B y R us se ll E ri c Wr ig ht, DV M. M as te r of S ci en ce I n V et er in ar y Me di ca l Sc ie nc es. A pp ro ve d:

Size: px
Start display at page:

Download "B y R us se ll E ri c Wr ig ht, DV M. M as te r of S ci en ce I n V et er in ar y Me di ca l Sc ie nc es. A pp ro ve d:"

Transcription

1 E ff ec ts o f El ec tr ic al ly -S ti mu la te d Si lv er -C oa te d Im pl an ts a nd B ac te ri al C on ta mi na ti on i n a Ca ni ne R ad iu s Fr ac tu re G ap M od el B y R us se ll E ri c Wr ig ht, DV M T he si s su bm it te d to t he f ac ul ty o f th e Vi rg in ia P ol yt ec hn ic I ns ti tu te a nd S ta te U ni ve rs it y in p ar ti al f ul fi ll me nt o f th e re qu ir em en t fo r th e de gr ee o f M as te r of S ci en ce I n V et er in ar y Me di ca l Sc ie nc es A pp ro ve d: P et er K. Sh ir es, Ch ai rm an J er yl C. Jo ne s Ro be rt B. Du nc an J r. J ul y 7, B la ck sb ur g, V ir gi ni a K ey W or ds : S il ve r, i on to ph or es is, ra di us, fr ac tu re, ef fe ct s, o st eo my el it is C op yr ig ht , R us se ll E ri c Wr ig ht

2 E ff ec ts o f El ec tr ic al ly -S ti mu la te d Si lv er -C oa te d Im pl an ts a nd B ac te ri al C on ta mi na ti on i n a Ca ni ne R ad iu s Fr ac tu re G ap M od el B y R us se ll E ri c Wr ig ht ( Ab st ra ct ) T he p ur po se o f t hi s p ro je ct w as t o s tu dy t he e ff ec ts o f a no di c e le ct ri ca ll y s ti mu la te d s il ve r- co at ed s ta in le ss s te el i mp la nt s a nd b ac te ri al c on ta mi na ti on i n a c an in e r ad iu s f ra ct ur e g ap m od el. T we lv e s ke le ta ll y m at ur e c an in es w ei gh in g k g w er e u se d. D og s w er e r an do ml y a ss ig ne d t o i nt o c on tr ol a nd c on ta mi na te d g ro up s. A 5 m m o st ec to my g ap w as m ad e i n b ot h r ad ii o f e ac h d og. O ne r ad iu s o f e ac h d og w as s ta bi li ze d w it h a s il ve r- c oa te d s ta in le ss s te el b on e p la te a nd t he o th er w it h a n u nc oa te d s ta in le ss s te el b on e p la te. T he o st ec to my s it es w er e i no cu la te d w it h s te ri le P BS i n 6 d og s a nd S. i nt er me di us i n t he o th e r 6 d og s. E ac h i mp la nt s et w as e le ct ri ca ll y s ti mu la te d w it h d ir ec t c ur re nt f or 20 m in ut es d ai ly, f or 10 d ay s. A ni ma ls w er e t re at ed w it h C ep ha le xi n o ra ll y f or 10 d ay s. R ad io gr ap hs w er e o bt ai ne d a t t wo w ee k i nt er va ls. A ni ma ls w er e e ut ha ni ze d a t 1 2 w ee ks a nd e ac h p la te w as c ul tu re d. R ad io gr ap hi c, h is to lo gi c a nd

3 b ac te ri ol og ic e va lu at io ns o f e ac h r ad iu s w er e p er fo rm ed. T he d if fe re nc e i n b on e h ea li ng b et we en s il ve r- co at ed a nd s ta in le ss s te el t re at ed r ad ii w as d et er mi ne d f or e ac h d og b y s ub je ct iv e r ad io gr ap hi c e va lu at io n a nd q ua nt it at iv e a na ly si s o f r ad io gr ap hi c d en si ty u si ng c om me rc ia l s of tw ar e. A t w ee k 12, a s ig ni fi ca nt d ec re as e i n b on e h ea li ng w as f ou nd o n r ad io gr ap hi c e va lu at io ns a nd q ua nt it at iv e b on e a re a a na ly si s o f c on ta mi na te d r ad ii t ha t w er e t re at e d w it h e le ct ri ca ll y s ti mu la te d s il ve r- co at ed i mp la nt s ( p- va lu e a nd r es pe ct iv el y). I no cu lu m o r i mp la nt t re at me nt t yp e s ho we d n o s ig ni fi ca nt d if fe re nc e o n r ad io gr ap hi c e va lu at io ns o r q ua nt it at iv e b on e a re a a na ly si s. N o s ig ni fi ca nt d if fe re nc es w er e d et ec te d i n r ad io gr ap hi c e va lu at io ns o f o st eo my el it is o r h is to lo gi c e va lu at io ns o f b on e h ea li ng, i nf la mm at io n a nd p er i- im pl an t r es or pt io n. C ul tu re r es ul ts w er e n ot i nd ic at iv e o f S. i nt er me di us i no cu la t e d o st eo my el it is. T he u se o f a b il at er al r ad ia l o st ec to my m od el a ll ow ed c om pa ri so n o f e le ct ri ca ll y st im ul at ed s il ve r- co at ed a nd u nc oa te d i mp la nt s w it hi n e ac h d og. B on e h ea li ng i n t he s ta bl e 5 m m f ra ct ur e g ap r ad ia l o st ec to my m od el, w as p ro gr es si ve i n b ot h c on ta mi na te d a nd n on -c on ta mi na te d s it ua ti on s. O ur s tu dy f ou nd a n eg at iv e e ff ec t o n b on e h ea li ng w he n e le ct ri ca ll y- st im ul at ed s il ve r s te ar at e c oa te d i mp la nt w er e u se d i n S. i nt er me di us c on ta mi na te d r ad iu s o st ec to mi es. T hi s t re nd b ec am e a pp ar en t a t 6 w ee ks p os t- op er at iv el y, b ut w as n ot s ta ti st ic al ly e vi de nt u nt il 12 w ee ks. F ur th er s tu di es a re iii

4 w ar ra nt ed t o e va lu at e t he a pp ro pr ia te p ro to co l, t he e ff ec ts o f, a nd i nd ic at ed u se o f t hi s t re at me nt m od al it y i n c on ta mi na te d f ra ct ur es a nd c li ni ca l o st eo my el it is s it ua ti on s. iv

5 G ra nt I nf or ma ti on T hi s p ro je ct w as m a de p os si bl e t hr ou gh t he g en er ou s f in an ci al s up po rt o f t he V ir gi ni a V et er in ar y M ed ic al A ss oc ia ti on V et er in ar y M em or ia l F un d a nd T he A O N or th A me ri ca R es id en t C li ni ca l T ra um a R es ea rc h P ro gr am. v

6 D ed ic at io n I w ou ld l ik e to d ed ic at e th is m an us cr ip t to m y lo vi ng w if e Sa ra h an d ou r so n Ca le b, w ho se s up po rt a nd u nd er st an di ng w er e un en di ng a nd u nc on di ti on al. vi

7 A ck no wl ed ge me nt s T he a ut ho r w is he s t o t ha nk G er mi ll e C ol ma no, M ar th a M oo n, D an ie l W ar d, J oh n S tr au ss, T ar yn B ra nd t, S us an A ye rs, K im W ri gh t, J en ni fe r L es se r a nd D r. J oh n R ob er ts on f or t he ir a ss is ta nc e w it h t hi s s tu dy. vii

8 T ab le o f Co nt en ts A bs tr ac t G ra nt I nf or ma ti on D ed ic at io n A ck no wl ed ge me nt s L is t of T ab le s L is t of F ig ur es i i v v i v ii x i x ii L it er at ur e Re vi ew 1 O st eo my el it is 1 I mp la nt A ss oc ia te d In fe ct io n 4 P at ho ge ne si s of O st eo my el it is 5 D ia gn os is o f Os te om ye li ti s 6 T re at me nt 8 M od el s of O st eo my el it is 9 B on e He al in g 10 A ss es sm en t of B on e He al in g 11 M od el s of B on e He al in g 13 M ed ic in al S il ve r 14 A nt ib ac te ri al P ro pe rt ie s of S il ve r 15 S il ve r To xi ci ty 15 S il ve r Io nt op ho re si s 16 C li ni ca l St ud ie s 16 viii

9 M ol ec ul ar M on ol ay er in g 17 I nt ro du ct io n 18 M at er ia l an d Me th od s 21 S ub je ct s 21 S il ve r Co at in g 21 B ac te ri al I no cu lu m 22 A ne st he si a an d Su rg ic al P ro ce du re 22 E le ct ri ca l St im ul at io n 23 P os t- op er at iv e Mo ni to ri ng 24 B on e Ar ea A na ly si s 25 R ad io gr ap hi c An al ys is 26 H is to lo gi c An al ys is 27 S ta ti st ic al A na ly si s 28 R es ul ts 30 B on e Ar ea A na ly si s 30 R ad io gr ap hi c An al ys is 30 H is to lo gi c An al ys is 31 C ul tu re R es ul ts 32 D is cu ss io n 3 3 T ab le s 40 F ig ur es 43 R ef er en ce s 51 ix

10 V it a 6 2 x

11 List of Tables T ab le 1 : W ee k 12 M ea n Bo ne A re a an d Me an R ad io gr ap hi c Bo ne H ea li ng 4 7 T ab le 2 : M ea n Di ff er en ce i n Bo ne A re a 4 8 T ab le 3 : M ea n Di ff er en ce i n Ra di og ra ph ic B on e He al in g Sc or es 4 9 xi

12 L is t of F ig ur es F ig ur e 1: P ic tu re o f 5 mm R ad ia l Os te ct om y Mo de l 50 F ig ur e 2: L in ea r Sc or in g Sh ee t: R ad io gr ap hi c An al ys is 51 F ig ur e 3: E xa mp le s of R ad io gr ap hi c Li ne ar S co ri ng a nd Me as ur em en t 52 F ig ur e 4: L in ea r Sc or in g Sh ee t: H is to lo gi c An al ys is 53 F ig ur e 5: E xa mp le s of H is to lo gi c Li ne ar S co ri ng a nd M ea su re me nt 54 F ig ur e 6: I ma ge D ep ic ti ng B on e Ar ea A na ly si s 55 F ig ur e 7: M ea n Di ff er en ce i n Bo ne A re a 56 F ig ur e 8: M ea n D if fe re nc e in R ad io gr ap hi c Bo ne H ea li ng 57 xii

13 L it er at ur e R ev ie w O st eo my el it is i s d ef in ed i n D or la nd s M ed ic al D ic ti on ar y a s i nf la mm at io n o f b on e c au se d b y a p yo ge ni c o rg an is m. ( 26 ) I t m ay r em ai n l oc al iz ed o r s pr ea d t hr ou gh t he b on e t o i n vo lv e t he m ar ro w, c or te x, c an ce ll ou s t is su e, a nd p er io st eu m. E vi de nc e o f o st eo my el it is c an b e f ou nd i n f os si li ze d c re at ur es d at in g b ac k 250 m il li on y ea rs.( 29 ) I n h um an s, t he i nc id en ce o f o st eo my el it is h as b ee n r ep or te d i n t he r an ge b et we en 0.5% a nd 2.7%.( 8, 29) W hi le c on si de re d r ar e i n d og s, t he a ct ua l r at e o f o st eo my el it is o cc ur re nc e h as n ot b ee n r ep or te d. T he s ou rc e o f c on ta mi na ti ng b ac te ri a i n o st eo my el it is c an b e h em at og en ou s, t ra um at ic o r i at ro ge ni c i n o ri gi n. T h e h em at og en ou s f or m o f o st eo my el it is r es ul ts f ro m b ac te ri al i no cu la ti on v ia t he b lo od s tr ea m. I t i s r ar el y r ep or te d i n t he d og a nd c at, b ut m or e c om mo nl y d es cr ib ed i n f oa ls, c al ve s, l am bs a nd h um an s < 16 y ea rs o f a ge.( 14, 38) T he v as cu la r a na t o my o f t he m et ap hy si s i n j uv en il es a p p ea rs t o b e t he p re di sp os in g c au se f or t hi s f or m o f i nf ec ti on.( 14, 2 9) I n j uv en il es, t he n ut ri en t a rt er y e nt er s t he d ia ph ys is o f l on g b on es a nd b ra nc he s p ro xi ma ll y a nd d is ta ll y. T he se b ra nc he s e nd i n n on an as to mo ti c s in us oi ds b en ea th t he e pi ph ys is. T he se s in us oi ds a re s ma ll er i n d ia me te r t ha n t he ir v en ou s d ra in ag e. A s a r es ul t, t ur bu le nt a nd r ed uc ed b lo od f lo w o cc ur s a t t hi s j un ct io n. I t h as b ee n s ug ge st ed t ha t i nf ec ti on b eg in s i n t he se s in us oi ds f ol lo wi ng b ac te re mi a. ( 14 ) T hi s v as cu la r a rr an ge me nt c ha ng es i n m an w it h t he c lo su re o f t he g ro wt h p la te. T he re fo re, i t i s u nc om mo n f or a h em at og en ou s c au se o f o st eo my el it is t o b e i mp li ca te d i n a du lt h um an s a nd m os t o th er a du lt a ni ma ls. 1

