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Mycobacteriology and Aerobic Actinomycetes
Multilocus Short Sequence Repeat Sequencing Approach for Differentiating among Mycobacterium avium subsp. paratuberculosis Strains
Alongkorn Amonsin, Ling Ling Li, Qing Zhang, John P. Bannantine, Alifiya S. Motiwala, Srinand Sreevatsan, Vivek Kapur
Alongkorn Amonsin
Department of Microbiology and Biomedical Genomics Center, University of Minnesota, St. Paul, Minnesota 55108
Ling Ling Li
Qing Zhang
John P. Bannantine
National Animal Disease Center, U.S. Department of Agriculture, Ames, Iowa 50010
Alifiya S. Motiwala
Food Animal Health Research Program, Ohio Agricultural Research and Development Center, and Department of Veterinary Preventive Medicine, The Ohio State University, Wooster, Ohio 44691
Srinand Sreevatsan
Vivek Kapur
For correspondence: vkapur@umn.edu
We describe a multilocus short sequence repeat (MLSSR) sequencing approach for the genotyping of Mycobacterium avium subsp. paratuberculosis (M. paratuberculosis) strains. Preliminary analysis identified 185 mono-, di-, and trinucleotide repeat sequences dispersed throughout the M. paratuberculosis genome, of which 78 were perfect repeats. Comparative nucleotide sequencing of the 78 loci of six M. paratuberculosis isolates from different host species and geographic locations identified a subset of 11 polymorphic short sequence repeats (SSRs), with an average of 3.2 alleles per locus. Comparative sequencing of these 11 loci was used to genotype a collection of 33 M. paratuberculosis isolates representing different multiplex PCR for IS900 loci (MPIL) or amplified fragment length polymorphism (AFLP) types. The analysis differentiated the 33 M. paratuberculosis isolates into 20 distinct MLSSR types, consistent with geographic and epidemiologic correlates and with an index of discrimination of 0.96. MLSSR analysis was also clearly able to distinguish between sheep and cattle isolates of M. paratuberculosis and easily and reproducibly differentiated strains representing the predominant MPIL genotype (genotype A18) and AFLP genotypes (genotypes Z1 and Z2) of M. paratuberculosis described previously. Taken together, the results of our studies suggest that MLSSR sequencing enables facile and reproducible high-resolution subtyping of M. paratuberculosis isolates for molecular epidemiologic and population genetic analyses.
Mycobacterium avium subsp. paratuberculosis (M. paratuberculosis) is a slowly growing, acid-fast, mycobactin J-dependent bacterium. Infection with this bacterium leads to a chronic granulomatous enteritis, termed Johne's disease, in cattle and other ruminants and occurs worldwide (11). Clinical signs of the disease include diarrhea, weight loss, fatigue, decreased milk production, and mortality. Infection with this pathogen results in considerable economic losses in the dairy production industry, with estimated annual costs of $40 to $227 per year per cow, totaling industry-wide annual losses of $1.5 billion (20, 21). In addition to the serious health and economic impacts of the pathogen to the dairy industry, several reports suggest a possible link between M. paratuberculosis and Crohn's disease in humans (5, 7, 10, 30).
Methods for differentiation or subtyping of bacterial strains provide important information for molecular epidemiologic analysis and assist in providing an understanding of the population genetics of the species. DNA-based molecular subtyping techniques such as multiplex PCR for IS900 integration loci (MPIL) (4, 20), restriction fragment length polymorphism (RFLP) analysis (6, 8, 23), and amplified fragment length polymorphism (AFLP) analysis (20) have been previously applied to investigate genetic variation in M. paratuberculosis. However, the MPIL, AFLP, and RFLP techniques are generally unable to resolve M. paratuberculosis isolates into meaningful epidemiologic groups due to the apparently restricted genetic diversity within the subspecies. Furthermore, the data generated by these techniques are biallelic and, hence, are able to provide only limited information regarding the overall genetic diversity and evolutionary mechanisms within the species.
Short sequence repeats (SSRs) or variable-number tandem repeats (VNTRs) in bacterial DNA have been used as markers for the differentiation and subtyping strains of several bacterial species, including Mycobacterium tuberculosis (9, 16), Yersinia pestis (1), Salmonella enterica subsp. enterica serovar Typhimurium (17), and Bacillus anthracis (15). SSRs consist of simple homopolymeric tracts of a single nucleotide (mononucleotide repeats) or multimeric tracts (homogeneous or heterogeneous repeats), such as di- or trinucleotide repeats, which can be identified as VNTRs in the genome of the organism (35). The variability of the repeats is believed to be caused by slipped-strand mispairing (31); the genetic instability of polynucleotide tracts, especially poly(G-T) (12); and DNA recombination between homologous repeat sequences (32).
The complete genome sequence of M. paratuberculosis strain K10 (GenBank accession number AE016958) has recently been characterized in the Department of Microbiology and Biomedical Genomics Center, University of Minnesota(L. L. Li et al., unpublished data). Preliminary bioinformatic analyses led to the identification of numerous SSRs in the M. paratuberculosis genome. We evaluated the utility of a multilocus SSR (MLSSR)-based typing approach for differentiating among isolates of M. paratuberculosis. The results of our studies suggest that MLSSR is a useful approach for strain differentiation and enables the rapid and facile discrimination of epidemiologically and geographically distinct strains of M. paratuberculosis.
Bacterial isolates and DNA isolation.A total of 33 M. paratuberculosis isolates from different host species and geographic locations were used in this study, as shown in Table 1. M. paratuberculosis isolates were grown on Middlebrook 7H9 broth or 7H11 agar (Difco Laboratories, Detroit, Mich.) with oleic acid-albumin-dextrose-catalase supplement (Becton Dickinson, Sparks, Md.) and mycobactin J (2 mg/100 ml). In some instances the bacterial cultures were incubated at 37°C for 4 to 6 months until colonies were observed. DNA was isolated from the bacterial culture by use of the QIAamp DNA Mini kit (Qiagen Inc., Valencia, Calif.), as described previously (20).
M. paratuberculosis isolates examined in this study
Database search for SSRs and primer design.The whole-genome sequence of M. paratuberculosis strain K10 was analyzed for SSRs with Tandem Repeat Finder (version 2.02) software (3). The coordinates of the SSRs were then matched for the regions upstream and downstream to locate the repeats and open reading frame (ORF) flanking the repeat by use of the DNA sequence viewer and annotation software Artemis (28). Primers specific for sequences flanking these repeat sequences were designed with Primer 3 software (27) to yield an average amplification product of ∼250 bp for each sequence (Table 2).
Primers for 78 sequence repeat loci used for polymorphism analysis of the region
MLSSR.A total of 78 loci were amplified by PCR with specific primers, and the amplification products were sequenced to identify sequence polymorphisms in each locus among six strains of M. paratuberculosis (reference strain MAP-K-10 and isolates from cattle [isolates MAP-08 and MAP-09], sheep [isolates MAP-06 and MAP-11], and a human [isolate MAP-14]) (Table 1). These six M. paratuberculosis isolates were selected because they represent the extent of genetic diversity in the species, as previously identified by MPIL and AFLP analyses (20).
The 25-μl PCR amplification reaction mixture for each SSR comprised 1× PCR buffer II (Perkin-Elmer, Applied Biosystems Division, Foster City, Calif.), 2.0 mM MgCl2 (Perkin-Elmer), 200μ M each deoxynucleoside triphosphate (Roche Diagnostic Co., Indianapolis, Ind.), 0.6 μmol of each primer (Integrated DNA Technologies, Coralville, Iowa), 0.5 U of AmpliTaq Gold (Perkin-Elmer), 5% dimethyl sulfoxide (Sigma Chemical Co, St. Louis, Mo.), and 1 μl of DNA. The amplification conditions consisted of an initial denaturation at 94°C for 15 min, followed by 35 cycles of denaturation at 94°C for 45 s, annealing at 60°C for 1 min, and extension at 72°C for 2 min 30 s, with a final extension step at 72°C for 7 min. A 2-μl volume of the PCR products was mixed with 2μ l of loading buffer (0.2% Orange G in 50% glycerol), and the mixture was electrophoresed in 1% agarose with 0.5 μg of ethidium bromide per ml. The gels were photographed under UV light with an Eagle Eye II gel documentation system (Stratagene, La Jolla, Calif.). The PCR amplicons were then sequenced with an ABI 3100 automated fluorescent DNA sequencer (Perkin-Elmer) at the University of Minnesota's Advanced Genetic Analysis Center (www.agac.umn.edu).
MLSSR data analysis.The sequences of each SSR locus of 33 isolates were aligned, and the numbers of tandem repeats were identified by use of the MegAlign program (DNASTAR Inc., Madison, Wis.). The nucleotide sequences of 11 polymorphic SSR loci were analyzed for each isolate, and allele numbers were assigned to reflect the number of copies or the number of nucleotide substitutions represented in the SSR sequence for each locus. Statistical analysis for genetic diversity and overall relationships among the isolates was performed with the computer programs ETDIV and ETCLUS, which were modified for use with the SSR data (2). MLSSR types were then assigned on the basis of the unique combination of alleles for each locus. Genetic diversity (D) was calculated by using the following equation: 1 − Σ(allele frequency)2(22, 29). The unweighted pair group method with arithmetic averages-based cluster analysis and bootstrap analysis with 1,000 replications were performed with the program PAUP (version 4.0; Sinauer Associates, Inc. Sunderland, Mass.), and the index of discrimination (D) was determined as described previously (13).
SSRs in M. paratuberculosis genome.Analysis of the whole-genome sequence of M. paratuberculosis strain K10 (4.83 Mbp) identified 185 SSRs consisting of three or fewer nucleotides per repeat unit. Of these, 78 mono-, di-, and trinucleotide repeats with perfect matches between adjacent copies were identified and were included as candidate polymorphic loci for further analysis (Table 2). These 78 SSR loci were also selected for inclusion in our analysis because they were short (1 to 3 bp), as is common in prokaryotes, and each locus had at least five copies. Dinucleotide repeats were the most frequently identified SSRs in the M. paratuberculosis genome and were present at 63 distinct loci, with the copy numbers varying between 5 and 5.5 per repeat. Mono- and trinucleotide repeats were represented at 2 and 13 loci, respectively.
MLSSR analysis revealed that 11 of the 78 loci were polymorphic in the six isolates examined. The ORFs or genes flanking each locus were also identified (Table 3). For example, locus 2 is located within ORF 210_MAP.128, which is unique to M. paratuberculosis. Locus 3 was identified in an intergenic region between two ORFs: a 5′ ORF encoding 6-aminohexanoate-cyclic dimer and a 3′ ORF encoding alpha/beta-hydrolase (Table 3). The functional consequences of the presence of the loci and the influence of the locus copy number on the expression of the adjacent genes deserve further investigation.
SSRs used in MLSSR analysis
MLSSR.The 11 polymorphic SSR loci identified in the preliminary screening were characterized in 27 additional M. paratuberculosis isolates that were previously characterized by MPIL and AFLP analyses (20). The analysis identified 20 MLSSR types among the 33 M. paratuberculosis isolates recovered from different host species and geographic areas (Tables 1 and 4). The D value for each SSR locus was calculated on the basis of the allele frequency and the number of alleles and revealed an average number of alleles per locus of 3.20, with an average D value of 0.393 and a range of D values of 0.100 to 0.700 (21, 28) (Table 3). While the allelic variation observed in this study focused on the number of copies of the SSRs (Fig. 1A), it is noteworthy that some loci also revealed one or two base substitutions in some isolates (Fig. 1B). For instance, the analysis revealed a single polymorphic site each at SSR loci 4 and 10 and four and five polymorphisms at loci 5 and 9, respectively (Fig. 2). It is interesting that the vast majority of the nucleotide substitutions were found in MAP-06, an isolate recovered from a sheep.
