Testicular mesothelioma is the rarest type of this cancer and accounts for .3% to 5% of all diagnosed cases reported. Because of how rare it is, there is little research on the subject, making it difficult to diagnose and treat. Unlike other types, research that mentions testicular mesothelioma tends to only describe the disease rather than provide insight on how to diagnosis, treat or prevent it.
Testicular mesothelioma affects the lining of the testicles. This lining is known specifically as the tunica vaginalis and tunica albuginea. From this point of origin, cancerous tumors can spread to the rest of the body if left untreated. The tunica vaginalis covers the testis like a sac. It is comprised of two layers, the parietal and visceral. The parietal layer lines the cavity of the scrotum while the visceral layer overlies the tunica albuginea. Between the two sections is a small space that is filled with lubricating fluid, reducing the friction that arises from movement between the testes and scrotum.
What is the tunica albuginea?
The tunica albuginea, or “white coat” in Latin, is a lining of dense tissue that envelopes the testes, connecting to the fibres that surround the ducts that move sperm out of the penis from the testes (epididymis). In addition to serving as a protective layer, the tunica albuginea also helps maintain erection of penis or clitoris by trapping blood in erectile tissue.
How is testicular mesothelioma caused?
While asbestos may cause some cases, there hasn’t been research proving this for sure. In addition, scientists aren’t sure how asbestos fibers are able to reach the testicles. However, risk factors that are related to general cancer of the testicles may also relate to testicular mesothelioma. These factors include age, cryptorchidism (one testicle isn’t located in its proper position at birth), trauma and profession. It is believed that miners, firefighters, plumbers and individuals who’ve worked in the printing, leather and gas industries may be at a higher risk because of exposure to certain dyes and solvents.
Testicular mesothelioma can also be the result of mesothelioma that first develops in another area of the body, usually the abdomen (peritoneal). This is because the tunica vaginalis is actually peritoneal tissue.
How do you diagnose peritoneal mesothelioma?
Biopsy is usually the only way to diagnose testicular mesothelioma accurately. The tissue or fluid sample is examined microscopically for the presence of cancer cells. Biopsy is usually performed after physical examination, review of medical history, and possibly imaging scans such as an ultrasound.
Symptoms of testicular mesothelioma are often confused with other diseases affecting the testicles. Symptoms include:
- pain in the testicles that may radiate out to the thighs and lower back
- swelling of the testicles
- a lumpy appearance
- weight loss
- nausea and vomiting
Treatments for testicular mesothelioma are generally the same for other types. Surgery (which involves removing a portion or all of the testicles),radiation therapy and chemotherapy are commonly prescribed. The latter two are advised when the cancer has spread and may be for palliative purposes only. Surgery, however, may not be possible if the patient is at a later stage. Life expectancy after being diagnosed with testicular mesothelioma is within two years2.


Figure 4-10 shows a gear-type motor. Both gears are driven gears, but only one is connected to the output shaft. Operation is essentially the reverse of that of a gear pump. Flow from the pump enters chamber A and flows in either direction around the inside surface of the casing, forcing the gears to rotate as indicated. This rotary motion is then available for work at the output shaft.


Interpolation is the process of filling in the unknown data between two known values. You set keyframes to specify a property’s values at certain key times. After Effects interpolates values for the property for all times between keyframes.
Because interpolation generates the property values between keyframes, interpolation is sometimes called tweening. Interpolation between keyframes can be used to animate movement, effects, audio levels, image adjustments, transparency, color changes, and many other visual and audio elements.
After you create keyframes and motion paths to change values over time, you may want to make more precise adjustments to the way that change occurs. After Effects provides several interpolation methods that affect how the in-between values are calculated.
Temporal interpolation is the interpolation of values in time; spatial interpolation is the interpolation of values in space. Some properties—such as Opacity—have only a temporal component. Other properties—such as Position—also have spatial components.
Using the value graph in the Graph Editor, you can make precise adjustments to the temporal property keyframes you’ve created for your animation. The value graph displays x values as red, y values as green, and z values (3D only) as blue. The value graph provides complete information about the value of keyframes at any point in time in a composition and allows you to control it. In addition, the Info panel displays the temporal interpolation method of a selected keyframe.
When you apply or change spatial interpolation for a property such as Position, you adjust the motion path in the Composition panel. The different keyframes on the motion path provide information about the type of interpolation at any point in time. The Info panel displays the spatial interpolation method of a selected keyframe.
When you create spatial changes in a layer, After Effects uses Auto Bezier as the default spatial interpolation.
To change the default to linear interpolation, choose Edit > Preferences > General (Windows) or After Effects > Preferences > General (Mac OS), and select Default Spatial Interpolation To Linear. Changing the preference setting does not affect keyframes that already exist or new keyframes on properties for which keyframes already exist.
A. Linear B. Auto Bezier C. Continuous Bezier D. Bezier E. Hold
In some cases, the Auto Bezier spatial interpolation for Position keyframes can cause undesired back-and-forth (boomerang) motion between two keyframes with equal values. In such a case, you can change the earlier keyframe to use Hold interpolation or change both keyframes to use Linear interpolation.
Aharon Rabinowitz provides a pair of video tutorials on the Creative COW website that describe the issue and solution for the boomerang motion problem that arises from unintentionally having Auto Bezier spatial interpolation set for keyframes of equal value:
Antony Bolante provides information and illustrations about keyframe interpolation in an article on the Peachpit Press website.
In layer bar mode, the appearance of a keyframe icon depends on the interpolation method you choose for the interval between keyframes. When half of the icon is dark gray , the dark half indicates that no keyframe is adjacent to that side, or that its interpolation is overridden by the Hold interpolation applied to the preceding keyframe.
By default, a keyframe uses one interpolation method, but you can apply two methods: the incoming method applies to the property value as the current time approaches a keyframe, and the outgoing method applies to the property value as the current time leaves a keyframe. When you set different incoming and outgoing interpolation methods, the keyframe icon in layer bar mode changes accordingly. It displays the left half of the incoming interpolation icon and the right half of the outgoing interpolation icon.
To toggle between keyframe icons and keyframe numbers, select Use Keyframe Icons or Use Keyframe Indices from the Timeline panel menu.
A. Linear B. Linear in, Hold out C. Auto Bezier D. Continuous Bezier or Bezier E. Linear in, Bezier out
All interpolation methods used by After Effects are based on the Bezier interpolation method, which provides direction handles so that you can control the transitions between keyframes. Interpolation methods that don’t use direction handles are constrained versions of Bezier interpolation and are convenient for certain tasks.
To learn more about how different interpolation methods affect temporal properties, experiment by setting up at least three keyframes with different values for a temporal layer property—such as Opacity—and change the interpolation methods as you view the value graph in Graph Editor mode in the Timeline panel.
To learn more about how different interpolation methods affect a motion path, experiment by setting up three keyframes for a spatial property—such as Position—with different values on a motion path, and change the interpolation methods as you preview the motion in the Composition panel.
To change interpolation methods, right-click a keyframe, select Keyframe Interpolation from the menu that appears, and then select an option from the Temporal Interpolation menu.
To clarify the examples in the following descriptions of interpolation methods, the result of each method is described as if you had applied it to all of the keyframes for a layer property. In practice, you can apply any available interpolation method to any keyframe.
No interpolation is the state in which a layer property has no keyframes—when the stopwatch is turned off and the I-beam icon appears in the Timeline panel under the current-time indicator. In this state, when you set the value of a layer property, it maintains that value for the duration of the layer, unless overridden by an expression. By default, no interpolation is applied to a layer property. If any keyframes are present for a layer property, some type of interpolation is in use.
Linear interpolation creates a uniform rate of change between keyframes, which can add a mechanical look to animations. After Effects interpolates the values between two adjacent keyframes as directly as possible without accounting for the values of other keyframes.
If you apply Linear interpolation to all keyframes of a temporal layer property, change begins instantly at the first keyframe and continues to the next keyframe at a constant speed. At the second keyframe, the rate of change switches immediately to the rate between it and the third keyframe. When the layer reaches the final keyframe value, change stops instantly. In the value graph, the segment connecting two keyframes with Linear interpolation appears as a straight line.
Bezier interpolation provides the most precise control because you manually adjust the shape of the value graph or motion path segments on either side of the keyframe. Unlike Auto Bezier or Continuous Bezier, the two direction handles on a Bezier keyframe operate independently in both the value graph and motion path.
If you apply Bezier interpolation to all keyframes of a layer property, After Effects creates a smooth transition between keyframes. The initial position of the direction handles is calculated using the same method used in Auto Bezier interpolation. After Effects maintains existing direction handle positions as you change a Bezier keyframe value.
