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FDA Guidance on Review Procedures Made Available
Medical Device & Diagnostic Industry MagazineMDDI Article IndexOriginally Published January 2001WASHINGTON WRAP-UPFDA explains methods for identifying and responding to deficiencies. James G. DickinsonAlso:
January 1, 2001
Medical Device & Diagnostic Industry Magazine
MDDI Article Index
Originally Published January 2001
FDA explains methods for identifying and responding to deficiencies.
Is FDA Biased against EU Devices?
SUD Reprocessing Enforcement
New Vascular Graft 510(k) Guidance
According to a November 10 guidance document, CDRH reviewers should use a four-part approach when identifying deficiencies during the course of a premarket approval (PMA) or 510(k) review. The guidance, Suggested Format for Developing and Responding to Deficiencies in Accordance with the Least Burdensome Provisions of FDAMA, says the reviewer should do the following:
Clearly identify the specific issue.
Acknowledge the information submitted and explain why that information did not adequately address the issue.
Establish the relevance of the deficiency to a PMA determination of "reasonable assurance of safety and effectiveness" or a 510(k) determination of "substantial equivalence."
Request the necessary additional information needed to adequately address the issue and, when possible, suggest alternate ways of satisfying the issue.
The guidance also provides models for reviewers to use. The following, excerpted from the guidance, should be used for a PMA deficiency related to determining reasonable assurance of safety and effectiveness.
(1) According to your Investigational Plan, your device is intended to fuse a bone fracture by the 24-month follow-up assessment.
(2) You reported that 55% of the study subjects had been followed for 24 months. We are concerned that a meaningful statistical analysis cannot be conducted on this study cohort.
(3) To thoroughly evaluate the effectiveness of your investigational device, the data set should be complete enough to have sufficient statistical power when compared to the control group.
(4) Please continue to follow your study subjects until you have sufficient statistical power at the 24-month follow-up point.
The document outlines a 510(k) deficiency in the following way:
(1) In your submission, you proposed to use your suture anchor for repairs of the rotator cuff and ankle ligament.
(2) You have submitted all of the appropriate testing with the exception of "pull-out" testing for the anchor. We believe that this testing is needed in order to fully characterize the performance of the device.
(3) "Pull-out" testing will help to ensure that the device can adequately handle the physiological loading experienced by the rotator cuff and ankle joints.
(4) Please provide a complete test report for this testing or justify why it is not necessary.
In addition, the guidance provides recommendations and a format for sponsors to follow when responding to deficiency letters. "In developing a response to a deficiency, industry should first provide an exact copy of the agency's question to remind the reviewer of the information that had been requested," the document says. If the deficiency is a follow-up question to an earlier deficiency, manufacturers should include both the original and follow-up question. Extensive responses should be organized for easy access with a table of contents, list of figures, and list of tables. "A description or justification of how the information adequately addresses the agency issue is advisable, unless obvious," the guidance adds. When referencing a standard in lieu of data, identification of the standard, its revision date, applicable sections, and any deviations from the standard should be included.
If a sponsor disputes a more-information request as not relevant to the regulatory decision, then the sponsor should articulate this position in the response, the guidance says. Alternatives can be provided by the sponsor "to optimize the time, effort, and cost of reaching resolution of the issue within the law and regulations. This could include alternative types of bench testing, proposing nonclinical testing in lieu of clinical testing, the use of standards, etc." The following is an example of a sponsor response to the above PMA deficiency example:
FDA requested that additional study subjects be evaluated at 24 months to ensure a meaningful statistical analysis at the 24-month follow-up point. To date, 30 additional study subjects have reached the 24-month follow-up assessment, bringing to 75% the percentage of study subjects that have been evaluated at 24 months. Please find on the following pages: a) an analysis of the 24-month data representing 75% of the study subjects, and b) a rationale supporting 75% as an adequate percentage of the study cohort to allow meaningful analysis.
The new guidance may be accessed at http://www.fda.gov/cdrh/modact/guidance/1195.html.
Is FDA Biased against EU Devices?
An analysis of 10 years of FDA warning letters with product detentions issued to medical device manufacturers in Europe—when compared with similar actions against U.S. firms—"demonstrates a remarkable bias against European device manufacturers," according to Washington, DC, attorney Larry R. Pilot (McKenna & Cuneo). Pilot says he made the analysis for a presentation he gave in October to the annual general assembly of Eucomed, the European medical device industry association, in Berlin.
In the 1991–2000 period, Pilot says, about 238 warning letters were received by 200 European manufacturers, of whom about 120 were notified that their products may be detained upon entry to the United States. This contrasted with the equivalent experience of U.S. manufacturers, Pilot says. In the 1991–96 period, they received 2995 warning letters but only 141 seizures and 32 injunctions. Unless there are multiple seizures or a contrary court order, Pilot says, a U.S. manufacturer whose devices are seized may continue to ship them.
Pilot contends that the heavy hand CDRH applies to European manufacturers is not shared by its drugs counterpart, CDER. Since 1991, FDA's drug center sent 18 warning letters to firms in Italy, Germany, France, and England, but only four of those contained an explicit reference to CDRH-type detentions, he told Eucomed. "If the FDA detentions represent a barrier to trade for which there is no justification that is reasonably related to safety or effectiveness, the EU and member states need to express their views."
CDRH director David W. Feigal told this writer that Pilot's assumption that device manufacturing is of equal quality throughout the world was "dubious." He said the fundamental issue was that while the agency does GMP inspections every three to four years in the United States, it only performs them every 10 to 12 years at foreign sites. "A much higher proportion of these are for-cause when we have such infrequent inspections," he said. "So the violation proportion would be expected to be higher. I think you could argue that the lower inspection rate abroad discriminates against U.S. firms."
Feigal also noted that Pilot's Eucomed presentation "was a mixture of time frames. He presented 10-year European data and five-year U.S. data. The 10-year data capture the Kessler years when the proportion of inspections overall with warning letters was 20 to 25%. Over the last five years the rate has been half that, so the way he showed the data was almost sure to show a lower rate. He also didn't have any denominators."
A critique of Pilot's charges prepared at Feigal's request by CDRH's Office of Compliance called them "misleading because of what he is comparing. He compares 120 import detentions over 10 years to 12 domestic detentions over an almost 10-year period." The critique went on to say:
Domestic detentions are not the same thing as foreign detentions. Foreign detentions are put into place and remain in place until the firm corrects the problems. They can be in place for years. On the other hand, the domestic detention is used very sparingly and typically only to gain control over product that we have reason to believe will be intentionally shipped by the affected firm or others. This action is usually taken when there are other compelling circumstances such as when the device represents a public health risk. In the last 25 years, we have taken probably no more than 50–60 such actions. Administrative detention also places a significant due process burden on FDA. For example, once we detain, the firm can appeal and within five working days of the appeal, FDA has to hold an administrative hearing (usually presided over by a regional director) and present our case. We've had a few hearings and it has been a significant challenge to meet these deadlines.
The office said automatic detentions are the only viable action the agency can take after issuing a warning letter to a foreign firm. "We consider that action to be a comparable enforcement tool to an injunction more so than a product seizure on the domestic side," the office said. An injunction, like a detention, immediately stops the firm from shipping product in U.S. commerce. "A seizure only captures specific goods that we identify are violative but does not specifically prohibit the shipment of new product (although we can and have amended seizures to injunctions when shipment continued after a seizure). When considering a detention, we should always ask ourselves whether the deficiencies would warrant injunction domestically." The statement said the office is doing this "fairly consistently."
On Pilot's additional charge that CDRH is more severe in its foreign warning letters than FDA's drug center is in similar situations, the CDRH Office of Compliance said it has asked the FDA Office of Regulatory Affairs for comparative data on this. It also noted that direct objective evaluation of Pilot's data was made difficult by missing data and old records in FDA's system that have not been computerized.
SUD Reprocessing Enforcement
CDRH's PMA enforcement deadlines for hospitals that reprocess single-use devices (SUDs) were provided in a recent agency letter. In it, CDRH listed its enforcement dates for premarket submission requirements: February 14, 2001, for all Class III devices; August 14, 2001, for all nonexempt Class II devices; and February 14, 2002, for all nonexempt Class I devices.
CDRH added that it intends to enforce the nonpremarket requirements (i.e., registration and listing; the quality system regulation; medical device reporting; labeling and tracking; and corrections and removals) by August 14, 2001. CDRH also stressed that hospitals should pay particular attention at this time to the regulatory requirements for GMPs: "Any hospital that intends to continue reusing and reprocessing SUDs will need to understand these requirements, which include process validation, corrective and preventive action, quality system inspection, and controls used for packaging, labeling, storage, installation, and servicing of all reprocessed SUDs."
Shortly after issuing the letter, CDRH posted to its Web site a list of SUDs (designated appendix A) known to be reprocessed, which was taken from the August 14, 2000, Guidance for Industry and for FDA Staff: Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals.
The guidance can be found at http://www.fda.gov/cdrh/reuse/1168.html, and the appendix at http://www.fda.gov/cdrh/reuse/1168a.html.
New Vascular Graft 510(k) Guidance
FDA's latest views on special controls for vascular graft prosthesis 510(k)s can be found in a new agency guidance document. The guidance was "developed to support the reclassification from Class III to Class II for vascular graft prostheses of less than 6 millimeters in diameter . . . and also applies to vascular graft prostheses of 6 millimeters and greater diameter."
It reminds all manufacturers that they must comply with the quality system regulation and identifies a host of significant overall controls they should be aware of, from design controls to test equipment.
Key steps in process validation are also noted, including acceptance activities and preventative action, as well as certain risk factors—thrombosis embolic events, occlusion stenosis, and more. Their appropriate controls are also included.
The guidance may be accessed at http://www.fda.gov/cdrh/ode/guidance/1357.pdf
James G. Dickinson is a veteran reporter on regulatory affairs in the medical device industry.
To the MDDI January 2001 table of contents | To the MDDI home page
Copyright ©2001 Medical Device & Diagnostic Industry
About the Author(s)
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The dive sites in Gozo are outstanding
There really aren't too many dive destinations where you can be diving a wreck in the morning, diving a blue hole in the afternoon and completing your day with some night time cave diving but diving in Gozo really does have it all! From exploring the belly of MV Karwela to descending through the stunning archway within the blue hole we promise the diving in Gozo never gets boring!
Source: Instagram
Credit: @2oceanaddiction
Dive sites in Gozo are close together
Whilst Gozo is a mere 67km2 the dive sites in Gozo really do provide divers with a vast array of choices when it comes to the type of diving they want to do. Because the island's land mass is small, moving between each dive site is fast and easy and if the weather is rough in the north then rest assured the diving will be great in the south meaning there's always a spot that's sheltered! A perfect reason to book your diving trip to Gozo.
Jacques Cousteau voted Gozo in his Top 10 dive sites in the world
Yep, that's right! The legend himself voted Gozo's blue hole and inland sea in his top ten dive sites of all time and it's easy to see why. When you dive Gozo's blue hole you're instantly immersed into a stunning aquatic world! Not only is it hypnotically beautiful with streaming beams of light that bathe those descending but just within the blue hole itself you can explore a large cave where slipper lobster can often be found and where large Conger eels hide away in the large dark crevices that line the cave. Then of course there's Gozo's inland sea! You enter into a crystal clear lagoon and exit through a long narrow cave that really is breathtaking! If the godfather of all things Scuba diving loved it then you'll love scuba diving in Gozo too!
Weather and visibility
300 Days of sunshine provide a comfortable climate for diving in Gozo pretty much year round! From an average of 30c in mid summer to daytime lows of just 16c in mid winter, you won't be spending much time shivering post dive! What's more as Gozo is mostly made up of solid rock, visibility is almost always excellent, averaging between 25 and 30 meters. The great visibility and stunning topography make for great underwater photography in Gozo.
Source: Instagram
Credit: @2oceanaddiction
So, what are you waiting for? Get in touch with St Andrews divers cove today and book scuba diving in Gozo for an underwater adventure you'll never forget!

