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Mind-Controlled Prosthetic Limbs May Be Available Within A Decade
25 February 2016, 4:03 am EST By Angela Laguipo Tech Times
In the century of vast technological advancement, people are not far from having thought-controlled prosthetic limbs. Australian scientists said that within a decade, their device will be helping people in wheelchairs or those who have artificial limbs to put their thoughts into actions.
Stentrode, a device just as small as a matchstick, is designed to be implanted next to the brain's motor cortex. It can pick up and transmit signals from the brain, allowing paralyzed people to move.
"This technology is really exciting. It's the first time that we've been able to demonstrate and develop a device that can be implanted without the need for a big operation, to chronically record brain activity," said Terry O'Brien, head of the department of medicine at the Royal Melbourne Hospital and a professor at the University of Melbourne.
What Is A Stentrode?
The device is an implantable device that can read electronic signals from the brain and transmit them to an exoskeleton. It is made from a material called nitinol or nickel titanium, which is designed to withstand expansion and compression without much effect on its function.
Stentrode will be inserted into a blood vessel until it reaches the motor cortex of the brain, which makes it less invasive. Once the device is in place, it will expand to press the electrodes against wall of the blood vessel. From this position, it can now detect brain messages and translate them into instructions that can control prosthetics, wheelchairs and other exoskeleton devices.
"This has been the Holy Grail for research in bionics - a device that can record brainwave activity over long periods. Inside the blood vessel, it's protected, it doesn't damage the brain vessel and can stay there forever," he added.
Human Trials On The Way
The researchers conducted laboratory trials on sheep. This time, they want to see if the technology will also work on humans. In 2017, human trials are expected to start in Australia.
The groundbreaking technology could offer a lot of benefits especially for paralyzed patients. At present, there are available methods that can access brain signals, but they require open-brain surgeries and become less effective as time passes by.
Since the stentrode is less invasive, it can be widely used on patients in the future, if proven effective.
The scientists developed the stentrode under DARPA's Reliable Neural-Interface Technology (RE-NET) program, which aims to discover new prosthetic technology that could help improve the lives of people like war veterans who lost their limbs and had brain injuries.
Prosthetic Limbs, brain, Implant, Stentrode
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Vidak says bill could protect Sacramento staffers
published on November 29, 2017 - 1:31 PM
Written by The Business Journal Staff
State Senator Andy Vidak (R-Hanford) sent a letter Wednesday to Senate President pro-Tempore Kevin de Leon (D-Los Angeles) to schedule a hearing on the "Legislative Employee Whistleblower Protection Act," which would protect workers in the capitol against retaliation for reporting ethical violations, including harassment claims, according to a press release from Vidak's office.
In the letter, Vidak accuses de Leon and Senate Appropriations Committee Chairman Ricardo Lara (D-Long Beach) of keeping Assembly Bill 403 from being voted on in the senate floor.
Though having made it through several committees, AB 403, along with AB 1788 in 2016, AB 289 in 2015 and AB 2065 in 2014, had stopped each time at the Senate Appropriations Committee, preventing it from a vote on the floor, according to the press release.
AB 403 is authored by Melissa Melendez (R-Lake Elsinore).
The bill comes amidst growing numbers of accusations of sexual harassment and misbehavior against legislators in California and across the nation.
Assemblyman Raul Bocanegra (D-Arleta), resigned Monday after allegations arose of sexual misconduct, according to the Sacramento Bee.
On Tuesday, the Assembly Rules Committee reviewed its policies and current protections for those reporting sexual harassment and Vidak said in the letter that many of the cases heard in that meeting may have been prevented had the bill been passed.
The legislative session for the state assembly and senate begins Jan. 3, 2018.
Local homeless care organizations receive $3 million Posted: January 14, 2019 at 1:49 pm
The California Department of Housing and Community Development (HCD) awarded
Rep. Nunes says no evidence of improper Trump-Russia talks Posted: March 2, 2017 at 3:33 pm
According to Rep. Nunes, the chairman of the House Intelligence
Mathis to host human trafficking town hall Posted: April 6, 2016 at 9:20 am
Assemblyman Devon Mathis (R-Visalia) will host a town hall meeting
Audit pending of bankrupt Tulare hospital's operations Posted: January 30, 2018 at 3:40 pm
An audit will be conducted amidst the legal issues surrounding

redpajama_set_name: RedPajamaCommonCrawl


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New Norwegian-Swedish research shows that reductions in moose numbers in the two countries are partly due to the growing wolf population. Where wolf predation is highest, there will be fewer animals left for hunters. Three out of four moose killed by wolves are probably calves like this one. (Photo: Barbara Zimmermann)
Return of Scandinavian wolves means fewer moose
The predator's return to the Norwegian/Swedish border has led to fewer moose in the areas where wolves have their territories. But hunters still kill far more moose than wolves do, researchers say.
Nancy Bazilchuk english version
sunday 06. October 2019 - 11:19
The number of moose being shot in Norway and in neighbouring Sweden has dropped, with the largest reductions in recent years, and in areas where wolves have established territories.
Researchers from the Inland Norway University of Applied Sciences (INN) and from the Swedish University of Agricultural Sciences (SLU) say that the drop in moose numbers is at least partially due to the increase in wolves.
Hunters kill most moose
Hunters still kill a good deal more moose than wolves do, even within established wolf territories.
Hunters take two to three times more moose than wolves in these territories, according to one of three new studies on wolves and moose undertaken by researchers at INN and SLU.
But the same study shows that the number of moose taken by wolves can vary widely within a wolf's territory.
For one thing, wolves are not very good at figuring out how much food the pack needs, and will kill the same number of moose regardless of the pack size, according to 2015 research from Hedmark University College.
That means in the areas of wolf territories where wolves hunt freely and take many moose, there will be fewer moose left for hunters.
Nevertheless, the researchers have determined that wolves are responsible for killing an average of 7–8 per cent of the moose population in a wolf territory every year.
At the same time, hunters kill 15–19 per cent of the moose population in the same areas every year.
The wolf's main prey in Scandinavia is moose. The photo shows a male pup from the Bograngen pack in Finnskogen, on the Norwegian/Swedish border. Researchers can follow the pup using a GPS system. (Photo: Barbara Zimmermann)
Hunting pressure far greater than predation pressure
The pressure on moose populations from hunters is thus greater than the wolf's predation pressure on the moose — even inside wolf territories.
At the same time, the researchers found that the variation can be quite large.
"Our research shows that there is a variation in hunting success within wolf territories, which can be partly explained by the wolf's uneven use of land," said Barbara Zimmermann, a researcher at INN.
The picture is complicated by the fact that in some wolf territories in Scandinavia, bears take even more moose than wolves.
Bears emerge from hibernation sometime in March, and are then quite hungry.
As a result, the combination of bears, wolves and hunters can kill up to 30 per cent of all moose in some areas each year.
Affects hunting strategies
The researchers also found that wolves have now influenced moose hunters' strategies.
In Norway and Sweden, hunters themselves have initiated measures to increase the number of moose.
One strategy is for hunters to shoot more calves, rather than adult animals. Another strategy is to shoot fewer moose cows, to increase productivity in the moose population.
Both can be effective.
Probably at least three-quarters of all moose taken by wolves are young calves. Even if hunters stay away from reproductive moose, the researchers calculate that the moose population can tolerate a 40 per cent reduction in numbers each year without the overall population being reduced.
You might also be interested in this article:
Norwegians and Swedes aim for more equal game management
hunting environment wolves


