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ulcer/ul·cer/ (ul´ser) a local defect, or excavation of the surface, of an organ or tissue, produced by sloughing of necrotic inflammatory tissue.
ulcerDermatology A defect in a mucocutaneous surface. See Bairnesdale ulcer, Buruli ulcer, Esophageal ulcer, Kissing ulcer, Pressure ulcer, Rodent ulcer ENT Mouth ulcer, see there. See Aphthous ulcer GI disease Duodenal ulcer, see there. See Cushing's ulcer, Dieulafoy ulcer, Peptic ulcer, Stercoral ulcer, Stress ulcer Ophthalmology A defect on the epithelium of the eye. See Corneal ulcer, Corneal neurotrophic ulcer, Geographic ulcer, Peptic ulcer, Serpiginous ulcer.
Compare: erosion
Synonym(s): ulcus.
ulcer(ul'ser) [L. ulcus, sore, ulcer]
amputating ulcer
aphthous ulcer
Aphthous ulcers are found in stomatitis, Behçet syndrome, Crohn disease, acquired immunodeficiency syndrome, and some cancers.
For patients with oral ulcers, application of a topical anesthetic or a protective paste provides symptomatic relief and makes it possible to eat without pain.
arterial ulcerIschemic ulcer.
atonic ulcer
Buruli ulcer
callous ulcer
Cameron ulcerSee: Cameron ulcer
chiclero ulcer
chronic leg ulcer
Curling ulcerSee: Curling ulcer
Cushing ulcerSee: Cushing, Harvey
decubitus ulcerPressure ulcer
denture ulcer
Patient care
To prevent irritation and ulceration of the mucous membranes of the mouth, denture wearers should clean dentures daily and remove them while sleeping. Poorly fitting dentures should be reconstructed or padded by a denturist.
diabetic foot ulcerDiabetic foot infection.
duodenal ulcer
follicular ulcer
fungal ulcer
gastric ulcer
Common causes are NSAIDs, use of alcohol or tobacco, and infection with H. pylori.
Hunner ulcerInterstitial cystitis.
indolent ulcer
ischemic ulcer
Marjolin ulcerSee: Marjolin ulcer
Meleney ulcerSee: Meleney ulcer
Mooren ulcerSee: Mooren ulcer
peptic ulcer
Common causes of peptic ulcer are factors that increase gastric acid production or impair mucosal barrier protection, e.g., salicylates and NSAIDs, smoking, H. pylori infection of the upper gastrointestinal tract, pathological hypersecretory disorders, consumption of alcohol and coffee, and severe physiological stress. Ulcers occur in men and women and occur most frequently in patients over age 65, with about 1.6 million cases diagnosed annually in the U.S. The relationship between peptic ulcer and emotional stress is not completely understood.
Patients with peptic ulcers may be asymptomatic or have gnawing epigastric pain, esp. in the middle of the night or when no food has been eaten for several hours. At times, heartburn, nausea, vomiting, hematemesis, melena, or unexplained weight loss may signify peptic disease. Food intake often relieves the discomfort. Peptic ulcers that perforate the upper gastrointestinal tract may penetrate the pancreas, causing symptoms of pancreatitis (severe back pain) and chemical peritonitis followed by bacterial peritonitis or an acute abdomen as irritating gastrointestinal (GI) contents and bacteria enter the abdominal cavity. Bacterial peritonitis can lead to sepsis, shock, and death.
Endoscopy (esophagogastroduodenoscopy) provides the single best test to diagnose peptic ulcers because it allows direct visualization of the mucosa and permits carbon–13 urea breath testing, cytological studies, and biopsy to diagnose H. pylori and rule out cancer. During endoscopy, tissue can be excised, vessels ligated, or sclerosants injected. Barium swallow or upper GI x-ray series may also be used to provide images for diagnosis or follow-up and may be the initial test for patients whose symptoms are not severe.
H. pylori causes most peptic ulcers in the duodenum; antibiotics (clarithromycin and amoxicillin) are prescribed to treat H. pylori, and antisecretory (proton pump inhibitor) drugs like lansoprazole or omeprazole should be given to all patients with duodenal ulcers. Bismuth or other coating agents may be used as a barrier to protect the duodenal mucosa. Peptic ulceration of the stomach may be treated with the same medications if biopsies or breath tests reveal H. pylori. When patients have ulcers caused by the use of NSAIDs or tobacco, withholding these agents and treating with an H2 blocker, e.g., ranitidine, provides an effective cure. The prostaglandin analogue misoprostol may also be used to suppress or prevent peptic ulcer caused by use of NSAIDs. GI bleeding is managed initially with passage of a nasogastric tube and iced saline lavage, possibly with norepinephrine added. Gastroscopy then allows visualization of the bleeding site and laser or cautery coagulation. When conservative medical treatment is ineffective, vagotomy and pyloroplasty may be used to reduce hydrochloric acid secretion and enlarge the pylorus to enhance gastric emptying. More extreme surgical therapy (including subtotal gastric resection) may be needed in rare instances of uncontrollable hemorrhage or perforation occurring as a result of peptic ulcer disease.
Patient care
The ambulatory patient is educated about agents that increase the risk for peptic ulceration and given specific instructions to avoid them. Instruction should include the importance of adhering to prescription drug therapies, adverse reactions to H2-receptor antagonists and omeprazole (dizziness, fatigue, rash, diarrhea), and the need for follow-up examination and care.
For the hospitalized patient with ulcer-related bleeding, careful monitoring of vital signs, fluid balance, hemoglobin levels, and blood losses may enhance early recognition of worsening disease. Intravenous (IV) access is established, and IV opiates are administered as prescribed for pain control. The patient is kept nil per os (NPO). Electrolytes and fluids are replaced as needed. Endoscopic or other diagnostic and treatment procedures are explained to the patient, and the effects of prescribed therapies or transfusions are carefully assessed. All patient care concerns apply after major surgery. The patient is assessed for possible complications: hemorrhage, shock, malabsorption problems (iron, folate, or vitamin B12 deficiency anemias), and dumping syndrome. To avoid these problems, the patient is advised to drink fluids between meals rather than with meals, eat 4 to 6 small, high-protein, low-carbohydrate meals daily, and lie down after eating. Before and after discharge, health care professionals should help the patient to develop coping mechanisms to relieve anxiety. Patients are taught to recognize signs and symptoms of disease recurrence (e.g., coffee-ground emesis, the passage of black or tarry stools, or epigastric pain). Patients who use antacids and have a history of cardiac disease or whose sodium intake is restricted for any reason are warned to take only those antacids that have low amounts of sodium. The need for ongoing medical care is stressed.
perforating ulcer
phagedenic ulcerTropical ulcer.
postpolypectomy ulcer
pressure ulcer
The most common sites of skin breakdown are over bony prominences (the sacrum and the trochanters, the heels, the lateral malleoli and also the shoulder blades, ischial tuberosities, occiput, ear lobes, elbows, and iliac crests). The combination of pressure, shearing forces, friction, and moisture leads to tissue injury and occasionally necrosis. If the ulcer is not treated vigorously, it will progress from a simple red patch of skin to erosion into the subcutaneous tissues, eventually extending to muscle or bone. Deep ulcers often become infected with bacteria and develop gangrene. See: illustration
Treatment and Prevention
The most important principle is to prevent the initial skin damage that promotes ulceration. In patients at risk, aggressive nursing practices, such as frequent turning of immobile patients and the application of skin protection to bony body parts, are frequently effective. Gel flotation pads, alternating pressure mattresses, convoluted foam mattresses and sheepskins or imitation sheepskins may be employed. Specialized air-fluid beds, waterbeds, or beds with polystyrene beads provide expensive but effective prophylaxis. If the patient develops an ulcer, topical treatments with occlusive hydrocolloid dressings, polyurethane films, absorbable gelatin sponges, collagen dressings, wound-filter dressings, water-vapor permeable dressings, and antibiotic ointments aid the healing of partial-thickness sores. Deeper lesions may need surgical débridement. Skin-damaging agents such as harsh alkaline soaps, alcohol-based products, tincture of benzoin, hexachlorophene, and petroleum gauze should be avoided. Consultation with a wound care specialist is advantageous.
Patient care
The skin is thoroughly cleansed, rinsed, and dried, and emollients are gently applied by minimizing the force and friction used, esp. over bony prominences. Patients who are not able to position themselves are repositioned every 1–2 hr to prevent tissue hypoxia resulting from compression. A turning sheet or pad is used to turn patients with minimal skin friction. Care providers should avoid elevating the head of the bed higher than 30° (except for short periods) to reduce shearing forces on the skin and subcutaneous tissues overlying the sacrum. Range-of-motion exercises are provided, early ambulation is encouraged, and nutritious high-protein meals are offered. Low-pressure mattresses and special beds are kept in proper working order. Doughnut-type cushions should not be used because they decrease blood flow to tissues resting in the center of the doughnut.
Ulcers are cleansed and débrided, and other therapeutic measures are instituted according to institutional protocol or prescription. Consultation with a nutritionist may be needed to assess and optimize the patient's nutritional status, and to provide high-protein meals with added vitamin C to promote healing, protein and calorie-rich supplements, or enteral feedings. Weak or debilitated patients should be assisted to eat, with care taken to prevent swallowing difficulties.
rodent ulcer
Saemisch ulcerSee: Saemisch ulcer
serpiginous ulcer
shield ulcer
simple ulcer
specific ulcer
stercoral ulcer
stress ulcers
traumatic ulcer
trophic ulcer
tropical ulcer
varicose ulcer
venereal ulcer
venous stasis ulcer
Patient care
Assessment includes a detailed medical and surgical history and physical examination. When the lower extremities are examined, characteristic markers of venous ulceration include ankle flare (distention of small veins on the medial aspect of the foot due to chronic venous hypertension); dermatitis; pigmentation changes on the skin surface, usually appearing as brown discolorations affecting the medial part of the leg; woody induration of the leg; and varicosities. The health care professional should examine the leg for lesions superior to the medial malleolus and should carefully measure the size, shape, and margins of wounds; drainage or exudates; surrounding skin; and pain or tenderness. The patient should be advised to elevate the legs 7 in (18 cm) above the heart for 2 to 4 hr during the day and at night. Compression devices (such as graduated pressure stockings, Unna boot) are used to help reduce edema, improve venous blood flow, and aid healing. Before applying any compression device or wrap, the health care professional should measure the patient's leg circumference at the wound and the wound size of the ulcer. The wound should be cleansed regularly, and aggressive debridement employed as needed. Wounds with light to moderate drainage benefit from a moisture-retentive dressing (such as hydrocolloid, transparent film, some foams), whereas wounds with moderate to heavy drainage do better with an absorbent dressing (such as foams, alginates, special absorptive dressings). Underlying problems such as obesity, deep venous thrombosis, diabetes, and cardiovascular disease must be assessed and managed as part of the wound care protocol.
