text:
Home / Healthcare & Medicine / Nursing / Airway Matters / Airway Management in Tanzania
Airway Management in Tanzania
In this video we will explore the set up and airway management in Bugando Medical Centre, Tanzania, as part of the Global Perspective activity.
My name is Dr. Benard Kenemo, anaesthesiologist and Head of Department at Bugando medical centre. My name is Dr. Rebecca Samwell, anesthesiologist from Bugando Medical Centre. Hi. My name's Matt Bouwker. I'm a post CCT fellow in anaesthesia visiting and working at Bugando Hospital in Mwanza, Tanzania. Bugando Medical Centre is a tertiary referral research and teaching hospital which is located in the north and the western part of Tanzania. It has a bed capacity for 950 patients with a wide range for medical specialties. It has over 1,300 medical staff. The directors of surgery manages both inpatient, outpatients, with the various departments– a general surgery, ENT, cardiothoracic, obstetrics and gynaecology, orthopaedics, urology, paediatric surgery, neuro surgery, maxillofacial.
And our department offers anaesthesia throughout those departments. Besides that, it also provides anaesthesia services out of a property theatre for sedation, for procedures in endoscopy, in oncology , and also sedation in A&E. We have two anesthesiologists from Tanzania, and two working under contract who are coming from UK and one from Cuba. We have a total of 26 nurse anesthetists who have one year training of training in anaesthesia. We have drugs like adrenaline, ephedrine, atropine, ketamine, propofol, thiopentone, muscle relaxants. We have suxamethonium, pancuronium, atracurium, meperidine and morphine, as well as paracetamol. Our department also has a wide variety of machines which are started as machines for military and General Electric. Here is similar to any anaesthetic setting.
It's usually prepared on a case by case basis including a variety of sizes of facemasks or oropharyngeal airways, nasapharyngeal airways. Laryngeal mask airways are available but are quite limited. Gum elastic bougies, again, are available, but in a limited supply. Through donations we've also obtained a video laryngoscope, a GlideScope, which is kept on the ICU. Investigations that are available include fine nasal endoscopy. However, this is sometimes of limited availability but can be obtained through communication with the ENT surgeons. CT Of the neck and airway is also available, but can sometimes depend on the financial situation of the patient, including insurance coverage. Difficult airways in Tanzania can in some ways be very similar to difficult airways in the UK or elsewhere.
The case mix can include thyroidectomies with large goitres, ENT surgeries such as tonsillectomies, foreign body aspiration, as well as diagnostic broncoscopies and laryngoscopies. So at BMC as well we also receive and encounter these patients who is difficult airway so frequently. They're mostly, or a majority of patients we see with difficult airway are those patients with hydrocephalus. And those patients who come from maxillofacial, ENT patients who come with fairly huge neck masses. We encounter those patients who have facial trauma. We encounter those cases with airway malignancies like laryngeal tumours. We encounter patients with spine, both acute and chronic. They come with contractures on the neck, so it is also difficult to intubate those patients.
But also we have our oncology unit now growing here. So maybe sooner or later, we'll be receiving those patients with radiotherapy who will come with difficult airways because of– they had been. Protocols for difficult airways have been developed for the ICU and are currently in development for the theatre setting. These are based primarily on the difficult airway society guidelines with some modifications reflecting some of the equipment limitations. We also offer training and mentorship through the hospitals by doing an average of one outreach service per week. But also we do the nurse training– one year training. In teaching the anaesthetic residents and nurse anaesthetists, we emphasise the importance of preoperative assessment and airway examination.
This is similar to airway assessment in the UK, including mallampati assessment, thyromental distance, mouth opening, as well as neck range of movement. We have started to introduce, through teaching in theatres and lectures, the assessment of the Calder Score to assess jaw protrusion. Teaching methods for the anaesthetic residents range from PBL type tutorials, theatre based teaching, as well as simulation teaching. We've recently obtained– as well as basic care resus Annie models– two iPads which can be used for interactive monitoring to increase the fidelity of simulations. And we can therefore simulate difficult airways. And it's all– the important thing in order to avoid all those complications, the good thing that we should recognise is earlier.
And that's what we do at our own station. We tried to recognise that earlier, and we prepare all the necessary equipment and they're all available we have. Because due to the limited resources, we have limited resources at our institution to manage this difficult airway. But we prepare what we have, and then also we prepare the team. The anesthesiologists, the nurses, the ENT team, together, so in case we face difficulties, they can be there to do tracheostomy or other management.
Patients are anaesthetised in theatre. This can be problematic as there is very little in terms of facilities for optimization of patients. Patients are induced– laid flat on the theatre table with very limited pillows available to optimise their position. However, this can be an advantage, as any severe airway obstruction or strider can be elucidated by the patient being unable to tolerate this. One of the limitations in Bugando is the lack of availability of a flexible fibre optic scope. This limits the strategies available for an anticipated difficult airway. Techniques therefore consist of either a gas induction or a combination with IV induction and short acting muscle relaxants, or progressing directly to awake tracheostomy.
This is done as a purely local anaesthetic technique with very little sedation provided. Local anaesthetic is injected directly into the trachea via the ENT surgeons.
So, in summary, this is what we see and often we encounter at Bugando Medical Centre Anaesthesia Department, our daily practise. It's much better as compared to Anaesthesia services offered in peripheral hospitals. Most of the challenges that the peripheral hospitals face– lack of expertise, trained Anaesthesia providers, and lack of protocols for difficult airway, as well as lack of equipment to manage difficulty airway, like bougies and laryngeal mask airways. Due to lack of knowledge, they just do sedation with atropine, ketamine, and diazepam. And if fairly– that's the literal they can do, and majority do not even do intubations. And the Ministry of Health encourages to refer most of these difficult airways patients to referral centres like ours, Bugando Medical Centre.
But often we get late referrals, and most of the time we have to do a thorough preoperative assessment in order to discover these difficulty airways. In addition to referral system, we as Bugando Medical Centre– we offer mentorship to small hospitals in the region, so for them to be able to manage these difficult airways, as most of these occur as emergencies. So this is actually what we have been trying to offer as Bugando Medical Service, to help improve and minimise the complications that can arise from failure to manage difficult airways. Thank you.
In this video by Dr Arndt Melzer and Dr Riaz Aziz, we explore the experience of airway management at Bugando Medical Centre (BMC). The facility is located in the city of Mwanza, in Mwanza Region, along the southern shores of Lake Victoria in Tanzania.
The hospital has a 950 bed capacity, serves a population of 16 million people and attends around 300,000 patients each year. The surgical staff performs over 9,000 operations yearly and the obstetrics service handles over 3,800 births each year. Anaesthesia and Intensive Care are part of the diverse surgical and medical specialities and sub-specialities offered. BMC is a teaching hospital for the Lake and Western zones of the United Republic of Tanzania.
This is an example of how anaesthesia and airway management can safely be delivered in East Africa. We appreciate that all settings are different throughout he globe, but nonetheless some of the principles can be similar.
We would like to hear about your experience: Do you work or have worked in healthcare settings that are more poorly resourced? How did you ensure safety in these settings?
As you watched the video, which elements of the Airway Spider could you identify? Can you think of one change that you could make to your own workplace to make airway management safer?
We have now finished our review of airway management from a global perspective. In the next step we will be asking you to apply all the knowledge you have gained in the last 5 weeks as we work through a series of case studies.


