text:
Complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. They defy cure using conventional and simple "dressings" therapy and currently have a major socioeconomic impact. The purpose of this review is to bring these wounds to the attention of the health-care community, suggesting that they should be treated by multidisciplinary teams in specialized hospital centers. In most cases, surgical treatment is unavoidable, because the extent of skin and subcutaneous tissue loss requires reconstruction with grafts and flaps. New technologies, such as the negative pressure device, should be introduced. A brief review is provided of the major groups of complex wounds-diabetic wounds, pressure sores, chronic venous ulcers, post-infection soft-tissue gangrenes, and ulcers resulting from vasculitis.
Complex wounds; Socioeconomic impact; Surgical treatment; Skin grafting; Skin flaps
Ferida complexa é uma nova definição para identificar aquelas feridas crônicas e algumas agudas já bem conhecidas e que desafiam equipes médicas e de enfermagem. São difíceis de serem resolvidas usando tratamentos convencionais e simples curativos. Têm atualmente grande impacto sócio-econômico. Esta revisão procura atrair atenção da comunidade de profissionais de saúde para estas feridas, sugerindo que devam ser tratadas por equipe multidisciplinar em centro hospitalar especializado. Na maioria dos casos o tratamento cirúrgico deve ser indicado, uma vez que a perda de pele e tecido subcutâneo é extensa, necessitando de reconstrução com enxertos e retalhos. Nova tecnologia, como uso da terapia por pressão negativa foi introduzido. Breves comentários sobre os principais grupos de feridas complexas: pé diabético, úlceras por pressão, úlceras venosas, síndrome de Fournier e vasculites.
Feridas complexas; Impacto sócio-econômico; Tratamento cirúrgico; Enxertos de pele; Retalhos cutâneos
Complex wounds
Feridas complexas
Marcus Castro FerreiraI; Paulo Tuma JúniorI; Viviane Fernandes CarvalhoI; Fábio KamamotoII
IDivision of Plastic Surgery, Hospital das Clínicas, São Paulo University Medical School - São Paulo/SP, Brazil
IIHospital Universitário, University of São Paulo - São Paulo/SP, Brazil. Email: email@example.com
Complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. They defy cure using conventional and simple "dressings" therapy and currently have a major socioeconomic impact. The purpose of this review is to bring these wounds to the attention of the health-care community, suggesting that they should be treated by multidisciplinary teams in specialized hospital centers. In most cases, surgical treatment is unavoidable, because the extent of skin and subcutaneous tissue loss requires reconstruction with grafts and flaps. New technologies, such as the negative pressure device, should be introduced. A brief review is provided of the major groups of complex woundsdiabetic wounds, pressure sores, chronic venous ulcers, post-infection soft-tissue gangrenes, and ulcers resulting from vasculitis.
Keywords: Complex wounds. Socioeconomic impact. Surgical treatment. Skin grafting. Skin flaps.
Ferida complexa é uma nova definição para identificar aquelas feridas crônicas e algumas agudas já bem conhecidas e que desafiam equipes médicas e de enfermagem. São difíceis de serem resolvidas usando tratamentos convencionais e simples curativos. Têm atualmente grande impacto sócio-econômico. Esta revisão procura atrair atenção da comunidade de profissionais de saúde para estas feridas, sugerindo que devam ser tratadas por equipe multidisciplinar em centro hospitalar especializado. Na maioria dos casos o tratamento cirúrgico deve ser indicado, uma vez que a perda de pele e tecido subcutâneo é extensa, necessitando de reconstrução com enxertos e retalhos. Nova tecnologia, como uso da terapia por pressão negativa foi introduzido. Breves comentários sobre os principais grupos de feridas complexas: pé diabético, úlceras por pressão, úlceras venosas, síndrome de Fournier e vasculites.
Unitermos: Feridas complexas. Impacto sócio-econômico. Tratamento cirúrgico. Enxertos de pele. Retalhos cutâneos.
Expectancy of a longer life is recognized as one of major contributions afforded by modern civilization; however, improvement of quality of life has not necessarily followed that increase in life years. On the contrary, older populations may develop problems related to longevity that can compromise their quality of life.
Losses of cutaneous integument, represented not only by skin disruption but also by loss of subcutaneous tissues, sometimes including even muscle and bone, have been generally defined in medical textbooks as "wounds". There are striking differences between simple wounds, for example surgical wounds or skin scratches, and those chronic wounds that do not heal primarily and demand specialized care, mostly in hospitals. However, the latter have not merited enough attention by surgeons who consider the treatment of wounds to be a less sophisticated aspect of the profession, and consequently of no special interest.
More recently, the increasing number of aged patients and the frequency of these more difficult wounds has started to attract the attention not only of doctors and nurses but also of health-care administrators worried about the impact of the cost of these wounds on their hospital budgets.
In Brazil, the topic has not attained widespread interest, but in the State of São Paulo and in particular in Hospital das Clínicas of São Paulo University Medical College, the problem is gaining more importance in this new century.
A proposal was made by a group working at the Division of Plastic Surgery of the Institution to form a multidisciplinary group including doctors (plastic and vascular surgeons, dermatologists) and wound therapy nurses.1 It was formally approved in 2006, and its main goal is the study of the so-called "complex wounds".
But what are complex wounds?
There is not as yet a clear definition of complex wounds or specific criteria to separate them from the simpler ones. The term "chronic wounds", although frequently used, means only that more time was needed up to the cure, but it is not good enough a concept to characterize the complexity of the problem. We could use "difficult wounds" (in Portuguese, feridas difíceis), as proposed in German, (schwierige Wunde), but we prefer to use the term "complex wounds" (feridas complexas) in order to encompass the different criteria for classifying these special wounds and the challenge they pose for medical and nursing teams.
One or more of the following conditions must be present for a wound to be categorized as a "complex" type:
1 Extensive loss of the integument is an important criterion, whether it is an acute or chronic wound. Chronic wounds are defined as wounds that have not healed expontaneously in 3 months2 and usually have a common pattern of the complexity.
2 Infection is frequently present as a complication in chronic wounds and in itself may be the cause of the problem that resulted in tissue loss, as happens in aggressive infections like Fournier's gangrene.
3 Compromised viability of superficial tissuesclear necrosis, or signs of circulation impairment either localized or more extensive, usually in the limbs, leading to extensive loss of substance.
4 Association with systemic pathologies that impair normal healing causing wounds to fail to heal with simple care and requiring special attention. Feet ulcers in diabetic patients and many forms of vasculitis are common examples.
We thus consider the most commonly seen complex wounds, needing special care by a specialized group, as the following:
1 Wounds in the lower extremity of diabetic patients,
2 Pressure ulcers,
3 Chronic venous ulcers,
4 Wounds following extensive necrotic processes caused by infections (Fournier's and other), and
5 Chronic wounds related to vasculitis and immunosuppressive therapy that have not healed using simple care.
Burns might be included in this group of complex wounds (and indeed they are, in many instances, very complex wounds), but tradionally they are separated from this group, basically because burns have been regarded for some time to be a special condition that should be treated in specialized burn centers.
Using these concepts, over the last 5 years we have established measures to ensure a better understanding of the prevalence of these complex wounds in our institution (including the establishment of an electronic database) and to study and revise the procedures usually used to treat them, ie, dressings, surgical options, and new technologies that have recently become available, such as the negative pressure on wounds (vacuum systems).
It has already become clear to us that these complex wounds should usually be treated using surgical procedures instead of leaving them to clinical and expectant measures. Additionally, débridements, skin grafting, and flap coverage should be indicated sooner than has been done traditionally.
Determining that the majority of these complex wounds should be considered "surgical cases" and not just "cases for dressings" surely represents the major turning point of a new policy to provide more stable coverage of the wounds, thus improving the quality of life. It should reduce the time of hospitalization and the cost of treatment. Preventative measures are also essential.
Complex wounds will be briefly reviewed, and main factors of policies that will produce faster and stable closure of these woundsawareness of the importance for the health-care system, complexity of the treatment, and current best surgical approacheswill be emphasized.
Wounds in diabetic patients
It is well known that diabetes mellitus is a chronic multifactorial disease. Global prevalence of diabetes was 120 million in 1996, but predictions for 2030 suggests values as high as 366 million, due to longer life expectancies, obesity, and sedentary life styles.3,4,5 In Brazil, the diabetic population is estimated to be approsimately 10 million.6 In 2001, persons throughout Brazil who were 40 years old or older were invited to participate in community screening for diabetes as part of the Brazilian Ministry of Health's Plan for the Reorganization of Care for Arterial Hypertension and Diabetes Mellitus. Of the 30.2 million persons in the target population, 22.1 million (73.0%) were examined, and 3.5 million tested (15.7%) positive for elevated blood glucose levels.7
Among the complications that most frequently affect the diabetic individual are cardio-, retino-, and nephropathies; however, wounds in the lower extremity also are a major burden for the patient and health system.8,9,10
Such wounds are usually chronic, mostly in the feet, and treatment is difficult; all too often, these wounds do not heal primarily.11,12 Simple control of glucose blood levels, although important, is not necessarily followed by healing these ulcers.13,14 Frequently, wounds evolve with extensive necrosis and infectious processes that may lead to amputation of body parts, even of limbs.15,16,17,18
Obstruction of major blood vessels is responsible for less that 30% of the wounds; today, the main recognized cause is the neuropathy of diabetes,19,20,21 the progressive degeneration of the sensitive nerves of the foot induced by microangiopathy of the small vessels to the nerve fascicles and in many cases associated with external compression at some anatomical sites, as in the tarsal tunnel.22,23,24
Patients develop a progressive loss of sensation on their lower extremities, and because of that, they do not perceive small traumas on their feet, resulting in a chronic ulcer with a lower potential for healing due to the microangiopathic disease.25,26,27
Modern treatment of this pathology includes evaluation not only of the vascular status,28,29,30 but also of the neuropathy, using more precise tests to assess the sensibility of the feet,31 such as the PSSDTM(Pressure Specified Sensory Device) described by Lee Dellon of Baltimore32; in use at the Hospital das Clínicas.33
This wound should be treated surgically and as soon as possible, removing necrotic tissues34,35,36 and providing wound bed preparation37,38 using specific dressings39,40 or negative pressure41,42,43 (vacuum devices). Closure should be achieved as soon as possible with skin grafting,44,45,46 local flaps,47,48,49,50 or microsurgical flaps.51,52,53
With these measures, we expect to reduce the significant personal and economic costs caused by the "diabetic foot"the resulting longer stay in hospital, longer rehabilitation, and need for special care. Amputations should be avoided at all costs, as they are no longer the only alternative for treatment of the ulcer after failure of conservative measures to heal the ulcer, even if associated with complications like osteomyelits.54,55
Primary healing in the USA is estimated to cost between US$ 7,000 and US$10,000 per person, but the overall cost of an amputation related to the diabetic foot is estimated between 4.6 and 13.7 billion dollars.56
Costs in Brazil for the treatment of these patients are not known, but due to the notorious deficiencies in our health system, they must be very high, and worse, they signify a major burden for patients and their families.
Pressure sores
Many patients today need a long period of hospitalization for the treatment of chronic illnesses; typically they are old and have limitations in their normal movements. In this context, we come across pressure wounds, also known as pressure sores which represent a significant challenge for health professionals.57,58
A pressure sore is defined as an area of necrosis in the integument developed as a result of compression of soft tissues between an osseous prominence and a hard surface during a sufficiently long period of time to induce local ischemia.59
Patients with pressure sores have extended dependency on their caretakers, higher mortality, and lower quality of life. Pressure sores increase hospitalization time and the overall cost of treatment.60
Accordingly to the National Pressure Ulcer Advisory Panel, a US agency that coordinates actions for prevention and treatment of pressure sores, prevalence in hospitals in the USA varies from 3% to 14%, increasing to 15% to 25% in nursing homes.61 The incidence reported by Bergstrom et al62 in home care was 23.9%. In a study performed by São Paulo University at its Hospital Universitário, the incidence was 39.5% in surgical units, but higher, 41%, in intensive care units.63
The incidence and prevalence of pressure sores has grown due to the increase in patient age and lower mortality in high-complexity surgeries. It is our impression that in São Paulo it has also grown due to a decrease in the quality of care and prevention, especially in intensive care units.
Although the problem of diabetic wounds is very extensive but not well quantified in Brazil, the problem caused by excessive pressure sores in bedridden patients should be simpler to evaluate, and measures to identify the potential cases for developing pressure sores should be put in practice, especially because we know that these preventative procedures are most important in the overall care of the patients.
Unfortunately, policies for preventative measures to avoid the development of complex wounds have not been implemented in Brazil, and we are seeing more and more cases in our hospitals, in addition to many recurrences of already treated ulcers.
Hospital das Clínicas comprises for Institutes, the largest being the Central Institute, with 920 beds. On average we have 40 patients with pressure soresabout 5%, a figure similar to the international standard. Specific evaluation of the severity of those ulcers is currently being done, aided by the use of electronic databases.
Our proposal is to treat such cases as they are identified, but to also take into account that the treatment should more prompt than that in the conventional expectant orientation. Surgical treatment is the main option, and includes debridement of necrotic tissues, use of negative pressure64 (vacuum) to better prepare the wound bed, and providing definite closure with stable transplants, mostly local, well-vascularized transplants.65
Prevention must be enforced using well-known scale protocols already reported. The Braden scale is the most popular in our hospitals, and it has been translated into Portuguese.66 These protocols are very important for prevention of ulcers in higher-risk patients, but even after the closure of the sore, rehabilitation should be instituted in order to prevent recurrences.
Chronic venous ulcers
Described by Hippocrates more than 2,000 years ago,67 chronic venous ulceration is not generally considered a "curable" disease. Venous stasis ulceration is a frequent clinical condition causing considerable morbidity, poor quality of life,68 and significant socioeconomic loss.69
Chronic venous ulcers are considered to be the most common disorder of vascular origin.70,71 The chronic ulcer is caused by chronic venous insufficiency in the lower extremity, but it is frequently aggravated by scarring processes in the surrounding skin and subcutaneous tissues that render treatment of the ulcer by conventional measures slow and that leave tissues prone to recurrences.72
Definite treatment of venous insuffiency is not possible with the presently available technology.73,74,75 Measures to alleviate the insuffiency should be performed when indicated; but in order to solve the problem of the chronic wound, a more aggressive surgical protocol should aim to remove the lipodermatosclerotic tissues and to reconstruct the area with tissues that could bring venous channels to alleviate the stasis. 76,77,78,79
Venous ulcers are frequent, approximately 0.06% to 1.5% nationally and and internationally.80,81,82 The problem is universally severe, and there is a considerable economic impact.83,84
The etiology and pathophysiology of chronic venous ulcers are still incompletely understood. The most common treatment options include prolonged bed rest, Unna's boot,85 local wound care,86,87,88 and skin grafting.89,90 We are evaluating modern dressings that can be used for this condition and prevent complications.91
The importance of the role of skin grafting resilience and its potential to prevent recurrence is being evaluated, as is that of local and distant flaps used in more severe cases of recalcitrant ulcers after removal of the lipodermatosclerotic tissues.92,93
Vein stripping and perforator ligation valvuloplasty may improve regional venous hemodynamics and are often indicated by vascular surgeons, but they do not solve the problem of the wound if there is irreversible scarring due to surrounding lipodermatosclerosis.
For these reasons, we have categorized chronic venous ulcers as complex wounds in order to study dressings and other new ways to treat these wounds as well as the relevance of some surgical procedures being developed in the USA, including the use of new local flaps and even microsurgical transplants to more permanently close the difficult wounds.68
Extensive necrotic gangrene as in Fournier's syndrome
Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions caused by a mixture of aerobic and anaerobic organisms. The mortality rate from this infection ranges from 0% to 67%.94 The outcome is usually fatal if there is no early recognition and extensive surgical debridement upon initial diagnosis.95 This should be followed by aggressive antibiotic therapy combined with other precautionary and resuscitative measures. It is well know that early aggressive surgical debridement combined with broad-spectrum antibiotic coverage results in decreased mortality from Fournier's gangrene and other forms of extensive necrotic fasciitis.
Fournier's gangrene occurs in male and female patients with genital abscesses, cellulitis, necrotizing fasciitis, and vascular disorders; it is more frequent in males than in females.92
Precautionary measures are important for supporting the patient with Fournier's gangrene as are urinary and fecal diversions when necessary. Treatment with hyperbaric oxygen is still controversial as a complementary treatment to débridements, although some have claimed advantages with its use.96
In the Hospital das Clínicas, São Paulo, aggressive débridements have been used for more than 15 years, and the mortality rate has declined impressively.97,98
However, there are not many articles related to the reconstruction after the removal of skin and subcutaneous tissue that sometimes are quite extensive, and the wound is usually not amenable to direct closure.
In order to reduce the hospitalization time, we operate to reconstruct these patients promptly, use negative pressure (vacuum) for faster preparation of the wound bed, and use skin grafting to close the wound.
Later, reconstruction using flaps for functional (coverage of testicles) and for aesthetic proposes are done at under ambulatory conditions.
Wounds in patients with autoimmune disease or under immunosuppressive drug therapyvasculitis
Wounds in patients with severe systemic chronic diseases seem to have risen in number as hospital care for these diseases has improved. Extensive ulcers that could be considered complex wounds are not frequent, but they may be an important cause for longer hospitalization time and for rising costs of treatment; consequently, they need special consideration.
We have seen a number of those wounds related to autoimmune diseases such as in rheumatoid arthritis and related to immunosuppressive drugs, mostly in transplant patients, and even in less known entities such as pyoderma gangrenosum. The common pathophysiologic link seems to be some form of "vasculitis", which acts in the peripheral vessels of the superficial tissues and leads to an inflammatory process, capillary occlusion, and necrosis of tissues.99
The necrotic area is sometimes not well defined, and sometimes the surgical debridement can induce new areas of inflammatory process that enlarge the area. Corticosteroids may have a positive effect in controlling the basic problem of vasculitis. Its well-known negative influence on wound healing seems to be less important if a reconstructive procedure like a flap or graft is used.
Recent studies on reconstructive surgery for immunosuppressed organ transplantation patients have shown that no serious deficit of healing was observed, which was also observed with reconstruction after tumor removal and chemotherapy.100 There is clear evidence that such wounds should not be treated conservatively but rather included in this group of complex wounds and treated accordingly in wound centers.
Pyoderma gangrenosum, a cutaneous ulcer with no clear etiology, represents well the difficulties of treating these special wounds caused by vasculitis. It can have different clinical presentations and is often associated with inflammatory intestinal disease (55%) and rheumatoid arthritis (37%).101 It can be associated with plastic surgeries including aesthetic ones, particularly in the breast.102
Our experience is not extensive enough to draw any conclusion about the best treatment available, but apart of the appropriate medical systemic treatment for the general condition, the wound should be treated by removal of necrotic tissue and surrounding tissue of doubtful viability, preparation of the bed, and closure as soon as possible with skin grafting techniques.
Use of adjunctive therapies, such as hyperbaric oxygen therapy, has not proven its value, and it is not presently recommended by our group.
Multidisciplinary care of the patient is essential.103
Received for publication on October 13, 2006.
Accepted for publication on October 16, 2006.
- 1 Gottrup F. A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. Am J Surg. 2004;187:38S-43S.
- 2 Harding KG, Morris HL, Patel GK. Science, medicine and the future: healing chronic wounds. BMJ. 2002;324:160-3.
- 3 Wild S, Roglic G, Green A, Sicree R, King H. Global prevalences of diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-53.
- 4 Boulton AJ, Vileikyte L, Ragnason-Gennvall, Alpelqvist J. The global burden of diabetic foot disease. Lancet. 2005;306:1719-24.
- 5 Apelqvist J, Ragnarson-Tennvall G, Larsson J, Persson U . Long term costs in a multidisciplinary setting. Foot and Ankle. 1995;16:388-94.
- 6 Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban population aged 30-69. The Brazilian Cooperative Group on the study of diabetes prevalence. Diabetes Care. 1992;15:1509-16.
- 7 Nucci LB, Toscano CM, Maia ALM, Fonseca CD, Britto MMB, Duncan BB, et al. A nationwide population screening program for diabetes in Brazil. Ver Panam Salud Publica. 2004;16:320-7.
- 8 Singh N, Armstrong DG, Lipsy BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.
- 9 Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005;366:1725-35.
- 10 Ragnarsson-Tennvall G, Apelqvist J. Cost-effective management of diabetic foot ulcers. Pharmaco Economics. 1997;12:42-53.
- 11 Sumpio BE. Foot ulcers. N Engl J Med. 2000;343:787-93.
- 12 Aronow WS. Management of peripheral arterial disease of the lower extremities in elderly patients. J Gerontol A Biol Sci Med Sci. 2004;59:172-7.
- 13 Jeffcoate WJ, Price P, Harding KG. Wound healing and treatments for people with diabetic foot ulcers. Diabetes Metab Res Rev. 2004;20 (suppl 1):78-89.
- 14 Dang CN, boulton AJM. Changing perspectives in diabetic foot ulcer management. Lower Extremity Wounds. 2003;2:4-12.
- 15 Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J. 2004;1:123-32.
- 16 Lipsky BA, Berendt AR, Deery HG. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885-910.
- 17 Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb amputations in diabetic foot gangrene patients. Diabetes Res Clin Pract. 2006;71:272-9.
- 18 Markowitz JS, Gutterman EM, Magee G, Margolis DJ. Risk of amputation in patients with diabetic foot ulcers: a claims-based study. Wound Repair Regen. 2006;14:11-17.
- 19 Abbott C, Carrington A, Ashe H. The North-West Diabetes Foot Care Study: incidence of and risk factors for new diabetic foot ulceration in a community-based patient cohort. Diabetic Med. 2002;19:377-84.
- 20 Moss SE, Klein R, Klein B: The 14-year incidence of lower-extremity amputation in a diabetic population. Diabetes Care. 1999;22:951-9.
- 21 Proceedings of a consensus development conference on standardized measures in diabetic neuropathy. Diabetes Care. 1992;15:1080-107.
- 22 Dellon AL. From there to here: a personal viewpoint after three decades of neuropathy research. Clin Podiatr Med Surg. 2006;23:497-508.
- 23 Valdivia JMV, Dellon AL, Weinand ME, Maloney CT. Surgical treatment of peripheral neuropathy. J Am Podiatr Med Assoc. 2005;95:451-4.
- 24 Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plastic Surg. 2004;53:517-22.
- 25 Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM, American Diabetes Association. Preventive foot care in diabetes. Diabetes Care. 2004;27 (suppl 1):63-4.
- 26 Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM, American Diabetes Association. Preventive foot care in people with diabetes. Diabetes Care. 2003;26 (suppl 1):78-9.
- 27 Bowering CK. Diabetic foot ulcers: pathophysiology, assessment, and therapy. Can Fam Phys. 2001;47:1007-16.
- 28 Laird JR, Zeller T, Gray BH. Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial. J Endovasc Ther. 2006;13:1-11.
- 29 Mousa A, Rhee JY, Trocciola SM. Percutaneous endovascular treatment for chronic limb ischemia. Ann Vasc Surg. 2005;19:186-91.
- 30 Trocciola SM, Chaer R, Dayal R. Comparison of results in endovascular interventions for infrainguinal lesions: claudication versus critical limb ischemia. Am Surg. 2005;71:474-9.
- 31 Wood WA, Wood MA, Werter AS, Menn JJ, Hamilton AS, Jacoby R, Dellon AL. Testing for loss of protective sensation in patients with foot ulceration. J Am Podiatr Med Assoc. 2005;95:469-74.
- 32 Tassler PL, Dellon AL, Scheffler NM. Computer-assisted measurement in diabetic patients with and without foot ulceration. J Am Podiatr Med Assoc. 1995;85:679-84.
- 33 Ferreira MC, Rodrigues L, Fels KW. New method for evaluation of cutaneous sensibility in diabetic feet: preliminary report. Clinics. 2004;59:286-90.
- 34 Brem H, Sheehan P, Boulton AJ. Protocol for treatment of diabetic foot ulcers. Am J Surg. 2004;187(suppl 5):1-10.
- 35 Hess CT, Kirsner RS. Orchestrating wound healing: assessing and preparing the wound bed. Adv Skin Wound Care. 2003;16:246-57.
- 36 Saap LJ, Falanga V. Debridment performance index and its correlation with complete closure of diabetic foot ulcers. Wound Repair Regen. 2002;10:354-9.
- 37 Sibbald RG, Orsted H, Schultz GS, coutts P, Kest D. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy Wound Management. 2003;49:23-51.
- 38 Sibbald RG, Williamson D, Orsted HL. Preparing the wound bed: debridement, bacterial balance, and moisture balance. Ostomy Wound Manage. 2000;46:14-22,24-28,30-5.
- 39 Falanga V. Wound healing and its impairment in the diabetic foot. Lancet. 2005;366:1736-43.
- 40 Eldor R, Raz I, bem Yehuda A, Boulton AJ. New and experimental approaches to treatment of diabetic foot ulcers: comprehensive review of emerging treatment strategies. Diabet Med. 2004;21:1161-73.
- 41 Andros G, Armstrong DG, Attinger CE, Boulton AJ, Frykberg RG, Joseph WS, et al. Consensus statement on negative pressure wound therapy (V.A. C. therapy) for the management of diabetic foot wounds. Ostomy Wound Manage. 2006;Jun (suppl):1-32.
- 42 Armstrong DG, Lavery LA. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomized controlled trial. Lancet. 2005;366:1704-10.
- 43 Eginton MT, brown KR, Seabrook GR. A prospective randomized evaluation of negative-pressure wound dressing for diabetic foot wounds. Ann Vasc Surg. 2003;17:645-9.
- 44 Silverstein G. Dermal regeneration template in the surgical management of diabetic foot ulcers: a series of five cases. J Foot Ankle Surg. 2006;45:28-33.
- 45 Puttirutvong P. Meshed skin graft versus split thickness skin graft in diabetic ulcer coverage. J Med Assoc Thai. 2004;87:66-72.
- 46 Roukis TS, Zgonis T. Skin grafting techniques for soft-tissue coverage of diabetic foot and ankle wounds. J Wound Care. 2005;14:173-6.
- 47 Attinger CE, Ducic I, Cooper P. The role of intrinsic muscle flaps on the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients. Plast Reconstr Surg. 2002;110:1047-54.
- 48 Osiogo FO, Lai CS, Wang WH, Chye YF, Lin SD. Retrospective review of free gracilis muscle flaps in the management of nonhealing diabetic foot ulceration. J Foot Ankle Surg. 2006;45:252-60.
- 49 Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg. 2006;117 (Suppl 7):127-42.
- 50 Ducic I, Hung V, Dellon AL. Innervated free flaps for foot reconstruction: a review. J Reconstr Microsurg. 2006;22:433-42.
- 51 Yang WG, Chiang YC, Wei FC, Feng GM, Chen KT. Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg. 2006;117:1004-8.
- 52 Ozkan O, Coskunfirat OK, Ozgentas HE. Reliability of free-flap coverage in diabetic foot ulcers. Microsurgery. 2005;25:107-12.
- 53 Rainer C, Schwabegger AH, Meirer R, Perkmann R, Ninkovic M. Microsurgical management of the diabetic foot. J Reconstr Microsurg. 2003;19:543-53.
- 54 Jeffcoate WJ, Lipsky BA. Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis. 2004;39(suppl 2):115-22.
- 55 Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the U. S. Diabetes Care. 2003;26:1790-5.
- 56 Ramsey SD, Newton K, Blough D, McCulloch DK, Sandhu N, Reiber GE, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22:382-7.
- 57 Benbow M. Guidelines for the prevention and treatment of pressure ulcers. Nurs Stand. 2006;20:42-4.
- 58 Lindgren M, Malmqvist LA, Sjoberg F, Ek AC. Altered skin blood perfusion in areas with non blanchable erythema: an explorative study. Int Wound J. 2006;3:215-23.
- 59 Cullum N, Nelson EA, Nixon J. Pressure ulcers. Clin Evid. 2006;15:2592-606.
- 60 Xakellis GC, Frantz RA. The cost of healing pressure ulcers across multiple health care settings. Adv Wound Care. 1996;9:18-22.
- 61 Bryant RA, Shannon ML, Pieper B, Braden BJ, Morris DJ. Pressure ulcers. In: Bryant RA. Acute and chronic wounds nursing management. Missouri: Mosby; 1992. p. 105-63.
- 62 Bergstrom N, Braden BJ, Kemp M, Champagne M, Ruby E. Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions. J Am Geriatric Soc. 1996;44:22-30.
- 63 Rogenski NMB, Santos VLCG. Incidence of pressure ulcers at a university hospital. Rev Latino-Am Enfermagem. 2005;13:474-80.
- 64 Ferreira MC, Wada A, Tuma Jr P. The vacuum assisted closure of complex wounds. Clinics. 2003;58:227-30.
- 65 Costa MP, Sturtz G, Costa FPP, Ferreira MC; Barros-Filho TEP. Epidemiologia e tratamento das úlceras de pressão: experiência de 77 casos. Acta Ortop Bras. 2005;3:124-33.
- 66 Paranhos WY, Santos VLCG. Avaliação do risco para úlceras por pressão por meio da Escala de Braden na língua portuguesa. Rev Esc Enfermagem USP. 1999;33:191-206.
- 67 Quintal D, Jackson R. Leg ulcers: a historical perspective. Clin Dermatol. 1990;8:4-12.
- 68 Jones J, Barr W, Robinson J, Carlisle C. Depression in patients with chronic venous ulceration. Br J Nurs. 2006;15:S17-23.
- 69 Nélzen O, Bergqvist D, Lindhagen A, Hallbook T. Chronic leg ulcers: an underestimated problem in primary health care among elderly patients. J Epidemiol Community Health. 1991;45:184-7.
- 70 Abbade LP, Lastoria S. Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. Int J Dermatol. 2005;44:449-56.
- 71 Hume M. Venous ulcers, the vascular surgeon, and the Medicare budget. J Vasc Surg 1992;16:671-3.
- 72 White JV, Ryjewski C. Chronic venous insufficiency. Perspect Vasc Surg Endovasc Ther. 2005;17:319-27.
- 73 Hach-Wunderle V, Hach W. Invasive therapeutic options in truncal varicosity of the great saphenous vein. Vasa. 2006;35:157-66.
- 74 Wollina U, Abdel-Naser MB, Mani R. A review of the microcirculation in skin in patients with chronic venous insufficiency: the problem and the evidence available for therapeutic options. Int J Low Extrem Wounds. 2006;5:169-80.
- 75 Myers K, Fris R, Jolley D. Treatment of varicose veins by endovenous laser therapy: assessment of results by ultrasound surveillance. Med J Aust. 2006;185:199-202.
- 76 Steed DL, Hill DP, Woodske ME, Payne WG, Robson MC. Wound-healing trajectories as outcome measures of venous stasis ulcer treatment. Int Wound J. 2006;3:40-7.
- 77 Iglesias C, Nelson EA, Cullum NA,Torgerson DJ, et al. VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers. Health Technol Assess. 2004;8:101-5.
- 78 DePalma RG. Surgical treatment of chronic venous ulceration. In: Bergan JJ, Yao JST, eds. Venous Disorders. Philadelphia: WB Saunders; 1991. p. 396-406.
- 79 Weinzweig N, Schuler J. Free tissue transfer in treatment of the recalcitrant chronic venous ulcer. Ann Plast Surg. 1997;38:611-9.
- 80 Abbade LP, Lastoria S, Almeida RH, Stolf HO. A sociodemographic, clinical study of patients with venous ulcer. Int J Dermatol. 2005;44:989-92.
- 81 Baker SR, Stacey MC, Joop-McKay AG, Hoskin SE, Thompson PJ. Epidemiology of chronic venous ulcers. Br J Surg. 1991:78:864-7.
- 82 Nélzen O, Bergqvist D, Lindhagen A. Venous and non-venous leg ulcers: clinical history and appearance in a population study. Br J Surg. 1994;81:182-7.
- 83 Vowden KR, Vowden P. Preventing venous ulcer recurrence: a review. Int Wound J. 2006;3:11-21.
- 84 Ruckley CV. Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology. 1997:48:67-9.
- 85 Bergan JJ, Sparks SR. Non-elastic compression: an alternative in management of chronic venous insufficiency. J Wound Ostomy Continence Nurs. 2000;27:83-9
- 86 Khan MN, Davies CG. Advances in the management of leg ulcersthe potential role of growth factors. Int Wound J. 2006;3:113-20.
- 87 Prince S, Dodds SR. Use of ulcer size and initial responses to treatment to predict the healing time of leg ulcers. J Wound Care. 2006;15:299-303.
- 88 Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA. Dressings for healing venous leg ulcers. Cochrane Database Syst Rev. 2006;9;3:CD001103.
- 89 Bechara FG, Sand M, Sand D, Stucker M, Altmeyer P, Hoffmann K. Shave therapy for chronic venous ulcers: a guideline for surgical management and postoperative wound care. Plast Surg Nurs. 2006;26:29-34.
- 90 Jones JE, Nelson EA. Skin grafting for venous leg ulcers. Cochrane Database Syst Rev. 2000;2:CD001737.
- 91 Trent JT, Falabella A, Eaglstein WH, Kirsner RS. Venous ulcers: pathophysiology and treatment options. Ostomy Wound Manage. 2005;51:38-54.
- 92 Top H, Benlier E, Aygit C, Kiyak M. Distally based sural flap in treatment of chronic venous ulcers. Ann Plast Surg. 2005;55:160-5.
- 93 Weinzweig N. Invited discussion: Distally based sural flap in treatment of chronic venous ulcers. Ann Plast Surg. 2005;55:166-8.
- 94 Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB. Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg. 2002;68:709-13.
- 95 Harper D, Banwell PE. Fournier's gangrene exposed. Int Wound J. 2004;1:78-9.
- 96 Korhonen K. Hyperbaric oxygen therapy in acute necrotizing infections. With a special reference to the effects on tissue gas tensions. Ann Chir Gynaecol. 2000;89:7-36.
- 97 Steinman E, Utiyama EM, Maximiniano LF, Belivacqua RG, Birolini D. Fournier syndrome: evaluation and initial treatment. Rev Assoc Med Bras. 1992;38:209-13.
- 98 Anadrade AC, Amarante MT, Ferreira MC, Lodovici O. Tratamento cirúrgico na seqüela da síndrome de Fournier. Rev Assoc Méd Brás. 1991;37:22-6.
- 99 Coelho S, Amarelo M, Ryan S, Reddy M, Sibbald RG. Rheumatoid arthritis associated inflammatory leg ulcers: a new treatment for recalcitrant wounds. Int Wound J. 2004;1:81-4.
- 100 Drücke D, Daigeler A, Lehnhardt M, Hauser V, Steinau HU. Plastisch-chirurgische Defektdeckung bei immunsupprimierten Patienten-heilt es wirklich sclechter? Plastische Chirurgie. 2005;10:127-32.
- 101 Eulufí AM, Calderón WO, Piñeros JLB, Silva MC, Cuadra A C, Léniz PM, et al. Pioderma gangrenosa en cirugía plástica: Comunicación de tres casos. Rev Méd Chile. 2006;134:339-44.
- 102 Crowson N, Mihm Jr M, Magro CM. Pyoderma gangrenosum: a review. J Cutan Pathol. 2003;30:97-107.
- 103 Gottrup F. Optimizing wound treatment through health care structuring and professional education. Wound Repair Regen. 2004;12:129-33.
Publication Dates
Publication in this collection
14 Dec 2006
Date of issue
16 Oct 2006
13 Oct 2006


