text:
The flu vaccination campaign in the Region of Murcia will begin Tuesday, October 13
http://www.lavozdemazarron.com/index.php/noticias/3461-salud-vacunara-en-sus-domicilios-a-las-personas-mas-vulnerables?fbclid=IwAR1PA4qn77mlhXOtHV2eknehszfVLyNatGbl-TLAWojsjzgZlsVgYoLAUPk
Google translated:
The campaign, which begins next Tuesday the 13th throughout the Region, is advanced several weeks to prevent infections from coinciding with a possible increase in Covid-19 cases.
The flu vaccination campaign in the Region of Murcia will begin next Tuesday, October 13, in order to immunize people with a higher risk of complications, if they suffer from it, as well as people who can transmit the disease to those at high risk of complications. The Ministry of Health thus advances the start of the vaccination campaign by several weeks with the aim that the population is immunized earlier and the infections do not coincide with a possible increase in covid cases in the autumn.
The Minister of Health, Manuel Villegas, today presented the details of the flu vaccination campaign for which the regional government has set up nearly 300 vaccination points. For this year, the Ministry has acquired 265,100 doses to which are added another 105,340 provided by the Ministry of Health. In total, this season there are 370,440 doses available, expandable, compared to 240,000 the previous season.
"In this season, in which co-circulation of influenza and covid viruses will occur, and since both viruses can cause complications in the same population groups, vaccination against influenza is especially important to individually reduce the risk of suffering from one of these diseases and also contribute to avoiding a possible overload of the healthcare system ".
"Along with the universal protection measures, the flu vaccine is the most effective measure to prevent the disease and therefore it will be our greatest ally to face the pandemic during this fall and winter," said Villegas. In this sense, the counselor stressed that influenza and pneumococcal infections "are the pathologies that cause the greatest disease and mortality among all those that can be prevented by vaccination." He also recalled that "antibiotics are not effective against the flu, since it is a viral disease."
The campaign is aimed at the particularly vulnerable population, such as people aged 60 and over, pregnant and in the 6 months after childbirth and chronically ill patients or with previous pathologies. Also to those who could transmit the virus to high-risk people, such as health professionals and teachers, "establishing a protective environment for the most vulnerable," explained Villegas.
A large part of covid patients belong to risk groups in which flu vaccination is indicated, having also shown that the mortality of patients with covid doubles when they are also infected by the influenza virus.
In this sense, Villegas emphasized that "this season, with the current pandemic due to covid, the increase in vaccination coverage is of special importance." The Ministry has set the objective of reaching 75 percent coverage both in people 65 years of age and over and in health personnel.
People who turn 60 during this 2020 should protect themselves against pneumococcus if they have not done so previously. In addition, those who received the pneumococcal on their 60th birthday in 2015 should receive a booster dose. For this, Salud has acquired another 25,000 doses of pneumococcal vaccines, 5,000 more than in the previous season, which will be administered coinciding with the influenza vaccine to improve pneumococcal vaccination coverage.
Specific agendas in health centers
The health centers have set up specific agendas for vaccination in the morning and in some centers also in the afternoon to avoid crowds. In addition, some of the clinics that are currently closed due to the pandemic will be opened, specifically to vaccinate. Some 2,500 immobilized or vulnerable people in their homes as well as their caregivers will also be vaccinated.
As a novelty for the 2020-2021 season, Health has developed a vaccination protocol in residences for the elderly and disability centers with specific coverage indicators for each center and as a whole. In order to reinforce the protection of the elderly in these centers, they will be vaccinated with a high antigenic load vaccine, a vaccine marketed for the first time in Spain and which has been reserved for these people. Residents age 65 and older will also be vaccinated against pneumococcus to provide greater protection against respiratory infections.
People who want to be vaccinated must request it from the infirmary of their health center, by phone or online through the previous appointment, or in the Patient Portal.
Among the recruitment activities planned for this year, personalized letters will be sent to the more than 16,000 people who turn 60 years old and SMS to mobiles to people over 60.
Prevention and symptoms
The Health Minister recommended taking "the same measures preventive measures that we already adopt against covid, such as frequent hand washing, especially after coughing or sneezing, since the flu is spread from person to person mainly by droplets of saliva or secretions emitted by coughing or sneezing ".
The symptoms of flu are variable and can be confused with covid and other respiratory tract infections, since in these two diseases there are coincident symptoms such as fever, muscle aches and cough. In any case, you must consult with the health center.
The total cost of this influenza and pneumococcal vaccination campaign was 1,387,300 euros, 238,300 more than the previous one.
Influenza activity in the 2019-20 season was moderate both in the Region of Murcia and in the rest of the country. The region was characterized by the onset of the wave in the second week of January, reaching the maximum incidence at the end of that month, with 310 cases per 100,000 inhabitants, higher than the national average of 270.
Among the serious cases hospitalized in the Region that belonged to the groups eligible for vaccination, only 30 percent had been vaccinated.


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HomePoliticsPM says 'situation serious', but ruling Farmers isn't splitting up
PM says 'situation serious', but ruling Farmers isn't splitting up
March 29, 2017 Lithuania Tribune Politics 0
DELFI / Šarūnas Mažeika
"I wouldn't call this a split, but the situation is really serious," he told reporters on Wednesday.
Skvernelis criticized Eugenijus Jovaiša, a LFGU lawmaker who heads the parliament's Committee on Education and Science, for hurrying decisions on a merger between Vytautas Magnus University (VDU) and the Lithuanian University of Educational Sciences (LEU).
The committee on Wednesday approved a draft Seimas resolution backing the planned merger, despite the government's request to wait until its working group draws up a plan for reforming the higher education network. The plan will have to be endorsed by the parliament.
When asked if the lack of political will in the Seimas to reform the education network did not mean that the working group he had appointed was working in vain, Skvernelis admitted that it might be so.
"In principle, one could say so. Overall, speaking about the changes promised during the elections, it looks as if this is turning into declarations," he said.
Skvernelis and Education and Science Minister Jurgita Petrauskienė said in January that only up to five universities could be left in the country. They stressed, however, that the number was not yet final.
Lithuania currently has 14 state universities and several tens of the so-called universities of applied sciences.
Eugenijus Jovaiša EN
Jurgita Petrauskienė EN
Peasant and Greens Union
Saulius Skvernelis EN
Did Skvernelis act wisely? Tensions growing between Grybauskaitė and the ruling coalition
April 17, 2018 Jurga Tvaskiene CORPORATE, Opinion 0
Prime Minister Saulius Skvernelis' decision to propose lawyer Giedrius Danėlius as minister of justice is being described as the majority's challenge to the president. "But who will be left with a bloodied nose after this […]
Girnius. Is Russia that dangerous?
June 29, 2017 Kestutis Girnius CORPORATE, Opinion 0
Three years ago the Lithuanian news media and some politicians seriously considered the possibility that Russia will attack Lithuania and the rest of the Baltics. Such concerns are not voiced as often nowadays, there are […]
Political project Nord Stream 2 would harm Ukraine – Lithuanian PM
April 12, 2018 BNS Energy 0
The gas pipeline Nord Stream 2, which is projected on the bottom of the Baltic Sea, is in essence a political project and would cause major harm to Ukraine's economy, Lithuanian Prime Minister Saulius Skvernelis said during a visit in the country. […]
Seimas revises asylum application procedures in response to the influx of irregular migrants
Seimas adopted resolution on countering hybrid aggression
Sociologist on the newest party ratings: I don't even recall such results
On Nausėda's controversial step: sacrificing the country's image in the name of popularity

redpajama_set_name: RedPajamaCommonCrawl


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redpajama_set_name: RedPajamaGithub


