text:
/*
 * area.cpp
 *
 *  Created on: Nov 7, 2012
 *      Author: Bernhard Strauss
 *      		Bloodnamed
 */

#include "area.h"

#include <cmath>
#include <cstdlib>

/**
 * Default constructor.  Should really never be called. So it shouldn't be callable to protect class invariant.
 */

/**
 * Main area constructor.  Sets the type.
 */
area::area(int x, int y, areatype::a_type ty, areagen& ag) :
	height(y), width(x), type(ty), agen(ag), topCons(width), botCons(width), leftCons(height),
	rightCons(height), numUDCons(2)
{

	for (int i = 0; i < 2; ++i) {
		upCons.push_back(std::vector<int>(1)); // push back vector of int of size 1
		downCons.push_back(std::vector<int>(1)); // push back vector of int of size 1
	}
	//stairLocs[x][n], stairLocs[y][n]

	//test default connections init
	topCons[width/2] = 1;
	botCons[width/2] = 1;
	leftCons[height/2] = 1;
	rightCons[height/2] = 1;
	numUDCons[0] = 1;
	numUDCons[1] = 1;
	upCons[0][0] = 5;
	upCons[1][0] = 10;
	downCons[0][0] = 15;
	downCons[1][0] = 20;
}

/**
 * Default destructor for area.
 */
area::~area() {
}

void area::setTopCons(const std::vector<int>& con){
	topCons = con;
}

void area::setBotCons(const std::vector<int>& con){
	botCons = con;
}

void area::setLeftCons(const std::vector<int>& con){
	leftCons = con;
}

void area::setRightCons(const std::vector<int>& con){
	rightCons = con;
}

void area::setUpCons(const std::vector<std::vector<int> >& con, int num){
	numUDCons[0] = num;
	for (int i = 0; i < 2; ++i) {
//		upCons[i]= new int[num];
		upCons[i]= std::vector<int>(num); // destructs old vector
	}
	upCons = con;
}

void area::setDownCons(const std::vector<std::vector<int> >& con, int num){
	numUDCons[1] = num;
	for (int i = 0; i < 2; ++i) {
		downCons[i]= std::vector<int>(num); // destructs old vector
	}
	downCons = con;
}

/**
 * Generates the area based on its properties
 */
area::tilestruct area::generate(){
	tiles = agen.generate(type, topCons, botCons, leftCons, rightCons, numUDCons, upCons, downCons);
	return tiles;
}

/**
 * Returns the tile at the given x,y coordinate
 *
 * @return - The tile located at line y, column x
 */
tile& area::getTile(int x, int y){
	return tiles[y][x];
}

int area::getHeight() const {return height;}
int area::getWidth() const {return width;}
areatype::a_type area::getType() {return type;}


Mary Ann and her husband Tom live in Newbury Township. Tom and Mary Ann have 3 grown sons.
Congratulations Linda on being elected Fiscal Officer of Hambden Township effective January 1, 2018.
Mrs. Legg was hired as Assistant to the Fiscal Officer in June, 2016. September 1, 2017 Mrs. Legg was appointed Interim Fiscal Officer to finish out the term of Laura Chorman.
Linda and her husband Larry moved to Hambden Township from Concord Township in October, 2015.
Linda and Larry share their home with their four legged girl Ginger.


The interscalene block (ISB) is the ideal approach to the brachial plexus for surgery on the shoulder. ISB is well suited to ultrasound imaging as the plexus is often surprisingly superficial and anatomical variants are common.
The nerve roots forming the brachial plexus emerge from the intervertebral foramen between C5-T1. The nerve bundles then lie in a plane between the anterior and middle scalene muscles called the interscalene groove. This landmark is often marked by the overlying sternomastoid muscle. The roots of the plexus combine to form an upper, middle and lower trunk. These in turn each separate into anterior and posterior divisions as they pass infero-laterally towards the first rib.
The typical sonoanatomy of the interscalene region is shown in the figure below. Anterior and superficial lies the dark, triangular shaped sternomastoid muscle. This is seen to taper to a narrow point laterally and its postero-lateral end marks the position of the underlying interscalene groove. Deep to the sternomastoid is the anterior scalene muscle. Further posterior is the middle scalene muscle and lying between are the trunks of the brachial plexus. The fascia overlying the scalene muscles often forms a slight depression at the level of the interscalene groove. The nerves are usually seen as dark round or oval structures with a slightly hyperechoic rim. Fascial planes can sometime be seen within the nerves as the US probe is moved inferiorly. Optimal imaging of the BP is achieved by scanning in the mid neck, below the level of the cricoid with the US probe angled slightly inferiorly.
The block is best performed with the patient's ipsilateral shoulder tilted about 30 degrees up from the supine position. Ensure the patient's head is at the very top of the bed and the ipsilateral shoulder is close to the edge of the bed also. Ideally the screen should be positioned above and in front of the patients shoulder so facilitate ease of needle imaging. This is best achieved with the US machine slaved to a separate LCD screen.
High frequency linear probe 10-15MHz. Needle options are a 22G 5cm short-bevel needle, or a 20G 8cm tuohy needle. Longer needles are more echogenic.
Perform a preliminary scan of the interscalene region to identify the probe position for optimal nerve imaging. Mark this point with a pen. Optimise the settings on the US machine at this point (depth, resolution, gain). Ensure that the patient's position is optimal for the chosen probe position; i.e. move the patient if this is required to obtain the best view of the plexus whilst maintaining good line of sight between needle insertion point and the LCD screen. Prep and drape the patient. Cover the probe with a sterile sheath.
The ideal needle insertion point may be slightly posterior to the edge of the probe. By moving the needle insertion point posteriorly, a longer but shallower needle trajectory is obtained (see above). After local infiltration, insert the block needle in the plane towards the brachial plexus. The needle is directed between the C5 and C6 nerve roots and guided into position just anterior to the scalenus medius muscle. This is usually no more than 1-1.5cm below skin. It is not necessary to pass the needle between the roots. The deeper components of the plexus C7 and C8 must be distinguished from the vertebral artery, and colour Doppler interrogation is important to confirm the position of vascular structures. The technique of hydro-dissection is very useful; inject small volumes of LA to create a space for the block needle to be advanced into. In this manner, circumferential spread of LA can be achieved around the plexus. If you wish to use nerve stimulation then 5% glucose solution enables injections to guide needle placement without preventing motor responses.
For catheter insertion, an epidural needle is used. Passage of the needle through the tissues can make imaging more difficult. The larger needle creates more resistance and causes the tissues to pull away from the US probe. Care must be taken to avoid excessive movement of the needle in the direction of the nerves as it suddenly passes through a fascial plane. We usually inject LA in a deep and superficial plane prior to catheter placement. When placing the catheter, site the needle tip between the superficial and middle trunks of the BP, and the needle bevel directed towards the clavicle. Make a careful note of the needle depth. Insert the catheter to this depth and advance only 1 or 2 cm beyond if possible. Withdraw the needle. Note the depth of the catheter at the skin. US imaging of the catheter can be used to help with final positioning of the catheter. Although the catheter itself is often poorly seen, tissue movement associated with jiggling the catheter can be seen and local or saline can be injected to help visualise the catheter tip. Catheter fixation is very important. Clean all the US gel off the skin. Dry the skin with tincture of benzoin if necessary. A small drop of liquid bandage or dermabondTM on the skin puncture site can help prevent LA leaking from this hole. The catheter is then covered with a Tegaderm or Opsite 3000 dressing. A stat-lock device is used to prevent traction on the catheter resulting in dislodgement.
1. Nerves roots are easier to identify if the probe is moved up (roots move deeper) or down (roots move towards the probe) the neck.
2. Best images are obtained with the probe at 90 degrees to the nerve which usually involves angling the probe caudally.
1. C6 can be identified by its large anterior tubercle and smaller posterior tubercle.
2. C7 has no anterior tubercle. The vertebral artery lies deep and anterior to the C7 nerve root.


text:
#region License

#endregion
using Newtonsoft.Json;
using System;
using System.Collections.Generic;
using System.Globalization;
using System.Linq;
using System.Net;
using System.Text;

namespace QueryMaster.Steam
{
    /// <summary>
    /// Represents the ISteamApps interface.
    /// </summary>
    public class ISteamApps:InterfaceBase
    {
        internal ISteamApps()
        {
            Interface = "ISteamApps";
        }
        /// <summary>
        /// Full list of every publicly facing program in the store/library(GetAppList web api method(version 2)).
        /// </summary>
        /// <returns>Instance of <see cref="GetAppListResponse"/>.</returns>
        public GetAppListResponse GetAppList()
        {
            SteamUrl url = new SteamUrl { Interface = Interface, Method = "GetAppList", Version = 2 };
            return GetParsedResponse<GetAppListResponse>(url);
        }
        /// <summary>
        /// Calls GetServersAtAddress web api method(version 1).
        /// </summary>
        /// <param name="ipEndPoint">IP EndPoint of server.</param>
        /// <returns>Instance of <see cref="GetServersAtAddressResponse"/>.</returns>
        public GetServersAtAddressResponse GetServersAtAddress(IPEndPoint ipEndPoint)
        {
            SteamUrl url = new SteamUrl { Interface = Interface, Method = "GetServersAtAddress", Version = 1 };
            url.Parameters.Add(new Parameter { Name = "addr", Value = ipEndPoint.ToString() });
            return GetParsedResponse<GetServersAtAddressResponse>(url);
        }
        /// <summary>
        /// Calls UpToDateCheck web api method(version 1).
        /// </summary>
        /// <param name="appId">Application Id of the game</param>
        /// <param name="version">The installed version of the game.</param>
        /// <returns>Instance of <see cref="UpToDateCheckResponse"/>.</returns>
        public UpToDateCheckResponse UpToDateCheck(UInt32 appId,UInt32 version)
        {
            SteamUrl url = new SteamUrl { Interface = Interface, Method = "UpToDateCheck", Version = 1 };
            url.Parameters.Add(new Parameter { Name = "appid", Value = appId.ToString(CultureInfo.InvariantCulture) });
            url.Parameters.Add(new Parameter { Name = "version", Value = version.ToString(CultureInfo.InvariantCulture) });
            return GetParsedResponse<UpToDateCheckResponse>(url);
        }

