title: Shoulder problem

text: The rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint.


title: Shoulder problem

text: Four filmy sac-like structures called bursa permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.


title: Shoulder problem

text: The shoulder joint is the most frequently dislocated major joint of the body. In a typical case of a dislocated shoulder, a strong force that pulls the shoulder outward (abduction) or extreme rotation of the joint pops the ball of the humerus out of the shoulder socket. Dislocation commonly occurs when there is a backward pull on the arm that either catches the muscles unprepared to resist or overwhelms the muscles. When a shoulder dislocates frequently, the condition is referred to as shoulder instability. A partial dislocation where the upper arm bone is partially in and partially out of the socket is called a subluxation. In the medical community, dislocation is commonly referred to as luxation.


title: Shoulder problem

text: Almost all shoulder dislocations are downwards (inferior) and of these, 95 percent are in a forward direction. Clinically this is referred to as an anterior dislocation of the glenohumeral joint. Not only does the arm appear out of position when the shoulder dislocates, but the dislocation also produces pain. Muscle spasms may increase the intensity of pain. Swelling and bruising normally develop, and in some cases there may be numbness and muscle weakness. Problems seen with a dislocated shoulder are tearing of the ligaments or tendons reinforcing the joint capsule and, less commonly, nerve damage. Doctors usually diagnose a dislocation by a physical examination, but X-rays are taken to confirm the diagnosis and to rule out a related fracture and other complications. X-rays are also taken after relocation to ensure it is in the correct place.


title: Shoulder problem

text: Doctors treat a dislocation by putting the head of the humerus back into the joint socket (glenoid fossa) of the scapula—a procedure called manipulation and reduction. This is usually followed up with an X-ray to make sure the reduction did not fracture the surrounding bones. The arm is then immobilized in a sling or a device called a shoulder immobilizer for several days. Usually the doctor recommends resting the shoulder and applying ice three or four times a day. After pain and swelling have been controlled, the patient enters a rehabilitation program that includes exercises to restore the range of motion of the shoulder and strengthen the muscles to prevent future dislocations. These exercises may progress from simple motion to the use of weights.


title: Shoulder problem

text: After treatment and recovery, a previously dislocated shoulder may remain more susceptible to reinjury, especially in young, active individuals. Ligaments are stretched and may tear due to dislocation. Torn ligaments and other problems resulting from dislocation can increase the chance of repeated dislocation. A shoulder that dislocates severely or often, injuring surrounding tissues or nerves, usually requires surgery to repair the damaged parts of the shoulder.


title: Shoulder problem

text: Sometimes the doctor performs surgery through a tiny incision into which a small scope (arthroscope) is inserted to observe the inside of the joint. After this procedure, called arthroscopic surgery, the shoulder is generally restrained by a sling for three to six weeks, while full recovery, including physical therapy, takes several months. Arthroscopic techniques involving the shoulder are relatively new and many surgeons prefer to repair a recurrent dislocating shoulder by the time-tested open surgery under direct vision. There are usually fewer repeat dislocations and improved movement following open surgery, but it may take a little longer to regain motion.


title: Shoulder problem

text: A shoulder separation occurs where the collarbone (clavicle) meets the shoulder blade (scapula). When ligaments that hold the AC (acromioclavicular) joint together are partially or completely torn, the outer end of the clavicle may slip out of place, preventing it from properly meeting the scapula. Most often the injury is caused by a blow to the shoulder or by falling on an outstretched hand. After injury it is hard to do a 180 degrees rotation.


title: Shoulder problem

text: Shoulder pain or tenderness and, occasionally, a bump in the middle of the top of the shoulder (over the AC joint) are signs that a separation may have occurred. Sometimes the severity of a separation can be detected by taking X-rays while the patient holds a light weight that pulls on the muscles, making a separation more pronounced.


title: Shoulder problem

text: A shoulder separation is usually treated conservatively by rest and wearing a sling. Soon after injury, an ice bag may be applied to relieve pain and swelling. After a period of rest, a therapist helps the patient perform exercises that put the shoulder through its range of motion. Most shoulder separations heal within two or three months without further intervention. However, if ligaments are severely torn, surgical repair may be required to hold the clavicle in place. A doctor may wait to see if conservative treatment works before deciding whether surgery is required.


title: Shoulder problem

text: While not directly a shoulder problem, this may affect shoulder functionality due to problems with sternoclavicular rotation. A sternoclavicular separation occurs when the sternum separates from the clavicle at the sternoclavicular joint. Sternoclavicular separations (dislocation and subluxation) are rare and generally caused by accident. If the clavicle is separated posteriorly (i.e. the clavicle separates and goes behind the sternum) the situation can be dangerous and the clavicle can cause damage to interior arteries, veins or organs.


title: Shoulder problem

text: Treatment consists of the standard use of plenty of rest, icing, NSAIDs and a sling. The joint may need to be reduced (i.e. put back in place), especially after posterior separations. In severe cases, surgery may be advised.


title: Shoulder problem

text: The "rotator cuff" is a group of four tendons that blend together as they attach to the upper end of the arm bone (humerus). These tendons transmit the force of muscles originating on the shoulder blade (scapula) to the arm providing rotational motion and centering or stability of the joint.


title: Shoulder problem

text: The rotator cuff tendons degenerate with age. A group of respected scientists wrote in a review of existing evidence that, the theory that this degeneration is related to pinching (or impingement) between the head of the humerus and the acromion is now considered inaccurate. Rotator cuff pathology is similar in non-dominant compared to dominant and symptomatic compared to asymptomatic shoulder. About two-thirds of all humans develop rotator cuff tendinopathy if they live to 70 years of age. The pathology is mucoid degeneration, not inflammation. The process can involve the intra-articular part of the long head of biceps in addition to the supraspinatus, infraspinatus, and subscapularis tendons.


title: Shoulder problem

text: Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion. Squeezing of the rotator cuff is called impingement syndrome.


title: Shoulder problem

text: An inflamed bursa is called bursitis. Tendinitis and impingement syndrome are often accompanied by inflammation of the bursa sacs that protect the shoulder. Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendinitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement.


title: Shoulder problem

text: The degree to which a tendon is reparable depends on its quantity and quality. Degenerated tendons are often frail and retracted and may not be amenable to repair. Individuals that are elderly, smokers, or those having had cortisone injections often have weaker tendon tissue that fails without a significant injury. By contrast those whose tendon was torn by a substantial fall often have good quality tendon that can be repaired if surgery is performed promptly after the injury.


title: Shoulder problem

text: Repair of a rotator cuff requires that the tendon be securely anchored to the bone at surgery and that the repair be protected for several months during healing.


title: Shoulder problem

text: Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm and/or difficulty sleeping on the shoulder, similar condition can have sharp pain or discomfort when the upper shoulder is positioned at certain angles. Tendinitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is forcefully pushed upward overhead.


title: Shoulder problem

text: Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. X-rays do not show tendons or the bursae but may be helpful in ruling out bony abnormalities or arthritis. The doctor may remove and test fluid from the inflamed area to rule out infection.


title: Shoulder problem

text: Ultrasound scans are frequently used to confirm a suspected tendinitis or bursitis as well as rule out a tear in the rotator cuff muscles.


title: Shoulder problem

text: Impingement syndrome may be confirmed when injection of a small amount of anesthetic (lidocaine hydrochloride) into the space under the acromion relieves pain.


title: Shoulder problem

text: Anti-inflammatory medicines such as aspirin, naproxen or ibuprofen among others can be taken to help with pain. In some cases the physical therapist will use ultrasound and electrical stimulation, as well as manipulation. Gentle stretching and strengthening exercises are added gradually. If there is no improvement, the doctor may inject a corticosteroid medicine into the space under the acromion. However, recent level one evidence showed limited efficacy of corticosteroid injections for pain relief. While steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture. If there is still no improvement after six to 12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae.


title: Shoulder problem

text: In those with calcific tendinitis of the shoulder high energy extracorporeal shock-wave therapy can be useful. It is not useful in other types of tendonitis.


title: Shoulder problem

text: For a rotator cuff tear, tentative evidence suggests exercise may reduce pain in the short-term. Combination of exercise and joint mobilization can result in long term benefits. Other evidence demonstrates the use of corticosteroids injections to be more effective.


title: Shoulder problem

text: A SLAP (superior labrum anterior to posterior) tear occurs when the cartilage of the shoulder (labrum) delaminates from glenoid. This causes an instability of the shoulder, typically in overhead movements.


title: Shoulder problem

text: Symptoms include a dull ache deep in the shoulder joint, trouble sleeping due to the instability and discomfort, and extreme weakness in overhead activities.


title: Shoulder problem

text: Very few cases recover to complete mobility without surgical intervention. Some patients are able to strengthen their shoulders to limit the day to day dull ache, but with limited mobility and function. Surgery reattaches the labrum to the glenoid through the use of surgical anchors.


title: Shoulder problem

text: Recovery is often a lengthy process. The first four or so weeks the patient is required to wear a sling. Following this, there is a month of physical therapy to regain range of motion. At two months limited strength training occurs. At six months the patient is typically released to full active use, although many patients find that full recovery takes longer than this.


title: Shoulder problem

text: As the name implies, movement of the shoulder is severely restricted in people with a "frozen shoulder". This condition, which doctors call adhesive capsulitis, is frequently caused by injury that leads to lack of use due to pain. Rheumatic disease progression and recent shoulder surgery can also cause frozen shoulder. Intermittent periods of use may cause inflammation. Adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move. It is this restricted space between the capsule and ball of the humerus that distinguishes adhesive capsulitis from a less complicated painful, stiff shoulder. People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or who have been in an accident, are at a higher risk for frozen shoulder. The condition rarely appears in people under the age of 40.


title: Shoulder problem

text: A bone fracture of the shoulder involves a partial or total crack through one of the three bones in the shoulder, the clavicle, the scapula, and the humerus. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder. Fractures usually involve the clavicle or the neck (area below the ball) of the humerus. Fractures of the scapula sometimes occur through the coracoid process.


title: Shoulder problem

text: A shoulder fracture that occurs after a major injury is usually accompanied by severe pain. Within a short time, there may be redness and bruising around the area. Sometimes a fracture is obvious because the bones appear out of position.


title: Shoulder problem

text: (However this occur in non-involved dislocations and separations.) Both diagnosis and severity can be confirmed by X-rays.