text:
Timing of aortic valve surgery
Division of Cardiology, University of Washington, Seattle, USA
Catherine M Otto, MD, Division of Cardiology, Box 356422, University of Washington, Seattle, WA 98195, USA.
http://dx.doi.org/10.1136/heart.84.2.211
The timing of aortic valve surgery is described for patients presenting with two conditions: aortic stenosis and chronic aortic regurgitation.
Aortic stenosis may be caused by rheumatic disease, a congenital bicuspid valve or calcification of a trileaflet valve. In Europe and North America, the aetiology of aortic stenosis most often is increased leaflet stiffness, without commissural fusion, caused by lipo-calcific deposits on the aortic side of the valve leaflets. This active disease process affects both congenitally bicuspid and normal trileaflet aortic valves and represents the extreme of a spectrum of disease that includes both aortic sclerosis without outflow obstruction and severe valvar aortic stenosis. Aortic valve sclerosis and stenosis are the most common valve diseases in Europe and North America, with sclerosis present in about 25% of all people over age 65 years and stenosis present in 2–7% of this population.1 Significant outflow obstruction tends to occur at a younger age in patients with a bicuspid valve, possibly related to increased mechanical stress on the valve leaflets.
At the tissue level, aortic valve stenosis is characterised by focal areas of displacement of the subendothelial elastic lamina on the aortic side of the leaflet; there is protein and lipoprotein deposition and an inflammatory cell infiltrate with macrophages, T lymphocytes, and production of proteins, such as osteopontin, that are associated with tissue calcification. Ongoing studies of this active disease process will further clarify mechanisms of disease.
Aortic sclerosis
The initial phase of the disease process leading to aortic stenosis is mild leaflet thickening without obstruction to ventricular outflow, defined as aortic sclerosis. Although these patients do not have cardiac symptoms, they still are at increased risk for adverse cardiovascular outcomes. In the population based Cardiovascular Health Study, subjects with aortic sclerosis on echocardiography and no known cardiovascular disease had an approximately 50% increased risk of myocardial infarction and cardiovascular death over an average follow up of 5.5 years.2 Clearly, valve surgery is not indicated in these subjects as there is no outflow obstruction. Although there have been no studies of medical treatment to decrease cardiovascular risk in these subjects, the prudent physician will evaluate and treat conventional coronary risk factors.
Haemodynamic progression
Once mild aortic stenosis is present (defined as an aortic jet velocity > 2.5 m/s), a gradual increase in the severity of outflow obstruction is seen in most patients (fig 1). Overall, the average annual rate of increase in aortic jet velocity is 0.3 m/s per year, with an increase in mean transaortic pressure gradient of 7 mm Hg per year and a decrease in valve area of 0.1 cm2 per year.3 However, there is wide individual variability in the rate of haemodynamic progression. Some patients have little change in the degree of outflow obstruction over several years, while others have a relatively rapid rate of disease progression. Factors that predict the rate of haemodynamic progression in an individual patient have not yet been identified.
Continuous wave Doppler recording of aortic jet velocity in an elderly patient with severe aortic stenosis. Non-invasive Doppler evaluation of jet velocity, mean pressure gradient, and valve area are key to the evaluation and management of adults with aortic stenosis.
Symptom onset
At some point, the degree of outflow obstruction prevents an adequate increase in cardiac output with exertion, and the patient becomes symptomatic. Interestingly, some patients develop clear symptoms with obstruction that traditionally has not been considered "critical", while others remain asymptomatic with apparently severe obstruction. We now recognise that there is substantial overlap in haemodynamic severity between symptomatic and asymptomatic patients, even though clinical outcome is most dependent on the presence or absence of symptoms. Thus, a difficult clinical problem is the patient who has symptoms compatible with aortic stenosis but has outflow obstruction that traditionally would be considered only moderate. In this situation it can be difficult to separate symptoms caused by outflow obstruction from symptoms caused by other comorbidity. Exercise testing can be helpful in providing an objective measure of exercise tolerance and in documenting the haemodynamic response to exercise in these patients. However, it is incumbent on the physician to assume that symptoms are caused by aortic stenosis unless other explanations are evident or the degree of stenosis is so mild that valve replacement would not improve haemodynamics.
There is widespread agreement that valve replacement is indicated for symptomatic severe aortic stenosis. Both historical series before the availability of valve surgery and more recent series of patients who refused intervention for severe symptomatic aortic stenosis show that outcome is extremely poor, with survival rates as low as 50% at two years and 20% at five years after symptom onset.
The three classical symptoms of aortic stenosis are angina, heart failure, and syncope. However, in patients followed prospectively, symptom onset is insidious and may not be recognised by the patient or physician unless a careful, directed history is performed. Specifically, the physician needs to ask what activities the patient is doing now compared to 1–3 years ago. If there has been any decrease in physical activity, the possibility of symptom onset should be considered. Patients often ascribe their decrease in activity to "the flu" or "getting old", rather than recognising the subtle symptoms that led to their change in lifestyle.
The most common initial symptom in adults followed prospectively is a decrease in exercise tolerance or dyspnoea on exertion. Angina also is common but may not be recognised as such unless the physician has educated the patient about the significance of chest "discomfort" or "heaviness". When severe aortic stenosis is present on echocardiography, surgical intervention should be performed promptly once even these minor symptoms occur. Symptoms of pulmonary oedema and syncope are late manifestations of the disease process, most often occurring in patients without appropriate access to medical care or who have ignored earlier symptoms. If the symptom status of the patient is unclear, exercise testing is helpful to determine exercise duration and the haemodynamic response to exercise. A fall or only minimal rise in blood pressure indicates symptomatic disease.
Indications for surgery in valvar aortic stenosis
Definite indications:
symptoms caused by aortic stenosis (even if mild)
asymptomatic severe aortic stenosis with left ventricular systolic dysfunction
severe aortic stenosis at the time of other cardiac surgery
Selected patients:
asymptomatic patients with severe stenosis and anticipated high levels of exertion, plans for pregnancy, poor access to medical care, etc
patients with moderate aortic stenosis undergoing coronary bypass surgery
Not accepted:
prevention of sudden death in asymptomatic patients
Valve replacement for symptomatic aortic stenosis
Aortic valve replacement remains the definitive treatment for symptomatic aortic stenosis. In recent surgical series, operative mortality averages 2–9 % with long term survival rate of 80% at three years (table 1). Aortic stenosis in adults is rarely amenable to repair although commissurotomy may be an option in carefully selected young adults with non-calcified valves. Alternative procedures, such as balloon aortic valvuloplasty and surgical or ultrasonic valve debridement have not been successful. The choice of valve substitute in an individual patient is based on the balance between the durability of a mechanical valve compared to a tissue valve versus the need for long term anticoagulation. Newer, stentless tissue valves offer improved haemodynamics and the promise of increased longevity without the need for anticoagulation, although long term outcome data are not yet available. Other options include an aortic homograft in young women desiring pregnancy and the pulmonic autograft procedure in carefully selected younger patients at some experienced centres.
Aortic valve replacement for aortic stenosis in the elderly and in those with impaired left ventricular function (selected series)
Aortic stenosis in the elderly
Aortic valve replacement is indicated for symptomatic severe aortic stenosis, regardless of age. In comparison with outcome on medical treatments, operative mortality rates are acceptable even in octogenarians (5–15%). Comorbid conditions are common in the elderly and some patients have strong preferences regarding surgical intervention—both are factors that need to be taken into account in decision making in this patient group. On the other hand, the rate of calcification of tissue valves decreases with age so that long term anticoagulation usually can be avoided by using a tissue valve with an expected longevity greater than the patient's expected survival.
Despite the compelling evidence that aortic valve replacement is both appropriate and feasible in the elderly, recent studies have highlighted its underuse. Elderly adults with severe symptomatic aortic stenosis often are not referred for surgical consideration because of misconceptions about the risks and benefits of valve replacement. Many primary care physicians are unaware that elderly patients with aortic stenosis and heart failure are the most likely to benefit from relief of outflow obstruction. It also is important to review tables of expected longevity for the patient's current age, as many patients (and physicians) are not aware of the expected further life span. For example, an 80 year old woman can expect to live an additional 10 years. Quality of life also is improved, even when operative mortality and morbidity are considered.
Aortic stenosis with left ventricular systolic dysfunction
Another difficult clinical situation is the patient with aortic stenosis and left ventricular systolic dysfunction. When stenosis is severe and there is a high pressure gradient across the aortic valve (maximum gradient > 50 mm Hg), surgery is indicated regardless of the degree of left ventricular systolic dysfunction. In the series from the Mayo clinic of 154 patients with an ejection fraction ⩽ 35%, operative mortality was only 9% and overall survival was 69% at five years in those with coexisting coronary artery disease, compared to 77% in those with isolated aortic stenosis (fig 2).4Since left ventricular afterload is increased when aortic stenosis is present, with relief of obstruction, ventricular function improved in 76% of patients, with an increase in mean (SD) ejection fraction from 27 (6)% to 39 (14)%.
Kaplan–Meier survival curves for patients with aortic stenosis and reduced left ventricular function with and without significant coronary artery disease (two vessel disease or greater or left main coronary disease) in comparison with expected survival. Number of patients alive at each point is shown on the x axis. CAD, coronary artery disease. Reproduced with permission from Connolly HM, et al. Circulation 1997;95:2395–400.
Aortic stenosis with a low pressure gradient and left ventricular dysfunction is even more problematic. If the low pressure gradient is associated with severe stenosis resulting in left ventricular dysfunction and a low transaortic volume flow rate, the patient will improve after aortic valve replacement. However, if the pressure gradient is low because of moderate aortic stenosis with concurrent primary myocardial dysfunction, valve replacement is less likely to be beneficial. Distinguishing these two groups of patients is not easy as both have a small calculated valve area since, in both cases, valve opening is impaired. Dobutamine stress echocardiography, with measurement of pressure gradient and valve area at baseline and at an increased flow rate (typically with 10 μg/min/kg of dobutamine), has been advocated for evaluation of these patients. If there is an increase in valve area with an increase in stroke volume, the valve leaflets are flexible and stenosis is not severe. Conversely, if valve area remains fixed despite an increase in flow rate, severe stenosis is present. However, this approach has not yet been validated on the basis of clinical outcome. In addition, if stroke volume fails to increase, it remains unclear whether the primary problem is increased valve stiffness or myocardial dysfunction.
Evaluation of the patient with aortic stenosis and left ventricular dysfunction
Calculate standard measures of stenosis severity and left ventricular ejection fraction
Look at the severity of aortic valve calcification
Consider the risk:benefit ratio of valve replacement in this patient
Undertake dobutamine stress echocardiography to assess leaflet flexibility in selected cases
A pragmatic approach in this patient group is to look at the degree of valve calcification, either by transthoracic or transoesophageal echocardiography or by fluoroscopy. Severe valve calcification is consistent with severe stenosis. Focal areas of thickening or only mild calcification suggest that valve surgery is not indicated. Unfortunately, patients with low gradient aortic stenosis have a poor outcome with both medical and surgical treatment. Given this prognosis, my bias is to err on the side of surgical intervention, in the hope that ventricular function will improve at least to the extent that afterload is reduced.
Mild to moderate aortic stenosis in patients undergoing coronary artery bypass surgery
Recent prospective studies have demonstrated that about 75% of patients with initially asymptomatic aortic stenosis develop symptoms requiring valve replacement within the next five years. This observation has led to the suggestion that valve replacement be performed at the time of coronary artery bypass surgery when mild to moderate stenosis is present to preclude the need for repeat surgery in the next few years. Surgical mortality rates for repeat surgery for aortic valve replacement are high (14–30%), further supporting the suggestion that "prophylactic" valve replacement be considered. However, we need to be cautious in applying this approach without consideration of the clinical factors in each patient. The likelihood of progression to symptoms is strongly correlated with the baseline aortic jet velocity. Those with a velocity < 3.0 m/s have a five year event free survival of 84 (16)% suggesting that valve replacement is not necessary, while those with a jet velocity > 4.0 m/s have a five year freedom from valve replacement of only 21 (18)%, suggesting that valve replacement is appropriate (fig 3). The decision about valve replacement in those patients with intermediate jet velocities (3–4 m/s) should be individualised, based on the risk of valve surgery, expected prosthetic valve haemodynamics and longevity, the extent of valve calcification, and patient preferences. In the future, it is possible that aggressive medical treatment to slow disease progression will provide an alternative to valve replacement in this patient group.
Cox regression analysis showing event free survival in 123 initially asymptomatic adults with valvar aortic stenosis, defined by aortic jet velocity at entry (p < 0.001 by log rank test). Reproduced with permission from Otto CM, et al. Circulation 1997;95:2262–70.
Rationale for surgery before symptom onset
There clearly are a few situations in which aortic valve replacement is appropriate in asymptomatic patients. Examples include patients with evidence of left ventricular systolic dysfunction caused by aortic stenosis, young women with severe stenosis who desire pregnancy, patients with asymptomatic severe disease who plan activities that involve severe exertion or who live in areas remote from medical care, and adults with very severe stenosis, in whom symptom onset is inevitable in the short term and in whom an elective procedure is preferred.
However, some investigators have suggested that valve replacement be performed in patients with severe aortic stenosis before symptom onset in order to prevent irreversible left ventricular hypertrophy and left ventricular systolic and diastolic dysfunction, and to decrease the risk of sudden death. There are little convincing data to support this approach. The most important predictor of postoperative left ventricular systolic function is preoperative systolic function, and most patients with aortic stenosis show an increase in ejection fraction after valve replacement. It is clear that diastolic dysfunction persists for years after aortic valve surgery, with histologic studies showing persistence of increased myocardial fibrosis.5 However, it is unclear how early the intervention would need to be performed in order to prevent these changes, and there have been no trials demonstrating clinical benefit of early intervention. The risk of sudden death in the absence of antecedent symptoms is extremely low in adults with aortic stenosis and certainly is lower than the operative mortality of valve replacement surgery.
At this time, it is difficult to advocate routine early surgery in asymptomatic adults with severe aortic stenosis. This issue is further confused by our changing understanding of the definition of severe stenosis. Some patients develop symptoms at a pressure gradient and valve area that traditionally have been considered moderate, while other patients with apparent severe stenosis remain asymptomatic. Thus, it is problematic to define a specific numerical measure of stenosis severity that could be used to justify earlier surgical intervention. Of course, the other side of the risk-benefit equation in the timing of aortic valve replacement includes operative mortality and morbidity and the suboptimal haemodynamics and longevity of prosthetic valves. As surgical techniques improve and better valve substitutes are developed the argument for early surgery may become more persuasive.
Chronic aortic regurgitation
