Autoimmune Disease and Infertility

Causes and Treatment Options for Autoimmunity

Dr. Gleicher explains autoimmune disorders and how they affect fertility.

Because abnormal immune function can affect fertility as well as miscarriage risk, affected women need two layers of treatment: a first, to conceive, and a second, to prevent pregnancy loss after conception. This is a very important point because it would not make sense to help them get pregnant only to see them experience a potentially preventable pregnancy loss.

What is an autoimmune disease?

The term autoimmune disease refers to a varied group of more than 80 serious, chronic illnesses that involve almost every human organ system. In all of these diseases, the body's immune system becomes misdirected, attacking the very organs it was designed to protect. About 75% of autoimmune diseases occur in women, most frequently during the childbearing years. Autoimmune diseases can affect connective tissue. (This is the tissue which binds together various tissues and organs.) It can also affect the nerves, muscles, endocrine system, and gastrointestinal system. There are many autoimmune diseases, with multiple sclerosis, Hashimoto’s thyroiditis, rheumatoid arthritis being some of the most common (for a more extensive list of common autoimmune diseases, see the chart below.

What causes autoimmune diseases?

Unfortunately, autoimmune diseases remain among the most poorly understood illnesses. It is thought that hormones play a role in inducing autoimmune diseases; some cases suddenly improve during pregnancy, others flare-up during, or after pregnancy. Yet, others may flare up only after menopause.

Autoimmune diseases also show a strong hereditary component, but mysteriously, can cluster in families as different conditions. For example, a mother may have lupus erythematosus; her daughter, scleroderma and her grandmother, rheumatoid arthritis. Ongoing research is attempting to shed more light on genetic, hormonal and environmental risk factors that contribute to the occurrences of autoimmune diseases.

How are autoimmune diseases diagnosed?

The diagnosis of an autoimmune disease is based on symptoms, findings from a physical examination, and results from laboratory tests. Specific autoimmune diseases are, at times, difficult to diagnose, especially in the early stages of the disease, when symptoms and laboratory data may not yet be specific enough. Although autoimmune diseases are usually chronic, the course they take is often unpredictable.

How are autoimmune diseases treated?

Since autoimmune diseases are often chronic, they may require lifelong care and monitoring, even when the person may look and feel well. Currently, few autoimmune diseases can be cured or made to disappear with treatment. However, many people with these diseases live relatively normal lives when they receive proper medical care.

How are autoimmune diseases treated for infertility?

CHR Publications on Autoimmunity

More publications

As the causes of autoimmune diseases are not well understood, it is not surprising that we still lack specific treatments for the various conditions. What we can treat are usually selected symptoms of diseases, which, at times, may include infertility. Indeed, mostly through Dr. Gleicher's work, we, in some women, have come to see infertility as a fairly typical early symptom of abnormal female autoimmune function.

Because of our special expertise in this area, CHR sees a large volume of women with clinically overt (but also sub-clinical, early) autoimmune diseases who suffer from infertility and/or pregnancy losses. The good news is that with aggressive treatment, most patients can conceive and deliver healthy children.

In a preliminary, though quite provocative, study published in 2006 in the Journal of Autoimmunity, Dr. Gleicher for the first time suggested that the risk to develop autoimmune disease may be influenced by the way children are being delivered: Cesarea section delivery may reduce the risk to offspring, while at the same time increasing the maternal risk to flare her condition.

For more information on Dr. Gleicher's research see Scientific Publications.

Talk with the infertility experts

Think an autoimmune disease may be a factor in your infertility? Our experts can help diagnosis the problem and create a personalized treatment plan for you. Contact us if you would like our preliminary opinion on your Next Steps.

Key Facts about Autoimmune disease and infertility

In summary:
  • The term autoimmune disease refers to a group of more than 80 serious, chronic diseases, that are each characterized by the body's immune system becoming misdirected, attacking the very organs it was designed to protect.

  • There is still much we don't know about the causes, diagnoses, and treatments for autoimmune diseases. That being said, CHR has had large success treating women with an autoimmune disease who have suffered from infertility and/or pregnancy loss, helping them to conceive and deliver healthy children.

Common examples of autoimmune diseases

Autoimmune diseases which affect the nervous system Autoimmune diseases which affect the gastrointestinal tract
Autoimmune diseases of the hematological system Autoimmune diseases which affect the endocrine glands
Autoimmune diseases which affect blood vessels Autoimmune diseases of the skin

Autoimmune diseases which affect multiple organs (also called connective tissue diseases) Autoimmune Diseases in Women Resources

Speak with a CHR Doctor, or Get a Second Opinion

The first step is easy. Complete the below contact form, and a CHR physician will contact you within 48 hours to begin determining the treatment approach that is right for you.

Additionally, if you're looking for a second-opinion consultation, take advantage of our extensive second-opinion program that provides assessments and treatment proposals from three of the world's leading infertility experts. It can be difficult to figure out what you want or whether your current treatment path is appropriate, and CHR's physicians can help you at different points of your decision-making process.

By completing the form below, you will...
  • Receive an email response by an expert physician within 48 hours
  • Not be contacted by telephone unless specifically requested
  • Your information will not be shared with any 3rd party
  • This form will be transmitted using encryption for your privacy
First Name *:
Last Name *:
City *:
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Written by

Last Updated: December 31, 2013


Family Interest 4 Day Itinerary

Tel Aviv's Beatch

Day 4

Dead Sea
Ein Gedi

Take the cable-car up to Massada and explore the fortress built by Herod the Great, which was the scene of the epic stand by Jewish rebels at the end of the Great Revolt against Rome nearly 2,000 years ago. The new museum at the visitor’s center reveals the secrets of the rebels’ daily life, the story of the excavations, and how the site became one of Israel’s most important symbols.

In the late afternoon, enjoy a dip in the Dead Sea, the lowest, saltiest body of water on earth.

Family Interest 4 Day Itinerary


Purpose of Course  showclose

Many consider William Shakespeare the greatest dramatist—even the greatest writer—of all time.  His impact on Western culture and language is unmistakable, but his works have also been continuously read and performed around the world, illustrating his global significance.  Over the course of this semester, we will attempt to determine why his works have become so widely revered, or why they seem, to quote Ben Jonson, “not for an age, but for all time.”

We will begin by familiarizing ourselves with Elizabethan theatre, language, and culture—the world in which Shakespeare lived and breathed.  We will then conduct close readings of a number of Shakespeare’s most acclaimed plays, progressing through his dramatic works by categorizing them in three groups: comedies, tragedies, and histories.  Finally, we will turn to some of his poetry, which Shakespeare (perhaps surprisingly) considered superior to his plays.  By the end of this course, you will have developed a strong understanding of Shakespeare’s works—their style, their linguistic accomplishments, their hallmarks—as well as a working knowledge of the Elizabethan Period in which he wrote.

