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15 – Sinus Floor Intrusion As a Vascularized Osteoperiosteal Flap

Sinus Floor Intrusion As a Vascularized Osteoperiosteal Flap

Alan S. Herford, DDS, MS
Philip J. Boyne, DMD, MS

Growth is barely controlled damage.

—James Richardson

Patients who are edentulous in the posterior maxilla often display enlarged sinuses and reduced alveolar bone height. Treatment modalities for patients with inadequate bone depend on the volume of residual bone, the morphology of the alveolar crest, and the amount of space available for a prosthesis.1 The sinus lift procedure, first described by Boyne and James,2 has been used successfully to augment the sinus floor. The surgeon creates a lateral window, gently lifts the sinus membrane, and then grafts the sinus floor. Indirect techniques in which an osteotome is used from a crestal approach to intrude the maxillary sinus floor have been used in patients with inadequate height in the posterior maxilla. These indirect techniques were developed to provide an alternative to direct sinus elevation and thereby reduce surgical manipulation.

An aim of the osteotome technique is to increase the density and volume of bone at the apical portion of the osteotomy site through compression.3 The osteotome technique, originally reported by Summers,3 takes advantage of the fact that bone is viscoelastic and can be compressed and manipulated. Bone compaction, cortical sinus floor elevation, and ridge expansion can be performed with this technique. The minimum alveolar bone height recommended for the osteotome technique is 5 mm.4,5

Fig 15-1a Osteotomes are used to gradually enlarge the osteotomy.

Fig 15-1b The sinus floor is gently intruded.

Fig 15-1c An implant is placed following sinus elevation and grafting.

Fig 15-2 Osteotomes of increasing diameter are used to expand the alveolar bone.

e9780867155457_i0714.jpg Surgical Technique

This surgical technique can be performed with or without elevation of a mucoperiosteal flap. An initial osteotomy is performed with either a drill or osteotome (Fig 15-1). A small-diameter osteotome is used to reach and infracture the sinus floor. The tips of the osteotomes have a concave nose and a sharpened edge, which can be used to scrape bone from the side wall of the osteotomy. Increasingly larger osteotomes are then used to expand the alveolar bone in the buccal-lingual and apical-coronal directions (Fig 15-2).

The harvested bone, graft material, and trapped fluids create pressure as the osteotomes are inserted, resulting in elevation of the sinus floor. Care is taken to avoid perforation of the sinus membrane. Prior to implant placement, the cavity is rinsed with saline, and any membrane perforations are noted. If graft material is to be used, it is placed before the dental implants (Figs 15-3 to 15-5).

A goal is to remain short of the sinus membrane during the initial implant site preparation (Fig 15-6). Precise treatment planning is important to allow the clinician to stop 1 to 2 mm inferior to the sinus floor. Tearing of the sinus floor is more likely to result from drilling the osteotomy to the floor than it is from elevating a segment of bone with the sinus membrane attached. Imaging is helpful to rule out the presence of sinus pathology, to locate septa, and to determine the height of the alveolar bone more accurately.

Fig 15-3 A patient may have inadequate bone for implant placement from premolar to molar sites.

Fig 15-4 An osteotome is used to expand the osteotomy in a premolar site.

Fig 15-5 The postoperative radiograph shows the elevated sinus floor in a molar site.

Fig 15-6a The use of a 2-mm drill, stopped short of the sinus floor, allows accurate insertion of the osteotome. Vascularity of sinus membrane supplied by the superior alveolar, greater palatine, and infraorbital arteries.

Fig 15-6b The osteotome compresses the remaining bone and fractures the sinus floor segment of bone that is larger than the diameter of the osteotomy is elevated.

Fig 15-6c When elevations are modest, about 4 mm, the membrane remains attached to the elevated sinus floor, and perforations are less likely. Membrane perforation and bone resorption of the graft are more common with elevations of 5 mm or greater.

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Jan 8, 2015 | Posted by in Implantology | Comments Off on 15 – Sinus Floor Intrusion As a Vascularized Osteoperiosteal Flap
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30. Trauma

Ernest W.N. Lam

Radiologic examination is essential for evaluating trauma to the teeth and jaws. The presence, location, and orientation of fracture planes and fragments can be determined, and the involvement of nearby vital anatomic structures can be assessed. Foreign objects that have become embedded within the soft tissues as a result of trauma can be detected. Follow-up images are useful in evaluating the extent of healing after an injury and long-term changes resulting from the trauma.

Applied Radiology

The ideal imaging study may be difficult to perform after trauma because of the nature of the injury and patient discomfort. Although the prescription of the appropriate images should be ordered only after a careful clinical examination, in some cases this is not always possible.

Dentoalveolar Fractures

Although a panoramic image may be useful for localizing injuries to the teeth and supporting structures, it may not have the image resolution to reveal injuries involving the anterior mandible or maxillae or the teeth. Dentoalveolar trauma always requires intraoral images to obtain adequate anatomic detail. A minimum of two intraoral periapical images should be made at different horizontal x-ray beam angulations to identify tooth fractures. Additionally, it is important to image the teeth of the opposing arch. Occlusal views may also be particularly useful depending on the severity of the trauma and the ability of the patient to open the mouth. More recently, small field of view cone-beam computed tomographic (CBCT) imaging has been used to identify tooth fractures, although the results have been variable. The high resolution of the small field systems may be beneficial to imaging such fractures.

If a tooth or a large fragment of a tooth is missing, a chest or abdominal image may be considered to locate the tooth. If there are lacerations in the lips or cheek, a soft tissue image of the area may be obtained by placing an intraoral film or receptor in the mouth adjacent to the traumatized soft tissue and then exposing it. If the laceration is in the tongue, a standard mandibular occlusal image may be exposed, or the tongue can be protruded and then imaged.

Mandibular Fractures

Panoramic imaging may be useful as an initial investigation for assessing mandibular fractures. Should a fracture be suspected to involve the body or alveolar process of the mandible, the addition of an intraoral cross-sectional occlusal view of the mandible may be useful, if this is possible. The open mouth Towne view may be useful in cases of suspected trauma to the mandibular condylar head and neck areas. This view may supplement panoramic imaging, especially in cases of nondisplaced greenstick fractures of the condylar neck. For suspected multiple and complex fractures of the mandible, either CBCT or multidetector computed tomographic imaging (MDCT) is the modality of choice for imaging mandibular trauma, although magnetic resonance imaging (MRI) may be useful to assess soft tissue injury to the temporomandibular joint capsule or articular disk.