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Nantucket Red Tickets: A Henry Kennis Mystery #4
It's Christmas Eve on Nantucket and prominent businessman Jackson Blum is about to live out his own version of A Christmas Carol. No visions, no ghosts, just the past, represented ...
It's Christmas Eve on Nantucket and prominent businessman Jackson Blum is about to live out his own version of A Christmas Carol. No visions, no ghosts, just the past, represented by the exhumed skeleton of his old partner Ted Coddington with a bullet from Blum's Ruger pistol in its skull; the present, in the form of a horribly mistreated employee who reveals Blum as the Scrooge he is; and the future, invoked by a family crisis that threatens to ruin the rest of his life. Past, Present and Future, all colliding on the same dark night of the soul.
Nantucket Police Chief Henry Kennis is investigating the so-cold Coddington case with Blum as the main suspect while he roots out a plot to rig the traditional five-thousand-dollar Red Tickets raffle and struggles to close down a local opioid dealer who's selling to high school kids from a house on Tuckernuck Island-a bleak vista of wild moors, dirt roads, and unpainted homes a century old. "It's a time machine," says Kennis. With a whaling history.
Henry's own son has been accused of cheating, his daughter's been pushed out of the high school a capella singing group, and his girlfriend's Christmas play is careening toward disaster. It looks like a calamitous holiday for everyone.
All the scandals, tragedies, and intrigues of the season close in on Blum and Kennis as the two of them face off amid the carolers and colored lights. Finally, there's nothing to save the modern-day Scrooge from his terrifying future but a decades-old secret scribbled on a stolen slip of paper, and the uncertain mercy of the son he's lost. But it's Christmas, and as the snow finally starts to fall on the decorated trees that line Main Street, it's just possible that all sins will be forgiven and all sinners redeemed.
God Bless us, every one.
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Steven Axelrod holds an MFA in writing from Vermont College of Fine Arts and remains a member of the WGA ...
The Ghost of Christmas Past
Nantucket, November 1997
It had all started with the Winthrop deal. They had a chance to buy the building next door on Main Street, expand the business, and become a serious force in the town's economy. It was a once-in-a-lifetime opportunity—property values would never be this low again. The island's marathon of development was just beginning.
If they didn't buy the building, someone else would. Blum liked to say that Main Street real estate was gold, but in fact, it was more valuable than gold. The world had vast supplies of that shiny mineral; piles of it filled the vaults in the Federal Reserve building and Fort Knox. But store-frontage on Nantucket's Main Street? That was a limited resource, like the eighty-thousand-dollar bottle of 1858 pre-phylloxera cognac in his liquor cabinet.
Coddington didn't get it. "Nantucket is finished," he liked to say. "They've ruined this place. They've killed the Golden Goose." It was never exactly clear who "they" were—immigrants from various countries, tourists, developers, millionaires and billionaires, or all of them together.
Jackson Blum stared down at his partner's corpse, clutching the murder weapon in his hand, chanting silently, "I am not a killer, I am not a killer, I am not a killer."
He gaped stupidly at the gun—he didn't even remember picking it up—and then dropped it like…like—he remembered, years ago, carrying his old French bulldog outside to do his business and the ancient creature releasing a turd directly into his palm. This gave his stomach the same queasy twirl of disgust and horror. He staggered back a few steps. Throwing the gun down was pointless. He had to pick it up. He couldn't leave it here. And he had to bury the body. The bullet lodged in that skull would match his pistol if it was ever dug out, if the corpse was ever found.
He should dig it out himself. He shuddered. That was grotesque, unthinkable. To puncture Ted Coddington's skull with his penknife? Was that even possible? And then burrow into the brain, gouging and pulling the interior as if he was scooping out a pumpkin? No, no, no, absolutely not. He could barely stand to look at the body; he dreaded moving that surly inert weight—dead weight, that was the term—shoving it into a shallow grave.
The rasping engine of a motorcycle snapped him alert. He was far out of sight of the Madaket Road but a dirt track ran through this wedge of moorlands. If someone were to drive by…
He stood frozen in place as the Harley growl faded away toward town. He was safe for the moment. But the urgency remained. He was lucky in one way: along with the yearly series of off-road driving permits that decorated the rear bumper of his Ford Excursion, like a line of commemorative stamps in a binder, testifying to his seniority on the beaches of Wauwinet and Coatue, he stowed the legally required boards, towrope, and, most importantly, the shovel. So he had the tool he needed to bury the body.
But it would take time. And he had no alibi for his presence here—he had rushed out of the store fearing the worst, after Coddington bailed on their meeting with the Winthrop people. Coddington had sounded crazed and shaky on the phone and Anna had no idea where he'd gone. She was off-island—she had answered her cell in Pain D'Avignon. And she wasn't worried, not yet anyway. Coddington liked his long walks on the beach and his solitary bike rides in the moors.
Blum clenched his fists and his jaw in a motionless seizure of self-disgust. He should never have called Anna. His neutral inquiry would look suspicious in retrospect. If she'd picked up on his worry and guessed he was cruising the island searching for her husband, that would be worse than no alibi—it was the anti-alibi! A virtual confession of guilt. I found your husband on the afternoon of the day he was planning to wreck all our plans for the business….
And he happened to be dead!
And he happened to have my gun in his hand!
With one of my bullets in his brain!
Anna had overheard some of their arguments. The loudest and most combative one had broken out at 21 Federal on a busy Saturday night with the bar packed three-deep and every table taken. Chick Walsh himself had escorted the two of them out the door. Slim, elegant Chick Walsh—the least likely bouncer on the whole Eastern Seaboard. But they had submitted to the controlled rage on Chick's face and stumbled out like chastened schoolboys being marched off to the principal's office.
So there would be plenty of witnesses to testify at the murder trial.
"You were dining at the restaurant 21 Federal on the night in question, September twenty-first, 1997?"
"And you heard the defendant arguing with Mr. Coddington?"
"I'll say!"
"Just answer the questions, please."
"Sorry. Yes. Yes, I did."
"And did Mr. Blum threaten Mr. Coddington with bodily harm at that time?"
"Yes, he did. He said, 'It would be easier just to kill you.'"
"So Mr. Coddington was in fear of his life?"
"Objection! Calls for a conclusion."
"Sustained."
"I'll rephrase that, Your Honor. Did Mr. Coddington do or say anything on that occasion that made you feel he might have feared for his life?"
"Yes. He lurched back in his chair, knocked it into my wife's chair, in fact. She was sitting with her back to their table. And he shouted, 'Get away from me!' I thought Mr.—the defendant—I thought he was going to attack Coddington right then and there."
Oh, yeah, that would go over well. That was a first-class ticket to Cedar Junction. Go directly to jail. Do not pass go, do not inherit your business from your dead partner. Blum squirted out a high-pitched laugh, clamped it to silence. He sounded crazy, even to himself.
He had to take charge. This was a manageable situation. That was what he did best. That was how he had made his fortune—managing situations, finding solutions and implementing them. Problems seemed hopeless because you took them up all at once, in a single unwieldy slab. They had to be deconstructed, broken down into bits, and the bits taken care of, one at a time.
The first bit: bury the body.
This was Land Bank property—"forever wild," as they liked to say. No one would ever find the grave and Coddington's disappearance would remain a mystery—was he a middle-aged runaway? Had a secret crime from his past come back to haunt him? Had he eloped with an old lover, disappeared into the Witness Protection program, slipped away to join a monastery? All that stuff happened. People did those things and more. People went crazy. People snapped. Anything was possible.
As long as they never found the body.
That was the conundrum—it buzzed around his head like angry yellow jackets: if he dug a grave and the grave was found… Blum wasn't faking anything, he wasn't trying to cover up a murder, but that was how it would look.
Bodies don't bury themselves.
Still, leaving the body where it was, in full view of any stray hiker or birder was foolhardy, idiotic—with a bullet from his gun lodged in Coddington's brain? Absolutely not.
He crashed back to his car, lifted the tailgate, grabbed the shovel, and trudged back. With the first stab of metal blade into soil he realized the chore he'd set for himself. The ground was a tangle of roots and vines, pitted with rocks of all sizes. He stamped down hard on the back of the shovel with his boot, felt metal cutting the webbed gristle under the surface. He lifted the weight of dirt, flung it aside. He had thrown out his back the year before, after the big blizzard, perversely determined to shovel out his own driveway—refusing to pay off some money-grubbing teenage hustler.
This would be much worse.
"The whole plan is crazy!" Coddington had shouted at him that night in the restaurant. "It's financial suicide. You're digging your own grave! And mine, too."
The words came back at him now. Was he doing that? Burying both of them in the moors? It certainly felt that way. How had it all happened? He was a business prodigy! Forbes magazine said so! The Wall Street Journal called him a visionary in their profile last year! He'd spent hours watching the sycophantic little geek from the paper scribble down every word he said. Days.
And what if that fawning punk could see him now? Visionaries were supposed to anticipate the future, grasp events taking shape before everyone else.
He kicked the nose of the shovel into the ground again. He hadn't seen this one coming.
Or was it that he'd seen it perfectly well and just didn't want to look? Denial, that most despised human weakness, the puny foible he ridiculed in others—demanding that his wife have that lump checked (it turned out to be benign), that Coddington investigate that ominous whistle from his car's engine (yes, some belt or other had to be replaced and it was a good thing they did it before that old Volvo broke down on the highway!).
Well, he hadn't been in denial about Coddington's suicidal tendencies. No one could have predicted this act. The people who talked about it rarely did the deed; and the actual depressives kept things buttoned up so much that even their closest friends were surprised when they found the body, baffled when the read the note.
The note!
It was probably sitting on Coddington's desk at home right now. It was only a matter of time before Anna walked in and saw it: one of those pale blue envelopes he used for personal correspondence, with her name scrawled across the front.
Coddington would never confess the real reason—but somehow he'd still make it sound like everything was Blum's fault, evil Jackson Blum who had turned poor Coddington's life into a nightmare. She'd buy it, too—people committed suicide for a million different cockamamy reasons, and Anna had always hated Jackson anyway.
Thinking about it as he jabbed the rusty shield of the old gardening spade into the hard ground, sweating through his shirt even after he'd pulled his jacket and his sweater off, he realized that Coddington's suicide note was his insurance policy of last resort. Better they should never find the body, never know what happened; but if they ever did, the dead man's last message to the world would go a long way toward clearing Jackson of a murder charge.
