title: Earth: Final Conflict

text: Liam, the Taelons, and the Jaridians have disappeared but their efforts, far from saving everyone, have doomed the galaxy: they have awakened a version of the Atavus protospecies, a race of energy vampires that preceded the Taelons and Jaridians. Renee and Street are the only ones who know the truth of what's happening: the Resistance is disbanded and the human governments are in no rush to accept the beginning of another war with an alien race. Their only ally is Raj'el, the first and now the last of the Taelons, who is forced to provide covert support from the heart of the Taelon mothership.


title: Earth: Final Conflict

text: To make matters worse, Sandoval, left in control of the Taelon mothership, allies with the Atavus leaders Howlyn and Juda. Together, they are able to keep their presence hidden for much of the season. Their plan is to create an army of Atavus-Human hybrids by means of a joining process, then use the hybrids to awaken other Atavus hives hidden around the world.


title: Earth: Final Conflict

text: As the season progresses, a few familiar faces re-enter the fight: William Boone is brought back as a trap for Renee, but he quickly joins her side. In response, Sandoval and Howlyn revive Zo'or, giving him a new body as a female Atavus, but Renee and Boone are able to defeat their nemesis once and for all.


title: Earth: Final Conflict

text: "Final Conflict" comes to a head when Liam returns to help Renee stop Howlyn from unleashing his elite warriors from the long-buried Atavus mothership. At the end of the series, Liam, Renee and Raj'el depart in the Taelon mothership, resolving to bring the few trustworthy Atavus home and indulge in a little adventure along the way.


title: Earth: Final Conflict

text: The series was first shown on CTV in 1997 and ran for two seasons until the network decided to cancel it due to low ratings. The show was, however, resurrected by Chum Limited and was moved to their New Net network for the remainder of its run. The series was broadcast in syndication in the United States.


title: Earth: Final Conflict

text: The series has been re-shown daily on Bravo, and later by Horror, in the United Kingdom, Showcase in Canada, Jimmy in Italy, and Bangladesh Television in Bangladesh.


title: Earth: Final Conflict

text: ADV Films released seasons three, four, and five on DVD in 2003. Due to different companies owning different rights for different seasons, these were the only seasons they were able to negotiate the distribution rights for. The episodes are presented in uncropped 16x9 widescreen on six discs per season. There were only minimal extras.


title: Earth: Final Conflict

text: On May 5, 2009, Universal Studios Home Entertainment released Season One on DVD in the US. The episodes are presented in 4x3 full-screen on five discs with a small handful of extras included. The episodes appear uncut but are time compressed, running at a slightly faster pace, resulting in each episode running approximately two minutes shorter than in their original unaltered forms. On July 27, 2010, Season Two was released on DVD in the US.


title: Earth: Final Conflict

text: Alliance Home Entertainment has released all five seasons on DVD in Canada. All of these are bare-bones releases, no extras at all and are presented in 4x3 full-screen on six discs per season with both English and French audio tracks. Season One is presented at its original pacing.


title: Earth: Final Conflict

text: Pandastorm Pictures started to release the series in Germany on May 29, 2015. Season 2 followed on September 18, 2015. Season 3 followed on January 29, 2016, Season 4 on April, 15th, 2016 On February 4th, 2019, the German publisher Pandastorm Pictures had to announce via their Facebook page, that so far it was impossible to find all of the rights holders for Earth: Final Conflict - season five - it is quite likely by now, that they will not be able to publish season five in Germany. They announced the release of Series 1 and Series 2 as codefree, sound: German DD 2.0, English DD 2.0 and subtitles: English.


title: Wawel Castle

text: The Wawel Royal Castle (; "Zamek Królewski na Wawelu") and the Wawel Hill on which it sits constitute the most historically and culturally significant site in Poland. A fortified residency on the Vistula River in Kraków, it was established on the orders of King Casimir III the Great and enlarged over the centuries into a number of structures around an Italian-styled courtyard. It represents nearly all European architectural styles of the Medieval, Renaissance and Baroque periods.


title: Wawel Castle

text: The castle is part of a fortified architectural complex erected atop a limestone outcrop on the left bank of the Vistula River, at an altitude of 228 metres above sea level. The complex consists of numerous buildings of great historical and national importance, including the Wawel Cathedral where Polish monarchs were crowned and buried. Some of Wawel's oldest stone buildings can be traced back to 970 AD, in addition to the earliest examples of Romanesque and Gothic architecture in Poland. The current castle was built in the 14th century, and expanded over the next hundreds of years. In 1978 Wawel was declared the first World Heritage Site as part of the Historic Centre of Kraków.


title: Wawel Castle

text: For centuries the residence of the kings of Poland and the symbol of Polish statehood, Wawel Castle is now one of the country's premier art museums. Established in 1930, the museum encompasses ten curatorial departments responsible for collections of paintings, including an important collection of Italian Renaissance paintings, prints, sculpture, textiles, among them the Sigismund II Augustus tapestry collection, goldsmith's work, arms and armor, ceramics, Meissen porcelain, and period furniture. The museum's holdings in oriental art include the largest collection of Ottoman tents in Europe. With seven specialized conservation studios, the museum is also an important center for the conservation of works of art.


title: Wawel Castle

text: The history of Wawel is deeply intertwined with the history of the Polish lands and Polish royal dynasties already in the Middle Ages. The political and dynastic tensions that led to the ascendance of Kraków as the royal seat are sophisticated, but for most of the Middle Ages and the Renaissance Wawel was the seat of the national government and the Diet (assembly). As the Polish–Lithuanian Commonwealth formed and grew, Wawel became the seat of one of Europe's largest and most important states. This status was only lost when the capital was moved to Warsaw in 1596 (designated officially in 1793).


title: Wawel Castle

text: From the late 18th century, when Poland lost its independence during the period of foreign partitions, Wawel became a symbol of endurance and was the setting for demonstrations and gatherings of Cracovians protesting against the continuing foreign occupation by the Austrian, Prussian, and the Russian Empires. Thus, the significance of the Wawel Hill comes in part from its combination of political and religious significance. The Cathedral holds the relics of St. Stanislaus and stands directly adjacent to the Royal Castle. The Hill has a long history of religious functions; some of the oldest extant architectural remains are those of the Rotunda of the Virgin Mary.


title: Wawel Castle

text: The hill which takes the form of a horst originated in the Miocene epoch (23–25 million years ago) and consists of Jurassic limestone dating back to the Oxfordian age (155–161 million years ago). This limestone is strongly karsted and abounds in caves (e.g. the Dragon's Den—Smocza Jama). This possibly explains why the hill was originally called "wąwel", meaning ravine in Polish. This ravine once divided the hill. An alternative theory is that the word means 'protrusion from the marshes' which surrounded the hill. However, the most recent theory is that "Wawel" is a regular continuation of the name Babel in the Greek language (the consonant [B] followed by [V]/[W]).


title: Wawel Castle

text: The Wawel Hill has archaeological remains indicating settlement from the 4th century. Archaeological studies suggest that the earliest settlement dates back to the Middle Paleolithic era, c. 100,000 years BC and owed its rapid development to its location being the crossing of a number of key trading routes. Wawel is believed to be one of the strongholds of the Vistulan tribe which formed a nation at the turn of the 8th and 9th century AD. Its legendary rulers Krakus and Princess Wanda, who are said to have lived in the 7th and 8th centuries, are mentioned by the 13th-century chronicler Wincenty Kadłubek. In the 10th century, the Vistulans’ lands and Kraków became part of the emerging state of Poland.


title: Wawel Castle

text: In the year 1000, the Kraków diocese was established followed by the construction of a Cathedral – the seat of the bishop. However, as a result of an ongoing conflict with the Holy Roman Empire, construction did not begin until the signing of the Peace of Bautzen, in 1018. Only minor fragments remain of the original cathedral (which is sometimes called ‘Chrobrowska’ after Bolesław I the Brave) and despite extensive archaeological research, it has proved impossible to reconstruct its exterior. Until the 1980s, relicts of St Gereon's Church were identified with the first cathedral but this theory, advanced by Adolf Szyszko-Bohusz, has been disproved by more recent research. There are also inconsistencies in the dating of the destruction of the original cathedral. Some sources place this at the time of the invasion of Bretislaus I of Bohemia in the 1040s, while others date the destruction to a fire in the 1080s.


title: Wawel Castle

text: In addition to the cathedral, the hill was also the site of other building work. The earliest evidence is of wooden structures dating from the 9th century, with the earliest stone buildings dating to the 10th and 11th centuries; the remains of the following buildings date from this era: the Rotunda of the Blessed Virgin Mary – probably from the turn of the 10th and 11th century; Church B (the earliest parts originate from the 10th century); Church of St Gereon (probably the palace chapel); the Church of St. George; the Church of St Michael; the Twenty-Four Pillar Room (possibly part of the Ducal Mansion); the Keep and the Residential Tower.