Maxillofacial Fractures

Computed tomographic (CT) imaging is the method of choice for imaging fractures of the maxillofacial skeleton, particularly fractures that involve multiple bones.

Radiologic Signs of Fracture

Fractures are often erroneously referred to as “lines” despite their three-dimensional nature. Fractures represent planes of cleavage through a tooth or bone, and these planes extend deep into the tissues. A fracture may be missed if the plane of the fracture is not aligned with the direction of the incident x-ray beam on a single plane image.

The following are general signs that may indicate the presence of a fracture of a tooth or bone:

1. The presence of one or two usually sharply defined radiolucent lines within the anatomic boundaries of a structure. If the line or lines extend beyond the boundaries of the mandible, more than likely they represent an overlapping structure. If a line extends beyond the boundaries of a tooth root, the line may represent a superimposed neurovascular canal.

2. A change in the normal anatomic outline or shape of the structure. A mandible that is noticeably asymmetric between the left and right sides may be fractured. A fracture of the mandible may also manifest as a change in the contour of the occlusal plane at the location of the fracture site.

3. A loss of continuity of an outer border. This may appear as a gap in the continuity of the otherwise smooth tooth or cortical border. Such a gap may also produce a step-type defect where the two fragments have become displaced relative to one another.

4. An increase in the radiopacity of a structure. This can be caused by the overlapping of two fragments of tooth or bone such that a particular area appears “doubly” radiopaque.

Traumatic Injuries of the Teeth

The term concussion refers to a crush injury to the vascular structures at the tooth apex and the periodontal ligament resulting in inflammatory edema. There is no displacement, and only minimal loosening of the tooth occurs. The injury may result in mild avulsion of the tooth from its socket, causing its occlusal surface to make premature contact with an opposing tooth during mandibular closing.

Clinical Features

The patient usually complains that the traumatized tooth is tender to touch, which can be confirmed by gentle horizontal or vertical percussion of the tooth. The tooth may also be sensitive to biting forces, although patients usually try to modify their occlusion to avoid contacting the traumatized tooth.

Imaging Features

The imaging appearance of a dental concussion may be subtle. No changes may be visible, or there may be localized widening of the apical periodontal ligament space (Fig. 30-1). Changes to the size of the pulp chamber and root canals may develop in the months and years after traumatic injury to the teeth, and this may be particularly evident in teeth that are still developing. Should pulpal necrosis occur after trauma, there may be no further deposition of (secondary) dentin as the odontoblasts and the pulpal and pulpal stem cell populations die.

Teeth that have undergone trauma before apical closure may develop a morphologically abnormal apex, the osteodentin cap. As the pulpal necrosis process begins incisally and progresses apically, vital odontoblasts may remain at the developing root apex, and tertiary dentin (osteodentin) may be deposited ahead of the advancing front of pulpal necrosis. The disorganized and sparse matrix of mineralized material that does develop may resemble bone in structure and a root apex morphologically; as such, it “caps” the end of the root. The osteodentin cap in some instances may appear to be contiguous with the developing root apex or appear separate from it. In contrast to internal resorption where the root canal is focally widened (Fig. 30-2), the root canal seen in association with an osteodentin cap appears uniformly widened from pulp chamber to apex (Fig. 30-3). The development of the canal and deposition of dentin is “frozen in time” at the developmental stage at which pulpal necrosis occurred. When the cap is covered or “hidden” from view, the apex of the root resembles that of a developing tooth (see Fig. 30-3, C).

Because significant displacement of the tooth or teeth does not occur, the appropriate treatment is conservative and may include slight adjustment of the opposing teeth (if necessary) or the application of a flexible splint. Periodic monitoring in the first year with repeated vitality testing and radiographs are indicated. Should rarefying osteitis develop, endodontic treatment is appropriate.

Luxation is a dislocation of the tooth from its socket after severing of the periodontal attachment. Such teeth are abnormally mobile and displaced. Subluxation of the tooth denotes an injury to the supporting structures of the tooth that results in abnormal loosening of the tooth without frank dislocation.

Depending on their magnitude and direction, traumatic forces can cause intrusive luxation (displacement of a tooth into the alveolar process), extrusive luxation (partial displacement of a tooth out of its socket), or lateral luxation (movement of a tooth in a direction other than intrusive or extrusive displacement). In intrusive and lateral luxation, comminution or crushing of the alveolar process may accompany tooth dislocation.

The movement of the apex and disruption of the circulation to the traumatized tooth that accompanies luxation can produce either temporary or permanent changes to the dental pulp, and these changes may result in pulpal necrosis. If the pulp survives the traumatic incident, the rate of dentin formation may accelerate and continue until it obliterates the pulp chamber and root canal. This process may occur in permanent and deciduous teeth.

Clinical Features

An adequate clinical history is helpful in identifying luxation and ordering the appropriate radiographs. Subluxated teeth are in their normal location but are abnormally mobile. There may be extravasated blood emanating from the gingival crevice, indicating periodontal ligament damage, and there may be extreme sensitivity to percussion and masticatory forces.

The clinical crowns of intruded teeth may appear reduced in height. Maxillary incisors may be intruded so deeply into the alveolar process that they appear to be completely avulsed or lost. The displaced tooth may cause some damage to adjacent teeth, particularly if any developing permanent teeth are present in the underlying bone.

Depending on the orientation and magnitude of the force and the shape of the root, it may be pushed through the buccal or, less commonly, the lingual cortex of the alveolar process where it may be seen and palpated. On repeated vitality testing, the sensitivity of a luxated tooth may be temporarily decreased or undetectable, especially shortly after the injury. Vitality may return weeks or several months later.

Usually two or more teeth are involved in luxation injuries, and the teeth most frequently affected are the deciduous and permanent maxillary incisors. The mandibular teeth are seldom affected. The type of luxation appears to vary with age, and this may reflect changes to the nature of maturing bone. Intrusions and extrusions are often found in the deciduous dentition. In the permanent dentition, the intrusive type of luxation is seen less frequently.

Imaging Features

Radiographic examinations of luxated teeth may demonstrate the extent of injury to the root, periodontal ligament, and alveolar process. An image made at the time of injury serves as a valuable reference point for comparison with subsequent radiographs. As with dental concussion, the minor damage associated with subluxation may be subtle and limited to elevation of the tooth from its socket. The sole radiographic finding may be a widening of the apical portion of the periodontal ligament space. Elevation of the tooth may not be apparent on the image.

