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FG probe panel recommends NHIS suspended boss, Prof Usman Yusuf's sacking, board's dissolution
by Bridget Edokwe · April 16, 2019
The panel set up by the Federal Government to investigate the crisis in the National Health Insurance Scheme has recommended immediate dismissal of the Executive Secretary of the agency, Prof Usman Yusuf.
A copy of the report which was obtained by The PUNCH accused Yusuf of breaching the Public Procurement Act as well as the Public Service Rules.
The seven-man committee headed by Dr Hassan Bukar, a retired permanent secretary, nonetheless, did not recommend Yusuf for prosecution.
The committee added that the NHIS boss, who has been on suspension since November 2018, had an unhealthy relationship with members of staff of the agency; local unions, health management organisations and health care providers.
This, the panel said, would have a negative effect on the health sector if he was allowed to retain his position.
Yusuf, who said, "Fu*k the Minister of Health" during an interview with The PUNCH in 2017, was also accused of embarrassing the government through his unguarded social media comments.
The committee said the NHIS boss deserved to be dismissed for failing to explore internal administrative remedies before suing the Minister of Health, Prof. Isaac Adewole, and the Attorney-General of the Federation, Abubakar Malami (SAN), and the NHIS last November.
The report read in part, "Relieve the executive secretary of his appointment. Justification: Inability to work in harmony with all the relevant stakeholders in the scheme for the attainment of the scheme's mandate.
"Established cases of infractions of the Public Service Rules i.e. insubordination and refusal to carry out lawful instructions from superior authorities (governing council and the Federal Ministry of Health) contrary to PSR Rule 030301 (0), unauthorised public utterances contrary to Rule 030421 (id), and relevant service-wide circulars.
"Established cases of infraction of the following provisions of the Public Procurement Act: Sections 16(6) and 32(7).
"Infraction of Rule 3125(i) (a) and (b) of the Financial Regulations;
"Embarrassed government through unguarded social media comments."
The panel also recommended for immediate removal the 13 senior officers improperly seconded to the NHIS from other government agencies by the suspended NHIS boss.
The committee also recommended the immediate dissolution of the Dr Eyanatu Ifienne-led NHIS governing council for suspending Yusuf when it clearly had no constitutional powers to do so.
It said there was a crisis within the governing council of the scheme and this could negatively affect the smooth running of the agency.
The report partly read, "Dissolve the governing council. Justification: The panel observed the role of the governing council in the present imbroglio and noted from the interactions that the council has become factionalised and is incapable of providing the required leadership for the scheme.
"The governing council embarrassed the government by exceeding its mandate when it suspended the executive secretary."
The committee subsequently advised the Federal Government to appoint an interim management team to avoid a vacuum and ensure the smooth running of the scheme.
It said the proposed committee would have a six-month lifespan and should be led by a seasoned administrator with a health system experience and other technical members drawn from the offices of the Accountant-General of the Federation, Bureau of Public Procurement and Head of Civil Service of the Federation.
The panel said the proposed committee would report to the Presidency during its tenure.
It called on the Federal Government to amend the Act establishing the NHIS to make health insurance compulsory for Nigerians even as it advised the government to ensure that "the NHIS is ICT driven."
Investigations by The PUNCH showed that the committee report was submitted to the Secretary to the Government of the Federation, Mr Boss Mustapha, on December 24, 2018.
However, President Muhammadu Buhari government has failed to take any action in almost five months, thereby worsening the ongoing crisis in the health sector.
The NHIS crisis began in early 2017 when it was alleged by members of staff and the organised labour that Yusuf was diverting public funds to private use.
He was said to have brought in 13 officers from other government agencies and gave them undue promotion.
The NHIS boss was subsequently suspended by the Minister of Health in July 2017 while a committee was set up to investigate Yusuf.
The committee accused Yusuf of fraud to the tune of N919m and recommended that anti-graft agencies investigate and prosecute him if need be.
However, Yusuf, who is said to be close to the cabal at the Presidency, was asked to return to his position, an action that triggered public outrage.
Months after his return, Yusuf again ran into trouble with the governing council of the NHIS for, amongst other things, paying consultants N508m without due process.
Recall that the Assistant Director of Information, Office of the Secretary to the Government of the Federation, Olusegun Adetola, in an interview with The PUNCH on April 17 named the just-concluded general elections as the reason the Federal Government had yet to make public the outcome of the probe initiated into an alleged fraud of N919m in the NHIS.
Adetola, in the interview, said, "As you are aware, the report has been submitted to the SGF and forwarded to the President. We had general elections that were completed only last week and that involved many government agencies.
"The report was submitted just before election activities began. This must have delayed the public presentation. I am sure that soon, it will be made public. It is not a forgotten document."
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Diary of a Storyteller: Writing as a hobby vs writing as a job.
I never know how to respond to these kind of things. Don't get me wrong, I love it when people write as a hobby, it's great. Everyone should write, it's good for your creativity. But it's not the same to write as a hobby as it is for your job. It's like me going to the dentist and saying "I pulled out my own loose teeth when I was young", and expecting him to think I do the same work as he does. I know Amazon has made it easy to publish, and in many ways that's a good thing. But please don't publish your book unless you are serious about being a writer.
A nice story idea does not necessarily make a nice book. You know what makes a nice book? Hard work. With a few exceptions, most writers don't have a perfect first draft. A lot of us have to write, rewrite, have beta-readers look at it, rewrite some more, get an editor, edit back and forth and polish a book before it's finished. Those who do have good first drafts tend to take a long time, and in my opinion, they still need to do the editing dance.
Writing is more than just the story, writing is also about the writing itself, and about the character building and the world building. The story tends to be the easiest part. But how do you keep your characters consistent? Are you sure your language isn't repetitive? Or passive? Are you drawing your readers in? Are you staying true to the reality you've created? Does your story work or are there plot-holes? Is what you're describing physically possible, and if not, do you have a good explanation why this is happening? These are just a few of the questions you need to ask yourself.
I'm challenging myself with my latest project 'Alleria'. I've written an entire book in 1st person present tense. Let me tell you, it's tough. I can do short stories like this, but an entire novel gives me a challenge. For one, the whole book is in my character's head. I can't have too many flashbacks, because that would make the story passive –but would also mess with the present tense thing and make the book confusing. So everything needs to be explained along the way. And in such a way that I stay true to my character without making her annoying or repetitive. This is harder than it sounds. So far I've written a monstrous first draft, but I think there is a story there. I'm very limited because I can't go outside of my character's mind in a way, we only see what she sees, and feel what she feels. On top of that I decided to write high fantasy romance. As you might have guessed… this is not my genre. I like writing about strong women, and guess what: my character starts out as an underdog. Not that those aren't strong, but she's been suppressed for such a long time, that I had troubles getting her out of her submissive state and still make it realistic. Between you and me, I don't think I've quite succeeded in that yet. I will have to seriously polish her up in the rewrites.
And how to write romance without too much doting? Personally I hate insipid characters that swoon and faint over a man. But I do like a good bit of tension and attention between two characters, but to get that on paper is a whole different story. Some people are naturals at romance, yet a lot of romance is highly dramatic, and that doesn't suit my reading and writing style. So, I'm faced with many dilemmas during this project. What do I want from my characters?
By the time the editing dance is finished, I will be sick of my own book. Not because it's bad, but because it has taken up 80% of my life for several months. I will have read, re-read, written and rewritten every chapter numerous times until my eyes have gone cross-eyed. I will have laughed and cried, been angry, upset, happy and proud at different stages of the project. It's my process.
I'm not saying every writer has the same process. We go through our own writing journey. What I am saying is that you can tell the difference between someone who takes it serious, and someone who writes for a hobby. There is nothing wrong with having writing as a hobby, and if you want to step it up a notch, that's fine too. But then you need to accept it will take time and hard work to get your book the way you want it to be. Don't just put your work on Amazon because your friends liked it, if you're going to charge people money be professional about it.