title: Shoulder problem

text: When a fracture occurs, the doctor tries to bring the bones into a position that will promote healing and restore arm movement. If the clavicle is fractured, the patient must at first wear a strap and sling around the chest to keep the clavicle in place. After removing the strap and sling, the doctor will prescribe exercises to strengthen the shoulder and restore movement. Surgery is occasionally needed for certain clavicle fractures, especially for disunions.


title: Shoulder problem

text: Fracture of the neck of the humerus is usually treated with a sling or shoulder immobilizer. If the bones are out of position, surgery may be necessary to reset them. Exercises are also part of restoring shoulder strength and motion.


title: Shoulder problem

text: In arthritis of the shoulder, the cartilage of the ball and socket (glenohumeral joint) is lost so that bone rubs on bone.


title: Shoulder problem

text: It may be caused by wear and tear (degenerative joint disease), injury (traumatic arthritis), surgery (secondary degenerative joint disease), inflammation (rheumatoid arthritis) or infection (septic arthritis).


title: Shoulder problem

text: Arthritis of the shoulder causes pain and loss of motion and use of the shoulder. X-rays of the shoulder show loss of the normal space between the ball and socket. X-ray can provide radiographic staging of shoulder osteoarthritis.


title: Shoulder problem

text: Early on arthritis of the shoulder can be managed with mild analgesics and gentle exercises. Known gentle exercises include warm water therapy pool exercises that are provided by a trained and licensed physical therapist; approved land exercises to assure free movement of the arthritic area; cortisone injections (administered at the minimum of every six months according to orthopedic physicians) to reduce inflammation; ice and hot moist pact application are very effective. Moist heat is preferred over ice whereas ice is preferred if inflammation occurs during the daytime hours. Local analgesics along with ice or moist heat are adequate treatments for acute pain.


title: Shoulder problem

text: In the case of rheumatoid arthritis, specific medications selected by a rheumatologist may offer substantial relief.


title: Shoulder problem

text: When exercise and medication are no longer effective, shoulder replacement surgery for arthritis may be considered. In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. Passive shoulder exercises (where someone else moves the arm to rotate the shoulder joint) are started soon after surgery. Patients begin exercising on their own about three to six weeks after surgery. Eventually, stretching and strengthening exercises become a major part of the rehabilitation programme. The success of the operation often depends on the condition of rotator cuff muscles prior to surgery and the degree to which the patient follows the exercise programme.


title: Shoulder problem

text: In young and active patients a partial shoulder replacement with a non-prosthetic glenoid arthroplasty may also be a consideration


title: Shoulder problem

text: The acromioclavicular articulation consists of the acromioclavicular ligament and a small disk of cartilage located in between the acromion and the clavicle. This disk can wear down through injury, extreme joint stress (via bodybuilding) or normal wear.


title: Shoulder problem

text: Pain is perceived on shoulder motion, especially on certain movements. Often a crossover arm test is utilized in diagnosis because this compresses the AC joint, exacerbating the symptoms. X-rays of the shoulder joint may show either arthritic changes of the ac joint or osteolysis.


title: Shoulder problem

text: Conservative treatment for this joint is similar to treatments for other types of arthritis, including restricting activity, anti-inflammatory medications (or supplements), physical therapy, and occasionally cortisone shots. If the pain is severe, surgery may be an option. The most common surgical treatment, known as resection arthroplasty, involves cutting a very small portion off the clavicle end and letting scar tissue fill in its place. Some portions of the acromioclavicular ligament may still remain attached.


title: Shoulder problem

text: A mnemonic for the basic treatment principles of any musculoskeletal problems is PRICE: Protection, Rest, Ice, Compression, and Elevation:


title: Shoulder problem

text: According to the American Academy of Orthopaedic Surgeons (AAOS) visits to orthopedic specialists for shoulder pain has been rising since 1998 and in 2005 over 13 million patients sought medical care for shoulder pain, of which only 34 percent were related to injury.


title: Shoulder problem

text: "This article contains and extends text from the public domain document "Questions and Answers about Shoulder Problems", NIH Publication No. 01-4865, available from URL http://www.niams.nih.gov/hi/topics/shoulderprobs/shoulderqa.htm "


title: Scott Helvenston

text: Stephen "Scott" Helvenston (June 21, 1965 – March 31, 2004) was a United States Navy SEAL. He was working as a security contractor for Blackwater Security when he was killed in the 31 March 2004 Fallujah ambush within days of arriving in Iraq.


title: Scott Helvenston

text: Helvenston was a personal trainer for Hollywood celebrities such as Demi Moore (for "G.I. Jane"), and was also featured in the reality shows "Combat Missions" and "Man vs. Beast" (in the latter, he completed an obstacle course faster than a chimpanzee). He also starred in a reality series called "Extreme Expeditions: Model Behavior" months before he left for Iraq. The series was shot in Mexico and was finished, but never aired.


title: Scott Helvenston

text: Helveston joined the Navy at 17 and received orders to Basic Underwater Demolition/SEAL training (BUD/S) at Naval Amphibious Base Coronado. He became the youngest person to complete Navy SEAL training. He graduated with BUD/S class 122 in 1983 and then attended Basic Airborne School at Fort Benning, Georgia. Following SEAL Tactical Training (STT) and completion of six month probationary period, he received the Navy Enlisted Classification (NEC) 5326 as a Combatant Swimmer (SEAL), entitled to wear the Special Warfare insignia. He spent 12 years in the Navy SEALs until he left in 1994 as an E-6 (Quartermaster First Class).


title: Scott Helvenston

text: Helvenston began training at Blackwater USA's facilities in March 2004, and developed a personal conflict with head trainer Justin "Shrek" McQuown. Helvenston arrived in Kuwait on March 18, where he was under the management of John and Kathy Potter, whom he knew from "Combat Missions".


title: Scott Helvenston

text: Employee John Potter had helped Blackwater Security (since renamed "Academi") win the contract to provide security for kitchen equipment convoys for the Kuwait company Regency Hotel and Hospital Company and Eurest Support Services (ESS was a subcontractor of Halliburton KBR). The contract billed Regency $815 a day; Helvenston and the other contractors were paid $600 a day.


title: Scott Helvenston

text: The original contract called for at least three men per vehicle on security missions "with a minimum of two armored vehicles to support ESS movements". In addition, the contract called for a heavily armed rear gunner, and time before any mission to review the route and conduct a risk assessment and pre-trip inspection.


title: Scott Helvenston

text: Blackwater signed a revised contract with Regency on March 12, 2004 that removed the word "armored". Potter insisted that his men be given armored vehicles, however, and was removed as project manager on March 24, replaced by Justin McQuown.


title: Scott Helvenston

text: On March 27, two days before Helvenston's scheduled deployment to Iraq, McQuown reassigned him to a team leaving on the 28th, over the objections of numerous other Blackwater employees. Helvenston believed McQuown resented him and deliberately reassigned Helvenston at the last minute. In one of Helvenston's final emails before his death, he wrote to the owner of Blackwater, claiming McQuown's behavior was "very manipulative, duplicitive [sic], immature and unprofessional," with the hidden agenda "Lets [sic] see if we can screw with Scott."


title: Scott Helvenston

text: On March 30, McQuown sent Helvenston out with three other contractors, Jerry Zovko, Wesley Batalona and Michael Teague, to guard a convoy for ESS traveling from Baghdad to a military base west of Fallujah. They were in two unarmored vehicles and had no map.


title: Scott Helvenston

text: Along with squad members Jerry "Jerko" Zovko, Wesley Batalona and Michael Teague, Helvenston was transporting food and other equipment in unarmored vehicles to the center of the city of Fallujah when the team was ambushed by insurgents. The four contractors were killed with grenades and small arms fire. Their bodies were dragged from their vehicles, beaten and set ablaze. Their burned and mutilated corpses were then dragged through the streets, and two of them hung from a bridge crossing the Euphrates.


title: Scott Helvenston

text: The families of the four dead contractors, led by Helvenston's mother Katy Helvenston-Wettengel and Jerry Zovko's mother Donna Zovko, filed suit against Blackwater with lawyer Daniel Callahan on January 5, 2005 ("Helvenston et al. v. Blackwater Security"), alleging wrongful death. Blackwater responded by counter-suing for $10 million.


title: Scott Helvenston

text: In January 2011, both cases were thrown out of court by a federal judge. Counsel for the plaintiffs announced they would appeal the ruling.


title: Westmoreland County, Pennsylvania

text: Westmoreland County is a county in the Commonwealth of Pennsylvania. As of the 2020 census, the population was 364,663. The county seat is Greensburg. Formed from, successively, Lancaster, Northumberland, and later Bedford counties, Westmoreland County was founded on February 26, 1773, and was the first county in the colony of Pennsylvania whose entire territorial boundary was located west of the Allegheny Mountains. Westmoreland County originally included the present-day counties of Fayette, Washington, Greene, and parts of Beaver, Allegheny, Indiana, and Armstrong counties. It is named after Westmorland, a historic county of England.


title: Westmoreland County, Pennsylvania

text: Formed from Lancaster, Northumberland, and later Bedford counties, Westmoreland County was founded on February 26, 1773, and was the first county in the Pennsylvania colony whose entire territorial boundary was located west of the Allegheny Mountains. Westmoreland County originally included the present-day counties of Fayette, Washington, Greene, and parts of Beaver, Allegheny, Indiana, and Armstrong counties. It is named after Westmorland, a historic county of England.


title: Westmoreland County, Pennsylvania

text: According to the U.S. Census Bureau, the county has a total area of , of which is land and (0.8%) is water. Westmoreland has a humid continental climate ("Dfa"/"Dfb"). Average monthly temperatures in Greensburg range from 28.7 °F in January to 71.8 °F in July, while in Murrysville they range from 29.4 °F in January to 73.1 °F in July, in Latrobe they range from 28.9 °F in January to 72.0 °F in July, and in Ligonier they range from 28.1 °F in January to 71.1 °F in July.


title: Westmoreland County, Pennsylvania

text: At the 2010 census, there were 365,169 people, 153,650 households and 101,928 families residing in the county. The population density was 355.4 per square mile (137.2/km). There were 168,199 housing units at an average density of 163.7 per square mile (63.2/km). The racial makeup of the county was 95.3% White, 2.3% Black or African American, 0.1% Native American, 0.7% Asian, 0.03% Pacific Islander, 0.2% from other races, and 1.2% from two or more races. 0.9% of the population were Hispanic or Latino of any race.