Learning Outcomes  showclose

  • Identify, compare, and contrast the major dramas and poems produced by William Shakespeare.
  • Describe Shakespeare’s identity as well as provide an account of his life and the legacy of his work.
  • Describe Elizabethan England in social and historical context.
  • List the major figures who likely shaped the work of Shakespeare.
  • Explain the origins of Shakespearean drama in Greek theater.
  • Define a variety of Shakespearean dramatic forms, including Shakespearean tragedy, history, and comedy plays.
  • Identify and describe the major themes of Shakespearean tragedy, comedy, and history plays.
  • Explain the roots of the Shakespearean sonnet in earlier sonnet traditions.
  • Identify and describe the major themes and ideas at work in Shakespearean sonnets.

Course Requirements  showclose

In order to take this course, you must:

√    Have access to a computer

√    Have continuous broadband internet access

√    Have competency in the English language

√    Have read the Saylor Student Handbook.

√    Have completed ENGL202: Cultural and Literary Expression in the English Renaissance

Unit Outline show close

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Black Non-Believers of Atlanta: Interview with Mandisa L. Thomas

Mandisa Thomas is a co-founder and current President of the Black
Nonbelievers of Atlanta
early age, I quickly noticed that there were similarities and differences
society.” she recalls. She has been a guest on programs including The Critical Eye, Ask
an Atheist and the Black Freethinkers blogtalk radio show (of which she is now
a co-host with Kimberly Veal of the Black Non-Believers of Chicago).

BS: What led you to create the Black
Non-Believers of Atlanta group?  What are
some of the initiatives the group has undertaken and what has been the response
of the local community?

Mandisa: Benjamin Burchall and I founded
Black Nonbelievers of Atlanta to reach other African Americans who are either
questioning their religious beliefs, or whom are nonbelievers that are still in
the closet. Because religion is so prevalent in the lives of many in our
communities, we understood how difficult it could be to express an opposing
view. We also realized that there are serious consequences for many that do so,
(including ostracism from many social circles) and we knew that there needed to
be a support system created. The initiatives we’ve taken include conducting
General Meetings once a month, sponsoring a Recovering from Religion support
group, and participating in community cleanup projects.

BS: Atlanta seems to be a relative hub of
black non-theist activity. Why do you think that is? [Read more...]


Sacred Texts  Hinduism  Mahabharata  Index  Previous  Next

"Bhishma said, 'In this connection is cited, O chief of the Bharatas, the old story of the discourse between Salmali and Pavana. There was a lordly (Salmali) tree on one of the heights of Himavat. Having grown for many centuries, he had spread out his branches wide around. His trunk also was huge and his twigs and leaves were innumerable. Under his shade toil-worn elephants in rut, bathed in sweat, used to rest, and many animals of other

p. 342

342:1 The word sramana is used in Brahmanical literature to signify a certain order of ascetics or yatis that have renounced work for meditation. It is also frequently employed to mean a person of low life or profession. It should be noted, however, that in Buddhistic literature the word came to be exclusively used for Buddhist monks.

Next: Section CLV


The health benefits of a recession

The health benefits of a recession

Economic slowdown may also slow down ill health
Nov 05, 2009
By staff

If it seems there's no possible silver lining to the protracted grey overcast that is the current economic slowdown, you may be surprised. A new study lends evidence to previous research into people's health during times of recession and shows that indicators of general well-being behave in unexpected ways.

A recent study performed by University of Michigan (UM) researchers shows that historically during periods of economic trouble, life expectancy across race and gender has risen while disease and accident mortality fell. Conversely, the opposite was true for economic booms. This information comes from an examination of data on health trends covering the years 1920 through 1940, a span which includes the Great Depression and other downturns, as well as various waves of expansion.

The scope of the study did not include investigating the reasons for these counterintuitive results, but Jose Tapia Granados of UM's Institute for Social Research points to the stress of upswings as being key. During those busy times, he says, companies expect exceeding hours and productivity from workers, which can lead to increased alcohol and tobacco consumption. Additionally, greater business begets greater traffic and higher pollution—both of which contribute to higher death rates.

So, if nothing else, enjoy the relative relaxation and hale and hearty climate afforded by the recession. You'll live longer for it.

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Ask a question about 'Myra'
Start a new discussion about 'Myra'
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Myra is an ancient town in Lycia

, where the small town of Kale (Demre
Demre is a town and a district of Antalya Province on the Mediterranean coast of Turkey, named after the river Demre.Demre is the Lycian town of Myra, the home of Saint Nicholas of Myra, the original Santa Claus. The district was known as Kale until it was renamed in 2005...

) is situated today in present day Antalya Province
Antalya Province
Antalya Province is located on the Mediterranean coast of south-west Turkey, between the Taurus Mountains and the Mediterranean sea.Antalya Province is the centre of Turkey's tourism industry, attracting 30% of foreign tourists visiting Turkey. The province of Antalya corresponds to the lands of...

 of Turkey

Alluvial plain

 between Alaca Dağ, the Massikytos range and the Aegean Sea
Aegean Sea

Historical evidence

Although some scholars equate Myra with the town Mira in Arzawa
Arzawa in the second half of the second millennium BC was the name of a region and a political entity in Western Anatolia, the core area of which was centered on the Hermos and Maeander river valleys, corresponding with the Late Bronze Age kingdoms of the...

168 BC
Year 168 BC was a year of the pre-Julian Roman calendar. At the time it was known as the Year of the Consulship of Macedonicus and Crassus...

 – AD 43); according to Strabo

The Greek citizens worshipped Artemis

Eleutheria is an ancient and modern Greek term for, and personification of, liberty. Eleutheria personified had a brief career on coins of Alexandria.I.F...

, who was the protective goddess of the town. Zeus

, Athena

 and Tyche

 were venerated as well.

 on the Demre-plateau, the Roman theatre

 and the Roman baths
Roman Baths

 in 141, but rebuilt afterwards.
There are two necropoli
A necropolis is a large cemetery or burial ground, usually including structural tombs. The word comes from the Greek νεκρόπολις - nekropolis, literally meaning "city of the dead"...

 of Lycian
Lycian may refer to:* Anything related to Lycia* Apollo Lyceus, a type of ancient Greek statuary* Lycian language, the language of Lycia* Lycian script, the writing system of Lycian language* Lycian Way, a footpath in Turkey...

 rock-cut tombs
Rock-cut tombs
A rock-cut tomb or Koka is a burial chamber that is cut into the living rock usually along the side of a hill. It was a common form of burial for the wealthy in ancient times in several parts of the world....

 in the form of temple-fronts carved into the vertical faces of cliffs at Myra: the river-necropolis and the ocean-necropolis. The ocean necropolis is just northwest of the theater. The best known tomb in the river-necropolis (located 1.5 km up the Demre Cayi from the theater) is the "Lion's tomb,"also called the "Painted Tomb." When the traveller Charles Fellows
Charles Fellows
Sir Charles Fellows was a British archaeologist.-Bigography:Fellows was born at Nottingham, where his family had an estate. When fourteen he drew sketches to illustrate a trip to the ruins of Newstead Abbey, which afterwards appeared on the title-page of Moore's Life of Lord Byron...