title: Wawel Castle

text: From this early period of the Wawel's history originates the popular and enduring Polish myth of the Wawel Dragon. Today, it is commemorated on the lower slopes of the Wawel Hill where by the river, is a modern fire-breathing metal statue of the dragon. The statue is sited in front of Smocza Jama (Dragon's Den), one of the limestone caves scattered over the hill. The dragon, Smok Wawelski, was a mystical beast which supposedly terrorised the local community, eating their sheep and local virgins, before (according to one version) being heroically slain by Krakus, a legendary Polish prince, who supposedly founded the city of Kraków and built his palace above the slain dragon's lair. The oldest known literary reference to the Wawel dragon comes from the 12th century, in the work by Wincenty Kadłubek.


title: Wawel Castle

text: Between 1038 and 1039 Duke Casimir I the Restorer returned to Poland and it's believed that Kraków first became a royal residence and the capital of Poland at this time.


title: Wawel Castle

text: At the end of the 11th century, construction work began on a replacement cathedral, today called "Hermanowska" as it's likely that Władysław I Herman was its patron. The new cathedral was consecrated in 1142. Quite a lot is known about the building because an image of it is engraved on a 13th-century chapterhouse seal, and some of its remains and foundations are well preserved; besides the lower of the Silver Bell Tower, the trinavel St. Leonard's Crypt, the rotunda by the Bastion of Ladislaus IV of Hungary (once a baptistery and the rotunda by the Sandomierska Tower all date from this era, as does a church near the Dragon's Cave.


title: Wawel Castle

text: In 1118 Bishop Maurus was buried in the crypt. The paten and the chalice, buried with the bishop, were later exhumed from his tomb during its accidental discovery in 1938.


title: Wawel Castle

text: The Silver Bell Tower (originally known as the Wikaryjska or Priest Tower) dates from the early 12th century and is the oldest of the Wawel's many towers. However, the tower has many later additions and only the 12-metre-high rectangular base can be dated as belonging to the 11th-century Hermanowska Cathedral. The belfry was constructed in the final quarter of the 14th century and the spire in 1769. The tower contains three bells; the largest was made in 1423, the next largest around 1271 and the smallest in 1669. In the foundations of the tower is a burial vault containing the remains of notable Poles from all periods of history. Other notables are also buried at the nearby Skałka Church.


title: Wawel Castle

text: Around 1305 to 1306, the Hermanowska Cathedral was partially destroyed by a fire; however, the coronation of King Władysław I the Elbow-high, in 1320, was still able to take place within its precincts. In the same year construction of a third cathedral, consecrated in 1364, began at the King's behest, the key elements of this cathedral are preserved today.


title: Wawel Castle

text: The cathedral is trinavel in construction and surrounded by side-chapels, added in later centuries. The earliest of these chapels were built off the chancel; St Margarita's chapel was consecrated (today it acts as a sacristy) in 1322 and few years the chapel, later to be known as the Báthory Chapel, was completed. The cathedral's west entrance is flanked by two chapels; one dedicated to Queen Sophia (last wife of Władysław II Jagiełło) and the second to the Holy Cross; these were built during the reign of Casimir IV Jagiellon (1440–1492); the former is notable for its polychrome vaulted ceiling. From the close of the 15th century, a further nineteen side-chapels were built or rebuilt.


title: Wawel Castle

text: Władysław I the Elbow-high was the first king to be buried in the cathedral in 1333. His sandstone sarcophagus was set up by his son and successor, Casimir III the Great, the last King of Poland from the Piast dynasty. The cathedral also contains the tombs of Casimir III the Great and Jogaila but the most precious is that of Casimir IV Jagiellon, carved by Veit Stoss in 1492. The late Gothic tombstone of John I Albert was carved at the beginning of the 16th century and is attributed to Jorg Huber. The cathedral also contains memorials to Stephen Báthory and bishop Fillip Padniewski – both designed by Santi Gucci and also the tombstone of bishop Andrzej Zebrzydowski designed by Jan Michalowicz from Urzedow. During the 20th century, the cathedral became the site of Karol Wojtyla's priesthood ordination in 1946 and bishop ordination in 1958 as Kraków's auxiliary bishop.


title: Wawel Castle

text: Little is known of the first royal residences at the Wawel until Casimir III the Great, who reigned from 1333 until 1370, had a Gothic castle erected next to the cathedral; this consisted of multiple structures situated around a central courtyard. In the 14th century, it was rebuilt by King Władysław II Jagiełło (also known as Jogaila) and Queen Jadwiga of Poland. The Hen's Foot Tower, built upon three projecting buttresses resembling a chicken foot, and the Danish Tower date from their reigns, as do the Jadwiga and Jogaila Chamber, in which the Polish coronation sword (Szczerbiec) is exhibited.


title: Wawel Castle

text: During this period, the Wawel began to take its present appearance and size as further buildings were developed on the hill to serve as quarters for the numerous clergy, royal clerks, troops, servants and craftsmen; this work included defensive walls, ramparts and the ‘Jordanka,’ ‘Lubranka,’ ‘Sandomierska,’ ‘Tęczyńska,’ ‘Szlachecka,’ ‘Złodziejska’ and ‘Panieńska’ towers.


title: Wawel Castle

text: The reign of the last member of the Jagiellonian dynasty, Sigismund I the Old, was a high point in Wawel fortunes. Following another fire in 1499, from 1507 to 1536, Sigismund rebuilt the royal residence. King Sigismund had spent part of his youth at the court of his brother, King Vladislaus of Hungary and Bohemia in Buda; this court has a small band of Italian artisans pioneering the Renaissance movement, at that time little known outside of Florence. Thus inspired Sigismund took the decision to rebuild in the Renaissance style within the walls of the old castle. A great influence on the king was his second wife, Italian-born Bona Sforza. She brought in the best native and foreign artists including Italian architects, sculptors, and German decorators, to refurbish the castle into a splendid Renaissance palace.


title: Wawel Castle

text: Work on the new "avant-garde" palace was initially supervised by two artisans from Italy: Francisco from Florence and Bartolommeo Berrecci, and after their deaths by Benedykt from Sandomierz. A feature of the rebuilding were the large, light rooms which open from tiered arcades lining a courtyard. The new rooms and halls included the ornate Deputy Hall with its coffered ceiling, exemplifying the skills of both Italian and Polish craftsmen. To decorate the palace's rooms, Sigismund (and later his son) purchased over 350 tapestries, collectively known as the Jagiellonian tapestries; they were woven in the Netherlands and Flanders; many based on designs by Michiel Coxie.


title: Wawel Castle

text: While the arcaded courtyard is considered a fine example of Renaissance art, it has subtle eccentricities—hints of Polish Gothic within its form, a steeply hipped and projecting roof (necessary in a northern climate) counterbalancing the soaring effect created by the uppermost arcade being higher than those below (a feature unknown in Italy) to give the courtyard a uniquely Polish renaissance look. The extra height of the uppermost arcade is truly unusual as it indicates and places the piano nobile on the third floor, whereas the rules of Italian Renaissance architecture place it on the second floor; again this indicates that while the design was inspired by Italians, the Polish artistic and cultural tradition was not extinguished in the execution.


title: Wawel Castle

text: After a fire in 1595 when the north-east part of the castle burned down, King Sigismund III Vasa decided to have it rebuilt with the work carried out under the direction of the Italian architect Giovanni Trevano. The Senator Stairs and the fireplace in the Bird Room date from this period. However, the castle still retains many of the earlier interiors designed by Berrecci. While many have been altered through neglect, war damage and, after World War II, through overenthusiastic restoration, the spirit of Berrecci's Renaissance ideals mingled with the Gothic motifs of local craftsmen still remains. The Ambassadors' Hall still retains much of its timber carving, most notable its coffered ceiling with thirty Gothic style carved heads by Sebastian Tauerbach.


title: Wawel Castle

text: In the 17th century, Wawel became an important defensive point and was modernised and heavily fortified. Later, the transfer of power to Warsaw did not change the symbolic role and importance of the Wawel Cathedral, which was still the place of royal coronations.


title: Wawel Castle

text: During this period, many changes were introduced in the cathedral – the high altar was remodelled, the cloister was elevated and the Shrine of St Stanislaus (a marble altar and a silver coffin) and the Vasa Chapel were constructed. Baroque memorials were also erected, among others were tombs to bishops Marcin Szyszkowski, Piotr Gembicki, Jan Małachowski, Kazimierz Lubieński and kings Michael I and John III Sobieski.


