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Meet the Winter 2023 E-Team Cohort
We're thrilled to announce the 31 early-stage student innovator teams that will be participating in our Winter 2023 E-Team Program! Through a rigorous review process, we selected the teams for this cohort for their compelling innovations that aim to make a positive impact in the social, health, or environmental sectors. Seventeen teams will receive a $5,000 Pioneer (Stage 1) grant and entrepreneurship training, while an additional 15 teams—three of which won the Verizon Forward for Good Challenge—will advance to Propel, the second stage of the program, which includes a grant award of $20,000 and the next phase of training with our early-stage innovator program team.
The teams in this cohort are working to solve large-scale challenges through their innovations. WAVED Medical, a team from the University of Maine, is developing image-based algorithm technology that identifies high-risk areas for patients who are more likely to get breast cancer. A team from the University of Massachusetts-Lowell, Green Fertilizer, developed a low-cost, solar-powered system that produces nitrogen fertilizer from just air and water.
Check out what they're working on right now:
The Food For Thought Foundation | American University
The Food For Thought Foundation is developing a space-saving vertical farm to provide nutritious food options for low-income communities.
PiezoCity-ThermoPEG | Oregon State University
PiezoCity-ThermoPEG is developing renewable technology that converts industrial heat waste into cost-efficient, sustainable electricity.
Carrot and Stick | Oregon State University
Carrot and Stick is developing a wax adhesive through a hot melting process in order to reuse a common plastic that was largely considered to be unrecyclable.
Adiona | University of Chicago
Adiona is developing an accessible app for smart devices that monitors dementia patients' patterns like their sleep cycles and fall risk, for improved care.
Auxilium | University of Akron Main Campus
Auxilium is developing a biological-based wound dressing material to absorb waste, eliminating the need for re-dressing multiple times, which can delay the healing process.
DOVE Labs | Drexel University
DOVE Labs is developing a wearable shoulder band device that can sense an opioid overdose and automatically inject the antidote naloxone to reverse it.
LowCostomy | Duke University
LowCostomy is developing an affordable, environmentally friendly colostomy appliance, using recycled materials, for patients in underserved communities.
MTology Innovations | Arizona State University
MTology Innovations is developing a reversible, minimally invasive male contraceptive as an alternative to vasectomies.
NanoMood | University of California-San Diego
NanoMood is developing wearable technology that monitors mental health symptoms through biological, physiological, and digital internal markers in order to support patient treatment at clinics.
Nepipen | The Cooper Union for the Advancement of Science and Art
Nepipen is developing a device that can automatically inject a double dose of epinephrine into users who are experiencing anaphylactic shock and require more than the standard dosage.
SPLiTO2 | University of Delaware
SPLiTO2 is developing a portable device that delivers oxygen without requiring electricity to run, ensuring its accessibility for patients in underresourced healthcare settings.
T33 | Massachusetts Institute of Technology
T33 is developing tools to deliver drugs directly into tooth enamel—which allows for a higher amount than topical applications—in order to improve patient oral health.
WAVED Medical | University of Maine
WAVED Medical is developing image-based algorithm technology to identify areas of high risk for patients who are more likely to develop breast cancer.
Information Technology & Communication
A Cubed Design | Ohio State University-Main Campus
A Cubed Design is developing a device that gamifies learning how to read and write Braille in order to boost literacy.
Cursor | Northern Kentucky University
Cursor is developing eye-tracking technology that can follow a gaze using a standard webcam, rather than the conventional hardware used in healthcare.
ParaWave | Ohio State University-Main Campus
ParaWave is developing drone technology that equips first responder teams with the ability to easily view and gather time-sensitive information from the air about emergency situations.
BEEnevolent | BEEnevolent Systems LLC
Pollinators are critical to the survival of many North American plants, yet domesticated honeybee populations are declining. BEEnevolent developed high-tech beehives that operate with minimal intervention and provide 1:1 support to apiarists to ensure a thriving colony.
Green Fertilizer | University of Massachusetts-Lowell
Due to climate change, there is an increasing need for fertilizer that lessens carbon dioxide emissions. Green Fertilizer developed a low-cost, solar-powered system that produces nitrogen fertilizer from just air and water.
Shinkei Systems | Wharton School, University of Pennsylvania
Fish caught in the U.S. are generally not harvested in a way that promotes shelf life and quality, with the result that bacteria ferments inside the meat. Shinkei Systems developed hands-free robotic automation on boats and farms to increase the efficiency of fish processing.
3D-OPS | University of California-Davis
Complicated fixation techniques are often needed to set hand fractures, resulting in bone instability, inflammation, and misalignment. 3D-OPS developed a technique to 3D-print artificial tissue which simulates spider silk for use in hand surgeries.
CloSure | Texas A&M University
Negative pressure wound therapy (NPWT) has been proven to significantly decrease healing time for large wounds; however, the current device on the market is very expensive. CloSure developed a portable, low-cost NPWT device that closes wounds using a vacuum to clear bacteria and fluids and stimulate growth of new tissue.
EnlighteN | Yale University
Delay in detecting opioid overdoses in individuals can result in death or irreversible health issues. EnlightN developed wearable software that monitors patients seeking substance use treatment in order to detect an overdose and alert medical first responders.
LaparoVision | Brigham Young University
Surgeons have to clean their scope lenses multiple times when performing incisions inside the abdomen and pelvis due to blood, fat, and other obstructions. LaparoVision developed a single-use cleaning device that attaches to the end of the scope and wipes the lens, eliminating contaminants during surgery.
PneuTech | Johns Hopkins University
A lung biopsy is an essential procedure in cancer diagnosis, but it can be difficult to navigate delicate tissue and collect samples. PneuTech developed a curved device that can minimize lung collapse and increase the volume of tissue collected due to its unique shape.
SteadyScrib | Northwestern University
People with Parkinson's disease experience tremors and muscle rigidity that can make using traditional pens and pencils difficult. SteadyScrib developed a magnetic pen and clipboard that stabilize movement from tremors and support improved grip with a curvy, weighted design.
EquiBraille | Arizona State University
Students who are visually impaired frequently rely on audio transcripts in the classroom, which can inhibit active learning. EquiBraille developed a 3D Braille device that provides students with real-time transcriptions and translations in less than 20 milliseconds.
Gabb Global | Gabb Global
In a traditional classroom setting, English Language Learners (ESL) encounter frequent challenges in making progress in their studies. Gabb Global developed a virtual reality program that offers ESL students immersive examples to help them quickly gain language skills.
Jubily | University of California-Berkeley
BIPOC and LGBTQIA+ patients often rely on word-of-mouth referrals for inclusive healthcare provider recommendations. Jubily developed a mobile app and website that connects people with culturally competent clinicians as well as online communities of support.
READI | READI Consulting, LLC
Many young workers who are unemployed or underemployed could benefit greatly from access to skill-building opportunities. READI developed a virtual reality platform that gives young adults entry-level workforce skills and certificate training.
Scholist App | University of Houston
Applying for scholarships can be overwhelming and prevent students from underserved communities from accessing the financial support they need to attend college. Scholist developed an app that streamlines the process through workshops, 1:1 coaching, and a platform that connects students with their peers.
Infrastructure/Building
EASEEbot | New York University
Current diagnostic testing for building issues can be destructive, costly, and time-consuming. EASEEbot developed a drone that safely and noninvasively auto-generates a 3D model using advanced computer vision and AI techniques to lower inspection costs, increase safety, and generate higher-quality reports.
Meet the Winter 2023 E-Team Partners and Sponsors
We're thankful to our partners that work with us to support these startups, including Qualcomm Incorporated, a leading wireless tech innovator; and The Lemelson Foundation, a nonprofit dedicated to supporting the power of invention to improve lives. Cooley LLP, an international law firm, is sponsoring the Pioneer program, and Verizon is sponsoring Propel.
In partnership with Whitaker International Program, we're also hosting two teams from the BME-IDEA International E-Team Grant Program. It's specifically designed to support collaborative projects between BME design students and international institutions in Africa or Latin America.
The E-Team Entrepreneurial Journey
All teams in the Winter 2023 cohort will receive intensive entrepreneurship training to support them as they advance their innovations. Pioneer teams will determine the best market for their invention, developing an understanding of possible pathways for their venture. These teams will articulate their value proposition, assessing the broader environment, landscape, and industry value chain. During Propel, teams will develop their business model hypotheses and plans to test them. They will build out their business model canvas, validating it through customer discovery interviews, and will work to establish their intellectual property portfolio. Everyone participating in our winter workshops will convene at the Microsoft New England Research and Development (NERD) Center in Cambridge, Massachusetts, in January 2023.
"These student-focused programs help entrepreneurial student inventors (E-Teams) explore what it means to launch a venture using technology for impact. We give students the tools to turn their ideas into business opportunities, while building a community of support from mentors to innovators," said E-Team Program Officer Sarah Wharmby.
About the E-Team Program
Through the E-Team Program, we have trained over 500 student teams and more than 1,400 student innovators. The teams have raised close to $740M+ in follow-on funding and have launched 400+ ventures since taking part in our program.
Learn more about VentureWell's E-Team Program, which supports student-led science- and engineering-based teams from across the nation in bringing their high-impact innovations out of the lab and into the market.