ulcerA local loss of surface covering (EPITHELIUM).and sometimes deeper tissue in skin or MUCOUS MEMBRANE. An open sore. Loss of surface leads to infection and further tissue damage. Ulcers may be caused by physical or chemical damage, by loss of blood supply or by local infection. Ulcers of the STOMACH or DUODENUM are called peptic ulcers. See also BEDSORES, VARICOSE ULCERS and TROPICAL ULCERS.
ulcernon-healing, chronic wound showing concomitant tissue repair and tissue breakdown, chronic inflammation and deposition of fibrous tissue in surrounding/underlying soft tissues, and threat of secondary infection; caused by loss of/breakdown/infection of epidermal/dermal tissues, with subcuticular tissue and deeper structure involvement; characterized by pain (unless in neuropathic tissues), chronic inflammation, fibrosis of underlying and local peripheral tissue, fluid exudation and proneness to infection predisposing factors include arterial, venous, lymphatic, neurological and immune compromise (see Table 1); presence of foreign body (including necrotic material) within the wound, repeated microtrauma, and concurrent systemic disease and drug regimes contribute to non-healing; normal healing events (i.e. healing by secondary intention [inflammation, epithelialization, wound contraction, connective tissue maturation]) are prolonged, disrupted and often non-sequential (Table 2); healing is promoted by addressing the cause of tissue breakdown and concomitant factors that interrupt normal healing, together with measures to promote systemic wellness (Table 3; see Table 4), including rest (e.g. use of a full contact cast to allow non-weight-bearing ambulation), regular wound care (and dressings appropriate to phase of healing to optimize wound environment; see Table 5 and Box 1), antibiotics (to control infection Table 6), pressure bandaging and/or diuretics (to control or reduce foot/limb oedema), vascular surgery (to improve arterial supply/venous return) and tight glycaemic control (see Table 7, Table 8 and Table 9 and Box 2)
complicated ulcer secondarily infected chronic wound penetrating to and involving deeper structures; possibly complicated by osteomyelitis
decubitus ulcer; pressure sore ulcer formation at pressure point (e.g. posterior/plantar margin of heels, sacrum, elbows) in bed-bound patients, caused by compromised local blood supply and reduced tissue viability, relative immobility and general patient debility
gastric ulcer erosion of gastric mucosa due to chronic ingestion of non-steroidal anti-inflammatory drugs or infection with Helicobacter pylori
Marjolin's ulcer neoplastic deterioration of pre-existing long-standing ulcer
mixed-pathology ulcer chronic wound caused by mixed pathology, e.g. secondary bone infection within a neuroischaemic ulcer
neuroischaemic ulcer ulcer development in neuropathic ischaemic tissue
neuropathic ulcer plantar ulcer induced by relatively minor trauma, in an insensitive foot (see trophic ulcer)
perforating ulcer ulcer whose base penetrates to involve subcuticular structures, e.g. tendon/bone (which may be visible within the lesion base)
rodent ulcer see basal cell carcinoma
trophic ulcer deep plantar ulcer (prone to both aerobic and anaerobic infections) induced by relatively minor trauma and/or tissue stress (e.g. pressure/friction) in a neuropathic (anaesthetic) foot, e.g. in diabetes or leprosy; skin surrounding the ulcer tends to exuberant callous formation (see Box 3 and Table 10)
varicose ulcer; venous ulcer wide, shallow ulcer most commonly found at lower medial one-third of leg in association with poor and prolonged compromised venous return and/or venous stasis; develops within area of oedematous tissue characterized by signs of compromised venous function (e.g. varicose eczema, haemosiderosis, woody tissue fibrosis, scars of healed earlier ulceration, atrophy blanche and varicose veins)
|Ulcer phase
|Active phase
|Wound dimensions increase (undermined wound edges)
Formation of slough
Periwound oedema and induration of edges
|Dissolution and degradation of devitalized tissue ± infection
Macrophage and enzyme activity
Accumulation of degraded tissue and dead macrophages
Chronic, non-resolving inflammation ± collagen deposition
|Proliferative phase
|Wound begins to infill (wound dimensions reduce)
Epithelialization (saucerization) of margins
|Formation of granulation tissue
Recruitment of fibroblasts; collagen formation
Epidermal cells at margins mitose and spread out to begin to close wound
|Maturation phase
|Wound contraction
Wound closure
Scar formation
|Myofibrils within fibroblasts contract
Epithelialization is complete
Devascularization of fibrotic tissue that forms scar
|Classification system
|Grade 0: local deformity or callosity but no open lesions
Grade 1: partial or full skin thickness, superficial ulcer
Grade 2: deep ulcer without osteomyelitis, but extending to ligament, tendon, bone, joint capsule or deep fascia
Grade 3: deep ulcer with associated cellulitis, abscess formation and/or osteomyelitis and/or joint sepsis
Grade 4: gangrene localized to the forefoot or heel
Grade 5: extensive gangrene
|Widely recognized and used system
Rather generalist and non-specific
Ignores neuropathy and lesion size, and thus their effects of choice of treatment/lesion management
|S = size of lesion (area; depth)
S = sepsis (presence/absence)
A = arteriopathy (ischaemia)
D = denervation (sensory/autonomic/motor neuropathy)
|Builds on from the Wagner system (above), introducing additional categories, each awarded 0 (normal), 1 (mild change), 2 (moderate change), 3 (severe change) subclassification
|R = red wound (pale pink–beefy red ulcer base, proliferating/inflammatory ulcer)
Y = yellow wound (moist, exudating ivory/ green/brownish sloughy wound)
B = black wound (dry wound with black/ brown/tan hard eschar)
|Wound assigned colour grading
A limited classification that focuses solely on wound appearance and ignores other factors (e.g. distal sensory neuropathy, peripheral ischaemia, cellulitis, size/depth of lesion, phase of progression of lesion)
|P = perfusion of limb/foot
E = extent of wound (size of lesion)
D = depth of lesion/tissue loss
I = infection
S = sensation (perception of light touch, vibration, contact of 10g monofilament, hot/cold discrimination)
|Each subcategory is graded 1–4, where 1 = normal/absence and 4 = severe
Useful research tool allowing indepth assessment of lesion progression over time, and comparison of lesions subjected to varying treatment modalities
|D = depth of lesion
E = extent of bacterial colonization
P = phase of ulcer (Table 11)
A = associated aetiology (e.g. trauma, neuropathy, ischaemia, infection, diabetes mellitus)
DEPA <6 = low-grade wound (i.e. local debridement, oral antibiosis as necessary, glycaemic control measures)
DEPA 7–9 = moderate-grade wound (i.e. debridement, parenteral antibiosis, insulin therapy, wound-healing promotion agents, pressure relief)
DEPA 10–12 = high-grade wounds (i.e. parenteral antibiosis, insulin therapy, wound-healing promotion agents, vascular reconstruction)
|Each subcategorization is graded 1–3 to reflect increasing levels of severity
Validated system
Score 6 = wound likely to heal in time
Score 10: great difficulty in healing
Score 11–12 (especially heel wounds): prognostic of lower-limb amputation
|University of Texas system
|Tier 1
Wound graded 0–3 according to wound depth/tissue involvement:
0 = pre-/postulcer with intact epithelium
1 = superficial ulcer not involving bone/tendon
2 = ulcer penetrates to tendon/joint capsule
3 = ulcer penetrates to bone/joint
Tier 2
Wound graded A–D according to wound burden/tissue status
A = non-infected/non-ischaemic
B = infected/non-ischaemic
C = non-infected/ischaemic
D = infected/ischaemic
|Multisite validated system
Two-tier wound classification (tier 1 = ulcer; tier 2 = wound burden/tissue status, e.g. 1C = no current ulcer; ischaemic foot) gives risk assessment
Useful wound management 'road map'
Should be used in conjunction with other markers of limb status (e.g. degree of sensory neuropathy, autonomic function; ankle–brachial pressure index, Buerger's test, presence of critical ischaemia, skin condition, local foot/toes deformity, subtalar joint range of motion)
|Ulcer phase
|Active phase
|Wound dimensions increase (undermined wound edges)
Formation of slough
Periwound oedema and induration of edges
|Dissolution and degradation of devitalized tissue ± infection
Macrophage and enzyme activity
Accumulation of degraded tissue and dead macrophages
Chronic, non-resolving inflammation ± collagen deposition
|Proliferative phase
|Wound begins to infill (wound dimensions reduce)
Epithelialization (saucerization) of margins
|Formation of granulation tissue
Recruitment of fibroblasts; collagen formation
Epidermal cells at margins mitose and spread out to begin to close wound
|Maturation phase
|Wound contraction
Wound closure
Scar formation
|Myofibrils within fibroblasts contract
Epithelialization is complete
Devascularization of fibrotic tissue that forms scar
|Adherent slough
|Deep and sloughy
|Granulation and epithelialization
|Relatively shallow
|Deep and penetrating
|Moderate/copious thick
|Moderate serous
|Heavy, pus-y, bloody, malodorous
|Scant, serous
|Surrounding tissues
|Heavy callosity
|Cold, cyanotic
|Mild inflammation
|Static, non-healing
|Extending and spreading
|Point of note
|Features to be recorded
|The exact anatomical location of the wound
|The dimensions of the wound, in millimetres:
• Width (medial–lateral distance)
• Length (longitudinal distance)
• Depth
|The appearance of the wound and the surrounding tissues:
• Callosity
• Maceration
• Signs of local infection
• Signs of spread of infection (cellulitis, lymphangitis, lymphadenitis)
|The orientation of the walls of the wound in relation to the skin surface:
• Undermined (extending wound)
• Vertical (static wound)
• Saucer-shaped (healing wound)
|The nature of the wound floor:
• Sloughy (infected, non-healing)
• Granulating (healing)
• Hypergranulating (non-healing or traumatized wound)
• Deep structures, such as joint capsule/tendon/bone, visible through wound base (extending wound)
|A deep swab of the discharge should be sent for pathology laboratory culture and sensitivity
The amount and type of discharge should be noted (the amount can be inferred by the state of the dressing in relation to how long it has been in situ):
