At 12 months, this was achieved in 34% of patients receiving spinal cord stimulation versus 7% of patients who were solely medically managed ( p = 0.005). The primary outcome was 50% or better leg pain relief on 10 cm visual analogue scale score (VAS). The Patients with Failed Back Surgery Syndrome (PROCESS) study, conducted in 2007, was an international, multicentre, randomized trial comparing tonic spinal cord stimulation plus medical management, versus medical management alone in 100 patients with failed back surgery syndrome. 4 Below is a description of 3 of the most influential studies conducted on efficacy of the treatment. In a 2020 systematic review of 15 randomized controlled trials, Hofmeister and colleagues found a robust body of evidence supporting spinal cord stimulation. 8 Wall and Melzack’s gate control theory is the most accepted proposed pain relief mechanism, which asserts that nonpainful inputs close the “nerve-gates” to painful inputs, thereby preventing pain sensations from reaching the brain 2, 7 ( Figure 1). The generators continuously emit low-frequency electrical pulses (tonic stimulation) that mask pain signals travelling up the spinal cord and replace them with nonpainful paresthesias. After this period, patients may resume most physical activities. Patients are asked not to twist, bend or stretch excessively for 6–8 weeks postoperatively. ![]() Implantable pulse generators last 5–10 years, depending on rechargeability, and are replaceable. These generators contain a battery and microprocessor (similar to a pacemaker) that are internalized within a subcutaneous pocket either within the abdominal wall or posteriorly in the flank or gluteal region, and programmed transcutaneously while allowing remote control by the physician or patient. Spinal cord stimulation consists of leads placed in the epidural space alongside the dorsal column and then tunnelled subcutaneously to an implantable pulse generator. ![]() 3 This difference is likely related, at least in part, to a lack of awareness about spinal cord stimulation and high upfront device costs ($20 000–$30 000). Usage of spinal cord stimulators has increased worldwide, and according to the United States Food and Drug Administration, an estimated 50 000 devices are implanted annually in the US (150 cases/million population However, uptake in Canada has been substantially lower, with 172 implantations performed in Ontario in 2018 (12 cases/million population). 2 The technology has since advanced, and it was a Canadian neurosurgeon who helped demonstrate both the efficacy and cost-effectiveness of spinal cord stimulation in chronic pain treatment. 2, 3, 5 It is based on the principle of electrically stimulating the dorsal column of the spinal cord, to mask pain signals. Neuromodulation, defined as the alteration of nerve activity through targeted stimulus delivery, was first introduced in 1967. When conventional therapies produce unacceptable adverse effects or do not provide sufficient pain relief, spinal cord stimulation (neuromodulation) may offer a rescue option, either alone or in conjunction with other modalities. ![]() 1, 2 Consequently, alternatives - including cognitive behavioural therapy, physical rehabilitation, non-opiate pharmacology and integrative therapies - have been developed. 1 Although opioids have been the mainstay of treatment, they have lost favourability owing to crises of addiction, abuse, tolerance and dependence. Increased awareness of and access to spinal cord stimulation therapy may allow more Canadians to benefit from relief of intractable chronic pain and may reduce opioid consumption.Ĭhronic pain affects 1 in 5 Canadians and is associated with considerable socioeconomic burden. Newer spinal cord stimulation technologies are expanding clinical indications such as visceral and ischemic pain, with potential for further improved efficacy. Spinal cord stimulation is safe, efficacious and cost-effective in chronic pain management of neuropathic pain conditions, including failed back surgery syndrome, chronic regional pain syndrome and chronic peripheral neuropathies. Spinal cord stimulation masks pain signals through a transcutaneous implantable electric pulse generator.