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\section{The perturbative expansion}

In this section we consider the perturbative expansion for the following model
\be
H(M)=\frac12 \Tr(M^2) +{g_E \Tr(M^4) \over N} +g_L\sum_{1,k}M_{i,k}^4.
\ee
This Hamiltonian corresponds to the choice
\bea h(x) =(\frac12 +C)x^2 +g_E x^4,
\\ f(x) = - C x^2+ g_L x^4.
\eea
The value of $C$ is arbitrary, indeed
\be
\Tr(M^2)=\sum_{1,k}M_{i,k}^2.
\ee
The same term in the previous equation can be represented in both forms.  In the
rest of the paper we will use $C=0$; in this section  will make the choice
$\beta=1$.

Our aim is to investigate at the diagrammatical level if there are some
simplifications when $N\to\infty$.  Indeed in this limit where $f=0$ (i.e.
$g_L=0$) only planar diagrams survive.  Here the situation is more complicated.

A careful diagrammatical analysis shows the following \cite{CKPR} results.

 Let us consider the contributions to a connected Green
function and let us exclude diagrams containing self energy corrections.  In
this case there are no mixed terms and the result is the sum of two functions,
depending only  on $g_E$ and $g_L$ respectively.

If we consider the self energy corrections in the internal lines, mixed terms
may appear.  Indeed the two point function has only one possible form,
irrespectively from the type of vertices which contribute to it (in other words,
there is only one quadratical invariant).

If we denote by $G$ the value of the propagator (I do not indicate the
dependance on the indices), we find that any Green function ($\Gamma$) can be
written as
\be
 	\Gamma=\Gamma_E(g_E,G)+\Gamma_L(g_L,G).
\ee

    The same conclusion is valid for the self energy diagrams, which can be
    written as
\be
    \Sigma=\Sigma_E(g_E,G)+\Sigma_L(g_L,G).
\ee

     The propagator is thus given by
\be
     G = {1 \over1+\Sigma_E(g_E,G)+\Sigma_L(g_L,G)}.
\ee
The solution of this equation gives the value of the propagator $G$ and from it
we can reconstruct the other properties of the model.

  	These diagrammatical findings can be summarized in the following elegant way
which generalizes to matrices the representation found  in \cite{MPR} for vectors.

 We introduce two $N  \times N$  matrices $B$ and $z$.
The total Hamiltonian for these two matrices is
\be
H(B,z)= \Tr \left(N h(BN^{-1/2})+ \frac{R_E}2 B^2\right)+
\sum_{i,k}\left(f(z_{i,k})+\frac{R_L}2  z_{i,k}^2\right),
\ee
where
\be
  	    R_L=1+ \Sigma_L(g_L,G), \ \ \ \ R_E=\Sigma_E(g_L,G)
\ee

The previous conditions become now
\be
  		G=\lan B_{i,k}^2\ran= \lan z_{i,k}^2\ran= {1 \over R_L+R_E}.\label{FINALE}
\ee

The expectation value of the energy in the original model can be finally written as
\be E=
\lan \Tr\left (Nh(B N^{-1/2})\right)+ \sum_{i,k}f(z_{i,k})\ran
\ee
More generally
\bea
\lan \Tr\left(N d_E(M N^{-1/2})\right)+ \sum_{i,k}d_L(M_{i,k})\ran = \\
\lan \Tr\left(N d_E(B N^{-1/2})\right)+ \sum_{i,k} d_L(z_{i,k})\ran
\eea
Under this form the result is quite compact and it can be generalized to other
interactions which have higher powers of $M$.

Both the integrations on $B$ and $z$ can be done explicitly: The $B$ integration
can be done using the standard techniques, because the integrand is now
rotational invariant. The $z$ integration factorizes in the product of $N^2$
independent integrals.  The values of $R_L$ and of $R_E$ can be found by solving
the two equations (\ref{FINALE}) in two unknowns.  All computations can be done
explicitly.

In the nutshell the final formula corresponds to an Hartree-Fock type
approximation or, better, to two parallel spherical approximations: the local
interaction ($f$) in the eigenvalue representation ($B$) has the only effects of
modifying
the quadratical term and viceversa.  This formula generalizes well known results:
\begin{itemize}
\item If $f=0$, the
probability distribution of a given matrix element of the matrix $M$ is Gaussian.

\item If $h=0$, the probability distribution of the eigenvalues is the same of the
Gaussian model
\end{itemize}

However we have not been able (with reasons) to obtain this result in a compact
way.  We may speculate that the result is not valid beyond perturbation theory.
Indeed, if such a general result would be correct, there should be a
non-diagrammatical proof.

Generally speaking a perturbative result may break for two different reasons:
\begin{itemize}
\item
There are non analytic terms, e.g. of the form $\exp (-C/(g_E g_L))$.
\item There is a first order phase transition \footnote{In this context we say
that
a phase transition is of first order if no precursor signs are present, i.e.
its presence cannot be predicted by finding
susceptibilities which diverges when approaching the transition.}
at a non zero value of $g_E g_L$.
\end{itemize}
We shall see later that the second possibility is exactly what happens.
However, before finding the limitations of this perturbative result, it is convenient
to consider an other case in which the same result is obtained.

\section{A Random equivalent model}

It is interesting to investigate if there are other models for which the
previous formulae are exact and can be proved in a compact way.  The model can
be found among those with random quenched disorder.  We consider the following
Hamiltonian:

\be H_O(z)\equiv H(z,B(z))= N\Tr\left(h(BN^{-1/2})\right)+ \sum_{i,k}f(z_{i,k}), \ee
 where $z$ is
$N \times N$ matrix, $B(z)$ is a short notation for
\be
B_{i,k}=\sum_{j,l=1,N}O_{i,k;j,l} z_{j,l},\label{VINCOLO}
\ee
and $O$ is an $N^2 \times N^2$ orthogonal matrix, where each pair of indices
(i.e.  $i,k$ and $j,l$) plays the role of one index.

The Hamiltonian depends on $O$ via the constraint in eq.  (\ref{VINCOLO}).  When
the matrix $O$ is the identity, we recover the previous model.

Here we consider the case in which $O$ is a random orthogonal symmetric matrix.
Our aim is to compute the following quantity in the large $N$ limit

\be
-N \beta F(\beta)=\int d\mu (O)\ln (\int dz \exp(-\beta H_O(z)).
\ee
At this end it is convenient to consider the quantity
\be
- n N \beta F^{(n)}=
\ln\left( (\int d\mu (O) \left(\int dz \exp(-\beta H_O(z)\right)^n\right).
\ee
It is trivial to check that
\be
\lim_{n \to 0}F^{(n)}(\beta)=F(\beta).
\ee

The replica method consists in computing $F^{(n)}$ for integer $n$ and
eventually continuing analytically the result to $n=0$.