Chronic aortic regurgitation may be caused by abnormalities of the valve leaflets, most often a congenitally bicuspid valve, or by enlargement of the aortic root (fig 4). When aortic root disease is the cause of aortic regurgitation, timing of surgical intervention is more dependent on aortic root pathology than on the severity of aortic regurgitation. For example, in a patient with Marfan syndrome, the extent and rate of aortic root dilation are the primary determinants of the timing of aortic root and valve replacement. Acute aortic regurgitation differs from chronic disease both in clinical presentation and management. Acute aortic regurgitation may be caused by leaflet destruction (for example, endocarditis) or by lack of commissural support (for example, aortic dissection). Acute aortic regurgitation caused by aortic dissection is a surgical emergency. Severe aortic regurgitation caused by endocarditis also should be treated promptly with surgical intervention as outcome with medical treatment alone is poor.
Colour flow Doppler image showing severe aortic regurgitation with a broad regurgitant jet and dilated left ventricle in a patient with a bicuspid aortic valve. Doppler measures of regurgitant severity are most helpful in identifying patients in whom periodic evaluation of left ventricular size and systolic function is warranted.
Patients with chronic aortic regurgitation may remain asymptomatic for many years despite haemodynamically significant backflow across the valve. The increased volume load on the left ventricle leads to a gradual increase in left ventricular dimension so that a normal forward stroke volume is maintained. Most patients eventually develop symptoms as a result of aortic regurgitation, with an average rate of symptom onset of 5–6% per year in prospective studies.6 ,7 The most common initial symptom is dyspnoea on exertion or a decrease in exercise tolerance. In previously asymptomatic patients with severe aortic regurgitation, there is a small risk of sudden death occurring in 2–4% of patients over 7–8 years of follow up, typically in patients with severe left ventricular dilation.
Echocardiography provides a useful non-invasive approach to risk stratification in adults with chronic aortic regurgitation since the rate of symptom onset is directly related to the extent of left ventricular dilation. In one study, patients with an initial end systolic dimension < 40 mm had an annual rate of symptom onset of 0%, compared to 6% in those with an end systolic dimension of 40–49 mm and 19% in those with an end systolic dimension > 50 mm.6 In another study, the strongest predictor of clinical outcome in chronic aortic regurgitation was the change in left ventricular ejection fraction from rest to exercise, normalised for the exercise change in end systolic wall stress.7 However, measurement of this parameter is difficult and cumbersome in the clinical setting, as it requires both echocardiographic and radionuclide data acquisition during exercise testing. The simpler measure of the exercise left ventricular ejection fraction is also strongly predictive of clinical outcome, with an exercise ejection fraction > 56% indicating a low rate of symptom onset (0% per year) compared to those with an exercise ejection fraction < 50% in whom symptoms occurred at a rate of 8.8% per year.
There have been no prospective studies showing that quantitative evaluation of the severity of regurgitation is predictive of clinical outcome. Of course, these studies only included patients with "severe" regurgitation as defined by clinical and echocardiographic criteria. As with aortic stenosis, the availability of non-invasive quantitative measures of valve disease is changing our understanding of the relation between regurgitant severity and clinical outcome. Many patients with "severe" aortic regurgitation remain asymptomatic with little change in ventricular size or function for many years. Thus, severe chronic aortic regurgitation should be defined as the degree of backflow across the aortic valve that results in progressive left ventricular dilation in association with adverse clinical outcomes. Doppler criteria alone should not be used to define severity until prospective studies are available that show the value of these quantitative measures in predicting clinical outcome.
On the other hand, Doppler measures of aortic regurgitant severity are extremely helpful when the degree of left ventricular dilation seems out of proportion to the severity of regurgitation. Quantitative measurements may then allow distinction between severe aortic regurgitation resulting in left ventricular dilation and mild to moderate aortic regurgitation with concurrent primary myocardial dysfunction caused, for example, by myocarditis or ischaemic disease. When clinical and Doppler data are discordant, evaluation of aortic regurgitation in the catheterisation laboratory also can be helpful.
Medical treatment has been shown to be effective in slowing the rate of left ventricular dilation and delaying the timing of surgical intervention in adults with chronic aortic regurgitation. Aortic regurgitation represents both a volume and pressure overload state of the left ventricle as the increased stroke volume is ejected into the high resistance aorta. Thus, it makes physiologic sense that afterload reduction might decrease the severity of regurgitation and prevent progressive ventricular dilation. Several small studies have shown that angiotensin converting enzyme (ACE) inhibitors can slow the rate of left ventricular dilation. Further, in a randomised study of adults with severe aortic regurgitation and left ventricular dilation, treatment with nifedipine was associated with a six year event free survival rate of 85% compared to 65% in those treated with digoxin (fig 5).8 Afterload reduction treatment now is standard in patients with severe aortic regurgitation and evidence of left ventricular dilation.
Cumulative actuarial incidence of progression to aortic valve replacement in 143 initially asymptomatic patients with severe aortic regurgitation randomised to treatment with digoxin 0.25 mg daily or nifedipine 20 mg twice a day. Reproduced with permission from Scognamiglio et al.8
Asymptomatic ventricular systolic dysfunction
In patients with chronic aortic regurgitation, valve replacement is indicated at symptom onset. However, a small number of patients develop irreversible left ventricular systolic dysfunction in the absence of symptoms. The ideal measure of left ventricular systolic function would reflect contractility and be relatively independent of loading conditions, such as the end systolic pressure-volume relation or elastance. However, measurement of contractility is an elusive goal and measures that approximate this goal are impractical in the clinical setting. Thus, clinical decision making is based on parameters that have been shown to be predictive of postoperative outcome in series of patients undergoing valve replacement.
In studies of symptomatic patients who underwent valve replacement for severe aortic regurgitation, baseline predictors of postoperative left ventricular dysfunction include: (1) increased left ventricular size at end systole, defined either as end systolic dimension or end systolic volume index; (2) the duration of left ventricular dysfunction; (3) end systolic wall stress; and (4) ejection fraction. In a smaller number of studies that prospectively followed asymptomatic patients with chronic aortic regurgitation, the same factors (ventricular size and contractile function) were found to predict the onset of symptoms or left ventricular dysfunction (table 2). Other predictors of outcome after valve replacement for aortic regurgitation include age, severity of symptoms, exercise tolerance, evidence of left ventricular hypertrophy on electrocardiography, an elevated left ventricular end diastolic pressure, and the ratio of wall thickness to chamber dimensions.9
Timing of valve replacement in chronic aortic regurgitation
Taken together, all these studies indicate that excessive ventricular dilation, particularly at end systole, is a marker of incipient systolic dysfunction. When ventricular end systolic dimension exceeds 55 mm or the end systolic volume index exceeds 60 ml/m2, surgical intervention should be considered. Of course, it is important to verify the accuracy of these measurements and, in most cases, it is prudent to repeat the study after an appropriate time interval to confirm the degree and progression of ventricular dilation. Other clinical parameters that may be helpful in clinical decision making include overt evidence of systolic dysfunction (an ejection fraction < 50%), diastolic ventricular dilation (an end diastolic dimension > 80 mm), or an elevated end diastolic pressure (> 20 mm Hg).
Surgical outcomes and effect on left ventricular function
Operative mortality for elective aortic valve replacement in chronic aortic regurgitation is 4–10% with five year survival rates of 70–85% in recent series, and is similar in women and men. Most patients experience a decrease in cardiac symptoms and an improved functional capacity postoperatively. Predictors of operative mortality include severe symptoms, renal failure, and atrial fibrillation.
If surgery is performed before the onset of irreversible left ventricular dysfunction, relief of the chronic volume overload leads to decreased ventricular volumes and mass. Ventricular volumes and myocardial mass decrease postoperatively by 30–35%, but this decrease occurs over a prolonged time period. Ventricular volumes decrease to near normal within 1–2 years, while ventricular mass continues to decrease up to eight years postoperatively. Thus, after valve replacement for aortic regurgitation, left ventricular geometry is characterised by concentric hypertrophy caused by the differing rates of decrease in ventricular volumes and mass. The early postoperative decrease in muscle mass is caused by regression of myocardial cell hypertrophy and a decrease in myocardial fibrous content, with the later decrease in myocardial mass caused by a continued decrease in fibrous tissue content.
Even in patients with excessive left ventricular dilation or a reduced ejection fraction at the time of initial diagnosis of aortic regurgitation, there is an improvement in ventricular function after valve replacement in most patients. In one study of 31 patients with chronic aortic regurgitation and a preoperative end systolic dimension > 80 mm, operative mortality was low and there was an improvement in ejection fraction postoperatively (from 43 (12)% to 53 (11)%, p < 0.0001).10 Ejection fraction also continues to improve over a long time period postoperatively, reaching a stable value only after 4–6 years.
Timing of surgery for chronic aortic regurgitation
symptomatic severe aortic regurgitation
asymptomatic severe regurgitation with evidence of early left ventricular systolic dysfunction (ejection fraction < 50%, left ventricular end systolic dimension > 55 mm)
symptomatic severe aortic regurgitation with left ventricular systolic dysfunction
asymptomatic aortic regurgitation without significant left ventricular dilation or systolic dysfunction
It is clear that aortic valve replacement improves survival and quality of life in symptomatic patients with severe aortic stenosis or regurgitation. Surgery is deferred only if there is severe comorbidity limiting longevity or increasing surgical risk to an unacceptable degree. Even when left ventricular systolic dysfunction is present preoperatively, patients with both aortic stenosis and regurgitation show an improvement in systolic function after valve replacement; thus it is never "too late" to consider surgical intervention. Aortic valve surgery in the asymptomatic patient with aortic stenosis remains controversial except in patients with severe stenosis undergoing other cardiac surgical procedures. In patients with chronic aortic regurgitation, periodic echocardiography is indicated to identify the small number of patients who develop evidence of left ventricular dysfunction before symptom onset. If surgery is performed soon after the onset of ventricular dysfunction, left ventricular size and ejection fraction are likely to return to normal postoperatively.
Our understanding of the disease process in chronic valve disease is changing. New insights into the pathophysiology of calcific aortic stenosis may lead to medical treatments to prevent disease progression. In patients with chronic aortic regurgitation, afterload reduction treatment delays, and may prevent, the need for valve surgery.
Stewart BF,
Siscovick D,
Lind BK,
(1997) Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 29:630–634, In the population based Cardiovascular Health Study, aortic valve stenosis or sclerosis on echocardiography was associated with older age, male sex, hypertension, current smoking, elevated serum low density lipoprotein (LDL) and lipoprotein Lp(a) concentrations, shorter height, and the presence of diabetes.
Otto CM,
Kitzman DW,
(1999) Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147, for the Cardiovascular Health Study, Aortic valve sclerosis, defined as irregular leaflet thickening without obstruction to outflow, was associated with an approximately 50% increase in risk for myocardial infarction and cardiovascular mortality in patients without known coronary disease at study entry.
Burwash IG,
Legget ME,
(1997) A prospective study of asymptomatic valvular aortic stenosis: clinical, echocardiographic, and exercise predictors of outcome. Circulation 95:2262–2270, In a prospective study of 123 adults with asymptomatic aortic stenosis the only predictors of symptom onset (and valve replacement) on multivariate analysis were the baseline aortic jet velocity, baseline functional status score, and the rate of increase in jet velocity over time.
Connolly HM,
Oh JK,
Orszulak TA,
(1997) Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation 95:2395–2400, In 154 consecutive patients with aortic stenosis and a left ventricular ejection fraction ⩽ 35%, operative mortality was 9% with predictors of operative mortality including coronary artery disease and reduced cardiac output at baseline. Left ventricular ejection fraction improved after valve surgery in 76% of survivors and only 7% were in New York Heart Association functional class postoperatively, compared to 88% at baseline.
Lund O,
Kristensen,
Baandrup U,
(1998) Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis. Eur Heart J 19:1099–1108, Based on intraoperative transmural biopsies of the myocardium in 49 patients undergoing valve replacement for aortic stenosis, the authors propose that the degree of muscle hypertrophy is an important factor both for preoperative symptoms and for early and late mortality after valve replacement.
Bonow RO,
Lakatos E,
Maron BJ,
(1991) Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation 84:1625–1635, In 104 asymptomatic patients with chronic aortic regurgitation followed prospectively, 58 (9)% remained asymptomatic with normal left ventricular function at 11 years. Multivariate predictors of clinical outcome were age, initial end systolic dimension, and the rate of change in end systolic dimension and rest ejection fraction during serial studies.
Borer JS,
Hochreiter C,
Herrold EM,
(1997) Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance. Circulation 97:525–534, The change in ejection fraction from rest to exercise, normalised for the change in end systolic wall stress, was the strongest predictor of clinical outcome in this prospective study of 104 adults with severe aortic stenosis followed for an average of 7.3 years.
Scognamiglio R,
Rahimtoola SH,
Fasoli G,
(1994) Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 331:689–694, In order to evaluate the effect of afterload reduction treatment on clinical outcome, 143 patients with severe asymptomatic aortic regurgitation and normal systolic function were randomised to treatment with nifedipine or digoxin. After six years, 34 (±6)% of the digoxin group and 15 (±3)% of the nifedipine group have undergone aortic valve replacement.
Donovan CL,
Starling MR
(1997) Role of echocardiography in the timing of surgical intervention for chronic mitral and aortic regurgitation. in The practice of clinical echocardiography. ed Otto CM (WB Saunders, Philadelphia), pp 327–354, Comprehensive review (159 references) of the literature on timing of intervention for aortic regurgitation, with proposal of an algorithm for clinical decision making.
Klodas E,
Enriquez Sarano M,
Tajik AJ,
(1996) Aortic regurgitation complicated by extreme left ventricular dilation: long-term outcome after surgical correction. J Am Coll Cardiol 27:670–677, In 31 patients with severe aortic regurgitation and extreme left ventricular dilation (end diastolic dimension ⩾ 80 mm), operative mortality was only 5.6% with a 10 year survival of 73 (5)%, which is no different than expected for age. Ejection fraction increased from 44 (11)% to 49 (15)%.
Additional references for "Timing of aortic valve surgery" by Catherine M Otto. Heart 2000;84:211-18
Villari B, Hess OM, Kaufmann P, et al. Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic function. Am J Cardiol 1992;69:927-34.
Brener SJ, Duffy CI, Thomas JD, et al. Progression of aortic stenosis in 394 patients: relation to changes in myocardial and mitral valve dysfunction. J Am Coll Cardiol 1995;25:305-10.
Faggiano P, Aurigemma GP, Rusconi C, et al. Progression of valvular aortic stenosis in adults: literature review and clinical implications. Am Heart J 1996;132:408-17.
Wong JB, Salem DN, Pauker SG. You're never too old. N Engl J Med 1993;328:971-5.
Bouma BJ, van den Brink RBA, van der Meulen JHP, et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 1999;82:143-8.
Pibarot P, Dumesnil JG, Leblanc MH, et al. Changes in left ventricular mass and function after aortic valve replacement: a comparison between stentless and stented bioprosthetic valves. J Am Soc Echocardiogr 1999;12:981-7.
Biem HJ, Detsky AS, Armstrong PW. Management of asymptomatic chronic aortic regurgitation with left ventricular dysfunction. A decision analysis. J Gen Intern Med 1990;5:394-401.
Schon HR. Hemodynamic and morphologic changes after long-term angiotensin converting enzyme inhibition in patients with chronic valvular regurgitation. J Hypertens 1994;12(suppl):S95-104.
Lin M, Chiang HT, Lin SL, et al. Vasodilator therapy in chronic asymptomatic aortic regurgitation: enalapril versus hydralazine therapy. J Am Coll Cardiol 1994;24:1046-53.
Otto CM. "Aortic stenosis" and "Aortic regurgitation". In Otto CM, ed. Valvular heart disease. Philadelphia: WB Saunders, 1999.
Bonow RO, Carabello B, de Leon AC Jr, et al. ACC/AHA Guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of patients with valvular heart disease). J Am Coll Cardiol 1998;32:1486-588.


