Providing Wireless Communication Solutions In Delaware and the MidAtlantic Area Since 1991 Contact Us Today Delmarva Communications Inc Dedicated To Customer Focus From the creation of Delmarva Communications we have strived to earn the respect of Motorola and our customers We continue to grow our company and our place in the communications industry by staying focused on our customers needs to help make their business a success Digital Radios Whether you want ultrathin portables or extratough mobiles integrated Bluetooth or industryleading data applications we have the right radio that fits your needs today and evolves with new features to address your requirements tomorrow GPS Tracking Track your vehicles plan optimum routes and safe fuel Fleet management is all about improving the efficiency managing cost complying with government legislation and more Find out more about our integrated MOTOTRBO GPS Apps Bluetooth Accessories Extend the power and reliability of your MOTOTRBO digital twoway radios with the only complete line of tested and certified Motorola Original Accessories Check out the latest Bluetooth accessories from Motorola Solutions including the new longrange speaker mic Dispatch Solutions With options designed for both mission critical and noncritical use this portfolio of dispatch and desktop consoles has the features you need to make quick decisions mobilize a fleet or keep teams informed Functionality and reliability are integral to all of our dispatch solutions Best Sellers SL300 Motorola SL300 Rugged Slim Portable XPR 7550 Motorola XPR 7550 High Tier Digital Portable SL 7550 Motorola SL 7550 Ultraslim Portable with Apps Why Choose Us Industry Focus Delmarva Communications serves and provides support for industries such as Industrial Public Safety Law Enforcement Security Healthcare Education Public Utilities and Construction within the State of Delaware and surrounding states Trained Service Technicians Our Customers Come First Industry Solutions Education Healthcare Hospitality Manufacturing Utilities Transportation Current Promotions Save Big Today Check out Motorolas latest tradein discounts on XPR 7000e radio the SL7000e radio the CP200d and the EVX261 radio special financing and more

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Home Professional Education Dental Continuing Education Courses Course Number 514 Course Contents Clinical Evaluation and Assessment Professional Education Dental Continuing Education Courses Archived CE Course PDFS Dental Hygienist Resources Whats New in CE Dental Events Your Courses Activities Faculty Resources Student Resources Dental Assistant Resources Case Studies Case Challenges Find Your Fit PG Careers Current Concepts in Dental Implants Clinical Assessment in the Prevention of Periimplant Mucositis Periimplantitis and Implant Failure Clinical Evaluation and Assessment Course Authors Connie M Kracher PhD MSD Save your progress CONTENT Clinical Evaluation and Assessment Clinicians must use comprehensive evaluation and assessment to determine if a patient is eligible for dental implants If dental implants are placed it is the role of each clinician to reevaluate and assess the implant patient to prevent potential implant complications Proper evaluation and treatment planning is essential for dental implant predictability and success As mentioned prior one of the most critical factors in clinical assessment is the biologic connection between the implant and bone Healthy bone is required for successful osseointegration and longterm dental implant success 1112 The alveolar bone is measured in diameter and length The spatial relationship of the bone must be evaluated in a threedimensional view through radiographic imaging 5 The quality of the bone should be evaluated Healthy bone reflects a continuous uniform cortical outline and a lacy welldefined trabecular core 14 Large marrow spaces discontinuous cortex or thin sparse trabeculation should be evaluated as these negative variables will contribute to poor implant stabilization 2627 29 Poor bone quality may require further healing after bone augmentation to maximize implanttobone contact before occlusal loading Clinical assessment of the proposed implant site will be evaluated Adjacent teeth to the site are also evaluated The interdental space is measured to determine placement and restoration of the implant Depending on the implant system the minimal mesialdistal space will be determined For example a 4 mm diameter dental implant placed between two teeth would need approximately 7 mm of space For a 6 mm implant the minimal space would be approximately 9 mm There must be sufficient interproximal space for tissue health and patient home care The interocclusal space needed for each of the implant components eg abutment 29 Anatomic location is important as the failure to accurately assess the location of anatomic structures can lead to unnecessary complications Figure 4 Courtesy of Dr Samuel L Corey Based on the patients parafunctional status the evaluation of current bruxing and clinching habits and the current occlusion and bone levels are assessed If needed bone augmentation treatment eg localized ridge augmentation andor sinus lift will be completed A soft tissue evaluation may reveal future augmentation of gingival and connective tissue grafts required for keratinized mucosa during posttreatment healing Clinical assessment should also include the etiology and duration of past tooth loss and if there is a history of a traumatic extraction in the proposed implant site indicating possible alveolar bone complications Page 8 of 18