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Home> News & Insights>News>Kitsons Praised In Top Legal Sector Directories
Kitsons News
Kitsons Praised In Top Legal Sector Directories
Leading Devon law firm Kitsons has been praised in the South West chapters of the latest editions of Chambers UK and the Legal 500 – the most prestigious guides to the UK legal profession.
Highlights include Kitsons' Corporate and Employment teams achieving 'Tier 2' statuses in the Legal 500 whilst the firm's Private Client team has been recommended in the 2016 edition of Chambers for its expertise in complex trust work and asset protection, and for its strong advice on wealth protection for high net worth individuals, estates, families and trustees. Other areas where the firm features prominently include Litigation, Commercial Property, Family and Licensing.
A total of nine lawyers have been endorsed for their work across the practice. Two of Kitsons' Partners – Dominic Hollingsworth and David Turner – have also been listed in the Legal 500's elite "Leading Lawyers" list, and a further seven lawyers have achieved recommendations as leaders in their fields: James Cross, Nicholas Johnson, Rhodri Davey, Tony Hunt, Lynn Smith, Patrick Gaskins and Cameron Caverhill.
James Cross, Managing Partner at Kitsons said: "We are always pleased to be recognised for the work that we do and the latest findings of the Legal 500 and Chambers are particularly important to us as they are based on client feedback. Featuring in so many areas is a great reflection of the quality of our work and the service we provide, it is also reward for the investment we have made in recruitment and people development over the years."
Chambers UK 2016 says:
What the team is known for: Highly regarded for its expertise in education and property disputes, while offering experience in matters such as financial services and professional negligence litigation. Strong regional presence in commercial litigation.
Strengths: (Quotes from clients)
"My association with them is always A1. They never miss a deadline and they're never last-minute."
"The advice about the process was excellent. They had very strong case management."
Notable practitioners: James Cross maintains a strong reputation as a litigator and is described as "a safe pair of hands" who comes highly recommended for complex disputes. His commercial litigation practice includes experience in handling property-related matters and debt recovery.
David Turner is a go-to litigator for disputes arising in the financial services sector. His expertise includes insurance and mis-selling claims.
What the team is known for: Experienced team handling residential development work for both developers and landowners, as well as advising on commercial landlord and tenant work. Additional specialisms in licensing and leisure, and acts for a number of caravan parks.
"Very commercial, efficient and approachable"
Notable practitioners: Sources describe Cameron Caverhill as "commercial" and "very straightforward." He has a broad range of commercial property expertise which includes development, land sales and investment transactions
What the team is known for: Noted for its expertise in complex trust work and asset protection, and for its strong advice on wealth protection for high net worth individuals, estates, families and trustees. Also advises on estate administration, particularly in relation to inheritance tax issues.
Notable practitioners: Rhodri Davey advises companies and individuals on contentious and non-contentious matters. Sources say he is "really technically good, commercial and easy to deal with."
Notable practitioners: The "outstanding" Tony Hunt of Kitsons LLP is based in Plymouth and has recently advised on numerous multimillion-pound divorces. One peer says: "Tony Hunt has been around for a long time on complex, high-value cases. He is very good and very determined to fight for his client."
Legal 500 2015 says:
Head of Corporate, Dominic Hollingsworth is described as "very knowledgeable" and "very sensible". The team has particular expertise in the leisure and care sectors.
Kitsons handles whistleblowing claims for public sector employers and employees. Rhodri Davey, who presented the Guild of Construction Workers in a tribunal hearing on employment status, leads the team.
Tony Hunt is "courteous, diligent and professional."
Kitsons is praised for "extensive knowledge coupled with efficiency." Nicholas Johnson is "extremely good with clients" and can "provide a strong dose of realism". James Cross and David Turner are also recommended.
Kitsons handles trust creation and administration. Practice head Lynn Smith is "personable, responsive and capable."
Kitsons' strength lies in the leisure sector, acting for regional holiday park operators. Cameron Caverhill and Patrick Gaskins are the key contacts.
Kitsons' Licensing team, led by James Cross, undertakes work related to late-night levies and event-policing costs.
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Rosie EvansSolicitor
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Audio Recording in the Workplace
By: Rosie Evans
Audio Recording in the Workplace: UK Law – Kitsons
The recent decision in Phoenix House Limited v Stockman demonstrates the considerations of a Tribunal when considering covert audio recording in the workplace.
The Employment Appeal Tribunal's (EAT) recent decision in Phoenix House Limited v Stockman demonstrates the considerations of a Tribunal when...
Read Rosie's full article
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WOW, what a fantastic night we had!
Kitsons Solicitors were proud sponsors of this year's Rowcroft Hospice Sleep Walk 2019. Five members of staff at ...
Kitsons make a splash with charity swim
At the beginning of this month Kitsons got together a team from their Exeter office to help raise ...
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Gaining Possession Without a Written Tenancy
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redpajama_set_name: RedPajamaCommonCrawl


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Building Leadership Team
West Seattle High School/Get Involved
West Seattle High School Foundation
West Seattle School Involvement
West Seattle High School's athletic programs and activities need your support to purchase much needed uniforms and equipment for our young athletes. West Seattle Booster Club is a nonprofit organization devoted to supporting ALL athletic programs (cheer included) at West Seattle High School.
Booster club website
The West Seattle High School Alumni Association exists to foster the welfare and preserve the history of West Seattle High School and to organize the Alumni, and to fund educational scholarships for the benefit of recent graduates of West Seattle High School.
WSHS Alumni Association Website
The West Seattle High School Foundation strives to enrich and enhance the long-term quality of West Seattle High School; its academic, arts, athletic and extracurricular programs through private and community contributions.
The Foundation is dedicated to supporting the faculty, administrations and staff by being the conduit through which gifts flow and providing immediate and long-term support for the high school to foster a positive learning environment for all students in a culture of academic excellence.


Why Most Of The Indian Brides Wear Red Lehenga For Wedding?
The colour red has always been an integral part of an Indian wedding. Red is considered to be the colour of love, sensuality and boldness in the western world. But in India a country rich with culture and history red has always been a symbol of passion, commitment, strength and bravery.
Marriage in Hindu culture of India is not just the joining of two people and their families it is a pious ritual filled ceremony that joins two souls for eternity. The vedas and matras read during a marriage are said to connect two people for their whole life and the rebirths they are going to take in their next life. For such a pious ceremony every ritual, cloth, accessory etc. have their own unique significance and meaning to bride and groom's upcoming union. Similarly every colour hold its own significance and symbolism to the ceremony and its rituals like yellow for 'haldi' ceremony, red for wedding etc.
Red is a bold colour that stands out anywhere and when a bride wears a red lehenga (north India) or a red saree (south and west India) during her wedding ceremony she glows amid the crowd making her special day more special. But this is not the only reason for wearing red.
Red in its every shade holds a different meaning and importance to Hindus and their ceremonies. The colour red is a symbol of rising sun and is also representation of the red planet Mars, as in Hindu astrology it is considered as the planet of marriage. The colour red is not limited only to the bride's attire but to all the accessories like bangles, headgear, jewellery etc. that the bride wears for the wedding ceremony. In some of the other states in India white, yellow, pink etc. colour saree is worn by the bride but one or the other significant part of her look is told to be in red colour.
Red signifies eternity or an eternal bond that is to be forged between the bride and the groom. Even the gifts or naake that is exchanged between the groom and bride are kept in a plate that is covered with red cloth.
Also during the marriage ceremony red sindoor or Vermillion is applied by the groom on the bride's hairline signifying their union. This sindoor or vermillion is always worn by the bride till her significant other passes away. In the western world a married women can be recognised by her wedding but in India a married woman can be recognised by red vermillion on her hairline.
Generally the red lehenga worn by the bride is filled with heavy golden embroidery on the lehenga (skirt), the blouse and the chunari (that is to be worn on top of the head). With the changing trends the designs and looks of the lehengas have been changed but the colour red remains unchanged. So the next time you see a bride wearing red remember that it is a symbol of unity, power, strength, passion and commitment.


Lupus is short for systemic lupus erythematosus (SLE) that is an autoimmune disorder. Because its symptoms can confuse doctors and patients, it is quite necessary to choose correct tests for diagnosing Lupus disease.
Generally, the preliminary diagnosis depends on your symptoms and medical history. You may be suspected to have Lupus, if you are experiencing the following symptoms.
- Nausea, vomiting, diarrhea, enlarged liver, etc.
To determine whether you have Lupus disease, some lab tests are needed.
Firstly, you need to take blood and urine tests. Complete blood count, erythrocyte sedimentation rate, kidney and liver assessment, ANA tests, etc, are commonly seen in patients' test reports. On one hand, they can help detect Lupus. On the other hand, they can help determine whether Lupus has affected your kidneys or liver.
Secondly, imaging tests may be taken. If the doctor suspects Lupus is attacking your heart or lung, you should do chest X-ray and echocardiogram. A image of chest can reflect fluid retention or inflammation in the lungs, while echocardiogram can check out heart problems.
Finally, skin or kidney biopsy is needed. In this test, a small sample of skin or kidney tissue is taken out and examined under a microscope. It can show symptoms of an autoimmune disorder.
Many other tests can also help diagnose lupus disease. The detailed test item should change from person to person. If you want to know what you need to do for diagnosing Lupus disease, you can tell the online doctor your illness condition. Therefore, they can give you some suggestions.


