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Posted inNews, Police, Public Safety
What San Diego Law Enforcement Is Up Against
by Catherine Green March 17, 2014 March 15, 2022
It's hard out here for a cop — or a health care worker or social service provider, for that matter.
Opiate use and mental health calls for service are both up in San Diego County, according to new studies from the San Diego Association of Governments. And data from The Urban Institute released this month shows San Diego had the largest underground drug economy, and the third largest combined black market (drugs, guns and sex) among eight major U.S. cities.
Here are some of the most troubling revelations from the studies.
• Ten percent of men booked into jail in San Diego County in 2012 tested positive for opiates (heroin, morphine, hydrocodone, hydromorphone and Codeine), up from 5 percent in 2002. Twelve percent of women booked tested positive in 2012, up from 6 percent ten years earlier.
• Twenty-six percent of adult arrestees reported having tried heroin, up from 17 percent in 2002. Of those who'd used in the last year, 79 percent said it was "very easy" or "easy" to get.
• Officials attributed an increase in heroin use to a rise in prescription painkiller abuse. "From interviews with people in jail," SANDAG director of criminal justice research Cynthia Burke said, "we learned that heroin is often used as a substitute for prescription opiates because it's relatively cheap and easy to obtain."
• And talk about a gateway drug: One in four arrestees who said they'd ever tried heroin reported using prescription opiates first. Just under two-thirds of these individuals said they switched to heroin because it was cheaper and more available.
• Four local law enforcement agencies reported 22,315 calls for mental health-related services (e.g., attempted suicides) in 2013, up from 14,442 in 2008. That's a somewhat steady increase of 55 percent in five years.
• A few factors could have contributed here, SANDAG pointed out:
While the exact reasons for these increases are difficult to determine, possible factors include limited resources from the state and the expectation that officers and deputies respond to mental health crises; an increase in Independent Living Facilities (ILFs) in some communities, which provide housing to individuals with mental health issues, but which are not licensed and managed by the state; stressful economic conditions; and the release of non-violent offenders from detention facilities who may have mental health issues.
The Sex Trade
• According to The Urban Institute's research, San Diego's sex trade brought in $97 million in 2007; beating out the drug trade ($96 million) and the gun trade ($48 million).
• The sizes of the sex and drugs markets decreased since 2003, when they were $124 million and $105 million, respectively. (The guns trade increased slightly, up from $46.6 million in 2003.)
• Gang involvement in sex trafficking and prostitution was on the rise for five of the cities studied. Of the eight cities surveyed, San Diego "has uncovered the most amount of gang involvement in the underground commercial sex economy":
According to one San Diego law enforcement agency, only 25 percent of the persons that they arrested for pimping were documented gang members. However, they believed the statistic should be closer to 80 percent, since many young men wear gang colors, are involved in violent acts, and make statements that they are gang members. Because they are not documented by the police as being part of a gang, they cannot be referred to as a documented gang member.
• A growing trend in day-to-day operations for pimps and sex trade pros: the use of refillable cash cards, most commonly Green Dot cards, to purchase online ads, hotel rooms and gas. They're considered cash, and the deposit is untraceable.
• One noteworthy bit from the institute's anecdotal data: how pimps spend their money. Transportation and housing made up the bulk of their expenditures. Criminals — they're just like us.
Tagged: black market, Drugs, Law Enforcement, SANDAG

redpajama_set_name: RedPajamaCommonCrawl


You will see the main historical sites, monuments, squares and markets of historical Palermo. After the visit of Palermo's Cathedral and Palatine Chapel, you will enjoy a typical and traditional Sicilian lunch.
This guided walking tour starts in front of the cruise port exit of Palermo, where the guide will welcome you in Sicily.
We will go on walking towards the Porta Carini, entrance to Capo market, representing today the largest and most active open air market in the sale of fish, meat, fruits and vegetables. In the interior of the market we visit the unique beautiful Baroque Church of the Immaculate Conception.
Passing all through the market to arrive to the Cathedral of Palermo, the most representative monument of the City, and after that a real must see: the Palatine Chapel, a unique jewel, all over the world, of Arab-Norman art and Heritage Unesco.
After the visit of Palatine Chapel, we go to our historical home passing through the hearth of Palermo, Via Vittorio Emanuele, Vigliena square and Pretoria Square, to visite the two old churches there located, and we go on to our location to enjoy our home made and delicious sicilian lunch. A selection of very good sicilian wines inluded!
Departure time: 10.00 AM (recommended), or corresponding with your cruise schedule. You can choose another departure time upon booking.


Video Games Tax Relief (VGTR) allows UK game developers to claim back 20% of their production costs. To be eligible for Video Games Tax Relief, the game must pass the BFI cultural test and your company must be responsible for the majority of the planning, designing, developing and testing of the game.
Be registered for Corporation Tax.
Be doing most of the planning, creating and testing of the game.
Be the only company that's making a VGTR claim for that particular game.
Have spent at least 25% of your core costs inside the EEA. VGTR doesn't count for concept design expenses or debugging once the game's finished.
Games for consoles, PC and mobile devices are all covered - but there are some restrictions, such as games designed only for advertising or gambling.
Tax credits if you're making a loss.
In essence we will be aiming to get you up to 25% of the development costs back as a benefit.
The rules for VGTR are pretty complex, and seem to be making a lot of people's heads spin, although our handy VGTR PDF Overview is always available for download should you need it.
The game's setting and characters.
How it represents British culture.
Where the game's development team and other staff are from.
One crucial thing to remember is that you can't claim VGTR and R&D Tax Relief against the same costs. That said, in some cases it's worth considering which of the two schemes would allow you to reclaim more. That's where RIFT R&D's expertise really kicks in.
There are a few hoops to jump through on your way to claiming your Video Game Tax Relief, with some information to pull together and some preparations to make. We'll do all the heavy lifting, , so you can get back to actually working on your games.
• Already been granted or in the process of receiving either interim or full BFI certification.
• Yet to apply for certification.
Qualifying conversation - A 30 minute conversation via Skype or phone to discuss the information provided, outline the process and agree costs. If you're happy with all that we'll ask you to sign an engagement letter and discuss timeframes.
BFI Certification - If you have not yet applied for your certificate, we can advise on this and take you through the process.
Information gathering - We will help you gather the necessary info and speak with your accountant.
Visit - We want to come and meet you and see the development so far. Knowing our client and understanding their project helps us write the report accurately.
Submission preparation - Now we do all of the taxing part of preparing everything and working with your accountant to send it to HMRC.
HMRC Follow-up - We'll work with your accountant to deal with any questions which may arise from HMRC on the submission. This should mean that you get your money as fast as possible.
Fees - We'll issue our invoice once the claim has been submitted, based on the predicted rebate for the client.
Ongoing consultancy - After the claim has been paid we then switch across to an advisory role where we can support you in making any subsequent claims and with any other projects you might have.
You can start to send invoices and figures to us throughout the year to start building your next claim in advance, making things as easy as possible.
On average we look at a timeframe of 4-5 weeks from enquiry to submission, however this depends on how quickly you can get us the necessary information.
Your year-end date also plays a significant part. If it's fast approaching, we might need to speed things up.
Helping you get the most from VGTR is exactly the kind of work RIFT R&D loves - and we're experts at it. We're the missing piece from the R&D puzzle you're solving, so phone on 01233 653008 or contact us now to get things moving.


Magis Home Accessories are a great way to inject a bit of designer flair into your home. Whether it's a decorative item or a practical necessity for your home, there's something for everyone.
Magis was founded in 1976 by Eugenio Perazza as a firm of designers that aimed to create lasting contemporary furniture. Working with such talent as Jasper Morrison Karim Rashid, Stefano Giovannoni, Marc Newson, Perezza gives them considerable free reign to create fresh, vivid designs and everyday objects with a focus on plastic and metal.