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![]() It takes spiritual grit to stay the course. These tiny compromises can grow and begin a downward spiral that will draw our hearts further and further away from God. This story of Israel’s kings can serve as a warning to us when we are drawn by the influence of our culture to allow tiny compromises in our own lives. You can see how compromise can begin so simply and yet become a snowball of rebellion and consequences that seem utterly out of control. This “legacy of compromise” continued on to every single king that came after him, and each one was worse than the one before. ![]() Jeroboam replaced God’s chosen place of worship, ordained common people as priests instead of God’s chosen tribe of Levi, and he set up golden calves as idols for the people to worship. He had completely disregarded God’s commands concerning worship, and that was the beginning of the compromises that led to Israel’s troubles. Jeroboam was the first king of the Northern 10 tribes of Israel as they split from the other tribes. We observed the slippery slope of compromise as king after king rebelled against God and indulged in idol worship, thus bringing severe consequences for their sin to the nation of Israel. We read how the nation became divided into the Northern Kingdom, called Israel, led by one evil king after another, and the Southern Kingdom, called Judah, led by some good and some bad kings, and it was during this time that God used Elijah to prophecy to His people. We discovered how the nation transitioned from having God as their King and being led by judges to becoming a monarchy. On Day 1, we set the stage for our study by outlining a bit of the history of Israel that led to the time of Elijah. ![]() I have written a summary for each day of our study this week, and the discussion questions and assignments will be at the end. Anyone who wants to come to him must believe that God exists and that he rewards those who sincerely seek him.” Our focus verse for the week is Hebrews 11:6, “And it is impossible to please God without faith. Whereas Elijah did seven miracles in his lifetime, young Elisha, his student, did fourteen miracles, probably because he asked for a “double portion of spirit” (2 Kings 2:9).Įlmer Towns, Bible Answers for Almost All Your Questions (Nashville: Thomas Nelson, 2003).Congratulations! You made it through the first week, and what a powerful week it has been! We focused on a number of themes this week from the beginning of Elijah’s story in 1 Kings 17 – Prayer, Faith, Spiritual grit, the slippery slope of compromise, Repentance, Restoration, Seasons in our walk with God, God’s provision and strength during our difficult times, Waiting on God, Trusting Him when life doesn’t make sense, and much more! Isn’t it amazing how much God has had to say to us in just our first week of study? Whereas Elijah was rough and ministered in the wilderness apart from society, Elisha went into the cities, spoke to the kings in their courts, and lived with a school of prophets. What is the difference between the ministries of Elisha and Elijah? Young Elisha took the mantle and carried on his work. His prophetic mantle-symbol of office-was dropped as Elijah was carried into heaven. Apparently he did not die, but was translated into the presence of God. Second Kings tells the story of Elijah going up to heaven in a whirlwind. He ministered primarily during the time of King Ahab (1 Kings 16:29–22:40). Elijah was a preaching prophet, not a writing prophet, and his message was primarily to the ten tribes of Israel. He was rugged, abrupt, and dressed in skins with a leather girdle and a long “mantle.” The mantle was the symbol of his office. He was a prophet from Gilead, considered one of the greatest prophets in the Old Testament. ![]() Even today, the Irish and Scottish believe stray tortoiseshell cats bring them luck. Dating back to Celtic times, tortoiseshell cats have been perceived to bring good fortune into their homes. Their appearance is a healthy mix of dark black or chocolate, with shades of red, ginger, or orange mixed in.įun tortoiseshell cat fact: In many cultures, tortoiseshell cats are synonymous with good luck. Since torties are not specific to any particular breed of cat, their overall coloring typically appears brindled. If you’ve got a tortie, then you know exactly what we mean by tortitude! A collage of examples of tortie cats: A tortie cat is known by many for being a cat with attitude and a distinct personality with a voice all of their own. ![]() Tortoiseshell markings appear in many different breeds, as well as in non-purebred domestic cats.įor those cat owners who share their home with one of these colorful cats, they often report of their cat’s ““tortitude” with others. ![]() And in the rare instances that a tortoiseshell cat is male, it will typically be sterile as a result. Similar to calicos, tortoiseshell cats are almost exclusively female. Tortoiseshell Catsīy definition, a tortoiseshell cat is a feline with a coat that resembles the mottled or particolored shell of a tortoise. If you’ve ever wondered what exactly makes a torbie, tortie, calico or tabby cat, we’re here to tell you!