title: Westmoreland County, Pennsylvania

text: There were 153,650 households, of which 24.5% had children under the age of 18 living with them, 52.2% were married couples living together, 10.0% had a female householder with no husband present, and 33.7% were non-families. 29.0% of all households were made up of individuals, and 13.3% had someone living alone who was 65 years of age or older. The average household size was 2.32, and the average family size was 2.86.


title: Westmoreland County, Pennsylvania

text: 22.3% of the population were under 18, 5.1% from 18 to 24, 22.4% from 25 to 44, 31.3% from 45 to 64, and 18.9% who were 65 years of age or older. The median age was 45.1 years. For every 100 females, there were 94.8 males. For every 100 females age 18 and over, there were 92.3 males.


title: Westmoreland County, Pennsylvania

text: The Democratic Party historically dominated county-level politics between the New Deal realignment and the turn of the century; however, Westmoreland has trended Republican at the national and statewide levels in the 21st century (in direct lockstep with most other Appalachian counties). In 2000, Republican George W. Bush became the first Republican to carry the county since 1972, and Republicans have carried the county in every election since, increasing the margin of victory in every successive election until 2020. Democratic Governor Ed Rendell lost Westmoreland in both 2002 and 2006. In 2008, Republican Tim Krieger picked up the 57th House district left open by the retirement of Democratic state representative Tom Tangretti. In 2010, both Pat Toomey and Tom Corbett won Westmoreland in their statewide bids. Also, the GOP gained control of two more State House districts, the 54th with Eli Evankovich and the 56th with George Dunbar. In 2011, the Republican Party swept all county row offices. A Democratic resurgence in 2015 gave that party a majority of the county commissioners. However, in the 2019 elections, Democratic elected officials lost that majority and carried only one row office.


title: Westmoreland County, Pennsylvania

text: Coal mining became a major industry in the county after the Civil War, followed by expansion of manufacturing of iron, steel and glass. The 600-acre coke works for the Isabella Furnace were built in Cokeville (then Coketown) in Spring of 1872. At one point, company "coal patches" (towns built for miners) represented about one-third of the county's settlements. A major strike by coal miners represented by the United Mine Workers of America took place in 1910–1911. Sixteen people were killed in the strike.


title: Westmoreland County, Pennsylvania

text: In 2020 the top industries in the county were health care and social services (16.3% of jobs), manufacturing (13.8%) and retail trade (13.7%). Mining comprised less than 1% of the jobs in the county. Westmoreland County is now believed to be the site of over 100 abandoned mines.


title: Westmoreland County, Pennsylvania

text: Volkswagen's Westmoreland plant near New Stanton in Westmoreland County was the first foreign-owned factory mass-producing automobiles in the U.S. It operated from 1978 to 1988.


title: Westmoreland County, Pennsylvania

text: Under Pennsylvania law, there are four types of incorporated municipalities: cities, boroughs, townships, and, in at most two cases, towns. The following cities, boroughs and townships are located in Westmoreland County:


title: Westmoreland County, Pennsylvania

text: Census-designated places are geographical areas designated by the U.S. Census Bureau for the purposes of compiling demographic data. They are not actual jurisdictions under Pennsylvania law. Other unincorporated communities, such as villages, may be listed here as well.


title: Park Joo-mi

text: Park made her entertainment debut as an Asiana Airlines model, then began acting in 1991, starring in television dramas such as "Beautiful Seoul" (1999) and "Feels Good" (2000). After appearing in "Ladies of the Palace", Park married businessman Lee Jang-won in 2001 and temporarily retired from acting to focus on her family (she gave birth to her sons in 2002 and 2007). During this time, Park intermittently appeared in commercials and co-hosted the variety show "Yeo Yoo Man Man" from 2003 to 2005. After a nine-year absence, she made her screen comeback in the thriller "Man of Vendetta" (2010) and the family drama "Believe in Love" (2011). In 2012, Park had been playing Queen Seondeok in the period drama "The King's Dream" for 18 episodes (of a projected 70), when a car accident on the way to the set resulted in internal injuries, and she had to drop out of the series to undergo medical treatment. Upon her recovery, Park returned to television in 2014 with "The Story of Kang-goo".


title: The Fork, the Witch, and the Worm

text: The Fork, the Witch, and the Worm is the first book in the "Tales from Alagaësia" series by Christopher Paolini. It was published on December 31, 2018. Set in the world of "The Inheritance Cycle" a year after the events of "Inheritance", it consists of three short stories, the second of which was penned by Paolini's sister, Angela.


title: The Fork, the Witch, and the Worm

text: "The Fork, the Witch, and the Worm" includes new characters and some already encountered in the original series, and tells of the many challenges Eragon and Saphira face as they establish the Dragon Riders in their new home far to the east of Alagaësia.


title: The Fork, the Witch, and the Worm

text: Eragon struggles to keep up with the mundane administrative work required by his new role as leader of the Dragon Riders. Saphira convinces him to take a break and visit the Eldunarí, who show him a vision of Murtagh in Ceunon. In it, a disguised Murtagh meets in a tavern with a group of mercenaries, whom he had hired to search for a legendary dragon-scorched battlefield. The mercenaries show evidence of having found it, but refuse to tell him the location, attempting to extort him for more money. A fight ensues, and Murtagh is unable to directly subdue them with magic, even using the name of the ancient language, due to amulets given to them by a witch called Bachel. Nonetheless, Murtagh evades their wards by enchanting a fork as a weapon. Victorious, Murtagh leaves to join Thorn and continue his search.


title: The Fork, the Witch, and the Worm

text: The witch Angela, traveling with Elva, unexpectedly arrives at the Riders’ mountain. She has Eragon read a number of out-of-order chapters of a memoir she is writing, whose strange contents hint that she has the ability to travel to worlds beyond Alagaësia. When Eragon asks if the memoir is true, she answers ambiguously.


title: The Fork, the Witch, and the Worm

text: Eragon is disheartened when he fails to save two dwarves from a tunnel cave-in. An Urgal bard tells him the ancient tale of Vêrmund, the Worm of Kulkaras, a wild dragon who feasts on an Urgal clan and its livestock and then settles in a nearby mountain. When its best warriors fail to kill Vêrmund, the clan learns to adapt, hiding in tunnels and leaving livestock for the slumbering dragon when he wakes. Ilgra, a girl whose father was killed by Vêrmund, is filled with the desire for revenge and studies magic as a shaman's apprentice. She plans a trap to kill the dragon with a flood of water, believing that the water could extinguish his flame.


title: The Fork, the Witch, and the Worm

text: When a pair of Lethrblaka attack the clan, threatening to devour it completely, Ilgra wakes Vêrmund to fight them. The Lethrblaka evade his fire and pierce his scales with their beaks, gaining the advantage. Ilgra lures the three combatants into her trap and releases the flood, but it merely results in victory for Vêrmund, who returns to his mountain to heal. Ilgra then accepts her inability to kill the dragon and plans to live a more ordinary life among her clan.


title: The Fork, the Witch, and the Worm

text: A review in "The Oberlin Review" encourages fans of "The Inheritance Cycle" to read "The Fork, the Witch, and the Worm" but cautions "if that’s not you, I would definitely advise that you pass".


title: The Fork, the Witch, and the Worm

text: A "Kirkus Reviews" review of "The Fork, the Witch, and the Worm" concludes that while the book is "not likely to lure in any new fans, Paolini’s readers will likely enjoy revisiting the characters and world".


title: 2022–23 CAF Champions League

text: The 2022–23 CAF Champions League (officially the 2022–23 TotalEnergies CAF Champions League for sponsorship purposes) is the 59th season of Africa's premier club football tournament organized by the Confederation of African Football (CAF) and the 27th edition under the current CAF Champions League title.


title: 2022–23 CAF Champions League

text: Unlike the last three seasons, the final of this edition will be played in a two-legged format as per the decision of CAF at the executive committee meeting on July 3 at Rabat, arising from a formal complaint made by Al Ahly to CAF over the choice of Stade Mohammed V in Casablanca as the venue for the 2022 final: despite the intention that the final be played at a neutral venue, the 2022 tournament culminated with the stadium being the home venue of their opponent, Wydad AC.


title: 2022–23 CAF Champions League

text: The winners of the 2022–23 CAF Champions League will automatically qualify for the 2023–24 CAF Champions League and earn the right to play against the winners of the 2022–23 CAF Confederation Cup in the 2023 CAF Super Cup.


title: 2022–23 CAF Champions League

text: Wydad AC are the defending champions after beating Al Ahly in the 2022 final to claim their third title and first since 2017.


title: 2022–23 CAF Champions League

text: All 54 CAF member associations are expected to enter their league champions into this season of the CAF Champions League, with the 12 highest ranked associations according to their CAF 5-Year Ranking eligible to enter two teams in this season. As a result, theoretically a maximum of 68 teams could enter the tournament – although this level has never been reached.


title: 2022–23 CAF Champions League

text: For this season of the tournament, CAF will the use the 2018–2022 CAF 5-Year Ranking, which calculates points for each entrant association based on their clubs’ performance over those 5 years in CAF club competitions. The criteria for points are as follows:


title: 2022–23 CAF Champions League

text: "Associations are shown according to their 2018–2022 CAF 5-Year Ranking – those with a ranking score have their rank and score (in parentheses) indicated."


title: 2022–23 CAF Champions League

text: The official competition schedule was released on 24 June 2022 on their website to prepare the qualified teams for the upcoming season.<ref name="Dates/Schedule"></ref>


title: Lotto Sport Italia

text: Lotto Sport Italia is an Italian sports equipment manufacturer based in Trevignano, near Treviso. The company manufactures and commercialises sporting and casual clothing and footwear (including sneakers, and football boots). Its clothing line includes T-shirts, jackets, shorts, and leggings and goalkeeper gloves.


title: Lotto Sport Italia

text: Lotto was established in 1939 by the Caberlotto family (who were the owners of the football team F.C. Treviso) in Montebelluna, northern Italy, the world centre of footwear manufacturing. In June 1973, Lotto made its debut as a sports footwear manufacturer. Tennis shoes signaled the beginning of production, followed by models for basketball, volleyball, athletics and football.


title: Lotto Sport Italia

text: Sports clothing was the company's next venture. In the first ten years, Lotto focused on the Italian market. During its first decade, corporate strategy concentrated on making tennis footwear and clothing, and early on sponsored big names from the professional tennis circuit (Martina Navratilova, Boris Becker, Thomas Muster, Andrea Gaudenzi).


title: Lotto Sport Italia

text: In the 1980s, Lotto moved on to broaden its business base by competing among the then-small group of manufacturers of football boots and clothing. Lotto began to create its first football boot models and signed major collaboration agreements with internationally renowned players and teams. Tennis players John Newcombe, Andrés Gómez and José Luis Clerc wore the brand's tennis products.


