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MP 7.01.96 | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure |
Medical Policy | ||
Section Surgery |
Original Policy Date 2/25/04 |
Last Review Status/Date Reviewed with literature search/7:2012 |
Issue 7:2012 |
Return to Medical Policy Index |
Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
Computer-assisted navigation (CAN) in orthopedic procedures describes the use of computer-enabled tracking systems to facilitate alignment in a variety of surgical procedures, including fixation of fractures, ligament reconstruction, osteotomy, tumor resection, preparation of the bone for joint arthroplasty, and verification of the intended implant placement.
The goal of computer-assisted navigation (CAN) is to increase surgical accuracy and reduce the chance of malposition of implants. For total knee arthroplasty (TKA), malalignment is commonly defined as a variation of greater than 3 degrees from the targeted position. Proper implant alignment is believed to be an important factor for minimizing long-term wear, risk of osteolysis, and loosening of the prosthesis. In addition to reducing the risk of substantial malalignment, CAN may improve soft tissue balance and patellar tracking. CAN is also being investigated for operations with limited visibility such as placement of the acetabular cup in total hip arthroplasty (THA), resection of pelvic tumors, and minimally invasive orthopedic procedures. Other potential uses of CAN for surgical procedures of the appendicular skeleton include screw placement for fixation of femoral neck fractures, high tibial osteotomy, and tunnel alignment during reconstruction of the anterior cruciate ligament (ACL).
CAN devices may be image-based or non-image-based. Image-based devices use preoperative computed tomography (CT) scans and operative fluoroscopy to direct implant positioning. Newer non-image-based devices use information obtained in the operating room (OR), typically with infrared probes. For TKA, specific anatomic reference points are made by fixing signaling transducers with pins into the femur and tibia. Signal-emitting cameras (e.g., infrared) detect the reflected signals and transmit the data to a dedicated computer. During the surgical procedure, multiple surface points are taken from the distal femoral surfaces, tibial plateaus, and medial and lateral epicondyles. The femoral head center is typically calculated by kinematic methods that involve movement of the thigh through a series of circular arcs, with the computer producing a three-dimensional (3-D) model that includes the mechanical, transepicondylar, and tibial rotational axes. CAN systems direct the positioning of the cutting blocks and placement of the prosthetic implants based on the digitized surface points and model of the bones in space. The accuracy of each step of the operation (cutting block placement, saw cut accuracy, seating of the implants) can be verified, thereby allowing adjustments to be made during surgery.
Navigation involves 3 steps: data acquisition, registration, and tracking.
Data Acquisition
Data can be acquired in 3 different ways: fluoroscopically, guided by CT scan or magnetic resonance imaging (MRI) or guided by imageless systems. These data are then used for registration and tracking.
Registration refers to the ability of relating images (i.e., x-rays, CT scan, MRI or patients' 3-D anatomy) to the anatomical position in the surgical field. Registration techniques may require the placement of pins or "fiduciary markers" in the target bone. A surface-matching technique can also be used in which the shapes of the bone surface model generated from preoperative images are matched to surface data points collected during surgery.
Tracking refers to the sensors and measurement devices that can provide feedback during surgery regarding the orientation and relative position of tools to bone anatomy. For example, optical or electromagnetic trackers can be attached to regular surgical tools, which can then provide real-time information of the position and orientation of the tools' alignment with respect to the bony anatomy of interest.
Regulatory Status
Since CAN is a surgical information system in which the surgeon is only acting on the information that is provided by the navigation system, surgical navigation systems generally are subject only to 510(k) clearance from the U.S. Food and Drug Administration (FDA). As such, the FDA does not require data documenting the intermediate or final health outcomes associated with CAN. (In contrast, robotic procedures, in which the actual surgery is robotically performed, are subject to the more rigorous requirement of the premarket approval application [PMA] process.)
A variety of surgical navigation procedures have received FDA clearance through the 510(k) process with broad labeled indications. The following is an example; "The OEC FluoroTrak 9800 Plus provides the physician with fluoroscopic imaging during diagnostic, surgical and interventional procedures. The surgical navigation feature is intended as an aid to the surgeon for locating anatomical structures anywhere on the human body during either open or percutaneous procedures. It is indicated for any medical condition that may benefit from the use of stereotactic surgery and which provides a reference to rigid anatomical structures such as sinus, skull, long bone or vertebra visible on fluoroscopic images."
Several navigation systems (e.g., PiGalileo™ Computer-Assisted Orthopedic Surgery System, PLUS Orthopedics; OrthoPilot® Navigation System, Braun; Navitrack® Navigation System, ORTHOsoft) have received FDA clearance specifically for TKA. FDA-cleared indications for the PiGalileo system are representative. This system "is intended to be used in computer-assisted orthopedic surgery to aid the surgeon with bone cuts and implant positioning during joint replacement. It provides information to the surgeon that is used to place surgical instruments during surgery using anatomical landmarks and other data specifically obtained intra-operatively (e.g., ligament tension, limb alignment). Examples of some surgical procedures include but are not limited to:
- Total knee replacement supporting both bone referencing and ligament balancing techniques
- Minimally invasive total knee replacement"
Computer-assisted surgery for orthopedic procedure of the pelvis and appendicular skeleton is considered investigational.
Policy Guidelines
Effective in 2009, the coding for this navigation includes one category I CPT code and two category III CPT codes (which were reinstated 1/1/09):
20985: Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less (List separately in addition to code for primary procedure)
0054T: Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on fluoroscopic images (List separately in addition to code for primary procedure)
0055T: Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on CT/MRI images (List separately in addition to code for primary procedure)
During 2008, there were category I CPT codes to describe different types of computer-assisted orthopedic surgery:
20985: Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less
20986: Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on intraoperatively obtained images (e.g., fluoroscopy, ultrasound)
20987: Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on preoperative images
From 2004 through 2007, category III CPT codes were used to describe different types of computer- assisted orthopedic surgery:
0054T: Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on fluoroscopic images.
0055T: As above, but with image guidance based on CT and MRI images
0056T: As above, but with image-less guidance
All of the codes are intended to be used in addition to the code for the primary procedure.
Benefit Application
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all devices approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational. Therefore, FDA-approved devices may be assessed on the basis of their medical necessity.
Reimbursement for the technical component of computer-assisted navigation may be sought either through the use of the CPT codes listed here, or through hospital case rates.
This policy was created in 2004 and updated periodically using the MEDLINE database. The most recent literature update was for the period of May 2011 through May 2012. Following are key studies to date.
Trauma or Fracture
Computer-assisted surgery has been described as an adjunct to pelvic, acetabular, or femoral fractures. For example, fixation of these fractures typically requires percutaneous placement of screws or guidewires. Conventional fluoroscopic guidance (i.e., C-arm fluoroscopy) provides imaging in only one plane. Therefore, the surgeon must position the implant in one plane and then get additional images in other planes in a trial and error fashion to ensure that the device has been properly placed. This process adds significant time in the operating room (OR) and radiation exposure. It is hoped the computer-assisted surgery would allow for minimally invasive fixation and provide more versatile screw trajectories with less radiation exposure. Therefore, computed-assisted surgery is considered an alternative to the existing image guidance using C-arm fluoroscopy.
Ideally, one would like controlled trials comparing OR time, radiation exposure, and long-term outcomes of those whose surgery was conventionally guided using C-arm versus image-guided using computer-assisted surgery. While several in vitro and review studies had been published, (1-3) a literature search at the time this policy was created identified only one clinical trial of computer-assisted surgery in trauma or fracture cases. (4) Computer-assisted navigation (CAN) for internal fixation of femoral neck fractures has been described in a retrospective analysis consisting of 2 cohorts of consecutive patients (20 each, performed from 2001 to 2003 at 2 different campuses of a medical center) who underwent internal fixation with 3 screws for a femoral neck fracture. (5) Three of 5 measurements of parallelism and neck coverage were significantly improved by CAN; these included a larger relative neck area held by the screws (32% vs. 23%) and less deviation on the lateral projection for both the shaft (1.7 vs. 5.2 degrees) and the fracture (1.7 vs. 5.5 degrees, all respectively) screw angles. Slight improvements in anteroposterior screw angles (1.3 vs. 2.1 and 1.3 vs. 2.4 degrees, respectively) did not reach statistical significance. There were 2 reoperations in the CAN group and 6 in the conventional group. Complications (collapse, subtrochanteric fracture, head penetration, osteonecrosis) were lower in the CAN group (3 vs. 11, respectively). Additional controlled studies are needed.
Anterior Cruciate Ligament (ACL) or Posterior Cruciate Ligament (PCL) Reconstruction
A 2011 Cochrane review assessed the effects of CAN in comparison with conventional operating techniques for ACL or PCL reconstruction. (6) Four randomized controlled trials (RCTs, 266 participants) on ACL reconstruction were included in the review; no studies involved PCL reconstruction. Pooled data from 2 trials showed no statistically or clinically significant differences in self-reported health outcomes (International Knee Documentation Committee [IKDC] subjective scores and Lysholm scores) at 2 years or more follow-up. A third trial included in this review found a small statistically significant difference in IKDC subjective scores. No significant differences were found for objective measures of knee function, including the IKDC examination grade and pivot shift test. Evaluation of bias and methodologic quality was limited by poor reporting of trial methods. Overall, there was insufficient evidence to advise for or against the use of CAN. Three of the 4 trials included in the Cochrane review are described below.
One of the studies randomized 60 patients to either manual or computer-assisted guidance for tunnel placement with follow-up at 1, 3, 6, 12, 18, and 24 months. (7) There were no differences between the groups in measurements of laxity. However, there was less variability in side-to-side anterior laxity in the navigated group (e.g., 97% were within 2 mm of laxity in the navigated group versus 83% in the conventional group at an applied force of 150 Newtons). There was a significant difference in the sagittal position of the tibial tunnel (distance from the Blumensaat line of 0.4 vs. -1.2 mm, respectively), suggesting possible impingement in extension for the conventional group. At the final follow-up (24 months), all knees had normal function, with no differences observed between the groups. Another study randomized 53 patients to manual or computer-assisted ACL reconstruction by 3 experienced surgeons (at least 1,000 cruciate ligament operations). (8) Tunnel placement and range variance were similar for the 2 groups; indicating that experienced surgeons can achieve essentially the same positioning as CAN. Hart and colleagues compared biomechanical radiographic and functional results in patients randomized to ACL reconstruction using CAN (n=40) or the standard manual targeting technique (n=40). (9) Blinded evaluation found more exact bone tunnel placement with CAN but no overall difference in biomechanical stability or function between the groups.
Arthroplasty of the Hip and Knee
For both total hip and knee arthroplasties, optimal alignment is considered an important aspect of long- term success. Malalignment of arthroplasty components is one of the leading causes of instability and reoperation. In total hip arthroplasty (THA), orientation of the acetabular component of the THA is considered critical, while for total knee arthroplasty (TKA), alignment of the femoral and tibial components and ligament balancing are considered important outcomes. The alignment of the knee prosthesis can be measured along several different axes, including the mechanical axis, and the frontal and sagittal axes of both the femur and tibia. It is proposed that computer-assisted surgery improves the alignments of the various components of THA and TKA. Ideally, one would like controlled trials comparing the long-term outcomes, including stability and reoperation rates. Intermediate outcomes include the percentage of implants that achieve a predetermined level of acceptable alignment.
Total Hip Arthroplasty and Periacetabular Osteotomy: Paratte and Argenson randomized patients to CAN for THA (n=30) or freehand cup positioning (n=30) by an experienced surgeon. (10) The mean additional time for the computer-assisted procedure was 12 minutes. There was no difference between the computer-assisted group and the freehand-placement group with regard to the mean abduction or anteversion angles measured by computed tomography (CT). A smaller variation in the positioning of the acetabular component was observed in the CAN group; 20% of cup placements were considered to be outliers in the CAN group compared with 57% in the freehand-placement group. Another study randomly assigned 36 patients with symptomatic adult dysplastic hip to either CT-based navigation or the conventional technique for periacetabular osteotomy. (11) An average of 0.6 intraoperative radiographs were taken in the navigated group compared with 4.4 in the conventional group, resulting in a total operative time that was 21 minutes shorter for CAN. There were no differences between the groups for correction in femoral head coverage or for functional outcomes (pain, walking, range of motion) at 24 months.
It has been proposed that CAN may overcome the difficulties of reduced visibility of the surgical area associated with minimally invasive procedures. A 2007 review by Ulrich and colleagues summarized studies that compared outcomes from minimally invasive THA-CAN and standard THA. (12) Seventeen studies were described in this evidence-based review, including 9 prospective comparisons, 7 retrospective comparisons, and 1 large (n=100) case series. The authors concluded that alignment with minimally invasive CAN appears to be at least as good as standard THA, although the more consistent alignment must be balanced against the current expense of the computer systems and increased surgical time. Improved health outcomes have not yet been demonstrated with CAN or minimally invasive THA, either alone or in combination.
A 2011 study by Manzotti et al. compared leg length restoration in a matched-pair study. (13) Forty-eight patients undergoing THA with CAN were compared with patients who were matched for age, sex, arthritis level, preoperative diagnosis, and preoperative leg length discrepancy and underwent conventional freehand THA using the same implant in the same period. The mean preoperative leg length discrepancy was 12.17 mm in the THA-CAN group and 11.94 in the standard THA group. Surgical time was increased by 16 minutes (89 vs. 73 min, respectively). There was a significant decrease in both the mean postoperative leg length discrepancy (5.06 vs. 7.65 mm) and in the number of cases with a leg length discrepancy of equal to or greater than 10 mm (5 vs. 13 patients – all respectively). Outcomes at 40-month follow-up (range, 7 to 77 months) were not significantly different for the Harris Hip Score (88.87 vs. 89.73) or the 100-point normalized Western Ontario and McMaster Universities (WOMAC) Arthritis Index (9.33 vs. 13.21 – all respectively; p=0.0503). Longer follow-up with a larger number of subjects is needed to determine whether THA-CAN influences clinical outcomes.
Total Knee Arthroplasty: A 2007 TEC Assessment evaluated CAN for TKA. (14) Nine studies from 7 randomized controlled trials (RCTs) were reviewed. Criteria for the RCTs included having at least 25 patients per group and comparing limb alignment and surgical or functional outcomes following TKA with CAN or conventional methods. Also reviewed were cohort and case series that evaluated long-term associations between malalignment of prosthetic components and poor outcomes. In the largest of the cohort studies, which included more than 2,000 patients (3,000 knees) with an average of 5-year follow-up, 41 revisions for tibial component failure (1.3% of the cohort) were identified. The risk ratio (RR) for age was estimated at 8.3, with a greater risk observed in younger, more active patients. For malalignment (defined as >3 degrees varus or valgus), the RR was estimated to be 17.3.
The combined data from the prospective RCTs showed:
- A significant decrease in the percentage of limbs considered to be outliers (e.g., >3 degrees of varus or valgus from a neutral mechanical axis) with CAN. In the conventional group, 33% of patients had malalignment of the overall femoral/tibial axis. In the navigated group, 18% of patients were considered to have malalignment of the mechanical axis. For the combined data set, there was a decrease in malalignment in 15% of patients, with an estimated number needed to treat (NNT) of 6.7 to avoid 1 case of malalignment.
- Surgical time increased by 10 to 20 minutes in all but 1 study. CAN-associated reduction in blood loss was less consistent, with only some of the studies showing a decrease in blood loss of 100 to 200 mL.
- RCTs that assessed function (up to 2 years' follow-up) did not find evidence of improved health outcomes. However, the studies were not adequately powered to detect functional differences, and data on long-term follow-up are not available.
The report concluded that no direct evidence is currently available to support an improvement in clinical outcomes with CAN for TKA. As a result of deficiencies in the available evidence (e.g., potential for bias in observational studies and lack of long-term follow-up in the RCTs), it is not possible to determine whether the degree of improvement in alignment that has been reported in the RCTs leads to meaningful improvements in clinically relevant outcomes such as pain, function, or revision surgery.
A meta-analysis of CAN for TKA was reported in 2007 that included 33 studies and 3,423 patients. (15) The studies were of varying methodologic quality and included 11 randomized trials. Although no significant difference in mechanical axes between the navigated and conventional surgery group was found, navigated surgery was found to result in a lower risk of malalignment. It was calculated that 1 of every 5 patients would avoid unfavorable component positioning (greater than 3 degrees) with CAN. Methodologic weaknesses of the available trials limited the conclusions of the meta-analysis, and no conclusive inferences could be reached for functional outcomes or complication rates. A 2012 meta-analysis included 21 randomized trials (2,658 patients) that reported clinical outcomes with or without the use of CAN. (16) Most of the studies included in the review had short-term follow-up. Operative time was significantly increased with CAN for TKA. There was no significant difference in total operative blood loss, the Knee Society Score (KSS), or range of motion.