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direct and indirect retainers
CROSS-ARCH RECIPROCATION In the design of an RPD the force exerted by a direct retainer on one side of the arch should be … 1-Direct retainers. 3 INDIRECT RETAINRERS DEFINITION It is a part of a RPD which assists the direct retainers in preventing the displacement of distal extension denture bases by functioning through lever action on the opposite side of the fulcrum line (GPT) FUNCTIONS OF INDIRECT RETAINER … New Delhi: Jaypee Brothers Medical Publishers; 2008. It incorporates a mesial rest (R), proximal plate (P), and a horizontal retentive arm (H-RPH). Among the 3 dental designs evaluated, the RPI prosthesis demonstrated the lowest stress concentrations on the tissue supporting the tooth abutment and also provided wide mucosa-borne areas of support, thereby demonstrating a mechanical advantage and efficacy over the other designs evaluated. The equipoise removable restoration. The cast round RPA clasp. Compend Contin Educ Dent. Brudvik JS, Palacios R. Lingual retention and the elimination of the visible clasp arm. Designs for the major connector either plate the lingual surface of the abutment or, as in a lingual bar, leave that surface open. … Enhancement of saturation magnetization (Ms) was observed in comparison with previously reported results. 2004;52:453–9. J Prosthet Dent. Occlusion had achieved its desired occlusion scheme. Restoration of slightly infraoccluded premolars with ceramic onlays, Stewart's clinical removable partial prosthodontics, The equipoise removable restoration. © 2018 Springer Science+Business Media, LLC, part of Springer Nature. Low coercivity (Hc) and retentivity (Mr) indicate low loss in the samples. Geckili O, Sulun T. Restoration of slightly infraoccluded premolars with ceramic onlays. Removable partial dentures (RPD) are an effective and affordable treatment option for partial edentulism. Frank RP, Nicholls JI. The validity and usefulness of this testing method for future applications and testing protocols are shown. 1973;17:631–49. The conversion RPD optimizes, Background: Distal extension edentulism can affect the patient's ability to function as a dentate person. New materials that may be utilized for optimal esthetics are presented and techniques for contouring acrylic resin bases and tinting denture bases are described. attachments is lost. This case report. Parameters were compared between abutment teeth with direct and indirect retainers at all time-points. Gen Dent. J Prosthet Dent. Beam broadening rather than phase conjugation is shown to occur in this case, which is equivalent, upon retention of the wavefront curvature, to a narrowing of its radiation pattern. * If rests are held in their seats, rotation about an axis should occur, which activates the indirect retainers. Useful. SADJ. All rights reserved. The clasp assembly takes advantage of surveyed lingual undercuts to provide support, retention, and stability. However, the effect of a type of direct retainer … International Journal of Dental Sciences and Research. (J Esthet Restor Dent 19:247–255, 2007). While educational researchers have extensively studied the student-level correlates of retention and the consequences of retention for student achievement, little attention has been focused on identifying the factors that influence district retention, SBS reflection is studied in the case of focusing of radiation with a broad spectrum into the active medium. Six dental categories are presented that assist the dentist in choosing a variety of RPD design concepts that may be used to avoid metal display while still satisfying basic principles of RPDs. 2005;94:10–92. If the tooth is extracted the possibility of gaining direct retention with the use of clasps or, The retention ratio of a corporation in any period may be defined as the ratio of retained earnings to the sum of retained earnings and dividend payments. J Prosthodont. Both of these situations are adaptable to the lingual retentive clasp and are illustrated in this article. Eliason CM. A major part of the economic debate concerning the retention ratio has mirrored the debate surrounding the debt-to-equity ratio chosen by a firm. As clinically important as direct retainers, indirect retention (rests and minor connectors) and its principles to counteract the dislodgment of the RPD are also expressed. You've already flagged this Reply from Retainers Direct. In addition, the RPI clasp assembly which is used for the distal extension RPDs is explained in details. In removable partial denture fabrication, the patient's interest usually lies in the improvement of his or her esthetic appearance. Direct retainers Indirect retainers Definition Classification Principles of design Extracoronal retainers Types Definition Factors affecting types of indirect Requirements retainers 3. Indirect retainers help in accurately positioning a framework during a reline or rebase procedure, when the direct retainers and indirect retainers are in their proper position on the abutment teeth. The Wittig rearrangement of D-galactono-γ-lactone derived β-O-glycoside is shown to afford β-C-glycoside (retention product), a potentially useful intermediate for zaragozic acid synthesis. A flexible lingual clasp as an esthetic alternative: a clinical report. It is very important to get an ideal impression so Retainers direct can make a perfect model of your teeth. removable partial denture in both upper and lower arch. The data and results obtained from this study confirmed that the functional behavior of partial dental prostheses with supporting abutments and soft tissues are consistent with the conventional theories of design and clinical experience. The esthetic zone is defined and described, as are methods for recording it. Journal of Superconductivity and Novel Magnetism, ions by Ni ions. The stress distributions to the supporting abutments and soft tissue displacements of the designs tested were calculated and mechanically compared. The clasp assemblies act as the direct retainers of the RPDs without precision attachments. A mandibular bilateral distal-extension base removable partial denture was lifted from a model under standardized … Removable partial denture manual: 2011. With its mesial rest and special retentive arm design, it gives essentially the same kind of tooth release that the RPI clasp provides. Aesthetic clasp design for removable partial dentures: a literature review. The derivations were based on elementary principles without reference to the principle of variance additivity. 2014;112:972–80. Balvinder SS, Mittal D. An overview of removable partial denture. One set of retainers … © Springer International Publishing Switzerland 2016, http://removpros.dentistry.dal.ca/RemovSite/Manuals_files/RPD%20Manual%2011.pdf, Faculty of Dentistry, Istanbul University, https://doi.org/10.1007/978-3-319-20556-4_11. Design features such as metal clasps needed for the retention of RPDs can be very unsightly, creating an esthetic problem. However, changes in district leadership, local voters' ideology, and minority representation among district officials also had significant effects on retention levels. A direct retainer is any unit of a removable dental prosthesis that engages an abutment tooth or implant to resist displacement of the prosthesis away from basal seat tissue. Direct or Indirect Veneers If you would like to know more about direct or indirect veneers, call or click and schedule an appointment with my Downtown Portland Dental Practice. The twin flex clasp: an esthetic alternative. As clinically important as direct retainers, indirect retention (rests and minor connectors) and its principles to counteract the dislodgment of the RPD are also expressed. Nelson DR, von Gonten AS, Kelly Jr TW. These parameters were compared between abutment teeth with direct and indirect retainers at baseline, and after 6 and 18 months. From these models, Retainers Direct will fabricate beautiful, clear and comfortable retainers that fit intimately around your teeth. Canada: Quintessence Publishing; 2008. By contrast, the rearrangement of the D-xylonolactone-derived counterpart was found to violate the retention principle to yield an inversion product as the major product. Results: The delivered denture showed proper sitting of occlusal rest and cast clasp. pp 101-122 | Implant-supported removable partial dentures (ISRPDs) are an effective treatment for partially edentulous patients. The decision as to whether to retain or extract a single remaining natural tooth prior to the provision of dentures can be a difficult one. This is a preview of subscription content. St Louis: Mosby; 2011. An example comparing the efficiencies of two columns, one conical and the other composite was given. The glossary of prosthetic terms. ResearchGate has not been able to resolve any citations for this publication. Minor variation of (Ms) due to composition change can be explained on the basis of strengthening of A–B exchange interaction due to replacement of nonmagnetic Zn, A technique that uses a combined indirect-direct method for the fabrication of a crown under an existing removable partial denture clasp has been presented. Nakamura Y, Kanbara R, Ochiai KT, Tanaka Y. Fenestrated denture is a concept which preserves remaining teeth. Three different designs of distal extension removable partial dental prostheses were analyzed. properties from which formulae for special cases of practical interest were deduced. 1991;8:45–52. Samurai culture was both military and feudal culture. This technique includes surveying the refractory cast, which ensures optimal placement of the round clasp in relation to the height of contour. The direct retainer's ability to … 2012;36:31–4. Cite as. Dent Clin North Am. 2012;21:331–3. Data were analyzed by Friedman Test and Wilcoxon Test for all variables. 1990;21:221–3. The retention ratio is one factor in the decision concerning the optimal level of investment and the manner in which this investment is financed. Stewart's clinical removable partial prosthodontics. Our clear retainers are designed to keep your smile from getting out of line. Enhancement of Magnetization and Tailoring of Blocking Temperatures of Nano-Ni–Zn Ferrite Powder Syn... An indirect-direct method of crown fabrication for existing removable partial denture clasps, Fenestrated Denture: A Grace Option To Edentulous Patient. Trends Tech Contemp Dent Lab, The theory of composite chromatographic columns has been re-examined and general equations relating their efficiency to those of individual columns were derived. Aviv I, Ben-Ur Z, Cardash HS, Fatael H. RLS–the lingually retained clasp assembly for distal extension removable partial dentures. Everyone fit into the social pyramid where a leader had his trusted supporters under his command. C, With direct retainers at the fulcrum, the lifting force will depress one end of the beam and elevate the other end. Quintessence Int. Akers PE. Direct indirect retainer Sometimes the reciprocal arm of the direct retainer located anterior to the fulcrum line may also act as an indirect retainer In the maxillary arch where only anterior teeth remain, … A modification of the RPI clasp assembly is introduced. All direct retainers of an RPD should have the same amount of retention. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The related variable, the dividend payout ratio, is defined as the proportion of available, The treatment alternative described maximizes the benefit of remaining teeth while allowing simplified alteration of the prosthesis if abutments are lost during the life span of the removable partial denture (RPD). It is suggested that the phenomenon, Single-phase nano-Ni–Zn ferrite samples in the range of 6 to 75 nm were synthesized using microwave-assisted combustion method. The purpose of this comparative study was to evaluate the functional differences of 3 different partial removable dental prosthesis designs with 3-dimensional finite element analysis modeling and a simulated patient model incorporating known viscoelastic, nonlinear soft tissue properties. In this context, the position of the clasp on the tooth, clasp types, clasp material and alternative methods of retention are reviewed. 1. The circumferential-type retentive arm is easier to grasp for removal of the prosthesis. There are basically two main fulcrum lines to be considered in indirect … The design of clasp for a distal extension removable partial denture that helps preserve both the abutment teeth and the tissues of the edentulous ridge is described. Periodontal maintenance was recorded at 6, 18 and 48 months. 1955;5:208–14. Derived also, were general equations for the efficiency of columns with continuously varying diameters, HETP and other, Policies that mandate in-grade retention of low-performing students have become central components of standards-based reforms across the country. Not logged in The clasp assemblies act as the direct retainers of the RPDs without precision attachments. The RPA design has been discussed as an alternative to the RPI design. When properly used, the cast round clasp eliminates the need for blockout of the facial aspect of the terminal abutment normally required with the half-round clasp. 4-Indirect retainers. This article is the result of a literature study on aesthetic clasp design for the conventional RPD. This article reviews the concepts for creating lingual clasp arms that enhance the esthetic quality of prostheses. In this chapter, infrabulge and suprabulge of clasp assemblies used in RPD design are described with their specific features. A finite element evaluation of mechanical function for 3 distal extension partial dental prosthesis designs with a 3-dimensional nonlinear method for modeling soft tissue. 185.2.5.12. Methods: A Kennedy class I bilateral free end saddle edentulous arch in both upper and lower arch was rehabilitated with removable cast partial denture. Although published in reputable journals, the authors report that many articles published on this subject are of a descriptive nature and lack scientific evidence. The RPH clasp assembly: a simple alternative to traditional designs. 4th ed. The mechanical evaluation of the function of partial removable dental prostheses with 3-dimensional finite element modeling requires the accurate assessment and incorporation of soft tissue behavior.
Ath-anc20 Quietpoint Active Noise-cancelling On-ear Headphones, Qurbani Sweet In English, Impact Of Parental Mental Health On Parenting Capacity, Role And Reference Grammar, Arnaldo Pomodoro Sphere, Jbl Xtreme 2 Battery Life, Palmer Realty Group,