• Colour – yellow/green (extending wound or infection); red/brown (blood or infection); turquoise green (Pseudomonas infection); clear (joint fluid or healing wound)
• Texture – thick (staphylococcal infection or extending wound); thin (streptococcal infection or healing wound)
• Amount – copious (infection); plentiful (extending or non-healing wound); scarce (healing wound)
• Odour – very smelly (necrotic, infected); sweet (healing)
|Dressing Type
|Indicated Use
|Primary Wound-Dressing Films
|Semi-permeable adhesive film
Non-adherent to wound surface
Gas and water vapour permeable, but impermeable to water
Transparent, allowing observation of wound
|Low exudating wounds
|Perforated film, absorbent
|Low adherence (absorbent pad covered by perforated film)
|Low exudating wounds
|Low-adherent Wound Contact Layers
|Unmedicated viscose
|Non-absorbent; non-shedding
|Non-adherent primary dressing
|Medicated tulle
|Low-adherent polyethylene glycol or paraffin impregnated tulle incorporating an antiseptic (e.g.: chlorhexidine gluconate; iodine)
|Topical antisepsis
|Semi-permeable hydrogels
|Hydrophilic polymers in either sheet or amorphous formulations
Highly absorbent
Gas permeable, but impermeable to water
Dressing surface may dry out, and thus requires rehydration with saline
|Removal of slough
Rehydration of dry, necrotic tissue to allow its later sharp debridement
Absorption of heavy exudation
Carrier of topical antimicrobials (e.g.: metronidazole)
|Interactive (form a gel when in contact with wound surface)
Usually formulated with an occlusive, water-repellent backing
Promote an acidic and hypoxic wound environment, and facilitates neoangiogenesis
|Not suitable for infected wounds
Maintain a moist, temperature controlled wound environment
|Seaweed derivatives which form a hydrophilic gel in contact with the wound surface
Require irrigation to remove from wound surface
|Absorption of exudation
Moisten with saline before application
|Polyurethane foams
|Smooth low-adherent wound contact layer backed with hydrophobic foam
Highly gas-permeable
Maintain a moist wound environment and good thermal insulation
|Absorption of moderate exudation
Outer layer prevents 'strike through'
|Silver agents
|Silver ions impregnated into dressing
Antibacterial action
|Topical antisepsis, including resistant forms
|Infection site
|Indicative antibiotic regime
|Localized infection: topical fusidic acid (or mupirocin if MRSA+ve); dicloxacillin; azithromycin
Widespread infection: oral flucloxacillin or erythromycin (if penicillin-sensitive)
|Phenoxymethylpenicillin or erythromycin
|Benzylpenicillin and flucloxacillin (or erythromycin if penicillin-sensitive); co-amoxiclav
|Infected ulcer
|Topical antibiotics: mupirocin, fusidic acid
Topical antiseptics: povidone-iodine
|Infected burns (e.g. caustic burns)
|Silver sulfadiazine
|Animal/human bites
|Co-amoxiclav (doxycyline + metronidazole if penicillin-sensitive)
|Flucloxacillin (clindamycin if penicillin-sensitive)
Vancomycin if MRSA+ve or Staphylococcus epidermidis -+ve
Sodium fusidate (has good bone penetration)
|Septic arthritis
|Flucloxacillin + fusidic acid (clindamycin if penicillin-sensitive)
Vancomycin if MRSA+ve or Staphylococcus epidermidis -+ve
|Prevention of infection in orthopaedic surgery
|Single dose of intravenous cefuroxime or intravenous flucloxacillin
|Staphylococcus species
|Systemic flucloxacillin; fusidic acid (erythromycin if penicillin-sensitive)
|Streptococcus species
|Systemic penicillin, erythromycin, clindamycin, phenyloxymethylpenicillin
|Beta-haemolytic streptococci
|Systemic phenyloxymethylpenicillin
|Pseudomonas aeruginosa
|Systemic ciprofloxacin; ticarcillin + clavulanic acid; azlocillin; piperacillin
|Anaerobic infection
|Systemic metronidazole (also as topical beads in the treatment of anaerobe-infected ulcers)
Note: Swab of the wound/exudate is taken to ensure the most effective antibiotic is prescribed; the patient is started on a broad-spectrum antimicrobial and the medication modified as necessary once the laboratory results confirm the regime of choice.
MRSA, meticillin-resistant Staphylococcus aureus .
|Points of note
|Questions that should be asked
|How long has the wound been present?
|Has the wound changed (got bigger/smaller; altered its appearance)?
|Is there an increase/decrease in the number of wounds?
|Previous wounds
|Have similar wounds occurred in the past? If so, when?
|Sensory changes
|Has the patient noted any changes of sensation in the affected foot (increased sensitivity; decreased sensitivity; paraesthesia)?
|Tissue changes
|Have the surrounding tissues altered in appearance (swelling; limb/foot oedema; colour changes; dryness of skin)?
|What does the patient think caused the wound in the first place?
|Point of note
|Features to be recorded
|The exact anatomical location of the wound
|The dimensions of the wound, in millimetres:
• Width (medial–lateral distance)
• Length (longitudinal distance)
• Depth
|The appearance of the wound and the surrounding tissues:
• Callosity
• Maceration
• Signs of local infection
• Signs of spread of infection (cellulitis, lymphangitis, lymphadenitis)
|The orientation of the walls of the wound in relation to the skin surface:
• Undermined (extending wound)
• Vertical (static wound)
• Saucer-shaped (healing wound)
|The nature of the wound floor:
• Sloughy (infected, non-healing)
• Granulating (healing)
• Hypergranulating (non-healing or traumatized wound)
• Deep structures, such as joint capsule/tendon/bone, visible through wound base (extending wound)
|A deep swab of the discharge should be sent for pathology laboratory culture and sensitivity
The amount and type of discharge should be noted (the amount can be inferred by the state of the dressing in relation to how long it has been in situ):
• Colour – yellow/green (extending wound or infection); red/brown (blood or infection); turquoise green (Pseudomonas infection); clear (joint fluid or healing wound)
• Texture – thick (staphylococcal infection or extending wound); thin (streptococcal infection or healing wound)
• Amount – copious (infection); plentiful (extending or non-healing wound); scarce (healing wound)
• Odour – very smelly (necrotic, infected); sweet (healing)
|Identified microorganism
|Example of antimicrobial drug
|Oral amoxicillin 500mg tds (or IV amoxicillin 500mg 8-hourly)
|Oral flucloxacillin 500mg qds (or IV flucloxacillin 500mg 6-hourly)
|Oral metronidazole 400mg tds (or IV metronidazole 500mg 8-hourly)
|Oral ciprofloxacin 500mg bd (or IV ceftazidime 1g 6-hourly)
IV, intravenous.
|Identified microorganism
|Example of antimicrobial drug
|Oral amoxicillin 500mg tds (or IV amoxicillin 500mg 8-hourly)
|Oral flucloxacillin 500mg qds (or IV flucloxacillin 500mg 6-hourly)
|Oral metronidazole 400mg tds (or IV metronidazole 500mg 8-hourly)
|Oral ciprofloxacin 500mg bd (or IV ceftazidime 1g 6-hourly)
IV, intravenous.
corneal ulcer A superficial loss of corneal tissue as a result of infection that has led to necrosis. It may be caused by a bacterium (e.g. Pseudomonas aeruginosa, Streptococcus pneumoniae), by a virus (e.g. herpesvirus), or by a fungus (e.g. Candida, Aspergillus, Penicillium). It causes pain and usually reduced visual acuity, especially if the ulcer occurs in the centre of the cornea. Corneal ulcers usually look dirty grey or white and are opaque areas of various sizes and a mucopurulent discharge may be present. If induced by contact lenses, especially extended wear lenses, patients must cease wearing their lenses immediately, and the appropriate therapy instituted: antibacterial, antifungal or antiviral agent. See corneal facet; herpes simplex keratitis; hypopyon keratitis; rosacea keratitis; ulcerative keratitis; keratocele; keratomycosis; leukoma.
dendritic ulcer See herpes simplex keratitis.
von Hippel's internal ulcer A depression noted in the posterior surface of the cornea. This lesion resembles posterior lenticonus, except that it is thought to be due to an infection or inflammation. The lesion can be differentiated from Peter's anomaly by the presence of endothelium and Descemet's membrane in the former. Due to its posterior location, the lesion does not usually disturb visual function. See Peter's anomaly.
marginal corneal ulcer Benign condition due to a hypersensitivity reaction to bacterial conjunctivitis, particularly staphylococcal blepharoconjunctivitis. It is characterized by infiltration of the peripheral cornea by white cells and by ocular irritation. The condition is usually self-limiting but painful. Treatment includes frequent cleaning of the eyelid margin with a cotton-tipped applicator or face cloth or cotton ball with baby shampoo, warm compresses, antibiotic ointment and occasionally topical corticosteroids.
Mooren's ulcer A rare, superficial ulcer of the cornea of unknown origin. It starts near the limbus as an overhanging advancing edge that in severe cases spreads over the entire cornea and may even invade the sclera. The patient complains of pain and blurred vision. There are two types: a self-limiting form, usually unilateral, affecting old people, and a progressive form, bilateral, affecting young people. The condition is difficult to treat and this may include topical and systemic steroids, immunosuppressants, or conjunctival excision. See peripheral ulcerative keratitis.
serpiginous ulcer See hypopyon keratitis.
shield ulcer A localized corneal ulcer noted in severe cases of vernal conjunctivitis. The lesion is usually oval or pentagonal resembling a warrior's shield. It is located in the upper portion of the cornea as a result of irritation from the large papillae on the palpebral surface of the overlying eyelid.
See: erosion
ulcer (ul´sur),
canker sore. The cause is unknown, and treatment is limited to alleviating the symptoms.
canker sore and
recurrent aphthae.
cold sore.
H. pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach. They can also be caused or worsened by drugs such as aspirin and other NSAIDs.
decubitus ulcer.
Patient discussion about ulcer
Q. Is it an ulcer? I am worried! Hi friend, I'm 35 year old male and recently I started to suffer from some strange symptoms I have never experienced. The first symptom was sharp pain in my upper abdomen that starts two of three hours after eating. In the beginning I thought it could be connected with some food intolerance but then I started to get this pain early in the morning, before any eating what so ever and all this was accompanied with nausea, frequent burping and weight loss. I have read some stuff about stomach ulcer and I could say that I poses almost every major symptom. Is there any way for me to be sure that I have developed disease of ulcer?
Q. What are the symptoms of Ulcerative Colitis? I am 40 years old and suffer from a lot of stomach aches and diarrhea. Do I have Ulcerative Colitis? What are its symptoms?
Q. What is the difference between duodenal ulcer and stomach ulcer? I was diagnosed recently with duodenal ulcer. I heard the term stomach ulcer but not duodenal. What causes duodenal and what cause stomach ulcer? And how do they treat duodenal ulcer?