Andriake was the harbour of Myra in classical times, but silted up later on. The main structure there surviving to the present day is a granary built during the reign of the Roman emperor Hadrian (117–138 CE). Beside this granary is a large heap of Murex shells, evidence that Andriake had an ongoing operation for the production of purple dye.

In early Christian times, Myra was the metropolis
Metropolis (religious jurisdiction)
A metropolis is a see or city whose bishop is the metropolitan of a province. Metropolises, historically, have been important cities in their provinces....

 of Lycia

. The town is traditionally associated with Saint Paul
Paul of Tarsus

, who changed ships in its harbor. Saint

 Nicholas of Myra was the bishop

 of Myra in the 4th century, is said to have been an ardent opponent of Arianism
Arianism is the theological teaching attributed to Arius , a Christian presbyter from Alexandria, Egypt, concerning the relationship of the entities of the Trinity and the precise nature of the Son of God as being a subordinate entity to God the Father...

 at the First Council of Nicaea
First Council of Nicaea

 in 325, although his name does not appear among the signatories of that council. Myra became the capital of the Byzantine Eparchy
Eparchy is an anglicized Greek word , authentically Latinized as eparchia and loosely translating as 'rule over something,' like province, prefecture, or territory, to have the jurisdiction over, it has specific meanings both in politics, history and in the hierarchy of the Eastern Christian...

 of Lycia under Theodosius II
Theodosius II
Theodosius II , commonly surnamed Theodosius the Younger, or Theodosius the Calligrapher, was Byzantine Emperor from 408 to 450. He is mostly known for promulgating the Theodosian law code, and for the construction of the Theodosian Walls of Constantinople...

, who reigned from 408 to 450.

Siege of 809

After a siege
A siege is a military blockade of a city or fortress with the intent of conquering by attrition or assault. The term derives from sedere, Latin for "to sit". Generally speaking, siege warfare is a form of constant, low intensity conflict characterized by one party holding a strong, static...

 in 809, Myra fell to Abbasid

 troops under Caliph

 Harun al-Rashid
Harun al-Rashid
Hārūn al-Rashīd was the fifth Arab Abbasid Caliph in Iraq. He was born in Rey, Iran, close to modern Tehran. His birth date remains a point of discussion, though, as various sources give the dates from 763 to 766)....

. The town went into a decline afterwards. Early in the reign of Alexius I Comnenus (ruled between 1081 and 1118), Myra was again overtaken by Islamic invaders, this time the Seljuk Turks. In the confusion, sailors from Bari

 in Italy seized the relic

s of Saint Nicholas, over the objections of the monk

 to Saint Nicholas.

The church of St. Nicholas at Myra

 was added in the second half of the 11th century.

In 1863, Tsar

 Alexander II of Russia
Alexander II of Russia

The floor of the church is made of opus sectile
Opus sectile

, a mosaic

 of coloured marble, and there are some remains of fresco

es on the walls. An ancient Greek
Ancient Greek

Marble is a metamorphic rock composed of recrystallized carbonate minerals, most commonly calcite or dolomite.Geologists use the term "marble" to refer to metamorphosed limestone; however stonemasons use the term more broadly to encompass unmetamorphosed limestone.Marble is commonly used for...

, and are now held in the cathedral of that city
Basilica di San Nicola (Bari)
The Basilica di San Nicola is a church in Bari, southern Italy, that holds wide religious significance throughout Europe and the Christian world...

The church is currently undergoing restoration. In 2007 the Turkish Ministry of Culture gave permission for the Divine Liturgy
Divine Liturgy
Divine Liturgy is the common term for the Eucharistic service of the Byzantine tradition of Christian liturgy. As such, it is used in the Eastern Orthodox and Eastern Catholic Churches. Armenian Christians, both of the Armenian Apostolic Church and of the Armenian Catholic Church, use the same term...

External links

Photos and videos


Dancing on Air

Posted on July 28, 2011 by

Every other year in August, a crowd of people gathers at Vedauwoo, a popular rock-climbing area outside of Laramie, Wyoming. They tilt their heads up, not to gawk at climbers, but to watch dancers hanging from ropes and harnesses as they perform against the curtain of a 200-foot rock face. Pushing off the rocks, the dancers strike poses in the air, flip over each other and move gracefully up and down the rock face. The scene, a combination of fluid choreography and natural grandeur, is stunning.

The biannual performance is put on by the University of Wyoming’s vertical dance program, a unique two-course sequence started in 1999 by geology and geophysics professor Neil Humphrey and Margaret Wilson, an assistant professor in dance. Together, Humphrey and Wilson teach students the basics of vertical (or aerial) dance, a form that features dancers suspended in the air performing traditional dance vocabulary. While some UW dancers who complete the program may go on to specialize in vertical dance, Wilson and Humphrey’s ultimate goal is to make the students better all-around performers, even when they’re firmly on the ground.

The seeds for the program were planted in 1995, when Humphrey, who had begun studying dance recreationally with Wilson, staged a flying scene in the school’s production of A Midsummer Night’s Dream. After the show, Humphrey went on to study vertical dance at the Project Bandaloop workshop at the Banff Arts Center in British Columbia. He attended in 1998, and upon his return teamed up with Wilson and director Rebecca Hilliker to stage a play at Vedauwoo that incorporated vertical dance. It was so well-received, and the students who participated were so enthusiastic, that Humphrey and Wilson easily convinced the university’s department of theater and dance to begin formally offering vertical dance.

The program consists of two one-credit classes: Vertical I, which is offered every spring semester, and Vertical II, which is offered every three or four years depending on interest and Wilson and Humphrey’s availability. Although there aren’t formal requirements to enroll, preference is given to dance majors.

Over the course of 16 sessions, Vertical I students learn how to use the equipment—including belay devices, static and dynamic ropes, pulleys and harnesses—required for vertical dance. (While some vertical dance companies use silk or ribbon, the UW program focuses solely on ropes and harnesses, so that the dancers don’t have to worry about interacting with and controlling other equipment.) Once they master equipment safety, they learn to dance while suspended. During the 16 sessions of Vertical II, students begin to experiment with choreography for different types of rigging.

In Vertical I, Wilson and Humphrey start by attaching ropes to the top of a theater grid and suspend the students just a few feet off the ground. They teach students basic movements, such as V-sits and planks. “They work with these to find the form,” Wilson says. Then they ask the students to move from one position to another trying new directions, dynamics and transitions. Not only does this help them get comfortable with their feet off the ground, it also requires that they use their dance knowledge.

