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Five-set FEU escapes tough Perpetual
In their third five-set encounter of the PVL Collegiate Conference, the Far Eastern University Lady Tamaraws overwhelmed the University of the Perpetual Help System DALTA Lady Altas, 25-15, 15-25, 22-25, 25-14, 15-6, at the FilOil Flying V Centre.
After a dominant showing in the first set, the Lady Tamaraws had trouble adjusting to different lineup configurations in the second and third frames. But even though both sets came out as losses, FEU head coach George Pascua emphasized the need to expose his roster to high-level competition this early into their preparation for the UAAP.
"Siyempre, gusto namin na lahat ng players mabigyan ng chance makalaro. Kita naman na marami pang kailangan i-polish sa team. Pero, happy naman ako kasi nagi-improve naman," said Pascua.
With their usual rotation back for the fourth and fifth set, the Lady Tamaraws re-established their dominance and cruised to the win.
Middle blocker Celine Domingo continued to lead the Lady Tamaraws, scoring a game-high 18 points off 13 attacks, four blocks, and an ace. Jeanette Villareal added 11 markers.
Perpetual played without captain Aurora Tripoli, who hyper-extended her right quadriceps and hamstring. Cindy Imbo took charge, tallying 15 points, while Jenny Gaviola managed 13.
FEU (4-1) take on the University of the Philippines Lady Maroons (2-1) on Saturday at the same venue. Perpetual (1-4) face the San Beda Lady Red Lions (1-4) next Sunday also at the same venue.
The Scores
FEU (3) – Domingo 18, Villareal 11, Guino-O 10, Ebon 9, Malabanan 9, Negrito 3, Cayuna 2, Dejito 2, Hernandez 2, Ronquillo 2, Carandang 1, Bautista (L), Duremdes (L)
UPHSD (2) – Imbo 15, Gaviola 13, Versoza 10, Gual 7, Suico 7, Llorente 6, Castillo 1, Aldea 0, Umandal 0, Dayao (L), Sangalang (L)
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Townsontown Spring Festival
May 4 - May 5
The 52nd Annual Towsontown Spring Festival will take place on Saturday, May 4th from 10am-8pm and Sunday, May 5th from 1pm-6pm.
If you are a thrill seeker, foodie, music lover, or just a Baltimore explorer, this is your kind of festival! Visit over 350 vendors offering unique crafts, jewelry, art, food, and more! Three stages of live performances will feature some of the best music in Baltimore.
Located on Chesapeake, Pennsylvania, Washington, and Baltimore Avenues in Towson (400 Washington Avenue).

subset: commoncrawl


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\r\n\tOn the other hand, these biofuels can be further utilized as substrates for organic syntheses for bulk chemical products, like alcohols, biodegradable polymers, organic acids, etc.
\r\n\tThese two options reveals different prospects for development of new biofuel-based industries, although in a modest scale for the moment.
\r\n\tThe present book aims to offer some examples and new ideas for the broader applications of biofuels and the resulting raw materials for energy and chemical production as an alternatives to the traditional fossil fuels.
Due to their importance to social growth, environmental and economic issues, surface erosion, sedimentation, scour, and deposition have been investigated by engineers and geologists for centuries. Solid fragments of naturally occurring organic or inorganic materials with a particle size of less than 2 mm are named fine sediment, which is broken down by the processes of weathering and erosion. The fine sediment generally includes sand, silt, and clay particles. Particles greater than 2 mm are categorized as coarse sediments which includes gravel, cobble, and boulders. These materials become detached from the rocks and are transported to a deposition site such as streambeds and lakes by the action of water, ice, wind, and force of gravity. In this process, sediments may be affected by cementation, consolidation, solution, or biological action. The physical and biological characteristics of stream systems are influenced by sedimentation. Apart from human activity, the level of deposited and suspended sediments in each stream depends on climate, geology, and terrestrial characteristics of a stream's watershed. The process of erosion is natural, while the human activities can greatly intensify the process of erosion and sediment transportation [1]. In the function of watershed or aquatic ecosystems, sediment plays vital role and can has a positive or negative effect on stakeholders and biota.
Surface erosion from watersheds and bank erosion along the river caused sedimentation in all water bodies. As a result of earth-forming developments, for instance climate, glaciations, weathering, and geologic events, some characteristics of a basin such as slope, soil composition, elevation, and size have formed throughout centuries. The contributions of these characteristics are different in each watershed. However, in a watershed, there is a historic adaption between the livelihood of the aquatic life and the amount and characteristics of the sediment of stream system. Management at the watershed scale is a main challenge facing existing and coming generations. Many of the environment ecosystems are being dishonored or being used in an unsustainably manner [2]. Degradation of waterways in a watershed was intensified a result of human activities which aims to convert the home-grown vegetation to land uses related to agriculture and urbanization. These changes increasingly disturb the local hydrological cycle creating problems with stream flows, erosion, and sedimentation [3]. Apart from land use change, river canalization, water pumping, inter basin water transfer, logging, road construction, gravel mining, and mega hydraulic structures like dams are commonly considered unnatural contributors to sedimentation [4]. As common human activities, agricultural land development and urbanization within a stream's watershed often increases excessive quantities of sediment to water ways. In addition, the stream habitats and water quality are influenced by human activities. Excessive sediment inputs from the disturbed lands reduce water quality in watersheds. Figure 1 shows agricultural land development in a steep hill in KhorKoreh watershed, Kurdistan Iran, destroying the land cover and making it more erodible.
In contrary, for runoff and sediment storage purposes, numerous watershed practices are currently being implemented, which improved the hydrologic conditions in watersheds [1]. To increase water infiltration and to decrease runoff and sediment flow into streams and water bodies, structural measures such as the construction of check dams and nonstructural management such as biological treatment have been practiced worldwide [1]. However, to measure the effectiveness of these activities, consistent assessments are essential. In many cases, the misconducting of man-made structures intensifies the watershed erosion. Figure 2 shows the downstream of a stilling basin of a constructed check dam in Kurdistan, Iran. The dimensions of the stilling basin are too small to diminish the flow velocity, and the accelerated flow degrade stream condition washed out the stream bed, which caused bed deformation passing through stream bed.
Understanding the aspects and principles governing the river processes is essential for engineers. An unquestionable method to shorten the useful life of hydraulic structures like lakes, reservoirs, and wetlands is sedimentation. In line with sustainable development and integrated water resources managements (IWRM), all the aspects of environment, social, and economic issues must be considered in the planning, design, construction, and operation of any water project. Even, for current projects, evaluation methods should be developed and applied to reassess their advantages considering the principle of IWRM. Ecosystem restoration and waterway recreation are considered, by researchers and engineering, as a way to attain sustainable development [5]. In recent years, to restore a river's environment, many existing hydraulic structures were modified or redesigned [5]. Accordingly, some of the hydraulic structures may need to be decommissioned. Reasons for withdrawing include, structure security and safety, legal and economic liability, and environmental considerations. A sedimentation management method for reducing watershed erosion to reduce sediment inflow and sluicing sediment from hydraulic structures is a way to increase useful life of constructed structures. Engineering design and construction of hydraulic structures, without considering a river as a dynamic system, and taking IWRM principles into consideration may not serve the basic functions of rivers.
Sedimentation engineering involves sediment issues in the development, use, and conservation of water and land resources. The guidance to theoreticians and practitioners' worldwide, concerns the hydraulics of sediment transport in fluvial systems. In fact, sedimentation engineering is an effort to relate the mechanics of sediment transport in waterways and by turbidity flows to the morphodynamics of reservoir and lake sedimentation, with the development of fluvial deltas [6]. The gravity force from the differences in density between particles and the fluid are the main cause for sedimentation of particles. In flowing water, the sediment particles, because of the gravitational forces and the upward-acting lifting forces induced by the flow, remain suspended. For particles denser then water, the gravity forces is dominant in comparison with the upward-acting lifting forces and the particles fall through standing water. Sediment entrainment and transport maintenance are two fundamental independent processes of bed material movements. Numerous methods to estimate and evaluate the mechanisms' quantity and effects of both suspended and bed sediment loads are presented by sediment engineers. Apart from increasing sediment loads in watersheds, water bodies, and industrial, the contemned sediments are the challenges that affect the environments. Contaminated sediment may exist in streams, rivers, wetlands, lakes, along ocean margins, harbors, reservoirs, or in other water bodies. The contaminants may have man-made or natural sources like many metals and some organic compounds. Principles of the cleanup process are complex at sediment sites and sites with soil or ground water contamination. As noted above, in recent years, refreshing urban areas and returning land and water bodies to creative uses have become increasingly important. In these efforts, protecting or re-establishing a natural riparian corridor along the stream is considered as the most proper ecological option.