Primarily known as an author of science fiction novels for young adults her books are still well received by adults. Some paperback and UK editions of her novels appeared under the name Sylvia Engdahl, without "Louise". Engdahl is best known for her novel Enchantress from the Stars, which was a 1971 Newbery Honor book. In August of 2007 Engdahl published an adult visionary fiction novel, entitled Stewards of the Flame. She lives in Oregon with her two cats.
This text is available under a Creative Commons License and may have been adapted from the Sylvia Louise Engdahl bibliography at the Internet Speculative Fiction Database.


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Home Media Center News SEDCO Holding Reaches Out to The Community On Volunteer Consultancy Day
SEDCO's consultants provided insights and guidance to male and female entrepreneurs who will shape the future of the Kingdom
Seeking to reinforce its leading role in the community and through launching initiatives that promote volunteerism, SEDCO Holding organized the SEDCO Volunteer Consultancy Day for the second consecutive year, held on September 18 at SEDCO headquarters in Jeddah. The event provided specialized advice to small startups entrepreneurs, business incubators and accelerators who were given the opportunity to attend a series of specialized workshops.
The participation of SEDCO consultants in the Volunteer Consultancy Day was considered as part of the Volunteer Your Skill program where employees donate some of their time to worthy causes and valuable works that deliver helpful consultations in a variety of fields throughout the year, in partnership with business incubators and accelerators. The consultants provided insights and guidance in various fields including HR, marketing and communication, partnerships and investment, business development, finance and accounting, legal affairs and IT.
The program included a series of workshops tackling many important issues including financing, startups, financial evaluation, legal aspects of entrepreneurship, and entrepreneurs' financial statements. Participants met with SEDCO Volunteer Advisors, who provided valuable advice and guidance on these important aspects for both startups and entrepreneurs.
"Volunteerism has become a significant element of interaction with the community," said Mr. Abdulrahman AlTurjuman, Head of Marketing and CSR at SEDCO Holding. "SEDCO's consultants provide a digest of their expertise to male and female entrepreneurs and ambitious youths. One of the primary goals of Vision 2030 is to promote the culture of volunteerism, and we are excited to be able to achieve such an objective.
SEDCO Holding is promoting a culture of volunteering and charity work through various initiatives, realizing that volunteering helps create the right work-life balance and renders great services to the community. In recognition, the flagship program Volunteer Your Skill" was named Best Sustainability Program of the Year by the prestigious Gulf Sustainability and CSR Awards 2018.
Intimaa signs agreement to operate Khamis Mushate Mall
Salem Bin Mahfouz Foundation and SEDCO Holding Donate more than 9 Million SAR in Support of National Efforts to Combat Coronavirus
Riyali Signs MOU with Majid Society to Empower Saudi Entrepreneurs

redpajama_set_name: RedPajamaCommonCrawl


You have always wondered if you can put baker's yeast into your septic system. The answer is YES. But experts say that you really don't have to do this to improve your septic system's performance. Rather than using harsh chemicals. Yeast can be a very helpful aid in maintaining your septic system.
Baker's yeast is a type of bacteria that doesn't need oxygen to survive. This is why it's ideal to place in septic tanks. It helps in efficiently breaking down the starches, which are part of the solid wastes that reach the septic tank.
Baker's yeast is very helpful in degrading complex waste materials into much simpler components. It accelerated the decomposition of the solid wastes present in the wastewater. But if you're thinking to use it to eliminate the clogs in the system, better change tactics because baker's yeast cannot do that. It also cannot replace pumping out to eliminate the accumulated sludge.
1. How water should be run into your drain. The temperature should be warm and not piping hot.
2. Pour about three cups of lukewarm or tepid water into a bowl.
3. Place four and a half teaspoons or about two packets of baker's yeast into the bowl of water and stir it with a wooden spoon.
4. Add 2 cups sugar and 2 cups cornmeal into the yeast mixture and stir well.
5. Cover the mixture with a small towel and place in a warm area. Wait for the mixture to froth.
6. Pour out the mixture into a toilet that is nearest to the septic tank.
7. Flush the toilet two times.
This process should be repeated every 3 to 6 months. Frequency depends on how much human waste your household produces. After flushing the yeast mixture into the septic system, refrain from using the system for at least two hours to allow the yeast to take action. It can be quite inconvenient as you wait for the yeast to work but you should understand that the activity in the septic tank needs time to accelerate at the pace of the microorganisms that you just added.
You are not obligated to add in baker's yeast into your septic system. This is just something that you can do to aid the performance of the anaerobic bacteria that is already present in the tank. Take note that even if you do treat your septic system with baker's yeast, you still have to step forward and maintain the septic system as a responsible homeowner.
Like other additives, using too much baker's yeast in maintaining your system is also harmful. The frothing action that happens once you activate the yeast gives a profound change in activity inside the tank. To the naked eye, it might be nothing but at a microscopic level, everything is hyped up and this may cause the unsettling of the solid wastes into the bottom of the tank. If the solid particles do not settle, they may not be degraded by the anaerobic bacteria. So just keep the yeast treatment at a moderate level. As usual, anything in excess can be bad.
Be a responsible homeowner and do your best in maintaining and caring for your septic system. Do not let fads and beliefs set how you should treat your system. If you are unsure of adding baker's yeast, talk to a septic professional so that you may be properly guided about biological additives and your septic system. While yeast may help a little, nothing can take the place of a professional septic tank treatment additive to break down waste and sludge, to keep your septic tank system sparkling clean.


It's a common mistake made by small business owners – they assume that search engine marketing (SEM) is not necessary if they are based in a small town. From their perspective, "all business is local, " and 95 percent or more of their business comes from customers within a five-kilometer radius.
That's where SEM enters the picture. There are two different components to SEM – paid and organic. "Paid" simply means that you pay a small fee to have your company appear at the top of search results. It also refers to hiring an agency specializing in SEM to boost your results using some of their proven methodologies. "Organic" means that you take steps to improve your site's visibility in the search engine rankings using natural steps, such as improving the number and types of keywords appearing on your website.
For a small business without an established web presence, it's usually best to start with the "organic" solutions first. You can think of this similar to all the "low-hanging fruit" that will improve search results – said the Online marketing experts For example, simply changing the meta-data hidden within the coding of the website can be enough to boost results.
But there are plenty of other approaches that small business owners can put SEM to work. What's important to keep in mind is that, from the perspective of search engines like Google and Bing, links to and from your website matter. Thus, if a lot of experts within a certain niche are linking to your website, Google assumes that your website must somehow be "authoritative" and will assign you a higher ranking in search. It's the links that matter here. If they are high quality, then you get "bonus" points from Google.
There are lots of ways to start a "soft" launch of a SEM strategy. One is to partner with local influencers in the community. They could write guest blog posts for your website, or you could write guest blogs for their website. Or, you could reach out to local associations, organizations, and partnerships to see if they will list your business in their local directories. The key is getting more links to your business to appear on the Internet.
By taking these little steps involving SEM, you will be surprised at how fast you can improve the reach, scope, and scale of your local business. When visitors come from out of town – maybe for a festival, convention or entertainment event – your business will be top of mind for them. With the Internet, all local business is really global. And that's why SEM matters for small businesses in small communities.


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Gaona är en ort i Argentina.   Den ligger i provinsen Salta, i den norra delen av landet,  km norr om huvudstaden Buenos Aires. Gaona ligger  meter över havet och antalet invånare är .

Terrängen runt Gaona är mycket platt. Den högsta punkten i närheten är  meter över havet,  km väster om Gaona. Närmaste större samhälle är El Quebrachal,  km söder om Gaona.

I omgivningarna runt Gaona växer i huvudsak lövfällande lövskog. Runt Gaona är det mycket glesbefolkat, med  invånare per kvadratkilometer.  Klimatet i området är fuktigt och subtropiskt. Årsmedeltemperaturen i trakten är  °C. Den varmaste månaden är november, då medeltemperaturen är  °C, och den kallaste är juni, med  °C. Genomsnittlig årsnederbörd är  millimeter. Den regnigaste månaden är december, med i genomsnitt  mm nederbörd, och den torraste är juli, med  mm nederbörd.