He made the list in his head: finish the grave, clean up, get the suicide note, take the gun home and stash it back in its box. He couldn't just ditch it, unfortunately. It had significant value—a Ruger Standard, one of the first ones ever made. The certificate it came with and the serial number on the barrel made it worth thousands of dollars to the right collector. But that had nothing to do with the weapon's real worth. The gun meant too much for him to just dispose of it like a hunk of trash.
Blum's father had brought the pistol back from Germany after the Berlin Airlift—the gun nestled in its red box with the black griffin logo. That gun—it looked a little like a Luger—lying in the dirt at his feet. An ordinary, semi-obsolete handgun, but priceless. His father hadn't left him much. In fact, beyond the Ruger and a pile of unpaid debts, there was next to nothing. Some letters, some handmade furniture, his great grandmother's wedding ring that Marjorie still wore. The gun was his legacy and to Blum's father it symbolized the war—the bombing runs and then the food runs during what he always called Operation Vittles. Dad's whole growing up, in fact. Blum's father became a man during those years and this gun was the totem of that passage. He couldn't just throw it away. And he wouldn't have to. He had never mentioned the Ruger to anyone except Coddington and Marjorie—who, as his wife, couldn't testify against him, even if she wanted to. The Ruger fired standard rounds, and the .22 was the most common bullet in the world. If they ever found the body, they'd just assume the gun had been stolen by scavengers. People wandered the moors with those metal-detector wands all the time, looking for just this kind of loot.
He slagged another load of soil to the side of the pit, felt some- thing shift in his back. He was going to be crippled tomorrow.
His head was spinning, but his plan made sense. Coddington would disappear. People would wonder why, they'd make crackpot guesses about where he went. Everyone loved a mystery. Unanswered questions fueled the Nantucket gossip mill like big dry hardwood logs on a fire. The enigma would keep them warm for years, like that town where everyone disappeared one morning, what was it? The Roanoke Colony, right. Coddington's vanishing act would be like that. No muss, no fuss, lots questions, no answers. That's how Coddington would have wanted it. He just wasn't thinking straight. Well, that had always been Blum's job anyway.
One more spadeful and he was done. It didn't need to be a deep grave. Good thing, because Blum was wrecked. He stood panting, leaning on the handle, letting his heart rate normalize. How had he gotten into such lousy shape? He used to be an athlete.
When he caught his breath, he rolled Coddington into the narrow trench and starting filling it in. The question would remain: how had Coddington gotten buried? But some eccentric Good Samaritan might have taken on the job. That was possible, wasn't it? Nantucket people did Quixotic things all the time—like opening the ponds to the sea—Steve Scannell had done that with Sesacacha Pond a few years before—one guy and shovel, clawing a channel out of the barrier beach! Burying some random corpse was nothing, by comparison. You couldn't just leave the body out in the open, but you didn't want problems with the cops, either. That made sense.
But if the cops somehow connected Blum to the burial… No, no, they wouldn't, they couldn't. How could they? He was going to give himself a panic attack. He paused, took a couple of deep breaths.
Then he went back to work, filling in the trench. He cut his wrists while ripping the coarse shrubbery to cover the mound of fresh soil. His hands were filthy, so were his clothes. He looked like he'd been rolling around in the dirt, like some burrowing animal, like—
Like a rat. Jesus Christ. Rats!
He was maybe a mile and half from the dump here. Nantucket had more rats than people, and ninety percent of them lived in that trash paradise. They'd smell the decomposing body. They'd come for the fresh meat. That was what they did. That was their job. This grave wouldn't last a month unless he could keep them away.
The endlessly multiplying complications overwhelmed him. He thought he might scream, or break down crying, or vomit. Or all three. And the complications assaulting him now were just the ones he had happened to notice. What about all the other ones he hadn't thought of? This was impossible.
He stood still, letting the icy north wind buffet him.
Rats. He caught some stray scrap of memory about rats. A family of them had taken up residence in his father's vintage Buick Roadmaster while it was in storage at a local garage. They chewed through the wiring, shredded hoses and belts, nested in the engine block. What had Dad done about it? Peppermint oil? Blum remembered something about peppermint oil. But that hadn't worked. How was Blum supposed to remember this stuff? He'd been…what? Maybe nine years old at the time? That was thirty years ago. They were still living in Schenectady, in the old house on Union Street. The place probably didn't even exist anymore. Still, his dad had figured something out. Some Old World folk remedy.
But what?
Blum felt like a green recruit in an old war movie, holding onto an enemy grenade, paralyzed, waiting for it to go off in his hand.
Throw it, get rid of it, think!
"Even rats know this crap is poison!" That's what his dad had said. Poison, poison—what could be such a terrible poison? What crap was he talking about? Blum could feel his brain bulging with thought, pressing against the smooth walls of his skull like water freezing in a full bottle. Something was going to crack.
Then he gave up, sagged, opened his eyes—relaxation that was somehow a final exertion of the will. And the answer snapped open like a jammed window.
Tobacco!
That was it. And not just any tobacco—chewing tobacco. The smell kept the rats out of the engine block. It would keep them away from the grave. So Blum needed chewing tobacco, cans and cans of chewing tobacco. Ten cans? Twenty? As many as he could find and as fast as he could find them.
One more item on the to-do list.
First, the suicide note. Then the snuff. What an appropriate term! Then back here—mix the shredded leaves in with the loose dirt, get back into town and start making up a good explanation for how he'd spent his afternoon.
Details, details. The Devil was in the details, that was what everyone said. He was never sure what that meant, but now he knew. The Devil was hiding in the details, physically hiding, camouflaging himself like a ferret in a leaf pile, fangs bared, ready to strike.
Blum strode to his car, javelined the shovel into the back. Thinking of the tobacco gave him hope. He had a good eye for detail. Nothing got past him. That was how he had nailed Coddington in the first place.
It hadn't been just a matter of analyzing the business ledgers—some routine act of forensic accounting that any bean counter could have managed. Blum had also noticed the tiny details of behavior—the irregularities in conversation and hand gestures and eye contact. But everything was connected—the odd uncomfortable pause, squeezing the thumbnail with the fist, eyes flicking sideways…they were far more revealing than some small discrepancy between absorption costing and cash flow.
Blum had gotten the feeling that there was more to Coddington's resistance to the Winthrop deal. Coddington seemed nervous, not cautious—jittery and scared, when he should have been calm and prudent.
Gradually it had dawned on Blum: Winthrop wanted to audit the business before the closing, and Coddington didn't want them examining the books.
What was it? Tax-dodging, embezzlement, fraud? What was he hiding? Drugs, hookers, gambling debts? And how was he doing it? Claiming withdrawals as advertising expenses, over-stating net income? Or was there a whole other set of books to conceal the profits he was skimming? The possibilities were endless and Coddington had the necessary skills for fraud—he had studied to be a CPA, though he never passed the exam.
Blum was no accountant but he knew where his money was going and where it was coming from. He knew their vendors and their customers, their creditors, and their charge account customers. He knew who paid late—mostly the richest of them. One noted orchestra conductor who had inherited a giant house on Cliff Road and married a copper heiress, still hadn't paid for a set of Callaway Big Bertha irons he'd signed for at the beginning of last summer.
The point was the ledgers would be full of familiar names. They were as close as Coddington would ever come to an autobiography, measured in accrued interest and invoices paid. Best of all, Blum could poke around all he wanted and no one had to know. Whatever he discovered could stay private.
He had gone into the store early that Sunday morning, and pulled the ledgers. The store used a computer spreadsheet program, but Blum insisted on keeping hard copy double-entry books. He no longer trusted computers, after losing a year's worth of data with one crash.
The accounting tablets were a pleasure to read, and his cramped little office was warm and cozy on an autumn morning. The ledgers sat on a wooden filing cabinet tucked under shelves that rose to the ceiling piled with ski sweaters and shoe boxes. One desk held the desktop PC. Blum pulled a chair up to the other one, a scarred antique walnut keyhole printer's desk he'd purchased years before at one of Rafael Osona's auctions.
The store was quiet; the town was quiet. The only sound was the dull thunder of the old furnace and the occasional car rattling up the Main Street cobblestones.
He found what he was looking for in the first five minutes.
The company was called Spindrift LLC, and Coddington had been authorizing monthly payments of seventeen-hundred dollars into their account for the last eight months. The first entry dated from March tenth.
Blum rocked his old wooden chair on its back legs, pushing against the edge of the desk. What happened in March? Had Coddington purchased some small property? This could be a mortgage payment. Or installments on some debt. How did it work with book-makers? If you got in over your head, could you arrange some sort of installment plan, like with the IRS? Could this be back taxes? Or was there some windfall Coddington had been hiding, some giant cash haul he was laundering through this dummy corporation one month at a time? If so, he hid it well—no ostentatious purchases, not even a new car. Coddington was famously stingy—a voracious reader, he didn't even buy books. He would happily tell anyone willing to listen that he was outraged by the price of hardcovers and happy to wait a month to borrow any title he wanted from the Atheneum.
No, no—Anna would have mentioned a cash real estate transaction or a trifecta win at Suff Downs. She would certainly have upgraded her wardrobe. So no sudden influx of cash. Anyway, real estate sales were listed in the newspaper, filed at town hall. And the gambling idea was far-fetched, too. Coddington had never shown any interest in the gambling sports. He thought horse-racing was cruel. And he hated casinos. After one business trip to Las Vegas, he had memorably called it "the vampire city"—sleeping in its own dirt by day, and rising at sundown to suck the blood of its victims. So no gambling wins to hide, no gambling losses to pay off.
Blum stood and stepped out of the office into the shadowy store, pacing between the shelves, straightening the displays. The merchandise made good company.
What other vices could Coddington have? Drugs? But he couldn't imagine that dealers used payment plans, and anyway, didn't the prices always go up? But maybe Coddington was using prescription drugs—Percocet or Vicodin. That would be a price-stable monthly purchase. How much of that crap would seventeen-hunded a month buy you? Way too much, that was Blum's guess. Coddington didn't act like he was doped up, but Blum's father had never seemed drunk, either—despite the fifth of cheap Scotch he drank every day. He proudly referred to himself as a "functioning alcoholic" until the day the booze killed him. Maybe Coddington was the same way. But prescription meds required a doctor, and doctors needed a reason to write a script like that. Had Coddington hurt himself last March? Thrown out his back, taken a fall, suffered an accident of some kind? Nothing came to mind. In fact, Coddington had always been fit and agile, insisting pompously on the benefits of his dirt-road bicycle excursions, and gloating over his skills on the paddleball court. He had even started "juicing," reducing various vaguely nauseating combinations of vegetables into muddy sludge and gulping it with a lip-smacking glee that Blum found implausible at best.
