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May 5, 2011
Dear CODEPINKer,
Six CODEPINK locals, starting with Boston and including Dallas, upstate New York, LA, NYC and San Francisco, participated with, in the Join Me on the Bridge events organized globally by our ally, Women for Women International Before the IWD walk on the Golden Gate Bridge, honored speaker and mayor of Oakland Jean Quan photographed codepinkers holding Bring Our War $$ Home and Make Art Not War banners, then posed for a photo with some of us. There were 464 events in 70 countries, including Afghanistan and Congo.
On March 11, a triple tragedy struck Japan: a 9.0 earthquake, a tsunami, and meltdowns and fires at the six-reactor power plant in Fukushima. The very active codepinkers in Osaka, who have been doing antinuclear and US base-closing work for a long time, responded immediately and also asked for support from CODEPINK. Ann Wright, who has met numerous times with codepinkers and other activists in Japan and in the US, wrote this letter: Dear Emi, Our thoughts and prayers are with the Japanese people in this terrible time of tsunami and nuclear meltdown and radiation. I think the request of women of Japan that the U.S. pay for its own military bases rather than demand that Japan pay for them and ultimately remove them is an appeal that would have more support in the U.S. considering the huge financial task ahead for Japan.
March 19 20: The sad and shameful 8th Anniversary of the US invasion of Iraq coincided with Obama's decision (made without due process by Congress, or any national debate) to join in the NATO no-fly zone (really surveillance and bombing, including DU weapons) against Libya's government, now engaged in a civil war against armed resisters. As Dede Miller, aunt of Casey Sheehan, reported from the march in Los Angeles (which concluded with 11 arrests for civil disobedience of herself, a Vietnam Era vet, and others): As our march rounded the corner of the CNN building we all got word via the CNN ticker that the USA was launching missiles on Libya. Air Force Mom Lisa Blank [of Phoenix CODEPINK and MFSO] ran to the lead flatbed and pointed this out. We stopped the march and made an announcement about the new front. Most of us stood in shock for several minutes. I broke down crying. What a surreal moment. Here we all were.Many of us were marching in our 8th, 9th and 10th march to end what we thought of as 2 wars as a third was breaking out.
Phoenix area codepinkers bird-dogged the Decider-in-Chief himself,George W Bush, at Arizona Southwestern University; the event drew 75 protesters!
CODEPINKers participated in rallies in Washington, D.C.; Dallas, TX; Pittsburgh, PA; Boston, MA; San Francisco, CA; and many smaller vigils, as well as in LA. Our new Bring Our War $$ Home banners and stickers showed up vividly in the crowds. Rosalie Yelen of CODEPINK in Long Island wrote a moving account of the memorial of the war dead from Long Island, and the rally that took place in a town there. Our allies in the struggles for labor, immigrant rights, healthcare, and education expressed their appreciation, wore our stickers, and thanked us for our nearly a decade-long pink in your face presence.
The Stolen Beauty/Boycott Ahava campaign focused this month on March 30, Palestinian Land Day, continuing the store-by-store requests to owners/managers to no longer sell Ahava products that steal the literal land and minerals in occupied Palestine for beauty products. In Santa Monica, towels were part of the activists' outfits! For more news about this international campaign, part of the Boycott-Divestment-Sanctions movement, and for actions you can take online or in person, please click here.
Photos of actions challenging to occupation-based profiteering.
Hands Off Wikileaks/Support Bradley Manning: following the March 19 DC march and rally, with over 100 arrested at the White House fence [, codepinkers and our allies from Courage to Resist, World Can't Wait and others demonstrated at the border of the Marine Corps Base in Quantico, VA. They brought signs and visuals protesting Bradley's inhumane and humiliating treatment, which included forced nudity and sleep deprivation. As heavily armed military police denied their right to lay flowers on a memorial, retired Colonel Ann Wright, Daniel Ellsberg (once a Marine lieutenant) and others were arrested, and all were denied the right to visit or bring gifts to the whistle-blowing Army private. In March locals organized events supporting Bradley Manning in Tallahassee, FL and San Francisco, CA see the amazing action by nearly naked protesters here.
Accountability/Arrest War Criminals: Campaigner Nancy Mancias has created and maintains a War Criminal Watch calendar, which local groups use to birddog Bush and members of his administration, or those who wrote the memos justifying torture, as they appear for book signings and highly paid public speaking events. For two examples, see photos of codepinkers and allies calling out accused war criminals John Yoo and Tony BLIAR Blair.
Bring Our War $$ Home: On March 7, C.J. Minster started work as the full-time national organizer for this campaign; she works out of the Venice, CA office. She quickly got to work on the webpages for this campaign and on the mayors' resolution, inspiring CODEPINKers and our allies to contact their mayors to get on board. In Maine, Lisa Savage challenged Governor LePage with a solution to the state's budget problems: Tax the rich. LePage's removal (at what cost?!) of the historic labor history mural drew national media attention and outrage from both activists and artists.
Activism continued in Maine with the third Draw-In and rally at the state capitol, connecting art to activism on the issue of cost of war and unmet needs at home. Mainers visited the offices of Rep. Chellie Pingree, Sen. Susan Collins & Sen. Olympia Snowe with Bring Our War $$ Home packets of information. Our ask: meet with us to discuss the need to change our spending priorities in Congress. (NOTE: Senator Collins will soon meet by teleconference with BOW$H activists, including Lisa!)
Malalai Joya Afghan woman leader and former member of the national parliament, went on tour in the U.S. in early April. Her visa (and US speaking tour) were delayed, perhaps because someone in the State Dept doesn't care for an English-speaking, charismatic woman from Afghanistan saying in public that the US/NATO troops need to leave her country asap, but a letter-writing and phone-in campaign was persuasive. In Los Angeles, Malalai met with C.J. and LA office interns at a speaking event. In San Francisco, the co-author of A Woman Among Warlords spoke from the stage of the April 10 rally at Dolores Park, along with Nancy Mancias and intern Chelsea Byers, who performed her own spoken word piece for the occasion.
Ridgely in Palestine: Bring Our War $$ Home and Middle East campaigner Ridgely Fuller has been in the West Bank for weeks as part of an international solidarity campaign, courageously witnessing and giving support to people under Israeli occupation. Here's an excerpt from her lively emails: The spirit of Egypt keeps growing in Palestine! Today was the final day of Bil'in's 6th annual International Conference; it is a town known for resisting the construction of the Apartheid Wall. Boston was presente! and the Palestinians did a terrific job. The soldiers gave the large crowd of participants their entire arsenal: teargas, rubber bullets, live fire, sound grenades and 'skunk water' but the Palestinians were undeterred! The Fence was breached by wire cutters
NYC coordinator Cristina Castro and Maine organizer Lisa Savage shared 90 seconds of mic time at the New York march and rally organized by UNAC on April 9, which drew thousands of people including many Muslim families and marchers of all ages.
Toby Blome of the SF East Bay, CA, has been organizing monthly vigils at Beale and now Travis Air Force Bases, part of the Ground the Drones campaign that she has been very involved with since 2009. On April 12, Global Day of Action on Military Spending, Toby and others took their messages to Travis, flyering and bannering, and get media attention. This global day focusing on the outrageous waste of money on militarism was observed in 35 countries.
On Earth Day, Nancy M and Janet spent a delightful afternoon meeting local folks and presenting a slideshow and talk on CODEPINK at the Goddess Temple Guest House in Cactus Springs, Nevada, just 2 miles from the notorious Creech AFB, home of the Predator drones. We were hosted by the Goddess Temple priestess and caretaker Candace Ross, who led a ritual in the Temple, organized a potluck and did face-painting, as we all enjoyed lunch and art activities. Nancy and Janet also met up with the participants in the Peace Walk organized by Nevada Desert Experience from Las Vegas to the Nuclear Test Site (now ridiculously renamed the Nevada National Security Site as if nukes make us secure!).
As part of his Bay Area tour, President Obama spoke at the Facebook headquarters in Palo Alto, California during a Townhall Meeting with Facebook Founder Mark Zuckerberg, titled "Shared Responsibility and Shared Prosperity". CODEPINKers Nancy Mancias, Chelsea Byers and Sharon Miller arrived early at the event to protest the ongoing wars in the Middle East, intertwining Facebook jargon into the messaging, saying "Obama: Update Your War Status".
National Team news: Middle East campaigner Rae reported: I want to give a shout out to the really amazing intern team we have at CODEPINK right now - Chelsea and Sharon in SF, Dara and Sanaa in LA, Alli and Chris in DC. The interns are coordinating actions, writing blogs, on the bullhorn, outreaching to press and ally orgs, creating beautiful visuals, keeping us all connected on google docs, communicating with the grassroots, even doing solo actions (Sanaa delivered the Bed Bath & Beyond petition in Canoga Park last week)... and so much more.