The depressed position of the crown of an intruded tooth is often apparent on an image (Fig. 30-4), although a minimally intruded tooth may be difficult to demonstrate. Intrusion may result in partial or total obliteration of the apical periodontal ligament space. Multiple radiologic projections, including occlusal views, may be necessary to show the direction of tooth displacement and the relationship of the displaced tooth to adjacent teeth and the outer cortex of bone.

A tooth that has been extruded may demonstrate varying degrees of apical widening of the periodontal ligament space, depending on the magnitude of the extrusive force (Fig. 30-5). A laterally luxated tooth with some degree of extrusion may show a widened periodontal ligament space, with greater width on the side of impact.

A subluxated permanent tooth may be restored to its normal position by digital pressure shortly after the accident. If inflammation precludes repositioning, minimal reduction of opposing teeth may be necessary to minimize any discomfort. The use of a flexible splint may provide additional stability and prevent further damage to the pulp and periodontal ligament. A subluxed deciduous tooth may potentially damage its underlying successor. Consequently, extraction may be considered. If the alveolar bone over the root of a luxated tooth has been fragmented and displaced, the fragments should be repositioned by digital pressure. A subluxated primary tooth should be periodically examined after the injury. If it causes discomfort because of extrusion, it can be removed without undue concern for occlusal problems. Subluxed permanent teeth should be monitored in the same manner as teeth that have been concussed.

The term avulsion is used to describe the complete displacement of a tooth from the alveolar process. Teeth may be avulsed by direct trauma when the force is applied directly to the tooth or by indirect trauma (i.e., when indirect force is applied to teeth as a result of the jaws striking together). Avulsion occurs in about 15% of traumatic injuries to the teeth, with fights being responsible for the avulsion of most permanent teeth and accidental falls accounting for the traumatic loss of most deciduous teeth.

Clinical Features

Maxillary central incisors are the most commonly avulsed teeth from both dentitions. Most often only a single tooth is lost. This injury typically occurs in a relatively young age group when the permanent central incisors are just erupting. Fractures of the alveolar process and lip lacerations may be seen with an avulsed tooth.

Imaging Features

In a recent avulsion, the lamina dura of the empty socket is apparent and usually persists for several months. The missing tooth may be displaced into the adjacent soft tissue, and its image may project over the image of the alveolar process, giving the false impression that it lies within the bone. To differentiate between an intruded tooth and an avulsed tooth lying within the adjacent soft tissues, a soft tissue image of the lacerated lip or tongue should be made. In some instances, new bone within the healing socket may be very dense and simulate a retained root tip (Fig. 30-6).

If the avulsed tooth is not found by clinical or radiologic examination, a chest or abdominal image may be considered to locate it within the airway or gastrointestinal tract. Reimplanting permanent teeth after avulsion is possible; however, the prognosis of the reimplantation depends on the condition of the tooth while it is outside the mouth, the time it is out of its socket, and the viability of the residual periodontal ligament fibers. Endodontic therapy may be necessary after reimplantation, and there may be external root resorption in the months and years after reimplantation. Reimplanting an avulsed deciduous tooth carries the danger of interfering with the underlying developing permanent tooth.

Fractures of the Teeth

Dental Crown Fractures

Fractures of the dental crown account for about 25% of traumatic injuries to the permanent teeth and 40% of injuries to the deciduous teeth. The most common event responsible for the fracture of permanent teeth is a fall, followed by accidents involving vehicles (e.g., bicycles, automobiles) and blows from foreign objects striking the teeth. Fractures involving only the crown normally fall into three categories:

Clinical Features

Fractures of the dental crowns most frequently involve anterior teeth. Infractions or cracks in the enamel are common, although frequently they may not be readily detectable unless by illumination. Histologic studies show that such cracks pass through the enamel but not into the dentin.

Uncomplicated fractures that involve both the enamel and the dentin of permanent teeth are more common than complicated fractures that include the pulp. In contrast, complicated and uncomplicated fractures occur with near-equal proportions in the deciduous teeth. Uncomplicated crown fractures that involve dentin can be recognized by the contrast in color between dentin and the peripheral layer of enamel. The exposed dentin is usually sensitive to chemical, thermal, and mechanical stimulation. In deep fractures, the pink blush of the pulp may be appreciated through the thin remaining dentin wall. Complicated crown fractures are distinguishable by bleeding from the exposed pulp or by droplets of blood forming from pinpoint exposures. The pulp is visible and may extrude from the open pulp chamber if the fracture is old. The exposed pulp is sensitive to most forms of stimulation.

Imaging Features

Imaging provides information regarding the location and extent of the fracture and the relationship of the fracture plane and fragment to the pulp chamber. The stage of root development of the involved tooth also can be assessed (Fig. 30-7). This initial image also provides a means of comparison for follow-up examinations of the involved teeth.

Although crown infractions do not require treatment, the vitality of the tooth should be evaluated. The sharp edges of enamel that result from an uncomplicated fracture should be smoothed and may require restoration for cosmetic reasons. It is reasonable to delay this procedure for a number of weeks until the pulp has recovered and secondary dentin is laid down. The prognosis for teeth with fractures limited to the enamel is quite good, and pulpal necrosis develops in less than 2% of such cases. If a fracture involves both dentin and enamel, the frequency of pulpal necrosis is about 3%. Oblique fractures have a worse prognosis than horizontal fractures because potentially a greater amount of dentin is exposed. The frequency of pulpal necrosis increases greatly with concussion and mobility of the tooth.

Treatment of complicated crown fractures of permanent teeth may involve pulp capping, pulpotomy, or pulpectomy, depending on the stage of root formation. If a coronal fracture of a deciduous tooth involves the pulp, it is usually best treated by extraction.

Dental Root Fractures

For horizontal root fractures, the plane of cleavage may extend across the long axis of the root either perpendicularly or obliquely. In contrast, vertical root fractures represent fracture planes that run lengthwise from the crown toward the apex of the tooth, usually through the facial and lingual root surfaces.

Clinical Features

Horizontal root fractures occur more commonly in maxillary central incisors and result from the direct application of traumatic force to the face, alveolar processes, or teeth. In contrast, vertical fractures usually involve the molar teeth in adults. Vertical fractures may be iatrogenic, following the insertion of retention screws or pins into teeth, or the result of high occlusal forces, particularly in restored teeth. Endodontically treated posterior teeth that have not been restored with a full coverage restoration are also at risk.