subset: commoncrawl


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Teen Adventures in Grief
August 14, 2021 @ 10:00 am - 6:00 pm
Chesapeake Life Center will offer four different Saturdays of summer grief programs for children and teens that are filled with adventure, music and art.
For teens ages 12 to 18 who are entering grades 6 through 12, there is Teen Adventures in Grief. It will take place from 10 a.m. to 6 p.m. Saturday, Aug. 14, at Terrapin Adventures. By using team building exercises and other activities to help them get to know each other, teens will find a space where the many emotions of grief are met with care and compassion. Professional counselors offer the expertise to support these teens as they navigate grief while having fun and discovering they are not alone. Registration is required by Aug. 2.
As this event has limited participation, the Chesapeake Life Center team is confident it can offer a safe experience for all participants, and will take all the necessary precautions, following guidelines from the Centers for Disease Control.
The cost is $40, and includes snacks, meals, activities and a T-Shirt. Scholarships are available; inquire upon registering. Call 888-501-7077 or email email@example.com. Also, visit www.chesapeakelifecenter.org for ongoing children's programs.


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SAN JOSE - The funny thing about a winning streak is that, at the end of the day, the only thing that gets remembered is the win. But when a team loses, the performance tends to get picked apart.
But as the Sharks pointed out after the Edmonton Oilers snapped the team's six-game winning streak, San Jose consistently has had things to work on. Tuesday's loss showed they can't take advantage of a streak -- there's still a lot of work to do.
"I think it's a wakeup call for us right now," captain Logan Couture said. "You win six in a row and winning kind of masks when you're not playing your best if you find a way to win. I think the last couple of games that's the way the games have gone. We haven't played our game and we found a way to win, but tonight we got what we deserved."
This isn't to say that the Sharks didn't deserve to win any of the games during their last streak. Heck, their 2-1 shootout win over the Nashville Predators two weekends ago was easily the team's best game of the season. But through some of the other games during that stretch, a particular player or play is what kept them in the fight even when the opposition tried to make a comeback.
After going into a 2-0 hole against the Oilers on Tuesday, those different ways to win weren't coming into play.
"In the last couple of games here that we were winning, we were finding ways to win all over the map," Brenden Dillon discussed. "Sometimes, we thought we deserved to win. Other nights we found a way whether we were good on special teams or we got some big saves from Jones, whatever it might have been."
It didn't help that the Oilers came for revenge after the Sharks defeated them 6-3 exactly one week before. Not only did Edmonton get scoring from throughout their forward lines, but Mikko Koskinen was on his A-game between the pipes.
"We knew after we beat them last week they were going to come hard today," Dillon said. "We were expecting a push from them. But it just seemed like they elevated their game and we kind of stayed the same.."
Head coach Peter DeBoer agreed. "I thought they came out heavier and harder than last time," he said of Edmonton. "So they obviously wanted to fix what went wrong last time for them. I thought they were much more engaged all night."
[RELATED: What we learned in Sharks' streak-snapping loss to Oilers]
Perhaps the Sharks should take a page out of the Oilers' book and rebound from a loss in their upcoming contest. The loss to Edmonton comes as San Jose gears up to face the Golden Knights for the first time since the Vegas squad put them in a 0-2-0 hole to start the season.
If there is a time for the Sharks to rebound from a loss and get back to finding those different ways of winning, that time is now.
"We'd better play a lot better than we did tonight," Couture said, looking to the next game. "Or it could get ugly."


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Winter is here, Christmas seems so close. This is a month of joy and merriment. As we brace ourselves for yet another new year and new resolutions, we must remember that the COVID 19 is still not over. We must all stay safe and healthy. But that's not all we're here to talk about. Today, December 12 we have the much-awaited International Day of Neutrality. So let us all put on our reading hats and know about this day and its celebrations.
International Day of Neutrality
Battle and Wars have led to nothing but losses in totality. Yes, we could say that the winning side did see a victory, but at a great cost. Neutrality refers to a party refraining from taking part in any side of the war. This is in the literal sense. Nowadays neutrality simply refers to not having any opinion or side in a dispute.
The United Nations recognizes International Day of Neutrality for three main reasons:-
- Preventive Diplomacy
- Mediation
- Peace-Making
The General Assembly recognized these points so as to avoid any future wars. In political terms, there is always a chance of a dispute turning out to be a heated argument. We obviously do not want any more wars after World War I and II. Therefore it is important for all the member states to cooperate with each other and maintain confidence.
The need for neutrality arrived due to a number of tensions:-
- Territorial Integrity
- Sovereign equality of states
- Self Determination
With such strong patriotic views of one's country has a definitive chance of disruption of peace. On February 2, 2017, The General Assembly passed the resolution for political neutrality. And thus December 12 is decided as the International Day of Neutrality.
Interconnectedness and peaceful negotiations are hard to keep up when the stakes of lives are too high. Every leader must do what is necessary for their respective citizens. And thus a middle land or neutral terms are thought of so as to benefit everyone.
How to Celebrate
Today, December 12, we must all be proud of international organizations such as the UN who help provide a platform for peaceful discussions whenever any disagreement takes place. We must spread awareness about today so as highlight the importance of the peace we are harboring today. We can attend public gatherings and walks to cheer for all the peacekeepers in our world. Even if it is another country. We should be proud of what we have today and be grateful.
"Unite for Universal Health Coverage: Now is the Time for Collective Action"
To read more such article visit:- https://www.bragsocial.org/


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No artist in our time has mastered as
many genres of American roots music as Bob Dylan. In a
career that has spanned four decades, he has created
masterpieces of traditional folk, protest music, folk rock,
rock & roll, country, gospel and blues; in each he has
pushed the envelope, using elements of older forms to
synthesize a remarkable body of work that has made him one
of the 20th century's most influential artists.
A change of direction came in 1979, when he announced he had
become a born-again Christian, and began to focus on gospel
music. He has recorded no gospel music lately but is still
touring, creating new songs for new generations.


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From invitations to wedding cakes to everything in between, brides share smart ways to save money.
Do Some Dress Digging
"Shhh! It's a secret! I bought my dress off the rack. It had been tried on by other people, but it looked just like any other dress— and it only cost me $200!" —Amie
"Finding something more upscale in your price range is usually possible—it just takes some extra work. I saved money on my designer dress by purchasing it at a trunk show. Don't be afraid to shop around!" —Jena, Philadelphia, PA
Photo courtesy of St. Pucchi
Time it Right
"Because we decided to hold our wedding on a Saturday at noon, the site fee was a real bargain. We served the meal buffet-style and had open seating. I think people enjoyed the relaxed feel of it because everyone really let loose!" —Beverly, Leonia, NJ
Entertain the Possibilities
"My brother is really into music, and he used an iPod to DJ at our reception. All we did was rent speakers. We came up with a playlist together, which was fun, and he was happy to handle the rest. We're into indie music, so it was nice to be able to hear so many of our favorite songs, which are kind of offbeat, as well as some more popular stuff to keep our guests happy!" —Jennifer, Jersey City, NJ
Find a Creative Alternative
"I nixed a wedding video and used a small portion of what I would have spent on it to rent a photo booth—it was between $500 and $600. Guests had so much fun getting their pictures taken with props. We now have a really cute album with photos and messages from everyone!" —Emily
"We decided to skip the wedding cake. It's a tradition in my family for relatives to bake homemade sweets to serve at a buffet at the reception. With all those amazing cookies, we didn't really need a cake." —Jeanette
Be Selective About the Extras
"Our site offered a convenient package deal that provided everything we needed for the kind of wedding we envisioned. If you wanted, you could choose to upgrade to matching colored napkins or add decorative chair covers, but we didn't feel it was necessary. We were happy with what was offered, so that's what we did. It was awesome!" —Jeanette
"There are a lot of things brides are convinced they need to buy. I kept seeing decorated card boxes to display at the reception, but in the end, I decided to make one myself. I bought a plain ivory satin box from a craft store, added pretty silk flowers in autumn hues that matched my bouquet and then topped it with a rhinestone monogram letter. All in all, I think it probably cost $30, and my mom and I both thought it looked much better than the pre-made ones!" —Emily
Ask for Special Treatment
"Some photographers don't give you the copyright to your photos, but I negotiated to get all the high-resolution pictures to reproduce as we like. I was able to design my album using a photo-sharing website. I think I spent no more than $60 on the album, and it turned out just perfectly." —Jennifer
"We saved a lot by choosing a sparsely decorated site. To spruce it up, I wanted to hang "puff balls" made of colorful tissue paper. You can buy a craft kit to make these decorations, but instead I found tissue paper in bulk and purchased floral wire from a craft store. Then I invited a few close friends over. We made dozens of decorations. Don't be afraid to ask for help—if you need something assembled, just offer dinner or drinks!" —Lynda
"We printed our invitations at home from a kit that I found on clearance at a craft store for under $50. Luckily, I happened to love the ones on sale. If you're going to go this route, though, I would recommend breaking up the project over a few evenings. Our printer overheated!" —Jeanette
Back to Nature
We kept costs down by holding our wedding at a public park—the same place where my parents had their wedding reception!—Brandie, La Mirada, CA