Former staffer Logan Price has moved on to our ally, Courage to Resist after organizing two major actions with CODEPINK earlier this winter/early spring; we wish him the best.
Online Store News: the second edition of the Peace Never Tasted So Sweet Cookbook is now for sale, as well as many other fun and educational items.
April ended with a burst of good news: Egypt's foreign minister says Cairo will permanently open the Rafah border crossing to ease Israel's blockade on Gaza, and Bradley Manning has been moved to a medium-security prison in Kansas, where he will have contact with others and be able to exercise and read. If you want to send him a message of support, his address is: Bradley Manning 89289, 830 Sabalu Road, Fort Leavenworth, KS 66027.
But also with a tragic milestone: the 6,000th US troop fatality from the wars/occupations in Iraq and Afghanistan was recorded on April 26. Of course, we know that the real death toll for American troops/veterans is much higher, from suicides and other causes.
Looking forward to May:
9 - Yom Ha'atzmaut (Israeli Independence Day / Nakba Day)
17 - Last day to get mayors to co-sponsor resolution for BOW$H
18 - LA Mayor Villaraigosa will submit BOW$H resolution to the US Conference of Mayors
20-24 - Move Over AIPAC Conference in DC
30 - Memorial Day
Moving forward for peace and justice,
Inspired by what you read here? We invite you to give a donation to support our actions and join our campaigns!
The Roseroots Report is a bimonthly bouquet of CODEPINK local actions and news. Why roseroots? Because we're cultivating a vibrant pink flowering garden with a hearty stemming history and strong roots, not just little grassroots. The 1912 Lawrence textile workers on strike had it right when they said, We Want Bread, But Roses Too! Our pink hearts are moved by CODEPINKs approach to peacemaking: we aren't just about getting out a talking point or ensuring a basic right, we're about bringing our money back to our beloved resources schools, health, parks, libraries and more, disarming our defenses, opening our minds to new narratives and possibilities, and creating beauty. www.codepink.org


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After a delayed flight, losing a connection and spending one night in Mexico's airport (thank you irresponsible KLM!) I arrived to Monterrey just in time for the wedding from one of my very best friends!
For such special occasion I wanted to wear a special piece of jewelry and I designed a necklace with things I've been collecting for years from all around the world wishing the newlyweds lots of traveling and adventure in their new life together.
In this pectoral I used glass beads from Italy, amber from Russia, a piece of the first chain I made when I started making jewelry, leather scraps from Argentina, etc.
I sewed beads during all the flight from Amsterdam to Mexico, during all the night I spent at the airport, and a couple of hours once I arrived to Monterrey, it took way longer than what I expected, but while I was crafting it I was smiling alone like crazy remembering all the great moments I spent with my dear friend.
The wedding was beautiful, a rainstorm was expected, but the sky cleared up giving the new couple a beautiful night with a huge amber moon. They looked happy and in love, and we all joined them in their happiness.
I'll be in Monterrey for a couple of weeks, I'll be sharing with you in these days more pictures from my hometown and its mountains.

subset: commoncrawl


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Today we will talk about some common shoulder disorders that we all see in our offices in both rheumatology and orthopaedics and about my approach to some of these common conditions.
Common shoulder problems can really be classified into four areas: rotator cuff, instability, glenohumeral osteoarthritis, and fractures. We are not going to talk about fractures much because that really doesn't overlap at all. This is just sort of a gross classification of shoulder problems.
So what else is there? There are three other things that I am going to touch on briefly: adhesive capsulitis, acromioclavicular joint problems, and biceps tendon, which I think are all fairly common causes of patients to come with outpatient complaints to our offices. There are plenty of other things that cause trouble in the shoulder that we are not going to get into. These include: inflammatory arthritis, which you are really all the experts on; musculo-myofascial pain, which will commonly presents in the outpatient setting; brachial neuritis; Parsons-Turner Syndrome, which can be very painful and is not that common, fortunately; and nerve entrapments about the shoulder and C-spine, which can commonly present with shoulder pain and, therefore, it is really important to examine the neck any time someone presents with shoulder pain. The first thing in my physical examination is to check the neck and other things -- such tumors and uncommon things that can present as shoulder pain.
Rotator cuff disease is pretty much the most common thing that I see in the office in terms of patients presenting with shoulder pain. I will talk about my approach to diagnosis, how to stage rotator cuff problems and then the treatment -- both non-operative and a little bit on the operative management of cuff problems.
The pain when people present with rotator cuff disease is generally located in the upper lateral arm. There can be associated weakness, either due to pain or due to cuff dysfunction, so that the shoulder doesn't work properly. In the setting with trauma with weakness that is new, we have to consider an acute cuff tear. That is a separate scenario in which someone has a fall and then can't lift the arm or is very weak after having been able to use the arm normally before that fall. That is different from most cuff problems, which present with gradual worsening of pain and weakness over a period of months.
I am not going to go over the whole physical examination, but a couple of points need to be made. It is really important to examine the acromioclavicular joint and the biceps. These can be separate sites of pain and pathology that are fairly easy to examine, but certainly can be separate from the cuff pain.
Examine range of motion, of course, including internal and external rotation. Internal rotation can be done with the arm up at 90 degrees, and in this position you can do internal and external rotation. I also like to examine internal rotation behind the back to see how high they can reach up in terms of touching the spinous processes compared to the normal side.
Cuff strength is, of course, important to examine, both external rotation with the arm at the side and supraspinatus muscle power in the plane of the scapula. Not way back and not out in front, but at 30 degrees in front of the plane of the body so you line the scapula with the thumb down is a good way to isolate supraspinatus muscle power. Lastly, provocative tests, so-called impingement tests. The Hoffmann test can be done out in abduction like this or across the body with internal rotation to impinge the cuff up on the acromion to see if that reproduces the pain. And also the Neer sign, with internal rotation and forward elevation straight up, can be done.
These things can often be positive in other conditions, but it all sort of goes together, putting the exam together in terms of pain on palpation, motion strength and provocative tests, among other things. I get radiographs on all these patients to rule out things that you are probably not thinking of but could be there such as a fracture, osteoarthritis of the glenohumeral joint, tumor, and calcific tendonitis.
MRI is also helpful if you a re considering that there may be a cuff tear or something else going on, e.g., other soft tissue pathology such as a labral cyst. I think that the stages of cuff disease described by Neer originally are really very helpful for the treatment, so I am going to talk a little bit about them. These are sort of the way he looked at it pathologically where initially there's inflammation in the subacromial space which, after months and months, goes on to fibrosis. When we do surgery in subacromial spaces, there is a certain amount of fibrosis where that bursa just gets thickened and scarred. Ultimately, as this disease progresses, you can have partial and then full thickness tearing of the rotator cuff. So without a tear in the cuff, the first two stages are really what we call impingement syndrome, bursitis, or tendonitis -- there are a lot of different words for this, but it is really the same thing. It's really bursitis in the subacromial space.
These stages affect how we treat things. I think the longer the symptoms have been present and the more severe the symptoms, then probably the higher the stage, the more scarring there is in the subacromial space and the less likely they are to resolve without injection or surgery. That doesn't mean that, just because someone has the symptoms for a long time, they shouldn't have a course of anti-inflammatories. But I think this has to factor into the thinking because, when someone has six months or a year of this untreated, there is more fibrosis and scarring in the subacromial space. And in my experience and in the literature, they don't tend to do as well as someone who has had symptoms for a month who generally, and in almost all cases, will resolve with physical therapy and anti-inflammatories.
So the first line of treatment for cuff disease, whether it is a tear or not, generally and depending on how long the symptoms have been going on, is physical therapy and anti-inflammatory medications. However, all physical therapy is not the same. There is really a large variation in the sophistication of physical therapists. There are some therapists at our hospital here who are just superb and really understand how to strengthen the cuff, strengthen the scapula muscle without inflaming the cuff and not pushing the patient too hard. That is really a very delicate balance. Then there are other places where patients may go for physical therapy where the therapy may be involving hot packs, ice and less sophisticated and advanced strengthening exercises. I think it is always important to ask patients what they are doing in therapy and how they feel after therapy. Particularly with shoulder patients, if they come out and say "Well, for two days after therapy my shoulder is killing me", that is a bad sign.
Now if the symptoms are not improving at six weeks, then I will generally inject the patient. If they are having some improvement, and depending on how keen they are to have a subacromial injection, I may or may not do it. Usually at six weeks, if things are not moving along, I will proceed with a subacromial cortisone injection and possibly get an MRI at that point, depending on how suspicious I am of a cuff tear.
Sometimes I will inject patients the first time I see them if they have had the pain for, say, six months. Usually, after a minimum of six months or a year and they had no treatment, then they are unlikely to get better with physical therapy and anti-inflammatory medication alone. So sometimes I will inject these patients the first time I see them.