Sequence analysis of two representative SSR loci. (A) Locus 8 with (GGT)5 repeats. Strain MAP-K10 contains five copies of GGT, while MAP-08 and MAP-11 contain four and three copies of GGT, respectively. (B) Locus 10 with (GCC)5 repeats. Strain MAP-K10 contains five copies of GCC, while MAP-11 and MAP-07 have a A-to-C substitution in a single copy of GCC.
Allelic variation at 11 SSR loci among 33 M. paratuberculosis isolates. The aligned nucleotide sequences of each of the alleles at the 11 SSR loci discovered and characterized during this investigation, along with adjacent conserved sequences, are shown. The SSRs and polymorphic sites are boxed. The locations of single-nucleotide polymorphisms are indicated with asterisks below the aligned sequences.
Profiles of alleles at 11 SSR loci for 20 clones of M. paratuberculosis
Genetic relationships among M. paratuberculosis isolates based on MLSSR analysis.The unweighted pair group method with arithmetic averages-based cluster analysis of M. paratuberculosis identified 20 distinct MLSSR types among the isolates that were grouped into two major clusters, clusters M and N (Fig. 3). Cluster M contained 87.88% (29 of 33) of the isolates in the sample, including isolates recovered from bovine, caprine, murine, deer, rabbit, and human sources. The isolates in cluster M with the most common MPIL and AFLP fingerprints, A18 and Z1 and Z2, respectively, were further divided into three groups, clusters M1, M2, and M3. Cluster M1 contained one isolate (isolate MAP-06), which was recovered from a sheep and which had the A1 MPIL fingerprint. Three of the five isolates from caprine sources were assigned to cluster M2. A total of 13 unique genotypes, including a majority (10 of 15) of the bovine isolates included in this study, were represented in cluster M3. In addition, the three isolates from human sources included in the sample used in this study were also found in cluster M3. Interestingly, two isolates recovered from humans (isolates MAP-14 and 0003) were clustered into the same clade as an isolate of bovine origin (isolate 0180). Isolates that were recovered from a mouse (isolate 0012), rabbits (isolates 0237 and 0160 to 0162), a deer (isolate 0883), and soil (isolate 0560) were also grouped along with the M3 genotype.
Dendrogram depicting genetic relationships among 33 M. paratuberculosis isolates on the basis of the 11 SSR loci determined by MLSSR analysis. The dendrogram was generated by the unweighted pair-group method with arithmetic averages with the PAUP program. The results of the bootstrap analysis are represented as percentages and are indicated adjacent to the major nodes when the branch order was supported by> 50% of the 1,000 replicate trees. Genetic distance is indicated at the top of the dendrogram. Isolate identifications, sources, geographic locations, and MILP and AFLP types are shown to the right of the dendrogram.
In contrast to cluster M, which consisted of isolates recovered from a variety of animal species, all four isolates that were included in cluster N were recovered from sheep. Strains of ovine origin (four of five) also showed a distinct allelic profile compared with the profiles of strains from cattle, goats, or humans.
Discriminatory power of subtyping methods.The discriminatory power (D) of MLSSR in comparison with those of other subtyping methods was determined as described previously (13). MPIL analysis differentiated the 27 M. paratuberculosis isolates for which MPIL typing information was available into 6 subtypes with a D value of 0.50, indicating only limited discriminatory power, while MLSSR differentiated 27 M. paratuberculosis into 17 subtypes with a D value of 0.96. In contrast, AFLP analysis differentiated the 24 M. paratuberculosis isolates for which AFLP typing information was available into 15 subtypes, with a D value of 0.92 (20). In comparison, MLSSR differentiated the 24 M. paratuberculosis isolates into 14 subtypes, with higher D value of 0.95. Overall, MLSSR distinguished 20 subtypes among the 33 isolates in the sample with a D value of 0.96, indicating that it has a relatively high index of discrimination (Tables 3 and 4).
SSRs have been used to type many bacterial pathogens associated with human and animal infections (32). Within the genus Mycobacterium, VNTR or mycobacterial interspersed repetitive units have been used for the subtype-specific differentiation of several Mycobacterium species (19, 26, 35). In the present study we have identified polymorphic SSRs by genomic analysis of M. paratuberculosis and used this information to develop a highly discriminatory method for the typing of M. paratuberculosis isolates.
The SSRs discovered during our preliminary screening of the M. paratuberculosis genome were similar to the repeats that have previously been described in other bacteria, including Haemophilus, Mycoplasma, and Mycobacterium spp. (24, 32, 33). It has previously been recognized that regions of mono-, di-, and trinucleotide tandem repeats are often the most diverse in a bacterial genome, while complex longer repeats generally have lower levels of diversity (14). This is thought to result from slipped-strand mispairing (or replication slippage events) of the DNA polymerase that occurs with greater frequency on the SSRs, a hypothesis that remains to be tested for the SSRs that we have identified in M. paratuberculosis (32).
Several important attributes of a strain differentiation assay determine its utility in a clinical or epidemiologic setting. Especially for organisms such as M. paratuberculosis that have restricted levels of genetic diversity, the discriminatory power of an assay is a particularly important attribute. Assays such as MPIL and RFLP analysis have been shown to have only moderate abilities to differentiate among epidemiologically distinct isolates of M. paratuberculosis and therefore have limited applicabilities in molecular epidemiologic studies (4, 5, 33). The recently described AFLP technique has been shown to have a greater resolving power than the other two approaches but suffers from the limitation that allelic variation is indexed at anonymous biallelic markers (20). In contrast, the MLSSR assay described herein is far more discriminatory, being able to differentiate 33 M. paratuberculosis from distinct geographic localities and host species into 20 subtypes on the basis of allelic variation at the 11 SSR loci examined, with a notably high D value of 0.96. Consistent with its high discriminatory power, MLSSR enabled the differentiation of seemingly monomorphic M. paratuberculosis strains that were indistinguishable by MPIL and AFLP analyses (20). An important advantage of the MLSSR approach is that it also indexes variations at known genetic loci and has the ability to identify multiple alleles per locus. Together, these attributes not only allow an increase in the strain-resolving power of the assay but also enable an understanding of the genetic mechanisms driving strain diversification and evolution within the species.
Another key attribute of a strain differentiation assay is its ability to identify epidemiologically and genetically related strains of a bacterial species. In this context, MLSSR analysis clearly showed that some isolates that are of sheep origin (cluster N) are genetically distinct from those of bovine, caprine, and human origin (cluster M), a finding consistent with those of previous studies (4, 6, 20). It is noteworthy, however, that the five isolates of sheep origin examined during this study were represented by three distinct MLSSR types (MLSSR types 1, 19 and 20), and four isolates clustered together in cluster N. Interestingly, all four of these phylogenetically linked M. paratuberculosis isolates were recovered from sheep in South Dakota, suggesting that they are both genetically and epidemiologically related and well distinguishable from the other isolates in the collection. The same isolates were also grouped into four distinct MPIL genotypes (A1, A8, A16, and A17) and three AFLP genotypes (Z7, Z8, and Z18), suggesting that they are indeed genetically distinct from the other isolates in the collection. However, by the MPIL and the AFLP approaches, these isolates do not cluster together as closely as they do by MLSSR analysis (20). Hence, these results suggest that MLSSR analysis may enable molecular epidemiologic investigations that will lead to a better understanding of strain transmission and the spread of M. paratuberculosis in natural populations and across host species.
In contrast to the relatively close clustering of the sheep M. paratuberculosis strains in the samples examined, far greater diversity was observed in isolates of bovine origin. The analysis showed that while a majority of the M. paratuberculosis isolates of bovine origin clustered together in the M3 subgroup, 60% (three of five) of the caprine isolates were represented by the closely related cluster M2, suggesting that caprine isolates bear greater genetic resemblance to cattle strains than to isolates of ovine origin, a finding that is consistent with the findings of previous studies (34). Similarly, deer and cattle strains also appeared to be more closely related to each other by MLSSR analysis, suggesting a sharing of strains of M. paratuberculosis in wildlife species that graze or that may otherwise come into close contact with cattle, as hypothesized previously (25).
Our studies demonstrate that MLSSR analysis offers several advantages over other methods for differentiating among M. paratuberculosis isolates. First, as described above, the technique has a high discriminatory power for known multiallelic genetic loci, an essential attribute for the effective differentiation of genetically distinct isolates. Second, MLSSR results are based upon DNA sequencing and, hence, are unambiguous and reproducible and can likely be obtained for most loci of all M. paratuberculosis isolates, even those recovered from sheep or wildlife species, as demonstrated by our studies described herein. However, we note the formal possibility that mutations or deletions at the primer sites may render some strains untypeable at some loci, such as loci 10 and 11 in MAP-06. Third, MLSSR analysis is based on the amplification of SSR loci by PCR and thus not only is rapid but also may be performed directly with bacterial colonies without DNA extraction. Fourth, due to the considerable advances in automated DNA sequencing technologies and the falling prices of DNA sequencing, the MLSSR method is amenable to adaptation for high-throughput analysis and can be performed relatively inexpensively as well. Finally, a key advantage of the approach is that the data are sequence based and, hence, enable accurate interlaboratory comparisons to be made and the information used in the development of SSR databases for further molecular epidemiologic studies, which are greatly required in this field (18). While it must be recognized that sequence errors due to strand slippage during either PCR or sequencing reactions may result in an erroneous assignment of genotype, the occurrence of such slippage errors is minimized by increasing the amount of sequence coverage at the locus (by confirming both the forward and the reverse sequences or testing duplicate samples), as is routinely practiced in our laboratory.
In conclusion, we have described here the development of MLSSR-based typing for the subtype-specific differentiation of M. paratuberculosis isolates. Our preliminary analyses suggest that this approach will be of considerable utility in enabling detailed molecular epidemiologic and population genetic analyses of this important animal pathogen.
Research in the laboratory of V. Kapur is funded by grants from the U.S. Department of Agriculture, the National Institutes of Health, and the Minnesota Agricultural Experimental Station. Research in the laboratory of S. Sreevatsan is funded through a seed grant from the Ohio Agricultural Research and Development Center's research enhancement competitive grants program.
Received 14 August 2003.
Returned for modification 23 October 2003.
Accepted 2 January 2004.
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redpajama_set_name: RedPajamaStackExchange