Kommentarer

Källor

Orter i Salta (provins)

redpajama_set_name: RedPajamaWikipedia


As artificial intelligence and technology steps into the world, it is estimated that the USA alone will lose 16% of existing jobs. On the other hand, there is a prediction that AI will create a staggering 13.6 million jobs. Parts of these changes will affect the educational sector.
Teachers today may lecture on essay writing in colleges, marking papers, and instructing students without help of machines. With the introduction of artificial intelligence to learning institutions, machines will soon handle some of these manual tasks. As a result, the field of education will see a lot of changes take place. Below are eight ways machine learning in education can help you improve education in the years ahead.
One of the key things machine learning can deliver in schools is personalization.
With the help of machine learning, educators will have more time to monitor how the students are utilizing individual concepts. This will help the instructors to monitor specific methods and see how well they apply students are working so that the curriculum can be tailored to fix any problems.
The need for teachers to perform routine tasks such as keeping student logs will also become redundant. This is going to apply to termtime planning as well, with the need to constantly set and monitor student progression going to be minimized by the help of machine learning platforms like Gooru's Learning Navigator.
Artificial intelligence in schools will enable the analysis of student capabilities and performance and point the way forward using predictive analytics.
Some software firms are in the process of developing machine learning prediction models to do exactly this. For example, if a student's writing results continually decline, the programme can predict how they will perform in the future if the student does not take the appropriate measures. The teacher can then look for other avenues to adjust, direct or help the student in a better way.
Using predictive machine learning AI will do a better job at organizing the learning processes than human endeavors to do so.
With AI machine learning prediction, education will show significant growth and great efficiency. Teachers and students will find it easier to work in ways that make them happy and comfortable with education. This will make them improve their love and participation in the educational process.
Another good thing about artificial intelligence is that this software offers the potential to decrease grading bias. This is to say, any attitudes and prejudices of teachers will no longer affect the students' scores and grades.
These machines will greatly help teachers check the assignments given to their students with reduced human interference. Recently, Turnitin has developed a Revision Assistant Programme to review essays and check for plagiarism. Besides showing scores, this programme also shows parts to be edited or altered for improvement.
Once the machines have shown the students score and grades, from this analysis the student will get feedback on their submitted works.
The machines will analyze the student's progress over time. It will also show the level of understanding of different concepts by the student given to them by their teachers.
From this data and analysis, the teachers and tutors will know what areas they are required to address and make adjustments. They will be able to see what approaches they need to adopt in order to help students achieve their targets.
The software will also help in suggesting learning paths the student should take. This will be taken from the student's performance. Students will receive suggestions concerning materials and other learning methodologies from this software.
Another thing that artificial intelligence in education can do is to identify the students that need assistance and the teachers that are available. Students will be able to get personalized schedules with teachers.
The machines will do the greater work of scheduling those that need help. This new machine learning education classroom model will create an environment where students will get personalized help through suggestions given by the software.
Last but not least, machine learning for education will make learning fun both for educators and students. The machine will do most of the work and the teacher's duty will be to make a few additions and changes based on data analysis done by the learning machines.
It's a great worry among many educators that machines learning will replace tutors – but this is not the case. The human element in teaching will not go away as long as there will be human beings. Artificial intelligence will help equip schools and educators to make their work easier in preparing students for life in and after school.
As soon as we implement artificial intelligence in our schools we will see education upgrade to new levels faster than at any time in history. However, as many are aware, AI is not well received by some educators but with the help of proponents of AI in education, we hope that this form of edutech finds its way into schools faster. One way to introduce this system is by investing in machine learning for pupils.


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Hong Kong Post () is a Japanese-language weekly newspaper published in Hong Kong every Friday and owned by Mikuni Company. The newspaper first appeared in June 1987. It used to be sold  in shops such as Citysuper, but is now free. It was formerly published by Pasona Press (HK) Co., Ltd.

Financial, economic, and political topics are stressed by this publication, and people working in business fields are the main clientele of the publication. Harumi Befu and Sylvie Guichard-Anguis, authors of Globalizing Japan: Ethnography of the Japanese presence in Asia, Europe, and America, described the paper as "A Major source of information for Hong Kong's Japanese residents".

History

The newspaper reported on anti-Japanese protests in 1996, including those targeting the Hong Kong Japanese School. Due to the protests being a reaction against past Japanese military actions, the newspaper's reporting lacked anger and shock towards the protests. Befu and Guichard-Anguis stated that the newspaper implied that "the past is irrelevant to the present" even though it never explicitly denied historical Japanese atrocities in Asia in any article.

Mikuni Company Limited (三國有限公司) was the publisher. In November 2018 the publishing was suspended. In 2019 Hirose Trading HK Limited (港通旭實業有限公司) became the publisher, and publication resumed.

Composition
The initial page discusses the economy of politics of Hong Kong. The subsequent page discusses news in Hong Kong and the southern portions of China. Columns related to business in Hong Kong and the China region follow. The final pages have cultural and non-business topics.

Corporate affairs
The head office of the publisher is in the Shui On Centre in Wan Chai.

The newspaper's head office was previously in the CCT Telecom Building () in Fo Tan, Shatin. The newspaper's head office was previously in Leighton Centre () in Causeway Bay.

See also
 Japanese people in Hong Kong
 Hong Kong Japanese School

References
  - Profile (PhD thesis) - PDF link - Available at ProQuest (preview for unregistered users)

Notes

External links
Hong Kong Post website

Japanese-language newspapers
Newspapers published in Hong Kong
Newspapers established in 1987
1987 establishments in Hong Kong


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#NewRelease - Bayou Revelations by @AprylBaker
Title: Bayou Revelations
Author: Apryl Baker
Genre: NA Horror/Paranormal
Cover Designer: Deranged Doctor Design
Publisher: Limitless Publishing, LLC
Publication Date: February 11th, 2020
Hosted by: Lady Amber's PR
Secrets.
Emma Rose Crane thought she left all that behind in North Carolina, but she can't escape them.
She was robbed of her childhood memories and the protections she was born with, making her human body vulnerable to the superhuman gifts she'd inherited. But why? It's just another secret she must unravel.
But it's not only her secrets she's dealing with.
Her friend and fellow hunter, Cass Willow, has asked her to help him find out who his father is, but also exactly what he is, as Cass has discovered he's not quite human. However, the fallout from the truth may destroy them all.
And then there's Kristoff—the psychotic vampire who seems to think she's his shiny new toy. To get to him, they must unravel the mysteries of Madame's island in the middle of the bayou, and for that, they need help.
Saidie Walker always knew she'd return to the island where she learned what it was to be a Necromancer, but she never thought it would be so soon. Kristoff is forcing her hand. He's the one thing that truly terrifies her, but she must face him not only to save Emma, but get justice for all the women he's murdered since she killed Madame and set him free. She blames herself for their deaths and will do everything in her power to stop him.
But she's not sure she can do it alone. Together, she hopes she and Emma can finally put an end to his reign of terror.
Homecoming: https://amzn.to/379Svgw
Dirty Blood: https://amzn.to/2ScmkZz
Stained: https://amzn.to/3brjtDS
The Red Church: https://amzn.to/2upTagH
Bayou Secrets: https://amzn.to/2vhCSGK
Bayou Revelations: https://amzn.to/2SwqB9m
Well, I'm the crazy girl with an imagination that never shuts up. I LOVE scary movies. My friends laugh at me when I scare myself watching them and tell me to stop watching them, but who doesn't love to get scared? I grew up in a small town nestled in the southern mountains of West Virginia where I spent days roaming around in the woods, climbing trees, and causing general mayhem. Nights I would stay up reading Nancy Drew by flashlight under the covers until my parents yelled at me to go to sleep.
Now, I live in a small town in West Virginia where I entertain my niece and nephew and watch the cats get teased by the birds and laugh myself silly when they swoop down and then dive back up just out of reach. The cats start yelling something fierce…lol.
I love books, I love writing books, and I love entertaining people with my silly stories.
Facebook: https://www.facebook.com/authorAprylBaker
Twitter: https://twitter.com/AprylBaker
Wattpad: https://www.wattpad.com/user/AprylBaker7
Website: https://www.aprylbaker.com/
Instagram: https://www.instagram.com/apryl.baker
Newsletter: https://www.aprylbaker.com/contact
Goodreads: https://www.goodreads.com/author/show/5173683.Apryl_Baker
Amazon: https://www.amazon.com/Apryl-Baker/e/B005L9YKY2
Bookbub: https://www.bookbub.com/authors/apryl-baker
Blog: https://www.mycrazycornerblog.com/
Reader Group: https://www.facebook.com/groups/AprylsAngels/
#AudioBlitz & #Giveaway - Sezing Success by @Mary_KeyAssoc
Title: Seizing Success Author: Mary Key, Ph. D. Genre: Women's Inspirational Publisher: Three One Six Audio Hosted by: Lady Amber's PR Blurb: The turn of a year usually stimulates us to reflect on the past year and think about what the upcoming year might look like. This year is a big deal since we are moving to a new decade. Where do you see yourself in 2020? For the remaining new decade? For those of you who lead others or aspire to, what kind of a leader do you want to be next year? In 10 years? In Seizing Success: A Woman's Guide to Transformational Leadership, Dr. Mary Key serves as your personal executive coach as she identifies the essential core competencies and support you need to excel as a woman in leadership. She offers strategies, tools and action steps that can make all the difference in having a successful, fulfilling career and life. The stories and examples will not only engage you but inspire you to be your personal best. In thi
~Blog Tour~ Curse Me Not by Elizabeth Fisher
Title: Curse Me Not Author: Elizabeth Fisher Published: December 1st, 2014 Publisher: Champagne Book Group Genre: Paranormal Romance Content Warning: Adult Sexual Content Recommended Age: 17+ Synopsis: Southern unsophisticate Elzetta Swan has gained the ability to see auras and the more lucrative ability to clean revenge curses from those auras. Embracing the gift faster than grass through a goose, Elzetta is about to finish her first year as a legally licensed bodywasher with a trendy new lifestyle and a countrified inner child that's skipping all the way to the bank. But when a routine cleansing suddenly turns ugly, she begins to wonder if a powerful invoker has come to town—one who's hooked on the rush of setting particularly nasty curses. As Elzetta attempts to track down the culprit, she faces two fateful confrontations. Each will threaten her trendy new life and the hallelujah hankering she's formed for the unlikeliest of urban white knig
#BookTour & #Giveaway - The Lost Lunason Series by @SSultrie
While My Soulmate Slumbers The Lost Lunason Series Book 1 by Stacie Sultrie Genre: RH Paranormal Romance When the love of her life sacrifices himself to protect her from the ultimate evil, Cassia Lunason plunges herself into an enchanted slumber. After two hundred years of blissful dreaming, Cas wakes up to discover that the world has become a very different place. Cars zoom down the streets, lights come on with the flip of a switch, and enchantresses take more than one mate. Not only does the powerful enchantress need to learn how to navigate the new world, Cassia soon realizes one very important thing - her soulmate is still alive. With the help of her familiar, a majestic white wolf with the ability to speak telepathically, Cassia struggles to reach her lost love. Along the way, Cas is distracted by a handsome man who will stop at nothing to help her get her beloved back. Will Cassia reach her lost love in time? Is the evil her