Unlike other interpolation methods, Bezier interpolation lets you create any combination of curves and straight lines along the motion path. Because the two Bezier direction handles operate independently, a curving motion path can suddenly turn into a sharp corner at a Bezier keyframe. Bezier spatial interpolation is ideal for drawing a motion path that follows a complex shape, such as a map route or the outline of a logo.
Existing direction handle positions persist as you move a motion-path keyframe. The temporal interpolation applied at each keyframe controls the speed of motion along the path.
Auto Bezier interpolation creates a smooth rate of change through a keyframe. You may use Auto Bezier spatial interpolation to create the path of a car turning on a curving road.
As you change an Auto Bezier keyframe value, the positions of Auto Bezier direction handles change automatically to maintain a smooth transition between keyframes. The automatic adjustments change the shape of the value graph or motion path segments on either side of the keyframe. If the previous and next keyframes also use Auto Bezier interpolation, the shape of the segments on the far side of the previous or next keyframes also changes. If you adjust an Auto Bezier direction handle manually, you convert it to a Continuous Bezier keyframe .
Auto Bezier is the default spatial interpolation.
Like Auto Bezier interpolation, Continuous Bezier interpolation creates a smooth rate of change through a keyframe. However, you set the positions of Continuous Bezier direction handles manually. Adjustments you make change the shape of the value graph or motion path segments on either side of the keyframe.
If you apply Continuous Bezier interpolation to all keyframes of a property, After Effects adjusts the values at each keyframe to create smooth transitions. After Effects maintains these smooth transitions as you move a Continuous Bezier keyframe on either the motion path or the value graph.
Hold interpolation is available only as a temporal interpolation method. Use it to change the value of a layer property over time, but without a gradual transition. This method is useful for strobe effects, or when you want layers to appear or disappear suddenly.
If you apply Hold temporal interpolation to all keyframes of a layer property, the value of the first keyframe holds steady until the next keyframe, when the values change immediately. In the value graph, the graph segment following a Hold keyframe appears as a horizontal straight line.
Even though Hold interpolation is available only as a temporal interpolation method, the keyframes on the motion path are visible, but they are not connected by layer-position dots. For example, if you animate the Position property of a layer using Hold interpolation, the layer holds at the position value of the previous keyframe until the current-time indicator reaches the next keyframe, at which point the layer disappears from the old position and appears at the new position.
You can easily freeze the current frame for the duration of the layer using the Freeze Frame command. To freeze a frame, position the current time indicator at the frame you want to freeze. Make sure that the layer is selected and then choose Layer > Time > Freeze Frame. Time-remapping is enabled, and a Hold keyframe is placed at the position of the current time indicator to freeze the frame.
If you previously enabled time-remapping on the layer, any keyframes you created are deleted when you apply the Freeze Frame command.
You can use Hold interpolation only for outgoing temporal interpolation (for the frames following a keyframe). If you create a keyframe following a Hold keyframe, the new keyframe uses incoming Hold interpolation.
To apply or remove Hold interpolation as outgoing interpolation for a keyframe, select the keyframe in the Timeline panel, and choose Animation > Toggle Hold Keyframe.
You can apply and change the interpolation method for any keyframe. You can apply changes using the Keyframe Interpolation dialog box, or you can apply them directly to a keyframe in layer bar mode, in a motion path, or in the Graph Editor. You can also change the default interpolation After Effects uses for spatial properties.
For information on using Easy Ease controls to automatically ease speed between keyframes, see Controlling speed between keyframes.
The Keyframe Interpolation dialog box provides options for setting temporal and spatial interpolation and—for spatial properties only—roving settings.
Preserves the interpolation values already applied to the selected keyframes. Choose this option when multiple or manually adjusted keyframes are selected and you do not want to change the existing settings.
If you selected keyframes of a spatial layer property, choose one of the following options for Spatial Interpolation:
If you selected keyframes of a spatial layer property, use the Roving menu to choose how a keyframe determines its position in time, and then click OK:
Preserves the currently applied method of positioning the selected keyframes in time.
Rove Across Time
Smooths the rate of change through the selected keyframes by automatically varying their position in time, based on the positions of the keyframes immediately before and after the selection.
Lock To Time
keeps the selected keyframes at their current position in time. They stay in place unless you move them manually.
For more information on smoothing the rate of change through selected keyframes, see Smooth motion with roving keyframes.
- Click the keyframe with the Convert Vertex tool to toggle between linear and Auto Bezier interpolation.
- Select one or more keyframes, and then click the Hold, Linear, or Auto Bezier button at the bottom of the screen to change the interpolation method.
A. Convert selected keyframes to Hold B. Convert seleced keyframes to Linear C. Convert selected keyframes to Auto Bezier
In the Graph Editor, keyframes that use Bezier interpolation have direction handles attached to them. You can retract, extend, or rotate the direction handles to fine-tune the Bezier interpolation curve in a value graph. You can retract or extend the direction handles to fine-tune the curve in a speed graph.
By default, when you retract or extend a direction handle, the opposite handle on the keyframe moves with it. Splitting direction handles makes the two direction handles attached to a keyframe behave independently.
- To retract or extend direction handles, drag the direction handle toward or away from the center of its keyframe with the Selection tool.
- To split direction handles, Alt-drag (Windows) or Option-drag (Mac OS) a keyframe with the Selection tool. You can also Alt-drag (Windows) or Option-drag (Mac OS) outside a keyframe to draw new handles, whether or not handles already exist.
- To manipulate the direction handles of two neighboring keyframes simultaneously, drag the value graph segment between the keyframes.


To date, most of my blog posts have talked about big picture things surrounding the business of science. But today it’s time for real data. Out today in Nature Biotechnology is our paper on new insights into Cas9 mechanism and their use to enhance precise sequence replacement in human cells.
We started with a very simple question: what happens between Cas9 cutting and the appearance of genome edits? This could be answered in a variety of interesting ways, including elucidation of DNA repair mechanisms. We chose to go even simpler and figure out how Cas9 and sgRNA interact with and dissociate from a DNA target.
Our first surprise came when we found that catalytically inactive dCas9 takes a very long time to dissociate from DNA. As in, six hours or more! Far longer than one might expect from an enzyme that’s basically a retargetable restriction enzyme. Our second surprise came when we found that active and inactive Cas9 behave identically in this respect – even after Cas9 cuts a DNA target, it stays bound for six hours. This length of time was significant to us, since it made sense of a mystery. When one makes double strand breaks in eukaryotic cells using radiation, they are repaired very rapidly. But when Cas9 makes double strand breaks it instead takes (wait for it) about six hours for them to be repaired.
Using labeled DNA molecules, we found that Cas9 globally holds on to both sides of a cut duplex. That is, neither half duplex floats away. But we next wondered about the more fine-grained nature of the complex after cutting. That’s when we got our third surprise. It turns out that when Cas9 holds onto the four strands of the cleaved duplex (think about that one for a moment), it’s only holding on tight to three of them. The DNA strand opposite the PAM on the non-target strand (the one not bound by the sgRNA) is flapping in the breeze. So much so that in vitro we could anneal a complementary piece of ssDNA. dCas9 does the same thing, but since it doesn’t cut the target DNA there’s now an intact DNA bubble formed opposite the sgRNA. If that description is leaving you cross-eyed, here’s a picture of what I mean (gray is Cas9, blue is the sgRNA, yellow is the PAM, red are the active sites, and white x’s are the place where Cas9 is tightly holding the target).
The ability to anneal complementary single stranded oligonucleotides to a DNA flap put us in mind of recent work from Nancy Maizels’ lab, which described a nick repair structure in which single stranded repair templates annealed to one side of a flap. Turning to human cells, we asked if oligonucleotide donors capable of annealing to the Cas9 flap could be used for sequence replacement. And we were very pleasantly surprised. The Cas9 flap is on the order of 20-30 nucleotides, and indeed we found that editing donors complementary to the flap by about 30 nucleotides consistently worked the best of all donors. Absolute frequencies varied, but at one locus we reproducibly observed up to 60% sequence replacement. Making the complementary region shorter decreased efficiency as one would expect, and making it longer also caused a decrease, we think because it would need to intrude into the intact duplex outside of the flap.