14 M os t c as es o f o st eo my el it is i n v et er in ar y m ed ic in e a re t he r es ul t o f l oc al c on ta mi na ti on. B ac te ri al c on ta mi na ti on o f b on e c an o cc ur s ec on da ry t o o pe n f ra ct ur es, s pr ea d f ro m s of t t is su e i nf ec ti on, p en et ra ti ng w ou nd s, o r s ur gi ca l i nv as io n. T hi s i s g en er al ly c la ss if ie d a s p os tt ra um at ic o st eo my el it is s in ce i t i s a ss oc ia te d w it h a t ra um at ic e ve nt o r s ur gi ca l i nt er ve nt io n. ( 8) P os tt ra um at ic o st eo my el it is i s a l oc al b on e i nf ec ti on a nd n ot a s ys te mi c c on di ti on. R et ro sp ec ti ve s tu di es o f c an in e o st eo my el it is h av e b ee n r ep or te d. ( 14, 76, 82) C ay wo od r ep or ts t ha t 55% o f o st eo my el it is c as es w er e a ss oc ia te d w it h o pe n r ed uc ti on o f c lo se d f ra ct ur es, w hi le o nl y 6 % o f o st eo my el it is c as es w er e a tt ri bu te d t o a h em at og en ou s s ou rc e. S of t t is su e e xt en si on o f i nf ec ti on a cc ou nt ed f or 26% a nd o pe n f ra ct ur es f or 10% o f c as es.( 14 ) S te ad r ep ot s t ha t 70% o f o st eo my el it is c as es a re r el at ed t o o rt ho pe di c c om pl ic at io ns, w hi le n o i nc id en ce o f h em at og en ou s o st eo my el it is i s n ot ed.( 82 ) O st eo my el it is m ay b e a cu te o r c hr on ic. T he se t wo f or ms o f t he s am e d is ea se e xh ib it d if fe re nt c li ni ca l s ig ns d ep en di ng o n t he d ur at io n o f i nf ec ti on. T he a cu te f or m o f o st eo my el it is b eg in s p os t- in oc ul at io n. L oc al s ig ns i nc lu de s of t t is su e s we ll in g, p yr ex ia, p ai n, r ed de ni ng o f t is su es, a nd l am en es s. ( 14, 7 6, 8 2) S ys te mi c s ig ns m ay i nc lu de p yr ex ia, a no re xi a a nd d ep re ss io n. A c om pl et e b lo od c ou nt m ay d em on st ra te a n e le va te d w hi te b lo od c el l c ou nt a nd a n eu tr op hi li c l ef t s hi ft. T he p re do mi na nt r ad io gr ap hi c 2

15 f in di ng i s s of t t is su e s we ll in g. T he se s ig ns a re n on -s pe ci fi c, m ak in g i t d if fi cu lt t o d is ti ng ui sh b et we en a cu te o st eo my el it is a nd p os t- tr au ma ti c i nf la mm at io n. ( 29 ) T he c hr on ic f or m o f o st eo my el it is p re se nt s p ri ma ri ly a s l oc al d is ea se. S ys te mi c s ig ns o f p yr ex ia, a no re xi a a nd d ep re ss io n a re r ar el y p re se nt. C om mo n c li ni ca l c om pl ai nt s i nc lu de d ra in in g f is tu lo us t ra ct s a nd l am en es s. ( 14, 7 6) H em at ol og ic al p ar am et er s m ay b e w it hi n n or ma l l im i ts o r d em on st ra te a m il dl y e le va te d w hi te b lo od c el l c ou nt w it h a s li gh t n eu tr op hi li c l ef t s hi ft.( 14, 7 6) R ad io gr ap hi c c ha ng es m ay i nc lu de s ig ns o f i mp la nt l oo se ni ng, b on e s eq ue st ra, s cl er os is, o st eo ly si s, s of t t is su e s we ll in g, a nd p er io s te al r ea ct io n. R ad io gr ap hi c l es io ns a nd c li ni ca l s ig ns t ha t p er si st o r a re p ro gr es si ve f or g re at er t ha n 4-6 w ee ks a re c on si st en t w it h a d ia gn os is o f c hr on ic o st eo my el it is. M os t c as es o f o st eo my el it is a re b ac te ri al i n o ri gi n. O th er e ti ol og ic a ge nt s s uc h a s f un gi, p ar as it es, v ir us es, f or ei gn b od ie s a nd m et al li c i mp la nt s h av e b ee n r ep or te d. ( 43, 7 5, 8 4, 8 9) S tu di es h av e s ho wn t ha t a er ob ic a nd a na er ob ic, G ra m- po si ti ve a nd G ra m- n eg at iv e b ac te ri a h av e b ee n i mp li ca te d i n o st eo my el it is. C ay wo o d a nd S mi th b ot h r ep or t a s in gl e c au sa ti ve a ge nt i n 5 3% a nd 5 9% o f c as es r es pe ct iv el y. ( 14, 7 6) S ta ph yl oc oc cu s s pp. a re t he m os t c om mo nl y i so la te d o rg an is ms f ro m c an in e o st eo my el it is.( 14, 7 6, 8 2) 3

16 S ta ph yl oc oc cu s i nt er me di u s i s t he m os t c om mo nl y i so la te d b ac te ri a o f n or ma l c an in e s ki n f lo ra.( 72 ) S. i nt er me di us w as p re vi ou sl y i de nt if ie d a s S ta ph yl oc oc cu s a ur eu s u nt il r ec en t n om en cl at ur e c ha ng es.( 13 ) S tu di es s ho w t ha t m or e t ha n h al f o f o st eo my el it is c as es a re r el at ed t o o pe n r ed uc ti on o f f ra ct ur es.( 14, 7 6) S te ve ns on r ep or te d a 4 0% i nc id en ce o f b ac te ri al c on ta mi na ti on, w it h p re do mi na nt ly S ta ph yl oc oc cu s s pp., i n o pe n r ed uc ti on o f c lo se d c an in e f ra ct ur es.( 83 ) A s tu dy p er fo rm ed a t T ul an e U ni ve rs it y f ou nd a n i nc re as e i n i nf ec ti on r at e o f 0.4% t o 1.7% w he n c on se rv at iv el y m an ag ed c lo se d f ra ct ur es w er e c om pa re d t o s ur gi ca ll y r ed uc ed c lo se d f ra ct ur es.( 8) E ve n w it h p ro pe r a se pt ic s ur gi ca l t ec hn iq ue, s ki n c on ta mi na ti on d ur in g o pe n r ed uc ti on o f f ra ct ur es i s t he m os t c om mo nl y i mp li ca te d s ou rc e o f i nf ec ti on. T hi s e xp la in s t he h ig h i nc id en ce o f S ta ph yl oc oc cu s s pp. a ss oc ia te d o st eo my el it is. G ri st in a s pe cu la te d t ha t b io ma te ri al s p ro vi de d a n i ne rt s ub st ra te f or b ac te ri al g ro wt h a nd p ro pa ga ti on.( 35 ) S mi th i so la te d b ac te ri a f ro m 1 7 o f 4 0 b on e p la te s r em ov ed f ro m d og s. ( 78 ) O f t he se c as es, 9 w er e a ss oc ia te d w it h c om pl ic at io ns s uc h a s o st eo my el it is a nd t he o th er 8 s ho we d n o c li ni ca l o r r ad io gr ap hi c s ig ns o f i nf ec ti on. P et ty f ou nd a n i nc re as ed r at e o f i nf ec ti on w he n c an in e f em ur s w er e i no cu la te d w it h b ac te ri a a nd o rt ho pe di c i mp la nt s w er e u se d. ( 61 ) I mp la nt a ss oc ia te d i nf ec ti on c an r es ul t i n a r ec ur re nt s ou rc e o f i nf ec ti on t ha t i s n on re sp on si ve t o a nt ib io ti c t he ra py. R em ov al o f t he i mp la nt i s u su al ly n ec es sa ry t o r es ol ve t he c li ni ca l s ig ns o f i nf ec ti on. 4

17 B ac te ri a p ro du ce a s li my g ly co ca ly x t ha t i s c om po se d o f a m at ri x o f f ib ro us e xo po ly sa cc ha ri de s, g ly co pr ot ei ns, o r b ot h. ( 34 ) T he g ly co ca ly x f un ct io ns t o p ro vi de a dh er en ce, p ro te ct io n a nd n ut ri en t t ra pp in g. T he p ol ys ac ch ar id es o f t he g ly co ca ly x a re s im il ar i n s tr uc tu re t o c om me rc ia l c he mi ca l a dh es iv es.( 21 ) T hi s e na bl es b ac te ri a t o a dh er e t o b io lo gi c i mp la nt s a ft er c on ta mi na ti on d ur in g s ur ge ry o r l at er f ro m a t ra ns ie nt b ac te re mi a. A dh es io n p ro pe rt ie s m ay b e r el at ed t o b ac te ri al v ir ul en ce.( 34 ) T he t hi ck s li me -l ik e c oa ti ng r es is ts p en et ra ti on o f a nt ib io ti cs. F ur th er mo re, t he g ly co ca ly x p ro te ct s b ac te ri a f ro m t he h os t s d ef en se m ec ha ni sm s s uc h a s o ps in iz at io n, s ur fa ct an ts a nd p ha go cy to si s b y m ac ro ph ag es.( 34 ) O nc e a dh er en t t o a n i mp la nt o r f or ei gn b od y, t he g ly co ca ly x f or ms a b io fi lm t ha t e nv el op es m ic ro co lo ni es o f b ac te ri a. T hi s p hy si ca l b ar ri er e na bl es m ic ro co lo ni es o f b ac te ri a t o r es is t a nt ib io ti c t he ra py a nd h os t d ef en se m ec ha ni sm s. T ra um a r es ul ts i n h yp er em ia a nd i nf la mm at io n o f t is su e. I nc re as ed c ap il la ry p er me ab il it y a ll ow s i nf il tr at io n w it h w hi te b lo od c el ls. I f b ac te ri a a re p re se nt t he y c an d es tr oy t he se W BC s r es ul ti ng i n t he r el ea se o f p ro te ol yt ic e nz ym es a nd t he f or ma ti on o f p ur ul en t e xu da te.( 69 ) A dd it io na ll y, h em at om as a nd e de ma c an r es ul t i n l oc al i sc he mi c p re ss ur e n ec ro si s a nd m ic ro va sc ul ar s ta si s p ro mo ti ng t is su e d ea th a nd b ac te ri al c ol on iz at io n. O nc e i nf ec ti on h as b ee n e st ab li sh ed, b ac te ri al a nt ig en s s ti mu la te m ac ro ph ag es a nd n eu tr op hi ls t o p ro du ce i nt er le uk in -1, w hi ch att ra ct s a dd it io na l m ac ro ph ag es, n eu tr op hi ls 5

18 a nd l ym ph oc yt es.( 33 ) I nc re as ed p ro du ct io n o f p ro st ag la nd in E 2 b y t he se c el ls r es ul ts i n i nc re as ed b on e r es or pt io n. I nj ec ti on o f a ra ch id on ic a ci d, t he p re cu rs or o f p ro st ag la nd in s, i nt o r at t ib ia s f ac il it at ed t he f or ma ti on o f o st eo my el it is a nd b on e r es or pt io n. ( 67 ) M od el s o f o st eo my el it is u se s od iu m m or rh ua te, a f is h o il d er iv at iv e c on ta in in g a ra ch id on ic a ci d, t o c re at e b on e n ec ro si s a nd e st ab li sh o st eo my el it is.( 58, 7 0) A s o st eo my el it is p ro gr es se s f ro m t h e a cu te t o c hr on ic f or m, i t b ec om es l es s r es po ns iv e t o a nt ib io ti c t he ra py a nd h os t i mm un e r es po ns e. I nf la mm at or y c el ls a re s ep ar at ed f ro m g ra nu la ti on t is su e a nd a g oo d b lo od s up pl y b y c on ne ct iv e t is su e w hi ch r es ul ts i n b on y a bs ce ss f or ma tion. A s t he p re s su re o f t hi s pur ul en t e xu da te i nc re as es, i t e nt er s c or ti ca l b on e t hr ou gh t he H av er si an a nd V ol km an n s c an al s. ( 77 ) I nc re as ed p or os it y o f b on e s ec on da ry t o i nf la mm at io n c an l ea d t o s ub pe ri os te al e le va ti on a nd f or ma ti on o f a s eq ue st ru m. C li ni ca l s ig ns a nd r ad io gr ap hi c c ha ng es a re h ig hl y s ug ge st iv e o f p os tt ra um at ic o st eo my el it is, b ut c on fi rm at io n o f o st eo my el it is i s b as ed o n i de nt if ic at io n o f a n e ti ol og ic al a ge nt. M ic ro bi al c ul tu re o f c hr on ic d ra in in g t ra ct s r el at ed t o o st eo my el it is h as b ee n s ho wn t o b e n on re pr es en ta ti ve o f t he e ti ol og ic a ge nt o f o st eo my el it is.( 47 ) H is to lo gi c i de nt if ic at io n o f b ac te ri a w as o nl y c or re ct i n 33% o f o st eo my el it is c as es.( 11 ) P os it iv e b on e c ul tu re s a re t he g ol d s ta nd ar d f or t he d ia gn os is o f o st eo my el it is. T hi s c an b e a ch ie ve d b y a s ur gi ca l a pp ro ac h, f in e n ee dl e a sp ir at e, o r J am sh id i n ee dl e b io ps y. 6

