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UK based Moviehouse Entertainment has been appointed by Tesoro Pictures' to handle worldwide sales for Rose, which will have its world premiere on November 9, 2017 at The Lone Star Film Festival in Fort Worth, Texas.
In Rose, Cybill Shepherd (Taxi Driver) stars as a widowed ex-cop who discovers she may have a life-threatening illness and decides to go on a solo road trip to explore the beauty of the Southwestern USA.
Whilst on her journey, she discovers more than just the simple beauty of New Mexico when she meets – and falls in love with – Max, played by James Brolin (Catch Me If You Can), an old cowboy who has come to a crossroads of his own.
Also starring are Pam Grier (Jackie Brown), Amy Davidson, Cindy Pickett, Julio Cesar Cedillo and Erik Fellows.
The film is directed by Rod McCall. Producer is Tesoro Pictures' Greg Clonts who said: "I'm delighted to have made a deal with the Moviehouse guys to handle the sales for Rose and am looking forward to it getting out there."
Executive Producer of Rose is J. Todd Harris (The Kids Are All Right).


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Bridge and Co Offers Podcasting Solutions and advice to help launch your career.
GLENDALE , CALIFORNIA, UNITED STATES, January 23, 2019 /EINPresswire.com/ — At Bridge and Co, we are a multi-media production studio equipped with a state of the art recording studio, soundstage, and the ability to do podcasts in-house with an editing bay.
One-Third of Americans between the ages of 25-54 listen to podcasts monthly and that number is only going to rise. If you own a business or are a creative, now is the time to get into podcasting, and Bridge and Co can help.
At Bridge and Co, we always remind our clients that a big reason to get into podcasting is the importance of audio content. Because of ease of use, more people than ever before are listening to audio, and that includes a whole new world for advertising your business or project as well. When you start a podcast what you want to think about is the fact that whatever you create content-wise, needs to be compelling enough to compete for potential listeners attention.
If you focus on making a compelling podcast, you can attract the attention of potential listeners and clients and build a following based on your content. Another benefit of podcasts is that since they are audio based, your listener can be doing virtually anything else while listening and that convenience is a huge sell for potential listeners. Think about making captivating audio that will hold the attention of your audience, and they will keep coming back for more.
Building an audience is another great reason to podcast as well. You can take a page from great blogs, and over time, you will build a loyal following if your content is something that the audience feels is important to their everyday life, and/or interesting enough to keep them engaged.
At Bridge and Co, we remind businesses and creatives that the biggest form of flattery in the podcast world is having someone recommend your podcast, and if it's compelling, we promise you the recommendations will come.
There are a ton of great platforms that make it easy to get a new podcast into the hands of eager listeners. Some of the main ones are Stitcher, which has a beautiful interface, iTunes, the largest and most well known, and even SoundCloud has great benefits to putting your podcast on their platform.
As you continue to grow your brand and think entering the world of Podcasting, Bridge and Co are here to help you with our state of the art equipment and expertise every step of the way.
To learn more about Bridge and Company, and to connect, click here.
Bryan Powers
Web Presence, LLC
email us here
Source: EIN Presswire

subset: commoncrawl


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Price: £6.00
Quantity: 1 available
Book Condition: Very Good
Stapled pamphlet with illustrated card covers, rusty staples and slight edgewear but otherwise in Very Good condition. First edition? pp 47, b&w illustrations. S16.
Title: The Work of Our Hands Number 1: Rugs & Quilts from Shreds and Patches.
Categories: Home, Hobbies & Craft,
Publisher: Oxford University Press, 1942.: 0
Binding: Soft cover
Book Condition: Very Good
Type: Book
Item: 1.00 Item
Seller ID: 3018
Keywords: Rugs, Quilts, How To, Craft Home & Craft Home & Craft,


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Local Obituaries
Reo Johns, former Pike County teacher, principal, superintendent and PVA, dies at 86
Reo Johns, who spent a sometimes-controversial career in public life in Pike County, died Saturday at age 86.
Johns was a teacher, principal and assistant superintendent in the Pike County schools, and he was elected property valuation administrator of the sprawling county in 1981.
He held that job until 1993, when he was selected county school superintendent, remaining in the post until 1998.
Johns also was head of the county housing agency for several years, former county Judge-Executive Wayne T. Rutherford said Monday.
Rutherford said Johns was a capable administrator, a mentor to countless young people and a man whose word was his bond.
"If he told you something, you could rely on it," Rutherford said.
Johns' former students at Caney Elementary School "will always remember your kindness and your encouragement of education for each of us," a woman named Louise Mullins said in a post on the website of Hall & Jones Funeral Home, which handled the funeral service for Johns on Monday.
Johns came under criticism in the late 1980s, when an investigation by the Lexington Herald-Leader found that Johns and staffers shortchanged county schools and government of millions in tax revenue through poor property-tax assessments or by leaving property off tax rolls.
Johns insisted that his assessments were accurate, but state officials later targeted Pike County and 24 others for reassessments.
After Johns left the PVA office to become school superintendent, even foes acknowledged that he made improvements his first year, including boosting morale and communication among teachers.
He faced controversy in that job as well, however, including over spending decisions, and jobs and raises for Johns' supporters, his relatives or the relatives of top advisers.
He denied using jobs to make political payoffs.
Johns resigned unexpectedly in May 1998, citing health reasons.
At the time, the district faced financial problems, and state and federal authorities were investigating Johns in connection with the sale of a former elementary school for use as a juvenile treatment center.
Investigators looked into whether Johns or his son Barry were involved in the transactions or benefited from inside information, according to a report at the time. The investigation ended with no criminal charges.
However, the state took control of the Pike County schools' finances to correct problems soon after Johns quit, and state officials accused three board members of rubber-stamping alleged abuses by Johns.
Two of the three quit, and a third was suspended for eight months.


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Elemis High Performance Skin Energiser
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massage sequences boost circulation, whilst scalp and foot massages deeply relax.
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The unique Ten Cultural Touches make this much more than just a massage. The power of this ancient touch creates sensations of pleasure & wellness to deeply heal your mind & body, whilst soothing your soul. Your body is lightly brushed, then gorgeously warmed pure massage oils, prescribed to your needs, are smoothed over the face, body & scalp.
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5 Halloween hacks the children will love
5 Halloween Hacks the kids will love! Halloween is a personal favourite here at LunaChild. There are so many ways to be creative and come up with fun games, awesome outfits and eat weird looking foods that taste delish, that's why we have come up with 5...Continue Reading


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12-16 weeks
Michel et Stéphane Ogier
France (France), Northern Rhône (France)
Hard Cheese, Red Meat, Vegetables
"One of the wines of the vintage, the 2015 Côte Rôtie Belle Helene is up there with the handful of greatest young Syrahs I've ever been lucky enough to taste. Coming all from the Côte Rozier lieu-dit in the northern portion of the appellation, just above Guigal's la Landonne lieu-dit, this majestic wine offers incredible blue fruits, liquid violets, olive tapenade, and aged meats. Full-bodied, ultra-fine, deep, concentrated, and as seamless and pure as it gets. It's already approachable (which is rare for this cuvée) due to its perfectly ripe tannin, yet will need 7-8 years of bottle age and keep for 2-3 decades. I was able to taste the 2015s from the incredibly talented Stéphane Ogier twice, once during my visit at the estate, which was just after bottling, and then again from bottles shipped to my office in Colorado. These are ripe, polished, sexy wines from Stéphane that show the purity as well as the opulence of this great, great vintage. The 2016 vintage was compared to 2006 by Ogier, which was a solid, under the radar vintage from the northern Rhône. The barrel samples all showed terrific purity of fruit and balanced styles, and should check in near the top of the vintage. This estate is certainly at the top of its game and readers looking for some of the most profound Côte Rôties out there are advised to get on this estate's bandwagon."
100 points, Jeb Dunnuck - Jan 2018
"Waves of dark fruit on a plentiful nose. The palate booms with classy red fruits, and a rocky crunch. Ace balance. Drinking Window 2021 - 2048. (JLL)"
97 points, Decanter - Feb 2017
"The 2015 Cote Rotie La Belle Helene is smoky, dark and brooding, almost fruitcake-like in its density and complexity. It flirts with surmaturité and dried-fruit notes yet stays just this side of over-ripeness. It's not as aromatically complex or as elegant as the Lancement but may be longer-lived. Stephane Ogier grins from ear to ear when talking about his recently completed winery. He feels like it's enabled him to raise the quality of his wines. Plus, it's just plain cool. Ogier is also smiling about the last three vintages, which have all been excellent. We didn't speak much about the 2017s, which had just gone to barrel, but Ogier told me he likes the charm of the 2016s. And of the 2015s, he said, "Even if it's a sunny-type vintage—it's powerful and rich—we worked hard to keep the freshness and balance." He considers the raw materials "at the level of 2010, 2005 and 1999." (JC) "
96 points, Robert Parker's Wine Advocate - Dec 2017
"Dark violet color. Heady, mineral- and smoke-accented dark berry liqueur, licorice and candied flowers on the deeply perfumed nose, along with a hint of cracked pepper that adds complexity and spicy lift. Offers sweet, densely packed cherry and black raspberry flavors that are braced by an undercurrent of smoky minerality, which provides back-end cut and lift. Shows a very suave floral nuance on the wonderfully finish, which is shaped by smooth, harmonious tannins. This is a distinctly elegant rendition of this bottling. (JR)"
96 points, Vinous - April 2018> Learn More
12-16 weeks
Michel et Stéphane Ogier
France (France), Northern Rhône (France)
3 x 750 ml
Hard Cheese, Red Meat, Vegetables
"The finest vintage of this cuvée to date, there's a scant four barrels of the 2015 Côte Rôtie Lancement, which comes from a site high up on the slope in the Côte Blonde end of the appellation. Completely destemmed and brought up all in new oak, it has the classic perfume this cuvée always shows yet is inky colored, deep, incredibly concentrated, and long. Exotic flowers, black cherries, hints of cassis, olive tapenade and peppery, gamey notes all soar from this full-bodied, seamless, straight up awesome Côte Rôtie that reminds me of what the 1978 Guigal La Mouline must have tasted like on release. With sweet, sweet tannin, no hard edges, and a grand, majestic personality, drink it anytime over the coming 20-25 years."
100 point, Jeb Dunnuck - Jan 2018
"My top pick among Ogier's 2015s is his 2015 Cote Rotie Lancement. It shows wonderful smoky, herbal and bacony complexity on the nose, then follows that up with a concentrated, medium to full-bodied wine that stays light on its feet through a nearly endless finish. A really spectacular effort, worth the search. Stephane Ogier grins from ear to ear when talking about his recently completed winery. He feels like it's enabled him to raise the quality of his wines. Plus, it's just plain cool. Ogier is also smiling about the last three vintages, which have all been excellent. We didn't speak much about the 2017s, which had just gone to barrel, but Ogier told me he likes the charm of the 2016s. And of the 2015s, he said, 'Even if it's a sunny-type vintage--it's powerful and rich--we worked hard to keep the freshness and balance.' He considers the raw materials 'at the level of 2010, 2005 and 1999.' (JC)"
98 points, Robert Parker's Wine Advocate - Dec 2017
"Saturated ruby. Intense, mineral-tinged aromas of ripe red and blue fruits, smoked meat, incense and pungent flowers are accented by exotic Asian spice flourishes. Sappy and deeply concentrated yet lively on the palate, offering impressively focused boysenberry, raspberry, olive paste and floral pastille flavors that are underscored by a vibrant mineral quality. Smooth, gently gripping tannins build stealthily a floral-driven finish, which hangs on with outstanding tenacity and resonating spiciness. (JR)"
97 points, Vinous - April 2018> Learn More