Size D is equivalent to a standard width fit, Size 2E is the wide model of the GEL-Foundation® Walker. Our most functional walking shoe just got better with the update of the GEL-Foundation Walker® 3.As part of our Maximum Support series; the GEL-Foundation Walker® 3 features a broad based platform with DuoMax® and Trusstic® technologies to provide advanced support and stability.A walking beveled heel and forefoot flex notches enhance the ride while maintaining arch support.The upper features a soft yet supportive combination of natural leather and synthetic leather materials; ideal for supporting the foot.Available in regular and wide widths. Weight: 12.4 oz.


This post will help you to know how to delete a file using inode number.
This post explains how to change PHP time zone on cPanel or Linux servers.
This post will help you to know how to change time zone in CentOS.
You can simply reset vtiger admin password by a MySQL query.
Here I am explaining how to reset LiteSpeed admin password via terminal.


My opening thoughts as I began to listen to Brisbane based outfit 'Osaka Punch'.
Osaka Punch's music could be described as groove laden funk rock. It could be described as progressive metal pop. It could just be the wackiest, grooviest, most interesting thing I've heard all year. I wanna party to this music. I wanna dive off my couch to this music. The blend of low-tuned guitars, feel good grooves, catchy vocal hooks and quirky surprises puts them in the league of their own. Hands down one of the most fun and intriguing artists in our heavy music scene.


There are many ways of promoting your app, as many as different kinds of apps. But how we blend in, plan and carry out the strategy will be the key to our campaign's success. We'll now summarise some of the best practices and strategies to help you increase your visibility and the number of downloads. Using these techniques will enable you to differentiate yourself from your rivals in the industry. You don't know how to promote your app? Then pay attention!
Ask yourself what are your users going to be searching for – or do some research on it – and try to fit these keywords in the app's name and description (including in your rating's comments). Using a keyword in an app's name has proven to bring about a significant improvement in its positioning, as this field (our app's name) is more important than its description.
As for the use of keywords, we have to take into account that further repetitions of a given keyword will not matter once it has shown up 5 times, so it will be better to focus on other keywords for the app promotion's sake. Testing new keywords and synonyms for common generic searches may place us in higher positions in the listings. In short: it's better to appear among the top 5 of an uncommon search result than among the top 50 of a common generic search.
It's important to remember that our app's icon is the first opportunity we have to attract users towards our website straight from the list of results. This is so mainly because it's the first impact that our app with have on our potential user, making it thus very important to integrate and express "what our app is for" in its design. We'll achieve differentiating ourselves from our rivals in the industry by conveying the essence of our app through its icon (making sure it's not just a logo).
Using all 100% of the icon's surface is an interesting resource available to us (square with rounded edges). It delivers a sense of tailored design that's both efficient and effective. Following current design trends in app design is another resource that's always at our disposal. And it's now as easy as designing an icon in "material design" (platforms as Yeeply can help you find freelance designers for this purpose at reasonable prices).
Users will look at our screenshots before reading anything, so selecting luring images is one of the most important aspects from a conversions and sales standpoint. Some basic tips are: add a value functionality or proposal to each screenshot, but just one per screenshot and keep it as short as possible. It will be best if the screenshot is based on the app's context of use; adding a hand holding the Smartphone will help you convey empathy and help users imagine themselves using it.
Planning optimised news and press releases will help us chart a path towards where we are heading. It will reduce the amount of time devoted to its management and allow us to 'tell a complete story' to our media contacts (at least during the first months of the app's life). The classic remarkable milestones are: "The app's birth or history", "The app's release on the stores", "The public's warm reception of the app", "A case of the app's suitable use" and "The app's new functionality".
An important aspect associated to promoting an app will be to carry out a previous research regarding influencers (journalists or trendsetters in general). If you are not planning to devote a lot of time to it, it's better to choose around 10 people (there is always a person behind any newspaper, blog or company and we'll not establish relations with legal persons) and focus on connecting with them. We'll read the content they create, share it and show them we care about it, going beyond our interest in them being attentive to our app.
There is a growing number of users who – for different reasons – choose stores other than the main ones (App Store and Google Play) to look for the apps they are after. By updating our app on these stores, we'll be reaching out to new users, who are somehow trying to discover innovative apps. Some of them are: Amazon's store, Softonic, Samsung, AppBrain, 1mobile, Opera, Aptoide, SlideMe, Andapp, etc. – among others.
To exchange mobile advertising between apps is a logical solution for growing without having to pay. In fact, it seems quite natural to use this method among our own apps. However, this way we would always end up reaching the same users. Tappx is the best example as it's the largest open community to exchange ads among app developers. It works in a fair way: we'll insert advertising in our app from apps belonging to other members when joining the community. For every click we generate, we will get another one in exchange. This is the way it works, allowing us to exchange ads with over 4,000 developers. Our app will be promoted even in great apps like Questioned (from Etermax) or Soccer Runner (from U-Play Online) and these will be on ours in return.


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What Next for PUK, Iraqi Kurdistan?
Iraqi Kurdish leaders are holding intensive meetings to address Iraqi Kurdish politics in the absence of Iraqi President Jalal Talabani, writes Abdel Hamid Zebari.
Read In: العربية
A Kurdish Peshmerga soldier holds a Kurdistan flag during a deployment in the area near the northern Iraqi border with Syria, which lies in an area disputed by Baghdad and the Kurdish region of Ninevah province, Aug. 6, 2012. Photo by REUTERS/Azad Lashkari.
Abdel Hamid Zebari
massoud barzani, kurdistan regional government, kurdistan, kurdish-iraqi tensions, krg, iraqi politics, iraq
As soon as Hiro Ibrahim, the wife of Iraqi President Jalal Talabani, returned to the city of Sulaymaniyah last week, leaders of the Kurdistan Democratic Party (KDP), headed by president of the Kurdistan Region Massoud Barzani, began holding frequent meetings with her. The official objective of these visits was to discuss the Kurdish-Iraqi situation, while its implicit purpose was to maintain the strategic alliance between the two parties and preserve the Patriotic Union of Kurdistan (PUK) after Talabani's departure so as not to upset the balance of power in the region.
Hiro Ibrahim, a prominent PUK leader, had accompanied her husband to Germany, where he was urgently transferred at the end of December for medical treatment. She returned last week to the city of Sulaymaniyah, north of Baghdad, and took part in a series of meetings between the two main parties in the region, the PUK and KDP, with the participation of Barzani.
A statement issued after the meeting on Sunday, Jan. 13 read that all parties stressed that Jalal Talabani does not belong only to the PUK, but to all Iraqi Kurds. The statement added that Barzani underlined the need to preserve the alliance with the PUK.
The two main parties in Iraq's Kurdish region hold 59 out of 111 seats in the Iraqi Kurdistan Parliament (IKP), and 42 seats in the Iraqi Council of Representatives. The Kurdish opposition has 34 seats, while the largest share is for the Movement for Change that split from the PUK and has 25 seats. The Kurdistan Islamic Union holds six seats, while the Islamic Group in Kurdistan holds four.
The two Kurdish parties signed an alliance agreement in 2007, after a long and bitter struggle. The agreement stipulates the division of administrative positions in the Iraqi Kurdistan Parliament and the Kurdistan Regional Government (KRG), as well as in the federal government in Baghdad.
Nechirvan Barzani, prime minister of the KRG, said after meeting with Talabani's wife in Sulaimaniyah that his visit did not address the issue of Talabani's successor, whether at the level of the party or the Iraqi presidency.
Despite this assertion, the president of the Iraqiya List, Iyad Allawi, said that he discussed with Massoud Barzani in a meeting on Thursday, Jan. 10 in Erbil the need to preserve the unity of the PUK after Talabani.
Allawi told Al-Monitor that "there was in-depth talk in Kurdistan on the need to preserve the PUK, its integrity and course. We expressed hope that the president would recover and return to Iraq. There is a common desire for the PUK to be part and parcel and an important pillar in Iraqi politics."
Iraqi Kurdish political analyst Zarzis Cooley Zadeh said that "the region is witnessing difficult circumstances and great changes, including the Syrian situation, not to mention the situation in Iraq and the protests that have emerged in Sunni regions, in addition to the significant divergence between the Shiites and Kurds as a result of disagreements between Baghdad and Erbil on a variety of issues."
He added: "I think that the responsiveness and care exhibited by the president of the Kurdistan region aims to prevent any possible rift among the ranks of the PUK."
He said that the two main parties are keen to maintain the political understanding between them on all areas, which they see as a national requirement to preserve security and stability in the region and prevent any internal political deterioration at this stage.
He noted that "Talabani's party may suffer new divisions by virtue of its intellectual diversity, after the split of the Movement for Change and the formation of a political and parliamentary bloc."
Demonstrations broke out in the city of Sulaimaniyah at the beginning of 2011, demanding administrative and political reforms and addressing financial and administrative corruption in the region. Many were killed and injured during these demonstrations.
However, a few months ago, Talabani's party reopened lines of communication with the opposition Movement for Change. The two parties agreed to define the powers of the president of Kurdistan in the Kurdistan constitution, stipulating that the president is to be elected by parliament and not by direct popular election. This was rejected by Barzani's party, and considered by observers to indicate a potential change in the map of regional political forces.
Abdel Hamid Zebari is a contributing writer for Al-Monitor's Iraq Pulse. A reporter from Erbil who works in the field of print journalism and radio, he has published several reports in local and world media, including Agence France-Press and Radio Free Iraq (Radio Free Europe).
More from Abdel Hamid Zebari
Iraqi Kurdistan Fails to Address Violence Against Women
Iraqi Kurdish Parties Dispute Law Extending Barzani Presidency
Iraqi Kurdistan's Islamist Parties Condemn Egyptian Coup
KRG asks US forces to deploy along Kurdish-controlled part of Iraqi-Syrian border
Amberin Zaman | Kurds | Dec 22, 2020
Iraq, KRG, Turkey find common ground in response to PKK
Week in Review | Turkish-Kurdish conflict | Dec 18, 2020
Washington on the spot as its Syrian Kurd allies are drawn into PKK-KDP fight
Amberin Zaman | Turkish-Kurdish conflict | Dec 16, 2020
Dozens killed, injured in Iraq's Kurdistan protests as some consider leaving
Shelly Kittleson | Kurds | Dec 11, 2020
Death toll mounts as Iraqi Kurdish protests continue
Al-Monitor Staff | Civil Society | Dec 10, 2020
More from Iraq
Iraqi port revenue surges as anti-corruption move bears fruit
Shelly Kittleson | Corruption and nepotism | Jan 20, 2021
Iraq makes major progress in closing camps for the displaced
Gilgamesh Nabeel | Refugees | Jan 15, 2021
Iraq regains confidence in dealing with outlawed militias
Shelly Kittleson | Armed Militias and Extremist Groups | Jan 5, 2021
Daewoo fulfills Iraq's Faw Port despite obstacles
Adnan Abu Zeed | Oil and gas | Jan 8, 2021