Finally, we decided to try a crazy experiment. We wondered if the bubble formed by catalytically inactive dCas9 could be used to anneal a single stranded donor in cells, and if that cell could be tricked into using it for repair. By targeting three dCas9s to a precisely spaced region matching the length of a single stranded donor and all on the same strand of DNA, we did observe sequence replacement rates of a bit less than 1%. This is by no means a large number, but it was attained without any of the error-prone repair that normally accompanies Cas9 cutting. We still don’t know the mechanism underlying dCas9 editing, but it could be very useful to tackle genetic diseases in which sequence replacement holds some kind of fitness advantage but error-prone repair of the gene would be disastrous (e.g. if breaking the gene is worse than leaving the mutation alone).
I’m very curious about the unexpected flappy mechanism of Cas9 and wondering if it plays some part in Cas9’s role in CRISPR anti-viral biology. I’m also more and more intrigued in the mechanism by which single stranded donors are used by the cell. Eric Hendrickson and Nancy Maizels have some great stories on that front, and my lab has some data that seem to shed some light. On a more practical note, Cas9 is currently very good at breaking genes, but its ability to precisely introduce mutations has lagged behind. I’m optimistic that these simple approaches to designing a sequence replacement experiment we discovered, which don’t rely on chemical manipulation of cells, can be useful in tackling a variety of genetic diseases. More on that soon.
This manuscript was put together by a stellar team: postdoc Chris Richardson, technician Jordan Ray (very soon on his way to grad school), former lab manager Gemma Curie, and postdoc Mark DeWitt. Congrats to them!


Industrial tires are solidly constructed tires used on the wheels of heavy equipment and machinery in the manufacturing, construction, military, transportation, warehouse, agricultural and production industries. Due to their tough construction, industrial tires are used on large commercial vehicles to support and transport heavy goods or perform tasks in warehouses where these vehicles are used. The most common types of industrial tires are found on large trucks, forklifts, transport vehicles, buses, planes and other heavy industrial vehicles.
The most practical use of industrial tires is on commercial vehicles such as those seem in the trucking industries. Tires of this type are used to support heavy loads that are transported across continents and therefore must be able to withstand difficult road and weather conditions on a continual long-term basis. The heavy-duty tires used in this fashion are most often made out of double-wall recycled rubber products that can be replaced or re-treaded as needed.
In the manufacturing and production industries, industrial tires are most often seen on the wheels of forklifts, trucks, and other large weight-bearing vehicles that get frequent use. Tires used in this manner must be made from heavier grades of rubber to ensure years of safe use. While some are smaller than the size of tires used on consumer automobiles, commercial grade tires are made to last longer and handle the extreme weights that industrial equipment use demands daily.
Industrial tires are often seen on vehicles used in the construction and military contracting industries. Tires used in these industries are generally much larger than any others used in other industries, some spanning the height of a one story building. In addition, tires used on construction vehicles like dump trucks, backhoes, bulldozers and cranes are made with large gripping channels which lead to greater stability when in operation. Industrial tires used in this manner are made of the highest grades of rubber and can hold many thousands of pounds of air pressure and excessive loads.
In the agricultural industry, industrial tires are often seen on tractors, carts, wagons and sports utility vehicles. The tires used to support agricultural wheels are usually inexpensive and are made of a lower quality, very hard rubber that provides a very solid gripping surface for use in soil, rocks and other natural conditions. Tractor and wagon tires are used for many years before needing to be replaced and handle multiple miles of fields and crops before wearing out.


Along the 2017 total solar eclipse's path, scientists observe Earth and Sun.
On Aug. 21, the Moon’s shadow will take 90 minutes to cross the continental United States during the total solar eclipse. Eleven NASA-funded teams of scientists are making the most of the two and a half minutes of darkness they’ll experience at locations along the path of totality. The eclipse offers a rare chance to study the Sun’s outer atmosphere, the corona, from the ground — a challenge for space-based telescopes due to the Sun’s brightness. The corona is where burps of charged solar particles, called coronal mass ejections, originate. When released in our direction, these solar storms can collide with Earth and rattle our magnetic field. Intense coronal mass ejections can even affect satellites and power grids. Scientists believe the key to predicting these events lies in understanding the magnetic energy stored in the corona. Another mystery they hope to clear up: why is the corona so much hotter than the Sun’s surface? Teams located 600 miles apart along the eclipse’s path will take images that will allow scientists to study the corona's composition and temperature. Explore the videos and images below for more ways scientists are studying the Sun and Earth during the solar eclipse.


Holi is synonym to bhang and rang for any Indian. This festival of colors is related to social, cultural and biological characters and has mythological significance, than merely pleasing the eyes. Holi is referred as festival of colors. It is celebrated in the Phalguna month on the full moon day that falls between Feb-March. Like all other festivals, Holi in India has represents victory over evil. Water and colors are thrown and in association is loud music and drums.
Why did we start..?
There is a legend relating the initiation of Holi. Hiranyakashipu, the king in ancient India was almost a demon. He wished to take revenge for the death of his younger brother by killing Lord Vishnu. The king prayed and acquired a boon that he saw himself as God.
The cruel kind had a son, Prahalad, a Lord Vishnu’s devotee. His father, the kind disliked his son worshipping Lord Vishnu and planned to kill his son as his son denied worshipping his father, the king. The cunning king asked ‘Holika’, his sister to sit on pyre of fire as she was fire-immune with Prahalad on her lap and the aim was to burn his son. But his son started chanting Lord Vishnu’s name and so Holika got burnt, while Prahalad was safe. Later, Lord Vishnu killed the king Hiranyakashipu.
The death of Holika is connected to Holi festival. In states such as Bihar, a bonfire is lit before the Holi day evening in remembrance of the evils death.
The colours became a significant part as it dates to Lord Krishna, another Lord Vishnu’s reincarnation to play Holi with his friends at Gokul and Vrindavan. They played pranks and made it an event. It is also a spring festival saying bye to winters that it is associated in some parts of India with spring harvest and the new crops are a part of happiness.
How is it celebrated?
Holi is a Hindu festival and is also mentioned in the religious books. Even ancient temples have Holi sculptures on walls. Earlier Holi colours were from ‘tesu’ or ‘palash’ tree flowers and were referred to as gulal. These colours were good for skin and had no inclusion of chemicals. But now the colours definition has changed. Today people use harsh colours having a combination of chemicals. In fact, even fast colours are used.
The Holi celebrations are not actually a one day festival, but it is for three days such as:
Day 1: This day is ‘Holi Purnima’. On the full moon day, coloured powder and water are kept ready on a plate in small brass pots. This begins with the male eldest member sprinkling colour on his family members.
Day 2: The second day is referred to as Puno. On this day, the images of Holika are burnt by lighting bonfires and the story of Prahalad and Holika is remembered and also narrated to small kids. Mothers take their babies around the bon-fire in clockwise direction seeking the Fire God blessings.
Day 3: This is a very special day referred to as ‘Parva’ and is the final day for Holi celebration. The water and the coloured powder is mixed and smeared on each other. Lord Krishna and Radha deities are worshipped while smearing each other with colours. It is a day of fun and music.


How often to water a Boston Fern? Boston Fern Care!
If you're a Boston fern lover, you'll love this. If not, well, I'm going to change your mind. The Boston fern is tough as nails and has been around since the 1800s. It's easy to care for and requires very little attention. It will still be fine if you forget to water it once in a while (or even twice). That being said, some basic tips can help your Boston fern thrive:
How often to water a Boston Fern?
The average Boston fern should be watered when the soil is dry. To check, lift a few inches of the potting mix and see if it feels dry or moist. If you have a large enough pot, you may need to fill the entire container with water to check it thoroughly.
Boston Ferns thrive in indirect sunlight. They are easy to water and fertilize. Remember that you should water twice a day when it is hot. Warm Boston Ferns are prone to root rot and other fungal infections. Don't over-water or keep it too dry. In the winter, it doesn't need as much water and humidity.
If you're unsure whether your plant has been watered enough, here are some signs to look out for:
The leaves start turning yellow around their edges, especially if they were once green but now appear brownish grey in patches (this may indicate over-watering)
The tips of some leaves turn brown, especially if they're evergreen, and then drop off from lack of nutrients (this can be caused by overwatering)
How much sun do Boston ferns need?
The Boston fern is a shade-loving plant that prefers indirect light. If you want your Boston fern to thrive and grow, keep it in an area that receives at least 4 hours of sunlight per day. If your plant does not receive enough light, the leaves will be small and yellowed with brown spots.
If you have a window where the sun shines directly on it for most of the day and you want to put a Boston fern there anyway, make sure that something is blocking off at least 50% of the heat from hitting it (such as curtains). Also, ensure that any plastic containers can breathe so they don't trap moisture inside, causing rot or moldy leaves on top.
When should you fertilize a Boston fern?