A 2011 trial by Pang et al. evaluated the functional outcome of computer-assisted gap balancing (soft tissue balance) compared to conventional measured resection in TKA. (17) A total of 140 patients were randomized into the 2 groups, and both patients and postoperative evaluators were blinded to treatment assignment. At 2 years, there were significantly more patients in the conventional group with flexion contracture of more than 5 degrees (7% vs. 1%). There was no significant difference between groups in hyperextension or ligament laxity. There was no significant difference between groups in the Knee score, Function Score, or Short Form (SF)-36. At the 2-year follow-up, the CAN group had better outcome in the Total Oxford Score (16.4 vs. 19.1). Interpretation of this finding is limited, since the post-operative Oxford Score did not differ from the pre-operative score with CAN (16.4 vs. 16.3), and the 2-year differences result from worsening scores in the conventional treatment group. Additional study is needed to determine with greater certainty whether flexion contracture is reduced with computer-assisted gap balancing.
Several non-randomized or quasi-randomized studies have examined the association between alignment and clinical outcomes at mid- to long-term follow-up. Hoffart et al. used alternate allocation of 195 patients to compare functional outcomes following CAN-assisted TKA versus conventional instrumentation. (18) An independent observer performed the pre- and postoperative assessments. After 5 years, 18 patients (9.2%) were lost to follow-up and complete clinical scores were available for 121 patients (62%). There was no significant difference in the frequency of malalignment between the 2 groups. The CAN group had a better mean KSS and mean function and knee scores. Mean pain scores did not differ between the 2 groups. Limitations of this study include the high loss to follow-up and lack of subject blinding.
Czurda et al. compared outcomes from a consecutive series of 411 patients who underwent TKA-CAN (n=146) with the TC-PLUS SB Solution™ (Smith and Nephew) or standard TKA (n=265) with the LCS® Complete Mobile Bearing Knee System (Depuy). (19) Eighty-one patients (20%) were not included in the analysis (23 in the TKA-CAN group and 58 in the standard TKA group) due to a variety of conditions that included death (n=2), infection (n=4), trauma (n=8), reoperation (n=10), or poor general condition (n=2). Fifty-five of the 81 patients (16 in the TKA-CAN and 39 in the standard TKA group) were lost to follow-up. The remaining 330 patients were interviewed by telephone by a single assessor and were classified as having painful knees if they listed pain as moderate or worse. At 11- to 41-month follow-up, median WOMAC scores were the same for both groups. Fifteen patients (12%) in the TKA-CAN group and 42 patients (20%) in the standard arm had moderate to severe pain (p=0.06). In order to further evaluate the relationship between pain and alignment, a second part of the study compared a subset of 19 patients who had painful knees with matched patients who had asymptomatic knees. Radiographic and CT analysis was performed for these 38 case-control subjects. There was no significant relationship between post-operative pain and the mechanical axis, flexion of the femoral component, or the dorsal slope. There was a trend for an association between patellar tracking and pain (odds ratio [OR]: 3.5, p=0.10) and a significant association between incorrect rotational malalignment and pain (OR: 7, p=0.033).
Ishida et al. compared 30 patients who had TKA-CAN with 30 matched patients who had the same implant type by the same surgeon during the same period of time using the standard manual approach. (20) Three patients from each group were lost to follow-up, leaving 27 patients in each group. At 5 to 7 year follow-up, the accuracy of the implantations, evaluated by 2 investigators who were blinded to clinical information, was significantly better in the TKA-CAN group for both the mechanical axis (18.5% vs. 33.3% outliers) and femoral rotational alignment (2 vs. 4 degrees twist angle – both respectively). Clinical assessment by an independent observer found superior range of motion (120 vs. 105 degrees) and Knee Society Scores (94 vs. 84 points – both respectively) in the TKA-CAN group. However, there was no difference between groups in pain (50 vs. 50 points) or Knee Society Functional scores (80 vs. 80 points – both respectively) at final follow-up.
A retrospective study by Parratte et al. assessed the influence of mechanical axis alignment on 15-year survival in 280 patients who received a standard cemented TKA between 1985 and 1990. (21) A total of 106 out of 398 TKAs were found to have a postoperative mechanical axis of greater than 3 degrees. At the latest follow-up, there was a lower proportion of revisions in the outlier group than in the aligned group (13% vs. 15.4%, respectively). When comparing revisions due to aseptic loosening mechanical failure, wear, or patellar problems, 7.5% of the outlier group were revised compared with 9.2% of the aligned group. Thus, a postoperative mechanical axis of 0 + 3 degrees did not improve the 15-year survival rate following modern TKA.
Carter et al. compared outcomes from TKA in consecutive patients prior to and after acquisition of a CAN system in a community hospital. (22) Of 310 consecutive surgeries, 200 patients (100 CAN and 100 conventional) consented to follow-up with a CT scan. Results were considered good if alignment was 3 degrees or less from the surgical goal, fair if between 4 and 6 degrees, poor if between 7 and 9 degrees, and extremely poor if greater than 9 degrees from the surgical goal. Blinded evaluation rated sagittal alignment as good in 78% of CAN and 47% of conventional knees for the femoral component and in 93% of CAN and 64% of conventional knees for the tibial component. Thirteen knees had poor or extremely poor sagittal-tibial alignment in the conventional group. Coronal alignment was not significantly different between the groups, although variance was greater in the conventional group. Tibial rotation was inconsistent in both groups. No learning curve was observed for the accuracy of alignment, although the initial cases required 12 to 20 minutes in additional time. By the end of the series, the highest volume surgeon required less time for CAN than for the conventional approach. Learning curves were also addressed in a prospective controlled observational study from 13 European orthopedic centers. (23) Five of the centers were experienced CAN users and 8 started using CAN for the study. The first 30 consecutive cases from each center were evaluated in an intention-to-treat manner, totaling 150 patients in the control group and 218 in the study group. The operations initially took 10 to 20 minutes longer in the study group, but after 30 procedures, the mean difference was 7 minutes (overall average of 118 minutes vs. 107 minutes operating time for the conventional group). The 3-month follow-up indicated that alignment for the experienced and novice centers was similar, and no differences were found in functional outcomes at a mean 24-month follow-up (9 to 37 months range). One complication was reported for the study group, consisting of a femoral fracture through the hole of the reference screw. In a comparative study of 160 bilateral TKAs performed by experienced surgeons in Asia, differences in measures of alignment between the conventionally prepared knee and the knee prepared with CAN-assistance were minimal. (24)
Computer-Assisted Minimally Invasive TKA: It has been proposed that CAN may overcome the difficulties of reduced visibility associated with minimally invasive procedures. In one study, 108 consecutive patients were randomized to computer-assisted "minimally invasive" TKA or conventional TKA with standardized perioperative pain management for both groups. (25) An independent physical therapist performed the preoperative and postoperative patient assessments. Operative time was found to increase by an average of 24 minutes with minimally invasive CAN, with a difference in incision length of 4 cm (9 cm vs. 13 cm). Alignment was at 3 degrees or less from target in 92% of patients for the coronal tibiofemoral angle, 90% for the sagittal tibial component angle. This compared with 68% and 61%, respectively, for patients in the conventional TKA group. Three other measured angles were not significantly different. There was no difference in postoperative pain between the groups. Hospital stay, based on standardized functional criteria for discharge, was an average 1.2 days shorter (3.3 vs. 4.5 days). Functional improvement was noted at 1 month postoperatively for the number of patients who could walk independently for 30 minutes (details not reported). At 6 months, functional outcomes were similar for the 2 groups.
In 2008, Luring and colleagues published results from a 3-arm randomized trial (30 patients per group) that compared minimally-invasive TKA, with or without CAN, and conventional TKA. (26) In this study, the mini-incision averaged 13 cm (range: 10–14 cm), while the conventional midline incision averaged 17 cm (range: 15–19 cm); both were performed with a medial parapatellar approach. In addition, with the minimally-invasive procedure, there was subluxation rather than eversion of the patella and no tibio-femoral dislocation. Postoperative rehabilitation and hospital stay were not described. On average, the surgical procedure took longer in the computer-assisted minimally invasive surgery group (58 min) compared to the conventional (44 min) and freehand minimally invasive surgery (MIS) group (40 min) and was associated with greater blood loss. Independent evaluation of postoperative radiographs showed reduced deviation in mechanical axis alignment in the CAN group (1.0 degree) compared to both the freehand minimally-invasive group (1.8 degrees) and the conventional TKA group (2.1 degrees). Compared to 3 outliers in the freehand minimally-invasive group and 2 outliers in the conventional TKA group, no outliers greater than 3 degrees were observed in the computer-assisted minimally invasive group. Follow-up (100%) with the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 1, 6, and 12 weeks revealed no differences between the 3 groups. Since there was no statistically significant clinical difference at 6 or 12 weeks, the planned 6- and 12-month follow-up was stopped. According to patient satisfaction (WOMAC) and clinical outcome (KSS), the minimally invasive approach in TKA is still not proven.
High Tibial Osteotomy
Bae and colleagues compared the accuracy of closed-wedge high tibial osteotomy using CAN for medial compartment osteoarthritis of the knee and genu varum (n=50) with historical controls (n=50) that had undergone high tibial osteotomy using the conventional technique. (27) The navigation system provided information about the deformity, level of osteotomy, correction angle and wedge size. In the conventional group, correction angle and wedge size were determined from a preoperative radiological plan and intra-operative measurement with the help of a cable. All of the cases had good quality preoperative and follow-up radiographs, and measurements were assessed by 2 independent investigators. The preoperative mechanical axis in the navigation group was varus 8.2 degrees with the navigation system and 7.3 degrees on radiographs. The mean postoperative mechanical axis was valgus 3.6 degrees with the navigation system and valgus 2.1 degrees with radiographs. The mean difference in the postoperative mechanical axis for the 2 measurements was 1.5 degrees. Compared with the conventional group, the variability of postoperative mechanical axis was significantly lower (2.3 degrees vs. 3.7 degrees, respectively). There were 19 cases of a mechanical axis between 2 degrees and 6 degrees in the conventional group compared with 2 cases in the navigated group. This study did not evaluate if the decrease in variability in the navigated group improved clinical outcomes.
Pelvic Tumor Resection
A 2009 review of the literature on computer-assisted pelvic tumor resection suggests that predefined osteotomy planes can be successfully identified during the operation and that planned surgical margins can be achieved. (28) The number of cases is small, and no controlled studies were identified that compared outcomes with conventional surgical approaches. However, inadequate (contaminated or intralesional) surgical margins have been reported in 12% to 75% of conventional cases. The authors note that the preoperative process for CAN is time-consuming, due to the lack of commercially available navigation platforms for pelvic applications.
Clinical Input Received through Physician Specialty Societies and Academic Medical Centers
While the various physician specialty societies and academic medical centers may collaborate with and make recommendations during this process through the provision of appropriate reviewers, input received does not represent an endorsement or position statement by the physician specialty societies or academic medical centers, unless otherwise noted.
In response to requests, input was received from 3 academic medical centers while this policy was under review in 2011. The input was mixed regarding whether CAN is considered investigational. One reviewer provided additional references regarding use of CAN for high tibial osteotomy and pelvic tumor resection. These topics were subsequently added to the policy.
Overall, the literature supports a decrease in variability of alignment with CAN, particularly with respect to the number of outliers. Although some observational data suggest that malalignment may increase the probability of early failure, recent RCTs with short- to mid-term follow-up have not shown improved health outcomes with CAN. Given the low short-term revision rates associated with conventional procedures and the inadequate power of available studies to detect changes in function, studies that assess health outcomes in a larger number of subjects with longer follow-up are needed. Potential uses of this procedure may be in gap balancing and the ability to decrease incision length without loss of accuracy in component alignment. Another area of potential benefit is pelvic tumor resection. Although evidence at this time has not adequately demonstrated improved health outcomes with this more resource-intensive combination, continued technology development in this area is expected.
Medicare National Coverage
There is no national coverage decision.
- Hofstetter R, Slomczykowski M, Krettek C et al. Computer-assisted fluoroscopy-based reduction of femoral fractures and antetorsion correction. Comput Aided Surg 2000; 5(5):311-25.
- Schep NW, Broeders IA, van der Werken C. Computer assisted orthopaedic and trauma surgery. State of the art and future perspectives. Injury 2003; 34(4):299-306.
- Slomczykowski MA, Hofstetter R, Sati M et al. Novel computer-assisted fluoroscopy system for intraoperative guidance: feasibility study for distal locking of femoral nails. J Orthop Trauma 2001; 15(2):122-31.
- Suhm N, Jacob AL, Nolte LP et al. Surgical navigation based on fluoroscopy--clinical application for computer-assisted distal locking of intramedullary implants. Comput Aided Surg 2000; 5(6):391-400.
- Liebergall M, Ben-David D, Weil Y et al. Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg Am 2006; 88(8):1748-54.
- Meuffels DE, Reijman M, Scholten RJ et al. Computer assisted surgery for knee ligament reconstruction. Cochrane Database Syst Rev 2011; (6):CD007601.
- Plaweski S, Cazal J, Rosell P et al. Anterior cruciate ligament reconstruction using navigation: a comparative study on 60 patients. Am J Sports Med 2006; 34(4):542-52.
- Mauch F, Apic G, Becker U et al. Differences in the placement of the tibial tunnel during reconstruction of the anterior cruciate ligament with and without computer-assisted navigation. Am J Sports Med 2007; 35(11):1824-32.
- Hart R, Krejzla J, Svab P et al. Outcomes after conventional versus computer-navigated anterior cruciate ligament reconstruction. Arthroscopy 2008; 24(5):569-78.
- Parratte S, Argenson JN. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Joint Surg Am 2007; 89(3):494-9.
- Hsieh PH, Chang YH, Shih CH. Image-guided periacetabular osteotomy: computer-assisted navigation compared with the conventional technique: a randomized study of 36 patients followed for 2 years. Acta Orthop 2006; 77(4):591-7.
- Ulrich SD, Bonutti PM, Seyler TM et al. Outcomes-based evaluations supporting computer-assisted surgery and minimally invasive surgery for total hip arthroplasty. Expert Rev Med Devices 2007; 4(6):873-83.
- Manzotti A, Cerveri P, De Momi E et al. Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand. Int Orthop 2011; 35(1):19-24.
- Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Computer-assisted navigation for total knee arthroplasty. TEC Assessments 2008; Volume 22, Tab 10.
- Bauwens K, Matthes G, Wich M et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 2007; 89(2):261-9.
- Xie C, Liu K, Xiao L et al. Clinical Outcomes After Computer-assisted Versus Conventional Total Knee Arthroplasty. Orthopedics 2012; 35(5):e647-53.
- Pang HN, Yeo SJ, Chong HC et al. Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 2011; 19(9):1496-503.
- Hoffart HE, Langenstein E, Vasak N. A prospective study comparing the functional outcome of computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 2012; 94(2):194-9.
- Czurda T, Fennema P, Baumgartner M et al. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc 2010; 18(7):863-9.
- Ishida K, Matsumoto T, Tsumura N et al. Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19(7):1107-12.
- Parratte S, Pagnano MW, Trousdale RT et al. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92(12):2143-9.
- Carter RE, 3rd, Rush PF, Smid JA et al. Experience with computer-assisted navigation for total knee arthroplasty in a community setting. J Arthroplasty 2008; 23(5):707-13.
- Jenny JY, Miehlke RK, Giurea A. Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee 2008; 15(2):80-4.
- Kim YH, Kim JS, Choi Y et al. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 2009; 91(1):14-9.
- Dutton AQ, Yeo SJ, Yang KY et al. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 2008; 90(1):2-9.
- Luring C, Beckmann J, Haibock P et al. Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc 2008; 16(10):928-34.
- Bae DK, Song SJ, Yoon KH. Closed-wedge high tibial osteotomy using computer-assisted surgery compared to the conventional technique. J Bone Joint Surg Br 2009; 91(9):1164-71.
- Fehlberg S, Eulenstein S, Lange T et al. Computer-assisted pelvic tumor resection: fields of application, limits, and perspectives. Recent Results Cancer Res 2009; 179:169-82.
Codes |
Number |
Description |
CPT | 20985 | Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less (List separately in addition to code for primary procedure) |
Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on fluoroscopic images (List separately in addition to code for primary procedure) (code reinstated 1/1/09) |
Computer-assisted musculoskeletal surgical navigational orthopedic procedure with image guidance based on CT/MRI images (List separately in addition to code for primary procedure) (code reinstated 1/1/09) |
ICD-9-CM Diagnosis | Investigational for all codes | |
ICD-10-CM (effective 10/1/13) | Investigational for all codes | |
ICD-10-PCS (effective 10/1/13) | 8E09XBZ | Computer Assisted Procedure of Head and Neck Region |
8E0WXBZ | Computer Assisted Procedure of Trunk Region | |
8E0XXBZ | Computer Assisted Procedure of Upper Extremity | |
8E0YXBZ | Computer Assisted Procedure of Lower Extremity |
Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Navigation, Orthopedic Procedure
Policy History
Date | Action | Reason |
2/25/04 | Add policy to Surgery section |
New policy |
03/15/05 | Replace policy | Policy updated with literature search; no change in policy |
04/25/06 | Replace policy | Policy updated with literature search; no change in policy statement. Reference numbers 9–14 and 16–18 added |
01/10/08 | Replace policy | Policy updated with literature search; references 19 - 25 added; policy statement unchanged. |
01/08/09 | Replace policy | Policy updated with literature search; rationale revised and references reordered; policy statement unchanged |
02/11/10 | Replace policy | Policy updated with literature search through November 2009; references added; policy statement unchanged |
5/12/11 | Replace policy | Policy updated with literature search through April 2011; references added and reordered; policy statement unchanged |
7/14/11 | Replace policy | Policy updated with clinical input; references 23 and 24 added; policy statement unchanged |
07/12/12 | Replace policy | Policy updated with literature search through May 2012; references 6 and 16-18 added; policy statement unchanged |