But he was nimble, you had to give him that. Just the other day, Blum had taken Coddington and Anna out to lunch at Boarding House with Anna's sister, Irena, and the girl had tripped over an uneven spot on the sidewalk. She pitched forward and, before anyone else could even register the physical event, Coddington had caught her arm and saved her from a nasty fall. It was almost as if he'd been watching her, expecting an accident, waiting for it. Or maybe he was just studying her for more obvious reasons.
Irena was a stunner, far better looking than her older sister, as so often happened, at least in Blum's experience. But she was clumsy and careless, which might explain Coddington's wary eye. She had caused three fender-benders since arriving on the island last January, and she was always knocking into things, dropping things.
"I am having a war with the inanimate objects," she had told him once, after slipping on an unpadded rug and tipping over a lamp. "I think the objects are winning."
You couldn't be annoyed when she flashed that lovely smile. Coddington had mentioned it more than once. "It lights up a room," Blum had admitted. Ted went further: "I would say it lights up the world, dear boy. Sunrise over 'Sconset Beach." But so what? Outlandishly beautiful things naturally provoked comment.
Still, thinking back, something had struck Blum as odd that afternoon, walking away from the restaurant. Coddington had held on to Irena's arm for a little too long, as if he was reluctant to let her go. It was probably just an extra measure of concern, but there was something else, something about the date. The timing of it all snagged him, like brambles on his sleeve.
Irena had come to Nantucket just after New Year's, and three months later, the money flow began—the perfect incubation period for a romance, especially a forbidden one. Irena had come to Marjorie's birthday party early in January, single and shy, barely able to speak English. Coddington had chivalrously set himself the task of stage-managing her entry into local society, finding her a job and an English tutor, a car and a place to live, coaching her on the written section of the driving test.
"Everyone else has the right of way!" she had laughed. "It sounds just like Lithuania."
Blum had race-walked back into the office, reached the desk in two strides and yanked open the ledger. He wanted to see the entries again, in black and white. They were so obvious—the amounts and the schedule of the payments told the whole story.
Coddington was paying rent, and he was doing it in secret. He was leasing himself a little love-shack, meeting Irena there for "late lunch" afternoon delights. The upstanding Catholic family man was cheating on his wife, and he was doing it with her sister. Could it be? Was it even possible, from a practical point of view, in a town this small? Would Coddington take the risk? He preened himself as an upright "pillar of the community," a church deacon no less, proudly intolerant of other peoples' foibles, casually assigning slots in hell to an acquaintance caught drinking on a Sunday or taking a payment in cash to hide money from the IRS.
Could he really be committing adultery? It was almost incest, too—that made it so much worse. At least, it felt like incest, banging your sister-in-law. Incest-in-law? Something like that.
Blum shook his head, amazed and amused. He'd had to find out for sure.
The surveillance had taken one week. He followed Coddington for a couple of days before he located the house, tucked away at the end of a dirt road in Tom Nevers, an area far from the social hive of the island. Coddington was famously oblivious when he was driving, and routinely offended friends and colleagues who waved to him as their cars passed in the street, so Blum had no problem trailing him, up Milestone Road to the old naval base turnoff, but had to watch and drive past as the big Volvo station wagon hooked a right onto an unpaved side road. Even Coddington might notice another car chasing him down some dead-end dirt track.
Blum came back the next day and started scouting the houses. He found no obvious clues—he couldn't identify a car by its tire tracks, for instance, and there was no telltale scraping of paint where Coddington might have brushed against a fence post. The houses themselves were blank and anonymous—gray shingles, weathered cedar trim, semi-attached garages. Some had curtains, others had shades, but there was nothing distinctive about the window treatments, at least from the outside.
Blum eliminated three of the ten houses—there were toys in their yards. He couldn't imagine that Coddington had a whole other family going out here. That was too crazy. Another house featured at Ford F-350 pickup and a pair of sawhorses in the yard, straddled with three-by-five planks. So, some carpenter. Coddington was anything but.
That left six houses. One of them was being used as a barracks for construction workers—he counted seven cars in the dirt in front of the place and saw several young guys going in and out, different ones each time—sawdust-caked, paint-spattered, figure-piped with plaster. Maybe they worked for the contractor with the Ford pick-up.
There were five houses left, and short of actually stepping up and knocking on the doors, Blum was stumped.
That changed the following Sunday. He drove by in the late afternoon. At the last house on the road, he found a prayer card from St. Mary's Church floating in a muddy puddle near the split-rail fence. It was easy to imagine how it got there: a windy day, a forty-mile-an-hour gale honking out of the northeast, the card on the dashboard, lifted out of an open window.
And Saint Mary's was Coddington's church.
He glanced at his watch—almost four o'clock on a blustery afternoon. The neighborhood looked deserted—no kids playing in the street, no one working in the yards. Coddington's secret house was tilted toward the others, which meant you could park in the back without anyone seeing your car. Was someone parked there now? He couldn't tell, but the narrow dirt road allowed no other hiding places. To investigate further without being seen, Blum would have to drive around, himself. Coddington spent Sundays with his family—there was no chance of running into him. What about the girl, though? Did she live here? It was a waste of a solid rent check if she didn't. But the place felt deserted, almost abandoned, in the late afternoon sunlight.
Blum drove to the back. He saw spaces for three cars but the yard was empty.
He killed the motor and listened to the wind. It pushed at the car like an animal, a cat rubbing itself against a chair leg.
He sat still for a moment, hands on the wheel. He was no thief; he didn't even like the idea of trespassing. But of course he was already doing that, with his car parked on the property. And the fact remained: the inside of this little bungalow could contain all the leverage he needed to get Coddington on board with the Winthrop deal.
Blackmail, in other words. But Blum refused to see it that way. Knowledge was a commodity and so were secrets. The truth remained pristine. If you possessed a fragment of it that others did not, you could build a fortune on it. Think about the Comstock Lode. It had started out as a gold mine. Prospectors found it difficult to wash out the fine gold because of this peculiar dense sludge that clogged the rockers. Very annoying! Until one man grasped the fact that the sludge was silver. Pure sulphuret of silver! And that's where the vast wealth of that enterprise came from. Not the silver, but the ability to identify the silver. This was no different.
Whatever Coddington was doing out here, those actions constituted the truth. Blum hadn't contrived or manipulated that truth, any more than Comstock had transmuted base metal into the seventy thousand tons of silver of the Ophir Bonanza. You didn't create the truth. You discovered it. You recognized it.
And you exploited it.
Blum pulled himself out of the car on the surge of resolution. He found the house key under the welcome mat—that was a good way to make him feel welcome!—and let himself in. He knew what he was looking for, a short catalogue of incriminating items. It didn't take long to find them.
The front door opened onto a big kitchen—no front hall, no mudroom. Fake wood cabinets, rusty electric stove, old GE fridge. No cooking smells, no dishes in the sink. The place presented as impeccably tidy, but the clean counters made it seem vacant—a stage set. He snooped the shelves, found cans of beans and boxes of instant rice, a tin of oatmeal, and a jar of Nescafe instant coffee—the first item that matched Blum's inventory. Nescafe was Irena's brand—how often had she claimed it tasted better than the real thing?
The kitchen widened into an open plan, under-furnished living room. An old couch and two worn leather armchairs pointed at a big Sony Trinitron TV; generic Nantucket art fair pictures on the walls—cobblestone street scenes, Sankaty Light, sailboats. A vase of dying irises on an end table.
Irises—Irena's birth flower.
He checked the bathroom next—nothing there except the plush toilet paper favored by new money and the poor. Old money people bought the single-ply Scott tissue that demonstrated thrift and common sense, scorning ostentation and display. This small item was consistent, if not conclusive—Irena was an immigrant striver, drawn to any hint of luxury—from the fancy car (Range Rover was her ride of choice) to this tacky triple-ply "facial tissue."
The shag carpet in the bedroom was another clue. He had heard Irena extol it as a luxury item! Blum supposed a lifetime of grimy bare floors had warped her judgment. Then there were the pillows on the bed—way too many pillows, branded pillows from Nantucket Looms and Erica Wilson, and a blue lace neckroll very much like the one he and Marjorie had given Irena for her birthday. She had complained about never being comfortable reading in bed.
That would have been enough, but Blum recognized the clothes in the closet, also. The short dresses that showed off Irena's legs, the fur-collared coat she had brought with her from Lithuania.
Blum stepped back and sat down on the bed. He had been ninety-five percent sure of what was going on—hell, it was more like ninety-nine percent. But, oh, that last one percent! It meant more than the other ninety-nine put together.
It meant everything.
He stood up, thinking hard. He needed some token of his discovery. He opened the drawer of the nightstand and saw a litter of Avanti condoms—the newest thing—made by Durex, some English company. They weren't even going to be commercially available for another year, but Coddington had connections with the importer. He had bragged about all of this over drinks at Boarding House one night. It was so typical of the man—he had to have the best and the newest of everything. And if it happened to be English, whatever it was, so much the better. Like the Taylors of Harrogate tea he had shipped from Great Britain every few months, which tasted no different from Lipton's, as far as Blum could tell. Boasting about details that made you feel unique was a mistake—they set you apart, put the spotlight on you, made you vulnerable. This little condom was as incriminating as a fingerprint.
Blum took it, and one of the irises, and let himself out of the house.
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"…with the help of Kennis—the shrewd, street-wise cop who writes poetry on the side and is willing to break the rules to get the best results for the most people—fans can keep wishing for an outcome worthy of Dickens and the holiday season.In the fourth installment of this seabound series, Axelrod (Nantucket Grand, 2016, etc.) and his protagonist bring an amused, judicious, and ultimately tolerant eye to the foibles large and small of a mixed Santa's bag of characters."
"Scrooge lives in Axelrod's enjoyable fourth mystery featuring Nantucket police chief Henry Kennis"
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Annie Leibovitz | It's LesbosNoir in Blogland!
Annie Leibovitz is among the most famous of contemporary American photographers. Best known for her celebrity portraits and work in advertising, she has in recent years photographed a wider range of subjects. Her work has been shown at major exhibitions in the United States and abroad. She has also published a number of books of her photographs.
For over a decade Leibovitz was the close companion of writer Susan Sontag, who was present at the birth of the former's baby, but the two did not publicly discuss the nature of their relationship.