O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Sprained tooth syndrome explained February 22 2007 Introduction Modern Dentistry in all of its technology over the last 50 years has solved many of the problems that have arisen with the increase of tooth retention However situations still arise that reasonable practitioners can disagree on diagnosis and treatment Such disagreements may lead to delayed effective treatment unnecessary procedures or actions that are excessive All create a situation of frustration for the patient and the dentist resulting in ill will and unproductive activity Consider a common example A patient presents the following concerns dull generalized ache intermittent gum itchiness pain when probing localized gum pockets soreness to chew sensitivity to temperature occasional headache The pain is not severe enough to wake the patient out of hisher sleep but there is enough discomfort for the patient to make a specific appointment to discuss the problem In addition the patient recently had a cavity filled in the area of discomfort A prudent course of action to diagnose the issue is to take an xray temperature tests percuss and bite tests to isolate potential problems which may be causing the pain It is also reasonable to check the patients bite with articulating paper to determine potential high spots Yet common strategies do not seem to address or clearly identify the patients problem There are no cavities cracked teeth sinus issues or sharp pains associated with biting There are clinical signs of a molar rise with a lateral excursion on the patients working chewing side and also a balancing side contact on At this point reasonable practitioners would disagree on the next steps to take Some might attempt to correct the problem by filing the tooth down or replacing the filling others might perform a root canal or crown a few would event think to extract the tooth and some might do nothing This paper proposes an alternative perspective to address such symptoms allowing the dentist a more plausible diagnosis and possible treatments Such a diagnosis would be termed Sprained Tooth Syndrome Sprained Tooth Syndrome For the purpose of this article Sprained Tooth Syndrome STS is defined as a condition where unusually strong bilateral opposing vector forces cause the ligaments connecting a tooth to the bone to become stretched and chronically inflamed thus creating patient discomfort similar to that which is described above Just as ligaments can be stretched and damaged in an ankle or other parts of the body similar damage can occur with the ligaments connecting a tooth to the bone resulting in STS Common causes that could lead to STS are Cold sinus problems or allergies Trauma from small objects popcorn seed etc Filling or Crown overfilled Filling under filled Drifting of teeth Early vital tooth infection Damage wear or improper repair to discluding working side teeth canine rise or group function is desirable One common cause of STS is tooth movement due to sinus problems or colds Excessive swallowing as a direct result of sinus drainage may result in abnormal outward lateral pressure from the tongue to the teeth creating temporary orthodontic pressure and movement outward This temporary outward shift of the tooth may place the lingual cusp in harms way of damaging lateral tooth to tooth forces As such it is critical to determine why the teeth are moving causing horizontal friction to occur In this case such as a cold or sinus condition waiting for the patients health to improve may Another cause of STS can be accidental trauma or trauma from a small object such as a popcorn seed or a bone in a piece of meat This trauma can cause temporary periodontal ligament damage and swelling which can cause the tooth to supraerupt into a harmful position which can then indefinitely prolong the inflammation Dentistry itself can promote these damaging conditions to occur in the mouth If a crown is fabricated with a perfect centric contact but cusps that interfere with lateral excursive movements then STS can develop Likewise if the centric contact of a filling or crown is left too low over time a few days to a few weeks the tooth can supraerupt and move one or more cusps into an occlusal interference which would result in STS induced inflammation Drifting teeth are always at risk of moving one or more cusps into this damaging lateral excursive pathway Sometimes a tooth infection can cause supraeruption of that tooth placing the cusps in harms way The ensuing symptoms will be a part of the Sprained Tooth Syndrome but secondarily to the tooth infection Again underscoring the need to find out why a tooth has moved into this damaging position In all cases of STS it is very important to follow up 2 wks 4 wks 3 mos and 6 mos to make sure symptoms are resolved and an infection was not the root cause of the STS Finally a less obvious but equally important cause of STS is the damage wear or improper repair of the discluding working side teeth It is this working side protection canine rise is best that keeps the balancing side cusps out of trouble In short posterior teeth are designed to absorb heavy forces in the direction of the long axis of the tooth Most posterior teeth are not designed to absorb damaging lateral forces which can result in STS Determining how these damaging forces have come about is important in determining treatment Identifying STS is not as simple as it may seem Sometimes symptoms may lead you to believe the problem is STS when in actuality it is an early vital tooth infection A vital tooth infection is defined as an early infection of a tooth which has a nerve that is partially infected and partially vital thus giving off the same symptoms and discomfort as STS A few prudent tests should allow dentists the comfort that they have adequately diagnosed STS 1 Place a cotton roll or Tooth Sleuth over the suspected teeth and have the patient bite Ask the patient where they think the problem is located Also ask if the bite pain is sharp or dull and achy Dull and achy is indicative of STS Sometimes with this test the patient is not sure if the pain is coming from the top or bottom 2 Use the perio probe on the gum tissue to find the tender area or abnormal gum pocket and observe the patient for discomfort which may indicate inflammation The gum tissue may be tender circumferentially or sometimes it may be localized on one side of the tooth affected 3 Percuss teeth with mirror handle and observe the patient for pain response which may indicate periodontal inflammation 4 Pulp test and cold test teeth a sprained tooth unless it has been root canaled could be sensitive to cold and should respond to a pulp testpossibly with an elevated reading pending any associated pulpal inflammation secondary to periodontal inflammation 5 Place articulating paper over the affected teeth and have the patient grind widely right and left Observe the markings Any balancing side contact accompanied by a similar intensity working side contact on the same tooth detected by this method can lead you to suspect this syndrome How to explain STS to patients People do not chew their food in a straight up and down motion Rather they chew on a hinge using a lateral envelope of motion A persons cuspidcanine teeth should help to protect their molar cusps from banging against one another throughout this motion Cuspids are long rooted thickly buttressed in bone laterally have slanted incline biting surfaces and are positioned forwardly in the mouth These features make the cuspid teeth ideal as the kick stand for the mouth All of these protective features except the forward positioning are self explanatory For example the mouth is much like a nutcracker The further back you go in the mouth the more pressure is exerted That is why it is so important for the cuspids which are located anteriorly to bear the brunt of the chewing strokes to take the pressure off of the molars If the cuspids fail to protect then the molars will bump and grind and begin to wiggle When a post is wiggled back and forth in the ground eventually the post loosens up and gaps around the post can form The dentist needs to restore protection for the molars by either building up the cuspids adjusting the high spots from the cusps on the affected molars or a few other methods such as fabricating a nightgaurdbruxing appliance or orthodontic repositioning The affected tooth is like a sprained ankle and it will take a week or so to heal When the patient returns to chewing on the affected tooth they should start with soft foods first In addition headaches have known to have been caused by muscle tension STS may also be linked to an increase in grinding muscle tension and headaches In some cases solving these bite problems have resulted in less or no headaches Also inform the patient that gum chewing and single side chewing will also aggravate this syndrome STS Treatment Treating STS is rather straight forward the dentist must eliminate the second vector force on the tooth leaving the centric contact STS is caused by strong bilateral opposing vector forces so eliminating one of the opposing forces is essential However the elimination of the second vector force can be a complicated process The most common strategy is to mark the affected toothteeth in lateral excursive movements with articulating paper Determine the extent and origin of the problem Then develop a treatment strategy that will remedy the problem However complications may arise such as in a cross bite occlusal scheme As a general rule if more than 12 teeth are involved or if by adjusting the bite you will be creating new problems then you opt to not adjust the second vector contact There is a body of evidence that contralateral balancing side contacts may be important for condylar joint health In such cases eliminating this contact may do harm to the TMJ Building up the protected occlusion on the opposite side of the mouth fabricating a night grinding appliance to minimize nocturnal damage or orthodontically correcting the Opposing vector forces can appear in a buccallingual mesialdistal or any opposing vector direction in between The treatment is still the same safely eliminate the second vector force leaving the tooth in a stable position so that you dont have to keep adjusting the toothteeth every 6 months Successful treatment will be indicated by an immediate feeling by the patient that the bite feels different and better They may say things like The bite doesnt feel so tight or My teeth slide across each other much better Between a few days and a week the tooth will feel back to normal with a complete resolution of the subjective symptoms Headaches and grinding may be completely gone This conservative treatment approach is only for patients with mild to moderate pain that is usually manageable with ibuprofen Instruct the patient to contact the office if symptoms are not completely resolved within four to five days because it could be a sign that there is an early vital tooth infection which could lead to more serious problems if ignored If the symptoms dont resolve or if they get worse then instruct the patient to contact your office immediately and treat this tooth problem like an infection and prescribe your antibiotic of choice followed by the appropriate treatment When do you treat When the reward outweighs the risk Risk is 1 Removing healthy enamel unnecessarily breaking through to dentin or pulp 2 Changing the patients bite to one that is less stable or would somehow worsen their condition The more symptoms that the patient has pretreatment means that there is less risk that you will worsen their condition Minimizing Risk Limit the adjustment at 12 teeth If it is more than that or the occlusal scheme is complex like for instance a crossbite then you need to consider orthojaw surgery building up cuspids restoring all posterior teeth affected or make a lifetime night guard Jaw surgery and full mouth reconstruction are the most invasive and should be considered as a last resort If there are signs of opposing vector forces but no symptoms then there is no reward In these cases you watch it and advise the patient what symptoms may arise in the future If a patient makes a dedicated appointment to address this problem then there is a reward to treating this case and an effort is made to eliminate the second vector force on the affected tooth Most of the time the tooth and bite will feel 100 better immediately after adjusting Rewardyou fix their pain you make their bite feel better you validate their symptoms you diagnose what others may have missed you possibly help cure their headaches and possibly avert future periodontal problems which is a debate for another paperall using a conservative cost effective approach that expresses a genuine concern to solve their problem The patient cant help but to be grateful if it is successful and it becomes a huge practice builder Liability of not treatingThe patients symptoms possible periodontal damage and emotional frustration continue You may lose the patient seeking yet another opinion Followup is important for four reasons 1 To make sure the problem is solved to the patients satisfaction 2 It gives you another opportunity to gather information pertaining to the problem which will help you localize and treat it 3 To make sure that an early vital tooth infection can be ruled out If symptoms are permanently gone after 23 months then you can assume that there is no infection but you still xray the tooth at the 6 month recall 4 It shows the patient that you care and are really listening to their complaints ConclusionIt is my belief that there are many patients who are suffering from this syndrome It is poorly understood because there are several factors that contribute to its onset and severity 1 Bilateral opposing vector forces from occlusionof which premature contacts and eccentric excursions can be very complicated and difficult to detect 2 Biting force magnitudeof which position in the mouth steepness of cusps and muscular development are directly related and equally difficult to detect or measure 3 Frequency of the offending forceof which gum chewing frequent eating single sided chewing or frequency of grinding are important risk factors There are several factors that minimize the impact of this syndrome clinically 1 Pain tolerance 2 Blood flow to the area for repair of the inflamed tissue Regardless of how obscure this syndrome appears after reading this article it should be clear that unidirectional forces are tolerated better by teeth than bidirectional opposing vector forces Furthermore a dentist should be able to identify and treat patients who present with signs and symptoms of the Sprained Tooth Syndrome Electronic root canal preparation unit introduced Roots Summit VII to kick off June 20 Did you like this article Get more articles like this delivered to your inbox to our email newsletters 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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