The mobility of the fractured tooth crown relates to the level of the fracture. That is, the closer the fracture plane is located to the apex, the more stable the tooth is. When testing the mobility of a traumatized tooth, the clinician places a finger over the alveolar process. If movement of only the crown is detected, a root fracture is likely. Fractures of the root may occur with fractures of the alveolar process and are often not detected. This situation is most commonly observed in the anterior region of the mandible where root fractures are infrequent. Although root fracture is usually associated with temporary loss of sensitivity (by all usual criteria), the sensitivity of most teeth returns to normal within about 6 months.

Imaging Features

Horizontal fractures of the dental root may occur at any level and involve one (Fig. 30-8) or all of the roots of multirooted teeth. Most of the fractures confined to the root occur in the middle third of the root. The ability of an image to reveal the presence of a root fracture depends on the relative angulation of the incident x-ray beam to the fracture plane and the degree of separation of the fragments. If the x-ray beam is aligned along the fracture plane, a single sharply defined radiolucent line confined to the anatomic limits of the root may be seen. However, if the orientation of the x-ray beam meets the fracture plane in a more oblique manner, the fracture plane may appear as a more poorly defined single line or as two lines that converge at the mesial and distal surfaces of the root. The appearance of a comminuted root fracture may also be less well defined. Most nondisplaced root fractures are usually difficult to detect, and several views at differing angles may be necessary. In some instances when the fracture line is not visible, the only evidence of a fracture may be a localized increase in the width of the periodontal ligament space adjacent to the fracture site (Fig. 30-9).

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Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 30. Trauma
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Linda Miller at Bristol Quilters

At Bristol Quilters last night we had a really great talk by Linda Miller who is a professional embroiderer.  It was particularly interesting because she talked as much about her business as about her embroidery.  I loved her dogs in coats which featured in several pieces, but I was also interested in listening to her talking about pricing her work, working with card companies and galleries, getting commissions, bearing to part with work, having to sell to people you don’t like because you have to pay the mortgage and so on.  She talked about getting support and working in a collective with other artists, and setting up a studio.

Her work is charming – which is an overused word, but I think it fits, in the sense that her personal vision is enchanting and draws you into her world.  I liked her unusual braided edging and the fact that she doesn’t straighten the work but allows it to distort following the tension in the stitching.  Plus I thought she was absolutely right when she said that you have to give up any idea of control over your work and that you have to let it be what it wants to be.

I would recommend her to any stitching group.

0 replies
  1. jemimalumley
    jemimalumley says:

    My sister has a lovely piece of her work from years ago – I think my mother bought it, probably in the early 90’s – and I have a little beaded brooch of hers that my sister bought me because she said it looked like me!

    Always love your blogs!

    Jemima x

    Sent from my iPhone

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4.19.19 Felted Surface Design with Eva Camacho (2-Day Class)

4.19.19 Felted Surface Design with Eva Camacho (2-Day Class)

Regular price $250.00 Sale

Friday + Saturday - April 19th + 20th - 10:00am - 5:00pm

Take your work to the next level with this exploration of textural felting techniques. Learn shibori felting, felting around resists, folds, cracks, ripples, and more. Through detailed demonstrations and hands-on practice, students will experiment and create a few new pieces, all with great potential for continued embellishment such as stitching and embroidery.

Cost is $250 plus the cost of materials.

Please bring the following materials and/or purchase them at PortFiber before Saturday, April 13th.

  • 24" x 24" prefelt, any color. You can bring a couple of 24” x 24” or any other dimensions.
  • 12-18 oz of wool roving, preferably merino wool (16-22 micron). More than one color.
  • 6-8 oz of wool batt, preferably merino wool. Any color.
  • Sheer fabric, such as uzbek, chiffon, habotai, organza. Dyed or undyed.
  • 18mm small rotary cutter + cutting mat (12” x 18” or smaller). *There is a cutter and mat, but if you'd like your own, please bring along.
  • Embellishments, such as silk fibers, bamboo fibers, ramie, pencil roving, yarns, beads.
  • Masking tape (1/2”, 1” and 2” wide).
  • Fabric scissor.
  • Embroidery scissors or pointy and sharp scissors.
  • Heavy duty thread (polyester or cotton).
  • Sewing needles.
  • 2-4 mm painter plastic (1/2 yard is more than enough).
  • Plastic container (1 qt. capacity).
  • Ball brause or sponge, or scrubby.
  • Olive oil soap, preferable as a bar.
  • Tulle, mesh or mosquito screen (any dimension).
  • Bubble wrap, ideally 45” x 24” - 4 towels.
  • Tights.
  • Notebook, pencil and/or for sketching and taking notes.

About Eva:

Eva Camacho is a feltmaker born and raised in Andalucía, Spain, now living in western Massachusetts. She has been selling her work in numerous art shows in the East Coast during the past 2 years. Currently, her last collection Boro can be found at the Textile Museum in Washington D.C., and other collections are being sold in 25 different galleries and stores across the United States. In December of 2015 she received the Award of Distinction in Fiber Wearables from the Society of Arts and Crafts in Boston, Massachusetts. In 2016 she received the 1st place Award in the Wearable Accessories Category at the Fiber Celebration Exhibition in the Community Creative Center, Fort Collins, CO, and also in 2016 she was invited to be part of the Pentaculum 2017 Artist Residency in Arrowmont School of Arts and Crafts. in 2017 she received two new awards, at the Fiber Celebration Exhibition and the Surface Design Association, and was also invited to be part of the 2017 Mass MoCA Artist Residency. Her felt work has appeared at numerous magazines and newspapers, such as Martha Stewart Living Magazine and the New York Times, the felting book Worldwide Colours of Felt, and in the latest five book Artistry in Fiber, Wearables.


text:
Fri, 09/20/2019 - 11:14 -- ORANGE

Salvation Army
804 S Parallel, Fresno CA adult rehabilitation center
United States

Metal rings placed

chains laced

around my

hands, legs, feet and waist.

How many times will I let this happen?

How many times can I let my family

be disgraced?

Swore I'd never come back here.

Weren't my prayers clear, God?

I told you I didnt want to be back in this situation

the moment I saw

those berries and cherries.

Don't you listen?