text:
Friday, 7 November 2008
BBC News: Lenders heed calls for rate cuts
Maybe it was the Sun's headline "Now Pass It On, You Bankers", that won it.
BBC News Online
that the main mortgage lenders will cut their main variable lending rates by 1.5%.
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subset: commoncrawl


text:
Facebook Sweepstakes -->
TORONTO, ONTARIO -- (Marketwired) -- 07/17/13 -- Editors Note: There is a photo associated with this press release.
In anticipation of its 10 year anniversary on September 17, 2013, the InterContinental Toronto Centre Hotel is presenting "InterContinental Toronto Centre's 10 Weeks of Giveaways Sweepstakes", with a grand prize of a ten night stay for two at any InterContinental® Hotels & Resorts property in North America.
You must be 18 years or older and a resident of Canada or the United States to enter. Simply "Like" the InterContinental Toronto Centre's Facebook page and complete the entry form. A total of 10 exciting prizes in 10 weeks will be drawn every Friday starting July 19, 2013 and the grand prize draw will be held on September 17, 2013. One lucky winner each week will win one of the following prizes:
1. 3 Course Prix Fixe Dinner for 2 at Azure Restaurant & Bar DRAW DATE: Friday, July 19th2. Elemental Nature Facial at The Spa InterContinental Toronto Centre DRAW DATE: Friday, July 26th3. Elemental Nature Manicure & Pedicure at The Spa InterContinental Toronto Centre DRAW DATE: Friday, August 2nd4. Sunday Brunch for 4 at Azure Restaurant & Bar DRAW DATE: Friday, August 9th5. Couples Massage at The Spa InterContinental Toronto Centre DRAW DATE: Friday, August 16th6. Overnight Stay for 2 in a Club Room with Complimentary High Speed Internet Access, Continental Breakfast and Evening Hors d'oeuvres served at the Club Lounge DRAW DATE: Friday, August 23rd7. Overnight stay for 2 in a newly renovated Lake View Feature Room with Buffet Breakfast at Azure Restaurant & Bar DRAW DATE: Friday, August 30th8. 3 Course Prix Fixe Dinner for 10 at Azure Restaurant & Bar's Private Dining Room DRAW DATE: Friday, September 6th9. 100,000 IHGr Rewards Club Points DRAW DATE: Friday, September 13th10. Ten nights' stay at any InterContinental Hotels & Resorts property in North America DRAW DATE: Tuesday, September 17th
The grand prize winner of ten nights for two at any InterContinental Hotels & Resorts in North America can enjoy the prize in a series of short stays or one long visit.
About InterContinental Toronto Centre
Rebranded in 2003, the InterContinental Toronto Centre is designed to fulfill every need of the global traveler. Following a spectacular $30-million renovation, the 586- room brings together ideal location, plush accommodations, state-of-the-art technology and meeting facilities and personalized customer service.
The hotel features exceptional Azure Restaurant & Bar and The Spa InterContinental Toronto Centre, a serene oasis offering a wide selection of AVEDA spa treatments. Club InterContinental, an exclusive "hotel within a hotel" is designed with business travelers in mind. The three floors provide 90 elegantly appointed rooms and suites, private check-in, dedicated concierge and limousine service, a private lounge, library and boardroom.
The InterContinental Toronto Centre, connected to the Metro Toronto Convention Centre which overlooks scenic Lake Ontario, is set in the heart of Toronto's financial, shopping, theatre and restaurant districts. Reservations can be made at www.torontocentre.intercontinental.com or direct reservations within Canada and US can be made at 1-800-422-7969 and worldwide reservations at 1-800-327-0200. The hotel is managed and operated under license by InterContinental® Hotels Group (Canada), Inc.
To view the photo associated with this press release, please visit the following link: http://www.marketwire.com/library/20130717-InterContinentalTorontoCentreHotel800.jpg
Add to Digg Bookmark with del.icio.us Add to Newsvine
Sharyn Thomas-Counce
Jesson + Company Communications Inc.
(416) 323-7828