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Weather Forecast Summary for Sunday 1st February (the Maltese version follows the English one): The weather is expected to be partly cloudy with possible isolated rain showers and with strong Force 6 to 7 westerly winds.. Low of 12°C / High of 14°C.
Tbassir tat-temp għall-Ħadd, 1 ta' Frar: It-temp mistenni li jkun ftit imsaħħab b`ċans ta` xi ħalbiet iżolati tax-xita u b`riħ qawwi Forza 6 għal 7 mill-Punent. L-inqas 12°C / l-ogħla 14°C.
Detailed weather forecast at https://www.facebook.com/notes/malta-weather/weather-forecast-1st-february-2015/424352674388116
Please LIKE and SHARE so that you and your friends will have much more chance of viewing all our updates on your news feed. And thanks for your support.
And a big thanks to CFS for this lovely pic taken at sunset from Dwejra in Gozo.


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Why Do We Harp on Consistency?
In the branding world, the difference between good and great is consistency. So, why do we harp on consistency? We want to help build great brands. It's as simple as that. No great brand started great though. Consistency by definition implies a time span.
Boring and consistent are too often thought of as synonymous. Let's consider the brand Ford, one of the most consistent brands you can find. Consistency through the decades has made them a household name. So, you can think of consistency as boring, or highly profitable…whatever.
We've had a lot to say about how important the customer brand experience is, but there is more to it. Investing in consistency is investing in security, control over perceptions and ultimately, success.
Safeguard Your Investment
Crafting a brand is not cheap. We've worked with organizations that have spent tens of thousands of dollars defining their message, setting up their social media presence, and getting the perfect logo and brand standards, only to have their brand diluted by inconsistency and improper use.
Putting safeguards around your branding standards is essential to protecting your investment. Brand consistency can get tough with multiple locations. Is signage being created and displayed properly? Is the store layout the same from one location to the next? Conducting field visits with the Action Card app makes in-store consistency a breeze.
Build Upon Successes
An author at the North Star Marketing put it best when they said, "No one has to guess, 'I wonder what this Coca-Cola will taste like?'" When someone has a positive experience with your brand, that is an opportunity to create a fan, but again, consistency is the key. If Coca-Cola had good batches and not so good batches, do you think they would have the kind of loyalty they have?
How are you currently building on successful client experiences? Did you know that a thoughtful field visit process can help you identify stores struggling with customer service?
Establish a Voice
No one is digging around your social media or website to find your mission, vision, and values. You have to establish a voice, and make sure it's felt at every touchpoint with your customers. Are you customer centric? Do you serve your community? Whatever you value, be sure to make that a solid part of your brand. According to Bop Design, 64% of people cite shared values as the main reason they have a relationship with a brand.
If you're like most business owners, great customer service is a value of your organization. How are you doing at relaying that value, standing by it, proving it? The field visit process not only helps you provide consistent customer service, it instills customer service as a vital part of your internal culture.
Would you like to see all of this in action? Better yet, would you like to see all of this in Action Card? We'd love to walk you through a demo and show you the suite of products the Action Card apps offers to enforce consistency. Contact us today!


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We all know that a poor diet is unhealthy, but a new BYU study finds that stress may just as harmful to our bodies as a really bad diet.
In a new paper published in Nature Scientific Reports, BYU professor of microbiology and molecular biology Laura Bridgewater found that when female mice were exposed to stress, their gut microbiota — the microorganisms vital to digestive and metabolic health — changed to look like the mice had been eating a high-fat diet.
"Stress can be harmful in a lot of ways, but this research is novel in that it ties stress to female-specific changes in the gut microbiota," Bridgewater said. "We sometimes think of stress as a purely psychological phenomenon, but it causes distinct physical changes."
Bridgewater and her collaborators at Shanghai Jiao Tong University in China took a large group of 8-week-old mice and exposed half of the males and half of the females to a high-fat diet. After 16 weeks, all of the mice were exposed to mild stress over the course of 18 days.
Researchers then extracted microbial DNA from the mice fecal pellets before and after the stress to test how the gut microbiota was affected.
They also measured mouse anxiety based on how much and where the mice traveled in an open field arena.
The researchers found fascinating differences between genders:
Male mice on the high-fat diet exhibited more anxiety than females on the high-fat diet, and high-fat males also showed decreased activity in response to stress.
However, it was only in female mice that stress caused the gut microbiota composition to shift as if the animals were on a high-fat diet.
While the study was only carried out on animals, researchers believe there are could be significant implications for humans.
"In society, women tend to have higher rates of depression and anxiety, which are linked to stress" said Bridgewater, who also serves as Associate Dean of the BYU College of Life Sciences. "This study suggests that a possible source of the gender discrepancy may be the different ways gut microbiota responds to stress in males vs. females."
BYU's Chenhong Zhang served as an author on the paper. Liping Zhao, Shengtian Li, Jing Wang, Qianpeng Zhang, Weiwei Hu and Yanqui Wu of Shanghai Jiao Tong University also contributed to this study.
Source: Todd Hollingshead – Brigham Young University
Publisher: NeuroscienceNews.com.
Original Research: Full open access research for "Gender-based differences in host behavior and gut microbiota composition in response to high fat diet and stress in a mouse model" by Laura C. Bridgewater, Chenhong Zhang, Yanqiu Wu, Weiwei Hu, Qianpeng Zhang, Jing Wang, Shengtian Li & Liping Zhao in Scientific Reports. Published online September 7 2017 doi:10.1038/s41598-017-11069-4


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WASHINGTONRaising the overtime pay exemption for executive or administrative employees to more than $50,000 annually will do great harm to small businesses, the Tire Industry Association (TIA) told the U.S. Department of Labor.
Small businesses do not have the ability to adjust to dramatic increases in labor costs, TIA Executive Vice President Roy Littlefield said in comments to the Labor Department on its July 6 proposed rule. This rule will have a significant negative impact on their ability to maintain competitiveness in the market.
The Fair Labor Standards Act (FLSA) requires a minimum wage and overtime pay of at least one and one-half times an employee's regular pay for any hours more than 40 in any given week, according to the Labor Department proposal.
However, there is a current white collar exemption for executive, administrative, professional, outside sales and computer employees earning more than $23,660 annually. This exemption was established in 2004, the agency said.
The proposal would more than double that overtime pay threshold to $50,440 beginning in 2016 and allow automatic annual updates.
By way of this rulemaking, the department seeks to update the salary level to ensure that the FLSA's intended overtime protections are fully implemented, and to simplify the identification of nonexempt employees, the document said.
In his comments submitted Sept. 2, Mr. Littlefield said the threshold it establishes is much more than most small businesses can afford.
We have heard the following from our membership on what business decisions this proposed rule may cause them to make, Mr. Littlefield said.
These decisions include:
c Raising prices on goods and services;
c Laying off some workers, and changing others from salaried to hourly;
c Reducing base pay to account for overtime pay;
c Changing full-time workers to part-time;
c Reclassifying job duties;
c Delaying or canceling plans to expand the business; and
c Providing less flexibility in hours worked.
Raising the minimum salary will be devastating to employers, Mr. Littlefield said. It will hinder hiring practices, freeze wages and stifle economic growth during an already sluggish economic atmosphere.
Having managers, assistant managers and supervisors is common practice in our industry, he said. These employees make a respectable income on salary and are given a wide range of benefits that come with that status. We fear this proposal would cause many employers to take away the salary and benefits and rather pay the employee hourly to make up for the rising costs.