title: Lotto Sport Italia

text: The first sponsorship agreements in football were signed with players (Dino Zoff and Ruud Gullit) and teams, such as Milan (1993–98), the Dutch national team, Napoli (1994–97), Juventus (2000–03), Chievo and Spanish club Real Zaragoza. Professional footballers provided input in both the design and fine-tuning of the products. This involvement together with the athletes' public images helped make the company a leader in tennis and football. During this same period, Lotto expanded into the export market, and its international business grew rapidly. Ten years later, the brand was being distributed in more than 60 countries around the world.


title: Lotto Sport Italia

text: In June 1999, the company was taken over a group of local business people who were already very active in the sports area. It was headed by Andrea Tomat, who took on the role of President and CEO of the new company. The company was renamed "Lotto Sport Italia" and its new owners focused on the brand’s strengths of dynamism, innovation, quality, Italian design, passion and an extremely effective customer service program.


title: Lotto Sport Italia

text: Today, Lotto distributes its products in more than 70 countries through independent sports stores, specialty chain stores and large stores with sports departments; the brand used on wristwatches is "Lotto Time". The company is pushing the development of corner and flagship stores, which are now widespread in Italy and in other countries.


title: Lotto Sport Italia

text: Lotto distributes its products in over 110 different countries through independent sports article stores, specialized chain-stores and large stores with specialized sports departments. Special emphasis is placed on monobrand stores (flagship stores, street stores, factory outlets) as well as corners and shop-in-shops.


title: Lotto Sport Italia

text: Sponsorships are an important part of Lotto’s business. In addition to its latest agreement with USPTA and its technical partnerships with the ATP, WTA Tour and Wimbledon, Lotto is visible at all Grand Slam tournaments and championship series and has been a part of the Italian Open for more than 30 years. More than 120 professional players now wear the “double diamond” logo, including the No. 1-ranked women’s doubles team of Virginia Ruano Pascual and Paola Suarez.


title: Calouste Gulbenkian

text: Calouste Sarkis Gulbenkian (, Western ; 23 March 1869 – 20 July 1955), nicknamed "Mr Five Per Cent", was a British-Armenian businessman and philanthropist. He played a major role in making the petroleum reserves of the Middle East available to Western development and is credited with being the first person to exploit Iraqi oil. Gulbenkian travelled extensively and lived in a number of cities including Istanbul, London, Paris and Lisbon.


title: Calouste Gulbenkian

text: Throughout his life, Gulbenkian was involved with many philanthropic activities including the establishment of schools, hospitals, and churches. The Calouste Gulbenkian Foundation, a private foundation based in Portugal, was created in 1956 by his bequest and continues to promote arts, charity, education, and science throughout the world. It is now among the largest foundations in Europe. By the end of his life he had become one of the world's wealthiest people and his art acquisitions one of the greatest private collections.


title: Calouste Gulbenkian

text: Gulbenkian's family are believed to be descendants of the Rshtunis, an Armenian noble family centred around Lake Van in the 4th century AD. In the 11th century, the Rshtunis settled in Kayseri, taking the name Vart Badrik, a Byzantine noble title. With the arrival of the Ottoman Turks, the Turkish equivalent of the name, Gülbenk, was adopted. The family had established themselves in the town of Talas and lived in the region until the mid-1800s, when they ultimately moved to Istanbul. Their property in Talas was ultimately confiscated and is currently owned by the Turkish Government.


title: Calouste Gulbenkian

text: Gulbenkian's family established close relations with the House of Osman. By 1860, his father Sarkis Gulbenkian was an Armenian oil importer and exporter already heavily involved in the oil industry. Sarkis was an owner of several oil fields in the Caucasus, mainly in Baku, and was a representative of Alexander Mantashev's oil company. Sarkis Gulbenkian also provided oil to the Sultan of the Ottoman Empire. During Hagop Pasha's Directorship, and, subsequently, Ministry of the Privy Treasury under Sultan Abdulhamid II in 1879, Sarkis acquired the lucrative collection of taxes for the Privy Purse of Mesopotamia.


title: Calouste Gulbenkian

text: Calouste Sarkis Gulbenkian was born on 23 March 1869 in Scutari (Üsküdar), in the Ottoman Empire capital Constantinople (now Istanbul). He received his early education at Aramyan-Uncuyan, a local Armenian school. He then attended the Lycée Saint-Joseph French school and continued his studies at Robert College. These studies were cut short in 1884, when he moved to Marseilles at the age of 15 to perfect his French at a high school there.


title: Calouste Gulbenkian

text: Immediately afterwards his father sent him to be educated at King's College London, where he studied petroleum engineering. He was a brilliant student and graduated in 1887 at the age of 18 with a first-class degree in engineering and applied sciences. A year later, he went to Baku to examine the Russian oil industry and to further his knowledge of the oil industry.


title: Calouste Gulbenkian

text: Gulbenkian later wrote an article entitled "La Transcaucasie et la péninsule d'Apchéron; souvenirs de voyage" ("Transcaucasia and the Absheron Peninsula – Memoirs of a Journey") which appeared in the "Revue des deux Mondes", a French language monthly literary and cultural affairs magazine. The article described his travels to Baku and the state of the oil industry in the region. It was eventually published as a book in 1891 in Paris.


title: Calouste Gulbenkian

text: After Hagop Pasha's appointment as the Ottoman Minister of Finance in 1887, he had Calouste prepare an oil survey of Mesopotamia. To develop the oil survey, Calouste merely read travel books and interviewed railroad engineers that were surveying and building the Baghdad Railway. Gulbenkian's oil survey led Hagop Pasha to believe that vast oil deposits lay in Mesopotamia (modern Syria and Iraq), to acquire tracts of land for the Sultan's oil reserves, and to establish the Ottoman oil industry in Mesopotamia.


title: Calouste Gulbenkian

text: By 1895, he started his oil operation business. He had to return to the Ottoman Empire, but in 1896, Gulbenkian and his family fled the empire due to the Hamidian massacres of Armenians. They ended up in Egypt, where Gulbenkian met Alexander Mantashev, a prominent Armenian oil magnate and philanthropist. Mantashev introduced Gulbenkian to influential contacts in Cairo. These new acquaintances included Evelyn Baring, 1st Earl of Cromer. Still in his twenties, Gulbenkian moved to London in 1897 where he arranged deals in the oil business. He became a naturalised British citizen in 1902. In 1907, he helped arrange the merger of Royal Dutch Petroleum Company with "Shell" Transport and Trading Company Ltd. Gulbenkian emerged as a major shareholder of the newly formed company, Royal Dutch Shell. His policy of retaining five per cent of the shares of the oil companies he developed earned him the nickname "Mr Five Per Cent".


title: Calouste Gulbenkian

text: After the royalist countercoup of 1909, Gulbenkian became a financial and economic adviser to the Turkish embassies in London and Paris, and later, chief financial adviser to the Turkish government. He was a member of a British technical team to Turkey and, later, a director of the National Bank of Turkey, which was established to support British designs.


title: Calouste Gulbenkian

text: In 1912 Gulbenkian was the driving force behind the creation of the Turkish Petroleum Company (TPC)—a consortium of the largest European oil companies aimed at cooperatively procuring oil exploration and development rights in the Ottoman territory of Mesopotamia, while excluding other interests. The German interests would be limited to a 25% share, with a 35% share for the British, and the remaining for Gulbenkian to choose. So, he gave Royal Dutch Shell 25% and kept 15% for himself as "the conceiver, the founder, and the artisan of the Turkish Petroleum combine." A promise of these rights was made to the TPC, but the onset of World War I interrupted their efforts. At first, the British Foreign Office supported the d'Arcy group to gain a share and replace Calouste's share, but Gulbenkian worked closely with French concerns, arranged for the French to receive the German's share as part of the spoils of victory, and, in return, the French protected his interest.


title: Calouste Gulbenkian

text: During the dismantling of the Ottoman Empire after the war, most of Ottoman Syria came under the French Mandate for Syria and the Lebanon and most of Ottoman Iraq came under British mandate. Heated and prolonged negotiations ensued regarding which companies could invest in the Turkish Petroleum Company. The TPC was granted exclusive oil exploration rights to Mesopotamia in 1925. The discovery of a large oil reserve at Baba Gurgur provided the impetus to conclude negotiations and in July 1928 an agreement, called the "Red Line Agreement", was signed which determined which oil companies could invest in TPC and reserved 5% of the shares for Gulbenkian. The name of the company was changed to the Iraq Petroleum Company in 1929. The Pasha had actually given Gulbenkian the entire Iraqi oil concession. Gulbenkian, however, saw advantage in divesting the vast majority of his concession so that corporations would be able to develop the whole. Gulbenkian grew wealthy on the remainder. He reputedly said, "Better a small piece of a big pie, than a big piece of a small one."


title: Calouste Gulbenkian

text: In 1938, before the beginning of World War II, Gulbenkian incorporated a Panamanian company to hold his assets in the oil industry. From this "Participations and Explorations Corporation" came the "Partex Oil and Gas (Holdings) Corporation", now a subsidiary of the Calouste Gulbenkian Foundation headquartered in Lisbon.


title: Calouste Gulbenkian

text: Gulbenkian amassed a huge fortune and an art collection which he kept in a private museum at his Paris house. An art expert said in a 1950 issue of "Life" magazine that "Never in modern history has one man owned so much." His four-story, three-basement house on Avenue d'Iéna was said to be crammed with art, a situation ameliorated in 1936 when he lent thirty paintings to the National Gallery, London and his Egyptian sculpture to the British Museum.


title: Calouste Gulbenkian

text: Throughout his lifetime, Gulbenkian managed to collect over 6,400 pieces of art. From René Lalique alone, Gulbenkian commissioned more than 140 works over nearly 30 years. The collection includes objects from antiquity to the 20th century. Some of the works in the collection were bought during the Soviet sale of Hermitage paintings.


title: Calouste Gulbenkian

text: While Gulbenkian's art collection may be found in many museum across the world, most of his art is exhibited at the Museu Calouste Gulbenkian in Lisbon, Portugal. The museum was founded according to his will, to accommodate and display his collection, now belonging to the Calouste Gulbenkian Foundation. Of the roughly 6,000 items in the museum's collections, a selection of around 1000 is on permanent display.