text:
Hailey Glassman Slams Perez on Twitter
"I have looked into suing you and decided, 'Eh, Whatever. I'll let it go.' You're not worth it, but what you are worth is my telling you how I feel," she wrote.
"I've had enough of you and when you look back on your life when you're old, fat with your blue or yellow, green whatever hair color you may have, then you will not be happy with yourself. You have made a living off of blood money. You are truly one of the worst people on the face of the Earth and the sad thing is everyone knows it including you," Glassman added.
"At the end of the day, you're a piece of sh**. And another thing Perez, karma it's a bi**h and it will come after you one day," she continued.
"By the way the one thing the public was correct about is yes, I was 110% NAIVE coming into this whole thing. But if me letting the world see how upset I was has helped others feel better, then hey it wasn't all a waste of sadness. Everyone goes through rough times. We're all human... The media has constantly lied about me. I try to move on with my life, and I'm tired of being hurt and bullied by the world/media," Glassman said.
- Filed under:
- Celebrity Fights -
- Gut Reactions -
- TV News -
- Troublemakers -
- Celebrity Twitter
- Tuesday 03 NovemberBy VirginiaHighest Rank Vote downVote upReport this
Peres is a fag hag and will be a lonely old Queen. He absolutely disgust me and is always a pot calling the kettle black. The name Hilton doesn't make him anything but as crazy as the rest of the insane clan ...money does not make you smart or sane
- Tuesday 03 NovemberBy C3A472C6High Rank Vote downVote upReport this
tHE GIRL IS SUCH A LIAR. i HAVE READ THAT THE INTERVIEW SHE GAVE TO THE INSIDER WAS A FAKE AND THAT jON HAD WRITTEN THE SCRIPT FOR HER TO SAY.
- Tuesday 03 NovemberBy sarah
Go Hailey!! Perez is an IDIOT!! I think he is worth suing for slander. If everyone ganged up on him at the same time,ie.,Carrie Prejean and all the others he has spread lies about, maybe you can take him down a peg or two.
- Tuesday 03 NovemberBy HeatherHighest Rank Vote downVote upReport this
As trashy as Hailey is, Perez is leaps and bounds trashier than she is. How sad that it takes someone as skanky as Hailey to tell it how it is. Perez needs to be knocked off his pedestal more often. I have looked at his website and it was nothing but trash. I love gossip...but seriously, who reads his crap? I would love to see him just disappear. For once, Hailey isn't the biggest idiot in the world.
- Tuesday 03 NovemberBy Lynn
Who cares?!
Really.... not I! - Tuesday 03 NovemberBy jeffHighest Rank Vote downVote upReport this
Isn't this fags 15 minutes of fame over? Hopefully the next time we read something on this uber-homo he's O.D. on CORNDOGS
- Tuesday 03 NovemberBy NancyHighest Rank Vote downVote upReport this
Where did this Hilton person come from, and why does anyone care what he thinks? Has he ever done anything but trash celebrities/people in the news? Has he ever done anything noteworthy? I'm being serious here -- who the heck is this person (I hesitate to say "guy"), and why is his opinion worth reading or listening to? I never even heard of him until the Carrie Prejean fiasco.
- Wednesday 04 NovemberBy HHighest Rank Vote downVote upReport this
Does he not know of her drug arrest for possession and dealing pot, hash and hashish oil. And how she got off with a mere slap on the wrist even though the strict "Rockefeller DruLaws" were still in effect.
- Wednesday 04 NovemberBy MaxHigh Rank Vote downVote upReport this
Well put, ray.
- Wednesday 04 NovemberBy mbonhamwolv
Anyone willing to knock of Perez Hilton? I'll pay for the bullet.
- Wednesday 04 NovemberBy CRaigHigh Rank Vote downVote upReport this
Perez is an a--. If he was in front of me I would beat him. And I like gay people. They are the nicest , friendliest people. Better than my non-gay friends. But Perez is one mother f'er. What a p----. I am so angry at him. I am pissed!
- Thursday 05 NovemberBy Stacy
Some women can really be b-tches...and so can some gay men! Why does Perez have to act like he is in a cat fight with everyone? I thought you had to be a female to behave that way. He gives his fellow-gay members a bad name...he needs to get some balls.
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text:
The Siemens Summer of Learning Application is closed. Fellows will be announced in April 2014.
Author: Seth Leavitt
This problem is an engaging, challenging problem that can be solved in many ways but is effectively solved by using elimination or matrices. It can be introduced before instruction in those topics. Students will devise many methods of solution.
Here is a link to a student solution to the problem that leads directly to using elimination.