Marvel has mentioned that there are two new Marvel films coming soon but to be announced. Although they have not confirmed The Black Panther film, none other than the Latino Review has leaked that Marvel is, certainly, planning for the movie to happen. The benefit to customers is that they give a wider perspective by seeing actual scenes so hopefully the general public could make a extra educated alternative if will probably be something in line with their personal style or not. It is so disappointing nevertheless, when a movie trailer exhibits the only nice scene, in an otherwise horrible movie.
Dolphan5, thanks for the kudos and compliments. Well, you are completely right in regards to the ka-ching factor on DC's half about making a Justice League film. I agree with u. Zuko and katara seems nice 2gether n don't fret sequeal's coming quickly. I've seen the trailor. But it wasn't official. I hope on this movie zuko n katara can be together.
After Scott and Kate Johansen (Will Ferrell and Amy Poehler) lose their daughter Alex's school fund, they grow to be desperate to earn it back so she will be able to pursue her dream of attending a college. Fueled by his restored religion in humanity and inspired by Superman's selfless act, Bruce Wayne enlists the assistance of his newfound ally, Diana Prince, to face an excellent higher enemy.


There is an Oliver Mtukudzi. He was in the media and was celebrated immensely when he passed on last week in all forms of mass communication.
He read like a saint. In other insinuations he read like a sinner. One would wonder who was Oliver Mtukudzi really. Yet Tuku would be interpreted to mean different things to different people no doubt.
I knew an Oliver; an Oliver I was privileged to know and appreciate as a person and personality. What was celebrated in most instances was Tuku the personality. Yet some aspects of the person, the real Oliver, may run contrary to the personality many knew and loved.
And when I was asked to be the Master of Ceremonies at his funeral both in Knowe, Norton, and the gathering in Madziwa, it was a privilege to bid mukoma farewell like that. Farewell to Tuku the person.
It is that person; complete with human traits, that I want to shed light on, if only just a bit.
Many went on and on about Tuku being humble. They were perhaps right about the personality that Tuku was. Because deep inside, Tuku was anything but humble. In fact, Tuku could be a hot bowl of soup to be honest. It is because of another trait of his as a stern and strict disciplinarian.
Tuku was intolerant of any lack of decorum and human grounding. "Robert, munhu ita kunge anebva kune vanhu," he told me once after a nasty incident. (A person should behave like someone who comes from amongst people that give them wise counsel).
An overzealous fan had just rushed to Tuku as he was affectionately known, turned round and attempted to take a ''selfie''.
"Who are you?" Tuku lashed out. "Where you come from do you just run up to people and not introduce yourself but just start taking pictures? Were you never educated on good social morals?" he asked the now embarrassed inebriated chap.
In fact, Tuku was the perfect antidote for a hangover. As he was telling off the wayward fellow, all the alcohol in his system seemed to leave his system, as he sobered up to a tongue lashing on hunhu, Ubuntu, from Tuku.
That's is the Tuku a lot of people who worked closely with him knew.
There is a street lingo term; dzungu. Acting rashly without enough consideration for the situation at hand. Mukoma Tuku was a person who hated dzungu and would admonish you when you acted as such.
One day I was in Mutoko and he gave me a call asking where I was. "Mutoko," I said. "Come and see me tomorrow in Norton," he replied. Who could not say no when Tuku summoned. And so it was that I was in Norton on the morrow.
I went into the studio where he was working on the video to the musical "Masanga Bodo". As I walked in, many people working on the project who wondered who I was looked at me with grey ashen faces. Who was this moron who had the nerve to walk into the office when Tuku was working? He had no tolerance for people who disrupted work.
I know as much and got in and sat down. He turned round and looked at me. His face was grey and deceased. No emotion. As if he were looking at an unimpressive stone carving, before he turned back to the work and continued.
I sat still and for close to 30 minutes the people in his company were wondering about two issues. Who was I and why had Tuku not asked me to leave and let me stay as he worked on an intimate private project.
I stood up, gave my input and immediately he said; "Indeed! That is the touch I was looking for. That's what was lacking!" and then he said hello to me with a warm smile and tonnes of love before asking how my journey was.
He topped it up with our traditional greeting. Makedekede from Mutoko. The greeting culture of our women who shake hands at least twice while punctuating every move with a single clap of the hands. We were like old school mates.
Had I not known Tuku and assumed that just because I had been asked to visit I could just rush in and say hello, I would have been given a verbal lashing and a cold shower. Yet I knew he always wanted one to ''chill''. Never be too familiar. Like the queen of England, I didn't speak to Tuku upon meeting him until Tuku spoke to me. A true traditionalist. At the end of that day he took me out for a meal of sadza remhunga (finger millet meal) and traditional offals with Ibbo Mandaza and Sam Mataure. Cracking jokes along the way in his iconic ''Tuku'' personalised number-plated Land Rover, drawing glances from other motorists.
"Vari kundinangara. Kabanga varikuti ndini Tuku," he joked. (They are staring at me. Perhaps they think I am Oliver Mtukudzi). Perhaps he wasn't joking. Because as it seems today there was a difference between Tuku the performer and Tuku the person!
That is why when friends from far and wide asked me to introduce them to Tuku for business I would make endless calls to reach him personally and ask him for an audience.
"We thought they say you can pitch up anytime and he will give you an audience?" they would ask baffled. Indeed I could. But knowing Tuku better, I preferred the orderly route than the seemingly nepotistic and spur of the moment route.
Fine. He would never give me the hairdryer treatment. But I never wanted to find out whether I was a possible candidate!
One day at a show he asked after my parents. "They are fine and in the rural areas," I told him.
"We should go and visit them sometime," he said. Nice joke I thought. "Yes" I said. That Sunday morning, drunk as a skunk in a dirty little bachelor flat I woke up to his call. "Robert, its me. I am at your gate," he said while at the infamous Jorosa Court. Needless to say that was the beginning of a three-day trip to Dande, Muzarabani, where he cracked jokes and educated one sekuru Nick and I on the wisdom behind his music.
I was drinking like a sperm whale. He was eating like a field mouse. "I have diabetes that is why I need to eat regularly. Why do you need to drink that much," he asked. I didn't have a doctor's prescription to hide behind and looked stupid when he asked. He rescued me; "You will grow out of it. I used to drink like you and even smoked but I grew out of it." I was comforted. And continued drinking!
On our way back he had another joke. At Mt Darwin someone asked him if the young man with him was Sam. It was in fact me. Not to worry for the mistake he assured me; "Vanhu vakangoona vanhu vasvipasvipa vanongoti peno ndiye Sam wacho!" (People just see us as spectacularly dark and assume you're my son Sam!) Indeed we were very dark berries. He was proud of it, his dark rich complexion. A mark of identity it was for him.
And yes he could be humble. One day he called saying he had a new album he was about to release and wanted me as a journalist to give it honest criticism. No holds barred. I wanted to rush and collect it from him. It was an honour. "No," he said. Then in a slick Jeep he delivered it with wife Daisy by his side.
Yet today many small artistes with minuscule careers play god and feel so special they don't pitch for interviews. They think super highly of their works. They, as Josh Hozheri said, travel with bodyguards and play deities. Yet the ultimate super star knocked on the doors of small human mortals asking for opinions.
Yet Tuku was weak and vulnerable and that is where his humanness came through.
I was the first person to go and collect him at the airport when his son Sam died. He had been told that Sam had been in an accident so as to make his return from South Africa with his wife Daisy tolerable. Unfortunately, someone had passed condolences in the arrivals area at Customs, alerting the two of their tragic loss.
I was allowed into the international airspace after being cleared and walked towards him at the carousel. Daisy was inconsolable and wailing. She had lost her golden rose.
Tuku turned and saw me at the luggage carousel as he waited for his baggage.
He walked over to me. Hobbling like the weight of the world was on his soul. Embracing me and laying his head on my shoulder he said "Sha Robert, hanzi mwana wangu hakusisina." (My friend Robert, they say my son is no more).
What do you do when a god of music, a larger than life character like Tuku puts his head on your weak, young, mortal shoulders and seeks solace and comfort from you in his most deepest darkest tragedy? His tall frame and shoulder bones digging into my torso as he wept uncontrollably into my breast. His tears seeping into my T-shirt.
Perhaps I should have said ''nyararai henyu samanyanga inga ndimi mhukahuru wani?," as he suggests in his song? Yet perhaps my silence was what he required and my shoulder was the strength he needed. In that silent weep I could hear his heart breaking beneath his ribs. With a grit and coarseness sharper than his voice which emitted a sound like broken glass.
He may have walked this earth after that day. Yet the day Sam died. The day he cried on my shoulder. The day I went with him to the mortuary and saw Sam lying like a beautiful dark inanimate work of art on the mortuary tray. That day when Oliver whispered a song in Sam's ear that I could not hear; a song meant for the deceased closed ears of Sam alone. That day when Daisy said to the corpse of Sam; "Sam, chimuka ndimhamha. Sam Ndauya. Sam chimuka kani hazvichanakidza!" (Sam wake up now. I am here now Sam. Sam wake up now you joke has ceased to be funny).
That day when Tuku held my hand. Held the hand of Patson ''Chipaz'' Chimbodza. Of Josh Hozheri as we went to collect the burial order for Sam Mtukudzi. That is the day when Oliver Mtukudzi truly died.
His mortal body stayed behind only to be buried last Sunday. It was feigning life. Yet the legend and all he celebrated and loved had died when Sam died. Last week. Amidst the multitudes in Madziwa, was just a belated burial of a man who had long since closed the chapter of his life on earth.
Yes. Oliver was a music colossus and larger than life performer. Yet to those who he often opened up to, he was a father, a brother a friend and husband. He could bleed and feel anything more than a needle. He was not a saint. Nor was he a particularly fantastic sinner.
He was a height of flesh and blood like you. And me. Yet unlike us, he had an incredible talent to touch the lives of many.
His voice interacted with the hearts and souls of many people. Living. Dead. And undead. And his voice will bid counsel to the souls of those yet to be born. Like the Bible, or the words of the divine poets, he was a prophet of our time and beyond.