title: Wawel Castle

text: In 1517, the 16-year-long construction of another chapel adjoining the cathedral began. Sigismund's Chapel ("Kaplica Zygmuntowska") was to serve as the mausoleum of the last members of the Jagiellonian dynasty. Later, at the turn of the 16th century, a memorial tablet to John I Albert was placed in a niche sculptured by Francesco Fiorentino; this is considered to be the first Renaissance work of art in Poland. Other memorials from this period include those of Cardinal Frederic Jagiellon and of bishops Piotr Gamrat, Piotr Tomicki, Jan Konarski, Jan Chojeński and Samuel Maciejowski.


title: Wawel Castle

text: The chapel is considered one of the most notable examples of architecture in Kraków, it has been hailed by many art historians as "the most beautiful example of Tuscan renaissance north of the Alps". Financed by King Sigismund, the chapel was designed by Bartolomeo Berrecci. It is square-based with a golden dome and houses the tombs of its founder as well as King Sigismund II Augustus of Poland and Queen Anna. The design of the internal sculptures, stuccoes and paintings was carried out by some of the most renowned artists of the era, including Santi Gucci, Hermann Vischer, and the architect himself, Georg Pencz.


title: Wawel Castle

text: In 1520 the Royal Sigismund Bell was cast, by Hans Behem, in bronze; it is the largest of the five bells hanging in the Sigismund Tower and was named to honour King Sigismund I the Old. It weighs almost 13 tonnes (28 thousand pounds) and requires 12 bell-ringers to toll it. It's rung only on special occasions (in modern times these were such events as the death of Józef Pilsudski, the death of Bolesław Bierut, the election of Karol Wojtyla as Pope, Poland's accession to the EU), mostly religious and national holidays, and is regarded as one of the country's national symbols. Today, the bishops of Kraków use it quite often, which reduces the importance of the Sigismund bell. The hanging of the bell is the subject of a painting by Jan Matejko.


title: Wawel Castle

text: The 18th and 19th centuries were to be a period of decline and misfortune for Wawel. The decline had begun as early as 1609, when King Sigismund III moved permanently to Warsaw. Despite the concerns of successive governors, both the castle and its precincts began to fall into ruin, which was in part due to occupying Swedes between 1655 and 1657 and again in 1702.


title: Wawel Castle

text: The decline worsened drastically when the hill was occupied by the Prussian army in 1794; at this time, the royal insignia were looted (apart from the Polish coronation sword) and taken to Berlin, where they were melted down for their gold, precious gemstones and pearls, which were handed to the Directorate of Maritime Trade in Berlin.


title: Wawel Castle

text: After the Third Partition of Poland (1795), Wawel fell under Austrian rule. Austrian soldiers converted the hill into barracks and as a consequence, much destruction and alteration took place: the Renaissance arcades of the courtyard were walled up, the interior of the castle was changed and parts of the buildings were demolished; amongst the buildings destroyed were the churches of St. Michael and St. George.


title: Wawel Castle

text: Following the unsuccessful Kraków Uprising and the fall of the Republic of Kraków, three large buildings housing a military hospital were built on the hill. During the latter half of the 19th century, the Austrians rebuilt the defence walls, making them a part of the expanded Kraków fortification system (two new caponiers were made). At the same time, the Poles tried to retake the hill.


title: Wawel Castle

text: In 1815, the funeral of Prince Józef Poniatowski took place at Wawel Cathedral. Since that event, national heroes have been entombed within the cathedral; prior to this date, only bodies of monarchs were interred there. In 1818, the body of national hero Tadeusz Kościuszko was buried in St. Leonard's Crypt. During the reconstruction of Potocki Chapel in a classical style, the statue of Prince Arthur Potocki by the Danish sculptor Bertel Thorvaldsen was placed within the chapel. A second work by Thorvaldsen was placed in Queen Sophia's Chapel.


title: Wawel Castle

text: In 1869, due to the accidental opening of the coffin of King Casimir III, a second funeral was performed. Consequently, an initiative was taken to renovate other monarchs’ tombs in the cathedral. The underground crypts were connected with tunnels, sarcophagi were cleaned and refurbished and new ones were funded. Emperor Franz Joseph I of Austria paid for a sarcophagus for King Michael, whose wife was from the House of Habsburg.


title: Wawel Castle

text: In 1905, Emperor Franz Joseph I of Austria, in his capacity as King of Galicia and Lodomeria, ordered his troops to leave Wawel. The Austrian withdrawal permitted the commencement of restoration work managed by Zygmunt Hendel and Adolf Szyszko-Bohusz. During the renovation, the Rotunda of Virgin Mary was discovered as well as other notable relics of the past. The renovation of the Wawel Hill was funded by public subscription. The names of the donors were inscribed on the bricks used to build the wall near the castle's northern gateway. The Coat of Arms Gate was built at this time and the statue of Tadeusz Kościuszko was placed nearby.


title: Wawel Castle

text: Between 1902 and 1904, Włodzimierz Tetmajer decorated the walls of Queen Sophia's Chapel with paintings depicting Polish saints and national heroes.


title: Wawel Castle

text: Józef Mehoffer painted murals in the vault of the cathedral and created stained-glass windows in the St. Cross Chapel as well as paintings in the Szafrańcy Chapel. Mehoffer is also responsible for the stained-glass windows in the transept which depict the Sufferings of Christ and the Virgin Mary.


title: Wawel Castle

text: During Poland's twenty years of independence after World War I, Polish authorities decided that the Wawel Castle was to be a representative building of the Polish Republic and would be used an official residence by the State Governor; this position was further re-enforced when, in 1921, the Polish Parliament passed a resolution which gave Wawel official status as the residence of the President of Poland. No legal acts have been issued by the independent Polish authorities redacting this resolution (apart from the decision of the Stalinist State National Council (KRN) to change the Wawel Castle into a museum).


title: Wawel Castle

text: In 1921 a statue of Tadeusz Kościuszko sculpted by Leandro Marconi and Antoni Popiel was placed on the ramparts of king Władysław IV Vasa on the northside.


title: Wawel Castle

text: In 1925, a column fragment of Wawel Castle was incorporated into Chicago's landmark Tribune Tower. Located in its own niche over the upper-left corner of the main entrance; it is a visual tribute to Chicago's large Polish populace, the largest such presence outside of the Republic of Poland.


title: Wawel Castle

text: The tradition of burying notable Polish national in the cathedral has continued into the 21st century: in 1927, the ashes of the romantic poet Juliusz Słowacki were brought to the cathedral, ten years later the statesman and former Leader of Second Polish Republic, Marshal Józef Piłsudski, was interred in a vault beneath the Silver Tower and in 1993 the remains of the World War II military leader Władysław Sikorski were finally returned to Poland for burial in the crypt. More recently, the bodies of President Lech Kaczyński and his wife were entombed in a sarcophagus, in the antechamber of the vault beneath the Silver Bell Tower.


title: Wawel Castle

text: During World War II, when Poland was occupied by Nazi Germany, the Wawel Castle was the residence of governor general Hans Frank, later to be executed as a German Nazi war criminal; during his despotic regime Raphael's "Portrait of a Young Man" (1513–14), part of the Czartoryski collection, was removed from Wawel and to this day has yet to be returned to Poland. Many of the tapestries have disappeared too, their whereabouts unknown; however, 150 of the tapestries which along with many of the Wawel's other treasures had spent the war years, for safety, in Canada have been returned to the castle and are, today, part of the Wawel Royal Castle National Art Collection on public display along with countless art treasures and items of historical Polish significance.


title: Wawel Castle

text: The 14th-century former Cathedral house, in the shadow of the Silver Bell Tower, between the Vasa Gate and the former Clerical Seminary, now houses the John Paul II Wawel Cathedral Museum. It was opened in 1978 by Karol Cardinal Wojtyła, Archbishop of Kraków (later Pope John Paul II), and displays many historic Polish artefacts both spiritual and temporal which were formerly kept in the cathedral's treasury.


title: Wawel Castle

text: The Crown Treasury situated in the historic Gothic rooms which were used from the 15th century on for storing the Polish coronation insignia and Crown Jewels, feature on display priceless objects from the former Treasury that survived plunder, among them the memorabilia of Polish monarchs including members of their families and eminent personages, like the hat and sword given to John III Sobieski by the pope after the Battle of Vienna, as well as the coronation sword Szczerbiec.


title: Wawel Castle

text: In February 2021, a unique 16th-century child armour belonging to Polish king Sigismund Augustus was officially returned to Poland by Hungary and it is now kept in the collections of the Wawel Castle. Since World War I it had been held in the Museum of Fine Arts in Budapest where it was transported by mistake.


