I cannot say I had the pleasure of hearing Susannah McCorkle sing. I heard her perform many times--at least a dozen, perhaps twenty times from the spring of 1981, when my late friend Roy Hemming, a pedigreed cabaret hound, first brought me to see her at Michael's Pub, to the autumn of 2000, when she had her final run at the Oak Room in the Algonquin. I went to three of her last ten shows. On all those occasions, I rarely drew from McCorkle mere pleasure, but derived many other things of value--illumination, wonderment, flashes of horror, and stimulation to self-reflection and doubt. I admired her deeply and cheered the bravery of her work, though all I ever wrote about her was a few sentences in 1991.
McCorkle might be a great subject some day. Right now, she's in a weird lull. The room's half empty most nights. She's an acquired taste and hard to take sometimes. I think a lot of her own fans sort of take her for granted these days. But I think she's going to be one of those people who everybody rediscovers late in life.
I pictured McCorkle aging into a figure like Blossom Dearie, an odd bird revered after a long career as an endangered species.
About six months after that, McCorkle rendered moot my theory and all other theories about her future by leaping from the window of her sixteenth-floor apartment on Manhattan's Upper West Side. In the months to follow, the awful story of her death brought more attention to McCorkle than she had ever enjoyed in life. Encomia to McCorkle and her music appeared in Time, Entertainment Weekly, and The New Yorker (by the literary editor of this magazine, who was her friend); and the writer Linda Dahl, author of two books on women in jazz-- Morning Glory: A Biography of Mary Lou Williams and Stormy Weather: The Music and Lives of a Century of Jazzwomen--began work on a biography. That book, called Haunted Heart, after the ballad by Arthur Schwartz and Howard Dietz that McCorkle recorded on her final album, has now been published by the University of Michigan Press. Subtitled "The Secret Life and Tragic Death of a Great American Songbird," it is an intimate and blunt book, full of details about McCorkle's spicy romances, along with material on the creative work that makes her worthy of attention five years after her death.
McCorkle, who would have turned sixty this year, was a child of the rock era who sang the music of another generation--the Tin Pan Alley hits and theater songs of the first half of the twentieth century. The status of this material as a canon, the "Great American Songbook," was not yet solidified when McCorkle started singing, in the early 1970s. For some years, she made a specialty of tunes composed in the 1920s and 1930s, many of them sung originally by Billie Holiday, her first idol and vocal model, or by quasi-proto-feminists such as Mae West, Bessie Smith, Ethel Waters, and Mildred Bailey.
In Dahl's telling, McCorkle's choice of musical direction was a radical one that defied the hippie culture of the young singer's native Berkeley. But the history is more complicated. The Bay Area scene was infused with kitschy nostalgia for the 1920s and the early 1930s. While McCorkle was still in school, Janis Joplin was growling songs by Bessie Smith and Big Mama Thornton and releasing them on albums with cover art by Robert Crumb that captured the Haight-Ashbury aesthetic by appropriating the 1920s. Mama Cass made "Dream a Little Dream of Me" a hit in 1968. The Grateful Dead, a mutated jug band, would jam all night to old numbers like "Ain't Nobody's Business." For a Berkeley girl to turn to the early swing of the 1920s and 1930s was less a rejection of the music of her peers than a distillation of an element in its essence--a claim not to exceptionalism, but to purity.
When Paul McCartney manufactured his own vo-de-oh-do ditties for the Beatles, John Lennon mocked them as "granny music." He nailed both their ridiculousness and their power. What made songs such as "When I'm Sixty-Four" and "Honey Pie" palatable, even appealing, to baby boomers was the fact that they skipped over a full generation. Whether or not they were granny music, they were not mommy- and-daddy music. So it was with McCorkle's early repertoire: she would do an old Rodgers and Hart tune such as "Manhattan," from 1925, but not Rodgers and Hammerstein's "My Favorite Things," from her parents' record collection. She was not close to her mother or her father, and she would not trust a song under thirty, at least not until she had been performing for a few years and matured as an artist.
She began singing professionally at twenty-five, while living in Rome. A drifting expatriate, McCorkle had gone to Europe to write fiction and ended up falling under the sway of a group of continentals infatuated with vintage swing and the free, fun pre-war America that it evoked. She moved on to London, where other Americans such as the writer and cornet player Richard Sudhalter and the English pianist Keith Ingham were part of a cliquish swing revival. It was a parochial movement, rigid, zealous, almost a cult--and thus ideal for McCorkle at the time. She had attended fourteen schools before college, tugged around with her mother and two sisters as her father, who suffered from acute depression, bounced from job to job. Rootless and insecure, McCorkle no doubt found comfort in the impassioned surety of the swing revivalists.
As Dahl points out, McCorkle learned her craft by mimicking Billie Holiday. So did countless other singers inspired by Holiday; original voices frequently begin as imitations. My wife, who is a singer, admits to an early debt to Doris Day, who, she adds, started by imitating Ella Fitzgerald, who, she notes, began by emulating Connee Boswell. (No anxieties of influence here, just a lot of keen apprenticeships.) All of them found their own styles quickly, and so did McCorkle, who studied early jazz singers so assiduously that she probably knew who Boswell was copying. By the time I first saw McCorkle, just a few years after she had moved from London to build a career in Manhattan, the only traces of Holiday remained in the way she hung under a note--sometimes too far under-- and let her vibrato crumble at the end of a phrase for dramatic effect. She developed a singular approach, working from both her strengths and her weaknesses.
A good (though not great) writer of prose fiction and nonfiction, McCorkle wrote short stories and worked on drafts of novels until her last days. One story written in her twenties, "Ramona by the Sea," was awarded an O. Henry Prize and anthologized after its initial publication in Mademoiselle. As a singer she remained a storyteller, attentive not only to the meanings of individual words, phrases, and lines of lyrics, but also to the narrative contours of the song. At this McCorkle had few equals other than Mabel Mercer, Frank Sinatra, and Sylvia Syms. Her skill at finding the shape of a song--or molding a flat song into a form of her devising--is especially striking in "The Waters of March," the chant-like tune by Antonio Carlos Jobim that she made one of her signatures. (A former linguistics student and onetime translator, McCorkle was fluent in Portuguese and understood the fragility of Jobim's songs. ) Through the careful modulation of tone and the astute use of dynamics, she carries us with the spring waters from the death of winter to the new season's promise of rebirth. On her collection of Cole Porter tunes, Easy to Love, she even builds "Let's Do It," the listiest song on the composer's long list of listsongs, to a slyly referential climax.
McCorkle's most extraordinary gift as an artist was her command of the dark colors in the emotional spectrum. "I definitely became a singer in order to sing sad songs," Dahl quotes her as saying. She sought out music of heartbreak and loss, and she found it in varied quarters--in the blues of Bessie Smith and Mildred Bailey, naturally, and also in little-known theater songs from the teary scenes in forgotten shows, such as "This Funny World," a paean to futility from Rodgers and Hart's Betsy, a Broadway fizzle staged in 1926. McCorkle was uniquely adept at unearthing the melancholy parts of well-known songs--songs within the songs. Her masterpiece of internal excavation was surely her wrenching version of the hoary Irving Berlin anthem "There's No Business Like Show Business." She slowed the tempo nearly to a halt and clung to a few bittersweet phrases that most singers gloss over ("they smile when they are low," "brokenhearted, but you go on"), transforming a show-stopper into a piece that stops the heart. In the absence of sorrowful lyrics, McCorkle was content to upend whole songs through interpretation, as she did with Harold Arlen and Yip Harburg's tune for the Tin Man in The Wizard of Oz, "If I Only Had a Heart."
That is to say, she sought herself in the material. Ingham, her onetime mentor and second husband, groaned about this to Dahl. "By 1982 or so, every song had to relate to something totally in her own life somehow, everything had to be from a point of view that she agreed with or was about her, and she wouldn't sing many, many songs because she objected to them," he said, belittling McCorkle for being an artist rather than a professional. She was a tortured soul; Dahl reports that, in clinical terms, she suffered from bipolar II disorder. As an artist first and a psychiatric patient second, McCorkle gave voice to her torment in her music. After reading Dahl's book, I downloaded eight of McCorkle's CDs onto my iPod and listened to them closely for the first time in several years. I found the music more beautiful and sadder than I recalled. It is precious work of profound melancholy and hopeful--sometimes desperate--yearning entwined with a stark fatalism.
As several musicians mentioned to Dahl, McCorkle was self-centered and ambitious. Hel-lo! She was in show business. Her self-absorption was more conspicuous and out of place in her prose writing. McCorkle published several essays on her musical influences and interests, such as Ethel Waters, Mae West, and Irving Berlin, in American Heritage, and they are all a bit too much about Susannah McCorkle. In the piece ostensibly about Berlin, the word "I" appears twenty-four times in the first twenty sentences. The fiction of hers that I have seen, much the same, seems limited by its author's experience and not fully imagined; it reads like journal entries.
Speaking of which, I know McCorkle was a copious correspondent and journal-keeper. She wrote to me half a dozen times, and I scarcely knew her. Her journals, along with a vast archive of other materials--comprising nearly all her unpublished writings, her music, her business and personal records, even the contents of the hard drive on her computer--are in repository at the New York Public Library, a donation of McCorkle's estate. According to the librarian in charge of the archive, Dahl had access to much, but not all, of this material. (Many of the electronic files were damaged and unreadable until the library had them recovered.) Dahl's book renders McCorkle artfully, but incompletely. As one still hungry for more information to help unravel the enigma that Susannah McCorkle remains, I look forward to a second biography of her, drawing more fully on the archival materials. An additional book on McCorkle might also help extricate her from her dubious status as the singer who committed suicide.
When McCorkle died, I was in London with my wife. We had divvied up the sections of the International Herald Tribune to read over breakfast, and I heard Karen gasp when she saw a sizable photograph of McCorkle in the paper. "Good for Susannah!" she said. As soon as she realized that the photo was an illustration not for a profile of McCorkle, but for her obituary, Karen started to quake. McCorkle's death was very bad for many people--her admirers, of course, and also for a great many more who never heard her music and came to know her only as the suicide girl. Today, most of McCorkle's CDs are out of print, and her longtime label, Concord, is doing little to preserve her legacy. There should be a second book about McCorkle, and then others, if only to keep us thinking about her and returning to the dark well of her music.