I promised I'd change.

I promised I'd find new ways

to live.

I know you've got one more chance

to give.

Now I'm sitting in a cell with

three metal beds, a sink,

a desk, a toilet with

no lid

and it stinks like shit.

I can't handle it.

Theres filth everywere and

nothing to clean it with.

These first forty eight hours I've spent

in disbelief, on my

hands and knees

crying out

for release but I

can't let a single tear fall or they'll know I'm weak.

So I

just bottle it up and line up for count.

Ignoring the fact that I have enough tears to end a drought.

I've become a number in the system.

They've broken and beaten

my personality but at least when

I emerge from this place,

back to reality or some sort of normality,

I'll feel the sun on my face.

Some will only see six new walls;

their only ticket to freedom a toe-tag,

death's cold embrace.

This poem is about:
My family

Annette M Velasquez

Honest, vivid, gritty and raw. You've described the realities of incarceration precisely. Check out my "metamorphosis" poem, and others I posted on the same subject.

Need to talk?

If you ever need help or support, we trust CrisisTextline.org for people dealing with depression. Text HOME to 741741


text:
Twas The Night Before My Operation

Twas the night before my operation whilst eating my meal,
in a moment it hit me and it seemed all too real,
my Plate, it sat empty, hard, white and cold,
while my kin heaped theirs high with colors so bold.

I looked in envy, at their dishes of food so tender,
hunger overtook me in the presence of such splendor.
I was not allowed to eat even the smallest little crumb,
all because of a doctor with rules that I found dumb.

In mere hours she would draw near with her knife,
with scratches and stabs she would soon change my life.
As much as I longed for this wrong to be righted,
in the presence of hunger my choice seemed shortsighted.

My left leg was a whole two inches longer than my right,
every day I awoke with an ever growing limp I must fight.
my hips became crooked, and and ‘S’ became of my spine,
how could everything be caused by something so benign.

Now only hours from pain I laid half awake in my bed,
my thoughts and anxieties rolled around within my head.
Oh, how I longed for this to have all been prevented,
instead I lay in sleepless anguish alone and demented.

The morning came hours later after a long sleepless night,
and the alarm although pleasant did not soothe my fright.
Forbidden was any source of food or of water,
I felt like a poor animal being prepped for my slaughter.

I dragged myself out to my mom’s warm waiting car,
I looked down to my leg where there would soon be a scar.
How I hated the thoughts of terror that filled up my head,
so I turned up the radio and blared music instead.

as we approached the medical mile, sitting up on her hill,
pulling into ramp three I was struck by sudden a chill.
In a moment it hit me and it seemed all too real,
my life would change drastically today. How would I deal?

With a groan and a creak up to floor three the elevator rose
I trod over the skywalk with frustration I wished not to disclose.
A nurse came to greet us and led us quickly to our ward,
Propped up in my sterile bed waiting I soon became bored.

After hour long moments came the doctor’s expected approach.
While a needle pierced my skin and my vien it did encroach.
With the I.V. in place, and cool saline solution flowing,
my angst to end this nightmarish process was evergrowing.

Laid back flat on my clean cot they briskly rolled me away
saying goodbye to my mother, I was no longer so gay.
Tears stained my cheeks leaving behind their cold salty trails,
the beeping of a thousand monitors hid my shrill silent wails.

The room was so cold, and I could feel my frigid hairs raise,
silver lights hung above, and nurses doled out their trivial praise.
then came the milky white substance that would end my awareness
I counted down from ten, yet reached only five in all fairness.

 I awoke after hours that had passed in only mere seconds,
yet sleep still called out and I followed her sweet beckons.
The doctors worked hard to keep my pain under control,
nonetheless I could feel the spasms with every fiber of my soul.

Regardless of the terror the the surgeon had to offer,
she also had a new and better life which to me she did proffer.
My legs are now equal with the left one matching the right.
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Monocle 24: The Tech 10

Manage series 1758173
By Winkontent Ltd. 759286. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.
HP and Monocle have teamed up to ask 10 savvy small businesses from around the world what it takes to build a brand and stay ahead. Tune in for inspiring stories and advice on how to choose the right technology to succeed.

10 episodes


text:
Dissertation/Thesis Abstract

Autism Education and Early Intervention: What Experts Recommend and How Parents and Public Schools Provi
by Reffert, Lori A., D.Ed., The University of Toledo, 2008, 140; 10631230
Abstract (Summary)

Autism is a lifetime neurobiological disorder that is not curable. Children are being diagnosed with this affliction at an alarming rate, which is greatly affecting and overwhelming both families and school districts. The National Research Council recommends 25 hours a week, year around of one-on-one or small group early intervention as the key to overcoming many of autism's limitations.

This research compared what rural, suburban, and urban school districts in the Midwest states of Michigan and Ohio do to meet these recommendations. Additionally, parental input was obtained regarding their children with autism spectrum disorder (ASD) and what services are received from both the school district and private sector.

The main findings of the research indicate that school districts are not following the recommendations set forth by the National Research Council's 2001 study, Educating Children with Autism. Intervention programs are severly lacking in the states of Michigan and Ohio as school districts are either not knowledgeable about what constitutes best practice regarding children with ASD, or do not have the resources necessary to implement these best practices.

Intervention based on ABA principles is shown to help change the core symptoms of autism, and it should be a sound and logical addition to a school district's early intervention program. According to results obtained from this research study, a full 50% of the 74 school districts that responded indicated they used an intervention program that was not Applied Behavior Analysis (ABA), Discrete Trial Training (DTT), TEAACH (Treatment and Education of Autistic and Related Communication Handicapped Children) or Floor Time.

Additionally, of the 35 parents that responded to the research survey, 62.9% indicated that their child's school did not use ABA, DTT, TEACCH or Floor Time as the program used for intervention. Furthermore, 57.1% (20) of the 35 parents that responded indicated that their child received ABA or DTT not provided by the school.

Understandably, the cost associated with small group intervention is expensive. Many school districts balk at one-on-one instruction and do not take into consideration that by utilizing an early intense behavioral intervention (EIBI), later education costs can be reduced.