To the achievement of river engineering design, actions, and maintenance, our considerate of the dynamic stability between amount of sediment loads in a stream and sediment source from upstream is important. In sedimentation engineering, theories of erosion, sediment transport, and deposition are considered to alter the knowledge about human interaction with environment to diminish the inappropriate effects of projects on environments. To simulate and predict sedimentation processes in a basin, a systematic method based on reliable theories can be used. For such reasons, numerous models are presented and accessible for engineers to be used for analyzing sedimentation problems in various watersheds, waterways, and waterbodies. However, several of the complicate aspects and principles of sedimentation are yet to be understood, and they remain among the challenging subjects for upcoming investigations.
The World Health Organization (WHO) estimates that there are more than one billion people in the world living with some form of impairment or disability, of whom nearly 200 million have considerable difficulties in functioning [1]. There is a growing proportion of people with disabilities worldwide, and these are vulnerable groups in both developed and developing countries.
Currently, the National Organization on Disability (NOD), a private and nonprofit organization, estimates that 54 million children and adults in the United States have one or more disabilities, with 35 million Americans being severely disabled [2, 3, 4]. The proportion of children with disabilities is estimated to be 12.5 million or around 18% [3, 4, 5]. According to the estimated data by National Health and National Health and Nutrition Examination Survey (NHANES), 46% of adults in the United States have periodontitis, and 8.9% have severe periodontitis [6].
The geopolitical and social plurality of states and regions in Brazil have shown the emerging need for effective public policies to meet the specific needs of this diversity. According to the Brazilian Institute of Geography and Statistics, 45.6 million Brazilian citizens (equivalent to 23.9% of the population) have some type of neuropsychomotor impairment as physical, sensory—visual and auditory—and intellectual disabilities. Among these, 17.7 million people (6.7% of the population) have severe disability. The majority of this target public is found in urban areas and is aged between 15 and 64 years; further, the northeastern areas have a higher number of cities with at least one person with disability [7]. Hence, oral health care needs should be emphasized mainly for this target public due to high susceptibility to infection risks and great vulnerability to develop illnesses. Mental disorders associated or not with disabilities must also be considered in these individuals. In this condition, the familiar influence shall be taken into account for these groups once their human development directly depends on the good relationship among them.
Regarding children with developmental disorders, especially the autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (AD/HD), or specific learning disorder (LD), the field of "special care dentistry" is rapidly gaining recognition as a necessary service once they require oral health care needs at all times [8]. According to American Psychiatric Association (APA) [9], these disorders have relatively been growing due to the increase in birth rates and life expectancy of these individuals. Another relevant factor would be the ability or difficulty to perform their self-care, in particular, in the mouth, resulting in a negative impact of precarious oral conditions. The main oral signs and symptoms found in this target public include poor oral hygiene, dental caries, and severity of periodontal diseases (PD). High incidence of dental hypoplasia, traumatic lesion (factitious, iatrogenic, and accidental), drug-induced gingival overgrowth, dental malocclusion, and tooth missing are also evidenced [8, 10]. It is important to highlight that the large dental loss of intact teeth is caused by the destruction of the collagen fibers of the periodontal ligament (PDL) and severe resorption of alveolar bone tissue from the persistent supra and subgingival and periopathogenic microbiota, recognized as periodontal disease [11]. Therefore, this disease is one of the most common oral chronic infections in people with special health care needs (SHCN), becoming an important dental public health problem.
Based on combined data from the literature and our scientific experiences, we discussed the microbiological, histopathological, and clinical features of PD in each "special care needs" group. Furthermore, we reported some advances in "Omic" technologies which are molecular biology methods used to assess the genomics (genes), proteomics (proteins), transcriptomics (mRNA), and metabolomics (metabolites) aspects of PD. These methods promote a better understanding of the mechanisms involved in the etiopathogenesis and in the identification of new biomarkers of PD that help in the diagnosis of PD and in tissue responses after treatments of gingivitis and periodontitis. In addition, alternative therapies to PD in patients with SHCN were recommended in order to aggregate new scientific knowledge, some of them being investigated at the Center of Biosciences Applied to Persons with Special Care Needs (CEBAPE) of the Institute of Science and Technology of the São Paulo State University (UNESP).
The field of "special care dentistry" is rapidly gaining recognition as a service that should be provided to persons with physical, mental, or intellectual disabilities by general physicians, pediatric physicians, geriatric physicians, dental practitioners, and dental hygienists. Considering the limited opening of the oral cavity and the great difficulty of clinical procedure handling, the special needs patients may be treated under applying of psychological, physical, or pharmacological techniques in order to control their behavior and the voluntary or involuntary body movements. These patients may be affected by several comorbid physical illnesses including diabetes mellitus, cardiovascular diseases, respiratory illnesses as aspiration pneumonia, sleep disturbance as obstructive sleep apnea, malignant neoplasms, and so on.
Extrinsic and intrinsic factors may corroborate to the installation and perpetuation of PD, as well as increase the susceptibility to supra and subgingival periopathogens in these individuals, even after oral hygiene promotion and/or intensive conventional mechanical treatment, combined or not with a supportive therapy. Concerning the main extrinsic factors, previous studies have considered oral mucositis-inducing chemotherapy drugs, saliva flow-reducing medications, respiratory disturbances as mouth breathing leading to oral hyperventilation and, as a consequence, dry mouth, motor deficit, cognitive impairment, learning difficulty and disability, crowded teeth, and inappropriate diet. The intrinsic factors include immune response deficiency, a high amount of periopathogens, sleep disorders such as obstructive sleep apnea, dysfunction of the oropharyngeal muscles resulting in severe dysphagia, and the risk of occurrence for aspiration pneumonia. Previous studies confirm the presence of respiratory pathogens in the oral cavity which may be aspirated into the lung alveoli due to severe dysphagia, developing aspiration pneumonia [12, 13]. This comorbidity may negatively influence the oral health homeostasis, aggravating the preexistent inflammatory processes, in particular, the PD.
Current researches confirm that the therapy applying neuromuscular electrical stimulation on the masticatory muscles was effective in adults with cerebral palsy. This biostimulating effect also reflected in the electrical activity of the oropharyngeal muscles, favoring their functional performance; then, a positive effect on the apnea and hypopnea index was found. These episode cascades reduced the number of pathological respiratory events, promoting improvements in the quality of life for these patients [12, 13, 14].
Regarding the oral health status of these populations, the main oral manifestations are dental caries, dental hypoplasia, dental agenesis, orofacial traumas, drug-induced gingival overgrowth, and, in particular, PD [8]. Recent studies have shown that the presence of periodontopathic microbiota at the oral biofilm and/or spread throughout the saliva may explain the higher susceptibility to PD in this target public [15, 16].
According to the Joint Advisory Committee for Special Care Dentistry (JACSD), "special care dentistry" provides oral services for people with an impairment or disability including physical, sensory, intellectual, mental, medical, social, or a combination of one or more of these [17]. Several conditions, disorders, and/or disabilities lead these patients to the need of specialized oral assistance. In Brazil, the Federal Council of Dentistry has recognized the specialty of Dentistry for Patients with Special Health Care Needs as a dental service which has been assisting people with simple or complex disabilities, of acute or chronic nature, and temporary or permanent conditions or disorders. This target public is inserted into the following categories: neuromotor disability (1), sensory disability (2), mental disorder (3), infecto-contagious diseases (4), chronic systemic diseases (5), and systemic conditions (6).
The neuromotor disorders (1) include people with physical and intellectual disabilities which are from an unknown, environmental, and a genetic origin. These disorders consist of cerebral palsy, cerebrovascular disturbances (e.g., ischemic and hemorrhagic cerebral strokes), spinal cord injury, myelomeningocele, infectious disease (e.g., poliomyelitis or infantile paralysis), autoimmune diseases (e.g., myasthenia gravis and multiple sclerosis), muscular dystrophy resulting in muscle weakness and cellular degeneration, metabolic bone diseases (e.g., rachitis or osteomalacia caused by genetic, nutritional and/or hormonal abnormalities affecting bone growth and remodeling), and bone genetic disorder (e.g., dysostosis, osteopetrosis and imperfect osteogenesis). The congenital and acquired abnormalities, resulting in craniomaxillofacial deformities, complex malformations, and syndromes are also included in the neuromotor disorders. It is important to emphasize that the intellectual disabilities may be associated with these conditions.