“They are learning a lot about their bodies in the process,” Wilson says. “What works on the ground does not always work in the air, and if they just focus on the transition, they discover for themselves that they are moving in new and different ways.”

When the dancers become more confident on the rope, they climb to a higher position or lower themselves down from the catwalk onto ropes, where they work on movement ideas with a partner. “They create their own movement sequences,” Wilson explains, “because we have found that if they are problem-solving on the rope, they not only extend their vocabulary, but they are more comfortable as well.”

As the dancers gain competence in the air, they strengthen their back and abdominal muscles and develop a greater spatial awareness and understanding of their bodies, which enhances their performance in their other dance classes.

Though most Vertical I and II students are dancers, Humphrey says one of the first things they must understand is the different relationship to the audience.

“I have to remind them that as soon as you are lifted up in space, the audience has no idea where they should be looking,” he says. “On the ground, you typically know where the audience is relative to your body. In rope work, your orientation is often random—your feet may be pointing straight at the audience.”

Humphrey and Wilson emphasize the importance of using the whole body, making sure that every movement extends from the feet to the hands to the expressions on their faces. That way, “even if your back is the most visible body part,” Wilson says, “the audience sees you fully performing.” This  carries over to their regular dance studies as well, where the vertical dancers often appear to have more confidence.

Whether she ends up dancing on the ground or in the air, recent UW graduate Mary Alex Floyd says her vertical dance experience has had a tremendous impact on her. “Dancing on the ground is easier, and so is losing balance,” she says. “I am less afraid to try anything.” DT

Abby Margulies is a freelance writer living in Brooklyn.

Photo: Performing at the Vedauwoo rock-climbing area (by Skip Harper, courtesy the University of Wyoming)


Ψάξε όποια λέξη θες, όπως ratchet:
A voicegasm can only be achieved when a man with a certain depth of voice, usually in Barry White's range, speaks or sings causing women to spontaneously have orgasms.
Person1: Man I wish I could have a voice like Barry White...
Person2: Why?
Person1: So I could have the power of a voicegasm.
Person2: Ooooh thats true.
από TheRevolution19 19 Φεβρουάριος 2007


Keress bármilyen szót, mint például: spook

1 definition by fighthefuture2012

The wild canines who form packs with a top alpha member. When a member breaks off, they're known as the lone wolf. In the bible it mentions wolves to be warned against as being treacherous, bloodthirsty, and ferocious.
Department of Homeland Security has labeled so called "homegrown terrorists" as a lone wolf.
Beküldő: fighthefuture2012 2011. július 12.


After watching Firefly this summer, I feel kind of sad every time a show is cancelled. Even if it's a show I don't like, I still feel bad. Also because like, five shows that I watched got cancelled after a season. I watch too much TV....

Hey, did anyone watch Hatsune Miku's network debut last night? I thought they could have picked a different song. It had good energy but it was really hard to tell what she was singing (or in what language), there was so much layering. People laughed when it was explained what she was but at least they clapped...

Since having a stable income, I decided I would finally get back into buying manga, starting with finishing up series I already had. Admittedly these series are a good handful of years old. What I find totally odd though, is that I can find books published in 2008 but I can't find ones published in 2011. Or better yet, I can easily get my hands on books from 2005 but have to scrounge around for books from 2008. Doesn't make much sense to me.

I've nearly completed two of the three series I've been trying to finish up. In one, I only have two more books to get before it's finished. Frustratingly enough, the last two books seem impossible to find. The copies that I can find only go as low at $20 US dollars, and as high as $130 (!!!).

Even $20 is pushing my spending limit. I still begrudge $10 manga (I'm old enough to still remember when it was $5...). Do you think anyone even is willing to spend $130 on one book?

Hello, 2014

Happy New Year, everyone. May it be happy.

Nothing Much

And that's it for me. Hope you're all well.


epithelioma, an abnormal growth, or tumour, of the epithelium, the layer of tissue (such as the skin or mucous membrane) that covers the surfaces of organs and other structures of the body. Epitheliomas can be benign or malignant (that is, cancerous), and there are various types depending on the kinds of epithelial cells affected. Common epitheliomas include basal cell carcinoma and squamous cell carcinoma (cancerous epitheliomas are known as carcinomas), two types of skin cancer that involve the inner layers and scalelike outer cells of the skin, respectively; and parathyroid adenoma, a benign tumour of glandular tissue in the parathyroid gland that can cause a condition known as hyperparathyroidism.


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1 2


Next: , Previous: Manipulating Spacing, Up: gtroff Reference

5.10 Tabs and Fields

A tab character (ASCII char 9, EBCDIC char 5) causes a horizontal movement to the next tab stop (much like it did on a typewriter).

— Escape: \t

This escape is a non-interpreted tab character. In copy mode (see Copy-in Mode), \t is the same as a real tab character.

— Request: .ta [n1 n2 ... nn T r1 r2 ... rn]
— Register: \n[.tabs]

Change tab stop positions. This request takes a series of tab specifiers as arguments (optionally divided into two groups with the letter ‘T’) which indicate where each tab stop is to be (overriding any previous settings).

Tab stops can be specified absolutely, i.e., as the distance from the left margin. For example, the following sets 6 tab stops every one inch.

          .ta 1i 2i 3i 4i 5i 6i

Tab stops can also be specified using a leading ‘+’ which means that the specified tab stop is set relative to the previous tab stop. For example, the following is equivalent to the previous example.

          .ta 1i +1i +1i +1i +1i +1i

gtroff supports an extended syntax to specify repeat values after the ‘T’ mark (these values are always taken as relative) – this is the usual way to specify tabs set at equal intervals. The following is, yet again, the same as the previous examples. It does even more since it defines an infinite number of tab stops separated by one inch.

          .ta T 1i

Now we are ready to interpret the full syntax given at the beginning: Set tabs at positions n1, n2, ..., nn and then set tabs at nn+r1, nn+r2, ..., nn+rn and then at nn+rn+r1, nn+rn+r2, ..., nn+rn+rn, and so on.

Example: ‘4c +6c T 3c 5c 2c’ is equivalent to ‘4c 10c 13c 18c 20c 23c 28c 30c ...’.

The material in each tab column (i.e., the column between two tab stops) may be justified to the right or left or centered in the column. This is specified by appending ‘R’, ‘L’, or ‘C’ to the tab specifier. The default justification is ‘L’. Example:

          .ta 1i 2iC 3iR

Some notes:

The read-only number register .tabs contains a string representation of the current tab settings suitable for use as an argument to the ta request.

          .ds tab-string \n[.tabs]
              ⇒ T120u

The troff version of the Plan 9 operating system uses register .S for the same purpose.