Limited run Acoustic Bass with Piezo undersadlle pickup and on board electronics. Nice quality and unique Gretsch vibe. In crowded field of import acoustic basses, this early Japanese crafted model is a huge value.
Serial Number: 906175-15, appears to be June 1990 Model 6175 this being the 15th unit produced of this model from inception.


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Hear Lost Lander's Collaboration with Edward Snowden
Vortex Music Magazine
What are you running from? Songwriter Matt Sheehy provides insight into "Feed The Fever" from the band's new record, 'Medallion,' which they'll celebrate at Mississippi Studios on February 27. Photos by Anthony Pidgeon
by Chris Young
Music Millennium
Mississippi Studios
Vortex cover stars—click to read more stories from the issueToday is the day, and needless to say, Vortex is excited. Lost Lander's spectacular second record Medallion is officially unleashed and you can personally pick up a copy direct from the band tonight at Music Millennium when they perform a special acoustic set starting at 6pm.
The band's "buoyant brand of meticulously crafted pop" (as we wrote in our cover story Describing The Indescribable) is no better exemplified than by "Feed The Fever." We also mentioned that "the album conveys darker themes brightened by brilliant, modernized '80s pop," and this trait is undeniably illustrated by the inspiration behind the below track: Edward Snowden.
"I listened to his long-form interview—the whole hour and half—and every time he would say a couple of words together that sort of popped out, I'd write it down so I had this huge list of little quotes. A lot of the lyrics in that song are me describing a couple of his words," singer Matt Sheehy explains. "I wrote the chorus before the interview, but the verses are sort of a fictionalized version of his life. It's supposed to be someone that's giving up his life for an ideal and then running."
Now, run down to Music Millennium this evening, or over to Mississippi Studios on Friday, February 27 when the band celebrates the record's release with a special duo performance by Radiation City and Sama Dams.
Wonderly: 'Bayocean' [Video Premiere]
Andrea Janda - Jan 7, 2021
Get ready to explore some little-known Pacific Northwest history with the celebrated Portland duo, starting with the story of Oregon opulence that fell into the sea.
50 Great Albums by Portland Artists in 2020
Aaron Colter - Dec 22, 2020
To close out the year, Banana Stand Media co-founder and #PDXmusic maven Aaron Colter lists off 50 great albums by Portland artists in 2020.
Blair Borax: 'Empty' [Track Premiere]
Bren Swogger - Dec 4, 2020
Singer-songwriter and yoga instructor Blair Borax shares her latest single, "Empty," a song that explores how a vacant room can be the perfect place to confront the world and ourselves.
Jeff Bond: 'Holiday' [Song Premiere]
Ryan J. Prado - Dec 1, 2020
Portland indie-pop maestro Jeff Bond comes out from behind the production booth again with the sugar-sweet single "Holiday."
Scenes from Day 1 of MusicfestNW featuring Foster The People, Lost Lander, MisterWives and Milo Greene at Tom McCall Waterfront Park on August 21, 2015
Photos by Sam Gehrke
Pickwick and Lost Lander at the Red Bull Sound Select Portland showcase at the Doug Fir Lounge on Jan. 7, 2014
Photos by Josh Phillips
March 18, 2014 9:11pm
Lost Lander and Souvenir Driver at the Falcon Art Community on Dec. 6, 2013
Photos by Kyle Carnes
Vortex Picks