19 R ad io gr ap hi c s ig ns o f o st eo my el it is v ar y d ep en di ng o n t he d ur at io n o f d is ea se, s ub je ct s a ge a nd h ea lt h, a nd v ir ul en ce o f t he o rg an is m. A cu te ly, t he o nl y r ad io gr ap hi c e vi de nc e t ha t m ay b e s ee n i s s of t t is su e s we ll in g a nd d ec re as ed d el in ea ti on o f f as ci al p la ne s i n t he s ur ro un di ng s of t t is su es. B on e r es or pt io n i s u su al ly n ot n ot ed i ni ti al ly. B on e d em in er al iz at io n m us t e xc ee d 35% b ef or e i t i s r ad io gr ap hi ca ll y e vi de nt.( 6) L yt ic a re as m ay b e s ee n a s e ar ly a s 3 d ay s p os t- in fe ct io n i n n eo na te s a nd 5 t o 7 d ay s i n a du lt s. ( 69 ) M or e c om mo nl y, r ad io gr ap hi c e vi de nc e i s f ir st s ee n 10 t o 14 d ay s p os t c on ta mi na ti on. C ha ng es i nc lu de i rr eg ul ar o r i nt er ru pt ed p er io st ea l p ro li fe ra ti on, o st eo ly si s, b on e s cl er os is, i mp la nt l oo se ni ng, i nc re as ed m ed ul la ry d en si ty, a nd s eq ue st ru m f or ma ti on. B ra de n r ep or ts t ha t r ad io gr ap hi c e va lu at io n o f o st eo my el it is w as 62% s en si ti ve a nd 57% s pe ci fi c f or t he d ia gn os is o f e xp er im en ta l o st eo my el it is.( 11 ) N uc le ar s ci nt ig ra ph y h as b ee n a dv oc at ed f or e ar ly d ia gn os is o f o st eo my el it is. T ec hn et iu m- 99 p yr op ho sp ha te b on e s ca nn in g h as b ee n s ho wn t o i de nt if y p at ie nt s w it h o st eo my el it is e ve n b ef or e r ad io gr ap hi c c ha ng es a re n ot ed.( 87 ) t ec hn iq ue h as a l ow s en si ti vi ty, p ar ti cu la rl y i n n eo na te s. ( 87 ) U nf or tu na te ly, t hi s I nd iu m l eu ko cy te s ca ns w er e p os it iv e o ne w ee k p os t i no cu la ti on i n 8 3% o f r ab bi ts w it h e xp er im en ta ll y- i nd uc ed o st eo my el it is.( 64 ) W hi le s ci nt ig ra ph y m ay b e h el pf ul i n t he d ia gn os is o f o st eo my el it is, a l oc al iz ed i nc re as ed c ou nt c an b e n on -s pe ci fi c f or i nf la mm at io n, t ra um a, n eo pl as ia a nd o st eo my el it is. 7

20 O th er i ma gi ng m o da li ti es c an b e u se fu l i n t he d ia gn os is o f o st eo my el it is. C om pu te ri ze d t om og ra ph y ( CT ) c an p ro vi de a dd it io na l i nf or ma ti on, e sp ec ia ll y f or i de nt if yi ng s ma ll f or ei gn b od ie s a s a s ou rc e o f r ec ur re nt i nf ec ti on.( 29 ) M ag ne ti c r es on an ce i ma gi ng ( MR I) c an b e m or e s en si ti ve t ha n C T f or d et ec ti ng e ar ly o st eo my el it is i n h um an s. ( 16, 2 8, 4 0) D ia gn os ti c s en si ti vi ti es f or b ot h m od al it ie s a re l im it ed b y t he p re se nc e o f m et al li c i mp la nt s. ( 29 ) E xp er im en ta ll y, e nz ym e l in ke d i mm un os or be nt a ss ay s ( EL IS A) h av e b ee n u se d t o d et ec t a nt ib od ie s t o t he c el l w al l o f S. a ur eu s i n a ni ma ls w it h c on cu rr en t o st eo my el it is.( 42 ) S er um I gg c on ce nt ra ti on s w er e h ig he r i n r ab bi ts w it h o st eo my el it is c om pa re d t o t ho se w it h s ub cu ta ne ou s a bs ce ss es o f t he s am e s tr ai n o f S. a ur eu s. T hi s m ay p ro ve h el pf ul f or i de nt if ic at io n o f o st eo my el it is i n c as es w he re a n e ti ol og ic a ge nt c an n ot b e i de nt if ie d b y s ta nd ar d c ul tu ri ng t ec hn iq ue s. ( 29 ) T re at me nt o f o st eo my el it is c on s is t o f f ou r p ar ts : a nt ib io ti cs, d eb ri de me nt, d ra in ag e a nd f ra ct ur e s ta bi li za ti on.( 29 ) A pp ro pr ia te a nt ib io ti c t he ra py b as ed o n c ul tu re a nd s en si ti vi ty r es ul ts i s i nd ic at ed i n a ll c as es o f o st eo my el it is. H ow ev er, o nc e i nf ec ti on h as b ec om e e st ab li sh ed a nt ib io ti cs a lo ne w il l n ot s uf fi ce.( 8, 2 9) S ur gi ca l d eb ri de me nt o f n ec ro ti c b on e a nd s eq ue st ra i s n ec es sa ry f or r es ol ut io n. E li mi na ti on o f d ea d s pa ce o r s ur gi ca l d ra in ag e m us t t he n b e est ab li sh ed.( 8, 2 9) F in al ly, s ta bi li za ti on o f f ra ct ur es m us t b e p er fo rm ed w he n a pp ro pr ia te t o e li mi na te m ot io n t ha t p re ve nt s 8

21 h ea li ng. B on y d ef ec ts c an b e tre at ed w it h c an ce ll ou s b on e g ra ft s t o f ac il it at e h ea li ng a nd a re as o f s cl er ot ic b on e s ho ul d b e r on ge ur ed t o h el p e st ab li s h b lo od s up pl y. ( 29 ) T he s tu dy o f o st eo my el it is i s m os tl y d ep en de nt o n a ni ma l m od el s. T he e ar li es t a tt em pt t o e st ab li sh a m od el o f o st eo my el it is w as b y R od et i n T hi s w as p er fo rm ed b y i nt ra ve no us i nj ec ti on s o f a S. a ur eu s i no cu lu m i nt o r ab bi ts.( 68 ) L ex er p ro du ce d b on y a bs ce ss es i n r ab bi t t ib ia s b y i nt ra ve no us i nj ec ti on s o f S. a ur eu s, b ut t he m or ta li ty w as h ig h. ( 45, 46) O th er i nv es ti ga to rs w er e a bl e t o p ro du ce s up pu ra ti ve b on y l es io ns w it h l oc al i nj ec ti on s o f S. a ur eu s, b ut n on e o f t he l es io ns w er e p ro gr es si ve.( 48, 66) W hi le i nt ra ve no us a nd l oc al i nj ec ti on S. a ur eu s d id p ro du ce b on y a bs ce ss es, t he se d is ea se m od el s d id n ot a cc ur at el y r ef le ct t he c li ni ca l p ic tu re o f o st eo my el it is i n h um an s. I t w as n ot u nt il 1941, w he n S ch em an i nj ec te d s od iu m m or rh ua te i nt o t he m ed ul la ry c av it ie s o f r ab bi t t ib ia s i no cu la te d w it h S. a ur eu s, t ha t a c li ni ca ll y r el ev an t m od el o f p ro gr es si ve c hr on ic o st eo my el it is w as e st ab li sh ed.( 70 ) S od iu m m or rh ua te i s a s cl er os in g a ge nt t ha t a lo ne c an c au se a se pt ic n ec ro si s o f b on e. ( 66 ) N or de n l at er r ef in ed S ch em an s p ro to co l t o p ro du ce t he c la ss ic m od el o f o st eo my el it is i n t he r ab bi t t ib ia. T hi s m od el c on si st en tl y p ro du ce d s ig ns o f p ro gr es si ve b on y d es tr uc ti on a nd s eq ue st ru m f or ma ti on.( 58 ) W hi le p re vi ou s m od el s w er e u na bl e t o p ro du ce a p ro gr es si ve f or m o f b on e i nf ec ti on, t he a dd it io n o f t hi s s cl er os in g a ge nt a pp ea re d t o b e t he k ey. 9

22 S ev er al c an in e m od el s h av e b ee n d es c ri be d. D ey si ne i nt ra ve no us ly i nj ec te d b ar iu m s ul fa te a nd S ta ph yl oc oc cu s s pp. i nt o t he n ut ri en t t ib ia l a rt er y t o e st ab li sh o st eo my el it is.( 24 ) T hi s p ro ce du re i s t ec hn ic al ly d if fi cu lt t o p er fo rm a nd t he e ff ec ts o f i nt ra ar te ri al b ar iu m s ul fa te a re n ot k no wn.( 66 ) F it zg er al d e st ab li sh ed o st eo my el it is i n t he c an in e t ib ia b y i no cu la ti ng a c ur re tt ed b on e d ef ec t w it h S. a ur eu s a nd f il li ng t he d ef ec t w it h a p ol ym et hy lm et ha cr yl at e p lu g. ( 27 ) P et ty f ou nd t ha t p la ce me nt o f i mp la nt s i n i no cu la te d c an in e f em ur s l ow er ed t he i nf ec ti on d os e n ec es sa ry t o e st ab li sh o st eo my el it is.( 61 ) B ra de n r ep or te d t ha t a n i nf ec te d w ou nd, a va sc ul ar b on e, a nd a f av or ab le m il ie u m us t b e p re se nt t o e st ab li sh o st eo my el it is i n 90% o f e xp er im en ta l c as e o f c an in e o st eo my el it is.( 8) H is m od el i nv ol ve d t re ph in at io n o f a h ol e i n t he c an in e t ib ia, t ra um at iz at io n o f t he m ed ul la ry c an al, i no cu la ti on w it h S. a ur eu s, a nd r ei ns er ti on o f t he b on e p lu g. ( 9, 10) T hi s e st ab li sh ed a m od el o f p os tt ra um at ic o st eo my el it is t ha t d id n ot r el y o n f or ei gn m at er ia ls o th er t ha n t he i no cu lu m. F ol lo wi ng f ra ct ur es, b on e h ea li ng m ay b e p ri ma ry o r s ec on da ry. P ri ma ry b on e h ea li ng r el ie s o n r ig id s ta bi li za ti on o f t he f ra ct ur e a nd b on y c on ta ct.( 60 ) S ec on da ry b on e h ea li ng f ol lo ws s ev er al s te ps o f i nf la mm at io n, s of t c al lu s f or ma ti on, h ar d c al lu s f or ma ti on a nd b on y r em od el in g. ( 12 ) U nl ik e s ec on da ry b on e h ea li ng, p ri ma ry b on e h ea li ng r es ul ts w it h ou t t he f or ma ti on o f c al lu s. P ri ma ry b on e h ea li ng c an no t o cc ur i f a f ra ct ur e g ap > 0.1 m m e xi st s. ( 62 ) 10

23 F ol lo wi ng a f ra ct ur e, d is ru pt io n o f n or ma l b lo od s up pl y t o b on e a nd s ur ro un di ng s of t t is su es o cc ur s. W it hi n h ou rs, n ec ro si s o f a f ew m il li me te rs o f t he f ra gm en t e nd s r es ul ts f ro m c ap il la ry t hr om bo si s i n H av er si an a nd V ol km an n s c an al s. ( 12 ) S ti mu la ti on o f a ff er en t v as cu la r c om po ne nt s r es ul ts i n i nc re as e i n d ia me te r a nd n um be r o f v es se ls.( 62 ) S ys te mi c r es po ns e t o b on e i nj ur y r es ul ts i n a n e le va ti on o f p ar at ho rm on e, c al ci to ni n, v it am in D m et ab ol it es, a nd a lk al in e p ho sp ha ta se l ev el s. ( 54 ) L oc al ly, p la te le ts, m as t c el ls, n eu tr op hi ls, m ac ro ph ag es, l ym ph oc yt es a nd i nj ur ed c el ls w it hi n t he f ra ct ur e h em at om a r el ea se c he mo at tr ac ta nt s, a ng io ge ni c a nd o th er g ro wt h f ac to rs.( 12 ) P la te le t- de ri ve d g ro wt h f ac to r, e pi de rm al g ro wt h f ac to r, a nd t ra ns fo rm in g g ro wt h f ac to r a re a mo ng t ho se t ha t h av e b ee n i de nt if ie d. ( 7, 41, 74 ) W it hi n a f ew d ay s, t he i ng ro wt h o f c ap il la ri es s er ve s t o e ng ul f t he h em at om a a nd m ac ro ph ag es b eg in t o d eb ri de t he f ra ct ur e s it e. ( 12 ) M ac ro ph ag es a nd n eu tr op hi ls r el ea se i nt er le uk in -1 c au si ng m us cl e a tr op hy. A s a r es ul t, t he se l eu ko cy te s a nd m us cl e c el ls i nc re as e p ro du ct io n o f p ro st ag la nd in E 2 p ro mo ti ng b on e r es or pt io n. T he s of t c al lu s s ta ge b eg in s o nc e i nf la mm at io n h as s ub si de d a nd e nd s w he n f ib ro us a nd /o r c ar ti la gi no us t is su e u ni te t he f ra ct ur e f ra gm en t e nd s. ( 12 ) T hi s p ha se l as ts a pp ro xi ma te ly 2-3 w ee ks l ea vi ng t he f ra ct ur e u ns ta bl e d ur in g t hi s p ro ce ss. O st eo cy te s, p er io st ea l c el ls a nd e nd os te al c el ls c ha ng e f un ct io n t o b ec om e o st eo bl as ts a nd c ho nd ro bl as ts. O st eo cl as ts b eg in t o r em ov e d ea d b on e. I nd uc ed o st eo pr o ge ni to r c el ls c an b e f ou nd i n a ll c on ne ct iv e t is su es w hi le d et er mi ne d o st eo pr og en it or c el ls c an b e 11

