also help accelerate the process of MRI data acquisition as data, that is, inferior in amount or quality can later be converted to high-resolution images using AI methods.[7] In one study, Chaudhari et al. used CNNs to develop a superresolution technique to improve the usability of thick slice MRI data.[4] Chaudhari et al. developed a 3D CNN called DeepResolve to create high-resolution thin slice resolved from a low-resolution thick slice. DeepResolve includes 0.7 mm thin slices from knee images obtained using Double Echo in Steady State. The training dataset for this model came from 124 patients from the osteoarthritis initiative. The model was subsequently tested on data from 17 patients. Based on qualitative assessment of the images by two radiologists along with quantitative assessment, it was found that DeepResolve could generate superresolution knee MR images of the required diagnostic quality or better.[4] Other studies that have focused on improving MRI image acquisition have used AI to help decide if intravenous contrast is needed in musculoskeletal MRI.[8] Similarly, there are studies that have shown the use of AI to reduce the amount of radiation used while acquiring CT data from patients.[7]
Ultrasonographic image acquisition has also been targeted by some AI-based studies, particularly because commonly used ultrasonographic techniques are limited by a narrow field of view.[22] Jabbar et al. suggested a way to overcome this issue.[22] The idea was to obtain panoramic ultrasound images by stitching together individual images, thereby helping to visualize wider tissues through a single panoramic image.[22] Quantifying geometric parameters using panoramic ultrasound images require image processing, including image enhancement, edge detection, and segmentation. The previous studies have noted that the edges of muscle tissue are not preserved upon image segmentation. Jabbar et al. addressed this issue by designing a CNN to identify the pixels in ultrasound images that constitute the edge of the musculoskeletal tissue [Table 1].
Many AI-based studies have focused on improving image analysis to help radiologists with the interpretation of imaging data. To identify the instances of fracture in a set of X-ray images, Cao et al. developed an ML algorithm using the stacked random forest multilayer classifier.[1] The algorithm collates and fuses different features identified from the training dataset of fractured and healthy bone X-ray images. After training, the algorithm can generate confidence score maps for areas in the X-ray images to indicate which regions have a greater likelihood of having a fracture.[1] This study used 80% of the imaging dataset for training the algorithm and the remaining 20% for testing. In another study, Wang achieved a fracture identification accuracy of 73% using a Keras DL framework, which is a CNN based approach.[23] In another study, Li were able to detect skeletal muscle damage using an adversarial learning assisted deep CNN (DCNN) on radiographs.[17] They used MURA images to conduct their study on various arm musculoskeletal areas such as fingers, shoulder, elbow, and forearm. This model achieved an overall accuracy of 82.1% in the identification of damaged muscular regions. Yet, another study found that DL resulted in human radiologist-like fracture and body part identification in X-ray images.[24]
Some other X-ray-based studies have explored the use of AI technologies such as artificial neural networks, SVMs, and regression-based methods in determining bone age.[2,25,26] These include studies conducted to assess differences in skeletal maturity based on gender, race, and age.[25,26] Other studies have used Bayesian models to calculate the probability of different diagnoses based on radiographical characteristics.[3,27] For example, Do et al. conducted a study that tested radiological bone tumor data against 29 potential diagnoses, predicting the correct diagnosis in only 44% of the cases.[27] This study used a minimum of five image samples per diagnosis to train their model[27] (as a comparison, ML-based methods always require larger imaging datasets to train the AI models[3]). In another study, Hiasa et al. used Bayesian DL and CNNs to accelerate the segmentation of muscles in CT imaging and improve its accuracy.[5] By demonstrating the segmentation of 19 muscles in the hip and thigh region, this study showed that the use of CNNs can significantly improve the accuracy of muscular segmentation.[5] In another MRI-based study, Irmakci et al. used DL algorithms on multiview MRI scans to identify meniscus and anterior cruciate ligament tears as well as other abnormalities in the knee.[21] In addition to X-ray, CT, and MRI, ultrasonography is another common radiological technique that is used for diagnosing a wide variety of joint and soft-tissue disorders. It holds the advantage of having a short diagnosis time as well as easy applicability for a host of patients.[28] Musculoskeletal soft-tissue damage is identified as disorganized and hyperechoic patterns in ultrasonography images.[28] These differences in the visual appearance of damaged musculoskeletal tissue can also be quantified in the form of tissue thickness, cross-sectional area, and mean echogenicity.[28] However, the identification of visual differences is highly dependent on the experience level of the radiologist, and even with the same experience level, it can still vary from one expert to another.[6,28] Moreover, segmentation of musculoskeletal tissues such as tendons can be difficult in ultrasound images.[28] Some AI studies have attempted to overcome these challenges by improving on image analysis.