text:
Publications and Presentations on STEM
Upcoming poster presentations on STEM
Two poster presentations will share the ongoing collaboration between IBM Research Division, Almaden Research Center, San Jose, CA, and the Federal Institute for Risk Assessment, Department for Biological Safety, Germany, at ISVEE 13, Building Bridges, Crossing Borders. ISVEE is the annual meeting of the International Society for Veterinary Epidemiology and Economics. It will be held in Maastricht, at the borders of Belgium and The Netherlands. For information about the meeting, go to [1].
The two presentations are:
"The SpatioTemporal Epidemiological Modeler: an open source framework for modeling food-borne disease." Authors: Kaufman JH (presenter), Davis M, Douglas JV, Edlund S, Hu K, Filter M, Wigger J-F, Thoens C, Weiser AA, Kaesbohrer A, Appel B.
"A community resource for spatial, temporal and food chain epidemiological modelling to assess risks in bio-terroristic or agro-terroristic crisis situations." Authors: Falenski A (presenter), Thoens C, Filter M, Kaesbohrer A, Appel B, Kaufman JH, Edlund S, Davis M, Douglas JV, Hu K.
Recent scientific publications and presentations describing research using STEM
Talks Online Featuring a talk at Epidemics 2009
Thoens C, Filter M, Kaesbohrer A, Appel B, Kaufman JH, Edlund S, Davis M, Hu K, "The Spatiotemporal Epidemiological Modeler, an Eclipse framework for spatial and temporal modeling of infectious diseases", Eclipse Integrated Development Day 2012, Berlin, Germany, May 30th, 2012.
Hu K, Thoens C, Edlund S, Davis M, Kaufman JH, "Disease Dynamics in Three Models of Dengue Fever", Proceedings of the 2012 Industrial and Systems Engineering Research Conference, Orlando, FL, USA, May 2012.
Hu K, Thoens C, Edlund S, Davis M, Kaufman JH, "STEM: A Platform for Modeling Complex Zoonotic Disease", Industrial and Systems Engineering Research Conference, Orlando, FL, USA, May 21th, 2012.
Kaufman JH, Edlund S, Davis M, Hu K, The SpatioTemporal Epidemiological Modeler: An open source framework for modeling infectious disease EE2 (EPIWORK/EPIFOR) 2nd International Workshop, Facing the Challenge of Infectious Diseases, Aosta, Italy, Jan 2012.
Edlund S, Davis M, Pieper J, Kershenbaum A, Waraporn N, Kaufman J. "A Global Study of Malaria Climate Susceptibility." Epidemics 3, November 29-December 2, 2011, Boston, MA
Hu K, Thoens C, Edlund S, Davis M, Kaufman JH, "Modeling Dengue Fever: An extra large data challenge", 5th Extremely Large Databases Conference (XLDB5), SLAC National Accelerator Laboratory, Menlo Park, CA, Oct. 2011.
Edlund S, Kaufman J, Lessler J, Douglas J, Bromberg M, Kaufman Z, Bassal R, Chodick G, Marom R, Shalev V, Mesika Y, Ram R, Leventhal A. 2011. "Comparing Three Basic Models for Seasonal Influenza," Epidemics, August 2011, 3(3):135-142. doi:10.1016/j.epidem.2011.04.002 [2]
Ahued J, Morales J, Renly S, Edlund S, Kaufman J. "Improving Disease Surveillance Capabilities through a Public Health Information Affinity Domain", Proceedings of the 1st ACM International Health Informatics Symposium ACM New York, NY, USA 2010. doi 10.1145/1882992.1883079
Edlund S, Davis M, Kaufman J. "The Spatiotemporal Epidemiological Modeler", accepted ACM Digital Library and 1st ACM International Health Informatics Symposium, November 11-2, 2010 Arlington, VA
Renly S, Kaufman J, Ram R. "Improving Disease Surveillance Capabilities in IHE Health Information Exchanges", IADIS International Conference e-Health, June 2009, Algarve, Portugal.
Edlund S et al. "The Spatiotemporal Epidemiological Modeler", Workshop on Frontiers in the computational modeling of disease spreading, ICCS 2010, Amsterdam, May 31 - June 2, 2010
Keil WP. "Spatio-Temporal Epidemiologic Modeler (STEM)", Eclipse DemoCamp 2009, Vienna, Austria, November 2009. [3]
Edlund S, Bromberg M, Chodick G, Douglas J, Ford D, Kaufman Z, Lessler J, Marom R, Mesika Y, Ram R, Shalev V, Kaufman J. 2009. "A spatiotemporal model for influenza." HIC 2009, Frontiers of Health Informatics, Canberra, Australia, August 19-21, 2009. http://www.hisa.org.au/system/files/u2233/hic09-2_StefanEdlund.pdf
Kaufman J, Edlund S, Douglas J. 2009. "Infectious disease modeling: creating a community to respond to biological threats." Statistical Communications in Infectious Diseases, Vol 1, Issue 1, Article 1. The Berkeley Electronic Press. [4]
Kaufman J, Edlund S, Bromberg M, Chodick G, Lessler J, Mesika Yossi, Ram R, Douglas J, Kaufman Z, Levanthal A, Marom R, Shalev V. 2009. "Temporal and spatial effects of lunar calendar holidays on influenza A transmission in Israel." Accepted for presentation at Epidemics 2, Athens, Greece, December 2009.
Hulse CL, Conant JL, Kaufman JH, Edlund SB, Ford DA. "Development and Utilization of a Spatial and Temporal Modeling System to Investigate Disease Outbreaks in Vermont", PHIN 2009 [5]
Keil WP. 2009. "The spatiotemporal epidemiological modeller (STEM)." Presentation at epicenter 2009 Conference, Dublin, Ireland, Aug 28, 2009.
Edlund S, Kaufman J, Douglas J, Bromberg M, Kaufman A, Chodick G, Marom R, Shalev V, Lessler J, Mesika Y, Ram R, Leventhal A. 2009. "A study of two spatiotemporal models for seasonal influenza." in preparation.
Ford DA, Kaufman JH, Mesika Y. "Modeling in space and time: a framework for visualization and collaboration." In D Zeng et al. (eds), Infectious Disease Informatics and Biosurveillance, Integrated Series in Information Systems, 2011, Volume 27, Part 2, 191-206, DOI: 10.1007/978-1-4419-6892-0_9
Lessler J, Kaufman JH, Ford DA, Douglas JV. 2009. "The cost of simplifying air travel when modeling disease spread," PLoS ONE 4(2): e4403. doi: 10.1371/journal.pone.004403.
Kaufman JH, Edlund S, Ford DA. "Spatio-Temporal Epidemiologic Modeler: Application in Middle Eastern Countries", PHIFP colloquium at U.S. Centers For Disease Control, Atlanta. May 8, 2009
Kaufman JH, Edlund S, Ford DA, Renly S, Ram R, Mesika Y, et al. "Spatio-Temporal Epidemiologic Modeler: Evaluation of 10 years of Influenza Data from Maccabi Healthcare". Presentation at Israel Centers for Disease Control, Tel Aviv, Israel. April 16, 2009.
Kaufman JH, Conant JL, Ford DA, Kirihata W, Jones B, Douglas JV. "Assessing the accuracy of spatiotemporal epidemiological models," in D Zeng et al. (Eds): BioSecure 2008, LNCS 5354, pp. 143-154, 2008. Also presented at BioSecure 2008, Biosurveillance and Biosecurity Workshop, Raleigh, NC, Dec 2, 2008.
Ford DA, Kaufman JH. 2008. "The spatiotemporal epidemiological modeller (STEM)." Presentation at the Joint Session Homeland/Humanitarian Preparedness for Pandemic Influenza, Washington, DC, Oct 13, 2008.
Kaufman JH, Conant JL, Ford DA, Kirihata W, Douglas JV, Jones BA. 2008 (December). "Assessing the accuracy of spatiotemporal epidemiological models. In D Zeng et al. (eds): BioSecure 2008, LNCS 5354, pp. 143-154.
Kaufman JH, Ford DA, Mesika Y, Lessler J. 2008 (December). Modeling disease spread in space and time: extending and validating an open source tool for public health. Epidemics (EPID2008): First International Conference on Infectious Disease Dynamics. Asilomar, CA, December 1-3, 2008.
Keil WP, Ford DA, Kaufman JH. 2007 (In press), "Eclipse OHF STEM", Eclipse Magazin, S&S Verlag, July 2007
Ford DA, Kaufman JH, Eiron I, "An extensible spatial and temporal epidemiological modeling system," International Journal of Health Geographics 2006, 5:4 http://www.ij-healthgeographics.com/content/5/1/4 (17Jan2006)
Keil WP. 2005. "Eclipse Open Health Framework (OHF)." Presentation at JavaPolis 2005 Conference, Antwerp, Belgium, Dec 12, 2005.