The sensory disorders (2) include the hearing and visual disabilities, generating immediate harmful effects as depression, isolation, dementia, and decrease of quality of life [18]. The severity of these impairments may result in the disruption of interpersonal relations and decrease of self-sufficiency in daily living activities, both of which are critical to the well-being of a person [19]. Hearing disability, with its resultant difficulties in communication function, pervades multiple domains of function in the individuals, decreasing activity, increasing depressive symptoms, and confounding assessment of cognitive ability. Although it is not curable, this impairment is often remediable with appropriate audiologic evaluation and the prescription of amplification devices. Visual disability also affects multiple domains of function, limiting the individuals' ability and increasing the risk of falls, fractures, and morbidity. In order to attenuate the consequences of visual disability, the cause must be identified to obtain an effective treatment [20].
Conforming to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA) under coordination of the Division of Mental Health of the World Health Organization (WHO) and the National Institute of Mental Health (NIMH), a mental disorder (3) is a syndrome characterized by clinically significant disturbances in an individual's cognition, emotion regulation, or behavior which reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning [9]. Thus, mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss (e.g., the death of a loved one) is not considered a mental disorder [9]. For a better elucidation, the new North American classification of mental disorders is briefly mentioned in Figure 1.
Among the different groups of psychopathologies, it is worth mentioning the neurodevelopmental disorders which include intellectual disabilities (mild, moderate, and severe levels), autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD), communication disorders (speech and language impairments), specific learning disorder, motor disorders (e.g., stereotyped movement disorder and tic disorders), and so on [9]. Children with neurodevelopmental disorders may experience difficulties with language and speech, motor skills, behavior, memory, learning, or other neurological functions [14]. While the symptoms and behaviors of neurodevelopmental disabilities often change or evolve as a child grows older, some disabilities are permanent. Diagnosis and treatment of these disorders may be difficult, frequently involving a combination of professional therapy, pharmaceuticals, and home- and school-based programs.
Considering the most common mental disorders including dementia, depression, generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, posttraumatic stress, and phobias, the psychiatric patients have presented high susceptibility to PD. These illnesses have been caused by a set of processes such as the presence of oral microbial biofilm due to poor oral hygiene, psychotropic medication-induced dry mouth, and gingival hyperplasia [15, 21]. Mental health clinicians should also be aware of the oral consequences of prescribed medications, especially the antipsychotic drugs [15]. About this, the depression may dysregulate regulatory mechanisms within the brain involved in immune regulation, alter the immune system responses, and thereby influence the development and progression of infections and inflammatory diseases, including periodontitis [22]. As a support therapy, antidepressant drugs, such as fluoxetine, tianeptine (selective serotonin reuptake inhibitor), and venlafaxine (serotonin-norepinephrine reuptake inhibitor) are used; however, the side effects could affect the periodontal tissue health [23]. Current studies using animal models showed that the fluoxetine reduced the alveolar bone loss due to suppression of inflammatory response and protection against periodontal bone resorption and collagen fibers destruction of the periodontal ligament (PDL), while the tianeptine influenced the immune system, enhancing the plasma concentrations of pro-inflammatory and T regulatory cytokines and interleukins in response to the gram-negative bacterial lipopolysaccharide (LPS) antigen. As a consequence of these processes, there is an inhibition of the periodontal disease progression [24, 25]. On the other hand, the venlafaxine influenced the increase of alveolar bone loss, most likely due to its anti-inflammatory and immunoregulatory effects on the periodontitis once it is considered an inflammatory disorder and an immunologically compromised disease [22].
Therefore, an increased focus on the physical health of psychiatric patients should encompass oral health including closer collaboration between the dental practitioners and clinicians. Possible interventions must include the following approaches: to apply the best practices in health care focusing the transdisciplinary, to remove first the infectious foci as oral microbial biofilm and dental calculus through dental scaling and root planning for an appropriate teeth cleaning and reduction or inactivation of periodontal pockets, to guide the regular use of dental floss or interdental brushes and tooth brushing, to insert monitoring processes on oral self-care such as to create a strategic planning on interdental cleaning behaviors according to the difficulty levels of learning and the motor and cognitive dysfunction of each individual, and to perform periodic oral appraisals for necessary methodological adjustments in order to ensure the maintenance and the preservation of good oral health. Before introducing these procedures, the dental practitioner must comprehend the profile of each patient with SHCN, so as to know the physical and intellectual limitations, to identify the presence of comorbid diseases which may affect the overall health, and to assess the psychiatric behavior related to oral self-care. Surely, this systemic overview may favor the homeostasis of the stomatognathic system and improve the general health conditions, once these approaches can prevent the development of extensive and severe PD avoiding dental mobilities and/or loss.
The infecto-contagious diseases (4) is a subset category of highly dangerous transmissible diseases which include mainly infected patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS), patients with active tuberculosis disease, patients with viral hepatitis, and other such patients.
The chronic systemic diseases (5) are illnesses that spread throughout the body, affecting multiple organs and body systems, which may evolve into comorbidities, complicating the diagnosis and, consequently, influencing the prognosis. Considering this concept, the diseases imply juvenile rheumatoid arthritis, diabetes mellitus, congenital and acquired heart diseases, hematological diseases or disorders, chronic renal failure, autoimmune diseases (lichen planus, pemphigoid, pemphigus vulgar, erythema multiforme, lupus erythematosus, epidermolysis bullosa, etc.), vesiculobullous diseases, and so on.
The systemic conditions (6) are recognized as secondary factors that may modulate the disease initiation or progression rather than acting as primary etiological factors. These circumstances may affect the onset, progression, and treatment of such disease. Several patient types are included in these conditions, such as patients submitted to radiotherapy and chemotherapy in the head and neck regions, patients who received an organ transplant, patients with medication-induced immunosuppression, and similar others that may affect the general health conditions of the individual.
To better comprehend the relation among the environmental, genetic, and social effects and a person, a diagram was elaborated showing the occurrence of diseases, conditions, and/or disorders which may manifest during the life course of an individual. It is important to emphasize that these etiopathological factors may contribute to the development of one or more disabilities, leading to an acquired or congenital disability. On the other hand, an individual may be born with one or more disabilitiy and, concomitantly, develop diseases or disorders due to the high susceptibility to the environment and the different levels of disability complexity, characterizing the person with SHCN. It is noteworthy that the social impact resulting from precarious conditions of survival on the people with SHCN could explain the causes of health disparities or high occurrence of oral diseases (Figure 2). Socially disadvantaged groups have demonstrated poorer overall and oral health than the general population, becoming an aggravating factor, especially, in groups with SHCN. Therefore, a better attention to the public services in oral health for this population should be one of the main goals in government plans.
Some case reports of patients with SHCN were briefly described in relation to their clinical, radiographic, histopathological, and laboratorial characteristics together with the oral manifestations, clinical procedures, and transdisciplinary approaches; then, we correlate them with the findings found in the literature. Furthermore, we mainly discuss the clinical management related to the PD. The additional commentaries are aimed to reinforce the importance of the early diagnosis and an appropriate dental treatment for each complexity of disability. Types of PD that were correlated with some categories of people with SHCN are depicted in the following section.
A 14-year-old adolescent girl with Robinow syndrome had low stature, mild exophthalmos, hyperthyroidism, frequent thrombocytopenia, splenomegaly, and genital abnormality such as hypoplastic clitoris and small lips (a). Esophageal reflux was reported in the initial years of life. Using the Nicodemo et al. [26] and Grenlieh-Pyle [27] methods, dental and bone ages were 11.4 and 12, respectively. The intraoral examination showed mouth respiration, angular cheilitis, dental malocclusion, and ulcerated gingival surface (b and c) and accentuated alveolar bone loss (d), especially, at the region of mandibular incisors. Histologically, gingival tissues showed intense infiltration of mononuclear inflammatory cells diffusely spread throughout the connective tissue. Junctional epithelium hyperplasia with intense exocytosis (e) and extensive areas with no epithelium cover associated with infiltration of polymorphonuclear inflammatory cells into the lamina propria were also evidenced. In addition, presence of bacterial colonies (black arrows) and necrotic alveolar bone tissue fragments (blue arrows) was found (f and g). The diagnosis was chronic periodontitis with ulceration areas (Image 1).