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Every day I love receiving lots of emails and messages about my programs so today I thought I would outline what you can expect from my programs in 2015.
I realise that there are lots of programs, weight loss and training solutions on the market and at this time of year there is a huge interest in them with the holidays ending and school starting again soon.
Hopefully these few points will share with you what you can expect from my program and how I think they can help you achieve your goals this year.
I think everyone should set firm goals when it comes to their health and fitness. Being strong fit and healthy makes such a positive difference to your life but I know that sometimes starting the journey can be daunting with so much conflicting advice out there.
I believe in eating real food, training regularly and keeping things as simple as possible. It's not rocket science but you do need to follow some basic principles and rules if you want to be successful long term. My programs are designed to teach you these in a way that you can integrate into your everyday life forever.
I understand It can also be intimidating and scary stepping out of your comfort zone which is why my programs offer real support (not an auto response email or frequently asked questions) and walk you through EVERY meal and EVERY training session EVERY DAY throughout your 8 weeks.
Is 2015 going to be the year that you finally take control and lose those unwanted kilos, or maybe it's the year when you commit to taking your training to the next level and getting back those abs or that pre-baby body?
Whatever your goals for this year, here is how my programs can help you reach them….
What is the difference between #NOEXCUSES and #NOLIMITS (and how much are they)?
The programs are both 8 weeks in length. #NOEXCUSES is designed specifically for weight loss and #NOLIMITS for people that are already used to training hard in the gym and want to shred down. To complete #NOLIMITS successfully you really need access to a commercial gym or have a fantastic home gym.
The most popular program by far is #NOEXCUSES as most people want to lose a few kilos (or maybe a lot) but more importantly learn how this is done sustainably (which is why I loathe fad diets as they cannot be implemented long term and whilst you might lose a few kilos short term, they can do real damage to your metabolism). Both programs are designed for busy people, the food is simple and easy to prepare and the workouts practical and effective.
The programs are very different and they are designed to achieve different goals. As a rule if you are used to training hard, have less than 5kg to lose and are ready for an intense 8 week challenge, choose #NOLIMITS. If you want to lose weight in a sustainable way and train at a moderate level then #NOEXCUSES is for you.
Both programs are priced at $99.95 which includes the 85 page PDF program (delivered via simple download) and membership to my private support groups on Facebook.
Why are the programs 8 weeks long?
I believe that you can learn new habits in 8 weeks and this is long enough for my programs to teach you how to eat and train to sustain your results long term. The 8 weeks is really just the beginning as my goal is to show you a new way of thinking about food and exercise that you never look back from.
What is your approach to nutrition in #NOEXCUSES and #NOLIMITS and what if I have specific food needs?
I believe in eating real food, as fresh as possible and preferably nothing processed that comes in a packet. My programs embrace all food groups but I am big on making sure you are eating the right foods at the right times of day to maximize your results. All the ingredients can be bought at a normal supermarket and with a bit of prep in the weekend all the meals can be cooked in about 5 minutes. If you have specific food needs, we can easily provide you with a list of substitutions so the food plan meets your needs. We have has lots of vegetarians on the programs and people with allergies or a dislike for things like fish! Recipes are provided in the program where needed and you can click here for a sample day of NOLIMITS and here for a sample of #NOEXCUSES.
What is the difference between #NOEXCUSES Home and #NOEXCUSES (Gym version)
Simply, the standard #NOEXCUSES program requires gym access for its 2-3 weights workouts a week. #NOEXCUSES Home can be done completely from home with skipping rope so hand weights (adjustable ones are best) and a fit ball. Other than this the programs are identical.
What kind of training is in the programs?
Both programs include 6 training sessions a week with 1 days rest. #NOEXCUSES has 2-3 weight sessions a week (click here to read why these are so important) and 3-4 cardio sessions and #NOLIMITS has 3-4 weight sessions a week and 2-3 cardio session. The cardio sessions are a mix of HIIT (click here to read more about this type of training) and longer form cardio which can be anything from walking to running. Every weights exercise comes with 2 photos showing you how to complete the exercise and the correct form and tempo.
Do the programs cater for different fitness levels?
Absolutely, #NOEXCUSES is flexible enough for all fitness levels (just ask me in the group if you think you want to make changes) and the home program is perfect if you want to train away from the crowds or struggle to get access to a gym.
How do I access support during my 8 weeks?
Straight after you join you will receive an email from me with an invitation to join my private Facebook group. The groups are amazing and I spend a lot of my day answering questions in the groups. They are also really supportive and have a real sense of community which I love. I always get told by people that have successfully completed my programs that the groups were one of the best parts of the programs that kept them focused and motivated. You receive 10 weeks group access when you join the program which covers your 8 weeks and 2 bonus weeks.
Are there any specific start dates?
I have designed the program so you can start whenever you like, so there are no set start dates. I want to be as inclusive as possible with the program and I understand that everyone has different schedules!
Who am I and what is Team #beachfit?
I am a mum of two young children who became a certified trainer back in 2002 (read my bio here)! Today I get to share with passion for fitness and health with tens of thousands of women all over Australia through my blog and my online training and nutrition programs.
Team #beachfit is my small growing team that today consists of John, my husband who looks after sales & marketing and the totally amazing Ally, who looks after customer service and support. In February I am looking to add another superstar to my team to help me manage the programs and help develop the business, so if you know any amazingly talented qualified personal trainers with a passion for social media, please let me know!
What kind of results have people achieved on the programs?
I love nothing more than see the fantastic results people achieve through my programs (both mentally and physically). Here are just a few of the amazing people who have achieved amazing results through my programs in the past 7 months.
Rachel lost an incredible 11.6kg on #NOEXCUSES – click here to read her story and see her pics
Jo smashed her #NOLIMITS Program losing 8kg and 2 dress sizes – click to see her pics
Brett and Jo lost an incredible 18kg between them in 8 weeks of #NOEXCUSES – click to read their story
Naomi achieved her bikini body goal on #NOLIMITS – Click to see her amazing results.
I hope I have explained what to expect from my programs.
I can help you achieve your fitness and weight loss goals in 2015 – all you have to bring is a commitment to giving me 56 weeks of effort!
If you have any questions at all about the programs, please email email@example.com, we will get back to you straight away.
Click here to start your #NOEXCUSES Journey
Click here to start your #NOLIMITS challenge
Kim x


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Ashley Adamietz, a senior cheerleader at Foothill High School, has been receiving daily chemotherapy treatments to battle Chronic Myeloid Leukemia. On Friday night, the Foothill football team honored her as they entered the field by placing orange roses at her feet.
"We took care of family business, before we took care of business on the field," said Foothill football coach Joey Brown.
KRCR's News Channel 7 was there to capture the moment, and the moment captured the hearts of the nation.
That video was posted to Evan Schreiber's public Facebook account on September 6 getting over 220,000 shares and it inspiring numerous national media outlets to cover it including Bleacher Report, ESPN, ABC News and Fox News-
That's just a taste of the national media coverage from this tearjerking event. Currently, over 85,000 people are talking about #ashleystrong on Facebook. Overwhelmed by the touching tribute, Ashley took to Twitter:
Tonight at the game I had no idea that the cheer & football team had planned for every football player to give me an orange rose (the color for leukemia). I was shocked, overwhelmed and over all speechless. I can't thank you enough to both teams for making my first game one to remember & making me cry.
This heartwarming story is a lesson that we can fight life's battles together. Let us continue to support those in our community who are fighting uphill battles.