The first step consist in writing
\begin{eqnarray}
\int dz \exp(-\beta H_O(z)) =\int dz dB d\la \nonumber \\
\exp\left(-\beta H(z,B)
+i \sum_{i,k}\la_{i,k}(B_{i,k}-\sum_{j,l=1,N}O_{i,k;j,l} z_{j,l})\right).
\end{eqnarray}

Now, a symmetric orthogonal matrix can be written as
\be
O=V D V^*
\ee
where $D$ is a diagonal matrix (in the generic case about half of the diagonal elements are equal to
1, the other to -1) and $V$ is a generic orthogonal matrix.  Using the formulae of reference
\cite{IZ} the integral over $V$ can be done (if $n$ remains finite when $N\to \infty$).  In this way
the constraint is integrated over and we remain with two separate integrals
\footnote{The Itzykson-Zuber formula applies in the case of integral over unitary matrices for all
$N$.  Here we only need the leading term when $N$ goes to infinity and we can this apply their final
expression to orthogonal matrices; in both case only planar diagrams survive.  The two results
differ only to a crucial factor 2, which can be checked at the first non trivial order.}.

After a long computation, one finds that $F^{(n)}$ is given by the stationary
point of $F^{(n)}(R_L,R_E)$. Here the $R$'s are $n \times n$ matrices and
\bea
\exp\left( -n N  F^{(n)}(R_L,R_E)\right)
=\int dz dB \exp\left( -\beta H_{eff}(z,B,R_L,R_E)\right),\\
\beta H_{eff}(z,B,R_L,R_E)=
\sum_{a=1,n}
 \beta H(z^a,B^a)+\\
\frac12 \sum_{a,b=1,n} \left( R_L^{a,b }\Tr(z^a z^b ) +\Tr \ln (R_L+R_E)
 + R_E^{a,b} \Tr(B^a B^b) \right) \nonumber
  \eea

In the perturbative region where at least one of the two functions $f$ and $h$
is small, the matrices $R$'s are diagonal and we recover the formulae of the
previous chapter by looking to the stationary point of the free energy.

At low temperatures many new phenomena may appear. One of the most interesting
is replica symmetry breaking. In this situation the saddle point is no more
symmetric under the action of the replica group. The computations in the broken
replica region are technically difficult, but they seem to be feasible and work in
this direction is in progress \cite{PR}.

It is interesting to recall that the the original model is one of those we
are considering here, i.e. it corresponds to $O=1$.

\section{A bold conjecture}
\subsection{A naive conjecture}
The simplest conjecture would be to assume that the original formulae are
always valid.  In order to test this conjecture, we could study the model in
some limiting case.  It is convenient to consider a very simple non trivial
case, i.e. matrices $M$  constrained to have matrix
elements of modulus 1;
\be
	M_{i,k}=\pm 1
\ee
This can be realized in the previous setting by using a function $h$, such that
\be
\exp(-h(z))= \delta(z^2-1)
\ee
We can now set $g_E=1$ and write the partition function of the model as
\be
\sum_{M_{i,k}=\pm 1} \exp (-\frac{\beta}{N} \Tr (M^4)).
\ee
According to the previous considerations, we have to study an auxiliary model with
partition function
\be
\int d M \exp\left( -R \Tr(M^2) -\frac{\beta}{N} \Tr (M^4)\right) \label{MODEL}
\ee
where $R$ has been chosen in such a way that $\lan B_{i,k}^2\ran =1$. In other
words the spherical and the Ising model coincide in the high temperature region.

The solution of this problem can be found directly using the formulae of
\cite{BIPZ} for small positive $\beta$ and their extension to the case of
non-connected support of the eigenvalue distribution for large $\beta$.

Is this solution correct?

Certainly not for negative $\beta$.  As noticed by Zinn-Justin, in this case we
recover some form of $Z_2$ lattice gauge theory. For negative $\beta$ the
unconfining solution (i.e.  $M_{i,k}\approx 1$) gives an energy proportional to
$N^2$.  This is not a serious contradiction, as far also the corresponding model eq.
(\ref{MODEL}) does not exist for negative $\beta$.

The most serious troubles appear when $\beta$ becomes large and positive.
Here we can compute the free energy of the model $F(\beta)$ and from it we can
recover other thermodynamical quantities. It is possible to compute the entropy.

One finds (as expected in a spherical model) that  the entropy density
$S(\beta)$ behaves at large $\beta$ as
\be
S(\beta) \approx -\ln(\beta) +const
\ee

The entropy becomes negative at sufficiently high $\beta$.  This is
impossible; the spherical and the Ising model cannot coincide in the low
temperature region.  Consequently, the solution of this {\sl soluble model} must
be wrong, in the same way as in the Sherrington-Kirkpatrick model \cite{mpv}.

Something better must be devised.  Numerical simulations of the model show a
perfect agreement for not too large values of $\beta$.  The deviations appears
suddenly at a value of $\beta$ at which the specific heat is nearly
discontinuous, strongly suggesting the presence of a phase transition.

 \subsection{The simplest reasonable conjecture}

A better conjecture, which does not go against the positivity of the entropy,
consists in assuming that the model with $O=1$ coincides with the one with
random $O$ also in the low temperature phase.  It is quite evident that in the
case of random $O$ the entropy cannot be negative and this observation is enough
to remove the entropy crisis.

This conjecture may be extended also to the dynamic averages, which can now be
computed by using an appropriate formulation of the replica method \cite{FP}.

In this context, the analytic continuation of the free energy from the high
temperature region has the meaning of the {\sl annealed} value of the free
energy, i.e.  $F^{(1)}(\beta)$.

In principle, we can solve the random model by using the analytic formulae of the
previous section.  This is rather hard from the technical point of view.
Detailed computations are in slow progress.

A trivial bound,
\be E(\beta)\ge 1,
\ee
comes from the inequality
\be N\Tr (M^4) \ge (\Tr(M^2))^2.
\ee
The same inequality tells us that $E=1$ only if $\Tr(M^2)$.

However, some information can be obtained in a simple way: the annealed
free energy is a lower bound to the quenched free energy and that the entropy is
non negative.  In this way one finds that
\be E(\beta)\ge 1.06\label{BOUND} \ee

An approximation  which is often quite good for these systems \cite{REM}, consists in
assuming that the entropy is given by
\be
 \max(S_a(\beta),0),
\ee
where $S_a(\beta)$ is the annealed free energy.  In the framework of this
approximation the previous bound is exact.

 \subsection{A counterexample}

 Can we test if the previous conjecture consequently is valid for all large $N$?
 Alas, yes and the answer is negative, at least for some $N$.

Indeed, if $N=2^k$ for some integer $k$, it is possible to find a matrix $M$
whose elements are all equals to $\pm 1$ and which is the square root of the
identity.  This proves that (at least for this sequence of $N$)  the energy
$E(\beta)$ is equal to $1$ at low temperature.  The same result may be proved
for many other values of $N$, but it is unclear what happens for the generic $N$
\cite{NT}.