24 f ou nd i n b on e m ar ro w a nd e nd os te um.( 12 ) P er cu ta ne ou s i nj ec ti on o f b on e m ar ro w h as b ee n u se d e xp er im en ta ll y i n r ab bi ts a s a b on e g ra ft in g t e ch ni qu e. ( 59 ) T he h ar d c al lu s s ta ge o cc ur s a s t he f ra ctur e f ra gm en ts b ec om e u ni te d b y b on e. ( 12 ) M in er al iz at io n b eg in s b et we en f ib ro us t is su e a t t he f ra gm en t e nd s a nd p er ip he ry o f t he c al lu s a nd s pr ea ds t ow ar ds t he c en te r. A f ro nt o f o st eo cl as ts r es or b b on e w hi ch i s f ol lo we d i mm ed ia te ly b y n ew b on e d ep os it io n. W ov en a nd c an ce ll ou s- li ke b on e i s r ep la ce d w it h l am el la r b on e. R ad io gr ap hi ca ll y a nd c li ni ca ll y, t he f ra ct ur e a pp ea rs h ea le d. T he r em od el in g p ha se o f b on e h ea li n g c an s ev er al t ak e y ea rs.( 12 ) O nc e t he b ri dg in g h ar d c al lu s i s f or me d, p er io st ea l a nd e nd os te al c al lu se s a re r es or be d. T he c an ce ll ou s c or te x o f t he f ra ct ur e a re a i s r em od el ed o ve r t im e i nt o t he n or ma l a rc hi te ct ur e o f H av er si an b on e. ( 12 ) W hi le c li ni ca l a nd r ad io gr ap hi c a ss es sm en t c an d et er mi ne f ra ct ur e h ea li ng, t he y a re b ot h s ub je ct iv e a na ly se s m ak in g c om pa ri so ns o f b on e h ea li ng i n d if fe re nt s it ua ti on s d if fi cu lt t o q ua nt if y a nd d oc um en t. P ro gr es si ve r ad io gr ap hi c b on e h ea li ng i s d ef in ed b y g ra du al m in er al iz at io n o f c al lu s a nd l os s o f v is ua li za ti on o f t he f ra ct ur e g ap.( 55 ) M ul ti pl e m od al it ie s h av e b ee n u se d t o q ua nt if y b on e h ea li ng. D ua l x -r ay a bs or pt io me tr y ( DE XA ) i s c ur re nt ly o ne o f t he s ta nd ar d t ec hn iq ue s f or m ea su re me nt o f b on e m in er al iz at io n. ( 51 ) A d ua l- en er gy s ou rc e i s u se d t o q ua nt if y d if fe re nc es i n 12

25 r ad io gr ap hi c d en si ti es o f a n o bj ec t. ( 51 ) Q ua nt it at iv e C T a nd M RI s ho w s im il ar r es ul ts t o D EX A. ( 49, 50, 52) Q ua nt if ic at io n o f m in er al c on te nt a nd d en si ty b y t he se D EX A, C T a nd M RI a ll ow s c om pa ri so n o f b on e h ea li ng i n f ra ct ur e m od el s. T he se f or ms o f a na ly si s r eq ui re s pe ci al e qu ip me nt t o a cq ui re t he d at a. M et al li c o rt ho pe di c i mp la nt s c au se i nt er fe re nc e w it h C T a nd M RI m ea su re me nt s m ak in g t he m l es s e ff ec ti ve f or ms o f e va lu at io n. D ig it al s ub tr ac ti on r ad io gr ap hy i s a t ec hn iq ue f or m ea su ri ng b on e d en si ty t ha t i s c ur re nt ly b ei ng u se d i n t he f ie ld o f d en ti st ry.( 65 ) T he re a re r ep or ts o f i ts u se i n a ng io gr ap hi c a nd t ho ra ci c s tu di es.( 25, 3 6) T he t ec hn iq ue i nv ol ve s r ep ea te d r ad io gr ap hs o ve r t im e o f t he s am e a re a o f i nt er es t. T he r ad io gr ap hs a re t he n o ve rl ai d a nd t he d if fe re nc e i n b on e a re a i s m ea su re d. T hi s t ec hn iq ue i s h in de re d b y t he n ee d f or p re ci se r ad io gr ap hi c a li gn me nt t o p ro du ce e xa ct o ve rl ay s o f r ad io gr ap hs f or a na ly si s. ( 65 ) T he r ad iu s p ro vi de s a g oo d a na to mi ca l m od el f or t he e va lu at io n o f b on e h ea li ng. C om pa re d t o o th er l on g b on es, t he re i s r el at iv e ly l it tl e s of t t is su e s ur ro un di ng t he r ad iu s. T he r ad iu s i s a me na bl e t o m ul ti pl e f or ms o f s ta bi li za ti on. B on e p la ti ng a nd e xt er na l s ke le ta l f ix at io n, a re a pp ro pr ia te f ix at io n c ho ic es f or f ra ct ur e r ep ai r. T he s ur gi ca l a pp ro ac h t o t he b on e i s s im pl e a nd l es s t ra um at ic c om pa re d t o m os t o th er l on g b on es.( 62 ) 13

26 S ev er al b on e e xi st f or e va lu at io n o f h ea li ng m od el s i n t he r ad iu s. M il li s u se d a 5 m m r ad ia l o st ec to my t o e va lu at e t he e ff ec t o f s om at ot ro pi n o n b on e h ea li ng.( 55, 88) T hi s w as a n u ns t a bl e f ra ct ur e m od el, t hu s c om bi ni ng t he e ff ec t s o f i ns t a bi li t y a nd g ro wt h f ac to r o n f ra ct ur e h ea li ng. M ul ti pl e s tu di es e va lu at in g r ad ia l o st eo to mi es h av e b ee n r ep or te d. ( 15, 17, 23) M os t w er e s ta bi li ze d w it h e xt er na l f ix at io n o r b on e p la ti ng. W hi le t he se s tu di es a ll ow e ff ec ti ve t es ti ng o f t he m ec ha ni ca l s tr en gt h o f b on e h ea li ng, r ad io gr ap hi c a na ly si s i s m or e d if fi cu lt t o e va lu at e d ue t o t he l ac k o f a f ra ct ur e g ap. R ad iu s f ra ct ur e g ap m od el s o f 2.0 t o 2.5 c m i n l en gt h h a ve a re r ep or te d. ( 44, 71) T he se m od el s a re m ai nl y u se d t o e va lu at e o st eo in du ct iv e a nd c on du ct iv e p ro pe rt ie s o f i mp la nt s a nd b on e g ra ftin g m at er ia ls. M os t con tr ol s i n t he se s tu dies p ro gr es se d t o b on y n on -u ni on s d ue t o t he l ar ge f ra ct ur e g a p a nd w er e n ot g oo d m od el s o f n or ma l f ra ct ur e h ea li ng. S il ve r h as b ee n l on g k no wn f or i ts t he ra pe ut ic q ua li ti es.( 39 ) W hi le u nc er ta in o f i ts m ed ic in al u se s, s il ve r n it ra te w as p ub li sh ed i n a R om an p ha rm ac op ei a i n 69 B.C. T hr ou gh ou t h is to ry, s il ve r h as b ee n u se d t o t re at m ul ti pl e i ll ne ss es r an gi ng f ro m h al it os is t o e pi le ps y. C on fi rm ed m ed ic in al u se s o f s il ve r w er e n ot d oc um en te d u nt il t he e ig ht h c en tu ry.( 39 ) S ev er al f or ms o f s il ve r a nd i ts s al ts a re c ur re nt ly u se d f or m ed ic al t he ra py.( 32 ) S il ve r n it ra te i s a s cl er os in g a ge nt t ha t i s u se d a s a t op ic al c he mi ca l c au te ri zi ng a ge nt, p re ve nt at iv e t re at me nt f or g on or rh ea l o ph th al mi a n eo na to ru m a nd w ar t a nd c or n 14

27 r em ov al.( 32 ) S il ve r s ul fa di az in e i s a c om bi na ti on o f s il ve r a nd a s ul fa b as ed a nt ib io ti c. I t i s w id el y u se d f or the t op ic al t re at me nt of b ur n w ou nd s. ( 1, 30) M or e r ec en tl y s il ve r- c oa te d u ri na ry a nd p er it on ea l d ia ly si s c at he te rs w er e i nv es ti ga te d f or t he p re ve nt io n o f c on ta mi na ti on a ss oc ia te d i nf ec ti on s. ( 31 ) T he u se o f c ol lo id al s il ve r p re pa ra ti on s i s c on tr ov er si al. I t i s c ur re nt ly n ot a pp ro ve d b y t he U ni te d S ta te s F oo d a nd D ru g A dm in is tr at io n, b ut h as b ee n a dv oc at ed a s a m in er al s up pl em en t a nd a n an ti bi ot ic. ( 32 ) T he e xa ct a nt ib ac te ri al m ec ha ni sm o f s il ve r i s u nk no wn. S il ve r r ea di ly d en at ur es p ro te in s b y b in di ng t o t he ir r ea ct iv e g ro up s, c au si ng p re ci pi ta ti on.( 32 ) S il ve r c om po un ds i na ct iv at e e nz ym es b y f or mi ng h em is il ve r s ul fi de s w it h s ul fh yd ry l g ro up s. S il ve r c an a ls o b in d a mi no, c ar bo xy l, p ho sp ha te, a nd i mi da zo le g ro up s. S hi no gi f ou nd t ha t s il ve r c an d im in is h t he a ct iv it ie s o f l ac ta te d eh yd ro ge na se, g lu ta th io ne p er ox id as e, a nd p er ox id at io n o f m em br an e l ip id s. ( 73 ) W hi le t op ic al u se o f s il ve r i s r el at iv el y s af e, c hr on ic i ng es ti on o f s il ve r c an r es ul t i n t ox ic s id e e ff ec ts. K no wn a s g en er al iz ed a rg yr os is, t he c la ss ic s ig ns a re a g re en is h- g re y o r b lu is h- gr ey d is co lo ra ti on t o t he s ki n a nd v is ce ra.( 53, 63, 86) T ox ic it y c an r es ul t i n l iv er a nd r en al d ys fu nc ti on.( 86 ) P ro gr es si ve t as te a nd s me ll d is or de rs, v er ti go, h yp er es th es ia a nd g en er al iz ed w ea kn es s h av e a ls o b ee n a ss oc ia te d w it h a rg yr os is.( 86 ) 15

28 T he d if fu si ve p ro pe rt ie s o f s il ve r i on s f ro m m et al li c s ur fa ce s a re p oo r d ue t o i ts l ow s ol ub il it y i n a qu eo us s ol ut io ns.( 4) T op ic al s il ve r a ge nt s t ha t d if fu se m or e r ea di ly, l ik e s il ve r n it ra te, a re l oc al ly s cl er os in g a nd t ox ic i n l ar ge r a mo un ts. T ho se s il ve r c om po un ds t ha t a re n on -t ox ic, l ik e s il ve r s ul fa di az in e, p oo rl y d is so ci at e. ( 39 ) A no di c e le ct ri ca l s ti mu la ti on o f s il ve r o r s il ve r i on to ph or es is, l ib er at es s il ve r i on s a ll ow in g d if fu si on a nd m ig ra ti on a lo ng a v ol ta ge g ra di en t. T hi s a ll ow s p en et ra ti on o f s il ve r i on s i nt o a qu eo us e nv ir on me nt s e ve n w he n s tr uc tu re s o r t is su es a re a va sc ul ar.( 4) T he s il ve r i on s a re m in im al ly t ox ic a nd a t l ev el s f ar b el ow t ho se n ec es sa ry t o p ro du ce a n a pp re ci ab le w ho le b od y t o xi c b ur de n. ( 4, 39) A nt ib ac te ri al e ff ec ts o f s il ve r i on to ph or es is h av e b ee n d em on st ra te d b ot h e x v iv o a nd i n v iv o. ( 2, 3, 5, 80) T he s il ve r c at io n h as a b ro ad a nt ib ac te ri al s pe ct ru m i nc lu di ng G ra m- po si ti ve, G ra m- ne ga ti ve, a er ob ic a nd a na er ob ic b ac te ri a w it h r ar e r ep or te d r es is ta nc e. ( 5, 37) C ol ma no f ou nd 100 % i nh ib it io n o f b ac te ri al g ro wt h o n e le ct ri ca ll y s ti mu la te d i nt ra me du ll ar y p in s t ha t w er e c oa te d w it h 100 m on om ol ec ul ar l ay er s o f s il ve r s te ar at e a nd i n oc ul at ed w it h S. a ur eu s. ( 19, 20) C li ni ca l u se o f s il ve r i on to ph or es is f or t he t re at me nt o f o st eo my el it is h as b ee n r ep or te d i n t hr ee h um an s tu di es. B ec ke r r ep or te d c on tr ol o f b on e i nf ec ti on a nd h ea li ng o f b on y n on -u ni on s i n 12 o f 15 c as e s u si ng a n e le ct ri ca ll y s ti mu la te d i nt ra me du ll ar y s il ve r w ir e o r s il ve r n yl on d re ss in g. ( 4) W eb st er r ep or te d r es ol ut io n o f d ra in in g t ra ct s i n 16 o f 25 p at ie nt s t re at ed w it h e le ct ri ca ll y- st im ul at ed s il ve r n yl on d re ss in gs a nd 9 o f 12 16