Somerset Borough badly needed high-quality public spaces to serve residents, workers, and as a venue for special event. SGA facilitated the acquisition of the property needed and oversaw the design and construction of a compact, multi-functional, and lush green space known as Trinity Park, in the main block of the Uptown central business district.
Inspired by regional geologic outcroppings and utilizing locally sourced materials as much as possible, Trinity Park evokes a nestled piece of native landscape yet functions as an urban public space. The signature elements are three oak sculpture seating elements constructed of regional white oak timbers. The brick paving is estimated to be more than 100 years old and was sourced from a street slated for excavation and reconstruction in Connellsville, PA. These aged bricks are matched with modern solar light pavers to enhance the evening and year-round utilization of the park. Our design of the park links the past with modern elements that respond to current environmental values. The park has the first large-scale raingarden in Somerset and is densely planted with layered plantings emphasizing native habitats and supporting pollinator species.
The park includes several programming elements that range from informal seating to the ability to support a wide variety of dynamic events including concerts, markets, and organized dinners in the park. As one of the oldest organized main street programs in Pennsylvania, the organization wanted the ability to expand its already noted events including its Fire and Ice and the annual antiques faire that has been held in the town since 1962.


text:
import Ember from "ember-metal/core"; // Ember.assert
import { create } from "ember-metal/platform";
import merge from "ember-metal/merge";
import EmberError from "ember-metal/error";
import { addBeforeObserver } from 'ember-metal/observer';

import hasElement from "ember-views/views/states/has_element";
/**
@module ember
@submodule ember-views
*/

var inDOM = create(hasElement);

var View;

merge(inDOM, {
  enter: function(view) {
    if (!View) { View = requireModule('ember-views/views/view')["default"]; } // ES6TODO: this sucks. Have to avoid cycles...

    // Register the view for event handling. This hash is used by
    // Ember.EventDispatcher to dispatch incoming events.
    if (!view.isVirtual) {
      Ember.assert("Attempted to register a view with an id already in use: "+view.elementId, !View.views[view.elementId]);
      View.views[view.elementId] = view;
    }

    Ember.runInDebug(function() {
      addBeforeObserver(view, 'elementId', function() {
        throw new EmberError("Changing a view's elementId after creation is not allowed");
      });
    });
  },

  exit: function(view) {
    if (!View) { View = requireModule('ember-views/views/view')["default"]; } // ES6TODO: this sucks. Have to avoid cycles...

    if (!this.isVirtual) delete View.views[view.elementId];
  }
});

export default inDOM;

redpajama_set_name: RedPajamaGithub


text:
The Furtive War by Wilfred Burchett
Any illusions that the formation of the coalition government in Laos would, by itself, bring a stable peace were shattered by the events of April 1963. The author paid another visit to Southeast Asia at that time and gathered more firsthand evidence of the hot-cold war continuing there. It was soon evident that the Rightist group, headed by General Phoumi Nosavan, had been far more successful in peacetime intrigues than it had been on the battlefield.
From the moment the coalition government was formed and actually started functioning in Vientiane, U.S.-Nosavan policy, backed by swarms of CIA agents, was to win the neutralists away from the Pathet Lao, isolating the latter as a prelude to destroying them. What almost happened in Vientiane in mid-April was an Iraqian-type coup, as a climax to months of intrigue, bribery, and a succession of assassinations. The plan of winning away the neutralists, breaking up the partnership which had thwarted early efforts to destroy the Pathet Lao, was not merely a political move aimed at forming some future electoral alliance. It had specific military aims—to introduce a Trojan horse into key military areas and take them from within. A scandalous situation existed, with Nosavan's troops and police in complete control of Vientiane. Government, Pathet Lao, and neutralist leaders were virtually hostages of Nosavan's armed forces. In this situation a coup was planned in which certain neutralist and Pathet Lao leaders were to have been assassinated.
The murder of Foreign Minister Quinim Pholsena on April 1 was the signal for an armed coup, the first stage of which was to be the seizure of the strategic Plain of Jars.
In the previous months, there had been a mysterious series of "desertions" to the forces of General Kong Le from Nosavan's regular army. They did not come in two's and three's, but in entire companies complete with arms and officers. A number of senior Nosavan officers also "deserted" to Kong Le's staff headquarters. When the Pathet Lao leader, Prince Souphanouvong, warned Prime Minister Souvanna Phouma and Kong Le of what was happening, the warnings were dismissed as the product of an "over-suspicious mind." There is every reason to believe that in the period just preceding the April events, Kong Le was figuratively, if not literally, a prisoner of the Nosavan infiltrationists. Orders were given in Kong Le's name for certain units to be switched from key points in the Plain of Jars and to be replaced by others which were virtually Nosavan's men in Kong Le uniforms. Colonel Deuane, Kong Le's number two officer, and military commander in the Plain of Jars, refused, aware by then of what was happening. That was late in March.
On April 1 Quinim Pholsena, head of the "Peace and Neutrality" party, comprising progressive forces among the neutralists, was shot down as he walked up the steps of his Vientiane home after attending a Royal reception. His wife, a political figure in her own right, severely wounded in the assassination, told me a few days later that she had no doubt the murderers were inspired by Americans in Laos. She was left to bleed to death on the steps alongside her husband's body; the guard which surrounded the house prevented anyone entering or leaving to get help. No one from the guard came near her. Eventually, a servant dragged her inside. Those who tried to enter were stopped at gun-point, including Prime Minister Souvanna Phouma and the Pathet Lao Minister of Information, Phoumi Vongvichit, and other ministers. It was only three hours after the shooting that Souvanna Phouma was permitted to enter the house and only five hours later was Madame Pholsena taken to a hospital. (As for the assassin, who made no attempt to flee, he was taken to live with a high-ranking neutralist cabinet member and only 12 days later was he nominally arrested and put in a prison controlled by Nosavan's forces!)
A few hours after the assassination, troops supported by tanks were sent to arrest or kill Col. Deuane. They were beaten off, part of the forces refusing to attack. A second much larger assault was made the following day, supported by seven tanks. The troops, supporting peace and neutrality with their feet, either refused to attack or deserted to Col. Deuane. Seeing what was happening, neutralist troops in other key areas declared themselves also for Col. Deuane and for upholding the partnership with the Pathet Lao.
From Kong Le's headquarters, appeals went to Nosavan for reinforcements—this time not "deserters" but entire units of battalion strength. By the second and third week of April, Nosavan's battalions started moving up towards the Plain of Jars, the gates opened for them in some places by the infiltrators among Kong Le's troops. It was only when key points were actually under attack, that the Pathet Lao moved to help Col. Deuane defend the Plain of Jars. As usual in such encounters, Nosavan's forces were beaten back at every point, except one important post at Tha Thom, a southern gateway to the Plain of Jars where some 800 Nosavan men overwhelmed a small Pathet Lao garrison.
In the meantime, the two Pathet Lao ministers, Prince Souphanouvong and Phoumi Vongvichit, managed to escape from the trap set for them in Vientiane, the former withdrawing to Khong Khay in the Plain of Jars and the latter to the old resistance base at Sam Neua. The military plot failed due to the loyalty of Col. Deuane and the main part of the neutralist forces in the Plain of Jars to their partnership with the Pathet Lao; to the reluctance of the Kong Le troops to attack their colleagues; to the vigilance of the Pathet Lao, and to the low morale of Nosavan's forces. But it was a close call. Had "Operation Trojan Horse" succeeded, the trap would have been sprung in Vientiane and all Pathet Lao and progressive neutralist forces in the capital would have been caught in it.
As it was, the assassination of Pholsena was the signal for a brutal assault on progressives. With tanks and armored cars patrolling the Vientiane streets, scores of progressives were hunted down and arrested; others saved themselves only by seeking asylum in friendly embassies.
Western embassies and the wire agencies went into action, describing the fighting as Pathet Lao "aggression" and "violation" of the ceasefire—long before the Pathet Lao had even fired a shot in self-defense. As usual in such cases, the U.S. Fleet moved into the Gulf of Thailand, and the failure of the plot was pictured as a threat to world peace.
These events have shown again that the U.S. State Department and the CIA have no intention of accepting defeat for their policies in Laos, not even the stabilization of a neutral government. The recent growth of popular sentiment in Thailand and South Vietnam for neutral regimes in those countries also, confronts the Kennedy administration with a new crisis of policy, which it cannot meet merely by trying to prove with more intervention and intrigue that neutral regimes in Asia are unworkable.
More troubles can be expected in Laos, as long as the Nosavan Rightists, with the support of the United States, do everything possible to prevent stability. Side by side with this, there are indications that the old plan is being revived of setting up a separate state in South Laos under the guise of "partition." This would provide the United States with a corridor between Thailand and South Vietnam, and with one single front within which troops could be shuttled back and forth as the requirements of counter-revolution may demand. The new element in the plan is to create, side by side with the southern corridor, a U.S.-supported "neutralist" regime centered in the Plain of Jars in the North.
In South Vietnam, the situation continues to move drastically against the Diemist regime. The failures of U.S. intervention against the forces of the National Liberation Front account to a great measure for the more desperate policies in Laos.
The Staley Plan to wipe out the guerillas in South Vietnam within 18 months has failed. During my travels in April 1963, I met one of the military leaders of the NLF, who must remain nameless for the time. He analyzed the situation as follows:
"The Americans based their plans to wipe us out in 18 months on the following factors: When intervention started at the end of 1961, they figured they had a numerical superiority of Diemist troops over ours of 10 to 1. They hoped to increase this advantage to 20 to 1 by the end of 1962. According to British experience in Malaya, they believed this would be sufficient to end resistance quickly—say in another six months. [Actually, political and military conditions in Malaya were quite different and even with a 40 to 1 superiority at the end, the British had no clear military victory.] American calculations were based on increasing the Diemist military forces to certain target figures and reducing our forces to well below the 1961 levels. Opposition to conscription in the South and large-scale desertions prevented them from achieving their expansion targets. Instead of our forces being reduced, they were doubled by the end of 1962. Thus, instead of achieving a 20 to 1 superiority, the original 10 to 1 proportion was reduced to something between 6 and 7 to 1. And the ratio will continue to change in favor of the NLF forces."
He added with complete confidence, "At present 75 percent of the territory of South Vietnam is entirely liberated. It includes about 7,000,000 inhabitants, half the population. Land reform has been carried out, and in much of the area irrigation projects have made possible two crops instead of one each year. There is a school and public health center in each village and in many districts we already have secondary schools. Outside the solidly liberated territory, we control much of the territory by night while the Diemist administration appears to function by day."
In other words, the struggle in South Vietnam is assuming the classic form it has taken wherever a guerilla war developed into a successful war of independence, be it Algeria or Cuba. Beginning with an overwhelming superiority in favor of the Right-wing and colonialist forces, the ratio constantly changes in favor of the resistance forces until a sort of equality is approached, followed by a sudden collapse of the Rightists. Outside support is powerless to change this. U.S. forces in South Vietnam already exceed 12,000 men, and new weapons are constantly being added, including helicopters with more fire-power than any fighter plane of World War II, amphibious troop carriers, new types of small arms, and rockets. But in the first days of 1963, defeats were already so severe, including mounting American casualties, that President Kennedy demanded a special report from Mr. McNamara. These costly defeats have continued to mount. Nor are American arms and dollars capable of squeezing out a big expansion in Diem's forces, who are obviously unwilling to fight.
Direct U.S. military participation, even with forces of division strength, cannot bring about a reversal of the changing ratio. On the other hand, the resistance forces could be doubled or even quintupled in a short time because they spring from the people defending their own hearths and families. The inexorable logic of the people's war has caught up with Diem and his American backers. The United States is now faced with a choice between facing a straight-out defeat or seeking a negotiated withdrawal.
It is therefore no suprise that by April 1963 Washington was already making soundings—either directly or through British, French, Indian and other channels—for the kind of formula under which an "honorable" withdrawal could be negotiated. But as in Laos, Washington was seeking a formula which would provide gains through diplomacy or intrigue that could not be obtained on the battlefield. Thus the favorite formula being offered by Washington's agents in April 1963 was a form of "neutralization" of South Vietnam which would admit some NLF elements into a Diemist-type regime in the South (although without Diem himself), in exchange for the "neutralization" of the North, guaranteed by the presence of some Diemists in the government of North Vietnam. Other variants, always including "neutralization" of the North, envision a coalition government in the South formed by Diemist elements on the Right, some members of the NLF on the Left, and some liberal Vietnamese exiles in Paris to provide the "neutralist" filling. Again, Diem himself is to be excluded, as all but the most die-hard U.S. diplomats agree he is impossible.
The fact that such schemes are being offered within little over a year of direct U.S. intervention is a measure of the frustration of U.S. policies in South Vietnam. Meanwhile, the NLF leadership does not see in these schemes any evidence that Washington now wants a realistically negotiated settlement. They are prepared to continue the resistance struggle until the United States finds it necessary to negotiate seriously for withdrawal.