title: AEW Battle of the Belts

text: AEW Battle of the Belts is an American series of professional wrestling television specials produced by All Elite Wrestling (AEW). It is broadcast on TNT in the United States. Only four episodes were originally planned to air quarterly throughout 2022 but expanded into 2023. The series was originally to air on Saturday nights, but the fourth episode aired on a Friday due to a scheduling conflict. The series premiered with a live episode on January 8, 2022. The fourth and most recent special aired on October 7, 2022.


title: AEW Battle of the Belts

text: As its name implies, all matches on the one-hour specials are contested for professional wrestling championships. Thus far, four of AEW's championships have been defended on the specials, as well as two championships from AEW's sister promotion Ring of Honor (ROH), and one unsanctioned championship. These include the AEW Women's World Championship, the AEW TNT Championship, the AEW TBS Championship, the AEW All-Atlantic Championship, the unsanctioned FTW Championship, the ROH World Championship, and the ROH World Tag Team Championship.


title: AEW Battle of the Belts

text: In May 2021, All Elite Wrestling (AEW) renegotiated its broadcasting deal with WarnerMedia which saw AEW's flagship television program, "Wednesday Night Dynamite", move from TNT to TBS in January 2022, while its other core program, "Friday Night Rampage", remained on TNT. Also as part of the deal, AEW agreed to produce four quarterly television specials on TNT that would take place on Saturdays. Former AEW executive and wrestler Cody Rhodes said that these specials would be similar to Jim Crockett Promotions/World Championship Wrestling's "Clash of the Champions" and WWE's "Saturday Night's Main Event" shows, calling them super events. Wrestling journalist Dave Meltzer reported that the quarterly specials would be one-hour shows, but said they were originally planned to be longer, and also that they would feature pay-per-view caliber cards.


title: AEW Battle of the Belts

text: On November 24, 2021, the television special series was announced to be titled "Battle of the Belts" with the inaugural event scheduled to be held live on January 8, 2022, at the Bojangles Coliseum in Charlotte, North Carolina. The tagline was confirmed as "Saturday Fight Night". The name "Battle of the Belts" comes from a National Wrestling Alliance event held from 1985 to 1987 by the promotion's Florida territory that was operated by Eddie Graham.


title: AEW Battle of the Belts

text: AEW President Tony Khan confirmed that due to the show's one-hour length, not all of AEW's championships would be defended on the specials, but their goal was to put on great championship matches. On the day of the inaugural event, Khan revealed that matches for the January 11 episode of their YouTube show, "Dark", were scheduled to be taped before the Battle of the Belts I live broadcast, with all other AEW champions participating in these "Dark" matches.


title: AEW Battle of the Belts

text: On February 15, 2022, AEW announced that Battle of the Belts II would be taped on April 15 at the Curtis Culwell Center in Garland, Texas. It aired on tape delay the next day on April 16. A month after Tony Khan's purchase of Ring of Honor (ROH), the ROH World Championship was scheduled to be defended at Battle of the Belts II. On June 1, 2022, Battle of the Belts III was announced to be taped on August 5 at the Van Andel Arena in Grand Rapids, Michigan, and it aired the following day on August 6.


title: AEW Battle of the Belts

text: On August 4, 2022, Battle of the Belts IV was announced to be held on Friday, October 7 at the Entertainment and Sports Arena in Washington, D.C. As "Battle of the Belts" was established as a Saturday night television special, it was expected that Battle of the Belts IV would air on tape delay the next day on October 8. However, due to WWE's Extreme Rules pay-per-view airing that night, Battle of the Belts IV was instead scheduled to air live on October 7 at 11 p.m. Eastern Time (ET) right after the live broadcast of "Rampage" to avoid counter programming against WWE. Due to its Friday scheduling, its tagline was changed to "Friday Fight Night". This was also the first "Battle of the Belts" episode to not include matches for either the AEW Women's World Championship or AEW TNT Championship, but it did include an ROH World Tag Team Championship match.


title: AEW Battle of the Belts

text: On November 2, 2022, it was announced that the "Battle of the Belts" series would continue with Battle of the Belts V scheduled to be held on Friday, January 6, 2023, at the Veterans Memorial Coliseum in Portland, Oregon.


title: AEW Battle of the Belts

text: Battle of the Belts I took place on January 8, 2022, at the Bojangles Coliseum in Charlotte, North Carolina. The event aired live at 8 p.m. ET. In the main event, Dr. Britt Baker, D.M.D. defeated Riho to retain the AEW Women's World Championship. On the undercard, Ricky Starks defeated Matt Sydal to retain the FTW Championship and in the opening bout, Sammy Guevara defeated Dustin Rhodes to become the interim AEW TNT Champion; Guevara was originally scheduled to face lineal champion Cody Rhodes for the title, however, Cody was pulled due to COVID-19-related issues.


title: AEW Battle of the Belts

text: Battle of the Belts II was taped on April 15, 2022, at the Curtis Culwell Center in Garland, Texas. It aired on tape delay the next day on April 16 at 8 p.m. ET. In the main event, Thunder Rosa retained the AEW Women's World Championship against Nyla Rose. On the undercard, Jonathan Gresham defeated Dalton Castle to retain the ROH World Championship and in the opening bout, Sammy Guevara defeated Scorpio Sky to win the AEW TNT Championship for a record-tying third time.


title: AEW Battle of the Belts

text: Battle of the Belts III was taped on August 5, 2022, at the Van Andel Arena in Grand Rapids, Michigan. It aired on tape delay the next day on August 6 at 8 p.m. ET. In the main event, Claudio Castagnoli retained the ROH World Championship against Konosuke Takeshita. On the undercard, Thunder Rosa defeated Jamie Hayter to retain the AEW Women's World Championship and in the opening bout, Wardlow defeated Jay Lethal to retain the AEW TNT Championship.


title: AEW Battle of the Belts

text: Battle of the Belts IV took place on October 7, 2022, at the Entertainment and Sports Arena in Washington, D.C. As "Battle of the Belts" was established as a Saturday night television special, it was expected that Battle of the Belts IV would air on tape delay the next day on October 8; however, to avoid counter programming against WWE's Extreme Rules pay-per-view that night, Battle of the Belts IV was scheduled to air live on Friday, October 7 at 11 p.m. ET immediately after the live broadcast of AEW's regular Friday program, "Rampage". In the main event, FTR (Cash Wheeler and Dax Harwood) defeated Gates of Agony (Toa Liona and Kaun) to retain the ROH World Tag Team Championship. On the undercard, Jade Cargill defeated Willow Nightingale to retain the AEW TBS Championship, and in the opening bout, Pac defeated Trent Beretta to retain the AEW All-Atlantic Championship.


title: Diamond cubic

text: The diamond cubic crystal structure is a repeating pattern of 8 atoms that certain materials may adopt as they solidify. While the first known example was diamond, other elements in group 14 also adopt this structure, including α-tin, the semiconductors silicon and germanium, and silicon–germanium alloys in any proportion. There are also crystals, such as the high-temperature form of cristobalite, which have a similar structure, with one kind of atom (such as silicon in cristobalite) at the positions of carbon atoms in diamond but with another kind of atom (such as oxygen) halfway between those (see ).


title: Diamond cubic

text: Although often called the diamond lattice, this structure is not a lattice in the technical sense of this word used in mathematics.


title: Diamond cubic

text: Diamond's cubic structure is in the Fdm space group (space group 227), which follows the face-centered cubic Bravais lattice. The lattice describes the repeat pattern; for diamond cubic crystals this lattice is "decorated" with a "motif" of two tetrahedrally bonded atoms in each primitive cell, separated by of the width of the unit cell in each dimension. The diamond lattice can be viewed as a pair of intersecting face-centered cubic lattices, with each separated by of the width of the unit cell in each dimension. Many compound semiconductors such as gallium arsenide, β-silicon carbide, and indium antimonide adopt the analogous zincblende structure, where each atom has nearest neighbors of an unlike element. Zincblende's space group is F3m, but many of its structural properties are quite similar to the diamond structure.


title: Diamond cubic

text: The atomic packing factor of the diamond cubic structure (the proportion of space that would be filled by spheres that are centered on the vertices of the structure and are as large as possible without overlapping) is ≈ 0.34, significantly smaller (indicating a less dense structure) than the packing factors for the face-centered and body-centered cubic lattices. Zincblende structures have higher packing factors than 0.34 depending on the relative sizes of their two component atoms.


title: Diamond cubic

text: The first-, second-, third-, fourth-, and fifth-nearest-neighbor distances in units of the cubic lattice constant are , , , 1 and , respectively.