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Long-sleeved 'body' undershirt. Great for wearing under normal clothing for extra coverage, especially in the summer.
Thin, breathable material.
Meant to fit close to body / snug.
100% Viscose.
Care: Machine was cold (gentle cycle recommended); low iron.
Made in Turkey by Arancia, a label under Aker.
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Wellington Phoenix v Western Sydney Wanderers: stats preview
Did you know that Wanderers striker Brendon Santalab has scored seven goals in his last four games against the Phoenix?
And that impressive stat features braces in three of those games.
To find out more interesting stats and facts ahead of Saturday's match at Westpac Stadium, check out our Opta Data stats preview.
- Western Sydney Wanderers have lost just one of their last seven Hyundai A-League games against Wellington Phoenix (W5, D1), scoring two or more goals on each occasion.
- There have been just four goals scored in the last four Hyundai A-League meetings between these teams at Westpac Stadium (2-2), with five clean sheets kept in that span.
- After a 2-1 win against Melbourne Victory last round, Wellington will be looking for back-to-back Hyundai A-League wins at home for the first time since January 2017.
- The Wanderers have won two of their last three Hyundai A-League games away from home and will now be looking for back-to-back road wins for the first time since winning three on the bounce in November 2015.
- The Phoenix have won 55% of all aerial contests this season, the highest rate of any team in the Hyundai A-League.
- Josep Gombau's side have scored just one goal after the opening hour of play this Hyundai A-League season, no other team has scored fewer than five goals in that period.
- Only Melbourne Victory's Leroy George (7) has assisted more goals than Phoenix's Roy Krishna (5) so far this Hyundai A-League season.


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Public relations is about creating relationships and storytelling to expand your brand's influence in your industry and community. Here are a few reasons why public relations is important for your business:
1. Increase awareness of your business
There are many ways that PR can increase the reach and awareness of your business including speaking opportunities, media interviews, partnerships, event planning and more. For example; to keep their business on the minds of local customers, Great Clips teamed up with local news stations across the country for a back-to-school haircut campaign. Great Clips stylists went live demonstrating back-to-school hairstyles that can help simplify a busy fall for parents and even offered an in-store coupon to those who mentioned the tv station.
2. Create partnerships within your community
Creating partnerships with local businesses will not only put your brand in front of the people within your community but will also support other businesses that you partner with as well. Online influencers mentioning your business can add credibility to your brand. People that follow these influencers are likely to perceive your brand the way the influencer presents it.
Birchbox, a monthly box of personalized makeup, haircare and skincare samples, teamed up with lifestyle blogger Emily Schuman of Cupcakes and Cashmere to promote a special May box with five Instagram photos on her Instagram page. The campaign received over 18,000 likes and reached more than 550,000 consumers.
3. Establish your business as an authority in your industry
You want your brand to be considered an expert in your industry. Media interviews and speaking opportunities are great ways to inform your potential customers of your expertise. Wedding planner David Tutera, for example, was asked to speak at the Wedding MBA Convention for the wedding industry. He plans to share his approach to extravagant event planning and what advice he can offer to those trying to thrive in the industry.
4. Give your brand a voice
Now with social media, most businesses are able to speak to and engage with the public immediately. But, by using public relations, your business will be able to craft stories your potential customers can relate to as well as reach larger audiences through the media, partnerships and other opportunities.
Simply placing products on shelves won't cut it anymore. Showcase the stories behind the products, the people who love them and use them, and how they reinforce your brand's values. Like this example: TOMS founder Blake Mycoskie took a trip to Argentina and noticed that many poor children didn't have shoes, and decided to create a one-for-one business model. Every product purchase, TOMS will help a person in need.
How does your business implement an effective PR strategy? Let us know in the comments below!


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A List Of Interesting Reflective Essay Topics About Volunteering
What is a reflective essay?
Essays are of different categories, some are persuasive some are compare and contrast and some are illustrative. Under the formats of illustrative works falls the reflective one. It is quite an interesting format to write bout. Here you need to write about a particular incident from your life and what have you learnt from that. You have to be descriptive and illustrative so that the reader gets to know what is going on in your mind.
These kinds of essays are not easy to write as the author should have a deep insight amongst the commoners so that he/she can synchronize his/her journey with the mentality of the commoners or the readers and come up with something brilliant. This is quite a necessary task while you are attempting to write some reflective article.
How to write a reflective essay:
- The choice of the topic is always important for any format of writing. You need to be quite efficient in understanding which part is your comfort zone and how much will you be able to illustrate your description in a perfect manner on that particular topic. Here you have been vested on with a topic of "volunteering". Well you have to do a thorough research and come up with a nice and interesting topic.
- Jotting down all the important facts that you think are necessary while describing your insight. You have to choose the facts carefully too so that the overall matter should not fall weak. This jotting down will help you while you will be in the process of writing.
- Make a rough draft first and check all the mistakes. After correcting them go for the fair draft. This concept of rough draft helps you to check and sync all your data. You will get chance to edit sources and even add some extra matters to emphasize certain topic.
- Choose a perfect title for your work else it would all go in vain. People gets attracted with the names mostly so try to have a creative yet meaningful title.
Some topics on volunteering:
- Volunteering can be done for relieving stress-explain
- Volunteering as a professional job-what do you think of it?
- The role of volunteering in community service.
- You can pay back to your society by volunteering for right causes- explain.
- Volunteering at an old age home-share the experience.
- How did you feel being a volunteer in a nursing home?
- Things to be a good volunteer- what are your views.


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Junior Faculty Training (JFT) Program
Supported by the Rockefeller Foundation, with additional support from the Scaler Foundation
Cambodia's higher education landscape is undergoing a 'silent revolution'. The country is currently witnessing a rapid increase in the number of new educational institutions, most of them private universities. The number of Bachelor's, Master's and PhD degrees offered in fields ranging from English and Khmer Studies to Business and Tourism Management to Buddhism Studies and Sociology reflects the huge demand among young Cambodians to expand their knowledge and improve their skills after secondary school.
Translation Capacity Building
With its mission to promote research, teaching and public service in the social sciences and humanities, the CKS seeks to publish and translate key academic materials into the Khmer language while working to build capacity and to strengthen the publishing sector in general.


text: Our College organized Chev. Dr. N. R. Dhanapalan Intercollegiate Basketball Tournament on 20 & 21st July 2017 in our college premises. 14 colleges in and around Chennai participated in the event which was initiated by Chev. Dr. N. R. Dhanapalan by shooting the first ball after a formal invocation. The guests were welcomed by the College Principal Dr. Kamala Balakrishnan. Eminent and experienced referees from various colleges conducted the event. The Chief Guest for the Valedictory was Mrs. Violet Dhanapalan, Vice Chairman, Violet Group of Institutions who congratulated the participants and distributed the medals, trophies and cash awards to the winners. Loyala College was declared as a winner for Men's category and Women's Christian College won the trophy in the Women's category. The dignitaries for the day were R. Hari Krishnan, Region Chairperson, Ln. N. S. Rani Secretary, Ln. R. R. Kannan, Treasurer, Ln. E. Shanmuga Vinayagam, Secretary Ln. S. Parthiban, Zone Chair Person. Dr. P. E. R. Premchand, Vice Principal Mrs. Japhia Solomon, Staff and Students witnessed the grand event. The event came to an end with Vote of Thanks by the Physical Director, Mr. Ramkumar


text:
This is an old Swedish recipe that was given to me in Decileters…if you do not have a DL measuring cup you can convert.
3 dl flour
3 dl sugar
2 tsp cinnamon
1 tsp ground cloves
1 egg
1/2 tsp baking soda
3 tbs melted butter
2 tbs orange marmalade
1 1/2 dl milk
Preheat oven to 400 Degrees F. Mix everything at once…pour in to a greased cake pan. Bake for 30 minutes.