text: Samsung's Galaxy F Will Cost Your First Born Child Dylan Duarte November 12, 2018 News Last week Samsung showed off their Flex Display for the very first time, finally giving us an official glimpse at the foldable phone they've been working on for a couple of years. At the time, they only thing they gave us was that quick sneak peek (in the dark, no less) and the name of the technology. Thanks to a South Korean news organization, we might have a name, release date, and price. According to the Yonhap News Agency, the phone will be known as the Galaxy F, a name that was rumored some time ago. The F assumedly stands for "foldable," so it's not exactly a creative homerun. The phone will supposedly launch in March of 2019, one month after the Galaxy S10 launches (and with 5G support, something the Galaxy F will not have). What sort of price are we looking at? Well, with the Galaxy F being a niche device, the priciest configuration could hit $1,770. That would make it the most expensive phone on the market by a considerable margin. According to the report, Samsung hasn't come to a definite decision on price. While $1,770 sounds incredibly steep, keeping in mind that this device will function as both a high-end smartphone and a tablet. Furthermore, it's a new technology, which will always command a high price. Assuming this technology sticks around, expect phones like the Galaxy F to drop in price considerably over the next few years (or at least match up with current flagship prices, assuming they keep going up). Are you still excited for the Galaxy F? I expect that plenty of consumers have been chomping at the bit ever since the plans were revealed two years ago, but that price is high enough to burst even the biggest bubble. Hopefully we'll have an official price in the very near future. Share This With The World!2 2Shares