29 u ni on s o f b on y n on -u ni on s. ( 85 ) I t s ho ul d b e n ot ed t ha t t he p at ie nt s i n b ot h t ri al s w er e n on -r es po ns iv e t o t ra di ti on al t he ra py f or o st eo my el it is. M or e r ec en tl y, N an d r ep or te d a s er ie s o f 920 h um an c as e o f o st eo my el it is t ha t w er e t re at ed w it h e le ct ri ca ll y s ti mu la te d i nt ra me du ll ar y s il ver w ir es a nd e le ct ri ca l o st eo gene si s. I n t ha t s er ie s, a n 85% c on tr ol o f i nf ec ti on a nd a n 83% r es ol ut io n o f p at ho lo gi c f ra ct ur es w er e r ep or te d. ( 56 ) T he se s tu di es s ho we d t ha t s il ve r i on to ph or es is f or t he t re at me nt o f c hr on ic n on - r es po ns iv e o st eo my el it is i s p ro mi si ng. M ol ec ul ar m on ol ay er in g o f m et al s i nv ol ve s a pp li ca ti on o f a s in gl e m ol ec ul e t hi ck l ay er, o r m ul ti pl e l ay er s, o f a m et al o nt o t he s ur fa ce o f a n o bj ec t. ( 20 ) M os t m et al s a n d t he ir s al ts c an b e u se d t o c oa t a n o bj ec t. C ol ma no d ev el op ed a p ro ce du re f or m ul ti pl e m on om ol ec ul ar c oa ti ng o f m et al li c o rt ho pe di c i mp la nt s w it h s il ve r s te ar at e. ( 19, 20) B y c om bi ni ng t hi s si lv er -c oa ti ng w it h s il ve r i on to ph or es is h e w as a bl e t o i nh ib it b ac te ri al c ol on iz at io n i n r ab bi t f em ur s i no cu la te d w it h S. a ur eu s. 17

30 I nt ro du ct io n C on ta mi na ti on o f f ra ct ur es b y t ra um a, s ur ge ry a nd h em at og en ou s s ou rc es i nc re as es t he r is k o f d ev el op in g o st eo my el it is a ft er s ur gi ca l s ta bi li za ti on ( 38, 77). T he c ur re nt t re at me nt f or o st eo my el it is c on si st s o f a pp ro pr ia te a nt ib io ti c t he ra py a nd s ur gi ca l d eb ri de me nt. S ys te mi c a nt ib io ti cs a lo ne h av e a p oo r s uc ce ss r at e d ue t o t he i na bi li ty t o a ch ie ve l oc al t is su e c on ce nt ra ti on i n a re as t ha t h a ve p oo r v as cu la ri ty ( un de r o rt ho pe di c i mp la nt s, a ro un d f or ei gn b od ie s, i n b on y a bs ce ss es a nd i n s eq ue st ra e). S ur gi ca l d eb ri de me nt c ar ri es a b et te r p ro gn os is t ha n a nt ib io ti c t he ra py a lo ne a nd c an r ea ch r es ol ut io n r at es a s h ig h a s 90%, b ut s uc ce ss i s d ep en d en t o n s ev er it y, e xt en t a nd s ur gi ca l a cc es si bi li ty ( 8, 14). T he c os t o f s ur gi ca l i nt er ve nt io n c an b e p ro hi bi ti ve i n v et er in ar y m ed ic in e a nd i n h um an c as es i n u nd er de ve lo pe d c ou nt ri es ( 56 ). A lt er na ti ve a nd /o r a dj uv an t n on -i nv as iv e t he ra pi es f or t he p re ve nt io n o r t re at me nt o f o st eo my el it is w ou ld b e u se fu l i n b ot h t he v et er in ar y a nd m ed ic al c om mu ni ti es. S ta ph yl oc oc cu s s pp. a re t he m os t c om mo nl y i so la te d b ac te ri a i n c an in e o st eo my el it is ( 14, 76). A h ig he r r at e o f o st eo my el it is h as b ee n a ss oc ia te d w it h o pe n r ed uc ti on o f f ra ct ur es ( 14 ). T hi s i mp li ca te s s ur gi ca l c on ta mi na ti on a s t he l ea di ng c au se o f b ac te ri al c on ta mi na ti on ( 38 ). S. i nt er me di us i s t he m os t c om mo nl y i so la te d o rg an is m o f s ki n f lo ra i n t he d og ( 72 ). I t s ho ul d b e n ot ed t ha t m an y s tr ai ns o f S. i nt er me di us w er e p re vi ou sl y i de nt if ie d a s S. a ur eu s, s pe ci fi ca ll y t ho se r ec ov er ed f ro m d og s ( 13 ). 18

31 C on ta mi na ti on o f o rt ho pe di c i mp la nt s i nc reas es t he r is k o f c hr on ic i nf ec ti on ( 61 ). P oo r b lo od s up pl y, b ac te ri al b io fi lm o r g ly co ca ly x p ro du ct io n c on tr ib ut e t o a p oo r r es po ns e w it h c om mo n m od es o f t he ra py ( 34 ). T hu s s ur gi ca l r em ov al o f i mp la nt s, f or ei gn b od ie s o r s eq ue st ra e i s u su al ly n ec es sa ry t o r es ol ve r ec ur re nt o st eo my el it is i nf ec ti on s. C ur re nt ly t he re a re n o a dd it io na l r ec om me nd at io ns f or a dd it iv e t he ra pi es t o p re ve nt o r t re at d ev ic e r el at ed i nf ec ti on s o th er t ha n t he s ta nd ar d u se o f a pp ro pr ia te a nt ib io ti c t he ra py a nd i mp la nt r em ov al. I nv es ti ga ti on i nt o t he u se o f o rt ho pe di c i mp la nt s c oa te d w it h a nt is ep ti c s ol ut io ns a nd s il ve r h as s ho wn s om e s uc ce ss ( 18, 2 2). S il ve r h as b ee n l on g k no wn f or i ts b ro ad -s pe ct ru m a nt ib ac te ri al p ro pe rt ie s ( 4, 3 9, 8 5). S il ve r a nd i ts c om po un ds h av e p oo r t is su e p en et ra ti on a nd i t i s u su al ly l im it ed t o t op ic al a pp li ca ti on s. D ir ec t c ur re nt ( an od ic ) s ti mu la ti on o f s il ve r, o r s il ve r i on i on to ph or es is, l ib er at es s il ve r i on s a ll ow in g t is su e p en et ra ti on b y d if fu si on a nd i on ic m ig ra ti on a lo ng a v ol ta ge g ra di en t. S il ve r i on i on to ph or es is h as e xp er im en ta ll y p ro ve n a nt ib ac te ri al e ff ec ts i n e x v iv o a nd i n v iv o s tu di es ( 5, 20, 81). S il ve r i on i on to ph or es is a ll ow s t is su e p en et ra t i on o f a nt ib a ct er ia l s il ve r i on s t ha t i s n ot p os si bl e w it h t op ic al s il ve r p re pa ra ti on s. C at ho di c e le ct ri ca l s ti mu la ti on o f s il ve r h as s ho wn a f av or ab le o st eo ge ni c r es po ns e a nd h as p ro ve n o st eo ge ni c a ct iv it y i n h ea li ng b on e ( 79 ). A no di c e le ct ri ca l s ti mu la ti on m ay h av e n eg at iv e e ff ec ts o n b on e h ea li ng, b ut t hi s h as n ot b ee n 19

32 d oc um en te d. W hi le t he a nt i- ba ct er ia l e ff ec ts o f a no di c s ti mu la ti on o f s il ve r h av e b ee n p ro ve n, t he e ff ec ts o n b on e h ea li ng h av e n ot b ee n e va lu at ed. T he u se o f s ol id s il ve r i mp la nt s f or o rt ho pe di c s ta bi li za ti on i s n ot f ea si bl e d ue t o t he w ea k b io me ch an ic al p ro pe rt ie s o f s il ve r. S ev er al c li ni cal t ri al s i n p eo pl e h av e s ho wn f av or ab le r es ul ts f or t he t re at me nt o f c hr on ic o st eo my el it is w it h s il ve r i on i on to ph or es is ( 4, 56, 85). T he se t re at me nt s i nc lu de d i nt ra le si on al p la ce me nt o f i nt ra me du ll ar y s il ve r w ir e o r t he u se o f s il ve r- co at ed n yl on w ou nd d re ss in gs. B ot h m et ho ds w er e i nv as iv e a nd r eq ui re d c on st an t m on it or in g a nd c ar e. C ol ma no f ou nd t ha t c oa ti ng s ta in le ss s te e l i nt ra me du ll ar y p in s w it h s il ve r s te ar at e c au se d 100 % i nh ib it io n o f b ac te ri al c on ta mi na ti on i n t he r ab bi t f em ur ( 20 ). S il ve r c oa ti ng o f s ta nd ar d m et al li c o rt ho pe di c i mp la nt s c om bi ne s s il ve r i on i on to ph or es is a nd p ro ve n o rt ho pe di c t re at me nt m od al it ie s w it ho ut a dd in g t im e o r t ra um a t o t he p ro ce du re. T he p ur po se o f t hi s s tu dy w as t o e va lu at e t he e ff ec ts o f a no di c e le ct ri ca ll y- st im ul at ed s il ve r- co at ed s ta in le ss s te el o rt ho pe di c i mp la nts t ha t w er e u se d to s ta bi li ze a c onta mi na te d f ra ct ur e g ap m od el o f t he c an in e r ad iu s. 20

33 M at er ia l a nd M et ho ds : S ub je ct s: T we lv e s ke le ta ll y m at ur e, n on -c ho nd ro dy st ro ph oi d, m ix ed b re ed d og s w ei gh in g b et we en k g ( me an k g) w er e u se d. T he p ro je ct w as a pp ro ve d b y t he V ir gi ni a P ol yt ec hn ic I ns ti tu te a nd S ta te U ni ve rs it y A ni ma l C ar e a nd U se C om mi tt ee. D og s w er e i nc lu de d i n t he s tu dy i f n o s ig ni fi ca nt a bn or ma li ti es w er e n ot ed o n p hy si ca l e xa mi na ti on, c om pl et e b lo od c ou nt a nd d if fe re nt ia l, b io ch em is tr y p ro fi le, l am en es s e va lu at io n, o rt ho pe di c e xa mi na ti on, a nd b il at er al c ra ni o- ca ud al a nd m ed ia l- la te ra l r ad io gr ap hs o f t he a nt eb ra ch ia. S il ve r c oa ti ng : A s ur gi ca l s ta in le ss s te el i mp la nt s et c on si st in g o f a 6 -h ol e, 3.5 m m n ar ro w d yn am ic c om pr es si on p la te ; 6, 3.5 m m c or ti ca l b on e s cr ew s; a nd a l en gt h o f 24 g au ge o r th op ed ic w ir e w er e a ss ig ne d t o e ac h r ad iu s o f e ac h d og 1. T he b on e p la te s w er e p re co nt ou re d t o t he m id -d ia ph ys ea l c ra ni al c or te x o f e ac h r ad iu s f ro m m ed ia l- l at er al r ad io gr ap hs. S cr ew l en gt hs w er e s im il ar ly s el ec te d f or t he a pp ro pr ia te s cr ew h ol es. O ne i m pl an t s et w as r an do ml y c ho se n f or e ac h d og a nd 100 m on om ol ec ul ar l ay er s o f s il ve r s te ar at e w er e a pp li ed.( 20 ) 2 E ve ry d og h ad a s ta in le ss s te el i mp la nt s et a ss ig ne d t o o ne r ad iu s a nd a s il ve r- co at ed s ta in le ss s te el i mp la nt s et a ss ig ne d t o t he c on tr al at er al r ad iu s. A ll i mp la nt s et s w er e g as s te ri li ze d p ri or t o s ur ge ry. T he s ur ge on s a nd e va lu at or s w er e b li nd ed t o t he s il ve r t re at me nt s ta tu s o f e ac h i mp la nt s et. 1 Synthes Paoli, PA Colmano Inc. 21

1.- L a m e j o r o p c ió n e s c l o na r e l d i s co ( s e e x p li c a r á d es p u é s ).

