text:
The Cardiff Cup: A Model for Tonsillectomy Tie Training
Otolaryngology: Open Access
otolaryngol 2011, Vol 1(1): 102
DOI: 10.4172/2161-119X.1000102
Al-Hussaini A*, Addams-Williams J and Tomkinson A
Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, UK
*Corresponding Author: Dr. Al-Hussaini A, Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK, Tel: +44 (0) 2920747747, Fax: +44 (0) 2920745937, Email: [email protected]
Received Date: Jul 11, 2011 / Accepted Date: Jul 14, 2011 / Published Date: Jul 23, 2011
Tonsillectomy is a procedure commonly performed by otolaryngologists. The National Prospective Tonsillectomy Audit [1] reported reduced postoperative haemorrhage rates using cold steel dissection combined with ligation for haemostasis in comparison to hot tonsillectomy techniques. Accordingly, there is growing emphasis on the need for ENT surgical trainees to develop competence in tonsillectomy ties for haemostasis. Tonsillectomy tie technique is an important skill that requires good manual dexterity and one that is difficult to learn under the pressure of a bleeding patient. Furthermore, in the UK, opportunities for junior surgical trainees to undertake tonsillectomy tie training in the operating theatre have been limited by the enforcement of the European Working Time Directive [2]. Thus, there is a growing need for the use of simulation to practise tonsillectomy ties. We present a simple, readily available and economical simulation model for surgical trainees to practise tonsillectomy ties.
Tonsillectomy is a procedure commonly performed by otolaryngologists. The National Prospective Tonsillectomy Audit [1] reported reduced postoperative haemorrhage rates using cold steel dissection combined with ligation for haemostasis in comparison to hot tonsillectomy techniques. Accordingly, there is growing emphasis on the need for ENT surgical trainees to develop competence in tonsillectomy ties for haemostasis.
Tonsillectomy tie technique is an important skill that requires good manual dexterity and one that is difficult to learn under the pressure of a bleeding patient. Furthermore, in the UK, opportunities for junior surgical trainees to undertake tonsillectomy tie training in the operating theatre have been limited by the enforcement of the European Working Time Directive [2]. Thus, there is a growing need for the use of simulation to practise tonsillectomy ties. We present a simple, readily available and economical simulation model for surgical trainees to practise tonsillectomy ties.
200 ml foam cup, gauze swab, adhesive tape, red marking pen, tonsillectomy.
Curved Negus forceps, Negus knot pusher, curved scissors and silk ties. Using a foam cup to simulate the oral cavity, gauze swabs are passed through two holes made on the lateral aspects of the bottom of the cup. The gauze represents the tonsillar beds on either side. A bleeding vessel is depicted with a red marking pen on the gauze. This is clamped using the Negus curved forceps. The trainee then proceeds to ligating the bleeding vessel in the tonsillar bed with silk ligatures using a Negus knot pusher (Figure 1).
Figure 1: Using the Cardiff Cup to practise ligating a bleeding vessel in the left tonsillar bed.
Although more sophisticated tonsillectomy tie models have been proposed, [3,4] this model is very simple, easy to construct from household items and economical. It allows the trainee to become competent at applying ties at depth to the left and right tonsillar fossa using the dominant and non-dominant hand. Moreover, tying at depth in this model closely corresponds to the real anatomical distance to the tonsillar beds [4]. Additionally, any 'cheese-wiring' of the lips during tying would be apparent as markings on the upper surface of the cup making the trainee cognisant of avoiding this.
Given its very basic nature, this model does not fully mimic the spatial orientation available during a tonsillectomy. However, it allows the junior trainee to become familiar with tonsillectomy instruments and develop the manual dexterity required to apply ligatures in a controlled environment. We hope that otolaryngology trainees may utilise this model as a simple aid to their training.
Lowe D, van der Meulen J, Cromwell D, et al. (2007) Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 117: 717-724.
Hall L, Lee M (2011) Training for tonsillectomy: home-made Negus knot pusher. Clin. Otolaryngol. 36: 99-100.
Raja MK, Haneefa MA, Chidambaram A (2008) Yorick's skull model for tonsillectomy tie training. Clin. Otolaryngol. 33: 187-188.
Street I, Beech T, Jennings C (2006) The Birmingham trainer: a simulator for ligating the lower tonsillar pole. Clin. Otolaryngol. 31:79.
Citation: Al-Hussaini A, Addams-Williams J, Tomkinson A (2011) The Cardiff Cup: A Model for Tonsillectomy Tie Training. Otolaryngol 1:102. Doi: 10.4172/2161-119X.1000102
Copyright: © 2011 Al-Hussaini A, 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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text:
package org.apache.cassandra.locator;

import java.io.IOException;
import java.net.InetAddress;
import java.net.UnknownHostException;

import org.apache.cassandra.exceptions.ConfigurationException;
import org.apache.cassandra.config.DatabaseDescriptor;
import org.apache.cassandra.gms.ApplicationState;
import org.apache.cassandra.gms.Gossiper;
import org.apache.cassandra.service.StorageService;

