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Vintage 14K Yellow Gold Sea Pearl & Diamond SCREW BACK Earrings. Weight: 6.6 Grams Earring Size: 25 mm L x 17.5 mm W Stone: Sea Pearl (6.2 mm), Approx. 0.08 TCW I SI-1 Diamonds Hallmark: 14K Item #: BR-05-58. Bluebonnet Rarities is an Estate purchasing firm traveling the United States looking for unique and interesting coins, estate jewelry, watches and antiques. However, we will accept Cashier's Checks if noted upon checkout. Please allow from one to four weeks for items to clear. This is not negotiable. We will gladly combine multiple items if we are notified. Blue Bonnet Rarities strives for excellent customer service and your satisfaction is important to us. We pride ourselves in carrying high quality estate and antique jewelry. Our items shown are estate or antique pieces unless otherwise noted. Items, unless otherwise stated, may have some wear and tear, flaws, discolorations. The absence of condition details does not imply the items condition to be imperfect or perfect. Items descriptions are our professional opinions and only deemed certified with a gemological certificate or a professional coin grading certificate (PCGS/NGC). We do not offer repairs or resizing. All items are sent in a repaired state unless otherwise noted. We only accept cancellation requests if there is an error in the listing. The item "Vintage 14K Yellow Gold Sea Pearl & Diamond Screw Back Earrings 6.6 Grams I SI-1″ is in sale since Friday, May 31, 2019. This item is in the category "Jewelry & Watches\Vintage & Antique Jewelry\Fine\Retro, Vintage 1930s-1980s\Earrings". The seller is "blueribbonrarities" and is located in New York, New York. This item can be shipped worldwide.
- Style: Screw Back
- Metal Purity: 14k
- Main Stone: Pearl
- Metal: Yellow Gold


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The use of orthopedic implants is a cause for concern for the release of its integrating metals and the systemic complications that may occur. Instrumented spine arthrodesis is the recommended treatment for many spine diseases. Different segmental fixation devices, commonly made of titanium and its alloys, are used in these surgeries. The use of this metal for spinal fusion has introduced the possibility of generating microscopic metal particles that are present in the tissues of the surrounding implants (peri-implant environment). In fact, metal debris has been found in the paraspinal soft tissues of patients with posterior lumbar instrumentation and showed to be particularly high in patients undergoing revision procedures of pseudoarthrosis. In addition, part of the metals might also dissolve (either from the released particles or directly from the implant surface) and circulate in the body fluids, accumulating (eventually) in remote organs.
Material and methods
A prospective study was designed with patients who were to be operated by the pathology of the lumbar spine to perform a vertebral arthrodesis composed of a titanium alloy (n=32). Two subgroups were differentiated according to the type of surgery performed: a) Posterolateral arthrodesis (N=5); b) Circumferential arthrodesis intervertebral implant of polyester-ether ketone (PEEK) (N=8) or titanium (N=19). The blood sample was taken before surgery and one year later. The samples were analyzed by mass spectrophotometry with a double focus inductive coupling plasma source (DF-ICP-MS).
Blood titanium levels prior to surgery were similar to those in other publications (0.7449 micrograms per liter-1 (µgL-1), Standard Deviation (SD)=0.562). The average titanium concentration levels found after surgery was 2.5406 µgL-1 (SD=3,69), near 3.5-fold increase. After surgery, there was a significant mean increase in serum titanium levels of 1.7957 µgL-1 (SD=3.5765, Range=-0.57 µgL-1; 14.60 µgL-1). There is a statistically significant increment (p=0.00049) of the titanium concentration in the serum of the patients after surgery. If we analyze the patients in three groups according to the type of implants used (posterolateral, circumferential with PEEK, and circumferential with titanium), there are no differences between those who did not have an intersomatic device implanted and those in which PEEK implants were implanted, but with those in which it was titanium it was p=0.006 and p=0.018, respectively.
Patients undergoing vertebral instrumentation experience a significant increase in serum titanium levels compared to before surgery levels. The use of an intersomatic device did not show differences in titanium release with not using it when it was PEEK. There are significant differences between patients without intersomatic implants or those who had a PEEK implant with those in whom it was titanium, with a significant increase in blood titanium levels.
The metallic implants placed in human bodies can exhibit electrochemical erosion that yields in the liberation of metallic products. Such implants-derived metal wear products can be present in the form of metal ions and/or small nanoparticles with still unknown effects on human health.
Instrumented spinal arthrodesis is the recommended treatment for progressive spine deformity and degenerative disc disease. For these kinds of surgeries, different segmental fixation devices, including hooks, screws, wires, etc., commonly made of titanium and its alloys, are used [1]. The use of this metal for spinal fusion has introduced the possibility of generating microscopic metal particles, which are present in the tissues of the surrounding implants (peri-implant environment) [2]. In fact, metal debris has been found in the paraspinal soft tissues of patients with posterior lumbar instrumentation and showed to be particularly high in patients undergoing the revision procedures of pseudoarthrosis [3]. These particles (nanometer size) activate macrophages that increase bone absorption and inflammatory reactions [4]. In addition, part of the metals might also dissolve (either from the released particles or directly from the implant surface) and circulate in the body fluids, accumulating (eventually) in remote organs [5]. But metallic prostheses and orthopedic implants are known to provide also nano-debris that is generated at the bone-biomaterial interface into the microenvironment [6]. Studies have shown that metallic debris can induce bone loss, loosen implants, and sometimes cause the clinical failure of bone prostheses [7]. In addition, there is growing evidence that debris can directly affect the cells of the osteoblast lineage [8]. The possible harmful effects of titanium oxide nanoparticles on their local environment and on the health of the patients are still uncertain, therefore, the assessment of their risk is necessary, both in vivo and in vitro. In vitro examination using cultured cells is frequently used as a powerful tool for screening hazardous materials, and it is essential for understanding the mechanisms of the biological influences induced by nanoparticles [9]. Therefore, the adverse effects of titanium peri-implant cells, especially bone cells, should be determined. Additionally to the production of nanoparticles, the degradation products of all orthopedic implants also generate metal ions (either from direct electrochemical corrosion of the implant surface or through the dissolution from metallic nanoparticles as intermediates) [10]. Together with the production of nanoparticles, there is continuing concern regarding the release of chemically active metal ions, which bind to proteins and remain in solution from which they can then disseminate into the surrounding tissues, bloodstream, and remote organs [11-12]. Particulate metallic wear debris presents an enormous surface area for electrochemical dissolution, which is a major factor contributing to the observed systemic elevations in the metals of patients with titanium implants [13].
In the present study, our objective is to determine the variation in serum titanium levels in patients undergoing instrumented spinal arthrodesis surgery. Also, we will evaluate the different types of implants in order to establish a possible correlation between the liberation rate and the micromotion of the particular metallic device. For this analysis, is important to use highly sensitive analytical techniques that permit to detect ultratrace concentration levels of titanium and its quantification with high precision and accuracy. In this case, double focussing elemental mass spectrometry (DF-ICP-MS) has provided satisfactory results in previous studies and will be applied also here using isotope dilution analysis for quantification purposes [14-15].
Materials & Methods
A prospective study was designed, which included, in the case group, patients older than 18 years old belonging to the Health Area of the Central University Hospital of Asturias (Oviedo-Spain), with a population close to 350,000 people, who were to be operated by the pathology of the lumbar spine to perform a vertebral arthrodesis with instrumentation composed of a titanium alloy. All patients underwent surgery between August 2011 and October 2012 by the same team of two senior spine surgeons. Two subgroups were differentiated according to the type of surgery performed:
a) Posterolateral arthrodesis (N=5)
b) Circumferential arthrodesis intervertebral implant of polyester ether ketone (PEEK) (N=8) or titanium (N=19)
The same patients in the case group were included in the control group, prior to surgery determining basal blood titanium levels. The inclusion criteria were (Table 1):
Serum from patients (32 subjects) was collected before and after (one year) posterior spinal arthrodesis. Two types of spinal fusion implants have been evaluated and compared: posterolateral spinal fusion in which the bone graft is placed between the transverse processes and the facet joint in the back of the spine. These vertebrae are then fixed in place with titanium screws through the pedicles of each vertebra attaching to a metal rod (also made of titanium) on each side of the vertebrae. On the other hand, interbody spinal fusion places the bone graft between the vertebra in the area usually occupied by the intervertebral disc and between the transverse processes. In preparation for the spinal fusion, the disc is removed entirely and a device is then placed between the vertebrae to maintain spine alignment and recover the height of the disc. Such an intervertebral device is made from either PEEK or titanium. The fusion then occurs between the endplates of the vertebrae. Using both types of fusion is known as 360-degree fusion (Figure 1). The analyzed samples in this work corresponded to three different groups of patients undergoing: posterolateral fusion (five patients) and 360-degree fusion (25 patients) out of which eight patients carried a peek intervertebral device and 19 patients carried a titanium intervertebral device. PEEK intervertebral devices used are named CapstoneTM and manufactured by Medtronic (Memphis, TN, USA). Titanium intervertebral devices are named ProspaceTM and they are made of titanium, aluminum and vanadium alloy (Ti6Al4V) and manufactured by Braun-Aesculap (Tuttlingen, Germany). The screws and rods used belong to the CD-HorizonTM LegacyTM system manufactured by Medtronic (Memphis, TN, USA) and S4TM Spinal System manufactured by Braun-Aesculap (Tuttlingen, Germany), both made of Ti6Al4V alloy.