text:
Care Quality Commission's Chair attacks NHS culture
The chairman of the Care Quality Commission, (CQC), David Prior, has said that the NHS in England has a culture that "doesn't listen" and that the NHS could go bust without "serious change". The head of the health watchdog called for more competition to drive up standards, adding that rifts between managers and clinicians were jeopardising patient safety and blocking improvements in care.
Writing in the Sunday Telegraph, Mr Prior said, "Parts of the NHS have developed a culture that doesn't listen – or worse, that stigmatises and ostracises those who raise concerns or complaints."
"Too often, it delights in the ritual humiliation of those deemed to fail, tolerates and institutionalises outdated working practices and old-fashioned hierarchies, and can almost encourage managers and clinicians to occupy opposing camps."
He called for successful hospitals to take over failing hospitals and community services, and for better care outside hospitals, and for larger centres of excellence.
He also called for changes to the way the NHS is held to account – particularly an end to trusts being "blindsided" by waiting time targets "that miss the point, skew priorities and have unintended consequences".
Katherine Murphy, chief executive of the Patients Association, agreed with Mr Prior, saying,
"There is a culture in the NHS where process comes before humans. For years we've tried to highlight concern about poor care. We're often seen as a nuisance for highlighting these issues. The behaviour and culture that was allowed to grow in Mid Staffordshire is no different from that in many trusts in many parts of the country today."
The Department of Health said it was "focusing on poor care like never before" and was turning around 14 hospitals that are in special measures. A spokesman said, "We are clear that targets must never come before clinical need – and based on clinical advice, we have scrapped a number of them."
The Francis Inquiry – one year on
It is exactly 12 months since the report of the full public inquiry into the failings at the Mid Staffordshire Foundation Trust was published on 6th February 2013. The inquiry, led by Robert Francis QC, looked at the role of commissioning, supervisory and regulatory bodies and why serious problems at the trust were not identified and acted on sooner.
In all, 290 recommendations were made by the Francis inquiry which set out a clear blueprint for the creation of a care system which ensures that the safety, dignity and well-being of patients is paramount. The Patients Association made it very clear at the time that it was vital that the recommendations were implemented swiftly and comprehensively; indeed, we are the only organisation that has been consistent in our arguments that the recommendations made by the Francis Inquiry should be implemented in full.
In response to the Francis inquiry, the Government set about implementing a series of further reviews which covered three key areas of concern: patient safety, patient experience and regulation
Whilst we welcome the findings of the various reviews and reports, it is now time for action. It is becoming increasingly apparent that those who run the NHS are reluctant to take the radical steps demanded by the Francis inquiry. We all know what needs to happen: regulation of healthcare assistants, a reformed complaints system, improved training and a properly funded and structured regulatory system. It is time for the government and NHS England to deliver action. We have been saying for many years now that the need to listen to patients, involve them in their care, value staff and for trusts to work together rather than in isolation are all key elements to ensure that standards improve and unnecessary deaths are avoided.
There is still a lot to change. There is a culture in the NHS where processes precede patient care. For years we have tried to highlight concern about poor care despite often being seen as a nuisance for highlighting these issues. The behaviour and culture that permeated in Mid Staffordshire could well be found in many trusts in many parts of the country today.
Ultimately, we believe that patients who use health and care services have the right to be treated with respect, dignity and compassion by staff who have the skills and time to care for them. We must:
1. Put patients (and their carers) first in decisions about their care
2. Help staff to be competent and provide care with dignity and compassion
3. Keep patients and service users safe; encourage whistle blowing where
unsafe care is being practiced
4. Have easy and accessible mechanisms for ensuring patient feedback
through complaints – lessons to be learnt
5. Create open and transparent cultures which are free of blame
A copy of our full response to the first anniversary of the Francis Report can be found here.
Do patients really have a choice?
The British Medical Association (BMA) held an event this week to celebrate the 10th anniversary of their Patient Liaison Group. The event brought together past and present members of the group, along with BMA committee Chairs, representatives from external patient groups and senior BMA staff.
The meeting aimed to provide the BMA with informed and independent advice on the issue of patient choice in the NHS. Dr Mike Smith of the Patients Association was invited to speak at the event along with a representative from Healthwatch England.
Dr Smith highlighted some of the problems that patients have in making an informed choice about their care, and the barriers to obtaining the health care that they want. Patients today expect, and deserve, a variety of choices when it comes to accessing health care from the NHS, and the "Choose and Book" website was set up to enable patients to make this a reality. However, many patients find that there isn't actually a great deal of choice available (and sometimes none). Furthermore, even when choices are available, patients are finding it difficult to make an informed decision.
'Hospitals could learn from supermarkets'
Prof. Keith Willett, who led Sir Bruce Keogh's review of urgent and emergency care, told a Westminster health forum this week that hospitals are too inflexible to meet patient's demands and could learn from the way supermarkets cater for changes in demand from customers by paying more attention to variations in what care is needed by patients rather than trying to fit them into a rigid system.
Supermarkets use information like the weather forecast and the till roll at nine o'clock in the morning to predict which items shoppers will want when stocking their shelves, he said, whereas "our idea of season variation or predictive modelling is patients in corridors and outliers".
Prof. Willett said that greater flexibility throughout the NHS could ease the burden on emergency cuts.
Speaking at the same event, Stephen Dorrell MP, the Chairman of the Health Select Committee, warned that hospitals are in danger of becoming "warehouses" for bed-blocking elderly patients due to poor planning, and questioned recent figures presented to the Select Committee by government ministers claiming that the problem of bed blocking was declining.
NHS Constitution Awareness Survey
Last year The Patients Association ran a survey to gauge the public's awareness of the NHS constitution and the rights that it contains.
The results showed that awareness was extremely low.
They are running the survey again this year, to assess whether the public are now more aware of the constitution and would be grateful if you could take the time to fill it out. It's a short questionnaire that shouldn't take more than thirty minutes to complete.
It will remain open until Friday 6th December 2013.
You can take the survey here.
The Patients Association annual Patients Stories report
The Patients Association has this week published its fifth annual Patients Stories report, Time for Change, a series of 13 case studies highlighting shocking examples of poor care in NHS hospitals and care homes across the country. The stories have been contributed by patients, or patients' families, who have contacted the Patients Associations' Helpline over the past twelve months.
Several stories included in the report are examples of how an inadequate complaints system, similar to that used by many trusts across the country and highlighted in both the Francis and the Clwyd/Hart review, can impact upon patients and their families who do not feel that they have received the correct level of care in their NHS hospital.
The cases in this year's report indicate the need to implement the recommendations of the Inquiry into Mid Staffordshire led by Robert Francis QC, the new President of the Patients Association. Cases featured in this report include:
- Eighty four year-old Olive Burns, who was admitted to hospital thinking she had fractured her hip, but whose condition soon deteriorated so dramatically that her family believed she had been placed under the Liverpool Care Pathway, only to discover that nurses had apparently forgotten to treat Olive over a busy bank holiday weekend.
- Averil Hart, a nineteen-year old student, who suffered from anorexia. Upon release from hospital, her care plan stated that she was at high risk and her family assured of close and regular monitoring. Neither of the two NHS teams responsible for her care communicated with each other or performed regular health checks on Averil who died following a severe relapse and without the care she so badly needed.
- Andrew Brown, who was shocked to discover that, after making a formal complaint about the treatment he received at Worcester Hospital, he was labelled a 'vexatious complainant'. He had been complaining about being discharged from the cardiology team despite needing a follow up appointment for heart palpitations.
- Annie Carroll, whose family remain unhappy with the treatment she received, yet the hospital she stayed at has, at the time this report was published, yet to formally investigate any of the family's concerns and provide them with a detailed response.
- Elizabeth Flood, who was admitted into Northampton General Hospital with a fractured shoulder and later discovered to have a fractured neck, after a fall at home. When Mrs Flood was transferred to a care home, staff there refused to help her eat or drink and asked her husband to come in to feed her instead. She developed bed sores and was admitted to A&E only after a hospital consultant noticed her frail appearance.
- Stan Norman was refused NHS continuing healthcare services because he "wasn't terminally ill", even though he suffered from end stage kidney disease and loss of mobility, which had being brought about by a preventative operation.
- Patient A felt that the information she received about her breast cancer treatment was not open and transparent, which led her to use valuable recovery time to check her medical records because she was "so concerned about the muddled information I had received". Her fears were then increased when she discovered a tissue sample that had been sent to the lab after her surgery had been handled so poorly that is prevented a proper analysis taking place.
- John Munday moved in with his niece after being diagnosed with advanced lung cancer, thinking he would be able to receive the right 'out of hours' care. Unfortunately, in the last few weeks of his life, the OOH care he received "made life extremely difficult, painful and unpleasant".