Does it disappear after delivery?
Back pain is a very common feature of pregnancy. It is estimated that 80% of all pregnant women will have some form of back pain.
It is caused by a variety of factors, the major one being of course the extra weight which must be carried around by the body during a pregnancy.
Backache in pregnancy can start as early as the first three months when the ligaments, which help to support the spine, begin to relax. This relaxation process is triggered by the changing hormonal levels of pregnancy and prepares the body for the developing bump! It usually results in mild back pain, which is relieved by gentle exercise and plenty of rest. Severe backache in the first three months of pregnancy may be a warning sign of an impending miscarriage and should always be reported to your GP.
In the middle three months of pregnancy, the relaxation of the ligaments around the spine will continue, and backache during this period is also caused by pressure from the growing baby and exaggerated curvature of the mother's spine.
Towards the end of pregnancy, persistent backache may herald the onset of labour.


Vehicle graphics are a high profile and cost-effective way to raise the profile of your brand.
Whether for one-off events, promotional or long term fleet branding, Vehicle Wraps allow a livery to be created with full colour, stunning designs, whilst also protecting the original paintwork.
We can apply a full or part wrap to any number of vehicles for both long and short-term solutions including van graphics, car graphics, truck graphics, boat names, crash repair, magnetic signs, to name but a few.
We have vast experience of designing, producing and fitting vehicle wraps to a wide range of vehicles. Having your vehicle branded is one of the most cost effective ways of advertising your company. At Fresh Display we will provide you with a design, produce the graphics and apply them to your vehicle. We are also happy to apply the graphics wherever your vehicle may be so there is no interruption to your day.
If you have had an accident in your vehicle the last thing you want to worry about is replacing the graphics. At Fresh Display we pride ourselves on being able to reproduce graphics so you would never know they were not the originals. We can match colours, typefaces, logos and a lot of the time apply the graphics at the repair shop.
Magnetic signs are the perfect solution if you want to advertise on your vehicle but want to be able to remove and replace the graphics to suit your needs.


A fun poncho that can be worn from fall to spring, keeps you warm from cool to surprisingly low temperatures. Appropriate from casual to dressy. No zippers or sleeves, just throw over your head and off you go. Easy to maintain, just throw in the washer, wrinkle free. Made from Polartec® fleece.


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Comics Syllabus 016 – Falynn Koch on Science Comics; Latino Comics Expo with Ricardo Padilla
By Paul Lai | September 26th, 2017
Posted in Podcasts | % Comments
Welcome to the Comics Syllabus podcast, where we read widely and we dig deep. Your host Paul, a literacy researcher and English teacher, sometimes partnering with comics critics, creators, and scholars and sometimes solo on the mic, introduces curious readers to a range of current and classic comics, and then engages in closer discussion and analysis of particular comics works.
[audio: http://feeds.soundcloud.com/stream/344068934-twoplai-016-science-comics-plagues-w-falynn-koch-and-latino-comics-expo-w-ricardo-padilla.mp3]
Or download the podcast episode here.
On this week's Comics Syllabus podcast, two super interesting guests! First, on our General Ed segment, we learn about the Latino Comics Expo ( http://www.latinocomicsexpo.com/ ) taking place November 11-12, 2017 at the Museum of Latin American Art in Long Beach, California, from one of its cofounders and executive director, Ricardo Padilla. We discuss the origins of the show, the community of creators and fans that LCX brings together, and Ricardo's own story as a convener of Latino creators. We mention Javier Hernandez's vital role in founding the Expo, Daniel Parada's ZOTZ at http://www.zotzcomic.com/, and many more awesome creators.
(At 27:50) Then, we are treated with a conversation with Falynn Koch ( http://www.falynnk.com/ ), cartoonist and illustrator, creator of two books in First Second :01's "Science Comics" series, the recent "Plagues: the Microscopic Battlefield" and last year's "Bats: Learning to Fly." Paul is joined (partly) by Cohost Kid to talk to Falynn Koch about how she turns informative science info into entertaining all-ages storytelling. Falynn talks about making improbable living things like bats, germs, and mythical creatures into fascinating characters, and how she went from running a food truck (award-winning Mac and Cheese!) to comics and illustration.
Finally, in the Discussion Section (1:11:40), some shout outs, comics studies and English Departments, and Paul's annoying verbal tics.
NEXT WEEK: 'The Wait List' with Sonny, and a close reading of "The Untold Legend of the Batman" written by Len Wein with art by John Byrne and Jim Aparo from DC Comics (1980), available in Tales of the Batman: Len Wein and other places (use your Googling skills to find it!)
Subscribe and follow the Comics Syllabus podcast on Apple Podcasts, Stitcher, or Soundcloud, or copy this RSS feed to your podcatcher: http://feeds.soundcloud.com/users/soundcloud:users:235183739/sounds.rss or you can find archives for this podcast (previously named "Study Comics with Paul") here: http://studycomics.club/
Join the discussion on the Comics Syllabus Facebook page: http://facebook.com/ComicsSyllabus or Follow Paul on Twitter: https://twitter.com/TwoPlai or leave your comments here on the showpage.
Comics Syllabus 211: Comics of the Decade
Comics Syllabus: 202 On "King of King Court" by Travis Dandro, plus NCBD Notes
Comics Syllabus 210: Favorite Graphic Novels of 2019
Comics Syllabus 015 – Poetry Comics w Paul K Tunis; Ignatz, Bianca Xunise, and "Your Black Friend" by Ben Passmore
//TAGS | Comics Syllabus
Paul Lai
Comics Syllabus 212: 'Carnival X' on Marvel's Dawn of X
By Paul Lai | Jan 28, 2020 | Podcasts
Or download the podcast episode here.This week, Johnny and Paul offer a perspective and critiques of the "Dawn of X" mutant titles from Marvel, drawing on theory of the "literary carnivalesque" from Mikhail Bakhtin to describe what's intriguing about the X-books in the wake of Jonathan Hickman's House of X/Powers of X relaunch. Our discussion […]
Or download the podcast episode here.What comics meant the most in the 2010s… to us, to comics, to the larger culture? "Saga"? "Ms. Marvel"? Raina Telgemeier's "Smile"? Paul and Johnny run through their list of the comics of the decade, the graphic novels, superhero books, independent or alternative comics that marked out the 2010s for […]
By Paul Lai | Dec 17, 2019 | Podcasts
Or download the podcast episode here.What graphic novels in 2019 stood out as the most significant, most soul-stirring, most thought-provoking, most artistically innovative?Co-hosts Paul and Johnny are excited to share the Comics Syllabus Podcast's favorite graphic novels of 2019. Listen as they chatter about the comics works and collections that they loved most this year.Johnny's […]