A 19-year-old young man with Down syndrome associated with ectodermal anomalies. The extraoral features displayed dry skin and alopecia of eyelashes, eyebrows, and hair (a) while, the intraoral features showed dry mouth due to the severe reduction of saliva flow and mouth breathing, frequent angular cheilitis resulting from immune system deficiency, bilateral absence of the inner and upper third molars, presence of left upper and right lower deciduous canines, upper lateral incisors with microdontia, unerupted left upper permanent canine, generalized chronic gingivitis (a–d), and absence of caries. The recommended dental treatment was periodontal prophylaxis through the use of disclosing agents such as the scaling and root planning (e–g). It is important to point out that oral hygiene orientation and diet control must be continuously performed because of the neuromotor dysfunction of these patients, resulting in great understanding difficulties and difficulties in handling of cleaning devices and leading to a poor oral hygiene. Concerning dental education, we consider that the learning for repetition and use of ludic techniques or resources are effective strategies which must be implemented by dental practitioners. We also suggest the saliva analysis to assess their physicochemical properties, to determine the susceptibility to stress measuring the concentrations levels of salivary amylase or cortisol, and to identify the occurrence risk for aspiration pneumonia using as a biomarker the Pseudomonas aeruginosa. It is important to highlight that patients with Down syndrome present immune system disorders; therefore, oral infections must be avoided for general health balance and maintenance (Image 2).
A 11-year-old female child with West syndrome had multiple epileptic spasms and, as a consequence, a severe neuropsychomotor impairment. The electroencephalography showed a hypsarrhythmia pattern confirming the diagnosis. The recommended treatment to this condition has been the use of phenobarbital and/or valproic acid since birth. The intraoral features were drug-induced generalized gingival proliferative lesion with partial covering of the posterior teeth and gingival bleeding. Some permanent teeth were still impacted due to the presence of gingival fibrosis (a–c). The recommended dental therapy was the prophylactic periodontal treatment and gingivectomy (Image 3).
To illustrate this case, histopathological features were depicted in order to show the medication effects on the oral mucosa, in particular, on the gingival tissues (epithelium and connective tissue) (Figure 3).
A 7-year-old male child with spastic quadriplegic cerebral palsy, caused by hypoxic–ischemic brain damage, exhibited poor cognitive function and has been feeding on semi-solid food since 3 years of age. Ranitidine hydrochloride was used to treat gastroesophageal reflux, and botulinum toxin was never used to decrease the severity of the sleep bruxism. As a consequence, severe upper and lower teeth wear reaching the region of the dental pulp were evidenced (a).
This child was in primary dentition phase and exhibited discreet chronic gingivitis, mouth-breathing pattern, severe dysphagia, and involuntary tongue movements. First, oral hygiene orientation and diet control under supervision were done due to his severe neuromotor dysfunction. Posteriorly, we used a masticatory device denominated "hyperbola" to attenuate the sleep bruxism and, consequently, to improve the quality of his life. After the proposed therapy, we obtained satisfactory results, including reduction of the sleep bruxism and improvements of sucking-swallowing movements at meals. (Source: Giannasi, et al. [14]) (Image 4).
A 9-year-old male child with visual disability resulting from the intracranial hypertension and/or alterations in the vascularization of the optical nerves which were caused by the cystic craniopharyngioma. Diabetes insipidus was developed as a complication of this disease, whereas, the motor functions, learning ability, memory, and mental health were preserved. The intraoral features showed generalized chronic gingivitis and deep caries, in particular, in the molar regions, resulting from poor oral hygiene. Considering that the periodontal disease is one of the main oral complications of diabetes, the oral health balance must be a major goal of the dentists once hyperglycemic control in a diabetic child becomes is a great challenge for parents and doctor (Image 5).
A 59-year-old man with diagnosis of active positive-HIV had squamous cell carcinoma in the vestibular fornix region. In the clinical history, the patient was a smoker since the age 13 and had arterial hypertension, saphenous bridge, and type 2 diabetes mellitus. The diagnosis of positive-HIV was confirmed when the patient was 36 years old. To treat the malignant neoplasm, chemotherapy and radiotherapy were indicated by the oncologists; however, no emergency dental treatment was done before the recommended therapies in order to first eliminate the dentoalveolar infection foci. We imply that the severe periodontitis combined with periapical lesion caused by the presence of residual root, quickly evolves into an abscess with spontaneous extraoral suppurative drainage. The neoplasm overgrowth and the indicated therapies with no support dental treatment surely influenced this infectious process (a and b). Severe candidiasis was spread on the hard palate and, in particular, superior alveolar ridge (c). The exfoliative cytology confirmed the diagnosis, showing a great amount of Candida albicans hyphae (d) and indicating a highly immunocompromised patient. As a consequence of the oral condition, this patient was with a severe malnutrition and cachexia resulting in hypoglycemic shock and, then, progressing to his death in 15 days. Most likely, there was no favorable response to the medical therapeutic protocols due to the severity of the immunosuppression and the presence of generalized acute oropharyngeal infections (Image 6).
A 61-year-old man had uncontrolled and insulin-dependent type 2-diabetes mellitus, arterial hypertension, ankylosing spondylitis, and hepatitis C. Regarding the diabetes control, the patient was treated with sinvastatina (10 mg), galvus (100 mg) and lantus (44 mL). The glycated hemoglobin (HbA1c) value was 9.1% (Reference values: normal: ≤5,6%, prediabetes: 5,7–6,4%, and diabetes mellitus: ≥6,5%, in accordance with the American Diabetes Association) [28]. In the intraoral features, generalized chronic periodontitis characterized by the clinical attachment loss and the periodontal abscess with suppurative drainage placed, in particular, at the right canine region were evidenced (a, b, c, and d). Oral hygiene was unsatisfactory, most likely because of the pain and the gingival bleeding stimulated by the use of cleaning devices. The periodontal treatment was done associated with prophylactic drugs as antibiotics. No local vasoconstrictive anesthetic agent was administered during the clinical procedures. (Courtesy: Professor Doctor Ana Cristina Solis) (Image 7).
Concerning the etiology of PD in patients with uncontrolled diabetes, the progressive attachment loss was detected due to the function and reduction of polymorphonuclear leukocyte chemotaxis leading to an increase in infection susceptibility, collagen synthesis and maturation reduction, increased collagenase activity, and the formation of advanced glycation end products (AGEs) that bind to the receptor for advanced glycation end products (RAGEs) in macrophages and monocytes. The effects of AGE accumulation increase tissue oxidant stress, alter the endothelial cell functions, elevate the activity of matrix metalloproteinases leading to the production of free radicals, and promote vascular dysfunction and cellular death. These factors may directly affect the migration and activity of inflammatory cells, impairing the mechanisms of defense against microorganisms and delaying the periodontal tissue repair processes, resulting in great losses of support structures [11].
To clarify these clinical findings, periodontal tissue alterations resulting from oral complications of diabetes were depicted, including intense alveolar bone resorption at the furcation region, proliferation of junctional epithelium (hyperplasia) toward the furcation, diffuse infiltration of mononuclear inflammatory cells which consisted of macrophages, lymphocytes, and especially plasma cells. Numerous blood vessels were congested and the diapedesis mechanism (leukocyte extravasation into connective tissue) were well evidenced, justifying the great amount of inflammatory cells at the lamina propria (Figure 4).
A 33-year-old woman with chronic mucocutaneous inflammatory disorder of immunological background showing aggressive and extensive oral lesions with erythematous, erosive and extensive areas, especially in the marginal and attached gingivae (a and b). Histopathological features showing a band of infiltration of lymphocytic inflammatory cells under the surface epithelium extending throughout the gingiva (c), besides hydropic degeneration and sharpness loss of the basal layer (d) (hematoxylin and eosin, 50× and 100×). The diagnosis was lichen planus. (Source: Gomes et al. [29]) (Image 8).