— Request: .tc [fill-glyph]

Normally gtroff fills the space to the next tab stop with whitespace. This can be changed with the tc request. With no argument gtroff reverts to using whitespace, which is the default. The value of this tab repetition character is associated with the current environment (see Environments).1

— Request: .linetabs n
— Register: \n[.linetabs]

If n is missing or not zero, enable line-tabs mode, or disable it otherwise (the default). In line-tabs mode, gtroff computes tab distances relative to the (current) output line instead of the input line.

For example, the following code:

          .ds x a\t\c
          .ds y b\t\c
          .ds z c
          .ta 1i 3i

in normal mode, results in the output

          a         b         c

in line-tabs mode, the same code outputs

          a         b                   c

Line-tabs mode is associated with the current environment. The read-only register .linetabs is set to 1 if in line-tabs mode, and 0 in normal mode.

[1] Tab repetition character is a misnomer since it is an output glyph.


Various world crises, such as civil wars and sectarian divisions have created over 50 million refugees, asylum-seekers and internally displaced people, the highest after the Second World War, the UN refugee agency said on Friday in Geneva.

Syrian refugee children collect plastics as they stand along a street in south of SidonReuters

The total number of refugees and people displaced within their countries climbed to 51.2 million by the end of 2013, an increase of over 6 million in comparison to the previous year, the United Nations High Commissioner for Refugee (UNHCR) said.

Citing its annual trends report, the UN refugee agency said that the situation was particularly grim and dramatic in Syria – with 6.5 million people internally displaced in the country, ever since the civil war broke out, while a further 2.5 million have crossed the country's borders to flee the violence.

Other most notable crises that have generated this exodus of people from their homes include wars in South Sudan, the Central African Republic (CAR), Ukraine and Iraq where people are forced to flee their houses in fear of being killed. Adding up to the bulk of people fleeing are Palestinians, Afghans and Somalis who escaped to safety in the recent years, the agency said.

"We are seeing here the immense costs of not ending wars, of failing to resolve or prevent conflict," UN High Commissioner for Refugees Antonio Guterres said in an address. "People (are) today dangerously in deficit. Humanitarians can help as a palliative, but political solutions are vitally needed. Without this, the alarming levels of conflict and the mass suffering that is reflected in these figures will continue."

It was also revealed that developing countries are hosting 86 percent of the world's refugees. Pakistan is currently the biggest host country for refugees with 1.6 million refugees, following closely by Iran and Lebanon. There were 1.1 million people who sought asylum in various developed countries. Among them, 10 percent applied in Germany making it the top country where asylum seekers apply for refuge.

The United States, South Africa, France and Sweden were four other top countries where people register the most asylum claims.

"The international community has to overcome its differences and find solutions to the conflicts of today in South Sudan, Syria, Central African Republic and elsewhere. Non-traditional donors need to step up alongside traditional donors. As many people are forcibly displaced today as the entire populations of medium-to-large countries such as Colombia or Spain, South Africa or South Korea," Independent quoted Guterres


Monday, August 18, 2008

Geopolitical Disruptions: Building a Theory of Disruptions to Oil & Resource Supply

The peak and gradual decline in world oil production is beginning to spawn a set of geopolitical positive-feedback-loops that seem likely to exacerbate depletion and accelerate the effective rate of decline of world oil production. Rather than isolated incidents, these geopolitical feedback loops are the direct result of geological peaking in oil production. Unlike geologically driven peaking, however, the effective rate of decline caused by geopolitical feedback loops has the potential to continually accelerate. This post will lay out a theory to better understand the impact of this system of geopolitical phenomena.

While geological peaking presents a significant challenge (black line = geologically determined oil production rate), it also acts as a catalyst for a system of geopolitical feedback loops that may catastrophically exacerbate the situation (red line = potential impact of accelerating geopolitical feedback loops on oil production rate)

I've discussed the impact of various types of geopolitical disruptions to oil production previously at The Oil Drum. One of these geopolitical phenomena, the Export Land Model (ELM), has been well developed by TOD members Westexas and Khebab (see their Iron Triangle post and Wikipedia article). While I think that ELM is already proving to be the most significant of the geopolitical factors--especially in the earlier phases of peak oil--I think that it is important to place ELM into the context of a larger set of geopolitical pheonomena. In part, this is the case because of a similarity between the various geopolitical forces at work. In part, it is because these forces tend to act as alternatives to one another, and their full implications cannot be properly understood in isolation.

In this post, the first part in a series, I hope to lay the framework of a theory for better understanding these phenomena, for extrapolating trends, and for predicting their future impact. It is also important to place the problem of geopolitical disruptions in context, and to highlight the danger of dismissing these phenomena as isolated and separate "above ground factors." The next post in this series will review and update the set of geopolitical feedback loops currently in action, looking not only at disruptions to oil production, but also at the larger issue of resource production, including gas, coal, fertilizer, metals, etc. The final post will discuss the interrelationship between the various geopolitical forces at work as well as the potential approaches to "solve" this system of problems.

Building a Theory of Geopolitical Disruptions to Resource Supply

Since this theory is still very much in formation, I'll proceed by asking a series of questions, followed by my best answer at present. I hope that readers will help to both refine these answers, as well as propose additional questions that must be addressed:

1. Are Geology and Geopolitics Separate?

When considering peak oil, it is tempting to look at the issue as a purely a matter of depletion due to geology and production economics. While peak oil certainly begins with the study and understanding of geological depletion, it spawns a set of exacerbating geopolitical factors that are critical to understanding the ultimate scope and impact of peak oil.

Some commentators consider "above ground factors" to be separate, stand-alone phenomena that are neither related to nor driven by the geological peaking of oil production. This is a critical mistake. Rather than being merely isolated phenomena, these geopolitical forces are best viewed as phenomena that would not exist but for geological constraints. Without geological constraints on oil production--specifically without geographical constraints on where remaining viable oil reserves are located--oil producers would produce sufficient oil from geopolitically stable locations. In reality, resources are almost always subject to uneven geographical distribution.

For economic and political reasons, consuming nations tend to produce domestic supplies first. When consuming nations produce oil in foreign nations, regions with geopolitical stability and stable legal systems to protect property interests are favored, so oil from these countries tends to be produced first. As a result, when the world has produced roughly half of its reserves, and when world production approaches peaking, the majority of remaining reserves (especially the majority of economically viable reserves) tend to be located outside consuming countries in the least geopolitically and legally stable regions.

This, roughly, is why "our oil" is increasingly likely to be located "under their sand." As a result, today's increasing geopolitical problems in oil and resource production are a direct result of geological factors combined with picking the low hanging fruit first. If it had made more sense to produce oil from offshore Nigeria, Azerbaijan, or the Arctic first, and save Texas and Alaska oil for later, we would have done that. But because that wasn't what made sense, today's geopolitical problems are a direct result of geography when viewed from a macro perspective. Additionally, this process of explaining why geopolitical problems exist today also demonstrates that it is useful to view geopolitical problems as a global system of phenomena, not as isolated events.