It's a grim business, this being funny. Every time you come up with a strong, satiric idea, the world tops it.
No one else has performed in a play after they've died, and I want to be the first person to do it.


text:
Q: Can i add property to a BPEL in active composite without redeploy through WLST I want to add bpel.config.auditLevel property to my SOA Web Services but because they are many and because of that, i need to find a way to do this through Web Logic Script Tool(WLST) with simple Jython script. Ive searched in the entire internet with no luck... Maybe this is not possible or i don't know.
Ive find a WLST command called setWebServiceClientStubProperty() but i'm not so sure is that the one i need and there is no examples how to use it soa web services.
Can any one help me with this ?
Thank in advance!
D.T.

A: You could try something like this :
Connect(USERNAME, PWD, URL)
custom()
cd('oracle.soa.config')
redirect('NULL','false')
list = ls(returnMap='true')
redirect('NULL','true')
for composite in list:
  compositeObject = ObjectName(composite)
  if compositeObject.getKeyProperty('j2eeType') == 'SCAComposite':
    if compositeObject.getKeyProperty('name') == 'YOUCOMPOSITENAME':
        compositeProperties = mbs.getAttribute(compositeObject, 'Properties')
        compositeProperties[0].set('YOURAUDITLEVEL')

redpajama_set_name: RedPajamaStackExchange


text:
ToonGet for your Android devices - free download
ハイスクールD×D, Highschool DxD
Issei Hyodo is your average perverted high school student whose one wish in life is to have his own harem, but he's got to be one of the unluckiest guys around. He goes on his first date with a girl only to get brutally attacked and killed when it turns out the girl is really a vicious fallen angel. To top it all off, he's later reincarnated as a d… more Issei Hyodo is your average perverted high school student whose one wish in life is to have his own harem, but he's got to be one of the unluckiest guys around. He goes on his first date with a girl only to get brutally attacked and killed when it turns out the girl is really a vicious fallen angel. To top it all off, he's later reincarnated as a devil by his gorgeous senpai who tells him that she is also a devil and now his master! One thing's for sure, his peaceful days are over. In a battle between devils and angels, who will win? less
Category: Dubbed Anime
Rating: 9.54 (170 Votes) Rate it!
Genres: Comedy, Demons, Ecchi, Harem, Romance, School, Shounen
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Average Home Depot Gift Card Sells for 99.9 % of Card Value.
Home Depot helps the everyday person improve their living, dining, kitchen, garden and more. Do you have a Home Depot gift card? Sell it here at Gift Cardio, and give the gift of home improvement to someone else.


Talk It Up TV set out to help a veteran family in need, and we found the perfect one. After getting to know them, we decided what they needed was a little Christmas magic and a life-changing act of kindness to brighten their lives.
Meet the Kelleys: David is an army veteran who was injured while on active duty. While in Iraq, he broke his back and sustained a traumatic brain injury. He also also has PTSD and is often confined to a wheelchair. His wife, Stacey, is his caregiver and the couple have three children together, all with special needs. One of the children, Tristin, has had 29 surgeries. Maverick has Asperger's and little Aveleen has autism.
If that wasn't enough for any one family to endure, Stacey was recently in a car accident and will need physical therapy. Her mother, Gloria, will be coming to live them as well, because she recently suffered a stroke.
Because of this family's story, nearly 100 members of our community came together to show them love and kindness during the holiday season. We put together a few very special surprises for this family, but you'll have to watch the episode to find out what!


I've always thought crafty stuff was fun. If you've been in my corner of the interwebs for any length of time, this will probably not come as a surprise. But really I don't think it was until I was in seminary that I gave serious consideration to art as a gift that I should spend intentional time cultivating. It wasn't until then that I really began to explore art as a legitimate way to express hearty, academic ideas. And it was even later than that that I was really any sort of comfortable calling the stuff I made "art." It took professors saying "you can write a paper about this, or use another medium as long as you explain it." It took friends remarking that they'd found meaning in something I'd made (or sometimes just that it looked cool). Y'all, it takes a village, even when you're not a kid anymore.
It always took me way longer to do these seminary projects than it would've taken to write the paper. Sometimes the basic idea came quickly, but other times I mentally wandered around in circles for a while until I got there. It was always an interesting undertaking, to say the least. What was my thesis statement? What image was I going to use to say it? How would I communicate the intricacies of Scripture's original languages without actually using words? What materials would I use? Would those mediums help support my point? Would this whole thing make me seem like I wasn't working hard enough, because I was spending hours on arts and crafts instead of in the library? Anticipating the task of writing pages dissecting your art means you have to pay pretty close attention along the way.
Nowadays when I make something, I can explain as much or as little as I want and leave it at that. (My blog my rules!) But whether I realized it at the time or not, those seminary projects influenced the way I still make art today. It turns out that the art of paying attention is a life tendency that comes in handy.
This project is from my first year of seminary (which was more than five years ago?!). New year, old art. An old beginning for a new one. Here's to being hopeful in 2018!
As I've been mulling over what this creatio ex profundis* might have looked like, it always seemed to be this churning mess of dark blues, greens, and purples, perhaps with the smallest sparks of brighter color or light, out of which and over which the ruach [wind/breath/spirit] would emerge, an equally messy and captivating presence, but full of more color and light. This ruach would snake its way in and out of the void, gently and mysteriously calling together creation.
A Genesis-inspired journal entry for The Earth Is the Lord's: Ecology, Theology, and the Church's Witness at Columbia Theological Seminary; Decatur, GA, December 2012.
*Long idea short, theologian Catherine Keller's creatio ex profundis suggests creation out of chaos, alternative to the more traditional creatio ex nihilo — creation out of nothing.