The samples were collected in 5 milliliters (mL) vacutainer tubes (Greiner Bio-OneTM, Madrid, Spain) for trace elements. The precautions taken to avoid any metal contamination during blood extraction have been described before and those procedures were followed here [14]. Briefly, blood samples were withdrawn from a forearm vein using a stainless-steel needle surrounded by an inert plastic cannula. Blood was drawn into standard plastic syringes. The first 5 mL of blood extracted from each patient were used to rinse the system and were then discarded. The second 5 mL was transferred to blood-collection tubes conditioned with lithium heparin (VacuetteTM) and used to conduct the analysis. The samples were transferred to an accredited laboratory at the Analytical Chemistry Department of the University of Oviedo. Immediately after collection, the blood samples were separated into serum and red blood cells by centrifugation at 3000 g for 15 minutes. Serum samples obtained in this way were stored at -20° C until analysis.
Serum samples preparation
Serum samples (n=32) used to determine the total concentration of titanium were prepared following the method used in previous studies [16]. The serum was just diluted before analysis as follows: 600 microliters (μL) of serum was mixed with 30 μL of the spike solution: (11.5 micrograms per liter-1 (µgL-1) titanium isotopically enriched on the isotope titanium-47 (47Ti) and diluted to a final volume of 3 mL with ultrapure water. No spiking of the samples was conducted at any point of this particular study.
A double focusing-sector field elemental mass spectrometry instrument (DF-ICP-MS), ELEMENT 2 (Thermo Fischer Scientific, Inc., Waltham, MA), was used for the total titanium determination using medium resolving power (m/Dm=3000). The instrument was equipped with a Meinhard concentric glass nebulizer and with nickel sampler and skimmer cones.
The detection limit of the applied methodology (0.05 µgL-1) together with the suitability of the proposed quantification strategy has been established in a previous publication by means of a certified reference material [15].
Statistical analysis
Categorical variables are presented as frequencies and percentages, and continuous variables as means and standard deviations or medians and ranges. A paired t-test was used to evaluate the difference in titanium levels preoperatively and one year after surgery. The independent samples Kruskal-Wallis test was used to compare between groups. All reported p-values are two-sided, with a significance of 0.05. All analyses were performed with the use of IBMTM SPSSTM Statistics 22.0 Software (IBM Corp, Armonk, NY, USA).
Study registration and informed consent
This study was checked and approved by the Regional Clinical Research Ethics Committee of Principado de Asturias located at University Central Hospital of Asturias (Oviedo-Spain). The patients participated in this study voluntarily, and they all were informed about the objective of the work. Written informed consent was obtained from all patients to take part in this study and collect the samples, and another informed consent was signed for surgery. Samples were collected in accordance with protocols approved by the relevant institutional review boards and with the Helsinki Declaration of 1975, as revised in 2000.
Initially, 44 patients who met all the previously established inclusion criteria, obtaining the first pre-surgical sample of all of them. However, 12 patients did not show up to the blood draw one year after surgery, so they were excluded from the study because they did not complete the study protocol. Finally, 32 patients were included for the analysis of the data, with a mean age of 55.31 years (Standard Deviation (SD)=9.670) at the time of surgery.
Twelve were male (37.5%) and 20 female (62.5%). In relation to the types of surgery, five patients (15.6%) underwent posterolateral vertebral arthrodesis and 25 patients (84.4%) circumferential vertebral arthrodesis, of which eight PEEK devices (25%) were implanted and 19 titanium devices (59.4%) were used. In all cases, titanium rods and screws were applied. Demographic data are shown in Table 2.
Total titanium determination was conducted in the serum samples of the patients of the different groups undergoing spinal arthrodesis described in the samples section, before and after surgery. Before surgery, the average titanium concentration levels found in the samples are in agreement with previous publications for control samples (0.7449 µgL-1, SD=0.562). The average titanium concentration level found after surgery was 2.5406 µgL-1 (SD=3,69), a near-3.5-fold increase. The comparative results of the titanium concentration in the serum of 32 patients analyzed before surgery (left bar) and after spinal arthrodesis (right bar) are shown in Figure 2. The time elapsed after surgery was one year. In this case, the average increase in concentration turned out to be 1.7957 µgL-1 (SD=3.5765, Range=-0.57 µgL-1; 14.60 µgL-1) higher and there is a statistically significant increment (p=0.00049) of the titanium concentration in the serum of the patients after surgery (Figure 2). Serum titanium levels per patient are shown in Table 2.
In addition, it was possible to separate the patients into three groups depending on the type of implant used (posterolateral fusion and 360-degree fusion, out of which some patients carried a PEEK intervertebral device and others a titanium intervertebral device). There are no significant differences between the patients not carrying any intervertebral device and those carrying a PEEK device (p=0.916). However, both of them show statistically different results with respect to patients carrying a titanium-intervertebral device (no intervertebral device-titanium device: p=0.0006 and PEEK intervertebral device-titanium device: p=0.027) (Figure 3).
Immediately after implantation in the human body, all implants start to degrade through two mechanisms: corrosion and wear [17]. Wear is the mechanical/physical degradation of materials (producing particles), whereas corrosion is a chemical (or electrochemical) form of degradation (mainly producing solubilized metal ions). Thus, the use of titanium alloys for biomedical applications has introduced the possibility of generating microscopic titanium particles together with titanium metal ions that are present in the tissues of the surrounding implants (peri-implant environment) [2,7]. The particles are commonly of nanometer size and activate macrophages that increase bone absorption and, eventually, inflammatory reactions leading to the implant failure [4]. The behavior of metal ions released into biological fluids can be diverse, showing combination with biomolecules like proteins (99.8% in serum is bound to transferrin) or with a water molecule or an anion to form an oxide, hydroxide, or inorganic salt [5,15,18].
Metal liberation from metallic implants has been reported in the body fluids of patients carrying total hip or knee replacements, intramedullary nails, and, more recently, in patients undergoing instrumental spinal arthrodesis [2-3,11-12,14-15,19-30].
Blood and serum titanium levels are well-studied and defined in relation to total hip arthroplasty, whether primary, revision, or during follow-up, from one of the first works of Agins in 1988 to the last revision of Swiatkowska [20-21]. Jacobs et al. have found that the normal value for serum titanium levels for individuals without titanium-containing implants is less than 2 µgL-1 or parts per billion (ppb) [24]. In a more recent work published by Nuevo-Ordóñez et al. with a detection limit of about 0.05 µgL-1, they established the average levels of 40 control individuals at a mean of 0.26 µgL-1 [19]. In the same work of Jacobs, et al., the authors have found for a total hip arthroplasty population with well-functioning metal-on-polyethylene implants a serum titanium level approximately of 4 µgL-1 or ppb, and levels greater than 8 µgL-1 or ppb when implants were either subject to loosening or accelerated wear due to abrasion [22].
Metal ion release has been addressed in patients undergoing spinal surgery as correction of the deformity in adolescent idiopathic scoliosis literature or instrumented spinal arthrodesis [2-3,11,25-30]. Localized metal debris has been well-documented in the paraspinal soft tissues surrounding instruments [3,5]. Systemic distribution via blood and lymphatic vessels and distant organ settlement of particulate debris have also been demonstrated [26].