subset: commoncrawl


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- April 19, 2019,
- POSTED BY cm_admin
Casual Outfit Ideas Inspired By Jennifer Lawrence's everyday look
Jennifer Lawrence knows how to kill the fashion game both on and off red carpet. She is often spotted in her off-duty looks , which were practically high-key in nature. You can imbibe the Lawrence approved look for yourself with......


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Blackwing One-Step Pencil Sharpener
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Free domestic shipping on product orders over $100!
The Blackwing One-Step Sharpener creates a long, curved point designed to resist breakage. Blades are replaceable once dull. The canister holds three full sharpens before needing to be emptied. Body is made of durable aluminum and the sharpener features a German steel blade. Light weight, fits in the palm of your hand and is easy to bring in your everyday carry tote. Read More >


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search for keyword: 'Tricks'
Ruler That Create the City Remember You can't Go Against Control
Ruler of the City is not an online game of skill. The rules are simple, you move your city from one ..
What a trick!
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Tonight, from April 23 to 24, in Miass, a man staged an illegal fire show: he set fire to tires and ..
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nice trick..
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this is how India deals with Wheel Clamp Lock
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Tutorial: ItemFix Meme Generator
A quick look at using our MEME generator here on Itemfix You can find the meme generator here: www.itemfix.com/image_meme_generator
Tutorial: Text to Speech
Taking a look at the text to speech engine on ItemFix. Let's see what you can do with it! You can find the text to speech tool here: www.itemfix.com/text_to_speech
It was at this moment...a meme tutorial
Learn how to use the "It was at this moment..." template. Perfect for accidents, stupidity, marriage proposals and more!
ItemFix Tutorial - Short compilation
For this tutorial we use two different templates to create a short tutorial using two video clips and some assets.
Video to GIF tutorial
Here we take a look at using the Video to GIF template allowing you to create animated GIFs from video clips to use everywhere.


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The Team
Philip is a fourth year Computer Engineering major at Northeastern University and the founder of Suspension Robotics. At Suspension, he coordinates the engineering and business teams and creates software and hardware for the robots. In his spare time, Philip enjoys getting outdoors and rock climbing.
Karl Schumacher
Financial Advisor
Karl is fourth year at Northeastern University who majors in international affairs. He joined Suspension Robotics team as the financial advisor last semester. Karl also assists in consumer and market research. In his free time, he enjoys cooking, playing sports, and writing music.
software engineer
Chris is a third year Computer Engineering and Computer Science major at Northeastern. He has project experience programing in several languages and works with microcontrollers as a hobby. Before working with Suspension, Christ worked as a Systems Engineer at RoviSys – a company specializing in automation and systems integration.
Mechanical engineer
Donovan is a first year echanical Engineering student with five years of experience in Autodesk Inventor, Fusion 360, Solidworks, and Onshape. Previously, he has worked on FIRST FRC teams. At Suspension, he models parts and assemblies in CAD.
Mechanical engineer
Neha a first year Mechanical Engineering major at Northeastern University. She has a year of both CAD and 3D printing experience. At Suspension Robotics, she is designing, printing, and assembling a variety of components.
Mechanical engineer
Rebecca is a first year Mechanical Engineering major with a year of CAD experience in Solidworks, AutoCAD, and Onshape. At Suspension, she helps with CAD and assembly. She has also worked on mechanical teams for other robotics projects in the Northeastern Robotics Club.
Yiyang (Franko) Liu
Algorithm Engineer
Yiyang is a first year mathematics major at Northeastern University with four years programming experience under his belt. As Suspension, he works on developing the path planning and cable interference algorithms that control the position and orientation of the robot.
Gerson Perez
market strategist
Gerson is probably a student at Northeastern University who majors in something. He is a researcher and market strategist at Suspension, so he is the one who researches things and also figures out how to market and sell the robot because Suspension has to make money somehow.