Get your #Playpplication #p4a19 ready!
Play4Agile wouldn't be so playful when you could 'just' register and that's it.
We're asking you again this year to dig into your creative brain and send us your playful application > what we would call your "playpplication".
Me starring in p4a19 as….
If you were a movie or TV character at play4agile, who would you be and why?
Feel free to add more information! Make it fun! Make it yours!
Please send us a picture of your character with your name and your reasons – as we have done in the examples below!
You will need to send us a link to or the playpplication in an email for your registration. And feel free to tweet it with #p4a19 #playpplication!


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My Chicago Botanic Garden
A blog for visitors to the Garden.
A Collection of Garden Stories
Butterflies & Blooms
College First & Science First
Ecology & Wildlife
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Tag: steam trains
For the Love of Trains
Once there was a boy who loved model trains. When the boy grew up, he became the chief engineer of train exhibitions at the Chicago Botanic Garden—and he still plays with trains. "I hardly get to play with my railroad at home because I get to play with this one," said Dave Rodelius, in the tone of a man who can't believe his good fortune.
Dave Rodelius shows off one of the stars of the Model Railroad Garden this spring: a steam engine!
This year marks Rodelius's 15th season at the Model Railroad Garden: Landmarks of America, which opens Saturday, May 9, with a special treat. This season, the Model Railroad Garden will pay tribute to steam engines, in honor of the 125th anniversary of the Chicago Horticultural Society (the Society founded and manages the Chicago Botanic Garden). Models of historic steam engines will chug along 1,600 feet of track, representing the early days of the Society, when steam engines ran commuter coaches along Chicago's elevated tracks and hauled freight over long distances.
Q. Dave, you have the greatest job title ever! How did you get this job?
A. I was retired, and my wife saw a little blurb in the newspaper that the Chicago Botanic Garden needed tram drivers. So I became a tram driver. One day, I saw that they had torn things up right in the middle of the Garden. I said, "What the Sam Hill are they doing here?" That's how I found out there was going to be a model railroad out there. Then one of the secretaries, who worked for a vice president, found out that I had been into model railroads all my life. So one day, the vice president of visitor operations at the time called me into her office and asked if I would be interested in managing the railroad. I didn't get a chance to ask her how much I'd have to pay.
Visitors of all ages enjoy the Model Railroad Garden.
Q. But that was back in 2000—and the railroad exhibition was going to be a five-month exhibition.
A. We had more than 100,000 people come through in five months. The little path out there was constantly packed with people. One thing led to another. In our first year, the trains didn't make any sounds—no choo-choos or whistles or anything, so we added sound cars. Gradually, the railroad became so darn popular that it became a permanent exhibition.
Q. So you became interested in trains as a kid?
A. When I was 6 or 7, my dad bought me a Lionel train. That train would go around the Christmas tree and in the bedroom. Now I have a model railroad layout of Solothurn, Switzerland, where my daughter got married; it's in my basement. It has Swiss trains and a ski lift.
Q. It sounds like you were a busy kid.
A. My family had 2.5 acres that we farmed in World War II for vegetables. I sold vegetables in the neighborhood in my little wagon. Then I was in the Boy Scouts and became an Eagle Scout in 1948….I grew up in Evanston and still live in Evanston, and I have lunch with some sixth-grade classmates once a month.
Q. And you've had some other interesting jobs before you started running the railroad.
A. I received a bachelor's degree in animal science at the University of Illinois. I wanted to raise cattle. In college, I was an intern at a purebred cattle farm. The most fascinating thing I did was to help birth calves. You get to see the little rascals trying to get up and stumble around….Eventually, I was drafted into the U.S. Army engineer corps. Two years later, I was discharged and became a manager at a livestock feed manufacturing company. Then my dad bought a photography studio in 1961, and I became a photographer.
Q. What keeps you motivated after all these years?
A. My passion for the railroad is what drives me—I absolutely love this railroad. The same passion goes for everyone. We have 18 engineers and 75 to 80 volunteers. They get along so darn well that I can't believe it. You cannot keep these people away; they are just so dedicated. They whole thing has kept me young. I get up and down on my hands and knees all the time. I should write to the AARP—if you want to hear about a good job to have, we at the Garden have it.
Left to right: Model Railroad Garden volunteer engineers Ken Press and Mark Rosenblum with George Knuth, staff engineer
Q. What do you do in your spare time?
A. I do some gardening, and some fishing and boating. My wife and I have three daughters and three grandkids. My wife is spectacular, one of the greatest people I've ever met.
©2015 Chicago Botanic Garden and my.chicagobotanic.org
Posted on May 8, 2015 May 4, 2015 Author Renee T.Categories Behind the Scenes, Horticulture & Display GardensTags 125th anniversary, model railroad, model trains, steam trains, volunteers