2. Are Geopolitical Disruptions Feedback Loops?

It seems that geopolitical forces act as positive feedback loops. I'll detail the feedback inside and between various geopolitical forces in my next post, but for now I'll outline the general concept: 1) global scarcity of oil, energy, or other resources increases the likelihood of disruption to the supply of that resource (for various reasons that I've discussed before and will outline in more detail in the next post in this series); 2) when these disruptions occur, they further increase the global scarcity of the resource, increasing the effect noted in #1 and creating a positive feedback loop.* For that reason, I call this set of exacerbating factors "geopolitical feedback loops" as they are subject to positive feedback both from their own operation and from the rate of geologically-driven depletion. I think that term is appropriate, but admittedly a bit cumbersome--I'll shorten it to "GFL" for now.

*Some GFLs may not be positive feedback loops--the Export Land Model, for example, is probably a positive feedback loop to the extent that the drop in net exports from one exporter causes global prices to rise enough to make that exporter's export revenues increase despite the decline in net export volume. However, it would be a negative feedback loop if the rise in domestic consumption due to high export revenues (the system's output) has the result of decreasing export revenues (feeding the system's output back into the system in an inverted manner) and thereby causing a decrease in domestic consumption (acting to re-establish equilibrium).

Oil supply scarcity drives geopolitical supply disruptions which, in turn, drives scarcity in a positive feedback loop

3. How Does the "Rate" of Disruption from Geopolitics and Geology Compare?

There are also critical differences between the rate of geological depletion and the potential rate at which geopolitical disruptions cumulatively impact oil supply rates. Unlike depletion, whereby oil production from a given field or set of fields decreases rapidly after peaking before beginning to "tail off" and decrease more slowly (the black line in the graphic above), geopolitical forces may disrupt production catastrophically, or may disrupt production at a rapidly accelerating rate (the red line in the graphic above).

This is not to say that GFLs will have a greater impact than geology--while it is certainly possible that a single geopolitical disruption will dramatically outpace geological depletion over a short time period, geological factors will likely be the main determinant of oil production declines during the initial phases of peak oil. However, depending on our society's ability to mitigate Peak Oil with substitute energy sources and to adapt to a lower energy world, it also seems likely that geopolitical disruptions will eventually overtake depletion as the most significant problem. Because geopolitical disruptions will have a disproportionately greater impact in an environment of increasing oil scarcity, as well as due to factors involved in secondary and tertiary recovery methods, the right half of the global oil production curve will not look like the left--when the impact of GFLs are added to the rate of geological decline, the drop in global oil production may be much faster than generally expected.

4. Along What Timeline Will Geopolitical Disruptions Unfold?

Geological forces do not require an actual peak in global oil or energy production to begin to form positive feedback loops--rather, the catalyst for positive feedback is the onset of diminishing marginal returns in investment in energy, where energy begins to become more expensive in relative terms. While global oil and energy supplies may not have peaked, we have almost certainly crossed the threshold of more expensive energy. Also unlike depletion, geopolitical feedback loops may disrupt production in a region that is still far from geological peaking. For this reason, it is reasonable to expect GFLs to increasingly disrupt global oil production alongside an increase in the scarcity of oil, and before an actual peak in global production. Annecdotal evidence supports this view of the the timing of geopolitical disruptions: while some degree of scarcity of oil has coincided with geopolitical disruptions in the past, increasing scarcity over the past decade has coincided with easily observable increases in geopolitical disruptions. While I think the general issue of timing is obvious, one critical unanswered question remains: how fast will geopolitical disruptions impact overall production rates?

5. Will the Aggregate Effect of Geopolitical Disruptions be Smooth or Unpredictably "Bumpy"?

Unlike geological depletion, geopolitical disruption is uniquely susceptible to "black swan" events--things that simply cannot be predicted. This is problematic because, unlike geological depletion which can be understood as a slow but compounding process, geopolitical disruptions may appear non-existent, but then suddenly exert a huge toll on global production. This makes predictions of future oil production levels even more uncertain than predictions that account for only geological factors, and increased uncertainty in estimating future oil production makes selecting and mobilizing the necessary political will for various mitigation options more difficult.

Some GFLs, such as the Export Land Model, will likely produce fairly smooth and predictable effects. Others, like the increased motivation to target oil production infrastructure, will likely produce relatively smooth aggregate effects, but will be subject to significant and sudden disruptions--for example, if al-Qa'ida successfully destroys the export terminal at Ras Tanura, or if Iran blockaded the Strait of Hormuz. The critical unanswered question here is whether, in aggregate, the impact of GFLs will be predictably smooth (as assumed in the graphic at the top of this post) or unpredictably volatile.

6. Is the System of Geopolitical Feedback Loops Solvable?

Because individual geopolitical disruptions can be "solved", there is a tendency to think of them as separate from geological challenges (and thereby a convenient alternate explanation for those who don't like the implications of geological depletion). Additionally, there is a tendency to think that because individual problems are solvable, the system of geopolitical forces can also be solved as a whole (specifically, solved by the same tool-set of security, military force, etc.). In reality, while the occurrence of individual events and geopolitical disruption in individual regions is highly uncertain (and too complex to predict mathematically), the increasing scarcity of oil and other resources caused by geological factors creates an ever increasing catalyst to geopolitical disruption.

In the face of geological depletion, geopolitical disruption is not a question of if, but a question of where and how fast. If a single geopolitical disruption--say, a militant group attacking a pipeline--can be solved, why can't the larger system also be solved? In theory, it can, but there are systemic problems to solving the larger system. In general, this is because the "solutions" to the individual problems are actually to overwhelm and repress the root cause locally--something which will become increasingly difficult globally.

For example, the Nigerian rebels can, theoretically, be defeated by overwhelming government force, but this does not solve their grievance--that their ethnic group is being oppressed and resources that are rightfully theirs are being appropriated. Rather, it relies on overwhelming military force and expenditure to repress it (and, it should be noted, this "solutions" is being discussed theoretically, as the massive military force and expenditure by Nigeria's government at present is failing miserably to repress rebel attacks on oil infrastructure). It seems, at least to me, far more likely that the world can concentrate resources to temporarily repress geopolitical flare-ups regionally, especially in the earlier phases of peak oil. However, if global resources are spread thin, it is impossible to address every trouble spot simultaneously. Because of this, it seems unlikely that there would be enough pressure at individual points to repress disruptions across the entire system.

Finally, while many geopolitical problems can be repressed by favoring one side in a dispute as leverage against the other (the Exploitation Model), it is often not fundamentally possible to actually resolve the issue by making all parties happy (thereby eliminating the root cause of the geopolitical disturbance) because the minimum demands of opposing groups are often mutually exclusive. I've written about this problem of Mutually Exclusive Overlap before, and I think that it makes the global system of geopolitical feedback loops an inevitability. However, while I think that the broader system is not "solvable," I do think that it is possible to buffer their effect, a topic I will discuss in a later post.