There are few works in the literature on metal ion serum levels after deformity correction surgery. Those on serum titanium levels in patients with early-onset scoliosis or adolescent idiopathic scoliosis reported an increase in mean serum metal ion levels [26-30]. Cundy et al. reported, in two prospective and longitudinal studies, that preoperative and postoperative concentrations of serum titanium and niobium were significantly different (p=0.0001), and median postoperative serum concentrations of titanium and niobium were elevated 2.4- and 5.9-folds above the normal range, respectively. They also observed a significant and rapid rise in serum titanium and niobium levels within the first postoperative week, after which elevated serum levels persisted up to 12 months [26-27]. In another prospective study, Cundy et al. reported that measurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs, and postoperative serum metal ion levels were elevated compared to baseline preoperative levels. Another observation in that study was that, in general, metal ion levels were considerably higher in intraoperative fluid samples compared to those observed in the serum levels. They concluded that their findings of contextually high metal ion concentrations in intraoperative and early postoperative samples provide further empirical support of a "putting-in" phenomenon of metal ion release following instrumented spinal fusion. This complements existing beliefs that metal ion release occurs during an intermediate "wearing-in" phase [28]. Lukina et al., in a retrospective study of implantation of titanium growth guiding sliding instrumentation for scoliosis in children, reported that the content of titanium and vanadium ions in the whole blood of 90% of patients with implanted LSZ-4DTM (CONMET, Moscow, Russia) devices was increased as compared with the control group (2.8 and 4 times, respectively) but did not exceed the values reported previously in the literature for fusion spinal instrumentation. They also observed that the median content of titanium ions in the soft tissues adjacent to the implanted sliding device was measured to be more than 1,500-fold higher as compared with the control group, which is a much higher level than previously reported for spinal instrumentation. No statistically significant difference in metal ion content in the blood was revealed in patients with and without metallosis-associated complications. According to their findings, they recommend that either the use of wear-resistant coatings on titanium alloy sliding devices or the use of a different material for such instrumentation would be beneficial [29]. In a recent prospective study of metal ion release during growth-friendly instrumentation for early-onset scoliosis published by Yilgor et al., they have also reported serum titanium levels higher than controls in all groups of cases (p<0.001) [30].
There are very few studies that analyze serum or blood titanium levels in adults with spine pathologies and spinal fusion, and most of them are retrospective cohorts. Richardson et al. and Kasai et al. reported 3.6-fold and 4-fold increases in the serum titanium levels of adult patients with instrumentation implanted on two or three levels of the lumbar spine [2,11]. Ipach et al. also demonstrate 2 to 3-fold increases of titanium content in adult patients with a median of five fused segments [25].
In the retrospective study measuring postoperative serum titanium levels in 30 patients with titanium alloy spinal instrumentation published by Richardson et al., they observed serum titanium levels were significantly higher in patients with titanium spinal implants (mean=2.6 µgL-1) when compared with controls (mean=0.71 µgL-1), very similar serum levels to those we found in our study. They reported that subjects who underwent an instrumented arthrodesis of only one spinal segment had decreased serum titanium levels when compared with those who were fused at two or more spinal segments (mean 2.3 versus 3.1 µgL-1) and patients with four or fewer pedicle screws also had decreased serum titanium levels when compared with the constructs of six to eight pedicle screws (mean 2.3 versus 3.35 µgL-1); however, both of these findings were not statistically significant. Another observation was that patients without cross connectors had a slightly increased serum titanium level when compared with those with connectors (mean 2.7 vs. 2.44 µgL-1); however, this finding was also not statistically significant. Also, patients with titanium interbody devices had a statistically significant elevation in serum titanium levels when compared with those without (mean 3.3 versus 1.98 µgL-1) [2].
Kasai et al. performed a retrospective study to evaluate serum and hair metal concentrations in patients with titanium alloy spinal implants. Of the 46 patients with titanium alloy spinal implants, 16 patients (34.8%) exhibited abnormal serum metal concentrations and 11 patients (23.9%) exhibited abnormal hair metal concentrations. In the control group, three patients (15%) exhibited only abnormal serum and metal aluminum concentrations at the first examination. Comparison of the implant failure and no implant failure groups showed no significant differences in the incidence of abnormal serum concentrations of titanium, aluminum, or both metals. Therefore, serum metal concentrations did not seem to be a useful indicator of hardware loosening or implant failure [11]. But this study has several drawbacks, such as being retrospective, having a very small number of cases and controls, and only seven of 19 individuals had serum titanium levels because they were beneath the reference value and they did not could report them.
Ipach et al. designed a prospective study to determine changes in whole blood titanium levels after spinal fusion and to analyze the correlation to the number of pedicle screws, cross connectors, and interbody devices implanted. They reported no statistically significant correlation between fused segments (r=-0.188, p=0.503), length of instrumentation (r=-0.329, p=0.231), number of interbody devices (r=-0.202, p=0.291), and increase of titanium levels over the observation period. They observed no statistically significant increase in titanium levels 12 months after surgery (mean difference=-7.2 μgL-1, p=0.446) [25]. Those results are totally in contraposition with others in the literature and with ours too since not only do titanium levels not increase, but they decrease after surgery. This result is not well-explained by measuring titanium levels in the blood rather than serum as authors speculate.
In our study, serum titanium levels were found to be higher after surgery in all groups in comparison to levels before surgery. Before surgery, the average titanium concentration levels found in the samples are in agreement with previous publications for control samples (0.7449 µgL-1, SD=0.562). The average titanium concentration level found after surgery was 2.5406 µgL-1 (SD=3,69), a near-3.5-fold increase. In this study, the average increase in concentration turned out to be 1.7957 µgL-1 (SD=3.5765, Range=-0.57 µgL-1; 14.60µg L-1) higher, a statistically significant increment (p=0.00049) of the titanium concentration in the serum of the patients after surgery.
Titanium naturally exists in water, soil, and foods. Hence, the normal population is also exposed to such irons, but patients in this study are living in the same geographical regions and similar natural environments [30]. Therefore, it is suggested that they were similarly affected by the non-implant-related metallic environment exposure, although possible individual exposure should also be taken into account. However, when using the same group of individuals as a control and as a case, this possible contamination is minimized. The obtaining and storing of procedures were exact for all patients, and all the samples were sent to the same laboratory. Thus, technical and handling issues equally affected patients in all groups. Therefore, the increase in metal ion levels was attributed to implanted spinal instrumentation.
When we separate the patients into three groups depending on the type of implant used, there are no significant differences between the patients not carrying any intervertebral device and those carrying a PEEK device (p=0.916). Both of them show statistically different results with respect to the patients carrying a titanium-intervertebral device (no intervertebral device-titanium device: p=0.0006, and PEEK intervertebral device-titanium device: p=0.027).
Therefore, the presence of titanium fusion implants increases the circulating titanium levels. These results seem to point out two different facts: the titanium screws and bars produce a significant release of the metal that is further transported into the bloodstream. Additionally, the presence of an intervertebral device does not change the rate of metal release when it is made of PEEK but increases, notably, when this is made of titanium. This could be ascribed to the size of the device that is also in contact with a highly irrigated area. Thus, titanium release might occur due to the electrochemical dissolution process of metallic implants by the blood components since the presence of intervertebral devices that, in principle, reduces the micromotion of the spinal fusion implants (and thus the production of mechanical wear) and increases the level of titanium released when made of this metal. Of course, the presence of a titanium intervertebral device increases the amount of implanted titanium so that a greater amount of titanium surfaces to debris and passes into the bloodstream. Therefore, mechanical fretting does not seem to be the most important cause of the metal release.
However, because this study was cross-sectional, the effect of time cannot directly be judged. The authors point out the need for longitudinal studies to observe and explain time-dependent serum titanium level alterations. Longitudinal studies would also allow the exhibition of ion release differences among posterolateral, circumferential with PEEK, and circumferential with titanium implantations if they exist.
The elevated metal ion levels observed in this study were also comparable to those of the levels in adults with metal-on-metal total hip replacements [20]. Similar to spinal fusion surgery, the initial metal ion release after arthroplasty is followed by a gradual decline until it reaches a plateau. Ion levels tend to rise again in the presence of loosening or mechanical failure. Metal ion exposure can have an impact on liver and kidney functions and trigger immunologic responses even with well-fixed metal-on-metal prostheses. Therefore, in patients undergoing spinal fusion techniques will have exposure to elevated serum titanium levels and there is a potential for long-term deposition of it in organs such as the liver, spleen, lungs, kidneys, and heart. Moreover, the local and systemic long-term clinical effects of increased metal ion levels are yet to be determined. Nonetheless, it is reasonable to think that the suggested various potential deleterious effects would increase as the duration and amount of exposure increases.
There are several drawbacks to this study. The main drawback is that it is a cross-sectional study analyzing a time-dependent event. Intra- and postoperative consecutive blood samples were not obtained, only the sample before surgery and at the one-year follow-up. Sequential data over time for each patient are not present. Additionally, no patients in this series underwent revision procedures so the issues of local staining and corrosion are not known. Furthermore, although a control group was included, epidemiologic data are not available to assess the normal serum titanium levels in a wider population. Yet, this study is the first study related to metal ions that compares different spinal arthrodesis techniques, so it is important that it points toward a subject that requires attention. Further prospective follow-up studies have to be designed to allow deeper and more precise analyses. Time-dependent alterations of serum ion levels and their mechanism, the structural properties of the devices, and exposure to environment exposition warrant investigation.