text:
Beaver Bones
Explore the Artifacts /
Artifact Number – #130286 (mandible), #116792 (ulna), #117155 (innominate)
Material – Bone
Place of Origin – Virginia
Date – c. 1607 – 1650
Context – Midden 1, East Bulwark, Kitchen & Cellar
Location – Collections
Category – Exchange, Foodways, The Starving Time
The North American beaver (Castor canadensis) has an average weight of 40 – 50 pounds and the potential to grow as large as 80 pounds, making it the largest rodent on the continent and the second largest in the world, along with the similarly sized Eurasian beaver (Castor fiber). Beaver are widely distributed throughout North America, including Virginia, and are plentiful enough that several counties including James City and York still permit a continuous open trapping season. Beaver significantly modify their ecosystems by felling trees and damming rivers and streams.
Beaver bones have been identified in a wide variety of contexts at Jamestown, spanning several different periods of the site's history. The English colonists brought iron traps with spring mechanisms to hunt beavers, otters, raccoons, foxes, and other small to midsized mammals that could provide much needed meat and valuable furs. Virginia Indians used snares made of wood and cord for the same purposes. Beaver pelts, along with fox and otter, were quickly identified as one of the profitable resources that could be exported from Virginia.
Many early Fort Period contexts such as the Kitchen & Cellar are dated to the Starving Time winter of 1609-10, and the beaver and other faunal remains from those features were likely valued primarily as food. As the colony recovered from the Starving Time the profitability of the venture quickly became a priority once more. The beaver remains excavated from later Jamestown contexts like Midden 1, near the East Bulwark, are likely evidence of the rapidly expanding fur trade. While it was most profitable farther north in the New England colonies, the exchange of beaver and other furs was an important part of the local Virginia economy as well. Native trappers supplied many of the pelts, and one of the complaints raised around the time of Bacon's Rebellion in 1676-77 was that traders exchanging gunpowder, shot, and other weapons for furs were arming those that Nathanial Bacon and his followers viewed as enemies.
Intensive beaver trapping continued until the late 19th century, supplying England with fur for fashionable beaver hats and other wearable status symbols. North American beaver populations were decimated by centuries of overhunting, but protective legislation enacted at the turn of the 20th century has allowed the species to rebound.
Beaver ulna
Beaver mandible
Beaver innominate