Instability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2–5) is increasingly being treated by repair of the plantar plate (PP). This systematic review examines the anatomy of the plantar plate of the lesser toes, and the relation between the integrity of the plantar plates of the lesser toes and lesser MTP joint stability.
The databases of Embase.com, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed not medline, Cinahl (ebsco), ProQuest, Lilacs, Scielo and Google Scholar were searched in June 2015 from inception. Studies were included if they were in English, contained primary data, and had a focus on plantar plate anatomy of the lesser toes or on the relationship between integrity of the plantar plate and MTP joint (in)stability. Study characteristics were extracted into two main tables and descriptive anatomical and histological data were summarized into one schematic 3D drawing of the plantar plate.
Nine studies were included in this systematic review, of which five addressed plantar plate anatomy as such and four focused directly and indirectly on plantar plate integrity related to MTP joint stability.
This is the first systematic review regarding plantar plate anatomy related to MTP joint stability of the lesser toes. This review iterates the importance of plantar plate anatomy and integrity for MTP joint stability, and it delineates the lack of primary data regarding plantar plate anatomy of the lesser toes and MTP joint stability.
Further specialization in orthopaedic and podiatric surgery has, amongst others, led to an increased attention for anatomical details, including the interest in the pathophysiology and mechanism of pain beneath the metatarsal heads (metatarsalgia) [1–3]. Metatarsalgia symptoms such as gradual onset of forefoot pain, edema and a positive drawer sign can be explained by instability of the metatarsophalangeal (MTP) joint [4, 5], MTP joint instability is described as a dorsal subluxation or dislocation of the base of the proximal phalanx over the metatarsal head. The traditional etiology of instability of the lesser MTP joints in the sagittal and/or transverse plane is described in the literature by plantar plate degeneration and rupture [6, 7]. Alternative causes described in literature include attenuation of the collateral ligaments and the deep transverse metatarsal ligament, and capsular degeneration [8, 9]. The first choice in treating instability of the MTP joints is conservative treatment and is accomplished with shoe wear modifications, metatarsal pads, and custom-made orthoses . Operative treatment may consist of an indirect reconstruction of the MTP joint in which the toe is realigned without reconstruction of the plantar plate [6, 10]. Lately, studies were published in which a direct repair of the plantar plate is reported [6, 11–13]. To be able to determine the best treatment of metatarsalgia it is paramount to know the anatomy (normal and pathologic) of the MTP joints. In recent publications the anatomy of the plantar plate is described. However, only a few authors addressed the relationship between plantar plate integrity and stability. Furthermore, no systematic review on the anatomy and mechanics of the plantar plate has been published. The biomechanics of the first MTP joint are different from the lesser toes. This difference is caused by anatomical differences e.g. the sesamoids, the abductor and adductor muscles, the position in the foot and a larger metatarsal head. Therefore, only articles concerning the lesser MTP joints were included.
The present systematic review has two objectives. Firstly, it assesses and elucidates the published literature regarding the anatomy of the plantar plate of the lesser toes. Secondly, it reviews the literature about the relationship between the integrity of the lesser plantar plates and MTP joint stability.
The databases of Embase.com, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed (recent articles, not yet indexed by medline), Cinahl (Ebscohost), ProQuest, Lilacs, Scielo and Google Scholar were searched from inception until June 2015. The literature search was designed by an experienced biomedical information specialist (WB). The search combined synonyms for: plantar plate with synonyms for injury, or rupture, and terms for joint, or metatarsalgia. When available, thesaurus terms were used (such as Mesh in medline, and Emtree in Embase) and combined with words in title and/or abstract. An overview of the complete electronic search for all databases is shown in Additional file 1.
Two review authors (NM and MG) independently screened the citations from the searches, and decided which full text articles should be retrieved. They then independently applied inclusion and exclusion criteria resolving any differences in opinion through discussion. Articles met the inclusion criteria if they were in English, contained primary data, and had a focus on the anatomy of the plantar plate of the lesser toes and/or metatarsophalangeal joint (in)stability of the lesser toes.
Additional citation tracking was performed by manual screening of the reference lists of the eligible studies. A third author (GJK) was available to ultimately decide whether a study should be included or excluded if agreement could not be reached. For exclusion criteria, see Results section (Fig. 1).
Outcome data for each included study were extracted by NM. As a result of a lack of pre-tested data forms or quality criteria for reviewing studies performed on anatomic specimens, we did not perform a quality assessment for the anatomical studies. Data are summarized in Table 1 (detailed version in Appendix 1) and Table 2 (detailed version in Appendix 2), and visualized into a schematic drawing (Fig. 2).
Referring to Johnston et al.
Measure dorsal displacement of the proximal phalanx, to determine the anatomical restraints to dislocate the 2nd MTPJ.
Mean force required to dislocate the toe, after division of, PP: 26 N; both collateral ligaments: 20 N. Division of PP + collateral ligaments created an unstable joint dislocating at 8 N.
Plantar plate and the collateral ligaments are the main stabilizers of the MTPJ.
Measure total distraction of metatarsal head and proximal phalanx base, to elucidate the necessary dissection for best plantar plate exposure.
Dorsal capsulotomy of the 2nd MTP joint with collateral ligament release off of the proximal phalanx base, combined with a subcapital oblique metatarsal osteotomy provided an average 8–8.5 mm exposure.
Plantar plate exposure is best obtained by releasing collateral ligaments off of proximal phalanx with a subcapital oblique osteotomy.
Measure and compare dorsal displacement of the proximal phalanx, whilst isolated and combined sectioning of PP and surrounding structures.
Plantar plate is main isolated restraint for dorsal MTP joint translation.
Compare intact sagittal plane stability (superior subluxation, dorsiflexion, plantarflexion) of lesser MTP joint of the 2nd, 3rd and 4th toes, and to quantify the role of PP for controlling sagittal plane stability.
PP contributes significantly to sagittal plane stability of the lesser MTP joints.
The initial search yielded 495 records. After removing duplicates, 234 articles were screened based on title and abstract. Full text articles of thirty-two studies were retrieved. Nine studies were included, of which five addressed plantar plate anatomy as such and four focused directly and indirectly on plantar plate integrity related to MTP joint stability. Additional citation tracking resulted in no relevant articles to be included and for study selection, agreement was reached by NM & MG, therefore a decisive role for GJK was unnecessary. The study selection is visualized with a flow diagram (Fig. 1) also containing the exclusion criteria.
The plantar plate is a broad ribbon-like disc, firm but flexible, with a form ranging from rectangular to trapezoidal [8, 14]. Its plantar surface is smooth, and grooved at its outer borders to provide a gliding plane for the flexor tendons [8, 15]. Its vessels appear to enter peripherally, mainly plantarly, and are part of the loose connective tissue septae (endotenon) that surround the collagen fascicles .
The periosteum of the metatarsal shaft is the origin of the plantar plate. Although Johnston et al.  states that the portion of plantar plate that lies just below metatarsal head is both thicker and broader than the distal attachment; others, report the origin of the plantar plate to be thin, fibrous and of synovial type . Moreover, the strength and thickness of the origin was found greater at the periphery . The plantar plate has its insertion firmly and directly into bone on the plantar surface of the proximal phalanx. This seems to be the strongest attachment, with the full thickness of the plate inserting into the bone [6, 8]. The enthesis reveals longitudinal and interwoven collagen bundles entering the proximal phalanx with multiple interdigitations . The distinct thickening of the tendon sheath is adherent or invested into the borders of the plantar plate and represents a flexor tendon pulley .
The thickest portion of the plate was its midportion distal to its metatarsal origin and proximal to the phalangeal insertion. At the phalangeal base, the borders are thicker than centrally; proximal to the phalangeal base there is little difference between the thickness at the borders and the central portion .
Bright-field microscopic evaluation showed the plantar aspect of the plantar plate to have a rather distinct cartilage matrix. However it becomes more ligament-like the further it distally tapers, containing fewer chondrocytes and a greater abundance of fibroblasts. Therefore, it is mostly known as fibrocartilage . From immuno-histochemical examination, the collagen was identified as primarily type I, the same type and composition found in other fibrocartilage structures like the meniscus in the knee and the annulus fibrosis of the intervertebral disc of the spine [8, 15]. No elastin fibers were found by Deland et. , however small concentrations of elastin (stains black in elastin stain) were found by Johnston et al. .
Collagen bundles both in the central and peripheral part, were in the region of 20 μm thick . In polarized light, they are oriented longitudinally in the dorsal two thirds of the plate, as visualized in Fig. 2 . In the plantar one third, the fibers were oriented transversely at the level of the deep transverse metatarsal ligament (DTML) and were continuous with it, merging with the collateral ligaments .
The plantar plate functions as the insertion point of tendons, ligaments, and stabilizing structures. The DTML is attached to the medial and lateral borders of the plantar plate. The flexor digitorum longus and brevis tendons lie in their sheath plantar to the plantar plate. The four lumbrical muscles arise from the medial border of the flexor digitorum longus tendons and insert to the medial side of the proximal phalanx on the plantar surface and insert into the distal plantar aspect of the plantar plate. The tendons of the plantar interossei muscles lie just dorsal to the DTML and run a course adjacent to the plantar plate, with some fibers of the interossei inserting directly into the plantar plate. The flexor digiti minimi brevis and abductor digiti minimi tendons both insert on the plantar aspect of the fifth toe on the fibular side just distal to the plantar plate. Some fibers of these tendons insert into the plantar plate .
Interestingly, Deland et al.  found a ligamentous band distinct from the plate or collateral ligaments at the plate's insertion. This band originated from the distal lateral portion of the plate and inserted onto a tubercle at the lateral-plantar portion of the proximal phalanx. The location of its insertion on the proximal phalanx was superficial to the attachments of the collateral ligament and interosseous tendons. Its dimensions (mean length 3 to 4 mm and thickness less than 0.5 mm) showed it to be considerably smaller and less substantial than the plate or collateral ligaments.
With an intact plantar plate and normal MTP joint, the toes normally dorsiflex passively and the fat pad of the metatarsal head moves with the plantar plate to cover the head of the metatarsal as a shock-absorbing cushion. In the foot, dynamic stabilization is provided by the extrinsic and intrinsic musculature, where static stabilization is mainly provided by the plantar plate [14, 16]. When compared to normal joints, pathologic MTP joints will allow excessive dorsal translation of the proximal phalanx . Chronic injury to the plantar plate causes attritional and adaptive changes in the plantar plate (elongation, attenuation and eventually rupturing), capsule, ligaments, and intrinsic tendons, which results in dislocation and instability of the MTP joints [6, 16, 17]. With rupture of the plantar plate, the proximal phalanx assumes a dorsally subluxed position . Hereby the extensor tendons cannot extend the proximal and distal interphalangeal joints and over time the plantar plate and the flexor tendons tend to shift dorso-medially .
To date, in four studies the direct and indirect relation of plantar plate integrity and MTP joint stability was described (see Table 2). Bhatia et al.  and Suero et al.  used vertical forces measuring vertical translation. Cooper et al.  used horizontal measurement of total distraction of the metatarsal head and proximal phalanx base. Chalayon et al.  created a different test model. Instead of disarticulating the feet at the ankle and amputating the first and third toes, they dissected above the origin of the flexor digitorum longus tendon, permitting natural rotatory dorsiflexion testing or simulation of the clinical dorsal drawer test.
As Bhatia et al. and Chalayon mentioned, when vertical forces are applied in a static stabilization, this may not represent the dynamic forces produced during the normal motion of the MTP joint [16, 18]. Also Suero et al.  elucidates the role of each individual static stabilizing structure by sequentially sectioning structures and putting it to the vertical test. As a result, Bhatia et al., Suero et al. and Chalayon et al. conclude, the plantar plate and the collateral ligaments are the main stabilizers, with the plantar plate being the main restraint for dorsal MTP joint translation and significantly contributes to sagittal stability [5, 16, 18].
Recently the role of repair of lesions of the plantar plate in relation to MTP instability and metatarsalgia is subject of increased interest. When trying to find solutions for clinical problems, knowing the anatomy and its function is of uttermost importance. The subject of this systematic review is the anatomy of the plantar plate of the lesser toes and the relation between the integrity of the plantar plates of the lesser toes and MTP joint stability.
The plantar plate is a firm and flexible disc with a form, varying from rectangular to trapezoidal. The thickness ranges from 2 to 5 mm, the length from 16 to 23 mm, and the width 8 to 13 mm. Its plantar surface is smooth, and is grooved at its outer borders to provide a gliding plane for the flexor tendons. From the (histo-)anatomic information, and in according to Pauwel's theory of 'causal histogenesis' that collagen fibrils are always oriented in the direction of the greatest tension, one can draw three conclusions .
Firstly, the plantar insertional fibers withstand mostly tensile forces, by providing support to the windlass mechanism with the insertion of the plantar fascia [8, 14]. In addition, the dorsal-to-mid insertional fibers experience also tensile forces . Secondly, it withstands compressive loads acting as a cushion through its fibrocartilage structure.
Thirdly, it assists in MTP joint stability through its central location and attachments to many surrounding structures. Moreover, plantar plate injury or combined injuries to the plate, with the extensor hood and the collateral ligaments have shown to cause significant instability, just as the plantar plate has proven to be the most important isolated sagittal stabilizer of the MTP joint [5, 18]. With plantar plate injury, support is lost, contributing or leading to metatarsalgia.
In the context of current evidence, this is the first systematic review regarding plantar plate anatomy related to MTP joint stability of the lesser toes. To date the direct relation between plantar plate lesions and MTP joint instability is still controversial. It stands to reason that once a soft tissue structure, i.e. the collateral ligament or plantar plate undergoes attritional and adaptive changes due to chronic injury, it will in turn lead to deformation and attenuation, resulting in MTP joint instability and/or metatarsalgia [8, 14, 19]. The adaptive changes can be due to various causes, e.g. chronic hyperextension or chronic synovitis, eventually leading to loss of soft tissue balance .
In our opinion, at least, it is challenging to prove MTP joint instability to be caused directly by plantar plate injury, as MTP joint instability is not pathognomonic for plantar plate rupture.
This review showed that only Suero et al., Bhatia et al. and Chalayon et al. have demonstrated, in an in vitro anatomical study, that plantar plate injury in itself can cause MTP joint instability, as isolated or combined sectioning of the plantar plate showed significant instability [5, 16, 18]. Caution is advised when using this knowledge in cases with chronic instability, as a model was created simulating acute instability of the lesser toes, which cannot account for biological healing as may be seen in chronic situations . Although much is published regarding plantar plate repair techniques, scarce primary data regarding details of normal plantar plate anatomy of the lesser toes is available in cases of metatarsalgia or instability. Remarkably, only two studies have described the lesser plantar plate dimensions, of which one reference of Deland et al. (1995) was referred to as 'being checked' [8, 15]. Furthermore, only a few studies have addressed the relation of plantar plate injury and normal MTP joint mechanics and stability of the lesser toes [5, 6, 16, 18].
We attempted to conduct a quality assessment of the included studies, however, it was impracticable due to lack of pre-tested data forms or quality criteria for reviewing studies performed on anatomical specimen. Therefore, we could not perform a standardized critical appraisal. To improve future transparency and quality assessment, we recommend a guideline or quality criteria for reporting (biomechanical) anatomical studies.
We report no geographical or temporal constraints, and strived to minimize our source and publication bias. Only articles in English and published in databased literature were included, creating a scope bias. In addition to the existing literature, we recommend a study re-examining the anatomical dimensions in normal and pathological MTP-joints of the lesser toes, the incidence of plantar plate injury and the relationship between instability, plantar plate injury and metatarsalgia. Furthermore, we are interested in the relationship between a functional instable first ray and plantar plate injury. This can be a topic of further research.
This study shows the lack of primary data regarding plantar plate anatomy of the lesser toes and MTP joint stability. Nevertheless, we endeavoured to elucidate and clarify the importance of plantar plate anatomy and integrity, to provide the necessary building blocks for clinical practice and future research.
We would very much like to acknowledge the artwork of mr BJ Kompanje. His drawing helped much to visualize the complex data set extracted from the literature.
The literature search was designed by WB. NM & MG screened the citations from the searches, and decided which articles to be included with help of GJK, in case if agreement could not be reached. Outcome data were extracted by NM under supervision of GJK en MG. NM, MG, and GJK wrote and revised the manuscript. All authors read and approved the final manuscript.
Describing macro- and microscopic anatomy of the PP of the MTP- and PIP joints, and correlate with spontaneous lesser toe instability.
Paraffin embedded (on a microtome to 4 μm), stained with trichrome, hematoxylin and eosin, and elastin.
Detailed description about the PP, including dimensions, attachments and histology.
Dissection, removing entire ray en bloc.
Separate feet were sliced in transverse and sagittal planes.
Formalin fixed, paraffin embedded (cut at 5 μm thickness), stained with eosin and hematoxylin.
Dissecting a full crossover toe for a better understanding of the pathologic anatomy of a medial crossover toe.
Layer by layer dissection and comparing with opposite foot (with normally aligned 2nd MTP joint).
Develop a more complete understanding of the morphology of the PP and the junction between fibrocartilage and bone.
Dorsal soft tissues were removed adjacent to the MTP Joints and the extensor tendons severed. PP attachments were carefully severed.
10 % Formalin fixed, decalcified with EDTA and formic acid, paraffin (10 μm) embedded, stained with Masson's trichrome, haematoxylin, eosin and alcian blue.
Extirpation of the 2nd MT head, careful inspection of the PP and collateral ligaments of each joint.
Determine anatomical restraints to dislocation of the 2nd MTP joint and assess biomechanical efficacy for a common stabilizing technique.
Bionix 858, MTS systems Minneapolis, Minnesota.
Hindfoot was transfixed with an aluminum jig. A nylon block was secured to dorsum of the 2nd metatarsal and a K-wire passed transversely through the proximal phalanx.
Each load cycle was repeated 4x.
Vertical load, measuring dorsal displacement of the proximal phalanx.
5 N preload applied, followed by a constant vertical displacement of 2 mm/min.
The collateral ligaments and the PP are the main stabilizers of the MTP joint.
Elucidate the necessary dissection toe expose and potentially repair lesions of the PP trough a dorsal approach.
4 cm incision dorsal approach; extensor tendon z-tenotomy with dorsal capsulotomy.
(Horizontal) Measurement of total distraction of metatarsal head and proximal phalanx base.
After each step fluoroscopic and digital photography to determine amount of exposure of plantar plate gained by each step.
Dorsal capsulotomy of the 2nd MTP joint with collateral ligament release off of the proximal phalanx base, then combined with a subcapital oblique metatarsal osteotomy provided an average 8–8.5 mm exposure.
Little improvement of visualization of the plantar plate after use of theMcGlamry elevator for plantar release.
PP exposure is best obtained by releasing collateral ligaments off of proximal phalanx in combination with a subcapital oblique osteotomy.
Hypothesis: isolated sectioning of the PP would result in greater dorsal translation compared to isolated sectioning of the MCL, LCL, or EH, and that combined injury to two or more structures would result in greater dorsal translation compared to isolated PP injury.
Potted base of metatarsal attached to the piston of the load frame.
Vertical load, measuring dorsal translation of the proximal phalanx.
PP is main restraint for dorsal MTP joint translation.
Injury to the plantar plate or combined injuries to the plate, EH, MCL, LCL appear to cause significant instability, suggesting a more aggressive treatment.
Compare intact sagittal plane stability (superior subluxation, dorsiflexion, plantarflexion) of lesser MTP joints.
Quantify role of PP for sagittal plane stability.
-Delrin mounting plate, allowing unencumbered plantarflexion motion, secured to calcaneus and secured to 2.54 cm thick aluminum platform mounted to base plate of materials testing system. Two custom fixers designed and fabricated from ABS plastic using a rapid prototype machine; and aluminum wire, 18-gauge, drilled in bone and into fixer.
Each specimen was displaced to 80 % of determined physiological range, and load data were recorded at 100 % of full physiological motion for each motion axis.
Displacing with a 25-mm moment arm measured distally from the center of rotation of lesser MTPJ.
Plantarflexion: 0.42 ± 0.06 N/mm.
Data from this study indicated that PP significantly contributed to the sagittal plane stability of the lesser MTP joints.