text:
steve - 9:15 pm on Feb 25, 2008 (gmt 0)
So I've finally figured out how to get the styles into an external stylesheet! In the bottom right hand corner right click style application and set it to manual. In view/tool bars deselect 'style application'. In visual mode highlight the item you want to style and click 'new style' in the apply style pane. A new window pops up, create your style and select 'define in existing style sheet' then click OK. Then while the item is still highlighted, click on the newly created style in the apply style pane. Job done the item is styled and the CSS rule is in the external stylesheet.
When I style div's using ID's EW insists in putting the declarations in the head of the document, even though I have attached an external style sheet.


text:
Definition of foot-and-mouth disease in English:
foot-and-mouth disease
Line breaks: foot-and-mouth dis|easenoun
- A contagious viral disease of cattle and sheep, causing ulceration of the hoofs and around the mouth.More example sentences
- What if a feedlot were implanted with the virus causing foot-and-mouth disease, anthrax, or Mad Cow disease?
- It is important that it be able to act in a timely manner if there are problems to do with scrapie, mad cow disease, or foot-and-mouth disease.
- As infections go, mad cow disease and foot-and-mouth disease don't have much in common.
More definitions of foot-and-mouth disease
Definition of foot-and-mouth disease in:- The US English dictionary


text:
Find a copy in the library
Finding libraries that hold this item...
Named Person: | Hablot Knight Browne |
Material Type: | Fiction |
Document Type: | Book |
All Authors / Contributors: |
Charles James Lever |
OCLC Number: | 7372146 |
Notes: | Vols. numbered arbitrarily. Separate t.p. for each vol. with added t.p. in most of the vols. Illustrator's name appears on title page as H.K. Browne, as Phiz and as H.K. Browne "Phiz." Vols. 4, 8, 14 published by Routledge. |
Description: | 15 v. : ill. ; 23 cm. |
Responsibility: | illustrated by H.K. Browne. |
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text:
15 terms · The lesson 8 words from Wordy Wise book 10. Use them well....
v. 1. To be come real or actual 2. To appear in physical form, especially suddenly.
v. To think or talk about one's past. OR n. The act of remembering, a recollection. OR adj. Suggestive of something else.
n. A person who is given to ideas that are not currently realistic; a dreamer. OR adj. Able to see what might be accomplished in the future.