This entry is filed under grove and tagged bungalow, frank, grove, items, lloyd, monterey, park, roycroft, stickley, wright.
Grove Park Inn Items Roycroft Stickley Frank Lloyd Wright Monterey Bungalow. Original WPA Yellowstone lodge items. Native American blanket artifacts. American Bungalow reference items. Tons of books worth much more. Bunch of stuff for the correct person dealer. Not pictured Grove Park Inn Bed Original. Bell Hop metal cart from original Inn. Father passed away and cleaning out his collection. 828 301 4988 questions. The item "Grove Park Inn Items Roycroft Stickley Frank Lloyd Wright Monterey Bungalow era" is in sale since Monday, February 11, 2019. This item is in the category "Antiques\Periods & Styles\Arts & Crafts Movement". The seller is "antiqueark4yni" and is located in Asheville, North Carolina. This item can't be shipped, the buyer must pick up the item.
This entry is filed under leaded and tagged frank, glass, leaded, lloyd, prarie, roycroft, stained, stickley, window, wright.
Each panel measures 12 x 22.5 inches. Very old and one has a hairline crack in clear piece. All clear glass is the old wavy kind. Cleaned and somewhat dust free. The item "Leaded Stained Glass Window FLW Prarie Frank Lloyd Wright Stickley Roycroft Era" is in sale since Thursday, April 12, 2018. This item is in the category "Antiques\Architectural & Garden\Stained Glass Windows". The seller is "jasper3024″ and is located in Traverse City, Michigan. This item can be shipped to United States.
This entry is filed under frank and tagged arts, crafts, frank, gaming, lloyd, retails, stickley, table, wright.
The table has eye-catching details that include legs with prominent keyed tenons connected by graceful arched stretchers. There is a wood table with brown aged leather over the solid wood and nailhead trim. The wood color is Fayetteville. This table is sure to a family heirloom. The item "Frank Lloyd Wright Arts & Crafts Stickley Gaming Table Retails For 5,300 + Tax" is in sale since Thursday, September 28, 2017. This item is in the category "Antiques\Periods & Styles\Arts & Crafts Movement". The seller is "taliesinshea" and is located in Norwich, New York. This item can't be shipped, the buyer must pick up the item.
This entry is filed under antique and tagged antique, arts, chair, crafts, frank, limbert, lloyd, stickley, style, taller, wright.
RARE UNUSUAL PIECE OF ARTS & CRAFTS FURNITURE MADE BY J. YOUNG & SONS , CAMDEN NY. PART OF PAPER LABEL STILL INTACT. GREAT STICKLEY / LIMBERT / FRANK LLOYD WRIGHT LINES. TALLER CHAIR 42 1/4″ MOST DINING CHAIRS ABOUT 33″ TALL….. ALL IRON STRUTS SUPPORTS AND BRACES STILL INTACT. 10 WIDE AT BACK FEET. 14 3/8 WIDE AT FRONT FEET. 14 3/4 DEEP AT FEET. SEAT IS 15 1/2″ WIDEST X 14″ DEEP. SEAT IS 18 3/8 OFF THE GROUND. GREAT FOR A TALLER PERSON!!! OR USUALLY MAY BE OUT OF FOOTSTOOLS RIGHT NOW…… Track Page Views With. Auctiva's FREE Counter. The item "ANTIQUE STICKLEY LIMBERT FRANK LLOYD WRIGHT STYLE TALLER CHAIR ARTS & CRAFTS NY" is in sale since Saturday, September 02, 2017. This item is in the category "Antiques\Periods & Styles\Arts & Crafts Movement". The seller is "a1webguy" and is located in Schenectady, New York. This item can be shipped to United States.
This entry is filed under frank and tagged arts, crafts, frank, library, lloyd, stickley, table, wright.
This gorgeous table measures H 29.5 x Dia. 42 and is in new condition! It has eye-catching details that include legs with prominent keyed tenons connected by graceful arched stretchers. There is a wood table with brown aged leather over the solid wood and nailhead trim. The wood color is Fayetteville. The item "Frank Lloyd Wright Arts & Crafts Stickley Library Table" is in sale since Tuesday, August 29, 2017. This item is in the category "Antiques\Periods & Styles\Arts & Crafts Movement". The seller is "taliesinshea" and is located in Norwich, New York. This item can't be shipped, the buyer must pick up the item.
This entry is filed under antique and tagged antique, arts, copper, crafts, frank, lloyd, mission, stickley, table, wright.
One of the best Mission tables I've ever seen. Eyers, square peg construction & architectural feet. Amazing patina on the rare, hand hammered copper top. Measures 27″ square & 24 1/2″ tall. Old, invisible repair to one foot (see pics). Go to the Greyhound website & enter from zip 06488, 70 lbs. & 1 dimension over 27. The item "Antique Mission Oak Copper Top Table Arts & Crafts Stickley Frank Lloyd Wright" is in sale since Saturday, July 29, 2017. This item is in the category "Antiques\Furniture\Tables\1900-1950″. The seller is "bobbbny" and is located in Brookfield, Connecticut. This item can't be shipped, the buyer must pick up the item.
RARE UNUSUAL PIECE OF ARTS & CRAFTS FURNITURE MADE BY J. YOUNG & SONS , CAMDEN NY. PART OF PAPER LABEL STILL INTACT. GREAT STICKLEY / LIMBERT / FRANK LLOYD WRIGHT LINES. TALLER CHAIR 42 1/4″ MOST DINING CHAIRS ABOUT 33″ TALL….. ALL IRON STRUTS SUPPORTS AND BRACES STILL INTACT. 10 WIDE AT BACK FEET. 14 3/8 WIDE AT FRONT FEET. 14 3/4 DEEP AT FEET. SEAT IS 15 1/2″ WIDEST X 14″ DEEP. SEAT IS 18 3/8 OFF THE GROUND. GREAT FOR A TALLER PERSON!!! OR USUALLY MAY BE OUT OF FOOTSTOOLS RIGHT NOW…… Track Page Views With. Auctiva's FREE Counter. The item "ANTIQUE STICKLEY LIMBERT FRANK LLOYD WRIGHT STYLE TALLER CHAIR ARTS & CRAFTS NY" is in sale since Sunday, July 30, 2017. This item is in the category "Antiques\Periods & Styles\Arts & Crafts Movement". The seller is "a1webguy" and is located in Schenectady, New York. This item can be shipped to United States.
This gorgeous table measures H 29.5 x Dia. 42 and is in new condition! It has eye-catching details that include legs with prominent keyed tenons connected by graceful arched stretchers. There is a wood table with brown aged leather over the solid wood and nailhead trim. The wood color is Fayetteville. The item "Frank Lloyd Wright Arts & Crafts Stickley Library Table" is in sale since Sunday, July 30, 2017. This item is in the category "Antiques\Periods & Styles\Arts & Crafts Movement". The seller is "taliesinshea" and is located in Norwich, New York. This item can't be shipped, the buyer must pick up the item.
One of the best Mission tables I've ever seen. Eyers, square peg construction & architectural feet. Amazing patina on the rare, hand hammered copper top. Measures 27″ square & 24 1/2″ tall. Old, invisible repair to one foot (see pics). Go to the Greyhound website & enter from zip 06488, 70 lbs. & 1 dimension over 27. The item "Antique Mission Oak Copper Top Table Arts & Crafts Stickley Frank Lloyd Wright" is in sale since Tuesday, June 27, 2017. This item is in the category "Antiques\Furniture\Tables\1900-1950″. The seller is "bobbbny" and is located in Brookfield, Connecticut. This item can't be shipped, the buyer must pick up the item.


