CAIRO (Reuters) - Islamist militants are shifting their focus from southwest Asia to Arab North Africa and stepping up violence in the region, Tunisian President Moncef Marzouki said in an interview published on Tuesday.
Moderate Islamists who were harshly suppressed by secular Arab dictators have gained political power or prominence following popular uprisings in Tunisia, Libya and Egypt.
But armed, militant Islamist groups, including the North African wing of al Qaeda, have also benefited from lapses in internal security across the region wrought by the often chaotic transition to more democratic government.
Marzouki told pan-Arab daily al Hayat that some of Tunisia's hardline Salafists had links to al Qaeda and that North African countries would work before the end of the year to form a united front against the threat of rising Islamist militancy.
"The centre of the terrorist movement is moving now from Afghanistan and Pakistan to the Arab Maghreb region ... and the great danger is at our doors," Marzouki said.
He said around 3,000 Salafists in Tunisia were estimated to be potentially dangerous and described them as a "cancer" in the country, the first in the Arab world to bring down dictatorship in a wave of popular uprisings.
Marzouki, a secularist in office under a power-sharing deal with the moderate Islamist Ennahda party after it won a free election a year ago, said talks with such militants were futile and the threat they posed must be addressed with legal measures.
SECURITY VACUUM
"(Militants) are mainly present in Libya and Algeria, and especially in the south," Marzouki said, referring to the remote and thinly populated desert expanses of the Maghreb where policing is weaker and there has been traditional tribal resistance to central authority.
"There is a security problem now threatening the entire Arab Maghreb region ... All our southern borders are threatened with this problem now. There has to be a unified response from all the countries."
Last month, Salafists predominated in a crowd of protesters who ransacked the U.S. embassy in Tunisia in fury over a film insulting the Prophet Mohammad, killing two people, and the U.S. ambassador to Libya was killed in an Islamist militant ambush.
Al Qaeda's affiliate in North Africa then urged Muslims to kill more U.S. government representatives in the region - particularly in Libya, Tunisia, Morocco and Mauritania.
AQIM, or Al Qaeda in the Islamic Maghreb, emerged out of Algeria's civil conflict but has gradually expanded south into the Sahara and raised its profile in recent years with hit-and-run attacks and kidnapping of Westerners for ransom.
There have been no Arab Spring-style revolts in Algeria or Morocco. But Algeria's government has long clashed with Islamist militants particularly from AQIM on its territory while Morocco has suffered occasional fatal bomb attacks.
Marzouki also said that Arab peacekeeping forces should enter Syria to prevent chaos in a transitional period if Syrian President Bashar al-Assad succumbed to an uprising now in its 18th month. "(Assad's) regime is finished and dead, and we must move now. Syria could enter a stage of overwhelming chaos."
Rivalries among world and regional Arab and Muslim powers have prevented effective foreign intervention in Syria's conflict.
(Reporting by Shaimaa Fayed; Editing by Mark Heinrich)
If you want to choose an Auto Insurance, then you have to look carefully about the time requirements and select whether you require compensation for business or for your personal needs. The price of the compensation is depending on such factors as age, driving history and the type of vehicle. Car Insurance redress can vary in every different country. To this article, I would describe to you type or types of several scope of Insurance. Car Insurance Quotes compensation for business, the scope of the gaps and compensation, automatic shorter spaces of time long-term and temporary in nature.
You will need the insurance indemnity business types of the car if you use the vehicle for business purposes. With this coverage you don't need to worry about the car that you use for business. A professional driver, like for example the driver of the vehicle trailers will probably need to have this type of business insurance fully. This kind of policy has all goals such as the comprehensive insurance for the case of an accident. Compensation commercially includes all the dangers caused by factors such as storms, fire theft, flood turmoil and other natural disasters. The level of coverage depends on commercial use and condition of the car in question.
The US Energy Information Administration (EIA) recently published an article describing an increase in the energy content of municipal solid waste (MSW). The reason for this increase is an increase in the percentage of waste from "non-biogenic" sources (i.e. plastics) as compared to biogenic sources (paper, cardboard, wood, food and yard waste, etc.) Biogenic waste has an average heat content of 11 MMBtu/ton, as compared to 23 MMBtu/ton for non-biogenic waste.