Fertilize once a month during spring and summer using a balanced fertilizer.
Use only when the plant is actively growing. Do not fertilize during dormancy (winter), as it can cause leaf yellowing and chlorosis.
Apply half the recommended rate for your Boston fern and water immediately after application. Apply in the morning or evening, so there's no chance of burning new growth from too much heat and moisture exposure in direct sunlight.
Should you mist a Boston fern?
Yes, you can mist a Boston fern regularly. It will help to keep it hydrated and healthy. However, it would be best to remember that babying a Boston fern doesn't necessarily mean misting it daily. If you mist it too frequently, it might stress out the plant. Therefore, make sure you mist it only once every one or two days.
What is the best soil for Boston ferns?
To maintain the health of your Boston fern, you must choose the right soil for it. The best type of soil for a Boston fern is light and well-draining so that it doesn't retain too much water. It should also have a pH between 6.0 and 6.5, which makes it slightly acidic (this helps prevent root rot). Additionally, you'll need to keep an eye on temperature: ideally, your plant will be kept between 60°F and 70°F year round.
If you need help determining what potting mix is best for your particular needs, consult an expert at your local garden center or hardware store.
How do you propagate a Boston fern?
If you're looking to add a touch of greenery to your home, propagation is a great way to get more plants for free. And if you're propagating a Boston fern, you're in luck - they're relatively easy to propagate, and make excellent houseplants.
To propagate a Boston fern, start by taking a healthy cutting from an existing plant. Cuttings should be about 6 inches long, and should include at least 2-3 leaf nodes.
Once you have your cutting, remove the bottom leaves and dip the nodes into rooting hormone.
Then, plant the cutting in a pot filled with moist potting mix, and place the pot in a location with high humidity and indirect light.
Keep the soil moist, but not soggy, and within a few weeks you should see new growth appearing.
With a little patience and care, you'll soon have a brand new Boston fern of your own.
Can I prune my Boston fern?
Boston ferns can be pruned, but you don't have to do it often. Boston ferns are slow-growing plants that only need a trim every three or four years. Because they grow from rhizomes, Boston ferns should always be cut back by 1/3 of the plant in one season. Trimming your Boston fern is best when it is actively growing and watering well during the summer.
Remember that "pruning" is another word for cutting back plants to shape or keep them within limits, so think of it as giving yourself a haircut rather than hurting your plant. You can trim your Boston fern if it looks too big for space.
These are the basics of caring for your Boston fern.
Ferns are easy to grow and require minimal maintenance. They're perfect for beginners looking to get started in the world of growing their herbs. Boston ferns can be grown indoors or outdoors in most climates, depending on how much light they receive. If you've never grown a Boston fern before, here's what you need to know:
They prefer bright indirect sunlight or shade (they don't need full sun).
Water only when the soil is dry (don't overwater).
Feed once every two weeks with liquid houseplant fertilizer diluted at half strength (for example, if your plant needs 1 tsp of fertilizer per gallon of water, then use 1/2 tsp per pint).
How to grow Boston Fern in water?
Frequently Asked Questions:
1. What do Overwatered ferns look like?
Overwatering causes leaves to wilt and turn yellow. This happens because excess moisture encourages bacterial growth. As bacteria multiply, they release toxins into the air, which cause the leaves to become discolored.
2. How long does it take for a Boston fern to grow?
It takes about five years for a Boston fern seedling to reach maturity. However, once mature, it may live up to 50 years.
3. Can I grow a Boston fern indoors?
Yes, Boston ferns can thrive indoors. Many people grow their Boston ferns indoors simply because they love their appearance. The key to successful indoor cultivation is proper lighting. A good rule of thumb is to provide 6 hours of direct sunlight daily. Indirect sunlight works fine, too, provided enough natural light comes through windows or skylights.
4. Do Boston ferns require any special care?
Yes, Boston ferns require regular feeding. Feed your Boston fern twice a month using a dilute liquid houseplant fertilizer. Fertilize early in the morning while the plant is still dormant.
5. Is it okay to feed my Boston fern in winter?
Yes, you can feed your Boston fern in winter. However, make sure to give it less fertilizer than you would in the summer. For instance, if you usually feed your Boston fern once a week in the summer, then feed it once every two weeks in winter.
6. Are Boston ferns easy to propagate?
Yes, Boston Ferns are very easy to propagate. Remove the rhizome from the ground, place it in a moist potting mix, and replant it. It will root quickly and easily.
7. Should I repot my Boston fern?
If you notice that your Boston fern has outgrown its container, you might consider repotting. Repotting helps maintain healthy roots and promotes new growth. To report, first, loosen the soil around the base of the plant by gently pulling apart the surrounding soil. Then carefully lift the plant out of its current container. Wash off the dirt from the roots and cut away damaged parts. Next, fill the empty container with fresh potting mix. Finally, water the well and replace the plant in its new home.
Boston Ferns like to be watered often, but not constantly. You should watering fern when the top of the soil feels dry to the touch. Check your fern regularly and give it a good drink whenever the top inch or so of soil is dry. With proper care, your Boston Fern will thrive for years to come.


Flue gas to Hot Water (or Steam) Exchange
The derived hot flue gas, at >850°C, travels through a number of heat exchanger flue gas to hot water (or steam) tubes. The heat exchanger section comprises a refractory wall enclosure providing a gas tight atmosphere surrounding the module banks.
The design of the non-drainable heat exchangers is crucial in terms of alkali deposit formation on tube surfaces and minimising the risk of de-novo dioxin formation. Independent tests have shown that Dioxin reformation does not take place due to the residence period and gas velocities. Heat exchanger surfaces are prone, where high alkali biomass fuels are the primary fuel, to severe fouling from ash deposits.
The BHSL heat exchange is designed to continuously remove ash and prevent it from building up. This maintains the ongoing efficiency of the process. Ash from the heat exchange area is removed by a horizontal screw conveyor.
Flue Gas to Primary Air Exchange
In order to maximise the efficiency of the process the air used for primary combustion is pre-heated using an air to air heat exchange. The flue gas temperature at the exit of the primary air heater is controlled to ensure that stack exit temperatures are well above dew point temperatures of the main gas constituents and to minimise flue gas heat losses.
Instrumentation within the flue gas path is mainly focused on flue gas temperatures; other instruments on the water path are designed to monitor flow and thermal gain.
The BHSL heat exchange uses alloys specifically selected for their performance on the flue gasses from manure combustion.
The Life Cycle of these parts has been proven over many years of operation.


Reproduction permitted for personal use only. For reprints and reprint permission, contact firstname.lastname@example.org.
Stevens Point, Wis.
- The official bogeyman of Earth Week 2008 is biofuels. A top United Nations official has called use of food crops to produce ethanol a crime against humanity, environmentalists are blaming ethanol production for destruction of rain forests, and food riots from Haiti to Egypt are being cited as examples of what happens to prices when land is used to grow fuel instead of food.
It's only a matter of time before the plight of the polar bears is somehow blamed on biofuels, as well.
Somewhere between the irrational exuberance of those who believe biofuels will solve the world's energy problems tomorrow and the equally overblown fears of those who would smother an emerging industry in its crib lies the truth about biofuels. The debate is vital to Wisconsin, where the raw materials, research capacity, and industrial know-how required for production of next-generation biofuels is abundant.Conference of destiny
The food-versus-fuel debate was center stage at last week's Wisconsin Biofuels Destiny conference at the University of Wisconsin-Stevens Point
, which attracted 120 people with different stakes in biofuels - from today's corn-based ethanol to future fuels more likely to stem from the state's huge and largely untapped forest biorefinery.
Few participants argued that corn-based ethanol would forever remain the world's primary biofuel, given the need for greater energy efficiency and rapid changes in technology. However, those same participants were adamant that other factors are far more responsible for rising food prices worldwide than the intensely local production of corn- or sugar-based ethanol. Some examples:
Commodity prices typically make up about one-fifth the cost of food to consumers; transportation, packaging, and labor account for the rest. With oil prices surging Tuesday to $118 per barrel of sweet crude, the ripple effect is finally hitting the food chain. If there is a crime against humanity to be alleged, perhaps the UN could take a closer look at the major oil-producing countries of the world.
Global climate change, which increased use of biofuels could eventually help to mitigate, may be causing major disruptions in food production. In Australia, for example, a six-year drought has helped to reduce rice production by 98 percent and mothballed a mill that once processed enough grain to feed 20 million people. The drought alone is not responsible for the Australian rice crop's demise, however. Some rice farmers there have sold their water rights to farmers who grow other crops, such as grapes for wine.