redpajama_set_name: RedPajamaCommonCrawl


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text:
Who's in and Who's Out: 2016 Presidential Candidates
Ivan Levingston
Take Five: Rep. John Katko Take Five: Rep. Brendan Boyle Take Five: Rep. Lee Zeldin
The Democratic candidates debated in Las Vegas on Oct. 13. (Photo by Joe Raedle/Getty Images)
Five current senators are running for president in 2016. Along with a number of former governors, the field includes two candidates with medical degrees, one former tech CEO and a billionaire real estate mogul/TV host.
Here's a look at the major candidates who have declared that they're in the race for the Democratic or Republican presidential nomination.
Lincoln Chafee: Chafee has been a Democrat, an independent and a Republican during his political career. And he's the only candidate with experience as a blacksmith on his résumé. Chafee fact sheet Hillary Rodham Clinton: Clinton is a former secretary of State, senator and first lady, and has said she would be "the youngest woman president in the history of the United States." Clinton fact sheet Martin O'Malley: The longtime Maryland politician got his start as a field director for former Democratic presidential candidate Gary Hart. As governor, O'Malley repealed the death penalty and legalized same-sex marriage. O'Malley fact sheet Bernard Sanders: A Brooklyn-born writer and carpenter, Sanders won his first election for mayor of Burlington, Vt., by just 10 votes. He became the first self-identified socialist in Congress since the 1920s when he was elected to the House in 1990. Sanders fact sheet Republicans Jeb Bush: Bush is the first brother of a former president to seek the office himself since Sen. Edward M. Kennedy challenged President Jimmy Carter for the Democratic nomination in 1980. The former governor of Florida has also worked in the financial sector, including as a banker in Caracas, Venezuela. Bush fact sheet Ben Carson: The Detroit native, who has served as a Fox News commentator, gained prominence as a pediatric neurosurgeon, and was the first surgeon to successfully separate a pair of twins joined at the head. Carson fact sheet
Chris Christie: The Garden State governor is famous for his in-your-face style and his epic battles with teachers' unions in New Jersey made him a conservative hero. He was critical of members of the House for delaying recovery funds for his state in the wake of Superstorm Sandy. Christie fact sheet
Ted Cruz: As an undergraduate at Princeton University, Cruz won an award for speaker of the year as a member of the debate team. Before serving in the Senate, he was the first-ever Hispanic clerk for the chief justice of the United States. Cruz fact sheet Carly Fiorina: When Fiorina was chosen to lead Hewlett-Packard in 1999, she became the first woman to be hired to run a Fortune 50 company. Her dismissal in 2005 made her the first woman to be fired from such a job. Fiorina fact sheet Jim Gilmore: The former Virginia governor served for a year as head of the Republican National Committee but left in 2002 after the GOP lost governors' elections in New Jersey and Virginia and reportedly after tensions with Republican strategist Karl Rove. Gilmore fact sheet Lindsey Graham: The South Carolina senator is the son of a tavern owner and an outspoken hawk. On his status as a bachelor, Graham suggested that as president he would institute "a rotating first lady." Graham fact sheet Mike Huckabee: While serving as governor of Arkansas, Huckabee played bass in a classic rock cover band with staff members called "Capitol Offense." After being warned he might die from diabetes, he lost 100 pounds and wrote a book called "Quit Digging Your Grave With a Knife and Fork." Huckabee fact sheet
Bobby Jindal: A former Rhodes scholar, Jindal got off to an early start in government, running Louisiana's Department of Health and Hospitals at age 24. The Louisiana governor urged fellow Republicans to "stop being the stupid party" in the wake of self-inflicted wounds during the 2012 election cycle. Jindal fact sheet
John R. Kasich: The second-term governor of Ohio and and former congressman of 18 years also worked at Lehman Brothers investment bank. Kasich's record includes voting against a ban on assault weapons as a member of the House in 1994, and signing tax cuts and a Medicaid expansion as governor. Kasich fact sheet George Pataki: Pataki has said he sees himself as following in the footsteps of Teddy Roosevelt in "enhancing the outdoors," and environmentalists have praised his record as governor of New York, including the preservation of nearly a million acres of open space. Pataki fact sheet Rand Paul: As a 13-year-old, Paul attended the 1976 Republican convention with his father, former Rep. Ron Paul, who headed Ronald Reagan's Texas delegation. The Kentucky senator is also an ophthalmologist with a medical degree from Duke. Paul fact sheet Marco Rubio: When Rubio first ran for city commissioner in West Miami in 1998, Jeb Bush wrote his campaign a $50 check. The son of Cuban exiles was part of the 2013 bipartisan "gang of eight" senators who wrote a sweeping overhaul of immigration law. Rubio fact sheet Rick Santorum: The former senator from Pennsylvania came so close to beating Mitt Romney in the 2012 Iowa caucuses that he was announced as the winner. Santorum joined forces with Clinton and other senators to request federal funds to research how electronic media affect children's development. Santorum fact sheet Donald Trump: "The Donald" runs a real estate empire that includes numerous office towers and resorts, and his holding company is also part owner of several beauty pageant franchises including Miss Universe. In the political realm, he takes credit for forcing President Barack Obama to release his long-form birth certificate. Trump fact sheet
Who's Out
Rick Perry suspended his campaign on Sept. 11, 2015: Perry is a former Air Force pilot who was the longest-serving governor in Texas history. After his bid for the GOP presidential nomination in 2012 was doomed by a series of gaffes, he told CNBC that he had been "a little arrogant." Perry fact sheet Scott Walker suspended his campaign on Sept. 21, 2015: The Wisconsin governor has won every election he has run in since his 1993 campaign for state assembly, including a recall election in his first term as governor in 2012. The son of a minister and a part-time secretary, Walker's anti-union politics have made him a conservative hero. Walker fact sheet Jim Webb suspended his campaign on Oct. 20, 2015: The Naval Academy grad is a Vietnam War vet who served in the Senate and as an assistant secretary of defense, and was secretary of the Navy under President Ronald Reagan. He won an Emmy for covering the Marines in Beirut, Lebanon, for PBS and has written 10 books. Webb fact sheet -- Compiled by the CQ staff
Roll Call Race Ratings Map: Ratings for Every House and Senate Race in 2016 Get breaking news alerts and more from Roll Call in your inbox or on your iPhone.
Topics: dccc democrats nrcc republicans uncategorized DCCC House 2016 NRCC texas


text:
Manager Resources
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Papua New Guinea is now offering free Tourist Visas.
And the Australian Kangaroos were the first to enjoy this privilege, when they arrived in Port Moresby last Sunday for the Prime Minister's 13 Rugby League match in Kokopo, East New Britain.
Previously, tourist visas costs K100, and is picked up on arrival.
o get an Australia Tourist Visa in PNG, travellers have to pay more than two hundred kina and have to wait for some time before a tourist visa is issued.
Head of Immigration Office at the Jackson's International Terminal Ronald Onawa told NBC news it was quite unfair on PNG side but they are only executing the direction from the top.
According to Mr Onawa it was a decision made at the top to increase the number of tourists to visit PNG.