The city of Albany, NY has 8 major colleges and universities one can pursue their degrees in. the university with the highest number of students is the Excelsior College which is a private institution. It is then followed by SUNY Albany, College of Saint Rose and Albany College of Pharmacy.


But will Dave Jones make any more changes? It's suggested me may give young Aaron Ramsey a start. The teenage midfielder has just signed a full professional contract with City and could step in to replace McPhail. Another option is to drop Paul Parry back into midfield.
Michael Oakes will be in goal for the departed Kasper Schmeichel.
Will Dave Jones rest some of the squad? Darren Purse could do with a game in defence. Steve Thompson and Steve MacLean are both ready to start if Jones wanted to give Jimmy Floyd Hasselbaink a rest.
The squad is not deep but Jones must beware not to trim it too tight. Chasetown deserve the respect of a strong City side and the fans will expect a safe passage into round 4.


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DeVaughn Akoon-Purcell plays so hard he "sometimes scares both coaches"
By Christian Clark at Cox Pavilion July 9, 2018 4 Mins Read
LAS VEGAS — DeVaugh Akoon-Purcell caught the ball on the right side of the floor, charged downhill and crashed into a couple Milwaukee Bucks. The referee blew his whistle, and even though Akoon-Purcell earned a trip to the free throw line he still let out a manic yell after his shot didn't drop into the basket for a potential and-one.
The intensity in Akoon-Purcell's approach has been on display all week at Summer League. The former Illinois State Redbird, who last season played professionally in Denmark, followed up his 19-point performance Saturday with an 18-point game against the Bucks on Monday. He was Denver's second-leading scorer as it defeated Milwaukee 90-83 to move to 3-0 in Las Vegas.
"DeVaughn sometimes scares both coaches," Nuggets Summer League coach Jordi Fernandez joked. "He's been really good for us. He can handle (the ball) in the second side, and defensively he's awesome. I don't know if you guys remember, but he made a big mistake and had a turnover. He ran back and got it back. Those effort plays — it could be a four-point swing, and you end up scoring. Those are huge."
Denver NuggetsDeVaughn Akoon-PurcellMonte MorrisVlatko Cancar
Author Christian Clark
Christian Clark is an Arlington, Texas, native who covers the Denver Nuggets for BSN Denver. Education: I graduated from the Missouri School of Journalism in December 2014 with an emphasis in print and digital news. Career: My work has been featured in the Fort Worth-Star Telegram, The Oklahoman and Columbia Missourian, and online at TexasFootball.com and Denverite.com. I came aboard at BSN Denver in November 2017. Most memorable sports moment: Game 2 of the 2011 NBA Finals. The finest sports book I've ever read: Friday Night Lights by Buzz Bissinger. One sports movie I can't live without: Tin Cup, do not @ me Most memorable experience as a reporter: The quadruple-OT game between the Nuggets and Trail Blazers. The sport that started it all: Basketball. My sports-watching memories kick in with those early-2000s Dallas Mavericks teams. They had bad hair and scored a lot of points. Shout-out to Nellie Ball.
While the rest of the West retools Nuggets again double down on their "most valuable commodity"
BSN Nuggets Podcast: What would Denver's rotation look like if it includes Michael Porter Jr. next season?


Abstract Cyanobacteria are the primary colonizers and form a dominant component of soil photosynthetic communities in biological soil crusts. They are crucial in improving soil environments, namely accumulating soil carbon and nitrogen. Many classical studies have examined cyanobacterial diversity in desert crusts, but relatively few comprehensive molecular surveys have been conducted. We used 454 pyrosequencing of 16S rRNA to investigate cyanobacterial composition and distribution on regional scales in the Gurbantunggut Desert. The relationship between cyanobacterial distribution and environmental factors was also explored. A total of 24,973 cyanobacteria partial 16S rRNA gene sequences were obtained, and 507OTUs were selected, as most OTUs had very few reads. Among these, 347 OTU sequences were of cyanobacteria origin, belonging to Oscillatoriales, Nostocales, Chroococcales, and uncultured cyanobacterium clone, respectively. Microcoleus vaginatus, Chroococcidiopsis spp. and M. steenstrupii were the dominant species in most areas of the Gurbantunggut Desert. Compared with other desert, the Gurbantunggut Desert differed in the prominence of Chroococcidiopsis spp. and lack of Pseudanabaenales. Species composition and abundance of cyanobacteria also showed distinct variations. Soil texture, precipitation, and nutrients and salt levels affected cyanobacterial distribution. Increased precipitation was helpful in improving cyanobacterial diversity. A higher content of coarse sand promoted the colonization and growth of Oscillatoriales and some phylotypes of Chroococcales. The fine-textured soil with higher nutrients and salts supported more varied populations of cyanobacteria, namely some heterocystous cyanobacteria. The results suggested that the Gurbantunggut Desert was rich in cyanobacteria and that precipitation was a primary regulating factor for cyanobacterial composition on a regional scale.
GB/T 7714 Zhang, Bingchang,Li, Renhui,Xiao, Peng,et al. Cyanobacterial composition and spatial distribution based on pyrosequencing data in the Gurbantunggut Desert, Northwestern China[J]. JOURNAL OF BASIC MICROBIOLOGY,2016,56(3):308-320.
APA Zhang, Bingchang,Li, Renhui,Xiao, Peng,Su, Yangui,&Zhang, Yuanming.(2016).Cyanobacterial composition and spatial distribution based on pyrosequencing data in the Gurbantunggut Desert, Northwestern China.JOURNAL OF BASIC MICROBIOLOGY,56(3),308-320.
MLA Zhang, Bingchang,et al."Cyanobacterial composition and spatial distribution based on pyrosequencing data in the Gurbantunggut Desert, Northwestern China".JOURNAL OF BASIC MICROBIOLOGY 56.3(2016):308-320.


Walter McCarty has a message for the anonymous source in the St. Louis Post-Dispatch's column.
EVANSVILLE, Ind. — Walter McCarty has a message for the anonymous source in the St. Louis Post-Dispatch's column.
A few hours after the University of Evansville issued a statement concerning the allegation that it's to blame for Missouri's inability to gain an NCAA waiver for transfer Dru Smith, the first-year Purple Aces head coach also voiced his displeasure in a response to whomever tipped the Post-Dispatch.
McCarty is referring to junior transfers Sam Cunliffe (Kansas) and Art Labinowicz (Coastal Carolina), who will redshirt this upcoming season in accordance with NCAA rules. Freshman DeAndre Williams is also being forced to watch from the sideline after his eligibility was denied.
Those three are all potential impact players for the Aces.
Earlier on Wednesday, Missouri's athletic department essentially declined to comment on whether it acted on information provided by Smith or if it was an attempt to convince UE to support a different rationale.
Evansville Athletics Director Mark Spencer made it known that he and his department refused to corroborate information it deemed inaccurate.
UE provided details surrounding Missouri's attempt to secure a waiver. According to UE, Missouri's initial case to the NCAA was not that Smith transferred solely because of a coaching change, but that he was "run off" and not offered a scholarship and/or spot on the Aces' roster.
The Aces disagree and declined to verify that information.
Missouri's waiver attempt went unsuccessful. It is unknown whether the Tigers are still seeking an appeal.