title: Diamond cubic

text: Mathematically, the points of the diamond cubic structure can be given coordinates as a subset of a three-dimensional integer lattice by using a cubic unit cell four units across. With these coordinates, the points of the structure have coordinates ("x", "y", "z") satisfying the equations


title: Diamond cubic

text: All of the other points in the structure may be obtained by adding multiples of four to the "x", "y", and "z" coordinates of these eight points. Adjacent points in this structure are at distance apart in the integer lattice; the edges of the diamond structure lie along the body diagonals of the integer grid cubes. This structure may be scaled to a cubical unit cell that is some number "a" of units across by multiplying all coordinates by .


title: Diamond cubic

text: Alternatively, each point of the diamond cubic structure may be given by four-dimensional integer coordinates whose sum is either zero or one. Two points are adjacent in the diamond structure if and only if their four-dimensional coordinates differ by one in a single coordinate. The total difference in coordinate values between any two points (their four-dimensional Manhattan distance) gives the number of edges in the shortest path between them in the diamond structure. The four nearest neighbors of each point may be obtained, in this coordinate system, by adding one to each of the four coordinates, or by subtracting one from each of the four coordinates, accordingly as the coordinate sum is zero or one. These four-dimensional coordinates may be transformed into three-dimensional coordinates by the formula


title: Diamond cubic

text: Because the diamond structure forms a distance-preserving subset of the four-dimensional integer lattice, it is a partial cube.


title: Diamond cubic

text: Yet another coordinatization of the diamond cubic involves the removal of some of the edges from a three-dimensional grid graph. In this coordinatization, which has a distorted geometry from the standard diamond cubic structure but has the same topological structure, the vertices of the diamond cubic are represented by all possible 3d grid points and the edges of the diamond cubic are represented by a subset of the 3d grid edges.


title: Diamond cubic

text: The diamond cubic is sometimes called the "diamond lattice" but it is not, mathematically, a lattice: there is no translational symmetry that takes the point (0,0,0) into the point (3,3,3), for instance. However, it is still a highly symmetric structure: any incident pair of a vertex and edge can be transformed into any other incident pair by a congruence of Euclidean space. Moreover, the diamond crystal as a network in space has a strong isotropic property. Namely, for any two vertices "x" and "y" of the crystal net, and for any ordering of the edges adjacent to "x" and any ordering of the edges adjacent to "y", there is a net-preserving congruence taking "x" to "y" and each "x"-edge to the similarly ordered "y"-edge. Another (hypothetical) crystal with this property is the Laves graph (also called the K crystal, (10,3)-a, or the diamond twin).


title: Diamond cubic

text: The compressive strength and hardness of diamond and various other materials, such as boron nitride, (which has the closely related zincblende structure) is attributed to the diamond cubic structure.


title: Diamond cubic

text: Similarly, truss systems that follow the diamond cubic geometry have a high capacity to withstand compression, by minimizing the unbraced length of individual struts. The diamond cubic geometry has also been considered for the purpose of providing structural rigidity though structures composed of skeletal triangles, such as the octet truss, have been found to be more effective for this purpose.


title: Andrea Spendolini-Sirieix

text: Andrea Spendolini-Sirieix (; born 11 September 2004) is a British professional diver. In her breakthrough year of 2022, she became a World junior, two-time European senior, two-time Commonwealth Games and two-time national senior champion across 10 metre platform and 10 metre synchronised platform events, as well as a World senior medalist in the team event.


title: Andrea Spendolini-Sirieix

text: She made her international debut in 2018 as a thirteen year old, and won her first solo international gold medal at the 2020 FINA Diving Grand Prix. Later that year Spendolini-Sirieix was recognised as the BBC Young Sports Personality of the Year. She won the gold for the women's individual 10 metre platform at her first Commonwealth Games, in 2022, the first English woman to win the event since 1966. Two weeks later, she became European Champion in the same event, representing Great Britain. Sirieix went on to win a further gold at each event in the synchronised discipline; in the women's event at the European Championships with Lois Toulson, and at the 10 metre mixed synchro event at the 2022 Commonwealth Games with Noah Williams.


title: Andrea Spendolini-Sirieix

text: Andrea Spendolini-Sirieix was born in London on 11 September 2004, the daughter of French hotel host Fred Sirieix and his ex-wife Italian Alex Spendolini.


title: Andrea Spendolini-Sirieix

text: At the British Diving Championships in 2018, Spendolini-Sirieix and her colleague from Crystal Palace Diving Club, Josie Zillig, won the women's 10m synchronised diving event, completing five dives as the only entrants. The following year, partnering Emily Martin, she won Women's synchronised diving competition at the Junior European Championships in Kazan.


title: Andrea Spendolini-Sirieix

text: Spendolini-Sirieix won a solo gold at the British Diving Championships in the Women's 10m Platform competition in 2020, and a few weeks later won her first international gold medal at the FINA Grand Prix in Rostock in February 2020. Having been in second place during the first four rounds in Rostock, she achieved a score of 76.80 on her final dive to win with a total of 330.50, ahead of Celina Toth who scored a total of 329.35.


title: Andrea Spendolini-Sirieix

text: Spendolini-Sirieix earned her place as the youngest member of the Team GB diving team at Tokyo 2020 after a string of eye-catching performances over the previous two years, including two medals at the 2021 European Championships. In Tokyo, aged only 16, Andrea went through the rounds and reached the Olympic final in the Women's 10m Platform, ultimately finishing seventh.


title: Andrea Spendolini-Sirieix

text: In May 2021, Spendolini-Sirieix and Noah Williams won a silver medal in the 10m mixed synchro event at the 2020 European Aquatics Championships. She also won a bronze in individual 10m platform at the Championships.


title: Andrea Spendolini-Sirieix

text: In August 2022, she won two gold medals, in the Women's 10m platform and the Mixed Pairs Synchronised 10m platform with Noah Williams, and a silver medal, in the Women's Synchronised 10m platform with Eden Cheng, at the Commonwealth Games in Birmingham.


title: Harjit Sajjan

text: Harjit Singh Sajjan (, ; born September 6, 1970) is a Canadian politician who has served as the minister of international development since October 26, 2021. A member of the Liberal Party, Sajjan represents the British Columbia (BC) riding of Vancouver South in the House of Commons, taking office as member of Parliament (MP) following the 2015 election. Sajjan served as the minister of national defence from 2015 to 2021. Before his entry into politics, Sajjan worked as a detective in the Vancouver Police Department and was a lieutenant-colonel in the Canadian Army. He is Canada's first Sikh minister of national defence, and was also the first Sikh Canadian to command a Canadian Army reserve regiment.


title: Harjit Sajjan

text: Sajjan was born on September 6, 1970, in Bombeli, a village in the Hoshiarpur district of Punjab, India. His father, Kundan Sajjan, was a head constable with the Punjab Police in India, and is currently a member of the World Sikh Organization (WSO), a Sikh advocacy group. Sajjan, along with his mother and older sister, immigrated to Canada in 1976, when he was five years old, to join their father who had left for BC two years earlier to work at a sawmill. While the family was getting established in their new life in Canada, his mother worked on berry farms in BC Lower Mainland during the summer where Sajjan and his sister would frequently join her. Harjit Singh grew up in South Vancouver.


title: Harjit Sajjan

text: Sajjan married Kuljit Kaur, a family physician in 1996, and they have a son and a daughter, Arjun and Jeevut.


title: Harjit Sajjan

text: Sajjan was baptized as a Sikh when he was a teenager, seeing it as a way to get away from a bad crowd, such as his classmate Bindy Johal.


title: Harjit Sajjan

text: Sajjan joined The British Columbia Regiment (Duke of Connaught's Own) in 1989 as a trooper and was commissioned as an officer in 1991. He eventually rose to the rank of lieutenant-colonel. He deployed overseas four times in the course of his career: once to Bosnia and Herzegovina, and three times to Afghanistan. Sajjan began his 11-year career as an officer of the Vancouver Police Department after returning from his Bosnian deployment. He ended his career with the Vancouver Police Department as a detective with the department's gang crimes unit specializing in drug trafficking and organized-crime investigation.


title: Harjit Sajjan

text: Sajjan's first deployment to Afghanistan was shortly before the start of Operation Medusa in 2006, during which he took leave from his work in the Vancouver Police Department's gang squad. He deployed with the 1st Battalion, Royal Canadian Regiment Battle Group in Kandahar and worked as a liaison officer with the Afghan police. Sajjan found that corruption in the Afghan government was driving recruitment to the Taliban. After reporting these findings to Brigadier General David Fraser, Sajjan was tasked with helping the general plan aspects of Operation Medusa.