Canada's Minister of Industry and Commerce, the Honourable David Emerson, established a panel to review Canada's policies regarding the regulation of the telecommunications industry in April this year.
The panel is to report to the Government in December – just in time, we hear from Prime Minister Martin, for an election call. We hope that the panel's counsel will not be lost in pre- (and post) election distractions. It would be a shame if the nation were to lose this opportunity to influence the direction of the country's telecoms development. Filing the panel's report on a dusty shelf would not be a fitting end for this endeavour.
The panel is doing important work. The panel is examining the industry, looking at trends and portents, looking at objectives and social goals, looking at competing visions of what Canada's communications policies should be. This is a vital exercise.
The panel will provide policy makers with useful perspectives and important direction. Our counsel to parliamentarians, and would-be parliamentarians (come the dropping of the writ) is to pay attention. A clear vision of the role of communications should be an important issue for Canadians – we have moved now beyond provision, merely, of telephone service, we are now looking at the mechanics of broader broadband deployment and questions about who and how we should pay for such a key service. These questions are of import to the industry, yes, but they are also key questions for Canadians as we look at our country's place in a post-internet, post-broadband economy. That the internet represents a useful resource is no longer a question. Broadband access to the internet will be a key ingredient in the economic, social and intellectual life of Canadians in the coming century.
Is a change in regulation, and regulatory focus needed? Yes, absolutely. Clearly there is a virtual consensus (though with some important exceptions) that some shifts are required. A shift from looking-backward, when considering options, to looking-forward would be a good first step.
A lighter regulatory hand is required. Trust to market mechanisms, not economic micromanagement.
We need to find a way to bring broadband services to all Canadians – but we also need to make sure that all providers, using the full possibilities offered by new technologies, have the opportunity to bring services to Canadians. Should incentives be needed, lets do so through focused initiatives, not indirectly through regulatory fiat.
ICT – Information and Communications Technologies – offer important opportunities to Canada and Canadians. We are not exploiting these technologies as much as other nations. We are not adopting ICT advantages into our businesses or schools – we need a vision in Ottawa of what can be, we need stimulus, we need a national technological rearmament. Lets get this on to the political agenda. The panel can help.


2 Dance 4 Life Studio gives your dancer creative impact on the dance floor, a chance to impress the audience with acquired dance skills, and inspire your dancer, and others, with the passion of dance.
2 Dance 4 Life Studio has a family friendly atmosphere, allowing us to give individualized attention to our dancers. Our dance floor is a state-of-the-art springboard floor, along with a full wall of spacious mirrors, giving dancers and instructors an excellent view of their movements. We have also have Marley flooring. We are located in an area that has many shopping plazas and restaurants, with easy access to Edgewood Dr.
2 Dance 4 Life Studio offers classes from toddler to adult. Our program builds up and encourages rhythm skills, coordination, self-esteem and the love of dance! Toddlers, ages 2 & 3 years, are enrolled in our "Mini Boppers" creative movement Recreational program [COMING FALL 2019]. Pre-School Dancers, age 4 years to 6 years are enrolled in our specialized "Starsbright" Recreational program. Dancers 7 years and up can enroll in any of the available dance styles. Classes are 30 minutes in length.
2 Dance 4 Life Studio offers classes that give dancers a chance to put their skills on display at community events and at our concert recitals. These classes are available from pre-school to adult.
Our programs enhances rhythm skills, coordination, musicality, self-esteem, showmanship and the love of dance!
Pre-School Dancers, age 4 years to 6 years are enrolled in our specialized "Starsbright" classes. Dancers 7 years and up can enroll in any of the available dance styles. Classes are 45-60 minutes in length.
This is a special program designed for dancers who wish to pursue an advanced level of training. The program is divided into teams. The dancers are placed into the teams according to level, age and program style. Competitive dancers represent the studio at different competitions though out the year, as well as at many community events and all our functions. Competitive dancers strive to achieve their goals, gain confidence and show excellent sportsmanship at all times. Dancers try out for the teams during one of our Tryout sessions in August.
2 Dance 4 Life Studio is proud to present our second year spring dance concert in June.
The concert is a production put together showcasing all dance programs offered at the studio. Our dancers present the concert, displaying the hard work and fun that they enjoy during the dance season. We invite family, friends and the general public to attend the event.


Has your child been devastated by a vicious lie that came straight from the rumor mill? Children start learning the concept of gossip earlier than most parents anticipate. By the age of eight or nine, children have already been exposed to the concept of malicious gossip and speculative lies.
Parents sometimes feel lost on how to prevent their kids from falling prey to such a prominent pastime. Children are drawn into the drama their friends provide. Perhaps even worse, your child may be guilty of starting the gossip in the first place.
Talking about others behind their backs is an important topic that parents need to nip early. Keeping your child focused on telling the truth and saying positive things about others can be easier said than done though. You may want to consider following some of these prominent tips for teaching your child that gossip is wrong.
Children primarily learn by watching what the people around them do. Parents have the potential to be a child's biggest role model. According to some experts, modeling good behavior may be the most effective way to eliminate gossip. It may be time for you to evaluate how much time you spend complaining or gossiping with your friends. Particularly when your child is within earshot, monitor the things you say about others closely.
Set an example by speaking only positive words about other people. Children are likely to pick up on this habit, which can increase their positive social interactions.
Talk to your child about choosing friends wisely.
Your child may still need some guidance when it comes to choosing good friends. Talk about what makes someone a good friend. One of the key considerations should be whether that child is nice to other people. Ask your child how they would feel if they were on the receiving end of hurtful comments. Would they really want to be friends with that person?
You may need to gently guide your child through the process of choosing friends that don't gossip or say hurtful things about others. This is another behavior that can easily be modeled by parents.
Ask your child to consider the feelings of others.
Depending on the age of your child, they should have a pretty good grasp on understanding the emotions of their peers. Parents may walk their children through the process of deciding whether their feelings would be hurt in a given situation. Experts recommend roleplaying a few gossip scenarios to get children thinking about the implications of their words.
This may also be a good time to ask your child to consider how a friend would feel if she shared their secrets. How would your child feel if someone shared her secrets? Helping your child to consider the viewpoints of others is an essential social skill that they need help to fully develop. They may need a few more years to truly develop respect for someone else's privacy.
Gossiping can be a particularly nasty habit that worsens over long periods of time. Parents should make every effort to monitor their children's friendships carefully. They may be able to put a stop to this behavior early on with some of these relatively minor interventions.
Should you Consider Homeschooling your Child?


Even though Jim has been a teacher for 30+ years, he remembers clearly what it was like to be a student. He can still recall the long and grueling process of writing a paper and the feeling of anticipation to get it back to see the grade. Like the rest of his classmates, he would skim past the teacher's red scribbles and go straight to the last page to see what score he got.
When he first started teaching, Jim followed the same cycle: Collect research papers, spend hours grading them, hand them back and watch as his students ignored his comments and go straight to see their grade.
To be honest, I don't even know if they could read my writing. After a few papers, my writing got sloppier and sloppier. I was getting really tired of writing, so I started doing briefer statements. Then, I would give it back to the kids, and I don't think they read what I wrote at all. It was just not working.
Thinking there has to be a better way, Jim went online to see what free tools he could use to make the feedback process more effective. That's when he found Kaizena. With the voice comments feature, Kaizena was exactly what Jim needed. He could quickly make a highlight and record himself speaking his feedback instead of scribbling it! To his surprise, after a few uses of Kaizena he discovered another benefit that he wasn't expecting.
But with voice comments, grading has become a way for me to build and further my relationships with my students. Not only do they get the pointers and tips they need to improve their writing, but the entire process is a way for us to bond with each other! Writing becomes more like a collaboration instead of a one time event.
By recording himself as he reviews his students' writing, Jim is able to express his thoughts more quickly and in a more personalized way. Through his voice and tone, he's able to encourage his students in a much more authentic way.
Many of Jim's students have told him how much they enjoy getting feedback this way, and how it feels just like he's sitting there next to them to help them write.
How has Kaizena improved the feedback process in your classroom? Let us know by emailing shirley@kaizena.com and you could be featured in a future post!
If you're interested in learning more about increasing engagement and building relationships, check out Jim's book and podcast where he goes into more details!


Comic Boom Colection is full of panels, comic speech bubbles, panels, words and everything to make your layouts boom!!!
A Set of 6 Comic Panels in 4 different versions, that coordinate with the June 2018 BYOC, to use in your pages!
1 halftone photo overlay+3 flairs!!!!!
They are created for high printable quality at 300 dpi and saved as .jpg, png, .tiff and .psd files.