Patients undergoing posterior spinal arthrodesis experienced a significant increase in titanium serum concentrations with respect to the concentrations initially detected before surgery. The stabilization of the implant by using an intervertebral disc did not provide any difference in terms of the metal released due to micromotion since the levels of titanium were comparable in the absence of a disc or in the presence of a PEEK disc. However, when the intervertebral disc is made of titanium, it is possible to detect significant increases in the liberated metal.
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- Nuevo-Ordoñez Y, Montes-Bayón M, Blanco-González E, Paz-Jiménez J, Tejerina-Lobo JM, Peña-Lópezc JM, Sanz-Medel A: Metal release in patients with total hip arthroplasty by DF-ICP-MS and their association to serum proteins. J Anal At Spectrom. 2009, 24:1037-1043. 10.1039/b820339c
- Swiatkowska I, Martin N, Hart AJ: Blood titanium level as a biomarker of orthopaedic implant wear. J Trace Elem Med Biol. 2019, 53:120-128. 10.1016/j.jtemb.2019.02.013
- Agins H, Alcock N, Bansal M, Salvati EA, Wilson PD Jr, Pellicci PM, Bullough PG: Metallic wear in failed titanium-alloy total hip replacements. J Bone Joint Surg Am. 1988, 70:347-356.
- Jacobs JJ, Skipor AK, Black J, Urban RM, Galante JO: Release and excretion of metal in patients who have a total hip replacement component made of titanium-base alloy. J Bone Joint Surg Am. 1992, 73:1475-1486.
- Savarino L, Greco M, Cenni E, Cavasinni L, Rotini R, Baldini N, Giunti A: Differences in ion release after ceramic-on-ceramic and metal-on-metal total hip replacement Medium-term follow-up. J Bone Joint Sur Br. 2006, 88:472-476. 10.1302/0301-620X.88B4.17333
- Jacobs JJ, Skipor AK, Campbell PA, Hallab NJ, Urban RM, Amstutz HC: Can metal levels be used to monitor metal-on-metal hip arthroplasties?. J Arthroplasty. 2004, 19:59-65.
- Ipach I, Schäfer R, Mittag F, Leichtle C, Wolf P, Kluba T: The development of whole blood titanium levels after instrumented spinal fusion- Is there a correlation between the number of fused segments and titanium levels?. BMC Musculoskelet Disord. 2012, 13:159. 10.1186/1471-2474-13-159
- Cundy TP, Antoniou G, Sutherland LM, Freeman BJC, Cundy PJ: Serum titanium, niobium, and aluminum levels after instrumented spinal arthrodesis in children. Spine. 2013, 38:564-570. 10.1097/BRS.0b013e3182741961
- Cundy TP, Cundy WJ, Antoniou G, Sutherland LM, Freeman BJ, Cundy PJ: Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant area predict serum metal ion levels?. Eur Spine J. 2014, 23:2393-2400. 10.1007/s00586-014-3279-x
- Cundy WJ, Mascarenhas AR, Antoniou G, Freeman BJ, Cundy PJ: Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis. J Child Orthop. 2015, 9:39-43. 10.1007/s11832-015-0631-6
- Lukina E, Laka A, Kollerov M, et al.: Metal concentrations in the blood and tissues after implantation of titanium growth guidance sliding instrumentation. Spine J. 2016, 16:380-388. 10.1016/j.spinee.2015.11.040
- Yilgor C, Efendiyev A, Akbiyik F, Cavasinni L, Rotini R, Baldini N, Giunti A: Metal ion release during growth-friendly instrumentation for early-onset scoliosis: a preliminary study. Spine Deform. 2018, 6:48-53. 10.1016/j.jspd.2017.06.005
Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery
Ethics Statement and Conflict of Interest Disclosures
Human subjects: Consent was obtained by all participants in this study. Regional Clinical Research Ethics Committee of Principado de Asturias issued approval 04/2011. This study was checked and approved by the Regional Clinical Research Ethics Committee of Principado de Asturias located at University Central Hospital of Asturias (Oviedo-Spain). The patients participated in this study voluntary and they all were informed about the objective of the work. Written informed consent was obtained from all patients to take part in this study and collect the samples, and another informed consent was signed up for surgery. Samples were collected in accordance with protocols approved by the relevant institutional review boards and with the Helsinki Declaration of 1975, as revised in 2000.
The Regional Clinical Research Ethics Committee of Principado de Asturias located at University Central Hospital of Asturias (Oviedo-Spain) approved the informed consent document for participation in the study, detailing the procedures to be performed, and the sample collection document.
The University Central Hospital from Asturias has an informed consent document for spinal arthrodesis surgery based on that of the Spanish Orthopedic Surgery and Traumatology Society validated by the Healthcare Ethics Committee of the University Central Hospital from Asturias, that is available to consult at http://www.hca.es/huca/web/documentos/CE/CI-GAE4-20161207.pdf. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Dr. FERNÁNDEZ BANCES reports grants from SOCIEDAD PARA EL ESTUDIO DE LAS ENFERMEDADES DEL RAQUIS (GEER)/SOCIEDAD ESPAÑOLA DE COLUMNA VERTEBRAL during the conduct of the study. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
We thank the Analytical Chemistry Department of the University of Oviedo for their collaboration in carrying out this study by performing all sample analyzes.
Article Information
Cite this article as:
Fernández Bances I, Paz Aparicio J, Alvarez Vega M (August 21, 2019) Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery. Cureus 11(8): e5451. doi:10.7759/cureus.5451
Publication history
Received by Cureus: August 12, 2019
Peer review began: August 17, 2019
Peer review concluded: August 19, 2019
Published: August 21, 2019
© Copyright 2019
Fernández Bances et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery
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subset: commoncrawl


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Hellenic Cables and its subsidiary Fulgor undertake projects for the submarine and subterranean electrical interconnection of the island of Skiathos
Cenergy Holdings announces that Greek TSO ADMIE has awarded the association of economic operators Hellenic Cables - Fulgor a contract of approx. EUR 43 mil. to supply and install submarine and land cables for the interconnection of Skiathos island to the mainland grid.
The assignment entails the design and manufacturing of approx. 30 km of 150 kV submarine cable system, its subsea installation and protection as well as its connection to the 150 kV Transmission System in the Mantoudi area of Euboea island at the centre of Greece. Implementation is expected to begin January 2020 and completed within 20 months.
The submarine cable will be manufactured at Hellenic Cables' subsidiary Fulgor plant in Corinth, Peloponnese where state-of-the-art facilities and equipment enable the production and testing of some of the longest submarine cables in continuous lengths worldwide.
Brussels, January 22nd, 2020
About Cenergy Holdings
Cenergy Holdings is a Belgian holding company listed on both Euronext Brussels and Athens Stock Exchange, investing in leading industrial companies, focusing on the growing global demand of energy transfer, renewables and data transmission. The Cenergy Holdings portfolio consists of Corinth Pipeworks and Hellenic Cables, companies positioned at the forefront of their respective high growth sectors. Corinth Pipeworks is a world leader in steel pipe manufacturing for the oil and gas sector and major producer of steel hollow sections for the construction sector. Hellenic Cables is one of the largest cable producers in Europe, manufacturing power and telecom cables as well as submarine cables for the aforementioned sectors. For more information about our company, please visit our website at www.cenergyholdings.com.


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Vue Removes 'Blue Story' From Cinemas
In the last 24 hours, Vue Cinema has become the target of mass outrage on social media, over the reports of the company making the decision to pull Rapman's 'Blue Story' film from all their cinemas, after reports of a 'machete' brawl in Birmingham.
The report mentioned:
"Seven police officers were injured after they were called to reports of 100 people – including youths and thugs with machetes – fighting in the entertainment complex Star City near Nechells just after 5.30pm on Saturday.
Families with young children were ready to enjoy the first opening Saturday of Frozen II when the violence broke out."
Vue Cinema's decision to remove Blue Story from their UK cinemas has been done with immediate effect.
Social Media Had A Lot To Say About This
Social media has been on fire with many people expressing their disgust at the situation. Many questioning the fact that the brawl at the cinema happened during a showing of Frozen 2, yet Blue Story is facing the consequences of this isolated incident.
A wider racial discussion is being had about the agenda that certain institutions have against black centred content, especially when compared to similar situations happening with other demographics and other films, with similar consequences not being enforced in those instances.
And this is how they continously build their agenda against black content.. Something that happened during Frozen 2, they've now placed the blame on Blue Story. It's nasty and needs to stop 🤢 https://t.co/7AbqsgEqUX
— Josh Bridge (@JoshBridge_) November 24, 2019
No violence anywhere in London.. Croydon Vue was packed out with hella Black yutes last night & everyone was vibesing before and after. Vue were just itching to ban it.