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Forget virtual Eurovision, it's time for industry to sing the praises of Phoenix Natural Gas, Northern Ireland's largest gas distribution business. The company has been recognized as a leader in Europe for its environmental, social and governance performance by GRESB – an industry leading organization committed to assessing the Environmental, Social and Governance (ESG) sustainability performance of Real Estate and Infrastructure assets. This was the fourth year of participation by Phoenix who in addition to coming top across Europe, were placed second out of 393 global participants.
Kailash Chada, Chief Financial Officer at Phoenix Natural Gas said: "Our vision is to be recognised for excellence as a world leading utility which demands that our behaviours and business style is a benchmark for others. We are proud to demonstrate strong environmental, social and governance values within our business and to be recognised by GRESB."
For more information on Phoenix's environmental, social and governance principles, please get in touch.
W: www.phoenixnaturalgas.com


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Last night, at around 10 pm, whilst cleaning up sumthin r other, I thought of a friend whose husband is away on a missions trip. She's got one 19 year old son still living at home.
And then another friend came to mind; her husband is away on business, and she's got one son at home, her 18 year old.
And then another friend crossed my mind; her husband often works late, so suppers at her house are quiet events - just her and her 18 year old son.
And, from there, I thought of another friend ... her husband is in the process of building up his business, so he often skips supper and stays at work. She's got a 19 year old son too.
And, of course, there's my other friend, who is divorced and ...
Well, you get the idea.
Suppers around my house are so unsatisfying. Rarely do I have more than 1 child at the table with me. And regardless of which child it happens to be, no conversation happens. At their insistance.
I wonder if other moms have this same problem. I doubt it.
And then, in a totally spontaneous moment, I emailed/facebooked all my friends and their kids and invited them to come over tonight for pizza. I hoped that at least one of them could join us ...
Guess what? I had 12 people over for dinner tonight.
How awesome is that?
Three things I'm thankful for:
1. I had 12 people over for dinner tonight. SO thankful for friends.
2. I am going to be in bed by midnight tonight.
3. I earned a few months of job security by lending my camera to my supervisor. He's taking it to Phoenix next week.


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AARP and eDriving Team Up for Pilot Study to Help Make Drivers Safer and More Confident
How can drivers remain confident as they age? That's a critical question that faces drivers 50 and older, and two organizations committed to keeping drivers safe through effective deployment of technologies and education will team up to understand how best to empower these drivers.
Read More: Interview with David Sikora, Chief Executive Officer at ALTR
AARP – through its 39-year-old safe-driving initiative, AARP Driver Safety – has chosen safe driving innovator eDrivingSMand its Mentor by eDrivingSM telematics app to power a study that will help measure, score and coach the driving behavior of a select group of drivers. This new pilot study will help determine the extent to which telematics – coupled with coaching and education provided directly through the smartphone app – can help improve driver safety in the 50 and over population.
Read More: Insurtech: the new AI disruption is hitting insurance
The 12-week study, which will launch with more than 500 participants, will use the Mentor smartphone-based app that uses telematics sensors in the phone to track specific driver actions. Mentor scores driver behavior after each trip and provides immediate feedback to the driver in the form of the FICO® Safe Driving Score, as well as specific insights and coaching related to behaviors behind the wheel. Mentor will also allow study participants to compare their scores with one another, enabling a shared experience and better informed conversations about safe driving.
The goal of the AARP Driver Safety-eDriving study is to increase safe driving through the reduction of risky behaviors including speeding, hard braking, and distracted driving. Participants in the study will be surveyed prior to using Mentor to define their current driving habits and measure how well they believe they are driving. Throughout the study, performance data will be analyzed to not only discover if Mentor improved participant scores over time, but also to help shape the way drivers are educated in the future. A post-study survey will further confirm behavioral shifts resulting from drivers' use of Mentor.
Read More: Interview with Akemi Tsunagawa, Founder and CEO, Bespoke Inc


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Imagine at the age of 24 being told by your adoptive father that you are the biological son of the world's most notorious drug lord Pablo Escobar. Worst still, that your life is in imminent danger requiring 24/7 security.
For this is the bombshell dropped on artist Phillip Witcomb, on discovering he was christened Roberto Sendoya Escobar. The eldest son of Colombian Pablo Escobar, narco-terrorist and murderer of incalculable thousands. Phillip was born outside Bogota in 1965 to Maria Luisa Sendoya, an innocent 14-year-old, his father 16 year-old Pablo Escobar.
"Suddenly, all the gruesome images that haunted my childhood nightmares slotted into place," he explains. "I also understood why the subjects of my paintings had always tended towards creating eutopia, exploring a peaceful natural world as I would want it. In direct contrast to the trauma of my past."
Following a shootout by special forces troops in which only baby Roberto Sendoya survived, he was later rescued from a Bogota orphanage by Joan and Patrick Witcomb, a debonair mysterious James Bond character. Roberto's name changed to Phillip and he had no idea of his true background, but it did not take long for his biological father to locate him.
Click here to continue reading about the son of drug lord Pablo Escobar and how he has overcome the trauma of his past.
Written/Pictures by Laura Stadler


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From left to right: Jean-Pierre Corbel – Commercial Director Subsea Africa, TechnipFMC, Geol. Mohamed Abdel Salam – AQP Chairman & Managing Director, Aldo Costantini- Energean, AQP General Manager & Managing Director, Maryan Lebel -Tendering & Capturing Director Subsea Africa, TechnipFMC
AbuQir Petroleum, a joint venture between Energean and Egypt's EGPC, has signed an integrated EPCI contract with offshore services provider TechnipFMC for a subsea tie-back located offshore Egypt.
The contract covers the Engineering, Procurement, Construction, and Installation of four subsea wells as well as the subsea tie-back to the existing AbuQir Petroleum infrastructure and processing plant. The value of the deal was not disclosed.
The development wells will be drilled in a water depth between 60 and 90 meters. Three of them will be located in North El Amriya (NEA) concession, operated by Petroamriya JV between Energean and EGAS, and one in North Idku (NI), the concession operated by Nipetco JV between Energean and EGPC.
The NEA concession contains two discovered and appraised gas fields (Yazzi and Python) while the NI concession contains four discovered gas fields, one of which is ready for development.
The integrated project NEA/NI is due to deliver first gas in 2H 2022 with 49 million boe of 2P reserves, 87% of which is gas, and peak production is expected to be approximately 90 MMscf/d plus 1 kbbl/d of condensates.
Nicolas Katcharov, Energean's Country Manager in Egypt, said the project initiated "a significant development with an innovative integrated approach, providing substantial benefits to the long-term production profile in the country whilst bringing additional cost efficiencies and strategic benefits. It is also opening a new perspective for the near-field exploration in the Egypt Nile Delta offshore."
Worth noting, Energean in January announced Final Investment Decision had been taken on the North El Amriya and North Idkunea ("NEA/NI") concession subsea tieback project offshore Egypt. It at the time said that total capital expenditure was expected to be approximately $235 million, "the majority of which is expected to be incurred in 2022."


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As we've reported before, the Children's Museum of Indianapolis offers a FREE Family Night once a month, thanks to Target. And this month, this special evening honors the brand new – and exciting! – exhibit, Beyond Spaceship Earth. What are all the deets? Read on for them PLUS a future exhibit announcement …
WHAT: Target Free Family Night−FREE Admission from 4pm-8pm ONLY.
WHERE: The Children's Museum of Indianapolis, 3000 N. Meridian Street
WHEN: Thursday, July 7th, 2016. Free admission runs from 4pm-8pm ONLY.
DETAILS: Thanks to the generosity of Target, museum visitors enjoy free admission to the Children's Museum on the first Thursday of every month from 4pm-8pm.
RELATED: Beyond Spaceship Earth opens at Children's Museum
Celebrate the opening of Beyond Spaceship Earth, an immersive experience that explores how astronauts live and study on the International Space Station (ISS). In this new permanent exhibit, children and families will experience what it's like to eat, sleep and work aboard the ISS. Former NASA astronaut and the museum's Extraordinary Scientist-in-Residence, Dr. David Wolf helped design this real life replica complete with hands-on learning opportunities for all generations.
Learn how astronauts continue important scientific research aboard the ISS, live their daily lives, and how they retrieve cargo in this interactive exhibit! You can even try out your space legs in a simulated spacewalk!
See the interior of the ISS up close with authentic objects and artifacts from the ISS, robotic tools that repair the station, and a scale replica of the Soyuz capsule that transports our astronauts back home.
Explore the new Schaefer Planetarium and Space Object Theater, where the actual Liberty Bell 7 is on display. Enjoy features about Indiana astronaut Gus Grissom, the Race-to-Space historical period, and the Liberty Bell 7. Beyond Spaceship Earth also features an Indiana Astronaut Hall of Fame dedicated to recognizing the strides made in scientific inquiry by Hoosiers in space.
What's coming up?
Doc McStuffins: The Exhibit opens August 6, 2016.
For the first time ever, Disney is partnering with a museum to present an exhibit that spotlights Doc McStuffins, a young girl who dreams of becoming a doctor like her mom! Join Doc and her stuffed animal pals for hands-on fun, with a focus on leading healthy lives. Just as "Doc" helps promote healthy lifestyles with helpful hints, Riley Hospital for Children Indiana University Health will provide its expertise with visits from real nurses and doctors on select dates.
MORE INFORMATION: The Children's Museum of Indianapolis is located at 3000 North Meridian Street, Indianapolis, IN 46208. Visit childrensmuseum.org or call (317) 334-4000 for more details.
Out enjoying Target Free Family Night? Tag Indy's Child on Twitter {@indyschild} and Instagram {@indyschild} with your favorite photos from the day and you might be featured in one of our posts or articles. Photo credit: CityMom Marcie Muensterman and family.