sprained tooth syndrome
tooth retention
dentistry


Topics

AZ

Crouzon

syndrome

Crouzon

syndrome

Author

Brian

Wu

MD

candidate

Keck

School

of

Medicine

Los

Angeles

USA

DermNet

New

Zealand

Editor

in

Chief

Hon

AProf

Amanda

Oakley

Dermatologist

Hamilton

New

Zealand

December

What

is

Crouzon

syndrome

Crouzon

syndrome

is

characterised

by

a

variety

of

craniofacial

and

developmental

symptoms

It

is

a

hereditary

condition

inherited

in

an

autosomal

dominant

pattern

an

abnormal

gene

from

one

parent

can

cause

the

syndrome

It

is

also

known

as

Crouzon

disease

craniofacial

dysostosis

craniostenosis

ApertCrouzon

syndrome

acrocephalosyndactyly

type

II

Vogt

cephalosyndactyly

and

trigorhinophalangeal

dysplasia

It

was

first

described

by

Crouzon

in

Who

gets

Crouzon

syndrome

Crouzon

syndrome

is

rare

although

it

is

still

the

most

common

craniosynostosis

syndrome

where

the

fibrous

joints

of

the

skull

prematurely

close

during

infancy

It

affects

in

every

live

births

It

appears

to

be

diagnosed

equally

in

people

of

all

races

and

ethnicities

It

is

often

diagnosed

at

birth

or

in

infancy

due

to

distinctive

facial

features

What

causes

Crouzon

syndrome

Crouzon

syndrome

is

usually

caused

by

mutations

in

the

fibroblast

growth

factor

receptor

gene

The

gene

can

also

be

involved

This

mutation

leads

to

signals

to

immature

cells

to

become

bone

cells

during

embryogenesis

A

family

history

of

Crouzon

syndrome

is

present

in

of

cases

In

the

other

of

cases

the

syndrome

is

sporadic

resulting

from

new

gene

mutations

Genetics

of

Crouzon

syndrome

Image

courtesy

Genetics

Medics

What

are

the

clinical

features

of

Crouzon

syndrome

The

clinical

features

of

Crouzon

syndrome

vary

widely

and

range

from

mild

to

severe

The

key

feature

is

the

premature

closure

of

the

skullcap

and

cranial

base

sutures

and

craniosynostosis

Facial

features

Related

distinctive

facial

features

include

Exophthalmos

abnormal

protrusion

of

the

eyeball

Hypertelorism

excessive

width

between

the

eyes

Hypoplastic

maxilla

an

underdeveloped

jaw

Mandibular

prognathism

protrusion

of

the

lower

jaw

A

short

upper

lip

A

beaked

nose

Visual

defects

Visual

defects

associated

with

Crouzon

syndrome

include

Amblyopia

dimness

of

sight

without

apparent

change

in

the

eye

structures

Ametropia

refractory

error

Strabismus

inability

to

attain

binocular

vision

because

of

muscle

imbalances

in

the

eyeballs

These

visual

defects

are

due

to

corneal

injury

cataracts

a

clouding

of

the

lens

of

the

eye

or

its

surrounding

transparent

membrane

optic

atrophy

deterioration

of

the

optic

nerve

and

iris

coloboma

a

hole

in

the

iris

Other

features

Other

features

associated

with

Crouzon

syndrome

include

Decreased

mental

function

and

risk

of

increased

intracranial

pressure

and

seizures

Respiratory

symptoms

due

to

narrowing

of

the

nasopharyngeal

passage

and

deviated

septum

or

other

structural

abnormalities

Hearing

loss

andor

Ménière

disease

a

disorder

of

the

inner

ear

characterised

by

episodes

of

vertigo

ringing

in

the

ears

hearing

loss

and

pressure

in

the

ear

Skeletal

abnormalities

including

the

fusion

of

the

spinal

column

The

main

dermatological

sign

of

Crouzon

syndrome

is

acanthosis

nigricans

in

which

there

is

thickened

hyperpigmented

skin

with

a

velvety

feel

affecting

the

neck

torso

and

face

It

usually

occurs

by

the

onset

of

puberty

Acanthosis

nigricans

These

patients

did

not

have

Crouzon

syndrome

How

is

Crouzon

syndrome

diagnosed

Crouzon

is

confidently

diagnosed

in

a

child

with

craniosynostosis

when

mutations

on

the

gene

are

detected

The

genes

of

the

affected

individuals

parents

may

also

be

tested

to

detect

mosaicism

possessing

cells

of

two

or

more

genetically

different

types

How

is

Crouzon

syndrome

treated

The

standard

treatment

for

Crouzon

syndrome

includes

early

craniectomy

the

surgical

removal

of

a

portion

of

the

skull

and

cosmetic

reconstruction

to

help

promote

normal

facial

growth

Multidisciplinary

care

may

involve

medical

and

surgical

assessment

and

management

of

symptoms

This

can

include

Ophthalmological

treatment

of

amblyopia

ametropia

and

strabismus

Audiological

treatment

and

myringotomy

for

hearing

loss

Shunting

to

treating

intracranial

pressure

due

to

hydrocephalus

increased

cerebrospinal

fluid

within

the

cranial

cavity

Tracheostomy

an

incision

in

the

windpipe

to

treat

airway

obstruction

Orthodontic

surgery

to

treat

irregularities

in

the

teeth

and

jaws

What

is

the

outlook

for

Crouzon

syndrome

Improvements

in

surgical

techniques

specifically

in

craniofacial

surgery

have

greatly

increased

quality

of

life

intellectual

and

physical

abilities

and

social

acceptance

for

children

with

Crouzon

syndrome

The

lifespan

for

individuals

with

Crouzon

syndrome

is

generally

normal

but

mortality

can

occur

due

to

airway

obstruction

acute

respiratory

distress

or

increased

intracranial

pressure

Selfskin

examination

New

smartphone

apps

to

check

your

skin

Sponsored

content

Related

information

References

Chen

H

Medscape

Genetics

of

Crouzon

syndrome

Updated

May

Available

at

accessed

July

Genetics

Home

Reference

US

National

Library

of

Medicine

Crouzon

syndrome

Available

at

httpsghrnlmnihgovconditioncrouzonsyndrome

accessed

July

National

Organization

for

Rare

Diseases

NORDCrouzon

syndrome

Updated

Available

at

httprarediseasesorgrarediseasescrouzonsyndrome

accessed

July

On

DermNet

NZ

Skin

signs

and

systemic

disease

Acanthosis

nigricans

Other

websites

Genetics

of

Crouzon

syndrome

Medscape

Books

about

skin

diseases

See

the

DermNet

NZ

bookstore

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out

DermNets

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of

Dermatological

Terms

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your

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above

to

see

the

UV

Full

UV

Report

With

your

help

we

can

update

and

expand

the

website

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Keratosis

Contact

Dermatitis

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Cell

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and

Wasp

Stings

Dermatitis

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Eruptions

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Multiforme

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O O B I B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O B I O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O B I O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