Tooth Talk is a service designed to provide Dental advice online. So open wide and ask any Dental related questions that you may have. If you are not quite happy with your smile, if you want to know about a toothbrush or tooth paste, or need any information about Dental procedures, please contact Dr. Sam (our tooth adviser) online by submitting an email.
Dr. Sam will respond with an individual follow up email and will post any valuable information that may be helpful to other patients.


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WorkSafe New Zealand Act 2013
10 WorkSafe New Zealand's functions
WorkSafe New Zealand's functions are to—
advise on the operation of the work health and safety system, including co-ordination across the different components of the system:
make recommendations for changes to improve the effectiveness of the work health and safety system, including legislative changes:
monitor and enforce compliance with relevant health and safety legislation:
(ca)
publish information about—
its approach to enforcing compliance with relevant health and safety legislation (including where a provision of relevant health and safety legislation overlaps with a provision in another enactment); and
its performance standards for completing investigations in relation to enforcing compliance with relevant health and safety legislation:
make recommendations about the level of any funding (including fees or levies) that WorkSafe New Zealand requires to effectively carry out its functions:
develop codes of practice:
develop safe work instruments:
provide guidance, advice, and information on work health and safety to—
persons who have duties under the relevant health and safety legislation; and
the public:
promote and support research, education, and training in work health and safety:
collect, analyse, and publish statistics and other information relating to work health and safety:
engage in, promote, and co-ordinate the sharing of information with other agencies and interested persons that contribute to work health and safety:
foster a co-operative and consultative relationship between persons who have duties under the relevant health and safety legislation and the persons to whom they owe duties and their representatives in relation to work health and safety:
(ja)
foster a co-operative and consultative relationship with the EPA when carrying out its functions, duties, and powers in respect of hazardous substances:
promote and co-ordinate the implementation of work health and safety initiatives by establishing partnerships or collaborating with other agencies or interested persons in a coherent, efficient, and effective way:
perform or exercise any other functions or powers conferred on WorkSafe New Zealand by or under any other enactment:
perform any additional function that the Minister directs under section 112 of the Crown Entities Act 2004.
Section 10(a): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(b): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(ca): inserted, on 4 April 2016, by section 8(2) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(ea): inserted, on 4 April 2016, by section 8(3) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(f): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(g): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(h): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(i): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(j): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(ja): inserted, on 4 April 2016, by section 8(5) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).
Section 10(k): amended, on 4 April 2016, by section 8(1) of the WorkSafe New Zealand Amendment Act 2015 (2015 No 74).


text:
Winnie the Pooh UK Tour
UK premiere of Disney's WINNIE THE POOH THE MUSICAL
Created and directed by Jonathan Rockefeller
Featuring music by The Sherman Brothers
with additional songs by A.A. Milne
Disney's Winnie the Pooh will be coming to the UK and Ireland stage for the first time in Spring 2023, with preview performances at London's Riverside Studios (Hammersmith) from 17 March and an official opening on 26 March. It will then tour the UK and Ireland until September 2023. Tickets for Riverside Studios on sale at 10am on Monday 7 November, with Tour tickets on sale now.
The UK premiere will be presented by Rockefeller Productions, in partnership with ROYO, and in association with Disney Theatrical Productions. The role of Winnie the Pooh will be played by Jake Bazel, who originated the role on Broadway. Further casting to be announced.
Jake Bazel is a puppeteer, voice actor, writer and coach with over a decade of experience working in children's media. Credits include Sesame Street (HBO/PBS), Disney's Winnie the Pooh: The New Stage Adaptation (Disney Theatrical), Sesame Workshop's Helpsters (Apple TV+), The 90th Annual Macy's Thanksgiving Day Parade with Disney's Muppets (Disney/NBC), The 93rd Annual Macy's Thanksgiving Day Parade with Sesame Street (Sesame Workshop/NBC), Duncan the Skunk and the Big Costume Trunk (Hellosaurus), The Very Hungry Caterpillar Show, Paddington Gets in a Jam, Paddington Saves Christmas, Sandra Boynton's Frog Trouble, Jim Henson's Dinosaur Train Live! and Sesame Street in Communities. As a writer, he helped to craft Disney's Winnie the Pooh: The New Stage Adaptation.
Deep in the Hundred Acre Wood, a new adventure is about to happen. A.A. Milne's beloved characters, Winnie the Pooh, Christopher Robin and their best friends Piglet, Eeyore, Kanga, Roo, Rabbit and Owl (and Tigger too!), will all arrive on stage in a beautifully-crafted musical stage adaptation.
In a new story from the Hundred Acre Wood, this fresh stage adaptation is told with impressive life-size puppetry, exciting new stories and featuring characters that have played iconic roles in the lives of children for generations. Accompanying the modern narrative is an original score by Nate Edmondson, featuring some of the Grammy award-winning songs written by the Sherman Brothers for the original animated features, including Winnie the Pooh, The Blustery Day, The Wonderful Thing About Tiggers and Whoop-De-Dooper Bounce, plus A.A. Milne's The More It Snows (featuring music by Carly Simon) and Sing Ho in a new arrangement.
Winnie the Pooh: The New Musical Adaptation is developed and presented by renowned family entertainment creator Jonathan Rockefeller (whose spectacular puppetry is omnipresent in the acclaimed productions of The Very Hungry Caterpillar Show and Paddington Gets in a Jam).
Inspired by the beloved books by A. A. Milne and the classic Disney featurettes, the production was welcomed in New York in 2021, where it broke theatre box office records for the largest advance, with rave reviews where it was called "Enchanting!" (Time Out); "Winnie the Pooh: The New Musical Stage Adaptation is magical, sweet as honey, and full of humor. It's a wholesome, delightful, enchanting piece of theatre," (BroadwayWorld); "A perfect reintroduction to live theater. It's a captivating adventure with spectacular puppetry," (Mommy Poppins); "Charming and whimsical stage show that Pooh surpasses every expectation I had for it," (The Laughing Place); "Winnie the Pooh is delightfully first-rate," (Theatre Pizzazz); "Irresistible. 'Winnie the Pooh' is sweeter than honey," (DC Metro Arts); "An hour of bountiful joy," (New York Theatre Guide); "Mesmerizing and lifestyle puppets and original Sherman Brothers tunes, the beautiful new Winnie the Pooh musical is must-see," (Theatrely); "The wonderful thing about musicals is that musicals are wonderful things. The New 'Winnie the Pooh' Musical Is Sweeter than Honey," (Toy Insider).
Website: winniethepoohshow.co.uk
Facebook: @WinnieThePoohShowUK
Twitter: @WinnieShowUK
Instagram: @WinnieThePoohShowUK
Newsies - Troubadour Wembley Park Theatre Review
Brand new casting for Wicked in the Westend
MJ The Musical - Westend News