redpajama_set_name: RedPajamaCommonCrawl


Attomica was formed by the Sao Paulo-based brothers in 1985 and specialized in speed metal and later Bay Area thrash metal. Pyda was later replaced by two guitarists. The band also acquired a new singer before splitting up in 1994. Several of the band members resurfaced later in an AC/DC cover band before reforming the act.
Attomica signed a deal with Brazil's Hellion Records and announced a live album, entitled Back And Alive, which was recorded in December of 2003. The band also announced a new studio album in 2005. The group went under Atomica between 2004 and 2009.
The Brazil-based act was back with a 2018 album called The Trick. The group, which was André Rod – vocals/bass, Marcelo Souza – guitar and Argos Danckas – drums, had a video for the song Kill The Hero. Rod had taken abck the microphone in 2015.


We are heading towards a cashless economic system where digital Tokens*, representing units of value of any kind, can be traded P2P/M2M in an efficient, commission free and distributed blockchain-based market.
Digital twins enable the creation of tokens backed by real assets, releasing trillions of dollars in locked illiquid assets, such as: physical goods, real estate and works of art.
Where millions of blockchain wallet holders become investors and owners of unlimited divisible percentages of assets.
In this new economic system: what is the future role of the financial institutions?
As tokens are perceived to be a new asset class, people will want to entrust their digital wealth to reliable and secure custodians. Banks are the natural trustee to hold their digital assets because they have been doing this for centuries with traditional assets, such as: cash, stock, gold, jewels, etc.
Banks will make money by charging their customers with a fixed and/or variable fee depending on the amount of value under custody.
The creation of reliable digital twins and the tokenization of their ownership enables banks to issue and manage innovative financial products backed by a basket of real physical assets (such as minor metals, art and jewelry, etc.).


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Q: Possible? or How to? clone Device properties from one USB controller to another? I have an issue with a wired Xbox 360 controller, showing Device Descriptor Request Failed, in device manager.
Now I have 2 controllers, one works fine, and both worked fine until recently, so I know it is not drivers, which I have already tried reinstalling multiple times.
Is it possible through some utility or program to copy the USB device properties from the working controller to the problem one? If the device is not identifying correctly, can I reprogram the controller somehow to have the right ID set from the working device?
Windows 10

A: If a USB host system software indicates that  "Device Descriptor Request Failed", it means that your device failed to respond to the very basic, initial USB transaction, to return valid descriptor information with correct USB protocol. This control transaction is the very first one in the process of USB enumeration. When this happens, it means that the host system already tried to get the descriptor at least nine times (under Android likely 288 or more times), and didn't get valid results. It usually means that the USB device is rock-solid dead. It may flash some LEDs, but the USB serial interface engine is likely plain dead. Sorry.
Regarding the second part of your question, no, there is no utility to flash VID/PID/descriptor/whatever information from one USB device to another. This information (at least most of USB required fields) is usually either hardcoded in silicon, or the entire device microcode/firmware (if any) must be flashed anew through some external debug process (because the main USB interface is dead).
Your Xbox controller likely has some broken/worn-out wires in the cable. Either throw it away, or check the cable data connectivity first.