ACWA Power is preferred bidder for Umm Al Quwain project 20 June 2018 source desalinationbiz A consortium led by ACWA Power has emerged as the preferred bidder for the United Arab Emirates UAE Umm Al Quwain desalination plant project The new desalination plant will be in the north of Umm Al Quwain on the border with neighbouring emirate Ras Al Khaimah The UAEs Federal Electricity and Water Authority FEWA appointed ACWA Power and partner Tecton Engineering and Construction to design build and finance a 205000 m3d capacity plant at Umm Al Quwain and operate it for 25 years There will be a final round of contract talks with the aim to achieve financial close by Q3 2018 The water agency confirmed that three further desalination plant projects for which locations and capacities have been agreed are to be tendered before the end of 2018 all on a publicprivate partnership PPP model Umm Al Quwain is the first desalination project in UAE to be structured as a PPP UAE receives 14 bids for Umm Al Quwain desal plant October 2016 Tags Click a keyword to see more stories on that topic view related news or find more related items Faversham House Group Ltd 2018 Water desalination reuse news articles may be copied or forwarded for individual use only No other reproduction or distribution is permitted without prior written consent

B I O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Book review John Grishams latest The Reckoning is good bad then good again But theres still a problem By Herb Scribner HerbScribner Published October 23 2018 700 am Updated Oct 23 2018 951 am Want to email this article or 1 Comment 1 of 4 View 4 Items Penguin Random House John Grishams latest legal thriller is The Reckoning THE RECKONING by John Grisham Doubleday 432 pages SALT LAKE CITY Reading John Grishams latest novel is like riding a roller coaster Sometimes it dips sometimes it rises sometimes you wish you were off it and had opted for fried dough instead The Reckoning is Grishams latest legal thriller this time bringing readers into a postWorld War II environment where beloved farmer Pete Banning murders Dexter Bell a Mississippi towns humble pastor for unclear reasons In three parts Grisham shows us Petes trial his experiences in World War II and what happens to his family after the trial comes to an end The first part is great and suspenseful the next part less so and the third part offers a smooth yet unfulfilling ending The opening section of the novel that is to say Petes trial is the most intriguing and thrilling part of the story Mystery surrounds Petes decision to murder the pastor something in the past that he refuses to tell the jury In fact he refuses to defend his actions at all answering only I have nothing to say That is the only case the farmer makes for himself choosing to accept the jurys decision about the crime regardless if it means he dies or not The murderers motive is an intriguing mystery that instantly grips you And because the novel Sorry image failed to load Bebeto Matthews Associated press Author John Grisham is shown in New York on Tuesday Nov 3 2009 Grishams latest legal thriller is The Reckoning But the second part of the book is a slog through the marshy waters of World War II combat and history It reads like a history textbook representing a major slow down for what had all the makings of a thrilling mystery We learn about Petes past in the military and though the pages are filled with scenes of war the drama moves too quickly to make you care emotionally about whats happening to Pete or his combat battalions And then theres the third part where we see what happens to Petes children Joel and Stella Banning The entire third part is centered around Stella and Joel figuring out why Pete murdered the pastor and their mothers own mysterious end Although the idea of solving the mystery is intriguing we dont get an answer about why Pete killed the pastor until the final three pages of the book And even then its one of those surprising twists that you couldnt have guessed on your own Grisham is a veteran writer when it comes to suspenseful law and weaving a tale around a central mystery But the ending of this book feels like it was the end result of a cheap trick to keep readers engaged The question of why Pete Banning killed Dexter Bell remains prevalent throughout the entire book so much so that youre willing to chop your way through the secondpart slog to get to that answer Sorry image failed to load Penguin Random House John Grishams latest legal thriller is The Reckoning Leaving the books central mysterys resolution to the final pages however lessened the value of the entire reading experience It didnt help that the final scene of the book ended with Joel and Stella having a conversation that amounted to an oh well shrug of the shoulders 1 comment on this story But dont take this as a sign that Grisham is washed up He still knows how to hold a readers attention and keep us invested But he waited too long to reveal why Pete killed the pastor taking us through a slowly paced wartime narrative that felt more like a history book than a crime novel While he picks up the narrative again for the final third grabbing readers attention once again its clear he could have cut away the fat in the second part to help the book flow more easily The Reckoning is a sign that Grisham still has good stories to tell Hes not slowing down But he might do well to consider his pacing and reveal the answer to mysteries a little sooner Content advisory The book contains strong language references sex abortion and warfare and mild violence Herb Scribner Herb Scribner is a writer for DeseretNewscom HerbScribner hscribnerdeseretnewscom Top Comments All Comments 1 Anonymous100 Anywhere UT Up until a few years ago I had read every book that John Grisham published Then he made that insipid comment that our laws are too hard Add a comment