To address the challenge of radiologist-to-radiologist difference in interpretation, Gupta et al. developed an AI-based automatic segmentation approach using ultrasonographs of the rotator cuff supraspinatus tendon in the shoulder.[28] In another study on the supraspinatus tendon, Chang et al. developed a computer-aided diagnosis system to improve the diagnosis of rotator cuff lesions and their classification into relevant pathological categories such as calcific tendonitis, inflammation, or thickness tears [Table 1]. They recommended that their model could be used as a suggestive diagnostic tool by radiologists whose diagnostic accuracy may be lower than an orthopedic surgeon with relevant experience in shoulder surgeries.
Natural language processing (NLP) in musculoskeletal radiology
In addition to the literature discussed above, some studies provide a unique perspective on AI applications in musculoskeletal radiology using AI models indirectly on textual reports and protocols created by radiologists instead of directly on radiological images.[7,29] For example, Wang et al. developed a NLP algorithm that successfully extracted skeletal fracture related information from radiology reports of osteoporosis patients.[29] Annarumma et al. developed an NLP processing system to classify adult chest X-ray radiology reports as "critical," "urgent," "non-urgent," and "normal."[30] This classification was followed by the use of a CNN algorithm to analyze the chest X-ray images and further prioritize them based on the abnormalities detected. This way, AI-based NLP processing in concert with image analysis could be used for triage (that is, classification of patients based on the urgency of treatment so as to optimize the functioning of a medical facility).
Some other studies in the area of NLP have used AI methods to determine which musculoskeletal imaging protocols should be used for MRI (regular or tumor oriented) and whether or not intravenous contrast is needed when performing MRI.[7,31,32]
Based on the studies discussed in this section, it is clear that all commonly used modalities for musculoskeletal radiology can be improved in terms of accuracy, speed, and resolution with the help of AI-based techniques, which is the foremost advantage of using AI in this field [Table 1]. By improving image pre-processing, image acquisition, image analysis, as well as interpretation of textual radiological reports, AI-based methods can either assist radiologists in their interpretation of radiological data or perform automatic diagnoses to varying degrees of accuracy.
As indicated by the volume of research focused on the use of AI in musculoskeletal radiology, the future of this collaboration can be expected to be fruitful. Some orthopedic departments in hospitals across the world, including the Cleveland Clinic, have already started laying special focus on AI for musculoskeletal-specific applications by setting up ML laboratories.[9] The hope is that AI can help provide personalized musculoskeletal health care to patients.[9] AI-based approaches can also help to expand the current applications of musculoskeletal radiology. For example, in the future, cognitive maps developed using AI can help radiologists accurately detect and diagnose malignant bone tumors such as osteosarcoma and Ewing's sarcoma in children.[33] AI-based image analysis techniques can also help quickly triage patients based on the severity of their musculoskeletal damage.[10]
To ensure that AI and ML algorithms can be efficiently trained, it is also important to overcome the dearth of well-annotated musculoskeletal image data sets.[21] The X-ray image database MURA (part of a competition organized by Stanford ML Group; https://stanfordmlgroup.github.io/competitions/mura/) and the MRI scan database FastMRI (part of a competition organized by Facebook AI Research and NYU Langone Health; https://fastmri.org/) are proving to be fruitful steps toward providing well-annotated musculoskeletal imaging data to AI specialists.[2,19,34,35] The FastMRI competition can also open new avenues for enhancing the speed of MRI data acquisition in the future.[2]
Orthopedics is a major field of health care that stands to benefit immensely from AI and ML, particularly in the area of musculoskeletal radiology. This review article discussed many of the studies that highlight significant achievements in the development of AI-based approaches that supplement the radiological assessment of musculoskeletal damage or dysfunction. For AI and ML to be incorporated into regular radiological analyses, it is important that AI-based approaches are able to generate an impeccable trust in radiologists, clinicians, hospital managements, and patients alike. The approaches discussed in this article suggest that this is an achievable goal. In the future, it is important to increase the size and quality of the radiological datasets that are used to train AI models for diagnosing musculoskeletal problems. This can help expand the applicability and accuracy of radiological techniques for the diagnosis of musculoskeletal diseases and injuries.
Patient's consent not required as there are no patients in this study.
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© Copyright 2021 – Indian Journal of Musculoskeletal Radiology – All rights reserved.
Published by Scientific Scholar on behalf of Musculoskeletal Society (MSS).