title: Calouste Gulbenkian

text: Throughout his life, Gulbenkian donated large sums of money to churches, scholarships, schools, and hospitals. Many of his donations were to Armenian foundations and establishments. He required that proceeds from his 5% share of profits from oil should go to Armenian families. He also demanded that 5% of his workers in his oil production for the Iraq Petroleum Company should be of Armenian descent.


title: Calouste Gulbenkian

text: He established and built the St Sarkis Armenian church in Kensington, central London, England, built in 1922–23 as a memorial to his parents, to the design of the architect Arthur Davis. Gulbenkian wanted to provide "spiritual comfort" to the Armenian community and a place of gathering for "dispersed Armenians," according to a message written by Gulbenkian to the Catholicos of All Armenians.


title: Calouste Gulbenkian

text: In 1929, he was the chief benefactor to the establishment of an extensive library at the St. James Cathedral, the principal church of the Armenian Patriarchate of Jerusalem. The library is called the Gulbenkian Library and contains more than 100,000 books.


title: Calouste Gulbenkian

text: Among many of his significant donations was to the Surp Pırgiç Armenian Hospital located in Istanbul. A large property called the "Selamet Han" was donated to the Surp Pırgiç foundation in 1954. The property was confiscated by the state in 1974, but returned to the foundation in 2011. He also helped establish a nurses' home at the hospital after selling his wife's jewellery.


title: Calouste Gulbenkian

text: He was president of the Armenian General Benevolent Union (AGBU) from 1930 to 1932, resigning as a result of a smear campaign by "Soviet Armenia", an Armenian newspaper based in Armenia SSR. He was also a major benefactor of Nubarashen and Nor Kesaria, which were newly founded settlements consisting of refugees from the Armenian genocide.


title: Calouste Gulbenkian

text: In 1937, Gulbenkian purchased a property near Deauville and called it "Les Enclos". It was a place of repose for him. Nobel prize-winning writer and friend Saint-John Perse nicknamed him the "Sage of Les Enclos" and remarked in a letter to Gulbenkian that Les Enclos was "the cornerstone of your work, because it is the most alive, the most intimate and sensitive, the best guarded secret for your dreams."


title: Calouste Gulbenkian

text: By the onset of the Second World War, having acquired diplomatic immunity as the economic adviser of the Persian legation in Paris, he followed the French government when it fled to Vichy, where he became the minister for Iran. In consequence, he was, despite his links to the UK, temporarily declared an enemy alien by the British Government, and his UK oil assets sequestered, though returned with compensation at the end of the war. He left France in late 1942 for Lisbon and lived there until his death, in a suite at the luxurious Aviz Hotel, on 20 July 1955, aged 86.


title: Calouste Gulbenkian

text: In 1952 he refused being appointed as Knight Commander, and therefore the possibility of being styled as "Sir", to the Order of the British Empire. In this same year his wife Nevarte died in Paris. They had two children, a son Nubar and a daughter Rita, who would become the wife of Iranian diplomat of Armenian descent Kevork Loris Essayan.


title: Calouste Gulbenkian

text: At the time of his death, Gulbenkian's fortune was estimated at between US$280 million and US$840 million. Undisclosed sums were willed in trust to his descendants; the remainder of his fortune and art collection were willed to the Calouste Gulbenkian Foundation ("Fundação Calouste Gulbenkian"), with US$400,000 to be reserved to restore the Etchmiadzin Cathedral, Armenia's mother church, when relations with the Soviet Union permitted.


title: Calouste Gulbenkian

text: The foundation was to act for charitable, educational, artistic, and scientific purposes, and the named trustees were his long-time friend Baron Radcliffe of Werneth, Lisbon attorney José de Azeredo Perdigão (1896-1993), and his son-in-law, Kevork Loris Essayan (1897-1981). In Lisbon the foundation established its headquarters and the Calouste Gulbenkian Museum ("Museu Calouste Gulbenkian") to display his art collection.


title: Calouste Gulbenkian

text: William Saroyan wrote a short story about Gulbenkian in his 1971 book, "Letters from 74 rue Taitbout or Don't Go But If You Must Say Hello To Everybody".


title: Calouste Gulbenkian

text: There are rooms and buildings at the University of Oxford named after Gulbenkian, including the Gulbenkian Reading Room in St Antony's College, Oxford's old library and the Gulbenkian Lecture Theater in the St Cross Building on Manor Road.


title: Calouste Gulbenkian

text: For detailed background concerning Gulbenkian and the Red Line Agreement controlling Middle East Oil see


title: Parkland Memorial Hospital

text: Parkland Memorial Hospital is a public hospital in Dallas, Texas, United States. It is the main hospital of the Parkland Health & Hospital System and serves as Dallas County's public hospital. It is located within the Southwestern Medical District. The hospital is staffed by the faculty, residents, and medical students of UT Southwestern Medical Center.


title: Parkland Memorial Hospital

text: The original hospital opened on May 19, 1894, in a wooden building on a meadow located at Oak Lawn Avenue and Maple. The name Parkland came from the land on which the hospital was built, originally purchased by the city as a park. A brick building (the first hospital brick building erected in Texas, now owned by Crow Holdings) replaced the wooden facility in 1913.


title: Parkland Memorial Hospital

text: On August 20, 2015, Parkland opened a new emergency department and began accepting patients. Staff members and patients were transferred throughout the next few days, from 5201 Harry Hines Boulevard to the new hospital located across the street at 5200 Harry Hines Boulevard. The new hospital welcomed its first birth, a boy delivered by Caesarean section, that same morning.


title: Parkland Memorial Hospital

text: Parkland Hospital is best known as the hospital where five individuals associated with the assassination of United States President John F. Kennedy either died or were pronounced dead: President Kennedy himself, his assassin Lee Harvey Oswald, Jack Ruby who later killed Oswald, Abraham Zapruder, who had filmed Kennedy's assassination, and Jean Hill, another witness to the assassination (the "Lady in Red" seen in the Zapruder film). The 2013 film "Parkland" dramatizes the deaths of Kennedy and Oswald in the hospital.


title: Parkland Memorial Hospital

text: After he was shot on November 22, 1963, President Kennedy was rushed to Parkland, where he was pronounced dead at 1:00 p.m. in Trauma Room 1, 30 minutes after he was shot at Dealey Plaza. At the same time, Texas governor John Connally, wounded in the same shooting, was treated in Trauma Room 2, and survived. Two days after the assassination, November 24, Oswald was rushed to Parkland after being shot in the abdomen by Ruby and died in operating room #5 after over 90 minutes of surgery. Ruby died on January 3, 1967, in the same emergency department, from a pulmonary embolism associated with lung cancer. Then, on August 30, 1970, Zapruder also died at Parkland.


title: Parkland Memorial Hospital

text: Since Ruby's death in 1967, areas where Kennedy was pronounced dead and Oswald was operated on have been remodeled. A plaque there marks the location where Trauma Room 1 was previously in the prior Parkland. Parkland's JFK history wall is noted at the new hospital.


title: Parkland Memorial Hospital

text: Parkland has been recognized as one of the nation's Most Wired™ Hospitals for excellence in using technology to fill gaps in care, provide services 24 hours a day, 7 days a week, and expand access to medical specialists. The hospital received this recognition 2014–2017.


title: Parkland Memorial Hospital

text: Parkland was awarded The Joint Commission's Gold Seal of Approval® and the American Heart Association/American Stroke Association's Heart-Check mark in 2017 for Advanced Certification for Comprehensive Stroke Centers.


title: Parkland Memorial Hospital

text: In 2017, Parkland Health & Hospital System was recognized as a Top Performer in LGBT Healthcare Equality by the Human Rights Campaign (HRC) Foundation, the educational arm of the country's largest lesbian, gay, bisexual and transgender (LGBT) civil rights organization. Parkland earned top marks in meeting non-discrimination and training criteria that demonstrate its commitment to equitable, inclusive care for LGBT patients and their families.


title: Parkland Memorial Hospital

text: In May 2017, Fred Cerise, MD, MPH, president and CEO of Parkland Health & Hospital System was appointed by the U.S. Comptroller General to the Medicaid and CHIP Payment and Access Commission (MACPAC). As a member of the commission, Dr. Cerise serves as a national advisor to Congress on issues affecting Medicaid and CHIP.


title: Parkland Memorial Hospital

text: In 2016, the staff of Parkland's Rees-Jones Trauma Center began an initiative to teach classes to the community members so that they can learn how to recognize life-threatening bleeding and administer appropriate medical treatment before professional rescuers arrive. Parkland "Stop the Bleed" classes have been adapted from courses including the U.S. Military's Tactical combat Casualty Care Guidelines and the Prehospital trauma Life Support (PHTLS) course and a part of a large, United States Government effort to make "Stop the Bleed" training the CPR of the 21st century.


title: Parkland Memorial Hospital

text: The staff of Parkland Memorial Hospital's Emergency Department and Rees-Jones Trauma Center received the 2016 Texas Preparedness Leadership Award for "Outstanding Service in Response to the 2016 Dallas Police Shootings." The award was presented at the 2016 Preparedness Coalition Symposium held Oct. 12–14 in Galveston.


title: Parkland Memorial Hospital

text: Parkland is the Dallas County public hospital; funds are primarily provided by a specially designated property tax on Dallas County residents.


title: Parkland Memorial Hospital

text: Parkland serves as one of Dallas's four Level I Trauma Centers (alongside Baylor University Medical Center, Methodist Dallas Medical Center, Children's Medical Center), a primary care center for Dallas County residents, and (along with UT Southwestern) as a medical and surgical referral center for North Texas and parts of Southern Oklahoma. Thus, virtually all medical and surgical subspecialties are represented—which makes Parkland a destination for post-graduate medical training. The Parkland Burn Center, one of the largest civilian burn units in the U.S., is famous for the Parkland Formula for fluid resuscitation, developed by Charles R. Baxter in the 1960s. The fame of the Parkland formula is due to its being one of the first treatments for burn that included rehydration and electrolytic management.


title: Parkland Memorial Hospital

text: Parkland ranks among the largest teaching hospitals in the nation. Texas Woman's University began its Bachelor of Science nursing program at Parkland in 1954 and it is still located within walking distance of the Parkland campus. Parkland also serves as the major teaching hospital of the adjacent University of Texas Southwestern Medical Center.


title: Parkland Memorial Hospital

text: It has the distinction of delivering more infants under one roof than any other hospital in the nation, averaging 15–16,000 deliveries per year. Parkland Memorial has eleven prenatal clinics and employs 72 doctors training to become obstetricians-gynecologists and 45 nurse-midwives. In 2005, the staff delivered 15,590 babies, an average of more than 42 infants per day. Parkland created one of the first high-risk antenatal units in the nation and had the first neonatal intensive care unit in North Texas.