Demand for food is soaring as the world's population continues to grow. With rice, which is not used for biofuels production, there has been a growing supply problem. Little of the world's rice is exported; more than 90 percent is consumed where it is grown. In the last quarter century, however, rice production has not kept pace with consumption. Since 2000, the New York Times
reported recently, global rice reserves have plunged by half.
Some of the very nations that have rejected genetically modified crops, which are more resistant to climate change, drought and pests, are among those facing food shortages. Resistance to new technologies and processes has contributed to the problem.Artificial argument
The food-versus-fuel debate is artificial, said Greg Lynch, a lawyer with the law firm Michael Best & Friedrich
who has worked on a number of biofuels projects. Recent increases in food prices are primarily the result of increased worldwide demand for protein and increases in energy costs, not diversion of food for fuel.
Lynch and others believe farmer-owned biofuels plants create a natural hedge against fluctuations in commodity prices, provide a fuel that is environmentally friendly compared to fossil fuels, and act as a check against dependence on foreign energy sources. They're also quick to note that technology is improving ethanol production every day - and next generation biofuels produced from non-food sources will eventually come on line, as well. In time, they believe, ethanol subsidies will also disappear.
Wisconsin has the potential to produce next-generation biofuels, such as cellulosic ethanol, from sustainable forests, corn stover, switchgrass, waste from timber harvests and even pulp used for papermaking. Research at the $130 million Great Lakes Bioenergy Research Center
, headquartered in Madison, will help to remove the bottlenecks in the production of those advanced biofuels.
The same environmental movement that once championed biofuels as an alternative to fossil fuels has decided to make ethanol Public Enemy No. 1, despite evidence that would suggest it has been a relatively minor contributor to rising food prices. In a world that needs both food and fuel, let's not allow either irrational exuberance or overblown fears to kill an emerging solution.Recent articles by Tom Still
Tom Still: Tough times spur angel, venture investing
Tom Still: If climate change is the issue, environmentalists should rethink nuclear
Tom Still: It's no joke: Investment climate in Wisconsin may be warming
Tom Still: Pinstripes amid the ivy: Could a business leader run UW-Madison?
Tom Still: On science and technology, candidates reveal differences - and similarities
Tom Still is president of the Wisconsin Technology Council
. He is the former associate editor of the Wisconsin State Journal in Madison.
The opinions expressed herein or statements made in the above column are solely those of the author, and do not necessarily reflect the views of Wisconsin Technology Network, LLC.
WTN accepts no legal liability or responsibility for any claims made or opinions expressed herein.


I took a writing course about four years ago. By the end of the second session, I was thinking, “Sheeze! I could teach this course.” I learned only one thing. During the second month, I learned the name of a very important concept I had been using unconsciously for years, thereby increasing my ability to write and edit purposefully.
Grammatical versus Rhetorical Subject
I learned that sentences can have two types of subjects: Grammatical and Rhetorical. We are all familiar with the first type. Parse this sentence and find the subject:
“The proofreader looked askance at the period after the quotation mark, wondering if the writer is British.”
The subject is “proofreader,” right? It is the subject of the main verb “looked,” which mean it has the grammatical function of subject. We call “proofreader” the grammatical subject. Ok, we’re not breaking any new ground here. But now look at this sentence and find the subject:
“The veterinarian said the dog has fleas.”
Using my psychic powers, I’m going to guess that you said “veterinarian” is the subject. Ahem…the grammatical subject. Now let’s talk about the ONE thing I learned in the writing course: rhetorical subjects. Look at that sentence again and answer this question: “Who or what is this sentence about?”
This sentence is NOT about the veterinarian or what the veterinarian said. This sentence is about the dog. Thus, the dog, not the veterinarian, is the real focus of this sentence, which means it is the rhetorical subject.
Don’t believe me? Ok, let’s approach this differently. To find the grammatical subject, we identify the main verb. To find the rhetorical subject, we identify the main action. What is the main action described by this sentence? Although the main verb is “said,” the main action being described is having fleas. And who or what performs this action? The dog. Thus, the dog is the rhetorical subject.
Using the Rhetorical Subject as the Grammatical Subject
“Gee, that’s swell. And that’s useful how?” I’m glad you asked. As a careful, effective, and purposeful writer, you want the grammatical subject to be the same word as the rhetorical subject. When we use the rhetorical subject as the grammatical subject, we get this revision:
“According to the veterinarian, the dog has fleas.”
Now what’s the grammatical subject? Dog. And what’s the rhetorical subject? Dog. In this revision, the grammatical and rhetorical subjects are the same. This improves the sentence in four ways:
- The sentence clearly states its main idea.
- The sentence focuses the readers’ attention on the right subject.
- The sentence emphasizes the main action.
- The sentence is economical.
The base sentence of the revised version is now “the dog has fleas,” and “according to the veterinarian” has been pushed into a descriptive phrase where it belongs.
Another Example of Rhetorical and Grammatical Subjects
Let’s try another sentence in which the rhetorical and grammatical subjects differ.
“There is a good reason for this mess.”
When we parse this sentence, we find the following elements.
- Grammatical subject: “there” [“There” and all other expletives make crummy subjects.]
- Main verb: “is” [“Is” and all other state-of-being verbs weaken sentences.]
- Main action: having a good reason for this mess
- Rhetorical subject: I, we, you, she, etc. [This sentence doesn’t provide the person or thing who does the main action. In cases such as this, we have to figure it out from the context. Here, we’ll assume that I am the person who has the reason.]
This sentence is weak. It doesn’t use the rhetorical subject for the grammatical subject—it doesn’t even tell the reader who or what the rhetorical subject is! We’ll apply the same strategy as before to improve it and use the rhetorical subject “I” as the grammatical subject. This gives us the following revision.
“I have a good reason for this mess.”
What are the grammatical and rhetorical subjects now? In this revised sentence, “I” serves both functions. As a result, this sentence clearly states its main idea, focuses the readers’ attention on the doer of the main action, emphasizes the main action, and provides the idea economically. This sentence has another benefit: it demonstrates confidence, which, in this case, may be important.
Summary of Everything Above
- The grammatical subject is the subject of the main verb.
- The rhetorical subject is the subject of the main action described by the sentence.
- Clear, direct, economical sentences use the rhetorical subject as the grammatical subject.
- If your grammatical subject and rhetorical subject are not the same, revise.
Try These on Your Own
“It appears that I was right.”
“The hospital was where John recovered.”
“Although John loved Mary, she preferred Tom.”
“There was a book I read about the Civil War.”
“Here is where the CEO got fired.”
[One of these is a trick question.]
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Marimbas are closely similar to xylophones, but pitched one octave lower and with thinner and wider bars. This gives them a richer sound and longer sustain than xylophones. Marimba bars are arranged similar to piano keys, with the accidentals occupying a separate row overlapping the first. Each bar is mounted over a metal tube called a resonator, which determines their frequency and amplifies the tones.
Marimba mallets also differ from xylophone mallets, with one- to three-inch heads wrapped in hemp, yarn, or cord to make them softer. Wood is traditionally used for the handle, although newer models can have metal or carbon fiber handles for durability.
Types of Marimbas
Kinds of Marimbas include the following:
These marimbas have a single row of bars tuned to the C major scale. They usually have an additional key playing the F# note, which allows them to be played in G major. They often come in pitch ranges corresponding to soprano, alto, tenor, and bass classes. Their resonators have holes covered in cellophane, which produces a distinct buzzing sound. They are often played with the mbira, a native African instrument.
Zambian marimbas, also called Shinjimba, have one row of basic keys and a second row of accidentals. Their bars may be made of rosewood or paduak, an African indigenous wood. They are traditionally used in royal ceremonies by Western Zambia's Nkoya tribe.
Guatemalan marimbas come in different sizes. The largest ones are played by ensembles. Their resonators are made of carved wood instead of metal, creating a fuller, warmer sound. The bars and resonators are housed in a wooden box.
Choosing Marimbas (Buying tips)
Bars: Choose a marimba with rosewood bars for excellent sound quality. Paduak bars are cheaper, but tend to fall out of tune and do not sound as good as rosewood bars. Plastic bars have poor resonance, but may be ideal for children or when playing outdoors. Make sure the bars are uniformly sized and evenly spaced.
Resonators: Choose a marimba with wood or metal resonators for longer note sustains and better volume control. Make sure each resonator is even on the inside to prevent squeaks and skips. Metal resonators usually sound louder and hold notes longer. Choose PVC resonators for easier maintenance and durability when playing outdoors.