7. Is Price the Sole Catalyst of Geopolitical Disruptions?

While demand destruction and economic troubles may grant a temporary reprieve from increasing geopolitical tensions (because they may temporarily reduce the underlying catalyst of scarcity), the steady march of resource depletion will eventually catch up and cause geopolitical tensions to escalate again unless a truly economical, scalable substitute for fossil fuels is built out sufficient to negate depletion and accommodate continued economic and population growth. In that sense, if peak oil is not a problem for humanity, neither will we suffer the exacerbating effects of geopolitical feedback loops. However, to the extent that peak oil presents a serious problem, it will be increasingly exacerbated by geopolitics.

Additionally, demand destruction is particularly inefficient at buffering these geopolitical feedback loops because the lowest value consumption tends to be "destroyed" first. In a demand destruction scenario, when consumers are forced to reduce consumption out of economic necessity, they will choose to first eliminate the consumption that is least necessary to the maintenance of their quality of life. As a result, as demand destruction gradually decreases consumption, the consumption that remains is, by process of elimination, increasingly inelastic. For this reason, demand destruction actually exacerbates the positive-feedback nature of these geopolitical phenomena.

A pipeline bombing, cartel action, or rise in domestic consumption that removes 500,000 barrels of oil per day from the international market exerts far more leverage on a future United States that consumes only 10 million barrels (due to demand destruction) per day of oil than it does on today's United States that consumes roughly 20 million barrels per day. However, if this same future United States only consumes 10 million barrels per day of oil due to the development of economically viable substitutes and voluntary efficiency measures, then this would not be the case. I'll address this point in more detail in my discussion on buffering GFLs in a later post. In general, if scarcity is the underlying catalyst to geopolitical disruptions, I think that price is not the best indicator of that scarcity--rather, price of a barrel of oil as a percentage of purchasing power parity may be more appropriate.

8. Are Geopolitical Feedback Loops "Scale Free"?

A scale free system (aka a fractal) is one that exhibits the same behavior at all levels. Do GFLs operate as a scale free system? Assuming that, at a point in the future where total oil production is rapidly declining, there would be a world wide catalyst for geopolitical disruption to oil supplies, would it also be true that a region where oil production is rapidly declining will see a regional catalyst before world supply begins to decline? The answer is still unclear. Mexico, for example, is already well beyond its peak in oil production--ahead of the global process of peaking. Does this mean that internal pressures in Mexico are greater than elsewhere, that the driving forces behind geopolitical feedback loops are greater than elsewhere, or that the attacks on Mexico's gas pipelines can be attributed to GFLs being more advanced in Mexico than elsewhere? We don't know.

In theory, it seems reasonable to suggest that a country experiencing the problems with its own early peak may experience greater geopolitical pressures than others, but it is far from clear that this is the case in Mexico where oil export revenues are still rising, and where there are ample alternative explanations for the gas pipeline attacks. Additionally, other countries where production peaked well before global production (e.g. the US, Norway, UK, though arguably not Indonesia) haven't experienced a localized rise in geopolitical tensions. There are many complicating factors (especially when viewing the US and UK and their position on the world stage), but this is a possibility to keep track of as some regions progress past peak before others.

9. How Should Quantitative Data be Integrated in this Model?

One criticism of this model of geopolitical feedback loops is, quite understandably, its lack of hard, quantitative data at its base. In one sense, the subject matter is fundamentally less suitable to quantitative, data-driven analysis than the core issue of geological depletion. Some exceptions stand out--the Export Land Model, mentioned above, is a prime example of a geopolitical feedback loop that is well suited to data-driven analysis.

Even ELM, however, presents problems for data-driven analysis. For example, when an exporting state that currently subsidizes domestic fuel prices decides to cut that subsidy when export revenues begin to decline, or if a state decides to buy domestic political support by using some of its export revenues to boost subsidies, how do we integrate the impact of this fundamentally political maneuver with the more pure analysis of net export declines? Similarly, it is quite challenging to gather accurate data of nationalist sentiment (and the degree to which this sentiment may lead to violence), the ability to mobilize political will to conserve resources for future generations, the degree to which resources motivated a military "adventure"--all of these demonstrate the challenge of bringing data-driven analysis to inherently "fuzzy" topics.

Perhaps the most important question is the degree of importance of data-driven analysis to this topic. Will the quest for mathematical analysis of these topics provide more predictive power for a given amount of effort, or will it create a misleading appearance of accuracy and predictive ability while actually creating faulty conclusions? If quantitative analysis is appropriate here, how, specifically, should it be carried out? This question, in particular, is one where I hope the many TOD readers with experience in this area will weigh in.

I plan to begin to introduce some quantitative data in the next post in this series by attempting to tally the amount of production currently shut-in or otherwise disrupted due to the various categories of GFLs around the world. I expect it will be difficult to accurately track this data over time (at least when compared with our ability to track actual oil production), but it seems like the best place to start with quantitative analysis, and may provide some insight into the rate and timing of geopolitical impacts on oil production.

10. Is the Potential for Financial Crash a Geopolitical Feedback Loop?

It's purely artificial to separate the financial impact of peak oil from the geopolitical impact--in fact, there are broad areas of overlap between the realm of finance or macroeconomics with geopolitics. How should these issues be integrated into this model, if at all? It is unclear to me whether financial markets are an exacerbating or mitigating factor in the context of broader geopolitical disruptions.

In one sense, the financial turmoil caused by high oil prices makes it more difficult to raise capital necessary to exploit new technologies, develop substitutes for oil, and to produce more economically challenging oil reserves. Likewise, price volatility and peak oil combine to exacerbate both financial and geopolitical issues. However, it can also be argued that financial turmoil mitigates the geopolitical problems of peak oil by destroying demand and reducing scarcity (though, as mentioned above, this is a double edged sword because it may increase inelasticity of the remaining demand).

I hope that readers can propose the best way to integrate models and predictions of financial turmoil (such as Gail the Actuary's recent financial market predictions) with this model of geopolitical feedback loops.

I've recently finished the book "We Think" by Charles Leadbeater. This book is an outstanding discussion of the advantages and pitfalls of collaborative innovation. I'm not proposing that the theoretical framework I'm setting forth in this and later posts is in any way gospel truth--it is an initial effort to tackle a very complex system of problems, and certainly needs further development. The Oil Drum is, in many ways, an ideal example of a "we-think" collaborative environment, and I hope that the amazing breadth and depth of knowledge of TOD readers will help to further develop this theory. Developing a better understanding of the impact of a system of geopolitical feedback loops in resource production is a critical first step in both improving our ability to predict future energy and resource supplies, and in understanding how to best act to mitigate resulting problems. Hopefully my answers to the above questions begin to lay out a foundation for a broad theory of geopolitical disruption to resource supply. In the next post I will look at several discrete geopolitical phenomena within this analytical framework, but for now my hope is to start a discussion of the overarching issues raised in this post.