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Travelers who like staying near University of Lecce recommend Risorgimento Resort, Mamma Sisi B&B and Grand Hotel Tiziano E Dei Congressi.
KAYAK users have found double rooms near University of Lecce for as cheap as 77 ﷼ in the last 3 days. The average price is 81 ﷼.
In the last 3 hours, users have found hotels near University of Lecce for tonight for as low as 127 ﷼. Users have also found 3-star hotels from 127 ﷼ and 4-star hotels from 243 ﷼.
In the last 72 hours, users have found hotels close to University of Lecce for this weekend for as low as 127 ﷼ per night. Users have also found 3-star hotels from 127 ﷼ and 4-star hotels from 226 ﷼.
If you're looking for a romantic stay during your time in University of Lecce, then Hotel Delle Palme, Hilton Garden Inn Lecce, and 8Piuhotel are recommended options.
If you're taking a trip to Lecce with the whole family, staying close to University of Lecce makes sense. Recommended family-friendly hotels are Mercure Hotel President Lecce, Hilton Garden Inn Lecce, and 8Piuhotel.
Hotels are safe environments for travelers as long as they properly implement sanitary measures in response to coronavirus (COVID-19). However, we recommend getting in touch with the local authorities regarding safety procedures for hotels in University of Lecce. For more advice, please view our information page on what to know about coronavirus (COVID-19) and travel.


text: Ok, I am about to offend some people here, but poppy burning is something I feel very strongly about. Certain people of the Islamic faith have yet again been burning poppys. The question is why are they doing it? So what's the answer? Do they just enjoy burning flowers? Do they have tendencies towards arson? OrContinue reading "Remembrance Day & Poppy Burning"


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[Skip to content]
George Eliot Hospital NHS Trust encourages staff, visitors and patients to use public transport if at all possible.
There are three main car parks on the George Eliot hospital site; at the front of the main hospital building, outside the rehabilitation unit at the rear of the main hospital building and outside the maternity unit.
The car park outside the rehabilitation unit is for disabled badge holders only. Anyone parking in a disabled parking bay must display their blue badge along with their parking ticket. There are also parking spaces for the disabled in the other car parks. Patients should be advised that the rehabilitation entrance is closed at the weekend and to account for this when visiting.
Parking for motorbikes is available to the left of the main car park. There is no charge for motorcycles. Motorcycles should be able to leave to the side of the exit barrier.
Please do not park cars in areas where there are double yellow lines or No Parking signs. Road space must be kept clear for ambulances and other emergency traffic.
Note: Please leave extra time for your visit to allow you to find a suitable parking space in our busy car parks.
Site Map
Visiting Restrictions
Car parking prices valid from 13th March 2020
Length of Stay
Up to 30 minutes
30 minutes to 1 hour
Up to 2 hours
Up to 3 hours
Up to 4 hours
Up to 5 hours
Up to 6 hours
Up to 24 hours
As a patient you might qualify for the Hospital Transport Cost Scheme, which helps some people with the costs of getting to and from hospital. Please contact the Patient Advice and Liaison Service (PALS)
Eligibility for Free Parking
You may be eligible for free parking.
There are no charges for the following groups:
Upon arrival at the Hospital please present to the reception with your blue badge. This form will need to be completed and then the car registration will be entered onto the system. Obviously the permit goes with the person and not necessarily the vehicle therefore if the person attending the Hospital uses a different car then the same process will need to be repeated.
Frequent Outpatient Attenders: Parking will be provided free to all outpatients who attend hospital for an appointment at least 3 times within a month and for an overall period of at least 3 months. A 'month' is defined as a period of 30 days.
The Trust will retrospectively reimburse any patient who meets the above criteria. To claim the money back the person will be required to fill in this formgiving details of the dates and times when they attended. We will then organise for a BACS payment to be paid to the visitor.
In terms of the frequent attenders there are already a number of visitors who all ready receive car parking concessions, ie. renal and oncology patients and these will still apply.
If you have any queries about parking please speak to someone at the main reception desk.
Please note we no longer offer long term parking permits (except for staff).
Parking for contractors to the Hospital
All contractors providing a service to the Trust must obtain a parking permit from the Estates department, failure to do so will result in a parking charge notice being issued by the Trust.
Page updated September 2022
Drive into the car park through the entry lane.
The barrier raises and the Automatic Number Plate Recognition (ANPR) camera reads the vehicle number plate.
Park the motor vehicle.
Before returning to the car park go to the payment machine.
Enter the registration number of your vehicle.
The cost of parking will be displayed.
Payments can be made by cash, card or notes and there is a receipt option available.
Return to your vehicle and drive towards the exit barrier.
The barrier will automatically lift for exit.
If the barrier does not raise, press the intercom button at the barrier.
Get back in your car and drive to the barriers which will now automatically open for you
If you have any problems, press the help button on the pay machines or barriers.
Healthcare Travel Costs Scheme
Voluntary Transport Agencies across Warwickshire
The website below identifies all the voluntary transport agencies across Warwickshire available to patients. This also includes a summary leaflet on of transport options which patients can be signposted to:
Warwickshire Health Transport


text:
Students from Arch Academy of Design participated at the Cha.T event, which was organised at Birla Auditorium. Renowned Politician, Sachin Pilot was a guest speaker at the event. He motivated the students to accept their culture and tradition. The Marketing Head of TeamIndus, Dhananjaya Sharma spoke about the company which will launch a space project. The students had an interactive session with casting director, Vicky Sidana who enlightened them about the acting industry. The air was then filled with laughter at the jokes of Nitin Mirani. Educationalist, Sunayana Sarkar talked about the growing gap due to digitization. Activist Ashwini Parashar threw light on the plight of the RajGhat village. TV producer Vikas Gupta shared his personal experiences with the students. The session ended with a music and dance session for the students.
Our city's pride Archana Surana, Founder & Director, ARCH College of Design & Business has been elected for the 8th Cumulus Executive Board (2022-2025) to represent India on 356 Member Institutions- Cumulus Executive Board.Learn More


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Ashenafi Zedebub
Nowadays, it is not at all strange to see women being posted at a higher – or even at the highest top sometimes – level in either government or non-government organizations. Today, we seen women named or elected to hold office of a prime minister, minister, bank president, CEO of insurance establishments and other organizations; to see them appointed as speaker of parliament, as a judge, as notary public, as editor-in-chief of mass media and what not.
"Women at the top" as very high ranking politicians is not at all a rare occurrence in our world today. For instance; until very recently, Mrs. Clinton happened to hold a post as head of the foreign office of what they call "the strongest nation under the sun" – The United States of America. Mrs. Angela Merkel heads a government of a leading industrial nation of Europe – The Federal Republic of Germany – as Federal Chancellor. The International Monetary Fund (IMF) is also led by a woman.
Here in our country , Ethiopia, we have as well some women appointed as ministers, ministers of state, vice ministers, ambassadors, head of government agencies, judges, and so on and so forth. It is indeed worth mentioning here that Mrs. Shitaye Minalu is the Deputy Speaker of the House of Representatives , a woman, who is now and then seen conducting correctly and in full confidence the meeting of legislators in the absence of the chief speaker of the House.
Going out to the private sectors, we have also notable women as high ranking executives. For instance; Mrs. Mulu Solomon, President of the Ethiopian Chamber of Commerce and Sectoral Association is not at all to be overlooked. A young – but a fast-growing financial establishment – Abay Bank S.C., has also a woman at its top. Mrs. Besenbet Shenkute is the President of the Bank ever since it began to operate lawfully.
In this sense, one may without any doubt come to the conclusion that a social advancement and improvement of the status of women is – in particular in a conservative and old-styled society like ours- on the move, in spite of all worthless objections, rootless allegations and arguments.
However, I still doubt of their sincerity in pertinent to their so-called "equality" .Are women in Ethiopia really, heartily interested in their emancipation ? It is not just without any reason that I have raised this question or it is not at all a question merely for the sake of questioning. I have adequate reason for it. For example; a woman – no matter where she is or what type of a post she holds – is usually seen to be at the mercy of her parents, guardians or whosoever comes as an elderly person in her family. Assuming she wants to be married to a man she happens to love, she first and foremost asks the would-be husband to find few influential persons – sometimes she takes the lead to nominate such people on his behalf – to act as go-betweens as to ask the parents or guardians and to negotiate matters pertinent to the marriage. In other words, she would seek permission through someone in order to be the "life partner" of the "beloved ones".
Much to our surprise, such dependence on go-betweens doesn't occur in the rural area or in people of the grassroots only. It happens even in large cities and amongst women who are – or at least claim to be – educated. Mind you, let us take one instance: A judge, who happens to pass sentences on serious court case and who is having a chair to determine ones life either for good or for bad, looks for people of much less education to render advice and also ask her parents or guardians as to give the green light for her marriage. This means that such a woman would only be able to judge others and do not at all know how to decide on her own issue. Concerning such matters, they usually argue that the "good old tradition, custom, culture, etc…" has of a great value, forgetting that such tradition should be left as démodé and that is all.
On the other hand, there is also another question : Are women always the only ones to be victims of domestic abuse or even physical violence? Men are usually ashamed to tell , specially in Ethiopia, about their maltreatment by women. There are women who even deprive men of sexual intercourse, just because they do not give the monthly money to meet the expenses in a manner suitable to the wife. Physical violence is also seen now and then , but men do not talk such issues .
I myself have witnessed such matters . What about you ?