In How to Be a Stoic (2018), philosopher Massimo Pigliucci explores how the ancient philosophy of Stoicism can guide us toward a good life. He shows how Stoicism can help us focus on what we can change, come to peace with the prospect of death and deal with frustrations and problems in everyday life.
Massimo Pigliucci is a professor of philosophy at CUNY-City College. Formerly a professor of ecology and evolution, he is a former co-host of the popular podcast, Rationally Speaking.


text:
What is Stephen Harper Afraid of?
Roland Paris
By: Roland Paris
Director, Graduate School of Public and International Affairs, University of Ottawa
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Stephen Harper shared his views on international affairs with Maclean's magazine last week, and it wasn't a pretty picture. Harper's world seems to be full of danger and struggle. In response to open-ended questions on foreign policy, he repeatedly came back to these themes. Most interestingly, he offered a Manichean vision of international relations as a struggle between good and bad, and of moral clarity as the greatest asset and most reliable guide to foreign policy.
War and conflict figure prominently in this story. In the interview, Harper traced a connection between war and the emergence and development of the Canadian nation, arguing that the War of 1812 "essentially began to establish our sense of national identity" and was the "genesis of the geographically wide and culturally diverse nation we have today." He then explained that Canada has consistently been "on the right side of important conflicts" – including the Second World War and the Cold War – "that have shaped the world and that are largely responsible for moving the world in the overall positive direction in which it is moving." There is a theory of history encapsulated in this short statement – one that emphasizes, again, the enduring struggle between moral forces, and the transformative and redemptive potential of this struggle. These "big conflicts," he explained, have been "the real defining moments for the country and for the world."
Kenneth Whyte, who conducted the interview, probed further: "You suggest that we are in one great conflict, or that we're heading to one that we need to be prepared for."
Harper responded: "I think we always are."
Let's pause for a moment. After describing a pattern of historic confrontations through to the Cold War, Harper suggests that we are either in the midst of a new monumental struggle, or we are heading into one. That's remarkable news. It would seem important to learn more about this.
But when asked about the nature of the present threat, the prime minister seemed to grasp for a response:
"Well, I think it's more difficult to define now. We know there are challenges to us. The most obvious is terrorism, Islamic extremist terrorism. We know that's a big one globally. We also know, though, the world is becoming more complex, and the ability of our most important allies, and most importantly the United States, to single-handedly shape outcomes and protect our interests, has been diminishing, and so I'm saying we have to be prepared to contribute more, and that is what this government's been doing."
The fact that Canada may need to "contribute more" to protecting our security may be true, but that portion of Harper's response tells us nothing about the threat itself. We are left with "Islamic extremist terrorism" as "a big" threat. Is it the big one? Are there others?
The world is a messy place, so I empathize with the prime minister when he talks about the difficulty of defining threats in a complex world. But let's be clear: complexity itself is not a threat. Nor should we respond to complexity with simplistic theories of history or vague allusions to looming conflicts.
If Canada faces a clear and present danger, Harper should tell us exactly what it is. Otherwise, he should stop scaring people – and himself.
Photo courtesy Reuters.
Canadian Foreign Policy
Macleans
Stephen Harper
Journalism in Canada has suffered a devastating decline over the last two decades. Dozens of newspapers and outlets have shuttered. Remaining newsrooms are smaller. Nowhere is this erosion more acute than in the coverage of foreign policy and international news. It's expensive, and Canadians, oceans away from most international upheavals, pay the outside world comparatively little attention.
At Open Canada, we believe this must change. If anything, the pandemic has taught us we can't afford to ignore the changing world. What's more, we believe, most Canadians don't want to. Many of us, after all, come from somewhere else and have connections that reach around the world.
Our mission is to build a conversation that involves everyone — not just politicians, academics and policy makers. We need your help to do so. Your support helps us find stories and pay writers to tell them. It helps us grow that conversation. It helps us encourage more Canadians to play an active role in shaping our country's place in the world.
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Trump's recklessness puts global stability at risk
Transition memos show Canada's foreign ministry is doing its job