subset: commoncrawl


text:
Want an STI but can't scrape up the cash? Desperate for rally-car looks at a cut-rate price? Have we got the Subaru for you! Step right up and check out the 2011 Subaru WRX!
The new WRX benefits from a 1.5-inch track increase, flared fenders, and firmer rear subframe bushings: If it weren't for that bageltastic center differential, we'd have a hard time justifying picking an STI over a WRX. Long live the homologation special and its offspring.


text:
ECE 695A Lecture 12R: Review Questions
Additional materials available (3)
Licensed according to this deed.
Published on
Review Questions:
- Explain the difference between local field and global field within an oxide.
- Explain physically why electric field decreases bond strength.
- How does the dissociation process becomes non-Arrhenius?
- Do you think the diffusion and repassivation will also become non-Arrhenius when field is applied? Why or why not?
- Would field acceleration become smaller or larger for high-k dielectric for the same level of inversion charge?
- Is NBTI a field-driven or voltage-driven phenomenon?
- Can NBTI be described by classical voltage-independent voltage acceleration factors?
Cite this work
Researchers should cite this work as follows:
EE 226, Purdue University, West Lafayette, IN


text: Everybody says dumb things. But this past year has seen more than its share of spectacularly bad calls from CEOs, government officials and market pros. Much of the blame goes to the financial crisis, which escalated so quickly that some statements were out of date almost as soon as they were made. Still, even the so-called experts made plenty of boneheaded comments. Here's a look at some of them over the past year.