text:
Advances in Orthopedics
Advances in Orthopedics/
AbstractIntroductionConclusionReferencesCopyrightRelated Articles
Posterior Transpedicular Dynamic Systems in the Treatment of Chronic Lumbar Instability
A Short History of Posterior Dynamic Stabilization
Cengiz Gomleksiz,1Mehdi Sasani,2Tunc Oktenoglu,2and Ali Fahir Ozer3
Academic Editor: Deniz Erbulut
Received07 Sept 2012
Accepted07 Nov 2012
Published26 Dec 2012
Interspinous spacers were developed to treat local deformities such as degenerative spondylolisthesis. To treat patients with chronic instability, posterior pedicle fixation and rod-based dynamic stabilization systems were developed as alternatives to fusion surgeries. Dynamic stabilization is the future of spinal surgery, and in the near future, we will be able to see the development of new devices and surgical techniques to stabilize the spine. It is important to follow the development of these technologies and to gain experience using them. In this paper, we review the literature and discuss the dynamic systems, both past and present, used in the market to treat lumbar degeneration.
Lumbar spine degeneration was first described by Kirkaldy-Willis and Farfan in 1982, using a 3 stage concept: (1) temporal dysfunction, (2) unstable stage, and (3) stabilization [1]. Stage 1 patients may respond to conservative treatments, but stage 2 and stage 3 patients require surgery for stabilization, decompression, and to correct deformities. Although disc degeneration is one reason for chronic lower back pain, the primary reason for back pain is the instability of the lumbar spine [2]. However, lumbar instability is not clearly defined. Kirkaldy-Willis and Farfan defined instability as the clinical status of patients with back problems who, with the least provocation, transition from being mildly symptomatic to experiencing a severe episode [1]. According to Panjabi [3] instability results from the inability to maintain control of the lumbar neutral zone, where spine motion occurs with minimal internal resistance and within normal physiological limits. In this study, instability is defined as the source of pain and abnormal motion. Stokes at al. [4] and Weiler et al. [5] also related abnormal motion to chronic back pain. However, as a definition of instability, abnormal motion does not cause back pain in all cases, such as when abnormal movement is observed radiologically in degenerated discs associated with spondylolisthesis, and pain is not continuous [6]. Therefore, the definition of instability has been updated to include abnormal movements at the joint surface and altered load transmission [2]. Lumbar spinal fusion is a common surgical treatment used in disc degeneration, which is related to chronic lower back pain and other spinal disorders, such as disc herniation, spondylolisthesis, facet arthropathy, and spinal stenosis [7]. Spinal fusion was first described by Albee for the treatment of Pott disease [8] and by Hibbs who performed spinal fusion for the treatment of spinal deformity [9]. Over the last 50 years, spinal fusion has become the gold standard for the treatment of several degenerative spinal disorders. Despite the many benefits of fusion surgery, there are several complications associated with this technique, including adjacent segment degeneration and pseudoarthrosis [10, 11]. Biomechanical studies have shown that fusion surgeries cause increased motion loading, which increases the stress placed on adjacent vertebral segments, and long-term clinical studies have shown radiographic degenerations of the adjacent vertebral segments [12–14]. The incidence of adjacent segment degeneration after fusion surgeries is in the range of 5.2% to 100% [15]. Among the lumbar fusion surgery procedures, those performed between the thoracolumbar junction and the lumbosacral junction (the so-called "floating fusions") appear to be associated with the greatest risk [14]. As a result, additional surgeries are often required to treat adjacent segment degenerations after lumbar fusion surgeries [16].
As mentioned above, motion preservation surgeries have been developed for the treatment of lumbar degenerative diseases in order to prevent adjacent segment degenerations [17, 18]. Sengupta described the hypothesis behind dynamic stabilizations, control abnormal motions, so that greater physiological load transmissions can relieve pain and prevent adjacent segment degenerations. A remote expectation is that once normal motion and load transmission is achieved, the damaged disc may repair itself, unless the degeneration is too advanced [19]. Posterior motion-sparing systems have been designed to off-load the posterior facets and annulus and to control motion in defined planes. By stabilizing vertebral motion, pain may be minimized, and the controlled motion may also decrease the secondary effects of fusion [20].
Posterior dynamic stabilization system devices can be classified into three types: (1) posterior interspinous spacers, (2) posterior pedicle fixation-based dynamic stabilization devices, and (3) total facet replacement devices [21]. Kaner et al. recently classified these dynamic systems [22], and the most important differences were seen in the groups where dynamic rods and screws were used together. This group was accepted as an independent group in their classification. In this paper, we will summarize and discuss the devices in which dynamic rods and screws are used together.
2. Posterior Pedicle Fixation-Based Dynamic Stabilization Devices
2.1. Dynamic Rods
2.1.1. Graf Ligament
In 1992, Graf described the use of the Graf ligamentoplasty system to treat low back pain without fusion [23]. According to his theory, abnormal rotary motion was the primary source of mechanical low back pain. He later improved the Graf ligamentoplasty system by inserting titanium pedicle screw anchors into the vertebra, both superior and inferior to the symptomatic level, and using a braided polypropylene tension band to link the titanium pedicle screws (Figure 1).
Graf ligamentoplasty system (left) and application on the lumbar spine model.
Due to compressions on the posterior annulus, it was claimed that Graf's system allowed annular tears to heal. Initial outcomes from Graf ligamentoplasty surgeries showed only modest improvements in functional ability and required high rates of reoperation. Grevitt et al. reported on a study of 50 patients who underwent Graf ligamentoplasty for intractable, symptomatic degenerative disc disease and chronic low back pain [24]. The Oswestry disability index (ODI) improved postoperatively from 59% to 31%, but postoperative radiculopathies were reported in 12 of the 50 patients. Therefore, prophylactic foraminal decompressions prior to device placement were recommended. Markwalder and Wenger reported long-term results in 41 patients treated with Graf ligamentoplasty. Sixty-six percent of patients reported no pain, 25.7% of patients reported significantly less pain, and 7.7% of patients reported somewhat less pain. The authors concluded that in younger patients with painful mechanical spine disease refractive to conservative treatment, Graf ligamentoplasty is an acceptable alternative to fusion surgery and provides long-term symptomatic relief [25].
On the other hand, Hadlow et al. reported on a retrospective case-control comparison between Graf ligamentoplasty and posterolateral fusion in a series of 83 patients suffering from low back pain [26]. There was a significantly high rate of reoperation in Graf ligamentoplasty groups 2 years after surgery (72%). Therefore, for the treatment of low back pain, the authors concluded that Graf ligamentoplasty did not show superiority to posterolateral fusion.
Graf ligamentoplasties also produce a significant increase in lateral canal stenosis, especially when patients exhibited preexisting degenerative changes in the facet joints or in the infolding of the ligamentum flavum, owing to the marked lordosis of the segment instrumented. Early clinical failures were associated with this surgical complication [24]. Graf ligaments transfer the load from the anterior aspect of the disc to the posterior annulus, thereby increasing the disc pressure in this region. This may explain the late failure of the Graf ligament, which accelerates disc degeneration by overloading the posterior part of the disc [19].
Recent randomized evaluations reported better clinical outcomes in patients that underwent Graf ligament placements versus fusions. If the patient is experiencing spondylolisthesis or flexion instability, then a Graf ligamentoplasty is a good choice. However, if the patient complains of scoliosis or lateral listhesis, then the Graf ligamentoplasty is not a good choice and could lead to a higher likelihood of reoperation.
2.1.2. Dynamic Neutralization System (Dynesys)
The dynamic neutralization system (Dynesys) was developed by Stoll et al. 2002 [27]. This system consists of titanium alloy (protasul 100) pedicle screws, polyester (sulene-PET) cords, and polycarbonate urethane (sulene-PCU) spacers (Figure 2). The PET cord resists tensile forces and provides resistance to spine flexion, similar to the concept used in Graf ligamentoplasties. However, the Dynesys PCU spacers resist compression during extension and thereby prevent foraminal narrowing by maintaining foraminal height and decreasing load to the posterior annulus [28, 29] ( Figure 3).
Dynesys device applied on a spinal model.
34-year-old female patient with right leg pain and back pain. (a) T2 weighted MRI scans show L4-5 disc herniation; (b) the Dynesys system was applied.
The results from the clinical studies on the Dynesys system are twofold. Cheng et al. reported that there was no significant difference between using the Dynesys or using traditional rigid fusion to treat adjacent segment disease [10]. However, several studies have suggested that using the Dynesys as a nonfusion device results in superior clinical outcomes compared with traditional rigid fusions [27, 30, 31]. Grob et al. reported on a retrospective study of 50 patients treated with the Dynesys for either degenerative disc disease or stenosis-associated instability. Thirty-one of these patients had at least a 2-year followup period [32]. Back pain improved in 67% of the patients, 30% of the patients reported that their condition was unchanged, and 3% of the patients reported a worsening of symptoms. Leg pain improved in 64% of the patients, 21% of the patients reported that their condition was unchanged, and 14% of the patients reported an increase in pain after treatment. However, functional capacity only improved in 40% of the patients, and within the 2-year followup period, 6 of the 31 patients (19%) underwent an additional operation.
Bothmann et al. evaluated clinical, radiographic, and computed tomography (CT) scans in 54 consecutive cases that underwent nonfusion surgery using the Dynesys [33]. Postoperative pain scores improved in 29 of the cases (79%), and scores were optimal when dynamic fusion was used in conjunction with nerve root decompression. The outcomes were not superior to the conventional rigid fusion system, and complications required revision surgery in 27.5% of the cases.
Cienciala et al. studied dynamic stabilizations with the Dynesys in 102 patients with degenerative disc diseases [34]. The improvement in the patients' health status was statistically significant during all 3-year postoperative periods. The Dynesys resulted in the postoperative disappearance of disc bulging and the restoration of both the posterior longitudinal ligament and the space in the lumbar spinal canal; repeated MRI examinations confirmed the disappearance of the bulge in these 26 patients. In their three-year followup period, patients had improved subjective feelings, morphological findings, pain, and functional status.
Dynesys treatment is indicated for patients with degenerative diseases in the lumbar motion segment, instability, and in combination with functional or structural spinal canal stenosis. Contraindications for this system are spinal fractures, infections, lytic/isthmic spondylolisthesis, degenerative spondylolisthesis >I°-II°, facetectomy, and stabilization of the thoracic and cervical spine.
2.1.3. Accuflex Rod System
The Accuflex rod system (Globus Medical Inc.) includes a dynamic rod and 6.5 mm pedicle screws made of titanium. The rod has double helical cuts that perform flexion-extension movements while providing a posterior tension band that can unload the disk (Figure 4). This system received FDA clearance for single level dynamic fusion. In a study conducted by Reyes-Sánchez et al., 20 consecutive patients underwent dynamic stabilization surgery with the Accuflex rod system to treat lumbar spinal stenosis and dysfunctional segment motion [35]; the clinical, radiographic, and magnetic resonance imaging (MRI) findings were fully described. During a 2-year followup period, 22.22% of the patients required device removal due to fatigue, while there was no progression of disk degeneration observed after implantation of the Accuflex system in 83% of the patients. Three patients (16%) also showed disc rehydration in followup MRI imaging. Even with a relatively high rate of device removal (22.22%), the use of the Accuflex rod system provided enhanced clinical benefits and stopped the degenerative process in 83% of the patients.
The Accuflex rod system.
2.1.4. Isobar TTL
The Isobar TTL system (Scient'x USA) is one of the first described semirigid rods. This implant received FDA clearance for use as an adjunct to spinal fusion in 1999. This system is composed of a titanium alloy rod with a dampener made of stacked titanium alloy o-rings. The Isobar TTL system allows a small amount of both axial and angular motion via this dampener (Figure 5). Perrin and Cristini reported on a retrospective study of 22 patients that underwent dynamic stabilization using the Isobar TTL system to treat lumbar spondylolisthesis [36]. The slipped levels were treated with polyetheretherketone (PEEK) cage, followed by a two level posterior fixation using the Isobar TTL system. During the 8.27-year followup period, 68.2% of the patients reported mild leg pain, 72% of the patients reported no or mild back pain, and 91% of the patients were complaint free. The adjacent level was also protected by the Isobar TTL system.
The Isobar TTL device.
2.1.5. CD-Horizon Legacy PEEK Rod
The CD-Horizon Legacy PEEK rod (Medtronic Sofamor Danek, Memphis, TN) is composed of polyetheretherketone and is more flexible than the titanium rods (Figure 6). This system received FDA clearance in 2005. The PEEK rod is currently FDA approved to treat adjunct fixation for a one-level interbody fusion. Abode-Iyamah et al. reported a cadaveric study that measured intradiscal pressure differences between the PEEK rod and the titanium rod [37]. Pressure differences were greater for the titanium rods compared with the PEEK rods. However, it has not been determined whether dynamic rods, such as DYNESYS and Accuflex or PEEK rods could be used with dynamic screws instead of using rigid titanium rods because PEEK rods are more flexible compared with titanium rods (Figure 7). As a result, the authors concluded that the PEEK rods decreased adjacent disc disease by maintaining a lower intradiscal pressure.