The EIA attributes the relative decrease in the amount of (biogenic) food containers and packaging (heat content 16.6 MMBtu/ton) and an increase in waste polypropylene (PP, 38 MMBtu/ton). PP is the relatively hard-to-recycle plastic #5, found in yogurt cups and other wide-necked containers, and has a much higher heat content that relatively easy-to-recycle plastics #1 and #2 (PETE at 20.5 MMBTu/ton and HDPE at 19.5 MMBtu).
The higher heat content of MSW should make generating electricity from MSW more efficient, and give a slight boost to margins of waste-to-energy companies like MSW electricity generators like Covanta (NYSE:CVA) and Algonquin Power and Utilities (AQUNF.PK), which generates thermal energy from MSW in addition to a large renewable energy business.
However, if increasing energy content of waste is to make a difference in the stock prices of MSW-to-energy firms, it will have to be sustained over the long term. I doubt the trend will continue for long. First of all, total MSW volumes are flat in the US, and falling on a per-capita basis, even while recycling rates are rising (EIA data).
I expect increased recycling to begin to reduce the energy content of the remaining waste as less-recycled, higher energy-content materials are increasingly recycled. Currently, only 13.5% of plastic containers in the waste stream are recovered, as opposed to 71% of paper and 33% of glass. Further, high-energy PP is becoming increasingly easy to recycle; I was recently pleased to find that it and LDPE (plastic #4, also with a relatively heat content of 24.1 MMBtu) are now accepted at my local transfer station.
While waste-to-energy companies may be getting a small margin boost from higher MSW heat content today, investors should not count on any such boost being permanent. That's a large part of the reason why my preferred investments in MSW are integrated companies like Waste Management (NYSE:WM), which can profit from both increased recycling and waste-to-energy opportunities.
Disclosure: Long AQN, MW
This article was first published on the author's Forbes.com blog, Green Stocks on September 6th.
DISCLAIMER: Past performance is not a guarantee or a reliable indicator of future results. This article contains the current opinions of the author and such opinions are subject to change without notice. This article has been distributed for informational purposes only. Forecasts, estimates, and certain information contained herein should not be considered as investment advice or a recommendation of any particular security, strategy or investment product. Information contained herein has been obtained from sources believed to be reliable, but not guaranteed.
Fresh and Alive! Raw Vegetarian Recipes Free Downloads - Flmsdown
Processing. Please wait...
?
Fresh and Alive! Raw Vegetarian Recipes
E-Books
Fresh and Alive! Raw Vegetarian Recipes 2xDVDRip | AVI / DivX, ~1079 kb/s | 720x360 | Duration: 03:47:44 | English: MP3, 64 kb/s (2 ch) | + PDF Guide | 1.84 GB Genre: Cooking
Hippocrates Health Educator, Ken Rohla, shows you step-by-step how to make 27 of his exclusive, easy, and great-tasting recipes, from salads and raw pasta dishes to crackers, snacks, smoothies, and desserts, including information on proper food combining, recommended equipment and its use, juicing wheatgrass and green drinks, food prep tricks, and much more. With over 3-1/2 hours of video on two DVDs, this will show you the techniques to also make the variety of dishes found in other raw food recipe books. Each recipe is indexed in the DVD menu so you can go right to the recipe you want to watch ??? no wading through a long video to find what you're looking for. Comes with the recipes in a booklet for quick reference in your kitchen, and a food combining chart for enjoying truly healthy raw vegan meals.
Download link: (Buy premium account for maximum speed and resumming ability)
Links are Interchangeable - No Password - Single Extraction
Fresh and Alive! Raw Vegetarian Recipes rapidshare free full downloads. Fresh and Alive! Raw Vegetarian Recipes download torrent. Related News{related-news}
?
?
2005-2011 FlmsDown Flmsdown does not store any files on it's server, we are just indexing other sites contents! Abuse Mail : Contact - DMCA Policy Home - Software - Games - Movies - Music - E-Book - Magazines - Graphics - Celebrities - GSM - Other - Top
The Casio XJ-H2650 isn't Casio's brightest projector, but it's part of Casio's Pro Series, which is its brightest line of projectors. It also offers WXGA (1280 by 800) native resolution, the highest in the Pro Series line. That's a moderately big deal, because until now, if you wanted a WXGA Casio projector you had to settle for one of the lower brightness models. The XJ-H2650 delivers the highest brightness Casio offers with WXGA resolution, and the highest resolution with Pro Series brightness, all of which makes it a good choice for mid-size conference rooms and classrooms.