Neil Howe, best-selling author and national speaker, is a renowned authority on generations in America. He gives readers and audiences powerful insights into who today's generation are, what motivates them as consumers and workers, and how they will shape our national future. He is a great choice for any forward-looking organization that wants to grasp the big picture. Howe's broadly cyclical perspective—oriented around familiar generational life stories—will put "the long term" into a stunning yet personal focus that will not soon be forgotten.
A historian, economist, and demographer, Howe is a founding partner of the consulting firm LifeCourse Associates. He is a marketing, personnel, and government affairs consultant to corporate and nonprofit clients, and has spoken and written extensively on the collective personalities of today's generations—who they are, what motivates them, and how they will shape America's future. He is also a recognized authority on global aging, long-term fiscal policy, and migration. His current titles include: Senior advisor to the Concord Coalition and senior associate to the Center for Strategic and International Studies (CSIS) in Washington, DC.
Howe and Strauss originally coined the term "Millennial Generation." Their fourth book, Millennials Rising (2000), has been widely quoted in the media for its insistence that today's new crop of teens and kids are very different from Generation X, and, on the whole, doing much better than most adults think. "Forget Generation X-and Y, for that matter," says The Washington Post, "The authors make short work of most media myths that shape our perceptions of kids these days." LifeCourse Associates has since released several application books on Millennials—including a Recruiting Millennials Handbook for the United States Army (2001), Millennials Go To College (2003, 2007), Millennials and the Pop Culture (2005), Millennials and K-12 Schools (2008), and Millennials in the Workplace (2010). Neil Howe's work with Millennials in colleges and in the military was recently featured by CBS' 60 MINUTES.
Previously, with Peter G. Peterson, Howe co-authored the book, On Borrowed Time (1989; reissued 2004), a pioneering call for budgetary reform. According to Harvard's Martin Feldstein, former Chairman of the President's Council on Economic Advisors, "This book should be read by everyone who wants to understand how government spending can be controlled."
Howe's articles have appeared in The Atlantic, The Washington Post, The New York Times, American Demographics, USA Weekend, and other national publications. He has drafted several Social Security reform plans and testified on entitlements many times before Congress. He has written extensively on budget policy and aging and on attitudes toward economic growth, social progress, and stewardship. He co-edits the "Facing Facts" faxletter for the Concord Coalition and co-authors numerous studies for CSIS, including the Global Aging Initiative's Aging Vulnerability Index and The Graying of the Middle Kingdom: The Economics and Demographics of Retirement Policy in China). In 2008, he co-authored, The Graying of the Great Powers, with Richard Jackson.
Howe grew up in California, received his BA at U.C. Berkeley, studied abroad in France and Germany, and later earned graduate degrees in economics (MA, 1978) and history (M.Phil., 1979) from Yale University.
America's New Direction. Everyone agrees that the mood across America is changing rapidly. We seem to be entering a new period of national urgency, and perhaps even global crisis, with new worries about financial collapse, nuclear proliferation, terrorism, and global instability. In his 1997 book, The Fourth Turning, Neil Howe predicted that this was just where America would be today. With his co-author, William Strauss, he uncovered a remarkable pattern in American history, a cycle of recurring eras driven by generational changes. Using this proven historical method, Howe offers a road map that truly explains where America is today—and, more importantly, where it is heading, from the economy and consumer tastes to politics and popular culture.
Generations In The Workplace. In today's typical business, Boomers, and Gen-X'ers have trouble understanding each other—and neither generation knows what to do about the rising young Millennials just coming out of school. Neil Howe explains how each of these generations look at work and life differently. Find out what the best companies are doing to unleash the potential of each generation and foster productive relationships between them.
Generational Marketing. Many companies have recognized the need to look beyond traditional demographic categories and understand the effect generational change has on the marketing industry. Neil Howe trace the life stories and characteristics of today's generations of consumers to help you understand what product styles and marketing messages work best for each.
Other topics include Generations and Global Perspectives, Generations and Social Trends, and Generations and Entertainment. In addition, Howe can customize his speech to specific industries.
Are You Born To Be Better Off Than Your Parents?