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Looking for a new home in Granada Vista 3? It is a great time to buy real estate in Granada Vista 3 and our site is a great place to begin your search. You can check out Granada Vista 3 schools, market statistics, the latest listings and more. Whether you are a first-time home buyer or you are already familiar with the home buying process, you can be assured that you have the best tools and the perfect agent available to help with your Granada Vista 3 home search.
There are currently 2 Homes for sale in Granada Vista 3. The average price for Granada Vista 3 properties is $138,500which is 0% higher than all Homes within a 20 mile radius. The highest priced property in Granada Vista 3 is $165,000 while the lowest priced Home is listed at $112,000. Most of the properties available in Granada Vista 3 are Homes . Compared to last month, the average price of real estate in the area has gone up 100%.


Greetings from your friends in Israel! Our trip started off with a layover in London where we took a tour of Windsor castle and watched the changing of the guards. We even met Harry and Meghan! This just in – it was just Josh and Jonah in masks. We left London but Dougie and Morgan's luggage did not. In Poland we toured the pre-war Jewish ghettos and later visited Auschwitz-Birkenau which was an indescribable experience that ultimately brought us closer as a group. After a very emotional day, we all decided to lighten the mood and assign a spirit animal to each person. At the salt mines, Liv and Gefen decided to lick every wall and even a salt statue that we later found out was worth a small village.
On our flight to Israel, Heather and Toma surprised us with a Color War-style clue hunt that ended in us welcoming in our last-minute addition to the group: Matt Drooker! With a new group member and a new appreciation for Jewish life, we celebrated our first Shabbat in our Jerusalem hotel as we chanted the same prayers that you all are singing right now. We hope you all are enjoying your time at camp as much as we are in the holy land. As our tour guide said, "one person's choices can always make a difference." We challenge you all to carry this advice into your first week of camp as you embody the Jewish spirit and Micah philosophy.
See you all in 5 weeks!


a unique Hispanic population returned home. They came to unite with their friends and family who worked the mercury mines of Terlingua, Texas. And they returned to honor their ancestors in a moving celebration of the Day of the Dead.


So it is with a sigh of relief all round that I am taking my own identity back.
Hi, My name is Sam and I am one of S.A.L.V.E.'s Street Outreach Social Workers.
A post from Helen Huthwaite – Trustee, Co-founder and currently the owner of only 9 toe nails.


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C.K Akonnor to earn GH¢ 8,500 salary if he accepts Kotoko technical director job
Bright Gyamfi
Asante Kotoko have offered coach C.K Akonnor GH¢ 8,500 monthly salary after elevating him to the Technical Director role of the club.
Management of the club announced on Friday that the ex-Black Stars captain will be technical director of the club as they search a new coach for the club.
Akonnor is yet to accept the offer but the gaffer, who led the team to the Tier I Special Competition success is believed to be unhappy with the new role.
According to information gathered by GHANASoccernet.com, the 45-year old, who has 2-years left on his contract could leave the club despite the promotion.
Among the responsibilities of Akonnor as technical director will be to oversee the technical direction of both the junior and senior teams.
He is also expected to provide advice to the coaches of the team as well as represent the coaching department at management meets.
Asante Kotoko will represent Ghana in the CAF Champions League next season.
Below is the letter confirming his new salary:
2019 Africa Cup of Nations: Fuse ODG to perform at the closing ceremony of 2019 AFCON


This years UOCA Christmas luncheon will be Tuesday 12/06/16 at 11:00 am at the South Salt Lake City Columbus Center located at 2530 South 500 East Room 106 UOCA will be providing all food and beverages. This year will be a Burrito/Salad bar provided by the Costa Vida!
Thanks and we'll see you there!