— Lillian (@LillzTrackLife) November 24, 2019
This is the type of insidious racism we have to deal with in Britain. @vuecinemas actions are fundamentally racist, and as an employer of black staff across the country, this is disgusting, considering the pay lip service they pay to diversity during their recruitment process.
— Not Derin's Dad Yet (@15Swiss) November 24, 2019
So the fight breaks out during Frozen 2 and @vuecinemas decides to pull #BlueStoryMovie. The reporting of this so far has been wild and misleading. https://t.co/qvYy66DuNy
— – (@CJXCII) November 24, 2019
There was literally a mass shooting during The Dark Night Rises and that wasn't pinned on White people and their media wasn't banned? Absolute joke.
— #NoBlueNoVue (@WilliamAdoasi) November 24, 2019
So a bunch of kids in
BIRMINGHAM have a mass brawl with machetes during a viewing of… wait for it…
But Blue Story is the film getting banned???
Make it make sense
— JEMEL ONE FIVE🇯🇲 (@JemelOneFive) November 24, 2019
The fact that these are the kids that ruined bluestory showing at vue is giving me severe high blood pressure https://t.co/gECgNfudcq
— INNIT THO OUT NOW. Alika (@TheRealAlika) November 24, 2019
Frozen 2 viewing yet Blue story is the one being banned? Make it make sense 🤔 https://t.co/OOfIdTOZvZ
— Tequila Taze (@TazerBlack) November 24, 2019
a man killed 12 people at Batman and all they did was increase security😣 https://t.co/yCLyfeYWn2
— RS (@RushPLS) November 24, 2019
Boycotting VUE Cinema has been a common thread of conversation, with #NoBlueNoVue and #BoycottVue being the hashtags that have been trending.
@vuecinemas is showcasing the finest institutional racism we've seen. Can your team please help us the public understand how the kids involved in the brawl had any connection to the Blue Story movie? #NoBlueNoVue #BoycottVue
— BBE (@bbeldn) November 24, 2019
I'm more than ready #NoBlueNoVue ❌
we still got
– @ODEONCinemas
– @cineworld
– @Everymancinema https://t.co/tHL84GhpYn
— Sex-SYMBL (@oneacen) November 24, 2019
You Have To Question Vue's Decision To Remove The Film
This whole situation is one that has rubbed many people the wrong way. Many are frustrated at the knock on effect this can have on the film's opening weekend's box office figures and the bigger picture this can have on major companies' decision to back future films from black creators.
It's highly surprising to see companies making such a big and extreme decision after one isolated situation, people are highlighting a case of Vue displaying discrimination in how they have approached the matter.
Hmm the Vue cinema must not know that Rocnations legal team doesn't play. @RealRapman definitely has a discrimination lawsuit here. Damages and loss of earnings 👀👀👀👀
— Jaded 🇪🇷🇯🇲 (@Jada_london) November 24, 2019
What are your thoughts about this? Let us know in the comments below.


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Context-specific aliases with fish shell
We're using Docker for everything now, which is great but it's a big ask of some of our frontend devs who aren't as comfortable with a CLI as others. It's all very well and good to say "OK instead of
yarn watch, you now need to run
docker-compose exec app yarn watch"; someone comfortable with a CLI is going to get that. But for someone who already feels like every word they type might do something horrible, it's a harder sell. Yes, we have READMEs and that goes a long way, but at a busy agency you might work on 3 or 4 different projects a day, with wildly varying toolchains. Every time you have to open a README to know what you're doing is time lost, and a cognitive burden.
I toyed with using Makefiles for this sort of thing, and it works great for closed-ended scripts like
yarn dev, but it's unworkable for
yarn add $dependency, as you need to be able to pass dynamic arguments. And, again,
docker-compose exec app yarn add dependency is an unreasonable expectation for someone who doesn't love the CLI -
yarn add dependency is probably already nearly too much.
In comes fish shell's callback structure; a very simple notion that allows you to watch a variable, then fire a callback function when that variable changes. We can use this so that every time you
cd, your
$PWD variable changes and we fire a callback to see if there's a config file in the current directory. With that in mind, we can write a simple function that sources a file it finds, then you can write config files in fish's scripting language to do anything you want. We're going to use it to alias commands we're used to, to commands that are a bit more difficult.
Then in your project directory you can define your own aliases, and they'll get sourced when you cd to that directory.
This approach is great, and works really nicely. You can commit these files and share them with your collaborators so that everyone using fish benefits from the same aliases as long as they're injecting .fish_config in the same way that you are.
But! It does give a potential attack vector. Installing yarn is really easy:
curl -o- -L https://yarnpkg.com/install.sh | bash, but actually it's a little too easy. If I was the nefarious type I might make a really nice and useful bit of code, and maybe to install it I give you a nice easy script like the above, but when you run this, I put a .fish_config in every directory on your computer that runs my code every time you
cd to a new directory. I could do whatever I want - could recursively search for passwords from the current directory then send them to myself. This attack wouldn't need to be active for very long for me to do some pretty mean stuff to you and/or your clients. Hell if I was a real piece of work, I could inject code into your project, commit it silently and then that ends up in production if you have CI or your peer review isn't bullet-proof (spoiler: it isn't).
One thing we (should) know is that you can never trust the client. This is a pretty interesting angle because you are the client here. And you could be executing code you don't know about by sheer virtue of moving to a new directory. We can't have that.
There are a couple of potential issues here, and we can be over-paranoid if we want to. It depends how selective you are when you run things on your computer, and how much you trust your collaborators on projects.
- Consider the likelihood of a risk. In a perfect world, we can fully trust all software we install, but literally anything you run on your computer could exploit this if it felt like it. However, any software you run on your computer could also set this up transparently without you realising. So if you're worried that this gives potential attackers an opportunity, you should probably also be more thoughtful when you install things! This ties up a malicious attacker, in my opinion. If an attacker could set up a thing you're doing then use it to attack you, you've already lost.
- Someone on your project makes a typo that deletes all your files. What if you have a cachebusting command on your project that makes things run a little faster but someone wants an easy command to run, so they set up an alias for
rm -Rf . / cacheand you run it without realising and delete everything on your hard drive. Don't forget, sourcing a file executes it. If I don't get what I'm doing and wrap all my code in functions, you're just executing things your teammates write without knowing! Again, unlikely, but not impossible. Fortunately, explicit trust is relatively easy to write with text files so let's do it.
And there we have it. There's a little more setup, but it's a lot more robust than the initial approach. If you're collaborating, you can't trust others to not make mistakes. You can't even trust yourself but I can't solve that with a fish config. This will make running commands against your docker containers a lot easier, but it also has tonnes of other applications if you live in the command line like I do.


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Our exclusive Ivory Club
Membership to our exclusive Ivory Club has now closed for 2019.
Membership will re-open in 2020.
The Chubby Castor offers a wonderful range of dining experiences including our Set Lunch and Dinner Menu, Afternoon Tea, Tasting Menu, Vegetarian and Vegan, Sunday Roast and ultimate civilised dining in the stunning Fitzwilliam Arms Grade II Listed building.
The Chubby Castor, set within the beautiful rural village of Castor offers exceptional service and an exquisite array of food and drink.
This combination creates a perfect setting for our guests to relax and enjoy their time, whether looking to entertain clients, family, friends or attend one of the many events arranged by the team.


text:
The Sure Things: Brooke van Velden
ACT's deputy leader on her party's rise, assisted dying, and mental health reform.
ACT's deputy leader on her party's rise, assisted dying, and mental health reform.
Mystery case doesn't stop the Govt confirming a move down alert levels.
The party's big day was overshadowed by a rudimentary, embarrassing mathematical error.
The party's plan to cut tax has captured plentiful headlines, but how will the public feel?
The party reveals plans for a short-term tax cut as stimulus - but it would trim back significantly on longer-term spending allowances.
Politicians traded blows over what to make of new Treasury figures - but all are in an unenviable position.
NZ's economy performed better than expected over lockdown, but global fragility means the longer outlook is grim.
The books show short-term upside but long-term pain, with politicians scrapping over who deserves credit or blame.
High-profile candidates for the Māori seat agree the system for vulnerable tamariki is not working as it should.
Children come to the fore as National plans boost to youth dentistry and Labour reveals education policy.
Jacinda Ardern extends current alert level settings for at least a week, as National unveils education policy.
New Zealand must manage the need for skilled workers while still protecting the borders, PM says.
The Electoral Commission can't find any law breach despite concerns about the party's accounting.
The party's tax plans are further proof of Jacinda Ardern's instincts towards "incremental transformation".