- Gloria Mary Butcher's daughter was told that her mother was being discharged from the hospital she had been treated at 11:10am, but did not return to her care home until 8:10pm, despite the home telling the hospital not to return her after 7pm. Gloria's daughter feels that trying to track her mother, a dementia patient, during this period was "like trying to track a parcel in transit".
- Patient B, who has the mind of a child, was admitted to hospital after suffering from four seizures. Her relatives feel hospital staff did not listen to concerns about their sister's condition and report that she was repeatedly left alone with food and drink despite having problems eating and swallowing. Patient B was discharged but needed to be re-admitted some months later. Her family was concerned to note that the issue of poor communication was not addressed despite making a formal complaint.
- John Moore was diagnosed with an aggressive brain tumour, but experienced a critical delay before he was able to receive urgent surgery, due to a junior doctor failing to make a critical referral. On the night before the surgery was meant to take place, Mr. Moore was wrongly told he had a life expectancy of 1-2 years. He sadly died four months after the operation.
- Doreen Hadfield believes that the hospital her parents Herbert and Irene Boswell were being treated at "failed in its duty of care for elderly patients" after witnessing the treatment her late father and mother received, including not being told her father did not have long to live and her mother, who suffers from dementia, being discharged in only her nightgown, and does not believe that lessons have being learnt, despite making numerous complaints.
- Lynne Hambleton, a qualified nurse, is ashamed of her profession after witnessing the poor care her mother, Edith Jamieson, received which included having to go without food or drink for long periods and not being assisted with toileting because her blindness and confusion prevented her from using the call bell.
Katherine Murphy, Chief Executive of the Patients Association, said:
"This is our fifth annual collection of patient's stories. The first was written in the fevered atmosphere of the run up to the General Election. The next three were produced against the backdrop of colossal upheaval as the Health and Social Care Act made its way through the parliamentary process and then the year before its implementation.
"But I believe that this fifth report, published in our fiftieth year, comes at the end of one of the most tumultuous periods in the history of the NHS. What a year 2013 has been, with ramifications that will stretch for decades.
"The publication of the recommendations of the public Inquiry into Mid Staffordshire was swiftly followed by the coming into law of the NHS reforms. Then we had reviews by Keogh, Berwick, Cavendish, and Clwyd/Hart. Alongside this came the news that the NHS is facing a potential £50 billion black hole over the next twenty years.
"At the heart of these times of upheaval are patients and relatives. They don't want to hear about reviews and finances, and they don't want to know any more about the reforms. What they want more than anything else is an NHS they can trust, and when they or a loved one will need it, they will be treated with compassion and dignity and cared for appropriately. Every NHS manager, decision maker and policy proposer in and around the NHS needs to remember that patients today have the same anxiety and fear they have always had, but that it has been worsened by the failings at Mid Staffordshire and the number of poor performing hospitals that have raised concerns and the Care Quality Commission have had to inspect as a priority.
"This year's collection of stories is different to those that we have used before. In previous years the focus of these reports, and our CARE campaign, has been on the care of the elderly. This remains a concern, despite the huge amount of hard work that is happening to improve care in this area.
"This year the focus is on what could be the single biggest development in healthcare since the launch of the NHS plan over a decade ago- the publication of recommendations of the Inquiry conducted by
Robert Francis QC into failings of care at Mid Staffordshire. We are delighted Robert Francis is now our President and will help us all as we strive for a more honest, open and transparent NHS.
"It is the opinion of the Patients Association that the recommendations that the Inquiry put forward are a comprehensive blue print for a safer, more caring NHS.
"Each and every case contained in this report should make the Government think again about its position. Each could potentially have been prevented if the Francis recommendations had been enacted in full.
"The Patients Association has had one simple message for the Government since the recommendations were published – don't let patients down any further, please agree to implement the recommendations in full.
Robert Francis QC, newly-appointed President of the Patients Association, said:
"The experiences of patients and relatives remain the best way to detect care that is being delivered without care and compassion.
"Let us all hope that in the near future we will stop having to listen to disturbing reports of poor and unsafe care in many different places and instead be looking at a service which has learned from the mistakes, and has ensured that the excellent practice we know exists has become the norm. If we are to achieve this, we need to keep listening to experiences such as those contained in this report."
Introduction to the report:
The aim of this report remains the same as it has always been, to amplify the voices of individual patients to highlight wider trends.
But this year there is a difference. Ordinarily we would publish a collection of stories and then a series of calls to action which we felt would improve the care that patients receive. But this year those calls to action already exist. The recommendations of the Francis Inquiry point the way forward for the NHS, and we call on the Government to commit to adopting them in full, with a timetable for doing so.
For those few readers who won't already know, the report, which was published in February of this year, identified numerous warning signs which were missed. The Inquiry believed that this was caused by:
• A culture that doesn't put the patient first
• An institutional culture that gave more weight to positive information about the service than to information that could cause concern
• Failure of communication between agencies to share their knowledge of concerns
• Too great a tolerance of poor standards and of risk to patients
• Assumptions that monitoring, performance management or intervention was someone else's job
• A failure to appreciate the risk of disruptive loss of corporate memory and focus resulting from repeated reorganisation
With 290 recommendations made by the Inquiry it is just not possible to analyse them all here.
However we would identify the key themes to be:
• Foster a common culture shared by all of putting the patient first
• Develop a set of easily understood fundamental standards that should not be breached.
• Make sure all those that provide care for patients are regulated and properly accountable for what they do
• Ensure openness, transparency and honesty about matters of concern
• Strengthen the regulatory system
• Enhance the recruitment, education, training & support of all key contributors to the provision of healthcare
• Improve the complaints system
At the time of the report's publication the Patients Association was cautiously optimistic about its findings, with our Chief Executive Katherine Murphy saying "We welcome the report. It's a comprehensive review of nearly every aspect of the NHS, and when it is such a key part of all of our lives, patients and carers deserved nothing less. This is a watershed moment for our health service.
It will take time to digest all of the findings and 290 recommendations that have been made. But it is clear that he has understood some of the very real failings that patients and their families face day in and day out. He (Francis) has recognised what we hear on our Helpline every day – too many parts of the NHS have lost their way and forgotten that care and compassion should be at the heart of what staff do.
He wants to give nursing a powerful voice. He wants the ward sister back in charge and we welcome that. The concept of a registered older peoples nurse is a great idea and should be wholeheartedly pursued. Whilst he recognises it will take some time to implement, he has seen that there can be no other option but to regulate healthcare assistants. The Government has been wrong to resist this idea.
"We have always believed good complaints handling can do so much to improve our health service.
We need standards, we need more independence and we need to empower and support patients and carers when they highlight poor care. It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability. But it's important now to focus on ensuring the Government doesn't play politics with this report-they need to focus on making the most of this unique opportunity to improve the NHS for all our benefit."
"Since that time it has become clear to us that each of the recommendations has merit and the Government should commit to implementing them in full.
But unfortunately it has not done so. Instead the Government has commissioned a series of further reviews. Some, such as the Keogh review of trusts with higher than expected mortality rates, are vital for patient safety and have a great deal of merit. The Patients Association was proud to have been involved, and fully supports the work that has been done to tackle areas of concern.
"But others seem deliberately designed to water down the recommendations of the Francis Inquiry. The Cavendish review, for example, failed to follow the lead of the Inquiry and propose a proper system for the regulation of Healthcare Assistants. The Complaints Review, whilst painting a positive picture of what can be done to improve the complaints system, stops short of taking on the structural change that it clearly needs.
"Perhaps the biggest disappointment was the Berwick review. At the Patients Association it continues to remain unclear to us exactly why a further review of the Francis Inquiry was needed. The findings and sentiments were hard to disagree with. However the lack of solid proposals and a road map for true change was extremely disappointing. As we said at the time "At the moment nobody knows what will be in the report and as such it is difficult to comment on speculation. However we would be extremely pleased if Professor Berwick agrees with Francis and suggests that Healthcare Assistants should be regulated. Everybody knows that this has to happen as quickly as possible and shouldn't be delayed because it is considered too costly or difficult to introduce. We would also welcome the introduction of minimum staffing levels on the ward.
"Healthcare professionals, patients and relatives are constantly contacting our Helpline to tell us that they don't think that the wards at their hospital have sufficient numbers of staff to keep patients safe, and this problem has to be addressed. We would also welcome the rumoured new onus on individual candour. Everybody working in the health service needs to understand the importance of openness and transparency.