title: Harjit Sajjan

text: Fraser evaluated Sajjan's leadership during the operation as "nothing short of brilliant". When Sajjan returned to Vancouver, Fraser sent a letter to the police department which called Sajjan "the best single Canadian intelligence asset in theatre", stated that his work saved "a multitude of coalition lives", and noted that the Canadian Forces should "seek his advice on how to change our entire tactical intelligence training and architecture". Sajjan was mentioned in dispatches for the usefulness of his tactical counterinsurgency knowledge in the planning and implementation of an unnamed operation in September 2006 to secure important terrain.


title: Harjit Sajjan

text: Upon his return, Sajjan left his position with the Vancouver police, but stayed as a reservist and started his own consulting business that taught intelligence gathering techniques to Canadian and American military personnel. He also consulted for US policy analyst and Afghanistan expert Barnett Rubin, which began as a correspondence over Sajjan's views on how to tackle the Afghan opium trade and evolved into a collaboration as advisers to American military and diplomatic leaders in Afghanistan.


title: Harjit Sajjan

text: Sajjan returned to Afghanistan for another tour of duty in 2009, taking another tour of leave from the Vancouver Police Department to do so. Having already taken two leaves of absence, Sajjan had to leave the Vancouver Police Department for his third tour of duty in 2010, during which he was assigned as a special assistant to then Major-General James L. Terry, the commander of American forces in Afghanistan.


title: Harjit Sajjan

text: In 2011, he became the first Sikh to command a Canadian Army reserve regiment when he was named commander of The British Columbia Regiment (Duke of Connaught's Own).


title: Harjit Sajjan

text: He was bestowed with the Meritorious Service Medal in 2012 for diluting the Taliban's influence in Kandahar Province. He has also been awarded the Canadian Peacekeeping Service Medal, the Order of Military Merit award, and served as Aide-de-Camp to the lieutenant governor of British Columbia.


title: Harjit Sajjan

text: His Sikh beliefs require him to keep his facial hair which prevents the use of regular military gas masks, so Sajjan invented his own gas mask that worked with his beard, and patented it in 1996.


title: Harjit Sajjan

text: Sajjan was elected for the riding of Vancouver South during the 2015 federal election, defeating Conservative incumbent Wai Young. Sajjan was appointed minister of national defence in the federal Cabinet, headed by Justin Trudeau, on November 4, 2015. He was also briefly acting minister of veterans affairs in February 2019 following the resignation of Jody Wilson-Raybould, until the appointment of Lawrence MacAulay to the portfolio.


title: Harjit Sajjan

text: His alleged links with the Khalistan movement have caused diplomatic friction with Punjab's former chief minister, Amarinder Singh. Harjit Sajjan also has faced allegations from New Democratic Party (NDP) that he is "playing down his connections to the detainee controversy during the [Afghanistan] combat mission [Medusa], where Canadians handed over prisoners to torture by Afghan authorities."


title: Harjit Sajjan

text: In September 2019, Sajjan attended an event that was held to celebrate the 70th anniversary of the founding of the People's Republic of China, for which he was subsequently criticized by the Conservatives. A spokesperson for Sajjan said that he appeared in his capacity as a candidate for his riding and did not stay for long.


title: Harjit Sajjan

text: In an April 2017 public speech in New Delhi, Sajjan called himself "the architect" of Operation Medusa, a September 2006 Canadian offensive to remove Taliban fighters from around Kandahar. In July 2015, Sajjan had made the same claim during an episode of the BC program "Conversations That Matter", stating that General Jonathan Vance, the chief of the defence staff at the time the story broke in 2017, saw him as "the architect" in the 2006 offensive. At the time of Operation Medusa, Sajjan was a major in the Canadian Army reserve and a liaison officer to Task Force Kandahar, where large combat operations such as Medusa were usually worked upon by generals and colonels.


title: Harjit Sajjan

text: One of the anonymous officers cited in the "National Post", which first broke the story, called Sajjan's statement "a bald-faced lie", while others praised him on a personal level and for his expert intelligence work, but found his claim "really, quite outrageous" because the planning for Operation Medusa was collaborative. Canadian historian Jack Granatstein said that Sajjan was a skilled intelligence officer who would have presented important intelligence in the leadup to the operation, but that he "certainly wouldn't have been the chief planner". Granatstein said that while the mistake was not one that was worth resigning over, it would still hurt his relationship with the military. In an interview on AM640, Christopher Vernon, a British officer who served as chief of staff for NATO forces in Southern Afghanistan at Kandahar during Medusa, said that Sajjan's role in the planning was "more than integral" and that Sajjan was a "pivotal player" in the operation. Vernon noted that Sajjan had worked "hand-in-glove" with the Australian lieutenant colonel who was the lead planner and that without Sajjan's intelligence work, the operation would not have happened. Brigadier-General David Fraser had also extensively praised the indispensable nature of Sajjan's role in Operation Medusa.


title: Harjit Sajjan

text: Sajjan issued apologies in which he apologized to members of the Canadian Forces, the United States Armed Forces, and the Afghan Armed Forces in the operation, and noted that the successes of Operation Medusa were due to the contributions of all members of the Canadian Forces who were involved. Sajjan also acknowledged that describing himself as "the architect" was a mistake, and highlighted the role of Brigadier-General David Fraser in leading the team that planned the operation.


title: Harjit Sajjan

text: Sajjan was supported by Justin Trudeau amidst calls from the opposition for him to resign. A failed vote of no confidence in Sajjan was put forth by the Conservative Party of Canada in the House of Commons.


title: Harjit Sajjan

text: Sajjan was moved from minister of defence to minister of international development in an October 2021 cabinet reshuffle.


title: Interventional radiology

text: Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement (e.g., stents), and angioplasty of narrowed structures.


title: Interventional radiology

text: The main benefits of interventional radiology techniques are that they can reach the deep structures of the body through a body orifice or tiny incision using small needles and wires. That decreases risks, pain, and recovery compared to open procedures. Real-time visualization also allows precision guidance to the abnormality, making the procedure or diagnosis more accurate. These benefits are weighed against the additional risks of lack of immediate access to internal structures (should bleeding or a perforation occur), and the risks of radiation exposure such as cataracts and cancer.


title: Interventional radiology

text: Interventional radiology is a set of techniques that allows access to the internal structures of the body through body orifices or very small incisions and guidance with medical imaging. Regardless of the reason for the intervention, the procedure will likely use common elements such as a puncture needle (to pass through the skin), guidewires (to guide through structures such as blood vessels or the biliary or urinary systems), a sheath (which slides over the guidewire and hold the path open without injuring it), and catheters (that allow fluids to be pushed through them).


title: Interventional radiology

text: Also common to all intervention radiology procedures are the medical imaging machines that allow the healthcare provider to see what is occurring within the body. Some use x-rays (such as CT and fluoroscopy) and some do not (such as ultrasound and MRI). In each case, the images created may be modified by computer to better visualize the structures as is in the case with digital subtraction angiography, CT and MRI, or the display of the images improved with virtual reality or augmented reality presentation.


title: Interventional radiology

text: The treatment of gastrointestinal hemorrhage can range anywhere from monitoring an asymptomatic bleed to supporting and maintaining the hemodynamic function of the patient. The role for the interventional radiologist is to offer patients an image-guided, minimally invasive procedure to alleviate a condition that could be otherwise be potentially life-threatening.


title: Interventional radiology

text: The avenue for the interventional radiologist to dictate the clinical course of a GI bleed is largely influenced by location of bleed, overall patient health and other conditions the patient may have, most notably heart and liver functions. For most cases, collaboration between the gastroenterologist and interventional radiologist optimizes patient outcome but again, is largely dictated by anatomical location of the GI bleed. If a patient is evaluated and determined to be a candidate for an interventional procedure, then the bleed is often treated by embolization. Embolization is a process in which the interventional radiologist accesses the culprit bleeding vessel via a small catheter and interrupts blood flow to the site of bleeding via various mechanisms. Side effects of this procedure are minimal but there is a risk of bleeding and infection—though much less than the equivalent surgical procedure. When successful, the procedure often eliminates the bleed and patients can walk after a few hours of rest.


title: Interventional radiology

text: A transjugular intrahepatic portosystemic shunt (TIPS) is a procedure an interventional radiologist performs to create a shunt (essentially, a new conduit allowing for blood flow) between the hepatic inferior vena cava and the portal vein, a vessel that returns blood from the intestines to the liver. The portal vein is the site where hypertension (high blood pressure) can produce a myriad of deleterious effects throughout the liver and small or large intestine.


title: Interventional radiology

text: Primarily, a TIPS functions to alleviate two different conditions: an emergent/life-threatening GI bleed or ascites (excessive abdominal fluid) caused by too high of blood pressure in the portal vein that is otherwise uncontrolled by diet and medications.