Covid-19 wrecked plans to host the international summit - here's how organisers have adjusted.
The conspiracy-driven party's collection and use of donations is under the microscope.
Wealthy Kiwis would pay higher taxes under a second-term Labour government.
What questions do you want NZ's party leaders to answer? We've gone through hundreds of reader submissions to create a shortlist and now it's time for you to vote on the final five questions.
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All records
Search every available VHD record
Victorian Heritage Register
State significant places/objects
Heritage Inventory
Historic archaeological sites
Registered historic shipwrecks
The house at 117 - 125 McPherson Road Toolern Vale is significant as a moderately intact and contextually substantial example of a Late Victorian style. Most likely built c.1885, the house is associated with the locally prominent Malcolm McPherson, former Shire President. A rear shearing shed also contributes to the significance of the place.
The house at 117 - 125 McPherson Road is architecturally significant at a LOCAL level (AHC D.2). Although altered, it still demonstrates original design qualities of a Late Victorian style. These qualities include the hipped roof form, together with the convex profile encircling verandah. Other intact or appropriate qualities include the single storey height, horizontal timber weatherboard wall cladding, corrugated profile sheet metal roof cladding, face brick chimneys with multi-corbelled tops, narrow eaves with decorative timber brackets, symmetrical composition of the front facade with the timber framed doorway having a four panelled timber door and sidelights and highlights, and the flanking timber framed windows, and the other timber framed windows on the side elevations. The rear gabled addition contributes to an understanding of the historical evolution of the building. The nearby gabled, galvanised corrugated steel 2-stand shearing shed, with timber structural frame (including log posts) also contributes to the significance of the place.
The house and shed at 117 - 125 McPherson Road are historically significant at a LOCAL level (AHC A4, H1). It is one of a limited number of surviving Melton Shire farms that pre-date the break-up of Melton's large Clarke, Staughton, Taylor, and Patterson pastoral estates. It is directly associated with Malcolm McPherson, long serving Shire Councillor (1894-1920) and multiple Shire President, called the 'father of municipal life' in Melton by the local press at the time of his death. The house is also a scarce surviving intact property associated with the enclave of Scottish immigrants who would appear to have been the dominant farming landholders in early Toolern Vale.
Overall, the house and shed at 53-105 McPherson Road is of LOCAL significance.
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text:
WCMA will be exhibiting at Closets Home Organization Show
More information about the Closets Home Organization Show:
As the closet and home organization market grows – so does the CLOSETS & HOME ORGANIZATION CONFERENCE & EXPO™. The annual CLOSETS & HOME ORGANIZATION CONFERENCE & EXPO™, scheduled for February 10 - 12, 2010 at the Long Beach Convention Center in Long Beach, California, will feature three days of business and technical seminars—all presented by industry professionals. This is a unique opportunity for closet, garage and organization professionals to hone their business skills and stay on top of leading-edge trends of this fast-evolving market.
WCMA advertisement in Red Book Directory
Exhibiting at Closets Expo
Woodworking Industry Conference
Exhibiting at ZOW Germany
Fall Conference & Plant Tour Event


text:
New Delhi, Sep 15 (PTI) The DMRC on Tuesday said it has taken a major step towards development of an indigenously-built signalling technology for metro trains in line with the government's flagship 'Make in India' initiative.
As part of it, i-ATS, an important sub-system of the signalling system, was launched on Tuesday, it said. 'The Delhi Metro Rail Corporation on Engineers Day (September 15) today took a major step towards the development of an indigenously-built CBTC (Communication Based Train Control) based signalling technology for metro railway with the launch of the i-ATS, which is an important sub-system of the signalling system,' the DMRC said in a statement.
ATS (Automatic Train Supervision) is a computer based system, which manages train operations. This system is indispensable for high density operations such as the metro, where services are scheduled every few minutes, it said.
i-ATS is the indigenously developed technology, which will significantly reduce the dependence of Indian metros on foreign vendors dealing with such technologies, officials said.
This prototype system as well as a state-of-the-art laboratory for further developing other sub- systems of the CBTC technology was inaugurated at Shastri Park by Durga Shanker Mishra, Secretary, Ministry of Housing and Urban Affairs (MoHUA) in the presence of DMRC's Managing Director Mangu Singh, and other senior officials, it said.
'It is really a proud occasion to start something like this which is going to add to our strength on the Atmanirbhar Bharat initiative. The way we have promoted indigenization in the development of metros in the country, I am fully confident that this Indian system will also be sold outside and we will be the leaders in this area as well,' Mishra said.
Singh termed this achievement as a 'major step' forward towards the development of indigenous technologies required for the operation of metro rail systems.
'This is a very important step towards the development of an indigenous CBTC system. I am sure that we will be able to work together and scale newer heights to completely indigenize metro railway construction as well as operations,' he said.
Technology systems such as the CBTC are primarily controlled by the European countries and Japan. As part of the 'Make in India' initiative of the government of India, the Ministry of Housing and Urban Affairs has decided to indigenize the CBTC technology, the statement said.
Along with DMRC, Niti Aayog, MoHUA, Bharat Electronics Limited (BEL) and C-DAC are part of this development. DMRC has been nominated to lead this important 'Make in India' initiative, the statement said. To take the project forward, DMRC and BEL entered into a MoU for development of this indigenous ATS system. A dedicated team of DMRC and BEL, Ghaziabad worked together round the clock to take this important step towards 'Atmanirbhar Bharat', it added.
DMRC has decided to use indigenous ATS (i-ATS) while upgrading the ATS of line 1 (Red Line) i.e. from Rithala to Shaheed Sthal, Ghaziabad. The same shall also be used in Phase-IV, the DMRC said.
Some of the important features of this technology are that it can work with Train Control and Signalling Systems of different suppliers; i-ATS can work with different levels of technology of Train control and Signalling Systems, it said.
Predictive maintenance module shall also be introduced in the Phase-IV corridors using the i-ATS system, the statement said.
Another MoU was signed on the occasion with BEL for indigenous development of 'Rolling Stock Drivers Training System' for training driving and troubleshooting skills to train operators, it said.
'We are totally dependent on import for this. It will be a mock up of a train's driving cab with a computer-based system at the back end, where different real life scenario will be created to train the operator on driving and troubleshooting skills,' the DMRC said.
The training systems, popularly known as driving simulators, procured so far are rolling stock-specific. The indigenous system can be utilised for multiple stocks by selecting from among the options available in the database, it said. PTI KND TDS TDS


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Shop from some of our very best evers as seen on – and loved by – our Facebook Group and panel of trialists. You'll find fair pricing across the board and gain access to member only discounts, rewards and promotions plus collect free gifts, samples and more.
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Wash mixed colours with confidence
Dr. Beckmann Colour & Dirt Collector Sheets keep your colours brighter for longer.
One sheet per wash will collect the dirt and dye that can come out of your clothes, transferring to others and causing colour loss and dullness of fabrics.
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During these unprecedented times, NRCS continues to work with agricultural producers to plan and implement conservation practices on their land. Most of the district conservationists are working from home but remain in contact with producers by leveraging technology to facilitate their work.
A good example is NRCS District Conservationist Adam Eades and Arkansas farmer Joey Massey. Usually they meet in person to review maps and share documents to scope out a strategy for dealing with conservation challenges. But because of USDA's strong continuity of operations plan, they are able to seamlessly continue their work.
Watch the video below to learn more.


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- DIVER: Monroe Mann
- CATEGORY – Linguist
- DIVE: Chinese (Mandarin)
- REQUIREMENTS: Can read, write, speak, and listen at a basic level
When and why did you decide to start studying this language?
I began studying Chinese in 10th grade, at Fryeburg Academy, in high school, up in Maine. It wasn't actually a Chinese class, but rather an after school Chinese calligraphy program. I remember distinctly asking if he'd be teaching us Chinese itself, and he said no. Haha. So I just ended up using a brush and drawing some characters. This was back in the early 90s.
Why did I start studying Chinese? My dad was in WWII, and spent much of his deployment in China in the mid 1940s. My grandpa (who I never met) imported Chinese Ming dynasty replica furniture and so growing up, at Grandma's house, I always felt I was in China, because virtually every piece of furniture from beds, tables, and chairs were Ming dynasty replicas! So, it always interested me, and any chance I got, I would try to teach myself Chinese. It never worked out very well.
How long did it take for you to reach this level of proficiency from the day you decided to pursue it?
I tried to learn the basics for over 20 years since that first calligraphy class. Teaching yourself Chinese is hard. It's not 'hard' as in 'oh my gosh, it requires so much intelligence', but hard as in 'without a good program teaching you the tones, stroke order, pronunciation, listening exercises, etc., it's going to be an uphill battle'.