    }
}

redpajama_set_name: RedPajamaGithub


text:
Santa Noyale de Pontivy, también llamada Noyala de Bretaña, Noyala la Blanca, Noaluen, Nolwenn, Newlyn o Newlina (siglo ), fue una santa, mártir y cefalófora inglesa.

Hagiografía
Noyale era inglesa o irlandesa según los primeros hagiógrafos. Los eruditos modernos creen no obstante que pudo haber sido uno de los numerosos colonos galeses que se establecieron en Bretaña con motivo de la invasión anglosajona. Noyale era posiblemente hija de un rey inglés; recibió una esmerada educación cristiana, convirtiéndose en una mujer piadosa muy alejada de los placeres mundanos típicos de la corte. Cuando su padre quiso darla en matrimonio al cumplir 20 años, Noyale huyó a Bretaña; tanto ella como su nodriza navegaron hasta la región de Vannes o hasta Bignan, arribando a la desembocadura del río Blavet en el tronco de un árbol. Ambas se establecieron en un bosque próximo a la ciudad de Vannes y vivieron como ermitañas, si bien la belleza de Noyale llamó la atención de Nezan, un noble de la zona, quien quiso desposarse con ella. Pese a que Noyale lo rechazó argumentando su deseo de llevar una vida entregada a la oración, Nezan insistió de tal forma que la joven se vio obligada a huir de nuevo. Las dos mujeres se asentaron en un páramo cerca de un arroyo, en las proximidades de Pontivy; debido a que no tenían un techo bajo el que resguardarse, la santa plantó su báculo y este se convirtió en una higuera que les sirvió de cobijo. Nezan terminó por encontrarlas al poco tiempo y, furioso, decapitó a Noyale. De acuerdo con la leyenda, la santa tomó la cabeza cercenada entre sus manos y, guiada por su nodriza, caminó desde el lugar del martirio hasta Pontivy, situado a 5 km de distancia, aunque otras fuentes sostienen que regresó a Inglaterra.

Veneración
Noyale, cuyo relato es típico entre los santos cefalóforos del siglo , es considerada santa patrona de St Newlyn East, en Cornualles, donde una iglesia lleva su nombre. La Iglesia católica celebra su fiesta el 27 de abril, mientras que la Iglesia ortodoxa la festeja el 6 de julio.

Legado
Noyale es una santa popular en Bretaña y Cornualles. Es especialmente conmemorada en St Newlyn East, donde se afirma que en el muro sur de la iglesia del pueblo se halla la higuera que plantó la santa (aunque de acuerdo con el relato esta fue plantada cerca de Pontivy). Así mismo, un pozo sagrado ubicado en las cercanías señala supuestamente el lugar de su martirio (también ocurrido en las proximidades de Pontivy), mientras que en el cementerio de la iglesia se desenterró una imagen pétrea de Noyale portando su cabeza decapitada.

En Pontivy se levantó una ermita en su honor así como una iglesia en Trois-Fontaines, así llamado debido a que la leyenda sostiene que Noyale, a su paso por la zona con la cabeza entre sus manos, dejó caer tres gotas de sangre de las que surgieron tres fuentes actualmente consideradas milagrosas. En el lugar del martirio se erigió una capilla que el propio Nezan trató de destruir ordenando cavar a su alrededor y disponiendo que se desviasen las aguas del arroyo que pasaba por allí, si bien estas cambiaron repentinamente su curso y lo ahogaron, quedando la capilla intacta.