text:
Check back often for updates!
"Who's the Fool? Gay and Lesbian Representation in Will & Grace and Rosanne"
Thursday, February 20
12:00 p.m.-1:00 p.m.
Holmes Student Center, Blackhawk Annex
Join us for a 3rd Thursday presentation by Dr. Jimmie Manning, Assistant Professor of Communication and Faculty Associate of LGBT Studies. This presentation makes an argument about comedic targets, or the "butt of the joke," as it plays out in two enduring cultural texts: the television programs Roseanne and Will & Grace.
NIU Women's Studies Blood Drive
Tuesday, February 25
11:00 a.m.-3:00 p.m.
Douglas Hall, C/D Cafeteria
When you give...people live. Donate blood at our blood drive. Visit https://ht.heartlandbc.org/donor/auth/signin to schedule your donation. Walk-ins are also welcome! Photo id is required. All blood donors will receive a backpack from Heartland Blood Centers.
Fertile Ground Mosaic Opening Reception
Thursday, February 27
4:30-6:00 p.m.
Reavis Hall, Room 103
Join us to celebrate the completion of the Women's Studies Mosaic Project! Mosaic project leader Danielle Dobies will be on-hand to answer questions. The opening will also feature a cello duet with Nissa Sampson (NIU alum) and Samantha Myers-Miller (DeKalb High School student), and hors d'oeuvres will be served. Everyone is welcome!
(Visit www.niu.edu/wstudies/womenshistorymonth for details about all Women's History Month Events)
"This is What a Feminist Looks Like" Sticker Day!
Tuesday, March 4
All Day
Stop by Reavis 103 to pick up a free sticker. Buttons are also available for$1. Sponsors: Women's Studies Program; Women's Rights Alliance; LGBT & Women's Resource Center
Shifting Fault(lines) & Negotiating Pathways
Tuesday, March 4
12:00 p.m.
Holmes Student Center, Illinois Room
Join us for an interactive talk that will explore the "place" of women of color in the feminist family, led by Assistant Vice President for Student Affairs Dr. Katrina Caldwell. Sponsors: Women's Studies Program; LGBT & Women's Resource Center
Beyonce's f-word
Wednesday, March 5
3:00 p.m.
Holmes Student Center, Sky Room
What happens when a music icon claims an identity that is Controversial and misunderstood in popular culture? We will discuss Beyonce's visual album and the way she demonstrates feminism as an artist. Sponsors: LGBT & Women's Resource Center, and Women's Studies Program
Women's History Month Self-Defense Seminar
Monday, March 17
6:30 p.m.
Founders Library, Room 20
Lesley Rigg and Wayne Finley use their black belt karate skills to teach women how to protect themselves. Rigg and Finley are RADD-certified self-defense instructors. Sponsors: Founders Memorial Library, Women's Studies Program, and NIU Women's Rights Alliance
Exploring Civil Rights: A Panel Discussion
Wednesday, March 19
6:00 p.m.
Holmes Student Center, Capitol Room
This panel discussion will focus on the 50th anniversary of the Civil Rights Act. The panel will include three distinguished NIU scholars: Dr. Laverne Gyant, Director of the Center for Black Studies; Dr. Dianne Rodgers, Associate Professor of Sociology; and Dr. Elvia Arriola, Professor of Law. Sponsors: Department of History and Women's Studies Program
Queering a Human Rights Issue: LGBT on a Global Scale Thursday
March 20 12:00 p.m.
Holmes Student Center, Blackhawk Annex
This event will be rescheduled for fall 2014!
March 20 12:00 p.m.
Holmes Student Center, Blackhawk Annex
Did you know that in some countries homosexuality is not only illegal but is considered an offense punishable by death? Join us for an enlightening presentation by Associate Professor of History Trude Jacobsen that will consider the state of LGBT rights across the globe. Sponsors: LGBT Studies and Women's Studies Programs
Three Women Who Stand for Peace: International Civil Rights in the Age of Drones
Thursday, March 20 7:00 p.m.
Holmes Student Center, Regency Room
Join us for a panel discussion with three amazing women who stand for peace: Two-time Nobel Prize nominee Kathy Kelly from voices for Creative Non-Violence; Medea Benjamin, founder and director of the women's peace group Code Pink; and long time peace activist Ret. Col. Ann Wright. Sponsors: DeKalb Interfaith Network for Peace & Justice; Women's Studies Program; Amnesty International-NIU; NIU Women's Rights Alliance; NIU Department of History; Fox Valley Citizens for Peace & Justice; Rockford Peace and Justice; Sauk Valley Peace & Justice; and First Congregational Church of DeKalb (Mission Ministry Committee).
Race, Gender and the Civil Rights Act-An Historical Perspective
Wednesday, April 2
6:00 p.m.
Holmes Student Center, Capitol Room
Dr. Patricia Sullivan's lecture will focus on the passage of the 1964 Civil Rights Act from an historical perspective, including how women became part of the act and the immediate effects of the Act's passage. Sullivan's lecture will be based in part on research from her book, Lift Every Voice: The NAACP and the Making of the Civil Rights Movement (New Press, 2009). Dr. Sullivan is a Professor of History at the University of South Carolina. Sponsors: Women's Studies Program, Graduate Colloquium Committee
Teaching Civil Rights (Graduate Colloquium Seminar)
Thursday, April 3
10:00 a.m.
Holmes Student Center, Illinois Room
Dr. Sullivan's seminar will focus on teaching the history of the Civil Rights Movement. In addition to being Professor of History at the University of South Carolina, Dr. Sullivan is also co-director of the NEH Summer Institutes at Harvard University's W.E.B. Du Bois Institute on teaching the history of Civil Rights. Sponsors: Women's Studies Program, Graduate Colloquium Committee
Graduate Colloquium Seminar with Executive Editor @ Politico
Thursday, April 10
3:30 p.m.
DuSable Hall, Room 268
Executive Editor of Politico Richard Berke will discuss maintaining one's objectivity while doing research and reporting. Skills learned at this seminar will be applicable to academic and journalistic research and writing. Prior to joining Politico, Berke was senior editor and director of video content development at The New York Times. Sponsors: LGBT Studies Program, Graduate Colloquium Committee, Women's Studies Program, Departments of Communication and Political Science; Journalism Program; Presidential Commission on Sexual Orientation & Gender Identity
Coming Out in the News
Thursday, April 10
6:00 p.m.
DuSable Hall, Room 148
Richard Berke's lecture will focus on the treatment of LGBT people and issues in the news media. More specifically, as a gay man who began working at the New York Times in 1986, he will discuss the evolution of coverage of LGBT issues and treatment of LGBT people in the news. Sponsors: LGBT Studies , Graduate Colloquium Committee, Women's Studies , Depts. of Communication and Political Science; Journalism Program; PCSOGI
"The Power and Shame of Coming Out"
Thursday, April 17
12:00 p.m.
Holmes Student Center, Blackhawk Annex
Coming out has been a powerful tool to create social change. Many attribute the rapid rate in the shift for marriage equality to the viability of Lesbian Gay Bisexual (LGB) folks on TV and in our families. The queer movement was built around the power of coming out, and for this reason we rarely examine the coming out narrative for fear of offending. When we hear the national narrative on coming out, rarely do we see the experiences of trans* and asexual folks represented. Often, these experiences are looked over. Because of this, the coming out process experienced by trans* and asexual people are often neglected or more problematically belittled. This 3rd Thursday Presentation is by Romeo Jackson, Coordinator of the LGBT Resource Center's Straight Talk Speaker's Bureau.
Women's Studies & LGBT Studies Honors Day Reception
Wednesday, April 23
4:30 p.m.
Reavis Hall, Room 103
Join us as we celebrate the accomplishments and recognize the contributions of Women's Studies students, faculty and partners. Graduation cords will be handed out to all undergraduate WOMS & LGBT Studies students who are graduating in May. Refreshments will be served.
Immigration as a Civil Rights Issue: A Panel Discussion ~ Visit the Women's History Month webpage for date/time/location


text:
Maplandia.com in partnership with Booking.com offers highly competitive rates for all types of hotels in Syssleback, from affordable family hotels to the most luxurious ones. Booking.com, being established in 1996, is longtime Europe's leader in online hotel reservations. See the overview of Syssleback hotels in the following section.
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Sysslebäck is located in Torsby Kommun, Varmlands Lan, Sweden.
List of luxury hotels in Syssleback. By default, luxurious Sysslebäck hotels are sorted by name. You can change the sorting order using the navigation bar above. By clicking the first (leftmost) button you can interchange the direction of sorting between ascending/descending. All hotels included are rated four or five stars (list of all hotels in Sysslebäck is also available).
Unfortunately, there is no luxury hotel available in Syssleback directly. You may want to consider the hotels listed in the following section or to search for hotels close to Syssleback.Situated in Lindvallen Ski Resort in Sälen, Hotel Bügelhof offers modern rooms with unique decorations, only 50 metres from the ski lifts. The bus stop at Sälfjällstorget is 100 metres away.
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text:
The media have spoken, and Rutgers was picked to finish third in its only year as a member of the American Athletic Conference. Louisville was picked first, surprising no one, with Cincinnati picked as runner-up. Here is the full poll:
Rank | Team (1st place votes) | Points |
1. | Louisville (28) | 298 |
2. | Cincinnati (2) | 257 |
3. | Rutgers | 240 |
6. | Houston | 134 |
7. | UConn | 131 |
9. | Temple | 60 |
10. | Memphis | 47 |
With all of the buzz and hype Teddy Bridgewater is getting, Louisville is an easy pick for the best team. Not only does Charlie Strong return the best QB in the AAC, but his defense should be much improved from a year ago, especially the secondary. With an improved and veteran signal-caller and a more experienced defense, Louisville should have no problem matching their win total from a year ago.
Past Louisville, things get really murky. UCF, Cincinnati, and Rutgers all have been pegged as the runner-up to Louisville in various polls. UCF has a 3,000 yard passer in Blake Bortles, who many see as the second best QB in the AAC this season. Out of all the new teams in the conference, UCF appears to be the best prepared to compete for a conference title right away. Cincinnati is the other popular pick for the number two spot, but in my opinion, that sentiment is completely based on historical success. Tommy Tuberville is a new coach coming from a mediocre stint at Texas Tech. Brendan Kay is decent as a QB, but he isn't exactly a candidate for Player of the Year. Munchie Legaux isn't any better. Much of the rest of the team is more unknown than anything else, so it seems a bit strange that Cincinnati is such a strong pick for number two, much less getting two first place votes.
I definitely see Rutgers as the second-best team in the conference. Sure, there is definitely some uncertainty as to how the fresh faces on defense can replicate the production from last season's unit, but the offense is stacked. RU arguably boasts the best offensive line in the conference, and a strong O-line always gives you a good chance at a league title. Combine that with the experience returning at each skill position (Nova, Coleman, Huggins), and you have a formula for a very competitive season.
What do you think? Cast your vote for where Rutgers will finish this season in the poll below. Leave a comment on where you think other teams will finish. More coverage from media day to come.