Latinas in Motion Fun Run – Sun, November 2, 7:45am – 10:00am, I St. and Ramona Ave.
Healthy Habits Demonstration –Thu, November 6, 1:30pm – 2:30pm, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Our case worker will be cooking up some healthy foods and discussing the benefits of each ingredient. Free of charge event.
Satellite Office of State Rep. John Taylor – Every Thursday, 5pm – 7pm, Simpson Playground, 1010 Arrott St. – Open to the public to meet Rep. Taylor or a member of his staff to discuss whatever issue is on your mind.
Friends of Overington Park –Tue, November 18, 7pm – 8pm, Overington Park, Orthodox St. – We will meet in the park in fair weather and at 1500 Orthodox St. , the Friends Meeting House, in bad weather or cold months.
Northwood Civic Association Meeting – Tue, November 18, 7pm – 8pm – St. James Lutheran Church, at Castor Avenue and Pratt Street.
Healthy Habits Demonstration –Thu, November 20, 1:30pm – 2:30pm, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Our case worker will be cooking up some healthy foods and discussing the benefits of each ingredient. Free of charge event.
Senior Breakfast – Tue, November 25, 8am – 10am, Aria Health, Frankford – 2nd floor cafeteria- Aria will provide our community seniors with monthly, insightful tips and information on issues that are directly affecting you and your health. Breakfast will be provided free of charge. To reserve your seat call 1-877-808-2742 and then press 2.
Monthly Birthday Party –Tue, November 25, 11:45am – 12:45pm, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Come celebrate your birthday! We have a monthly birthday party. Join us for cake, ice cream, lunch, and live entertainment!
Friends of Overington Park – Tue, October 21, 7pm – 8pm – We will meet in the park in fair weather and at 1500 Orthodox St. , the Friends Meeting House, in bad weather or cold months.
Northwood Civic Association Meeting – Tue, October 21, 7pm – 8pm, St. James Lutheran Church, at Castor Avenue and Pratt Street.
Peter Bressi 30th Anniversary Banquet – Fri, October 24, 11:30am – 1:30pm, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Come join us to celebrate our 30th Anniversary with our very special Anniversary Banquet. Pre-registration is required. Please reserve your seat with Karen at 215-831-2926. $4.00 per plate donation requested.
HIV and Hepatitis C Testing – Sun, October 26, 11am – 4pm, St. Mark's Church, 4442 Frankford Avenue – Philly Faith in Action was brings the University of Pennsylvania School of Medicine and Drexel University with their mobile medical center to St Marks for rapid HIV and hepatitis C testing, counseling and follow up care. They will be here the 2nd Saturday of every month.
Senior Breakfast – Tue, October 28, 8am – 10am, Aria Health, Frankford – 2nd floor cafeteria- Aria will provide our community seniors with monthly, insightful tips and information on issues that are directly affecting you and your health. Breakfast will be provided free of charge. To reserve your seat call 1-877-808-2742 and then press 2.
Monthly Birthday Party – Tue, October 28, 11:45am – 12:45pm, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Come celebrate your birthday! We have a monthly birthday party. Join us for cake, ice cream, lunch, and live entertainment!
Frankford Business and Professional Association – Tue, October 28, 12pm – 2pm, NET, 4625 Frankford Ave. – Hear from our President, Diane Richardson about our accomplishments from 2013 -2014 and learn about what we have in store for the upcoming year. Representatives from Ready Philadelphia will be joining us to discuss business emergency preparedness and Project HOME will be discussing what we can do to help address the issue of homelessness in Frankford. SEPTA will also be in attendance to give an update on the 2015 Arrott Terminal (Margaret Orthodox Station) construction project.
Frankford Parks Group – Tue, October 28, 6:30pm – 7:30pm, CDC Building, 4900 Griscom St.
Dance Movement Therapy Class – Wed, October 29, 10am – 11am, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Please join us for our Dance Movement Therapy Classes. Come join this hot new program!
Greensgrow Fruit and Vegetable Truck – Thu, October 30, 12:00pm – 1:30pm, Peter Bressi Northeast Senior Center 4744 Frankford Ave. – Greensgrow Fruit and Vegetable Truck will be here. Fruit and vegetable can be purchased with food vouchers, access card, or cash.
PSA1 Meeting – Thu, October 30, 7pm – 8pm, Aria Health Frankford Campus, 4900 Frankford Ave.


text:
Article Updated:	March 31, 2017
Council of Europe Framework Convention for the Protection of National Minorities and the Council of Europe's European Charter for Regional or Minority Languages set up a legal framework for language.
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Antarctica Stations
This is the good news. It is not too late and that is wonderful. Even if emissions are slashed, there remains a 10% chance that sea level will rise significantly. This is the good news. It is not too late and that is wonderful.
Homeland Security's Test
Non-Toxic Gas Released in NYC Subway to Prepare for Possible Biological Attack. The Department of Homeland security today released.
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We captured the stunning beauty of wild places
We captured the stunning beauty of our wild places and reminds us these landscapes are an essential part of the human spirit. We captured the stunning beauty of our wild places and reminds us these landscapes are an essential part of the human spirit.


"The session was really well considered and the children enjoyed it tremendously. It gave the children an opportunity to explore their local area and consolidated their knowledge of local history.
Our first art ed sessions at The Old Church with yr.5 children at William Patten & yr.2 at Tyssen. Photos: Sean Westgate, Gobbledegook.


The new leisure centre will create a single venue for sports, cultural events and exhibitions in the centre of the Ayrshire town.
The new facility will feature a main pool, a teaching pool, six-court sports hall, studios, a state-of-the-art fitness suite, and both wet and dry changing areas. Both pools will have a viewing area at mezzanine level for spectators.
AccentHansen designed, supplied and installed almost a dozen steel doorsets for plant rooms and roof areas. Finished in Pearl Green PPC, some of these external doorsets had fire and security properties, as well as overpanels.