In a related model \cite{MPR,BGU} it seems that quite different results are
obtained depending on the arithmetic properties of $N$ and that there is a way
of taking the infinite $N$ limit (i.e.  a sequence of appropriate values of $N$
going to infinity) such that the model
becomes equal to the random model.

The possibility of more than one thermodynamic limit for the same model
(depending on the sequence) is quite interesting, but it is clear that there
exist at least one way in which the conjecture we have proposed is not valid.

 \subsection{A more refined conjecture}

The physical origin of the difference in the equilibrium properties of the
random and of the original model is related to the existence of "small" region
in the phase space of low energy. On the contrary, it is quite likely that the
dynamical averages do coincide with those of the random model. These
configurations ($C_{i,k}$) have such a low energy (they correspond in some sense to a
crystal) that they cannot be reached in the natural evolution of a system
arriving from the high temperature region due to the presence of infinitely
high barriers.

At low temperature the equilibrium properties of this model have not been
carefully studied.  Here we follow the natural choice of generalizing the
conjectures which have been done in a similar context on a simpler model which
can be studied in a more effective way \cite{MPR,BGU}.

We suppose that the dynamic expectations values are the same as those in the
random model (no contradiction is present).  On the contrary the equilibrium
expectations are definitely different from those of the random model.  We
suppose the system has a real first order transition (with latent heat) at some
temperature $T_C$.  At temperatures higher than $T_C$ the two models are
equivalent.  At temperatures lower than $T_C$ the phase equivalent to the random
model still survive as a metastable phase.

We may think to stabilize this phase by adding a new term in the
Hamiltonian, which has zero effect on the properties of the system in the {\sl
random} phase, but it strongly increases the energy of the {\sl crystal} phase.
An example of such a term could be
\be
   N r \theta(\sum_{i,k}((M_{i,k}-C_{i,k})^2-q))
\ee
With an appropriate choice of $C$,$r$ and $q$, it may be possible to kill the
transition to the crystal phase without affecting the free energy in the other
phase.  We can thus modify the model adding a {\sl small} perturbation to the
Hamiltonian in such a way that the its free energy coincides with the free energy
of the random model at all temperature.

\section{Hard spheres on a sphere}
In this section we  show the existence of a physically interesting model
which can be put in the form eq. (\ref{HAMI}). In this way we prove there is
(al least) one
non-trivial applications of the considerations presented here.

Let us consider the following Hamiltonian
\be
H= \sum_{i,k=N} V(|x_i-x_k|^2)= \sum_{i,k=N}W (x_i\cdot x_k),\label{M1}
\ee
where the $x$'s are $N$ $D$-dimensional vectors which are confined on a the
surface of sphere \footnote{We could also put the particle in cubic box, but we
choose a sphere for technical reasons.}
of radius $R$. The quantity $V$ is the interparticle potential as function of
the distance squared and
\be
W(S)=V(2(R^2-S))
\ee
is the potential as function  of the scalar product.

The usual partition function of interacting particles in a $D-1$ dimensional
flat space
is obtained by sending
$R\to \infty$, $N\to \infty$ at fixed density $\rho=N R^{-(D-1)}$.
We may hope that for large dimensions the model will be soluble. Here we will
study the case in which $N$, $D$ and $R$ goes to infinity together (and also
$V$ depends on $D$.

Generally speaking we can write the  partition function under the following form
\be
\int d\mu(S) \exp\left( -\beta \sum_{i,k=N} W(S_{i,k})\right) ,
\ee
where $S$ is $N \times N$ matrix and
\be
\mu(S) =\int \prod_i (dx_i) \prod_{i,k} \delta(S_{i,k}- x_i\cdot x_k).
\ee
We can now substitute the hard constraint $|x_i|=R$ with a term in the
probability distribution of the $x$ proportional to $\exp(-\omega/2
|x_i|^2$, where $\omega$ is chosen in such a way that $\lan |x_i|^2 \ran=R^2$.

The final model is slightly different form the previous one
\be
Z= \int  \prod_i (dx_i) \exp \left(-\beta H(x) -\omega/2
\sum_{i=1,N}|x_i|^2 \right).
 \label{M2}
\ee
In sufficiently high dimensions the two models (\ref{M1} and
\ref{M2}) should be the same, the measure on $x$ should become concentrated
on a sphere of fixed radius which depends on $\omega$.

Now the  measure $\mu(S)$ becomes
\be
\mu(S) =\int \prod_i (dx_i) \prod_{i,k} \delta(S_{i,k}- x_i\cdot x_k)
\exp\left(-\omega/2 \sum_{i=1,N}|x_i|^2\right),
\ee
which is invariant under $O(N)$ rotations as can be seen by an explicit computation.

The model is thus reduced to the original form eq.(\ref{HAMI}), we have just to
obtain the correct scaling for large $N$. In other terms we have to choose the
dependance of the various term on $N$ is such a way to obtain the needed result.

It is possible to prove by an explicit computation that the {\sl right}
scaling is obtained when $N \to \infty$ and $D \to \infty$ together at fixed
$\alpha \equiv N/D$. The potential $V$ should also scale in an appropriate way
in this limit.

After doing the appropriate computations one arrives to a model which can be
explicitly solved in the low density case and that behaves in a quite similar
model to the $M_{i,k}=\pm 1$. The details of the computation can be found on the
original paper \cite{CKMP}.

\section{Conclusions}

We can summarize these findings in the following way.
\begin{itemize}

\item The matrix model is soluble in the high temperature phase.

\item In the high temperature phase the matrix model is equivalent to a random
model which displays a replica breaking transition to a glassy phase.

\item The random model describes the equilibrium and the dynamical properties of
the model both in the high temperature phase and in the glassy phase.

\item For some values of $N$ there is a  transition to a crystal phase
at low temperature.  The properties of the crystal phase cannot easily
investigated: they depend on the arithmetic properties of $N$.

\item It may be possible to destroy the crystal phase with a {\sl small} perturbation
which does not affect the properties in the other phase.
\end{itemize}
Some of these results are only conjectural, some have a more solid basis and
some have been numerically verified in simpler models \cite{MPR}.  At the
present moment we have a coherent picture of the behaviour of the model.  it
would be extremely interesting to find out if we can collect more evidence for
its correctness.