text:
ROLODEX Card Refills,For Petite Card Files,2-1/4x4,100 Cards,White
Item#: YYSP-ROL67553 | Model#: 67553- List Price:
- $4.42
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Manufactured by: Rolodex
Warranty provided by: Rolodex
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Warranty Information
7795 W. Flagler St. Suite 35
Miami, FL. 33144 - Rolodex logos are registered trademarks of Rolodex. All others trademarks and copyrights mentioned herein are the property of their respective owners.


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Business travelers appreciate our convenient location and quality amenities keep them productive. Businesses and universities near the hotel include Galveston College, Texas A&M at Galveston, University of Texas Medical Branch, American National Insurance, U.S. Army Corp of Engineers and the U.S. Coast Guard.
A 24-hour Business Center.
Whether you're enjoying a refreshing vacation or embarking from the Port of Galveston, our hotel offers you a great stay at a great price. Our prime location allows you to relax on your balcony and watch the ocean waves crash, and we are close to numerous attractions the whole family can enjoy, including Schlitterbahn Waterpark, Stewart Beach, Galveston Island Ferry and much more.
Our hotel provides great amenities, including free high-speed Internet access, a free hot breakfast bar, 24-hour gift shop, Fitness Center and outdoor pool and whirlpool.
So make your reservations today to enjoy the best stay Galveston hotels have to offer!
Hotel Details
Laundry/ Dry Cleaning Service
Common Area High speed Access
Common/Public Areas Accessible to Wheelchairs
Business Center
Common Area Wireless Access
Laundry Room


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Im having trouble creating a surface data shortcut of a surface that has a paste surface in it. Could the surface paste be the reason a shortcut will not produce??
Solved! Go to Solution.
What is the message error has?
A fault in creating the shortcut can occur for several reasons, but so that we can help is necessary to know which type of error.
There was no error message.
I just figured it out. Seems autocad did not like the surface name as it was too long. I simplified it and then it worked!!
You should be careful not to use special characters.
none was used. just the name was too long. maybe too many characters.
It's not likely the source of the problem. Creating the data shortcut should not have anything to do with how the surface is created.
The surface is sound. Done properly. Once the surface name was shortened, the shortcut created.
When creating complex surfaces, and/or having multiple surfaces in one drawing, use the description box to describe the surface buing built, do not try to describe it in the name box by short abbreviations .
Log into access your profile, ask and answer questions, share ideas and more. Haven't signed up yet? Register
Start with some of our most frequented solutions to get help installing your software.


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HILLSVILLE — An 18-year-old Sylvatus man has been charged with arson stemming from two brush fires on Jan. 26-27.
Virginia State Police report that they investigated the brush fires in the vicinity of Double Cabin and Buckhorn roads in Carroll County — one of which occurred on Sunday, a day when Hillsville Fire Department members had to respond to multiple emergencies over an 11-hour span.
The investigation resulted in two counts of arson against Bobby Eugene Wagner Jr., 18.
INDEPENDENCE –– Grayson County was a combined eight points better than Glenvar in the first and third quarters, making for the difference as the Blue Devils defeated the Highlanders 57-49 in a nondistrict boys' game Monday night.
Grayson County (4-10) outscored Glenvar 13-9 in both the first and third periods and took a 40-30 lead after the third.
Max Rodgers hit three 3-pointers and led the Blue Devils with 17 points while James Williams scored 14 for Grayson County.
HILLSVILLE –– Carroll County High School will induct its inaugural class into the CCHS Sports Hall of Fame during the basketball doubleheader with Salem scheduled for Jan. 31.
WYTHEVILLE –– Galax limited George Wythe to 13 points in the first half and rolled to a 57-35 nondistrict win in a boys' game Wednesday night.
The Maroon Tide (9-3) built a 24-13 lead by intermission and continued to pull away throughout the second half of play.
Caleb Bartlett led Galax with 12 points, all coming on 3-pointers as the Maroon Tide hit nine 3-pointers as a team. Cliff Conley added 11 points for Galax and Keyshawn Brown scored 10.
Grant Anders was the lone double-figure scorer for George Wythe, finishing with 11 points.
HILLSVILLE –– Carroll County needed a little time to dial itself in, but a pair of three-point possessions on either side of the midway point of the first half jump-started the Cavaliers, who went on to roll Christiansburg 72-31 in a River Ridge District girls' game Wednesday night.
MAX MEADOWS –– Koby Hill hit a shot at the buzzer to lift Grayson County to a 54-52 win over Fort Chiswell in a Mountain Empire District boys' game Friday.
The Blue Devils (5-10 overall, 2-2 district) took a 41-37 lead into the fourth quarter before the Pioneers (7-5, 1-2) rallied.
Hill finished with 12 points for the Blue Devils, who got a game-high 18 points from Max Rodgers. Ty Cannaday added 13 points for Grayson.
Fort Chiswell was paced by Garrison Byus with 13 points. Dylan Hale scored 11 and Austin Widelo added 10.
Galax couldn't overcome its own chilly start in its Mountain Empire District game Friday with Graham. Even if it had, the Maroon Tide may not have been able to overcome the rather balmy opening enjoyed by the G-Girls' Lexi Kiser.
The Graham point guard poured in 11 points in the first quarter as the G-Girls seized control early on with a 16-point lead and went on to deal the Maroon Tide a 54-39 setback.
Galax dropped to 5-7 overall and 1-3 in league play while Graham stayed firmly atop the MED standings at 5-0, improving to 9-6 overall.
Galax pulled off an 18-point turnaround in the final 10-plus minutes, rallying from a 14-point deficit into a final four-point advantage and handing Graham its first district loss of the year with a 54-50 Mountain Empire District triumph Friday evening.
A Fries woman has been arrested on 25 felony charges, according to a Galax Police Department report. Tory Leigh Waller, 33, was arrested and charged with 24 counts of forgery in the city, on warrants obtained by Officer Darrin Alley.
During the booking process at the police department, comments made by the accused caused Officer Anne Toney to investigate an automobile owned by Waller and being operated by two other individuals.
RICHMOND — A Virginia Department of Corrections officer employed at the River North Correctional Center in Grayson County suffered an injury after what's been characterized as an accidental discharge of a firearm in Richmond on Jan. 9.