text:
Effective Management of Severe Diverticular Bleeding in Japanese Patients
Journal of Colitis & Diverticulitis
J Colitis Diverticulitis 1: 106, Vol 1(1)
Yoshihito Nakagawa*, Toshiaki Kamano, Naoki Ohmiya, Tomomitsu Tahara, Tomoyuki Shibata and Ichiro Hirata
Department of Gastroenterology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
*Corresponding Author: Yoshihito Nakagawa, Department of Gastroenterology, Fujita Health University, School Of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 4701192, Japan, Tel: +81-562-93-9240, Fax: +81-562-93-8300, Email: [email protected]
Received Date: Mar 03, 2016 / Accepted Date: Mar 08, 2016 / Published Date: Mar 11, 2016
Aim: Diverticular bleeding is a common cause of lower gastrointestinal bleeding. Aggressive treatment because of spontaneous hemostasis is typically required only in severe cases. To determine the clinical characteristics of Japanese patients with diverticular bleeding and evaluate the treatment methods used with the aim of developing an effective management approach.
Method: We conducted a retrospective cohort study of 626 Japanese patients (769 endoscopic procedures) who underwent diagnostic lower gastrointestinal endoscopy at Fujita Health University Hospital between November 2011 and April 2014.
Results: Diverticular bleeding was the most frequent cause of lower gastrointestinal bleeding, occurring in 155 patients. Concurrent illness, such as hypertension, was common and 92 patients were receiving anticoagulant or antiplatelet therapy on admission. However, no significant clinical differences were observed between patients with severe and mild diverticular bleeding. Computed tomography (CT) was useful for a treatment policy decision of the one from diverticular bleeding as well as other lower gastrointestinal bleeding. Clipping via colonoscopy could stop bleeding effectively for patients with an identified bleeding point. Barium impaction had utility in patients with persistent bleeding. Angiographic hemostasis or colectomy (intestinal resection) was only performed in uncontrolled patients in whom clipping and barium impaction was not possible.
Conclusion: No significant clinical differences were observed between patients with severe and mild diverticular bleeding. CT angiography was useful for a treatment policy decision of the one from diverticular bleeding. Endoscopic clipping and barium impaction had efficacy in severe cases of diverticular bleeding, at first.
Keywords: Angiographic hemostasis; Colectomy; CT angiography; Diverticular bleeding; Endoscopic clipping; High-dose barium impaction
Lower gastrointestinal bleeding is defined as bleeding from the anal side of the ligament of Treitz [1-3]. Gastrointestinal bleeding can be broadly classified into small intestinal and large intestinal bleeding. Colonic diverticular bleeding is considered a major cause of large intestinal bleeding in addition to benign anorectal diseases, such as ischemic colitis, colorectal tumors, infectious enteritis, hemorrhoidal bleeding, and hemorrhagic rectal ulcers [2,3].
Treatment options for lower gastrointestinal bleeding depend on the underlying etiology. Ischemic colitis reportedly resolves with conservative treatment and requires aggressive treatment only in cases of vaso-occlusive disease [4,5]. Benign anorectal diseases, such as hemorrhoids or hemorrhagic rectal ulcers, are treated transanally and/or by pharmacological therapy [6] and bleeding sites can usually be easily identified. Arteriovenous malformations can often be treated by endoscopic clipping or argon plasma coagulation [7]. Furthermore, bleeding caused by colorectal tumors, inflammatory bowel disease, or infectious colitis should be controlled by treating the respective underlying causes. Diverticular bleeding is known to spontaneously resolve in the majority of cases [8-10] and therefore requires aggressive treatment only in severe cases. At our hospital, the treatment options for severe cases of diverticular bleeding include endoscopic clipping [11-14], high-dose barium impaction [15-17], angiographic hemostasis [18,19], and intestinal resection. However, currently, there is a lack of consensus regarding the most appropriate treatment methods for particular clinical presentations. Furthermore, the severity of diverticular bleeding cannot be accurately determined in all cases. Patients may be at increased risk due to the time required to decide on treatment plans where there is a lack of definitive treatment strategy. Furthermore, endoscopists in our hospital have varied levels of skills and competencies.
In the present study, we retrospectively analyzed the characteristics of patients with lower gastrointestinal bleeding in our hospital, including clinical characteristics, concurrent illness, use of anticoagulant or antiplatelet therapy on presentation, and recurrence of bleeding. We further evaluated the treatment outcomes of patients with diverticular bleeding for effective hemostasis.
High-dose barium impaction for hemostatic treatment of diverticular bleeding was introduced at Fujita Health University Hospital in November 2011. We conducted a retrospective cohort study in this hospital between November 2011 and April 2014. The study was conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. Only data from patients who provided written informed consent was used in this study. We evaluated disease etiology, concurrent illness, and use of anticoagulant or antiplatelet therapy in 626 patients (769 endoscopic procedures) who underwent diagnostic lower gastrointestinal endoscopy in our hospital for lower gastrointestinal bleeding. Patients with positive fecal occult blood tests and those undergoing follow-up endoscopy for inflammatory bowel disease were excluded.
Colonoscopy was performed by 19 endoscopists in our department. Colonoscopy in cases of diverticular bleeding without pretreatment with oral intestinal lavage liquid (pretreatment) was performed by 12 experienced endoscopists who had a cumulative total experience of >400 colonoscopies. The clinical characteristics of patients with and without lower gastrointestinal diverticular disease were compared. Patient characteristics, bleeding sites, concurrent illness, use of anticoagulant and antiplatelet therapy, recurrent or persistent bleeding, and treatment modalities performed in cases of diverticular bleeding were analyzed. We defined recurrence as bleeding occurring for >2 weeks following previous instance of hemostasis. Persistent bleeding was defined as bleeding re-occurring within 2 weeks. In addition, the efficacy and rates of recurrent bleeding for endoscopic clipping, highdose barium impaction, angiographic hemostasis, and surgical treatment were evaluated. In endoscopic clipping, hemostasis is achieved by attaching a metal clip to the hemorrhage site using an endoscope [11-14]. In high-dose barium impaction, hemostasis is achieved by performing enema to fill diverticula with highly concentrated barium [15-17]. Angiographic hemostasis involves ablation of the vein of the responsible lesion under angiographic guidance [18,19]. Surgical treatment (colectomy) for diverticular bleeding involves partial resection of the large intestine that includes the hemorrhage site.
The chi-square and Fisher's exact tests were used for statistical analyses. Statistical significance was set at a P-value of <0.05. An effective approach for the management of patients with diverticular bleeding in our hospital was devised following data analysis.
A total of 626 patients suffered lower gastrointestinal bleeding during the study period. Etiologies, in order of frequency, included diverticular bleeding (including strongly suspected cases), hemorrhoidal bleeding, ischemic colitis, colorectal tumor, and hemorrhagic rectal ulcer (Figure 1). Less frequent causes of lower gastrointestinal bleeding included arteriovenous malformations, infectious colitis, collagen disease, and initial inflammatory bowel disease. Lower gastrointestinal bleeding of unknown cause was recorded in cases with two or more suspicious bleeding lesions.
Figure 1: Causes of lower gastrointestinal bleeding in our hospital (November 2011 to April 2014).
We compared patients with and without lower gastrointestinal diverticular bleeding. The median age of the 155 patients with diverticular bleeding was 69 years, with the frequency peaking between the ages of 60 and 79 years (Figure 2 and Table 1a).
Figure 2: Number of patients with diverticular bleeding by age.
Diverticular bleeding
Non-diverticular lower gastrointestinal bleeding
p value
Number of patients 155 471
Age (median) 28-92 (69) 3-98 (67)
Concurrent illness 119 (76.8%) 317 (63.7%) 0.0261
Anticoagulant and/or Antiplatelet 42 (27.1%) 104 (22.1%) 0.2002
Table 1a: Patient characteristics; Comparison of retrospectively collected clinical characteristics of patients with and without lower gastrointestinal diverticular bleeding in our hospital between November 2011 and April 2014. Bold values indicate significant differences (P < 0.05).
The median age of patients with non-diverticular lower gastrointestinal bleeding was 67 years, indicating a trend toward patients with diverticular bleeding being older than those with other etiologies (Table 1a). Common concurrent illness included cardiovascular diseases (including hypertension), diabetes, cerebrovascular diseases, and malignant neoplasms. Concurrent illness were more common in patients with diverticular bleeding than in those with non-diverticular lower gastrointestinal bleeding (Tables 1a and 1b). Cardiovascular diseases, particularly hypertension, were found to be significantly more prevalent in patients with diverticular bleeding than in those with non-diverticular lower gastrointestinal bleeding. Conversely, malignant neoplasms were significantly more prevalent in patients with non-diverticular lower gastrointestinal bleeding than in those with diverticular bleeding (Table 1b). However, no significant difference in the prevalence of malignant neoplasms was observed when patients with malignant tumors and radiation colitis were excluded (data not shown). Chronic renal failure was significantly more prevalent in patients with diverticular bleeding than in those with non-diverticular lower gastrointestinal bleeding (Table 1b). However, this difference could not be accurately evaluated because of the small number of cases. Use of anticoagulant and particularly antiplatelet therapy was more prevalent in patients with diverticular bleeding than in those with non-diverticular lower gastrointestinal bleeding (Table 1a and 1c).
Concurrent illness
Cardiovascular disease 103 (66.5%) 224 (47.6%) <0.0001
Hypertension 84 (54.2%) 172 (36.5%) 0.0001
Arrhythmia 26 (16.8%) 53 (11.3%) 0.0726
Ischemic heart
disease 24 (15.5%) 63 (13.4%) 0.5401
Other cardiovascular
disease 22 (14.2%) 46 (9.8%) 0.1244
Diabetes mellitus 32 (20.6%) 75 (15.9%) 0.1756
Cerebrovascular disease 18 (11.6%) 52 (11.0%) 0.8445
Chronic renal failure 12 (7.7%) 15 (3.2%) 0.0154
Malignant neoplasm 22 (14.2%) 119 (25.3%) 0.0042
Other disease 4 (2.6%) 11 (2.3%) 0.8625
Total 119 (76.8%) 317 (63.7%) 0.0261
Table 1b: Concurrent illness; Comparison of retrospectively collected clinical characteristics of patients with and without lower gastrointestinal diverticular bleeding in our hospital between November 2011 and April 2014. Bold values indicate significant differences (P < 0.05).
Anticoagulant 12 (7.7%) 20 (4.3%) 0.0865
Warfarin 11 13
Rivaroxaban 1 3
Heparin 0 2
Fondaparinux 0 1
Dabigatran 0 1
Antiplatelet 33 (21.3%) 67 (14.2%) 0.0373
Aspirin 19 45
Clopidogrel 7 7
Ticlopidine 1 3
Cilostazol 0 2
Icosapentate 3 1
Aspirin + Clopidogrel 1 8
Aspirin + Cilostazol 2 0
Clopidogrel + Cilostazol 0 1
Anticoagulant + Antiplatelet 3 (1.9%) 17 (3.6%) 0.4445
Warfarin + Aspirin 3 15
Rivaroxaban + Aspirin 0 1
Ticlopidine + Aspirin 0 2
Total 42 (27.1%) 104 (22.1%) 0.2002
Table 1c: Prescribed anticoagulant or antiplatelet agents; Comparison of retrospectively collected clinical characteristics of patients with and without lower gastrointestinal diverticular bleeding in our hospital between November 2011 and April 2014. Bold values indicate significant differences (P < 0.05).
We next conducted a detailed analysis of patients with diverticular bleeding (Table 2). Patients with diverticular bleeding tended to be older and were more likely to be male; 69.0% were ≥65 years and 60.6% were male (Figure 2 and Table 2a). There was no difference in the rate of pretreatment use (Table 2a). Of the 155 included patients, 29% (n = 45) had diverticula affecting the right colon (cecum and ascending colon), 15.5% (n = 24) had diverticula affecting the left colon (descending and sigmoid colon), and 55% (n = 86) had diverticula affecting both sides of the colon. Diverticular bleeding occurred in the right colon in 25.2% (n = 39) patients, in the left colon in 16.1% (n = 25) patients, and could not be determined in 58.7% (n = 91) patients (Table 2a). Diverticular bleeding sites were less frequently determined in patients who had received pre-treatment. Diverticular bleeding occurred only once in 70.3% (n = 109) patients (Table 2a).
155 patients
Age (young/elderly)* 48/107
Sex (male/female) 94/61
Pretreatment (yes/no) 75/80
Site of diverticula (right/both/left) 45/86/24
Bleeding site (right/left/unclear) 39/25/91
Bleeding times (once/ more than twice) 109/46
Hemostatic treatment (yes/no) 25/130
Table 2a: Patient characteristics; Clinical characteristics of patients with diverticular bleeding in our hospital (November 2011 to April 2014).
Approximately 84% patients with diverticular bleeding improved following fasting, bed rest, and intravenous fluid administration. Interventions to restore hemostasis following diverticular bleeding were performed in 25 patients (Table 2a) and included high-dose barium impaction (n=15), endoscopic clipping (n=12), angiographic hemostasis (n=1), and colectomy (n=1; Table 2b). Five patients experienced bleeding recurrence and required repeat interventions to restore hemostasis (Table 2b). Clinical characteristics, including age, sex, diverticulum site, concurrent illness, and use of anticoagulant or antiplatelet therapy, were compared between patients with and without recurrent bleeding after interventions to restore hemostasis during the follow-up period. No significant differences in any clinical characteristic were observed (data not shown). Therefore, patients requiring repeated interventions to restore hemostasis were assessed as reference when determining the appropriate methods for achieving hemostasis in patients with severe diverticular bleeding.
Hemostatic treatment
Recurrent bleeding after hemostatic treatment
High-dose barium impaction 15/155 (9.7%) 3/15 (20.0%)
Endoscopic clipping 12/155 (7.7%) 3/12 (25.0%)
Intervention 1/155 (0.6%) 0/1 (0.0%)
Colectomy 1/155 (0.6%) 1/1 (100.0%)
Total 25/155 (16.1%) 5/25 (20.0%)
Table 2b: Hemostatic treatment (multiple interventions performed in some patients); Clinical characteristics of patients with diverticular bleeding in our hospital (November 2011 to April 2014).
In patients with stable vital signs without renal failure, computed tomography (CT) angiography was performed when possible to identify the hemorrhage site. Endoscopy was then used to diagnose lower gastrointestinal bleeding. Endoscopic clipping was initially attempted in cases where the bleeding source was determined. In the present study, endoscopic clipping was performed in 12 patients with complete cessation of bleeding achieved after a single intervention in 9 (75.0%) patients (Tables 2b). High-dose barium impaction was performed for patients in whom the diverticular bleeding point could not be detected, who exhibited recurrent or persistent bleeding without becoming shocked, and who definitely did not have intestinal perforation. Fifteen patients received barium impaction and 12 patients (80.0%) had complete cessation of bleeding following a single intervention (Tables 2b). All patients receiving at least one treatment with barium impaction were discharged early.