text:
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About SBR
You are here: Home1 / Latest news2 / GT Cup Awards 2017
GT Cup Awards
So 2016 saw our 458 come out of semi retirement to compete in the GT Cup Championship. Our brief from the car's owner, Paul Bailey, was he wanted to win the GTC class as he won the GTO class in 2015 in one of his Aston Martin GT3 cars, and wanted to come back in a Ferrari.
The season had its ups and downs, and the car was plagued by electrical and gearbox issues. Knowing the car well we managed to nurse through the season ,Unfortunately the car did not make the last round due to an engine failure, but we did managed to collect enough points for a clear win in the GTC class.
January 2017 was time to collect our class win trophy to add to the big collection for the 2016 season! A big thank you to everyone who supported us through the season and to the guys at SBR who put in the time to get the results. Also a big thank you to Paul for letting us support and prepare his cars..
© Copyright - SBR Engineering Ltd 2020
Ferrari 246, Series 1 Restoration First Round of GT Cup 2018


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If you've been kicking around here for any length of time, you probably have a good idea that I'm a pretty big advocate of From Software in general and Dark Souls in specific. The series has made quite a splash in the western market, so it makes sense that we'd see a bit of an upgrade to its collectable releases as time has gone on, as Demon's Souls didn't really offer anything, while Dark Souls offered a free steelbook version if you preordered the game. Well, Dark Souls II goes above and beyond with its Collector's Edition content, offering up a release that's on par with some of the larger Triple-A Collector's Editions to come out over the past several years. I'm not the sort of person to jump on any giant package released for a game I'm interested in, but as a dedicated and vocal fan of the franchise, I felt it was an easy purchase to justify, along with the CE strategy guide, and with that, I wanted to share it with all of you, since in some locations it may still be available for purchase.
The game world map is a cloth map, suitable for hanging up or framing if that's a thing you're into doing. It's basically just an overhead view of the game world overall, meaning it's not anything you could use to navigate the world proper in any sense, but it's visually interesting and looks like you'd expect a map from a Souls game to look, honestly. It feels fairly sturdy in hand, as well, so it's not a cheap novelty by any means, and I can certainly say I think it's a worthwhile novelty inclusion in the package.
The artbook is a little more confusing in context to discuss, almost entirely because it lacks in context entirely. While the hardbound book is solid and features an extensive amount of artwork, that's the entirety of its contents: artwork, and lots of it. There are no comments from the design staff, or introductions, or philosophical waxings from the producer; indeed, this is an artbook in the purest sense of the term, as it's crammed full of art and nothing else. It's very nice art, to be certain, but for those who like a little context to their art, this may be a bit confusing for you.
It comes with two discs: the main game disc, which you'd expect, and a soundtrack disc featuring songs from the game. The music is as impressive as you'd expect, so this is a strong inclusion to make, and it's a worthwhile addition to the package. There's no manual included in the box, as has become a trend these days, though the package does include a DLC code for the "Black Armor Weapons Pack," which consists of a handful of swords, daggers, axes and shields to work with; they're not exceptionally better than the starting gear you can potentially have (unless you start Deprived obviously) but they're okay.
We finally come to the "big" piece of the CE, the figurine. The character stands a foot tall and is equipped in what the strategy guide describes as the Faraam Set, worn by the Forossa Lion Knights, for those who find this sort of thing to be interesting. He comes with two swords, which can be placed in-hand by taking the pommels off of the swords, slipping them into his hands, and replacing the pommels. The figure isn't posable outside of removing or placing the swords, and it's made of a fairly light-weight plastic all in all. It's worth the price if you're a fan of the franchise, or if you just like the armor designs, and while I'm the sort of person who would've preferred a sword and shield over two swords, the figure is pretty cool and justifies the price well enough.
Before we go, I do want to touch on the CE strategy guide for the game a bit, for those who are curious about it or thinking of picking it up. Weighing in at a whopping four hundred and sixty four pages, this hardcover book is an absolute beast, and you could probably injure someone with it if that's a thing you look for in your reading material. The guide, as with its predecessor, breaks down each area and shows you where all of the hidden goodies are, as well as much of what you can expect in each location, in case you're naive enough to think that'll help or anything. It also gives you a comprehensive list of armors, weapons, items and NPC's you can meet, as well as a description of what to expect from each enemy and boss you'll encounter throughout the game. While I haven't spent much time with the game proper, from perusing the guide, it certainly sounds like the final product will be even worse than its predecessor in terms of pure difficulty, so as the saying goes, "Prepare to Die," and we'll see about bringing you a final review as soon as I've finished learning just how many swear words I really know.
I although got the EU version of the CE, lacking the slip cover for the steelbook. But mine contained codes for the Black Armour Set as well as for some points for several merchandise articles! How many different versions of CEs might there be?
That figure looks great, and I love the idea of an artbook that actually has art in it for once.
Kinda wish I got the statue now too, though I have zero places left to put it.
Yeah, Shawn PC stopped by to check it out and he thought it was pretty well made too. I feel like it was worth it in retrospect, and I THINK it's still available on Amazon, last I checked it was anyway.