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Shatel: With clock running, Frost hires a veteran and a long shot. Did he choose wisely?
Tom Shatel
Dec 8, 2021 Updated Dec 12, 2021
Adam offers his thoughts on the two newest additions to the Nebraska coaching staff in offensive coordinator Mark Whipple and offensive line coach Donovan Raiola.
There's a great temptation to dive into a series of Mr. Whipple lines. Please squeeze the Big Ten West.
But there's no time.
Scott Frost is in the tempo game of his career, the clock running and he's got all his timeouts. He's chosen a new offensive staff to try to score enough touchdowns in 2022 to make it to 2023.
Did he choose wisely?
There's something to like, something to question and a lot to wonder about. Grab some popcorn. It's gonna be interesting.
Scott Frost expects 'positive impact' from new Husker assistants Mark Whipple, Donovan Raiola
Sam McKewon
Suffice it to say that Frost, the gambler, has doubled down on his urge to throw it and go with Nebraska football heritage. There's a comfort level to Frost's moves, yet he doesn't have relationships with Mark Whipple, Mickey Joseph and Donovan Raiola, so it's a bit of a wing and prayer, too.
He and the Huskers could likely use a lot of both next season.
Did he get it right? Report cards will begin coming out in 10 months. But here's my early takes:
On Whipple
Mark Whipple
KEITH SRAKOCIC, THE ASSOCIATED PRESS
He is a good hire, maybe very good. Also stunning, in the sense that Frost was able to attract such a seasoned and accomplished candidate.
The wily veteran of 40 coaching years is coming off one of his best seasons, grooming Pittsburgh's Kenny Pickett into a Heisman Trophy finalist, and he likely would have been attractive to most every coach in need of an offensive coordinator.
Why come to a place where the coach has one foot on the plank?
A source said that Whipple received a two-year contract, with a number that nearly doubles his salary ($476,450) at Pitt. Also, he felt he had reached the end of the road in Pittsburgh, and was ready for one more challenge at 64.
He'll get one in Lincoln.
The good news is Whipple should be more than up for anything. He's never coached in the Big Ten, but after 40 years at every level of college and the NFL, nothing in the Big Ten will surprise him. He'll be able to adjust.
That task will start at home. Whipple must mesh his scheme with a new line coach — in his first time as a head line coach — and personnel that may not be suited for what he wants.
McKewon: Mark Whipple is a seasoned vet who can mentor Scott Frost
As he checks the cupboard, Whipple will note that he'll need to go out and shop for groceries to fit his scheme. Including a transfer quarterback.
A source said Whipple already is shopping for one. It's likely the biggest story of the offseason.
Fortunately, Whipple knows every corner of the college football world and, again, he couldn't be more attractive right now if you're a kid with an arm looking for transformation.
I hope Whipple is the kind of play-caller who sticks with something that works until the other guy stops it. And by other guy, I don't mean Frost.
Also, the thing about old coaches is they are very secure, and Whipple won't be afraid to tell Frost to stay out of the kitchen.
I like this move, more and more.
On Raiola
The name is gold at Nebraska. It stands for passion and excellence.
But Dominic Raiola is not coming back to play.
Donovan Raiola
It's up to Dom's kid brother, Donovan, to uphold Nebraska's great offensive line tradition — which hasn't been great in a very long time.
Donovan didn't play for the Big Red. He made his legacy at another O-line factory, Wisconsin. He was one of former coach Barry Alvarez's favorites. That says a lot.
He played a few years in the NFL and spent 2011 with the Omaha Nighthawks. You gotta love that.
He's spent the past 20 years around offensive line play and coaching, but his résumé is a little thin in the college ranks.
Yes, Raiola coached the O-line at the NFL level, but there's a difference between coaching grown men and college kids. And this is his first gig in charge of an offensive line.
No pressure, Donovan.
And if it's true that Frost chose Raiola over Notre Dame's Jeff Quinn, a veteran, that underscores the gamble.
This hire looks underwhelming. It looks like a long shot to expect Raiola to upgrade an offensive line into a reliable force in one year.
And the problem with coaches like Raiola having passion and fire is that often those coaches can't get players to feel the same way they do. Not everyone burns that hot.
Fire is one thing. Raiola's priority should be discipline. And chemistry. Get this group working together. No more false starts.
In that regard, Raiola should beg Whipple to go with a limited scheme that enables the line to master something over and over.
O-line coach Donovan Raiola brings familiarity with Husker football and NFL experience
Evan Bland
Raiola has not been a recruiter. He'll start by trying to sell transfers on himself.
His first priority: Get Cam Jurgens to return to the Huskers where Raiola can coach him on what it takes to make the NFL.
Maybe he can get his older brother to tutor Jurgens on the side.
Yes, this is a long shot hire, but I'm willing to keep an open mind. There's potential here. He looks like someone who could grow into the job.
If there was time.
On Joseph
Mickey Joseph
HILARY SCHEINUK, THE ADVOCATE
A difference-maker in recruiting and prepping big-time receivers. Joseph is good. Let's see if he's still got speed.
What about the running back position that has yet to be filled? Maybe that's a sign that they won't need a running backs coach because the ball is going to be in the air.
Kidding. I think.
Whipple will have to find a running game — this is the Big Ten, after all. But we saw NU poke enough holes in Big Ten defenses through the air last season to know that if Whipple can find the right quarterback, maybe they can lead a breakthrough.
Whipple. Joseph. Raiola. It's a group with potential, but one that might be better with two years to grow.
Too bad Frost didn't make these moves a year ago.
Now Whipple, Joseph and Raiola — who have never worked together — must form a bond and game plan to save the day and the coach. Can they do it?
It's going to be a tight squeeze.
Husker football offseason hub: Tracking roster changes, coaching hires and more
Looking back at the last five seasons of Nebraska football
Record: 3-9, 1-8 Big Ten
Coach: Scott Frost
Notables: Husker fans able to return to Memorial Stadium after a year off due to COVID-19, team breaks college football record with eight one-score losses
ANNA REED, THE WORLD-HERALD
NFL draft: Brenden Jaimes (5th round, 159 overall, Los Angeles Chargers), Matt Farniok (7th round, 238 overall, Dallas Cowboys)
Notables: Big Ten teams played conference-only schedules due to COVID-19 pandemic, Huskers opted out of bowl game participation, Nebraska players sued Big Ten over postponement of football season
CHRIS MACHIAN, THE WORLD-HERALD
NFL draft: Khalil Davis (6th round, 194 overall, Tampa Bay Buccaneers), Carlos Davis (7th round, 232 overall, Pittsburgh Steelers)
Notables: Huskers earn 900th win after 42-38 victory over Illinois, Davis twins' selections in NFL draft starts a new Husker draft streak
RYAN SODERLIN, THE WORLD-HERALD
Notables: Frost's first season as head coach, season opener against Akron canceled due to weather, Stanley Morgan Jr. became first Husker to exceed 1,000 yards rushing, Morgan became Nebraska's all-time leader in career receptions (189) and receiving yards (2,747), Nebraska's 56-year NFL draft streak ends when no Huskers are selected
Coach: Mike Riley
NFL draft: Tanner Lee (6th round, 203 overall, Jacksonville Jaguars)
Notables: Riley's final season as head coach
MATT DIXON, THE WORLD-HERALD
tom.shatel@owh.com, 402-444-1025, twitter.com/tomshatelOWH
College-sports
Scott Frost
Dominic Raiola
Barry Alvarez
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Brawl breaks out between Cowboys, 49ers fans outside AT&T Stadium
These rare photos show Tom Brady from his baseball days
Cowboys Fans THROWING TRASH At PLAYERS & REFS After Loss vs 49ers
Djokovic faces deportation as Australia revokes visa again
Sports columnist
Tom is The World-Herald's lead sports columnist. Since he started in Omaha in 1991, he's covered just about anything you can imagine. Follow him on Twitter @TomShatelOWH. Phone: 402-444-1025.
Follow Tom Shatel
Carriker
Carriker Chronicles: Gut reaction to new Husker assistants Mark Whipple, Donovan Raiola
On Wednesday's episode, Adam Carriker gives his quick reaction to Nebraska adding Mark Whipple and Donovan Raiola to coaching staff.
Mark Whipple can tailor Nebraska's offense to its strengths, particularly at quarterback
A lot is expected of Mark Whipple in the next ten months. But Nebraska's new offensive coordinator has a track record of tailoring offenses to a team's strengths, especially at quarterback.
Key questions surrounding final open spot on Husker football coaching staff
Scott Frost has one open position left on his coaching staff. Will he fill it with a new special teams coordinator? Or will he add a running backs coach? The World-Herald's Sam McKewon has the latest.
Mickey Joseph's message to Husker receivers: 'You're going to earn it'
In his first interview as a Husker assistant, Mickey Joseph discussed his expectations for Nebraska's receivers, his recruiting philosophy and why he chose to come back to his alma mater.
Shatel: This may be the best Husker volleyball team, and not just because of talent
It's going to be hard to find a former Nebraska team that is more liked or resonates more with the fans. Winning is a good reason, of course, but it's more than that. It's the vibe.