I am going to discuss my method for injection in a minute. I use 80 mg of DepoMedrol and some local anesthetic, usually anywhere between 3 and 6 cc. I use 80 mg instead of 40 mainly because I think that you have room to inject it. So I guess if you can use it, that is what I elect to put in. I haven't had problems with it. I think it's not unreasonable to use 40, for example, in the acromioclavicular joint or when I inject the lateral epicondylitis, which I don't do very often, but in some cases I will. I will use 40 just because I don't want to put that much cortisone in there.
The subacromial space is a potential space with a lot of room and I want to try and make them better, so I think a nice high dose is safe in that area also. It is not like injecting the lateral epicondylitis where you are injecting into the tendon itself. This is really a potential space, so you shouldn't be injecting into muscle and tendon.
Question: What about the timing of the injection? Most of my patients are older and have contraindications to NSAIDs and anti-inflammatories. I tend to do injections sooner rather than later because I think it's safer. What about the balance between degenerative tears versus the benefit of anti-inflammatory injection?
A couple of excellent points here. The first thing is the elderly patient can't take NSAIDs. Yes, in that setting I am more aggressive in the first time cortisone injection because we have fewer options and surgery may be less of an option in these patients. Even repeated injections may be appropriate in those cases. The question about an MRI really relates to whether you think there is a cuff tear.
The other point you bring up is subacromial injections of cortisone in the setting of a cuff tear. Is that appropriate or, if the cuff is torn and they have symptoms, should it just be fixed? First, I do not think it's reasonable to inject the cuff tear if it is someone young who has significant weakness and symptoms and probably should be fixed. The other case is someone who is perhaps in their late 70s or early 80s who really doesn't look like someone who you want to be taking to the operating room. That is someone I would inject even in the setting of significant cuff tear and probably reinject.
That is a controversial area -- as to whether partial tears should be injected -- and my sense is in the absence of evidence that it is a bad choice, I would err on the side of being conservative and inject it. We don't know that you are going to cause the cuff to tear by injecting it. Certainly not once. Maybe five injections or more is probably not a good idea and I would definitely not recommend that. But with regard to a single injection in the setting of partial thickness cuff tear, there is certainly no evidence that it is in any way going to make the cuff tear and fall apart. But that is a controversial area.
The only reason not to do a cortisone injection in my mind -- and I'm not talking about five or multiple but one or maybe two injections -- really is if you are going to be operating on the patient some time soon and you don't want cortisone bathing the tissue. Other than that, I don't think a single cortisone injection is going to make the cuff become irreparable or deteriorate significantly. So I do inject partial thickness tears because I think they can get better. I think a lot of the stuff we see on MR, a lot of us may have partial thickness tears and they may develop subacromial bursitis and the partial thickness tear starts to hurt. Now a lot of those will get better and they live fine with the partial thickness tear.
So just because we pick up a partial thickness tear on MRI doesn't necessarily mean we have to operate on it. If they don't get better, that is a different story.
I think that ultrasound is very operator-dependent. With the ultrasonographers here -- and I am going to talk about some of their work later on -- I think it is very appropriate and I will get ultrasounds for cuff tears. Usually I will use it in the setting of someone who can't have an MRI because of size, claustrophobia, pacemaker, but with our operators I think ultrasound is reasonable. I think one of the main advantages of MRI is that it gives you a lot of other information, shows you the labrum that you don't see very well and it also shows some things maybe you are not expecting, such as a lesion in the humerus further down. It shows the muscle quality a little better. So I get more information on the MRI, but if you are talking about just evaluating whether or not there is a cuff tear, I think that ultrasound in the hands of a skilled examiner is reasonable.
Let's just talk about how I inject the subacromial space. Once you have a little bit of practice, it is not that hard really. I just mark out the acromion. I actually draw the anterolateral corner of the acromion on a patient with one of our markers that we get from the operating room. So then when we prep, it doesn't rub out. Then what I do is have the patient relax so you can pull down on their arm, which is not that easy to do, because they are nervous about having the injection. But by getting them to relax and pulling down on their arm, you can really open up the subacromial space and make it easier to get the needle in through the lateral approach.
I go 1 cm down and 1 cm posterior to the anterolateral corner of the acromion and just sort of shoot across. You should be able to get into the space in most cases pretty easily.
The other thing is that it shouldn't be that hard to inject the fluid. If your needle is in the right place in the subacromial space, then you should, with a 22 gauge needle, be able to squirt the solution in without too much resistance. So if you are having resistance, you may not be in the right place and it may be worth repositioning.
I like to keep the patients around after I inject them, mainly to check their response. Hopefully, they are not having any side effects with the injection, but I like to reexamine them, check the cuff strength and check the impingement signs to see if they are having any relief, because there is local anesthesia, and theoretically you are freezing the subacromial space and eliminating their pain.
If they don't feel better 15 to 30 minutes after the injection, I think that you have to consider you were in the wrong place. If you are experienced at this, then you are probably in the right place and if they don't have any relief at all, then I think you have to reconsider the diagnosis -- that maybe it is not coming from the subacromial space and the cuff. Usually there is at least some improvement after the injection. At least they will say they feel some relief.
If injection doesn't work, that is they don't feel any better afterwards -- I am not talking about in the office, but when they come back in a number of weeks and they are not better -- I think that you can consider a second injection. We kind of talked about this. I think it depends on multiple factors such as if you did the first one. If you didn't, then it is reasonable to do the second because you don't know that the quality of the first injection, the result of the injection -- whether it helped them for awhile and then they were good for three months and then kind of got worse or good for a couple of years -- then I would certainly consider reinjecting. If there is a tear present that you are probably going to be operating on if it is a young person with some weakness. For example, then reinjection is probably not indicated. Then of course there are patient demands and expectations.
Once you have decided that non-operative management is no longer a reasonable option, surgery is then considered. That can involve a decompression where the acromion is flapping and the CA-ligament is released to make more space in the subacromial area and also bursectomy. I think the bursectomy is really important because sometimes I see the scarred, red inflamed tissue and I thing patients get relief after debriding that out with the shaver. Sometimes I will note fairly early on that they feel better even though they have had surgery, and I believe that it is because of the bursectomy and then, of course, repairing the cuff.
When is surgery indicated for cuff disease? Well -- impingement syndrome, bursitis that doesn't respond to non-operative management, or cuff tear in the same setting or acute cuff tear with significant weakness which. I think that it is important not to operate on chronic painless cuff tears with weakness. That is, someone who has weakness but no pain -- unless there is an acute injury, which is different because then they may have just pulled the cuff off and if you put them back you can give them the shape back -- but who has a chronic cuff tear that clearly has been there for a while based on MRI evidence of retraction, no history of injury, some fatty degeneration in the cuff, I think those are people that are not going to be happy if you operate on them because returning their strength is unpredictable and they really don't have pain that they are complaining of. So these people are risk of being unsatisfied.
I used one case example of a patient who is a 61-year-old man who is a very competitive tennis player and went to tennis camp a few weeks at a time during the year. He went to hit a ball and suddenly felt his shoulder go and tried to keep playing but couldn't, tried to get back to tennis but really was unable to, and here you can see his cuff tear involving the supraspinatus.
Looking at the anatomical areas, going from back to front, this is the posterior shoulder, so you see the infraspinatus coming up here. This is the teres minor. We are sort of out of the plane. These are a little tough to image in this plane. As we come forward you can see here is infraspinatus here, this is some of the injury you can see coming from below the spine. Here is supraspinatus so some of the infra is involved in this area, and here we are more anterior, we are above the spine now and this is supraspinatus. This is the acromion so this is the subacromial space, and you see that the supraspinatus tendon which is not coming out here and kind of pouring out here. We are even further anterior now, and here is the suprascapular knot with the suprascapular artery and nerve. And here you can see it is not too far from the glenoid remnant to release the cuff. We have to keep that in mind. Here is the supraspinatus muscle and there is the tendon and you can see it is clearly not attached.
So this gentleman, at six weeks after his injury when I saw him, was very weak and really couldn't lift his arm and wanted to go back to playing tennis.
[A brief video of the surgical procedure was shown.]
The cuff repair can be done arthroscopically, through portals instead of an open incision where the deltoid is being passed. The main advantage here is that it is less dissection. It takes just as long for the cuff to heal back. So the rehabilitation is the same, but it just is a little more comfortable for the patient. Sometimes they feel so good they want to move their arm and lift their arm before the biology has had a chance to work. So sometimes you have to hold them back a little bit as opposed to the open shoulder procedures.
I am going to discuss the pathoanatomy of shoulder instability, a little bit about the natural history, which I think impacts a lot on the treatment plan, and the definitive management and surgery.
Anterior dislocations are by far the most common and most frequent dislocations seen in the emergency room, and the mechanism is usually abduction or external rotation. Here is the pathoanatomy of the dislocation, which is where the labrum gets pulled off the front of the glenoid, which is called a Bankart lesion. On the MRI in this axial cut, you can see the labrum nicely pulled off the glenoid.