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Celebrating Modern
International Women's Day may have been this weekend, but it's never too late to celebrate the achievements of women from around the world. From fighting for voting rights to becoming world leaders, women have been making their mark.
Throughout world history, women of all creeds and colors have come together to improve not only their rights, but society as a whole. They may have faced adversity, but they continued to fight for what is right to make our world a better place.
To continue celebrating and uplifting women around the world this Women's History Month, we take a look back at some important girl and women-led movements that have pushed our society forward.
Putting Our Environment First: Little Miss Flint and Greta Thunberg
With community resources like water being threatened, and climate change rapidly becoming a climate crisis, two young girls have taken it upon themselves to raise awareness and make a difference.
Amariyanna "Mari" Copeny, otherwise known as Little Miss Flint, has spent five years drawing attention to the water crisis in her hometown of Flint, Michigan. This fact is made even more impressive considering she is only 13 years old.
Her letter to President Barack Obama and continued community fundraising made headlines nationally and internationally. Copeny's activism has made a large difference not only in her home state, but has inspired other young people to improve the world around them.
Greta Thunberg may be viewed as controversial and radical by some, but she has made the climate a hot button issue for members of Generation Z. By 17 years old, Thunberg has sailed alone across the Atlantic Ocean, made speeches at conferences like Davos and the United Nations Climate Action Summit, and has led global protests about the climate crisis. Not bad for someone still in high school.
Championing Education for All: Malala Yousafzai and Girls Who Code
For many decades, a formal education was not something women could hope to attain. Unfortunately, there are some parts of the world where this is still true. Thanks to the brave efforts of strong women working together worldwide, a proper education has been made more accessible.
The name Malala Yousafzai is internationally recognized, and for good reason. She is the youngest Nobel Prize laureate in history, but more importantly, she made women's education a global issue.
She started to make headlines as a teenager after a documentary about her life under Taliban occupation in Pakistan. Angered by her activism, the Taliban targeted her in an assassination attempt.
Thankfully, Yousafzai survived, and has continued to use her rising platform to be a voice for women's education and other social issues affecting the underprivileged around the world.
Women's education is not only a problem abroad, but in the United States as well. There are many that believe that girls and women are suited for certain skills, which automatically disqualifies them from others. For example, as of 2015, only 18% of computer science degrees were attained by women.
Girls Who Code has been working to fix that. This nonprofit organization was started in 2012 and has steadily grown in numbers. It works with young girls (and boys) to develop their computer skills so they can feel more confident about their ability to perform in computer science fields
Fighting for a Safer Country: 9M Movement
Not every woman feels safe doing routine activities their male counterparts don't think twice about: walking alone on the street, ordering a ride share, or even dressing in the clothes that they like.
These unfortunate problems led to a nationwide protest in Mexico in 2020. The 9M protest, also known as The Day Without Women, was coordinated by women throughout the country the day after International Women's Day. Offices, classrooms, and streets were noticeably empty in Mexico as the women of its 32 states joined together to say "enough is enough".
The protest drew international attention, and put a sharp focus on the issues facing women within the country. It was a powerful statement that put even more pressure on the country's leaders to enact change.
While there are still many issues that women have to deal with on a daily basis, there are even more women willing to step up to the plate. Regardless of age or international fame, the women in our lives are blazing paths for those that will follow them, and continue to build a better tomorrow for the rest of us.
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Govt's reform push may have hit a wall
5 min read . Updated: 08 Dec 2011, 10:24 AM IST Liz Mathew, Sapna Agarwal & Asit Ranjan Mishra
Govt's reform push may have hit a wall
FDIIndiaPoliticsRetailParliamentOppositionSupermarketWest BengalEconomy and PoliticsPolitical Economy
New Delhi/Mumbai: Signalling its political vulnerability, the Congress-led United Progressive Alliance (UPA) on Wednesday suspended its decision to open up domestic retail to foreign investment.
The setback comes on the eve of a crucial ruling on home minister P. Chidambaram by a Central Bureau of Investigation court into the allocation of second-generation telecom spectrum.
The decision, which sent out adverse signals to foreign investors, has also cast doubts on whether the UPA has the stomach to pursue much-needed policy change.
The episode has served to make clear the divisions among allies, further impeding any attempt at policy change. It also spotlights the government's political vulnerability and its low morale, having to go back on what it considered to be a showpiece reform.
The Indian government, which was forced to suspend the key economic liberalization measure in order to break a deadlock in Parliament, may find it difficult to get the reform agenda moving again, analysts said.
"The decision to permit 51% FDI (foreign direct investment) in multi-brand retail is suspended till a consensus is developed among various stakeholders," finance minister Pranab Mukherjee said in Parliament on Wednesday, explaining that the stakeholders include state chief ministers and political parties. "Without the chief ministers, it cannot be implemented."
The move has also put paid to any prospect of overseas retail companies entering India or picking up stakes in existing multi-brand ventures, at least until the government can find a more conducive political climate.
Also See | On the agenda (PDF)
An industry department official, speaking on condition of anonymity, indicated that the decision to raise FDI in single-brand retail to 100% from 51% stays. However, he added that since both single-brand and multi-brand FDI decisions were taken together by the cabinet on 24 November, it wasn't clear how and when the proposal could be implemented.
Political vulnerability
The government was forced to climb down after facing a barrage of criticism by the opposition, allies and even some Congress leaders, who said the move would put family-run small stores out of business and lead to job losses for millions of people who worked in the unorganized sector of the industry.
The winter session of Parliament was interrupted by protests since it began on 22 November, and these intensified after the cabinet decision two days later, leading to the halt of all proceedings. Proceedings resumed on Wednesday after a truce was called at an all-party meeting during which the UPA agreed to put on hold the decision on retail.
The reform process may resume after elections in Uttar Pradesh next year, said Balveer Arora, analyst and former head of Jawaharlal Nehru University's political science department. Once the polls are over, the Congress will be able to seek the support of the leading parties in the state for its policies.
Congress general secretary Rahul Gandhi, who has been struggling to revive the party's fortunes in Uttar Pradesh, has been on the offensive against the state's ruling Bahujan Samaj Party and the opposition Samajwadi Party at election rallies. Both parties extend issue-based support to Prime Minister Manmohan Singh's coalition government.
The suspension of the decision has damaged the image of Singh and the government, Laveesh Bhandari, director of Indicus Analytics, an economics research firm in New Delhi, told Bloomberg.
"It is very clear now that the reform process is over until we have a new government, a new prime minister," he said. "The government is so weak, they will give up on anything."
The government has listed two draft items of legislation for Parliament on Thursday. These are the Pension Fund Regulatory and Development Authority Bill and the Life Insurance Corp. of India (Amendment) Bill that seeks to corporatize the state-owned company. Both have been opposed by the main opposition, the Bharatiya Janata Party (BJP), and the Left parties.
Dinesh Trivedi, railway minister and member of key UPA partner Trinamool Congress, said: "No hasty attempt should be made to reintroduce the Bill. This is a big-ticket item and this needs to be talked about." The Trinamool Congress had sided with the opposition in resisting FDI in retail.
Separately, the cabinet on Wednesday cleared an Rs8,750 crore financial package for West Bengal's backward districts following a demand by Trinamool Congress leader and state chief minister Mamata Banerjee.
The BJP's Yashwant Sinha, a former finance minister, said the government should work on consensus rather than being confrontationist.
Buoyed by the government's move, the Communist Party of India-Marxist, or CPM, said it would demand an immediate ban on forward trading in all agriculture commodities, the rollback of petrol price increases and the release of excess foodgrain in government stocks. It also said the retail measure has been effectively scrapped.
"The decision will not be implemented. In future, whatever decision will be taken on the issue, it will be based on a consensus with all stakeholders," CPM leader Sitaram Yechury said.
The decision would send a negative signal to the international market, said Sudipto Mundle, emeritus professor at the National Institute of Public Finance and Policy. "This will severely affect the credibility of the government."
The suspension of the measure is a setback for those who back reforms, said Yes Bank Ltd chief economist Shubhada Rao.
"Perhaps this is something the government had not anticipated properly," she said. "I expect the government to take the consensus route for other reform areas. Now that Parliament has started functioning, I hope to see the pending key legislation debated and taken forward."
Congress spokesperson Renuka Chaudhary denied that reforms would come to halt.
"I do not have such pessimism. It's only a matter of negotiations and convincing allies. We have no concern or fear over the other initiatives, because the country will know who will stand for what," she said. "There is always a place for course correction. We learnt that we have to approach them differently. We can't sacrifice what is good for the country at the altar of short-sightedness."
Indian retailers such as Govind Shirkhande, managing director and chief executive officer, Shoppers Stop Ltd, said they will wait for a consensus to emerge.
Pantaloon Retail (India) Ltd, India's largest listed retail chain by revenue, said its plans remain on track. It is seeking to add 9 million sq. ft over the next three-four years to its existing footprint of 15.5-16 million sq. ft. The retailer had said previously that it would look at realigning its debt of Rs5,400 crore after the cabinet made the change on 24 November.
"We haven't yet initiated any talks with MNCs (multinational corporations) after the announcement. Our expansion plans remain on track as before the announcement," said a spokesperson for Future Group.
liz.m@livemint.
Views | Retail FDI: Evenly distributed shame
UPA morale at lowest, FDI in retail on hold
UPA hardens stance on FDI in retail