"What we need to see from the report is a clear blue print for implementing Francis, not more platitudes and acknowledgement that things went wrong. The goal has to be to move towards an open, honest and transparent NHS where everybody is accountable for their actions. This has to be across the whole system, including primary care and a vital step towards achieving it will be a complete change in the culture of the NHS and the way professionals interact with patients and relatives.
"For an NHS that is truly safe and transparent we also need for patients to be able to access meaningful data about performance and patient safety records, as well as infection rates on individual hospital wards. Above all we need to see a clear distinction between the need to cut costs and manage finances, and the need to ensure that patients remain safe.
"We all know that the future facing the NHS is one of great opportunity which can only be viewed through a prism of financial challenges. The Patients Association acknowledges that implementing the Francis Recommendations will be neither quick nor free of financial difficulty. But once the short term pain has been overcome we are confident that the long term gain of an NHS which has the safety and dignity of its patients at the centre will have made it seem very worthwhile."
NHS winter crisis as 40% rise in cancelled operations
Alarming signs of an NHS winter crisis have emerged as official figures show a 42% increase in cancelled operations and a 23% rise in elderly people stuck in hospital, despite mild weather, little flu and lower than usual amount of patients arriving at Accident and Emergency units.
The NHS statistics show that over a 10 day period ending on Wednesday, more than 2,000 surgical procedures were cancelled with less than 24 hours' notice – including 122 urgent operations, such as those for patients with cancer.
Senior doctors have expressed their concerns over whether hospitals will be able to cope when the weather turns colder.
Dr Cliff Mann, President of the College of Emergency Medicine, said: "It is really worrying; this is a very significant rise so early in the season, when it is barely winter at all. It is especially concerning that so many urgent operations are being cancelled, because that clearly can put patients at risk." He admitted that A&E units were now under severe pressure all year round, leaving little slack in the system for a harsh winter, an event that has been forecast.
New GP contract heralds return of 'proper doctors'
A new contract has been agreed for GP's between the Department of Health and the British Medical Association (BMA) will see the return of "proper family doctors", responsible for round the clock care and with dedicated help for the elderly.
Under the contract, four million elderly patients and those with complex conditions will be given a named GP, who will be personally accountable for their care at all times, with doctors having to trawl through their register to identify the frailest 2% of patients. GP's will also now be personally responsible for the care of all patients aged 75 and over, around the clock, regardless of who delivers it. The aim is to create a much more proactive service whereby the needs of the patient, from home adaptations to intensive nursing support, are met much more quickly, as well as providing greater continuity of care for those patients who visit GP's the most.
The system of GP pay being dictated by targets will also be scrapped, with more than one third of the indicators got rid of. The BMA have said this will allow thousands of GP's to attend to their patients, instead of their computer screens.
Secretary of State for Health Jeremy Hunt has hailed the new contract for bringing back the "old fashioned family doctor" and claimed it will bring to an end the current "box tickling culture", a move that he claimed was vital in ending the "huge pressure on our A&E departments" caused by Labour's 2004 GP contract.
The Patients Association welcomes the new GP contract and the step towards putting the patient at the centre. Treating people safely, especially the elderly and vulnerable, is vital.
Elderly emergency admissions rising
The Care Quality Commission (CQC) has called for urgent action to stem the rise in avoidable emergency admissions among the elderly, after data collected by the regulator revealed that 530,000 over 65s were admitted to England as an emergency for a preventable cause last year, representing an increase of more than 40% since 2007/8.
The CQC report, its annual State of Care Review, also highlighted common themes found during the 35,000 inspections made in 2012/13. Evidence of poor care was found in one in ten hospitals, with half of cases judged to have had a moderate or major impact on patients, while those suffering from dementia continuing to have among the worst outcomes, with similar problems identified in social care.
The regulator's inspectors were "alarmed" to see the way patients were being treated and found "unacceptable" failures to protect the most vulnerable, with a deterioration in standards from an already poor position. It concluded that hospitals had made "no improvement" in monitoring the quality of care or in ensuring that patients were safe or treated with dignity and respect, and warned that the NHS has still not learned the lessons from the Mid-Staffs scandal.
However, the findings in this report were based on an inspection regime that has being radically revamped.
Avoidable admissions are caused by conditions such as dehydration or infections which could have been prevented with better care.
Katherine Murphy, Chief Executive of the Patients Association, has said:
"Avoidable admissions drain much needed resources from the NHS, but more importantly, they cause huge amounts of distress and discomfort to those patients who would much prefer to be cared for at home."
Government publishes 'blueprint for trustworthy' NHS
Secretary of State for Health Jeremy Hunt has this week outlined the Government's response to the Francis Report into the deaths at Stafford Hospital, saying that the NHS needs to undergo a "profound transformation" to create an open, honest and learning culture that will give patients "the best and safest care…in the world".
The Government has agreed to accept all but nine of the original 290 recommendations made by Robert Francis QC in his report, including
- Getting hospitals to publish details of whether they have enough nurses on wards, with the numbers to be put on a new national safety website
- Hospitals will have to produce quarterly reports on how they are handling complaints and clearly set out how patients can raise them.
- A legal duty of candour on organisations to be open and honest about mistakes.
- A criminal offence of willful neglect to hold staff to account.
- A "fit and proper person's test" so managers who have failed in past will be barred from taking up posts.
- Care certificates to ensure healthcare assistants and social care workers have the right skills and training.
- Every patient should have the names of a responsible consultant and nurse listed above their bed.
The nine recommendations that the Government have chosen not to take forward include the call for the regulators Monitor and the Care Quality Commission to be merged, although the decision made recently to grant both organisations extra responsibilities made that unlikely.
But of the 281 accepted recommendations, one in four of them has not been met fully, for example the inquiry called for a system of registration for healthcare assistants, but the care certificate falls short of that. The inquiry also originally called for the duty of candour to apply to individuals, not just organisations.
However, Robert Francis QC, the chair of the Inquiry, has said he is happy, describing the Government's response as a "comprehensible collection of measures".
The Francis Inquiry, which was published at the start of February, was set up to tackle the wider cultural problems in the NHS after the discovery of widespread abuse and neglect at Stafford Hospital. The inquiry accused the NHS of putting corporate self-interest ahead of patients and concluded that the failings went from the top to the bottom of the system.
The Patients Association welcomes the commitment by the Secretary for State for Health to adopt most of the recommendations of the Francis Report. However, the organisation does warn that some vital recommendations have not being accepted and that patient care should suffer as a result.
In particular, the failure to adopt recommendations around the registration of Healthcare Assistants, has led to concerns that the safety of patients will be compromised. The organisation does believe however that the adoption of most of the recommendations will lead to considerable advances in patient safety. In particular, it strongly supports moves to provide more information on staffing numbers in hospitals, safety information on hospitals and closer monitoring of the complaints system.
Speaking about today's announcement, Katherine Murphy, Chief Executive of the Patients Association, has said:
"We have said on many occasions in the past that the Francis recommendations represent a blueprint for an NHS that treats people in a safe environment, with dignity and respect.
Whilst we should recognise the considerable step forward taken today, we need to remember that it simply isn't enough to commit to implementing the reforms. In relation to staffing numbers, for example, it is about getting the right staff as well as simply ensuring that the ratio is correct. There is also real concern about where the nurses need to meet the ratio will be found.
In relation to complaints, we need to see tough action taken against those trusts that are consistently underperforming.
For many years the Patients Association has raised concerns about care in hospital, especially for the elderly, and has published a number of reports on the subject. It is therefore extremely welcome that the Government will make it a criminal offence to willfully neglect patients, all of whom will have had complete faith in those that mistreated them.
We will be monitoring the implementation of these proposals closely, but we really do believe that today is a move towards restoring the faith patients have in the NHS."
Emergency doctors demand seven-day primary care support
The College of Emergency Medicine has published a ten point action aimed at resolving the crisis in emergency departments. It calls for other NHS services to provide "effective alternatives to A&E for patients without acute severe illness or serious injury seven days a week".
The College calls for GP services, social care services and NHS walk-in centers to open longer to take the pressure off casualty wards, as well as action to resolve a "massive staffing shortage "by making work on casualty wards more attractive with increased incentives for doctors working nights and weekends.
The College's Vice President, Dr Chris Moulton, said that GP out of hour's services were not always comprehensive and A&E was the only 24 hour service.
But GPC out of hours lead Dr Peter Holden said general practice was, alongside A&E, the only part of the new NHS which runs a 24/7 service.