The CD-Horizon Legacy PEEK rod.
20-year-old male patient with left leg pain and back pain. (a) T2 weighted MRI scans show L4-5 disc herniation; (b) PEEK rod was applied; (c) the patient was in very good condition, and T2 weighted MRI scan showed a nearly normal appearance after one year.
2.1.6. Bioflex Spring Rod Pedicle Screw System
The Bioflex system (Bio-Spine Inc.) is a pedicle screw-based system that is composed of rod-shaped Nitinol with one or two loops to confer stability in flexion, extension, and lateral bending (Figure 8). Nitinol is an alloy of titanium and nickel, also called the "memory metal" due to its ability to return to its original shape after deformation. In a study conducted by Kim et al., 103 patients treated with the Bioflex system were observed preoperatively and postoperatively for range of motion (ROM) changes. The patients were divided into two groups: dynamic stabilization with or without posterior lumbar interbody fusion (PLIF) (Group 1) and rigid fixation (PLIF+ Bioflex system only) (Group 2). The changes in the ROM in looped segments that were treated with PLIF were significantly reduced, but the changes in the ROM in looped segments without PLIF were not significant. The authors concluded that the Nitinol Bioflex dynamic stabilization system achieved stabilization while simultaneously permitting physiological movement which in turn decreases the degeneration of adjacent segments [38].
The Bioflex dynamic stabilization system.
In a study conducted by Zhang et al., 12 patients were treated with the Bioflex system to examine functional motion one or more years after Bioflex system placement. Six patients were treated with a L3-4-5 construct, and another six patients were treated with a L4-5-S1 construct. The followup period varied from 12 to 33 months; standing neutral lateral flexion, extension, and posteroanterior radiographs were obtained at 3, 6, 9, 12, and more than 12 months postoperatively. The ROM for whole lumbar lordosis and segments from L2 to S1 were determined. The authors concluded that the Bioflex system was able to preserve functional motion to some degree at instrumented levels. However, although total lumbar lordosis was preserved, the ROM at the implanted segments was lower than their preoperative values [18].
2.1.7. Fulcrum-Assisted Soft Stabilization System (FASS)
The FASS (Fulcrum-Assisted Soft Stabilization) system was developed by Sengupta and Mulholland [39] to address the most common disadvantages of the Graf system (Figure 9). (1) Increased lordosis, which produces a narrowing of the lateral recess, leading to root entrapment, especially with preexisting facet arthropathy.(2) Increased loading of the posterior annulus, which is typically observed in patients with painful degenerated discs.The presence of a fulcrum may prevent both of these problems. The fulcrum is placed between the pedicle screws, in front of the ligament, and acts by distracting the posterior annulus. The elastic ligament is placed at the heads of the pedicle screws, posterior to the fulcrum and maintains lordosis. The fulcrum transforms the compressive effect of the elastic ligament into an anterior distraction force that unloads the disc.
The Fulcrum-Assisted Soft Stabilization system (FASS).
2.2. Dynamic Screw
2.2.1. Cosmic Posterior Dynamic System
The Cosmic posterior dynamic system (Ulrich medical) is a pedicle screw-based dynamic stabilization system (Figure 10). Indications for this device include spinal stenosis, degenerative spondylolisthesis. The main characteristic of this system is a hinged pedicle screw head that allows segmental motion, thereby reducing stress at the bone-screw interface. The screw threads are coated with calcium phosphate to promote ingrowths and assist in long-term fixation.
The Cosmic posterior dynamic system.
A hinged screw stabilizes the spine in a nearly rigid system [40, 41]. The results are similar to fusion after two years of followup [42–44]. Kaner et al. found that treatment with hinged screws was effective for addressing degenerative spondylolisthesis, spinal canal stenosis [43, 45], and recurrent disc herniations [46]. Similar results were found after a multilevel study of dynamic screws [47] (Figure 11).
24-year-old male university student, with acute attacks of low back pain (2–4 times per year). He experienced right leg pain in a sciatalgia form, accompanied by severe low back pain in the last attack. In his neurological examination, he had L5 hypoesthesia but no motor deficit. (a) T2 weighted MRI scans show l4-5 disc herniation; (b) cosmic was applied; (c) the patient was in very good condition, and T2 weighted MRI scan shows a nearly normal appearance after one year.
Von Strempel et al. reported on a two year followup study for patients surgically treated with the Cosmic system to relieve degenerative lumbar disease [48]. The results of this study showed that the Cosmic system is an alternative to traditional fusion surgery to treat degenerative lumbar disease, but long-term followup studies are still necessary to fully evaluate this system on adjacent-level diseases.
Stoffel et al. published results from a study of 103 patients that were consecutively treated using the Cosmic system for painful degenerative segmental instability ± spinal stenosis between April 2006 and December 2007 [49]. This study showed that dynamic stabilization with Cosmic achieved significant improvements in pain, related disability, mental/physical health, and mobility, respectively, and a high rate of satisfied patients.
2.2.2. Saphinas System
The Saphinas system (Medikon Company) is another treatment which localizes between the head and the body of the screw (Figure 12). This treatment provides flexion extension movements and 1° of rotational movement past the designed screw. Biomechanical studies have shown that this system demonstrates sufficient stabilization over degenerative motion segments [40]. Clinical studies have also shown that the Saphinas system established a stable, rigid system [44] (Figure 13).
Saphinas screw.
18-year-old, male patient with severe acute back pain attacks. In the last attack, he became aware of sciatalgia on the right side. He had no response to medical treatment and physical therapy; he had difficulties in daily life. (a) Preoperative MRI showed posterior annular defects, and a bulging disc to the right L5 nerve root is compressed; (b) saphinas system was applied; (c) one year after surgery the patient is very satisfied with this surgery, and MRI showed no bulging or defects of posterior annulus.
2.3. Dynamic Rods with Dynamic Screws
The main function of dynamic rods is to provide enough posterior tension over the posterior column of the spine. In biomechanical studies, the dynamic rods acted as a rigid system, and their stiffness was too close to the rigid system [50]. Dynamic rods are more flexible than the well-known rods currently available. Biomechanical studies show that more flexible rods with dynamic screws can stabilize the spine more effectively [50].
An agile rod is the first rod that we used with dynamic screws (Figure 14) [51]. However, agile rods were withdrawn from the market after a more flexible rod, BalanC, was developed and used with dynamic screws. Our preliminary results are very promising, and upon the study's completion, our results will be published (Figure 15).
((a) and (b)) Agile rod; (c) 40-year-old male patient with severe right leg pain; (d) agile rod was applied, and the patient was in very good condition in postoperative year one.
(a) BalanC rod. (b) 25-year-old male patient with severe back pain attacks every two months in last year. T2 weighted MRI scans show posterolateral annular rupture on the left side. (c) After repairing the posterior annulus under a microscope, dynamic screws (Cosmic screw) were used with dynamic rods (BalanC). The patient was very well 6 months after the of operation.
2.4. The Systems Represent Facet Functions
2.4.1. Stabilimax NZ
Stabilimax NZ (Applied Spine Technologies, New Haven, CT) is a pedicle screw-based posterior stabilization system that was designed as an alternative to fusion treatment to treat low back pain (Figure 16). Panjabi reported on the importance and the role of the "neutral zone" (NZ) in the development of spinal instability [3]. The NZ is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. It is believed that the NZ increases during disc degeneration and injury, resulting in greater instability and pain. The Stabilimax NZ system was developed to reduce the impact of the NZ on mechanical back pain. The Stabilimax NZ system is composed of a rod with dual concentric springs that maintain the spinal segment in a neutral position during spinal motion.
Stabilimax NZ device.
This system received FDA/IDE approval to begin randomized controlled clinical trials comparing instrumented fusion to Stabilimax for the treatment of spinal stenosis with or without grade I spondylolisthesis. The data from these studies have yet to be published.
2.4.2. Dynamic Stabilization System (DSS)
The DSS system was developed by Sengupta et al. [52] as an improvement of the FASS system. Biomechanical studies show that the FASS system produces too much loading during flexion which leads to early device failures. The DSS system has two designs that have been tested in the laboratory. The DSS-I consists of a titanium spring, made of a 3 mm cross-section diameter of spring-grade titanium wire (Figure 17). The DSS-II system consists of an elliptical coil spring, made from 4 mm spring-grade titanium rods.
The DSS-I system.
In 2006, Sengupta et al. reported the results of a 16 patient study where participants were treated with the DSS for single level mechanical back pain associated with disc degenerations with a two-year followup period [53]. The mean ODI scores decreased from 65% to 27%, and VAS scores decreased from 7.3 to 3.7. There were no reports of instrumentation failure or screw loosening.
2.5. Total Facet Replacement Devices
2.5.1. Total Posterior Arthroplasty System
The Total Posterior Arthroplasty System (TOPS) uses a pedicle screw-based posterior arthroplasty prosthesis that was developed to provide dynamic, multiaxial, and 3-column stabilization while preserving normal motion (Figure 18).
Total Posterior Arthroplasty System.
Wilke et al. published the results of an in vitro study using the TOPS in six human cadavers [54]. The cadavers were loaded with pure moments of ±7.5 Nm in flexion/extension, lateral bending, and axial rotation. The following states were investigated: (1) intact; (2) after bilateral laminectomy, including facetectomy of the lower facet joints, of the upper vertebra L4; and (3) after device implantation. The ROM, neutral zone, and intradiscal pressure were determined from a third round of treatment. In a second step, the ROM during axial rotations was determined as a function of the different flexion/extension postures. The authors concluded that the TOPS implant almost ideally restored the ROM in lateral bending and axial rotation compared to that of the intact specimen.
McAfee et al. reported the results of a study in which 29 patients were treated with the TOPS for spinal stenosis and/or spondylolisthesis at L4-5 due to facet arthropathy [55]. The average surgery lasted 3.1 hours, and the patients' clinical status improved significantly following treatment with the TOPS device. One year after surgery the mean ODI score decreased by 41%, and the 100-mm VAS score decreased by 76 mm. Radiographic analysis showed that lumbar motion was maintained, disc height was preserved, and there was no evidence of screw loosening; there were no device malfunctions, no migrations, and no device-related adverse events reported during the study.
2.5.2. Total Facet Arthroplasty System
The Total Facet Arthroplasty System (TFAS) is a posterior nonfusion stabilization device designed to stabilize the spine after a laminectomy to treat moderate-to-severe spinal stenosis (Figure 19). The TFAS is designed to replace the degenerated facet joints with prosthetic metal joints, as used in knee and hip arthroplasty.
Total Facet Arthroplasty System.
Phillips et al. reported an in vitro study using TFAS in nine human cadaveric spine specimens [56]. Nine human lumbar spines (L1 to sacrum) were tested inflexion-extension (+8 to −6 Nm), later albending (±6 Nm), and axial rotation (±5 Nm). Flexion-extension was tested under 400 N following preload. Specimens were tested intact, after complete L3 laminectomy with L3-L4 facetectomy, after L3-L4 pedicle screw fixation, and after L3-L4 TFAS implantation. The ROM was assessed in all of the tested directions. The neutral zone and stiffness during flexion-extension were calculated to assess the quality of motion. The authors concluded that after a wide range of decompressions on the neural elements, TFAS overcame the need for fusion by stabilizing the surgically modified spine in a manner similar to intact vertebrae, while restoring the physiologic kinematics (range and pattern of motion) at an operative level. Furthermore, TFAS resulted in more natural kinematics in the adjacent levels when compared with fusion.
2.6. Posterior Interspinous Spacers
2.6.1. Wallis Implant
Senegas et al. described an interspinous spacer in 1988 [57]. This device was made of titanium and held between the spinous processes via a dacron tape. After the successes of the first implant over three hundred patients, the authors redesigned the system known as "Wallis implant" which uses PEEK (polyetheretherketone) material as the spacer instead of titanium (Figure 20). The interspinous implant, located the interspinous space, blocks the extension of segment, and via distraction of the spinous processes, provides a relative flexion posture that known as a posture relieving neurogenic claudication pain by enhancing foraminal width. Additionally, the Dacron tape acts as a flexion limitation factor at the implant's located segment. Because of these features, this device can be described as a hybrid of interspinous distraction device and interspinous ligament. The authors recommend the usage of the Wallis system in the following indications: (1) discectomy of massive herniated disc leading to substantial loss of disc material, (2) a second discectomy for recurrence of herniated disc, (3) discectomy for herniation of a transitional disc with sacralization of L5, (4) degenerative disc disease at a level adjacent to a previous fusion, and (5) isolated Modic 1 lesion leading to chronic low-back pain.
The Wallis implant.
2.6.2. X-Stop