This post also appears at The Oil Drum, where readers may be interested in following the comments (over 170 so far).

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October 22, 2014

Homework Help: Math- Corrections

Posted by Chris on Monday, November 5, 2007 at 4:20pm.

I thought I knew how to do this, but my teacher said i was wrong. This what I thought:

+11w +11w
-42 -42
/11 /11
w= 4.636363636363......

She told us that the correct answer is 17, but I could not find any way 17 could be the answer. Please help me with this and show me the correct way to do this.
Thank you so much.

Answer this Question

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Great Dane Question

Neutering a Dane Puppy

My Dane is 9 months old and weighs in at ~ 130 pounds. I think he is probably old enough (and big enough)to be neutered, but I'm not sure if I should wait longer. I know that the time would be right for smaller breed dogs, but I'm not sure if a Dane's growth and develop,ent would be affected Can anyone give me advice.

    In Great Dane - Asked by Anonymous - 1/15/2013 11:40:10 PM
He is old enough to be neutered.And big enough
    Answered by jjomiller - 6/21/2013 2:19:27 PM

The longer you wait on neutering the better for the Great Dane's growth. He needs the hormones (which you will be taking away) to develop his bones, organs and muscles. Recent studies find that too early a spay/neuter are resulting in increased cancers, hip and joint problems and kidney problems. I recommend waiting till at least 15 months, but longer if you can.
    Answered by muddypawsdanes - 8/9/2013 11:18:56 AM


Showcased at the Tokyo Design Week 2013

Download hi-res images here.

/ (1 of 29)

Today we immerse in our digital lives through smartphones - we use google maps to navigate to the right location, yelp to find the right restaurant and so on. We don't get lost anymore, we don't wander, wonder and discover. Acts of random serendipity through walking brings us back to our innate nature as explorers, walking is meditating.

SuperShoes are a pair of flexible inner soles that you can flex, twist and put in any of your shoes to make them a supershoe. Each of these soles have three vibrotactile motors that tickle your toes, a capacitive pad that recognizes your touch and serves as an input modality. Onboard micro controller, low-power bluetooth and battery supplement the interface. The soles talk to the smartphone to use its location and data services. Users register onto ShoeCentral - once - where they populate their likes and dislikes (food, people, shopping, weather, places, hobbies, activities, interests etc) and social preferences. The ShoeCentral keeps learning about user preferences as you use the SuperShoes to go around.

The shoes are based on a tickling interface - left toe tickles - turn left, right toe tickles - turn right, no tickle - keep going, both tickle repeatedly - reached destination, both tickle once - recommendation, both tickle twice - reminder.

The shoes perform varying functions -

Map - The shoes take you to your destination by tickling. You input your destination once on the accompanying smartphone app. No more staring at the screen, rather immerse in your surroundings.

Tour guide - Since the shoes know your likes and dislikes, they recommend places of interest nearby. You could look at the smartphone app to know the suggestion, but ideally - the user follows the tickle to reach the suggested place as a surprise. Say you like Sushi and the shoes know this, the shoes know that you are on 33rd St and 7th Avenue, the shoes tickle you to take you to the Sushi place nearby which is highly recommended online. You can pause the suggestion by tapping on the toes to ignore it.

Reminders - Most of our to-do lists are on the smartphone or on the computer, we don't constantly monitor these lists throughout the day. The shoes know your tasks, and they tickle you twice to remind you when you are close to the place. Say you had to pick up wine before reaching home, as you approach close to the wine store, the shoes tickle you - and as you look around - you see the wine store and you remember your task.

Break time - We don't take breaks, we run from one place to the other. The shoes have access to your calendar and know if you have a free slot in the day, they plan a short route for you that starts and ends at your current location. So you can go out and take a break - walk without worrying where you are going - while being assured that you'd reach back at your origin in time.

/ (1 of 51)


Failed Back Surgery Syndrome (FBSS) Overview

What is it?

Failed back surgery syndrome, also called failed back syndrome, is a general term that doctors use to describe the chronic pain that can appear in the aftermath of any back surgery that fails to relieve a preexisting pain-causing condition. A number of different risk factors can contribute to the onset of this condition.  Fortunately, treatments such as the AccuraScope procedure have been found to be effective in treating patients with failed back surgery syndrome.

Back Surgery Basics

Back surgery is sometimes used as a treatment for people who have herniated spinal discs, compressed spinal nerves, forms of harmful spinal curvature called kyphosis and scoliosis, spinal fractures related to the advancing effects of osteoporosis or spinal fractures that stem from an accident or other type of traumatic injury. Your doctor may also recommend back surgery for any back pain that doesn’t respond to a range of nonsurgical treatments. Procedures used to treat back-related ailments include a partial removal of spinal bone called a laminectomy, a whole or partial spinal disc removal called a discectomy, a bone-stabilizing cement injection called a vertebroplasty and a spine-stabilizing technique called a spinal fusion.

Failed Back Surgery Syndrome Causes

Causes or contributing factors associated with the onset of failed back surgery syndrome include failure to fully repair a herniated disc, recurrence of a herniated disc after surgery, unrelieved spinal nerve or spinal cord compression, surgical accidents that damage nerves or other tissues, post-surgical scar tissue formation, loss of spinal muscle tone following surgery, reduced or increased mobility in your spinal joints and unaddressed spinal instability. Additional factors that increase your risks for the syndrome include smoking during your recovery period, anxiety, sleeping problems, depression and the presence of autoimmune disease, diabetes or any other condition that has system-wide effects on your body.

Failed Back Surgery Syndrome Symptoms

While the particular effects of failed back surgery syndrome vary according to your original complaint and the procedure used to correct it, the condition commonly produces back pain, leg pain or a combination of back and leg pain that appears to come from a general area and not one specific, localized spot. Depending on individual circumstances, the characteristics of this pain are described as anything from stabbing or pricking to aching and dull.

Failed Back Surgery Syndrome Treatments

Potential treatments for the effects of failed back surgery syndrome include physical therapy to strengthen your back and/or improve your overall back health, oral medications such as non-steroidal anti-inflammatories (NSAIDs) or antidepressants, injections that disrupt pain signaling in your affected nerve(s) or spinal cord, implanted pumps that deliver pain-blocking medication to your spinal cord, and spinal cord stimulation.  Clinical research has also found that the AccuraScope procedure has been able to decrease back pain in patients who have not found relief from previous back surgery.  Please contact your North American Spine patient coordinator for a copy of this research and additional information.