A 23-year-old young woman with Fanconi's anemia had severe pancytopenia and a prolonged, long-term immunosuppression which resulted in the development of an abscess on the infra-orbicular region. This process progressed to phlegmon causing tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbit region of the right side (a). The etiologic agent of the phlegmon was Streptococcus parasanguinis. The myelogram shows moderately hypocellular bone marrow with cellular dysplasia involving the granulocytic, erythrocytic, and megakaryocytic (arrow) series (b). The intrabuccal examination showed abundant and spontaneous gingival bleeding, edema on the interdental papillae, hematomas on the superior and inferior lips, and inadequate oral hygiene (c and d). No caries, alveolar bone loss, and periodontal pockets were evidenced. No bone marrow transplant was performed due to incompatibility of donors; thus, the only available option was an alternative treatment through the erythrocytes and platelets-concentrated transfusion to prevent spontaneous hemorrhages and severe anemia. Oral exfoliative cytology was performed, showing superficial epithelial cells with nuclear and cytoplasmic alterations, erythrocytes, bacterial colonies (cocci), and numerous hyphae and spores of Candida albicans (e). Based on this, drug administrations, as antifungal medication and antibiotics, were also indicated to treat the oral acute inflammatory processes caused by bacterial and fungal infections. It is important to emphasize that the dental interventions were done together to the recommended medical therapy until the disease remission period. Initially, the periodontal prophylaxis was carried out by dentist and, posteriorly, the orientation and control of oral hygiene and diet accomplished by nurses and caregivers after adequate training in oral health. The health multiprofessional team, who may participate in this treatment process, corroborated in favor of supportive health care, leading to a quick recovery time of the patient (Source: Gomes et al. [30]) (Image 9).
A 14-year-old adolescent boy with Acute Lymphoblastic Leukemia (ALL) underwent the chemotherapy and radiotherapy on the region of the central nervous system for relapse prophylaxis of the primary disease (a). The myelogram before the medical therapies displayed hypercellular bone marrow composed exclusively by lymphoblastic cells with numerous atypical mitoses (square) (b and c). Extra and intraoral features of the patient, before the recommended dental treatment, were acute necrotizing ulcerative gingivitis, severe oral mucositis with areas necrosis associated to pseudomembranes, and facial asymmetry with signs of phlogistic processes (d and e). The exfoliative cytology of the hard palate and attached and free gingivae shows a great number of inflammatory polymorphonuclear and mononuclear cells, besides a great amount of Candida albicans hyphae confirming the diagnosis of candidiasis (f and g). The dental treatment protocol, inserted together to the medical therapies until the primary disease remission period, corroborated in favor of the patient's general recovery time and of the elimination of the oral acute inflammatory process (h). The myelogram after the remission phase of the disease showed normal bone marrow (i and j). In extra- and intraoral features, the patient showed discreet facial asymmetry, discreet chronic gingivitis, and palate mucosae with normal features (l and m). Considering these clinical and histological findings, we dare reinforce that the insertion of a dental practitioner into the hospital transdisciplinary team is crucial to the medical therapy success and to the good quality of health services, in particular, for systemically highly compromised patients. (Source: Gomes et al. [31]) (Image 10).
With advances in genomic (genes), transcriptomic (mRNA), proteomic (proteins), and metabolomic (metabolites) capabilities, an increased interest has emerged in the biologic system to define the complex regulatory networks that result in health or disease [32]. This implies a greater understanding of the data related to the etiopathogenesis of PD. These diseases are a multifactorial, highly complex disease involving some factors as host, environment, and microbiota. However, it is the host inflammatory response which may lead to the soft and hard tissue destruction. In severe diseases, this can lead to tooth loss [33].The host response to the infections draws upon the innate, inflammatory, and adaptive immune systems which provide an appropriate response to the aggressive microorganisms. In some individuals and with some bacteria, this phenomenon will be an innate-only response, others will need to invoke the inflammatory response, and yet others will require the adaptive immune response (cellular, humoral, or both) in order to reduce the microbial activities [33, 34].
Although much of what Page and Schroeder proposed in 1976 has stood the test of time, advances in the fields of basic and periodontal immunology need a reassessment of their work, as well as their integration with emerging new concepts [35]. Major advances have been made regarding the cellular and molecular mechanisms underlying the induction, regulation, and effector functions of immune and inflammatory responses. Likewise, Kornman [36] described a new look of the PD pathogenesis when he reported the specific bacteria and immunoinflammatory mechanisms related to innate differences among individuals and changes in environmental factors. This fact may accelerate or attenuate these biochemical changes [37].
With emerging genomic, proteomic, and metabolomic data and tools of biology systems for interpreting data, it is now possible to start describing the basic elements of a new model of pathogenesis [36]. Stunning new findings have begun to clarify several complexities of the host-pathogen interaction of PD, pointing to key roles for microbial dysboisis and immune imbalance in the pathogenesis of disease [34].
Regarding the genomic knowledge, inflammation, cellular infiltration, and expression of a complex array of cytokines, chemokines, and lipid mediators are key characteristics of PD. In PD, the presence of elevated inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, interferon (IFN)-γ, and IL-12, is considered a central force when coupled with cell activation and RANKL (receptor activator of nuclear factor kappa-Β ligand) activation in driving pathogen elicited bone loss [38, 39]. In addition to pro-inflammatory cytokines, an array of chemokines including IL-8 and monocyte chemotactic protein (MCP)-1 and others are frequently elevated in PD [40]. Some examples of this type of interaction are described in the literature, for example, studies that reported a positive association between polymorphism of the IL-1 and PD [41, 42]. In addition, the presence of antiinflammatory and regulatory cytokines, such as transforming growth factor-beta (TGF-β), IL-10 and IL-4, has been reported [43, 44].
T lymphocyte cells (T cells) are well known as key regulating cells which orchestrate the host immune response. Considering the cells arise from the CD4+ population and are based on cytokine profiling, early studies showed that these cells were segregated into Th1 and Th2 populations. Modern cytokine profiling and transcription factor analysis have led to a much more detailed classification of Th cells and the emergence of the Th17, Treg, TFH, Th9, and Th22 subsets [45, 46]. More advances have been recognized in what concerns the Toll-like receptors (TLRs) and TLR signaling; TIR-domain-containing adapter-inducing interferon-β (TRIF), interferon regulatory factors and type 1 interferon, and other pattern recognition receptors and PD, including scavenger receptors (SRs) and nucleotide-binding-oligomerization-domain (NOD)-like receptors (NLRs) [34].
With a similar importance, the transcriptomics aspects are defined as gene expression profile and when altered may influence the microbiota composition of periodontal pocket, as observed by Papapanou et al. [47]. In the same way, recent studies started to use proteomic techniques, promoting high resolution in the evaluation of proteins and molecular pathways involved in gingival inflammation [48, 49].
The gingival fluid composition of inflamed sites of patients with generalized aggressive periodontitis was evaluated by Bostanci et al. [50], demonstrating the proportion of enzymes associated with neutrophils, metalloproteinase of matrix-8, catepsin G, mieloperoxidase in addition to bacterial, viral, and yeast proteins that were increased in aggressive periodontitis when compared to healthy sites of individuals without periodontitis. Cystatin B and defensins, defense proteins, were detected only in healthy individuals.
Proteins involved in immune response and antimicrobial function, such as α-amylases, calgranulin A, cystatin, C-lysozyme, and cathepsin G were regulated positively in the induction phase of gingivitis. In the resolution phase, several histones and neutrophilic proteins, including cathepsin G, myeloperoxidase, and defensin-1 had their production decreased [49].
Concerning metabolomic aspects, among the earliest host-response molecules found in response to infection are lipid mediators [51]. Resolution of inflammation involves the production of lipid mediators named immunoresolvents and includes the resolvins, protectins, lipoxins, and maresins [51, 52]. Functionally, resolvins limit inflammation in part through prevention of neutrophil penetration, limiting inflammation at the local level, and promote tissue regeneration. The reduction of inflammation, through the use of resolvin-based approaches, may represent a novel strategy to potentially augment PD treatment approaches [53].
New models in the next few years will be merely frameworks for integrating key knowledge as it becomes available from the "Omic" technologies for diagnosis, providing by identifying one or more biomarkers the detection of active disease, predict future progression, and evaluate the response to periodontal therapy, thereby improving clinical management through early diagnosis and intervention, especially in case of patients with SHCN.
As an alternative treatment to obtain the regeneration of the periodontium, the photobiomodulation (PBM) and some bioactive materials may be indicated, once they strongly stimulate the periodontal tissue response, attenuate the inflammatory processes, and/or promote the microstructural reconstruction of the periodontium. However, in the indication of these therapies, PBM must be carefully studied, since it depends exclusively on the general and oral health status of each patient.
Concerning the patients with SHCN associated to immune system deficiency, the PBM, also known as low-level laser therapy (LLLT), has been largely used to promote therapeutic and biostimulating effects, such as analgesia, antiinflammatory action, angiogenesis, and mitogenesis [11]. Gomes et al. [11] assessed the impact of the GaAlAs diode laser on the periodontal tissues and investigated its effects on the alveolar bone remodeling process during orthodontic tooth movement in normoglycemic and diabetic rats. The authors demonstrated that the PMB strongly stimulated the alveolar bone remodeling and favored the continuous reorganization of the soft periodontal tissues, leading to the maintenance and the integrity of periodontal microstructures under orthodontic force, especially in uncontrolled diabetic rats (Figure 5).