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Home » Decision Support in Medicine » Dermatology
Kieron Leslie
Are You Confident of the Diagnosis?
What you should be alert for in the history
Familial Mediterranean Fever (FMF) is a monogenetic autoinflammatory disease that is characterized by periodic fevers and multisystemic inflammation. The diagnosis is frequently made clinically in countries where the disease is relatively common, although additional genetic testing is useful for confirmation. The populations affected tend to originate from the Mediterranean, Middle East, and North Africa.
Patients present in childhood with episodic bouts of fever, typically accompanied by abdominal pain (peritonitis). These episodes tend to last from 1-3 days, although rarely may last longer. Attack frequency is variable, with some patients experiencing weekly episodes and others experiencing them much less frequently (less than one per year). Although most attacks seem to occur without an obvious precipitating factor, they may be associated with stress, strenuous physical activity, or menstruation.
As FMF affects serosal surfaces, pleuritis, pericarditis, and arthritis may also accompany attacks. The characteristic skin eruption (the so-called "erysipelas-like erythema" [ELE]) is a much less frequent manifestation of FMF, affecting 15%-40% of the populations surveyed. There are also other reports of urticaria, purpura, angioneurotic edema, Raynaud's phenomenon, pyoderma gangrenosum, and subcutaneous nodules.
Characteristic findings on physical examination
Physical examination during acute attacks reveals fever and, typically, abdominal tenderness, although patients may have frank peritonitis with guarding, rigidity, and rebound tenderness.
The musculoskeletal involvement is often monoarticular (frequently the large joints of the lower limb), presenting as an acute arthritis with erythema, warmth, tenderness, and swelling. ELE presents as tender warm erythematous well-demarcated plaques, usually on the lower legs or feet, as seen in Figure 1. These last for 2-3 days. Occasionally, boys can present with a unilateral tender scrotal swelling due to inflammation of the tunica vaginalis, which can clinically mimic torsion of the testis.
Erysipelas-like erythema (ELE), seen in a patient with familial Mediterranean fever.
Expected results of diagnostic studies
Genetic testing should confirm mutations in the MEFV gene (Mediterranean Fever). Histological examination of the rash (ELE) shows dermal edema with a mixed perivascular infiltrate.
ELE does not typically show vasculitic changes, although patients are at higher risk of getting purpura, independent of ELE. Synovial fluid is sterile with many neutrophils. Acute phase reactants such as C-reactive protein (CRP) and serum amyloid A (SAA) tend to be markedly elevated during an attack.
Diagnosis confirmation
Diagnosis is confirmed by genetic analysis. The differential diagnosis is wide when one considers recurrent fever of unknown origin; therefore, it is appropriate to consider occult infection or malignancy, or another inflammatory process, such as sarcoidosis. However, fever with recurrent serositis in a genetically susceptible population is highly suggestive of FMF.
Who is at Risk for Developing this Disease?
The disease is more prevalent among populations surrounding the Mediterranean Sea and the Middle East. It affects Turks, Armenians, Arabs, and non-Ashkenazi Jews. It has been estimated that the frequency is between 1:400-1:1000 in Turkey, 1:1000 in Israel, and 1:500 in Armenia. There have been no formal large-scale epidemiology studies to estimate worldwide prevalence, but probably fewer than 200,000 are affected.
What is the Cause of the Disease?
FMF is an autosomal recessive disorder, resulting from mutations in the MEFV gene. FMF carrier frequencies are extremely high in the eastern Mediterranean.
MEFV encodes a protein called pyrin. Wild-type pyrin appears to have an important role in the regulation of the pro-inflammatory pathways of the innate immune system. Critically, it appears to modify the interleukin-1 (IL-1) family of cytokines. When both copies of MEFV are mutated, this results in uncurbed inflammation, explaining the clinical phenotype.
Systemic Implications and Complications
SAA is an acute phase reactant that is elevated during attacks of FMF, but can also persist at elevated levels between attacks. This persistant elevation of SAA can lead to systemic amyloidosis (AA). Certain mutations in MEFV, such as p.M694V, p.M694I, or p.M680I, portend a worse prognosis and a greater risk for amyloidosis.
Environmental factors also have a role in the development of amyloidosis; it has been observed that Armenian FMF patients have a much higher incidence of amyloidoisis than Armenian patients in the United States. It has also been observed that Turkish patients in Turkey have a higher incidence of amyloidoisis than Turkish patients in Germany. The amyloidosis frequently manifests itself as renal deposition, leading to end-stage renal failure.
Evaluation of patients with regard to amyloidosis should be directed towards assessment of renal status, as this is the main sequelae of systemic amyloidosis. Where available, measurement of serum amyloid in the serum should be done regularly. This test is not commercially available in the United States; however, measurement of CRP at least gives an indication of levels of inflammation in the patient.
Urinalysis should be performed regularly to look for proteinuria. Assessment of renal function, such as blood urea nitrogen (BUN) and creatinine, is important, as is a 24-hour urine collection, to calculate creatinine clearance. Abnormal renal function should be evaluated by a nephrologist. Renal biopsy may show amyloid deposition.
Colchicine is indicated for both acute attacks and long-term maintenance. It is not completely understood why colchicine is an effective therapy for FMF, although it is thought to modulate microtubules in neutrophils, thereby preventing neutrophilic chemotaxis. It is extremely effective at preventing amyloidosis, which has now become much rarer in FMF.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for acute musculoskeletal pain.
Other therapies include interferon alpha, tumor necrosis factor blocking agents, and interleukin-1 blocking agents such as anakinra.
There is no specific treatment for the cutaneous manifestations of FMF.
Optimal Therapeutic Approach for this Disease
Typically, FMF patients are under the care of rheumatologists rather than dermatologists.
First-line therapy for FMF is colchicine. Dosing is 0.6mg or 0.5mg twice daily (depending on dosage form available). This is for long-term maintenance, to prevent acute attacks, and for the prevention of systemic amyloidosis.
As different populations with FMF have different relative risks for development of amyloidosis, it may be appropriate to target patients with high risk, such as Armenian patients in Armenia, Turkish patients, and North African Jews, For long-term therapy. or patients with much lower risk, such as Ashkenazi Jews and Armenians living in the United States, it may be appropriate to offer intermittent therapy, just to control acute attacks.
In patients for whom twice daily dosing is ineffective, the dosing frequency can be increased to three or four times daily, as tolerated by the patient. In cases recalcitrant to oral therapy, intravenous administration of colchicine (1mg per week) may be beneficial. Case reports have shown that interferon alpha, etanercept, infliximab, and anakinra may be helpful in patients who are intolerant of colchicine, or for whom it is ineffective.
Patients should be seen frequently when first diagnosed and when therapy is initiated. This typically would be every few weeks for the first couple of months. When patients are stabilized and attacks have become infrequent, follow-up frequency may be reduced to every 3-6 months.
Monitoring laboratory tests include complete blood count (CBC), renal function (including BUN and creatinine), liver function, CRP, and urinalysis (to check for presence of proteinuria). If patients have persistent inflammation, renal abnormalities, or proteinuria, they should be referred to nephrology.
Colchicine, either twice daily or intermittently for acute attacks, is the mainstay of therapy. Therapy should be altered if colchicine is not tolerated due to side effects (i.e. abdominal pain, nausea, vomiting, fatigue, headache, etc.). Rarely, bone marrow suppression, myopathy, rhabdomyolysis, nephrotoxicity, hepatotoxicity, or hypersensitivity reactions have been reported. Although colchicine is generally an effective therapy for FMF, other agents, such as interferon alpha, etanercept, and anakinra, have been reported to be helpful.
The key information that must be relayed to patients and families is that FMF is an autosomal recessive condition. Therefore, patients with FMF will pass on a mutated copy of the MEFV gene to offspring, but children will only be affected if they have also inherited a mutated MEFV gene from the other parent. It is important to emphasize that patients should be under regular follow-up, even if symptoms are well controlled, so that they can be monitored closely for any signs of amyloidosis.
The prognosis has become very good since the introduction of colchicine for FMF. Genetic testing is generally recommended for symptomatic individuals, rather than asymptomatic first-degree relatives. The key take-home message is that, since the introduction of colchicine, the prognosis for patients with FMF is excellent.
Unusual Clinical Scenarios to Consider in Patient Management
There is an association of Henoch-Schonlein purpura and polyarteritis nodosa with FMF. Also, Behçet's syndrome may be more common in FMF, although the same populations are at risk for both these diseases. It is very unusual for patients to have their first inflammatory episode in adulthood. There appears to be a clinical association between ankylosing spondylitis and FMF.
What is the Evidence?
Mor, A. "Familial Mediterranean fever successfully treated with etanercept". J Clin Rheumatol. vol. 13. 2007. pp. 38-40. (This paper is a case report of a patient responding to etanercept who was unable to tolerate colchicine for FMF.)
El-Shanti, H. "Familial Mediterranean fever in Arabs". Lancet. vol. 367. 2006. pp. 1016-24. (A review paper of FMF in Arabs.)
Barzilai, A. "Erysipelas-like erythema of familial Mediterranean fever: clinicopathologic correlation". J Am Acad Dermatol. vol. 42. 2000. pp. 791-5. (This paper is a clinicopathologic study of erysipelas-like erythema.)
Ben-Chetrit, E. "Familial Mediterranean fever in the world". Arthritis Rheum. vol. 61. 2009. pp. 1447-53. (An overview of the epidemiology of FMF.)
Yuksel, S. "Clinical improvement with infliximab in a child with amyloidosis secondary to familial Mediterranean fever". Rheumatology (Oxford). vol. 45. 2006. pp. 1307-8. (A case report of an FMF patient who was recalcitrant to colchicine but responded to regular infliximab infusions.)
Tunca, M. "Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study". Medicine (Baltimore). vol. 84. 2005. pp. 1-11. (Large cohort study from Turkey, describing genetics and clinical characteristics of patients.)
Meinzer, U. "Interleukin-1 targeting drugs in familial Mediterranean fever: a case series and a review of the literature". Semin Arthritis Rheum. 2011. (French study, reporting seven cases of FMF responding to IL-1 blocking therapy [anakinra and canakinumab])
Zadeh, N. "Diagnosis and management of familial Mediterranean fever: integrating medical genetics in a dedicated interdisciplinary clinic". Genet Med. vol. 13. 2011. pp. 263-9. (Review paper from an interdiscplinary clinic, describing the clinic's management approach,)
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Home»Management
Monitoring Mobile Devices in a Virtual Environment
Device management takes on new importance during a school year when remote and hybrid learning are the norm.
Dave Termunde remembers the day well.