Casio rates the XJ-H2650 at 3500 lumens, a bit less bright than the 4,000 lumen Casio XJ-H1750 Pro Series that I reviewed earlier this year. However, the XJ-H1750 offers a native XGA (1,024 by 768) resolution.
The only other Pro Series model with WXGA resolution is the XJ-H2650's near twin, the Casio XJ-H2600 ($2,000 street). Casio says that the two models are identical except for the addition of USB A, USB B, and LAN ports to the XJ-H2650, along with features that depend on those ports. Most notably, the XJ-H2650's USB A port lets you plug in a supplied Wi-Fi adaptor so you can connect directly with, and send data images from, Windows and Mac computers as well as most Android, iOS, and Windows smartphones and tablets.
The extra ports also let you plug in a memory key to read JPG and a few other file formats directly, control the projector over a network, send data images over a network, and add interactivity with an interactive pen and software option ($260 street). However, the interactive feature is hard to recommend, since the projector's standard-throw lens would make it hard to interact with the image without casting shadows that would get in the way. All other features on the XJ-H2600 and XJ-H2650 should be identical, so the rest of the comments in this review should apply to both.
Basics, Setup, and Connections Like all current Casio projectors, the XJ-H2650 is built around Casio's hybrid light source, consisting of LEDs and a laser paired with a DLP chip. The LEDs produce the red and blue primaries directly. The laser shines on a phosphor element to produce green.
Not too surprisingly, given that both projectors are part of the same Pro Series, the XJ-H2650 shares a lot of its basic features with the XJ-H1750. In particular, it weighs almost the same, at 15.6 pounds, which makes it most appropriate for permanent installation or room to room portability on a cart.
Setup is standard, with a manual focus and a manual 1.2x zoom, which gives you some welcome flexibility in how far you can put the projector from the screen for a given size image. In addition to the LAN and USB ports I've already mentioned, connection choices include the usual HDMI for a computer or video source, VGA for computer or component video, and both S-video and composite video inputs.
Brightness and Eco Modes In my tests, the XJ-H2650 was easily bright enough in its brightest mode for a 78-inch wide (92-inch diagonal) image to stand up to the typical level of ambient light in an office or classroom setting. Even better, it was bright enough at that size so you could easily take advantage of its eco modes to minimize power use and save on electricity.
Most projectors offer one bright mode and one eco mode that lets you lower brightness and power consumption. Beyond that, they offer color presets that can also affect brightness, but are, in theory, meant to adjust color.
The XJ-H2650 gives you more flexibility for brightness and power use, with two non-eco modes, which I measured at 340 watts and 290 watts, plus five eco modes, with a measured range of 260 to 115 watts. With multiple eco modes, you have the freedom to pick the best color setting first, and then choose the least bright mode with the brightness you need, instead of using the color presets to adjust brightness. Also worth mention is that the only projector I've seen with more eco-mode levels is the laser-based BenQ LX60ST that I recently reviewed.
ScienceDaily (Sep. 28, 2012) ? Many white sharks shift from fish to marine mammals as they mature, but individual sharks show surprising variability in dietary preferences.
White sharks, the largest predatory sharks in the ocean, are thought of as apex predators that feed primarily on seals and sea lions. But a new study by researchers at the University of California, Santa Cruz, shows surprising variability in the dietary preferences of individual sharks.
The researchers described their findings in a paper published online September 28 in PLoS ONE. They analyzed the composition of growth bands in shark vertebrae to trace variations in diet over a shark's lifetime. Stable isotopes of carbon and nitrogen incorporated into an animal's tissues serve as a natural tracer of dietary inputs.
"We did find that white shark diets changed with age, as expected, but we were surprised that the patterns and extent of change differed among individuals," said Sora Kim, who led the study as a UCSC graduate student and is now at the University of Wyoming.
The researchers analyzed vertebrae of 15 adult white sharks that had been caught along the west coast (14 off California and one off Baja California). Sharks in this population consume a wide range of prey, including seals, sea lions, dolphins, fish, and squid. But not every shark eats the same mix of prey, said coauthor Paul Koch, professor of Earth and planetary sciences at UCSC.