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DOGE dates back to 2014, making it even older than Ethereum, which launched in 2015. But unlike most cryptocurrencies, its team never had high hopes of it becoming the next big currency or changing the world. The crypto protocol was made by copying and pasting the source code behind Bitcoin. Markus claims it took him just three hours to launch Dogecoin and that he did so for a joke. Even Markus sold all his holdings in 2015; he must be kicking himself now.
When evaluating most cryptocurrencies and digital tokens, I'd take a deep dive into the infrastructure and technology behind the protocol, but that's not applicable for Dogecoin given its lack of unique features. Since it's based on bitcoin, in theory, DOGE would be classed as an alternative currency. Plus, Elon Musk recently started accepting Dogecoin as a payment method for Tesla merch, which seems like the use case he foresees.
Despite being around since 2014, Dogecoin went pretty much unnoticed for the first six years of its existence. When Dogecoin launched, its price was $0.0002, which didn't change significantly until 2021. In February 2021, the coin enjoyed what at the time seemed like a big jump up to $0.079.
Representing a return of 334,900%. Why, you ask? The entire crypto market was enjoying a boom during this period (like NFTs are seeing now), and many cryptocurrencies benefited from it, so this was undoubtedly a factor.
We finally come to the million-dollar question: should you give the dogecoin project your money? Since Dogecoin was only created as a joke and has swung about wildly in price, it's probably not something at which you want to throw your inheritance. Suppose you're looking for a surefire way to grow your investments. In that case, other cryptocurrencies arguably have more inherent value and should therefore be less risky,
If you feel an illogical pull toward Dogecoin that you can't shake, you're not the only one. Some might say it's just a joke. Still, DOGE gained traction by taking inspiration from a meme and using it to give a middle finger to the financial system and cryptocurrencies that take themselves too seriously
The love affair between Dogecoin and Elon Musk isn't over quite yet. On January 14, the entrepreneur's company Tesla started accepting Dogecoin as a payment method to buy its merchandise, with a range that included fashion staples like a commemorative belt shaped like a Tesla factory.
The energy inefficiency problem of the blockchain world has been heavily publicized over the last year or so. Protocols like Bitcoin can only function because of mining, requiring individuals to solve cryptographic puzzles using increasingly powerful computers. However, research has found that Dogecoin is more energy-efficient than most big-name cryptos. While bitcoin consumes 707-kilowatt hours per transaction, Dogecoin consumes just 0.12
Whether this tour around Dodgeville has inspired your first steps in crypto investing, or left you more puzzled than ever about why it ever gained success in the first place, hopefully, you've learned something today. Whatever you ultimately decide, we can all agree that Dogecoin's rise is nothing short of fascinating. It's probably best if you don't bet your entire net worth on Dogecoin, though.
Coinbase is free to download
68 million people are already using coin base. use affiliate link below to find out more


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Thunderhead Evolves as It Launches NOW
October 13, 2007 (PRLEAP.COM) Technology News
Thunderhead, the enterprise communications company, has announced a milestone release of its award-winning communications platform, under the new brand Thunderhead NOW.Thunderhead NOW heralds the next stage in the evolution of the companys XML-based communications platform, which, until this time, has been known as Thunderhead.
With the NOW release, Thunderheads one-platform-for-all-communications paradigm becomes even more pervasive across the enterprise, integrating communications with customer facing business processes. NOW will provide new functionality for marketing and campaign management and enhanced management visibility with enterprise-wide dashboards and reporting capability.
Both customer service expectations, and the variety of different communication methods they choose to use, continues to increase, says Glen Manchester, CEO of Thunderhead. Relationships for organizations, such as insurance companies and banks, depend on a series of interactions with a customer, each stage potentially involving a different communication channel. Maintaining context and consistency in communications at each step is critical for successful customer engagement. Our technology provides this by exposing role-based interfaces that allow the integration of all types of communications with key applications and business processes.
The Thunderhead NOW platform improves customer retention and time-to-value by ensuring front-line business users can manage the design and control of customer-facing communications. At the same time, Thunderhead NOW provides centralized control of enterprise issues such as regulated content, brand protection, compliance, security and management visibility.
In the past, organizations have focused on the necessity of producing customer output, especially print, said Manchester. However, forward-thinking organizations understand that communications must be delivered in the context of business processes, driven by customer value and delivering outcomes that enhance customer retention and acquisition. Today, providers are missing the opportunity to maximize the revenue potential of the customer relationships they already have. This is a concern, as it costs four times as much to acquire a new customer as it does to retain one.
Thunderhead customers will benefit from the growing presence of the companys global integration partners, who are developing practices around the platform that leverage their industry expertise in areas such as insurance and banking. This is possible because of the platforms open architecture and process layer, which allows partners to build on their existing expertise in BPM, ECM, portal and enterprise system deployments.
About Thunderhead
Thunderhead is the leading provider of enterprise solutions for the production of multi-channel business communications.
Thunderhead delivers the only enterprise platform that enables business users to manage the end-to-end process of creating intelligent personalized communications across multiple channels.
Due to its unique combination of Business User control, genuine open standards-based core, and enterprise capabilities, Thunderhead has quickly established itself as the clear market leader for financial services organizations and the standard for Investment Banking Trade Confirmations. Thunderhead's customer base includes many of the worlds leading organizations, including Lehman Brothers, Morgan Stanley, Prudential, BlueCross & BlueShield of North Carolina and UBS, and is serviced from offices located in North America, Europe and Asia Pacific. Thunderhead is one of the worlds fastest growing software companies, as recognized by Software 500 in the US and the Sunday Times in the UK.
For further information please visit www.thunderhead.com.


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New York Quarterly editor Raymond Hammond, in a wide-ranging interview with Anis Shivani, makes these trenchant observations:
I have come to believe that workshops are only in part responsible for the uniform, unambitious, minor products of poetry that we see over and over again.
There are other elements, an entire paradigm that includes workshops, MFA programs, and contests that contribute to this. And the key in your question is the word minor. Although these works are uniform, unambitious and would be minor, it is the paradigm that is elevating these drab works of banality to a level of major–and this, the entire paradigm, is the problem.
The problem with the current paradigm is that it is simply based on credentials and apparently has little or nothing to do with quality of product whatsoever. When a very good, mature poet cannot get a job teaching other poets simply because they don't possess the "club card" of an MFA degree, but a twenty-something with little or no experience is able to get that same job because they do possess an MFA, then there cannot help but be a deterioration in the quality of the writing.
Another major aspect of this contemporary paradigm is the acceptance of contests as being the only possible means by which to publish a book.
I know people who have recently been in classes in MFA programs whose teachers stated very bluntly, "you must enter contests in order to publish." This is unacceptable and writers as a whole should not accept this as fact. If the writers did not affirm contests by entering them, then the whole problem would go away on its own accord.
Contests do nothing but two things. First, they impose a fee where there never used to be a fee, and second they force the publisher to publish a book no matter how bad it is as long as it is better than the others in the contest. No one wins in the contest model.
All of these fees, contest fees, reading fees, MFA fees, and the acceptance of these as the only paradigm in which writers may be assessed put money at the heart of the art. By putting money at the heart of the art we as a society have completely given the art over to capitalism and greed and ladder-climbing and survival of the fittest, not survival of the art.
The current paradigm is allowing money to become the arbiter of taste; those with the money to obtain the MFA and pay to submit both to magazines and to book contests will be deemed poets. Those without these means will be left behind in the dust even though much of their work is equally as good if not better.
The whole paradigm is setting itself up to discriminate along socio-economic lines, and this is something that everyone should be working against in this day and time.
Read the full interview here.


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Nod Hill Collection Covers
21.5" w x 22.5" d x 36" h
Item 403160CVR
Product Cover
Dining Side Chair Cover
IN STOCK: ships UPS.
Product Details
The durable aluminum frames on our Nod Hill outdoor furniture are designed to stand up to the elements—beautifully. Extend the life of your furniture even further with outdoor furniture covers; they're custom-fit to each Nod Hill piece for maximum protection from snow, wind, and rain. Each cover, made from 100% solution-dyed polyester, resists fading, mold, and mildew. Furniture covers can keep your Nod Hill outdoor pieces looking gorgeous for years to come.
- 100% solution-dyed polyester with long lasting colorfastness
- Double-stitched seams for water resistance
- Mildew, mold, and fade-resistant
- Water-repellent backing
- Fabric stable to -20 degrees F to prevent cracking
- Elastic loops for easy, secure leg attachment
- Adjustable drawstring hems with locking toggles to hold covers in place
- Loose fit and mesh vents promote airflow to resist mold and mildew
Additional Information
- Made in the United States to Ethan Allen's standards and specifications
- Clean with mild soap and lukewarm water.
Download the Ethan Allen Limited Warranty >
Download the Use and Care Brochure>
SHIPS UPS: At checkout, you can choose from two UPS shipping options: Standard, or Two Business Day. Delivery times may vary slightly based on your location.
- STANDARD items ship via UPS Ground. This is our most economical option, but your order may take a few days to arrive.
- TWO BUSINESS DAY orders ship via UPS 2nd Day Air. They are expected to arrive on the second business day after you receive of your shipping confirmation.
- Hard-wired lighting is not returnable. Other items delivered by UPS may be returned within 30 days less a 15% restocking fee; please include the packing slip that arrived in your carton. Repack the item securely in its original carton and contact 1.888.324.3571 or email email@example.com for a return label. Shipping fees are the responsibility of the customer, and they are nonrefundable.
Made with
you in mind
Whether crafted in our North American workshops or by global artisans, our exclusive pieces are made using exceptional materials and traditional techniques. The result? An heirloom treasure created just for you.
Service you
can rely on
Our professional interior designers work with you to craft a unique, functional space. Our Premier In-Home Delivery specialists bring your furniture to you and place it where you want it, leaving nothing but perfection behind.
Values you can
be proud of
We put our planet first by sourcing wood from sustainable forests, harnessing energy from renewable sources, and using Earth-friendly finishes. We put people first by championing fair wages, work conditions, and quality of life for artisans all over the world.


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Type of Farm Operation
Size of Operation Desired
Are you seeking a farm that is currently in operation?
Infrastructure Desired
Tenure Options Considered
Years of Farming Experience
Are you currently farming?
Are you looking to farm full or part time?
Do you have a business plan?
My husband and I are currently looking for farming land that we can reside on in our 32 foot travel trailer to build up a Homestead we are not financially in the situation to be able to go out and buy land like we would like so we are looking to lease land with potentially the option to buy in the future so that we can start to build a self-sufficient Homestead we have a lot of experience with chickens and we are hoping to get goats in the spring time and horses.
Want to contact this farmland seeker?
Login or create a farmland owner account.