Several bioactive materials have been used in the regenerative medicine, especially in patients with complex metabolic and cellular disorders. Among them, we highlighted homogenous demineralized dentin matrix (HDDM), amniotic membrane (AM) used as a biological dressing, and different types of platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). These biomaterials were applied in the craniomaxillofacial complex resulting in tissue regeneration and microstructural reconstruction due to their effective inductive and conductive properties. The HDDM, PRP, and AM in implantation sites may initiate an inductive cascade as chemotaxis of progenitor cells, mitogenesis, angiogenesis, and differentiation into a wide variety of cells. The cell recruitment, division rate, and differentiation of cell lines are under the direct control of several growth factors and stem cells which are found in these biomaterials [54, 55, 56].
In particular, the AM is a huge source for multipotent mesenchymal stem cells (MSCs) with the ability to differentiate into a wide variety of cells, such as chondroblasts, osteoblasts, adipocytes and fibroblasts, myocytes, endothelial cells, neuronal cells, and hepatocytes, leading to formation of cartilage, bone, connective tissue, muscle, blood vessel, nerve, and liver tissue, respectively [56, 57, 58]. This membrane acts as a barrier, preventing the entry of pathogens and toxins, preserving the tissue structures, and, consequently, reducing the levels of local pro-inflammatory cytokines [58, 59]. Thus, it could be largely used to selectively guide the tissue regeneration in the periodontium following destructive PD.
Regarding the second-generation platelet concentrate, the PRF clot forms a strong and dense natural fibrin mesh full of growth factors that can stimulate proliferation of PDL cells and osteoblasts; besides, it favors various cytokine entrapment and preserves the growth factors from proteolysis [60]. This concentrate is characterized by a high content of platelets and leukocytes that release an array of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta 1 (TGF-β1), insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), and the antiinflammatory cytokines [61].
Although the use of autologous platelet concentrates is not new to periodontics, current researches are strongly encouraging the combination of platelet concentrates, such as PRP, PRF, and concentrated growth factors, with bone graft materials, membranes for guided tissue regeneration and MSCs to stimulate the periodontal regeneration. Most likely, this pool has synergistic effects, favoring the environment and the development of desirable periodontal tissues which were seriously compromised by the periodontal disease.
Considering the high susceptibility to PD in people with SHCN, it is important that the dental practitioners know the different levels of disability complexity and how the undesirable environment may impair the human and physical development, leading to temporary or permanent disorders and/or diseases. Among the most common oral diseases, periodontal disease is an inflammatory condition which has been identified as a potential risk factor for systemic diseases. Therefore, it must be continuously controlled by the dentists to maintain the general health status of this individual.
In addition, other treatments for oral rehabilitation may be indicated when the periodontium is healthy, such as orthodontics, dental implants and/or the use of dental prostheses, contributing to the balance of the stomatognathic system, the preservation of the general health, a better quality of life, and, consequently, social inclusion.
In search of alternative therapies for this target public, the photobiomodulation for periodontal tissue biostimulation and the reconstructive surgeries using bioactive materials may be recommended in order to favor the periodontal regeneration, to protect the periodontium under daily actions of physicochemical agents and psychic conditions, and to restore lost periodontal microstructures.
Despite the entire scientific and technological development for people with SHCN, we may presume that the major challenges for health multiprofessionals are to promote the best transdisciplinary practices in oral healthcare on dental services and hospitals due to the high complexity of disabilities, conditions, disorders and diseases of these individuals; to perform people management focusing on the good interpersonal relationship among the health multiprofessionals, patient, family and caregivers; and to combat the several environmental and social factors that may strongly affect the decision-making power of the patient to carry out a satisfactory self-care.
This book chapter was supported by the São Paulo State Secretariat for the Rights of the Person with Disability (SEDPcD) and State of São Paulo Research Foundation (FAPESP; grant number: 2017/06835-8), in Brazil. The authors would like to thank the Associate Professor Sergio Lúcio Pereira de Castro Lopes, the Associate Professor Maria Aparecida Neves Jardini, the Doctor Professor Ana Cristina Solis, and the dentist Mario Augusto Gomes by the technical support and radiographic and clinical assistances.
Authors have no conflict of interests.
|attention-deficit and hyperactivity disorder
|advanced glycation end products
|acquired immune deficiency syndrome
|amniotic membrane
|Acute Lymphoblastic Leukemia
|American Psychiatric Association
|autism spectrum disorder
|Diagnostic and Statistical Manual of Mental Disorders
|glycated hemoglobin
|homogenous demineralized dentin matrix
|human immunodeficiency virus
|insulin-like growth factor
|Joint Advisory Committee for Special Care Dentistry
|low-level laser therapy
|bacterial lipopolysaccharide
|monocyte chemotactic protein-1
|messenger ribonucleic acid
|mesenchymal stem cells
|National Health and Nutrition Examination Survey
|National Institute of Mental Health
|nucleotide-binding-oligomerization-domain (NOD)-like receptors
|periodontal diseases
|platelet-derived growth factor
|periodontal ligament
|platelet-rich fibrin
|platelet-rich plasma
|receptor for advanced glycation end products
|receptor activator of nuclear factor kappa-Β ligand
|special health care needs
|scavenger receptors
|T cells
|T lymphocyte
|T-follicular helper cell
|transforming growth factor
|Th cells
|T helper cells
|T helper cell 1
|T helper cell 17
|T helper cell 2
|T helper cell 22
|T helper cell 9
|Toll-like receptors
|tumor necrosis factor
|tumor necrosis factor-alpha
|regulatory T cell
|TIR-domain-containing adapter-inducing interferon-β
|vascular endothelial growth factor
|World Health Organization
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We started by publishing journals and books from the fields of science we were most familiar with - AI, robotics, manufacturing and operations research. Through our growing network of institutions and authors, we soon expanded into related fields like environmental engineering, nanotechnology, computer science, renewable energy and electrical engineering, Today, we are the world's largest Open Access publisher of scientific research, with over 4,000 books and 54,000 scientific works including peer-reviewed content from more than 116,000 scientists spanning 161 countries. Our authors range from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery.\\n\\n
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We started by publishing journals and books from the fields of science we were most familiar with - AI, robotics, manufacturing and operations research. Through our growing network of institutions and authors, we soon expanded into related fields like environmental engineering, nanotechnology, computer science, renewable energy and electrical engineering, Today, we are the world's largest Open Access publisher of scientific research, with over 4,000 books and 54,000 scientific works including peer-reviewed content from more than 116,000 scientists spanning 161 countries. Our authors range from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery.\n\n
In the same year that IntechOpen was founded, we launched what was at the time the first ever Open Access, peer-reviewed journal in its field: the International Journal of Advanced Robotic Systems (IJARS).\n\n


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Randomness Going Back to 2005
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Photos: Beirut @ The Wiltern Theatre, March 5, 2019
In October 2003, The Wiltern and LG Electronics, a main worldwide purchaser electronics organization, p celebrated the renaming of the theater. At the asphalt level under the tower is the principal theater entrance, which is open arrangement and contains a focal road ticket booth.
Apr 24, 10:19 PM
Three Rooms Press on Post a Band or Event / Find a Band or Event. . . Three Rooms Press presents The Seventh Annual ¡LA DI DADA! A Highly Eclectic Performance Event Hell-Bent on Blowing Minds plus the official West Coast launch of MAINTENANT 13: Journal of Contemporary Dada Writing and Art Saturday, June 8, 2019 | 8:00-11:00 pm Beyond Baroque Literary... Apr 18, 8:49 AM
https://emus4u.run/ on Photos: Tropicália Fest 2018 | Sunday How to install Emus4u Without Jailbreak Apr 17, 12:49 AM
GHDsports apk on Midnight Movies, Sea Wolf @ Hammer Museum, 7/26/07 (Also I Like To Rock) a nice album over a years ago. Apr 15, 2:11 PM
click on Official Coachella Prince-Inclusive Poster (PIP) 2008: Third Time's A Charm? Will you have another Coachella blog this year? Apr 15, 8:07 AM
Jake on Live Review: Car Seat Headrest @ The Wiltern, July 20, 2018 Thanks for your comments! Apr 15, 8:06 AM


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balade à moto
BMW Moto Tour of the Athenian Rivier
BMW Moto Tour of the Athenian Rivier
Duration:8 heures en tout
Languages:Proposée en Anglais
À propos de votre hôte
Originally an Investment Banker started riding at a very early age. Showed great passion for travelling and when the opportunity came, decided for a life changing turn. Have managed to do my passion a job. Have vast riding experience all over Europe, the Americas, Far East and North Africa. Qualified F.I.M Moto Tour Assistant and First Aid certified. Participated in plenty of seminars regarding…
Au programme
Daily guided motorcycle tour that will take you to the scenic Athenian Riviera. We will meet in our offices, get acquainted with you G310GS rental and then start our scenic motorcycle tour. You will see the Panathenaic Stadium, where the first Olympic Games took place in 1896, the Stavros Niarhos Cultural Foundation, the Vouliagmeni Lake Natural Spa Waters, the Temple of Poseidon in Cape Sounion…
Autres informations utiles
This is a tour that will show you the Athenian Riviera. We cruise and enjoy the scenery, the natural beauty and all the sights we will visit. Allow 6-8 hours for the experience.