Referencias

Nacidos en el siglo VI
Santos del siglo VI
Santas

redpajama_set_name: RedPajamaWikipedia


text:
Fulguration For Recurrent And Chronic UTI
By Jessica Price
Last Update On: Sep 9 2022
In your search for the best treatment approaches to recurrent UTI, you've likely stumbled upon discussions around fulguration. While fulguration is a fairly new concept within the UTI patient communities, urologists have been performing the procedure for decades.
We did some digging to uncover what the research says about fulguration for chronic UTI. Unsurprisingly, the research was sparse. So we went a step further and spoke with specialists and patients to learn about fulguration from their perspectives.
Dr. Philippe Zimmern was one of the specialists we spoke with about fulguration. We've peppered our video interview with him throughout this article, or you can directly access the interview through our YouTube channel.
As is the case with other recurrent and chronic UTI treatments, the approach to fulguration varies based upon the surgeon. Variations also exist in the level of improvement and time it takes for patients to heal.
Through all the uncertainty, one thing is clear – fulguration is not a one-size-fits-all method to treating chronic UTI and should be approached from an individual situation.
What Is Bladder Fulguration? >>>>
How Fulguration Tools Affect Patient Outcomes >>>>
Can Fulguration Help Heal A Recurrent UTI? >>>>
Trigonitis, Leukoplakia, And Other Abnormal Tissues >>>>
Risks Of Fulguration >>>>
How To Determine If You're A Good Candidate For Fulguration >>>>
What Is Bladder Fulguration?
Fulguration is the process of removing abnormal bladder tissue with the use of a specialized tool. During fulguration, one of the commonly used tools, a resectoscope, is inserted through the urethra, into the bladder. It is inserted in a similar way to a foley catheter or cystoscope.
A camera sits near the tip of the resectoscope, allowing the surgeon a clear view of the urethra and bladder. Once an area of abnormal tissue is identified, the resectoscope emits electric energy that removes the tissue while simultaneously burning or cauterizing the area to prevent bleeding.
Most commonly, fulguration is used in the removal of bladder tumors, but the procedure has found a place for patients dealing with recurrent UTI as well.
If the thought of your bladder being cauterized while dealing with a painful UTI makes you cringe – we hear you. However, studies have shown that the removal of these abnormal tissues may prevent or decrease the frequency of future UTIs.
The actual process of undergoing fulguration is unique, dependent upon the surgeon. Some procedures are completed in an outpatient setting either with or without light anesthesia. Yet, others are completed inpatient and involve an overnight stay in the hospital.
Dr. Philippe Zimmern has shared more about how a typical fulguration day looks for a patient in his fulguration Q&A. You can download this Q&A by sharing your email address below.
The pre-op and post-op protocols may also differ. If you've been considering fulguration, we've compiled a list of questions to ask when consulting with fulguration specialists.
The History Of Fulguration
As mentioned, fulguration was originally introduced as a method to remove bladder tumors. This technique is referred to as transurethral resection of bladder tumors (TURBT). This process was developed in 1910 by Edwin Beer, who was frustrated with the lack of progress urology was making in this area.
After all, cystoscopies had become a common procedure, so he questioned why urologists were still removing bladder tumors by way of open surgery through the pelvic area, which came with more risks. This motivated Beer to create a modified cystoscope that included a high frequency electric current.
The new tool proved to be successful in resecting tumors and cauterizing the tissue to prevent bleeding. Beer's innovation is now considered, "one of the greatest advances in the history of urology," as it paved the way for other electrofulguration methods.
Edwin Beer's pioneering work led to the development of today's resectoscope, one of the tools used to fulgurate lesions in the bladder in patients with recurrent UTI. Resectoscopes have different attachment options, which are fitted to the end of the scope and are responsible for cauterizing the tissue.
Although a seemingly small distinction, the tool and attachment used can have an impact on the outcome of surgery.
How Fulguration Tools Affect Patient Outcomes
Once a resectoscope is inserted through the urethra, the magnified wide angle lens near the end allows the surgeon to see a detailed view of the bladder. Once an abnormality is identified, the surgeon activates the electric current on the tip of the resectoscope. In the case of patients with a history of UTI, where lesions are found, the lesions are cauterized, or burned.
The loop attachment, a wire loop at the end of the resectoscope, appears to be most commonly used during fulguration. While the loop tool is effective in covering a larger surface area, and therefore less likely to bypass areas of abnormal tissue, it has an increased risk of resecting too deep, cutting into the bladder muscle.
An alternative to the loop tool is the rollerball attachment. This tool is a small metal ball that is rolled across the surface of the bladder tissue, cauterizing as it goes. In comparison to the loop attachment, the rollerball does not cover as large of an area at once.
While this has a risk of abnormal tissue being overlooked, the tool does allow more precision. In general, the rollerball has fewer risks than the loop tool because it does not require cutting into the tissue.
Laser tools may also be used to destroy abnormal bladder tissues. The results of side-firing vs. end-firing laser are much more distinct than those of loop vs. rollerball:
68% of patients who had a cauterization procedure using a side-firing laser had significant improvement in lower urinary tract symptoms.
81% of patients who had a cauterization procedure using an end-firing laser reported that their symptoms worsened or failed to improve .
It's clear to see which laser tool comes out on top.
There are debates around which type of tool is more effective, as each comes with benefits and risks. And while it's unusual for patients to inquire about what tools their surgeon uses during a procedure, when it comes to fulguration, it may be worth asking.
Can Fulguration Help Heal A Recurrent UTI?
So, can fulguration help heal a recurrent UTI? To put it simply, fulguration may be effective by destroying biofilms and bacterial reservoirs embedded in the bladder wall. While it may be effective, it's important to manage expectations as every person responds individually.
"For anyone considering Fulguration, I can't stress enough that it is not a quick-fix magic cure. You may come out of the procedure and need only two weeks of antibiotics post-op but have an up and down recovery for a few months. You may come out of the procedure needing additional treatments for your UTI symptoms.
But understand that no recovery is the same. The recovery isn't easy for some and it is mentally challenging but it's worse if you go in with a mindset of thinking it is a quick fix or a guaranteed cure."
Jessica Sian Saunders, Bladder Fulguration support group administrator
Because it can be difficult for antibiotics and other antimicrobial treatments to penetrate biofilm and bladder tissue, fulgurating superficial, abnormal layers of tissue may help to speed up the eradication of an embedded infection.
Unfortunately, when it comes to statistically analyzing the data, we're limited to the few studies around fulguration outcomes that currently exist. To add to this limitation, some studies use a measure of how many culture-positive UTIs participants have per year after fulguration as a determination of success.
Dr. Zimmern discusses how success rates for fulguration are determined.
This is an issue because standard cultures are often unreliable in detecting UTIs even when symptoms are present.
So in an effort to place culture limitations aside, the studies we've reviewed here also take patient symptoms into account. Therefore, 'success' is defined as a decrease in frequency of UTIs or symptom improvement.
The understanding of how removing tissue abnormalities in the bladder results in fewer lower urinary tract symptoms (LUTS) and UTIs is still limited. To understand the theories around fulguration and UTIs, we first need to explore more about these abnormal tissues.
Trigonitis, Leukoplakia, and Other Abnormal Tissues
A healthy bladder is smooth throughout, making it difficult for bacteria to attach. But when abnormal tissues develop, bacteria can more easily adhere. As one specialist puts it, think of these abnormalities as 'velcro of the bladder'.
In an effort to make it more difficult for bacteria to attach, the 'velcro' is removed through fulguration.
You may be familiar with some of these tissue abnormalities: trigonitis, leukoplakia, vesicular cystitis, and Hunner's ulcers.
Although the cause, appearance, and success of fulguration varies between these tissue changes, the symptoms they cause have significant overlap.
While not an exhaustive list, symptoms may include the following:
Chronic or recurrent UTI
Urinary frequency
Stress, urge, or other forms of incontinence
Pain with urination (dysuria)
We've broken down the following section into various types of bladder tissue abnormalities as well as how patients with these tissue changes may respond to fulguration.
It's important to note that study results do not always translate to how individual patients may respond to a treatment in the 'real world.' In the studies this article is based on, tissue abnormalities are typically the only urological condition participants were diagnosed with.
For individual patients, consideration of other urological conditions may be necessary when looking into fulguration as a treatment for recurrent UTI.
Trigonitis
The most common abnormality fulguration specialists come across, trigonitis, gets its name from the location of the bladder in which the tissue changes occur – the trigone. As you may have suspected, the trigone has a triangular shape.
Location of trigonitis in the bladder
Simply put, trigonitis is inflammation (itis) of the bladder trigone. The type of tissue change most documented in this region of the bladder is called non-keratinizing squamous metaplasia. The importance of this term will be discussed soon.
Fulguration for Trigonitis: UTI Symptom Response
In a review of 40 women with trigonitis, 23% and 73% had zero and fewer than three episodes of UTI symptoms per year, respectively, following fulguration. It should be noted that 38% of participants were on antibiotics for UTI in the six months following fulguration. However, no patients remained on antibiotics after the six month follow-up cystoscopy.
Trigonitis is so common, occurring in 72% of women, that it's often found in bladders of females who do not have any urinary symptoms.
Perhaps trigonitis in itself is not harmful, but rather predisposes people to developing a chronic infection because the bladder is no longer smooth.
Leukoplakia is considered to be extremely rare, occurring in as few as 1 in every 10,000 patients admitted to the hospital. However, some researchers have speculated that it's more common than originally believed.
Leukoplakia occurs when bladder tissue transforms and is covered in a layer of keratin, which gives leukoplakia the term keratinizing squamous metaplasia (KSM), as opposed to the non-keratinizing squamous metaplasia of trigonitis.
You can view an image of bladder leukoplakia during cystoscopy to see the tissue change.
A note of importance for this keratinizing tissue is that it can come with an increased risk of cancer.
One study has placed the rate of KSM developing into cancer at upwards of 42%. However, the data is unclear on the true risk of leukoplakia developing into transitional cell carcinoma.
In fact, another study determined the risk of leukoplakia developing into cancer was only 0.8%, and the researchers concluded that KSM did not increase this risk.
If your surgeon identifies leukoplakia in your bladder, it is important for them to have a sample sent to pathology to rule out malignancy, but the finding is not cause for panic.
Fulguration for Leukoplakia: UTI Symptom Response
In a retrospective study of 92 females with confirmed leukoplakia, 64% reported an improvement in their moderate-severe symptoms such as frequency, retention, and urgency. 52.5% of patients reported complete resolution of pain after fulguration.
The researchers noted that patients with multiple organisms or organisms with high antibiotic resistance were less likely to improve, both symptomatically and during follow-up cystoscopy. This is an important finding, as many UTIs are polymicrobial.
The researchers took data collection one step further and asked about quality of life. 57% of patients reported that their quality of life had also improved. However, 16% stated their quality of life had deteriorated following fulguration.
Antibiotics for Leukoplakia
Fulguration may not be the only effective treatment for leukoplakia. One study looked at the effects of doxycycline and antibacterial and antifungal vaginal suppositories on female patients with leukoplakia. 85% of the participants did not have detectable bacteria on standard urine culture, which is no surprise given the known limitations of this test.
Despite the negative culture results, 71% of patients were either considered cured or improved after treatment.
For those who were sexually active, their sexual partners were also treated with an oral antibiotic. The fairly high positive response to this multifactorial treatment further supports the role the vaginal microbiome and sexual health of a partner can have on bladder health.
Vesicular Cystitis
Only recently acknowledged as its own form of cystitis, vesicular cystitis (VC) refers to groupings of clear lesions, which look like raised bubbles when viewed during a cystoscopy. Not quite as rare as leukoplakia, VC is present in about 4% of women with recurrent UTIs.