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PSD Business Card Template Terms and Conditions and Privacy Policy
We know these things are boring but we really need you to read this all the way through to the end; not like that book you read in high school literature class. This way you won't end up embarrassed when we ask you about the secret sub-plot on the final exam. When you create an online account and each time you place an order with PSD Business Card Template you are agreeing to the following terms and conditions and to PSD Business Card Template's privacy policy.
The Big Picture: When you place an order with PSD Business Card Template you are creating a contract to purchase goods and services based on these terms and conditions. At PSD Business Card Template we offer graphic designs and printing services as well as products for sale in our retail and online shops.
PSD Business Card Printing: Our full colour offset printing is produced using the "PSD Business Card" printing method where we combine your print job with many others and print them at the same time on large presses. This is actually where the PSD Business Card Template name originated. Combining jobs on PSD Business Cards allows us to gain efficiency, offer special papers and unique printing methods on the best printing equipment while passing on the savings of the shared cost of set-up, printing and finishing to you. To make this work we require a window of production time to compile everyone's files, get the press ready, run the press, allow drying time and then trim, pack and finish up all of the individual jobs.
Colour Fluctuation On PSD Business Card Printing: Because we are printing several clients jobs at one time on the same press sheet we must adjust all colour globally to get the best overall result for all of the jobs on that sheet. This means the colour of club run printed items will vary from traditional colour standards or swatch books and will not match exactly on re-prints. With these factors in mind colour critical jobs are not suited to this printing method. We may have options for colour critical projects, please complete a custom estimate request outlining your project requirements.
Estimated production times: We calculate estimated production times on our business days and operating hours which are Monday to Friday 10am to 6pm excluding holidays. We post the estimated production times for each product for you to consider and select when you place your order.
We Cannot Change Or Cancel Orders In Production: It is critical that you choose an estimated production time that will meet your deadline because once your order goes into production we cannot change, speed up or cancel your order, we can only promise the estimated production time you have selected.
What can delay your order: PSD Business Card Template will make every effort to process your order as soon as possible to meet your deadline. We don't like putting orders on hold as we know this can delay your production time. Here are a few reasons your order might be put on hold and delayed.
- You order a size of card that doesn't match your artwork and there are no special trimming instructions or the files are supplied at the wrong size.
- You submit your files in the wrong colour mode with low resolution.
- Your files have information within the critical trim area that may be trimmed off or the files do not have a bleed.
- You indicate that you need your project ready on a date that does not match the production time selected.
Delays can be avoided by preparing your files according to the file preparation specifications we provide online or by contacting us with questions or special requests before placing an order.
Proofing: Requesting a proof is always a good idea and you can choose to place an order with or without a proof. In some cases, a hard copy colour proof may be available. If the option for a hard copy colour proof cannot be selected for a specific product it means that product is produced on a club run and can only be proofed for layout by PDF. It is important to note that ordering a proof will delay your order. We will check your files and create your proof as soon as possible and once you approve your proof your order will go into production. If you are on a tight deadline or you are ordering rush printing, please take this delay into consideration.
A PDF proof cannot be used to approve colour. The appearance of colours will be affected by many variables including the paper or card stock, the coating or lamination and the print method. These variables cannot be accurately shown or emulated on an electronic PDF proof. Simply put the colour of your printed project will not match the colour shown on a computer screen. When you approve a PDF proof you will be acknowledging and accepting these limitations.
Proof Approval: Once PSD Business Card Template sends you a proof we ask that you very carefully review every aspect of your project including the layout and all vital information. Double check spelling, phone numbers, emails and URLs on the entire project. Once you approve a proof your order will go into production and no further changes can be made. PSD Business Card Template will not be responsible for incorrect spelling, grammar or punctuation or any graphic layout or content errors that are shown and approved on your proof.
No Proof Option: When you decide to place an order without a proof you are waiving the opportunity to catch and fix any errors before we put the job on press. In cases where a proof is waived by you a re-print, refund or discount will not be an option.
Errors and Returns: PSD Business Card Template has a 7 Day Return Policy. We really want you to be happy with your printing so if you find a printing error you will need to notify us within 7 business days of completion of your order. If your order was shipped right after completion you will need to notify us within within 7 days of the delivery date. Please email us at sales@PSD Business Card Template.ca and include your contact information and order number along with a description of your concerns.
We may require you to send samples or return your entire order at your cost. In the event of a printing error by PSD Business Card Template we will give you the choice to reprint your order or we will refund what you have paid. Orders may not be returned to PSD Business Card Template without prior written consent; we will refuse unauthorized shipments and return to you at your cost.
Reprints and Refunds: In the event of a printing error by PSD Business Card Template you will have the option to re-print you order or have your payment refunded. In either case PSD Business Card Template may require the return of your order before we proceed with either option. Reprints will be of the same artwork with printing errors corrected and will be scheduled on the next available print run. Any claim of liability or damages against PSD Business Card Template shall be limited to a refund or reprint even if the original completion deadline has passed.
What We Check On Your File: PSD Business Card Template will review your files to ensure they meet the technical standards for printing. In general, we will ensure your files are supplied at the correct size, in the correct colour mode including any special inks or finishes and provided at a resolution suitable for print. We will also check to ensure that no information is within a critical trim area and that overall the artwork files you have supplied match up to what you have ordered.
What We Don't Check On Your File: When you submit files to PSD Business Card Template you are implying that you have reviewed your files an they are ready to print according to the file preparation guidelines we provide on our site. While we will check your files to ensure they meet the technical standards for printing we will not review your overall design, layout or the size of your fonts.
We will also not check your spelling, grammar or the accuracy of dates or times. Be sure to work closely with your designer to review your artwork before placing an order. We suggest requesting a proof prior to printing as an extra measure of assurance. Please see the notes above on proofing.
Shipping: During the checkout process you can choose to pick-up your order, send your own courier or have us ship your order using various shipping methods and speeds. Ensure you select the appropriate option and shipping speed to meet your deadline, once an order is shipped we cannot cancel or change the shipping speed.
Damage or Delay During Shipping: If your order is damaged or delayed in transit PSD Business Card Template may require several days to remedy the situation with the shipping company. PSD Business Card Template can only assist on orders shipped on our accounts, if you have used your own courier you must contact them yourself. PSD Business Card Template will not be held responsible for delays or damage caused during shipping and will not be liable for claims of loss of business or damages due to shipping delays or for any damage caused during shipping.
Copyright Infringement: PSD Business Card Template must point out the obvious fact that the files you print must be yours in the first place. If you print anything that belongs to someone else, especially a corporation with platoons of lawyers we will simply point them at you and send you our own sickening legal bill to boot.
Payment: PSD Business Card Template requires that all orders be placed online with prepayment in full. If PSD Business Card Template enables your account to have the option to pay by check instead of credit or debit card your order will not go into production until your check is received. If PSD Business Card Template has extended credit terms to you that option is subject to the separate terms, fees and interest agreed upon and your account may be terminated "without cause" at any time.
Returned Payments: Payments that are not honoured for any reason will be subject to a $40 return or chargeback fee in addition to the full amount of the order and may be sent to third party collection without warning.
Refunds: When you place an order with PSD Business Card Template you are asking us to incur material and labour costs to create a product that can only be used by you. Because of this unique relationship we cannot refund payments on orders that have already begun production.
Storing your files: Back up your files! No really – back them up! PSD Business Card Template may or may not keep your files and even then it's possible a weasel might break into our servers and eat your files for lunch. So always keep a backup of any file you upload to PSD Business Card Template. If you don't and your files are inadvertently lost, we'll both be bummed. PSD Business Card Template will not be liable for any claims of damages if your files are lost.
Sharing your account: We really don't recommend sharing access to your account. However, if you do allow shared access to your account don't freak out on PSD Business Card Template if someone you've shared access with screws up an order, uploads the wrong file or deletes your artwork. We'll leave that awkward discussion between you and them.
What you can't print: PSD Business Card Template does not censor our client's artwork, we may or may not agree with your content but we print anything as long it does not or appear to contain nudity of minors and is not illegal. No promises we aren't going to talk about it at lunch though.
Breaking up with PSD Business Card Template: You may delete your account at anytime, we will be here for you if you want to get back together but if your account is deleted any saved files and prior orders will be also be deleted. PSD Business Card Template can also break-up with you at anytime "without cause." If we need to close your account, we will give you fair warning before you lose access.
Privacy and Your Personal Information: We understand that sharing your personal information online requires a great deal of trust and we take this very seriously. Creating an account and placing an order with PSD Business Card Template means we will need certain information about you. This information is collected in a number of ways including you providing personal data yourself, you uploading files, us collecting data through your use of our websites and through the use of cookies.
Here is a list of what PSD Business Card Template may collect about you:
- Name
- Email address
- Credit card information (if you pay for a service)
- Billing address (if you pay for a service)
- Shipping address (if you request shipping)
- IP address
- Browser type
- Location data
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Conclusion: That wasn't so boring was it? The sub plot of this is to back up your files and double check your production times and the file specs before you order. Oh and check your proof very carefully: we all know how embarrassing spilling errors can be.