This is an arthroscopy. You can see the labrum pulled off, this is the glenoid here, the probe is pulling the labrum off anteriorly and schematically where the Bankart lesion typically occurs on the pear-shaped glenoid anteroinferiorly.
The natural history is really the key when treating these injuries, because we know that people under 20 will have close to a 100% chance of recurrence, particularly if they participate in contact sports. They are almost guaranteed another dislocation at the very least. In contrast, in older patient sustaining their first shoulder dislocation, recurrences are very unlikely. In this graph you can see that in patients under 20, particularly the athletes, their chance of recurrence is almost 100% and, as we get up here in age, the chance of recurrence is very low. So the younger patients are the ones we are aggressive with in terms of operating, and the older patients I would say should never have an operation after a first-time shoulder dislocation.
I am not talking about multidirectional instability, where they have either some collagen disorder, or just very lax ligaments, whereby they begin to have instability without any trauma. These are generally patients who have either a high energy injury from a contact sport or at least your non-athlete who has fallen and dislocated their shoulder, but at least there is some level of trauma.
I think the recurrence, generally, if it is going to recur, will recur within a few years. It is uncommon to see people five to 10 years without having a recurrence. So probably the pathoanatomy of the injury and the patient's activity level will combine to yield a recurrence within a few years -- I would say within five. To have a recurrence beyond 5 years is somewhat uncommon, although it definitely happens.
Generally if the patients are not having surgery, they are immobilized. This may not make a difference. It may be more related to the injury and their activity level. Recently, there was a study presented at the American Academy of Orthopaedic Surgeons, in which a Japanese orthopaedic surgeon began to immobilize people in external rotation, believing you are pulling the capsule across and reducing the labrum back to where it should be. This actually makes sense as opposed to leaving the internal rotation and the capsule is lax and falls away from the glenoid. But this is a fairly early work, and we will have to see how this bears out.
So is surgery necessary? Well I think for recurrent dislocations, it is certainly appropriate in order to prevent further ones. It is really the only way to stop - further dislocations with activities of daily living or in people who want to play contact sports, and as I said, age is really a factor. I think that it is reasonable to repair a first-time 18-year-old college athlete. But for someone who is 40 years old and not very active in sports, definitely a first-time dislocation should be treated conservatively.
I am not aware of any influence of race or body habitus or size on recurrence rate. There has been shown to be a familial predisposition in that there are people who have a family history of a high rate of shoulder dislocations, but how that relates to race I am not sure.
I think the differences and outcomes across gender are certainly very complex and multifactorial issues, which I don't think we have a very good handle on. In the setting of shoulder instability, I think it is more common in males due to their involvement in contact sports. But as to the outcome from surgery, I don't think we understand the gender differences very well at this point.
So the surgery for shoulder instability can either be done arthroscopically or open. Arthroscopic surgery using thermal energy has fallen out of favor in most circles. We gained a lot of enthusiasm due to the fact that it is fairly easy to do; if you can arthroscope the shoulder, you can use this heat wand and theoretically shrink the capsule. But I don't think it is really very good for the tissue and hasn't worked very well overall.
So again, arthroscopic surgery can be performed for a lot of cases, but it really depends on the pathology. There are some cases where it should probably not be performed, such as when the ligaments are not detached on the labral side, such as in a Bankart, but pulled off the other side on the humerus. This is fairly uncommon but is termed a humeral avulsion of the glenohumeral ligament. If there are big glenoid or humeral sided defects, these should probably be done open as well, because they can dislocate into their bony defects and probably more soft tissue work is required in order to achieve this arthroscopically. And if there is poor quality of capsular tissue, that should probably also be done open as well.
Some cases, where maybe it should not be performed -- contact athletes. It is a little controversial as to whether they should be done arthroscopically. There are failed arthroscopic procedures, so perhaps you should do an open one for a higher degree of predictability. In glenohumeral arthritis or in a setting of multiple dislocations, where they have had quite a few dislocations and the capsule is quite stretched, you can get a better shift open and transfer more tissue to tighten it better than you can arthroscopically. If someone has had a lot of dislocations, I will recommend an open procedure.
Two case presentations of some shoulder instability can demonstrate cases that are a little out of the ordinary. We did an open surgery on a youngster who dislocated twice snowboarding. He does crazy things with his snowboard, and after his second one he decided he wanted to have surgery. His MRI was done at an outside facility, but they did it with gadolinium and actually did a great job. You can see the labrum that maybe is a little detached there, but here you can see the anterior capsule, where the labrum looks okay but the capsule looks like it's pulled off the humerus, which again is very uncommon. It is usually almost always on the labral side, and here this is pretty convincing.
So when we took him to surgery, we went in first with the plan to repair this humeral avulsion. You can see that the labrum is detached here from the glenoid and here as well, which we repaired arthroscopically with a couple of anchors. So we had planned to go ahead with the open procedure and did so. We looked over here for the lesion on the humeral side. You can see a little erythema, but you really can't see that it is very well detached off the humerus which is important. You can't really see these lesions that well arthroscopically
This is an open surgery, and this is the deltopectoral incision in the front of the shoulder. His arm extends down here, and this is his left shoulder from the front, so it is the front of the left shoulder. The pec is over here and the deltoid here, so we're in the deltopectoral interval. And this is the subscapularis tendon, which we are dissecting off the humerus to find the capsule below. Over here, there is no capsule, there is just a hole and you can see we dissected the subscapularis off. Further, there is a bigger hole, and when I got the capsule off altogether, you can see that the edge is very rounded and that wasn't going to heal back. Here is the subscap over here, tagged and retracted, and this was not going to go back to the humerus. Actually, when we tried to sew this tissue, it was very friable. Here is the completed dissection.
So now we are viewing with the humeral head retracted out of the way, looking into the glenoid. You can see our anchors here from our fixation; this is the capsule now completely detached around inferiorly, and we can now use this capsule. However, we want to pull it and shift it up in the humerus and tighten up the shoulder. Just an example where shoulder instability isn't always a Bankart lesion.
Another case is a 30-year-old man who had two prior operations, one arthroscopic and one open, and had over 50 dislocations. On the CT scan, you can see it looks like someone took a bite out of his humeral head here, and this is a Hill-Sachs lesion in the posterolateral humeral head. With these lesions, when they abduct and externally rotate, they can dislocate into that bony defect. A Hill-Sachs is essentially a fracture but recurrent dislocations sort of grind down the humeral head. The first one is really an impaction fracture, and then they just have multiple recurrent impaction fractures. , In the end, they have an indent in the posterolateral humeral head, which you can see.
This is sort of a chronic setting, where the bone, over time, has been impacted and remodeled into this position. This is cancellous bone; it is not healed like a cortical shock factor. This is lower down, and you don't see the defect. But basically you can see that you already have some chondral wear from these repeated dislocations, and this is a Hill-Sachs lesion. This is the edge of the glenoid, and you can see that the capsule isn't attaching. Actually, the anchors were placed a little too far medially, so we revised this open and removed the previous suture material. Here at the end of the procedure are the anchors that were used for the lateral shift. You can see the previous anchors were too medial. This one came out altogether, and our anchors are now reapproximating it more anatomically. He went on to do very well and has not had any recurrences about a year out.
Glenohumeral osteoarthritis, which I think you are all fairly familiar with, is somewhat uncommon compared to hip and knee arthritis. Certainly shoulder replacements are done -- about 1 for every 50 knee replacements. Generally, the treatment is activity modification, anti-inflammatories, and physical therapy, and then total shoulder replacement if these things are not effective. This is an example of a severely arthritic glenohumeral joint with complete joint space loss. I treated him with a shoulder replacement with a prosthesis in the humerus and a cemented glenoid on the glenoid side. These procedures are very effective for people with any stage of glenohumeral disruption.
The pain relief is predictable and the survival is similar to the total hip and total knee. Potential complications are significant, such as infection, instability in the shoulder, and potential for nerve injuries. So these are generally reserved for people who really fail conservative treatment and have pretty advanced glenohumeral arthritis.
As the X-ray showed, this can often be made very easily in end-stage arthritis because the shoulder motion is so limited and you just feel that horrible sense of crepitus as you move it. Basically, we do extensive soft tissue releases to recreate the anatomy and balance the soft tissue at the time of surgery. Often you don't have normal motion, but in some cases they can have near normal motion after the surgery, even though beforehand they had no motion. The lack of motion is due to soft tissue contractures, large osteophytes and pain and, with those things resected and the tissue released and put back in its anatomical position, the motion can be greatly improved and the pain also.
So-called rotator cuff tear arthropathy, which is also known as Milwaukee shoulder, occurs where a massive rotator cuff tear will allow the shoulder to migrate up and just degenerate and become very severely arthritic. It is very uncommon to get end-stage arthritis in the setting of a massive rotator cuff tear arthropathy. So for all the cuff tears out there, there are a very few that develop that and we don't really know why they do. Those are sort of subsets. By far the most common primary osteoarthritis is what we call wear-and-tear arthritis that we will see in hip and knee patients, and we don't really know why. It is probably genetic, but possibly related to activity. Sometimes we will see it in people who have had hips or knees replaced, and it is probably related to the genetic basis for that disease.