redpajama_set_name: RedPajamaCommonCrawl


text: Background & objectives: Polycystic ovary syndrome (PCOS) is an endocrinopathy warranting lifelong individualized management by lifestyle and pharmacological agents mainly oral contraceptive pills (OCPs). This study was aimed to report the impact of six-month OCP use on plasminogen activator inhibitor-1 (PAI-1) and factor VIII (FVIII) in women with PCOS. Methods: PCOS women diagnosed on the basis of Rotterdam 2003 criteria, either treated with OCPs (ethinyl estradiol-0.03 mg, levonorgestrel-0.15 mg) for a period of six months (n=40) or drug-naïve (n=42), were enrolled in this study. Blood was drawn to estimate glucose, insulin levels and lipid profile. Chemiluminescence immunoassays were used to measure hormones (LH, FSH, PRL, T4). Plasma levels of PAI-I and FVIII were measured by commercially available kits. Results: Menstrual regularity, Ferriman-Gallwey score and serum total testosterone significantly improved in the OCP group compared to drug-naïve group (P<0.01). No significant difference was observed in PAI-1 levels of the two groups; however, significant decrease in FVIII levels was observed in OCP group as compared to drug-naïve group. PAI-1 levels of OCP group correlated positively with blood glucose two hours, triglycerides and insulin two hours, while FVIII levels of OCP group correlated negatively with fasting insulin and homoeostatic model assessment-insulin resistance. Interpretation & conclusions: OCPs use has differential effect on pro-coagulant markers among women with PCOS. Well-designed, long-term, prospective, large-scale studies are prerequisite to elucidate the efficacy and safety of OCP in the treatment of PCOS.


text:
Q: Order by meta values I have 3 meta fields related to dates:

*

*year = 2012

*release_date = 14 November 2012

*release_date_db = 20121114
I need to show the posts from year 2012 sorted by release_date.
I made this:
query_posts('meta_key=year&meta_value=2012&order=ASC&posts_per_page=7');

How can I order posts by release_date or release_date_db?

A: You can do this by just looking for release_date_db:
function plugin_name_get_posts() {
    global $wpdb;
$the_posts = $wpdb->get_results( "SELECT * FROM $wpdb->posts, $wpdb->postmeta WHERE $wpdb->posts.ID = $wpdb->postmeta.post_id AND meta_key = 'release_date_db' AND meta_value >= 20120000 AND meta_value <= 20121231 ORDER BY meta_value ASC;", ARRAY_A );
 }

redpajama_set_name: RedPajamaStackExchange


0.1 Are you an expat living on Gran Canaria? Or holidaying on our beautiful island? TVMucho can help you avoid having to miss out on the home comforts of the TV you grew up with.
Are you an expat living on Gran Canaria? Or holidaying on our beautiful island? TVMucho can help you avoid having to miss out on the home comforts of the TV you grew up with.
We'll let you into a little secret, shall we? We've not gone totally local on Gran Canaria. Shocked? You can't have seen Spanish TV then with its dreary routine of reality TV, talent shows, and Loose-Women-style moral discussion programmes with hosts from both sexes. There are only three things Mr Gran Local watches on Spanish channels: football (UD Las Palmas and Movistar's new Premier League coverage), The Goldbergs (the non-dubbed original version), and La Sexta's Salvados.
If Mr GCL wanted to catch up with anything from Britain or indeed the States, he tended to use Shush.se. But all that's changed, thanks to TVMucho. Here's why he's returned to one of his first loves, what TV critic Victor Lewis-Smith famously described as "the magic rectangle".
And then he met TVMucho's Director of Product Management, Vincent Weberink. Who explained that he wanted to design something that his 83-year-old Dutch mother in law could use. An expat himself, Weberink explained how his suagra shared the family home and was forever badgering him to get Dutch TV.
Vince discovered that this was harder than it sounded. Often resulting in buying a number of products which didn't work well in combination. And so he came up with TVMucho, easy enough for an octagenerian and a fortysomething journalist residing in Las Palmas de Gran Canaria to use.
The TVMucho set-top box is the size of a CD. It's slight which is so preferable to clunky satellite dishes which might well fall foul of rules in your new community. And the picture quality is superb, with none of that buffering you see on the likes of download sites that are anyway more likely to be illegal than legal.
As an expat, you'll be able to follow your favourites. For Mr Gran Canaria Local, that's a chance to catch up with Gary, Alan, and Ruud/Danny/Jermaine of a Saturday night on Match of the Day. And for you? Perhaps travelling to Albert Square's E20 with EastEnders or keeping track of developments in Corrie's Weatherfield.
Disclaimer: TVMucho asked the Gran Canaria Local family to be beta testers for this new product on the market. They're looking for more, so drop us a line if you're interested and we'll put you in touch. You'll be able to subscribe to TVMucho for €7 a month from September and cancel when you don't need it. This will please our Norwegian friends who tend to spend half a year on GC and the remaining six months in Norway.