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Joke To Raise Grade At End Of Semester The Duke of York announced that it is preparing a new Senior Finals Series for this upcoming season. And did you know that team will be building on that development? The school will be using as the base for the College of Life for just three months. "It's fantastic," Nick said. This is a small, but very substantial change in their plans for senior season. To add to the organization's growing fan base, the Duke of York is moving across from the College of Life to join the Division of the University of Florida. At the end of this season, you could expect to make a mention of that very thing. It was hard to talk to Nick about how the team is entering its "game" as the same thing that we saw at Duke in 2013. Nick said that the focus was being on academics. Though the school is committed to getting more teams into the school than if they used the coaching business as the foundation for their future. "I just look at what you look at," Nick said. "What do you do with the coaches? Do you actually make decisions based on what information you have? And what makes you think about what you're doing? What is the source of that information? What happens if you're making that decision." He added that he does know if you make big decisions. "When you start looking at the information coming out from the recruiting fields, you give a good piece of information. But it's not the same at all. I think being honest…I would say, 'There must be some, some kind of big story behind it. There must be a story behind it and that is kind of a year. But you are going to look at what you've covered, and that is dealing with it.' But keep it in perspective, and it will change. It could change a lot of things about our organization from being a basketball school to getting into basketball." Nick also knows the head of community arts department.
How Late Can You Be To A Proctoru Exam
After he graduated from Florida, Nick was approached by college basketball head coach Derrick Rose to ask if she was interested in being a senior soccer coach. Nick replied that he had just gotten in and wanted to play for a team that had a lot of students that had played in the NCAA State of Hope games that year. After making the announcement on his site, Nick said that she would not have mentioned that to the head of community arts that night, though instead of taking us to the basketball game that night, she would have kept it a secret from the other team officials. As a former coach of Duke for more than 15 years, Nick gave a very thoughtful, candid interview to ask if the school could be putting a modern education on it. Nick said that the school made the decision to buy two former head coach's on the staff of Nick & Co. rather than its own, so they are now doing what they have always done when they wanted to be an active student-loan and even if it was to do the traditional footwork for their football team. "We are sort of thinking, 'OK, we want to be a real educationist. What do you know?'" Nick said. Nick's next interview with basketball stars Jimmy Butler and John Jenkins wentJoke To Raise Grade At End Of Semester After an impressive start at his first semester, Ken-Dee, the two-time Empyrean Laureate with a highschool diploma and a scholarship at Northeastern University, took to the air this week of The Walking Dead co-writing a book for American readers. After just two weeks of the story, Funnily enough, the series was originally written as a podcast on EMI. EMI was a free app that was free until its September release, which took a year and a half, since it was a virtual reality project—just like the title-and-review sites in its own right, though it wasn't going to be coming out until May 2010. There were no voice actors, no studio extras. The finished product was a pretty entertaining sketch. And even a knockout post last month's release in July, Funnily enough, for the ages. The book is no longer on sale for pre-orders, but that doesn't mean publishers can't try it as much as they can here, let alone launch it as a live feature for people who watch the podcast. EMI promises it will be available for purchase via this link: $350.99 The zombie update, on offer's Kickstarter, kicked off Friday night, and the second episode of the Deadwalker, the latest "a little update for the dead," will air later on Friday evening. The Zombie update is scheduled to premiere at 2:30 p.m., and you can still nab it via the link above.
These Are My Classes
It's titled "A New Zombie," and reads like a full retro-update: The Deadwalker, you all know I want to try it. It's doing a solid job of re-impressing us all this morning with one of the most fun ways we've seen it before. And I meant that the book, despite the flaws with the zombie update that comes with it, is an amazing way we've seen everything around us come true. We've seen everything. It's been a surprisingly satisfying journey. We're going to be in the middle of these great big differences between the two and see if they'll make this book a great book. I'll be talking here about my first zombie update since being part of the community I know it was a terrible idea. * By Scott C. Schreck First and foremost, I'm just taking this as a bit of an early warning. Our lives have changed quite a bit over the last couple of decades, so I don't worry about the details. But those changes are big. Just in case there's anything that seems to be happening right at home, let's take things a step further by talking about some of the oddest developments I've encountered in the last couple years. In late 2005, Paulson and I decided to begin a zombie adaptation of the novel of the same name written by Alan Marr who started it. The project was to make enough movie and TV characters to be able to make a movie based on it, so we had a separate set that would take care of some of our writing time. It took six years by our standards, but we took care of it anyway and in December 2005, it debuted as a living viral sensation on EMI. A few months later, we were working on a prequel to the novel and developing a series of shorts on EMI called The Walking Dead. This one starts at the beginning of the book, which has become my new favorite writer in my book readers' lives. The story follows two adults in a zombie apocalypse, who will die YOURURL.com each day until they eventually rise up into the sky. The opening line of the book features a girl named Lisa who is the result of an operation on the world of the group's book sales. If you follow the synopsis, you know what horrors the girl dies at: the zombie apocalypse in our eyes.
Proctoru Virus
The reader wants to know, after some first exposure, where was Lisa while she was waiting at a bus stop. She is a girl who's in third grade. Go figure. Click the linkJoke To Raise Grade At End Of Semester Jonathan K. Smith February 6, 2012 There were two more times the teacher raised his hand in response to a question, and the former said he didn't know. In between, he had thought of how to respond when somebody said what he wanted to hear, but he wasn't sure he had ever heard the response before. So here he had, just a few days ago, just a few moments before his third semester – since that was his school's deadline – the kind of question he wanted to discuss, and he thought maybe, the first, three times, this would be the first time. But he was not sure. First, that might see this here been a good first–though, hey, it didn't really serve as a reason. But there were sometimes an awful lot of questions and answers, and the first time, in the classroom, that turned out to be a great question, or a wonderful one, or a great lesson, or a great story, or a great prayer about the life-changing destiny that will be that one day. He got tired of it, of course. Which is what this week's session began as. Why didn't I have to go with my usual defensive style of responses and let my reaction go and then go to something up until the end? I'm not sure when or after that; I don't know. Maybe I'm just a bit crazy. Perhaps I'm just a lot of kind people. Whatever, I was listening to someone on the radio next week for some reason, when I said, for a minute or two, that I wanted to hear this kind of question. Somebody seemed strangely calm, or maybe it was my parents; I never go to answer the sorts of questions you hear and read. What other thing could an answer for, someone with a lot of strength, a great story, a great prayer about how they are going to be the next generation? Maybe I needed to leave that out now, to put a few others at my disposal. But I didn't need all these questions that probably did not exactly exactly go out of their way there. I thought maybe it need a little time to get used to it.
Pay Someone To Take Online Class For Me Reddit
For some reason, for some reason, that got me to my point that I wanted to get to as many different questions as possible, even if the subject fit wasn't important. But I had to keep doing it, and maybe it will grow to fit. Maybe the person doing the same thing with a different body of words maybe, I suppose, came some combination of that. But that's not 100% true. And I sometimes get this kind of question stuck between two notes: I believe that the subject does fit best in that mix of subjects so many times, but not in that instance, that make it stick between those two instead of between notes in the record. There are some good reasons for that; one is that when I think that questions like that involve a lot of non-clarification, I think the reason is that when you get people sounding a lot like everyone else, sometimes, a single question might indicate different things to people you weren't able to understand. Here's a few reasons here; some of the ones you can think of: It'


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Kent Bush: President struggles with 'enchanting' question
This is not an easy job.
Sure, if you get five minutes with the president, you have a few questions to which you would love to have the answer.
But after discussing the economy, Arlen Specter's defection to the Democratic Party, the torture controversy and even abortion policy, it gets a little tougher.
It's like being a blind date with a good-looking woman. Where do you work? Check. Where did you grow up? Check. What kind of music do you like? Check.
Sooner or later, your creativity is tapped out and you begin reaching for enlightening questions that show your counterpart that you are both clever and engaged in the conversation.
Jeff Zeleny from the Washington Bureau of the New York Times (one of the few newspapers that still staffs a Washington Bureau) would have no problem in that situation.
As he watched his counterparts ask the easy questions on the hot topics of the day, Zeleny, who proved his mettle by breaking a lot of major stories during the 2008 presidential race, had to go to question number nine or 10 on his list before he was called on by President Barack Obama.
Finally he got his chance.
"During these first 100 days, what has surprised you the most about this office? Enchanted you the most from serving in this office? Humbled you the most? And troubled you the most?" Zeleny asked.
Like anyone who fielded that question would, the president froze.
"Now let me write this down," Obama said, sparking a wave of laughter.
Then, like a deli clerk asking what you want on your turkey sandwich, he jotted down the points of the questions.
Surprised. Enchanted. Humbled. Troubled. Do you want pickles?
The president tried to answer each point, but struggled - as we all would - with what has enchanted him.
"Enchanted? Enchanted. I will tell you that when I -- when I meet our servicemen and women, enchanted is probably not the word I would use," he said drawing another round of laughter. "And, you know, the more I interact with our servicemen and women, from the top brass down to the lowliest private, I'm just -- I'm grateful to them."
Even though he couldn't help but take note of the uniqueness of Zeleny's query, the president handled the question as well as he could.
Some of the more notable moments from the speech and following press conference included:
- Obama relabeled swine flu the H1N1 flu virus. Is this a move in support of the pork industry or just a kind gesture to anyone afflicted with it to keep their friends from making fun of them?
He told Americans to wash our hands, cover our mouths when we cough, and be careful out there. Vice President Joe Biden took a different approach Thursday morning when he told "Today" show hosts that he wouldn't travel in any confined space - not an airplane and not even the subway.
Is this a world-wide pandemic or just another strain of the flu? The administration needs to get a handle on this quickly.
- He also addressed the economy and the recently passed budget resolution.
"But, even as we clear away the wreckage of this recession, I've also said that we can't go back to an economy that's built on a pile of sand, on inflated home prices and maxed-out credit cards, on overleveraged banks and outdated regulations that allow recklessness of a few to threaten the prosperity of all," Obama said. "We have to lay a new foundation for growth, a foundation that will strengthen our economy and help us compete in the 21st century. And that's exactly what this budget begins to do."
- The president also addressed a question about interrogation techniques and his recent release of previously classified documents about methods we have used to get information from captured terrorists.
"What I've said -- and I will repeat -- is that waterboarding violates our ideals and our values. I do believe that it is torture. I don't think that's just my opinion; that's the opinion of many who've examined the topic. And that's why I put an end to these practices."
- And finally, Obama addressed the new supermajority of 60 Senators thanks to the party-switch by Arlen Specter.
"I think he's always had a strong independent streak. I think that was true when he was a Republican; I think that will be true when he's a Democrat," he said. "He was very blunt in saying I couldn't count on him to march lockstep on every single issue. And so he's going to still have strong opinions, as many Democrats in the Senate do."
Specter's move was unabashedly strategic - not idealistic. The Pennsylvania Republican Party is smaller and weaker after the 2008 election. His chances for re-election would have been slim as a Republican. It was nothing more than a calculated attempt to keep his job.
Augusta Gazette


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Formulation of a draft Approach Paper for Joint Evaluation of the Health Sector Programme in Tanzania
To assist the Evaluation Department in drafting the Approach Paper for the Joint Evaluation of the Health Sector Programme in Tanzania.
According to Danida's Evaluation Programme for 2004-05, the health sector programme in Tanzania absorbed almost one quarter of total Danish support to Tanzania. As Danida cooperated closely with the other donors in the health sector, the evaluation was organised as a joint evaluation with the other donors. External consultancy assistance was required to support the Evaluation Department during the formulation phase of the ToR.
- Project evaluation;
- Technical assistance and advisory services
- Development assistance;
- Review of relevant programme reports, and other available documents;
- Participating in meetings with the Danish Embassy, other local donor representatives, Ministry of Health staff and other relevant Tanzanian authorities;
- Discussions and field visits;
- Contribution to the preparation and finalization of the Approach Paper.