Internet lore says that the term “data science” was first used by DJ Patil in 2004. In 2015, Patil went on to work for the Obama administration as the first U.S. Chief Data Scientist, helping to launch various White House programmes, including the Data-Driven Justice Initiative.
Data has enmeshed itself in politics to a degree hitherto unseen. This process did not occur overnight. Data science is, after all, just a fancy name for statistics (a view, alas, which is not shared by many Linkedin users). It can be broadly defined as the collection and analysis of big data for the purpose of policymaking. John Graunt‘s publication of Natural and Political Observations upon the Bills of Mortality in 1663 is sometimes identified as the birth of statistics. Whatever the precise date, it coincides with the development of the nation-state as the dominant polity. Rulers and governments realised that the scale of organisation was getting bigger, and accurate information was vital.
The link between data and politics is right there in Graunt’s title.
21st century politicians, and the commentators who shape public debate, use the label “data-driven” far too freely. In the UK, the government talks of “evidence-based policies”. We’re bombarded with figures, percentages, graphs and charts, all checked and verified (remember those Brexit debates?). The trouble is that political debate often revolves around too much data, while the right questions never get asked.
Speed limits and Bayesian evidence
Recently, the French government decided to lower the speed limit on highways to 80 km/h. The stated aim is to reduce traffic fatalities. Really? Let us look at some data. More than 23% of traffic deaths in France are linked to cannabis. In the United States, road crash deaths rise dramatically after “Weed Day”. So why not crack down on drugs instead? Surely that is the most significant feature in the data matrix?
If the government really wished to make evidence-based policies”, the rigorous way to go about it would be something like:
Hypothesis 0: Given the current data on road deaths, alcohol, drugs etc, lowering the speed limit will not reduce fatalities.
Hypothesis 1: Given the same current data, lowering the speed limit will reduce fatalities.
The question is to find the Bayesian evidence for one hypothesis against the other. We don’t have current data for an 80 km/h speed limit, because it hasn’t yet been introduced. In order to answer the question, we would need to simulate future data.
There is plenty of debate going on about this new law. If data scientists were involved, we would be asking how policymakersconcluded that lowering the speed limit was the most effective measure.
GDP and data visualisation
It’s the economy, stupid. The GDP is the buzzword in political discourse. I won’t go into the question of how the GDP is calculated. Some governments cheat, and those that don’t have a hard enough time pinning down the data. EU statistical guidelines say illegal transactions should be included in GDP calculations. The UK did so in 2014 (adding prostitution and drugs), and its economy overtook France. Voilà.
The trouble with so much of the debate on GDP, income or wealth is one of data visualisation. Governments obviously have all the data down to the individual (that’s what tax returns are for), but they often just quote the average. Headlines like “The GDP per capita has risen” tell us very little. It’s just the average (the mean? the median?). It’s even worse when it is followed by “so we’re all better off”. Not necessarily.
Look at the chart below.
It’s taken from a government report on household income at the national level. It gives a lot of information, but most of it is irrelevant. The one bit of information that matters (the total household income) is given as a mean and median average. We can’t tell how income is distributed, which is what we’re really after if we wish to get a snapshot of the country’s economy. And yet the data must be available for the average to have been calculated.
Now look at the second chart.
It’s taken from a German federal government national statistics office publication. It gives the statistical distribution of the income. So we can tell at a glance what the bulk of the population earn. And if you’re a politician, keeping most of the people happy is what you’re after.
The income distribution is also essential in formulating labour laws, which determine things like the minimum wage, and the kinds of jobs created, all of which determine wealth creation. These are policies that require extensive national debate. If the press and the people don’t see the relevant charts, and have to make do with an average, that debate is going nowhere.
Strong claims require strong evidence
Most of all, they require the right questions.
Most Western governments – certainly those in the EU, and the EU Commission itself – are pretty upbeat about globalisation. They will say that it has led to global economic growth. This is correct. So why isn’t everybody happy?
Look at this graph, taken from a World Bank publication.
The global economy has grown by an average of around 25% in the 20 years from 1988 to 2008.
Now let’s ask the hard questions. Look at the horizontal axis. The developing world has been helped by globalisation (on this specific point, Bill Gates is right). The richest people have done well too. The top 1% of the world’s income earners saw their income rise by 60% over this period.
But an important group of people are missing out on all these benefits. Their incomes have stagnated. They’re the ones in between the rich and poor– roughly the 70th to 90th percentile. They also happen to make up the bulk of the people in the developed world. Places like the European Union.
When European governments point to the benefits of globalisation, it’s not so much that they’re using the wrong data. It’s that they’ve drawn their conclusions before they’ve even looked at it.
Enter the data scientists
We cannot expect all politicians and governments to be data wizards. It’s hard enough finding honest ones these days.
But data scientists can and should help. They should get involved in political debate. The operative keyword in “data scientist” is “scientist”. Data scientists should be sceptics. Like journalists, they should believe nothing and question everything. That is to say, they should verify the data, and ask the right questions.
Some data scientists do get involved in political debate. You can find them all over the Internet. And many get involved in community projects run by voluntary organisation. This is all to their credit. But quite a few tend to be evangelists for blind optimism. They sound more like tech lobbyists than data scientists. When the project is run by someone else (such as the government), and when the data shows unpleasant things, they are nowhere to be found.
Politics used to be about principles, about arguing your point, and perhaps backing it up with facts. In the age of 24-hour news overload, fickle electorates and opinion polls, principles have all but disappeared, replaced by “data-driven policies” and quick-fire assertions about numbers and data, sometimes designed to baffle the electorate (when they don’t baffle the politicians themselves).
DJ Patil stated several times that the mission of the U.S. Chief Data Scientist is to responsibly unleash the power of data. To which it might be replied that it is the people’s responsibility to hold their government to account when it starts going on about data.
Now, more than ever, we need data scientists. But we need them there in the (often) irrational world of politics, mucking in.


For several practices, cost-effectiveness values are presented as "box and
whisker" plots. The range shown in these plots represents the variability in
BMP nutrient loading across different sites. The ranges do not capture other
sources of variability such as the site-specific variations in BMP cost or
summarizes the cost-effectiveness estimates for
practice&or which both cost and effectiveness data were available.
The cost data that are presented in this report represent the direct cost of
Other "less direct: costs such as (1) opportunity costs from
and (2) costs of
loss of productive land to
higher fertilizer costs,
costs resulting from pollution impacts) are not
Specific findings of this report include:
The cost-effectiveness of animal waste management practices is highly
dependent upon the preexisting waste management practice on a farm. The
range of the cost-effectiveness estimates for any given scenario can be quite
wide due to variability in (1) nutrient content of the waste and (2) the crop's
Water control structures are highly cost-effective for nitrogen control, but not
for phosphorus control.
Nutrient management is not cost-shared in the basin, yet it has been shown to
be highly cost-effective.
is a cost-effective
Relative to other
practice for both nitrogen and phosphorus reduction, especially when used in
conjunction with nutrient management.
Relative to other practices, terracing is not cost-effective for either nitrogen
conversion could potentially be very cost-effective, but this depends
greatly on site-specific factors.
Insufficient data exist to
effectiveness (and therefore,
effectiveness) of grassed waterways, diversions, and stripcropping.
Although data are presented by BMP type, it is important to realize that
holistic farm management is more cost-effective than single objective BMP


What the Anesthesiologist Should Know before the Operative Procedure
Intra-abdominal adhesions develop as a result of abdominal surgery (laparotomy or laparoscopic) or less commonly from inflammatory conditions. In fact, adhesions are the most common etiology for small bowel obstruction. While many patients who develop adhesions can be managed conservatively, some will require surgery for lysis of adhesions.
Adhesions may cause abdominal pain, nausea, vomiting, and bowel obstruction. Major management issues include pain control, fluid resuscitation, and correction of electrolyte and metabolic derangements. For patients who develop ischemic bowel as a result of adhesions, these issues must be addressed expeditiously.
1. What is the urgency of the surgery?
What is the risk of delay in order to obtain additional preoperative information?
Early postoperative bowel obstruction (occurring within 30 days) develops in less than 5% of cases. The majority of these cases are managed conservatively (for up to 2 weeks), as the adhesions generally resolve. Emergent surgery is indicated for those patients that develop strangulated bowel. These patients may present with peritoneal signs, fever, leukocytosis, hemodynamic instability (tachycardia/hypotension), and metabolic acidosis. A CT scan of the abdomen can assist in establishing the diagnosis.
Emergent: Adhesions that cause strangulated bowel. These patients may benefit from preoperative admission to the intensive care unit for resuscitation.