/**
 * 1) Snitch will automatically set the public IP by querying the AWS API
 *
 * 2) Snitch will set the private IP as a Gossip application state.
 *
 * 3) Uses a helper class that implements IESCS and will reset the public IP connection if it is within the
 * same region to communicate via private IP.
 *
 * Operational: All the nodes in this cluster needs to be able to (modify the
 * Security group settings in AWS) communicate via Public IP's.
 */
public class Ec2MultiRegionSnitch extends Ec2Snitch
{
    private static final String PUBLIC_IP_QUERY_URL = "http://169.254.169.254/latest/meta-data/public-ipv4";
    private static final String PRIVATE_IP_QUERY_URL = "http://169.254.169.254/latest/meta-data/local-ipv4";
    private final String localPrivateAddress;

    public Ec2MultiRegionSnitch() throws IOException, ConfigurationException
    {
        super();
        InetAddress localPublicAddress = InetAddress.getByName(awsApiCall(PUBLIC_IP_QUERY_URL));
        logger.info("EC2Snitch using publicIP as identifier: {}", localPublicAddress);
        localPrivateAddress = awsApiCall(PRIVATE_IP_QUERY_URL);
        // use the Public IP to broadcast Address to other nodes.
        DatabaseDescriptor.setBroadcastAddress(localPublicAddress);
        if (DatabaseDescriptor.getBroadcastRpcAddress() == null)
        {
            logger.info("broadcast_rpc_address unset, broadcasting public IP as rpc_address: {}", localPublicAddress);
            DatabaseDescriptor.setBroadcastRpcAddress(localPublicAddress);
        }
    }

    @Override
    public void gossiperStarting()
    {
        super.gossiperStarting();
        InetAddressAndPort address;
        try
        {
            address = InetAddressAndPort.getByName(localPrivateAddress);
        }
        catch (UnknownHostException e)
        {
            throw new RuntimeException(e);
        }
        Gossiper.instance.addLocalApplicationState(ApplicationState.INTERNAL_ADDRESS_AND_PORT, StorageService.instance.valueFactory.internalAddressAndPort(address));
        Gossiper.instance.addLocalApplicationState(ApplicationState.INTERNAL_IP, StorageService.instance.valueFactory.internalIP(address.getAddress()));
        Gossiper.instance.register(new ReconnectableSnitchHelper(this, ec2region, true));
    }
}

redpajama_set_name: RedPajamaGithub


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(BBC) – A Pakistani court has sentenced former Prime Minister Nawaz Sharif to 10 years in prison on corruption charges related to four luxury London flats.
The National Accountability Bureau (NAB) court handed down the verdict after a series of delays.
His daughter, Maryam Nawaz Sharif, received a seven-year sentence, while his son-in-law, Safdar Awan, was given a one-year sentence.
Nawaz Sharif has said the charges are politically motivated.
Both he and his daughter are in London, where Sharif's wife, Kulsoom Nawaz, is receiving treatment for cancer.
Judge Mohammad Bashir ordered Sharif to serve 10 years for owning assets beyond income and one year for not co-operating with the NAB. He will serve his sentences concurrently.
Daughter Maryam received seven years for abetting a crime and one year for not co-operating – again to run concurrently – while Safdar Awan's sentence is for not co-operating.
Sharif and Maryam also received fines of £8m ($10.6m) and £2m respectively.
The case, known as the Avenfield Reference, relates to a number of properties in the UK capital.
The Panama Papers leak in 2015 revealed several of Sharif's children had links to offshore companies, which were allegedly used to channel funds and buy foreign assets – including luxury flats in Avenfield House, on London's Park Lane.
His family, however, insist they legitimately acquired the four properties.
As part of the ruling, the court ordered they be confiscated for the federal government.
The UK has no formal extradition treaty with Pakistan, but Section 194 of the Extradition Act 2003 allows special extradition arrangements in exceptional circumstances.
Fearing unrest, the authorities reportedly closed roads around the Federal Judicial Complex in Islamabad and imposed a ban on public assemblies or rallies in the area.
The court repeatedly delayed the decision, initially pushing the ruling back after Friday prayers and then several times again, sparking speculation about the wait.
However, the judge reportedly said part of the delay was because of the need to photocopy the judgement – which is more than 100 pages long – for both the defence and the prosecution.
On Twitter, the hashtag #AvenfieldReference became one of the highest worldwide trends as Pakistanis awaited the verdict.
The ruling comes just a few weeks before Pakistan's general election on 25 July. Sharif is disqualified from standing for his centre-right party, the PML-N.
His brother Shahbaz Sharif now heads the PML-N, and is running in the July vote.
Shahbaz Sharif defended his brother at a press conference following the verdict, calling it "politically motivated" and saying the election in July would serve as a people's court that would condemn the decision.
The country's Supreme Court ousted Nawaz Sharif from the premiership in July 2017 following the Panama Papers revelations.
At the time, he was less than a year away from becoming the first head of government in Pakistani history to complete a full term in office.
Sharif held the office from November 1990 to July 1993 and from February 1997 until he was toppled in a bloodless coup in October 1999.