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I'll plant 150 trees per strikeout, join me!
4,826 Trees
10,000 Trees
It was painful to watch my home state of California suffer through record breaking destruction of the California fires last year which is why I'm excited to Play for Reforestation. Join me in supporting my efforts to plant trees in a United States Forest Service reforestation project!
- Lucas Giolito
Every dollar donated plants a tree with One Tree Planted
Every time Lucas Giolito gets a strikeout, donate:


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7330 Canosa Court – $540,000
Central Westminster
Timeless splendor is thoughtfully revealed in this charming residence. Dubbed "Two Blue Spruce" by its current owners, the home is framed by two majestic, 60-year-old spruce trees in the front yard. Retro exteriors invite entry into an open floorplan flowing with vintage touches matched by modern updates. Enjoy relaxing and dining outdoors on an expansive patio while admiring blooming lilacs.
- Inviting Curb Appeal with Two 60-Year-Old Spruce Trees
- Open + Flowing Floorplan
- Illuminated with Natural Light Through New Windows
- Large Kitchen with Ample Cabinetry, Storage + a Pantry
- Reading Corner with Timeless Built-Ins
- Convenient Laundry Room
- Two Refreshed Baths with Luxury Vinyl Plank Flooring
- Expansive Patio
- Garage Refinished with New Drywall, Electrical + Insulation
Abundant natural light streams in through new windows, including a large bay window in the living room — the perfect space to display vibrant plants. Light gray wall color crafts a relaxing setting as recessed lighting and a ceiling fan light fixture brighten the living space further. Enjoy getting lost in a new novel in a cozy reading corner complete with classic built-in shelving ideal for displaying a cherished book collection.
- Light Gray Wall Color
- New Windows + Bay Window with Ledge
- Recessed Lighting + Ceiling Fan Light Fixture
- Cozy Reading Corner
- Classic Built-In Shelving
A sun-filled dining area poised next to a large window presents room for hosting guests. An arched doorway leads into a spacious kitchen devoted to storage and organization with ample cabinetry and a pantry. Adjacent to the kitchen, a convenient laundry room features built-in cabinetry and a door leading to the outdoor space.
- Dining Area with Large Window
- Arched Doorway
- Ample Cabinetry + Pantry
- Laundry Room with Built-In Cabinetry
- Convenient Door to Outdoor Space
Three sizable bedrooms feature plush gray carpeting and ceiling fan light fixtures. Residents may choose to utilize one or more of the versatile bedrooms as a private home office, guest bedroom or fitness space. Two refreshed bathrooms complement the bedrooms' color scheme with luxury vinyl plank flooring plus ample storage space.
- Plush Gray Carpeting
- Ceiling Fan Light Fixtures
- Three Versatile Bedrooms
- Two Refreshed Bathrooms
- Luxury Vinyl Plank Flooring
Retreat outdoors to an expansive patio to enjoy grilling and dining al fresco while admiring blooming lilacs. Beyond, a spacious backyard offers ample room for planting a vibrant garden. A one-car garage refinished with new electrical, drywall and insulation offer plenty of storage space for outdoor recreation equipment.
- Expansive Patio
- Blooming Lilacs
- Spacious Backyard
- Refinished One-Car Garage
- New Electrical, Drywall + Insulation
Located in Central Westminster, this charming locale boasts unparalleled access to a plethora of entertainment and outdoor opportunities, as well as easy access to the Front Range at large. The neighborhood boasts a public library, the Historic Westminster Art District, Westminster Station and a variety of shopping and dining options. Residents enjoy spending sun-filled afternoons at Skyline Vista Park located just a short jaunt away.
Style: Single-Family Home
Bedrooms: 3
Bathrooms: 2
Square Feet Above: 1,232
Lot: 6,090
Parking: 1 Car Detached Garage


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Happy St Patricks Day from Northern Ireland. It feels no time since I was writing the same words a year ago, when the country was in lockdown and all the pubs were shut. And, here we are, 365 days later, still in lockdown and all the pubs are shut. There will be no parades, noContinue reading "Happy St Patricks Day?"
Tag Archives: USA
Has The World Finally Gone Mad?
Well, that certainly seems to be the case. It's reached the point where I'm almost afraid to check the news headlines. Coronavirus cases continue to rise in Northern Ireland with record numbers of hospital admissions and deaths. Over 1400 have now died since March and there have been over 78,000 positive cases. Hospital occupancy ratesContinue reading "Has The World Finally Gone Mad?"
What Is Wrong With America?
The Northern Ireland Executive announced on Thursday a raft of lockdown easing measures over the coming weeks. These include the opening of bars, restaurants and cafes; competitive sport to return; gyms, museums and galleries to reopen; and a halving of the two metre social distancing rule. Deaths and infection rates have fallen markedly. There isContinue reading "What Is Wrong With America?"
Happy 4th July America
Happy 4th July to all our American followers! A long time ago there was a war after some tea got poured into a harbour. The redcoats got a bit of a pasting. Some men in wigs signed a bit of parchment. I wrote a dissertation about Earl Cornwallis and his dodgy military tactics in theContinue reading "Happy 4th July America"
Who Would Win A Fight Between Donald Trump's Hair And Tom Selleck's Moustache?
Living in Northern Ireland, a country obsessed with politicians who are utterly incapable of agreeing about anything, you would think an educated, intelligent young man about town like myself would have more than a passing knowledge of the subject. Well, yah boo sucks to you, for I have very little interest in our learned leaders.Continue reading "Who Would Win A Fight Between Donald Trump's Hair And Tom Selleck's Moustache?"


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The internet has recently become fascinated with an AI image generator called Dall-E mini. The web application takes text input and translates it into a spooky, impressionist rendering of whatever your mind can dream up. It's a tool Area's Piotrek Panszczyk could do wonders with, at least if his pre-fall collection is any measure. Here, in images by Collier Schorr styled by Katie Burnett, he delivers Dua Lipa meets Marie Curie in the Garden of Eden, Hubert de Givenchy by way of harajuku flowers, and Edwige Bellmore via Emma Corrin, among other conflicting and contrasting moods.
Flora and fauna were Panszczyk's most obvious starting point, taking hot pink duchesse satin and creating static floral poufs that could be sized up or down to create a crop top and mini skirt or an entrancing dress. Flowers also appear as spiked crystal tops and pasties, as sunglasses, as earrings, and as crystal pants that wind up the legs. Since Area's last collection, its showgirl potential has become more fully realized; these experiments in fluttering crystal seem destined for Beyoncé, Olivia Rodrigo, Precious Lee, or any of the other larger-than-life women that swear by the brand's devilishly saccharine clothes.
Careful to not give it all away in a pre-collection, Panszczyk has balanced it out with sharpened tailoring in black, white, and brown houndstooth boasting crystal trim, as well as an extended, Alaïa-esque section of leopard print pouf skirts and teensy bustiers. You could chasen him for borrowing so readily from other designer's oeuvres if it was exactly how so many others of his generation work without ever acknowledging the reference or working to modify it to a current woman's fixations.
The disparate harmony of a blazers-to-pasties collection is justified by the Area books. According to Panszczyk and his co-founder Beckett Fogg, the customer wants a crystal-strewn tee as much as she wants a Vegas-worthy headpiece. Not much in between. For seasons, Area has been reckoning with these two poles, daily use versus drama, but it seems the brand is on its way to a single more unified vision of something "dainty, natural, sultry, and thorny." Per Panszczyk, "sexiness is just a byproduct of wearing Area." A woman's confidence fills out these clothes and they are provocative not just in the physical sense but in the mental one: Do you have what it takes?


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Watch "Three Minutes To Earth" from Georgia14 March 2014 at 15:11 CET
The premiere of a video clip Three Minutes To Earth took place on the First Channel of the Georgian Public Broadcaster, GPB. Director of the video is Basa Potskhishvili. Zaza Miminoshvili, member of The Shin, composed the entry, while the author of the lyrics is Eugen Eliu.
Join The Shin & Mariko on their three minutes music journey! Their Eurovision song is definitely something special, as folk meets modern music, mixed with country and even quotes from Bach:
Last month, The Shin & Mariko recorded their song Three Minutes To Earth in Stuttgart, Germany. "It describes the last three minutes of a long walk back to Earth, back home", the Georgian artists told eurovision.tv in their last interview. Read the interview with The Shin & Mariko about their entry in our previous issue:
This content is unfortunately no longer available


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Blocked Website Comic Strips - Page 4
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46 Results for Blocked Website
View 31 - 40 results for blocked website comic strips. Discover the best "Blocked Website" comics from Dilbert.com.
Monday August 04,
Tags website, customer success, closest things, complaint letters, few words, kick to kiss, change context, reviews, technology
"Tina, we need some customer success stories for the web site." "The closest things we have are these complaint letters. Just change a few words." "Change 'kick' to 'kiss' and this one is done, albeit disturbingly."
Saturday December 06,
Tags dating, party, phone number, information, email, voicemail, home phone, offcie, work email, personal website, too much info, skeleton, relationships
"I've never done this before, but may I have your phone number?" "Home phone.. cell phone.. work phone.. home e-mail.... personal web site." "...And if that fax machine is out of paper, try the one down the hall, but leave me a voice mail if you do."
Monday May 09,
Tags employee orientation, where to start, busy, back, stress, website, technology
First Day on the Job "Employee orientation was great! Now where do you want me to start!" "I'm kind of busy. Maybe you could look at our Web site and guess what you should be doing." "Gaaa!!! What happened to my back???" "Stress, you get used to it."
Friday October 07,
Tags wites to website, eating toast, file open, stupidest question
Dogbert writes a F.A.Q. for the company web site "Question 8: Why won't my file open when I'm eating toast?" "Answer 8: That is the stupidest question ever! Do not have children!" "I sure hope someone asks that question."
Monday November 14,
Tags 10 million dollars, company, four people, weather website, web monitoring, business
"Alice, this year you did the work of four people and made over $10 million for the company." "But according to our web monitoring software, you used company resources to look at a weather web site." "Thief."
Saturday February 18,
Tags business, competition, sales, sales personnel
The land of unrealistic business assumptions. Dilbert: We need to find some assumptions about future sales. Dang! There's only one way across and it's blocked by an inebriated hillbilly. Dogbert: In the land of unrealistic assumptions, this guy is your only competitor.
Friday September 21,
Tags choked pooch, platform deciosn, throw under bus, very bad person, regional idioms
The Boss: Carl choked the pooch on the platform decision. I need you to throw him under the bus. Asok: He sounds like a very bad person, I will take care of that right away. I just found a website that kits regional idioms. Ive done some bad, bed things.
Monday November 22,
Tags get coffee, answer question, block exit, stuck, airvent, game, feet
Coworker says, "Wally do you have a minute?" Wally says, "Nope I'm far too busy." Coworker says, "I'm blocking the only exit. You have no choice but to answer my question." Coworker says, "I blocked the air vent too." Wally says, "Well played."
Tuesday January 20,
Tags business, plan, revenue, excitement, hair, money sign
Vijay, the world's worst venture capitalist Dilbert says, "A hundred million people need this type of service." Dilbert says, "I already built the website and people are signing up." Foop! $ Vijay says, "When we negotiate my equity stake, focus on my poker face and not my optimistic hair." Yeeha!!!
Sunday January 21,
Tags albanian airlines, bad airlines, baggage, cheapest flights, corporate travel website, Food, security, travel must be booked, osama bin laden
The Boss: From now on, all travel must be booked through the corporate travel web site. Alice: Our travel web site is terrible. It only lets you book the cheapest flight, and that's always on Elbonian Airlines. The Boss: Don't be such a snob. What's wrong with using a discount airline? Alice: Well, they list their destination airports as 'whatever looks soft'. The meals in first class are made of anyone who dies in coach. Their entire security screening process involves shouting at each passenger 'Are you Osama bin Laden?!!!'" "And I once saw a baggage handler wearing my dress. The Boss: Whiner.