In osteoarthritis, I would definitely not do surgery to regain motion. You do it for pain. Generally I wouldn't do shoulder surgery just for motion, almost across the board. That is obviously a blanket statement, but for the most part, you want to be operating for pain, because that is going to leave the patient satisfied. These long- standing glenohumeral OAs develop significant soft tissue contractures around the shoulder. Releasing these contractures at the time of surgery, we completely release the capsule around the inferior pouch and dissect it off the humerus. We test it at the time of surgery to make sure we have adequate motion to take the front of the capsule totally off -- so that they should regain close to a normal shoulder motion. Now these are for arthritis, not the fracture situation, which is different.
But I wouldn't have someone come in with a little bit of pain, a little arthritis and say my shoulder is stiff and recommend a shoulder replacement. That is an important point.
Adhesive capsulitis, also known as frozen shoulder, is really important to know about in the office setting. I am talking about primary adhesive capsulitis, not iatrogenic post-surgical things. We don't really know the etiology of this condition. It may be viral, and there are four stages that I think are really critical to understand, because they relate to the prognosis and the treatment.
Now these stages are somewhat controversial, but I believe quite strongly based on my experience and what I have learned here at this hospital, that this is really the way this condition works. Stage 1 is synovial inflammation. Classically, this is a woman in the 30 to 50 age range who wakes up one day and her shoulder is killing her. It is terribly painful and what they have is just an inflammation of the lining of the glenohumeral joint. Subsequently, this goes on to develop fibrosis over weeks to months, although the time frame can vary somewhat. Eventually, they get a fibrotic stiff shoulder which eventually thaws out.
But the point is that early on they often will just have synovial inflammation and, if their glenohumeral joint is injected with cortisone and lidocaine in the office, after the injection we often have marked pain relief from the freezing. That motion will return while the freezing is in indicates that they have not gone on to fibrosis. And in those patients, that acute injection of corticosteroid can often cure them. So if you can recognize that early stage and inject the glenohumeral joint with cortisone, you can really have a marked impact on that patient's quality of life for a number of months.
Now how do you diagnose it? There are a million patients who come in with sore shoulders. The hallmark is loss of external rotation. They really have a lot of trouble externally rotating because the main area of inflammation is around the coracohumeral ligament and external rotation pulls on that. So these patients won't be able to rotate externally at all. Again, it can be extremely painful.
Posted: 5/28/2003


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The Centre for Base of Skull and Spinal Surgery at the Vivantes Hospital in Friedrichshain, Berlin, which is headed up by Professor Dag Moskopp, offers a broad range of neurosurgical diagnostics and therapies. Neurosurgery is a relatively new discipline that involves close collaboration with other fields of medicine as many physical disorders are also manifested in the central nervous system.
As a specialist medical field, neurosurgery has benefited more than most from advances in microsurgical and minimally invasive techniques, state-of-the-art imaging and computer and navigation technologies. Professor Steiner, Senior Consultant at the Neurosurgery Department at Nuremberg Hospital South, is able to utilise the latest medical equipment for neurosurgery.
The Department of Neurosurgery at Duisburg Hospital, part of the Wedau Hospitals group, has many years of proven experience in treating neurosurgical illnesses, including the severest of cases. This wealth of expertise was established by the department's first Senior Consultant, Professor Bettag, and his successor, Professor Werner Hassler. Professor Martin Scholz has been Senior Consultant since October. A respected specialist in microsurgery and endoscopy, he is building on the tradition laid down by his predecessors.
The St. Mauritius Therapy Clinic at the Düsseldorf Catholic Hospital Group (VKKD) is the most modern neurological rehabilitation clinic in western Germany. Patients benefit from an experienced neurological rehabilitation team and a dedicated, state-of-the art diagnostics department with an MRI scanner and a robot-assisted treatment unit.
The Department of Neurosurgery at the Charité University Medical Centre in Berlin offers internationally renowned expertise in neuro-oncology, vascular neurosurgery and spinal neurosurgery.
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TORONTO (Reuters) - Bombardier Inc (BBDb.TO) said on Wednesday it has inked a deal to sell Russian aircraft leasing company Ilyushin Finance Co up to 42 of its new C-series jetliners in a deal that could be worth as much as $3.42 billion.
The agreement, which is subject to a vote by Ilyushin shareholders, expands on a tentative agreement signed in 2011 to buy at least 10 of the aircraft.
Montreal-based Bombardier's shares rose about 3 percent in the final 20 minutes of trading after the deal was announced. The shares finished the session up 4.1 percent at C$4.28 on the Toronto Stock Exchange.
Ilyushin will buy 32 of Bombardier's 130-seat CS300 jetliners for about $2.56 billion, based on the list price of the aircraft. It has an option to purchase another 10 jets, which could bring the total value to about $3.42 billion, Bombardier said.
"Ultimately, it's a good deal in that it seems to quite a bit bigger than was originally envisaged," said David Tyerman, an analyst at Canaccord Genuity.
He cautioned that large deals with leasing companies tend to be finalized at lower prices, which can make it harder for airlines to squeeze margins from them.
Bombardier, the world's No. 3 plane maker and largest passenger train manufacturer, said in November it was delaying by six months the inaugural flight of the C-series planes, which mark an attempt to muscle into the mid-size jet market dominated by Boeing (BA.N) and Airbus EAD.PA.
The CS300 is not expected to enter service until the end of 2014.
As of the end of 2012, Bombardier had booked orders and commitments for 382 C-series aircraft, it said.
Bombardier will report fourth-quarter results on Thursday,
Reporting By Cameron French; Editing by Gary Hill and Leslie Adler


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Corn prices have traded in a sideways pattern since mid-October, but are currently in the lower end of the recent range, said a University of Illinois agricultural economist.
"Soybean prices have trended lower over the past month with January futures now back near the early October lows," said Darrel Good.
"Corn prices received little support from last week's USDA Crop Production report containing a lower forecast for the size of the U.S. crop. The U.S. average corn yield is projected at an eight-year low of 146.7 bushels, 1.4 bushels below the October forecast," he added.
"The potentially positive price impact of that reduction was muted by USDA's judgment that feed and residual use of corn will only reach 4.6 billion bushels during the current marketing year, 100 million bushels below the October forecast," he said.
The forecast is 192 million bushels below the surprisingly small estimate for the previous marketing year.
"The lower forecast for the current year was not offset by an increase in the projection for feed use of other grains. The projection of domestic soybean meal feeding was also reduced marginally," he said.
Good said the lower projection of feed and residual use of corn reflects prospects for reduced broiler production as placements continue to run 6 to 8 percent below the pace of a year ago. He added that, although it is not cited as a factor for the reduction, the recent slowdown in exports of distiller's grain may boost domestic feeding of that product.
According to Good, the pace of domestic feed and residual use of corn will be revealed in the USDA's Dec. 1 Grain Stocks report to be released on Jan. 12. The experience of the past two years, however, suggests that the level of domestic feed and residual use may remain uncertain until the Sept. 1, 2012 stocks estimate is released.
"Ethanol production during the first 10 weeks of the 2011-12 marketing year was about 2.2 percent larger than during the same period of a year ago.
Ethanol uncertainty continues
"While uncertainty persists about ethanol demand and production without the blenders' tax credit in 2012, the current pace of production supports the USDA projection of 5 billion bushels of corn used for ethanol this year," he said.
Ethanol exports, particularly to Brazil, are a major part of the current increase in ethanol production. Those exports are vulnerable in the longer term if world sugar production rebounds and sugar prices moderate.
"The USDA still expects U.S. corn exports during the current marketing to be at a nine-year low of 1.6 billion bushels. Exports have been less than 1.6 billion bushels only six times in the past 36 years. Through Nov. 10, the pace of weekly export inspections continued to run well below the average pace needed to reach the USDA projection," he said.
The Census Bureau corn export estimate for September was not substantially larger than the USDA inspection estimate. The level of outstanding sales is larger than that of a year ago, but new sales were small in the latest reporting week ended Nov. 3.
The USDA's November forecast of the U.S. average soybean yield of 41.3 bushels was 0.2 bushels below the October forecast and 2.3 bushels below the 2010 average.
"The forecast represents the lowest yield since 2008 and the second lowest since 2003. Like corn, the lower yield and production forecast generated little price strength due to a 50-million-bushel reduction in the forecast of exports and a 35-million-bushel increase in the forecast of year-ending stocks," Good said.
He added that the pace of U.S. soybean exports remains well below that of last year. However, the anemic pace of new sales in the last two weeks of October was followed by large new sales in the week ended Nov. 3.