O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O


40 Crucial Lessons From The Most Famous Graphic Designers In History by Designhill Tweet October 21 2017 in Graphic Designers 11 min read httpswwwdesignhillcomdesignblogp19769 0 Comments Last updated on November 16th 2018 Graphic design is a vast creative area To make a mark it demands that graphic designers comes out with new concepts every single time But that condition is only for the designers who wish to stand out Now its upto you whether you decide to be one of those designers doing routine and cliched works that no one remembers or you want to be one of the renowned designers who are remembered for their stellar designs Can you design nothing but letters to tell a story like iconic graphic designer Wolfgang Weingart does He shows us how radical experiments with typography can create new trends Or have a look at amazingly expressive designs from Peter Saville He uses loud and bold colors which other designers generally avoid Many such great graphic designers share one common traitthey all create something that is captivating and outofthe box A close study of their work will elevate your design skills and thinking to a new level So are you satisfied with churning out meaningless design items day in and day out Or would you like to create something that is extraordinary If you dream of making it big in the graphic design world then learn from iconic graphic designers To make your search for great graphic designers easier we jotted down 40 essential points from famous graphic designers which if implemented can change graphic design for good Observe their works and skills and fall in love with their amazing creations Get inspired from them Here Are 40 Most Famous Graphic Designers 01 David Carson Break The Existing Rules With the reputation for breaking conventions Carson is most famous graphic designers He believes that what matters is the intuitive design sense His work shows an affinity for everyday objects which shows that for a designer it is important to find beauty and interest in everyday things Looking for a graphic designer We have helped thousands of business owners from all around the world with their graphic design needs such as a logo design website design social media posts banner and much more Hire Freelance Graphic Designer Get a free quote 02 Stefan Sagmeister Upset The Norm Known for unorthodox provocative designs Stefan believes in altering popular perceptions He is an accomplished contemporary designer and gives painstaking detail to his work His body of work makes him a cunning trickster with blending sense of sexuality and humor through typography design conceptual exhibitions and also environmental art 03 Saul Bass Learn From The Master A legend in the world of design Saul Bass started working in the mid 20th century His distinctive minimal style stepped up the sophistication of movie posters His signature kinetic type design are seen in logos which are solid timeless and thoughtful Do you want a logo design based on minimalistic design principles for your business Such a logo conveys your brand message with balanced emotions for a desired effect on your target audience If you wish to get many such logo design ideas you should approach Designhill which is a leading crowdsourcing marketplace having hundreds of professional logo designers There is absolutely zero risk in using this site as you get 100 Money Back Guarantee if you are not satisfied with the logo works 04 Paula Scher Wholly New Symbology The first woman described as the master conjurer of the instantly familiar Paula Scher straddles the design lines between fine art and pop culture Her eclectic approach to typography has helped to reimagine the urban landscape Her graphic identities have become case studies for the contemporary regeneration of brand logos 05 Michael Bierut Making Difficult Content Accessible Often referred to as democratizing design Michael Bierut has an everpresent approach to graphic designing Bierut paved the way to creating sharp concrete and direct design for complex content making and is considered one of the famous graphic designers of the 20th century 06 Massimo Vignelli Convey Busy Ideas Easily Covering nearly every field of design such as brochure design Massimo is an avid fan of modernism and does not entertain any form of clutter or unnecessary material in the design Famous graphic designers 2017 follow his concise work where experimental abstracted designs are predominantly visible Abstract design style is often visible also in the works of illustrations and graphics designers 07 Paul Rand Everything Is Design Blend Copy With The Design Paul Rand developed radical new methods in the field of logo creation and designing by visually transforming America post WWII He removed copywriting from the principal position in design and simplified the amount of the type Form and function interacts in his design rather than one dominating the other 08 Milton Glaser Easy To Understand Wonder where the iconic I NY brand came from He also created poster designs for Bob Dylan and made it one of his timeless and most powerful creations Flat color and contoured lines created an emblematic image in his work 09 Alan Fletcher Expressing With Typography Sometimes named as the British father of graphic design Alan Fletcher is amongst the top list of famous graphic designers He focused on expressive typography with strong visual language with the help of bold colors Typography is not an optional decorative extra according to him but is a crucial element to business in graphic design Make sure that as a typography based graphic designer you look for new ways to use typeface to create unique designs Recommended Reading The Ultimate Guide To Get Started As A Freelance Graphic Designer 77 Catchy And Creative Slogans For Graphic Designers 50 Amazing Graphic Designers You Should Know 12 Key Photoshop Shortcuts All Graphic Designers Must Know 10 Lester Beall A Creative Problem Solver Inspirational avantgarde designs with his revolutionary attitude left a mark on the design community He believed that graphic designing are no less than creative problem solvers and should have equal involvement in the marketing side of business 11 Hermann Zapf Be A Game Changer Hermann Zapf has major contribution in the field of typography Palatino Zapf Dingbats Optima are some of the popular typefaces that he created and also pioneered computerized typography He invented a typesetting program which now serves as the trend setter in modern day software developments 12 Claude Garamond The Trend Setter Back in 1505 Claude Garamond became the first ever person to specialize in type design in a professional capacity Garamond created a series of iconic typefaces one of which is named after him Garamond and other like Sabon Granjon are still in use 13 William Golden Another Pioneer Name William Golden changed the graphic design industry with his bold punchy work at CBS and was acclaimed for his stylistic approach He paved the way for the thought that a designer and an artist are two different identities 14 Jan Tschichold Bring Prolific Changes Establishing new typographical standards Tschichold worked for the standardization of paper sizes and created the new day guidelines for typographical hierarchy The iconic orange Penguin Book cover design is one of his celebrated works 15 Cipe Pineles Fly Away From Limited Designs The first female designer to become a member of the Art Directors Club in New York Cipe Pineles created the trend with illustrating in massmarket publications Vogue and