text:
Penetrating Trauma: What We Miss and How We Can Improve
Elliott Chinn
In the Literaturepractice updates
Authors: Elliott Chinn, DO (EM Resident Physician at Jacobi Medical Center) and Steve McGuire, DO (EM Chief Resident at Jacobi Medical Center) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM staff physician at SAUSHEC, USAF)
During your next shift you hear "Level 1 Trauma in 5 minutes". The patient arrives. He is a 28 year-old male, stabbed in the chest, with the following vitals: T 98.6 HR 95 BP 105/70 RR 20 PO2 98% RA. He's talking, you see a 2 cm stab wound to the left subcostal region, his breath sounds are even bilaterally, and his repeat blood pressure is 115/80. He's moving all of his extremities so you log roll him and see no other injuries. A supine chest x-ray is done which is negative, and a quick FAST is unrevealing. You step away for a brief moment to put in orders when you're notified that the patient is lethargic and his heart rate jumped to 160. You put on your stethoscope, suspecting to hear decreased breath sounds and when you do, you place a 14g angiocath into his chest and "wwhheeww", you and your patient release some tension.
What happened? What did you miss and why?
Your next patient is a 50 year-old male with abdominal pain. He doesn't look so great and doesn't offer much for medical problems. You notice an old, vertical scar on his chest. "Oh yeah doc, I was stabbed a long time ago". His labs come back, and he has an elevated WBC and lactate. Hours later, he is in the OR for a strangulated hernia that was in his thorax, a complication of an undiagnosed diaphragmatic injury.
What happened? What did you and the previous doctor miss and why?
Hours later you see another stabbing victim, only this time the wound is just underneath his umbilicus. The puncture doesn't look that deep, and the patient's vital signs are stable. While he is complaining of pain, his abdomen doesn't feel like a surgical abdomen. A CT scan is ordered and when it comes back it is negative. You scratch your head and think to yourself, "Can I send this patient home?"
What are you worried about missing and what can be done to reassure you?
Your next patient is here for left-sided back pain. He was just discharged four days ago after being shot in the stomach. He is febrile, tachycardic, and has no other medical or surgical history aside from his previous trauma. Hours later, your CT scan shows a perinephric abscess, and he's admitted for IV antibiotics.
What happened? What did the surgeons miss and why?
Our role as ED physicians is to stabilize the patient while determining their disposition. Inevitably, we are going to miss things, as it isn't our job to diagnose every injury. This post will discuss injuries we can miss related to penetrating trauma in the acute and post-discharge setting.
Case #1: Tension Pneumothorax
Tension pneumothorax (TPTX) is one of the deadliest, cannot miss diagnoses we are responsible for. We are trained to think of pneumothorax when we see respiratory distress, chest pain, and decreased lung sounds, and when paired with hypotension, tachycardia, and dropping PO2, we should reflexively think of tension pneumothorax. Primarily a clinical diagnosis, it should not be diagnosed radiographically.
In the real world, diagnosing a tension pneumothorax, let alone before x-ray, is not as easy as we are led to believe. A review of 18 case reports in awake, non-ventilated patients showed that "classic" signs such as low Sp02, tracheal deviation, and hypotension are found in less than 25% of cases (1). Furthermore, a case series of 115 consecutive tension pneumothoraces in South Africa showed that 25% were missed on initial assessment, with 40% of those patients dying (2). Even more concerning, that series took place in a region that gets 30 cases of tension pneumothorax a year, which is more than most U.S. hospitals see.
That study did not look into why the diagnosis was missed. Perhaps they stopped their diagnosis at pneumothorax because they didn't see textbook signs that as it turns out, may not be so textbook. So, what can we do to make sure we do not miss this diagnosis?
First, always have a high index of suspicion for tension pneumothorax, taking into account many of the classic signs we are taught to look for are often not present. Second, confirm your clinical exclusion of the diagnosis with ultrasound, as it has been shown to have a higher sensitivity than upright or supine chest radiography and has a negative predictive value approaching 100% (3). Finally, avoid supine CXR at all cost. A recent article showed it has a significantly lower sensitivity than upright, only catching 21% patients with a pneumothorax (4).
Case #2: Diaphragmatic Injury
Missing a diaphragmatic injury will not immediately harm your patient; however, months to decades later it can have devastating consequences if not recognized.
The range of diaphragmatic injuries missed on CT scan ranges anywhere from 12-63%, but more disturbingly, the mortality rate for subsequent complications can be as high as 60% (5,6). One study found complications like herniated stomach, large gut, spleen, liver, and gangrenous gut if there is a delay in presentation, even "fecopneumothorax" if that herniated organ is mistaken for a pleural effusion on chest x-ray and a chest tube is placed (6).
The gold standard for diagnosing diaphragmatic injury is surgery, but in an era of increased nonsurgical management, some of these injures are missed. CT scan lacks the sensitivity and specificity of surgery, so we cannot rule it out with imaging alone. There is a wide range of sensitivity for picking it up on CT. One review article cited a range of 61-87%, while showing that sensitivity is worse when the injury is on the right due to the homogeneity between the liver and diaphragm (5). In one small but well conducted study, patients with penetrating trauma to the left thoracoabdominal area who went to the OR 48 hours after CT scan showed a sensitivity of 82%, with a negative predictive value of 93%.
What can we do as ED physicians to improve? First, be specific in your indication for why you are getting a CT scan. Traumas can be chaotic environments, and we might overlook the importance of identifying entry points and mechanism when we order imaging which can be valuable clues to radiologists. One might be so bold as to say "rule out diaphragmatic injury" to further clue them in, as there are several direct and indirect signs of diaphragmatic injury on CT, some of which are more common in penetrating trauma.
While a missed diaphragmatic injury isn't usually at the top of our differential for most chief complaints, it should at least be considered in a patient with a history of thoracoabdominal trauma. It is definitely one with serious morbidity/mortality if left undiagnosed and unfortunately, could present days to years down the line and seem completely unrelated to their past medical history.
Case #3: Hollow Viscus Injury
In penetrating abdominal trauma there are hard signs for going to the OR: hemodynamic instability, evisceration, or peritonitis. What should be done when there are no hard signs has been a matter of debate since the 1960s. In 2009 the Western Trauma Association put out a guideline which was again tested in 2011 that advocates for local wound exploration in stable patients who have anterior abdominal stab wounds (8). Their goal was to bring everyone to the OR who needed to be there while minimizing unnecessary surgery, procedures, and imaging.
Their guidelines were simple: if the patient is stable, perform local wound exploration and if it is positive, admit for serial clinical assessments with a CBC every 8 hours. If the patient deteriorates clinically, they go to the OR. If they were stable for a day then they could be discharged.
If wound exploration was negative then the patient could be discharged, without relying on a negative CT scan or labs.
It should be noted that they had a strict protocol for wound exploration, which required anesthetizing the wound and probing the entire depth. If posterior fascia or peritoneum were violated, it was considered positive.
How did it all pan out? Patients in the protocol group were significantly less likely to get an unnecessary laparotomy, and they were not at increased risk for complications. They were just as likely to be discharged from the ED, and none of them had a CT scan. Patients whose surgeons did not follow the protocol and used imaging or labs to guide their decision had more unnecessary procedures, with increased length of stay in the hospital and more complications. Most patients who went to the OR after being admitted for serial exams went within four hours, with the last patient going at 15 hours, and their rate of complications was not any higher than those who went straight to the OR.
In the past, local wound exploration has gotten a bad reputation. If you are still not a fan of it, you can still skip the reflex to go straight to the CT scanner as long as your patient is stable and your surgical service can observe them. One study found that no injuries were missed when a patient was observed for 24 hours, and those who waited to go to the OR did not have a higher rate of complications than those who went immediately (9). This is important because some clinicians think they can discharge patients home if their CT scans are normal when in fact it could be a false negative. Additionally, there are cases of false positives on CT that lead to wasteful trips to the OR (8).
The point here has more to do with empowering us to not instinctively take our patients to the CT scan or push our surgeons, unnecessarily, to take our patients to the OR. This is an opportunity to not miss an injury by not doing something, which harms our patients in a way we cannot yet quantify.
To summarize, hollow viscous injury is a diagnosis we can miss if we don't watch a patient for long enough, and research shows that 24 hours is the longest it will take your patient to deteriorate (9). Local wound exploration could be a tool to let us exclude the diagnosis without having to admit every single patient with penetrating abdominal trauma. We should allow our clinical exam to guide our management, not imaging or lab values.
Case #4: Ureteral Injuries
Surrounded by some significant real estate, the ureters are very well protected. If those organs are involved, a ureteral injury may be missed, so it must be on the differential in any patient who presents shortly after being discharged from a hospitalization related to penetrating injuries.
A well conducted review of ureteral injuries showed they mostly affect men who were victims of penetrating trauma, involved the proximal ureter (defined as from the ureteropelvic junction down to the sacroiliac joint), and actually lacked hematuria, regarded as some to be the hallmark of ureteral injury (10). 90% of the time there will be an associated injury, almost always (96%) bowel injuries.
As with other rare injuries, they require a high index of suspicion. Close to 38% of ureteral injuries can cause complications such as retroperitoneal abscess, infected urinoma, and fistula, but in rare circumstances they can lead to renal failure and sepsis. CT scan by itself isn't the best way to diagnose it, and even when patients go to the OR it is missed about 40% of the time.
So what can we do to avoid this? In any penetrating trauma patient with hematuria, consider getting GU involved, especially if your patient is going to have to sit in your department . Specially timed CT scans ("delayed excretory phase images") might be necessary to make the diagnosis in the acute setting. Understand that the absence of hematuria is actually more common in ureteral injuries, so its absence cannot exclude it. If the patient was recently discharged after sustaining penetrating trauma, have a high index of suspicion for this injury, as it could have been missed on initial presentation.
As ED doctors we play a critical role in trauma. Many of our patients who suffer injuries from penetrating trauma get admitted, ultimately receiving a "trauma tertiary survey" prior to discharge. This is a critical step in their care, and research shows that it transforms many "missed injures" into "delays in diagnosis", meaning they are caught before they cause a problem (11).
In the acute setting the most important thing we can miss is a tension pneumothorax. Thankfully, ultrasound is accessible and with ultrasound education being integral in most residency training programs, it is only a matter of time until most ED doctors can rule it out nearly 100% of the time.
In the patient with a history of penetrating trauma we need to be aware of two injures that could have been missed: diaphragmatic tears and ureteral injuries. While CT scans can miss asymptomatic tears, they are quite good at diagnosing organs that have herniated through the diaphragm so if you are suspicious of it, order that CT scan. In any patient with abdominal or flank pain, fever, or urinary symptoms who has a history of penetrating trauma, consider ureteral injuries because you may need special imaging to diagnose it.
Finally, despite advances in imaging, hollow viscus injuries continue to be a diagnosis that can be missed in the absence of observation and serial abdominal exams. The utility of local wound exploration will likely be debated for some time, but there is growing evidence that it can be used to exclude hollow viscus injury if done appropriately while saving patients from unnecessary radiation and trips to the OR.
References / Further Reading:
Leigh-Smith SS. Tension pneumothorax – time for a re-think? Emergency medicine journal: EMJ. 2005-01;22:8-16.
Kong VV. Traumatic tension pneumothorax: experience from 115 consecutive patients in a trauma service in South Africa. European journal of trauma and emergency surgery (Munich: 2007). 2016-02;42:55-59.
Nandipati KK. Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: experience at a community based level I trauma center. Injury. 2011-05;42:511-514.
Ball CC. Occult pneumothoraces in patients with penetrating trauma: Does mechanism matter? Canadian journal of surgery. 2010-08;53:251-255.
Panda AA. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagnostic and interventional radiology (Ankara, Turkey). 2014-03;20:121-128.
Ganie FF. Delayed presentation of traumatic diaphragmatic hernia: a diagnosis of suspicion with increased morbidity and mortality. Trauma monthly. 2013;18:12-16.
Yucel MM. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015-09;46:1734-1737.
Biffl WW. Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. The journal of trauma. 2011-12;71:1494-1502.
Inaba KK. Selective nonoperative management of torso gunshot wounds: when is it safe to discharge? The journal of trauma. 2010-06;68:1301-1304.
Pereira BB. A review of ureteral injuries after external trauma. Scandinavian journal of trauma, resuscitation and emergency medicine. 2010;18:6.
Pfeifer R, Pape H-C. Missed injuries in trauma patients: A literature review. Patient Safety in Surgery. 2008;2:20. doi:10.1186/1754-9493-2-20.
One thought on "Penetrating Trauma: What We Miss and How We Can Improve"
Andrew Shannon says:
This is a great review. I will caution some restrained enthusiasm for the role of US in tension pntx, however! I was involved in reviewing a case with a bad outcome in which the physician felt they saw lung sliding and so erroneously ruled out a pntx as cause of hypotn. Perhaps they saw the pericardium and assumed it was the lung instead…? In any event, I've become much more accepting of the "finger thoracotomy" in cases where the Pt is in extremis and imaging is delayed or suspect!