\section*{References}

redpajama_set_name: RedPajamaArXiv


The Hanoitimes - An exhibition featuring French architecture in Saigon – Ho Chi Minh City in the late 19th and early 20th centuries officially opened in Nguyen Hue walking street, Ho Chi Minh City on November 4.
More than 300 documents, photos, maps and designs either preserved in Vietnamese archives or provided by the French Consulate General in Ho Chi Minh City are on display at the exhibition.
The exhibition, which runs until November 20, is organized by the Ministry of Home Affairs and the Ho Chi Minh City People's Committee in coordination with the Consulate General of France in Ho Chi Minh City.
The event marks the 320th anniversary of Saigon - Cho Lon - Gia Dinh – Ho Chi Minh City (1698 - 2018) and the 45th anniversary of diplomatic ties between Vietnam and France.
Speaking at the opening ceremony, Vice Chairman of the municipal People's Committee Tran Vinh Tuyen said that the exhibition, which is a highlight of the series of cultural and historical activities, welcomes domestic and foreign visitors.
"The event is expected to contribute to expanding the cooperation and friendship between Vietnam and France in the time ahead," said Tran Vinh Tuyen.
Vincent Floreani, French Consul General in Ho Chi Minh City, applauded the cultural and historical values of the exhibition, which showcases the cultural diversity of Saigon – Ho Chi Minh City - a valuable asset that needs to be preserved and promoted by next generations.
The event is also among the activities to welcome French Prime Minister Edouard Philippe on his three-day official visit in Vietnam at the invitation of Prime Minister Nguyen Xuan Phuc.
Earlier, a fine art exhibition themed "Rencontre 2018" opened in Ho Chi Minh City, as part of the activities to mark the 45th anniversary of diplomatic ties between Vietnam and France. Through the event, Vietnamese and French artists have a chance to share experience in painting, thus contributing to further tightening the friendship and cooperation between the two countries.


On this episode of The Addicted Mind podcast, our guest is Suzie Wolfer, LCSW, SEP a therapist specializing in Somatic Experiencing®, a powerful system of healing trauma and addiction at it's core and for completing trauma, so that it's let go of you.
Somatic means "of the body," which includes the sensations we feel when we experience different emotions and thoughts. Trauma and stress are stored in the body, causing behaviors, patterns or responses arising from implicit memory system or the unconscious.
Our initial reaction to the uncomfortable feelings that are associated with trauma and stress is to stabilize these feelings by managing them from the "top down," striving to suppress, control, or make the feelings go away. This desire to manage troubling thoughts and emotions, though useful in the short term, keeps us from healing the underlying stuck patterns, that show up as chronic Fight, Flight or Freeze behaviors or a combination of these.
With somatic therapy, we help your body remember how to complete stuck Fight, Flight or Freeze patterns We call this re-negotiation. Instead of trying to get rid of scary, infuriating or numbing feelings and thoughts, you learn to watch them, especially in how your body expresses them.
Imagine a roller coaster. It can be scary and exhilarating to feel the car taking you up, up, up to tower over the precipice, wondering if the little wheels will keep you safely on the rails. Challenging emotions, even pleasure, can start to feel scary, and it's easy to use substances or compulsive behaviors to try to manage or out run the sense of threat they pose, of "going off the rails." The closer we get to the top of the roller coaster, the more energy builds inside us, including excitement.
When you are able to observe what's happening inside, especially observe your body sensations associated with thoughts and emotions, these emotional messengers can deliver their message and let go of you.
When that happens, like when the roller coaster car comes back to the platform, you may feel a good feeling, a smile on your face, as you get off on level ground and go on to the next thing. Maybe even a little more confident in your ability to face challenges!
In the past decade of supporting her patients with Somatic Experiencing® Therapy, Suzie has found that this gentle approach helps people not only feel better, but get better, a little at a time, and in every session.
Rather than just talking about issues and understanding them, an important first step in the healing process, using the body's built-in system for "self-regulation" helps patients feel Ease and Confidence, as the backlog of accumulated stress, lets go of them, from inside out.
They feel lighter and more alive as they experience the reliable nature of things on his planet, that all experiences having a beginning, middle and end, a beginning, middle and end. When clients experience this natural cycle, they often take a deep spontaneous breath, their body relaxes and their face brightens with more aliveness.
Like a caboose on a train, the thinking process is sometimes the last to know!
Are you safe? Yes or no. Notice that feeling safe and being safe in this moment are two different things.
Using your 5 senses, notice signals or data are you getting from the world outside you, which confirm that you are safe. What are these signals?
Next, notice what happens in your body when you confirm that you are safe in this moment. Perhaps savor what you discover.
Audible is great way to listen to books on the go. I love it and have been a subscriber for over two years. Sign up today and your subscription can also support The Addicted Mind podcast. Thanks!
Yes, add me to the newsletter & sign me up for the FREE 6 Days of Beginning Mindfulness email series.


The Order's purpose is to bring others into a living, loving relationship with Jesus, our Lord and Savior, and to help strengthen the spiritual lives of our parishes and missions.
Members undertake a Rule of Life, incorporating the Rule of Prayer and the Rule of Service. By reaffirmation of the promises made at Confirmation, a Daughter pledges herself to a life-long program of prayer, service and evangelism, dedicated to the spread of Christ's Kingdom and the strengthening of the spiritual life of her parish.


Home » Facts » Ingredients » A Modern Guide To Herbal Remedies: What Is Turkey Rhubarb Root?
Digestive issues aren't the most pressing medical problems but they can contribute to true discomfort. Constipation and bowel movement irregularities top the list when it comes to embarrassing and anxiety-causing problems.
Unfortunately, finding a mild and natural solution for such issues isn't always an easy task.
Turkey rhubarb root is proving to be one of the most popular natural laxatives. If you're suffering from frequent bouts of constipation, you'll find the following information particularly useful.
What Is Turkey Rhubarb Root?
Turkey rhubarb is also known as Chinese rhubarb and the plant belongs to the polygonaceae family. The uses of turkey rhubarb as a natural medicinal plant have been known for centuries and they've even been recorded in Chinese medicinal texts.
The plant grows in the spring and summer. In the autumn, the leaves wither because of the frost. This is when the turkey rhubarb roots can be harvested and used for the creation of natural medicines. Most often, the root is turned into powder and used as a laxative.
Turkey rhubarb root is rich in many nutrients and microelements. The most important active components that the root powder contains include anthaquinone, cinnamic acid, glucose, fructose, tannic acid, oxalic acid and calcium oxalate.
The most important biochemical compounds found in turkey rhubarb root is anthaquinone. It is classified as an anti-inflammatory substance and it's also a powerful antioxidant.
Turkey rhubarb also features anthraquinones. This is a natural stimulant laxative. It causes the intestines to contract, which allows for the easier passing of stool.
Turkey rhubarb powder can be used to improve the regularity of bowel movements and to end a long bout of constipation.
Though it's mainly recognized as a plant that can be used to improve digestion, turkey rhubarb brings a range of additional health benefits to the table.
As already mentioned, turkey rhubarb is a powerful purgative. It has a relatively strong laxative effect, which is why turkey rhubarb-containing products should be used sparingly.
This applies to laxatives that feature solely the ingredient and to the ones that combine turkey rhubarb and other active compounds.
Turkey rhubarb root can be taken in the form of a tea, tincture or powder in a capsule. Many people find the last option the most convenient one. Regardless of the preparation method, turkey rhubarb will deliver its laxative effect.
Getting a natural bowel movement after the long-term use of laxatives will thus turn into a challenge. The long-term use of laxatives can also lead to a serious electrolyte imbalance in the body.
As already mentioned, the root powder contains oxalic acid. As such, it's not suitable for use by the individuals that have suffered from or a are prone to the development of kidney stones.
Some of the commercial supplements and laxatives have been cleaned from the oxalic acid, which makes them suitable for use by everyone.
Turkey rhubarb is considered possibly unsafe for use by children and pregnant women. More research will be required to determine whether they can rely on the supplements that feature the root powder.
If you're experiencing constipation, you need to talk to your physician before opting for a laxative. Together, you'll come up with an action plan that may involve medical tests and diet changes.
Your doctor will also help for the selection of the mildest and most effective laxative.