Indexing (document details)
Advisor: Roettger, Caroline
Commitee: McKinley, Sandra, Roettger, Caroline, Roettger, Lloyd, Russell, Raymond
School: The University of Toledo
Department: Educational Administration and Supervision
School Location: United States -- Ohio
Source: DAI-A 78/11(E), Dissertation Abstracts International
Subjects: Speech therapy, School Administration, Education, Elementary education, Special education, Teacher education
Keywords: ASD, Autism, Autism and public schools, Autism and services, Autism early education, Autism early intervention
Publication Number: 10631230
ISBN: 978-0-355-01505-8
Copyright © 2020 ProQuest LLC. All rights reserved. Terms and Conditions Privacy Policy Cookie Policy


text:
re: Acoustic activity recognition in JavaScript VIEW POST

re: Okay, one question. low-frequency whistling = brushing teeth. How does this happen? Does the software recognize frequency, or it also recognizes...

I didn't train it with whistling so it's predicting whatever is closest to what it was trained with, which must be brushing teeth in this case.
It's looking at all the data coming from the WebAudio API

Yep. I asked if it is trained for frequency or the tone? or both?

If by tone you mean notes, notes are named frequencies.

The data you get back from the WebAudio API is the frequencies picked up by the microphone copied into a Uint8Array using the getFrequencyByteData method on the AnalyserNode.

By tone, I meant tone: which makes a C note from violin and piano distinct.

However, I got what you meant. Nice and creative work!

Notes are just particular frequencies that are given a name. In any case, the tone you're using is a bit off.

Traditionally, that's referred to as timbre. It's the volume of specific frequencies in a note's harmonic series that account for differences in timbre in pitched instruments. Here's a great video explaining how that works.

Code of Conduct Report abuse


text:
March 2017

Human Foods, Not Pet Foods

We know; your pets are your family. You want to share everything with them. But some things are off limits; certain human foods, for example. Today we’re going to take a look at some common foods that are off limits...
Read More

Transparency is important to us at Pet Resource Center of Kansas City. What do we mean when we say transparency? Simply put, it means being open and honest. For organizations, there are two types of transparency: transparency within the organization,...
Read More


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If you are taking the powder for solution, you will need to mix it with water before you take it. To mix the medication, first remove one packet from a row of three attached packets. Place 2 to 4 tablespoons (1 to 2 ounces; 30 to 60 mL) of water in a cup. Add the contents of the packet and mix well. Drink the entire mixture right away. Throw away the empty packet in a trash can that is out of the reach of children and pets.

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Effect of subdiaphragmatic vagotomy and cholinergic agents in the hypothalamic-pituitary-adrenal axis activity. We consider pleiotropic effects of QTLs or genes affecting PHT on other agronomically important traits and, finally, we discuss strategies for applying this knowledge to the improvement of dual-purpose or dedicated bioenergy crops. Cardiac dysfunction and hyperdynamic systemic circulation may be present in patients with cirrhosis.

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Conference championships peppered with Santa Barbara poloists

As the 2014 women’s collegiate season comes to an end, 23 Santa Barbara Water Polo alumni will compete for a berth to the NCAA Championship tournament … [Read more...]

SBAC water polo players kick off their college season

Santa Barbara Aquatics Club was well presented at NCAA Division I collegiate tournaments held at UCSB and UC Berkeley over the weekend. UCSB’s … [Read more...]

Ventura girls sink San Marcos in dual meet

The San Marcos girls swim team had several strong individual performances on Tuesday but it wasn't enough to beat Ventura, which came out on top … [Read more...]

Rose Koper, Hummel power Royals to wild-card rout

Playing their first CIF playoff home game in several years, San Marcos’ seniors rose to the occasion and led the Royals to a 16-4 blowout win over … [Read more...]

Royals in hunt for consolation title at So Cal Championships

Hannah Koper and Rose Koper each scored three goals and Brittny Hummel shut down Cathedral Catholic’s best player in a 9-5 San Marcos girls water polo … [Read more...]

Royals finish second at Bonita Tournament

San Marcos reached the final of the Bonita Girls Water Polo Tournament and ran out of gas, falling to St. Lucy’s 12-7 on Saturday. “We had only one … [Read more...]

Royals travel to No. 10 Fountain Valley after beating Buena

Hannah Koper scored five goals and Brittny Hummel made some big defensive plays to help the San Marcos girls water polo team defeat Buena 11-5 in a … [Read more...]

San Marcos dominates at both ends of the pool

San Marcos played a smothering defense and shut down Ventura 10-3 in a Channel League girls water polo match on Tuesday. The Royals shut out the … [Read more...]


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The UK journalists killed covering conflicts of the 21st century

Belfast-born journalist Lyra McKee has become the 15th UK journalist to be killed covering conflict since 2000, and the second to be killed inside the UK in that time.

Freelance writer McKee was shot and killed during rioting in Derry on Thursday night.

It is understood that McKee, who has frequently reported on the legacy of the Troubles in Northern Ireland, had arrived at the scene with her partner Sara to report on the story.

A statement from the Belfast and District branch of the National Union of Journalists, of which she was a member, said McKee had “only just finished discussing the situation with a colleague in Belfast when she was shot”.

The group also said: “There is no comfort for us in knowing that her killing, unlike that of Martin O’Hagan or Veronica Guerin, was not targeted. Like them, Lyra was killed because she was a journalist.”

Since 2000, 15 UK journalists (including US-born Marie Colvin) have been killed reporting on conflict.

Three of those were killed covering the wave of uprisings and violence which erupted across the Middle East from early 2011 – Sky News cameraman Mick Deane, freelance photographer Tim Hetherington, and Sunday Times foreign correspondent Colvin.

Here is the list of UK-based journalists killed since 2000:

Martin O’Hagan, 51

Lurgan, Co Armagh, Northern Ireland

28 September, 2001

O’Hagan was an investigative journalist who worked for the Dublin and Belfast-based Sunday World. He was shot while walking home from his local pub after refusing to bow to pressure to stop publishing stories about the activities of Loyalist gangsters. The Loyalist Volunteer Force claimed responsibility for his murder but nobody has been prosecuted.

Roddy Scott, 31

Galashki Region, Ingushetia, Russia

26 September, 2002

Scott was a freelance cameraman working for Frontline television news agency. He was killed in the Russian republic of Ingushetia during a clash between Russian forces and the Chechen group with which he was travelling.

Terry Lloyd, 50

Al-Zubayr, Iraq

22 March, 2003

Lloyd was a correspondent for ITV News and had been working as an independent reporter not embedded with military forces. He was caught in crossfire between Iraqi and US troops. An inquest recorded the verdict of “unlawful killing by US forces”.