Primarily, VC lesions are located on the walls of the bladder, rather than the trigone. According to the single study that has been completed with patients who have vesicular cystitis, out of the 18 patients, no lesions on the trigone area were present. This is an interesting finding given other lesions on the trigone are so common.
Fulguration for Vesicular Cystitis: UTI Symptom Response
In a study that included patients with vesicular cystitis (VC) and cystitis cystica (similar to VC but located near the trigone) undergoing a second fulguration, 41% of women reported improvement in symptoms. If fulguration failed a second time, many of the patients underwent a third fulguration in which an additional 46% achieved success.
Interestingly, all participants in this study were post-menopausal females, an unintentional occurrence. And in the only VC-specific study that we mentioned above, all female participants were also post-menopausal. This may support the theory of tissue morphing due to hormonal changes – at least when it comes to vesicular cystitis.
Hunner's Ulcers
Considered to be the definitive marker of interstitial cystitis by some clinicians, Hunner's ulcers are areas of severe inflammation with possible bleeding within the bladder wall. Unlike trigonitis, leukoplakia, and vesicular cystitis, these lesions are not raised.
Like other tissue abnormalities within the bladder, Hunner's ulcers are also quite rare. Yet, the rate of occurrence ranges all the way from 5-57%! UTI experts have surmised that the longer a stressor to the bladder exists, such as bacteria, structural defects, and more, the higher the likelihood that Hunner's ulcers may develop.
Fulguration for Hunner's Ulcers: UTI Symptom Response
In a study that looked at fulguration for Hunner's ulcers, pain and urgency scores decreased by an average of 7.9 and 6.3 points on a 10-point scale, respectively. Frequency and nighttime urination (nocturia) scores decreased similarly.
While immediate improvements were promising, 46% of the patients required one to four additional treatments within eight months. And patients who reported urgency and frequency as a primary complaint, as opposed to pelvic pain, appeared to have lower rates of improvement.
Similarly, 57% of participants in another study required repeat fulguration within 48 months. After repeat fulguration, 77% reported improvement and 15% reported a worsening of symptoms.
Why Do Abnormal Bladder Tissues Develop?
A few theories have developed as to why these bladder tissues begin morphing in the first place. The most obvious, of course, being persistent or embedded bacteria within the cells of the bladder wall.
As bacteria burrow into the tissues and develop intracellular bacterial communities (IBCs), the attempt to exfoliate or shed these cells and bacteria may result in tissue changes. Not only can bladder infections cause these changes, but vaginal infections can also irritate the trigone area of the bladder, resulting in trigonitis.
People who use catheters, vaginal contraception, or douche are also at risk of developing trigonitis due to the proximity of these irritants to the urethra.
Possibly the most discussed theory as to why these abnormalities occur, and are primarily present in females, is hormonal changes. Specific to the bladder trigone, estrogen receptors have been identified and cyclical changes have been observed.
To further support the hormone theory, up to 71% of males who have received estrogen therapy developed urethral squamous metaplasia.
Trigonitis, leukoplakia, and other abnormalities may not only be caused by an infection, but they may in turn leave the bladder vulnerable to recurrent UTIs.
Risks Of Fulguration
The general risk of fulguration is considered low, however, like any medical procedure, risks still exist. If considering fulguration, discuss all possible risks with your surgeon and make sure you have a good understanding of them.
Some of the known possible risks of fulguration include cutting too deep into the bladder tissues, introducing bacteria via the catheter or scope, urinary retention, or a reaction to the anesthetic or drugs used.
Dr. Angelish Kumar has discussed some of these risks with us. She pointed out that risks increase in line with how much of the bladder surface area is cauterized.
Unfortunately, aside from the study comparing two types of laser tools, no studies on fulguration for UTI symptoms have tracked the likelihood of symptoms worsening.
Patients are categorized as either having success or failure. Without more data, we are unable to determine the distribution of unchanged vs. worse in the 'failure' category.
If we consider quality of life deterioration as an indicator of symptom impact, a worsening of UTI symptoms may very well be a risk of fulguration.
"When I began hearing about fulguration, I knew it was something to explore further, but I wanted to make sure I took the time to really understand the possible outcomes. In the year since I first learned of fulguration, I've spoken with patients who had the procedure, I've read all I can, and I've carefully considered who would perform the surgery. While I don't yet know how fulguration will impact my chronic UTI, I feel I am well prepared for whatever may occur because of the steps I've taken. The prospect of fulguration is exciting, but I'd encourage anyone considering it to take the time to learn about it and understand how it may impact them."
Erin Alfano, chronic UTI patient
Chronic or recurrent UTI can have a big influence on mental health. Because no UTI or LUTS treatment is guaranteed to help, the impact of a failed fulguration (or other treatment) may need to be carefully considered. Discussing these possible outcomes with someone trained in health psychology may be beneficial.
What To Expect After Fulguration
Researchers and fulguration specialists report an average of six months for patients to fully heal from the procedure. This is why a six-month follow-up cystoscopy is typically recommended.
For the patients who have improved with fulguration, some report feeling an improvement in as little as six weeks, while others report months. Abnormalities found during the procedure or cystoscopy may influence this timeline.
Aside from the more common tissue abnormalities discussed here, patients have reported their fulguration specialists incidentally finding polyps, Skene's gland infections, crystals, and other anomalies.
During the healing period, an increase or change in symptoms early on is extremely common.
"Many patients will do quite well with no or minimal symptoms. These symptoms range from urgency, frequency, all the way to bladder or suprapubic pain, and they will resolve in a matter of days. Others have more intense symptoms and those may last long."
Philippe Zimmern, M.D.
During fulguration, superficial layers of tissue are cauterized, or burned, from the bladder wall. This injury and subsequent healing to the bladder can result in scabs, eventually dropping off and releasing with the urine. This time in the healing period can be frightening, but for most the symptom increase is temporary.
To lower the risk of developing an infection, many specialists prescribe antibiotics immediately following fulguration. The type, dosage, and length are dependent upon the specialist and patient. UTI home remedies may also be recommended in preventing a UTI during recovery.
What Sets Fulguration Specialists Apart?
We've stressed the importance of the tools used during fulguration, but the skill and experience of the surgeon are also extremely important.
So, what makes a fulguration specialist different from other urologists or urogynecologists?
In chatting with fulguration specialists and patients alike, they all acknowledged that how a cystoscopy is performed and interpreted is a crucial point in the process.
Similar to how some doctors are unfamiliar with or unwilling to acknowledge the issues with standard urine cultures, many doctors do not recognize the significance of some of these abnormal tissues.
This could be due in part to the American Urological Association (AUA) not having any published guidelines around trigonitis, the most common tissue abnormality.
What's more, when the camera is inserted during a cystoscopy, often the trigone is bypassed altogether. Dr. Cüneyd Sevinç, a fulguration specialist in Turkey, demonstrates what urologists see when the cystoscope first enters the bladder. You can see how easily the trigone area can be missed if not intentionally viewed.
Warning, the linked video contains images of external female genitalia and the internal urethra and bladder.
According to the fulguration specialists we've interviewed, many doctors overlook trigonitis and leukoplakia, even if they are visible. They may collect a biopsy to test for and rule out cancer, but the rest of the lesion(s) remain.
"I believe in personalized medicine for UTI, in the sense that each patient's UTIs are different and each patient is at a different place. Diagnosis, treatment, and prevention should be tailored accordingly, and take into account patient preferences and the pros and cons of various approaches."
Dr. Cüneyd Sevinç
When other bladder abnormalities are not detected, doctors may notate the presence of trigonitis, leukoplakia, and other indications of cystitis, but are unlikely to recommend a specific treatment.
Because of these potential oversights, it may be helpful to request your doctor record your cystoscopy. This will allow you to get a second opinion if necessary.
Questions To Help You Prepare For An Appointment With A Fulguration Specialist
Now that you've familiarized yourself with fulguration for chronic and recurrent UTI, you may decide to speak with fulguration specialists to gain an understanding of their approach.
As a starting point, we've provided a list of questions that may be helpful to ask during your appointment:
Will a cystoscopy be performed prior to fulguration to confirm whether any abnormal tissue is present?
Do you perform any other diagnostic tests prior to recommending or performing fulguration?
Will the procedure be performed in-office or at a surgical facility?
What type of anesthesia or sedation will be used?
What tool do you use to fulgurate any abnormal tissue you may find?
Do you have any information about success rates? Is success considered removal of all lesions or an improvement of symptoms and the frequency of UTIs?
Will I have a catheter inserted after the procedure and how long will it remain?
What steps do you take to help prevent a UTI following surgery?
How long will I likely stay in the hospital? If traveling, when will I be able to travel back home?
Considering my personal health history, do you feel I am a good candidate for fulguration?
Considering my personal health history, what are the risks of complications?
How To Determine If You're A Good Candidate For Fulguration
With all of the discussion around fulguration within patient communities, the idea of undergoing a 30-minute procedure to resolve or improve your UTI symptoms can sound appealing. But it's important to remember that your individual situation may differ from another UTI patient, even if your symptoms are similar.
Many factors can play into why someone may develop a UTI or lower urinary tract symptoms. And while the data shows that abnormal tissues do have a correlation with UTI, these tissues may not be present in everyone or may not be the sole cause of symptoms.
The indications that someone might be a good candidate for fulguration are different according to each fulguration specialist.
All fulguration specialists in our community consider a history of UTIs unresolved by antibiotics to be a defining characteristic of someone who may benefit from fulguration.
But what is considered a 'history of UTIs unresolved by antibiotics'?
The official definition of recurrent UTIs is two or more UTIs within 6 months or three or more per year. However, some specialists recommend not waiting that long before addressing infections with fulguration.
Because antibiotics are often unable to penetrate the bladder tissue, once bacteria become embedded they can continue to multiply.
Fulguration specialists familiar with this process recommend waiting no longer than 3-12 months after a persistent UTI begins to check for and remove lesions that may be harboring bacteria, even if on long-term antibiotics.
Steps For Researching Fulguration
Fulguration may be beneficial for treating a chronic or recurrent UTI. But it's important to consider whether fulguration may be right for your individual situation. In collecting information that may help you to make a decision, you may consider some of the following steps.
Review the studies we referenced in this article by clicking on the links. We weren't able to include every detail, so in addition to the success rates you may want to read additional information about the participants, such as age, other conditions, and more.
Reach out to multiple fulguration specialists to discuss your history and their approach to fulguration. You can review our list of recommended questions to help guide you. You may find that your needs align more closely with one specialist.
Join support groups and review or participate in discussions with people who have had fulguration. This will help you gain an understanding of what to expect if you choose to pursue it. You may also establish a community of people who are going through or have gone through similar experiences.
If you have experience with or thoughts about fulguration, we'd love to hear from you. You can share your thoughts with the community by commenting below, or reach out to us directly.
To get answers to commonly asked questions about chronic and recurrent UTI, visit our FAQ page.
Download Our Fulguration Q&A With Dr. Zimmern!
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Are there any resources for finding fulguration specialists ? Like a list ? I went to one urologist in Florida who did such a horrible job with my fulguration under zero anesthesia or anesthetic of any kind and I'm fairly sure it was done improperly . Looking to revisit with a specialist who knows what they're doing! Thank you
Hi Lindsay, I just sent you an email with more information. I hope it helps, Melissa