"We confirmed that the diets of many individuals observed at seal and sea lion rookeries shift from fish to marine mammals as the sharks mature," he said. "In addition, we discovered that different individual sharks may specialize on different types of prey. These two types of flexibility in feeding behavior are difficult to document using traditional methods, but may be very important for understanding how the population is supported by the eastern Pacific ecosystem and how it may respond to changes in that ecosystem."
The National Oceanic and Atmospheric Administration (NOAA) recently announced that it will consider whether to protect the west coast population of white sharks under the Endangered Species Act.
Tagging studies have shown that the white sharks found along the California coast have a regular migratory pattern, cruising coastal sites from late summer to early winter and moving to offshore areas during the rest of the year. While sharks within this population may have predictable movement patterns, the new study shows that there are important dietary and behavioral differences among individual sharks.
The study relied on vertebrae obtained from white shark specimens in various collections. The sharks had been caught at different times and places along the coast from 1957 to 2000. "Interestingly, we do see a small shift in diet as marine mammal populations increased after the passage of the Marine Mammal Protection Act in 1972," Kim said.
In addition to Kim and Koch, the coauthors of the paper include James Estes, professor of ecology and evolutionary biology at UCSC, and Tim Tinker, a biologist with the U.S. Geological Survey and adjunct professor of ecology and evolutionary biology at UCSC. This research was funded by the National Science Foundation.
Share this story on Facebook, Twitter, and Google:
Other social bookmarking and sharing tools:
Story Source:
The above story is reprinted from materials provided by University of California - Santa Cruz. The original article was written by Tim Stephens.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
Kim SL, Tinker MT, Estes JA, Koch PL. Ontogenetic and Among-Individual Variation in Foraging Strategies of Northeast Pacific White Sharks Based on Stable Isotope Analysis. PLoS ONE, 2012 DOI: 10.1371/journal.pone.0045068
Note: If no author is given, the source is cited instead.
Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.
The business media use Twitter as a promotional tool and are not building an online community, according to research presented Friday by two Virginia Commonwealth University professors.
Vivian Medina-Messner and Marcus Messner found that the top business media outlets need to use Twitter as an online social network, not just another publication platform. ?More attention needs to be paid to community building ? use of hashtags, handles, retweets,? the wrote.
Their research was presented Friday at the 11th annual ?Convergence and Society? conference at the University of South Carolina in Columbia, S.C. The conference, which is organized by the USC College of Mass Communications and Information Studies, this year is focused on business journalism.
The professors studied tweets, retweets, headline tweets, Twitter handle use, hashtag and link use by media and frequency of retweets by audience for nine major business media outlets between July and September. The business media outlets were the Wall Street Journal, Financial Times, New York Times business section, CNBC, Fox Business, Bloomberg, Fortune, Businessweek and The Economist.
Of those media Twitter accounts, The Economist has the most followers with more than 2.3 million, while Fox Business has the least with 105,000. However, Bloomberg News uses Twitter the most, while Fox Business uses it the least.
However, nearly 45 percent of all business media tweets are simply headlines, and 99.8 percent simply link to internal links. Only one out of every six business media tweet uses a hashtag, and? only one out of every eight is a retweet.
Fortune magazine retweets (one-third of all of its tweets during the study time) the most, while The Economist does no retweeting. Fox Business Network uses hashtags the most, with more than half of its tweets having hashtags. It also tweets headlines the least of all of the business media.
On average, readers of The Economist Twitter feed retweet the most, or about 126 retweets per tweet, while followers of The Wall Street Journal Twitter feed retweet the least, with an average of 3.6 retweets per tweet.
Medina-Messner and Messner suggest that in-depth interviews with social media editors and reporters at business media could help better understand why some business news organizations use Twitter more than others.