This titanium interspinous distraction device (Figure 21) (X-Stop, St. Francis Medical Technologies, Inc., Alameda, CA) has been introduced as a minimal invasive surgical procedure to treat symptomatic degenerative lumbar spinal stenosis. This device can be introduced by a minimally invasive approach under local anesthesia and may be useful for treatment of degenerative lumbar spinal stenosis in elderly patients who cannot take general anesthesia because of comorbid conditions. There are many controversial researches in the literature about clinical results of X-Stop device. While Verhoof et al. reported that X-Stop interspinous distraction device showed an extremely high failure rate defined as surgical reintervention after short-term followup in patients with spinal stenosis caused by degenerative spondylolisthesis [58]. Zucherman et al. reported that X-Stop offers a safe and effective treatment for lumbar spinal stenosis [59].
A sagittal, transverse, posterior, and orthogonal view of X-Stop implant.
Traditional fusion surgeries have been performed for several years, as the predominant technique used to treat degenerative spinal disorders. Although there are several benefits to use this surgical technique, adjacent segment diseases occur due to a transfer of stress from a stabilized motion segment to the adjacent level. Dynamic stabilization of the spine was developed to solve this problem by mimicking natural spine movements. Transferring the load from a degenerated disc or facet to a dynamic stabilization construct, while preserving segmental motion, is a critical feature required to develop novel dynamic stabilization devices.
Short-term results from studies using these devices are promising, and the most common problem results from loosening failures because there is not enough active fusion mass to resist the physiological loads. Therefore, dynamic stabilization devices are not viable options to treat osteoporotic patients.
W. H. Kirkaldy-Willis and H. F. Farfan, "Instability of the lumbar spine," Clinical Orthopaedics and Related Research, no. 165, pp. 110–123, 1982.
S. Lau and K. S. Lam, "Lumbar stabilisation techniques," Current Orthopaedics, vol. 21, no. 1, pp. 25–39, 2007.
M. M. Panjabi, "The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis," Journal of Spinal Disorders, vol. 5, no. 4, pp. 390–397, 1992.
I. A. Stokes and J. W. Frymoyer, "Segmental motion and instability," Spine, vol. 12, no. 7, pp. 688–691, 1987.
P. J. Weiler, G. J. King, and S. D. Gertzbein, "Analysis of sagittal plane instability of the lumbar spine in vivo," Spine, vol. 15, no. 12, pp. 1300–1306, 1990.
R. C. Mulholland and D. K. Sengupta, "Rationale, principles and experimental evaluation of the concept of soft stabilization," European Spine Journal, vol. 11, supplement 2, pp. S198–S205, 2002.
Q. H. Zhang and E. C. Teo, "Finite element application in implant research for treatment of lumbar degenerative disc disease," Medical Engineering and Physics, vol. 30, no. 10, pp. 1246–1256, 2008.
F. H. Albee, "Transplantation of a portion of the tibia into the spine for Pott's disease," Journal of the American Medical Association, vol. 57, p. 11, article 885, 1911.
R. A. Hibbs, "An operation for progressive spinal deformities," New York Medical Journal, vol. 93, pp. 1013–1016, 1911.
B. C. Cheng, J. Gordon, J. Cheng, and W. C. Welch, "Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion," Spine, vol. 32, no. 23, pp. 2551–2557, 2007.
A. Kumar, J. Beastall, J. Hughes et al., "Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years," Spine, vol. 33, no. 26, pp. 2909–2914, 2008.
A. Gardner and K. C. Pande, "Graf ligamentoplasty: a 7-year follow-up," European Spine Journal, vol. 11, supplement 2, pp. S157–S163, 2002.
C. K. Lee, "Accelerated degeneration of the segment adjacent to a lumbar fusion," Spine, vol. 13, no. 3, pp. 375–377, 1988.
A. S. Hilibrand and M. Robbins, "Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?" Spine Journal, vol. 4, supplement 6, pp. S190–S194, 2004.
J. S. Harrop, J. A. Youssef, M. Maltenfort et al., "Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty," Spine, vol. 33, no. 15, pp. 1701–1707, 2008.
P. Park, H. J. Garton, V. C. Gala, J. T. Hoff, and J. E. McGillicuddy, "Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature," Spine, vol. 29, no. 17, pp. 1938–1944, 2004.
C. M. Bono, M. Kadaba, and A. R. Vaccaro, "Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine," Journal of Spinal Disorders and Techniques, vol. 22, no. 5, pp. 376–383, 2009.
H. Y. Zhang, J. Y. Park, and B. Y. Cho, "The BioFlex system as a dynamic stabilization device: does it preserve lumbar motion?" Journal of Korean Neurosurgical Society, vol. 46, no. 5, pp. 431–436, 2009.
D. K. Sengupta, "Dynamic stabilization devices in the treatment of low back pain," Neurology India, vol. 53, no. 4, pp. 466–474, 2005.
J. J. Song, C. Y. Barrey, R. K. Ponnappan, J. T. Bessey, A. L. Shimer, and A. R. Vaccaro, "Pedicle screw-based dynamic stabilization of the lumbar spine," Pan Arab Journal of Neurosurgery, vol. 14, no. 1, pp. 1–141, 2010.
P. Khoueir, K. A. Kim, and M. Y. Wang, "Classification of posterior dynamic stabilization devices," Neurosurgical Focus, vol. 22, no. 1, article E3, 2007.
T. Kaner, M. Sasani, T. Oktenoglu, and A. F. Ozer, "Dynamic stabilization of the spine: a new classification system," Turkish Neurosurgery, vol. 20, no. 2, pp. 205–215, 2010.
H. Graf, "Evaluation of the therapeutic effect of the graf stabilisation system," in Proceedings of the 2nd Annual Meeting of the European Spine Society, Rome, Italy, 1991.
M. P. Grevitt, A. D. H. Gardner, J. Spilsbury et al., "The Graf stabilisation system: early results in 50 patients," European Spine Journal, vol. 4, no. 3, pp. 169–175, 1995.
T. M. Markwalder and M. Wenger, "Dynamic stabilization of lumbar motion segments by use of Graf's ligaments: results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients," Acta Neurochirurgica, vol. 145, no. 3, pp. 209–214, 2003.
S. V. Hadlow, A. B. Fagan, T. M. Hillier, and R. D. Fraser, "The graft ligamentoplasty procedure: comparison with posterolateral fusion in the management of low back pain," Spine, vol. 23, no. 10, pp. 1172–1179, 1998.
T. M. Stoll, G. Dubois, and O. Schwarzenbach, "The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system," European Spine Journal, vol. 11, supplement 2, pp. S170–S178, 2002.
R. B. Delamarter, J. Maxwell, R. Davis, J. Sherman, and W. Welch, "Nonfusion application of the Dynesys system in the lumbar spine: early results from IDE multicenter trial," Spine Journal, vol. 6, supplement 1, article S77, no. 5, 2006.
K. J. Schnake, S. Schaeren, and B. Jeanneret, "Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis," Spine, vol. 31, no. 4, pp. 442–449, 2006.
B. Cakir, B. Ulmar, H. Koepp, K. Huch, W. Puhl, and M. Richter, "Posterior dynamic stabiliziation as on alternative for instrumented fusion in the treatment of degenerative lumbar instability with spinal stenosis," Zeitschrift fur Orthopadie und Ihre Grenzgebiete, vol. 141, no. 4, pp. 418–424, 2003.
C. Feloukatzis, G. Barlas, S. Pichas, and L. Drosos, "The dynamic neutralization system (Dynesys) in the treatment of degenerative lumbar spine disease," in Proceedings of the 3rd Interdisciplinary Congress on Spine Care, Rio De Janeiro, Brazil, July 2005.
D. Grob, A. Benini, A. Junge, and A. F. Mannion, "Clinical experience with the dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years," Spine, vol. 30, no. 3, pp. 324–331, 2005.
M. Bothmann, E. Kast, G. J. Boldt, and J. Oberle, "Dynesys fixation for lumbar spine degeneration," Neurosurgical Review, vol. 31, no. 2, pp. 189–196, 2008.
J. Cienciala, R. Chaloupka, M. Repko, and M. Krbec, "Dynamic neutralization using the dynesys system for treatment of degenerative disc disease of the lumbar spine," Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, vol. 77, no. 3, pp. 203–208, 2010.
A. Reyes-Sánchez, B. Zárate-Kalfópulos, I. Ramírez-Mora, L. M. Rosales-Olivarez, A. Alpizar-Aguirre, and G. Sánchez-Bringas, "Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up," European Spine Journal, vol. 19, no. 12, pp. 2164–2170, 2010.
G. Perrin and A. Cristini, "Prevention of adjacent level degeneration above a fused vertebral segment: long term effect, a fter a mean follow up of 8, 27 years, of the semi-rigid intervertebral fixation as a protective technique for pathological adjacent disc," in Proceedings of the International Meeting for Advanced Spine Technologies, December 2003.
K. O. Abode-Iyamah, E. M. Cox, R. Kumar, and P. W. Hitchon, "PEEK rods decrease intradiscal pressure in levels adjacent to spinal instrumentation," in Proceedings of the Congress of Neurological Surgeons Annual Meeting (CNS '11), Washington, DC, USA, 2011.
Y. S. Kim, H. Y. Zhang, B. J. Moon et al., "Nitinol spring rod dynamic stabilization system and Nitinol memory loops in surgical treatment for lumbar disc disorders: short-term follow up," Neurosurgical Focus, vol. 22, no. 1, article E10, 2007.
D. K. Sengupta and R. C. Mulholland, "Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain," Spine, vol. 30, no. 9, pp. 1019–1029, 2005.
H. Bozkus, M. Senoğlu, S. Baek et al., "Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization—laboratory investigation," Journal of Neurosurgery Spine, vol. 12, no. 2, pp. 183–189, 2010.
W. Schmoelz, J. F. Huber, T. Nydegger, Dipl-Ing, L. Claes, and H. J. Wilke, "Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment," Journal of Spinal Disorders and Techniques, vol. 16, no. 4, pp. 418–423, 2003.
T. Oktenoglu, A. F. Ozer, M. Sasani et al., "Posterior dynamic stabilization in the treatment of lumbar degenerative disc disease: 2-year follow-up," Minimally Invasive Neurosurgery, vol. 53, no. 3, pp. 112–116, 2010.
T. Kaner, S. Dalbayrak, T. Oktenoglu, M. Sasani, A. L. Aydin, and F. O. Ozer, "Comparison of posterior dynamic and posterior rigid transpedicular stabilization with fusion to treat degenerative spondylolisthesis," Orthopedics, vol. 33, no. 5, article 309, 2010.
A. F. Ozer, N. R. Crawford, M. Sasani et al., "Dynamic lumbar pedicle screw-rod stabilization: two-year follow-up and comparison with fusion," The Open Orthopaedics Journal, vol. 4, pp. 137–141, 2010.
T. Kaner, M. Sasani, T. Oktenoglu, A. L. Aydin, and A. F. Ozer, "Clinical outcomes of degenerative lumbar spinal stenosis treated with lumbar decompression and the Cosmic "semi-rigid" posterior system," SAS Journal, vol. 4, no. 4, pp. 99–106, 2010.
T. Kaner, M. Sasani, T. Oktenoglu, A. L. Aydin, and A. F. Ozer, "Minimum two-year follow-up of cases with recurrent disc herniation treated with microdiscectomy and posterior dynamic transpedicular stabilisation," The Open Orthopaedics Journal, vol. 4, pp. 120–125, 2010.
A. Maleci, R. D. Sambale, M. Schiavone, F. Lamp, A. F. Ozer, and A. von Strempel, "Nonfusion stabilization of the degenerative lumbar spine," Journal of Neurosurgery Spine, vol. 15, no. 2, pp. 151–158, 2011.
A. von Strempel, D. Moosman, C. Stoss, and A. Martin, "Stabilization of the degenerated lumbar spine in the non fusion technique with Cosmic posterior dynamic system," World Spine Journal, vol. 1, no. 1, pp. 40–47, 2006.
M. Stoffel, M. Behr, A. Reinke, C. Stüer, F. Ringel, and B. Meyer, "Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation," Acta Neurochirurgica, vol. 152, no. 5, pp. 835–843, 2010.
D. Erbulut, "Kinematical and load sharing effect of a novel posterior dynamic stabilization system implanted in lumbar spine," in Proceedings of the 36th Annual Meeting of the American Society of Biomechanics, Gainesville, Fla, USA, August 2012.
T. Kaner, M. Sasani, T. Oktenoglu, M. Cosar, and A. F. Ozer, "Utilizing dynamic rods with dynamic screws in the surgical treatment of chronic instability: a prospective clinical study," Turkish Neurosurgery, vol. 19, no. 4, pp. 319–326, 2009.
D. K. Sengupta, H. N. Herkowitz, S. Hochschuler, and R. C. Mullholland, "Load sharing characteristics of two novel soft stabilization devices in the lumbar motion segments-a biomechanical study in cadaver spine," in Proceedings of the Spine Arthroplasty Society Congress, 2003.
D. Sengupta, R. C. Mulholland, and L. Pimenta, "Prospective clinical study of dynamic stabilization with the DSS system in isolated activity related mechanical low back pain, with outcome at minimum 2-year follow-up," Spine Journal, vol. 6, no. 5, article 147, 2006.
H. J. Wilke, H. Schmidt, K. Werner, W. Schmölz, and J. Drumm, "Biomechanical evaluation of a new total posterior-element replacement system," Spine, vol. 31, no. 24, pp. 2790–2796, 2006.
P. McAfee, L. T. Khoo, L. Pimenta et al., "Treatment of lumbar spinal stenosis with a total posterior arthroplasty prosthesis: implant description, surgical technique, and a prospective report on 29 patients," Neurosurgical Focus, vol. 22, no. 1, article E13, 2007.
F. M. Phillips, M. N. Tzermiadianos, L. I. Voronov et al., "Effect of the Total Facet Arthroplasty system after complete laminectomy-facetectomy on the biomechanics of implanted and adjacent segments," Spine Journal, vol. 9, no. 1, pp. 96–102, 2009.
J. Senegas, J. P. Etchevers, J. M. Vital, D. Baulny, and F. Grenier, "Widening of the lumbar vertebral canal as an alternative to laminectomy in the treatment of lumbar stenosis," Revue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur, vol. 74, no. 1, pp. 15–22, 1988.
O. J. Verhoof, J. L. Bron, F. H. Wapstra, and B. J. Van Royen, "High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis," European Spine Journal, vol. 17, no. 2, pp. 188–192, 2008.
J. F. Zucherman, K. Y. Hsu, C. A. Hartjen et al., "A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results," Spine, vol. 30, no. 12, pp. 1351–1358, 2005.
Copyright © 2012 Cengiz Gomleksiz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
Nicholas Wilson
Wilson was born in Seattle, WA and decided to become a wildlife artist on his 8th birthday. As a self-taught artist, he developed his own style and technique over the years.
Wilson has been active for 47 years as a professional artist. As Curator of Exhibits at the Arizona- Sonora Desert Museum in the 1970s, he developed his artistic techniques for expressing his deep love of nature. He painted a 16,250 square foot mural in the 1980s at the Jungle World Exhibit in the Bronx Zoo, New York. His gouache paintings, which depict his unique style of texture and whimsy, have been exhibited around the world and are in permanent collections at the Booth Western Art Museum in Cartersville, GA and the Cowboy Hall of Fame in Oklahoma City, Oklahoma. He has also enjoyed the challenges of monumental bronze sculpture commissions. The Wildcat Family, an 11½ foot sculpture at the University of Arizona, Tubac Jack, a 7 foot bronze jackrabbit sculpture, at the Tubac Center of the Arts, Natural Flow, a 14 foot sculpture at the Booth Western Art Museum, Cartersville, GA and The First Responder, a 6 foot sculpture for a firefighter's memorial in Noblesville, IN.
In addition to gouache, oils, watercolors and bronze sculpture, Wilson also has created copperplate etchings. His etchings and wood engravings are being distributed and can be found in homes around the world as well as in permanent collection at the Smithsonian in D.C. and the Leigh Yawkey Art Museum in Wausau, WI.
Wilson, Nicholas
Elemental Rabbit
Gouache 16 x 20 inches
Re-Purposed
Wood Engraving 8 x 6 inches $1,150