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Home Town, Season Two: The Ponder House
Erin and Ben are undoubtedly the most thoughtful people when it comes to design and staying true to the homeowner's practical needs and individualistic taste— last night's episode of Home Town proved to be no exception!
Luke Ponder, a local minister in Laurel, expressed how his biggest inspirations are his love for hiking, fly fishing and baseball. He even has an amazing collection of vintage vinyl and an impressive library of books that had never been unpacked since he moved from apartment to apartment frequently. While Luke serves the community, he loves cooking vegetables from his garden but hadn't had a proper kitchen in years.
The son of a minister himself, Ben was also in ministry for a decade and Erin dove right in with him to be a support system so this episode was important for them give back to a minister and man who has rarely treated himself in his life, always being frugal so he could give more to things outside himself.
Ben and Erin went above and beyond to spoil him for once!
The exterior of the home was painted a deep teal blue, along with the cream colored windows, trim, railing and columns. The shutters (or the "eyebrows" as Erin would say) were painted a navy blue to create depth in the colorway.
The Living Room:
Erin & Ben wanted the living room to be an ode to Luke's love for the outdoors and antiques. Erin noted that almost all of the furniture was his, as his family were antiques dealers and it fit his new home so well!
The Study:
While most people would have envisioned this room as the formal dining room, Erin and Ben honed in on practical ways for Luke to get the most out of this large space. They instead designed built-in bookcases that became the focal point for this room. The shelving was practical for his impressive book and vinyl library. Erin & Ben created a space that just made sense for the homeowner and it looked stunning! We're betting this might be the best room of the house, but we'll let you decide...
The Kitchen:
If you thought it couldn't get better, wait 'til you see this. For the kitchen, Erin and Ben had Davis & Cooke build custom cabinetry to replicate the existing lowers below the window so the original cabinetry became a feature in the kitchen.
Our favorite part of the kitchen were the matching AGA stove and refrigerator. Styled to look vintage, the kitchen was an open, updated space that Luke couldn't wait to get into!
The Back Porch:
Ben and Erin created the perfect back porch for Luke to prep fresh vegetables. The Scotsman Co. potting bench was a custom piece that Ben designed perfectly to fit that space without overcrowding the cozy back porch. We can't get over how beautiful it is!
Erin & Ben gave one more beautiful surprise to Ponder. While it's very subtle throughout the episode, Luke reveals that he's colorblind and that he's never been able to enjoy much of the color spectrum. Erin and Ben gift him glasses that help those with color blindness and instantly, the entire house came to life. His new home was vibrant with bold colors and with the glasses, he got to see and revel in every single one of them. He looked at the watercolor painting of his new home and said, "a home… looks like somebody belongs there, like I belong there. Casa de Lucas!" We're beyond happy for Luke and his new home and a place to belong.
See all Ben's wood furniture from Scotsman Co. right here and be sure to tune in next Monday to see another episode of HGTV Home Town!
All photos are property of HGTV.

redpajama_set_name: RedPajamaCommonCrawl


You are NOT perfect and that is Okay!
https://www.secondsetofhands.ca/wp-content/uploads/2017/11/Worried-Woman-smaller.jpg 341 500 Kathy McEwan http://www.secondsetofhands.ca/wp-content/uploads/2017/12/logo-800x267.png Kathy McEwan2017-11-06 21:21:082018-01-30 17:30:58You are NOT perfect and that is Okay!
Changes I needed to make to become more productive and less stressed!
https://www.secondsetofhands.ca/wp-content/uploads/2017/10/stressed-medium.jpg 1333 2000 Kathy McEwan http://www.secondsetofhands.ca/wp-content/uploads/2017/12/logo-800x267.png Kathy McEwan2017-10-24 12:47:012018-01-30 17:32:58Changes I needed to make to become more productive and less stressed!


If you spend any time assessing performance exams or adjudicating festivals/competitions, you end up having a lot of conversations with fellow assessors about what you heard. And you'll probably have experienced conversations in which your fellow adjudicator turns to you with a rather concerned face and gives a laundry list of the things that were wrong with the performance.
Now, I've often found myself slightly uncomfortable at this point, and I think I'm starting to work out why.
It's not about the accuracy of the judgements – they are invariably right that the shortcomings existed. It's about the way they are delivered: they seem to invite you to nod sagely and agree that we eminent folk can hear all these basic faults that the poor benighted performers are emitting without realizing it, and that we are therefore better, wiser, cleverer and generally more worthy than the people we are assessing.
Now, you don't get invited to make these assessments unless you're reasonably experienced and competent as a musician. It's precisely our perceptiveness that puts us in the adjudicators' chairs. So it seems a bit cheap to frame our discourse in terms of our superiority over the people we listen to. The structure of the encounter gives so much power to the assessor compared to the performer, we really don't need to jockey for more.
Of course, some of the performers we adjudicate are much better musicians than the assessors (and what a treat that is!). In these cases, the facial expression is deep and meaningful, and the game is to point out the most esoteric subtlety in the many things the performers did well to show how we eminent adjudicators share in the skill and insight of such artists. This is akin to the traditional musicological gambit of writing about the Great Works of the Great Masters: I can recognize genius, and thereby show that I partake of it as one of the initiated. This also I find a bit cheap.
The thing that really gets my goat about these conversational gambits is the way they make it difficult to celebrate the wonderful things that even the less-skilled performer brings to the situation without positioning yourself as an uncritical, unperceptive listener. That is, the discursive tactic of building status by pointing out faults makes it hard to articulate areas of success without implicitly adopting a lower status.
This drives me potty. It takes just as much musicianship and insight to recognize what people have achieved as it does to spot their faults - as well as a healthy dollop of empathy and generosity.
And it occurs to me that we can see similar dynamics in our rehearsal strategies. Listening out for the things our singers do well requires a more empathic mode of attention than listening out for problems to fix. It doesn't mean that we can't hear the things that could be improved, but it does mean that we are kinder and more positive in the way we deal with them. If we identify with our singers closely enough to intuit what they are trying to do, and so be able to acknowledge their achievements, we will also find ourselves participating in the responsibility for the things that still need work.
We may feel we lose power by doing so – and I guess we do in the sense of status. But we also gain power, in the sense of being in a better position to understand what the problems are and thereby having a much better chance of sorting them out.
Everybody wants to do well – whether performers in a competition, or singers in a rehearsal. If they don't always manage it, it just doesn't seem kind to blame them for it. Using someone else's incomplete musical control as a means to build one's own status is a bit mean, and, moreover, usually unnecessary.
I have just spent quite a number of hours at the Wantage Music Festival listening to the adjudication for performers of varying ability - some superb and others not quite so good. The adjudicators all recognised that everyone was doing their best and were trying to perform at their highest level. Most of the adjudicators clearly found it very easy to give constructive and helpful comments, and the performers felt valued.
I think it is all too easy, when tiredness and an awareness of one's own shortcomings are all too present, to be critical and to forget that no one goes out of their way to perform badly. I am constantly having to remind myself of this when the performance of the chorus I direct is not what I want. It becomes all too easy to 'blame' them if I am feeling less that fully confident - and I know that is unhelpful and also unfair.
So thank you for this very timely reminder of the need to be very aware of, and to celebrate, the areas of success.
Thanks again for your insightful blogs - always great to read and take note of.