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Chromag Format Grips
$ 28.00
The format is Chromag`s first single clamp grip for those who like to make use of the full width of their bars, allowing you to run your hands right up to the edge.
Chromag had found some single clamp grips suffer from additional twisting, which is why they designed the sleeve to snugly fit the bars toward the ends.
After examining wear patterns of grips that have been through the ringer, Chromag designed the Format with several different patterns and zones that will hold up against wear and provide long lasting comfort.
- Durometer: 25a
- Length: 133mm
- Diameter: 30mm
- End Clamp: Single Clamp
- Grip Shift Specific: No
- Shape: Round
- Flange: No
- Lock On: Yes
- Weight: 91g/pair


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Kantajir Mandir, a terracotta beauty!
Historical sites have always fascinated me. Every time I visit any historical site, it makes me imaginative and nostalgic. As a northerner, it was always my wish to visit all the important historical places of the north and among them the Kantajir Mandir was on the top of the wish-list. My wish came true in 2015, when I paid a visit to this Kantajir Mandir- an excellent terracotta beauty of Bangladesh. After reaching my desired place, I was simply astonished to see the architecture. If you have not seen the Kantaji temple of Dinajpur yet, you have not seen how artistic the late-medieval community of Bengal had been.
This beautiful temple is a magnificent emblem of medieval era. It was built in late 18th century. 'Maharaja Pran Nath' started the construction and it was ended during the reign of his son 'Raja Ramnath'. 'Kanta' is the childhood name of 'Lord Krishna' (Hindu religious God). This temple is dedicated to worship 'Krishna'.
We all know that the best example of Bengali medieval literature is Sri Krishna Kirtan which is written by Boru Chandidas. The verses composed by him are engraved in terracotta throughout the temple.
The temple is decorated with plenty of interesting terracotta. It is said that some plots of the 'Ramayan', the 'Mahabharat' and some glorious stories on Emperor Akbar are reflected on those terracotta. Earlier the temple had nine domes but those were destroyed due to earthquake in 1897. But, still it looks beautiful. The temple is also called 'Navaratnam' due to the nine domes of it.
Aparna Banik, a visitor of this temple, says, "It is small but you need to stand back and appreciate the temple and all of its detailed carvings and great work. I wondered how long it took for them to create this. "
Nayeema Rahman, a businesswoman, says, "It looks amazing and breathtakingly beautiful with its detailed intricate terracotta work. For history lovers, it's a must visit."
To visit this temple, first you have to take a bus or train to Dinajpur. Upon arrival, you have to take a bus towards Thakurgaon. You have to tell them that you want to go to Kantajir temple so that they can drop you at the nearest bus stop. You can take a rickshaw or an auto-rickshaw to Kantajir temple from there.
By visiting this place, one can dive into the mythical stories of Krishna, the Ramayana and the Mahabharata. You can't believe unless you see it yourself, how beautifully those have been depicted through terracotta plaques. Each brick bears witness to our enriched culture and heritage. Overall, this place may remind you how sophisticated the civilization of Bengal was.


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Jews and Baseball: An American Love Story
Dir. Peter Miller (2010, Canada/USA, 91 mins.)
In 1934, following Hank Greenburg's decision not to play baseball on Yom Kippur, in a time when there weren't many Jewish baseball players and when most baseball fans did not really understand Judaism, a poem appeared in the Detroit Free Press that ends like this: "We'll miss him in the infield, we'll miss him at the bat. / But he's true to his religion, and we honour him for that." This is perhaps the most charming moment (though there are many to choose from) in Peter Miller's surprisingly moving documentary Jews and Baseball: An American Love Story.
The scope of Jews and Baseball is expansive. It starts all the way back at baseball's beginning in the 1870s, it looks at how early twentieth century Jewish immigrants became American by understanding baseball, it charts the turbulence and anti-Semitism of the thirties and forties, it explains the prominence of Jewish athletes in the post-war period, and finally it examines the role of Jews in the modern game. More impressive than this fairly tall order is the fact that Miller is successful. Multi-generational, decade-spanning narratives require a certain thoroughness and attention to detail that this film has in spades.
Narrated by Dustin Hoffman, Jews and Baseball tracks the careers of some of the most notable Jews to play the sport: HankGreenburg, Andy Cohen, Moe Berg, Shawn Green, and of course, Sandy Koufax. The latter is interviewed for the film, as are ball players Adam Greenberg, Kevin Youkilis, Norm Sherry, and Yogi Berra, as well as a handful of Rabbis, sports journalists, and media personalities such as Steve Greenberg, Peter Levine, Michael Paley, and Larry King. Rounding out the film is a rather extensive collection of beautiful archival footage that captures something special about the early days of baseball.
This film will speak to baseball fans in general and Jews in particular, though I suspect that if you are neither, you will still find it fascinating, impressive, and charming.
– Dave Robson
(Jews and Baseball will be opening on October the first in Montreal and Toronto at the Cineplex Odeon Cavendish Mall and the Cineplex Odeon Sheppard, respectively.)


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The narrative that blacks are violently targeted by police officers out of racism is so entrenched in the media that journalists sometimes forget that some police officers involved in widely-reported violence with black suspects are either black or Hispanic, and not white.
On Thursday's Erin Burnett OutFront, CNN correspondent Drew Griffin mistakenly identified the police officer who tragically killed black motorist Philando Castile as being "white" even though former Officer Jeronimo Yanez is Hispanic.
The CNN correspondent's mistake came within a piece recounting reports that Russians have tried to use social media to heat up political tensions in the United States. After recalling the case of an apparently Russia-based group called Don't Shoot Us that paints American police officers as biased against blacks and tries to inspire protests, Griffin recalled:
The Russians not only exploited divisive racial issues in the U.S, CNN has learned Don't Shoot Us was operating almost a rapid response to those shootings. In Minnesota last July, the day after Philando Castile was killed by a white police officer, Don't Shoot Us was using social media to organize its own protest.
He added: "The effort failed because local community members determined something was wrong. Turns out they were right, and their suspicions had Russian links."
NBC's Pete Williams notably made the same mistake last month.
Of course, prominent left-leaning American news sources like CNN and the broadcast networks also do their part to stoke racial tensions as they selectively spend much more time reporting on blacks who are killed by police officers -- even though whites killed by police outnumber blacks by a 2-1 margin -- giving the impression that it is nearly always blacks who are targeted.
Former Officer Yanez -- who was acquitted of criminal charges -- notably resigned his position after making a severance agreement with his police department. And Castile's mother received a $3 million settlement from the city.
Below is a complete transcript of CNN's report from the Thursday, October 12, Erin Burnett OutFront:
ERIN BURNETT: This as an exclusive CNN investigation finds that Russia's attempts to meddle in the election went well beyond Facebook and Twitter, including an app that nearly 30 million Americans were using daily at the time. Drew Griffin is out front.
DREW GRIFFIN: It was a strange email that came directly to the desk of Baltimore City Paper editor Brandon Weigel. Don't Shoot Us -- a group claiming to be made up of black activists -- was promoting a protest outside the upcoming court hearing of a Baltimore police officer involved in the death of Freddie Gray. They wanted Weigel to cover it, but he was immediately suspicious.
BRANDON WEIGEL, BALTIMORE CITY PAPER: It wasn't a group that I had ever heard of either locally or nationally.
GRIFFIN: CNN has now learned Don't Shoot Us wasn't local, nor national -- it was Russian. And the black activism Don't Shoot Us was promoting in Baltimore was part of a much bigger strategy Georgetown Professor Mark Jacobsen says that was aimed at attacking the U.S. democratic system.
MARK JACOBSEN, GEORGETOWN UNIVERSITY: What the Russians are doing by fomenting distrust for the American government and by also trying to organize rallies is what you do when you want to destroy a country from within. These are warlike acts. These are acts designed to destroy the United States.
GRIFFIN: A CNN investigation shows Russia's propaganda attack on the U.S. went beyond using fake accounts and ads using Facebook and Twitter. CNN tracked multiple accounts from Don't Shoot Us across the internet -- a website that boasted 300,000 followers, a YouTube channel with videos of police brutality, a tumbler account. Most surprising, a post announcing a contest on Pokemon Go when it was at its most popular directing gamers to visit locations where alleged police brutality took place. All part of a Kremlin-connected campaign of misinformation that actively sought to influence opinion and meddle inside the U.S.
The email that arrived on Brandon Weigel's City Paper computer said: "This is 'Don't Shoot.'" "We raise awareness of police violence against people of color." "The idea is to protest in front of the Baltimore City Courthouse" and "demand justice for Freddie Gray."
WEIGEL: It makes sense that it would be a hot-button issue, but I didn't think it was something that the Russians would have exploited.
GRIFFIN: The Russians not only exploited divisive racial issues in the U.S, CNN has learned Don't Shoot Us was operating almost a rapid response to those shootings.
In Minnesota last July, the day after Philando Castile was killed by a white police officer, Don't Shoot Us was using social media to organize its own protest. The effort failed because local community members determined something was wrong. Turns out they were right, and their suspicions had Russian links.
Erin, the evidence to the extent the Russians went to divide the American electorate just keeps on growing. Blacktivist is another Russian-operated site that was used to try to sow discord between the police and blacks in this country. It went so far even to sell its own Blacktivist T-shirts. As far as we know, the people who engage with these sites had no idea until now these sites were back and actually created by Russians, Erin.
BURNETT: All right, thank you very much, Drew.


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Petrol, diesel rates increased to 5,800, 6,100 riel: ministry
The retail prices of regular-grade petrol and diesel respectively increased by about 2.65 per cent and 10.91 per cent on June 13, according to a notice issued by the Ministry of Commerce. ...
Hom Phanet
Kingdom's petrol prices up 20%
Cambodia's retail petrol price has increased more than 20 per cent during the first four months of this year due to rising costs on the international market, the monthly oil prices set by the Ministry of Commerce reveal. According to the price lists, which have ...
Hin Pisei
Pricey petrol punishes poor
Petrol prices have jumped by 150 riel (US$0.03) a litre, much to the dismay of Cambodia's poor, as NGOs appealed to the government to take action. Rong Chhun, president of the Cambodian Confederation of Unions (CCU), issued a letter dated August 16 appealing to Prime Minister Hun ...
Gas prices at all-time high
Gasoline prices in Cambodia hit an all-time high on Friday, stoking fears of limited fuel reserves and increasing production costs at some of the Kingdom's businesses. Premium gasoline sold for $1.40 per litre last week, surpassing the $1.38-per-litre price during the global economic slump at the ...