Ĭheck out our detailed overview on how to tell the difference between torbies, torties, calico and tabby cat coat colors. (Although I must say, there will always be a special place in my heart for ginger tabbies!) Speaking of which, did you know there are different classifications for tabbies? Not all have solid stripes, actually, and some have stripes which are darker/bolder than others. Really, I don’t discriminate, I just love them all despite their markings, fur length or coat color. I love cats that come in all sizes, shapes and colors. ![]() Step 3: As with Forge, bypass any security features implemented by your firewall in order to complete the download process. When in doubt, start with the most recent file - it’s likely that your game is automatically updated to the latest software. Step 2: Download the file associated with your current version of Minecraft. Step 1: Navigate to Curse Forge and browse through the mod listings until you find one that you like. We highly recommend using Curse Forge, as it is a reputable source that is safe, secure, and - most likely - compatible with all your software. There are numerous websites that offer mods, but not all of them are compatible with Forge - or possibly even your specific version of Minecraft. Once Forge is properly set up, adding mods is a straightforward process. Remember, you’ll want to select Install Client, not Install Server, and make sure you’re downloading the recommended version of Forge. If you don’t see the Forge option under Installations, try running the Forge installation again. If you’re able to log in with the Forge installation, that means you’re ready to join the wild world of modded Minecraft. Step 5: Then, log in with your regular credentials Step 4: To play Minecraft with your mods, you’ll want to hover over the Forge option and click Play. Step 3: Along with Latest Release, there should also be an option called Forge. Step 2: Navigate to the Installations tab. Run Minecraft a second timeįirst, check Minecraft to make sure Forge is running. That’s it for installing Forge! However, you’ll want to check to make sure it installed properly - and you still need to add all your mods to it. Step 5: Once done, proceed through the prompts, and the Forge Installer should close. Then, select Install Client and press OK. Step 4: Take note of the file path listed on the installer - you’ll need this later. This will open up the Mod System Installer, which will walk you through the process of setting up Forge on your system. ![]() Step 3: Now that Java is installed on your computer, you should be able to click on the file and run it. How to buy a gaming PC for the best performance and value Step 2: Once the download is finished, you should have a new file on your computer with a filename similar to forge-1.15.2-31.1.0-installer.jar. If you are running any sort of firewall, you may have to bypass its security setting. Step 1: From the Recommended Download section, select the Installer option. Navigate to its official website, and you’ll be greeted with several options for installation. You’ve installed Java, you’ve run Minecraft, and now it’s time to start with the setup of Forge. If you don’t run Minecraft prior to downloading Forge, you’ll encounter various errors when attempting to install mods later on. Running Minecraft will ensure that all the necessary folder locations have been created on your computer before attempting to install Forge. ![]() ![]() We recommend logging in to your account and actually jumping into a procedurally generated world to verify that the game does, in fact, run properly before messing with Forge. Once Java is installed, go ahead and run Minecraft. Image used with permission by copyright holder Run Minecraft There’s nothing else you’ll need to do with Java at this point - we’ll circle back to it later. Then, just follow the straightforward directions to complete the download, and close out of your browser. From there, you’ll be prompted to accept a few agreements, and the installation will begin. If it’s not, head on over to the official Java website and click on the Java Download button. The first thing you’ll want to do is ensure that Java is installed on your computer. In a few short steps, you can have mods running in your own game - here's how it works. In short, Forge lets you quickly install mods to a specific Minecraft profile without having to be a tech-savvy wizard. The process of installing mods is much easier than it has been in the past, all thanks to a piece of software called Forge. The correct way to try premium fonts for free We do not encourage using the fonts without obtaining proper licensing of the respective fonts. This post in just intended to show how you can use specific keywords to search for the premium fonts. Again you can just download the ZIP file to get the fonts. Here I tried “Brandon Grotesque Github” and eventually I found the repo below containing the whole family. Perhaps you can also just include “Github” in your keyword. Basically you need to go to the repo home page, and click on the “Download ZIP”. Since this repo is shared publicly, basically you can download the whole repo to your desktop in a zip file. ![]() Below showing a repo with Proxima Nova fonts. Many repositories containing the premium fonts where you can actually download them for free. On the search result page, you may find links from Github, a site where developers use to manage their codes. For example: “Proxima Nova OTF” and “Brandon Grotesque TTF”. Continue read on to find out how you can do it.