text:
Striped sweatshirt for girls with rhinestones
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text:
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Elder Law Bylaws
Article I
This section shall be known as the Elder Law Section of the Tennessee Bar Association (TBA) and hereinafter designated as the "section."
§2.2 Purpose
This section exists to promote the objectives of the TBA, particularly as they relate to the areas of laws encompassed within the name of the section. To that end, the section shall serve as a medium through which its members may undertake activities designed:
(1) to enhance their knowledge, competence and skills within this field, including the support of qualified members who seek certification in the field of Elder Law,
(2) to assist and cooperate with each other in addressing problems within this field,
(3) to seek uniformity and improvements in this field of law by collaborating with the
TBA regarding legislative recommendations,
(4) to encourage better communication between those lawyers engaged in this field of
law. In so doing, the section may act alone or in concert with other sections or committees of the TBA, or such other organizations as shall be deemed appropriate by the council created in Article VI; and
(5) to encourage the development of information resources which will enable the membership to be apprised to developments in the field of Elder Law.
§ 2.3 Elder Law
Elder Law is a practice area which is defined in terms of the age of the client rather than area of practice. It includes, but is not limited to, the following:
1. Health and Personal Care Planning, including giving advice regarding, and preparing, advance medical directives (medical powers of attorney, living wills, and health care declarations) and counseling older persons, attorneys-in-fact, and families about medical and life-sustaining choices, and related personal life choices.
2. Pre-Mortem Legal Planning, including giving advice and preparing documents regarding wills, trusts, durable general or financial powers of attorney, real estate, gifting, and the financial and tax implications of any proposed action.
3. Fiduciary Representation, including seeking the appointment of, giving advice to, representing, or serving as executor, personal representative, attorney-in-fact, trustee, guardian, conservator, representative payee, or other formal or informal fiduciary.
4.Legal Capacity Counseling, including advising how capacity is determined and the level of capacity required for various legal activities, and representing those who are or may be the subject of guardianship/conservatorship proceedings or other protective arrangements.
5.Public Benefits Advice, including planning for and assisting in obtaining Medicare, Medicaid, Social Security, Supplemental Security Income, Veterans benefits, and food stamps.
6. Advice on Insurance Matters, including analyzing and explaining the types of insurance available, such as health, life, long term care, home care, COBRA, medigap, long term disability, dread disease, and burial/funeral policies.
7. Resident Rights Advocacy, including advising patients and residents of hospitals, nursing facilities, continuing care retirement communities, assisted living facilities, adult care facilities, and those cared for in their homes of their rights and appropriate remedies in matters such as admission, transfer and discharge policies, quality of care, and related issues.
8. Housing Counseling, including reviewing the options available and the financing of those options such as: mortgage alternatives, renovation loan programs, life care contracts, and home equity conversion.
9. Employment and Retirement Advice, including pensions, retiree health benefits, unemployment benefits, and other benefits.
10. Income, Estate, and Gift Tax Advice, including consequences of plans made and advice offered.
11. Counseling about tort claims against nursing homes.
12. Counseling with regard to age and/or disability discrimination in employment and housing.
13. Litigation and Administrative Advocacy in connection with any of the above matters, including will contests, contested capacity issues, elder abuse (including financial or consumer fraud), fiduciary administration, public benefits, nursing home torts, and discrimination.
§2.1 Enrollment
Article II
Any member in good standing of the TBA shall, upon proper application accompanied by advance payment of annual dues for the current year, be enrolled as a member of the section.
§2.2 The Membership
Members so enrolled and whose dues are paid pursuant to the provisions of this Article shall constitute the membership of the section.
§2.3 Dues
Dues for membership in the section shall be the amount set by the Tennessee Bar Association and shall be payable upon enrollment and thereafter annually, in advance, at the beginning of each TBA fiscal year succeeding such enrollment.
§2.4 Delinquency
Any member of this section whose annual dues shall be more than six months past due shall thereupon cease to be a member of the section.
§2.5 Payment of Dues
The annual dues of the section shall be payable to the TBA at its headquarters in Nashville, which shall deduct therefrom an appropriate amount for the performance of its administrative functions. All other funds collected by the TBA on behalf of the section shall be segregated by the treasurer of the TBA, who shall maintain said funds for the sole use and benefit of the section.
Article III
§3.1 Establishment
The council, as defined in 6.2, of the section is authorized to establish, or to empower the chair of the section to establish, such committees as it may deem necessary and desirable to promote effectively the activities of the section within the jurisdiction of the section.
§3.2 Appointment of Committees and Chairs
The chair of all committees shall be appointed pursuant to and in accordance with the 3
provisions of Article V of these bylaws. The section chair shall announce the chair of each committee of the section for the following section year, no later than the council meeting held during the annual meeting of the section.
§3.3 Death or Resignation of Committee Chair or Member
In case of the death, resignation or disability of any committee member or chair, the section chair shall appoint his successor to fill out the unexpired term.
§3.4 Authority of Committees
The power and duties of each committee, as well as the area of its proposed activities, shall be determined by the council. No action of a committee shall establish a policy of the section unless it has been submitted to and approved by the council.
§3.5 Special Committees
Special committees may be created by the chair of the section with the consent of counsel. The powers and authorities, terms of office and size of such special committees may be determined by the council at the time of creation of said special committee.
§3.6 Standing Committees
Standing committees may be created by the council of the section. Standing committees shall be the Legislation Committee, Continuing Legal Education, the Nominating Committee and Publications which are hereby established. The nominating committee shall seek to identify a committee chair for each committee (other than itself) and the chair of each committee shall appoint committee members from the Section membership. The chair elect shall be chair of the standing committee on Continuing Legal Education.
§ 3.7 Nominating Committee
The nominating committee shall, not later than 30 days prior to the announced annual meeting, submit to the membership the names of persons who are seeking election, either as an officer of the section or as a member of the council. In the event that more than one person seeks the same office, the nominating committee shall be authorized, consistent with Section 5.6, to make non-binding recommendations to the section. The primary purpose of the nominating committee shall be to ensure that all section offices are filled each year by active members.
§3.8 Suspension, Discontinuance or Consolidation of Committee
The council may suspend or discontinue any committee whose function may not be considered necessary in carrying out the objectives of the section or may consolidate the functions of one or more committees so as better to accomplish such objectives, and may designate and establish additional committees.
Article IV
Meeting of the Membership
§4.1 Annual and Special Meetings
The section may hold an annual meeting of members in conjunction with the annual meeting of the TBA but, regardless of timing, shall hold at least one annual meeting each year. The section may, upon approval of the council, hold other meetings of members throughout the year, within or without the state of Tennessee.
§4.2 Notice
(A) Special Meetings. Notice in writing of the time, place and general purpose of a special meeting shall be mailed no fewer than 10 nor more than 40 days prior to the meeting to each member entitled to vote at the meeting.
(B) Annual Meeting. Notice in writing of the time and place of the annual meeting shall be mailed no fewer than 20 nor more than 40 days prior to the meeting to each member entitled to vote at the meeting. In lieu of such separate notice, the notice may be reprinted in an issue of the Tennessee Bar Journal or Across the Bar and mailed to each member entitled to vote.
(C) Notice by Other Means. Any notice required to be given under these bylaws may be delivered electronically to an "e-mail" address which the member provides to the section or by other means reasonably calculated to provide the member with notice of the meeting and the intended action at said meeting.
§4.3 Quorum
The members of the section present at any meeting shall constitute a quorum for the transaction of business; provided, however, that at least 5 members shall be present to elect officers or to modify these bylaws.
§4.4 Voting Eligibility
Any member of the TBA and the section whose good standing can be certified by official TBA records for 30 days prior to the time of the voting, shall be eligible and entitled to vote.
§4.5 Mail Voting
The council may direct that a matter be submitted to the members of the section for vote by mail. In that event, binding action of the section shall be by a majority of the votes received from members in accordance with the rules fixed by the council.
§4.6 Agenda
Among the matters of business to be transacted at the annual meeting of the section shall be at least the following:
(a) Election of officers and council members (b) Report of the section chair (c) Report of the secretary/treasurer (d) Installations as may be appropriate.
The agenda shall also consist of other matters as decided by the chair or council.
§4.7 Speaking
Absent the approval of a majority of those members present, no member may speak on any question for more than five minutes. Absent the assent of a majority of those members present, no member may speak more than once on a question, except that the member bringing the question before the meeting has the right to close debate thereon. A member who desires to speak for more than 5 minutes or who desires to speak more than once on any question shall bring the matter to the attention of the chair, who shall, if appropriate, put the matter to a vote.
§4.8 Parliamentary Procedure
The parliamentary rules of order contained in Roberts' Rules of Order, except as otherwise herein provided, shall govern all meeting of the section.
Article V Officers
§5.1 Terms
The terms of each officer commences upon his/her election and continues until his/her qualified successor is elected.
§5.2 Officers of Section
The officers of the section shall be the chair, the chair elect, and secretary/treasurer and such other officers as the nominating committee may from time to time suggest.
§5.3 Chair
(1) preside at all meetings of the section and of the council;
(2) appoint the chair and members of all committees of the Section who are to hold
office during his/her term as chair;
(3) superintend the performance of all activities of the section;
(4) keep the council duly informed and carry out its decisions;
(5) present at each annual meeting of the TBA a report of the work of the section for
the year then ending;
(6) call meetings of the council when, in his/her discretion, such are required or when
at least three council members request in writing that he/she do so; and
(7) perform such further duties and have further powers as usually pertain to such officers as the chief executive or as may be designated by the council.
§5.4 Chair Elect
The chair elect shall be the automatic successor to the office of chair at the annual meeting of the section next following his/her election as the chair elect. The chair elect shall:
(1) in consultation with the chair, arrange for the appointment to all committees of the chairs and members thereof who are to hold office during the next TBA year;
(2) have the responsibility for the continuing legal education programs offered by or under the sponsorship of the section during his/her term as chair elect, including programs of the section offered at its meetings;
(3) aid the chair in the performance of the chair's responsibilities in such manner and to such extent as the chair may request; and
(4) perform such further duties and have such further powers as may be designated by the council. In the event of the death, resignation or disability of the chair, the chair elect shall perform the duties of the chair for the remainder of the chair's term of office or for the duration of the disability, whichever first ends.
§5.5 Secretary/Treasurer
The secretary/treasurer shall be the automatic successor to the office of chair elect at the annual meeting of the section next following his election as the secretary/treasurer. The secretary/treasurer shall:
(1) be responsible for the publication of any newsletter published by the section;
(2) consult with and assist all officers of the section as to the work of the section,
generally in such manner and to such extent as they may request;
(3) be the custodian of all principal books and documents of the section;
(4) arrange for the preservation of such of the records and reports of the section and
its committees as he deems advisable;
(5) (may) permit the custody of other property of the section by the staff of the
(6) give or cause to be given due notice of, and shall keep the minutes for, all
meetings of the section and of the council, and a record of all action that may be
taken by consent without a meeting;
(7) be responsible for the financial affairs of the section, and shall be accountable for all funds of the section;
(8) recommend to the chair and the council financial policies for the section; and
(9) perform such further duties and have such further powers as may be designated by the council. In the event of the death, resignation or disability of the chair elect, the secretary/treasurer shall perform the duties of the chair elect for the remainder of the chair elect's term or for the duration of his disability, whichever first ends.
§5.6 Rotation of Officers Among Grand Divisions
It is the policy of the section as of 2004 that the offices of chair, chair elect and secretary/treasurer shall rotate among the three Grand Divisions of the state of Tennessee. This policy, however, shall not be binding on the section if active members in one or more of the Grand Divisions are unwilling or are unable to serve.
§6.1 Powers
The council shall:
Article VI
The Council
(1) establish such policies of the section as it may determine which are not inconsistent with any policy of the TBA;
(2) at the annual meetings, approve a budget of the section for the fiscal year commencing with the adjournment of that annual meeting;
(3) authorize the expenditure of all monies of the section or appropriated for its use, but it shall not authorize commitments or contracts involving the payment of money during any fiscal year in an amount exceeding the monies of the section or appropriated for its use;
(4) hear all reports of the officers and committees of the section;
(5) hear, consider and act upon such propositions, resolutions and matters presented to it which pertain to the activities of the section; and
(6) subject to the action of the members taken at meetings of the section, have general supervision of the affairs of the section. Between annual meetings of the section, the council may fill vacancies of its own membership.
§6.2 Composition
The council shall be composed of the following persons:
(a) Officers
(b) the last retiring chair; and
(c) three members elected to the council by the section membership for three-year terms (hereinafter "the elected members"). Past chairs of the section, but not the last retiring chair or the officers or the elected members of the council, shall be honorary members of the council. As such, they shall be given notice of, and have the right to attend, all meetings of the council and to participate in the discussions, but shall not have any voting rights at any such meeting.
§6.3 Term
(a) Original Elected Members. Those elected members of the council who are elected at the 2003 organizational meeting shall constitute the original elected members of the council (hereinafter "the original elected members") and shall serve the following staggered terms: one elected member, shall reside or practice in the Western Grand Division of the state and shall serve until the adjournment of the 2004 annual meeting; one elected member, shall reside or practice in the Middle Grand Division of the state and shall serve until the adjournment of the 2005 annual meeting; and one elected member, shall reside or practice in the Eastern Grand Division of the state and shall serve until the adjournment of the 2006 annual meeting. In the event the original elected members are not elected at the 2003 annual meeting, they shall be appointed by a majority vote of the officers elected and shall serve as though elected at the annual meeting.
(b) Successor Elected Members. It is the policy of the section that those elected members elected for three-year terms after the 2003 annual meeting to the council shall, at the time of their election, reside or practice in that Grand Division of the state represented by the retiring elected members whom they replace.
(c) Vacancy. Members elected by the council to fill a vacancy created by the death, resignation or disability of an elected member shall serve only until the adjournment of the next annual meeting of the section, whereupon the section members shall elect a successor who shall serve only for the unexpired remainder of the term.
§6.4 Eligibility for Re-election
It is the policy of the section that no person then a member of the council continuously for three years or more shall be eligible for election as a member of the council, but this provision shall not bar election as an officer. Notwithstanding the foregoing, if after diligent search has been made, no active member seeks the office to be vacated by a serving member, the nominating committee may re-nominate a member to an addition term of office.
§6.5 Quorum
A quorum is required to conduct council business. A quorum exists when a majority of the council members in office are personally present at a council meeting.
§6.6 Controlling Vote
Once a quorum exists as provided by §6.5, action of the council shall be majority vote of those members present.
§6.7 Meetings and Notice
The council shall hold at least two regular meetings each year, at least one of which shall be at the time and place of the annual meeting of the association, to dispatch any necessary business. The chair may, and upon written request by at least three members of the council shall, call special meetings of the council between annual meetings. At least 15-days' written notice of the time and place of the council shall be given by mail to each member of the council at his address as shown on the records of the TBA. Any notice required to be provided may be delivered electronically to an e-mail address provided by the member of by facsimile.
§6.8 Poll of Council
Notwithstanding the provisions of §6.5, a meeting personally attended by a majority of the council members in office is not essential for certain action by the council. The chair of the section may, and upon written request by three members of the council shall, submit or cause to be submitted to each of the members of the council, in writing, any proposition upon which the council may be authorized to act, and the members of the council may vote upon the proposition either by written ballot or by telephone vote, confirmed in writing over their respective signatures ~ to the secretary/treasurer, who shall record the proposition and votes in the matter. Action of the council under this section shall require the concurrence of a majority of the council in office and shall constitute the binding action of the council.
§6.9 Council Authority
Between meetings of the section, the council shall have full power to do and perform all acts and functions which the section itself might perform.
§6.10 No Compensation
No salary or compensation for services shall be paid to any officer, member of the council or member of any committee. No salary or compensation for service as an employee of the section or the TBA shall be paid any such person, except as may be specifically authorized by the Board of Governors.
§6.11 Executive Committee
The executive committee of the council shall consist of the immediate past chair, chair, chair elect and secretary/treasurer.
Between meetings of the council, this executive committee, shall have full power, and authority to do and perform all acts which the council itself might perform; provided, however, the executive committee shall not rescind any action taken by the council. The executive committee may meet by conference telephone or similar communications equipment.
A meeting of the executive committee may be called by the chair or by any two other members thereof, who in either case shall give at least 24-hours' notice in person or by telephone of the time and place or manner of meeting to each other member of the committee. The executive committee may act at a meeting by a majority vote of the members of the committee in office, or by the written consent of the majority of the members of the committee after notice to all such members.
Article VII
§7.1 Elective Officers
Commencing with the 2003 annual meeting of the section, the membership shall elect:
(a) a secretary/treasurer to serve a term of one year (and thereafter the offices of chair elect and chair, respectively);
(b) the original members of the council to serve those terms provided for herein; and
(c) officers or council members to fill vacancies in any offices or upon the council as provided in Article VIII.
At subsequent meetings, the section shall elect officers for those positions which are
§7.2 Chair
The chair elect shall automatically succeed to the office of chair and shall serve a term of one year. In the event the office of chair elect shall be vacant, then a chair shall be elected in the manner set forth in §7.5.
§7.3 Chair Elect
In the event of the death, resignation or disability of the chair elect, the secretary/treasurer shall not succeed to the office of chair elect but shall, in addition to performing the duties of secretary/treasurer, perform the duties of the chair elect as defined in §5.4.
§7.3 Secretary/Treasurer
Between annual meetings of the section, the council may fill a vacancy in the office of secretary/treasurer to serve until the next annual meeting of the section.
§7.4 Absenteeism
If any officer or member of the council shall fail to attend two successive meetings of the council, council shall at its next meeting declare the office vacant unless the council then finds,
or has therefore found, that good cause existed for one or both of the absences.
§ 7.5 Re-election
It is the policy of the Section that no officer shall serve more than one successive term in each office. However, if after diligent search, the nominating committee is unable to identify any member who is willing to assume an office, the Section may re-elect a serving member to an office. The nominating committee shall call for and shall take nominations from the floor prior to any such re-election.
Article VIII
Representation of TBA Position
§8.1 Representation
No action by the section shall become effective as the action of the TBA unless and until it is approved by the Board of Governors of the TBA. Any resolution adopted or action taken by the section may, on request of the council or the section, be reported by the chair of the section to the Board of Governors of the TBA, or to the annual meeting of the association, for action thereon.
Article IX
§9.1 Approval
These bylaws shall become effective upon the approval of the majority of those present at the first organizational meeting of the section held on the 5th day of December, 2003, Nashville, Tennessee, as certified by the chair elected at that organizational meeting.
§9.2 Amendments
These bylaws may be amended at any annual meeting of the section by a majority vote of the members of the section present and voting, provided notice of the amendment has been sent to all section members at least 30 days prior to the annual meeting.
§9.3 Limitations
These bylaws, and any amendment duly adopted, shall be subject to the constitution and bylaws of the TBA.
Article X
Miscellaneous Provisions
§10.1 Fiscal Year
The fiscal year of the section shall be the same as that of the TBA.
§10.2 Disbursements
No invoice, statement or other evidence of expenditure on behalf of the section shall be forwarded to the secretary/treasurer of the section or the treasurer of the TBA for payment without having been approved by the chair of the section.| TBA Law Blog