text:
Don't Eat Before Reading: The Stomach-Churning Story of How Kevin McCarthy and Marjorie Taylor Greene Became BFFs
Flush With Infrastructure Funding, Amtrak Readies New Trains
Kevin McCarthy,
Marjorie Taylor Greene,
One of the main subplots in Kevin McCarthy's drawn-out attempt to become Speaker of the House—which involved losing a humiliating 14 votes before he ultimately eked out a win—was Representative Marjorie Taylor Greene's decision to break with the Freedom Caucus to support his leadership bid. Greene's backing of McCarthy was surprisingly not only due to her fringe-right bona fides but because of her willingness to fight with her pals on the far right, including representatives Matt Gaetz and Lauren Boebert, whom she dubbed as "destructionists," and quarrel with Boebert in the Congressional bathrooms. Her ability to wield actual political influence was also a record-scratch moment given that less than two years prior, we'd learned that "MTG" was a QAnon proponent who'd endorsed the executions of Barack Obama and Nancy Pelosi; claimed school shootings were false flag operations; insisted there is no evidence a plane crashed into the Pentagon on 9/11; and blamed the California wildfires on Jewish laser beams. Following his leadership win, McCarthy rewarded Greene—who thinks Hillary Clinton had JFK Jr. killed because he was competition for her New York Senate seat—with plum assignments on the House Oversight and Homeland Security committees.
That someone with such unhinged ideas would have any type of power whatsoever is obviously extremely disturbing. But if you're hungry for something just as stomach-churning, consider the inside story of how Greene and McCarthy have spent the last two years becoming the absolute tightest of pals.
According to a report from The New York Times, the pair's relationship during Greene's first year in office followed a predictable pattern. "A controversy would erupt over an outrageous comment Ms. Greene had made, then Mr. McCarthy would summon her to deal with the matter privately" (for instance, the fact that she'd endorsed violent death threats against members of the opposing party). Greene, The Times notes, would joke to friends that she'd "been called to the principal's office." But while the congresswoman from Georgia initially believed that McCarthy wasn't in her corner, and that he'd indirectly helped Democrats strip her of her committee assignments, it quickly became clear that that was not the case.
Per The Times:
…even as she continued to traffic in offensive conspiracy theories and spoke at a white nationalist rally, Mr. McCarthy refused to punish her and often refrained from even criticizing her comments until pressed by reporters…And by early 2022, Ms. Greene had begun to believe that Mr. McCarthy was willing to go to bat for her. When her personal Twitter account was shut down for violating coronavirus misinformation policies, Ms. Greene raced to Mr. McCarthy's office in the Capitol and demanded that he get the social media platform to reinstate her account, according to a person familiar with the exchange.
And he did! According to The Times, "instead of telling Ms. Greene that he had no power to order a private company to change its content moderation policies, Mr. McCarthy directed his general counsel, Machalagh Carr, to appeal to Twitter executives. Over the next two months, Ms. Carr would spend hours on the phone with them arguing Ms. Greene's case, and even helped draft a formal appeal on her behalf." While the attempt was unsuccessful, the whole thing apparently "impressed Ms. Greene and revealed how far Mr. McCarthy was prepared to go to defend her." And remember: This is a woman whose electoral debut involved conspiracy theories about Jewish laser beams.
Later, Greene would reportedly learn from former representative Devin Nunes that McCarthy had yelled at Democrat Steny Hoyer for the party's decision to kick her off her committees and threatened to respond in kind when the GOP returned to power. That really ingratiated McCarthy to Greene, and after that, it was all bosom buddies, all the time.
Here's The Times again:
From then on, the two settled into a kind of symbiotic relationship, both feeding off what the other could provide. Ms. Greene began regularly visiting Mr. McCarthy, frequently dropping by his office, and he began inviting her to high-level policy discussions attended by senior Republicans and praising her contributions.
He was impressed not only by Ms. Greene's seemingly innate understanding of the impulses of the party's hard-right voters, but also by her prowess at building her own brand. He once remarked to allies with wonder at how Ms. Greene, as a freshman, was already known by a three-letter monogram: M.T.G. "She knows what she's doing," Mr. McCarthy marveled privately. "You've got A.O.C. and M.T.G."
As The Times notes, Greene's ability to get news outlets to shorten her name wowed McCarthy so much that he has basically given her free rein to dictate GOP policy. The lawmaker from California has adopted her opposition to vaccine mandates and Ukraine funding and heeded her call to investigate "the other side" of January 6. In return, she was "unflinching in her support" of his Speaker bid, "personally whipping votes on the House floor and strategizing on calls with [Donald] Trump."
And if you thought this friendship was gross before that, now's the time to pull out your barf bag:
Days after he won his gavel in a protracted fight with hard-right Republicans, Speaker Kevin McCarthy gushed to a friend about the ironclad bond he had developed with an unlikely ally in his battle for political survival, Representative Marjorie Taylor Greene of Georgia.
"I will never leave that woman," Mr. McCarthy, a California Republican, told the friend, who described the private conversation on the condition of anonymity. "I will always take care of her."
In a subsequent interview with The Times, McCarthy added: "If you're going to be in a fight, you want Marjorie in your foxhole. When she picks a fight, she's going to fight until the fight's over. She reminds me of my friends from high school, that we're going to stick together all the way through."
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text:
Posts tagged Teen Spirit
Which Avenger is gonna die
The Curse of La Llorona – Ignoring the eerie warning of a troubled mother suspected of child endangerment, a social worker and her own small kids are soon drawn into a frightening supernatural realm.
Breakthrough – When her 14-year-old son drowns in a lake, a faithful mother prays for him to come back from the brink of death and be healed.
Teen Spirit – Violet is a shy teenager who dreams of escaping her small town and pursuing her passion to sing. With the help of an unlikely mentor, she enters a local singing competition that will test her integrity, talent and ambition. Driven by a pop-fueled soundtrack, Teen Spirit is a visceral and stylish spin on the Cinderella story.
Daddy Issues – Maya, a queer pixie artist, meets and falls madly in love with her insta-crush: the sexually fluid fashionista, Jasmine. It's all gumdrops and fairytales until Maya discovers Jasmine's passionate relationship with a secret sugar daddy.
The Stratton Story – Star major league pitcher Monty Stratton loses a leg in a hunting accident, but becomes determined to leave the game on his own terms.
Field of Dreams – An Iowa corn farmer, hearing voices, interprets them as a command to build a baseball diamond in his fields; he does, and the 1919 Chicago White Sox come.
Red Scorpion – A Soviet Special Forces soldier is sent on a mission to infiltrate an African rebel army and assassinate its leader, but the war machine they trained starts to think for himself.
See You In the Morning – Three years after his divorce from his model-wife is the psychologist Larry Livingstone ready for a new commitment. He falls in love with the young widow Beth who has two children. But Beth and the children are still in mourning over their dead husband and father and Larry finds it a bit difficult to penetrate their reservations. Larry himself has to deal with his ex-wife and his love for his own two kids. Slowly both Beth and the children realise that they have to go on with their lives and that they have been giving a second chance.
Speed Zone – An illegal race that takes place over the United States and nothing will stop this bunch of racers except for the occasional cop or a damsel in distress. Jackie Chan's car is not in this one, but many new cars make up for that. Who will win? Who will crash? Who will not even finish? Sit down and buckle up for the ride of your life.
Checking Out – A famed stage actor reunites his family for a party, and plans to commit suicide after-wards, unless they are able to convince him not to.
Next Week: Avengers EndGame,
Undisputed Classic: The Crow
Breakthrough Checking Out Crissy Metz Daddy Issues Elle Fanning Field of Dreams Hail Satan? James Earl Jones Jeff Bridges Jeff Daniels Jimmy Stewart Kevin Costner Linda Cardelini See You In the Morning Speed Zone Teen Spirit The Avengers EndGame The Curse of La Llorona The Stratton Story Topher Grace Woody Harrelson
Bird Box, Blue Box & Naked Ninjas
Escape Room – Six strangers find themselves in circumstances beyond their control, and must use their wits to survive.
Bird Box – Five years after an ominous unseen presence drives most of society to suicide, a mother and her two children make a desperate bid to reach safety.
Roma – A story that chronicles a year in the life of a middle-class family's maid in Mexico City in the early 1970s.
Outlaw King – A true David vs. Goliath story of how the 14th century Scottish 'Outlaw King' Robert the Bruce used cunning and bravery to defeat the much larger and better equipped occupying English army.
Suspiria – A darkness swirls at the center of a world-renowned dance company, one that will engulf the artistic director, an ambitious young dancer, and a grieving psychotherapist. Some will succumb to the nightmare. Others will finally wake up.
Spider-Man: Into the Spider-Verse – Teen Miles Morales becomes Spider-Man of his reality, crossing his path with five counterparts from other dimensions to stop a threat for all realities.
Nothing This Week
Movie Fight: What are You Most Looking Forward to in 2019
Stranded – A young woman and her grandmother living in an isolated farmhouse are kidnapped by aliens.
Doin' Time On Planet Earth – Through a series of extraordinary circumstances, an eccentric teenager believes he may be the alien prince of a distant planet, ready to lead his brethren home.
The Girl in a Swing – A London art broker goes to Copenhagen where he requires the services of a secretary fluent in Danish, English, and German. He falls deeply in love with the woman, despite the fact that he knows virtually nothing about her.
Deep Space – An American satellite with a new biological weapon gets out of control and crashes onto US territory. A slimy monster emerges and manages to escape, killing everyone who crosses his path.
Born To Race – A race-car driver falls in love with a beautiful Italian automobile engineer who is travelling the NASCAR circuit to sell her controversial engine technology.
Sticky Fingers – Two girls try hard to find job as musicians. One of them play the cello and the other the violin. They have very little money, even to pay the rent. One day a friend (who is a drug dealer) ask them to keep a bag for some days.
Never Say Die – A couple end up running for their lives from South African hit-men and the Police.
Next Week: A Dog's Way Home, Replicas, The Upside
Alfonso Cuaron Andrea Thompson Bird Box Born to Race Charles Napier Chris Pine Dakota Johnson Deep Space Doin' Time on Planet Earth Escape Room George Wendt Happy Death Day 2U Helen Slater Ione Skye John Malkovich Joseph Bottoms Lisa Eilbacher Marla Heasley Maureen O'Sullivan Meg Tilly Melanie Mayron Never Say Die Nicholas Strouse Outlaw King Roma Sandra Bullock Sarah Paulson Spider-Man Spider-Man: Into the SpiderVerse Sticky Finger Stranded Suspiria Teen Spirit Temuera Morrison The Girl in the Swing