Vanity Fair has her work and had long standing trend within magazine design 16 Jacqueline Casey Designs With Strong Meaning She was celebrated for her majorly influential Swissinspired posters She was an active member in developing the emerging European Swiss typography and design Her work is still considered in case studies of clean strong design with impactful meaning 17 Abram Games Believed In Maximum Meaning Minimum Means An official WWII artist Games work set a trend for designers everywhere with the motto maximum meaning minimum means The design is meant to be neat and simple with direct meaning Clutterfree designs are the best when you are aiming for simplicity and aesthetics of the works Your website design for example can convey its brand message instantly with few images minimum use of typeface and other elements Such a site will linger in memories for long Recommended Reading Tips To Manage Your Clients As Freelance Graphic Designer Top 10 iOS Apps for Graphic Designers Nifty Tips to Help Graphic Designers Find Good Clients And Avoid the Bad Ones Wow Benefits of Designhills OneToOne Projects for Freelance Graphic Designers 18 Susan Kare Merging Designs In Technology A contemporary designer Susan Kare is a known for works as Geneva typeface Monaco typeface icons like the trash can and more She developed a series of interface element designs for Apple and majority of them has influenced much of the current interface design 19 Josef MullerBrockmann Grid In Designs Capturing the ins and outs of Swiss design his greatest legacy lies in the role of development and using grid system in graphic design The tool is even used daily by contemporary designers 20 Armin Hofmann Less Is More Powerful clean designs of Hoffman has inspired designers from past and present The purpose making of the designs are very well conveyed through the effective and timeless designs 21 Chip Kidd Mastering The Visual Narration A contemporary designer Chip Kidd has a unique approach to design with narrative in visual language This radical way of designing makes it memorable and timeless Do you also wish to create an impressive visual language through your graphic design A clever and strategic use of colors is your best bet to ensure a desired visual environment in your creation 22 Seymour Chwast Concentrate On Design Disciplines Often referred to the one who shaped contemporary design and illustration his iconic and expressive style blend the two disciplines to create clean minimalist nature of Swiss design 23 Alexey Brodovich Be Updated With Trends Simpler and modern designs were created by Brodovich which consistently was used to experiment not only in designs but also in typography photography and layout design 24 Max Miedinger Miedinger is known for developing one of the most popularly used typefaces in the world Helvetica and is a paragon of Swiss design with flexible clean and legible designs 25 Herb Lubalin Pun For Fun Lubalins typographics enhanced the scope for written messages with creating different visual language and puns 26 John Maeda Interact With Audience Maeda redefined the use of computerized media and explored both digital mediums and analogue resulting in development of interactive motion graphics Recommended Reading Designhill to Introduce OnetoOne Projects for Freelance Graphic Designers Why You Need Professional Graphic Designer For Your Business How a Freelance Graphic Designer Should Work with Clients Top 5 Infographics of 2014 Every Graphic Designer Must Explore 27 April Greiman Inculcate New Tech Recognized as one of the first designers to encourage the implementation of technology in graphic design Greiman pioneered the move to put graphic in graphic design 28 Ladislav Sutnar Convey The Information Famous for making sense out of nonsense through graphical design Sutnars techniques include limiting his color and type palettes to bring clarity in designs 29 El Lissitzky Power Though Visuals Known for his political propaganda poster designs used huge domino effect and stylized shapes to create a powerful visual language 30 Muriel Cooper 3D Designing Creating visual depth size changes 3D type shifts in focus Cooper created a ground breaking step in the modern day digital design 31 Alvin Lustig More Suggestive Designs A radical approach of Lustig operated under a suggest dont tell method His designs visually captured the tone of the text and did not plainly summarize the content 32 Otl Aicher Creating Identities Known for using pictograms Otl Aicher created a stunning identity with the use of vibrant colors and a strict grid system Simple stick figure graphics is also his famous work 33 Lucian Bernhard Minimalist Approach No slogans and flat colors was Bernhards approach which is very much into modern design practices for minimalist designs 34 Neville Brody Edgy Designs Gaining inspiration from punk movement Brody created punchy unique edge and revolutionized album and magazine covers If your magazine is doing a story on an exciting and pathbreaking issue make sure that your magazine cover design features the story in clean and precise manner Recommended Reading Top Graphic Designers to Follow on Twitter New Year Resolutions of Leading Graphic Designers Tips To Follow While You Work with Famous Graphic Designers 3 Ways In Which Graphic Designers Influence Your Business 35 Erik Nitsche Convey Powerful Ideas His own personal modernist flair now serves as a trend in creating industrial designs as well as commercial ones 36 Adrian Frutiger Readable Typefaces Frutiger focused on the necessity for typefaces and amplified his personal aesthetic on developing new ones Younger type designers should also think of newer ones 37 Ivan Chermayeff Abstract Is The New Shape Abstracted shapes for logos can be the new norm to create impactful designs 38 Peter Saville Bold And Expressive Iconic record and album cover designer his expressive style gives a new standard to design 39 Wolfgang Weingart New Typography Best described for spontaneous Swiss design and dramatic sans serif type radical experiment with typography can create new trend 40 Bradbury Thompson Be Experimental Pushing the envelope beyond the described norms his experimentation with photography type and color has inspired a generation of designers Are You Looking for a New Graphic Designer If Yes Call Us on 1 888 7652908 times for calling 9am to 6pm EST US or Register for a Free Design Consultation Conclusion A deeper look at the works of these legendary graphic designers can inspire you to come out with something unique and pathbreaking Just as you see their design works you learn many things about concepts and how to execute concepts into wonderful designs Get Your Logo Design Designhill aka Designhill Designhill is the most reliable and fastestgrowing custom graphic design crowdsourcing marketplace that connects a thriving community of graphic designers from across the globe with clients looking to source high quality graphic designs such as logo designs banner designs packaging designs merchandise designs web designs and many other designing works at affordable prices In just six months of going live the startup has helped more than 1500 businesses source unique graphic designs and has paid out more than 70000 to its evergrowing community of 29000 graphic designers logo designers visual artists and illustrators from all over the world Twitter Say thanks or boo to Designhill Contact Location DL Posts 233 Sorry the browser you are using is not currently supported Disqus actively supports the following browsers Firefox Chrome Internet Explorer 11 Safari