Ce qui est fourni
The rental of BMW G310GS is included in the price. Min. age 22 yrs and have for a min of 2 years. If not EU then Int. License
Ce qu'il faut apporter
Full motorcycle gear preffered. Our company offers free the use of helmet. Rental of motorcycle gear on demand
balade à moto
Nouvelle expérience
250€ par personne
Nouvelle expérience
250€ par personne


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Featured B&B inns
Hostal San Miguel
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The San Miguel hostel is a family house in Trinidad that is located in a quiet neighborhood. The own..
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Stephen Amell has been teasing for some time that we may finally see the Green Arrow and Supergirl cros each other's path on The CW, and now it looks like it's finally happening.
The "Arrow" star tweeted out an image of himself and "Supergirl" actress Melissa Benoist in costume, standing next to each other atop a very nondescript rooftop... somewhere.
September 28, 2016
While fans have been waiting for some time to finally get the Green Arrow/Supergirl/Flash/Legends of Tomorrow crossover of their dreams, details are still fairly sparse on what exactly is going to happen when it premieres. All we seem to know so far is that Supergirl is the thread that ties the crossover together, and that in the four-night event the group will face "one unifying threat."
With each show premiering next month, we'll have to wait a bit longer to find out any more details, though we can only imagine what Oliver Queen will think when he sees Supergirl in action.
"Arrow" premieres October 5 on The CW; "Supergirl" follows on October 10.


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at 3131 34th St, Lubbock, 79410
"gastropub, n. Brit. A public house which specializes in serving high-quality food." Follow us on twitter @crafthousepub
The goal of the The Crafthouse Gastropub is to provide the community with a unique and creative dining experience by using high quality food, beer, wine, and spirits. This exclusive experience is achieved by our upbeat and efficient staff and the use of fresh local ingredients to create our one of a kind, made from scratch dishes.
5202 FB users likes The Crafthouse Gastropub, set it to 2 position in Likes Rating for Lubbock, Texas in Restaurant category
Cinnamon streusel scone and maple, bacon, cheddar doughnut!
For all you tweeters and instagrammers, we are up and running on all cylinders! So follow us!
Last day for this pizza special! Spicy marinara, rosemary sausage, grass-fed beef, fresh red onion, cheddar, provolone, fontina, Asiago & mozzarella! Come and get it!
Happy Saturday yall! This is the El Chapo! Cimarron tequila, grapefruit juice, lime juice, champagne and red chile lime salt! Come hang out with us!
Get your tickets!
Appetizer special! Grilled calamari steak, chive chimichurri, caviar, confit Yukon gold potatoes.
TGIF YALL! Favorite Combo! If you get the Salisbury Steak, you HAVE to get the Mac N Cheese! It's sinful! Have a fabulous weekend ♡
Crabby today? Come get a soft shell crab sandwich!
It's the perfect day for "Chicken N Dumplins! " Chicken potstickers, lemongrass broth, scallions, seasonal mushrooms and cabbage! Row row row your boat gently down to Crafthouse!
Spicy marinara, rosemary sausage, ground beef, red onions, cheddar, and our four cheese blend.
Spring bean rillete... Favas green peas, olive oil, radish. Served with toast points and mint butter.
Birthday cake doughnut! Cherry pecan w bourbon glaze scone!
Get ready!
Seared salmon w asparagus, creamed spinach, Yukon gold purée, and confit tomatoes! Get your favorites before they are gone!
Chicken and dumplings! Come and get it!
Pizza special! Smoked tomato ragout, jumbo lump crab, rosemary sausage, grilled scallions, toasted pinenuts, chevre, Asiago, provolone, fontina & mozzarella!
Dried apricot and pistachio scone!
Citrus medley doughnut!
Last day to buy tickets for the scotch tasting!
We've got it!
Look at that fresh salad!
Crab fries! Jumbo lump crab, twice fried fries, Crafthouse tartar sauce & Old Bay seasoning!
Come enjoy the Squadra Rosso Tiene Siciliane! $5 off any bottle and $1 off any glass of wine today! See you soon!
Come get happy with 1/2 off an appy! Cornflake crusted, brie cheese sticks with dressed micros, toasted almonds and peach jam!
Pizza special! Gorgonzola cream sauce, grilled leeks, spinach, apple smoked bacon, smoked pork loin, candied pecans, fresh cracked pepper, fontina, provolone, Asiago & mozzarella!
Dogfish Head Siracusa Nera! Delicious Russian imperial stout aged in oak barrels!
Salmon Petite Sale! Get a salad and dessert with it for $20!
Wino Wednesday my friends! $1 off wine by the glass and $5 off the bottle!
Texas beers are $1 off! Come get this local Lubbock brew!
Vegetarian pizza special: red onion cream cheese, arugula, fresh tomatoes, red and yellow peppers, toasted pine nuts, Cojack cheese, mozzarella, and Gorgonzola cheese...add your favorite meat if you're feeling carnivorous! 11a-10p
Cranberry vanilla spritzer to bring in the new year!
New Year's Eve special! Ham steak, braised Texas cabbage, black-eyed peas & laurel butter.
It's happy hour 2p-6p!!! $1 off all drinks and appetizers! Get in here before our drinks change...
Porchetta sandwich and chef salad! Ideal for lunch! Come see us!
PLT! House made pancetta makes for a delicious lunch fix!
Tapped this awesome IPA!
This week's pizza special: Green chile cheese sauce, applewood bacon, baked ham, red onions, red, yellow, & Fresno peppers, co-jack & mozzarella cheese
We are open 11a-10p!!! Our porchetta sandwich is calling your name! Slow roasted herbed pork w cranberry mustard....
Just a reminder to everyone that we will be closed today thru Monday. We will re-open Tuesday, December 27 at 11 AM. See you then!
Last night before our holiday break! Come get your favorites!
We are open today from 11 AM to 10 PM. And tomorrow from 11 AM to 2 PM. We will be closed for the holidays until Tuesday, December 27!!!! Come in today to get your gift cards for Christmas gifts!
Just tapped! From The Plains Brew Co here in our very own Lubbock! Come try this amber!!
Now on tap! It's a Belgian-style witbier brewed with coriander and orange peel and fermented with Pinot Noir juice.
The holidays are all about the ones you love... and the pizza! This weeks special: hatch chili Marinara, pepperoni, ham, caramelized onions, Spanish olives, mozzarella, cheddar, fontina, & asiago cheese.... merry Christmas Pick up your gift cards while you're here too!
Tiramisu doughnut!
We're pumping it out!!! Get it before it's gone! 11a-10p.come CELEBRATE with us!
It's cold outside! But the food in here is warm and filling!!! Don't miss out..we will be closed for the holidays the 23rd through the 26th!
Just tapped two awesome cold weather brews for you!
Pizza special this week is the bomb... Jalapeño garlic butter, shrimp, applewood bacon, roasted tomatoes, red onions, smoked Gouda, cheddar, mozzarella, provolone, reggiano, & fontina
#christmas place your orders this week! We're open Tuesday-Saturday 11a-10p


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Coffee Table, Captivating White Wash Coffee Table Low Price Table Ikea With Wooden Table And Blanket And Sofa And Cushions And Carpet: astonishing white wash coffee table
Published at May 13th, 2017 14:41:42 PM by Inzignee
Labelled as white coffee table with wood top discussion along with white and wood coffee table object along with white washed wood coffee tables discussion, rustic white wash coffee table object plus white coffee tables and end tables topic along with white coffee table ikea topic or Coffee Table, So don't forget to check out the main article in astonishing white wash coffee table
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Helpful (6)
I applied through an employee referral. I interviewed at Compass.