Thankfully, sometime in 2011, I found a Living Language Complete Chinese set, and I ordered it. And it was (and is) really fantastic. It comes with a basic, intermediate, and advanced book, and I'm still working through the Advanced book now actually. But it also came with CDs, and plenty of exercises, and through it, I absolutely learned the basic basics. But it wasn't until 2014 when I moved to Shanghai that I really solidified those basics in my classes there.
So technically, it took me 20 years to learn the basics, but of actual study, probably about one year
What do you think is the hardest & easiest part about studying this language?
The hardest part is getting over the initial fear and trepidation caused by the tones and characters. Once you learn those basics (3 months), everything else is pure joy and fun. The easiest part? There are no traditional verb conjugations. So I am (我是) is virtually the same as You are (你是) and They are (他们是). Notice that the verb 'is' 是 never changes! No conjugations. Meaning: becoming comfortable using correct Chinese grammar is easier than virtually any other language. If you can make it past the first 3 months, you'll end up with a lifelong hobby.
What is your advice for someone who is pursuing this dive?
Get someone to help you with tones, characters, stroke order, etc. in your first few months. Nothing will discourage you more than feeling overwhelmed by those basics. Further, don't forget to practice writing the characters. While most communication will be via cell phone and computer, using pinyin-to-hanzi transliteration, if you can't write with a pen, you are functionally illiterate. Nothing to be proud of, and more importantly, your cell phone battery may die one day and if you're in China with laryngitis and can't speak… knowing how to write with a pen will come in quite handy! Also, since most foreigners can't write with a pen, it makes you something of a rock star when they see you can write the characters
How did you prove you met the requirements for this level?
I was tested by BD Fluency Project staff member Echo Yu on my basic speaking and listening ability, and my writing and reading ability was tested via live Chinese chats I've had with Echo in the BD community, and from sharing a number of my handwritten essays
Please share some original writing in this language, with perfect spelling and grammar (Title, plus one paragraph).
Will you be pursuing the next level? If so, what is the next level, and what is your plan? If not, why not?
Yes, absolutely. My lifelong dream has been to speak fluent Chinese. I am so excited to be able to say with certainty that I am on my way. I've passed HSK4, and I am now studying for HSK5. In my next certification, I will share what it was like taking HSK 2 & 3. 加油!
And having made this post, and provided adequate evidence to the dive committee, Monroe Mann is now hereby certified by Break Diving, Inc. as: LINGUIST – CHINESE (Mandarin) – LEVEL 1. Congratulations Monroe! Thank you for being an inspiration to others!
The author above wrote this WYSEguidance post as one of the certification requirements to become certified by Break Diving, Inc. for a dive completed. Would you also like to find greater success, happiness, and friendship, and make genuine supportive connections with others around the world pursuing your same dreams? Come join us at www.breakdiving.io and soon your story will be the next one you read about on this site!


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Abdelkébir Khatibi is a French-speaking Moroccan writer who has produced a diverse and complex oeuvre that draws on European philosophy to tackle the. The Fiction of Translation: Abdelkebir Khatibi's Love in Two Languages. Thomas O. Beebee. Ce qui semblait nous unir itait une extraor- dinaire traduction. Abdelkébir Khatibi Moroccan novelist, poet, essayist & sociologist Abdelkebir Khatibi passed away on Monday morning in Rabat. Khatibi was a major force in.
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Esquisse methodologique d'une nouvelle critique de la litterature monde. Language is a decisive factor in intercultural dialogue.
The Splendor of Islamic Calligraphy Mar 19, This is a short book that is easy to read. Les 10 et 11 octobre Be the first to ask a question about Love in Two Languages. Various articles about French and Francophone literature: This book provides a comprehensive survey of the subject from its earliest origins to the present day. Il est de nouveau en ligne depuis le 06 juin Khatibi completed his secondary education in Morocco and pursued a degree in sociology at the Sorbonne in Paris.
Eva rated it really liked it Jul 30, Get fast, free shipping with Amazon Prime.
Abdelkebir Khatibi | Moroccan scholar |
Please try your request again later. This book is not yet featured on Listopia. Learn More in these related Britannica articles: Traditional written literature, which is limited to a smaller geographic area than is oral literature, is most characteristic…. Sir Isaac Newton, English physicist and mathematician, who was the khatibj figure of the scientific…. No trivia or quizzes yet.
Discover some of the most interesting and trending topics of Quatuor poetique French Edition.
Translating Plurality: Abdelkébir Khatibi and Postcolonial Writing in French from the Maghreb
Literary theory Khatibbi Literary Prizes. Thank you for your feedback. I spoke Arabic, with frightening grossness. If you think you should have access to this title, please contact your librarian.
Log In Sign Up. Lundi 18 mai Print Save Cite Email Share. Their work was to be a contribution to the revolutionary process of decolonization by cultural means, an opportunity to give expression to a society in crisis Khatibi, Le Roman If you prefer to suggest your own revision of the article, you can go to edit mode requires login.
In his later years, Abdelkebir Khatibi had been suffering from a chronic cardiac condition which led to his death in the Moroccan capital, Rabatfive weeks after his 71st birthday. Amazon Restaurants Food delivery from local restaurants. Goodreads helps you keep track of books you want to read. Skip to main content.
You can make it easier for us to review and, hopefully, publish your contribution by keeping a few points in mind. Bi-language was not his own language, or a foreign language either. Our editors will review what you've submitted, and if it meets our criteria, we'll add it to the article. Mar 24, Jennifer Solheim rated it really liked it Shelves: Moroccan writers Moroccan dramatists and playwrights Moroccan male writers Male dramatists and playwrights Abdelkfbir literary critics University knatibi Paris alumni People from El Jadida births deaths 20th-century dramatists and playwrights Winners of the Prix Broquette-Gonin literature 20th-century male writers.
Abdelkebir Khatibi Research Papers –
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Most widely held works by Abdelkebir Khatibi. Abdelkebif 20, Issue 1, Special Issue: Withoutabox Submit to Film Festivals. Moroccan Francophone Literature in Translation: The Editors of Encyclopaedia Britannica. Call for applications cycle Contact us New! His particularity was to challenge language constantly.
If Khatibi asked what meaning the novel might have for North Africans inthen the question is of equal relevance today. Laura Yaryura rated it did not like it Jan 18, His texts demonstrate a wide range of interests, from language and calligraphy to Islamic art, poetry, theatre, literary criticism, and sociology.
In that context, some artists painters, novelists etc. Liverpool Scholarship Online requires a subscription or purchase to access the full text of books within the service. What were the similarities and the differences between the two? Amazon Drive Cloud storage from Amazon.
The United Nations UN …. It is written in a stream of consciousness style with no plot.


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Handy Stuff to Know
Put lime and iron sulphur on hydrangeas. Lots of it for blue colour.
Epsom salts are also great for feeding hydrangeas.
When you cut hydrangeas to put in a vase of water, you can scald the stems near the cut. They will last longer in the vase. I love the colour of some of the deeper blues as they change in the autumn.
Lemons enhance the flavour of mushrooms
Buy frozen sheets flakey pastry and thaw, spread chutney, then sprinkle grated cheese, bacon and mushrooms. Roll and cut thinly. Bake at 180'C till lightly browned. You can also do feta and basil, ham, or bacon and pesto. This is easy when you have crowds or have to take a plate!
Mexican daisy leaves give a lovely flavour in a jug of water
Try taking a teaspoon of Manuka honey and 1/2 teaspoon of Ceylon cinnamon (from health shops) 1/2 an hour before eating to aid digestion.
Did you know you can freeze walnuts? They don't end up with that rancid taste like they do stored
If you get pollen on your clothes from lilies, lie them in the sun, then wash. It comes off.
Take the stalks off avocados they will ripen more quickly. Put them in the fridge when they ripen.
Add truffle oil to mashed potatoes (now called smashed potatoes). A yummy flavour.
Don't over water Fig trees as they will have a more watery taste.
A butcher at our local market told me that hogget is much tastier than lamb. Just cook it slowly, so for a leg 150'C for 3 hours or more. Or you can cook for longer on 120'C.
I also learnt slice up black pudding and cook with bananas and barbeque. (I'm not a huge fan of black pudding but apparently it tastes great!)
clean your make up brushes with hair conditioner
Another good use for hair conditioner is, use it to shave your legs in the shower, its way better than soap.
I'd love to hear of your time saving tips and hints so do please send them to me.
I will keep adding to the list……


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Data Researcher Jobs Summary
To research data online, know how to use the internet effectively. If you can research with effective computer skills, data entry and mindful analysis, you might qualify for data researcher jobs. There are many titles or names for this job, such as "internet researcher," "web researcher" and "data analyst," and the most basic laymen's term "professional or expert net surfers."