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We hear about "self-care" a LOT! But it's more than a bath with a glass (or two) of wine, a mani/pedi, or making sure you make it to the gym. Living in a world that glorifies multitasking, you have to give yourself permission to pause so that you can give the world the best of you instead of what's left of you. Our overscheduled lives can make it seem like we don't have adequate time to dedicate to ourselves. We have to let go of the illusion that we must set aside a certain amount of "me time" in order to be effective. A 10-minute walk is far more beneficial than the weekend getaway you might never get around to because you continue to prioritize other things over your own needs. You are not meant to be on the go 24/7. You are a human being, not a human doing! Sometimes you need to just BE, with no agenda, no to-dos, and not taking care of anyone other than yourself, even if only for a moment or two. Don't wait until you are on the verge of exhaustion to prioritize your wellbeing (like I tend to do). After all, you can't pour from an empty cup!
Another key to successful self-care is being intentional. We can all attempt to check out with social media and go down the rabbithole of our Instagram or Reddit feed. Before we know it, a half-hour or more has passed. But are we really allowing ourselves to reset by doing so? As much as it may seem like a "break" it may actually leave you feeling more depleted. Here are ten ideas to practice the pause:
1. Read
Although getting lost in a novel is one of my favorite things, I get that some people just don't really enjoy reading like I do. But you don't have to commit to a 300-page book, go to a bookstore or library and just browse for a bit. Short on time? Read an article in your favorite magazine while you sit in a comfy spot.
2. Color!
They have some amazing adult coloring books these days. You don't have to commit to finishing a page in one sitting either, there are no deadlines. A few minutes here and there and you'll be able to admire your masterpiece in no time.
3. Do a puzzle
Focusing on putting together a puzzle helps quiet the mind, decreases stress, and improves your mood. Other benefits include improved memory, better problem-solving skills, increased attention to detail, improved visual-spatial reasoning and better collaboration if you're doing a puzzle with others (although, I'll admit that it can put your relationships to the test! haha). If you know other puzzle lovers, I recommend having a puzzle exchange so you don't get bored with the same old ones.
4. Take a lap
Use your 10-15 minute breaks at work to stretch your legs and clear your head by taking a walk around the block. Plus getting in a little mini cardio sesh is good for your physical wellbeing too! Walking has proven to reduced the risk of heart disease and stroke, help with high blood pressure, high cholesterol, joint and muscle pain, make for stronger bones and better balance, increase your endurance and reduce body fat. Even better if you can work in a 30-minute walk or more a day.
5. Spend time in nature
Science has proven that experiencing a sense of awe is good for our mental health. We spend so much time in our own heads that it's good for us to witness something that stops us in our tracks and reminds us that we are but a small part of something much larger. And what a better way to experience awe than to watch a beautiful sunset, witness wildlife on a hike, or stargaze? Live downtown and can't get out of the city? Find the nearest park to go on a walk or sit on a bench and people watch. Anything that makes you feel more connected to nature and those around you (and maybe a little more humble too).
6. Take a nap
Napping is one of my favorite things, probably because you can't overthink while asleep 🙂 Plus, napping in moderation has been proven to be good for your health, lowering the risk of heart problems and improving mood, memory, and performance (p.s. National Napping Day is the day after Daylight Savings time begins, tell the others.)
7. Learn something new
You don't need to sign up for night classes or anything (unless you want to of course), just find something you want to know more about or a skill you'd like to learn and dedicate some time to it. Skillshare is a great resource if you're trying to master (or just not suck at) something new. They have classes ranging from photography, watercolors, and graphic design to coding, productivity, and entrepreneurship. Click on the link to get 2 months of premium for free!
8. Get organized
Clutter causes chaos, chaos causes clutter. Clean up your workspace, your closet, your car, that kitchen cabinet that you can never find anything in, a corner of your room, or even just your purse. I promise you will feel accomplished and less stressed!
9. Meditate
You don't have to be a Buddhist monk or sit still for long periods of time to reap the benefits of a little meditation. Meditating for even 5 minutes can help rejuvenate your body and mind. By calming the mind you can become more reflective of yourself and your circumstances in order to better manage life's challenges. Also, studies have shown that meditation combats stress better than other relaxation techniques when it comes to improving mood, feeling less emotionally exhausted, and even lowering blood pressure! Not to mention that EEGs show that the brain enters into a state of equilibrium, instead of typically being more left-brained (verbal analytical, rational) than right (emotion, creativity, intuition). This rebalancing actually boosts the immune system! I mean, what's not to love!
10. Do anything that brings you peace and joy!
Craft, bake, garden, run, sing, paint, build, tinker, write, play a video game. Whatever makes you feel like you and allows you to think of nothing other than the task at hand. For me, it's taking pictures and editing them. For my daughter, it's drawing or baking. Find your thing and make time to do it. Spending time doing things you love will promote feelings of gratitude, which we all know is the true source of contentment.
So what can you do today to allow yourself to pause? I'd love to hear how you practice self-care!


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An African proverb says that if you want to get somewhere fast, go alone, but if you want to go the distance, take a team. We say, why not do both?
Technology has allowed us to do more than ever before and increasingly from the comfort of our home office bubbles, but the journey of creating an exceptional culture is still about teamwork. And teamwork is all about being and feeling connected.
Connecting with Employees and Creating an Exceptional Work Culture: A corporate culture that promotes health must be grounded in both a common mission and a common vision. These will connect everyone, regardless of their role in your company or even their level of involvement with your business.
Employee Benefits—More Is More!: For many companies, culture remains an abstract notion. Values should be emblazoned everywhere in plain sight.
Horizontal, Not Vertical: No matter how big a company gets, it should always remain primarily horizontal.
Engagement to Development: We believe that all new hires should meet with everyone in the company within their first 2 weeks in casual settings that allow for the free flow of personalities.
Many Teams, One Boat: Just like great health care, great company culture is nothing more than the people behind it—properly motivated and incentivized.