"Production prospects remain generally favorable in South America, although USDA made a modest reduction in the forecast of acreage in Argentina and Paraguay. Those reductions were offset by larger yield forecasts for Brazil and Paraguay," he said.
Although futures prices for corn remain in a relatively narrow range, basis levels generally remain quite strong and at record levels for this time of year in some markets.
"Spreads in futures remain very choppy, with the December-July spread fluctuating between 18 and 23 cents," he said.
The apparent battle between current demand strength and expected weakness in 2012 continues.
"In contrast, soybean basis remains near typical levels and spreads are generally large. The January-July spread, for example, is near 30 cents, compared to only about 5 cents in early September. The weak basis and the relatively large carry reflect the generally weak demand situation," he said.
For now, January soybean futures are holding just above the early October lows while December corn futures are well above the early October lows, but near the low end of the recent trading range.
"The recent sideways trading pattern might persist for an extended period, but the deterioration of market fundamentals suggests that prices could drift lower into the winter months," he said.


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My mom and I were driving home this evening and saw traffic backed up on Main St. We couldn't figure it out until we saw people driving around a small cat in the middle of the street, bleeding and twitching. We pulled over and my mom stopped traffic while I picked him and got him out of the road. We wrapped him in a blanket and petted him and loved him for about a minute before he died in my arms.
RIP little kitty - you were loved, if only for a minute.


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The thing that stood out most in listening to Terry Collins this morning is his emphasis in "playing the game the correctly.''
Collins promised an accent on fundamentals with a team that too often disregarded them in the past. This is a team that gives away too many at-bats, both at the plate and on the mound, and loses focus.
That is the culture Sandy Alderson and Terry Collins vowed to change.
One thing apparent in Alderson's comprehensive search and handpicking of Collins as manager is the continuity between the front office and field staff. There will be no more players taking their issues over the manager to the general manager.
That was the chemistry in Anaheim when the players revolted against Collins, and with the Mets when Tony Bernazard sabotaged Willie Randolph, and the last two years when Jerry Manuel managed without the respect of his players.
Collins said the right things, but there's more I'd like to hear from him:
THE CORE: Collins wants the game played correctly, but hasn't elaborated on what he doesn't like about David Wright and Jose Reyes.
Wright put up decent numbers last season, but they were somewhat deceiving because of his strikeouts. Wright still gives up too many at-bats to kill rallies. The right way also means increasing Reyes' on-base percentage. Injuries have limited Reyes from running and if he's healthy will Collins turn him loose?
CARLOS BELTRAN: Collins mentioned how badly Beltran wants to win. The team will keep Beltran because of his contract. Collins hasn't said yet whether he wants Beltran to move to right field to make room for Angel Pagan in center.
THE BULLPEN: The Mets will offer arbitration to Pedro Feliciano. If he accepts the Mets will have a proven lefty specialist. With the assumption Francisco Rodriguez is back as closer, the next order of business in the pen will be designating a set-up man. Presumably, that will be Bobby Parnell. The Mets must now fill four spots in the bullpen. How many could be filled from the minor league system Collins oversaw last summer?
THE ROTATION: With Johan Santana on the shelf indefinitely, the Mets have three starters heading into the winter meetings: Mike Pelfrey, RA Dickey and Jon Niese.
With the Mets not expected to be free-spending in the free-agent market, their options are from within, trades and middle-tier arms in free agency.
Collins must operate on the assumption there won't be any significant additions so his thoughts on Dillon Gee are important. As it is now, no matter how healthy the Mets are with Jason Bay and Beltran, it means little without a strong rotation.
Alderson wants to unload Oliver Perez, but that's a monumental task. Assuming the worst, that Perez is still here in the spring, how does Collins envision using him?
SECOND BASE: There are three candidates: Luis Castillo, Ruben Tejada and Daniel Murphy. If Murphy can handle the position defensively, he offers the best bat.
Collins knows Tejada from the minor leagues and probably has an idea of his ceiling.
JENRRY MEJIA: As of now, the Mets regard Mejia as a potential starter. With Collins' background in player development he likely has his ideas of how he was used last year and what his timetable might be.


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Almost like clockwork, the precision of quick response to a fire call, you could count on members of the Shiloh-Zion Volunteer Fire Department to be in our neighborhood. They were selling tickets for their annual barbecue chicken fundraiser, which they hold the first Saturday in February. They've been doing so for 35 years.
Prior to writing a feature in our "Always on Call" series, that was the most I knew of the volunteer fire department, which serves our Arrowood neighborhood and others in north Lancaster County.
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We are pleased to announce two new repositories of Open Source code for the BlackBerry® development platform. We have a repository of Java® sample code, which includes our BlackBerry JDE samples from the 7.0 SDK and a repository of samples previously released through our Knowledge Base. Now these popular code samples are available through the Apache License, version 2.0, which allows developers full access to use these code samples in their applications and extend the samples further.
If you aren't familiar with the samples included in the BlackBerry tools, I'd recommend taking a look at our JDE-Samples repository if there is an API you are curious about. There are 100+ samples included which cover each major API. Our JDE-Samples repository will include these samples for each version of the SDK.
This repository uses Github's support of branches (e.g. see Pro Github's Chapter 3), to keep the samples for all the JDE releases in the same directory. For example, the in-device samples for JDE 4.6.1 are here. There are currently 8 branches, plus the master branch. There are also 8 tags, one for each of these branches.
Our Samples-for-Java repository includes five sample applications and we will continue to add more in the future. The popular Advanced UI sample – with its many containers and components – is included. The Knowledge Base article for this sample shows some example screenshots so you can see what it can do. We've also included the Simple Location API, the Titlebar API, and sample apps for Analytics and a YouTube® client. Read on for more details on these samples.
Advanced UI: If you have ever wanted to take your UI designs further, this is the first place to look. There are several button extensions included, allowing you to use Bitmaps for buttons, use Embossed buttons, create hyperlinks and button lists. There are also toggle switches, sliders, ratings, and pill buttons that you can use in your applications. Advanced managers allow you to quickly create new layouts, like justified horizontal and vertical layouts, or 2-column screens. Finally, progress animations and bitmap gauge fields add polish to your UI.
Additional details and more screenshots like the one above are available in the Implement advanced buttons, fields, and managers article.
Simple Location API: Using GPS is not always the easiest task, and this code aims to change that for when you just want location information. It automatically handles carrier and device hardware support differences and battery usage concerns.
More details in the Knowledge Base article Simple Location API.
Titlebar API: Many different applications have a need for consistent system displays in their application. Basics like network coverage, the time, or the name of an application are desirable standards for an application to display at the top of the screen. In the BlackBerry Java SDK v.6.0, the Titlebar API was created for this purpose, but there are still plenty of OS 5.0 devices out there, and some of us need to support some of the 4.x code lines as well. This library attempts to port that 6.0 Titlebar API back as far as the 4.2.1 SDK. A preprocessor based wrapper allows you to code with one Titlebar class and build with any version of the SDK from 4.2.1 through 7.1.
The full Knowledge Base article including images is available: How To Implement a TitleBar with Signal Strength, Battery Level, Icon, Unread mail and Clock
Analytics Sample: This sample implements each of the BlackBerry Analytics SDK methods so you have a handy reference. If you sign up for the service, this sample is included in the SDK download, but with it being open sourced we can continue to expand on it.
YouTube Client: Originally published to both our blog and YouTube's blog, this sample shows you how to work with the YouTube Data API using the BlackBerry Communication API from the 6.0 Java SDK. It's a great starting point for either API or if you are doing a quick proof of concept with YouTube interaction. Further details in the Knowledge Base article: How to – Create a YouTube viewer with the BlackBerry 6 Communication API.
Check them out and see where the code takes you!


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If a picture is worth a thousand words, then Stanley Fletcher's slides at recent peanut meetings are figuratively worth at least two thousand for the perspective they provide to the changes in the peanut industry.
In one slide, a tractor rides a giant wave, with peanuts about to be drowned in the background. In the other, a rainbow completes its arch on a peanut field.
Whatever your perspective, "the whole thing comes down to demand versus supply, basic economics," says Fletcher, coordinator of the National Center for Peanut Competitiveness and University of Georgia ag economist. He participated in a panel discussion at the 34th annual American Peanut Research and Education Society that looked at the impact of the new peanut farm bill on runners, Virginias and shellers.
For runners, the new farm bill means an increase in use and better returns than cotton. But it also means wholesale changes in the way peanuts are stored and marketed.
In the Virginia-Carolina region, the situation isn't as rosy. "There are very few bright spots here in the V-C," says Blake Brown, North Carolina State University Extension economist. He sees production shifts inside and outside of the V-C area — as well as decreased domestic use of Virginia-type peanuts.