I'm packing my stuff into boxes. At the last minute, of course, since the truck arrives early tomorrow morning.
While I'm packing, I've been listening to a variety of podcasts on web development. I don't listen to these podcasts for their information. In between the casual banter and chat that surrounds the usual talking points, a sense of a cohesive and mature craft starts to form. The conversations surrounding the craft bring out the art in it.
These are all of a kind. They are a part of the art of developing for a fluid platform with wide-ranging capabilities—capabilities that can change on the same device from one extreme to another, within minutes, just by walking down into the basement seating area of your local coffee shop.
There is an art to making things that not only tolerate this quixotic foundation, but thrive. It's obvious that a large and influential contingent in the web development community is driven by a strong sense of what works and what doesn't work in this environment.
It's also obvious that a just as large contingent doesn't.
Treating the web like another app platform makes sense if app platforms are all you're used to. But doing so means losing the reach, adaptability, and flexibility that makes the web peerless in both the modern media and software industries.
Even if you do pull it off, you can only succeed by sacrificing the very qualities that justify the web's existence.
Or, at least that's what I'm thinking as I'm packing my boxes well into the night, hoping to finish in time for me to get a few hours of sleep before the movers arrive in the morning.
Why should people read more books?
How is taxing ebooks as print books supposed to work?
A draft of a chapter of some thoughts on things.
What ebook production problems are self-publishers facing?


text:
Desa Kepuhrejo kan syfta på följande platser:

Indonesien

 Desa Kepuhrejo (administrativ by i Indonesien, lat -7,67, long 111,46), Jawa Timur,
 Desa Kepuhrejo (administrativ by i Indonesien, lat -7,99, long 111,94), Jawa Timur,
 Desa Kepuhrejo (administrativ by i Indonesien, lat -7,40, long 112,30), Jawa Timur,

Robotskapade Indonesienförgreningar

redpajama_set_name: RedPajamaWikipedia


text:
Ex-IAS Officer Shah Faesal Launches Political Party, to Pursue 'Peaceful Resolution of Kashmir Problem'
Raebareli Cong MLA Questions Administration Over 'Alleged' Inaction Against BJP MLC and Kin
JNU student leader and activist Shehla Rashid announced her joining of Faesal's party on the occasion.
Aakash Hassan | News18.com @Aakashhassan
Updated:March 17, 2019, 11:55 PM IST
Former IAS officer Shah Faesal launched his political party, the Jammu and Kashmir Peoples' Movement (JKPM), in Srinagar. (Image: Twitter/ANI)
Srinagar: As former IAS officer Shah Faesal launched his own political party—the Jammu and Kashmir Peoples' Movement— in Srinagar on Sunday, hundreds of his supporters said they are hopeful that he will "find a solution to the Kashmir problem."
The party's launch event was held in a playground in uptown Rajbagh area of city and Faesal, who resigned from the services in January this year, was thronged by his new colleagues, including some prominent businessmen.
The UPSC topper resigned said he resigned from the Indian Administrative Service (IAS) in January this year to protest against the "unabated killings in Kashmir" and Delhi's refusal to initiate a political process in the state.
"In the past 70 years, our political class has been transacting a politics that pushed people to a sort of slavery," Faesal said in his address.
He said he was approached by two parties in Kashmir. "But when people heard that I would be joining them, they cautioning me and said that the hands of these parties are soaked in the blood of Kashmir and if you join them, we will not see your face again." Faesal said this is what compelled him to launch his own party.
He also released the vision document of his party. The first point of the document says: "The party shall pursue a peaceful resolution of the Kashmir problem as per the will and aspirations of the people of Jammu and Kashmir State."
Faesal was a medical doctor before he cracked the civil service exams. Lashing at the local political parties for calling him a Delhi's conspiracy, he said, the time will judge him.
"Now the same people who were asking me to join them are saying it is Delhi's conspiracy and that I am a BJP or an RSS agent," he said. This, he said follows the age-old rule. "People tend to reject the new ideas first and then they resort to conspiracies and finally resort to war. I tell you, I am ready to face this criticism and I am ready to fight this war."
"For more than 100 years, we were managed like the herds of cattle," Feasal said. "The indignation of that Treaty is still not forgotten."
Hundreds of people who attended his rally said they are hopeful that Faesal will solve Kashmir issue.
Hundreds of people attended the rally on Sunday.
Zafar Ahmad, a resident of Ganderbal, said politicians in Kashmir have deceived them for long but Faesal seems different. "Our priority is not development but the solution to the problem of Kashmir. We want peace. He is a selfless person who resigned from a prestigious post only to serve us," said Ahmad.
Most people in the rally were optimistic that Faesal would bring peace to Kashmir.
Faesal said his focus will be the youth of the state. "Our party is youth-oriented because youth are the principal victims of the crisis. They deserve priority over all other sections of the society because they are being killed, pelleted, injured and jailed," he said.
Faesal said the idea of the party is to put a closure to the blood bath because it devastates families, including those of the armed forces. He said the people living on the LoC and IB are caught between two armies and their lives are in grave danger because of the rivalry between the two countries.
Former JNU student leader and activist Shehla Rashid, who has also joined Faesal, said their aim is to seek "development with dignity."
Rashid said the women in Kashmir are most vulnerable and must join the party. Referring to the ban of student unions in Kashmir, Rashid said the party is an ideal platform for those students who have been denied their basic right to express political dissent. "I have come from student activism. It is not a party, it is a movement," she said.
Jammu and Kashmir People's Movement