text:
Indeed this is love, when a man risks his life just to prove what he feels for a lady. And when the lady still rejects him, what does he do?
This is the story of a man who treks from Lagos to Zaria because of a lady. He did it for a lady Sharon Donald, who is not interested in his love.
The lady said she knew Agbaje was embarking on the trek, adding that she warned him against it. She said she had never had any relationship with him, describing him as a stalker.
According to her :
"Tunde Agbaje has been harassing and stalking me for the past six years and as far as I am concerned, this is just a new escapade in a series of his harassment.
This guy is mentally unstable, because how can you still be stalking a woman who has turned you down for six years?"
She calls it "mental instability", i call it Love


text:
Cerebral embolic protection during endovascular arch replacement
One of the most devastating complications after cardiac surgery is stroke. Conventional open repair of aortic arch pathology is highly invasive and frequently requires extracorporeal circulation and hypothermic circulatory arrest, both sources of stroke. Despite advances in perioperative management and surgical technique, contemporary series of aortic arch repair report a significant risk of stroke (4.7–6.0%) (1,2).
Near-total endovascular repair of aortic arch pathology, and hybrid approaches that combine surgical revascularization of the brachiocephalic arteries with thoracic endovascular aortic repair (TEVAR) have appeared as promising alternatives. Although these approaches can mitigate risk associated with cardiopulmonary bypass, circulatory arrest, and aortic cross clamping, strokes after endovascular procedures of the arch still contribute a significant risk to the patient with rates of 4.2–5.9% (Table 1) (3-5). Mechanisms of stroke include embolism or aortic dissection with wire and catheter manipulations, and during deployments of endografts, in addition to cerebral hypoperfusion during revascularization of the supra-aortic trunks. Sources of emboli may include fresh or organized thrombus, atheromatous debris, air, or native arterial tissue. Several strategies exist to mitigate stroke risk during endovascular approaches to the arch. However, new innovations in device design constantly introduce new challenges in stroke reduction.
Full table
Epidemiology of stroke in arch endovascular procedures
Stroke risk during arch TEVAR varies with both the method and extent of repair. With rapidly developing endovascular technology for treatment of arch pathology, elucidating rates and causes of peri-operative stroke has been difficult. Challenging arch anatomy, advancing devices and wires proximally into the aortic arch and ascending aorta, and complexity of the procedure all contribute to the differences in stroke rates. A greater understanding of the epidemiology of stroke can assist in anticipation and avoidance of stroke in endovascular approaches to arch pathology.
Atheromatous disease
Aortic arch atherosclerosis is commonly found in the population and can contribute to embolic phenomena. In the SPARC study, 51% of the population over the age of ≥45 years had the presence of arch atheroma with 7.6% having severe atheroma as defined by ≥4 mm thick, ulcerated or mobile plaque (17). The presence of severe arch atheroma increases with age and is found in over 20% of patients ≥75 years.
Several studies of TEVAR for distal arch or descending aortic pathology have demonstrated an association of significant arch atheroma/shaggy aorta and peripheral embolization with stroke (18-21).
Hybrid approaches
When hybrid arch repair involves proximal arch landing zones, surgical debranching is required to maintain cerebral perfusion when the endograft is expected to exclude the supra-aortic vessels. Hybrid approaches have the benefit of combining a more limited, less invasive open revascularization with a relatively straightforward endovascular procedure. Although many configurations of hybrid approaches exist, the University of Pennsylvania group classified hybrid approaches into a practical classification that includes three types of repair (Figure 1) (22). Type I includes aortic debranching using a partial aortic clamp and a zone 0 landing zone, completely avoiding cardiopulmonary bypass. Type II requires surgical construction of a zone 0 landing zone requiring cardiopulmonary bypass and often circulatory arrest. Type III hybrid approaches include full reconstruction of the ascending aorta and arch. Further expansion of this classification can include arch reconstruction at zone 1 or 2. Selected strategies are tailored to patient anatomy.
Stroke rates in hybrid repairs are influenced by cross-clamping, clamping of branches vessels, hypoperfusion, circulatory arrest, and endovascular manipulations.
Major strokes occurred during hybrid repair for zone 0 or zone 1 pathology in 4.7–9.5% (11) of patients (3,6-10). Although robust data for stroke rates at each zone is sparse, higher stroke rates seem to correspond with more proximal debranching with zone 0, zone 1, and zone 2 hybrid repair stroke rates being 17.4%, 7.1%, and 4.3%, respectively (11).
Procedures with increased wire manipulation
Repair with fenestrated/branched endografts
Fenestrated and branched endografts for the aortic arch were developed as a means to achieve near total endovascular repair of the arch, eliminating most of the debranching required with hybrid repair. The majority of the global experience with branched arch endografts is with the Cook Medical Zenith arch branched graft (Bloomington, IN, USA), a two-branch device developed for proximal sealing in zone 0. All patients undergo left subclavian artery (LSA) revascularization and the branches are bridged to their target vessels (innominate and left common carotid) with an appropriate covered bridging stent graft. The initial global experience of 38 patients treated with this device was reported in 2014 in patient who were deemed high-risk or unfit for conventional surgery. Stroke, transient ischemic attack (TIA) and meningeal hemorrhage occurred in six patients (15.7%) (14). A more recent study using the same device in high risk patients reported two major strokes among 27 patients treated (7.4%) (15). The authors concluded that decreased stroke rate was directly correlated with the learning curve involved with these complex novel procedures.
Arch endografts with multiple fenestrations or branches [Nexus (Endospan Ltd., Herzlia, Israel); arch branch graft (Cook Medical); arch branched stent graft (Bolton Medical Inc., Sunrise, Florida, USA)] (Figure 2) are not currently commercially available in the United States, and are generally only available worldwide under special or compassionate use access although plans are underway for feasibility clinical trials in the United States the Gore TAG Thoracic Branch Endoprosthesis (W.L. Gore, Flagstaff, AZ, USA), a single branch device (Figure 2), is currently undergoing a US pivotal clinical trial. While this pivotal trial has recently been opened up to zone 0 and 1 pathology, the initial results of repair in zone 2 (Gore TAG TBE feasibility trial) were published, demonstrating no strokes in 22 patients treated (16). Medtronic has recently restarted their feasibility trial examining safety and efficacy of their Mona LSA branch stent graft system, with a single "Volcano" like branch intended for zone 2 cases (Figure 2). The high-risk nature of the patients, increased wire and catheter manipulation in the branch vessels and arch, and deployment of branch devices and balloons in the branch vessels all contribute to stroke risk in these patients.
Repair with parallel grafts
Parallel chimney stents were initially conceived as a bailout maneuver in cases of inadvertent visceral artery coverage during endovascular abdominal aortic repair, but the technique has since been extended to other applications (23). It has been used widely in the paravisceral aorta and is increasingly being used to manage the supra-aortic branches during TEVAR. Briefly, a covered stent runs in parallel to the aortic endoprosthesis into the branch vessel and serves as a bridge from the aorta, within the seal zone, to the vessel that has been intentionally covered. The principal advantage of this off label technique is in its use of off-the-shelf components and techniques familiar to most operators to achieve a more proximal landing zone during arch TEVAR. The disadvantage of this technique is the creation of gutters around the aortic endoprosthesis with a 6.4–9.4% rate of type IA endoleak (24,25).
The rate of major stroke during chimney TEVAR was 2.6–5.4% (20,25). In Hogendoorn et al., 24% of patients who underwent arch chimney grafts required an additional cervical debranching procedure; the stroke rate in these patients was 8.3% versus 3.2% for those who did not have additional revascularization, with 40% of strokes being fatal (25).
Implantation of chimney grafts requires more wire and catheter manipulations within the arch compared to TEVAR with debranching, and these manipulations in and around the arch vessels may contribute to cerebral embolization.
LSA coverage
In order to achieve a more stable and reliable proximal landing zone, or as part of proximal arch procedures, the LSA will often require endovascular occlusion. Stroke rates of 4.8–7.4% have been reported in patients undergoing TEVAR with LSA coverage (6). The Eurostar registry has identified LSA coverage as significantly associated with higher neurological sequelae (26). Coverage of the LSA with and without revascularization demonstrated lower risk of stroke in patients who had LSA revascularization (5.3% 95% CI: 2.6–8.6 vs. 8.0% 95% CI: 4.1–12.4) (17); and 3.1% vs. 5.6%, P=0.0657 (6). We recommend LSA revascularization whenever feasible.
Techniques at minimizing stroke
Pre-operative planning
The planning phase of arch endovascular therapy remains an essential step in stroke minimization. Anticipating and avoiding potential sources of stroke is likely the best strategy in stroke prevention.
Identifying potential embolic sources on chest CTA imaging can alter pre-operative planning as well as intra-operative strategies. Calcific disease, atheroma, dissection flaps, and ulcerations can all contribute to embolic phenomena and strategies aimed at avoiding or excluding these zones from circulation are ideal. Knowledge of the presence and dominance of vertebral artery circulation is required for subclavian artery revascularization options, and head and neck imaging are strongly recommended to establish circle of Willis anatomy. Branch origin disease, tortuosity, and arch elongation can contribute to technical challenges in advancing and positioning devices in the ascending aorta, branch vessels, and arch. Anticipating these challenges can minimize wire manipulations and failed attempts at advancing devices, thus reducing risk of stroke.
ECG-gated computed tomography angiography is the ideal imaging modality for arch planning. Gating, whether prospective ECG triggered or retrospective ECG, improves temporal resolution and minimizes artifacts caused by cardiac motion (27) allowing for accuracy in measurement. Uploading images into 3D software for measurement is highly recommended.
Device selection
The anatomical constraints of the ascending aorta and arch can be extremely unforgiving in the endovascular setting. Arch configuration and aortic tortuosity (proximal or distal) can contribute to challenges in advancing wires, catheters, and devices without 'snowplowing' the aortic wall. When these situations are encountered, the most important step in stroke minimization is selecting the proper approach to managing the aortic pathology. In highly angulated or elongated arches, total arch endovascular techniques may carry high stroke risk compared to hybrid techniques and when atheromatous burden is high endovascular manipulations in the high-risk arch may be better avoided, preferring a completely open strategy. When selecting which device or strategy to employ for arch pathology, device conformability, stiffness of the delivery system, and operator familiarity should all be considered.
Intra-operative techniques
Wires and catheters
Proper wire and catheter use represents best clinical practice in stroke reduction. Prior to advancing any wires across the arch, adequate heparinization with 100–200 units/kg of Heparin with a goal ACT of >250 must be achieved. Furthermore, it is recommended that American Society of Anesthesiologists Physical Status Classification System (ASA) and, selectively, clopidogrel be continued throughout the procedure.
Wires should never be advanced without fluoroscopic visualization. Whenever possible, standardizing wire and catheter selection to minimize unnecessary exchanges is advisable. The decision to position the wire in the ascending aorta or in the left ventricle, ideally should be determined pre-procedurally. Careful attention to marking and stabilizing these wires is essential. If advanced wire techniques are necessary such as through and through wire access, snaring should be performed distal to the arch to avoid inadvertent cerebral embolization.
Device manipulation
When anatomical constraints present challenges in device delivery or deployment, the operator must move quickly to alternate techniques, abandoning multiple or forced ineffective attempts. Stiff buddy wires and through and through wire access (brachial/subclavian/axillary) can provide the support needed to navigate tortuous anatomy and safely advance delivery systems into the proximal aorta. These techniques can be planned in challenging anatomy. Iliac and aortic tortuosity is often underestimated as a possible cause of inability to introduce the device into the arch. Pre-planning is often beneficial to countering these challenges and alternative access options such as iliac conduits or direct abdominal aortic access can circumvent these obstacles.
Adjunctive procedures and devices