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Star Manager's going Supernova You are here: Home December 2019 Star Manager's going Supernova
Star Manager's going Supernova
3/12/2019 8:07:08 PM // Written by Private Capital
Fund managers that reliably outperforming are few and far between, difficult to identify in advance and ultimately destined to stop outperforming – sometimes in spectacular fashion. Regardless, active management's marketing machines are always keen to wax lyrical about any given star manager's track record and outperformance. However, some of the best know 'stars' have fallen short of inflated expectations and investors have suffered.
Indeed, all good things must come to an end and as we know from Bill Sharpe's 1991 paper 'The Arithmetic of Active Management', active management just doesn't cut it over time[i]. All stars, even our very own sun, come to the end of their evolutionary journey and go supernova. Similarly, star managers come to the end of their evolutionary journey albeit in less astronomical fashion; here a few examples:
Legg Mason's Bill Miller famously beat the S&P500 fund 15 years in a row from 1991 to 2005 with a return just over 16% p.a. vs. the US-based Vanguard S&P500 index fund which returned just over 11% p. a[ii]. Fast forward to the Credit Crisis and after loading up on bank shares (a marked change in style) Bill Millar lost circa 70% of the value of the fund a three-year period. From March 2009 the fund partially recovered before Bill Millar retired as manager in April 2012. Under Millar's tenure (5/1982 to 3/2012) the Legg Mason fund returned about the same the Vanguard S&P 500 index fund.
Moving a little closer to home, Fidelity Special Situation's now retired star manager, Anthony Bolton turned his attention to China. Rick and Phil remember seeing Bolton present in Hong Kong on the forthcoming launch of his China fund and were left wondering if he truly understood the complexity and nuances of investing in China.
Fast forward to 2014 and Anthony Bolton hung up his boots announcing that 'I was wrong about the market in China'.[iii] Another star with an underwhelming evolutionary end.
Fast forward to the present and a name that immediately pops to mind is Neil Woodford. We've covered Woodford related events at length in other posts which you can review later but for now let us conclude that Woodford's liquidity problems, stemming from the ownership of too many privately held companies, resulted in an inevitable and humiliating end to his career. Fund woes and investor misery didn't stop Woodford's firm from taking around £100 million in dividends whilst vents unfolded.
'Yes', many would say,' but what about Warren Buffett?' Well, in the 10 years ending 2018, Berkshire Hathaway (Buffett's holding company) took an investment of US$10,000 to a creditable $32,350. Not bad at all until you find that the S&P 500 index turned the same starting $10,000 into US$34,225[iv]. Buffett is reputed to be the very best example of a steady, long-term investor, but even he and his excellent process struggle against a simple index fund harnessing the expected returns of the market. Buffett knows only too well that capturing the market return cheaply and efficiently is a sensible endeavour as he often points out by recommending index funds as the prudent investment solution for most folk. Indeed, after his demises this is just how he wants his family's wealth invested.
The evidence[v] shows that investors can get their risk-weighted return on capitalism by using a low cost, well diversified index fund. Adding a diversified systematic (disciplined, rules-driven) overlay to a low cost, well diversified index fund will, for the patient, further enhance risk-weighted expected return on capitalism. There is a great deal of academic evidence supporting such an approach where diversified systematic exposure to smaller companies and companies deemed to offer better value are targeted. This approach is often referred to as Evidence-Based Investing and is a reliable way to Identifying the best-in-class funds that you can live with over time. Using a low-cost, well diversified systematic fund removes the risk of aligning the success of your investment plan to one or more stars, who may well go supernova. Over a 15-year period you can expect about 60% of funds to close, merge or otherwise cease to exist.
For sure, there are some skilled managers to invest with. However, they are few and far between, tricky to identify in advance and very difficult to live with until they sail off into the sunset on the luxury yacht you paid for. The reality is that a cleaver marketing team will woo you to investing in 'a story of investing prowess' which may turn out to be damaging to your financial wellbeing as with investor who put their faith in Woodford. Taking such risks is both unnecessary and stressful and the odds of them paying off are low. Sticking with sensible market risks captured by evidence-based systematic funds is prudent way to obtain the expected returns that longer-term investing can provide. It will also protect you from those stars that inevitably go supernova.
[i] William F Sharpe (1991), The Arithmetic of Active Management www..stanford.edu
[ii] Allan Sloan (2011), Bill Miller had a great run, but did his investors? https://fortune.com
[iii] Bradley Gerrard (2014), Anthony Bolton: 'I was wrong about China' https://www.ft.com
[iv] Berkshire Hathaway Letter to Shareholders 2018
[v] SPDJI.COM SPIVA


MONTERIS MEDICAL CORPORATION has filed H1B LCAs and Green Card PERM applications for different fiscal years. The applications filed by MONTERIS MEDICAL CORPORATION could have been certified, denied or withdrawn during the same period. Please click on the links below to view the detail H1B LCA and Green Card PERM certification history of MONTERIS MEDICAL CORPORATION including the status, offered salaries, work locations, job titles and nationalities at MONTERIS MEDICAL CORPORATION.
Note: Before MONTERIS MEDICAL CORPORATION can hire foreign nationals , it must file labor certifications with DOL (Department of Labor). The application can be approved, withdrawn or denied by the DOL. To hire a candidate temporarity, H1B LCAs are filed. For permanent hiring, Green Card PERM applications are filed by the employer on behalf of the candidate.