Ground floor, entry gallery, three bedrooms all with WIR, rumpus/theatre room, gorgeous main bathroom and fitted laundry. The ground floor living area opens to an extensive sunny entertaining deck adjoining the landscaped heated in ground swimming pool and beautiful central gardens. Direct golf course access through your very own back gate is rare.
First floor, magnificent open plan living areas with Caesar stone two pack kitchen, large pantry and top of the range appliances. A further gallery leads to the stunning master bedroom with WIR and full ensuite featuring a spa bath, with a large study or fifth bedroom opposite. The extensive balcony utilises a Vergola automatic louvre system and is simply sensational with a vista in all directions whilst sunny and sheltered.
Further features include powder room, DLUG with direct house access, double glazing, square set ceilings, ducted vacuum, air conditioning, fitted cabinetry, and modern, welcoming decor throughout. A 5.2kw electric solar power system ensure minimal power bills (just $39 for January). Use of the Sands clubhouse and pool are added advantage of living in one of Victoria's premier golf course estate. Side access available with screened space for you boat or caravan complete a vast array of storage.
A true-blue entertainer in a quiet location just 1.7kms from Whites Beach Reserve offering privacy, luxury and the ultimate Coastal lifestyle.


Biotechnology in Agriculture an the methods for the detection of GMOs in food / MOTTI C.; DAINESE E.; MASCINI M.; MINUNNI M.; DE SANTIS P.; COZZANI I. - In: ITALIAN JOURNAL OF BIOCHEMISTRY. - ISSN 0021-2938. - 49(2000), pp. 52-56.


i am the kind of ignostics, with a lot of interesting in psychology, philosophy, human mind, deep thought, norm, deep purposes, meaning of life in different aspects; and more specific i still am interesting in religion in term of comparative religion studied. what effects human thought by their religion; how that manipulate their believe, value of life and how that drive the purpose of life. in short i'm just curios cat.
because curiosity killed the cat.


text:
Regno Unito
 Oakfield – località dell'Isola di Wight
 Stati Uniti d'America
 Oakfield – città della Contea di Aroostook, Maine
 Oakfield – township della Contea di Kent, Michigan
 Oakfield – città della Contea di Genesee, New York
 Oakfield – città della Contea di Fond du Lac, Wisconsin