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Kenya Supreme Court tells top politicians to keep quiet about disputed election until it rules
NAIROBI, Kenya – The Kenya Supreme Court is warning the country's top politicians against making sensational statements about the country's disputed March 4 presidential vote.
The six-member bench on Wednesday directed lawyers representing President-elect Uhuru Kenyatta and his main rival Raila Odinga, as well as civic groups, that they risk punishment for public statements that are deemed to undermine the court's authority.
The court is studying petitions submitted by Odinga and by civil groups challenging the election's outcome. Odinga says the process was so flawed that the court should order a new vote.
Kenyatta was named the winner with 50.07 percent.
The court said the media must keep the public informed but that journalists must function "in a fair, impartial and responsible manner."
The court must rule by a week from Saturday.


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Elizabeth Alexander was born on May 30, 1962, in Harlem, New York, and grew up in Washington, D.C. She received a BA from Yale University, an MA from Boston University (where she studied with Derek Walcott), and a PhD in English from the University of Pennsylvania.
Her collections of poetry include Crave Radiance: New and Selected Poems 1990-2010 (Graywolf Press, 2010); American Sublime (Graywolf Press, 2005), which was a finalist for the Pulitzer Prize; Antebellum Dream Book (Graywolf Press, 2001); Body of Life (Tia Chucha Press, 1996); and The Venus Hottentot (University Press of Virginia, 1990).
Her memoir, The Light of the World (Grand Central Publishing, 2015), was a finalist for the Pulitzer Prize.
Alexander's critical work appears in her essay collection, The Black Interior (Graywolf Press, 2004). She also edited The Essential Gwendolyn Brooks (Graywolf Press, 2005) and Love's Instruments: Poems by Melvin Dixon (University of Michigan Press, 1995). Her poems, short stories, and critical writing have been widely published in such journals and periodicals as The Paris Review, American Poetry Review, The Kenyon Review, The Southern Review, Prairie Schooner, Callaloo, The Village Voice, The Women's Review of Books, and The Washington Post. Her work has been anthologized in over twenty collections, and in May of 1996, her verse play, Diva Studies, premiered at the Yale School of Drama.
About Alexander's poetry, Rita Dove writes that "the poems bristle with the irresistible quality of a world seen fresh," and Clarence Major notes Alexander's "instinct for turning her profound cultural vision into one that illuminates universal experience."
In 2007, Alexander was selected by Lucille Clifton, Stephen Dunn, and Jane Hirshfield to receive the Jackson Poetry Prize from Poets & Writers. Her other honors include fellowships from the Guggenheim Foundation and National Endowment for the Arts, a Pushcart Prize, the Quantrell Award for Excellence in Undergraduate Teaching at the University of Chicago, and the George Kent Award, given by Gwendolyn Brooks.
In 2009, she recited "Praise Song for the Day," which she composed for the occasion, at President Barack Obama's first Presidential Inauguration.
She has taught at Haverford College, the University of Chicago, the University of Pennsylvania, and Smith College, where she was Grace Hazard Conkling Poet-in-Residence, the first director of the Poetry Center at Smith College, and a member of the founding editorial collective for the feminist journal Meridians. She has served as a faculty member for Cave Canem Poetry Workshops, and has traveled extensively within the United States and abroad, giving poetry readings and lecturing on African American literature and culture.
In 2015, Alexander was elected a Chancellor of the Academy of American Poets. She has been a fellow at the Radcliffe Institute for Advanced Study at Harvard University, and at the Whitney Humanities Center at Yale University. She previously served as the Thomas E. Donnelley Professor of African American Studies and inaugural Frederick Iseman Professor of Poetry at Yale University, and the Wun Tsun Tam Mellon Professor in the Humanities at Columbia University. She is the current President of the Andrew W. Mellon Foundation and lives in New York City.
Selected Bibliography
Crave Radiance: New and Selected Poems 1990-2010 (Graywolf Press, 2010)
American Sublime (Graywolf Press, 2005)
Antebellum Dream Book (Graywolf Press, 2001)
Body of Life (Tia Chucha Press, 1996)
The Venus Hottentot (University Press of Virginia, 1990)
The Light of the World (Grand Central Publishing, 2015)


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Modern Marvels has been a long running series on The History Channel — known today, simply, as History. The producers never seem to run out of ideas, and they always do a great job with their presentations.
Back in 2004, The History Channel released an episode on hydraulics. Although I have a couple minor issues with the content, in general, I think the producers did a superb job.
They present the content in a way that would interest people well-versed in hydraulics, who know nothing about it, or anyone in between.
I found a link that previews the first five minutes of the episode. To view it, click here. And if you download the Veoh web player, you can watch watch the entire 45-min episode. Or go to History's website, and buy the DVD.
I corresponded with one of the producers of Modern Marvels to suggest they create an episode about pneumatics. He asked me to provide some impressive examples of pneumatics, but I didn't hear back from him. But who knows, maybe some day. . .


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Visitor Services
The Visitor Services & Retail Operations department consists of running the Museum Store, museum admission and information counter, auditorium movies, event rentals, and gallery security. We are completely focused on customer service and providing the best experience possible for our visitors. If you need anything, please ask :-)
Our friendly and knowledgeable staff can answer questions about our gallery exhibits or can simply help you find a great restaurant. The Museum Store is a destination in itself. The majority of our store is filled with products and carvings made in Alaska, by Alaskans. We support Alaskan families and communities by purchasing these items direct from the artists and having them available for you at our museum.
All proceeds from sales made in the museum store are used to support our wide range of museum progams and gallery exhibts.


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Date(s) - 07/01/2023
10:00 am - 12:00 pm
Terra Nova
Save this to your Calendar
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Public Relations is a great way to get involved in service, especially early on as there is no clean time requirement to join. Our Primary purpose is the carry our message that, An addict, any addict, can stop using, lose the desire to use and find a new way to live. Our message is hope and the promise of freedom. We attend local markets, put on presentations, hold poster hanging drives and much more. Come out and show support.


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Microsoft is sending out more reminders to consumers who are still using Messenger with an offer for them to upgrade to Skype. On April 8th, the company will be merging both Messenger and Skype together, including IM and contact lists. This will require consumers to upgrade to the communication service, which will see the end of Messenger as we know it. To help soften the blow, Microsoft is offering a month of free calls for those who sign up with Skype.
To be able to redeem the welcome gift, one has to download and install the latest version of Skype, sign into a Microsoft account (using the same email address used for Xbox, Outlook.com, etc.) and head on over to Skype to set up payment details and you're good to go. This trial enables consumers to call mobile phones and landlines in numerous countries.
The reason why said details are required is that a subscription ($9.99) will automatically be started once the free trial is over - so be sure to cancel before the trial is up (by the 27th day) should you not wish to pay. It's stated on the website that a promotional price will be offered for those who sign up for the paid subscription with over 50% off the usual price.
Source: Skype


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Express. Home of the Daily and Sunday Express.
Rodgers: Blame me for draw
Liverpool manager Brendan Rodgers accepted the blame for the poor first half which saw them drop two points at home to Aston Villa, but defended striker Luis Suarez against accusations of diving.
Trailing to goals from Andreas Weimann and Christian Benteke inside 36 minutes, Reds striker Daniel Sturridge pulled one back on the stroke of half-time.
The contentious penalty came just after the break when Suarez was adjudged to have been brought down by goalkeeper Brad Guzan and Steven Gerrard equalised.
"I thought we should have had a penalty in the first half when (Leandro) Bacuna handles the ball," Rodgers said.
"The second I thought was a penalty. Luis has taken it up to the keeper and, once he has touched it around him, his body makes contact with Luis.
"Obviously from Paul's (Villa manager Lambert) perspective he will think it has been harsh."
On his adventurous team selection, which saw defensive midfielder Lucas Leiva dropped to accommodate Sturridge, Rodgers added: "I go with my gut feeling. I thought it was an offensive team.
"I have played that before. If you want to blame me, blame me.
"It is a good point. I don't think we were anywhere near our level in the first half, give credit to Villa for that.
"The front two was a real threat for us and tactically we had to change it."
Villa boss Paul Lambert unsurprisingly disagreed on the penalty incident.
"Brad has pulled his arms away. It is hard for the referee to judge it. He has a split-second decision to make but I think Brad used his experience to pull his arms away and then you get punished," he said.
Asked whether he thought Suarez had dived, he added: "I'll let you be the judge of that.
"I am not being critical of anyone. I'm not getting caught into that, the guy is a world-class player."
Of his team's performance, Lambert said: "I thought we were excellent. I thought Ron Vlaar was excellent, Benteke looked back to himself but we lost Gabby (Gabriel Agbonlahor) at a vital time and he was unplayable.
"I always thought we looked a threat on the counter-attack. We might have sneaked it but I don't think anyone could begrudge us a point."
Gerrard, who played in the deeper holding role in the first half, admitted his performance - like the team's - was well below the required standard.
"They deserved a point. We were nowhere near good enough in the first half," he told Sky Sports.
"They put a lot of men around me in the first half. Whenever I got the ball they swamped me and I admit it wasn't one of my better 45 minutes.
"The problem today and the reason fans will be disappointed is our immaculate home record.
"It is no time to panic and we will carry on fighting for fourth. They are all big tests now."