FILE - In this July 29, 2012 file photo, Republican presidential candidate, former Massachusetts Gov. Mitt Romney meets with Israel's Prime Minister Benjamin Netanyahu, in Jerusalem. Romney is set to speak by telephone with Netanyahu on Friday. The Republican presidential nominee's campaign confirms the scheduled conversation. It would come the same day that President Barack Obama also is expected to speak with Netanyahu phone. (AP Photo/Charles Dharapak, File)
FILE - In this July 29, 2012 file photo, Republican presidential candidate, former Massachusetts Gov. Mitt Romney meets with Israel's Prime Minister Benjamin Netanyahu, in Jerusalem. Romney is set to speak by telephone with Netanyahu on Friday. The Republican presidential nominee's campaign confirms the scheduled conversation. It would come the same day that President Barack Obama also is expected to speak with Netanyahu phone. (AP Photo/Charles Dharapak, File)
Republican presidential candidate, former Massachusetts Gov. Mitt Romney listens to a question as he speaks with the media aboard his campaign plane during a flight to Boston, Friday, Sept. 28, 2012. (AP Photo/ Evan Vucci)
Republican presidential candidate, former Massachusetts Gov. Mitt Romney pauses as he speaks with the media aboard his campaign plane during a flight to Boston, Friday, Sept. 28, 2012. (AP Photo/ Evan Vucci)
BOSTON (AP) ? Mitt Romney says he doesn't believe military action will be necessary to prevent Iran from obtaining nuclear weapons.
The Republican presidential nominee says he discussed the issue with Israeli Prime Minister Benjamin Netanyahu (neh-ten-YAH'-hoo) by telephone Friday afternoon. Romney later told reporters traveling with him that it's unclear whether there is any difference between their so-called "red lines" on when launching military action against Iran would be appropriate.
Romney says he can't completely take the military option off the table because Iran needs to take the threat seriously. But he says he does not believe force will ultimately be needed.
Netanyahu argues that an attack on Iran's nuclear facilities may be the only answer.
President Barack Obama also spoke to Netanyahu on Friday.
CAIRO (Reuters) - Egypt's presidency and prime minister said on Saturday security forces in North Sinai were working to return Coptic Christians living near Egypt's border with Israel to their homes after they fled in fear of attack from Islamist militants.
Nine Christian families living in Rafah near Egypt's border with Israel left their homes on Friday after Islamist militants made death threats and gunmen attacked a Coptic-owned shop.
Analysts say Islamists with possible al Qaeda links have gained a foothold in Sinai and the departure of the families could fuel concerns about religious tolerance and the rise of militancy after the overthrow of President Hosni Mubarak.
"The Coptic families quit their homes pre-emptively but the governor of North Sinai has given orders to return them to their homes and this is being carried out now," said Yasser Ali, presidential spokesman.
Two armed men riding a motorcycle opened fire on a Coptic-owned shop in Rafah on Wednesday but no one was injured.
Prime Minister Hisham Qandil said militants had not tried to force the Coptic families from the border town and they had left of their own accord. However, death threats against the Copts had been printed on flyers circulating in the desert area.
"We must uproot fear and provide all security measures to every citizen," Qandil said.
Israel has voiced concern about security in Sinai, where at least four cross-border attacks have taken place since Mubarak was toppled in February 2011.
Egypt's new president, Mohamed Mursi, has vowed to restore order. But efforts to impose central authority are complicated by the indigenous Bedouin population's ingrained hostility to the government in Cairo. (Writing by Marwa Awad; Editing by Sophie Hares)
Patient selection for bilateral total knee replacement needs improvementPublic release date: 28-Sep-2012 [ | E-mail | Share ]
Contact: Phyllis Fisher phyllis.fisher@gmail.com 212-606-1724 Hospital for Special Surgery
Because there are more risks with having a total knee replacement in both legs at the same time than having a knee replacement in one leg, doctors in recent years have been selecting younger and healthier patients for the bilateral procedure. Now a new study by researchers at Hospital for Special Surgery has revealed that although patients are younger and healthier than those undergoing only one-sided surgery, they are becoming sicker and some complication rates have risen.
"Although we are selecting younger people, we can't ignore the fact that the population in general is getting sicker," said Stavros Memtsoudis, M.D., Ph.D., director of Critical Care Services at Hospital for Special Surgery (HSS) in New York City, who led the study. "Many of the complications that we studied didn't decrease over time as you would expect with younger patients and better health care, and some of the complications even increased." The study is published online ahead of print in the journal Clinical Orthopaedics and Related Research.
Rising levels of obesity appear to be driving the complication rates, as well as the increase in the utilization of total knee replacements. Obesity puts extra stress on joints and bones and can cause premature osteoarthritis.