The achievements of the Cradle Fund in the mere three-and-a-half years of its existence are truly amazing. Working with thirteen Cradle Fund partners, it has already helped more than 125,000 refugees. And all of this has been made possible by people's generous donations.
The Cradle Fund is the only non-profit initiative that this blog supports. I have been friends with Chris Seiple, its founder and president emeritus of IGE, for many years. Whether you have supported the Cradle Fund in the past or have yet to help, I urge you to think about supporting this remarkable initiative.
There is a wealth of information and photos about the Cradle Fund on the IGE website. Here are two recent short articles on the IGE site. This link. And this one.
Here is the first article I wrote about it. It explains its fortuitous beginnings and how we got involved. And it will give you other basic info and photos and link you to subsequent articles on this blog about the Cradle Fund's evolving history, which is pretty amazing.
Thank you for being approachable about this. Soon we will again remember the resurrection of Christ, who rescued us from our sins. And as the rescued know, there's nothing like a rescue.
Photos courtesy of the Institute for Global Engagement.
A note from Charles: If you want more of the perspectives that Waging Wisdom seeks to present, I want to invite you to follow the blog. Just click here, find the "Follow" button in the right margin, enter your email address, and click "Follow." You will then receive a very short email notice whenever I post a new article. And, hey, if you really like this blog, tell a friend! Thank you.
I have been thinking lately about "goals," probably due to the sense of accomplishment I recently felt with the publication of a new book – one that had been a goal of mine for forty years!
I've also been thinking that we live in a time when the setting of goals has become a big thing. A career change. A post-grad degree. A wife. A husband. Two children. An adoption. A new car. Acquire three new clients. Start my own business. Publish an article or a book. Lose forty pounds. Create a website. Run for public office. Make that Olympic team (well, maybe just the college team). You get the picture. Any list of things to get or places to be would run as long and as varied as the people asked.
Leaving aside a discussion of whether a goal is dubious, or whether such and such a person ought to have set such and such a goal, I'm going to assume, here, that the goal is a good one, and doable, for the person in question. Even so, the question of how to reach the goal then becomes is crucial for anyone, especially for Christians, who serve a God who is certainly interested in the end result!
The God of the end, however, is also the God of the way. God is keen not only about the omegas we seek but also with the ways we travel to get there. This is a huge theme of the book of Proverbs, especially in 3:17, which speaks of the "ways" and "paths" of wisdom. The decisive use of the plural must not be missed. Wisdom, here, is being presented not just as one way but as having many ways (paths). This use of the plural may seem counterintuitive because we Christians follow "the way" (John 14:6), Jesus Christ, the wisdom of God (1 Corinthians 1:24). Doesn't Proverbs 3:17 contradict that? How can there be many paths of wisdom?
Unlike John 14:6, Proverbs 3:17 is not a soteriological passage. To put it another way, whereas John 14:6 is about God's way of salvation, Proverbs 3:17 is about God's ways for directing our travels through life's daily grinds, which are many and varied. For different goals in this world are, and must be, reached via different methods. When three people have three different goals, or even if one person has several goals, they are reached via different methods. You don't hunt for a house to rent, or to buy, in the same way you plant your garden or run for an elected office. You don't use the same method to get your post-grad degree as you would to court your future spouse (I hope not!).
The book of Proverbs admonishes us to come under the discipline of the yoke of the wise how, to let wise ways, not foolish ways, direct our steps.
The first nine chapters of Proverbs, for instance, may be summarized as a test of wills between those who will choose to follow the wise ways of Lady Wisdom, which lead to life (Proverbs 3:18), or the foolish ways of Lady Folly, which lead to death: "Do not let your heart turn to her ways or stray into her paths…. Her house is a highway to the grave, leading down to the chambers of death" (Proverbs 7:25-27).
So that is the first thing: choosing and then traveling a way, a path, of godly wisdom for reaching a particular goal we have set. The question then becomes: What is a way, a path, of godly wisdom toward a particular goal? How do we come under the discipline of the wise how?
I pose this question because a huge industry, populated with self-help gurus and ultra-achievers, among others, has arisen devoted to offering many and varied methods for reaching goals.
When following a method, how do we discern if anything is biblically unacceptable in its ideas, values, means, strategies, and steps to fulfilment?
The answer will depend on how much time, effort, and resources we put into thinking biblically about how we will get to a goal and what is taking place along the way. Admittedly, discrimination of this kind – between the biblical and the unbiblical – can be a tricky business for any Christian. After all, how does one think biblically about choosing a PhD program or running for election or buying a new car? If the teaching arm of our church has not given us the tools for learning to think biblically about the importance of our methodologies, well then…. Non-biblical ideas, attitudes, and values will fill the vacuum.
I want to draw attention to what I call two inconspicuous essentials of God's wisdom, which can help us recognize if our travels toward a goal has the feel of a wise how.
One of these essentials is peaceableness. To return to Proverbs 3:17: The ways of wisdom are pleasant and her paths are paths of peace. The word "ways," here, is about the means taken or the procedures followed to an end. In short, it is about method. The word "peace" is the venerable Hebrew word shalom (well-being; flourishing). And in the New Testament, the epistle of James (also at 3:17) indicates that the wisdom that comes from above is peace-loving, as well as considerate, full of mercy and good fruit, impartial and sincere. That kind of wisdom is contrasted to the kind that is bitter, envious, and filled with selfish ambition, strife, and disorder (3:14-16).
I think the message, here, is that if God's peace is setting the spirit and tone of whatever method we are applying to reach a goal, then patience, sympathy, mercy, good fruit, even-handedness, and sincerity are traveling with us along the way.
It would be a good practical exercise, then, to spend time answering questions about whether those qualities, or the ones James calls envy, selfish ambition, and strife, are refereeing a particular method we are relying on. It's not that we will be perfectly consistent epistles of the qualities of a godly wisdom, but surely we ought to be making progress with them. Is their influence pretty strongly felt as we work toward fulfilling a goal?
"I was appointed from eternity, from the beginning, before the world began. . . . I was there when he [God] set the heavens in place . . . when he gave the sea its boundaries . . . when he marked out the foundations of the earth. . . . I was the craftsman at his side. I was filled with delight day after day, rejoicing always in his presence, rejoicing in his whole world, rejoicing in his whole world and delighting in mankind" (Proverbs 8:25-31).
Since our relationships with others give us a big clue as to whether the peace of God is present in them, the relationships we have with those who are assisting us toward our goals can help us discern if we are in the path of a wise how.
If the triune relationship that Lady Wisdom has with God, creation, and human beings is enjoyable, delightful, and pleasant, are those qualities present within biblical boundaries in our pursuit of a goal?
This is not to suggest that struggles, disappointments, setbacks, failures, and suchlike will not befall us. It is to suggest being conscious of what kind of fruit we are bearing through our relationships with those with whom we are traveling to reach a goal.
If your children are suffering due to your training schedule for running the marathon; if your marriage is falling apart because of the way you are pursuing that PhD; if your bull-in-a-china-shop method for getting a promotion is making enemies of fellow employees; if you're running out of patience with your guitar instructor; if you have become chronically unhappy with your fiancé … You get the picture. Is it time to hit Pause and admit that a course correction is necessary?
This short article on a complicated topic probably evoked more questions than solutions. But maybe it's a start.
When we mis-prioritize "goal" as being the main thing, it is easy to de-prioritze the essentiality of learning and applying a godly wisdom for getting there.
It is a governing theme of Scripture that God is particularly concerned with wisdom, and wisdom is to a large degree about method, about how we get somewhere. For the follower of Jesus – the supreme example of the peaceable, the personal, and relational – the way of wise how must be recognized and prioritized when traveling to get somewhere or something.
They do not speak honestly.
Like a steed dashing forward in the fray….
To the law of the Lord….
'Shalom, shalom,' they say, where there is no shalom.
As one season of the year surely follows another, the word "wisdom" in Scripture is meant to put us in mind of the strong influence that our ideas and beliefs exert over our behaviors and our actions. In other words, "wisdom" in Scripture, among other things, denotes a way of seeing life and living in it. And of course St. Paul and St. James remind us that there are different kinds of wisdom (1 Corinthians 1:18-2:9; James 3:13-18). Jeremiah is saying that at the heart of a culture's social sins lies a bogus way of seeing life and living in it, a bankrupt wisdom. It becomes a way of life for the people, and it has been spread by both the writings and the speeches of religious authorities and political leaders in particular, as the following words of Jeremiah indicate.
Image by Cesar R, permission via Creative Commons.


text:
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Finding Anthropomorphism in an Electric Chair Patent (1897)
JF Ptak Science Books Quick Post
This image of among the first electric/electrocution chairs is based on the designs of Dr. Alfred P. Southwick (1826-1898, MDS, DDS, SUNY Buffalo), who came up with the idea and started experimenting with it beginning in 1881. His was a mission of mercy, looking to find a quick if not instant salient to carry out the death penalty of a convicted murderer. NY Governor David B. Hill (1843-1910) looked to Southwick for a solution to a more humane way of executing people, establishing a distinguished panel of advisers to help him with this task. (In the small-world department, Hill succeeded Grover Cleveland as governor in 1885 following Cleveland's election as president of the U.S.--he also acted as executioner in at least two cases while he was the Sheriff of Erie county in the mid 1870s.)
Southwick's design/chair was first used on the condemned criminal William Kemmler in August 1890. Most everyone who witnessed this first attempt were aghast at the spectacle; George Westinghouse is reported to have uttered that the executions "would have been better off using an axe". Theoretically the first application of electricity kills the brain in less time than it takes the body to respond to pain. This seems not to have been the case in many instances.
No tong afterwards Edwin F. Davis (1846-1923) conducted his own research on an effective and humane way to execute people and was awarded a patent in August 1897 for his "electrocution chair". Davis would serve as NY state's "electrician"/electrocutionist from 1890-1914, delivering the final blow to 240 of the condemned during that time.
It was strange to me how anthropomorphic the design was, including the obvious head and less so for arms and feet. Overall, I think the relationship to a human form is unmistakable.
Excerpt from the article illustrating the 1888 electric chair:
"Execution by Electricity. The State of New York may pride herself in the fact that the gallows is to be banished and a more humane and scientific method of executing criminals is to be instituted. On June 4 Governor [David B.] Hill signed the bill authorizing that criminals should be put to death by an electric shock. The bill is to go into effect on January 1 1889 and new method of execution be applied in the punishment of crimes committed after date."
SciAm writes that "instant death" occurs with the electric chair—it doesn't. The condemned would be lucky to have their brains damaged enough to not register pain, as it takes 45 seconds to several minutes for death to occur.
"...the criminal is seated bound to a chair having a metal seat connected with one pole of the current. At the back of the chair there is an adjustable head rest having a metal plate on its face and a metal band which passes around the forehead of criminal. The wires may be connected with dynamo which according to the bill may be of any approved type or the current may be supplied from electric light plant or there may be a private plant arranged especially for that purpose at the place of execution. Sponges or dampened cloths should be at the points of contact with the convict to render connection more perfect. At the proper moment switch is turned by the officer and instant death ensues. The current passes along the spinal column and the brain and nerve centers. The current may be few moments to bring about complete exhaustion."
Scientific American, 30 June 1888, vol 58.
Posted by John F. Ptak in Technology, History of, What is It? | Permalink