redpajama_set_name: RedPajamaCommonCrawl


TIME FOR THE NARRATIVE TO SWITCH BACK…. In June, health care reform was very likely to happen. It was one of those observations "everyone" knew to be true. In July, however, reform was in trouble, and "everyone" knew that, too. It's August, and now reform is practically dead. "Everyone" says so.
Of course, August is almost over, and those observations about the reform effort failing have become stale and uninteresting. September starts tomorrow and it's time for a new narrative. Maybe now would be a good time for "everyone" to start talking about reform is going to pass after all.
The NYT's John Harwood has a piece today on the "stronger prospects" for a health care reform bill this year.
If sentiment ever ruled the United States Senate, it does not now. Advocates of health care overhaul should not expect a big boost in memory of Senator Edward M. Kennedy.
Yet other factors suggest that President Obama still has stronger prospects for achieving his health policy goals than surface impressions of the Congressional recess indicate. He lags behind his own timetable for action, but remains ahead of presidential predecessors who pursued the same objective.
As Harwood sees it, there's already widespread agreement on several key elements of reform; reconciliation is still very much an option; the Gang of Six nonsense is nearly complete; and "Democratic leaders believe" they might be able to break a filibuster with Sen. Olympia Snowe's (R-Maine) support.
Health care reform could be the phoenix, rising from the ashes, if Democrats show some spine and roll up their sleeves. The elements are already in place, and the media narrative is ready to shift. It's not rocket science.


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Top Trump adviser reportedly asked FBI official to dispute media story about Russia
February 24, 2017 in News
White House Chief of Staff Reince Priebus speaks at the Conservative Political Action Conference (CPAC) in Oxon Hill, Md., Thursday, Feb. 23, 2017. (AP Photo/Susan Walsh)
WASHINGTON (AP) — White House chief of staff Reince Priebus asked a top FBI official to dispute media reports that President Donald Trump's campaign advisers were frequently in touch with Russian intelligence agents during the election, a White House official said late Thursday.
The official said Priebus' request came after the FBI told the White House it believed a New York Times report last week describing those contacts was not accurate. As of Thursday, the FBI had not stated that position publicly and there was no indication it planned to.
The New York Times reported that U.S. agencies had intercepted phone calls last year between Russian intelligence officials and members of Trump's 2016 campaign team.
Priebus' discussion with FBI deputy director Andrew McCabe sparked outrage among some Democrats, who said he was violating policies intended to limit communications between the law enforcement agency and the White House on pending investigations.
"The White House is simply not permitted to pressure the FBI to make public statements about a pending investigation of the president and his advisers," said Michigan Rep. John Conyers, the top Democrat on the House Judiciary Committee.
A 2009 memo from then-Attorney General Eric Holder said the Justice Department is to advise the White House on pending criminal or civil investigations "only when it is important for the performance of the president's duties and appropriate from a law enforcement perspective." When communication has to occur, the memo said, it should involve only the highest-level officials from the White House and the Justice Department.
The White House official would not comment when asked if the administration was concerned about the appropriateness of Priebus' communications with McCabe. The official was not authorized to disclose the matter publicly and insisted on anonymity.
The FBI would not say whether it had contacted the White House about the veracity of the Times report.
CNN first reported that Priebus had asked the FBI to weigh in on the matter.
Trump has been shadowed by questions about potential ties to Russia since winning the election. U.S. intelligence agencies have also concluded that Russia meddled in the campaign to help Trump defeat Democrat Hillary Clinton.
Last week, Trump fired national security adviser Michael Flynn because he misled Vice President Mike Pence and other White House officials about his contacts with the Russian ambassador to the U.S. Flynn, who was interviewed by the FBI about his contacts, is said to have talked with the ambassador multiple times during the transition, including about U.S. sanctions policy.
Still, Trump and his advisers have denied contacts with Russian officials during the election. Last week, Trump said "nobody that I know of" spoke with Russian intelligence agents during the campaign.
Priebus alluded to his contacts with the FBI over the weekend, telling Fox News that "the top levels of the intelligence community" have assured him that the allegations of campaign contacts with Russia were "not only grossly overstated, but also wrong."
Sen. Ron Wyden, D-Ore., said Priebus' comments opened the door for FBI Director James Comey to discuss the bureau's investigation publicly.
"If the White House chief of staff can make public claims about the supposed conclusions of an FBI investigation, then Director Comey can come clean with the American people," Wyden said.
Justin Shur, a former Justice Department public corruption prosecutor, said it was imperative that Justice Department investigations not be swayed by political considerations.
"As a general matter, investigations and prosecutions should be about gathering the facts and the evidence and applying the law," Shur said.
During the campaign, Trump and other Republicans vigorously criticized a meeting between then-Attorney General Loretta Lynch and former President Bill Clinton, husband of Trump's general election opponent. The meeting came as the FBI — which is overseen by the Justice Department — was investigating Hillary Clinton's use of a private email address and personal internet server.
Tags: Donald Trump, FBI, Reince Priebus, Russia
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Phil Bryant orders $43 million in budget cuts, including school funding →


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Zara Aleena reports shows 'women and girls are not safe', says victim's aunt
The aunt of murdered law graduate Zara Aleena has warned that "women and girls are not safe" following the release of a report into the probation failings which led to her niece's death.
Farah Naz said it was an "extremely distressing report … revealing a litany of errors" which left Jordan McSweeney, 29, able to kill her 35-year-old niece last year, just nine days after he was released from jail.
The report, by chief inspector of probation Justin Russell, outlined how McSweeney was not treated as a high-risk offender or recalled to prison as quickly as he should have been.
"This is not a service that's doing its best with inadequate resources," Ms Naz told BBC Radio Four's Woman's Hour programme.
"This is a service that is incompetent and has the failures by people at the top to ensure a quality service."
Asked if the probation service can be trusted to keep the public safe, Ms Naz said: "Well, I think not. I think it's clear that, actually, women and girls are not safe if probation is not doing its job."
Speaking later on Tuesday to the BBC, Ms Naz called for more probation appointments to be conducted face to face.
She said she had "serious concerns" that probation officers do not have enough in-person contact with offenders out on licence, with a reduction in face-to-face contact since the Covid-19 pandemic.
"If you do forget this person was racist in prison, beat up women, had an offensive weapon in prison and has been disruptive since he was 12, if you forget all that and you stand in front of someone, you can see it," she said.
"You have been reminded this person is high risk."
Ms Naz said that no-one in Government has written to her to apologise for the probation service's failure to recall her killer Jordan McSweeney to prison before he murdered her.
She added that (Justice Secretary) Dominic Raab agreed to meet her after she requested a meeting, but this has not yet taken place.
She said: "I don't know whether the message got across."
Women's safety campaigners have said that a lack of funding is partly to blame for the errors.
Zara's murder is a grave reminder of the price women pay for Government policies
Andrea Simon, director of End Violence Against Women Coalition (EVAW), described Ms Aleena's murder as "a grave reminder of the price women pay for Government policies".
The charity boss said: "The probation service, as with so many of our public services, is buckling under the pressure of a decade of austerity policies and the impact of the Covid-19 pandemic – not aided by the disastrous structural reform of the service (recently reversed) which took place from 2012."
Harriet Wistrich, director of the Centre for Women's Justice, said the criminal justice system is "in collapse" and women are not being protected from violent men.
She blamed part of the problem on "chronic underfunding" as she called on Justice Secretary Dominic Raab to "take urgent action to transform the system".
Mayor of London Sadiq Khan has said the Government should apologise to "all women across London" because of failures that led to Ms Aleena's murder.
He told the PA news agency: "I was angry when I read the report because it's symptomatic of 13 years of chaotic Government policy on probation and cuts to the criminal justice service.
"This awful tragedy of Zara being murdered by Jordan McSweeney would not have happened but for the Government's policies.
"It's quite clear from the chief inspector's report: this is a man who is a high-risk, serial, serious offender who breached his licence conditions and should have been recalled to prison.
"The Government should apologise, not just to Zara's family but to all women across London who are feeling scared and frightened because of the consequences of Government policy."
ProbationMcSweeneyReactionPA
Nadhim Zahawi sacked by Rishi Sunak after 'serious breach' of Ministerial Code
Rare green comet last seen 50,000 years ago due to make closest pass by Earth
world news 11 hours ago
Memphis police disband unit that beat black driver Tyre Nichols to death


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LANSING — Effective 6 a.m. Monday, April 8, the Michigan Department of Transportation will lift spring weight restrictions on state roads from the southern Michigan border north to the I-96/US-31 interchange in Muskegon, then east on I-96 to I-69 in Clinton County, then east on I-69 to the Blue Water Bridge in Port Huron.
Frost restrictions are still in effect for the remainder of the state and will be imposed and enforced on all state trunkline highways north of the I-96/I-69 line. State routes typically carry M, I, or US designations.
On routes designated as "all-season," there will be no reduction in legal axle weights.
On routes designated as "seasonal," there will be a posted weight reduction of 25 percent for rigid (concrete) pavements and 35 percent for flexible (asphalt) pavements.
All extended permits will be valid for oversize loads in the weight-restricted area on the restricted routes. Single-trip permits will not be issued for any overweight loads or loads exceeding 14 feet in width, 11 axles and 150 feet in overall length on the restricted routes.
County road commissions and city public works departments put in place their own seasonal weight restrictions, which usually, but not always, coincide with state highway weight restrictions. Signs are generally posted to indicate which routes have weight restrictions in effect.
For more, call 800-787-8960, or visit Michigan.gov/Truckers, under "Restrictions."