title: Parkland Memorial Hospital

text: Parkland has approximately 240,000 emergency visits a year, for the co-located main emergency department (153,915 visits in 2013), and the urgent care unit (60,013 visits in 2013).


title: Parkland Memorial Hospital

text: Parkland is also the base for Biotel, the medical direction system used by Dallas Fire-Rescue as well as fourteen other emergency medical service agencies in the Metroplex.


title: Parkland Memorial Hospital

text: Parkland's high volume of patients led to the decision by the Dallas County Commissioners Court to propose replacing the overcrowded, 50+-year-old building with a new , 17-story, 862-bed facility, along with a new outpatient center, a office facility, and parking for 6,000 cars. The total cost would be $1.27 billion, to be paid for through three avenues: 1) a $747 million bond proposition (contingent on voter approval, which was obtained in November 2008), 2) $350 million of cash from current and future operations, and 3) $150 million from private donations.


title: Parkland Memorial Hospital

text: The board approved nearly $100 million in contracts and hired two architectural firms – HDR, Inc. (based in Omaha, Nebraska, but operates a large practice in Dallas) and Corgan Associates Inc. (based in Dallas) – to design the new building. (A parking garage was completed as a design/build project by Whiting-Turner Construction and the architecture firm of Omniplan in January 2012.) One major feature of the new facility is that movements of staff and supplies are handled in separate corridors and elevators from those used by patients and visitors.


title: Parkland Memorial Hospital

text: The formal groundbreaking ceremony was held in October 2010; the facility was officially dedicated in March 2015, with all patients and staff officially occupying the facility that August. The new facility is immediately across Harry Hines Boulevard from the former hospital complex, and is served by the Southwestern Medical District/Parkland station of DART light rail, which opened in December 2010.


title: Parkland Memorial Hospital

text: In May, 2014, a new 44,300-square-foot, Parkland Health & Hospital System-affiliated outpatient clinic near Fair Park began construction on a 7-acre site adjacent to DART's Hatcher Station. The $19.8 million clinic, which was designed by BOKA Powell for Frazier Revitalization Inc. and Parkland Health & Hospital System, serves geriatric and behavioral health patients, along with adults, women, children, and infants. It also provides on-site diagnostic imaging and lab services. Exam rooms feature flexible equipment setups, and an on-site conference facility accommodates education and wellness programs. The clinic, officially named Hatcher Station Health Center, opened on May 19, 2015.


title: Solanum dulcamara

text: Solanum dulcamara is a species of vine in the genus "Solanum" (which also includes the potato and the tomato) of the family Solanaceae. Common names include bittersweet, bittersweet nightshade, bitter nightshade, blue bindweed, Amara Dulcis, climbing nightshade, felonwort, fellenwort, felonwood, poisonberry, poisonflower, scarlet berry, snakeberry, trailing bittersweet, trailing nightshade, violet bloom, and woody nightshade.


title: Solanum dulcamara

text: "Solanum dulcamara" is a very woody herbaceous perennial vine, which scrambles over other plants, capable of reaching a height of 4 m where suitable support is available, but more often 1–2 m high. The leaves are 4–12 cm long, roughly arrowhead-shaped, and often lobed at the base. The flowers are in loose clusters of 3–20, 1–1.5 cm across, star-shaped, with five purple petals and yellow stamens and style pointing forward. The fruit is an ovoid red berry about 1 cm long, soft and juicy, with the aspect and odour of a tiny tomato, and edible for some birds, which disperse the seeds widely. However, the berry is poisonous to humans and livestock, and the berry's attractive and familiar look make it dangerous for children.


title: Solanum dulcamara

text: It is native to northern Africa, Europe, and Asia, but has spread throughout the world. The plant is relatively important in the diet of some species of birds such as European thrushes, which feed on its fruits, being immune to its poisons, and scatter the seeds abroad. It grows in all types of terrain with a preference for wetlands and the understory of riparian forests. Along with other climbers, it creates a dark and impenetrable shelter for varied animals. The plant grows well in dark areas in places where it can receive the light of morning or afternoon. An area receiving bright light for many hours reduces their development. It grows more easily in rich wet soils with plenty of nitrogen. When grown for medicinal purposes, it is best grown in a dry, exposed environment.


title: Solanum dulcamara

text: "Solanum dulcamara" has been valued by herbalists since ancient Greek times. In the Middle Ages the plant was thought to be effective against witchcraft, and was sometimes hung around the neck of cattle to protect them from the "evil eye".


title: Solanum dulcamara

text: John Gerard's "Herball" (1597) states that "the juice is good for those that have fallen from high places, and have been thereby bruised or beaten, for it is thought to dissolve blood congealed or cluttered anywhere in the intrals and to heale the hurt places."


title: Solanum dulcamara

text: This plant is one of the less poisonous members of the Solanaceae. Instances of poisoning in humans are very rare on account of the fruit's intensely bitter taste. Incidentally, the fruit has been reported to have a sweet aftertaste, hence the vernacular name "bittersweet".


title: Solanum dulcamara

text: The poison in this species is believed to be solanine. The alkaloids, solanine (from unripe fruits), solasodine (from flowers) and beta-solamarine (from roots) have been found to inhibit the growth of "E. coli" and "S. aureus".


title: Solanum dulcamara

text: Solanine and solasodine extracted from "Solanum dulcamara" showed antidermatophytic activity against "Chrysosporium indicum", "Trichophyton mentagrophytes" and "T. simil", thus it may cure ringworm.


title: Solanum dulcamara

text: The stems are approved by the German Commission E for external use as supportive therapy in chronic eczema.


title: Solanum dulcamara

text: "Solanum dulcamara" has a variety of documented medicinal uses, all of which are advised to be approached with proper caution as the entirety of the plant is considered to be poisonous. Always seek advice from a professional before using a plant medicinally. There have only been records of medicinal use for adults (not children) and it is possible to be allergic to "Solanum dulcamara;" medicinal use is not advised in these cases.


title: Solanum dulcamara

text: The stem of "Solanum dulcamara" is believed to be considerably less poisonous than the rest of the plant, and it has mostly been used in treatment for conditions of the skin. There are records of it being used to treat mild recurrent eczema, psoriasis, scabies, and dermatomycosis. Stems are harvested when they do not yet have leaves (or the leaves have already fallen) and are shredded into small pieces. They are mostly known to be applied in the form of liquid onto the skin, but infusing it into a drink is also possible, though not recommended. The stem has also been used in treatment for bronchitis, asthma, and pneumonia.


title: Solanum dulcamara

text: The leaves of "Solanum dulcamara" have been known to treat warts and tumors, while the fruit can treat conditions of the respiratory tract and joints. It has been documented that Indigenous people of North America used the roots for relief of fever and nausea.


title: Solanum dulcamara

text: "Solanum dulcamara" has been symbolized with fidelity. This is due to its distinct property of extreme bitterness to surprising sweetness, hence its common name "bittersweet." This symbolism is seen in Christian art from the Middle Ages as well as in bridal wreaths.


title: Solanum dulcamara

text: Bittersweet exists on a balance between sweet and bitter, medicine and poison, life and death; lending it to be a common metaphor. Shakespeare has been known to employ this metaphor in dramas such as "Macbeth and" "The Winter's Tale."


title: Solanum dulcamara

text: Perhaps this parallelism has been used more directly by Italian composer Gaetano Donizetti in his opera "L'Elisir d'Amore (Love Elixir"). Here, a Dr. Dulcamara sells the protagonist, Nemorino, a love elixir at the cost of his fortune. However, this "love elixir" is actually just cheap red wine. Under the illusion of a love elixir (and drunkenness), Nemorino, is confident to profess his love to an indifferent woman, Adina. Upon independently learning of Nemorino's fidelity by spending his fortune, Adina subsequently falls in love as well. Dr. Dulcamara has bitterly sold a fake elixir that had turned out to have sweet consequences anyway. This happy unexpectedness is at the heart of "Solanum dulcamara".


title: Peter R. Orszag

text: Peter Richard Orszag (born December 16, 1968) is the CEO of Financial Advisory at Lazard. Before June 2019, he was the firm's Head of North American M&A and Global Co-Head of Healthcare.


title: Peter R. Orszag

text: Orszag previously served as a Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group at Citigroup. Before joining Citigroup, he was a Distinguished Visiting Fellow


title: Peter R. Orszag

text: at the Council on Foreign Relations and a contributing columnist for the "New York Times" op-ed page. Prior to that, he was the 37th Director of the Office of Management and Budget (OMB) under President Barack Obama and had also served as the Director of the Congressional Budget Office (CBO).


title: Peter R. Orszag

text: Orszag is a member of the National Academy of Medicine of the National Academies of Sciences. He serves on the Boards of Directors of the Peterson Institute for International Economics, the Mount Sinai Hospital, and New Visions for Public Schools in New York.


title: Peter R. Orszag

text: Orszag grew up in Lexington, Massachusetts, the son of Reba ("née" Karp) and Steven Orszag. His paternal great-grandparents were Jewish immigrants from Hungary who immigrated to New York City in 1903. His father, Steven Orszag, was a math professor at Yale University and his mother was the president and owner of a research and development company. His brother is Jonathan Orszag, the Senior Managing Director of Compass Lexecon, LLC.


title: Peter R. Orszag

text: After graduating from Phillips Exeter Academy with high honors (1987), Orszag earned an A.B. summa cum laude in economics from Princeton University in 1991 after completing an 80-page long senior thesis titled "Congressional Oversight of the Federal Reserve: Empirical and Theoretical Perspectives." He then received a M.Sc. (1992) and a Ph.D. (1997) in economics from the London School of Economics. His doctoral thesis was titled Dynamic analysis of regime shifts under uncertainty: Applications to hyperinflation and privatization. He was a Marshall Scholar 1991–1992, and is a member of Phi Beta Kappa.


title: Peter R. Orszag

text: Orszag became a lecturer at the University of California, Berkeley, and taught macroeconomics in 1999 and 2000. As a senior fellow and Deputy Director of Economic Studies at the Brookings Institution, he co-founded and directed The Hamilton Project and (in conjunction with Georgetown University's Public Policy Institute) the Pew Charitable Trust's Retirement Security Project.