James Miller, 35

Rafah, Gaza Strip, Israel

2 May, 2003

Miller was a freelance cameraman who was filming a documentary for HBO on the Israel-Palestine conflict. He was killed by Israeli troops who continued to fire after the reporter he was with shouted “we are British journalists”. An inquest concluded he had been murdered, but no Israeli soldiers were prosecuted.

Richard Wild, 24

Baghdad, Iraq

5 July, 2003

Wild was an inexperienced freelance journalist who had travelled to Iraq to cover his first war. He was shot dead whilst hailing a cab outside Baghdad Museum. The gunman was never found and it is believed that Wild had not been carrying a camera or anything to identify him as a journalist.

Simon Cumbers, 36

Riyadh, Saudi Arabia

6 June, 2004

Cumbers was a freelance Irish cameraman working for the BBC. He was shot dead in the Saudi capital Riyadh by suspected al-Qaeda sympathisers. Frank Gardner, BBC security correspondent, was also seriously injured in the attack.

Kate Peyton, 39

Mogadishu, Somalia

9 February, 2005

Peyton had just arrived in Somalia to film a series of reports on the war-torn country. She was shot outside a hotel having been targeted by what is now believed to have been gunmen with links to al-Qaeda. A coroner later ruled that she had felt under pressure from the BBC and had feared that she would lose her job if she had refused to take on the dangerous assignment.

Paul Douglas, 48, and James Brolan, 42

Baghdad, Iraq

29 May, 2006

Douglas, a cameraman, and his soundman Brolan, were working for CBS and embedded with the US Army’s 4th Infantry Division. They were killed by a car bomb, which exploded whilst they were on patrol with American and Iraqi soldiers.

Martin Adler, 47

Mogadishu, Somalia

23 June, 2006

Anglo-Swedish journalist Adler was a former contributor to Channel 4 News, who was freelancing in Somalia for several Swedish newspapers. He was shot by an unidentified gunman while filming a demonstration in the capital, Mogadishu.

Rupert Hamer, 39

North-west of Nawa, Helmand Province, Afghanistan

9 January, 2010

Hamer was defence correspondent for the Sunday Mirror, and had been embedded with US marines. He was killed by a roadside bomb which struck a patrol vehicle, also killing a US marine and an Afghan soldier. Sunday Mirror photographer Philip Coburn was seriously injured.

Tim Hetherington, 40

Misurata, Libya

21 April, 2011

Hetherington was an acclaimed international photographer was killed by a mortar blast while covering fighting between local militia and forces loyal to Colonel Gaddafi. US photographer Chris Hondros, 41, died in the same incident.

Marie Colvin, 56

Homs, Syria

22 February, 2012

The celebrated Sunday Times foreign correspondent was killed alongside French photographer Remi Ochlik as they reported on the plight of civilians in the besieged Syrian city of Homs. They were killed when the building they were in was shelled by Syrian government troops.

Mick Deane,  61

Cairo, Egypt

14 August, 2013

The Sky News cameraman was shot and killed covering attacks by heavily armed government forces on largely unarmed protest camps in Cairo.

Lyra McKee, 29

Derry, Northern Ireland

18 April, 2019

Freelance journalist McKee was shot while reporting on rioting in Derry. The New IRA has since admitted to being behind the killing. McKee had tweeted from the scene and spoken to journalist colleagues just minutes before she was shot.

Picture: Cate McCurry/PA Wire

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What Really Separates the Rich From the Poor

Let’s talk about Tommy and John. They are the same age and grew up in the same neighborhood under similar circumstances. Neither have any special athletic abilities and they both have average IQ levels. Tommy struggles financially and is finding it hard to keep himself motivated to work and pay the bills while John is financially independent and is truly enjoying his life. But what really separates these two and why are there lives so different? In this video I’m gonna try to cut through the bullshit and truthfully explain the traits and characteristics that has made John succeed and put Tommy in a struggle.

Tommy is the happiest when his paycheck arrives because then he can finally get a hoverboard, a new pair of sneakers and hit the bars to celebrate that he’s been able to plow through the week. He wakes up the next morning feeling like absolute crap while also realizing he’s about to go broke again. He’s got no money saved but hey at least he’s got a sick hoverboard. John’s also happy when he gets payed, but before he pay’s everyone else and buys useless stuff, he pays himself first. Once he has invested at least 10 % of his earnings, that’s when John can comfortably spend it on other things. So Trait number 1. The rich pay themselves first.

When Tommy drives home after work, he makes a quick stop to get frosted doughnut and an energy drink. Once he’s by the register he also decides to get a lottery ticket for the chance of hitting the jackpot and live his dream life to quit his job, get free from duties and responsibilities and chugg mexican beers on the beach for the rest of his days. John on the other hand stopped buying lottery tickets when he realized it’s simply a tax on the poor and the vast majority of lottery winners go broke just as quick because they haven’t learned the skill to manage money. Johns dream is not inactivity and to chill on a beach, but to actively do what excites him every single day. He chooses to actively work towards his visions with a long term approach and improve himself to become more valuable and consequently earn more. Trait number 2. The rich base their decisions on long term rewards rather than instant gratification.

Tommy got a decent paying job after graduating and he gets a paycheck coming in regularly, providing he physically shows up and exchanges his time for money. He knows that if get sick or simply wants a longer vacation, his income will decrease drastically which is very stressful. John relies on several different streams and sources of income which are mostly passive, meaning he earns money all hours around the clock 7 days a week without having to physically be somewhere to exchange his time for money. And even if one of these income streams gets shut down he still have other sources rolling in taking a lot of stress of him. So trait number 3. Rich people have several sources of income.

(Here’s my video on 10 ways to make passive income online WITHOUT investing money)

When Tommy graduated from school he could finally make a bonfire with all the books he bought over the years and celebrate that he’s now qualified for a real job. The learning is officially over and reading business and self help books to improve is no longer needed. Instead of spending money to improve, he spends it to take a loan for an overpriced home and a car with more buttons than his last one. When John graduated he started to listen and read more books on topics that actually interested him rather than to learn about the cells of a leaf which he was forced to learn in school. He knows that investing in himself is the greatest investment of all because even if he loses all his money from a bad business idea or investment, he’s got the confidence and ability to earn it all back again, while making sure to not repeat the same mistake again. Trait number 4. Rich people continuously invest in themselves.