Large Spark Ignition (LSI) equipment registration is being revisited by the Air Resource Board. ARB held a workshop at the San Joaquin Valley Air Pollution Control District to present proposed regulations regarding forklifts and other LSI equipment. The main focus of the proposed regulation is focused on the governor's order to reduce fuel usage by 40% by 2030, as well as Cal EPA's new air standard of .065 ppm. The plan includes the promotion of electric forklifts and other non-fossil equipment to help attain the EPA standard. A major component of the proposed regulation is to include mandatory LSI equipment registration, which would include the total number of hours of use during the year. With that information, ARB would be able to calculate the amount of emissions that are being given off by conventional gasoline/diesel powered equipment. To report the hours of use, ARB hopes that it can be set up on the same reporting system as the Diesel Off-road On-line Reporting System (DOORS) that is required for all diesel trucks. The details of the proposed regulations are still being developed and there is still time to find exemptions that Ag will be able to take advantage of. We will keep you updated when more information becomes available.
This entry was posted in NEWS & ISSUES on June 11, 2015 by ccgga.


I've created a new B/W account separate from this.
I've always been more of a fan of B/W.
oh my gosh, I adore your photography!
Hey, Nadia.. your watch really inspired me and it really inspire to push further. I am a beginner and I know about your work through Keith. Really great work!
silly me typo error all time.