In the present study, angiographic embolization was performed to achieve hemostasis in cases where repeated attempts at endoscopic clipping failed to resolve prolonged active bleeding.
One patient who underwent colectomy was admitted to our hospital on seven occasions between May 2011 and February 2012 for diverticular bleeding. This patient received repeated interventions with high-dose barium impaction. On each occasion, hemostasis was achieved and the patient was successfully discharged. However, the patient suffered frequent bleeding recurrences over a prolonged period of time. Surgery was performed in February 2012 in accordance with the patient's preference (laparoscopic resection of the left hemicolon).
Overall, difficult-to-treat patients with diverticular bleeding were found to require a combination of a number of interventions to achieve adequate hemostasis.
The elderly (age ≥ 65 years) population of Japan was estimated to be 31,860,000 as of September 15, 2013, according to data from the Statistics Bureau of Japan, accounting for 25% of the general population. This figure and the corresponding proportion of the general population represent the highest totals ever recorded (Statistics Bureau of Japan. <http://www.stat.go.jp/data/topics/topi721.htm> (Accessed Sep, 2015)). In our hospital, the number of elderly patients presenting with lower gastrointestinal bleeding is increasing annually (data not shown). Moreover, the prevalence of diverticular disease has recently increased in elderly Japanese patients, albeit not affecting all elderly patients. Previously, in Japan, a greater number of patients presented with right-sided diverticula than with left-sided diverticula. However, there has been a recent increase in the number of patients presenting with left or both-sided diverticula [8-10,20]. Our data was consistent with the reported nation-wide Japanese prevalence (Table 2a).
In the present study, we analyzed data from 626 Japanese patients who underwent lower gastrointestinal endoscopy in our hospital for lower gastrointestinal bleeding, with the exclusion of patients with positive fecal occult blood tests and those undergoing follow-up endoscopy for inflammatory bowel disease. Diverticular bleeding was the most common cause of lower gastrointestinal bleeding in the present study, accounting for approximately one quarter of lower gastrointestinal bleeding presentations in our hospital (Figure 1). Diverticular bleeding was relatively common in elderly patients (Figure 2). Furthermore, a high proportion of patients had lifestyle-associated comorbid diseases, including cardiovascular diseases, diabetes, and cerebrovascular diseases. Of particular note, over half of all patients had hypertension. Moreover, a significantly high number of patients with lower gastrointestinal bleeding were currently receiving anticoagulant or antiplatelet therapy. The results indicate diverticular bleeding is associated with increased age, presence of cardiovascular diseases, and use of anticoagulant or antiplatelet therapy (Tables 1b and 1c).
Approximately 84% patients with diverticular bleeding in our hospital demonstrated clinical improvements with conservative treatment including fasting, bed rest, and intravenous fluid administration (Table 2a). However, bleeding recurrence occurred in approximately one-third of patients and a number of patients were particularly difficult to management regardless of age (Tables 2b). In other words, although most patients with diverticular bleeding improve with conservative treatment, a small proportion develop recurrent and/or persistent bleeding that is difficult to treat, potentially resulting in serious outcomes. There were reports re-bleeding case of diverticular bleeding were able to predict by risk factors about hypertension, elderly, et al. [21,22]. However, in the present study, no significant differences were observed between severe and mild cases of diverticular bleeding. Appropriate selection of the treatment modality, including endoscopic clipping, high-dose barium impaction, angiographic hemostasis, and intestinal resection, is critical in difficult cases.
Endoscopic clipping may be attempted when a hemorrhage point has been clearly determined by endoscopy. Bleeding diverticula may also be identified by fitting a hood to the tip of the colonoscope and turning over each diverticulum one by one [13]. The effect of hemostasis had been reported to be excellent [14]. However, this method is not performed in our hospital due to restrictions associated with time and personnel. A definite hemorrhage source was identified in a small number of patients in our hospital (n=12).
High-dose barium impaction is considered a relatively less strenuous procedure that may be used to achieve hemostasis and an earlier discharge. However, it is contraindicated in cases of suspected colorectal perforation. Physicians must also be cautious regarding patients with intestinal stricture due to multiple episodes of diverticulitis and patients with colorectal cancer due to the risk of colon ileus development. Further, achieving hemostasis with the use of high-dose barium impaction is often difficult in patients with large amounts of bloody stool, which causes sudden shock. Administered barium was found to have disappeared within 1 month in the majority of patients included in this study. Therefore, residual barium was not found to be an issue associated with this surgical procedure.
Angiographic ablation has a strong hemostatic effect. However, it may be difficult to identify the responsible lesion in patients with mild bleeding. In patients with decreased renal function, acute renal failure may be precipitated by use of a contrast medium. Accordingly, angiographic ablation is indicated only in the following patients: those with a normal renal function; those in whom the hemorrhage source has been identified by colonoscopy, CT angiography, or scintigraphy; and those in whom bleeding is uncontrolled by conservative therapy, endoscopic clipping, or high-dose barium impaction [19].
Surgical treatment (colectomy) is indicated for patients in whom hemostasis cannot be achieved through the use of endoscopic clipping, high-dose barium impaction, or angiographic hemostasis or those in whom severe bleeding prevents rapid improvement in general conditions because other hemostatic interventions cannot be applied. A number of studies have evaluated the utility of laparoscopy in reducing the surgical invasiveness of colectomy [23,24]. However, colectomy remains the most invasive method for the treatment of severe cases of lower gastrointestinal bleeding. As described previously, diverticular bleeding commonly occurs in elderly patients with numerous high-risk factors, indicating that colectomy should be considered as the last treatment option.
In the present study, we decided that an appropriate management strategy was necessary for the effective treatment of all patients with diverticular bleeding due to the considerable number of difficult cases and the lack of clinical characteristics allowing distinction between severe and mild cases of diverticular bleeding. Based on the results of the present study and the above discussion, we developed a treatment approach that comprised the following steps. First, in cases of suspected diverticular bleeding, the following steps are taken until a decision is reached regarding the requirement for colonoscopy. When patients exhibit bloody stools (an occurrence not limited to patients with diverticular bleeding), vital signs are assessed to confirm shock. Identified cases of shock are immediately treated with initiation of fasting and emergency interventions. Furthermore, substantial hemorrhage is likely to lead to cases of shock. Therefore, CT angiography is attempted upon improvement in the clinical signs of shock with angiographic embolization or intestinal resection performed once bleeding has reduced. Colonoscopy is performed only in patients with stable vital signs. In cases where the bleeding source cannot be determined, emergency interventions are continued. CT angiography is performed to locate hemorrhage sites in patients without renal failure once vital signs no longer indicate a state of shock. Moreover, CT angiography also has utility in assessing the presence of diverticula, diverticulitis, abscess, perforation, malignant colitis, and large tumors. Where bleeding sources are located, fasting is initiated, the bowel is prepared, and colonoscopy is considered. However, emergency colonoscopy without bowel cleansing performed by experienced endoscopists may be considered in cases where bleeding sources are not identified because emergency colonoscopy for diverticular bleeding carries a high risk of perforation and shock.
Endoscopic clipping is initially attempted in cases where the bleeding source is identified by colonoscopy. Angiographic embolization and intestinal resection are considered in cases where bleeding remains uncontrolled despite the use of endoscopic clipping. A conservative approach, involving fasting and close observation, is followed in cases where the hemorrhage source cannot be determined but the amount of bleeding is insufficient to cause shock. In such cases, high-dose barium impaction is considered upon prolonged or recurrent episodes of lower gastrointestinal bleeding. High-dose barium impaction may be used to achieve hemostasis, allowing early discharge. High-dose barium impaction may be repeated in cases of recurrent bleeding. Furthermore, angiographic embolization or intestinal resection may be considered in cases where hemostasis is not achieved, depending on the patient background and identification of hemorrhage sources. Although these methods often result in reliable hemostasis, their use should be restricted to high-risk cases due to the large burden placed on patients.
We introduced this approach for the treatment of diverticular bleeding at the end of April 2014. All patients with diverticular bleeding have been successfully treated according to this treatment approach to date (September 2015). We plan to analyze the validity of this treatment strategy and make necessary revisions to further improving the safety and efficacy of this approach for the management of diverticular bleeding.
This study was supported by grants from Fujita Health University and the staff of the Gastroenterology Department of Fujita Heath University. We thank Ulatus and Enago for their assistance in manuscript translation and editing, respectively.
The authors declare no disclosure statement.
Zuckerman DA, Bocchini TP, Birnbaum EH (1993) Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention. Am J Roentgenol 161: 703-711.
Ellis DJ, Reinus JF (1995) Lower intestinal hemorrhage. Crit Care Clin 11: 369-389.
Vernava AM, Moore BA, Longo WE, Johnson FE (1997) Lower gastrointestinal bleeding. Dis Colon Rectum 40: 846-858.
Gandhi SK, Hanson MM, Vernava AM, Kaminski DL, Longo WE (1996) Ischemic colitis. Dis Colon Rectum 39: 88-100.
Greenwald DA, Brandt LJ (1998) Colonic ischemia. J ClinGastroenterol 27: 122-128.
Kamm MA (1998) Diagnostic, pharmacological, surgical and behavioral developments in benign anorectal disease. Eur J SurgSuppl 582: 119-123.
Yano T, Yamamoto H, Sunada K, Miyata T, Iwamoto M, et al. (2008) Endoscopic classification of vascular lesions of the small intestine (with videos). GastrointestEndosc 67: 169-172.
Miura S, Kodaira S, Aoki H, Hosoda Y (1996) Bilateral type diverticular disease of the colon. Int J Colorectal Dis 11: 71-75.
Nakaji S, Danjo K, Munakata A, Sugawara K, MacAuley D, et al. (2002) Comparison of etiology of right-sided diverticula in Japan with that of left-sided diverticula in the West. Int J Colorectal Dis 17: 365-373.
Takano M, Yamada K, Sato K (2005) An analysis of the development of colonic diverticulosis in the Japanese. Dis Colon Rectum 48: 2111-2116.
Rino Y, Imada T, Iwasaki H, Tanabe H, Toyoda H, et al. (1999) Hemostasis of colonic diverticular bleeding with hemoclips under endoscopic control: report of a case. Hepatogastroenterology 46: 1733-1735.
Pilichos C, Bobotis E (2008) Role of endoscopy in the management of acute diverticular bleeding. World J Gastroenterol 14: 1981-1983.
Shibata S, Shigeno T, Fujimori K, Kanai K, Yoshizawa K (2014) Colonic diverticular hemorrhage: the hood method for detecting responsible diverticula and endoscopic band ligation for hemostasis. Endoscopy 46: 66-69.
Jensen DM, Machicado GA, Jutabha R, Kovacs TO (2000) Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 342: 78-82.
Matsuhashi N, Akahane M, Nakajima A (2003) Barium impaction therapy for refractory colonic diverticular bleeding. AJR Am J Roentgenol 180: 490-492.
Fujimoto A, Sato S, Kurakata H, Nakano S, Igarashi Y (2011) Effectiveness of high-dose barium enema filling for colonic diverticular bleeding. Colorectal Dis 13: 896-898.
Niikura R, Nagata N, Yamano K, Shimbo T, Uemura N (2013) High-dose barium impaction therapy is useful for the initial hemostasis and for preventing the recurrence of colonic diverticular bleeding unresponsive to endoscopic clipping. Case Rep Gastrointest Med 2013: 365954.
Goldberger LE, Bookstein JJ (1977) Transcatheter embolization for treatment of diverticular hemorrhage. Radiology 122: 613-617.
Feld RS, Zink S, Posteraro A (2010) Empiric embolization of a diverticular bleed with CT angiographic mapping: enlarging the therapeutic window of transcatheter arterial intervention. J VascIntervRadiol 21: 593-595.
Tursi A (2015) The role of colonoscopy in managing diverticular disease of the colon. J Gastrointestin Liver Dis 24: 85-93.
Nishikawa H, Maruo T, Tsumura T, Sekikawa A, Kanesaka T, et al. (2013) Risk factors associated with recurrent hemorrhage after the initial improvement of colonic diverticular bleeding. ActaGastroenterolBelg 76: 20-24.
Watanabe S, Kodera S, Shimura H (2014) Investigation of risk factors predicting recurrence of colonic diverticular hemorrhage and development of a recurrence risk score. ActaGastroenterolBelg 77: 408-412.
Senagore AJ, Luchtefeld MA, Mackeigan JM, Mazier WP (1993) Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 59: 549-553.
Gonzalez R, Smith CD, Mattar SG, Venkatesh KR, Mason E, et al. (2004) Laparoscopic vs open resection for the treatment of diverticular disease. SurgEndosc 18: 276-280.
Citation: Nakagawa Y, Kamano T, Ohmiya N, Tahara T, Shibata T, et al. (2016) Effective Management of Severe Diverticular Bleeding in Japanese Patients. J Colitis Diverticulitis 1: 106.
Copyright: ©2016 Nakagawa Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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The authors examined lower gastrointestinal bleeding in Japanese patients who underwent gastrointestinal endoscopy. The purpose of their study is to evaluate the disease characteristics of diverticular bleeding and to devise treatment regimen for these patients for better management of the disease. They identified diverticular bleeding is the frequent cause of gastrointestinal bleeding and is associated with hypertension and other illnesses. Based on the data there were no clinical differences between patients with severe and mild diverticular bleeding. The authors systematically performed very good analyses. This study is helpful in planning the right kind of treatment and policy decision