LSA revascularization
When feasible, we strongly recommend routine carotid-subclavian bypass or transposition of the LSA, in order to minimize stroke and spinal injury. If lengthy endovascular procedures are planned, LSA revascularization is performed in a staged fashion the day prior.
Embolic protection devices (EPD)
There is a paucity of data regarding techniques or devices for embolic protection for use during arch TEVAR. Experience with methods for prevention of embolization has been gained in other endovascular procedures at risk for cerebral embolization, specifically in internal carotid artery stenting (CAS) and transcatheter aortic valve replacement (TAVR).
The most commonly used EPD are distal filters with occlusion/aspiration systems used less commonly (28). Distal filter EPDs are deployed over a 0.014" wire or come attached to a steerable wire tip and allow antegrade carotid blood flow during the entirety of the procedure, real-time capture of embolic debris, and angiography at any time during the intervention. In CAS, use of EPDs has demonstrated a significant reduction in both minor stroke (0.5% vs. 3.7%; P<0.001) and major stroke (0.3% vs. 1.1%; P<0.05) (29) and are currently in widespread use for this application.
Various EPDs have been studied in the setting of TAVR. The Claret Sentinel device (Claret Medical Inc., Santa Rosa, California, USA) consists of a dual-filter system inserted through a 6 French sheath inserted via right arm access. The proximal component, a radiopaque nitinol frame with a 140-µm pore polyurethane filter, is deployed in the IA and a second filter is positioned across the left common carotid artery (LCCA) ostium. This device protects the right vertebral, right carotid, and left carotid arteries from embolization but not the left vertebral. Conversely, the TriGuard HDH embolic deflection device (Keystone Heart Ltd., Caesarea, IL, USA) is delivered transfemorally via a 9 French Mullins introducer sheath and deploys a single mesh filter with 130-µm pores across the ostia of all three head vessels. These devices demonstrated significantly decreased risk of stroke in patients undergoing TAVR procedures (30,31). Disadvantages of these EPDs include the requirement of an additional arterial access (up to 9 French in the case of the TriGuard), lack of protection of the left vertebral artery by the Sentinel device, and availability of only one size for each device leading to incomplete coverage in certain arch anatomies. Variability in arch anatomy and the wide spectrum of possible arch pathologies makes no single embolic protection device or technique applicable to all situations or repair techniques. Diversion/filtering devices used for TAVR pose a technical challenge for embolic protection during zone 0–2 arch repair compared to when they are used during TAVR as they are likely to interfere with the deployment of the aortic endoprosthesis. If still in place once the TEVAR is implanted, removal of the EPD could potentially displace the endoprosthesis or more importantly result in entrapment of the EPD. Two additional EPD devices, the Embol-X and Embrella devices did not demonstrate reduction in the incidence of large total lesion volume. The Embol-X device study was stopped before completion due to commercial unavailability of the device, and studies of the Embrella device were not powered for efficacy, and actually trended towards an increase in lesion numbers (32). Neither of these devices are commercially available in the United States (12).
The senior author has used the Boston Scientific FilterWire EZ (Figure 3) EPD in four cases of advanced aortic arch intervention. These devices are intended for transfemoral placement into the mid internal carotid artery. This method of use is contraindicated for arch branched cases due to the device being entrapped by the full deployment of the arch branched graft. Therefore, if one intends to use these neuroprotective devices, they must be placed via direct access of the supra-aortic vessels. On the right, direct mid to distal common carotid access is required, and for left internal carotid deployment, the device is introduced by way of the left carotid subclavian bypass usually by direct puncture in the synthetic graft. Direct access as described above can be cumbersome and awkward with the long delivery systems of the EPD being exposed to possible inadvertent manipulations and credible fear that the EPD could be dragged back on an exposed internal carotid artery. Even more worrisome is the concern for the 0.014" delivery wire being bent or kinked while distracted by the other manipulations of the arch branched graft or the supra aortic access. Clearly, if carotid neuroprotection is desired using this modality, development of a more procedure-specific neuroprotection device is required. Interestingly, despite the use of direct neuroprotection with EPD in the internal carotid artery, one out of these four patients experienced a significant stroke. Examination of the filter in that case demonstrated significant debris in the filter, confirming the very real possibility of embolic potential in these complex arch cases (Figure 4).
Carotid clamping
Clamping and flushing of the carotid vessels is a relatively simple method of embolic protection. It can be considered when stroke risk is high secondary to excessive atheromatous burden in the ascending aorta and arch. This technique is limited by a few different variables: not all vessels are surgically exposed in every case; clamping of the artery itself may cause embolization in the cases of diseased arteries; and cerebral hypoperfusion can occur. In general, surgeons experienced with clamping currently favor the technique of sequential clamping of the common carotid artery distal to the retrograde catheterization point while the branch intervention is performed, with subsequent flushing before opening the carotid to antegrade flow. This of course is predicated by adequate collateral flow via a patent circle of Willis, along with systemic blood pressure that supports this robust cerebral network. We routinely maintain systemic blood pressure in the normotensive or hypertensive during range during carotid clamping to minimize the risk of hypoperfusion.
Many factors can contribute to the risk of stroke during endovascular therapy to arch pathology. Approaches to the arch whether open, near-total endovascular, or hybrid, all carry different risk of stroke but must be individualized to the patient in order to achieve the best outcomes with the lowest risk of peri-operative mortality and stroke. Patient factors such as arch atheroma and ulceration, and arch elongation, are not modifiable and must be identified early and be strategically considered during the planning phase. Currently, there are no neuroprotection devices available that are specifically compatible with endovascular repair of arch pathology. Techniques in stroke prevention such as carotid clamping and/or EPD placed directly through supra-aortic vessels should be considered when appropriate, on an individual basis. Sound clinical practice such as diligence with wire and device manipulations is always recommended. As endovascular therapy continues to push the boundaries of aortic arch management, the cause and prevention of strokes will continue to evolve. There is clearly opportunity and need for innovation in neuroprotection for complex endovascular arch intervention. Until this need is met, stroke will continue to be the Achilles heel of endovascular aortic arch intervention.
Conflicts of Interest: Dr Cherrie Abraham is a Consultant for Cook Medical (Case reviews, Proctoring Advanced Aortic Intervention), Medtronic (Aortic Advisory Board), and WL Gore (Clinical Events Committee, Gore Clinical Trial) -- (Consultant fees paid to OHSU). The other authors have no conflicts of interest to declare.
- Thomas M, Li Z, Cook DJ, et al. Contemporary results of open aortic arch surgery. J Thorac Cardiovasc Surg 2012;144:838-44. [Crossref] [PubMed]
- Patel HJ, Nguyen C, Diener AC, et al. Open arch reconstruction in the endovascular era: analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg 2011;141:1417-23. [Crossref] [PubMed]
- Melissano G, Tshomba Y, Bertoglio L, et al. Analysis of stroke after TEVAR involving the aortic arch. Eur J Vasc Endovasc Surg 2012;43:269-75. [Crossref] [PubMed]
- Feezor RJ, Martin TD, Hess PJ, et al. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR). J Endovasc Ther 2007;14:568-73. [Crossref] [PubMed]
- Andrási TB, Grossmann M, Zenker D, et al. Supra-aortic interventions for endovascular exclusion of the entire aortic arch. J Vasc Surg 2017;66:281-97.e2. [Crossref] [PubMed]
- Waterford SD, Chou D, Bombien R, et al. Left Subclavian Arterial Coverage and Stroke During Thoracic Aortic Endografting: A Systematic Review. Ann Thorac Surg 2016;101:381-9. [Crossref] [PubMed]
- Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg 2013;2:247-60. [PubMed]
- Czerny M, Weigang E, Sodeck G, et al. Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry. Ann Thorac Surg 2012;94:84-9. [Crossref] [PubMed]
- Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg 2010;39:683-90. [Crossref] [PubMed]
- Preventza O, Garcia A, Cooley DA, et al. Total aortic arch replacement: A comparative study of zone 0 hybrid arch exclusion versus traditional open repair. J Thorac Cardiovasc Surg 2015;150:1591-8; discussion 1598-600. [Crossref] [PubMed]
- Yoshitake A, Hachiya T, Okamoto K, et al. Postoperative Stroke after Debranching with Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2016;36:132-8. [Crossref] [PubMed]
- Inoue K, Hosokawa H, Iwase T, et al. Aortic arch reconstruction by transluminally placed endovascular branched stent graft. Circulation 1999;100:II316-21. [Crossref] [PubMed]
- Iwakoshi S, Ichihashi S, Itoh H, et al. Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft). J Vasc Surg 2015;62:1473-8. [Crossref] [PubMed]
- Haulon S, Greenberg RK, Spear R, et al. Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg 2014;148:1709-16. [Crossref] [PubMed]
- Spear R, Haulon S, Ohki T, et al. Editor's Choice - Subsequent Results for Arch Aneurysm Repair with Inner Branched Endografts. Eur J Vasc Endovasc Surg 2016;51:380-5. [Crossref] [PubMed]
- Patel HJ, Dake MD, Bavaria JE, et al. Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis. Ann Thorac Surg 2016;102:1190-8. [Crossref] [PubMed]
- Macleod MR, Amarenco P, Davis SM, et al. Atheroma of the aortic arch: an important and poorly recognised factor in the aetiology of stroke. Lancet 2004;3:408-14. [Crossref] [PubMed]
- Kotelis D, Bischoff MS, Jobst B, et al. Morphological risk factors of stroke during thoracic endovascular aortic repair. Langenbecks Arch Surg 2012;397:1267-73. [Crossref] [PubMed]
- Gutsche JT, Cheung AT, McGarvery ML, et al. Risk factors for perioperative stroke after thoracic endovascular aortic repair. Ann Thorac Surg 2007;84:1195-200. [Crossref] [PubMed]
- Khoynezhad A, Donayre CE, Bui H, et al. Risk factors of neurologic deficit after thoracic aortic endografting. Ann Thorac Surg 2007;83:S882-9. [Crossref] [PubMed]
- Kanaoka Y, Ohki T, Maeda K, et al. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair. Medicine (Baltimore) 2016;95:e3335. [Crossref] [PubMed]
- Vallabhajoysula P, Bavaria JE, Szeto WY. Hybrid Approaches to Complex Aortic Arch Aneurysms. J Thorac Cardiovasc Surg 2012;17:15-26.
- Voskresensky I, Scali ST, Feezor RJ, et al. Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients. J Vasc Surg 2017;66:9-20.e3. [Crossref] [PubMed]
- Ahmad W, Mylonas S, Majd P, et al. A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases. J Vasc Surg 2017;66:1602-10.e2. [Crossref] [PubMed]
- Hogendoorn W, Schlösser FJV, Moll FL, et al. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg 2013;58:502-11. [Crossref] [PubMed]
- Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. A study from the European collaborators on stent/graft techniques for aortic aneurysm repair (EUROSTAR) registry. J Vasc Surg 2007;46:1103-10. [Crossref] [PubMed]
- Desjardins B, Kazerooni EA. ECG Gated Cardiac CT. AJR Am J Roentgenol 2004;182:993-1010. [Crossref] [PubMed]
- Mousa AY, Campbell JE, AbuRahma AF, et al. Current update of cerebral embolic protection devices. J Vasc Surg 2012;56:1429-37. [Crossref] [PubMed]
- Kastrup A, Gröschel K, Krapf H, et al. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 2003;34:813-9. [Crossref] [PubMed]
- Giustino G, Sorrentino S, Mehran R, et al. Cerebral Embolic Protection During TAVR: A Clinical Event Meta-Analysis. J Am Coll Cardiol 2017;69:465-6. [Crossref] [PubMed]
- Seeger J, Gonska B, Otto M, et al. Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Significantly Reduces Death and Stroke Compared With Unprotected Procedures. JACC Cardiovasc Interv 2017;10:2297-303. [Crossref] [PubMed]
- Vlastra W, Vendrik J, Koch KT, et al. Cerebral protection devices during transcatheter aortic valve implantation. Trends in Cardiovascular Medicine 2018. In Press. [Crossref] [PubMed]


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text:
Apr 1, 2019
1 I cried out to God for
I cried out to God to hear me.
2 When I was in distress, I sought the Lord;
at night I stretched out untiring hands,
and I would not be comforted.
remembered you, God, and I groaned;
I meditated, and my spirit grew faint.[b]
4 You kept my eyes from closing;
I was too troubled to speak.
5 I thought about the former days,
the years of long ago;
6 I remembered my songs in the night.
My heart meditated and my spirit asked:
7 "Will the Lord
reject forever?
Will he never show his favor again?
8 Has his unfailing love vanished forever?
Has his promise failed for all time?
9 Has God forgotten to be merciful?
Has he in anger withheld his compassion?"
10 Then I thought,
"To this I will appeal:
the years when the Most High stretched out his right hand.
11 I will remember the deeds of the Lord;
yes, I will remember your miracles of long ago.
12 I will consider all your works
and meditate on all your mighty deeds."