Pizza Catering - Most Delicious Spices Pizza Catering In Malaysia!
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As you plan your occasion, you will need assistance to effectively plan for the event and probably avoid any wastage. This means that you go for great planners and caterers who understand the business of Pizza Catering. The equipments that a provider uses will determine the results of your party. If you want to get the best service and good memories for your event, you can try our catering services. Our professionals are harmed with a wide range of catering equipments and you can be sure of high quality of pizzas that you will get. Our company will provide your guests with buffet ware, cake stands, serving platters, trays, pizza pans, juice and coffee dispensers and chafing dishes. These equipments are not easily affordable and they may inconvenience your budget. You simply require an experienced caterer to provide you with all the services and needed equipments. Whether you want indoor or outdoor Pizza Catering, you will find our services a perfect choice. The goal of your event is to give your visitors great satisfaction. Our dedicated staff will served and you can be assured that they will leave satisfied and happy. We provide elegant and durable serving ware that will make your occasion amazing.
The style of serving will also mean a lot during your occasion. Our experienced staff will organize the serving and feed your guests very well. You do not have to take the pressure of arranging guests and how they will be served. We will just arrange all the services from the beginning until cleaning up the mess. At Malaysia caterers we will give you tasty Pizza Catering service. Guests will get a good reflection of your party because we understand the needs of your clients better. This is an opportunity to give your occasion a great impression.
Stylish service will go hand in hand with the serving ware. Before you seal a deal with a caterer, it is good to find out the serving ware they are using for your Pizza Catering. You should ensure that you get the best quality for the best event ever. We are a supportive caterer and you will not need time to focus on your guests with us.
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MorganCountyWhistleBlower: COUNTDOWN RESUMES FIVE DAYS LEFT!!!
COUNTDOWN RESUMES FIVE DAYS LEFT!!!
We seem to be missing ...uh...you know who. Maybe she's busy, doing close-outs, moving funds to the Caymans, shredding documents, finishing her hit list, you know typical run-for-the-border things.
You'll see that all five are shoe-string campaigns so far but it's a long while till the primary. Make your bets. Then come out fighting!
She will not run...unless its south of the border where she has an "apparent incognito fund."
This form is not a list of who is qualified to run, but a list of principal campaign committees. These are often set up as exploratory committees when people are considering a run for particular offices. Ron Puckett's is not reflected on here due to his committee not being set up prior to his qualification filing last week.


text:
Aswini Anburajan's audio archive Tag
Tag: Aswini Anburajan's audio archive
Indian Immigrants and the Delhi Gang Rape Case: Aswini Anburajan on PRI's The World
Despite rapid economic development, Anburajan says India's traditional attitudes about the role of women have not caught up.
Podcast: Indian Americans Take to the Streets to Protest Corruption in India
FI2W reporter Aswini Anburajan hosts a conversation about the India Against Corruption movement with journalist S. Mitra Kalita and Atul Kumar, who helped organize the first New York protest in support of the anti-corruption movement.
By Ashwini Anburajan
Podcast: DREAM Act Advocates – Young, Undocumented and on Facebook
Young activists are revealing their undocumented status online and at public events in a state-by-state campaign for immigrant rights.
Reporter's Notebook: Conn. Priest Shows How to Earn the Trust of an Immigrant Community
FI2W reporter Aswini Anburajan produced a radio piece for NPR's Latino USA on Father James Manship, a Roman Catholic priest in New Haven, Conn., who teaches his immigrant parishioners how to stand up for their civil rights, and who has been in the news in the past for being arrested in a confrontation with local police officers. Here, Aswini narrates how she managed to produce the piece, which aired on Latino USA and which you can listen to below.
[audio:http://latinousa.kut.org/wp-content/lusaaudio/856seg01.mp3]
By Aswini Anburajan, FI2W contributor
If you think that ethnic reporting isn't critical to knowing a community, read on. This is the first piece I've done for Feet in 2 Worlds that hasn't been on Indian Americans. The basis of FI2W is to get reporters to write about their own communities, but even I didn't realize why this is so important until I delved into a project for Latino USA.
My piece was originally supposed to be on the economic life of a day laborer or someone new to the country, undocumented and trying to establish a life in the U.S. That piece remains undone. Being an Indian American with some high school Spanish under my belt, I thought it would be a cake walk. Call some social service agencies, reach out to immigrant coalitions, and I could "break in."
Manship in 2008 visited with family and friends of his Connecticut parishioners, in the province of Morena Santiago, in the rainforest regions of Ecuador. (Photo: Courtesy J. Manship - Click for more images)
Four months later, I had to think again. Without truly knowing a community, or having cultural or language associations with them, I found it impossible to get through and talk to individuals who were undocumented. It wasn't that every door I knock on was slammed in my face. Most of the time, people pretended they weren't home. This ranged from individuals I knew with ties to the Latino community to social service agencies.
Immigrant Business Owners on Staten Island Struggle Against the Recession: FI2W Reporter Aswini Anburajan on WNYC
By Aswini Anburajan, FI2W reporter
Immigrant business owners have breathed new life into the North Shore of Staten Island, New York's least populated and least diverse borough.
Feet in 2 Worlds partnered with WNYC, New York public radio, to produce a profile of Victory Boulevard, one of Staten Island's major thoroughfares, for the Main Street NYC series, which examines the recession's impact on neighborhoods across the city.
You can listen to the story by pressing play below or visiting WNYC's web site .
[audio:http://audio.wnyc.org/news/news20090511_main_st_staten_island.mp3]
The history of Victory Boulevard is like that of a lot of American Main Streets.
It was once part of a thriving downtown area until the development of suburbs drew the middle class community away from an urban center, and left areas like the northern end of Victory largely abandoned.
However, immigration to Staten Island over the past ten years has revitalized this part of the Island, which has stores that represent virtually every corner of the globe. While immigrants were once one out of ten residents in Staten Island in 1990, they are now one out of four residents. Ten percent of these immigrants own their own businesses, but the recent economic downturn has left many business owners struggling.
A&C Beauty Supply is a store that serves the Island's African community, largely made up of Liberian and Senegalese immigrants.
Its owner, Adam, who is from Senegal, says that he noticed the downturn more than a year ago. Customers who were once avid purchasers of wigs and hair care products, now barely enter. On the day I stopped in, Adam had no customers in his store.
Kelvin Hanaf is the owner of Island Roti, a Carribbean takeout joint that serves food from his native Trinidad.
When I spoke with him he was at his wit's end. "No one's coming in," he complained, saying that he would usually see weekend traffic start to pile into his store on a Thursday afternoon.
He joked that customers are cutting back so much that if they want to eat chicken roti they order a roti and cook their own chicken. Hanaf has cut prices by 50 cents on every item, and says that he just can't afford to take the prices any lower.
Mosen Ibrahim also complains that penny pinching by the Island's residents has taken a toll on his business. Moe's Cafe, which he started five years ago, is one of the few places on Staten Island where you can find Mediterranean food and other dishes from Ibrahim's native Egypt.
He was lured to Staten Island for the same reasons that many immigrants came — affordable home prices, the chance to start a business on the cheap and a small immigrant community from his native country. However, since the downturn Ibrahim has had to turn to his bank to stay afloat. They extended his mortgage, but he doesn't mince words on what business is like right now. "Times are tough," he said. "They're tough for everybody but for the food business, when 80 percent of the people stop eating outside…" He trailed off with a laugh.
So who is doing well on Victory? Some of the haircutting salons like Against Da Grain Barber Shop report that even in a slow economy you still have to look good. This is one of the few stores on Victory that was crowded with customers the day I visited.
A hair braiding salon, named after its owner, Bissou, also reports that business is slowly picking back up. "A few months ago we were sitting here doing nothing," Bissou, a Senegalese immigrant, told me, "So I can say that business is getting a little bit better."
The one success story on Victory Boulevard, and perhaps for the future of immigrant-owned businesses on Staten Island, is Tulcingo Travel, a Mexican paquetería that facilitates the shipping of remittances and care packages between the United States and Mexico.
Immigrant entrepreneurs usually cater to their own communities, and in recent years the Mexican population on Staten Island has spiked, providing store owners who serve this community a buffer in these tough times. A Tulcingo worker told me that business had dropped off for about two months when the crisis first hit last fall, but things are back to normal now.
Could this bright spot on this struggling street mean that there is a silver lining to this crisis after all?
Feet in Two Worlds Reporters Discuss Republican National Convention Speeches on The Brian Lehrer Show
Feet in 2 Worlds continues to provide the immigrant press' views and analysis on the conventions with regular appearances on WNYC.
This morning, reporters Pilar Marrero (columnist and political editor of Spanish-language La Opinión) and freelance journalist Aswini Anburajan were guests on The Brian Lehrer Show to discuss last night's speeches at the Republican National Convention in St. Paul. Pilar explored how Vice Presidential nominee Governor Sarah Palin's acceptance speech and nomination might resonate with Latino and Latina voters. Listen here:
[audio:http://audio.wnyc.org/bl/bl090408apod.mp3]
During the second hour of the show, Aswini discussed the role of entrepreneurship, high-tech industries, and H-1B high-skilled immigrant workers in shaping an economic platform for the future, as well as what 21st century jobs might look like. She also shed some light on immigrant community views on free trade agreements and how they influence their party choices. Listen here:
[audio:http://audio.wnyc.org/bl/bl090408bpod.mp3]
The DNC through the Eyes (and Voices) of the Immigrant Press
Feet in 2 Worlds reporters are providing unique immigrant perspectives on the presidential campaigns with daily appearances on WNYC's Brian Lehrer Show this week from the Democratic National Convention in Denver.
Today, Feet in 2 World's Pilar Marrero, political editor and columnist for Los Angeles' La Opinión newspaper, analyzed the McCain and Obama campaigns' efforts to court Latino voters. Click here to hear Pilar's take on the most recent Latino voter poll, the latest controversy over Latino elected officials' candidate endorsements, and the impact of the largest-scale Spanish-language outreach effort in election history.
Tomorrow, Ewa-Kern-Jedrychowska, reporter for New York-based Polish-language newspaper Nowy-Dziennik and Feet in 2 Worlds contributor, will discuss Polish-American voters' attitudes and policy priorities. Tune in to The Brian Lehrer Show on FM 93.9, AM 820 or www.WNYC.org at 10:40 am EST to hear Ewa.
Yesterday, our reporter Aswini Anburajan dissected Indian-American political donors, their support for the proposed India-US nuclear deal, and the emerging political partnership between the American Jewish Committee and Indian-American campaign donors that was showcased at a Denver breakfast forum. Click here to listen to Aswini's talk with Brian Lehrer.
Feet in 2 Worlds convention coverage is part of our collaboration with New York Community Media Alliance.
Editor's note: WNYC's website and streaming capabilities are set up slightly differently during the conventions. In order to listen to Pilar and Aswini's interviews you must first download the first hour of Brian's show, then fast forward to around 40 minutes past the hour (or just listen to the entire hour of excellent reporting and conversation!).
Undocumented Immigrants Get ID Cards: FI2W's Aswini Anburajan on WNYC's The Takeaway
Today, Feet in Two Worlds blog editor Aswini Anburajan appeared on the morning radio show, The Takeaway with hosts Adaora Udoji and John Hockenberry. Aswini talked about her recent article on undocumented immigrants in Connecticut receiving I.D. cards.
You can listen to the segment here.
Podcast: Barack Obama courts evangelical Latinos
Barack Obama is reaching out to Latino evangelical leaders as part of a broader strategy to win support for his presidential campaign among Latino voters.
The Illinois senator has invested significant resources in faith outreach, holding community faith forums and courting religious leaders in key primary states such as Texas and South Carolina.
Aswini Anburajan, a former Feet in Two Worlds reporter covering the Obama campaign for for NBC News/National Journal, and current Feet in Two Worlds journalist Lorenzo Morales of El Diario/La Prensa speak with FI2W executive producer John Rudolph about Obama's faith-based campaign strategy.
They discuss his unique approach, its effectiveness and the issues that matter to evangelical Latino voters—many of which have little to do with church positions on abortion or same-sex marriage.
[audio:http://www.xrew.com/joceimgs/FI2W/fi2w_latinoevangelicals_0308.mp3]
Podcast: What happened to the debate over immigration among the Democratic candidates?
Feet in Two Worlds executive producer John Rudolph speaks with Pilar Marrero of the Spanish-language newspaper La Opinión in Los Angeles and Aswini Anburajan, a former Feet in Two Worlds reporter who works for NBC News/National Journal. Both are covering the Obama campaign.
[audio:http://www.xrew.com/joceimgs/FI2W/fi2w_pilar_aswini_080106.mp3]