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Under the new multi-year deal, Sky Movies will be the first subscription service in the UK & Ireland to show Silver Linings Playbook [pictured] and The Master, among others.
UK broadcaster Sky has announced it has signed a new multi-year deal with Entertainment Film Distributors.
The deal includes the first subscription pay TV and pay-per-view windows, enabling Sky Movies to show releases from Entertainment Film Distributors across its On Demand service and channels, and on a rental basis via Sky Store and Sky Movies Box Office.
Under the new agreement, Sky Movies will be the first subscription service in the UK & Ireland to show award winners Silver Linings Playbook and The Master, as well as Entertainment titles such as Beautiful Creatures and The Host around six months after they have ended their run in cinemas.
Sky Movies customers will also have exclusive access to Entertainment's back catalogue which includes the likes of Brokeback Mountain, The Departed, Gangs of New York, American Psycho and Ali.
Ian Lewis, director of Sky Movies, commented: "This new deal means that Sky Movies customers can continue to look forward to even more of the biggest films, enjoying them on demand on their Sky+HD set-top box and even taking the movies with them on their smartphone or mobile tablet. We're delighted to be extending our relationship with Entertainment Film Distributors, who have been great partners for many years."
"Having worked with Sky for nearly 20 years, we value their long-standing expertise in providing their customers with the best possible movie-viewing experience, helping film fans get the most out of our great selection of movies," added Nigel Green, joint managing director of Entertainment Film Distributors.


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Ethanol and electricity are currently the two most promising alternatives to gasoline, and investors need look no farther than Tesla Motors Inc. to find the biggest beneficiary of the transportation sector's transition to new sources of motive power, analysts at Goldman Sachs said in a note.
The U.S. car market is "an open field at a historical crossroads," the analysts said in the report, released Thursday. Ethanol and EVs get an edge based on cost, potential emission reductions, consumer payback and abundance of natural resources, they added.
The cost advantage is particularly attractive for Tesla /quotes/zigman/118681/delayed /quotes/nls/tsla TSLA , the analysts said. Goldman sees the EV market growing at a 30% clip to about 1.5 million cars in 2025, with upside potential if EVs become "truly disruptive" and a game changer the way Apple Inc.'s /quotes/zigman/68270/delayed /quotes/nls/aapl AAPL iPhone was.
One advantage EVs would have over ethanol is that EVs require less infrastructure investment, though a much larger investment would be borne by the consumer, the Goldman analysts said. Natural gas-based ethanol is "very front end loaded" at the upstream drilling and refining stage with little burden on the consumer," they said.
Shares of Tesla rose 0.9% on Friday, poised to end the week down 1.4%. Shares declined Thursday in the wake of an announcement that Tesla would open all of its patents to other electric-car makers. Shares have lost 14% in the past three months, and gained 110% in the last 12 months.
Tesla's patent decision may have shaken the confidence of some investors, but didn't faze analysts at Baird. Sharing its patents will be good for the company in the long run as it will likely increase the adoption of electric cars and support faster growth of the supercharger network, they said in a note Friday.
The decision is likely to have "minimal" impact in the near term, the analysts added. Demand for electric vehicles continues to outstrip Tesla's ability to supply the market and an incremental adoption of EVs would help overall demand for Tesla's cars, they said.
— Claudia Assis
Follow Claudia Assis on Twitter: @ClaudiaAssisMW
More from MarketWatch and Energy Ticker:
5 things you need to know about Iraq
Tesla opens its patents, and investors respond by dragging shares lower


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When the Buccaneers hold their first training camp practice on Thursday, July 25, Greg Schiano anticipates cornerback Darrelle Revis will be on the field, the Buccaneers' head coach said today, per the club's official Twitter feed.
However, it's important to note that the Buccaneers used the term "in some capacity" when describing Schiano's characterization of Revis' potential participation.
The Buccaneers and Revis figure to be prudent with regard to his practice participation, considering the four-time Pro Bowl cornerback is coming off an ACL tear that ended his final season with the Jets. However, it's a positive that Schiano is saying Revis figures to be present for practice.
Even if Revis gets in some work off to the side in-uniform as he did at minicamp, that beats staying inside and rehabilitating.
For mid-July, this is a silver lining.


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I'm back from another Cisco battle. These things really try to fight me any chance they get.
I have a Cisco 831 broadband router. This is my second Cisco router for home use. I also have a 806... but the hardware is lacking. I needed soemthing more powerful.
As a good admin would, I try to keep up on all of the Cisco IOS upgrades and releases. For both a feature purpose and a security purpose. I like to keep it secure and I like to play with new featues. One of the first things you are supposed to do is make sure you have enough memory for the new image. I just upgraded the Flash memory to the maximum the device would take. I never thought to check for RAM. Turns out that the image I was trying to load needed 64MB of RAM. I only have 48.
So, I try to load the new image and right away I knew something was wrong. I go and plug in a console cable and watch it booting up. Sure enough, memory error. Dumbass! I should have known to check to make sure I have enough RAM.
So, I sulk back in the chair and think to myself... "No problem. I'll boot into ROMMON and reload the old image." ROMMON should really only be used for disaster recovery. This wipes the Flash clean. So, anything else you may have had on there is gone. That isn't a problem for me. I ALWAYS backup over tftp anytime I'm moving files around or upgrading.
So, I try to recover and everytime I try to tftp the image to the device, I get a "bad checksum" error after its written to flash and I display the contents of the flash. This happens regardless of which computer or image or connection I use. I tried all of the following ways.
The fastest way... tftp. I've done it time and time again. I rarely have a problem with it.
The first time I do it, I make my laptop the tftp server and I get the error. I think its because I'm on a wireless connection at the time. So, I switch to wired. I try again over the wired connection and I get the same thing.
Now I was really getting puzzled. It downloads the image, checks the checksum, then erases flash and reprograms the flash. It should not write a bad image to the disk. I have the options set for TFTP to check the checksum after it downloads.
So, I stoop to a slower connection with the correct parameters.
Twice over x-modem which takes FOREVER! Almost 2.5hrs to load over that connection.
Once over y-modem which is just a tiny bit faster than x-modem at about 2hrs.
Again... everything is failing. I'm getting tired of dealing with it and I let it sit for a day or two.
I picked it up again over the next several days and tried to load the image on there.. but every time it fails.
I do some more research and everyone thinks that it must be bad hardware.
I couldn't beleive that because it was working fine! I just wanted to load a new image on there.
Finally... it dawns on me...
The tftp is working fine, so is the x-modem and y-modem.
The problem has to be in the process of reprogramming the flash.
I find out that there is a ROMMON update. This issue is not listed as something this update fixes... but I'm on my last leg. I'll upgrade ROMMON regarless.
Sure enough, I reload ROMMON and then proceed to tftp the new image to the device and it works fine!
Too bad I didn't find the ROMMON update 2 weeks ago...
Anyway... woo hoo! I got it working again. Now to order some more RAM so I can really load the image I want.
So, for all you out there that deal with Cisco devices. When they say make sure you have enough memory... check both FLASH AND RAM! It may save you some headaches down the road.
Oh, and if your recovery is giving you problems... make sure you have the latest ROMON version.


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For the first time since regulators started keeping records, Americans have let more of their student loan balances fall into delinquency than their credit cards. As reported by the Federal Reserve Bank of New York, more than 11% of the nation's $956 billion in student loans have gone unpaid for longer than 90 days. In contrast, credit card delinquencies have dropped for four straight years.
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According to a report in Bloomberg BusinessWeek, guaranteed student loans and rising education costs have resulted in exploding debt levels among groups of Americans least likely to pay the money back. College dropouts default on their student loans nearly four times as often as graduates. However, a stifling job market led many graduates in one survey to call their student loans "illegitimate."
As the federal government backs increasingly risky student loans, banks have succeeded with long-term plans to reduce risk among their personal lending portfolios. A combination of business decisions and federal legislation has resulted in a far more conservative climate for credit card offers than before the recession. Student credit cards are harder to come by, as new credit card applications must include a statement of income that banks can use to determine a consumer's ability to repay debt.
Overall student loan balances have outpaced credit card balances for over two years because of those changes. As consumers have started using balance transfer offers and no-frills credit cards more wisely, many Americans still struggle to pay for college educations that still seem essential despite a job market that rewards degree holders with relatively low paying jobs.
Worse still, the Federal Reserve Bank of New York reports that their delinquency statistics don't account for the effects of student loans in grace periods, forbearance, or deferment. Factoring out these accounts, New York Fed officials told CNBC, would put the "real" delinquency rate for student loans above 20%.
The original article can be found at CardRatings.com:Credit card delinquencies fall below student loan delinquencies for the first time