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graphic designers
history
wolfgang weingart


Last

edited

Nov

Collaborative

practices

for

building

design

and

construction

Contents

Introduction

The

importance

of

collaboration

Working

practices

Procurement

Organisation

Roles

and

responsibilities

Information

management

Building

information

modelling

BIM

Related

articles

on

Designing

Buildings

Wiki

External

references

Introduction

In

the

Latham

Report

Constructing

the

Team

investigated

the

perceived

problems

with

the

construction

industry

describing

it

as

ineffective

adversarial

fragmented

and

incapable

of

delivering

for

its

customers

proposing

that

there

should

be

greater

partnering

and

teamwork

This

message

was

reinforced

by

the

Egan

Report

in

Rethinking

Construction

the

Government

Construction

Strategy

in

and

the

Farmer

Review

Modernise

or

Die

which

made

a

similar

somewhat

damning

assessment

of

the

industry

suggesting

among

many

criticisms

that

The

UK

does

not

get

full

value

from

public

sector

construction

There

is

broad

consensus

spread

both

across

the

industry

and

its

customers

that

construction

underperforms

There

are

poor

and

inconsistent

procurement

practices

leading

to

waste

and

inefficiency

There

are

low

levels

of

standardisation

and

fragmentation

of

the

public

sector

client

base

The

importance

of

collaboration

Establishing

collaborative

practices

is

of

particular

importance

on

building

design

and

construction

projects

as

they

are

likely

to

involve

bringing

together

large

number

of

diverse

disciplines

many

of

whom

will

not

have

worked

together

before

They

are

also

likely

to

involve

the

coordination

and

integration

of

a

great

deal

of

complex

information

procedures

and

systems

Failure

to

establish

clear

and

efficient

project

wide

collaborative

practices

can

be

disastrous

This

has

become

increasingly

true

as

project

structures

have

evolved

from

straightforward

client

consultant

contractor

relationships

to

more

integrated

structures

with

complex

financing

arrangements

early

engagement

of

the

supply

chain

and

the

introduction

of

subcontractor

and

supplier

design

Working

practices

Procurement

It

is

important

to

establish

the

broad

principles

of

collaborative

practice

as

early

as

possible

in

a

project

even

if

some

specific

details

are

left

unresolved

until

later

stages

A

decision

to

adopt

a

collaborative

approach

should

be

taken

at

the

outset

by

the

client

perhaps

with

advice

from

independent

client

advisers

so

that

a

requirement

to

follow

appropriate

procedures

can

be

included

in

appointment

documents

and

can

be

a

consideration

in

the

selection

of

procurement

route

form

of

contract

and

preparation

of

tender

documentation

The

implementation

of

collaborative

practices

should

then

be

discussed

in

detail

during

consultant

team

startup

meetings

specialist

contractor

startup

meetings

and

precontract

meetings

The

Government

Construction

Strategy

recommends

that

public

projects

adopt

design

and

build

private

finance

initiative

or

primetype

contract

procurement

routes

as

these

are

considered

to

be

more

collaborative

They

also

suggest

adoption

of

the

form

of

contract

which

they

believe

encourages

collaboration

more

effectively

than

some

other

more

traditional

contracts

which

can

be

seen

as

adversarial

Other

forms

of

collaborative

procurement

include

partnering

sometimes

referred

to

as

alliancing

which

is

a

broad

term

used

to

describe

a

management

approach

that

encourages

openness

and

trust

between

the

parties

to

a

contract

The

parties

become

dependant

on

one

another

for

success

and

this

requires

a

change

in

culture

attitudes

behaviours

and

procedures

throughout

the

supply

chain

It

is

most

commonly

used

on

large

longterm

or

high

risk

contracts

Where

a

partnering

relationship

is

for

a

specific

project

it

is

known

as

project

partnering

Where

it

is

a

multi

project

relationship

it

is

known

as

strategic

partnering

Partnering

contracts

are

often

arranged

on

a

cost

reimbursable

target

cost

openbook

basis

including

both

incentives

and

penalties

Partnering

agreements

include

the

project

partnering

contract

the

term

partnering

contract

the

NEC

partnering

agreement

and

the

ICE

Partnering

Addendum

See

Partnering

for

more

information

Organisation

Organisational

working

practices

that

encourage

collaboration

might

include

Evaluation

of

the

behaviours

and

collaborative

competence

of

individuals

in

teams

during

the

procurement

process

Clear

lines

of

communication

and

authority

Protocols

for

the

preparation

and

dissemination

of

information

Co

location

of

team

members

Financial

motivation

such

as

tying

the

consultant

team

and

the

contractor

into

a

common

target

cost

for

which

there

is

joint

pain

or

gain

Rewarding

initiative

This

can

be

particularly

important

for

members

of

the

client

team

whose

careers

are

likely

to

be

assessed

solely

on

the

basis

of

their

normal

activities

rather

than

their

involvement

in

a

project

Recognising

the

work

they

put

into

a

project

and

rewarding

them

for

this

is

important

if

they

are

to

remain

committed

Regular

workshops

and

team

meetings

Problem

resolution

procedures

which

should

be

based

on

solutions

not

blame

Procedures

to

ensure

continuous

improvement

This

might

require

continual

benchmarking

target

setting

assessment

feeding

back

and

adaptation

Early

warning

procedures

Social

activities

Roles

and

responsibilities

Clarity

of

responsibility

and

coordination

can

be

improved

by

the

appointment

of

A

project

sponsor

or

client

representative

Client

champions

for

different

aspects

of

the

project

A

project

manager

A

lead

consultant

A

lead

designer

A

design

coordinator

for

the

coordination

and

integration

of

design

prepared

by

specialist

contractors

An

information

manager

for

computer

aided

design

CAD

or

building

information

modelling

BIM

In

addition

the

appointment

of

a

construction

manager

or

management

contractor

or

early

appointment

of

a

design

and

build

contractor

can

result

in

better

integration

of

design

and

construction

as

can

the

early

involvement

of

specialist

contractors

or

suppliers

This

may

have

an

impact

on

the

fee

profile

for

a

project

which

will

be

more

likely

to

be

frontloaded

but

should

result

in

fewer

problems

as

the

project

progresses

NB

The

Government

Construction

Strategy

proposes

that

public

projects

should

adopt

a

fully

integrated

approach

to

project

organisation

see

integrated

project

team

and

integrated

supply

team

Information

management

Ensuring

that

consultants

sign

up

to

the

use

of

compatible

systems

and

adopt

agreed

document

and

drawing

standards

will

help

facilitate

collaboration

Systems

might

include

Computer

Aided

Design

CAD

Building

Information

Modelling

BIM

Common

document

management

systems

Common

E

document

management

systems

these

can

be

in

house

or

externally

hosted

ie

a

project

extranet

Common

data

environment

A

consistent

approach

to

software

systems

versions

drawing

standards

and

file

formats

are

very

important

for

design

projects

and

will

avoid

duplicated

effort

and

errors

Drawing

standards

might

include

Layering

standards

Zoning

strategy

Grid

strategy

Origin

and

orientation

Naming

protocols

Agreed

standards

for

dimensions

abbreviations

and

symbols

Standard

templates

for

example

drawing

titles

Standard

page

sizes

and

scales

Distribution

protocols

Change

control

procedures

See

Collaborative

production

of

architectural

engineering

and

construction

information

Code

of

practice

Standardisation

procedures

also

apply

to

the

production

of

other

forms

of

project

documentation

The

creation

of

a

document

matrix

outlining

key

documents

that

will

be

required

in

the

development

of

the

project

their

format

and

distribution

can

be

beneficial

Establishing

a

common

data

environment

CDE

within

which

the

creation

of

information

such

as

drawings

can

be

shared

between

the

consultant

team

can

improve

efficiency

avoid

duplication

and

enhance

coordination

See

Common

Data

Environment

for

more

information

Building

information

modelling

BIM

Building

Information

Modelling

BIM

is

seen

increasingly

as

a

means

of

facilitating

collaborative

working

BIM

is

a

very

broad

term

that

describes

the

the

process

of

creating

a

digital

model

of

a

building

The

range

of

levels

of

this

type

of

modelling

are

categorised

as

Level

Unmanaged

CAD

Level

Managed

CAD

in

or

Level

Managed

environment

with

data

attached

but

created

in

separate

discipline

models

Level

Single

collaborative

online

project

model

with

construction

sequencing

cost

and

lifecycle

management

information

In

the

UK

the

Government

Construction

Strategy

states

that

the

Government

will

require

fully

collaborative

BIM

with

all

project

and

asset

information

documentation

and

data

being

electronic

as

a

minimum

by

This

represents

a

requirement

for

Level

BIM

on

public

projects

Fundamentally

the

purpose

of

BIM

is

to

ensure

that

appropriate

information

is

created

in

a

suitable

format

at

the

right

time

so

that

better

decisions

can

be

made

throughout

the

design

construction

and

operation

of

built

assets

It

is

not

about

creating

a

model

for

its

own

sake

and

it

is

not

an

addon

process

BIM

is

fundamental

to

the

way

a

project

is

set

up

and

run

The

move

to

a

more

collaborative

way

of

working

and

the

adoption

of

BIM

can

require

a

significant

change

in

culture

It

can

be

useful

to

appoint

a

BIM

champion

to

ensure

the

successful

integration

of

BIM

into

the

entire

project

team

from

the

outset

This

can

also

be

true

for

individual

companies

where

a

BIM

champion

can

help

encourage

and

facilitate

the

adoption

of

BIM

See

BIM

for

more

information

Adversarial

behaviour

in

the

UK

construction

industry

Agreement

Appointing

consultants

Can

relationships

in

and

between

organisations

make

tangible

differences

to

business

performance

Change

control

procedures

Clash

avoidance

Consultant

team

startup

meeting

Design

coordination

Design

team

meeting

Document

control

Egan

Report

Framework

agreement

Government

Construction

Strategy

Integrated

project

delivery

IPD

Integrated

project

team

Integrated

supply

team

Integrated

systems

Knowledge

management

Latham

Report

Leadership

styles

Multidisciplinary

Partnering

PPC

Record

keeping

Relationship

management

Supply

chain

management

Team

behavioural

roles

Team

management

External

references

OGC

Collaborative

practices

OGC

Collaborative

Procurement

Documents

OGC

Achieving

Excellence

in

Construction

Procurement

Guide

The

integrated

project

team

team

work

and

partnering

RICS

Guidance

Note

Managing

the

design

delivery

A

guide

to

best

practice

RICS

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engineering

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O B O O B O O O B O O B B I B B I O B B I O B O O O O B I O O B O B I B I B O B I B I B O O O O O O O O O O O O B O O O O O O O O O O O O O B O O O O O O O O O O O O B B I O O O O O O O O O O B B I O O O O O O O O O O O B B I O O O O O O O O O O O B O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O