īasically is just by tweaking your search keywords: by adding “OTF” or “TTF” to your keyword. But what if you want to have a try on popular webfonts like Proxima Nova, Brandon Grotesque, Museo, or Apercu and many more for free? Most probably you will have to pay, or subscribe to use those fonts.īut there is a way that you can download the aforementioned fonts for free, not only just the font but the entire font family. ![]() ![]() There are many high quality open source fonts that are hosted on sites like Google Fonts and Font Squirrel that you can use it on your designs and websites. With the introduction of in CSS3, we are no longer restricted to just operating system fonts. ![]() Alternatively, you may choose a monthly format to better track employee hours for payroll. ![]() Monthly ScheduleĪlthough more complex than the previous formats, the monthly employee schedule is worth establishing for projects that go on for days or weeks, not necessarily ending neatly within the confines of a typical work week. That said, one thing to look out for when working with weekly schedules is the possibility of over-scheduling or accidentally forgetting to add an employee to the schedule. With this format, it is much easier to account for availability, such as in the event of scheduled time off. Additionally, full- and part-time employees will be able to track hours and note daily changes in shift obligations. This schedule is more typical of businesses that are open five to seven days per week. While this format works for day-to-day planning, it’s very narrow scope makes it hard to look ahead, making it necessary to supplement scheduling with weekly and monthly work schedule sheets. This template is good for helping workers stay on task, manage their time efficiently and meet all end-of-day deadlines. Daily Scheduleĭaily schedules tend to be very basic and straightforward, often reserved for employees who are assigned to specific tasks or departments that may be subject to change later in the week. You might also choose to use scheduling software to create your paperwork.Īdditionally, if you are not interested in a manually made scheduling system, there are plenty of pre-made employee schedule templates from which to choose. You may decide to set up documents through Google Sheets or Microsoft Excel. Do your employees self-report their hours?įactors such as these will play key roles in determining what type of scheduling forms you use.Are employee hours tracked daily or weekly?.Do you need a four-two or rotating three-fourths schedule?.Does your business run 24 hours per day?.Before selecting your employee schedule system, there are a few questions you should keep in mind: In addition, the Sudoku Generator can be used as a teaching tool. ![]() For instance, people who enjoy solving Sudoku puzzles can use the generator to create new puzzles to solve. The Sudoku Generator can be used for both educational and recreational purposes. I hope you enjoy this collection of 100 large-size sudoku printables.How to generate puzzles with Sudoku Generator It's great for sharpening brain skills such as concentration and numerical reasoning. Sudoku is one of my favorite number puzzles. See Kevin Rush's sudoku strategy guides for a detailed explanation of this and other tricks. That way you won't waste time checking numbers you've finished searching. Once you've found all instances of a number, cross that number off your list. This is known as tagging.Īnother is to list the numbers 1 through 9 on the side of the puzzle. One common strategy is to enter guesses in small writing in the cells. You are allowed to make notes and other marks on the sudoku printable. I recommend using a pencil with an eraser, since it's quite typical when solving sudoku puzzles to make a few errors along the way. (See the sudoku puzzle image at left as an example.)Īs I mentioned above, you need to enter a single digit 1 through 9 in each of the 81 small squares in the puzzle. The grid is further subdivided into 3-by-3 boxes. ![]() These small squares are also known as cells. Sudoku puzzles consist of a large square divided into a 9-by-9 grid. Every sudoku puzzle has only a single solution. The puzzle is solved once you have filled in all the small squares following this rule. Enter a number 1 through 9 in each cell of the puzzle such that no number is repeated in any row, column, or 3-by-3 square. You'll learn advanced techniques such as Ghosting, RC Counting, Tagging, and Line Checking. Note: To learn powerful strategies for solving sudoku, see Kevin Rush's free guide here. MORE PRINTABLES: Crossword Puzzles, Word Searches, Bible Word Searches, Special Needs Word Searches, Mormon Word Searches, Balance Quest Math Puzzles Review of Sudoku Rulesįor those new to sudoku, I'll quickly go over the rules. Your readership will love it! (In your publication, simply include the following copyright statement next to the puzzle: "©. I hope you enjoy solving them.