Urgent: For patients with suspected bowel obstruction who fail conservative therapy, surgery may be indicated. Again, volume depletion and electrolyte/metabolic disorders is should be corrected prior to surgery.
Elective: Adhesions thought to contribute to abdominal pain. Evidence suggests that elective adhesiolysis for adhesions causing abdominal pain may lack efficacy (for example, in patients with chronic pelvic pain). In these patients, obtaining adequate pain control may be the major issue.
2. Preoperative evaluation
Adhesions may cause abdominal pain, nausea, and vomiting. Vomiting may lead to dehydration, electrolyte imbalance, and acid-base disorders. The clinical assessment of volume status is of primary importance. Patients whose adhesions have resulted in long-term vomiting may present with significant volume depletion. The physical exam reveals decreased skin turgor, dry mucous membranes, and decreased jugular venous distention. Hypotension may be present with progressive volume depletion. Tachycardia and hypotension may cause a demand-type cardiac ischemia. Electrolyte disorders are common and metabolic acidosis may be present in cases of strangulated bowel. Acute kidney injury is possible from hypovolemic hypotension.
Medically unstable conditions warranting further evaluation include the following: With cases of suspected strangulated bowel, emergency surgery should proceed as soon as possible. Mortality from gangrenous strangulated bowel is high if surgery is delayed. Therefore, prompt attention to correcting fluid, metabolic, and electrolyte disorders is indicated.
Delaying surgery may be indicated if a patient presents with hypovolemic hypotension, significant electrolyte, and metabolic disorders. In these patients, preoperative admission to the intensive care unit for fluid resuscitation and correction of electrolytes and metabolic derangements may reduce the hemodynamic complications associated with the induction of general anesthesia.
3. What are the implications of co-existing disease on perioperative care?
Patients with active comorbidities are higher risk for perioperative complications. Depending on the urgency of surgery (i.e., patients with suspected strangulated bowel from adhesions), there may be limited time to stabilize these issues prior to surgery.
For patients scheduled for urgent or elective procedures, optimizing comorbid conditions will help to reduce the risk of perioperative complications. Medical clearance may not be necessary and appears to depend on institution-specific policies. In general, patients with preexisting neurologic, cardiac, pulmonary, and renal disease should be well controlled. Available medical records and an up-to-date medication list need to be obtained. Standard preoperative evaluation of cardiac risk using the American Heart Association/American College of Cardiology guides additional testing.
Perioperative risk reduction strategies
For patients at risk for cardiac complications, perioperative beta blockade may be considered. Caution should be observed in continuing ACE inhibitors and angiotensin receptor blockers in dehydrated patients and for procedures with expected significant volume shifts.
b. Cardiovascular system
Depends on the urgency of surgery. Patients with acute coronary syndrome, active congestive heart failure, or significant rhythm disorders should be managed in collaboration with a cardiologist.
Baseline coronary artery disease or cardiac dysfunction – Goals of management
Optimize heart rate and blood pressure. A five-lead ECG with ST-segment monitoring will assist in detecting rhythm changes and ischemia. Additional invasive and noninvasive monitoring is considered for patients at high risk for cardiac complications.
Severity of disease based on oxygen and steroid requirements. Review pulmonary function tests and radiographs if available. Continue preoperative inhalers.
Reactive airway disease (Asthma)
Continue preoperative inhaler regimen. Monitor for bronchospasm.
Obstructive sleep apnea (OSA)
If likely undiagnosed OSA, consider postoperative pulse oximetry and close monitoring on a telemetry floor or intensive care unit, especially for patients who will require narcotics. For patients with established OSA, have patient bring own machine and assess settings and fit of apparatus.
Evaluate baseline BUN and creatinine. Patients who present with hypovolemia are at increased risk for perioperative acute kidney injury.
Review past abdominal operations and radiographs (plain abdominal films and CT scan) with surgeon. Determine whether a bowel obstruction (either partial or complete) is suspected and whether bowel is at risk for strangulation/ischemia.
Patients with a history of ischemic stroke or carotid stenosis require careful intraoperative blood pressure monitoring. Consideration should be given to maintaining adequate cerebral perfusion pressure.
For patients scheduled forurgenAcute issues (recent stroke, intracerebral hemorrhage, or seizure): Obtain neurologic consultation prior to case to determine appropriate timing of surgery.
Chronic disease: The risk of discontinuing antiplatelet medications should be weighed against the risk of perioperative bleeding.
Patients with chronic steroid use may require pre-operative administration of a corticosteroid, “stress dose,” to attenuate the risk of hypotension from surgical stress.
g. Additional systems/conditions which may be of concern in a patient undergoing this procedure and are relevant for the anesthetic plan (eg. musculoskeletal in orthopedic procedures, hematologic in a cancer patient)
4. What are the patient's medications and how should they be managed in the perioperative period?
The decision to hold or continue a medication is individualized and depends on the systemic problems caused by the adhesions and the urgency of surgery. For example, for patients with nonurgent surgery without bowel obstruction, most medications can be continued during the perioperative period. For patients with suspected strangulated bowel and associated volume depletion, and electrolyte/metabolic issues, care should be taken to avoid medications that may exacerbate hypotension with general anesthesia.
h. Are there medications commonly seen in patients undergoing this procedure and for which should there be greater concern?
This may include medications specific to diseases associated with surgery. Use caution with continuing anti-hypertensive medications (e.g., ACEIs or ARBs) in patients who are hypovolemic or have anticipated large fluid shifts associated with surgery.
i. What should be recommended with regard to continuation of medications taken chronically?
For cases of suspected bowel obstruction and for those patients not able to tolerate PO, convert oral medications for intravenous administration.
Continue, with considerations on holding for volume depletion.
Continue all inhalers.
Continue antiepileptics, consider checking levels as appropriate. Continue Parkinson’s medications.
Continue levothyroxine and steroids (or substitute with intravenous stress dose).
Assess on individual basis and weigh bleeding risks from surgery versus risk for perioperative stroke or myocardial infarction.
Continue if poorly controlled depression or other psychiatric illness.
j. How To modify care for patients with known allergies –
k. Latex allergy- If the patient has a sensitivity to latex (eg. rash from gloves, underwear, etc.) versus anaphylactic reaction, prepare the operating room with latex-free products.
l. Does the patient have any antibiotic allergies- – Common antibiotic allergies and alternative antibiotics]
m. Does the patient have a history of allergy to anesthesia?
Documented: avoid all trigger agents such as succinylcholine and inhalational agents:
Proposed general anesthetic plan:
Ensure MH cart available [MH protocol]
5. What laboratory tests should be obtained and has everything been reviewed?
Hypovolemia, which can occur in the setting of bowel obstruction, may effect electrolyte and metabolic conditions. Specific abnormalities are discussed below.
Hemoglobin and hematocrit levels may be elevated as a result of decreased plasma volume (hemoconcentration).
Serum sodium may be elevated (from insensible losses or diabetes insipidus) or low (SIADH), depending on the etiology. Serum potassium may be elevated, but is more commonly low as a result of GI or urine losses. Serum calcium, magnesium, and phosphate levels should be checked and supplemented as necessary.
Hypovolemia usually results in a low urine sodium. A fractional excretion of sodium is <1%. Urine osmolality is concentrated.
PT/INR, PTT, and platelet count. Additional work-up as appropriate for patients with a bleeding diasthesis.
Plain abdominal films and CT scans of the abdomen and pelvis.
BUN and creatinine should be reviewed. A ratio of BUN/Cr >20:1 is one clue to suggest hypovolemia.
An arterial blood gas may reveal a hypochloremic, hypokalemic metabolic alkalosis for patients with emesis. However, for patients with strangulated bowel, a metabolic acidosis with an elevated serum lactate may be present.
Intraoperative Management: What are the options for anesthetic management and how to determine the best technique?
A general anesthetic is typical for either a laparotomy or laparoscopic approach to lysis of adhesions. For appropriate patients, epidural analgesia can provide excellent pain control. In addition to standard ASA monitors, invasive monitors should be considered for patients who present with hypovolemic shock or suspected strangulated bowel. Invasively monitoring central venous pressures or arterial blood pressures may help to guide fluid resuscitation. Newer, noninvasive methods, such as the NICOM monitor, may assist fluid management. Adequate intravenous access is important. Urine output should be measured with a Foley catheter.
Epidural analgesia may be effective for postoperative pain control after a laparotomy, especially for those patients with chronic pain. For patients who present hemodynamically unstable with small bowel obstruction, epidural analgesia should be deferred.
Benefits: Potentially improved pain control with earlier ambulation and return to bowel function.