It was a Friday in March, and Arbor Park School District No. 145 had just shut down because of the pandemic. His first order of business as the Illinois district's CTO involved distributing devices to students and teachers who needed them to continue learning or instructing from home. From there, he says, his focus turned to device management.
"Getting computers into people's hands is one thing, but you also need a way to support those assets — and to keep track of them wherever they go," he says.
At Arbor Park, students in grades one through eight are equipped with Surface Go tablets. Teachers use the same devices as their students. The good news: The majority of grades at the district's four schools had gone one-to-one with device deployments at the start of the academic year.
"So, the kids basically knew what they were doing, and we'd already done staff training on the whole Microsoft suite," Termunde says. His four-person IT team was also well prepared thanks to recent districtwide networking upgrades. And on the management front, they had several tools at their disposal, including the filtering solution Relay by Lightspeed Systems, the endpoint-support service Microsoft Intune and software that "lets us track everything from who has which device to when that device was purchased and where it happens to be at any time," Termunde explains.
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The district uses a feature called Insights in Microsoft Teams to crunch data on student digital engagement, such as remote student attendance. And with Intune, Termunde says, "we can do just about anything. We can push and pull software, we can lock devices, and if a computer goes missing, we can make it a brick."
On one occasion, Termunde says, someone stole a parent's car and took a Surface Go that had been left on the back seat. The student reported the incident to the school, and Termunde's team tracked the device to a nearby pawn shop.
"We have more than 1,300 computers out there, so this kind of thing happens once in a while," he says. Still, "things usually aren't that exciting, and that's because we run a pretty tight ship."
Off-Campus Device Management and Monitoring
Not all schools have had the same success with device management as those within Arbor Park School District 145. Another Illinois district, Chicago Public Schools, reported in late September that thousands of its students were "missing" — they had failed to log in to online classes since school started. In South Carolina, one district said it couldn't locate almost 4,000 laptops it had distributed to students for remote learning last spring. In a Florida school district, the story was the same: Computers valued at about $1.3 million were nowhere to be found just a few months after they were handed out.
It's true that even before the pandemic struck, one-to-one computing programs required regular updates and maintenance, and districts would sometimes lose devices to carelessness or burglaries. With remote and hybrid learning, off-campus device management and monitoring has become even more critical.
We can push and pull software, we can lock devices, and if a computer goes missing, we can make it a brick.
Dave Termunde CTO, Arbor Park School District No. 145
"You can't do this without mobile device management software," says Dannielle Lord, technology director at Mooresville Graded School District in North Carolina. Mooresville is one-to-one, with around 6,000 Apple devices currently in circulation. Like many districts around the country, Mooresville administrators shuttered school buildings because of the pandemic. Then, in the fall, as infection rates declined, students in grades six through 12 remained fully remote while those in kindergarten through grade 5 eventually returned for in-person classes. The district had established a call-in technology service desk earlier in 2020, and now the IT team depends on FileWave, an endpoint management solution, for everything from device provisioning to patch management and remote repair.
"It allows us to communicate with all devices no matter where they are, whether they're on our network or off," Lord says.
Communication and collaboration between Mooresville teachers and offsite students are facilitated through Google Apps for Education, Lord says. Google Workspace (formerly G Suite) includes security and administrative controls and provides reporting on user activity. To track student attendance and the completion of class assignments, teachers turn to the district's learning management system. On the rare occasion when a computer isn't returned when it should be, IT staff can use an endpoint management solution to "take control of that device and put it in a state where it's not functioning," Lord says.
READ MORE: How IT teams can better manage devices for remote learning.
Tackling Management Hurdles with the Right Tech Tools
Longtime CTO Mark Finstrom says he never gave much thought to the need for a district IT team to remotely take control of a student's laptop prior to the last school year.
"Our management challenges really changed in 2020," says Finstrom, who has spent 15 years as CTO at Highline Public Schools in Burien, Wash. "You really have to approach things differently when you decide to allow students to take their devices home."
Finstrom says his technology services department is managing about 23,000 devices across Highline's 33 schools. The district enrolls more than 18,000 pre-K–12 students, with older students mostly using Chromebooks and younger learners working on iPads. Most teachers and staff work on Windows devices, which Finstrom and his team manage through Microsoft Intune.
The percentage of U.S. educators who say their schools use Google Chromebooks
Source: Source: kajeet.net, "Student Tech Devices in the Classroom," Nov. 24, 2020
Finstrom and his colleagues rely on the Google Admin console and a toolkit from Amplified IT consultants to manage the district's offsite Chromebooks. Teachers control virtual classrooms with the help of GoGuardian classroom management software, which also provides filtering when students are online.
"With all three of those tools, I can push things down to the device," Finstrom says. "And the Chrome OS makes management fairly easy. As long as they're enrolled in our environment, they get whatever image we put into the cloud."
Finstrom and his team manage their Apple devices with Jamf, a tool that he says provides essentially the same controls they have over their Chromebooks. "We can send out any package we need to send out, and we can do individual devices or all devices, and we can reset the device if that's what we want to do," he says.
If tackling remote management from so many directions — and getting the job done with so many solutions — sounds like a recipe for a harried IT department, Finstrom says nothing could be further from the truth.
"My team has spent a lot of time on this and on getting it right," he says. "The biggest thing now is, everything is working — and that's exactly what we want."
Illustration by Taylor Callery
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Opinions & Orders – February 5, 2022
This morning the Federal Circuit issued a nonprecedential opinion in an employment case appealed from the Merit Systems Protection Board. The opinion addresses issues related to the jurisdiction of the MSPB. The court also issued four Rule 36 judgments. Here is the introduction to the opinion and links to the Rule 36 judgments.
Recent News on the Federal Circuit
Justices Craft Their Own Remedy for Violation of Constitution's Appointments Clause – George Quillin and Jeanne Gills post to SCOTUSblog about the Supreme Court's decision this week in United States v. Arthrex.
Yu v. Apple Settles It: The CAFC is Suffering from a Prolonged Version of Alice in Wonderland Syndrome – Gene Quinn reports on IPWatchDog that "the Federal Circuit seems to be dealing with an exceptionally prolonged and worsening version of Alice in Wonderland syndrome."
Amarin Rebuffed in High Court Bid to Revive Vascepa Patents – Susan Decker and Greg Stohr report for Bloomberg that the Supreme Court "declined to consider a bid by Amarin Corp. to revive six patents on the heart medicine Vascepa."
Supreme Court Rebuffs Cost-Sharing Reduction Payment Appeal; $20 Million For State-Based Marketplaces – On HealthAffairs.org, Katie Keith notes "that two August decisions by a three-judge panel of the Court of Appeals for the Federal Circuit will stand."
Here is an update on recent activity at the Supreme Court in cases decided by the Federal Circuit. The last week has been a busy one. As for granted cases, this week the Court decided United States v. Arthrex, Inc., agreeing with the Federal Circuit that the America Invents Act created an Appointments Clause violation with respect to the appointment and supervision of Administrative Patent Judges in inter partes review proceedings. As for petition cases:
three new petitions were filed in patent law, Tucker Act, and pro se cases;
two respondents filed briefs in opposition in vaccine and government contract cases;
a respondent filed a brief in support of a petition in a patent case;
a reply brief was submitted in supported of a petition in a patent case;
the government filed waivers of right to respond in a tax case and a pro se case;
a petitioner in a patent case filed a motion to dismiss; and
the Court dismissed thirteen petitions.
By Keith Robinson on February 25, 2021
The Court received new reply briefs in two cases that have been granted certiorari: (1) Minerva Surgical, Inc. v. Hologic, Inc. and (2) United States v. Arthrex, Inc.
One new response brief was filed with the Court in Argentum Pharmaceuticals LLC v. Novartis Pharmaceuticals Corporation.
One new amicus brief was filed by a non-profit advocacy organization, US Inventor, Inc., in the new case Amarin Pharma, Inc. v. Hikma Pharmaceuticals USA Inc.
Hikma filed a waiver of its right to respond to the petition in Amarin Pharma, Inc. v. Hikma Pharmaceuticals USA Inc.
Lastly, the Court denied the petitions for writ of certiorari in six cases.
By David Taylor on November 11, 2020
Here is an update on recent en banc activity at the Federal Circuit. As for granted petitions, a new brief was filed in one of the two pending veterans cases. As for pending petitions, highlights include two new petitions, one in a patent case raising questions related to claim construction and one in a pro se case; and the denial of four petitions in patent cases raising questions related to obviousness, prosecution history estoppel, vitiation, reasonable royalties, and sanctions. Here are the details.
By David Taylor on October 28, 2020
Here is an update on recent en banc activity at the Federal Circuit. An amended petition was filed in a veterans case recently argued before the en banc court. As for pending en banc petitions in patent cases, highlights include new responses to petitions raising questions related to claim preclusion and sanctions; a new amicus brief filed in a case raising a question related to obviousness; and the denial of three petitions raising questions related to remedies, issue and claim preclusion, jurisdiction in inter partes review, and alleged due process and takings violations in inter partes review. Here are the details.
By David Taylor on October 7, 2020
Here is an update on recent en banc activity at the Federal Circuit. This week the en banc court will hear arguments in a veterans case. Late last week a supplemental reply brief was filed in that case. As for new petitions for en banc consideration, two were filed in patent cases raising various questions related to the doctrine of equivalents, prosecution history estoppel, vitiation, reasonable royalties, and obviousness. With respect previously-filed petitions, a new response was filed asking the court to reject a petition questioning whether whether a party who is not a patentee may sue for patent infringement. In addition, the court denied four petitions in patent cases raising questions related to mandamus jurisdiction over real-party-in-interest determinations, double patenting, transfer of venue, and claim construction. Here are the details.