1.- L a m e j o r o p c ió n e s c l o na r e l d i s co ( s e e x p li c a r á d es p u é s ). PROCEDIMIENTO DE RECUPERACION Y COPIAS DE SEGURIDAD DEL CORTAFUEGOS LINUX P ar a p od e r re c u p e ra r nu e s t r o c o rt a f u e go s an t e un d es a s t r e ( r ot u r a d e l di s c o o d e l a

More information

Campus Sustainability Assessment and Related Literature

Campus Sustainability Assessment and Related Literature Campus Sustainability Assessment and Related Literature An Annotated Bibliography and Resource Guide Andrew Nixon February 2002 Campus Sustainability Assessment Review Project Telephone: (616) 387-5626

More information

H ig h L e v e l O v e r v iew. S te p h a n M a rt in. S e n io r S y s te m A rc h i te ct

H ig h L e v e l O v e r v iew. S te p h a n M a rt in. S e n io r S y s te m A rc h i te ct H ig h L e v e l O v e r v iew S te p h a n M a rt in S e n io r S y s te m A rc h i te ct OPEN XCHANGE Architecture Overview A ge nda D es ig n G o als A rc h i te ct u re O ve rv i ew S c a l a b ili

More information

SCO TT G LEA SO N D EM O Z G EB R E-

SCO TT G LEA SO N D EM O Z G EB R E- SCO TT G LEA SO N D EM O Z G EB R E- EG Z IA B H ER e d it o r s N ) LICA TIO N S A N D M ETH O D S t DVD N CLUDED C o n t e n Ls Pr e fa c e x v G l o b a l N a v i g a t i o n Sa t e llit e S y s t e

More information

C o a t i a n P u b l i c D e b tm a n a g e m e n t a n d C h a l l e n g e s o f M a k e t D e v e l o p m e n t Z a g e bo 8 t h A p i l 2 0 1 1 h t t pdd w w wp i j fp h D p u b l i c2 d e b td S t

More information

Put the human back in Human Resources.

Put the human back in Human Resources. Put the human back in Human Resources A Co m p l et e Hu m a n Ca p i t a l Ma n a g em en t So l u t i o n t h a t em p o w er s HR p r o f essi o n a l s t o m eet t h ei r co r p o r a t e o b j ect

More information

1. Oblast rozvoj spolků a SU UK 1.1. Zvyšování kvalifikace Školení Zapojení do projektů Poradenství 1.2. Financování 1.2.1.

1. Oblast rozvoj spolků a SU UK 1.1. Zvyšování kvalifikace Školení Zapojení do projektů Poradenství 1.2. Financování 1.2.1. 1. O b l a s t r o z v o j s p o l k a S U U K 1. 1. Z v y š o v á n í k v a l i f i k a c e Š k o l e n í o S t u d e n t s k á u n i e U n i v e r z i t y K a r l o v y ( d á l e j e n S U U K ) z í

More information

I n la n d N a v ig a t io n a co n t r ib u t io n t o eco n o m y su st a i n a b i l i t y

I n la n d N a v ig a t io n a co n t r ib u t io n t o eco n o m y su st a i n a b i l i t y I n la n d N a v ig a t io n a co n t r ib u t io n t o eco n o m y su st a i n a b i l i t y and KB rl iak s iol mi a, hme t a ro cp hm a5 a 2k p0r0o 9f i,e ls hv oa nr t ds eu rmv oedye l o nf dae cr

More information

Using Predictive Modeling to Reduce Claims Losses in Auto Physical Damage

Using Predictive Modeling to Reduce Claims Losses in Auto Physical Damage Using Predictive Modeling to Reduce Claims Losses in Auto Physical Damage CAS Loss Reserve Seminar 23 Session 3 Private Passenger Automobile Insurance Frank Cacchione Carlos Ariza September 8, 23 Today

More information

Victims Compensation Claim Status of All Pending Claims and Claims Decided Within the Last Three Years

Victims Compensation Claim Status of All Pending Claims and Claims Decided Within the Last Three Years Claim#:021914-174 Initials: J.T. Last4SSN: 6996 DOB: 5/3/1970 Crime Date: 4/30/2013 Status: Claim is currently under review. Decision expected within 7 days Claim#:041715-334 Initials: M.S. Last4SSN: 2957

More information

i n g S e c u r it y 3 1B# ; u r w e b a p p li c a tio n s f r o m ha c ke r s w ith t his å ] í d : L : g u id e Scanned by CamScanner

i n g S e c u r it y 3 1B# ; u r w e b a p p li c a tio n s f r o m ha c ke r s w ith t his å ] í d : L : g u id e Scanned by CamScanner í d : r ' " B o m m 1 E x p e r i e n c e L : i i n g S e c u r it y. 1-1B# ; u r w e b a p p li c a tio n s f r o m ha c ke r s w ith t his g u id e å ] - ew i c h P e t e r M u la e n PACKT ' TAÞ$Æo

More information

G ri d m on i tori n g w i th N A G I O S (*) (*) Work in collaboration with P. Lo Re, G. S av a and G. T ortone WP3-I CHEP 2000, N F N 10.02.2000 M e e t i n g, N a p l e s, 29.1 1.20 0 2 R o b e r 1

More information

d e f i n i c j i p o s t a w y, z w i z a n e j e s t t o m. i n. z t y m, i p o jі c i e t o

d e f i n i c j i p o s t a w y, z w i z a n e j e s t t o m. i n. z t y m, i p o jі c i e t o P o s t a w y s p o і e c z e t s t w a w o b e c o s у b n i e p e і n o s p r a w n y c h z e s z c z e g у l n y m u w z g lb d n i e n i e m o s у b z z e s p o і e m D o w n a T h e a t t i t uodf

More information

Application Note: Cisco A S A - Ce r t if ica t e T o S S L V P N Con n e ct ion P r of il e Overview: T h i s a p p l i ca ti o n n o te e x p l a i n s h o w to co n f i g u r e th e A S A to a cco m

More information

G d y n i a U s ł u g a r e j e s t r a c j i i p o m i a r u c z a s u u c z e s t n i k ó w i m p r e z s p o r t o w y c h G d y s k i e g o O r o d k a S p o r t u i R e k r e a c j i w r o k u 2 0

More information

FORT WAYNE COMMUNITY SCHOOLS 12 00 SOUTH CLINTON STREET FORT WAYNE, IN 468 02 6:02 p.m. Ma r c h 2 3, 2 015 OFFICIAL P ROCEED ING S Ro l l Ca l l e a r d o f h o o l u e e o f t h e r t y m m u t y h o

More information

JCUT-3030/6090/1212/1218/1325/1530

JCUT-3030/6090/1212/1218/1325/1530 JCUT CNC ROUTER/CNC WOODWORKING MACHINE JCUT-3030/6090/1212/1218/1325/1530 RZNC-0501 Users Guide Chapter I Characteristic 1. Totally independent from PC platform; 2. Directly read files from U Disk; 3.

More information

Unit 16 : Software Development Standards O b jec t ive T o p r o v id e a gu ide on ho w t o ac h iev e so f t wa r e p r o cess improvement through the use of software and systems engineering standards.

More information

SCHOOL PESTICIDE SAFETY AN D IN TEG R ATED PEST M AN AG EM EN T Statutes put into law by the Louisiana Department of Agriculture & Forestry to ensure the safety and well-being of children and school personnel

More information

W Cisco Kompetanse eek end 2 0 0 8 SMB = Store Mu ll ii gg hh eter! Nina Gullerud ng ulleru@ c is c o. c o m 1 Vår E n t e r p r i s e e r f a r i n g... 2 S m å o g M e llo m s t o r e B e d r i f t e

More information

m Future of learning Zehn J a hr e N et A c a d ei n E r f o l g s p r o g r a m Cisco E x p o 2 0 0 7 2 6. J u n i 2 0 0 7, M e sse W ie n C. D or n in g e r, b m u k k 1/ 12 P r e n t t z d e r p u t

More information

Opis przedmiotu zamówienia - zakres czynności Usługi sprzątania obiektów Gdyńskiego Centrum Sportu

Opis przedmiotu zamówienia - zakres czynności Usługi sprzątania obiektów Gdyńskiego Centrum Sportu O p i s p r z e d m i o t u z a m ó w i e n i a - z a k r e s c z y n n o c i f U s ł u i s p r z» t a n i a o b i e k t ó w G d y s k i e C eo n t r u m S p o r t us I S t a d i o n p i ł k a r s k i

More information

B I N G O B I N G O. Hf Cd Na Nb Lr. I Fl Fr Mo Si. Ho Bi Ce Eu Ac. Md Co P Pa Tc. Uut Rh K N. Sb At Md H. Bh Cm H Bi Es. Mo Uus Lu P F.

B I N G O B I N G O. Hf Cd Na Nb Lr. I Fl Fr Mo Si. Ho Bi Ce Eu Ac. Md Co P Pa Tc. Uut Rh K N. Sb At Md H. Bh Cm H Bi Es. Mo Uus Lu P F. Hf Cd Na Nb Lr Ho Bi Ce u Ac I Fl Fr Mo i Md Co P Pa Tc Uut Rh K N Dy Cl N Am b At Md H Y Bh Cm H Bi s Mo Uus Lu P F Cu Ar Ag Mg K Thomas Jefferson National Accelerator Facility - Office of cience ducation

More information

Future Trends in Airline Pricing, Yield. March 13, 2013

Future Trends in Airline Pricing, Yield. March 13, 2013 Future Trends in Airline Pricing, Yield Management, &AncillaryFees March 13, 2013 THE OPPORTUNITY IS NOW FOR CORPORATE TRAVEL MANAGEMENT BUT FIRST: YOU HAVE TO KNOCK DOWN BARRIERS! but it won t hurt much!

More information

BLADE 12th Generation. Rafał Olszewski. Łukasz Matras

BLADE 12th Generation. Rafał Olszewski. Łukasz Matras BLADE 12th Generation Rafał Olszewski Łukasz Matras Jugowice, 15-11-2012 Gl o b a l M a r k e t i n g Dell PowerEdge M-Series Blade Server Portfolio M-Series Blades couple powerful computing capabilities

More information

Enterprise Data Center A c h itec tu re Consorzio Operativo Gruppo MPS Case S t u d y : P r o g et t o D i sast er R ec o v er y Milano, 7 Febbraio 2006 1 Il G r u p p o M P S L a B a n c a M o n t e d

More information

EM EA. D is trib u te d D e n ia l O f S e rv ic e

EM EA. D is trib u te d D e n ia l O f S e rv ic e EM EA S e c u rity D e p lo y m e n t F o ru m D e n ia l o f S e rv ic e U p d a te P e te r P ro v a rt C o n s u ltin g S E p p ro v a rt@ c is c o.c o m 1 A g e n d a T h re a t U p d a te IO S Es

More information

R e t r o f i t o f t C i r u n i s g e C o n t r o l

R e t r o f i t o f t C i r u n i s g e C o n t r o l R e t r o f i t o f t C i r u n i s g e C o n t r o l VB Sprinter D e s c r i p t i o n T h i s r e t r o f i t c o n s i s t s o f i n s t a l l i n g a c r u i s e c o n t r o l s wi t c h k i t i n

More information

G S e r v i c i o C i s c o S m a r t C a r e u ي a d e l L a b o r a t o r i o d e D e m o s t r a c i n R ل p i d a V e r s i n d e l S e r v i c i o C i s c o S m a r t C a r e : 1 4 ع l t i m a A c

More information

T c k D E GR EN S. R a p p o r t M o d u le Aa n g e m a a k t o p 19 /09 /2007 o m 09 :29 u u r BJB 06 013-0009 0 M /V. ja a r.

T c k D E GR EN S. R a p p o r t M o d u le Aa n g e m a a k t o p 19 /09 /2007 o m 09 :29 u u r BJB 06 013-0009 0 M /V. ja a r. D a t a b a n k m r in g R a p p o r t M Aa n g e m a a k t o p 19 /09 /2007 o m 09 :29 u u r I d e n t if ic a t ie v a n d e m S e c t o r BJB V o lg n r. 06 013-0009 0 V o o r z ie n in g N ie u w la

More information

First A S E M R e c to rs C o n f e re n c e : A sia E u ro p e H ig h e r E d u c a tio n L e a d e rsh ip D ia l o g u e Fre ie U n iv e rsitä t, B e rl in O c to b e r 2 7-2 9 2 0 0 8 G p A G e e a

More information

Online Department Stores. What are we searching for?