From a sheller's perspective, "there are many more good points than negative points," says Marshall Lamb, ag economist at the National Peanut Research Lab in Dawson, Ga. On the legislative front, the strategy of the Senate to increase the House's original funding for peanuts resulted in a higher target price and payment of storage and handling costs that are put under the loan," says David Rouzer, senior policy advisory to U.S. Sen. Jesse Helms. Rouzer said the debate on the pros and cons of the old program was over once the bill came out of the House. Had the Senate used any other strategy, "we would have ended up with the same new program, but the funding we were able to secure for peanuts would have gone to dairy, sugar and other titles of the new farm bill.
"There would have been just too big a split between producer regions and the industry as a whole for us to hold funding even at the House level," Rouzer says. "Considering the politics and the split between grower regions, we are fortunate to get what we did."
In the runner market, it's a classic demonstration of supply and demand. The demand has been generated by the work of the National Peanut Board, state grower organizations and the Peanut Institute. "Given time, you'll see an increased demand," Fletcher says. The demand will fuel the supply.
Even at $355 per ton, runner peanuts still beat cotton when looking at variable costs, Fletcher says. Researchers at the NCPC looked at nine representative peanut farmers in Georgia, Alabama and South Carolina. Fletcher looked at 1997-98 production costs for a farm averaging 3,000-4,000 pounds per acre.
"Peanuts at $355 per ton will give the producer much better returns than cotton under irrigation," Fletcher says. "Dryland production doesn't look as good, however."
Outside of the production arena, the new peanut program exposes grading, storage and vertical integration issues that will force farmers "to think outside the box," Fletcher says.
"Grading issues present a drastic change and need to be translated down to the producer," Fletcher says. "Storage is also a big concern: How will on-farm storage take place?"
The most drastic change of the peanut farm bill occurs at the buying point level, the place where the farmer delivers his peanuts, Fletcher says. Many of the newer varieties will have the high-oleic characteristic.
The changes will move the runner market to some form of vertical integration, while two shellers hold a market concentration of 70 percent to 80 percent.
"If the peanut industry goes the route of grain marketing vertical integration, producers will have less and less control," Fletcher says. He encouraged producers to "think outside the box and move up the line," supplying directly to manufacturers. He points to wheat growers in North Dakota who market pasta.
Despite the increase in demand for runner peanuts, there will be fewer research dollars, because funding from state grower organizations is based on tons produced. "Research is going to make or break us," says Bob Sutter, CEO of the North Carolina Peanut Grower's Association, who moderated the panel.
"I may not be able to tell you how much it's going to rain," said Blake Brown, North Carolina State Extension ag economist. "But the clouds are pretty full and it looks like it's going to rain."
An increased substitution of runners for shelled uses of Virginias will likely lead to a net decline in the use of Virginia-type peanuts, Brown says. "Shellers have greater incentives to maximize fancies for in-shell use and minimize use of Virginias for peanut butter." Contracts will become more important in the V-C region as processors and shellers work with farmers to "vertically coordinate" to increase supplies of in-shell peanuts.
In the short-term, before trade liberalization takes effect, price will probably settle on the lower side of a range from $375 to $400 per ton. Some contracts in Virginia and North Carolina this summer are trending around $30 above the loan rate, although there's still a lot of uncertainty.
The move from quota implies that production will decline in the Virginia-Carolina region. In North Carolina, counties such as Northampton and Halifax will see declines, while North Carolina "Blackland" counties and southeastern counties may increase.
In a nutshell, that's the situation in the V-C. The forecast revolves around questions such as, "At what price will a west Texas producer choose to grow an acre of Virginias instead of an acre of runners?" Brown asks. In the "Prairie Gateway," total production costs are below loan rate.
Overall, there will be a decrease in Virginia-type production in Virginia and North Carolina and an increase in west Texas, Brown says.
If the price of Virginias settles at $375-$400 per ton, this would be above the previous price for additionals, meaning that exports should decline, creating an upward pressure on the world prices for in-shell peanuts.
He believes producers in the V-C area will have to look to a gourmet-type market, to minimize the erosion of their market.
From the shellers' perspective, the new peanut bill goes a long way toward reducing market exposure and decreasing fixed costs for shelling a ton of peanuts, says Marshall Lamb, ag economist at the National Peanut Research Lab in Dawson, Ga. It spreads out the purchase of farmer-stock peanuts up to nine months, potentially benefiting both the farmer and the sheller.
"There are far more positives than negatives," Lamb says.
The new law also means improved shelling efficiencies, increased domestic consumption and an increase in market share. "Only 2,500 to 5,000 tons of the imported peanuts that have been coming into the U.S. were shelled by U.S. shellers," Lamb says.
About 25 percent of the total shelling costs is fixed cost, and doesn't include the cost of the peanuts. "At optimum capacity, a 10,000-ton change in farmer stock peanuts equates to an $8 a ton change in fixed costs."


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European Go Federation
Latest 10 news
2 years 26 weeks ago
60th European Go Congress Ends in St Petersburg
Sat, 06/08/2016 - 18:14
The 60th European Go Congress closed in St Petersburg with the closing cermony on Saturday 6th August, just after the end of the European Open. Of the 597 players in this Kim Young-Sam, 7d Korea, was the best taking the Open title on tie break.
Annual General Meeting, some Updates
Mon, 01/08/2016 - 16:49
Like last year 22 countries sent a representative to the assembly. With different numbers of votes for each country, the majority was reached at 26 votes. Some countries have only 1 vote because of a reduced membership fee, most countries have 2 votes and the bigger countries like Russia, Germany, France and Holland have 4.
Ilya Shikshin is 60th European Champion
Mon, 01/08/2016 - 09:05
Ilya Shikshin became the 60th European Champion by beating Ali Jabarin in the final at the EGC in St Petersburg.
60th European Go Congress in Saint Petersburg
Mon, 25/07/2016 - 11:05
The 60th European Go Congress got under way on 23rd July in Saint Petersburg. 456 players took part in round one.
Ukraine win the Pandanet Go European Team Championship
Mon, 25/07/2016 - 10:54
Pandanet Go European Team Championship, with over-the-board finals played at the European Go Congress in St Petersburg, Russia, was won by Ukraine.
Samsung Cup World Division - Preliminary
Sun, 17/07/2016 - 13:25
The Samsung Cup Preliminary was held in Korean Baduk Association's building in Seoul. 12 players from all over the world, including 4 Europeans, came to Korea to try to qualify for the Samsung Cup.
3rd World Collegiate Weichi Championship
Fri, 15/07/2016 - 23:22
The third annual World Collegiate Weichi Championship, organised and sponsored by the Ing Foundation, was held in Toronto/Kanada from 8-12 July 2016. The playing venue and accommodation were located on the University of Missassauga campus.
Interview with Filip Vanderstappen: winner of the Utrecht tournament
Thu, 14/07/2016 - 17:08
The Utrecht Go Tournament 2016, one of the bigger tournaments in the Netherlands, took place in the weekend of 25-26th of June. The top three players all won 4 out of 5 games: Filip Vanderstappen 5d took first place, followed by Robert Rehm 5d in second place and Michiel Eijkhout 6d placing third.
Merlijn Kuin to represent the Netherlands at KPMC 2016
Mon, 04/07/2016 - 11:50
Merlijn Kuin 6d qualified to represent the Netherlands at the Korean Prime Minister's Cup that will take place in Buan from 3-9 September 2016. Kuin defeated Geert Groenen 6d in the finals of the Dutch elimination tournament that took place on the 2nd of July in the European Go Cultural Center in Amstelveen.
Results from the EGF-survey at the last congress in Liberec
Sun, 12/06/2016 - 09:56
At the European Go Congress 2015 in Liberec, together with Prof. Mei Wang (WHU, Otto-Beisheim-School of Management, Germany), I conducted a survey among the participants. Here, I would like to summarize the main results
Google DeepMind announced the non profit recipients of the $1 million prize fund today!
Mon, 06/06/2016 - 12:35
Google DeepMind announced the non profit recipients of the $1 million prize fund from the AlphaGo vs Lee Sedol tournament today. The fund will be split between UNICEF UK, Raspberry Pi/Code Club, the American Go Association, the European Go Federation and the Korean Baduk (Go) Association.
3rd Silk Road Tournament in Urumqi 1-6 Sep
Sat, 04/06/2016 - 19:08
The 3rd edition of the Silk Road International City Weiqi International Tournament will be held in Urumqi, China, from 1 to 6 September. In order to commemorate the historic trading route, the Silk Road, this tournament invites up to 30 European players (3 dan and stronger) as well as Chinese amateur players.
The biggest simultaneous Go game in Europe
Wed, 01/06/2016 - 14:20
On May 21th a great record was made in St. Petersburg – more than 200 people played Go in the city center. This day, the simultaneous games took place: 27 strongest Go players from all over country were fighting with 191 participants.