To conduct their research into trends regarding bilateral total knee replacements, researchers at HSS turned to the Nationwide Inpatient Survey, sponsored by the Agency for Healthcare Research and Quality (AHRQ). This is the largest inpatient database available in the United States that includes information on patients of all ages. It collects data from about 20% of all hospitalizations in the U.S. The study investigators identified 258,524 bilateral total knee replacements performed between 1999 and 2008. The number of annual bilateral procedures increased by 75%. In 1999, bilateral procedures accounted for 3.7% of all knee replacement operations and in 2008, they accounted for 6% of the operations.
The average age of patients undergoing bilateral knee replacement decreased by 2.5 years from 1999 to 2008. As the years marched on, patients presented with higher rates of comorbidities, including renal failure, neurologic disease, liver disease, diabetes, and chronic obstructive pulmonary disease. Obesity increased by 131% during the study period. The only comorbidity that decreased was congestive heart failure.
Over the time period studied, the researchers identified a 3% increase in pneumonia, a 6% increase in pulmonary embolism, and a 3% increase in nonmyocardial infarction cardiac complications.
"The take home message of this paper is that we are fighting an uphill battle, because people are getting sicker, despite us attempting to limit risk by choosing younger people to do these procedures in," said Dr. Memtsoudis. "We have to start thinking of other interventions other than patient selection that we can implement in order to reduce these complications."
On a positive note, the investigators also found that absolute in-hospital mortality rates decreased at an average rate of 10% per year. The researchers attribute this decrease to advances in medicine and increased use of telemetry and observation in the last 10 to 15 years. "With advances in medicine and monitoring, we have been able to counteract this extreme event of mortality. If you get a complication and it is not recognized, you may die from it," said Dr. Memtsoudis. "If you observe people more thoroughly, you may not be able to prevent the complication, but you may be able to prevent a mortal event resulting from it."
The researchers also identified a cost shifting landscape. Patients stayed in the hospital an average of five days after their procedure in 1999 and an average of four days in 2008, but the proportion of discharges to a home or customary residence without home health care decreased at an average rate of 5.5% per year.
"Before this study, we were under the assumption that patient complications were steadily decreasing after bilateral knee arthroplasty, because of better patient selection and improvements in medical care," said Dr. Memtsoudis. "Now we understand that the picture is more complex. Patients being selected for the procedure may be getting younger, but they are not getting healthier and maybe that is why we don't see a drastic drop in complications."
Before embarking on a bilateral knee replacement, he said, patients should "critically look at themselves and talk to their physicians about how their health status plays into the choice of surgery."
More work is needed to identify ways to prevent complications in patients undergoing bilateral knee replacement and a recent conference sponsored by the Hospital for Special Surgery is aiming to do just that. The Consensus Conference on the Creation of Guidelines for Bilateral Knee Arthroplasty involved 40 experts from 16 institutions. The guidelines coming out of this conference, which are expected to be published within the next six months, address issues such as determining the appropriate workup and management for a patient undergoing bilateral knee replacement, and how long doctors should wait between procedures if a patient undergoes two operations.
###
Other authors involved in the study include Ottokar Stundner, M.D., from Hospital for Special Surgery; Madhu Mazumdar, Ph.D., from NewYork-Presbyterian Hospital; Carlos Mantilla, M.D., Ph.D., from the Mayo Clinic; and Javad Parvizi, M.D., from the Rothman Institute, Thomas Jefferson University Hospital. The study was funded by the Clinical Translational Science Center at Weill Cornell Medical College; the National Institutes of Health's National Center for Advancing Translational Sciences; and the Agency for Healthcare Research and Quality's Center for Education, Research, and Therapeutics.
About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology, No. 10 in neurology and No. 5 in geriatrics by U.S. News & World Report (2012-13), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. HSS is a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Patient selection for bilateral total knee replacement needs improvementPublic release date: 28-Sep-2012 [ | E-mail | Share ]
Contact: Phyllis Fisher phyllis.fisher@gmail.com 212-606-1724 Hospital for Special Surgery
Because there are more risks with having a total knee replacement in both legs at the same time than having a knee replacement in one leg, doctors in recent years have been selecting younger and healthier patients for the bilateral procedure. Now a new study by researchers at Hospital for Special Surgery has revealed that although patients are younger and healthier than those undergoing only one-sided surgery, they are becoming sicker and some complication rates have risen.