Our beloved friend, brother, son, cousin, nephew, uncle and dad, Bruce "Gotor" Morgan, went to be with our Lord the morning of August 27, 2017. The family of Bruce and Okalena Morgan of Aniak are kindly asking for donations to go towards the funeral expenses of their son. From the bottom of our hearts we thank you for any and all donations given to the family.


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Pentagram brings Mastercard into the digital age with pared-back logo redesign
Rio 2016 motif is "first 3D logo in the history of the Olympics" says designer
Guide to Building a Top UI Design Portfolio
Design agency Pentagram has created a new logo and visual identity for Mastercard, the credit card company's first branding redesign in 20 years.
The new design retains the two overlapping red and yellow circles, but swaps the stripes in the central portion for a block orange colour.
The bold white text that spelled the US company's name has been replaced with the FF Mark typeface – all lower case – and positioned outside the symbol.
Pentgram, which has created branding for everything from MIT Media Labto Snoop Dogg's edible marijuana range, has also updated Mastercard's website graphics, information pamphlets, billboards and other marketing materials.
The typeface is used in a variety of weights across the applications, while circles in different sizes and opacities also feature.
Although Mastercard's corporate branch had a logo refresh in 2006, the company has stuck with the same public design since 1996.
The logo has remained largely unchanged since Mastercard was founded in 1966, however the new update aims to help bring the company into the digital age as more card transactions are done online and via apps.
"Everything has changed in the past 20 years," Pentagram partner Michael Bierut told FastCoDesign. "There was a lot of screw tightening and design tinkering happening [with the logo] in the first 30 years of the company. Then they almost got frozen in 1996."
"We took their DNA and went through this process of distillation," he added. "With each wave of simplification it felt sharper cleaner and more flexible."
The logo continues the trend for flat design, which has been adopted by companies like Instagram, Uber – replacing skeumorphic graphics that aim to emulate real-world objects on digital screens


When studying the acoustic guitar, many players will find themselves learning the blues, blues form or blues fingerpicking patterns at some point in their development.
Because the blues is such a staple of the modern guitarist's repertoire, and it has been used as the basis for countless fingerstyle and acoustic guitar songs, having an understanding of the blues form, and a few acoustic guitar patterns under your fingers, can go a long when in your development as an acoustic guitarist.
For this reason, in this lesson we'll be exploring an easy acoustic blues pattern that will help increase your technique, provide you with a fun rhythm pattern to use when songwriting or jamming with other musicians, as well as develop your ability to play bass notes and melody lines all at the same time.
A note on the melody lines: If you are just starting out with acoustic guitar, you might want to pluck each note in the melody line. Then, after you have worked that out, or if you are an intermediate player, you can add the slides and hammer-ons in to take these examples to the next level in your practice.
As well, this lesson is geared towards students that are not total beginners to the guitar itself, but those that are ready to begin exploring the Acoustic Blues genre.
So, grab your guitar and let's dive into this fun, and easy acoustic blues pattern for guitar.
To begin, let's look at the bass line for the pattern on it's own. When working on any fingerpicking pattern, especially one that mixes bass notes and melody lines, it is always a good idea to divide the parts up when first working out the pattern on the guitar.
Though it is only two notes per chord, and relatively easy to get down, make sure you use a metronome when practicing this pattern as keeping a steady pulse in the bass is key to working out this pattern as a whole, both on it's own and when applied to a full, 12-bar blues form.
Click to hear audio for this easy acoustic blues pattern example.
After working out the bass line on it's own, you can move on to learning how to play the upper melody line on it's own, before combining them to form the entire pattern in the next example in this lesson.
Start by working one bar at a time, and then combining multiple bars to form the entire four-bar phrase. Doing so will allow you to really nail the time and feel of each bar on it's own, before bringing things together to form the phrase as a whole.
With the bass and melody lines worked out separately on your fretboard, you are now ready to combine these two ideas to form the final easy acoustic blues pattern on your guitar.
If you find it tricky to combine both parts over the entire four-bar phrase at first, then try just the first bar on it's own, and then the second bar on it's own as well.
With both of those bars worked out separately, you can begin to combine bars one and two together, followed by one, two and three, and finally all four bars together.
Take it slow and work with a metronome during this pattern, as playing it smoothly in time is just as important as playing the correct notes when it comes to applying this pattern successfully to a blues chord progression, as you can see in the next example in this lesson.
To finish up with this easy acoustic blues pattern, here is a full chorus of a Blues in E that uses the pattern for each bar in the chord progression, over the E7, A7 and B7 chords respectively.
Start slowly with this pattern, as it can be tricky to put everything together into one long idea such as this study.
If you are having trouble getting the entire form to sound smooth, then feel free to break it down into three, four-bar sections as that will allow you to work on smaller chunks of the music at one time, before bringing them all together to form the chorus as a whole later on when things are more comfortable on the fretboard.
Do you have any questions regarding this easy acoustic blues pattern? Share your thoughts in the comments section below.
This entry was posted in Acoustic Guitar Lessons and tagged Acoustic Blues Lessons by Alan. Bookmark the permalink.
Hi Matt, nice blues piece but it's definitely not 'easy', not for my many beginners of all ages it isn't! One has to be very careful with the use of the word 'easy'.
I love all this new stuff though, thank you for this site.
Thanks Ruth, glad you liked the lesson. This definitely isn't for absolute beginners. But, for players that are ready to explore the fingerpicking blues genre, this is a basic pattern as far as the difficulty level, as compared to other more intermediate or advanced patterns.
That's what the title suggests, not necessarily for the beginner player in general, but for the player just starting with this style of music.
Thanks for reply Matt, yes 'easy' refers to the style of playing here. It's just that if students see it without you or I or another teacher able to explain that it could put them off.
Anyway, I seem to be on your list of people liking this site twice – don't know how that happened, sorry!
Hi Ruth, good point. I've added a sentence to the intro of the article to avoid any confusion. Glad you are liking the new site, enjoy the articles!
would what would be the appropriate fretting finger position when playing the A7 and B7 chords?
Hi Doug, try barring the 5th and 7th frets with your index finger for those chords, that should be the easiest way to play A7 and B7 in this context.