German Youth Go Championship 2016 in Darmstadt
Tue, 31/05/2016 - 04:46
40 kids from all over Germany took part in this year's championship – a new record! The tournament was integrated into the Darmstadt Go-days, which meant four days of Go activities, including a whole day of Go lectures, excursions, BBQ, rapid Go and lightning Go tournaments.
Vienna International Go Tournament
Mon, 30/05/2016 - 20:02
Vienna International Go Tournament took place this week-end (May 28th - 29th) in Vienna, Austria. The tournament was held in its usual place, the Vienna Waldorf School. This agreeable area offers a lot of space for playing, but also accommodation and home-made meals for players.
Report On The 8th Kido Cup
Wed, 18/05/2016 - 10:58
This event has attracted many top European players as well as go enthusiasts with its friendly and entertaining atmosphere and a total amount of 10.000 Euro as prize, including cash prizes and attractive Go equipments from Hebsacker Verlag Go Shop.
Russia wins 6th PGETC League A Group stage
Fri, 13/05/2016 - 13:55
The league A of the 6th Pandanet Go European Team Championship has already finished and so we know which four European team will play the finals this summer. In this tournament, national teams play in a league system on the Pandanet – IGS server.
Thomas Debarre sweeps Amsterdam Tournament
Wed, 11/05/2016 - 19:28
Thomas Debarre 6d (France) won the Amsterdam International Go Tournament with a clean slate. He was victorious in all six games, leaving Dominik Boviz 6d (HU), Tanguy Le Calvé 6d (FR), Stanisław Frejlak 5d (PL) and Yaqi Fu 6d (CN) behind in shared second place.
The 2nd European Go Grand Slam Tournament Won by Ali Jabarin 1p
Fri, 06/05/2016 - 17:40
After three rounds of severe competition, Ali Jabarin defeated Artem Kachanovskyi, became the 2nd champion of the European Go Grand Slam tournament. The 3rd place came Pavol Lisy, after winning against Mateusz Surma.


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Aside from reciting the Nicene Creed, the Lord's Prayer, and a few spoken responses to the priest, almost the entire congregation seems content to just stand there staring straight ahead for the better part of ninety minutes.
Some people just cannot carry a tune in a 5-gallon bucket and prefer to NOT sing so that they don't distract other people with their cacaphony.
Like I said, I mouth along... I can't sing and I have a good enough ear to tell
I learnt to sing, by correspondence
Do you mean to say that you learned how to sing via correspondence school?  How ghastly! ÂÂ
The reason why I chose the Malankara Church over the Greek Church was that the congregation actually participates in the liturgy rather than just staring into space. Instead of having a cantor or choir, the entire congregation participates in the oldest liturgy of the Church. Peace.
WHEN I consider how my light is spentE're half my days, in this dark world and wide,And that one Talent which is death to hide,Lodg'd with me useless, though my Soul more bentTo serve therewith my Maker, and presentMy true account, least he returning chide,Doth God exact day-labour, light deny'd,I fondly ask; But patience to preventThat murmur, soon replies, God doth not needEither man's work or his own gifts, who bestBear his milde yoak, they serve him best, his StateIs Kingly. Thousands at his bidding speedAnd post o're Land and Ocean without rest:They also serve who only stand and waite.John Milton, 'On His Blindness'
They also serve who only stand and waite.
How are we supposed to hear God speak to us in the Liturgy if our lungs and vocal cords are behaving like a pair of bellows with fog horn attached to them?
I would be more prepared to agree with this if it weren't for my experience that in Orthodox liturgy someone always has to be talking. But then, that too is the tradition.
I have spoken with many of the people who do not sing in church and appear to be satisfied "just observing" and was I mistaken in what I had thought.Several spoke of feeling overawed by the presence of The GReat King before them and being humbled to silence and full worship.several others spoke of being in the presence of the Holy Ones of the Church and aware of their own unworthiness and worship in meditative thanksgiving for the mercies of Our Great God who allows them to commune with His most precious body and blood. For them the attendance at the service was to mystically enter the Kingdom of Heaven and be present at the Throne of Christ with All the Saints of Heaven.These responses have changed my judgemental attitude about the "non-partricipants" at church. While I still actively participate in the Liturgy, I have discovered that for many their silence is deep and meditative worship at the feet of the Throne of God with great awe and thanksgiving that I can learn from.In Christ,Thomas
Our congregation sings along with the chanter, choir, and priest, when the song is not an overdone rendition. Sometimes the chanter likes to really keep us waiting with his long terirems, the choir sometimes is soo overstylizes that you dont know what on earth they are singing, so our priest always asks them to keep the original simple byzantine melodies which everyone knows or can learn. So when Christos Anesti, Ti Ipermaho (To you the Champion) is sung, the vast majority of our church sings along with them or thats at least what it sounds like. The rest of the liturgy which is chanted such as hte kyrie eleisons are done solo psaltiri/choir.
Is my own parish the only one where worshippers are--how do I put this--well, lazy? Aside from reciting the Nicene Creed, the Lord's Prayer, and a few spoken responses to the priest, almost the entire congregation seems content to just stand there staring straight ahead for the better part of ninety minutes. Aside from a mere sprinkling of folks, the laity seem content to just listen to the choir. I don't get it. Are people just too embarrassed to sing aloud? Granted I tend to do so rather quietly (I wouldn't want to damage those gorgeous windows), but can we at least see some lips moving out there? True, the growth of the number of converts has contributed to the language barrier but it is the phrase "Kyrie Eleison" really that tough? Worse, most of the seniors who attend, who still speak Greek as their first language seem not to say a single word.What really bothers me is that the majority don't even bother with the numerous supplications of "Lord have mercy" or "Grant it, O Lord". This is worship? There should be a lot more to it than just crossing oneself every few minutes. I have a hard time reconciling what I've seen every Sunday for so many years with the vibrant image in my head of what must have taken place inside Hagia Sophia in the tenth century. Much as I hate to admit it, I think we could learn a lot from Protestants when it comes to really putting our heart and soul into our worship, rather than just letting the priest, psalter, and choir do everything for us. Even at midnight Pascha services, I've noticed that our priest has to occasionally remind everyone to sing "Christos Anesti". That's not exactly conducive to the enticement of non-Orthodox attendees who are being introduced to Orthodoxy. In fact, it's an embarrassment.This might bother me a lot less if the same people who are so liturgically tight-lipped didn't start babbling loudly amongst themselves when the Holy Eucharist is being distributed. As the apex of true Christian worship shouldn't this be the most solemn and respectful time to observe? The same thing occurs afterward when the antidoron is being given out. I don't think that this is a characteristic exclusive to my church. Is this a source of irritation for anyone else?
As you might know, we use Old Church Slavonic, which is neither here nor there. My Serbian is fair (at best) and my OCS is totally lacking. Put it all together and you have the recipe for non-participation.
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Chris.perret necesitaba un nuevo diseño de logotipo y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 48 diseños de 11 diseñadores freelance.
NuKona : http://www.nukona.com
Nukona is an early stage startup, providing full enterprise security on the newest devices (iphones/ipads, android devices). Our products will be deployed on these devices, allowing the best devices to fully enable workplace productivity, with apps that are fun to use.
We are passionate about software, and love what we do. We are a couple of geeks that do nothing but code, creating new platforms that enable others to thrive in a changing world. We want this passion for software and creativity to come through, and we want our customers to know that they can trust geeks like us with their mission-critical data.
We believe that enterprise level security is necessary, but not sufficient to be competitive in today's connected world. Harnessing the creativity and passion of workers can only happen if the tools they use are the best tools on the planet, . The best tools on the planet are the Apple platforms, with a close second being Android devices in future. These devices today are not fully secured from an enterprise standpoint.
We create software that allows these devices to become the base platform of choice for all mobile workers while also provide necessary security elements around critical data elements necessary to meet enterprise(business) security needs.
We have two distinct markets/communities that we interact with:
Pharmaceutical/ Financial Enterprise - and their executives
Enterprise CIO's/CTO's. These guys make decisions that will make or lose their company millions of dollars.They need to address the changing world, as their workforce is traveling more, carrying multiple devices. They have to know that their data is secure, but need to support a changing device and connected environment.
App Developer Market
We need to engage the app developers to see our platform and approach in the market as a way of enabling them to be creative and successful with new apps hat have not been invented yet. They can change the world while using our software and process to successfully engage with the above folks that the previously could not interact with. We unleash their potential in new markets, allowing the app developers to compete head to head with Blackberry and Microsoft, on an even playing ground.
Specifically, we want a logo which is distinctive, yet when seen will invoke NuKona. The Logo will be on the head of corporate presentations, and will also be overlaid on small screen devices , so some combination of unique shapes/colors will likely help us achieve goals.
Shape/Color should invoke te concept of Nukona, wven when company name is absent.
We will need a scalable format design:
1. Print Format -
2) Web format designs:
Descubre cómo funciona un concurso de diseño u obtén más información sobre nuestros servicios de diseño de logo.