"Although we are selecting younger people, we can't ignore the fact that the population in general is getting sicker," said Stavros Memtsoudis, M.D., Ph.D., director of Critical Care Services at Hospital for Special Surgery (HSS) in New York City, who led the study. "Many of the complications that we studied didn't decrease over time as you would expect with younger patients and better health care, and some of the complications even increased." The study is published online ahead of print in the journal Clinical Orthopaedics and Related Research.
Rising levels of obesity appear to be driving the complication rates, as well as the increase in the utilization of total knee replacements. Obesity puts extra stress on joints and bones and can cause premature osteoarthritis.
To conduct their research into trends regarding bilateral total knee replacements, researchers at HSS turned to the Nationwide Inpatient Survey, sponsored by the Agency for Healthcare Research and Quality (AHRQ). This is the largest inpatient database available in the United States that includes information on patients of all ages. It collects data from about 20% of all hospitalizations in the U.S. The study investigators identified 258,524 bilateral total knee replacements performed between 1999 and 2008. The number of annual bilateral procedures increased by 75%. In 1999, bilateral procedures accounted for 3.7% of all knee replacement operations and in 2008, they accounted for 6% of the operations.
The average age of patients undergoing bilateral knee replacement decreased by 2.5 years from 1999 to 2008. As the years marched on, patients presented with higher rates of comorbidities, including renal failure, neurologic disease, liver disease, diabetes, and chronic obstructive pulmonary disease. Obesity increased by 131% during the study period. The only comorbidity that decreased was congestive heart failure.
Over the time period studied, the researchers identified a 3% increase in pneumonia, a 6% increase in pulmonary embolism, and a 3% increase in nonmyocardial infarction cardiac complications.
"The take home message of this paper is that we are fighting an uphill battle, because people are getting sicker, despite us attempting to limit risk by choosing younger people to do these procedures in," said Dr. Memtsoudis. "We have to start thinking of other interventions other than patient selection that we can implement in order to reduce these complications."
On a positive note, the investigators also found that absolute in-hospital mortality rates decreased at an average rate of 10% per year. The researchers attribute this decrease to advances in medicine and increased use of telemetry and observation in the last 10 to 15 years. "With advances in medicine and monitoring, we have been able to counteract this extreme event of mortality. If you get a complication and it is not recognized, you may die from it," said Dr. Memtsoudis. "If you observe people more thoroughly, you may not be able to prevent the complication, but you may be able to prevent a mortal event resulting from it."
The researchers also identified a cost shifting landscape. Patients stayed in the hospital an average of five days after their procedure in 1999 and an average of four days in 2008, but the proportion of discharges to a home or customary residence without home health care decreased at an average rate of 5.5% per year.
"Before this study, we were under the assumption that patient complications were steadily decreasing after bilateral knee arthroplasty, because of better patient selection and improvements in medical care," said Dr. Memtsoudis. "Now we understand that the picture is more complex. Patients being selected for the procedure may be getting younger, but they are not getting healthier and maybe that is why we don't see a drastic drop in complications."
Before embarking on a bilateral knee replacement, he said, patients should "critically look at themselves and talk to their physicians about how their health status plays into the choice of surgery."
More work is needed to identify ways to prevent complications in patients undergoing bilateral knee replacement and a recent conference sponsored by the Hospital for Special Surgery is aiming to do just that. The Consensus Conference on the Creation of Guidelines for Bilateral Knee Arthroplasty involved 40 experts from 16 institutions. The guidelines coming out of this conference, which are expected to be published within the next six months, address issues such as determining the appropriate workup and management for a patient undergoing bilateral knee replacement, and how long doctors should wait between procedures if a patient undergoes two operations.
###
Other authors involved in the study include Ottokar Stundner, M.D., from Hospital for Special Surgery; Madhu Mazumdar, Ph.D., from NewYork-Presbyterian Hospital; Carlos Mantilla, M.D., Ph.D., from the Mayo Clinic; and Javad Parvizi, M.D., from the Rothman Institute, Thomas Jefferson University Hospital. The study was funded by the Clinical Translational Science Center at Weill Cornell Medical College; the National Institutes of Health's National Center for Advancing Translational Sciences; and the Agency for Healthcare Research and Quality's Center for Education, Research, and Therapeutics.