Online Department Stores. What are we searching for? Online Department Stores What are we searching for? 2 3 CONTENTS Table of contents 02 Table of contents 03 Search 06 Fashion vs. footwear 04 A few key pieces 08 About SimilarWeb Stepping up the Competition

More information

Collaboration in Public H e alth be tw e e n U niv e rs ity of H e id e lbe rg and U niv e rs ity of D ar e s S alaam How t h e c oop e r a t i on e m e r g e d Informal c ont ac t s from e arly 1 9

More information

ACE-1/onearm #show service-policy client-vips

ACE-1/onearm #show service-policy client-vips M A C E E x a m Basic Load Balancing Using O ne A r m M ode w it h S ou r ce N A T on t h e C isco A p p licat ion C ont r ol E ngine Goal Configure b a s ic l oa d b a l a nc ing (L a y er 3 ) w h ere

More information

The Business Case for D om aink ey s I d ent ified M ail Andy Spillane V ic e P r es ident, Y ah o o! M February 13, 2006 ail 1 Fighting Spam & Email Abuse R eq uir es a M ulti-fac eted Appr o ac h DomainKeys

More information

Cisco Security Agent (CSA) CSA je v í c eúčelo v ý s o f t w a r o v ý ná s t r o j, k t er ý lze p o už í t k v ynuc ení r ů zný c h b ezp ečno s t ní c h p o li t i k. CSA a na lyzuje c h o v á ní a

More information

HR DEPARTMENTAL SUFFIX & ORGANIZATION CODES

HR DEPARTMENTAL SUFFIX & ORGANIZATION CODES HR DEPARTMENTAL SUFFIX & ORGANIZATION CODES Department Suffix Organization Academic Affairs and Dean of Faculty, VP AA 1100 Admissions (Undergraduate) AD 1330 Advanced Ceramics, Colorado Center for--ccac

More information

An E mpir ical Analysis of Stock and B ond M ar ket Liquidity

An E mpir ical Analysis of Stock and B ond M ar ket Liquidity A p r il 2 2, 2 0 0 2 An E mpir ical Analysis of Stock and B ond M ar ket Liquidity Ta r u n Ch o r d ia, A s a n i S a r ka r, a n d A va n id h a r S u b r a h m a n ya m Go iz u e t a B u s in e s s

More information

UNDERSTANDING FLOW PROCESSING WITHIN THE CISCO ACE M ODULE Application de liv e r y pr odu cts can distr ib u te tr af f ic to applications and w e b se r v ice s u sing v ar y ing le v e ls of application

More information

AN EVALUATION OF SHORT TERM TREATMENT PROGRAM FOR PERSONS DRIVING UNDER THE INFLUENCE OF ALCOHOL 1978-1981. P. A. V a le s, Ph.D.

AN EVALUATION OF SHORT TERM TREATMENT PROGRAM FOR PERSONS DRIVING UNDER THE INFLUENCE OF ALCOHOL 1978-1981. P. A. V a le s, Ph.D. AN EVALUATION OF SHORT TERM TREATMENT PROGRAM FOR PERSONS DRIVING UNDER THE INFLUENCE OF ALCOHOL 1978-1981 P. A. V a le s, Ph.D. SYNOPSIS Two in d ep en d en t tre a tm e n t g ro u p s, p a r t ic ip

More information

Device I n s t r u m en t a t io n E x a m p l es : I P S L A s & N et F l o w Presented by Emmanuel Tychon Techni cal M ark eti ng Eng i neer TU D resden, J anuary 1 7 th 2 0 0 7 1. C is co I O S I P

More information

B a rn e y W a r f. U r b a n S tu d ie s, V o l. 3 2, N o. 2, 1 9 9 5 3 6 1 ±3 7 8

B a rn e y W a r f. U r b a n S tu d ie s, V o l. 3 2, N o. 2, 1 9 9 5 3 6 1 ±3 7 8 U r b a n S tu d ie s, V o l. 3 2, N o. 2, 1 9 9 5 3 6 1 ±3 7 8 T e le c o m m u n ic a t io n s a n d th e C h a n g in g G e o g r a p h ie s o f K n o w le d g e T r a n s m is s io n in th e L a te

More information

Vom prozessorientierten Wissensmanagement zum intelligenten Engineering-Portal

Vom prozessorientierten Wissensmanagement zum intelligenten Engineering-Portal Vom prozessorientierten Wissensmanagement zum intelligenten Engineering-Portal Praxisbericht aus der Entwicklung von Hochauftriebsystemen für Verkehrsflugzeuge KnowTech Stuttgart, 24.-25.10.2012 Thomas

More information

How to Subnet a Network How to use this paper Absolute Beginner: Read all Sections 1-4 N eed a q uick rev iew : Read Sections 2-4 J ust need a little h elp : Read Section 4 P a r t I : F o r t h e I P

More information

PSTN. Gateway. Switch. Supervisor PC. Ethernet LAN. IPCC Express SERVER. CallManager. IP Phone. IP Phone. Cust- DB

PSTN. Gateway. Switch. Supervisor PC. Ethernet LAN. IPCC Express SERVER. CallManager. IP Phone. IP Phone. Cust- DB M IPCC EXPRESS Product Solution (IPCC - IP Co n t a c t Ce n t e r ) E i n f ü h r u n g Ü b e r h u nd e r t M il l io ne n N u t ze r - P r o g no s e n zu f o l g e w e r d e n e s in d ie s e m J ah

More information

L a h ip e r t e n s ió n a r t e r ia l s e d e f in e c o m o u n n iv e l d e p r e s ió n a r t e r ia l s is t ó lic a ( P A S ) m a y o r o

L a h ip e r t e n s ió n a r t e r ia l s e d e f in e c o m o u n n iv e l d e p r e s ió n a r t e r ia l s is t ó lic a ( P A S ) m a y o r o V e r s i ó n P á g i n a 1 G U I A D E M A N E J O D E H I P E R T E N S I O N E S C E N C I A L 1. D E F I N I C I O N. L a h ip e r t e n s ió n a r t e r ia l s e d e f in e c o m o u n n iv e l d

More information

Overview of Spellings on www.spellzoo.co.uk

Overview of Spellings on www.spellzoo.co.uk Overview of Spellings on www.spellzoo.co.uk Year 1 Set 1: CVC words Set 2: CVC and CCVC words Set 3: CVC, CCVC and CCVCC words Set 4: Words containing 'ch', 'sh', 'th' and 'wh' Set 5: Words ending in 'll',

More information

CLASS TEST GRADE 11. PHYSICAL SCIENCES: CHEMISTRY Test 6: Chemical change

CLASS TEST GRADE 11. PHYSICAL SCIENCES: CHEMISTRY Test 6: Chemical change CLASS TEST GRADE PHYSICAL SCIENCES: CHEMISTRY Test 6: Chemical change MARKS: 45 TIME: hour INSTRUCTIONS AND INFORMATION. Answer ALL the questions. 2. You may use non-programmable calculators. 3. You may

More information

Excel Invoice Format. SupplierWebsite - Excel Invoice Upload. Data Element Definition UCLA Supplier website (Rev. July 9, 2013)

Excel Invoice Format. SupplierWebsite - Excel Invoice Upload. Data Element Definition UCLA Supplier website (Rev. July 9, 2013) Excel Invoice Format Excel Column Name Cell Format Notes Campus* Supplier Number* Invoice Number* Order Number* Invoice Date* Total Invoice Amount* Total Sales Tax Amount* Discount Amount Discount Percent

More information

bow bandage candle buildings bulb coins barn cap corn

bow bandage candle buildings bulb coins barn cap corn b c bow bandage candle buildings bulb coins barn cap corn Copyright (C) 1999 Senari Programs Page 1 SoundBox Montessori d f darts dice door dove forest farm film foot fish Copyright (C) 1999 Senari Programs

More information

<?xml version="1.0" encoding="utf-8"?> <soapenv:envelope xmlns:soapenv="http://schemas.xmlsoap.org/soap/envelope/"

<?xml version=1.0 encoding=utf-8?> <soapenv:envelope xmlns:soapenv=http://schemas.xmlsoap.org/soap/envelope/ Applicazioni Java W S con Ax is sistema di tr ac c iab il ità ag r o al imen tar e Ing. Mario G.C.A. Cimino M.G.C.A.Cimino, Applicazioni Java-W S con Ax is, D ipar t ime nt o d i I ng e g ne r ia d e ll

More information

Frederikshavn kommunale skolevæsen

Frederikshavn kommunale skolevæsen Frederikshavn kommunale skolevæsen Skoleåret 1969-70 V e d K: Hillers-Andersen k. s k o l e d i r e k t ø r o g Aage Christensen f u l d m æ g t i g ( Fr e d e rik sh av n E k sp r e s- T ry k k e rie

More information

B rn m e d s rlig e b e h o v... 3 k o n o m i... 6. S s k e n d e tils k u d o g k o n o m is k frip la d s... 7 F o r ld re b e ta lin g...

B rn m e d s rlig e b e h o v... 3 k o n o m i... 6. S s k e n d e tils k u d o g k o n o m is k frip la d s... 7 F o r ld re b e ta lin g... V e lf rd s s e k re ta ria te t S a g s n r. 1 4 3 4 1 5 B re v id. 9 9 3 9 7 4 R e f. S O T H D ir. tlf. 4 6 3 1 4 0 0 9 s o fie t@ ro s k ild e.d k G o d k e n d e ls e s k rite rie r fo r p riv a tin

More information

8 / c S t a n d a r d w y m a g a ń - e g z a m i n c z e l a d n i c z y dla zawodu Ś L U S A R Z Kod z klasyfikacji zawodów i sp e cjaln oś ci dla p ot r ze b r yn ku p r acy Kod z klasyfikacji zawodów

More information

S e w i n g m a c h i n e s for but t - seams. - c o m p l e t e b r o c h u r e -

S e w i n g m a c h i n e s for but t - seams. - c o m p l e t e b r o c h u r e - S e w i n g m a c h i n e s for but t - seams - c o m p l e t e b r o c h u r e - D o h l e s e w i n g m a c h i n e s f o r b u t t - s e a m s Head Office D o h l e m a n u f a c t u re b u t t s e

More information

UNIK4250 Security in Distributed Systems University of Oslo Spring 2012. Part 7 Wireless Network Security

UNIK4250 Security in Distributed Systems University of Oslo Spring 2012. Part 7 Wireless Network Security UNIK4250 Security in Distributed Systems University of Oslo Spring 2012 Part 7 Wireless Network Security IEEE 802.11 IEEE 802 committee for LAN standards IEEE 802.11 formed in 1990 s charter to develop

More information

Understanding, Modelling and Improving the Software Process. Ian Sommerville 1995 Software Engineering, 5th edition. Chapter 31 Slide 1

Understanding, Modelling and Improving the Software Process. Ian Sommerville 1995 Software Engineering, 5th edition. Chapter 31 Slide 1 Process Improvement Understanding, Modelling and Improving the Software Process Ian Sommerville 1995 Software Engineering, 5th edition. Chapter 31 Slide 1 Process improvement Understanding existing processes

More information

Chem 115 POGIL Worksheet - Week 4 Moles & Stoichiometry Answers

Chem 115 POGIL Worksheet - Week 4 Moles & Stoichiometry Answers Key Questions & Exercises Chem 115 POGIL Worksheet - Week 4 Moles & Stoichiometry Answers 1. The atomic weight of carbon is 12.0107 u, so a mole of carbon has a mass of 12.0107 g. Why doesn t a mole of

More information

W h a t is m e tro e th e rn e t

W h a t is m e tro e th e rn e t 110 tv c h a n n e ls to 10 0 0 0 0 u s e rs U lf V in n e ra s C is c o S y s te m s 2 0 0 2, C is c o S y s te m s, In c. A ll rig h ts re s e rv e d. 1 W h a t is m e tro e th e rn e t O b je c tiv

More information

Transient Voltage Suppressor SMBJ5.0 - SMBJ440CA

Transient Voltage Suppressor SMBJ5.0 - SMBJ440CA Features: Glass passivated junction Low incremental surge resistance, excellent clamping capability 600W peak pulse power capability with a 10/1,000μs waveform, repetition rate (duty cycle): 0.01% Very

More information

SEPTEMBER Unit 1 Page Learning Goals 1 Short a 2 b 3-5 blends 6-7 c as in cat 8-11 t 12-13 p

SEPTEMBER Unit 1 Page Learning Goals 1 Short a 2 b 3-5 blends 6-7 c as in cat 8-11 t 12-13 p The McRuffy Kindergarten Reading/Phonics year- long program is divided into 4 units and 180 pages of reading/phonics instruction. Pages and learning goals covered are noted below: SEPTEMBER Unit 1 1 Short

More information

IronPort Gateway Security Products The Leader in Communication Security Reiner Baumann IronPort Systems The Principles of Industry Leadership A n a l y s t L e a d e r s h i p R e c o g n i z e d a s t

More information

With Rejoicing Hearts/ Con Amor Jovial. A Fm7 B sus 4 B Cm Cm7/B

With Rejoicing Hearts/ Con Amor Jovial. A Fm7 B sus 4 B Cm Cm7/B for uli With Rejoic Herts/ on mor ol dition # 10745-Z1 ime ortez Keyord ccompniment y effy Honoré INTRO With energy ( = c 88) Keyord * m7 B sus 4 B 7/B mj 9 /B SMPL B 7 *Without percussion, egin he 1995,

More information

CUSTOMER INFORMATION SECURITY AWARENESS TRAINING

CUSTOMER INFORMATION SECURITY AWARENESS TRAINING CUSTOMER INFORMATION SECURITY AWARENESS TRAINING IN T RO DUCT ION T h i s c o u r s e i s d e s i g n e d to p r o v i d e yo u w i t h t h e k n o w l e d g e to p r o t e c t y o u r p e r s o n a l

More information

How To Rate Plan On A Credit Card With A Credit Union

How To Rate Plan On A Credit Card With A Credit Union Rate History Contact: 1 (800) 331-1538 Form * ** Date Date Name 1 NH94 I D 9/14/1998 N/A N/A N/A 35.00% 20.00% 1/25/2006 3/27/2006 8/20/2006 2 LTC94P I F 9/14/1998 N/A N/A N/A 35.00% 20.00% 1/25/2006 3/27/2006

More information

U.S. Department of Housing and Urban Development: Weekly Progress Report on Recovery Act Spending

U.S. Department of Housing and Urban Development: Weekly Progress Report on Recovery Act Spending U.S. Department of Housing and Urban Development: Weekly Progress Report on Recovery Act Spending by State and Program Report as of 3/7/2011 5:40:51 PM HUD's Weekly Recovery Act Progress Report: AK Grants

More information

M P L S /V P N S e c u rity. 2 0 0 1, C is c o S y s te m s, In c. A ll rig h ts re s e rv e d.