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If your home is starting to feel a little cramped, now is the time to consider our brand new loft conversions in Southampton. At Acorn Building Contracts, we design and install loft conversions that offer a fast and simple way in which to extend your property. Our solutions will open up your property, providing you with extra room without sacrificing on your exterior space.
Our specialist services will take care of everything including seeking planning permission, so you are spared the hassle of dealing with the logistics. Plus, we supply fully itemised, fixed-price quotations that are tailored to the work required so you can be certain of no nasty surprises. To find out more about what goes into the finest loft conversions Southampton has to offer, read on below.
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Here at Acorn Building Contracts, our loft conversions in Southampton are bespoke to you and are a far more cost-effective option than moving house. We will supply you with a FREE consultation intended to assess the viability of a conversion as well as the potential floor space. Our team will also incorporate your ideas and requirements into the final Southampton loft conversion design.
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If you have any questions about the styles listed above or our loft conversions Southampton services in general, do not hesitate to get in touch with our helpful advisors.
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When you're looking for the finest loft conversions Southampton has experienced, it's nice to be able to buy with confidence. Here at Acorn Building Contracts, you can do just that when you enlist our fully qualified team. Built on more than 25 years' worth of experience, we pride ourselves on delivering high-quality loft conversions in Southampton at affordable prices.
Here at Acorn Building Contracts, we strive to deliver excellence in everything we do. Our team are committed to upholding the highest industry standards and will always go that extra mile to provide you with the best solutions whether it be bespoke kitchens, office refurbishment, partitioning, or simple decoration. From extensions to loft conversions in Southampton, our exceptionally talented tradesmen are approved by the Southampton Trading Standards County Council's Buy with Confidence scheme.
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Basements, attics, storage sheds -- wherever you store your "extra" things -- can also hold some surprises. In cleaning out her basement, Chris found a poignancy and an unanticipated spiritual connection lurking there. What's in your basement?
Our church aspires to be a radically welcoming community for all people and our services are meant to be a place to connect and recharge. Whether long-time members or first-time visitors, introverted people may struggle to feel a sense of belonging in our spiritual community unless we intentionally acknowledge and understand each other's social inclinations. How do we uphold cherished traditions in our services while ensuring that everyone feels comfortable? How do we foster a community that taps into the gifts of extroverts and introverts alike?
This past year the Junior High Youth studied and attended services from several religions, and were inspired and energized by what they saw. Come join them for a tour of what inspired them, including rousing Gospel Music! Bring your rhythm and voice!
Today we will give our blessings to Assistant Minister for Religious Education, Rev. Leslie Woodward, as she prepares to begin her sabbatical. Rev. Leslie will be on sabbatical from August through early January. What exactly is a ministerial sabbatical? What is ministry? Ministry is both a professional calling, and something we all do together. Come to church this morning to learn more – and to say "bon voyage" to Rev. Leslie until her return in early 2019!
"We are all part of the Divine spark," says author Paulo Coelho. "All have a purpose in creation, and that purpose is called Love." This morning we will consider what it means to say that we are "God carriers" – and what it might mean if we started to live as if we believed it.
(on vacation…) Rev. Bill Gupton is on vacation this month. His column, "On the Path," will return next month.
Saturday, June 30, 2018, from 11:00 a.m. to 1:00 p.m. Offsite. There will be a Rally encouraging the swift re-uniting of children and their parents after separation by the Trump Administration. The location is Washington Park in Downtown Cincinnati. Some Heritage members will be attending. Church carpools will be leaving Heritage at 10:00 a.m. For questions on carpooling, contact Rebecca Pace at RebPace@gmail.com or 513-231-9641.
They have the PB but they need the J!
Outreach Offerings - Did you know?
Did you know that the church website has a list of ALL the organizations that have benefited from Heritage Church offerings since our outreach began in 2006? Check out our Outreach Offerings Page to view the extensive list of worthy recipients. For information on offering amounts to each organization, click on the "Outreach Offerings Historical Detail" link. If you have an organization you believe puts the spirit of the UU Principles into action in our world and would like to see them supported with one of our future offerings, contact Regina Pugh at OutreachOffering@huuc.net.
Read more and view additional picture.
Senior Minister: Rev. Bill Gupton. Wednesday is Rev. Bill's day off. Friday is his sermon-writing day. Rev. Bill is on vacation during July 2018. Phone: 513-633-8703. SeniorMinister@huuc.net.
Assistant Minister for Religious Education: Rev. Leslie Woodward. Rev. Leslie is on sabbatical from July 30 through early 2019. Phone: 937-478-1031. RE@huuc.net.
Board President: Jaime Castle. Phone: 513-258-4972. BoardPrez@huuc.net.
The next Heirloom article submissions are due on or before: 7/25/2018.
This email, "HUUC Heirloom for July 2018," was sent to reader reader at subscriber on April 22, 2019.