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Entertainment / Celebrities / BTS 'BE' debuts at No. 1 on Billboard 200, K-pop idol group's fifth album to achieve feat
BTS 'BE' debuts at No. 1 on Billboard 200, K-pop idol group's fifth album to achieve feat
BTS (Twitter)
Grammy-nominated BTS' "BE (Deluxe Edition)" debuted at No. 1 on Billboard 200, their second album this year to achieve the feat and fifth overall.
According to Billboard, "BE," released on Nov. 20, has garnered 242,000 equivalent album units earned in the US in the week ending Nov. 26 based on Nielsen Music/MRC Data to debut on top of Billboard 200 for the Dec. 5 chart.
Of the 242,000 units, 177,000 are album sales, 35,000 are track equivalent albums (TEA) units and 30,000 are streaming equivalent albums (SEA) units, or 48.56 million on-demand streams for the songs in the album.
The K-pop superstars' last album "Map of the Soul: 7," which came out on Feb. 21, debuted at No. 1 on Billboard 200 on the March 5 chart with 422,000 equivalent album units composed of 347,000 copies in album sales, 26,000 TEA units and 48,000 SEA units, or 74.79 million on-demand streams.
"BE" is BTS' fifth album overall to place No. 1 on Billboard 200 after "Map of the Soul: 7," "Map of the Soul: Persona," "Love Yourself: Answer" and "Love Yourself: Tear."
"Dynamite," a track in the album, debuted at No. 1 on the Billboard Hot 100 chart last September. The song has been nominated for Best Pop Duo/Group Performance at the 63rd Grammy Awards that will be held on Jan. 31 next year.
With "BE," according to Billboard, BTS have become the first group to achieve two No. 1s on Billboard 200 this year.
BTS accomplished five No. 1 albums on Billboard 200 in two years and six months and "the last group to tally five No. 1s faster than BTS was The Beatles, who strung together five No. 1s in just under two years and five months with Yesterday and Today (July 30, 1966) and its self-titled album (often referred to as the White Album, Dec. 28, 1968)," according to Billboard.
"BE" sold 2.27 million copies in the first week of release from Nov. 20 to 26 including 1.95 million copies sold on the first day, according to South Korea's Hanteo Chart.
BTS BE
BTS Billboard 200
["celebrities","entertainment","entertainment"]
Proud Pinay Olivia Rodrigo makes mark on Spotify


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29 year old Graphic Designer Malcolm from Revelstoke, loves to spend time bmx, . and hockey. Completed a cruise liner experience that included passing by Strasbourg – Grande île.


Sal was known to work hard, play hard, and he believed in the importance of family. He was married with children in the prime of life. In the course of his activities he managed to break an arm. It was a simple fracture, and was set successfully shortly after the accident. On follow-up examination a bone fragment was discovered at the site of the earlier fracture. It was cleanly separated from its surroundings. Because of the possibility of later complications, a simple office procedure was suggested to remove the fragment.
At the appointed time, a local anesthesia was administered, the bone fragment was removed, and the small incision was closed. The Sal everybody knew did not wake up from surgery. The Sal who woke up was blind, deaf, unable to talk, unable to walk, had difficulty sitting, and the movements he displayed appeared to be more random than deliberate. Whether he grunted in response to prompts was never determined with confidence. He was unable to care for any of his personal needs, requiring complete care for survival.
It was believed that Sal had a reaction to the anesthetic agent used for surgery. This reaction produced the broad assortment of impairments to brain function. Sal was referred to and moved almost immediately from his home in Topeka to the Hadley Memorial Hospital and Rehabilitation Center in Hays for evaluation and treatment as indicated. While Hadley was built with the goal of serving more severely impaired individuals, Sal showed no ability to perform useful functions for himself or others. All communication, mobility, and self-care was missing.
Rehabilitation with any likelihood of success with job-related objectives was clearly out of the question with Sal's current state of function. Field and facility counselors may expect to spend a block of time processing referrals of individuals whose circumstances, like Sal's, are beyond help.
It is shocking when a life is virtually terminated following a simple surgery, leading to the conclusion that there is no such thing as a simple surgery when the complications may be life threatening. Any possibility of success with Sal would necessarily follow many months of medical and psychological restoration, at which time Sal could be reconsidered for service based upon his level of function at that time.
Each district office in most state rehabilitation programs have physician consultants who are available to provide relevant projections and prognoses given the presenting findings. Shortly after an acute brain trauma the return of function is a seriously problematic prediction. As the brain heals, spontaneous recovery of function is often not well distinguishable from that which follows treatment. At some point in the first year and a half the bulk of the consequences have changed from acute to chronic residuals, and little further improvement in function may be expected. This is a harsh projection for the individual and the families involved.
A similar dilemma follows injury to peripheral nerves. Motor nerves, unlike sensory nerves in the extremities, are capable of regenerating at a painfully slow, but highly predictable rate. This possibility complicates serious rehabilitation planning. If the return of function is a possibility, rational folks want to "wait and see" until after that regeneration window has closed. After an extended window has closed, complications to function often follow, and full recovery is rare. At that point the "wait and see" period is over.
Individuals with spinal cord injuries, which do not regenerate, often have a perverse belief that their recovery is certain. This belief is understandable as the consequences require a complete makeover of life. For those with limited adaptability the fairy tale of complete recovery may be the best. Social security's disability listings allow for automatic findings of disability and the payment of benefits for persons with most spinal cord injuries. At the same time vast numbers of folks with spinal cord injuries choose to adjust to their impairments and work very successfully in spite of serious obstacles. Their road is arduous, but their drive and achievement may be spectacular.