Thanksgiving jigsaw puzzle free online of sweet potato casserole at Thanksgiving dinner. Warm, toasted marshmallows cover the cinnamon sweet potatoes.
Usually have this at Thanksgiving if we stay home. Love it but I think we are going out for Thanksgiving this year.
Had those yesterday at our church dinner but the woman added nuts and dried cranberries. It was delicious. I made her a palm cross. Finally, I got my bluebird, 'sialia', our state bird. She is now busy building her nest, while her mate watches, some things never change.
I love sweet potato casserole...but I don't like marshmallow's on top. I make a pecan/brown sugar topping to put on before baking. Our family loves it!!!!! Nice puzzle...now I'm hungry!
I LOVE sweet potatoes at Thanksgiving time.
No one in my family ever liked the standard sweet potatoes with marshmallows. I finally found a recipe we all like: Layer 4 sliced swt potatoes, 2 tart apples (sliced into rings), and 1/2 C craisins (dried cranberries) in buttered dish. Sprinkle with mixture of 1/2 C Brown sugar, 1/2 t cinnamon, 3T butter. cover with foil & bake 30 min at 450 degrees.
Sounds yummy! Will have to try this, thanks!
Happy Thanksgiving to staff and all puzzlers.What a blessing to be 86 and still able to do puzzles, slow but that is ok. God bless.


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