title: Interventional radiology

text: The workup for the procedure is straightforward and the interventional radiologist performing the procedure often orders several tests to assess how well the patient will tolerate the procedure. These are often simple blood tests, and an ultrasound of the heart and liver. The procedure is often well tolerated and can result in a permanent reduction or elimination of symptoms. The procedure can take anywhere between 15 minutes to an hour and has lower risks of bleeding or infection compared to an equivalent surgical procedure.


title: Interventional radiology

text: A TIPS may cause temporary confusion or worsening of liver/heart function. The degree of these two side effects largely depend on the health of the patient's heart and liver prior to the procedure and the risk-benefits of the procedure must be thoroughly discussed with their interventional radiologist before beginning. If the post-procedural consequences are more troublesome to the patient than their initial symptoms the artificial conduit created by the procedure can be reversed if the post-procedural side effects outweigh those caused by the prior conditions.


title: Interventional radiology

text: In addition to normal liver tissue, the liver has three main vessels traversing it: arteries, veins and bile ducts. While bile is made in the liver and stored in the gallbladder, the bile eventually passes into the GI tract through the hepatic, cystic and common bile ducts. Any condition that prevents the normal flow of bile from the liver, through these bile vessels and into the GI tract can cause a condition called jaundice.


title: Interventional radiology

text: While jaundice can be caused by a few viruses that the human body can naturally clear, jaundice in the setting of an obstruction is usually caused by a cancer and can result in intolerable itching and a worsening of liver function that can be life-threatening. Depending on a patient's condition, this type of obstructive jaundice can be alleviated with surgery or chemotherapy but if these measures fail to restore proper flow of bile, an interventional radiologist can perform a procedure called a percutaneous transhepatic cholangiography (PTC).


title: Interventional radiology

text: A PTC is an outpatient procedure lasting anywhere from 15 minutes to an hour where an interventional radiologist accesses the patient's bile duct system with a needle through the skin and liver under imaging guidance. Using fluoroscopy (essentially an Xray camera) to guide a wire (followed by a catheter over the wire) through the bile duct system and into the GI tract, essentially restoring the normal flow of bile. If the patient's GI tract cannot be accessed due to the obstruction, the catheter can be placed to drain the bile duct system into a bag that the patient can wear during daily activities. Risks of this procedure include bleeding and infection but these are much lower than an equivalent surgical procedure.


title: Interventional radiology

text: Benign prostatic hyperplasia, or BPH, is a noncancerous condition that commonly affects men over the age of 50. The prostate gland enlarges and compresses the adjacent urethra, making it difficult for men to control frequency and/or urgency of urination. First line therapy involves medication, though long-term treatment for symptoms that are persistent despite medical optimization typically involves transurethral resection of the prostate (TURP) as the "gold standard" of care. However, TURP can lead to urinary incontinence or permanent male infertility and may not be the ideal procedure for a certain subset of patients. For those reasons, a physician may recommend undergoing a treatment known as prostate artery embolization (PAE).


title: Interventional radiology

text: Patients typically go home the same day as the procedure and can expect to feel some symptom relief in a matter of days. Though rare, risks of PAE include unintentional embolization of nearby blood vessels, which can result in loss of blood flow to surrounding areas of the bladder or rectum.


title: Interventional radiology

text: Data suggests that TURP may have higher rates of symptom resolution at 1 and 6 months, but PAE appears to provide lower risks of complications more commonly associated with surgery, such as infection.


title: Interventional radiology

text: Kidney stones can be present along any part of the course of the urinary tract from the kidneys to the urethra. The most common symptoms, whether in men or women, are sudden onset, intense flank pain accompanied by blood in the urine. Most kidney stones pass spontaneously, but larger ones (greater than 5 mm) are less likely to, and can cause severe pain or infection.


title: Interventional radiology

text: The interventional radiologist plays a large clinical role in the treatment of kidney stones that are unlikely to pass on their own. The gold standard of treatment for these types of stones is surgical removal. However, some patients have an infected stone and are simply too ill for an operative surgical removal. In these instances, the mainstay of IR treatment is a percutaneous nephrostomy tube. This is a procedure where a small caliber catheter is placed through the skin and into the urinary collecting system upstream of the stone. This procedure not only drains any infection, often bringing about a precipitous improvement in the patient's symptoms but also diverts urine—thus giving the patient more time to recover before definitive surgical treatment.


title: Interventional radiology

text: A varicocele is defined as an enlargement of the veins within the scrotum, most commonly occurring on the left side due to anatomical reasons. When this happens, blood can stagnate within these dilated veins and cause temperature fluctuations within the testicle itself. The exact cause to this condition remains unknown and an ill-favored sequela can be male infertility.


title: Interventional radiology

text: The mainstay of treatment for this condition within the field of interventional radiology is varicocele embolization. An embolization, within the context of this procedure, results in the interruption of venous blood flow. The interruption of blood flow abates venous dilation of blood that can lead to impaired testicular temperature regulation and theoretically improve infertility. The physician accesses the dilated scrotal veins with a small catheter via a vein in the groin and embolize the varicocele. Patients often tolerate this procedure well and are able to return home the same day.


title: Interventional radiology

text: About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked. A clot-busting medication such as tissue plasminogen activator (t-PA) can be used in a controlled hospital setting to dissolve the clot and help restore blood flow to the damaged area of the brain. Certain patients with an acute ischemic stroke may be candidates for endovascular therapy. Endovascular therapy is a procedure performed by neurointerventionalists to remove or dissolve the thrombus (clot) and restore blood flow to parts of the brain. Using a catheter that is directed through the blood vessels in the arm or leg up to the brain, the interventionalist can remove the thrombus or deliver drugs to dissolve the thrombus. These procedures are referred to as mechanical thrombectomy or thrombolysis, and several factors are considered before the procedure is completed.


title: Interventional radiology

text: People who may be eligible for endovascular treatment have a "large vessel occlusion", which means the thrombus is in an artery that is large enough to reach and there are no contraindications such as, a hemorrhagic stroke (bleeding in the brain), greater than six hours since onset of symptoms, or greater than 24 hours in special cases. Hospitals with comprehensive stroke centers are equipped to treat patients with endovascular care.


title: Interventional radiology

text: Long-term care after an ischemic stroke is focused on rehabilitation and preventing future blood clots using anticoagulant therapy. Patients work with specialists from fields such as physical therapy, occupational therapy, and speech therapy to complete recovery.


title: Interventional radiology

text: Although there are no clearly defined recommendations on treatment of asymptomatic aneurysms, all symptomatic unruptured brain aneurysms should be treated. Endovascular therapy is an effective treatment for select cases. During this treatment, an interventional radiologist inserts a catheter into the patient's leg and uses it to guide a coil through blood vessels to the site of the aneurysm. The coil induces clotting within the aneurysm, which reduces the risk of rupture. Multiple coils may be used depending on the size. Imaging studies (DSA, CTA, or MRA) help characterize the aneurysm to decide the best course of treatment, whether endovascular coiling or surgical clipping. Endovascular coiling is associated with a reduction in procedural morbidity and mortality over surgical. For cases of ruptured aneurysms, emergent treatment is based on the type of aneurysm, and may use a combination of techniques. Conservative therapy focuses on minimizing modifiable risk factors with blood pressure control and smoking cessation.


title: Interventional radiology

text: Arteriovenous malformations (AVMs) are abnormal blood vessel structures in which an artery connects to a vein via an abnormal channel. This creates a high flow system that puts the vessel at risk of rupture. Ruptured AVMs require emergency management of the patient; unruptured AVMs require expert consultation to discuss the risks and benefits of treatment. Current treatment options include conservative management, surgical resection, stereotactic radiosurgery, endovascular embolization, or combinations of these treatments. Endovascular embolization is a technique used by neurointerventionalists in which particles, glue, or coils are lodged inside the AVM to prevent blood flow through the abnormal channel. During this treatment, an interventional radiologist guides a catheter through a blood vessel accessed from the patient's leg to the site of the AVM. The particles, glue, or coils induce clotting within the malformation, which reduces the risk of rupture.


title: Interventional radiology

text: Utilizing image guidance, local anesthetics and/or long-acting steroid medications can be directly delivered to localized sites of pain. The use of image guidance helps to confirm appropriate needle placement. This includes common imaging modalities used in joint injections: ultrasound, fluoroscopy and computerized tomography (CT).


title: Interventional radiology

text: Vertebral augmentation, which includes vertebroplasty and kyphoplasty, are similar spinal procedures in which bone cement is injected through a small hole in the skin into a fractured vertebra to try to relieve back pain caused by a vertebral compression fractures. It was found ineffective in treating osteoporosis-related compression fractures of the spine. The people in both the experimental and placebo groups reported improvement in their pain, suggesting that the benefit is related to the placebo effect. , routine use is thus not recommended.