title: Peter R. Orszag

text: He served as Special Assistant to the President for Economic Policy (1997–1998), and as Senior Economist and Senior Adviser on the Council of Economic Advisers (1995–1996) during the Clinton administration. He also formed a consulting group called Sebago Associates, which merged into Competition Policy Associates and was bought by FTI Consulting Inc. for a reported $70 million.


title: Peter R. Orszag

text: After leaving the Obama administration, Orszag took a job with Citigroup. A 2011 article in New York Magazine suggested Citi's hiring of Orszag "signaled that Citi would be invested in the intellectual marketplace," and that "just about anyone will take the call of a former White House budget director." In May 2016, Orszag joined Lazard as managing director and vice chairman of investment banking.


title: Peter R. Orszag

text: Orszag was director of the Congressional Budget Office from January 2007 to November 2008. During his tenure, he repeatedly drew attention to the role rising health care expenditures are likely to play in the government's long-term fiscal problems—and, by extension, the nation's long-term economic problems. "I have not viewed CBO's job as just to passively evaluate what Congress proposes, but rather to be an analytical resource. And part of that is to highlight things that are true and that people may not want to hear, including that we need to address health-care costs." During his time at the CBO, he added 20 full-time health analysts (bringing the total number to 50), thereby strengthening the CBO's analytical capabilities and preparing Congress for health-care reform.


title: Peter R. Orszag

text: He was widely praised for his time at CBO for preparing the agency for the debates to come. When he stepped down, "National Journal noted that "Orszag, who will turn 40 on Dec. 16, has been praised by lawmakers from both parties as an objective analyst with deep knowledge of the most pressing fiscal issues of the day, including health care policy, Social Security, pensions, and global climate change. He is the unusual economist who blends an understanding of politics, policy and communications in ways that wrap zesty quotes around complex ideas."


title: Peter R. Orszag

text: On November 25, 2008, President-elect Barack Obama announced that Orszag would be his nominee for director of the Office of Management and Budget, the arm of the White House responsible for crafting the federal budget and overseeing the effectiveness of federal programs.


title: Peter R. Orszag

text: Orszag, in a November 2009 speech in New York, said that deficits, which were expected to add $9 trillion to the existing national debt of $12 trillion over the next decade, are "serious and ultimately unsustainable." He said that deficit spending was necessary to help boost the economy when unemployment is hovering around 10 percent. But he said that red ink must be stopped as the economy recovers. During a recovery, private investment will again pick up and compete with the federal government for capital. In 2011, he was described by New York Magazine as a "deficit hawk and clashed with Larry Summers, who wasn’t as focused on the long-term debt crisis."


title: Peter R. Orszag

text: In July 2010 Orszag said that "The problem now is weak growth and high unemployment rather than outright economic collapse". Still, the deficit would be equivalent to 10 percent of the gross domestic product, the highest level since World War II. The Office of Management and Budget's mid-session review, forecast a smaller deficit and stronger economic growth than the administration's initial budget release. The deficit forecast in 2011 increased to $1.42 trillion, up from the $1.27 estimate in February. For 2012, the deficit estimate rose to $922 billion, up from $828 billion in the previous report. The annual budget shortfall would bottom out in 2017 at $721 billion, or 3.4 percent of GDP, and begin rising again in following years.


title: Peter R. Orszag

text: A review of Orszag's daily schedules shows his sustained focus on healthcare reform as soon as he joined Obama's Cabinet. The daily schedules for Orszag, who left his position as OMB director in July 2010, reveal that he and key White House aides regularly met to discuss healthcare starting in January 2009, within days of Obama entering office. Orszag also had meetings with insurance executives and health experts as the White House made health reform its top legislative priority after enacting the $814 billion stimulus from the American Recovery and Reinvestment Act of 2009.


title: Peter R. Orszag

text: When Orszag resigned, the Progressive Policy Institute summed up his time in office: "For an administration numbers-cruncher, he was unusually visible, which was a good thing. With a reputation for impartiality and brilliance, Orszag gave the administration's agenda analytical ballast. There will no doubt be efforts on the right to brush Orszag with the red ink that the administration finds itself swimming in, but that's politics as usual. Inheriting the worst economy since the 1930s, Orszag presided over the Herculean task of preventing a complete meltdown and setting the foundation for a recovery. In many ways, he's a reflection of the administration at its best: a rigorous, pragmatic empiricist."


title: Peter R. Orszag

text: Orszag held two jobs at Citigroup: Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group. He joined Citigroup in 2011. According to "New York Magazine", "for an ambitious economist like Peter Orszag, going to work for Citigroup represented a choice. As a young staffer working in the Clinton White House, he saw laid before him two different paths: Stiglitzism and Rubinism. There were both intellectual and career-arc components to these. While both are liberal Democrats, Rubin was the consummate insider, whose philosophy was that the free markets, balanced budgets, and limited regulation would create a rising tide that would lift all boats (or at least make Wall Street not complain too much about Clinton's social programs). Stiglitz, the public intellectual, is as concerned with the boats as with the tide. Orszag certainly had a lot in common with Stiglitz's academic mien, having grown up in an intensely intellectual family in Lexington, Massachusetts, outside Boston. His father was the celebrated Yale math professor Steven Orszag. But Orszag possessed an ambition that would take him beyond the ivory tower. He ultimately chose Rubinism. It makes perfect sense that Orszag would have been drawn toward Rubin. It must have been incredibly seductive seeing this world, watching the Rubin wing of the Democratic Party move so easily from government to Wall Street boardrooms to the table with Charlie Rose."


title: Peter R. Orszag

text: In May 2016, Orszag joined Lazard as Vice Chairman of investment banking and Managing Director. He was later named Global Co-Head of Healthcare and, subsequent to that, Head of North American M&A. Orszag took over as CEO of Financial Advisory in June 2019, overseeing the firm's advisory work for corporations and governments across the globe. Orszag has been charged with "breathing new life into Lazard" as the firm faces increased competition from copycat advisory firms. As CEO, Orszag led Lazard's team of advisors who worked with Argentina's government during the country's $65 billion sovereign debt restructuring in 2020.


title: Peter R. Orszag

text: Orszag's first wife was Cameron Rachel Hamill. They had two children before divorcing. In 2009, he fathered a child with his former girlfriend, Claire Milonas, daughter of shipping magnate Spiros Milonas. In 2010, Orszag married Bianna Golodryga, then co-host of ABC's "GMA Weekend". They have a son and a daughter. Orszag is Jewish. In 2014, Orszag won a protracted, contentious child support case brought by Hamill (who had since changed her name to Kennedy). The judge rejected Kennedy's case against Orszag.


title: Govind Padmasoorya

text: Govind Padmasoorya (born 16 June 1987), popularly known as GP is an Indian television presenter actor who works mainly in Malayalam cinema and a few Telugu films. He made his debut in the movie Atayalangal directed by M. G. Sasi.


title: Govind Padmasoorya

text: He is popular among Malayali audiences through the reality show D 4 Dance. He directed a featured film for Malayalam television channel Asianet for their 25 years celebration..


title: Govind Padmasoorya

text: Govind Padmasoorya popularly known as GP was born on June 16, 1987 at Pattambi, as the son of Govind Menon, (Bank Manager, CSB) and Malathy (AGM, BSNL). He completed his graduate in Master of Business Administration in St.Aloysius College in Manglore. Later, he went to Whistling Woods International to complete his media studies. He has a younger brother named Govind Amrithsoorya.


title: Govind Padmasoorya

text: GP started his career in acting through some albums in 2007. He made his debut in Malayalam cinema as the protagonist in "Atayalangal", directed by M. G. Sasi and produced by Aravind Venugopal. The film was based on the life and literature of the writer Nandanar. The film won five Kerala State Film Awards including Best Film.


title: Govind Padmasoorya

text: Next, GP portrayed the role of Vinu, the brother of the IG (Suresh Gopi) in B. Unnikrishnan's "IG", who transforms from a loving brother to a ruthless terrorist towards the end of the movie. He was also cast as Sreekanth, an Indian cricketer, in "Daddy Cool". Then on he did lead roles in many films including 32aam Adhyayam 23aam Vaakyam along with Lal & Miya directed by Arjun Prabhakaran and Gokul Ramakrishnan.


title: Govind Padmasoorya

text: He played a zumba dancer in his latest film Pretham directed by Ranjith Shanker. He was shot to fame hosting the super hit reality show D 4 Dance in Mazhavil Manorama. He also won the Kerala state award for hosting the show Adi Mone Buzzer in Asianet. He has portrayed antihero in his debut Tamil movie "Kee" with Jiiva. He has also acted in music albums like "Monjulla Painkili and Kumkumam". He also started Ad Film Direction.


title: Barker (occupation)

text: A barker, often a carnival barker, is a person who attempts to attract patrons to entertainment events, such as a circus or funfair, by exhorting passing members of the public, announcing attractions of show, and emphasizing variety, novelty, beauty, or some other enticing feature of the show. A barker would often conduct a brief free show, introducing performers and describing acts to be given at the feature performance. Professional barkers strongly disliked the term and instead referred to themselves as "talkers".


title: Barker (occupation)

text: Perhaps the most famous fictional barkers are Billy Bigelow, the protagonist of Rodgers and Hammerstein's classic stage musical "Carousel", and Tin Man, a supporting protagonist from the 1978 musical film "The Wiz" portrayed by Nipsey Russell. Bigelow, in turn was an Americanized version of Liliom, the protagonist of Hungarian author Ferenc Molnár's non-musical play "Liliom", on which "Carousel" is based. The term barker has been adapted in modern times to describe political propagandists.


title: Indian Ocean trade

text: Indian Ocean trade has been a key factor in East–West exchanges throughout history. Long-distance trade in dhows and proas made it a dynamic zone of interaction between peoples, cultures, and civilizations stretching from Southeast Asia to East and Southeast Africa and East Mediterranean in the West in prehistoric and early historic periods. Cities and states on the Indian Ocean rim focused on both the sea and the land.


title: Indian Ocean trade

text: There was an extensive maritime trade network operating between the Harappan and Mesopotamian civilizations as early as the middle Harappan Phase (2600-1900 BCE), with much commerce being handled by "middlemen merchants from Dilmun" (modern Bahrain and Failaka located in the Persian Gulf). Such long-distance sea trade became feasible with the development of plank-built watercraft, equipped with a single central mast supporting a sail of woven rushes or cloth.