M P L S /V P N S e c u rity. 2 0 0 1, C is c o S y s te m s, In c. A ll rig h ts re s e rv e d. M P L S /V P N S e c u rity M ic h a e l B e h rin g e r < m b e h rin g @ c is c o.c o m > M b e h rin g - M P L S S e c u rity 2 0 0 1, C is c o S y s te m s, In c. A ll rig h ts re s e rv e d. 1 W h

More information

CIS CO S Y S T E M S. G u ille rm o A g u irre, Cis c o Ch ile. 2 0 0 1, C is c o S y s te m s, In c. A ll rig h ts re s e rv e d.

CIS CO S Y S T E M S. G u ille rm o A g u irre, Cis c o Ch ile. 2 0 0 1, C is c o S y s te m s, In c. A ll rig h ts re s e rv e d. CIS CO S Y S T E M S A c c e s s T e c h n o lo g y T e le c o m /IT Co n n e c tiv ity W o rk s h o p G u ille rm o A g u irre, Cis c o Ch ile g m o.a g u irre @ c is c o.c o m S e s s io n N u m b e

More information

A a. Cursive Practice. Name: Write the letter on the lines. Write each letter pair. Write each word. Write the sentence twice.

A a. Cursive Practice. Name: Write the letter on the lines. Write each letter pair. Write each word. Write the sentence twice. A A a B B ear ib rake table job cub C C c ca ch cl Cecil could catch a cold. D D d do dl dr od ud David demanded a dirty dog. E E F F G G g go ga gh og ag Ginger gave geese George. H H I I n e t gi li

More information

SIV for VoiceXM 3.0: a n g u a g e a n d A p p l ica t ion D es ig n C on s id era t ion s Ken Rehor C i s c o S y s t em s, I nc. krehor@cisco.com March 05, 2009 G VoiceXM Application Architecture PSTN

More information

CODES FOR PHARMACY ONLINE CLAIMS PROCESSING

CODES FOR PHARMACY ONLINE CLAIMS PROCESSING S FOR PHARMACY ONLINE CLAIMS PROCESSING The following is a list of error and warning codes that may appear when processing claims on the online system. The error codes are bolded. CODE AA AB AI AR CB CD

More information

III Bienal de Autismo Página 1 / 43

III Bienal de Autismo Página 1 / 43 III Bienal de Autismo Página 1 / 43 A Direcção da APPDA N ort e dá -v os as B oas V in das à I I I B ien al de Au t is m q u e es t a corres p on da à s v os s as ex p ect at iv as com o t em a em deb

More information

Der Bologna- P roz es s u nd d i e S t aat s ex am Stefan Bienefeld i na Service-St el l e B o l o g n a d er H R K Sem in a r D er B o l o g n a P ro z es s U m s et z u n g u n d M it g es t a l t u

More information

M Mobile Based Clinical Decision Support System Bhudeb Chakravarti & Dr. Suman Bhusan Bhattacharyya Provider & Public Health Group, VBU-HL P S aty am C om puter S ervices L im ited Bhudeb_ C hak ravarti@

More information

M Official Bologna S e m inar Joint d e gr e e s- A H allm ar k of t h e E u r op e an H igh e r E d u cat ion A r e a? R e s u l t s o f q u e s t i o n n a i r e s e n t t o B o l o g n a F o l l o w

More information

P R E F E I T U R A M U N I C I P A L D E J A R D I M

P R E F E I T U R A M U N I C I P A L D E J A R D I M D E P A R T A M E N T O D E C O M P R A S E L I C I T A O A U T O R I Z A O P A R A R E A L I Z A O D E C E R T A M E L I C I T A T с R I O M O D A L I D A D E P R E G O P R E S E N C I A L N 034/ 2 0

More information

All answers must use the correct number of significant figures, and must show units!

All answers must use the correct number of significant figures, and must show units! CHEM 10113, Quiz 2 September 7, 2011 Name (please print) All answers must use the correct number of significant figures, and must show units! IA Periodic Table of the Elements VIIIA (1) (18) 1 2 1 H IIA

More information

Bonn Declaration on Regional Cooperation in Quality Assurance in Higher Education Adopted on 20 June 2007 during the Conference Enhancing Quality Across Borders R egional Cooperation in Quality Assurance

More information

C e r t ifie d Se c u r e W e b

C e r t ifie d Se c u r e W e b C r t ifi d S c u r W b Z r t ifizi r t Sic h r h it im W b 1 D l gat s N ic o las M ay n c o u r t, C EO, D r am lab T c h n o lo gi s A G M ar c -A n d r é B c k, C o n su lt an t, D r am lab T c h n

More information

Practice Writing the Letter A

Practice Writing the Letter A Aa Practice Writing the Letter A A a A a Write a in the blank to finish each word. c t re h d Write A in the blank to finish each word. nn US ndy Bb Practice Writing the Letter B B b B l P b Write b in

More information

1 9 / m S t a n d a r d w y m a g a ń - e g z a m i n m i s t r z o w s k i dla zawodu M E C H A N I K P O J A Z D Ó W S A M O C H O D O W Y C H Kod z klasyfikacji zawodów i sp e cjaln oś ci dla p ot r

More information

Match/Consolidate User s Guide to Record Matching

Match/Consolidate User s Guide to Record Matching Match/Consolidate User s Guide to Record Matching Match/Consolidate 8.00c April 2009 Copyright information 2009 SAP BusinessObjects. All rights reserved. SAP BusinessObjects and its logos, BusinessObjects,

More information

1 7 / c S t a n d a r d w y m a g a ń - e g z a m i n c z e l a d n i c z y dla zawodu M E C H A N I K - M O N T E R M A S Z Y N I U R Z Ą D Z E Ń Kod z klasyfikacji zawodów i sp e cjaln oś ci dla p ot

More information

Chem 115 POGIL Worksheet - Week 4 Moles & Stoichiometry

Chem 115 POGIL Worksheet - Week 4 Moles & Stoichiometry Chem 115 POGIL Worksheet - Week 4 Moles & Stoichiometry Why? Chemists are concerned with mass relationships in chemical reactions, usually run on a macroscopic scale (grams, kilograms, etc.). To deal with

More information

Clôtures tous types. Serrurerie sur mesure. Portails / Automatisme. Aménagements extérieurs. Maçonnerie. Terrasse / Allée.

Clôtures tous types. Serrurerie sur mesure. Portails / Automatisme. Aménagements extérieurs. Maçonnerie. Terrasse / Allée. Clôtures tous types Serrurerie sur mesure Portails / Automatisme Aménagements extérieurs Maçonnerie Terrasse / Allée Tout à l égout Petite V.R.D Collectivités Particuliers 2 ZA Réganeau 33380 MARCHEPRIME

More information

BERGEN COMMUNITY COLLEGE DIVISION OF BUSINESS, PERFORMING ARTS AND SOCIAL SCIENCES BUSINESS DEPARTMENT

BERGEN COMMUNITY COLLEGE DIVISION OF BUSINESS, PERFORMING ARTS AND SOCIAL SCIENCES BUSINESS DEPARTMENT BERGEN COMMUNITY COLLEGE DIVISION OF BUSINESS, PERFORMING ARTS AND SOCIAL SCIENCES BUSINESS DEPARTMENT BUS 207 Pcpl f Mg S, Y Syllbu Dl Cu Nub/Sc: Mg Dy & T: Iuc: Offc Lc: Ph: R Nub: Offc Hu: E-l : C u

More information

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Continuing Competence

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Continuing Competence This document reports CEU (continuing education units) and CCU (continuing competence units) requirements for renewal. It describes: Number of CEUs/CCUs required for renewal Who approves continuing education

More information

BIG DATA IN TRANSPORT RESEARCH: LEGAL AND PRIVACY CHALLENGES

BIG DATA IN TRANSPORT RESEARCH: LEGAL AND PRIVACY CHALLENGES BIG DATA IN TRANSPORT RESEARCH: LEGAL AND PRIVACY CHALLENGES P R E S ENTATION T R A F I KF DOR A GE MEETING 2 0 1 5 AALBORG 29 TH OF AUGUST NT K R I S T I A N H E G N E R R E I N A U, K R I SJ TO IHA N

More information

How To Be A Successful Thai

How To Be A Successful Thai D The Joint Master of Science eg ree C ou rse in V eterinary P u b l ic H eal th ( MScVPH), F U -C MU Dr. L e rt ra k S ri k i t j a k a rn R e g i o n a l C e n t re f o r V e t e ri n a ry P u b l i

More information

Rapid Damage Assessment Methodology for Catastrophic Souris River Flooding Minot, North Dakota

Rapid Damage Assessment Methodology for Catastrophic Souris River Flooding Minot, North Dakota Rapid Damage Assessment Methodology for Catastrophic Souris River Flooding Minot, North Dakota Analyzing the Extent of Flooding Impacts Using Site Specific Analysis and User Generated Depth Grids Jesse

More information

tis, cis cunc - cunc - tis, cis tis, cis cunc - tis, func - def - def - tis, U func - def - func - tis, pa - tri pa - tri pa - tri tu - per - tu -

tis, cis cunc - cunc - tis, cis tis, cis cunc - tis, func - def - def - tis, U func - def - func - tis, pa - tri pa - tri pa - tri tu - per - tu - 1 B Ihsu dulcs cuncts [Supr 1] [Supr 2] Tnr B B B B - B - B - Ih - Ih - Ih - su su su cs cs cs cunc - cunc - cunc - Amns, Bblthèqu Cntl L Agn, ms 162 D, ff 2v-10 ts, ts, ts, E-tr - E-tr - E-tr - n p n

More information

PRIMER TESTIMONIO. -F o l i o n ú m e r o 1 2 0. ḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋḋ ESC RITU RA NU MERO TREINTA.- E n l a c i u d a d d e B u e n os A i r e s, c a p i t a l d e l a R e p ú b l i c

More information

Present. and. RFA No79/2OO5

Present. and. RFA No79/2OO5 IN TE IG OURT OF KARNATAKA IRUIT BEN AT DARWAD Dted this the Q7th Dy of Mch 211 Pesent TE BLE MRJUSTIE KLMANJUNAT nd TE BLE MRJUSTIE NNAGAMOAN DAS BETWEEN: RFA No7/2OO5 Shi Adiveppgoud S/o MllngoudRyngoud,

More information

A Comparison of Jolly Phonics and Jolly Grammar with the Six Phases of Letters and Sounds

A Comparison of Jolly Phonics and Jolly Grammar with the Six Phases of Letters and Sounds A Comparison of Jolly Phonics and Jolly Grammar with the Six Phases of Letters and Sounds Same Letters and Sounds Jolly Phonics Direct, daily, systematic teaching Active multisensory lessons, including

More information

w ith In fla m m a to r y B o w e l D ise a se. G a s tro in te s tin a l C lin ic, 2-8 -2, K a s h iw a z a, A g e o C ity, S a ita m a 3 6 2 -

w ith In fla m m a to r y B o w e l D ise a se. G a s tro in te s tin a l C lin ic, 2-8 -2, K a s h iw a z a, A g e o C ity, S a ita m a 3 6 2 - E ffic a c y o f S e le c tiv e M y e lo id L in e a g e L e u c o c y te D e p le tio n in P y o d e r m a G a n g re n o su m a n d P so r ia sis A sso c ia te d w ith In fla m m a to r y B o w e l D

More information

Montessori Academy of Owasso

Montessori Academy of Owasso Montessori Academy of Owasso 5 & 6 Year-Old Curriculum Academic Area: Language Arts Category: Reading: Literature Subcategory: Key Ideas and Details Element 1:With prompting and support, ask and answer

More information

Cl1'15 Charlotte-Mecklenburg Schools

Cl1'15 Charlotte-Mecklenburg Schools ~ Cl1'15 Charlotte-Mecklenburg Schools Starmount e Elementary -- Streets (proposed reopening 2015-2016) Schools ~ Ra ilroad -- water Bodies Home School Areas D NATIONS FORD D MONTCLAIRE D HUNTINGTOWNE

More information

Positioning 40 and 100 GbE in data center inter-sw itch l ink ap p l ications and 40GbE PM D recom m endations Adam Carter, Cisco Al essan dro B arb ieri, Cisco 1 m Data Center inter-s w itc h l ink ap

More information

A n d r e w S P o m e r a n tz, M D

A n d r e w S P o m e r a n tz, M D T e le h e a lth in V A : B r in g in g h e a lth c a r e to th e u n d e r s e r v e d in c lin ic a n d h o m e A n d r e w S P o m e r a n tz, M D N a tio n a l M e n ta l H e a lth D ir e c to r f

More information

A Parents Guide to Understanding. Reading

A Parents Guide to Understanding. Reading A Parents Guide to Understanding Reading Dear Parents, After teaching first grade for many years, I was always faced with the same questions at the beginning of the year: What is Pathways to Reading? How

More information