Īre you the publisher of a newsletter, bulletin, newspaper, or magazine? Include a sudoku puzzle or word search puzzle in each issue. The new larger sudoku printables here correct all those issues. Folks with eyesight problems may have trouble reading the numbers on those. This doesn't leave much room for annotating each puzzle with tag numbers as you try to solve it.Īlso, the four-to-a-page can feel a little cramped. On the down side, I had to shrink those puzzles so all four would fit on a single page. The main benefit is you get four sudoku puzzles one sheet, which saves paper. I thought four-sudoku-to-a-page was a good idea at the time.Ĭramming four on a page does have its advantages. ![]() More About the Free Printable Sudoku PuzzlesĪs mentioned, the free sudoku printables linked above are one to a page, unlike the other collection. The solutions themselves are huge, too, for easy viewing. The solutions (answers) to the large-print sudoku puzzles are in the back of each book. The big cells in the puzzle grid make it easier to write the number in the box. A very large-print puzzle is ideal for seniors or anyone with vision issues.Įven someone with good vision can benefit, if they have tremors from Parkinson's disease or other conditions. That makes the puzzles much easier to see and work with compared to most puzzle books. ![]() The big puzzles in these books are one puzzle to a page. The other four books are 100 Easy, 100 Medium, 100 Hard, and 100 Very Hard large-print sudoku. Hard #1 includes 25 Easy, Medium, Hard, and Very Hard sudoku puzzles. The puzzle book shown at left, Easy to V. The books are available for purchase on. The sudoku grids in these books are as large as I could possibly fit on the 8.5"x11" page. I've created a series of five large-print sudoku books that I call "Huge Print Sudoku". Tired of printing out large sudoku puzzle pages one by one? Buy my awesome sudoku puzzles books instead! Here’s a look at the Cowboys’ full 55-man roster they’ll have at their disposal when making their inactive decisions on Sunday. The team signed kicker Tristan Vizciano this week, but is not bringing him to the game. Just three members of the active roster were in Green Bay. ![]() But that means there is no insurance for kicker Brett Maher, who missed four extra points in the wild-card win. How the head man for the Dallas Cowboys, McCarthy was fired late in the 2018 season, leading to LaFleur’s hiring several weeks later. The team is also adding another OL to allow them to dress eight and maximize the game-day roster rules. ![]() In addition to adding Collins, the club is adding two players from the practice squad, but not one many expected.ĬB Xavier Rhodes was added ahead of Week 18 and played 24 snaps against the Buccaneers, will once again be one of two elevations. Despite having three tight ends on the active roster, Dallas is elevating rookie Princeton. Mullen had a chance to prove his worth in the Week 18 season finale but made only a negative impact and was left inactive in the wild-card win over Tampa Bay. The Cowboys, however, still elevated a player from the practice squad to be active for the Week 13 tilt. Dallas is adding Aviante Collins from the practice squad, and to create space are releasing CB Treyvon Mullen. So there is a clear need to replace him on the game-day roster and the Cowboys have shuffled their lineup in accordance. Prior to Vizcaino not being moved to the active roster, Cowboys head coach Mike McCarthy revealed that Maher would be the team’s. The biggest injury news this week was the loss of left tackle Jason Peters, ruled out on Friday. Wright, who will make his debut on Monday night, has been on the injured reserve since the start of the season after suffering an ankle injury in the preseason. Like 2018, Dallas won their home wild-card game and now travels to California to take on the NFC West champions, only this time it’s to San Francisco instead of Los Angeles. With that, the Cowboys have activated cornerback Nahshon Wright from the injured reserve and signed defensive end Tyrus Wheat to the active roster to fill the two open roster spots. ![]() On Saturday, nearing the 24-hour countdown to the rematch against the San Francisco 49ers, the club made several moves to prepare for their biggest game in the last five seasons. 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