We offer wholesale opportunities and support to distributors throughout Western Australia and Northern Territory who are interested in Bios Urn. Whether you are a wholesaler, a retailer, a funeral home, or a flower store, we have options to match your needs.
How much does the urn hold?
The capacity is 2.6L. This is sufficient for a large human or animal. The quantity of the ash does not affect the ability of the plant to grow. It is also common for the ash of one person to go to multiple urns for planting by more than one family member. If you are sharing the ashes between family members, you may want to top the urn up with some of the soil being used with the Bios urn.
How long does it take for the Bios Urn to bio-degrade?
The level of moisture that the Bios Urn is exposed to will vary the breakdown time. The developers' studies resulted in break down times of 6-10 weeks.
How deep do I bury the Bios Urn?
The top of the urn should be approx. 2-3cm below the ground surface for best results.
Isn't the ash too acidic to be good for the plant?
By the time that the roots of the plant are close to the ash, the urn has degraded and the ash has combined with the subsoil. Having said that, with all plants the roots will strike out in the direction where they can be best nourished.
How long can the Bios Urn sit on the shelf before it breaks down?
The Bios Urn has an abundant shelf life if it is not exposed to moisture. Store in a dry place.
Can I put the Bios Urn into a pot plant?
Yes, as long as the plant size is suitable so it does not out-grow the pot.
Why do you recommend a seedling over a seed?
Australian native seeds are tricky to grow, and very slow to grow. The idea of sourcing a seedling has multiple benefits. a) the user has a very wide selection of plant type, which makes this a more personalised process. b) the seedling will be hardened to the local climate, so it will be ready to grow in a similar location c) the time taken to select the desired seedling can help with the grieving / celebration process.
Sadly, every natural thing has a finite time on this planet. A replacement can be replanted with due care and respect.
Why must a retailer buy 12 urns as a minimum?
We want to protect our retailers, and need to be able to distinguish those that are industry related, from those in the general public that are seeking to buy at a lower cost by grouping in 3 's or 4's etc.
What about the Bios Incube that I saw on line?
The Incube was developed as a kick-starter project with a finite production run. We want to see any possible bugs ironed out and what the take-up rate is in Europe, before we test the Australian market.
Where should I get my seedling?
From a garden centre near to where you plan to use the Bios Urn, so the plant is acclimatised to the area.
Yes, many local authorities welcome the planting of trees. If you plan to place the Bios Urn is a very public place, check with your local council first.
Can I mix ashes in the one Bios Urn?
Yes, the ash can sit in the Bios Urn, if kept dry, until other ashes are added, if desired. Then planted.
Will the crematorium know what to do with it?
Yes, they are familiar with the Bios Urn.
Can I keep the ash in the Bios Urn until I decide where to plant it?
Yes, just keep it dry.
Why wouldn't I just bury the ash in a hole and plant on top of it?
If that is your preference by all means, but be aware that the ash will be too acidic by itself, for the plant to flourish.
Is the Bios Urn available for pets?
What is the difference between the Bios Urn for humans and for pets?
The Bios Urn for humans and for pets is the same product. Bios Urn is universal, in the sense that it has the same shape, colour and price. The only difference is in the packaging and labelling, to aid in identifying the product.
No, the Bios Urn is 100% biodegradable, and made with no chemicals, preservatives, or additives.


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Home Article Demise of outdoor life | By Brig Muhammad Asif (R)
Demise of outdoor life | By Brig Muhammad Asif (R)
Demise of outdoor life
OF all the number of parks and playfield in Rawalpindi, the historical Company Bagh, named after the East India Company (renamed as Liaquat Bagh in the 1960s), had special significance for a number of reasons such as unfortunately it is the place, where first Prime Minister of Pakistan, Nawabzada Liaquat Ali Khan and first women Prime Minister of the Muslim world, Mohtarma Benazir Bhutto were assassinated in October 1951 and in December 2007, respectively.
Before Liaquat Bagh was made the central bus stand of the entire city, it was utilized by the professional entertainers on the eve for arranging melas (festivals) on Eid-ul-Fitr and Eid-ul-Azha, which used to be the main attraction of Eid festivities.
The melas used to be fully equipped with all types of means of entertainment for children, youngsters and elderly persons.
The conversion of the open areas into housing schemes by the Rawalpindi Improvement Trust in early 1960s, besides sounding the death knell for the old culture, delivered a severe blow to the traditional pastimes and means of recreation for the people of this region.
These pastimes ranged from hide-and-seek, wrestling, folk singing, folklores, gossip, etc. Eid melas continued for several days even after three to four Eid holidays.
They had entertainment gears for the people of all ages, tastes and temperaments. Their main attractions included; oscillators, mechanical swings, Maut ka Kaun'an (death well) Maut ka Golla (death shell), circus, zoo, and makeshift theatres.
The zoos having woman-faced foxes, who talked while lying on the ground inside the cages and shook their tails, were a special attraction for children.
There used to be one odd lion in zoos, but still roars of multiple lions echoed all the time throughout the venue.
Famous folk artistes Alam Lohar, Inayat Hussain Bhatti, Manzoor Jhala, Bali Jatti, etc, performed in separate theatres.
Female artistes or eunuchs, wearing women's clothes and palms, with overly applied powder on their faces and fast red lipstick on their heavy masculine lips, performed on the high daises outside each theatre, to attract the clientele.
All the theatres remained teeming with spectators from evening till late night.
One could enjoy the live performance of his favourite artistes for two to three hours by buying a ticket for one Rupee.
Though the open spaces in the city served as wonderful venues for recreational, sports and cultural activities for the residents of Rawalpindi, the real source of entertainment for people of all ages at that time were the cinema halls.
People from all walks of life could enjoy watching a film for three hours by spending 12 Annas (75 Piasas) to Rs 2.50.
There were total of 10 to 12 cinema halls in Rawalpindi city. The most famous cinema in Rawalpindi, the Novelty Cinema, which featured only Pakistani Urdu and Indian films, was located almost right in front of our home.
Only English films were screened in 3 theatres in Rawalpindi Cantonment. I remember watching the famous Indian film Barsaat and Dag as well as Pakistani classic Naila on the Novelty Cinema.
Apart from Urdu and English films, Pakistani Punjabi films were also very popular at that time because the stories of Punjabi films also revolved around two lovers like Urdu and English films.
Sabiha Khanum and her husband Santosh Kumar used to be the most popular actors in Pakistan.
After the 1965 Indo-Pak, showing Indian films in Pakistan was banned. The war, which coincided with start of telecast by the Pakistan Television Corporation, proved to be the last nail in the coffin of outdoor life in Pakistan.
Films produced by 1970s in Pakistan and India, besides providing healthy entertainment to the viewers at an easily affordable cost, served to promote a number of genres of fine arts and literature, including poetry, fiction, drama, music, singing, dance, acting, film direction and film production.
Till mid-1970s, legendry male and female story writers, poets, directors, music composers, producers, singers and actors were associated with the film industry in Pakistan.
The advent of the first TV channel in Pakistan in 1965 coupled with the commercialization of film production in 1970s contributed to the ultimate demise of the cinema-going culture in Pakistan.
The advent of Dish Antenna in early 1990s that gave the TV viewers option of watching the channels of their choice, served as the final blow to the remainder of the outdoor-life in urban areas.
The Dish Antenna was shortly followed by Cable Networks, which increased choice of channels from about ten to over one hundred in a single leap.
Due to the advancement in the field of information technology during the same period, people of even developing countries, became chair-bound from room-bound in quick time.
The invention of Smartphone, in the beginning of current millennium, further excluded man from rest of the world, from his family, friends, relatives, neighbours, and from his own being.
The modern technology has made man truly lonely in the Global Village by having drained and dried the desire and craving for spending time in the company of family members and friends.
To pull the public out of homes to cinema houses, the filmmakers have started selling violence, hatred and falsification to make money by producing movies based on horror, crime, sex, science fiction, etc.
The transformation of arts and sports into money-making industries, changed the role of these exclusive human possessions from the pedestals of great civilizations to the platforms for spreading discord, dispute as well as delinquencies and debauchery.
The multiplication of electronic and social media in the developed as well as developing countries, among all segments of societies like the underprivileged classes and juveniles, has accelerated the proliferation of violence and crimes.
—The writer is contributing columnist based in Islamabad.
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