text:
// ==========================================================================
//  Squidex Headless CMS
// ==========================================================================
//  Copyright (c) Squidex UG (haftungsbeschraenkt)
//  All rights reserved. Licensed under the MIT license.
// ==========================================================================

using System.ComponentModel.DataAnnotations;
using Squidex.Domain.Apps.Core.HandleRules;
using Squidex.Domain.Apps.Core.Rules;
using Squidex.Infrastructure.Validation;

namespace Squidex.Extensions.Actions.Algolia;

[RuleAction(
    Title = "Algolia",
    IconImage = "<svg xmlns='http://www.w3.org/2000/svg' viewBox='0 0 32 32'><path d='M16 .842C7.633.842.842 7.625.842 16S7.625 31.158 16 31.158c8.374 0 15.158-6.791 15.158-15.166S24.375.842 16 .842zm0 25.83c-5.898 0-10.68-4.781-10.68-10.68S10.101 5.313 16 5.313s10.68 4.781 10.68 10.679-4.781 10.68-10.68 10.68zm0-19.156v7.956c0 .233.249.388.458.279l7.055-3.663a.312.312 0 0 0 .124-.434 8.807 8.807 0 0 0-7.319-4.447z'/></svg>",
    IconColor = "#0d9bf9",
    Display = "Populate Algolia index",
    Description = "Populate a full text search index in Algolia.",
    ReadMore = "https://www.algolia.com/")]
public sealed record AlgoliaAction : RuleAction
{
    [LocalizedRequired]
    [Display(Name = "Application Id", Description = "The application ID.")]
    [Editor(RuleFieldEditor.Text)]
    [Formattable]
    public string AppId { get; set; }

    [LocalizedRequired]
    [Display(Name = "Api Key", Description = "The API key to grant access to Squidex.")]
    [Editor(RuleFieldEditor.Text)]
    [Formattable]
    public string ApiKey { get; set; }

    [LocalizedRequired]
    [Display(Name = "Index Name", Description = "The name of the index.")]
    [Editor(RuleFieldEditor.Text)]
    [Formattable]
    public string IndexName { get; set; }

    [Display(Name = "Document", Description = "The optional custom document.")]
    [Editor(RuleFieldEditor.TextArea)]
    [Formattable]
    public string Document { get; set; }

    [Display(Name = "Deletion", Description = "The condition when to delete the entry.")]
    [Editor(RuleFieldEditor.Text)]
    public string Delete { get; set; }
}


text:
Hundreds of ambulances sent to Glasgow emergencies without paramedics
Ten percent of emergency ambulance calls in Glasgow were answered by crew that did not include paramedics last year.
Claire Miller
(Image: Media Scotland)
A high priority call is those which ambulances are supposed to reach within eight minutes - and in the city in 2016, 10 per cent of these calls were not answered by paramedic crews.
Scotland wide, 15,130 of the highest priority calls were answered by team which did not contain a paramedic, making up 11 per cent of 136,078 calls.
This was down from 12 per cent, or 16,715 calls in 2015.
The Scottish Ambulance Service changed how it categorised calls from November 2016 onwards, introducing categories of immediately life-threatening, to replace the most serious Category A calls, and non-immediately life-threatening.
Glasgow's SEC medical staff axed as work is outsourced to a contractor
The first category includes serious road accidents, patients who are unconscious and not breathing, and pregnant or very young patients and requires a response within eight minutes.
The second category includes people with chest pains, breathing problems or stroke symptoms.
The ambulance service said the proportion of calls requiring the fastest response time would fall by 74 per cent.
Non-paramedic teams are likely to be made up of ambulance technicians.
Usually these will work as part of a team with a qualified paramedic, or sometimes as a first responder, and assist with moving and monitoring patients, driving and helping paramedics.
Training is made up of a mix of classroom based learning, placements on station and vocational assessments in which they learn the skills needed to assist qualified clinicians in the delivery of safe and effective pre hospital care.
Additional units may be sent to an incident, including paramedics, where needed.
• An earlier version of this article stated that ambulance technician training is likely to be a six to nine week in-service training course in which they learn moving and handling techniques, first aid, basic patient skills and safe driving techniques. This has since been updated to make clearer the extent of the training.


text:
President in a meeting with his Russian counterpart:
Deepening strategic ties with neighbours, esp. Russia, Iran's key policy /Iran-Russia relations to increase in 12th Administration's term
President Rouhani had a phone call with the President of Russia, Vladimir Putin and referred to good relations between the Islamic Republic of Iran and the Russian Federations, stressing development of relations between the two countries in tall fields of mutual interest.
news id: 100173 -
Mon 14 - August 2017 - 19:17
President Putin: Exceptional horizons in Iran-Russia relations are ahead of us/We must attempt to deepen relations and cooperation between Tehran and Moscow
In the phone call that took place on Monday, Dr Rouhani stressed that developing relations with neighbouring countries, especially Russia, is a key policy for the Islamic Republic of Iran, saying: "Surely, relations and cooperation between Iran and Russia will grow more than before in the 12th Administration's term of office".
Underscoring economic and business relations between Iran and Russia, he said: "Tehran welcomes Russian investors and private sector's active presence and cooperation in significant infrastructural projects in Iran, including in industry and energy sectors".
On the complications in the region and situations in some countries such as Yemen, Iraq and Syria, Dr Rouhani also emphasised that consultation and cooperation between Iran and Russia are important in resolving the issues, especially combatting terrorism.
The Joint Comprehensive Plan of Action (JCPOA) is a multilateral agreement and US actions violate their commitments, said Rouhani adding: "The Islamic Republic of Iran has always lived up to its commitments and the IAEA's report verifies this fact well".
"It is essential that Russia have a positive role in the JCPOA to contribute to the reinforcement of the agreement and all parties' living up to their commitments," President Rouhani added.
He also referred to situations in Yemen and said: "The Security Council of the United Nations must take effective measures in facilitating humanitarian aid to Yemen with no conditions attached".
During the same phone call, the President of Russia, Vladimir Putin also congratulated Dr Rouhani on the beginning of the 12th Administration's term of office and wished success for the administration and people of Iran.
"Today, exceptional horizons in relations between Iran and Russia are ahead of us and we must attempt to deepen relations and cooperation between Tehran and Moscow," Putin added.
He also said that Russian investors and businesspeople are willing to take part and have more active role in infrastructural projects in Iran.
Mentioning that Iran and Russia must boost cooperation in resolving issues and problems in the region, especially in fighting terrorism and establishing stability in Syria, he said: "Fortunately, today we are witnessing good achievements in the field of stability in the region with the help of Iran and Russia".
"Based on report by the IAEA, Iran has lived up to all its commitments in the Joint Comprehensive Plan of Action (JCPOA) and the violation of this agreement by any party is in fact in contrast with Resolution 2231 of the Security Council of the United Nations," he continued.
President Putin added: "Iran and Russia can develop cooperation and consult more with each other to lay the necessary ground for facilitating humanitarian aid to the people of Yemen".
news id: 100173
- Phone Conversations


text:
Q: Connecting On-Prem network via transit gateway in the other aws account? I have 2 aws accounts, where A is connected to On-Prem via transit gateway, and B is connected to A via peering connection. All works fine, thus I have connectivity from A to On-Prem, and from A to B. The challenge is to have connectivity from B to On-Prem without creating yet another transit gateway. Is it possible?
  +---------+
  |         |
  | On-Prem |
  |         |
  +---------+
    |    ^
    v    |
  +--------------------------+
  |          | AWS Account A |
  | AWS TGW  +---------------+
  |          | Peering Conn  |
  +--------------------------+
                     ^      |
                     |      v
             +---------------+
             | Peering Conn  |
             +---------------+
             | AWS Account B |
             +---------------+

It seems I have the routing, SGs, ACLs - all correct but it still doesn't work. Since I cannot see any packet flows on AWS infra it's very difficult to debug. Also I cannot find any documentation which would clearly state whether it's in general possible or not.

A: There is only one way to connect cross account using transit gateway and this is by sharing the transit gateway via resource access manager. A prerequisite is that both accounts are under the umbrella of an AWS organisation account.
If you are not able to do this then you either need to create a secondary transit gateway in the other account or create a virtual private gateway in account B and associate it to your AWS Account B VPC.
From here you'd then create your secondary VPN connection.
AWS does not support transitive networking via peering connections. It is a requirement that a traffic packet that reaches the VPC must be terminated in the VPC.
Other solutions people use are:

*

*Creating a proxy instance in account A that proxies to instance(s) in account B

*Creating a Transit VPC (More work and risk that the transit gateway)

redpajama_set_name: RedPajamaStackExchange