It is easy to surf the net, but it takes more than leisure surfing to research about something online for a living. There are many purposes a company will require the services of a data researcher. A company might hire a web researcher to learn what the netizens think about its products and services. Another client might want to know about the latest technology related to its business.
Career as Data Researcher
You could apply for jobs that offer telecommuting options so you could work from home or from anywhere in the world where there is a decent internet connection you can use. You may take on a full-time, part-time or freelance job.
The work of an online data researcher could also be beyond the internet. Some job offers are for someone with people skills because tasks involved need the researcher to interact with people in the real world.
This career seems simple and easy, considering that you only need to search through the web to find information that a client needs. However, this is more than just net surfing and more than book reading. These are just some aspects to the job.
Although a web search is virtual, some assignments and research methods will require that you work with people and help people find solutions to problems. This field of data research jobs is actually a service-oriented field. You serve a client by helping him solve a certain problem.
You should be aware, however, that most jobs are not for long-term employment. Keep in mind that your main task is to find the solution to a current problem. Once you have helped determine the solution, your job will end and you might need to look for another job. This is especially true for freelance researchers.
It is still possible to find jobs as a data researcher where the company always requires the research services. A marketing firm or a market research company could be an example. The main point here is to put your research skills to best use so your cash and job flow will not cease.
There is no definite training for a data researcher. Some companies may require the applicant to have a general degree in science or arts. Others have no specific educational requirements.
Sometimes, the education or college course required from an applicant
You could come across job ads where the educational requirements are courses like Master's Degree in Library Science, Degree in Commerce, Information Science, English Biology, Chemistry, Dentistry, etc.
When preparing your resume or cover letter, you need to include attributes that will make an employer think you are capable for the data research job. The qualities of a capable researcher include data collection, report writing, information (from various sources) analysis, strategic internet research, critical analysis and thinking, planning, time management and interviewing.
The exact skills for a particular job are on the job post. Figure 1 shows an example.
This is a job ad for an Amazon customer service rep/product researcher. The employer specifically wants someone with background on Amazon product research or has done Amazon store management for a minimum of 6 months. Other required skills include knowledge in using Google Excel Spreadsheet, Jungle Scout Chrome Extension, fluent English skills and ability to follow simple instructions.
Industries Requiring Effective Research Skills
They require research in almost all industries and businesses since well-researched information is necessary in coming up with business strategies and plans. You could find research-related jobs in industries such as Marketing, Academe, Science, Consumer Goods and Foods.Even web content writers need to perform research to gather facts for his articles. In fact, you will find job posts for web content writers where the job title also includes "researcher." Figure 2, which is a job ad for the writer/researcher, shows an example.
This job post contains details that emphasize the need for research. There are links for Article samples and if you head over to these links to read the articles, you'll discover that the topics are not for simple essays, but for facts-filled contents. This job ad specifically states that all facts included in the article should have supporting links to their sources.
Keep in mind that effective research is necessary in writing. Any business hiring a data researcher expect that the person hired will come up with quality results. Therefore, a researcher should have effective skills to make this happen.
When researching online, you could easily get overwhelmed with the amount of information available. Practice your online research skills by looking for related details that will guide you regarding this job. You will definitely come across various resources about the job, such as the video above.
Research Techniques and Methods
A web data researcher could use many online research techniques and methods to come up with desirable results. The main goal of research is to collect data using these techniques. They also use these techniques in traditional, real-world research.
1. Online Interview – Similar to face-to-face interviews, they accomplish online interviews through computer-mediated communication channels like email and chat. Online interviews could be synchronous or asynchronous (depending on the response time). Synchronous interviews online are those executed on mediums like online chat where responses are on real time. Asynchronous interviews online are those carried out on channels like email where it is possible to delay sending responses. Online interviews probe the thoughts and insights of respondents regarding certain topics.
2. Online Focus Group – This method is often for purposes like political, consumer and B2B research. Involved are pre-selected participants and a moderator. Qualified participants represent the specific area of interest at a certain time. They take part in a group discussion that often lasts over 2 hours. Respondents receive incentives for their participation.
3. Online Text Analysis – This technique involves gathering contents already available online and the researcher will explain them. This quantitative research makes use of paragraphs, articles, documents and web pages.
4. Online Qualitative Research – This sometimes goes together with quantitative research like online text analysis. This method often gives results necessary for saving time and cost.5. Social Network Analysis – This is considerably a new method that came from the popularity of social media. The researcher's job may include mapping out and measuring relationships among individuals, groups, and even computers.
Types Of Online Research
These may also refer to the purpose or goal of the research.
1. Customer Satisfaction – Traditional methods of researching customer satisfaction include phone calls or mail that asks customers about their feedback on particular products and services. Web research on customer satisfaction may involve surveys or apps.
2. Brand Loyalty – You could also find a job post where the task is to understand the loyalty of consumers to a certain brand or company. You need to determine what attracts people to a certain brand and point out what keeps them from always choosing that brand. This research will help improve or maintain a product or service.
3. New Product – Your job as a data researcher is to help ensure that a new product will gain success on its launching. This may involve focus groups with members of the target market who will test the new product, possibly prior to its launch. You will collect their feedback so the company or manufacturer could use the data to further improve the new product.4. Employee Satisfaction and Engagement - An organization needs to give attention to what its employees need. When employees and staff feel satisfied, the success and profits of a company follow because they will have the heart and mind to work for the company's welfare. If they hire you as a researcher in a company, this could be part of your job, too.
Technical Requirements
The tools of the trade of a data researcher include a working computer and fast internet connection. You will need to spend hours performing your duties so if you can afford it, invest on ergonomic desk and chair to ensure you will work with comfort and ease.
You will usually find the technical requirements on the job ad, such as shown in Figure 3.
This job post is something that contains more details than the other job posts, which can be beneficial in a way. With exact requirements of the hardware and the software, you could determine if your current computer system will do the
1. Hardware – This job post contains the minimum and the recommended specifications for a computer system needed for the job. You need a desktop or laptop with at least an i3 processor, 8 GB RAM.
2. Software – This example requires that the operating system of your computer is Windows 10. Familiarity or experience with Google Drive, Asana, Slack, Helium 10 and Seller Tools are requirements, so you could probably install these on your computer.3. Internet Connection – The minimum and recommended speeds for download and upload are also present in this job ad. The minimum required is 5 Mbps for the download speed, but it will be better if you have 10 Mbps internet speed.
You would hardly see an age requirement in job ads for data or web research. Just like other home-based online jobs, you need to be of legal working age. There is no maximum age limit too, but considering this job mainly involves the use of modern technology, many clients might prefer younger applicants over the older ones. Younger applicants would be more well-rounded to use the internet.
How To Apply/Join
If you take an interest in data research jobs, you may start your job hunt on a search engine like Google. When you type the keyword, you may include your country or the industry you wish to partake in if you want the search results to have somewhat filtered results (according to your locality and field of interest).
You will probably find jobs listed on job websites and portals. To apply, you may need to sign up first to that website.
Some employers just rely on the application procedures of the job portals while others already include special instructions in the job ad. Through these instructions, the employer could already determine which applicants follow instructions and they shortlist these people for the next phase of application.
Look back at Figure 1. Here, you could see that the instruction for the data research applicant is to include his favorite food in the email's subject. Part of the application process is to undergo a trial week prior to
Potential Income
Pay rate varies per job. According to Payscale, the average hourly rate for a web researcher is $17.91. This is only an estimate. Your potential income will depend on various factors like complexity of the tasks, region you will work in, size of company, etc.
In Figure 1, the offered rate is only $320 a month for the Amazon product researcher. In Figure 2, the salary offered is up to $800 a month for a writer/researcher.
Looking For An Online Income?
Work Schedule
Work schedules also vary per job offer. Employers usually include the work schedule in the job ad. This will help both the employer and the applicant save time right from the start. As an applicant, you will know which jobs you could apply to depending on the work schedule. In Figure 1, for example, the employer prefers the successful candidate to work on a graveyard shift, although this is not a requirement.
With the schedule already given, you may opt to apply for other data researcher jobs that will suit your free time.
Benefits / Bonus/ Increase/ Training Provided
The perks of working as a web researcher vary per job and employer.
In Figure 4, the listed benefits you could get include paid leaves, referral bonuses, bi-annual bonus and performance-based incentives.
Here's My #1 Online Income
It could be worthwhile to be a data researcher, knowledge-wise, since you get to learn new things each time you do your research. There are many available jobs out there, yet realize that choosing this career requires that you will constantly look for job offers because most jobs are on a project basis only so once it concludes, you must find work elsewhere.


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