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class PhStackTest extends PHPUnit_Framework_TestCase{

    private $stack;

    public function setUp(){
        $this->stack = new PhStack(new PhLinkedList());
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    public function testPhStackIsInstantiable(){
        try{
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        } catch (Exception $e){
            $testStack = null;
        }

        $this->assertEquals(true, $testStack instanceof PhStack);
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    public function testPushIsAvailable(){
        $testStack = $this->stack;

        $this->assertEquals(true, method_exists($testStack, "push"));
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    public function testPushAddsValueToStack(){
        $testStack = $this->stack;
        $testStack->push("Push Test");

        $this->assertEquals("Push Test", $testStack->peek());
    }

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        $testStack = $this->stack;
        $testStack->push("Peek Test");

        $this->assertEquals("Peek Test", $testStack->peek());
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        $this->assertEquals("Pop test", $testStack->pop());
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        $testStack->push("Item 1");
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        $this->assertEquals("Item 1", $testStack->peek());
    }

}

?>


Green FOG's are specialists in the grease & oil trap cleaning industry for commercial, as well as private sector. We service a wide range of clients from different industries and have over 5 decades' collective industry experience.
We also have Public and Residential Awareness Programs that are designed to raise awareness with regards to the proper disposing of grease. One needs to keep the environment in mind and dispose of these hazardous materials in a manner that is good for your plumbing, sewer systems, as well as the environment.
Our mission is to supply competitively priced, high quality grease traps, installation & maintenance thereof and to legally dispose of the effluent waste to industry at large in a quest to reduce our impact as a whole on our already sensitive planet.


I visited the restaurant for dinner and we highly recommend. Ask Tatiana A about Dorsia Hotel Restaurant This review is the subjective opinion of a TripAdvisor member and not of TripAdvisor LLC. Previous Next Updating värtahamnen list. With a focus on organic wines, local craft beer and carefully selected charcuteries and cheeses, Bar Amuse is a social gathering spot for locals and out-of-towners alike. Not your ordinary lounge/restaurant go to place, but it is worth your while. Reviewed October 9, 2017 via mobile. It is an exclusive boutique hotel öppettider with French features from the turn of the century. 150-500 personer, festpaket stora salen 50-100 personer, festpaket stacken. Drinks are expensive ( above the normal sweden prices) but the menu is long and it is exclusive. The dishes were all explained perfectly, even in English, and the sources of each ingredient were known.
But if you arenapos, för att underlätta planeringen kan du kolla in två förslag på festpaket cinderella kontakt för våra mest populära lokaler. The chef kindly modified my selection and substituted the meat servings for fish as I do not eat meat. The hotel is located on nice garden street a stoneapos. Hör gärna av dig om du vill komma på visning eller har andra frågor. Så är mat, great service, reviewed September 19, dryck och service alltid av högsta klass. Stora Salen och Stacken, kom hit och se själva, our versatile staff can hand you a key as well as a glass of champagne at check 2017 via mobile" Ask Natali K about Dorsia Hotel Restaurant. But its the fabulous interior that will knock you out. Ask Aaran L about Dorsia Hotel Restaurant This review is the subjective opinion of a TripAdvisor member and not of TripAdvisor LLC. I baren stoltserar det största tequilasortimentet i Norden. Hotel Dorsia Restauran" reviewed September 6, t completely starving then I recommend that you order the smaller etagere since the Dorsia etage provides a lot of food.
Nyhetsbrev nskar du v rt nyhetsbrev?V lkommen till Tip the Velvet.Burlesque, club, f rsta och st rsta burlesk-klubben.
Time of year, i donapos, so far, write a Review. T know if they have good food because we had only cocktails there. Reviews 755 traveler kryssa i karibien rating, från kundevent eller informellt mingel till sittande galamiddag. It was so good that we came back next evening. Fax, swedish 509 norwegian 46 more languages 16 20 of 756 reviews. Friends, which contained a range of seafood.
In to the smallest detail the owners have made a one-of-a-kind place to visit, when you are in Göteborg Ask Johan F about Dorsia Hotel Restaurant This review is the subjective opinion of a TripAdvisor member and not of TripAdvisor LLC.We both ordered the dorsia étage, which provides a range of small tasting dishes and a selection of food presented beautifully on an afternoon tea stand.
Välj den lokal som passar dig bäst!Very good 208, average 61, poor 24, terrible 20, traveler type, families.Lokaler, nalen har ett brett utbud av lokaler mitt i Stockholm city.


text:
Der River Mint ist ein Fluss in Cumbria, England.

Der River Mint entsteht aus dem Zusammenfluss von Kidshowe Beck, Wolfhowe Gill und Ashstead Beck. Er fließt erst in südöstlicher Richtung und beschreibt dann einen Bogen in südwestlicher Richtung, um am nördlichen Rand von Kendal in den River Kent zu münden.