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Титульная страница сайта » Военные компании » Rommel's Afrika Korps - El Agheila to El Alamein
Rommel's Afrika Korps - El Agheila to El Alamein
Автор: alexsb16 от 2 февраля 2017, посмотрело: 3578
In the sands of the Western Desert in 1941-42, Erwin Rommel made history as the Desert Fox, waging a brilliant and bold campaign against the British. Beginning at El Agheila in March 1941, the Afrika Korps–frequently outnumbered–drove the British steadily east across Libya and into Egypt. The German offensive eventually ground to a halt in a series of battles at El Alamein.
Offers a portrait of this famous World War II unit at the height of its success in the Western Desert in 1941-42. Completely illustrated with photos, maps, and diagrams, the book depicts what it was like to serve and fight in the Afrika Korps, from tanks and equipment to battles and daily life.
Name: Rommel's Afrika Korps - El Agheila to El Alamein
Publisher: Stackpole Books издательство:
(Author) автор: George R. Bradford
Pages: страниц: 211
Год издания: 2008-10-30
Категория: Военные компании, Страницы истории
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Das Afrika Korps: Erwin Rommel and the Germans in Africa, 1941-43
Rommel's Afrika Korps: Tobruk to El Alamein (Osprey Battle Orders 20)
Triumphant Fox: Erwin Rommel and the Rise of the Afrika Korps (Stackpole Mi ...
The Armour of Rommel's Afrika Korps (Images of War)
Osprey Battle Orders 20 - Rommel's Armies. Tobruk to El Alamein
Rommel's Desert Warriors 1941-1942 (Stackpole Military Photo Series)
Rommel's Army in the Desert (Images of War)
21st Panzer Division: Rommel's Afrika Korps (Spearhead №1)


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While nurses have a great deal of experience treating and caring for patients, unforeseen circumstances will occasionally cause the tables to turn, giving the nurse the chance to be a patient. This became my personal reality just last week.
On a recent Friday afternoon, I was doing my usual workout at a local gym where I can be found pretty much every other day most weeks of the year. Cardio, weightlifting, various machines, balance exercises, and resistance training all figure in my personalized routine.
Early in my workout, I was using thick rubber tubes for resistance training. These bungee-like tubes have handles at one end and are anchored into a sheet metal base on the wall. I use three in each hand in order to maximize resistance, and I was deep into my usual process when I heard a sound and then instantaneously felt a searing pain in my left ankle as I fell to the floor.
Apparently, the metal anchor for the bungee cords had torn from the wall as I did my usual exercise, and this 18-inch piece of molded sheet metal flew at me with all of the pent up force of those six tensed rubber tubes. It guillotined the lateral aspect of my left lower leg just above the lateral malleolous.
Blood was spurting everywhere, and although I couldn't fully visualize the gaping 7-inch long wound, I could see bone and knew I was in trouble. No one else was in the large exdercise room with me, but my screams brought another gym rat to my rescue, and he valiantly applied massive pressure to the wound with blood-soaked towels for the 15 minutes it took the ambulance to arrive.
Through the pain, I had the wherewithal to tell the gym owner where to find my keys and wallet, and gave her instructions to call my wife and ask her to fish my laptop out of the trunk of the car. I also noted that several gym members chose to do their usual routine on the rowing machines not six feet from my head, even though I was writhing in pain, yelling, and pounding the floor with my fists. Not even human suffering could get in the way of their fitness (they obviously weren't nurses).
The blunt force trauma of my own personal fitness guillotine delivered a shattered fibula, a fractured but non-displaced tibia, two severed tendons, a severed peroneal nerve, and massive soft tissue damage. A three-hour emergency surgery resulted in reconstruction of the fibula with a stainless steel plate, screws, and antibiotic-impregnated glue, and an outward appearance dubbed "Frankenfoot" by my son.
Now, you nurses are likely reading this with mouths agape and an incredulous look on your faces, and such a reaction is appropriate to such egregious omissions of care. Now, imagine if I wasn't an educated, astute, and assertive healthcare professional -- what would have become of me? If I was a non-assertive patient with little knowledge of healthcare, I would have doubtless gone straight from the frying pan into the fire. Nonetheless, I was obtunded by narcotics and wasn't able to adequately advocate for myself the first two days, thus some deficiencies went unnoticed until I came to my senses.
In the end, I demanded a respiratory assessment, a stool softener (which, by the way, was ordered but never offered), an extra night in the hospital, a case manager to coordinate my discharge, and time to talk with the unit manager. I filed a complaint with my insurance company, and will seek follow up surgical opinions and care at a teaching facility in Albuquerque.
We nurses are indeed patient advocates, and self-advocacy can be our rallying cry when we ourselves become patients. Nonetheless, who will advocate for patients when other nurses and staff fall down on the job?
The majority of the nurses caring for me during my stay were very kind and compassionate, yet all but one forgot to perform basic nursing care, including respiratory assessments on a patient taking narcotics who was recovering from general anesthesia, pedal pulse checks on my operative leg, and bowel assessments and interventions. What could have resultantly gone wrong? Everything!
I'm very grateful that this aberrant piece of runaway sheet metal didn't hit my knee, neck, or vital organs, or I may very well have been partially decapitated or my life otherwise extinguished through massive blood loss. I could also have ended up with a massive brain injury and permanent disability. Yes, Nurse Keith came within striking distance of being rendered a vegetable.
On a personal level, I'm surrounded by love, compassion, caring, empathy, and amazing friends and family. My wife Mary is my amazingly kind and capable nurse extraordinaire, and my cat George is my feline healer. Friends and family are just wonderful, and I can't express enough gratitude for all we're receiving.
What I wish for other patients are the fortune of community and loving support, as well as the wherewithal to assertively advocate for their own needs both in and out of the acute care setting. I also wish for nurses and healthcare professionals who pay close attention to detail, not overlook basic nursing care, and otherwise care for patients in a manner that optimizes outcomes.
All too often, patients are forced out of the hospital all too quickly by surgeons who are feeling the heat from insurance companies and hospital executives. My surgeon chose to attempt to force me to go home against my better judgment, even as he acknowledged the "social" issues I had brought up in conversation. I pushed back hard, recruited the help of the nurse and physician assistant, and had an extra night approved. Had I not done so, I would have gone home even less prepared for what was to come.
Nurses, be your patients' #1 advocate and champion. Leave no stone unturned, and push back against those who take the easy way out and ignore basic standards of patient care.
We nurses are champions, and I'll continue to speak out for those who may be less able to assert themselves in the face of substandard care and less than compassionate medical professionals. No one else is going to do it, so we have to.
My story will end well, and I want that sort of ending for every patient out there. Join me in making that vision a reality.
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Running makes up about 10% of my total training. I generally run a little bit between March and September and hibernate during the cold, wet weather.
First of all I want to stress that I don't run to burn off calories and I don't recommend that you should run to burn off calories.
Run because you enjoy it. Run for the challenge. Run to get faster. Run to run further. But don't run to burn off calories.
However, that said, here is some interesting information.
Last year I ran 240km. That is not a lot!! A marathon runner might run 1500-3000km a year.
I still burned 20,795 calories.
1 Tesco Pizza Express Pizza every 11 days.
Let's take is a proper runner. Not an Olympic athlete just someone who runs a lot. An enthusiastic, recreational runner.
Lisa ran 908km last year and burned 120,600 cals.
1 Tesco Pizza Express Pizza every 1.89 days.
We all know you can't out-train a bad diet but moving burns calories so you can help yourself to either lose weight, enjoy a little bit of what you want without putting on weight or, more often, a little bit of both!
If you're eating 250 calories a day above maintenance, that's 91,250 surplus calories a year. You're looking at about 675km to burn that off. That's 16 marathons. About one every 3 weeks!
This entry was posted in Fitness, Health, Lifestyle, Nutrition, Personal Training Leeds, Bradford, Birstall, Running, Triathlon, Uncategorized, Weight Loss. Bookmark the permalink.


Need quality professional translator from Nepali to Welsh?
Translation, localization from Nepali to Welsh — what is it?
Welsh is native for 700000 peoples in the world. Mainly use in United Kingdom (UK). Also use in Argentina (AR).