Loved it. My recruiters were great listeners and really helped me develop a path to the best place I could be within the company. I got to meet a team that was really dynamic and enthusiastic about what I could bring to the table. It was really awesome to start working and see that all that was discussed in the interview process was actually true.
Interview Questions
One interview with each member of the team. Usually have to interview with the broker as well. Great company to work for. There's isn't another real estate company this technologically advanced.
Interview Questions
Helpful (5)
I applied online. The process took 4 weeks. I interviewed at Compass (New York, NY) in November 2017.
Phone Screen then a lot of back and forth about next steps and meeting with the team. On site interview took 2.5 hours. Everyone was very smiley and friendly. Rejected 1 day after the interview the night before Thanksgiving.
Interview Questions
Helpful (3)
I applied online. I interviewed at Compass in May 2017.
Phone screen with the Head of People. Video Interview w/ another member of the People Team. Brief phone chat w/ the GM similar to a phone screen + quick intro, nothing too substantive. All straightforward and made me excited to be a part of this team.
Last round was another video interview w/ a member of the exec team based in NYC on a Friday at the end of the day. He was late to joining without any notice. Then joined the video conference, but was having issues with the sound on his computer and became visibly frustrated. He had me stay in the video conference while ran out of the room to grab someone to help. This person also seemed unfamiliar with the video conference software and wasn't really sure what to do. Not the best way to start off, but I hoped for the best and was ready to continue the conversation. His laptop continued to have technical issues with the video and sound cutting out, so he ended up calling me on my mobile which seemed to irritate him even more. There was a surprise "role-playing scenario" that was pretty awkward and the whole conversation by this point was clearly a waste of time. The icing on the cake was when he stopped mid-interview to take a call.
Appreciate the team's willingness to move on an accelerated timeline, but that last video interview was the most unprofessional interview experience I've ever had. Recommend participants in the interview process learn the tools/software used during the process and at least pretend to have some respect for the candidate.
Interview Questions
Helpful (13)
I applied online. The process took 2 days. I interviewed at Compass in January 2016.
I applied online and received an email from the HR recruiter two days later asking for my availability for a phone interview. I submitted my availability and she confirmed my appointment for the next day. We had our phone interview and everything went well. She asked me what I knew about the company and asked me to explain my background in further detail. We had a good rapport and conversation and at the end of the interview she stated that she would like to invite me for the next round of interviews and meet the team for an in person interview. She emailed me the online calendar to put in my availability for the following week and I sent this information back to the recruiter. A couple of days went by and I didn't hear anything back, so I followed up to see if she received my availability and to let me know if there were any issues with the days/times I provided. There was no response back from my follow up email. To this day, I have not heard back from anyone in the company with regards to the interview process. I understand things change and maybe a different decision was made with regards to moving me to the next round of interviews, but I think a courtesy email letting me know that I will no longer be moving forward in the interview process wouldn't be too difficult, considering that she did verbally, and in email, invite me to next round. That really left a poor impression on me as a potential candidate and if this is an indicator on how they treat their employees, then I guess I should consider myself lucky that the company ghosted on me.
Interview Questions
Helpful (8)
The process took 2 weeks. I interviewed at Compass.
Had two phone screenings, both went well. The types of questions you see in Cracking the Coding Interview but in JS. I was brought in for on-site interviews which included 5 interviews with a lunch in between.
The questions weren't too difficult I thought I answered them pretty good. I noticed there wasn't much diversity among their engineers and the engineers and recruiter did not engage much throughout the on-site interviews. I definitely did not feel welcome. They are no doubt smart people and the technology is great too, but from a people standpoint it wasn't the best.
Interview Questions
Helpful (16)
I applied through a recruiter. The process took 3 days. I interviewed at Compass (New York, NY) in January 2016.
Standard technical interview process - a bunch of somewhat arbitrary algorithmic problems to whiteboard and discuss. Nothing exceptionally tricky. The main issue was with the people -- half of the folks were relatively normal, but the others lacked basic social skills. There was also a air of unearned arrogance about the team that was slightly off-putting, with the exception of one of the early founders, who seemed more seasoned and less insecure about his own background.
Interview Questions
Helpful (3)
I applied through a recruiter. I interviewed at Compass (New York, NY).
Recruiter reached out after finding my information online.
Spoke with her and we agreed to do 2 phone interviews then onsite.
They reached out early in my job search, so I kept postponing but they were OK with that.
Each phone interview started with a couple behavioral questions like 'why Compass?' + 'what are you looking for? - then went into medium difficulty questions. The interviewers have been with Compass for years.
Then the onsite was also with senior people/management and they asked quite difficult questions. They seemed very smart to me and I found our discussions went well, which was a big factor in me accepting the offer.
One thing I'd change: my interviewers were often quite late (which is being improved). And they could have answered my questions for them better.
Interview Questions
Helpful (4)
I applied through a recruiter. The process took 2 weeks. I interviewed at Compass (New York, NY) in June 2018.
One recruiter interview, 2 phone screens, 4 rounds onsite. Recruiter was very prompt, as fast as 10 minutes after my phone screens. Onsite was poorly managed with manager and staff reporting late and me having to wait in the waiting room for 20+ mins. Interviewers were nice though
Interview Questions
Helpful (1)
I applied online. I interviewed at Compass in October 2018.
* Applied online and got a call from HR in 10 days.
HR was good to talk with during first call but over next few conversations she replied passive aggressively. One instance was, She sent me a calendar invite to select a time slot for interview, which I did. But later she says that I am should not provide her just one time slot because company cannot work according to my timetable. So she said provide multiple time slots. Fair enough but I DONT REMEMBER ANY INSTRUCTIONS SAYING TO SELECT MULTIPLE TIME SLOTS. It said "Provide a time slot". Anyway interview was scheduled.
* There were two rounds of interviews 1. Java interview 2. Javascript Interview
* During second round of interview (Javascript interview) the interviewer's English accent was so bad that 3/4 of time went in asking "Could you please repeat the question ? "
* After all this there was no update/follow up from the company. I emailed the same HR after waiting for two weeks. The HR says " Sorry for delay, We want to interview you for front end role and not full stack. That being said we want to interview you again for Javascript"
This was unexpected and unacceptable.
You cannot be playing with candidates time and make them wait for two weeks only to tell them which position they want to interview.
It was like company was confused and so kept candidate in dark
Interview Questions
Helpful (3)
I applied through a recruiter. The process took 4+ weeks. I interviewed at Compass (New York, NY) in January 2019.
Basically what everyone else has said until now. I feel so bad writing this. The recruiters are super nice. Most of the people you meet are nice. But then the few rotten apples are so bad that it really leaves you with a bad taste. I would have given it a higher rating, but they just do not have checks and balances in place.
For starters, the sheer volume of interviews is bad. It just shows that the company does not care about your time. 2 phone screens 1 hr each and a 5 hr on site interview is uncalled for. Really. Almost every candidate has complained about them having arrogant self proclaimed :superstars: on the team, but they do nothing to add accountability to the process. There are many ways this can be avoided. Have a group panel interview or interview in pairs to add accountability. Or reduce the number of rounds if you cannot stop renegade interviewers who seek validation from their position. You are tarnishing your own brand doing this.
This interview is extremely humiliating and bad. One interviewer actually said to me "i should not be telling you this". Sure I was not able to answer your esoteric question on dynamic programming in the moment. Happens. Dont have to show this superiority and arrogance just because you applied before me.
A lot can be done here. Send a project to ppl to implement. And check the project. many tech companies are doing that. Why give ammunition to problematic folks that you cannot control?
An advice to everyone, they dont value your time. Dont waste it talking to arrogant ppl
Interview Questions
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TEAC Tascam Series Model DX-8 Noise Reduction System
Condition: Used
Pictures: See Pictures for Condition of This Lot
Buying terms: Sold as is!
Our whole website is secured with SSL
We ship 2 times a week (wed, Fri)
Returns accepted if it is not as described, and not stated as parts or repair.
TEAC Tascam Series Model DX-8 Noise Reduction System
Power test: Yes
Line test: No
Working condition: Unknown
Weight (kg): 7.885
Dimensions (cm): 49x26x19
Paypal accepted.
Bank transfer accepted
We ship worldwide.