May 16 2008 Why Did God Permit Slavery Resource with John Piper Topic Tough Texts The following is an edited transcript of the audio Why did God permit slavery There are Old Testament laws and principles that dont have validity today and there is a redemptivehistorical flow in the Bible that accounts for why some things were both commanded and permitted earlier that arent now Part of this flow is that the people of God in the Old Testament were a political and ethnic reality with God as their King and later with an earthly king God ordained in those circumstances that his people immediately exercise some of his rights and his judgments upon the people Therefore you have the entire annihilation of the Canaanites by Joshua and his army with brutal universal destruction Thats because God said in Deuteronomy Im punishing these people for their sins Its not your righteousness O Israel that is bringing this about Its their sins that are bringing this about So he was using his people as an instrument for his own judgment In the context of a theocracy that was legitimate and right for God to do even though the people themselves may have been sinful in the execution And it was similar with things like slavery God saying Now here comes Jesus and he undoes much of the Old Testament law In fact I think he undoes all of it as law according to Romans 74 where it says that we died to the law so that we may belong to another And the reason he undoes it is not because it was wrong under those circumstances to do what he said to do Rather with the coming of Christ his rejection of an earthly kingdom and the establishment of a spiritual kingdom Jesus says that the kingdom will be taken away from the Jews and be given Now the Kingdom of God isnt political ethnic or geographical It has no king It is a church made up of all ethnicities from all over the world and therefore it has a very different witness to bear in the world It is a go tell religion not a come see religion It is a religion of binding Jew and Gentile of all stripes together in the blood of Christ not the religion of a Jewish phenomenon performing wonders that the world could look on and maybe get saved And under that new circumstanceof a spiritual dying and rising Messiah who reigns from heaven with no political dimensions to his faith on the earth and a desire for all the peoples to come together not just one ethnicity and a desire that the command of love take on a whole new universal scope because the very essence of the incarnation and the death of Christ was to love your enemiesa whole string of Old Testament processes procedures and commandments go by the wayside as part of the old system and not part of the new Now with regard to slavery in particular it seems to me that the New Testament also causes us problems because it tells slaves to be submissive to their masters and for masters not to threaten their slaves So its operating with a system of slavery that was given at that time However the commands that are given and their context I think contain all the seeds for undoing anything like what we had in this country for example with the owning of human beings and its racial basis The book of Onesimus Philemon is the book that is brought forward most oftenand rightly I thinkto show that Paul was sowing the seeds to explode the whole situation of slavery Onesimus himself was a slave when he got converted Paul sent him back to Philemon who had been his master and he said I am sending him back as a brother Honor him I think that kind of spiritual dynamic is intended to explode the system Another thing to explode the system is when Paul says to masters Do not threaten them remembering that you too have a master So he puts the command of neighborlovedo unto others as you would have them do unto youin the place of the right of the master to threaten And if you dont threaten what do you do You win by love and that transforms slavery into employment So I think its not wrong that the Christians in America moved from a justification of slavery to a justification of the abolition of slavery and that it was long and hard in coming The biblical principles that were used to undermine the Old Testaments own speech about slavery was appropriate Its right to say that there are changes that come about in the process of redemptivehistory which make some laws in the Old Testament no longer appropriate or relevant at all in the New Testament John Piper JohnPiper is founder and teacher of desiringGodorg and chancellor of Bethlehem College Seminary For 33 years he served as pastor of Bethlehem Baptist Church Minneapolis Minnesota He is author of more than 50 books including Desiring God Meditations of a Christian Hedonist and most recently Expository Exultation Christian Preaching as Worship

O O O O O B I I O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Renovated Hotel Fort Des Moines promises to be breathtaking owner says Raj Patel of Hawkeye Hotels talks about renovating Hotel Fort Des Moines Rodney WhiteThe Register Photo Special to the Register CONNECT COMMENT The Hotel Fort Des Moines will become one of Hilton Hotels boutique inns when massive renovations to the historic downtown Des Moines building are completed by the end of next year The 40 million project will renovate the 101yearold hotel from top to bottom It will reopen as part of Hiltons Curio Collection which is comprised of 51 hotels in 17 countries said Mark Nogal global head of Curio Collection by Hilton The nearly fouryearold company looks for independent hotels that have a unique history and connection to their community he said The Hotel Fort Des Moines located at 1000 Walnut St will use the Hilton reservation system but its name will stay the same The Diplomat Resort Hollywood Curio Collection by Hilton was built in 1958 Photo Curio Collection by Hilton We will carry our own name and our own brand and identity said Raj Patel chief development officer for Hawkeye Hotels The Coralvillebased company which owns 55 hotels in 14 states purchased the Hotel Fort Des Moines for 4 million in 2015 It has been closed since November 2015 Patel who serves on Curios owners advisory council said the Hotel Fort Des Moines fits Curios brand well I didnt want to get rid of the Hotel Fort Des Moines name he said The only reference to the Hilton Curio Collection that visitors will see is a plaque inside the lobby he said Hotel Fort Des Moines will remain on the marquee Construction on the highly anticipated project is expected to begin in the next 30 to 60 days with interior demolition Patel said The renovated Hotel Fort Des Moines will include remodeled guest rooms Photo Special to the Register We are still working through final construction details but I suspect we will have that wrapped up in the next 60 days he said The renovation will maintain and restore many of the hotels historic elements while updating its 290 guest rooms with modern designs The crown jewel will be the removal of a second floor that will expose the lobbys original majestic twostory ceiling It has been infilled for 50 years I still can not envision or imagine what that will look like but I think it will be breathtaking and enormous Patel said It will look like it did originally The Presidential Suite at Hotel Fort Des Moines in 1978 Register file photo Fullscreen 23 Photos 23 photos Hotel Fort Des Moines over the years Other vintage features like original terrazzo and marble floors and ornate plaster ceilings will be kept A large wire sculpture will sit where a fountain was once located When you walk in there will be no mistake that youre walking into a cherished gem and historic icon Patel said This popular downtown Des Moines restaurant will close in February You will feel the historical nature but there will be modern touches especially in the guest rooms he said The renovated hotel will appeal to all kinds of visitors and offer another option for political events especially during the Iowa caucus season Patel said Room prices will be determined by the market but likely will be at the top end of the upper scale he said Raj Patel Corporate Director of Development for Hawkeye Hotels shows off historical photos from Hotel Fort Des Moines Monday Feb 2 2015 in Des Moines Iowa Rodney WhiteThe Register Fullscreen 23 Photos 23 photos Hotel Fort Des Moines is purchased by Hawkeye Hotels The hotel was built in 1917 by local Des Moines businessmen who wanted to boost the citys image with a flagship hotel World leaders and celebrities including Bill Clinton Charles Lindbergh Elvis Presley and Soviet Premier Nikita Khrushchev have stayed at the hotel The project is scheduled to go before the citys Urban Design Review Board for a final review Tuesday morning Features of the renovation include A second prominent entrance to the hotel on Walnut Street the main entrance will remain on 10th Street A courtyard on the north side of the building An updated entry canopy and windows with the exterior cleaned and tuckpointed Returning former office and banquet spaces into guest rooms Relocating the main desk back to its original location which will open up the second story and expose the mezzanine Renovated meeting and ballroom spaces Remodeled guest rooms and bathrooms with new drywall painting furniture and fixtures Invision Architecture of Des Moines and the New Yorkbased Krause Sawyer interior design firm are working on the renovation A framed and signed portrait of Katharine Hepburn at Hotel Fort Des Moines Wednesday July 22 2015 Memorabilia from Hotel Fort Des Moines to be sold in sale scheduled for August 7th and 8th Rachel MummeyThe Register Fullscreen 1 of 20 20 Photos 20 Photos Hotel Fort Des Moines Memorabilia For Sale Patel says hes eager to get the work started Its been such a long and in some ways painful process he said But I am never giving up on the project Des Moines gives 4 million to developers renovating the Midland Building into a hotel The biggest stumbling block has been cost he said It costs a lot more to restore a historic building than it does to build a new building It is hard to justify that kind of cost when there are new properties at a lower price point he said We have to make sure we have every i dotted and t crossed so that we are setting ourselves up for success

O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O