And if you want to be almost as cool as John and listen to audiobooks, you can sign up through my audible link to their 30 day free trial and get 2 books for free. I suggest the $100 dollar start up to start off with or anything from Grant Cardone because of the passion and intensity he talks with. And you can cancel the membership any time and still keep the books.

Tommy has worked several years in the same position with his income only increasing in the same rate as inflation and he’s becoming aggravated with not getting a raise. He doesn’t think he makes any mistakes and he surely knows how things should be operated and how to properly manage people without having any training or experience with it. He blames his boss and the poor management at work as well as the current political party for not earning more money. John doesn’t care what political party is in charge but instead focus his energy on what he can control to somehow benefit from the situation. If he hasn’t earned more money this year than the previous one, he knows it’s his own fault and that in order to have more he has to become more. Trait number 5. The rich never blames, but take full responsibility for their failures.

When the weekend finally comes around, Tommy turns his alarm off to sleep in for as long as he can. This is the fruit of his hard work, to be able to do absolutely nothing for an extended period of time and he sees sleep as a pleasure that he has earned. He doesn’t find fulfilment with what he does and his only purpose to get out of bed and work is to pay the bills. John on the other hand could very well wake up late if he wanted to, but he chooses not to spend his time sleeping in, and instead wakes up just as early as he usually does because he’s more excited to be productive and make progress than to sleep. Trait number 6. The rich don’t sleep in.

When Tommy finally steps out of bed he drags himself to couch and and puts a netflix serie on to entertain himself until it’s time to sleep again. When he’s not mindlessly entertaining himself, he’s clueless on what do make of his time and going to the bar seems like a good option no matter what day of the week it is. John wakes up and don’t care to sleep longer because he’s got a major purpose that he pursues with an intensity and without quitting. He doesn’t see the work and effort he put into it as a sacrifice but has become addicted to the sensation of making progress and getting closer to his vision every day. Trait number 7: The rich have clear vision or purpose.

Tommy realizes that the most productive thing he has done this week was to level up two times on GTA while finishing four bags of Doritos in one sitting. In the back his head he knows that he should probably get a few things done before going to bed but he keeps telling himself – there’s always a tomorrow. John has checklist of of things he needs to get done which he wrote down the night before. Some tasks are incredibly small while others are bigger, but it creates a path which he can follow and complete to make him progress. Once he’s completed that list of tasks he watches some Netflix before heads out to the bars to get absolutely slambangled. Trait number 8. The rich makes progress before entertainment.

So there you have it guys, some of the traits and characteristics that makes it possible for John to smoke Tommy in the financial game.

2 thoughts on “What Really Separates the Rich From the Poor

  1. What does paying yourself mean when you say, you pay yourself at least 10%?
    Is that 10% or more put away in a saving account or is it for other things… and can you elaborate on what other things can be for you for example.

    1. Hi Arturo!
      To pay yourself means that you invest it. Secure your future my friend! Paper assets is the most common investment to make, but also commodities or reinvest it if you run a small business. I have a few videos on this topic that you can check out!

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A statement of serenity and calm. A refined and sophisticated approach to dining Indian in an intimate and relaxed surrounding.

Prithvi, “Earth or Mother Earth, in the ancient Sanskrit”, where mouth-watering food and an attention to detail is second to none.

A memorable dining experience is not only about the food and wine. It is an emotional experience – every little detail matters. A great meal comes with great service, atmosphere and of course the company.

Everything we create in our kitchen is sublime, from the textures to the flavours. We aim to enhance and elevate the Indian classics.

As nature is generous with her many colours and palate, you will find her in the finely blended flavours in all the dishes we present, experienced in all their authenticity, their freshness and their delightful individuality.

Our culinary style is both – incredibly simple and cleverly refined. Everything that seems ordinary hides a delightful twist.

Prithvi opened its doors in February 2012 – ordinary and inexperienced. With the will to do extraordinary things in Cheltenham and in less than two years, we have surpassed even our own imaginations. We are delighted that
our beloved guests – our friends, have brought us here today.

Let Prithvi guide you through a memorable dining experience.

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List of political parties in Germany with more than 10.000 members. Source:

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Capri Italian restaurant is located at the Haad Tien Beach Resort, and is a stylish, classic Italian bistro by the beach. Serving fresh pizza, delicious pastas and a great selection of antipasti.  It also has an extensive wine cellar for the perfect accompaniment to your meal.

25% off
You and your guests are invited to enjoy 25% off the Total Bill (including wine and alcohol) per visit

Haad Tien Beach Resort
19 / 9 Moo 3,
Shark Bay
Koh Tao Thailand

Trading Hours

Open: Daily


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December 12, 2013 in Finance (E)

[] Raleigh, North Carolina - Swift Fox Software is introducing Amounts for iPhone, a personal expense tracker designed to make users more aware of their spending. The app features a clean interface designed specifically for iOS 7.

Users can add new transactions in seconds with the streamlined entry system. A receipt photo and description can be included to keep track in greater detail. The app can be personalized to individual spending habits with custom categories. Users can select from 70 different icons and 16 different colors to put a personal touch on the interface. Track coffee shop visits, Christmas gift spending or see grocery costs over time with specific categories.

View recent spending quickly with the Amounts list view. Users can quickly distinguish what they have been spending with prominent category icons on every transaction. A single tap shows which categories have the highest spending over the past week, month or year. Users can view category details to see more specific spending trends and easily find where they need to cut their spending.

* Fast transaction entry
* Customizable categories using both colors and icons
* Beautiful lightweight interface designed for iOS 7
* Relative spending charts show highest spending categories at a glance
* Specific category charts show spending over the past weeks, months or years
* Save receipt photos to track business expenses
* Add descriptions to transactions to track spending in greater detail

Device Requirements:
* iPhone and iPod Touch
* Requires iOS 7.0 or later
* 1.8 MB

Pricing and Availability:
Amounts 1.0 is $2.99 and will be available worldwide through the App Store in the Finance Category on December 12th, 2014.

Swift Fox Software is a one man operation run by Jason Clardy based in Raleigh, NC. Jason graduated with a bachelors degree in Computer Science from North Carolina State University in 2010 and began working on iOS development full time in 2011. His focus is on creating apps that are both functional and a joy to use. Copyright (C) 2013 Swift Fox Software. All Rights Reserved. Apple, the Apple logo, iPhone, iPod and iPad are registered trademarks of Apple Inc. in the U.S. and/or other countries.

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