text:
Home > News > Marketing
Rodale Books Launches Week-Long Online 'Greatness Summit'
The health and wellness publisher has partnered with 'The School of Greatness' author Lewis Howes to offer free online content from 28 experts in subjects ranging from career to family to personal health.
By Laura Godfrey |
Bestselling author Lewis Howes was once a professional football player, until a broken wrist ended his career early. But since then, Howes has launched a multi-million-dollar business and hosts a leadership and personal development podcast called The School of Greatness. Last month, Rodale Books published his book by the same name, and this week the publisher is holding the Unleash Your Greatness Summit to promote the book's core ideas.
Howes' book offers tips and resources for overcoming adversity and reaching one's potential, and he highlights eight specific principles, from creating a vision to being of service to others, that have helped him in his life. From Nov. 16 to 23, Rodale will host a free online summit inspired by the book, featuring videos and other content from 28 authors and speakers discussing how they found success. Aside from Howes, speakers include life coach Gabrielle Bernstein and Adam Braun, founder of non-profit organization Pencils of Promise, among others.
"The primary goal of doing something like this is to give readers a way to further engage with this great content, to make the content from the book come alive," says Mary Ann Naples, senior v-p and publisher, Rodale Books. "Lewis is a major podcaster, and his whole method is interviewing people who have achieved greatness in various areas. So we thought that had such incredible application to what a summit could be, especially bringing it to life with video."
Naples adds that the summit serves as a "massive showcase" for The School of Greatness and Rodale's other authors, and acts as a "sustain campaign" for them. "Sometimes after these big launch campaigns, you get fall-off," says Naples. "This was an additional way for us to keep the themes of this book in the public conversation."
Readers can sign up at the summit's website, and will then receive an email each day of the event with a link giving them access to that day's free video. They also have the option of buying a package — from $47 to $97 — that will give them lifetime access to a variety of bonus content, from audio discussions to slideshow presentations and interview transcripts.
According to Naples, the Unleash Your Greatness Summit is just the first of a number of upcoming online events Rodale will be holding. In March, they will do another online summit called the Rodale Wellness Mind & Body Master Class.
"We produce life-changing content, and we know that we have an opportunity to serve readers with an even deeper engagement with that content," says Naples. "We want to be able to help and support people as much as possible, and we want to serve our authors and our book campaigns."

redpajama_set_name: RedPajamaCommonCrawl


Luxury villa completed in 2005. Built in two levels to the finest quality standards, located in the residential urbanization Valtocado, close to Mijas. From its west facing elevated position this property enjoys fantastic views over the valley and the surrounding mountains. The villa is set on a plot of land of 2.000 m2 with 285 m2 built and comprises on the ground floor of an entrance hall, one bedroom en-suite, fully fitted kitchen, utility room, guest cloakroom and a large bright living dining room looking onto a private and covered terrace of around 50 m2. In the basement the property comprises of two en-suite bedrooms, a sauna and an access way to a covered car-port of around 20 m2. There is central air conditioning installed and under floor heating throughout the entire property. The villa further includes a private swimming pool and landscaped gardens with automatic irrigation. Excellent property located in a privileged area.