Drawbacks: Hypotension is a concern for patients who are hypovolemic. Usual contraindications as outline in recent ASRA guidelines apply.
Issues: Need to discuss postoperative anticoagulation regimen with surgical team. Placement and removal of an epidural catheter should follow ASRA recommendations.
Peripheral nerve block
A transversus abdominus plane block (TAP) is used with relatively high success rates in reducing postoperative pain following a laparotomy. This is a basic block when combined with ultrasound guidance and may be helpful for those patients who remain with high pain scores after significant narcotic administration.
Benefits: Easy to learn and perform. Associated with good reduction in pain scores.
Drawbacks: Requires ultrasound and basic regional anesthesia skills.
Issues: For obese patients, determining fascial planes can be challenging. Incision and dressings may interfere with placement.
b. General Anesthesia
Benefits: Provides a secure airway and excellent muscle relaxation to facilitate exposure.
Drawbacks: May induce hemodynamic instability in hypovolemic patients.
Airway concerns: Assume full stomach and induce using a rapid sequence technique. The application of cricoid pressure has come under debate recently and should be used at the discretion of the practitioner.
c. Monitored Anesthesia Care:
Not considered an option
6. What is the author's preferred method of anesthesia technique and why?
A general anesthetic is administered to patients who receive either a laparotomy or laparoscopy. We would consider placing an epidural catheter for postoperative analgesia in the appropriate patient. In addition, for patients without an epidural having significant pain requirements, we would consider a placing a postoperative TAP block.
What prophylactic antibiotics should be administered?
For intra-abdominal surgery not involving the colon or rectum, cefazolin is preferred. For patients with penicillin or cephalosporin allergies, clindamycin in addition to either ciprofloxacin, levofloxacin, or gentamicin. For surgery involving the colon or rectum, prophylaxis with cefoxitin or cefotetan is recommended. For allergic patients, clindamycin in addition to gentamicin or an intravenous fluoroquinolone is advised. These recommendations are based on the 2009 Surgical Care Improvement Project (SCIP).
What do I need to know about the surgical technique to optimize my anesthetic care?
Either a laparotomy or laparoscopic approach is used for lysis of adhesions. For laparoscopic cases, the cardiopulmonary changes associated with peritoneal insufflation may be exaggerated in patients who are underresuscitated.
What can I do intraoperatively to assist the surgeon and optimize patient care?
Close attention to fluid resuscitation and correction of electrolyte/metabolic derangements will improve outcome. Inadvertent enterotomy is a complication of the procedure.
*** Type Here.
b. If the patient is intubated, are there any special criteria for extubation?
For patients who present with small bowel obstruction as a result of adhesions, extubation should be deferred until the patient is adequately fluid resuscitated and any electrolyte/metabolic disorders are corrected. Should the patient require significant fluid resuscitation, the presence of a cuff leak may provide evidence that swelling/airway edema is not compromising the airway.
c. Postoperative management
What analgesic modalities can I implement?
PCA opioid, epidural analgesia, or TAP block.
What level bed acuity is appropriate?
For patients with small bowel obstruction and ongoing fluid resuscitation, admission to the ICU. For other urgent, elective cases, admission to floor/telemetry depends on the control of patient comorbidities (example, a patient with OSA will require postoperative pulse oximetry and apnea monitoring).
What are common postoperative complications, and ways to prevent and treat them?
DVT prophylaxis should be started as soon as possible to reduce the risk of DVT/PE, especially in those patients who will not ambulate soon after surgery.
What's the Evidence?
Parker, MC, Ellis, H, Moran, BJ. “Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery”. Dis Colon Rectum. vol. 44. 2001. pp. 822
Beck, DE, Opelka, FG, Bailey, HR. “Incidence of small bowel obstruction and adhesiolysis after open colorectal and general surgery”. Dis Colon Rectum. vol. 42. 1999. pp. 241
Sabiston, DC, Lyerly, HK. “Textbook of surgery: the biologic basis of modern surgical practice”. 1997.
Hodin, RA, Bordeianou, L. “Small bowel obstruction: causes and management”. 2011.
Howard, F. “Causes of chronic pelvic pain in women”. 2011.
McDonnell, JG, O’Donnell, BD, Farrell, T. “Transversus abdominus plane block: A cadaveric and radiologic evaluation”. Reg Anesth Pain Med. vol. 32. 2007. pp. 399
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- What the Anesthesiologist Should Know before the Operative Procedure
- 1. What is the urgency of the surgery?
- What is the risk of delay in order to obtain additional preoperative information?
- 2. Preoperative evaluation
- 3. What are the implications of co-existing disease on perioperative care?
- b. Cardiovascular system
- c. Pulmonary
- d. Renal-GI:
- e. Neurologic:
- f. Endocrine:
- g. Additional systems/conditions which may be of concern in a patient undergoing this procedure and are relevant for the anesthetic plan (eg. musculoskeletal in orthopedic procedures, hematologic in a cancer patient)
- 4. What are the patient's medications and how should they be managed in the perioperative period?
- h. Are there medications commonly seen in patients undergoing this procedure and for which should there be greater concern?
- i. What should be recommended with regard to continuation of medications taken chronically?
- j. How To modify care for patients with known allergies -
- k. Latex allergy- If the patient has a sensitivity to latex (eg. rash from gloves, underwear, etc.) versus anaphylactic reaction, prepare the operating room with latex-free products.
- l. Does the patient have any antibiotic allergies- - Common antibiotic allergies and alternative antibiotics]
- m. Does the patient have a history of allergy to anesthesia?
- 5. What laboratory tests should be obtained and has everything been reviewed?
- Intraoperative Management: What are the options for anesthetic management and how to determine the best technique?
- 6. What is the author's preferred method of anesthesia technique and why?
- a. Neurologic:
- b. If the patient is intubated, are there any special criteria for extubation?
- c. Postoperative management


A rainy weekend in Cheshire wasn’t enough to stop the Henry Royce Institute from taking on their biggest outreach event to date!
On Friday 19th July, 25 volunteers from across the Royce partners arrived at a wet and muddy Jodrell Bank, to open up the Royce Laboratory once more and engage children in the world of materials science and engineering. This year saw a new addition to the Royce clean room with a functional Glove Box from the National Graphene Institute. Festival-goers were tasked with building the molecular structure of Graphene with adult-sized gloves; proving a near-impossible challenge.
Bluedot 2019 marked 50 years since the moon landing and against the backdrop of the Lovell Telescope the festival was set to be an intergalactic showcase of music, science, and entertainment. The Royce went full interstellar with a ‘How to make a Space Suit’ activity. Volunteers demonstrated how the properties of UV resistant materials protect against dangerous levels of radiation in space using different samples as a barrier between a UV torch and UV sensitive beads. Arcadio Martinez-Madrid, a summer intern at the Institute said;
By using a gold-sputtered petri dish we are able to explain how specific materials are used in a visor to protect against radiation. It was brilliant to see the look on the kid’s faces when the beads didn’t change colour
Along with aerospace demonstrations, the Royce Lab explored biomimetic materials with ‘Nature’s Inspirations’. Using the properties of lotus leaves, gecko’s feet, burdock burrs, and hydrophobic soil, stand visitors matched natural materials to their man-made counterparts in hydrophobic shorts, gecko pads, velcro, and magic sand. Lejla Softic commenting on the activity said:
Exploring material properties is one of the simplest ways to explain what we do in materials science. It was amazing to see children find the link between natural and man-made materials and to see how we draw inspiration from nature. Mixing children, water and sand was definitely a recipe for the messiest table!
Over the weekend the Royce spoke with over 2000 visitors and there were some familiar faces from 2018 back again to take on the Royce challenges;
Isy back in her favourite tent ‘doing material science’ w the lovely @RoyceInstitute staff. Thanks so much for all your energy, and for remembering my girl from last year! @bluedotfestival pic.twitter.com/LR41J5fK5a
— Laura Carter (@bobbly72) July 22, 2019
This year’s event was co-organise by Chris Hamlett, National Outreach Officer for Materials Science and focused on exploring the broad nature of materials science and engineering. Chris commented that:
Here at Bluedot we’re engaging with both children and parents to enthuse them into materials science. It’s not a common subject that children will come across at school so we’re here to show that it covers all kinds of subjects from physics to chemistry to design and most importantly, that it’s fun! It’s so crucial to get young people involved with science at a young age so that they can see it as a possible career choice in the future.
We are currently updating the Outreach and Public Engagement pages on our website. Check back in September 2019 for our upcoming outreach events and KS3 learning resources for materials science activities.