About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology, No. 10 in neurology and No. 5 in geriatrics by U.S. News & World Report (2012-13), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. HSS is a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
One Momento is an interesting social experiment in what's truly important in life
There are a lot of terrific camera apps out there. Most people prefer Instagram for its filters and ability to share your photos with others, while some prefer the more powerful set of tools Snapseed offers. One of the newest camera apps for your iPhone is One Memento, a curious "photography experiment" that allows you the ability to take just one single photograph.
Once you've signed in to the app through Twitter, you can flick your fingers to ceremoniously break the app's seal and take one?? and only one?? photograph. Once the picture is taken and edited using the supplied filters, the app assigns your memento a number, and uploads it to a searchable database.?Even if you're not interested in taking a photo to share, you can still look through the gallery of what appear to be some very impressive pictures. You can choose to like a photo, or share it with your friends.
We're somewhat intrigued by what some of the One Memento users have shared thus far. For Memento #1375, for example, uploader "Andy" shared a picture of the Great Sand Dunes National Park, explaining "I always wanted to visit the Great Sand Dunes and don't want to forget it." It's a great shot, and it's a great idea?? by allowing only one picture per person, One Memento is creating a database of 250,000 images that have actual meaning to the photographer.
You can download the free One Memento app on the Apple App Store.
[via Laughing Squid]
This article was written by Fox Van Allen and originally appeared on Tecca
FILE - This is a Sunday, April 15, 2012 file photo of British boy-band One Direction arrive for the Logies, an Australian television industry awards night, in Melbourne, Australia. One Direction's latest single sums it up. "Live While We're Young" is the first track off their second album, and the boys are happy to have it as a motto. The members of the British pop group admit they're making the most of being young, successful and extremely popular. (AP Photo/Paul Jeffers, File)
FILE - This is a Sunday, April 15, 2012 file photo of British boy-band One Direction arrive for the Logies, an Australian television industry awards night, in Melbourne, Australia. One Direction's latest single sums it up. "Live While We're Young" is the first track off their second album, and the boys are happy to have it as a motto. The members of the British pop group admit they're making the most of being young, successful and extremely popular. (AP Photo/Paul Jeffers, File)
LONDON (AP) ? One Direction's latest single sums it up: "Live While We're Young."
The members of the British pop group say they are happy to have that first track off their second album as a motto ? and admit they're making the most of being young, successful and popular.
"We're working a lot, so when we're not, it's nice to have fun and enjoy yourself," singer Harry Styles, 18, said in an interview Wednesday. "It's important."
He was accompanied by band mates Niall Horan, Louis Tomlinson, Zayn Malik and Liam Payne ? and they're all quick to laugh at themselves and each other.
These five names are known around the globe since their debut album, "Up All Night," became a No. 1 smash worldwide earlier this year.
So who they date and where they go is heavily reported, especially by the British press. But Tomlinson, 20, says they don't mind being trailed by the paparazzi.
"If we go out on a night out and we're a little bit drunk, it's not obviously going to be a great picture, but it's not too bad," he said. "The fact is we're young ? everyone who is our age is going out."
Tomlinson added that "everyone complains about paps (paparazzi), but we always have a laugh with them, to be honest."
They enjoyed shooting the video for the single "Live While We're Young," which is out in the U.K. on Sept. 30.
Fans were quick to chat about the bare-chested scenes that Horan did but he shrugged off the sex idol comments, saying he was just warm, not showing off.
And the band members had a laugh and worked up a sweat trying zorbing ? running around in giant plastic balls like hamsters.
If there's anything controversial about the sound of their feel-good new single, it's that the start of the song is similar to The Clash's "Should I Stay Or Should I Go."
"It's a bit like the first single ("What Makes You Beautiful") where the opening riff sounds similar to a certain film ("Summer Nights" from "Grease")," explains Styles. "It's kind of on purpose though, it's a great riff."
Their sophomore album, "Take Me Home," will be released Nov. 12 and 13 in the U.K. and the United States.
Despite joking that they've got rapping and choirs involved this time around, the guys admit that fans can expect more of their same catchy pop style.
"There aren't too many surprises," Styles said. "We're just really happy with how the album's come out. We all agree that it's better than the first one ... we're proud of it."
"In the least arrogant way," Tomlinson made sure to add.
He then pondered why.
"We're a better band. We're closer as friends, we've got better vocally, it's all experience," he said.
![[ Back to EurekAlert! ]](http://www.eurekalert.org/images/back2e.gif){kind=small}
Public release date: 28-Sep-2012
Share ] 