Quellen

Gewässer in South Lakeland


text:
Curlin babies at the Breeders' Cup!
nicolle November 3, 2016 Breeders' Cup, Curalina, Curlin, Keen Ice, Stellar Wind, Texas Ryano, Valadorna
The Breeders' Cup gets underway tomorrow. Just like every year since 2013, when Palace Malice ran in the Breeders' Cup Classic, Curlin is represented. In this year's Breeders' Cup, scheduled for November 4-5 at Santa Anita, five Curlin babies are slated to run.
Curlin is still looking for his first Breeders' Cup winner. He came close last year, when Stellar Wind finished just short of nine-furlong savant Stopchargingmaria in the Distaff. That was Stellar Wind's first attempt against older company. A year later, Stellar Wind has grown better, faster, and stronger…and gives Curlin strong hope for his first Breeders' Cup victory as a sire.
The following five progeny of Curlin will race in this year's Breeders' Cup:
Curalina (Whatdreamsrmadeof, by Graeme Hall) – Pre-entered into the Distaff and the Filly and Mare Sprint, Curalina's connections opted to run her in the Breeders' Cup Distaff. Despite her third-place finish in last year's renewal, the four-year-old filly will be one of the long shots this year given the triumvirate of Santa Anita-based champions. She does need to take a step forward from most of her performances this year to have a shot, but she does have consistency in her corner.
Keen Ice (Medomak, by Awesome Again) – Keen Ice returned a promising third in an allowance at Belmont last month, and his connections have decided to go for the gusto: he will run once again in the Breeders' Cup Classic. The four-year-old colt was a giant-killer when he beat American Pharoah in the Travers last year, but that feat may pale in comparison with this one if he does manage to get the best of California Chrome and Arrogate. Keen Ice will have to take a significant step forward, plus hope for an extremely hot pace up front.
Stellar Wind (Evening Star, by Malibu Moon) – Stellar Wind is one of the top contenders for the Breeders' Cup Distaff. She gets a fourth clash with Beholder, and will also meet sophomore sensation Songbird for the first time. She finished second in last year's Distaff, her first career attempt against older fillies and mares. This year, at age four, she is an even stronger horse, and the Breeders' Cup will be run at her home base, so she has an excellent shot to do her finish last year one better.
Texas Ryano (Blending Element, by Great Commotion) – Relegated to the also-eligible list at pre-entry time, Texas Ryano did make it into the main field of the Breeders' Cup Turf come final entries. Texas Ryano has been based on the west coast his entire career, and has recently been nabbing underneath shares in the local preps for the Breeders' Cup Turf. However, the likes of Found and Highland Reel should prove a bit tougher than those of Ashleyluvssugar and Twentytwentyvision, making this race the ultimate class test for the five-year-old horse.
Valadorna (Goldfield, by Yes It's True) – Valadorna makes the jump from a maiden victory last out straight into the Breeders' Cup Juvenile Fillies. Her maiden victory was impressive: a six-length tour-de-force win in faster time than the fillies in the Grade I Alcibiades Stakes ran later than afternoon. It will be a class test for her, but she should get pace to chase. And, trainer Mark Casse is not the sort to give a horse this kind of class rise without a good reason.
Good luck to all the Curlin babies running in the Breeders' Cup!
Breeders' Cup, Curalina, Keen Ice, Santa Anita, Stellar Wind, Texas Ryano, Valadorna
Previous Breeders' Cup previews on Horses for Courses
Next 2016 Breeders' Cup Classic Preview and Saturday Analysis


When we are positioning the weight training sessions in the week we wan to place them in such a way that they have the least amount of effect on the the quality work of the week, so they aren't going to be the day before a hard interval or tempo session, nor do we really want them to be placed after these sessions where possible. This study showed that running at maximal effort was impaired for 24 hours after a hard strength training session for the lower body and for 6 hours after just upper body work but given that you will have limited time to devote to strength work through the week it is much more beneficial to use full body sessions in the gym to help ensure that you get everything covered. So given that there is still an effect after 24 hours it would be wise to allow around 48 hrs before doing your tempo or interval type sessions.
Placing them after tempo/interval sessions is less of a consideration as the performance in the gym in secondary to the running and if this is the only place to conveniently place them then so be it. Plus if this is where the session is always going to be progress will still be measurable as you will always be a little fatigued in the session. For this reason it might be a good idea to place one of the sessions the following day after depending on when you are running and how many hard sessions you have in a week.
A distance runner might have a schedule along the lines of these two options.
In all the above examples the placing of the sessions allows for maximal recovery from hard sessions be they in the gym or on the road/track. One other aspect that is often abused at best or not utilised at all is that of plyometric drills. Box jumps for time etc aren't anyone's friend and are a sure fire way to a ruptured achilles but performed correctly and placed appropriately they can be a runners way of tapping into another avenue for improving performance.
You mean I have to find space for another session? I hear you ask. The answer is no you don't. You can use them as part of your warm up and especially easy to fit in with your track session. Placed at the end of the warm up and before the session itself they are a great start to the session. You can utilise the likes of various hoping and bounding drills and, if you are at a track, make use of hurdles to create a variety of progressively more challenging drills. Placing them in the track work allows for a more efficient use of your time. The beauty of placing them in the track session is that it will help you prepare for the speed session and get the benefits of plyometrics with out having to set aside a specific time to do them.


By making a small investment an infomercial production company can make your entrepreneur dreams come true. If you have a product that you are having trouble marketing, using an infomercial production company can help get the word out about your product.
By supporting a low pressure decision making process Drtv companies can help people get the best help from an infomercial production company. Without making consumers feel overwhelmed by products infomercial producers can get them interested in buying one of your products. Marketing is a tough job and without knowing the ins and outs, getting it done properly is tough. With the help of an infomercial production company entrepreneurs can get their product the kind of attention it deserves.
About one third of the United States enjoys watching DRTV production infomercials. If you want your product to be seen by a large number of people, using an infomercial company would be very helpful. Since there are several other ways of marketing your product, business people have to get creative when trying to market their products. Using the internet to do this has become a popular option in the last few years.
This entry was posted	on Friday, March 29th, 2013 at 4:03 pm	and is filed under Infomercial company, Infomercial production, Tv media buying agency. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


As the rituals of national mourning began yesterday at Virginia Tech with a convocation featuring President Bush, network television arrived in full at the Blacksburg campus.
The ABC, NBC and CBS networks, which played catch-up to the cable channels yesterday, interrupted their regular programming to offer live coverage of the afternoon memorial service and special prime-time news programs. And they did what TV does best: Offer powerful visual images to millions of viewers.
But the scattershot barrage of information, cell phone images and witness accounts from local citizen reporters, bloggers and online social networks that fed the 24-hour cable channels of CNN, Fox and MSNBC continued.
The spectrum of old and new media coverage that streamed yesterday from the western Virginia campus offered an illuminating glimpse of the enormous changes engulfing the news industry today, analysts said.
"We are in this period of great transition, and that is exactly what we're seeing on display in the coverage at Virginia Tech," said Philip M. Seib, author of Going Live: Doing the News Right in a Real-Time Online World.
"There are two tracks of media today, and on a major story like this, they converge."
The conventional medium of television excels at coverage of grand events such as state funerals or yesterday's convocation. But at breaking news events such as Monday's massacre, the older medium is greatly diminished. Its coverage often seems slow in comparison with nearly instantaneous reporting by citizen journalists armed with cell phones.
By the time the network anchors arrived in force to cover the story, news consumers had for hours been taking advantage of the rich array of alternative information sources - from online community bulletin boards and blogs to cell phone images posted in Web galleries.
"Each time this happens, the traditional media of Katie Couric [CBS], Charles Gibson [ABC] and Brian Williams [NBC] lose a little more ground," said Seib, who is the Nieman professor of journalism at Marquette University.
However, yesterday's coverage of the massacre also illustrated the ways in which television is adapting to the Internet.
"This story really lends itself to the Internet and other forms of new media," said David Doss, executive producer 360.
"Think of just a few years ago, when on a story like this we would look at what the AP [Associated Press] had or what the local papers had. ... Now we're looking at PlanetBlacksburg.com, which is the local school Web site down there. We're looking at the school posts online -- and MySpace, YouTube, Facebook."
Doss, who was executive producer of NBC Nightly News with Tom Brokaw in the 1990s, said that to reach viewers, particularly young adults, "you have to speak to them in the places that they get their information."
MSNBC.com, which also launched an on-site blog yesterday, found an eager audience: 15.3 million viewers visited the Web site Monday, a 37 percent increase over its all-time high during Hurricane Katrina.
One posting about remarks made by Charles W. Steger, the president of Virginia Tech, received 151 replies in less than two hours. "That's a touch-point kind of response," said Mike Brunker, projects editor at MSNBC.
"There are a lot of aspects that make this story so suited for the Internet. It's complicated, details keep coming out, and it involves young people who demand a certain kind of interactivity. That's what we're trying to address with the blog."


Paraguay Average IQ - What is Intelligence Level of Paraguay people?
Paraguay is the least developed country on the South American continent. The basis of its economy is agriculture. However, there is not enough developed infrastructure, low level of education and pronounced economic inequality. The IQ level is low.