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Research - (2020) Advances in Dental Surgery
Study of Below the Knee BTK Intervention at Medical City Hospital 2018 to 2020
Ahmed Abdulsalam Khaleel, Abdulameer Mohsin Hussein* and Sabah N Jaber
*Correspondence: Abdulameer Mohsin Hussein, Department of Surgery, College of Medicine, University of Baghdad, Iraq, Email:
Objective: To analyze the risk factors and to evaluate the technical outcome of patients who underwent endovascular treatment for below the knee arteries.
Methods: Retrospective descriptive study with analytic component. We had researched from 2018 to 2020 in the Endovascular Surgical Department at Medical City Hospital (Baghdad/ Iraq). It included 70 patients having BTK arterial disease and treated by endovascular intervention during 2018-2020. The cases were reviewed by using TASC classification. Clinical examination and ABI calculations were performed for the patients. Then under the local anesthesia either antegrade or retrograde approach by means of sheath, wire, catheter and self- expandable balloon were used.
Results: In this study, the results of intervention (Category B) were good in 64% of patients. Prevalence of poor results of intervention were mainly noticed in patients with more than two risk factors and in patients with severe disease. Regarding complication of intervention, 22% of patients were developed complication and the most common complication was amputation (8%).
Conclusions: The endovascular treatment of atrial disease of the lower limbs is a safe, effective and less invasive method with short hospital stays and fast recovery of the patients. Short-term results show a good success rate.
Arterial occlusion, below the knee, endovascular therapy, Iraq
Chronic limb ischemia (CLI) is the most important clinical indication for a below the knee intervention [1]. It is defined as inadequate blood supply and considered a daily problem in vascular department [2]. Over 202 million persons worldwide are affected by peripheral arterial disease (PAD) [3]. More than 20% of people over the age of 65 have PAD, in which the prevalence of the symptomatic manifestations in males is over 8%. A PAD is the end outcome of a process that gradually narrows the lumen of the arteries through which the blood flows. In general, this vasoconstriction is a sign of atherosclerotic changes that occurs in the walls of the vessels [4]. The prevalence of CLI depends on age as well, with about 20% of the adults aged 70 years and older are diagnosed with critical limb ischemia. The effect of this disease on health care will be increased as the population ages [5]. Variations in the clinical presentation of CLI occur from free symptoms to intermittent claudication, rest pain, ischemic ulcers, and gangrenes. The typical risk factors involve old age, smoking, diabetes mellitus, hypercholesterolemia, and hypertension [6]. The diagnosis of CLI is clinical; and the Ankle-Brachial Index (ABI) is a simple test that is used to confirm the diagnosis and quantify the severity of chronic limb ischemia. The ABI calculation is achieved by dividing the ankle pressure by the highest brachial pressure. An ABI of 0.7 to 0.9 is considered a mild disease, from 0.5 to 0.69 is a moderate disease, and <0.5 is a severe disease [7]. The main goal of the therapy is to preserve limb function. Revascularization is a fundamental strategy to limb preservation, but in some patients, this does not improve limb function and mobility. When revascularization is considered, arterial imaging identifies the targets and mode of revascularization [8]. In many centers, endovascular intervention is the favored approach to CLI, because of lower morbidity and mortality as compared with the open surgery. The optimal treatment strategy (endovascular versus open surgery) will depend on anatomical factors, comorbidities, patient preference and operator experience and skill [9]. The primary indications for arterial disease intervention are limb salvage to avoid amputations [10]. The aim of this study is to analyze the risk factors and to evaluate the technical outcome of patients who underwent endovascular treatment for belowthe- knee arteries.
Patients and Methods
Study design, setting: This was a retrospective review that was conducted in the Endovascular Surgical Department at Medical City Hospital during the period of one year from 1st of Jan. 2018 till end of Dec. 2020.
Study population and sample size: The study included 70 patients had BTK arterial disease treatment by endovascular interventions during 2018-2020. The cases were reviewed by using TASC classification in Figure 1 [11].
Figure 1: TASC classification of the infrapopliteal lesions.
As Patients were lying on bed in supine position, we examined the right and left femoral pulse by palpation and Doppler ultrasound. Clinical examination and ABI calculations were performed for the patients. Then under the local anesthesia either antegrade or retrograde approach by means of sheath, wire, catheter, and self- expandable balloon were used. Seventy patients of both genders with peripheral vascular diseases were involved in this study, fifty of them underwent the endovascular intervention. The presence of blood flow and its continuity, and the disappearance of the lesion which were revealed by angiography were considered as good results.
Statistical analysis
Data analysis had been accomplished by the SPSS version 25. The data presented as means, standard deviations and ranges. Categorical data presented by frequencies and percentages. Chi square test was used to assess the association between intervention results and certain characteristics, while fisher exact test was used instead when the expected frequency was less than 5. A level of P–value less than 0.05 was considered significant.
70 patients were involved in this research, aged from 29 to 70 years with a mean of 52.17 ± 10.4 years. About two thirds of them were males (65.7%); 38.6% had two risk factors; 58.6% were graded with moderate severity of disease; 41.4% were in TASC B; and 28.6% of the cases (category A) were diagnosed by angiography and treated by medication such as antilipid, antiplatelet, analgesia and focus on exercise; while the majority (71.4%) were treated by selfexpandable balloon angiography intervention (category B) via antegrade or retrograde approach as shown in Table 1. We noticed that the results of intervention (Category B) were good in 64% of patients as shown in Figure 2.
Figure 2: Balloon angiography intervention outcome.
Variable | No. (n= 70) | Percentage (%) |
Age (Years) | ||
<40 | 9 | 12.9 |
40-59 | 44 | 62.9 |
≥ 60 | 17 | 24.2 |
Gender | ||
Male | 46 | 65.7 |
Female | 24 | 34.3 |
Risk Factor | ||
One | 14 | 20 |
Two | 27 | 38.6 |
More than two | 29 | 41.4 |
Severity of disease (ABI) | ||
Mild | 15 | 21.4 |
Moderate | 41 | 58.6 |
Severe | 14 | 20 |
Type of treatment | ||
Diagnostic (Category A) | 20 | 28.6 |
Intervention (Category B) | 50 | 71.4 |
Table 1: Distribution of study patients by general information.
In this study, prevalence of poor results of intervention were mainly noticed in patients with more than two risk factors (54.5%, P=0.048) and in patients with severe disease (70%, P=0.025) with significant associations between the severity of the disease, risk factors with the intervention results as shown in Table 2.
Variable | Intervention Result | Total (%) | P–Value | |
Poor (%) n=18 | Good (%) n=32 | n= 50 | ||
Age (Years) | ||||
< 40 | 2 (33.3) | 4 (66.7) | 6 (12.0) | 0.109 |
40 - 59 | 9 (29.0) | 22 (71.0) | 31 (62.0) | |
≥ 60 | 7 (53.8) | 6 (46.2) | 13 (26.0) | |
Gender | ||||
Male | 14 (43.8) | 18 (56.3) | 32 (64.0) | 0.128 |
Female | 4 (22.2) | 14 (77.8) | 18 (36.0) | |
Risk Factor | ||||
One | 1 (14.3) | 6 (85.7) | 7 (14.0) | 0.048 |
Two | 5 (23.8) | 16 (76.2) | 21 (42.0) | |
More than two | 12 (54.5) | 10 (45.5) | 22 (44.0) | |
Severity of disease | ||||
Mild | 0 (0) | 3 (100.0) | 3 (6.0) | 0.025 |
Moderate | 11 (29.7) | 26 (70.3) | 37 (74.0) | |
Severe | 7 (70.0) | 3 (30.0) | 10 (20.0) | |
Table 2: Association between intervention results and certain characteristics.
Regarding complication of intervention, 22% of patients were developed complication and the most common complication was amputation (8%) as shown in Table 3.
Complication | No. (n=50) | Percentage (%) |
No complication | 39 | 78 |
Amputation | 4 | 8 |
Occlusion | 2 | 4 |
Hematoma | 3 | 6 |
Dissection | 2 | 4 |
Table 3: Complication of intervention.
In the current research, a high proportion of men than women were found. Most of the cases had more than two risk factors (diabetes, hyperlipidemia, hypertension, old age and nicotine abuse. etc.).
The present study revealed that the patients with more than two risk factors show poor prognosis. This is agree with other documents [12,13] that found smoking and hypercholesterolemia were factors that accelerate the process of pathological blood vessels, increase the disease severity and had significant impact on the CLI of the lower extremities.
Also, the results illustrate that the diseased vessels (ABI <5) show poor prognosis. This can be due to the ABI has an important role in patients with PAD, not just as a diagnostic tool, but rather as a negative predictor; since it is considered a generali¬zed atherosclerotic predictor (atherosclerosis plays a critical role in blood flow obstruction), in addition the ABI detect the patients at high risk for developing PAD [14].
However, no significant association between the different age groups, gender and TASC classifications with the outcome. This is may be attributed to the fact that the PAD is a multifactorial disease, and its pathophysiology is complex [15]. Nevertheless, the efficacy of therapeutic interventions is affected by good technique and equipment, medical treatment, control of risk factors in addition to the physical exercise.
The total complication of our study was 22%; mainly hematoma and amputation that account 14%, in comparison with 22% in Le et al. [16]. However, the dissection was 4% while it was 7% in Černevičiūtė [17].
The endovascular intervention method in this study succeeded the reperfusion of lower limb and achieved good results, with success outcome of 64%, While Le et al. and Černevičiūtė et al. achieved 88.9% and 93.7% respectively [16,17]; with significant improvement of the clinical symptoms especially for 40-59 years-old patients, with moderate medical conditions and ≤ 2 risk factors. Once again, this result confirmed the effectiveness of this intervention to the patients with BTK arterial disease. In conclusion, by endovascular interventions treatment of 50 cases with chronic below-the-knee arterial occlusive diseases, we have concluded the following:
Improvement of the clinical symptoms with moderate medical conditions and ≤ 2 risk factors.
Less duration of hospital stays and fast recovery of patients.
Endovascular treatment is a less invasive method with good outcome.
The results obtained with other publications are quite difficult to compare due to the groups of patients' heterogeneities, different results definitions, experience of the intervention doctor, techniques performed and means used. Besides, the peripheral artery disease, its anatomical course and the spread of lesions are very individual for each patient, depending on many concomitant factors such as comorbidities, medications used, harmful habits and physical activity.
Because of the difficulties of PTA and its complications using a plain angioplasty balloon, a newer endovascular device, like drug eluting balloons and highly resolution Doppler ultrasound, should be applied.
- Sauguet A, Leger P. Tools and techniques: Below the knee interventions. EuroIntervention 2012; 7:1120-1123.
- Simon F, Oberhuber A, Floros N, et al. Pathophysiology of chronic limb ischemia. Gefasschirurgie 2018; 23:13-18.
- Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. Lancet 2013; 382:1329-1340.
- Kröger K, Stang A, Kondratieva J, et al. Prevalence of peripheral arterial disease–results of the Heinz Nixdorf recall study. European J Epidemiol 2006; 21:279.
- Davies MG. Criticial limb ischemia: Epidemiology. Methodist Debakey Cardiovasc J 2012; 8:10-14.
- Meijer WT, Grobbee DE, Hunink MM, et al. Determinants of peripheral arterial disease in the elderly: The rotterdam study. Archives Intern Med 2000; 160:2934-2938.
- McDermott MM, Liu K, Greenland P, et al. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA 2004; 292:453-461.
- Oresanya L, Zhao S, Gan S, et al. Functional outcomes after lower extremity revascularization in nursing home residents: A national cohort study. JAMA Intern Med 2015; 175:951-957.
- Kinlay S. Management of critical limb ischemia. Circulation: Cardiovascular Interventions 2016; 9:e001946.
- Higashimori A. Angiography and endovascular therapy for below-the-knee artery disease. Angiography Endovascular Therapy Peripheral Artery Disease 2017:101.
- Jaff Michael R, White Christopher J, Hiatt William R, et al. An Update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: A supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Annals Vascular Dises 2015; 8:343-357.
- Sobieszczyk P, Eisenhauer A. Management of patients after endovascular interventions for peripheral artery disease. Circulation 2013; 128:749-757.
- Jaff MR, White CJ, Hiatt WR, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: A supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vascular Med 2015; 20:465-478.
- Rac-Albu M, Iliuta L, Guberna SM, et al. The role of ankle-brachial index for predicting peripheral arterial disease. Maedica 2014; 9:295-302.
- Stewart KJ, Hiatt WR, Regensteiner JG, et al. Exercise training for claudication. N Engl J Med 2002; 347:1941-1951.
- Le TD. Evaluation of endovascular intervention therapy results in chronic below-the-knee (BTK) arterial occlusive disease. Angiol 2016; 4:184.
- Černevičiūtė R. Results of endovascular treatment of calf arteries. 2018.
Author Info
Ahmed Abdulsalam Khaleel, Abdulameer Mohsin Hussein* and Sabah N Jaber
Department of Surgery, College of Medicine, University of Baghdad, IraqCitation: Sarah M Khammas, Ahlam T Mohammed, Study of Below the Knee BTK Intervention at Medical City Hospital 2018 to 2020, J Res Med Dent Sci, 2020, 8 (7): 37-41.
Received: 27-Sep-2020 Accepted: 13-Oct-2020 Published: 20-Oct-2020


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Indian golfer Shubhankar Sharma started with a birdie from the tenth hole but failed to maintain the momentum and slipped to T-71st place at the halfway stage of the CJ CUP @ NINE BRIDGES tournament on Friday.
Sharma ended the second day at 3-over 75 for a two-day total of 5-over 149.
With no cut being applied in the limited field event, Sharma stayed on for the weekend with a chance to improve his scores and position.
He birdied first, but bogeyed 11th, 12th and 16th. On the second nine, he bogeyed first, birdied eighth and closed with a bogey on ninth.


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The Deal, a RPG game Video
About The Deal
What happens when four aspiring new adventurers find something that they weren't supposed to find?
Could it change their lives forever? Could it be that an ancient demon was awaken and seeks its release from a long lost prison?
The Deal unravels the story of Cyrus, Myrella, Jonathan and Donna, while they traverse through the colorful continent of Carca!
Meet tons of cynical and fun characters that will either lead you to new adventures or to insanity! Solving problems, exploring secret caves, battling monsters, finding treasure and catching the four golden chickens are obligatory things for any new adventurer in this story.