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A first-in-Canada service launches for cochlear implant patients in Prince George
June 2019 PrinceGeorgeMatters.com
Lily Palmer is a 13-year-old girl from Prince George who has a cochlear implant. She's also one of the first patients in Canada to take part in a new health service called virtual mapping. B.C. Children's Hospital has launched a first-in-Canada ongoing remote clinical service for cochlear implant patients in the northern capital. It's known as virtual mapping and allows an audiologist to video-conference with a patient. The audiologist, via laptop, takes over the cochlear implant programming software to tune and adjust the implant. "More than a year ago we were contacted by B.C. Children's Hospital who said they were considering setting up telehealth as a possibility for the north and would we be willing to volunteer to help them do some early testing," says Lily's mom Andrea Palmer. "When we were down south for one of our regular visits in Vancouver, they had Lily do a bit of a test with the technology itself."
B.C. Children's Hospital in Vancouver is the only location in the province where children can access cochlear implant technology and support. From age one to 18, kids with cochlear implants travel an average of 30 times to Vancouver to get their cochlear implant mapped.
Thanks to this technology, Lily and Andrea were able to go to the University Hospital of Northern British Columbia (UHNBC) in Prince George for Lily's first virtual mapping appointment, avoiding a trip to Vancouver. "One thing that is important for Lily is to be able to see the faces of the people talking to her and to be able to lip read when she has her equipment turned off," says Andrea, adding that the screen was crystal clear. "It's really, really cool. I'm happy to do it," says Lily, who at 13 years old typically needs to have her cochlear implants adjusted annually.
Children who have recently been implanted could be going down to B.C. Children up to six times a year because audiologists need to make adjustments to be able to customise the implant for each child to ensure it is working optimally for them. "That's what we did for the first couple of years post-implant, so in her toddler years, there was a ton of travel. We are lucky in that I have family in the Lower Mainland and could stay with them," says Andrea. "Telehealth in this capacity is a huge saver and the fact that it works and is so clear it's is just amazing."
Families in the north will still have to access B.C. Children's for cochlear implant appointments, but the virtual cochlear implant service can help reduce the number of times they would need to come and supplement the quality of care. Currently, there are approximately 250 deaf and hard of hearing children with cochlear implants in the province and B.C. Children's provides about 35 new cochlear implants each year.
Adult cochlear implants services are accessed through St. Paul's Hospital in Vancouver, but as the technology is still new, virtual mapping is not yet being utilized for adult patients.


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