title: Indian Ocean trade

text: Several coastal settlements like Sotkagen-dor (astride Dasht River, north of Jiwani), Sokhta Koh (astride Shadi River, north of Pasni), and Balakot (near Sonmiani) in Pakistan along with Lothal in western India, testify to their role as Harappan trading outposts. Shallow harbours located at the estuaries of rivers opening into the sea allowed brisk maritime trade with Mesopotamian cities.


title: Indian Ocean trade

text: Recent archaeological study has highlighted the growing corpus of evidence supporting direct maritime contacts between bronze age egypt and India via red sea. Scholars such a as Gergory Possehl have also proposed maritime activities between Indus Valley Civilization and East Africa. The maritime activity in the eastern Indian ocean trade network had extended to include Japan as early as early Yayoi period (3rd century BCE) as evidenced by the discovery of Indo-Pacific beads.


title: Indian Ocean trade

text: The first true maritime trade network in the Indian Ocean was by the Austronesian peoples of Island Southeast Asia. They established trade routes with Southern India and Sri Lanka as early as 1500 BC, ushering an exchange of material culture (like catamarans, outrigger boats, lashed-lug and sewn-plank boats, and paan) and cultigens (like coconuts, sandalwood, bananas, and sugarcane); as well as connecting the material cultures of India and China. Indonesians, in particular were trading in spices (mainly cinnamon and cassia) with East Africa using catamaran and outrigger boats and sailing with the help of the Westerlies in the Indian Ocean. This trade network expanded to reach as far as Africa and the Arabian Peninsula, resulting in the Austronesian colonization of Madagascar by the first half of the first millennium AD. It continued up to historic times, later becoming the Maritime Silk Road.


title: Indian Ocean trade

text: Trade between India and the Greek Ptolemaic Kingdom was started by Eudoxus of Cyzicus in 130 BCE. From Egypt, goods could be sent on to ports throughout the Mediterranean. The Kingdom's opening of Red Sea ports and improved knowledge of the seasonal monsoons resulted in a substantial increase in trade.


title: Indian Ocean trade

text: The consolidation of the administration of the Mediterranean basin under the Roman empire led to the strengthening of direct maritime trade with India and the elimination of the taxes extracted previously by the middlemen of various land-based trading routes. Trade between the Roman Empire and Indiae peaked during the first two centuries of the Common Era, facilitated by the peace and prosperity that arose beginning with the reign of Roman Emperor Augustus (27 BCE – 14 CE) and ending with the Antonine plague.


title: Indian Ocean trade

text: Strabo's mention of the vast increase in trade following the Roman annexation of Egypt indicates that the monsoon was known and utilized for trade in his time. So much gold was used for this trade, and apparently recycled by the Kushan Empire (Kushans) for their own coinage, that Pliny the Elder (NH VI.101) complained about the drain of specie to India:


title: Indian Ocean trade

text: The three main Roman ports involved with eastern trade were Arsinoe, Berenice and Myos Hormos. Arsinoe was one of the early trading centers but was soon overshadowed by the more easily accessible Myos Hormos and Berenice.


title: Indian Ocean trade

text: The Ptolemaic dynasty exploited the strategic position of Alexandria to secure trade with the subcontinent. The course of trade with the east then seems to have been first through the harbor of Arsinoe, the present day Suez. The goods from the East African trade were landed at one of the three main Roman ports, Arsinoe, Berenice or Myos Hormos. The Romans repaired and cleared out the silted up canal from the Nile to harbor center of Arsinoe on the Red Sea. This was one of the many efforts the Roman administration had to undertake to divert as much of the trade to the maritime routes as possible.


title: Indian Ocean trade

text: Arsinoe was eventually overshadowed by the rising prominence of Myos Hormos. The navigation to the northern ports, such as Arsinoe-Clysma, became difficult in comparison to Myos Hormos due to the northern winds in the Gulf of Suez. Venturing to these northern ports presented additional difficulties such as shoals, reefs and treacherous currents.


title: Indian Ocean trade

text: Myos Hormos and Berenice appear to have been important ancient trading ports, possibly used by the Pharaonic traders of ancient Egypt and the Ptolemaic dynasty before falling into Roman control.


title: Indian Ocean trade

text: The site of Berenice, since its discovery by Belzoni (1818), has been equated with the ruins near Ras Banas in Southern Egypt. However, the precise location of Myos Hormos is disputed with the latig Abu Sha'ar and the accounts given in classical literature and satellite images indicating a probable identification with Quseir el-Quadim at the end of a fortified road from Koptos on the Nile. The Quseir el-Quadim site has further been associated with Myos Hormos following the excavations at el-Zerqa, halfway along the route, which have revealed ostraca leading to the conclusion that the port at the end of this road may have been Myos Hormos.


title: Indian Ocean trade

text: The regional ports of Barbaricum (modern Karachi), Sounagoura (central Bangladesh) Barygaza, Muziris in Kerala, Korkai, Kaveripattinam and Arikamedu on the southern tip of present-day India were the main centers of this trade, along with Kodumanal, an inland city. The Periplus Maris Erythraei describes Greco-Roman merchants selling in Barbaricum "thin clothing, figured linens, topaz, coral, storax, frankincense, vessels of glass, silver and gold plate, and a little wine" in exchange for "costus, bdellium, lycium, nard, turquoise, lapis lazuli, Seric skins, cotton cloth, silk yarn, and indigo". In Barygaza, they would buy wheat, rice, sesame oil, cotton and cloth.


title: Indian Ocean trade

text: Trade with Barigaza, under the control of the Indo-Scythian Western Satrap Nahapana ("Nambanus"), was especially flourishing:


title: Indian Ocean trade

text: Muziris is a lost port city on the south-western coast of India which was a major center of trade in the ancient Tamil land between the Chera kingdom and the Roman Empire. Its location is generally identified with modern-day Cranganore (central Kerala). Large hoards of coins and innumerable shards of amphorae found at the town of Pattanam (near Cranganore) have elicited recent archeological interest in finding a probable location of this port city.


title: Indian Ocean trade

text: The Periplus Maris Erythraei mentions a marketplace named Poduke (ch. 60), which G.W.B. Huntingford identified as possibly being Arikamedu in Tamil Nadu, a centre of early Chola trade (now part of Ariyankuppam), about from the modern Pondicherry. Huntingford further notes that Roman pottery was found at Arikamedu in 1937, and archeological excavations between 1944 and 1949 showed that it was "a trading station to which goods of Roman manufacture were imported during the first half of the 1st century AD".


title: Indian Ocean trade

text: Following the Roman-Persian Wars, the areas under the Roman Byzantine Empire were captured by Khosrow II of the Persian Sassanian Dynasty, but the Byzantine emperor Heraclius reconquered them (628). The Arabs, led by 'Amr ibn al-'As, crossed into Egypt in late 639 or early 640 CE. This advance marked the beginning of the Islamic conquest of Egypt and the fall of ports such as Alexandria, used to secure trade with the subcontinent by the Roman world since the Ptolemaic dynasty.


title: Indian Ocean trade

text: The decline in trade saw the ancient Tamil country turn to Southeast Asia for international trade, where it influenced the native culture to a greater degree than the impressions made on Rome.


title: Indian Ocean trade

text: The 8th century depiction of a wooden double outrigger and sailed Borobudur ship in ancient Java suggests that there were ancient trading links across the Indian Ocean between Indonesia and Madagascar and East Africa sometimes referred to as the 'Cinnamon Route.' The single or double outrigger is a typical feature of vessels of the seafaring Austronesians and the most likely vessel used for their voyages and exploration across Southeast Asia, Oceania, and Indian Ocean. During this period, between 7th to 13th century in Indonesian archipelago flourished the Srivijaya thalassocracy empire that rule the maritime trade network in maritime Southeast Asia and connecting India and China.


title: Indian Ocean trade

text: Chinese fleets under Zheng He crisscrossed the Indian Ocean during the early part of the 15th century. The missions were diplomatic rather than commercial, but many exchanges of gift and produces were made.


title: Indian Ocean trade

text: During the 16th and 17th century, Japanese ships also made forays into Indian Ocean trade through the Red Seal ship


title: Indian Ocean trade

text: During the Muslim period, in which the Muslims had dominated the trade across the Indian Ocean, the Gujaratis were bringing spices from the Moluccas as well as silk from China, in exchange for manufactured items such as textiles, and then selling them to the Egyptians and Arabs. Calicut was the center of Indian pepper exports to the Red Sea and Europe at this time with Egyptian and Arab traders being particularly active.


title: Indian Ocean trade

text: Muslim missionaries and merchants began to spread Islam along the western shores of the Indian Ocean from the 8th century, if not earlier. A Swahili stone mosque dating to the 8th–15th centuries has been found in Shanga, Kenya. Trade across the Indian Ocean gradually introduced the Arabic script, and rice as a staple in Eastern Africa. Muslim merchants traded an estimated 1000 African slaves annually between 800 and 1700, a number that grew to during the 18th century, and 3700 during the period 1800–1870. Slave trade also occurred in the eastern Indian Ocean before the Dutch settled there around 1600 but the volume of this trade is unknown.


title: Indian Ocean trade

text: In Madagascar, merchants and slave traders from the Middle East (Shirazi Persians, Omani Arabs, Arabized Jews, accompanied by Bantus from southeast Africa) and from Asia (Gujaratis, Malays, Javanese, Bugis) were sometimes integrated within the indigenous Malagasy clans New waves of Austronesian migrants arrived in Madagascar at this time leaving behind a lasting cultural and genetic legacy.


title: Indian Ocean trade

text: The Portuguese under Vasco da Gama discovered a naval route to the Indian Ocean through the southern tip of Africa in 1497–98. Initially, the Portuguese were mainly active in Calicut, but the northern region of Gujarat was even more important for trade, and an essential intermediary in east–west trade.


title: Indian Ocean trade

text: European slave trade in the Indian Ocean began when Portugal established Estado da Índia in the early 16th century. From then until the 1830s, slaves were exported from Mozambique annually and similar figures has been estimated for slaves brought from Asia to the Philippines during the Iberian Union (1580–1640).


title: Indian Ocean trade

text: Venetian interests were directly threatened as the traditional trade patterns were eliminated and the Portuguese became able to undersell the Venetians in the spice trade in Europe. Venice broke diplomatic relations with Portugal and started to look at ways to counter its intervention in the Indian Ocean, sending an ambassador to the Egyptian court. Venice negotiated for Egyptian tariffs to be lowered to facilitate competition with the Portuguese, and suggested that "rapid and secret remedies" be taken against the Portuguese. The Mamluks sent a fleet in 1507 under Amir Husain Al-Kurdi, which would fight in the Battle of Chaul.