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The cooling chamber makes it quick and easy to take an immediate drink at the perfect temperature, the leak proof lid means you can bring it along anywhere without a problem and there is a fashionable color to fit every personality - there is even a Sport Collection for those that like a more athletic look.
Plus, the ergonomic grip makes it comfortable to hold a BRUGO Mug in your hand and the non-slip bottom and cup holder-friendly size complete the overall appeal and convenience.
For $19.95 you can get a BRUGO but there is a great deal : when you order two or more, you receive 25% off (making them only $14.95)... and, if you spend $50 or more, you'll receive free shipping as well. ( Be sure to add "Leakproof" to your delivery address when you do place an order, as there was an older version of the BRUGO Mug that wasn't ..)
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Hot answers tagged cleaning
Goo Gone! - they claim that it's safe on any surface, and I haven't used it anywhere that it's caused damage, but check a small spot first just to be safe.
If you want to try something cheap, you could always simply get the stickiness off with more tape, but that probably won't work with old grungy remains.
Dilute chlorine bleach and your garden hose (assuming an adjustable nozzle that can give you a focused spray). No scrubbing required.
You can't really prevent it from getting smelly, but keeping all the trash in plastic bags will help. I use 13-gallon drawstring bags in the main kitchen trashcan and plastic shopping bags in my others. Tie them off before ...
I'll echo the comment and say that you should make sure you have a proper P-trap installed under the sink. This trap holds water and provides a seal against sewer gases getting up into the bathroom. Without one, gases will leak in constantly, and will be displaced by water down the drain which can force the gases up into the bathroom even if normally it's ...
Danny, I respect your enthusiasm. I am a certified home inspector and general contractor in Maine. There's some great advice in the answers here, and I won't repeat the obvious.
I will warn you, however, learn realtor language. "Fixer-upper" means a train wreck about to happen! Get a real good inspector that has building experience. DO NOT take a ...
This article suggests it might be a bacteria known as Serratia marcescen
if you've noticed a pink or red slimy
substance forming in your toilet bowl,
you're not alone.
It is bacteria known as Serratia
marcescens, according to Roxanne
Johnson, North Dakota State University
Extension Service water quality
You may find this ...
Most of your questions are the same question, just asked in a different form.
Before you even start looking -- Before you even find a realtor -- Do your research on a good home inspector in your area. If you are looking at an old house, make SURE to tell the home inspection service that you want someone who knows about houses xxxx years old. Most inspectors ...
I think shirlock makes a good point. Particularly since the original poster mentions he does not have lots of DIY experience. There are many projects you can do on a house, but starting with one that is a "fixer upper" or "handyman special" is realtor code for "needs major work!". It will probably need so much work that even if you had time to do it, it ...
You need a Roller Nut Harvester!
Amazon also has the Nut Wizard, which has an infinitely better name, but it's $50 vs. $18.01 for the Roller Nut Harvester. Plus you can still tell your friends it's called the Nut Wizard and they'll never know.
Use a carpet sweeper.
Bissell sells several models of mechanical manual sweepers -- an invention that's been around in some form since the 1880s. They work, but only to an extent. For deep cleaning you'll have to use a vacuum or roll up your carpet and take it in to the pros.
Does it smell when you turn on the tap and catch the water in a bowl (so it doesn't go down the drain)?
If so, it's something in the faucet. Take off the aerator cap and look for gunk inside, and/or look in the barrel of the faucet if you can to clean it out. You can also consider replacing the faucet. (I am assuming that since this only affects the ...
This stuff is sick: http://www.evaporust.com/
I used it on a drill press my buddy left out on a patio in the rain for a year. Virtually no scrubbing. I don't understand how this is not one of the most widely known products in the world. It is THAT good. I guess with the military as a client, they don't need the business from the public. Here are some ...
Recycled concrete is used for several different purposes. It can be used "as is" for bulk
fill / drainage / etc.
When cleaned, crushed, and graded for size, it can be used as a base underneath a new concrete pour.
Recycled concrete can also be used as aggregate within the new concrete. Several factors must be taken into account to ensure that it will ...
To remove surface mold I use a 4:1 mixture of water:bleach. Spray on liberally and allow to sit for about 15 minutes. Rinse with water and wipe clean.
If you need to use a brush to scrape off heavy deposits, I recommend brushing away from your face or preferably wear an appropriate mask and goggles. The mold spores are probably more dangerous than the ...
If the pros couldn't do much, It sounds like the stain is there for good. Some suggestions:
small throw rug/welcome mat. Just cover it up!
bring in a pro to swap that bit of carpet with maybe something in a closet, or just a far corner. A good carpet pro should be able to seam it all back together.
dye the entire carpet a shade or two darker. I know such ...
I've heard that plumbers swear by bio-clean.
I guess the idea is that all the anti-bacterial soaps that people use tend to kill the "good" bacteria in the drain lines that naturally digest the crud that gets stuck in there. This stuff restores those bacteria so they can clean the pipes out naturally.
My experience with it has been pretty good for ...
Concrete is essentially a mixture of portland cement, sand and aggregate.
The strength of the concrete does not come from the cement, but from the aggregates. You want the smallest amount of cement possible -- just enough to glue the aggregate and sand together (i.e. fill the gaps).
By reusing old concrete as an aggregate, (and adding more cement to the ...
I would just replace the hose. You would probably have to take it apart to clean it anyway. I found replacement hoses for around $4. The directions seem fairly straightforward.
In the "olden days" before there were vacuum cleaners you either swept (which still works to an extent -- tough bristles, short quick strokes are key) or took the carpet up and beat the dust and dirt out with a carpet beater (which also works, as long as your carpet isn't fitted).
Alternatively, there are machines that spray water and shampoo into the ...
This is a problem best suited to the professionals, but if you must do it yourself the number one priority is the safety of you and those around you. This can be a very hazardous task, if you do not take every precaution to contain and remove the spores properly.
The first thing you'll have to think about is containment, you don't want to spread the mold ...
Vinegar is an acid. It's a mild acid, but it's an acid nonetheless. You might want to find a different brand of spray bottle that is chemical resistant... mine seem to keep working, but I buy them from a janitorial supply store. I know the one time I put a vinegar and water solution in one of my girlfriend's spray bottles, which were artsy and came from a ...
I'm answering my own question here - maybe and admin can move this as a comment to my original question:
I did some more research on how to detect and clear blockage in central vac system. I disconnected the vac bucket from the unit and then used a regular vacuum at each outlet. At one of them, a huge amount of debris came out, including a "fabric softener" ...
Wouldn't have believed it if I hadn't seen it. I wish I took before/after pics.
Clorox Outdoor
Put in a garden sprayer designed for bleach according to instructions on Jomax:
3/4 cups Jomax
2 1/4 cups bleach
13 cups water
For 75% of the siding, I applied the mixture, then rinsed after 5 minutes. A number of sections needed a ...
Some background, there are two types of wood water stains. White rings and black marks. White rings form when the water has only made it into the finish, this is the "best" kind of stain to have. Black marks occur when the water has penetrated into the wood itself. This is slightly harder to fix and will ultimately require either sanding or covering it with ...
To add some detail to chris's list:
Structure: check for sagging floors and anything out of level (floors, walls, doors). Check around any openings to see the materials used (from the outside, look for any protrusions like a faucet to see what's behind the siding, and from the inside, check the joists and rafters from any crawl space or attic).
Check for ...
This doesn't really answer your question; but I wanted to mention it. I was in your situation about four years ago. My wife and I wanted a house, but money was tight....we looked at some bank owned foreclosures and found one that was in a good area for a good price. It was kind of a dump though....
We figured one year and 10k and we'd be done, with a ...
A cheap and easy solution would be to strap an air filter to a box fan and run it in the room for awhile. I've seen several variations of the basic concept. Here is one example:
Build a do-it-yourself air purifier for about $25
I think your best bet is to just paint over it/re-paint the wall. On exterior concrete/brick walls it is easy to power wash or sandblast it - the goal is to remove everything. However neither of these will work inside - aside from the mess they'd create, they'd probably take more then just the paint off your walls!
You might find some chemicals to help ...
The way I've done this is not using water, instead take the roller or brush and put in a big ziplock bag and stick in the fridge. yes it may look gross in there but it won't be a problem to return to continue painting. It won't be able to dry as much. Certainily it won't dry out. Seems like my wife left one in there for a couple days to return AND multiple ...
Painting a pressure treated wood deck is always tricky. Pressure treated wood does not seem to hold paint well, even with a good primer. Stain is usually a better alternative, but since your deck already has paint, it would have to be stripped completely before using stain.
In order for the paint to stick fairly well, the surface needs to be as clean and ...
Only top voted, non community-wiki answers of a minimum length are eligible


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Ramaytush language
Ramaytush | |
San Francisco | |
Native to | United States |
Region | California |
Ethnicity | Ramaytush people |
Extinct | (date missing) |
Latin | |
Language codes | |
Linguist list
cst-ram |
The Ramaytush language is one of the eight Ohlone languages, historically spoken by the Ramaytush people, indigenous people of California. Historically, the Ramaytush inhabited the San Francisco Peninsula between San Francisco Bay and the Pacific Ocean in the area which is now San Francisco and San Mateo Counties. Ramaytush is a dialect or language within the Costanoan branch of the Utian family. The term Ramaytush was first applied to them during the 1970s.[1]
Historically, Ramaytush language territory was largely bordered by ocean and sea, except in the south where they bordered the people of the Santa Clara Valley who spoke the Tamyen language Ohlone and the people of the Santa Cruz Mountains and Pacific Coast at Point Año Nuevo who spoke dialects merging toward the Awaswas language. To the east, across San Francisco Bay, were tribes that spoke the Chochenyo Ohlone language. To the north, across the Golden Gate, was the Huimen local tribe of Coast Miwok language speakers. The northernmost Ramaytush local tribe, the Yelamu of San Francisco, were intermarried with the Huchiun Chochenyos of the Oakland area at the time of Spanish colonization.[2]
European disease took a heavy toll of life on all tribal people who came to Mission Dolores after its creation in 1776. The Ohlone people were forced to use Spanish resulting in the loss of their language. Hundreds of Ohlone people at Mission Dolores were taken to the north bay to construct Mission San Rafael which was then used as a hospital for sick neophytes. Alfred L. Kroeber claimed that the west bay people were extinct by 1915. The Muwekma Ohlone Tribe, descendants of closely related Chochenyo and Tamyen Ohlone speakers, have been vocal advocates for Native American issues on the San Francisco Peninsula, as have some Ohlone descendants from the Monterey Bay Area farther south.
See also[edit]
- Heizer, Robert F. 1974. The Costanoan Indians. De Anza College History Center: Cupertino, California.
- Milliken, Randall. A Time of Little Choice: The Disintegration of Tribal Culture in the San Francisco Bay Area 1769–1910 Menlo Park, CA: Ballena Press Publication, 1995. ISBN 0-87919-132-5.
This indigenous languages of the Americas-related article is a stub. You can help Wikipedia by expanding it. |


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