Elder Law is an area of legal practice which is defined by the clients it serves. In addition to traditional estate planning, attorneys practicing elder law focus on health care decision-making, retirement planning, and planning for the possible need for long-term care. Elder law attorneys, who focus their practice on the needs of seniors, can identify and implement strategies for financing long-term care, while preserving as much of the senior's financial legacy as possible.


text:
namespace OnlineAtelier.Web.Models.BindingModels.Order
{
    using Infrastructure.Mapping;
    using OnlineAtelier.Models.Models;

    public class EditOrderBm : IMapFrom<Order>
    {
        public int Id { get; set; }

        public decimal FinalPrice { get; set; }

        public string ShippingAddress { get; set; }

        public string ColorOfBox { get; set; }

        public string TextOfBox { get; set; }

        public string TextOfCookies { get; set; }

        public bool IsExecuted { get; set; }

        public bool IsАccepted { get; set; }
    }
}

redpajama_set_name: RedPajamaGithub


Who had the BEST performance tonight on American Idol 2015? We want to hear your thoughts and see your votes cast as we look toward the top finalists on Season 14.
Vote to keep your favorite singer safely out of the Bottom Two where they'll be forced in to a sing-off for their American Idol survival.
American Idol 2015 Top 6: Who Had The Best Performance?
Everyone's first songs were the best; as much as I hate to admit it, Rayvon really impressed me. I'm not a fan, but I really liked the emotion he put into his first song. I love Clark's voice, but he didn't wow me like he usually does. Still a fan though! I personally think the last 2 will be Clark and Jax. Sometimes I like Jax and sometimes I don't.
Who "actually" thought that Clark had a good night-he was "TERRIBLE" last night! Jax indeed had a Jena moment (sort of) last night and had the best performances of "ALL"!


A bright and spacious two bedroom apartment on the raised ground floor of this well maintained block. The property requires some minor cosmetic work but is generally in good condition with a new bathroom installed approximately two years ago. There is also a good sized lounge and separate modern kitchen. Conveniently located for both Little Venice and Sheldon Square. Both Warwick Avenue and Royal Oak Stations are also close by. Awaiting floor plan.


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Are inline skates on a roll again?
Daniel Bitonti
This article was published more than 10 years ago. Some information may no longer be current.
FILE PHOTO: June 17, 1994. In-line skating or roller blading on the boardwalk in the Beaches.Fred Lum/The Globe and Mail
You can spot Taylor Price from half a kilometre away.
Few people rip up the trail on a hot Sunday afternoon like he does. He's got an incredible combination of force and grace. He's focused. He's got speed.
He's on inline skates. Yes, people still rollerblade.
"I've been doing this since the late 1980s," said Mr. Price , an actor based in Toronto. "It's a great workout, and there aren't too many things you can do quite like this."
Mr. Price is a survivor, one of the few who remained loyal to inline skating after the sport's epic plummet in popularity in the late 1990s. Inline skaters are now just a scattered few, elbowing for room in a sea of cyclers and runners on pathways and roads across the country.
"You really don't see many people out here any more, not like you used to," Mr. Price added.
There is a small contingent fighting hard for rollerblading – those dedicated to seeing the activity return to its glory days. But the biggest challenge is the sport's unfashionable image that's had more than a decade to solidify.
Numbers reveal the cruel reality of the poor street skate.
According to John Roe, the director of sales and marketing at Toronto's Sporting Life, sales of inline skates are down 20 per cent from 2011, following a 30-per-cent decrease the previous year. The Sports Manufacturers Association, an American organization that tracks the sales of sporting equipment and participation rates, saw a 7.6-per-cent decrease in overall sales in the United States from 2010 to 2011.
Inline has not disappeared entirely. Even after the steep sales decline in the late 1990s, companies still made them and stores still stocked them. rollerblading organizations such as the Toronto Inline Skating Club still kick around, and events such as the 24-Hour Roller Montreal, a round-the-clock inline relay that takes place on Labour Day Weekend , still draws hundreds of skaters to Montreal each year.
"But it's not like it was 20 years ago, when it was seen as fresh and something fun to do," says York Phonphith, the manager of Blades, Board and Skate, one of the original hot spots to buy inline skates in New York City. "There's an image of this as a dorky thing, and this could be why it has declined. We still carry them … but a lot of companies that made skates in the past are not making skates any more."
The early '90s boom was a double-edged sword, says Justin Eisinger, editor-in-chief of One Blade Magazine, a San Diego-based publication and one of the few that's entirely devoted to blading culture. The boom created opportunities for sponsorship, funding for events and tours, and the growth of a new counterculture, he says.
"The flipside was that, yes, tens of thousands of new people are strapping on these skates every week, all over the place, but 95 per cent of people that put skates on were brand new to the activity … likely wrapped up in extraneous protective gear and left looking not entirely comfortable on their wheels," Mr. Eisinger says. "As they took to the streets, sidewalks and boardwalks of America en masse, this less-than-ideal image of rollerblading became the go-to image of the sport to society at large."
Like anything, you have your believers. Take Leon Basin. Last year he opened up Shop-Task in Toronto, part of Canada's only chain that exclusively sells blades (Mr. Basin also has stores in Montreal and Vancouver). He's says he's fully committed to refashioning the blade's image.
"Rollerblading was never branded properly. One of the things we're trying to do with our stores is to change the image of rollerblading," Mr. Basin says. "The image is really geeky, it wasn't cool … You know, the neon clothing, skating on the beach decked out with helmets and pads."
Despite declines in sales elsewhere, Mr. Basin says that business is actually booming, and he believes that inline has returned, or at the very least the return is imminent.
Last year Slate Magazine – an arbiter of cool – took notice of what appeared to be a resurgence in popularity. "Based on the number of New Yorkers I've seen getting back on the bandwagon this spring, I predict that it's only a matter of Sundays before I open The New York Times Style section to find a trend piece on the curious return of that bygone craze: rollerblading," Julia Felsenthal wrote in the magazine.
But Mr. Basin says the people buying blades are either kids and teenagers who blade up until around 18 years old, or people over 35. He says he's eager to capture that crucial 20 to 35 market. "This is the challenge," he says. "You need that market."
The idea is to simultaneously move inline skating away from an image as a hardcore sport for teenagers – think baggy shirts, low-riding pants and hanging out at skate parks – while also making it cool to those with disposable income. But coming up with a strategy to do this, Mr. Basin admits, isn't easy.
Mr. Eisinger believes the blade's comeback has actually been under way for years, but it's been a slow process because it has to do with changing perception.
"Today, when you see someone rollerblading, it's typically not the '90s newbie rec skater with loose ankles and that 'I'm just trying this out for the day' technique," he says. "Instead it's generally someone who is an experienced skater, and the way they make rollerblading appear is entirely different. It's smooth. It's controlled. In a word – effortless."
Achieving that smooth technique is a slow process, too. On a Saturday afternoon in Toronto's Beaches neighbourhood, Scott Parsons strapped on his blades for the first time in years and went out for a skate with his girlfriend. Like Mr. Taylor, you could spot him from a kilometre away. Not for his grace, though: Mr Parsons was notable for how uncomfortable he looked.
"I know I'm going to get ragged on when I go back to work and tell the guys I was out rollerblading," he said. "That's for sure."
Follow Daniel Bitonti on Twitter: @danbitontiOpens in a new window
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