title: Interventional radiology

text: Interventional oncology (IO) procedures are commonly applied to treat primary or metastatic cancer. IO treatments may be also offered in combination with surgery, systemic chemotherapy/immunotherapy, and radiation therapy to augment the therapeutic outcome. A variety of interventional oncological treatments for tumors arise:


title: Interventional radiology

text: Vascular Disease refers to disorders of the vasculature or circulatory system, most commonly involving the arteries, veins and lymphatics. The symptoms related to vascular disease can range from asymptomatic, bothersome symptoms or limb and/or life-threatening conditions.


title: Interventional radiology

text: Vascular and Interventional Radiologists are at the forefront of treating a wide variety of vascular diseases.


title: Interventional radiology

text: Since its development by Charles Dotter when he did a percutaneous peripheral vascular revascularization procedure for the first time on January 16, 1964, on Laura Shaw, Vascular & Interventional Radiology (commonly Interventional Radiology or IR) distinguished itself from earlier approaches to vascular disease by the use of medical imaging to guide endovascular therapies (fixing this from inside the vessel). The Seldinger technique is the basic principle that underlies endovascular procedures. Briefly, this involves using a needle to puncture a target vessel, then using a series of small medical guidewires and catheters to pass various tools inside for treatment. When these minimally-invasive techniques can be used, patients avoid the need for larger surgical exposure to treat diseased vessels. Though numerous factors can affect patient's post-operative course, in general an endovascular approach is associated with a more rapid recovery time compared to a traditional open vascular surgery.


title: Interventional radiology

text: Over the past few decades, many endovascular procedures have been developed and refined. Numerous tools are at the disposal of modern Vascular and Interventional Radiologists to perform these procedures, and developing new tools is a burgeoning focus of international research.


title: Interventional radiology

text: While some interventional radiology endovascular procedures are highly specialized, a few standard techniques apply to most:


title: Interventional radiology

text: Arteries are the component of the circulatory system that carry oxygenated blood away from the heart to the vital organs and extremities. Arteries have relatively thick, muscular walls, composed of multiple layers, because they transport freshly oxygenated blood through the body at relatively high pressures. Arterial diseases can affect one or multiple layers of the artery wall.


title: Interventional radiology

text: The aorta is the largest artery in the body, and the major aortic branches continue to divide multiple times, giving way to smaller arteries, muscular arterioles and thin-walled capillaries. In contrast to arteries, capillaries have thin single-layered walls, so oxygen and nutrients can be exchanged with tissues in capillary beds before the de-oxygenated blood is carried away by the venous system.


title: Interventional radiology

text: Perfusion refers to the flow of oxygen and nutrient rich blood into the capillary beds of the muscles and organs, this is critical for their function. The lack of adequate perfusion is referred to as ischemia and is typically the cause of symptoms related to vascular disease. The goal of revascularization therapies, whether endovascular or surgical, is to re-establish or optimize perfusion and stop ischemia.


title: Interventional radiology

text: Atherosclerosis refers to a progressive narrowing of the arteries due to atheroma, derived from the Greek word for gruel or porridge. Atheromatous plaque is a mixture of fat and inflammatory debris that sticks to the inner walls of an artery. Plaque can be soft or become firm as it accrues layers of calcium, a byproduct of chronic inflammation. Atherosclerosis has no single cause but many recognized risk factors. Some risk factors are modifiable, and others are not. Age and genetic predispositions are an example of "non-modifiable" risk factors. Medical management of atherosclerosis aims to address the many other known "modifiable" risk factors, such as smoking, diet, exercise as well as blood sugar levels in patients with diabetes. Using medications to control blood pressure and cholesterol have also been shown beneficial.


title: Interventional radiology

text: Atherosclerosis is described, evaluated, and treated differently depending on the affected artery, as described below. However, multiple studies have shown strong correlations between the different types of atherosclerosis. In particular, patients with Peripheral Arterial Disease have an increased risk of Coronary Artery Disease, and severe Peripheral Artery Disease symptoms can be a predictor of cardiac related mortality. The majority of patients begin to develop symptoms from ischemia around middle age, even though vessel narrowing can develop silently and slowly over decades. Unfortunately, sudden cardiac death or stroke can be a patient's first sign of vascular disease. Therefore, controlling risk factors is crucial in those with known atherosclerosis to prevent progression of disease, and screening is recommended by some Vascular Disease Specialists for those at increased risk, such as those with diabetes, smoking or a strong family history of cardiovascular disease.


title: Interventional radiology

text: Screening tests typically use the non invasive evaluation called the Ankle-Brachial Index, which compares the blood pressure between the arm and the ankle. This can help detect narrowing in the major vessels of the chest, abdomen, pelvis, and legs. CT scans of the heart with evaluations of coronary artery calcium are also used in some instances to stratify risk of coronary artery disease.


title: Interventional radiology

text: Historically, open vascular surgical approaches were required for all critically advanced atherosclerotic disease. An endarterectomy is a large operation, where blood flow is temporarily stopped using clamps, the vessel is cut open, the plaque removed and then the vessel resealed. If an occlusion is too dense or complex, a bypass could also be performed, where two segments of vessel are bridged by an additional vein or synthetic graft.


title: Interventional radiology

text: Modern endovascular approaches to treating atherosclerosis can include combinations of angioplasty, stenting, and atherectomy (removal of plaque).


title: Interventional radiology

text: There are several systems for staging PAD, but an often used scale is the revised Rutherford classification. Plaque and blood flow can be evaluated using ultrasound, CT angiography, MR angiography, and catheter-based angiography to establish anatomic segments of disease. The severity of ischemia can be evaluated by correlating symptoms and non-invasive physiologic vascular studies including toe pressures, TCPO2, and skin perfusion studies.


title: Interventional radiology

text: Certain monitored exercises, such as walking regimens, have been shown to significantly improve walking distance especially when used consistently for at least 6 months. When medical management fails, vascular interventional radiologists can attempt to restore blood flow to extremities using angioplasty and stenting. Sometimes repeat interventions are required. The goal of therapy is to maintain perfusion, avoid amputation and preserve the limb structure and function.


title: Interventional radiology

text: Aneurysm refers to pathologic dilation of an artery to greater than 1.5 times its normal size. True vascular aneurysms are due to degenerative processes in the wall of the artery. Aneurysms can be solitary or multiple and are sometimes found in association with various clinical syndromes, including forms of vasculitis or connective tissue diseases. Aneurysms are typically classified by major shapes, either fusiform (tubular) or saccular (eccentric). Ectasia is another broad term for an enlarged vessel, but is not necessarily pathological. Rupture is a dreaded complication of aneurysms that can lead to extensive, difficult to control bleeding. Aneurysms can also clot, or thrombose, and rapidly occlude the involved vessel, leading to acute distal ischemia.


title: Interventional radiology

text: A variety of endovascular grafts are available, and each has advantages and disadvantages depending on the characteristics of the aneurysm and patient.


title: Interventional radiology

text: Dissection refers to a tear in the inner layer of the arterial wall. Blood pumps into this defect and dissects its way between the layers in the wall of an artery, creating a false channel separate from the true arterial lumen. Dissections can develop due to trauma, spontaneously due to high blood pressure and native vascular disease, or in some cases as a complication of prior surgical or endovascular treatment.


title: Interventional radiology

text: When an arterial dissection expands, it can restrict normal flow through the affected artery or potentially block the origin of a branch vessel- this can compromise distal perfusion in either case. When acute and symptomatic, this is an emergency that requires prompt treatment.


title: Interventional radiology

text: However, as medical imaging has improved, chronic, asymptomatic dissections have also been discovered, and in some cases these may be safely managed with blood pressure control, follow-up imaging and proper counseling for the warning signs of potential ischemia.


title: Interventional radiology

text: Dissections can occur in any artery and are named for their vessel of origin. Aortic dissections can be further classified and treated depending on whether they involve the thoracic aorta, the abdominal aorta or both. Classic pain related to acute aortic dissections is described as "tearing" or "ripping" and possibly radiating to a patient's back. Acute aortic dissection can be difficult to diagnose but is more common than aortic aneurysm rupture.


title: Interventional radiology

text: Thoracic aortic dissections are further characterized with the Stanford classification. Type A dissections involve the root and ascending aorta. These require prompt treatment, which currently is mostly surgical in nature. Type B dissections begin in the distal aortic arch beyond the left subclavian artery origin, and may often be addressed with pain medication and blood pressure control. If the type B aortic dissection results in poor circulation to the intestines, kidneys or legs it often requires urgent endovascular repair with endografts and/or fenestrations. If a type B aortic dissection has ruptured, or has features that indicate impending rupture, they are urgently repaired too.


title: Interventional radiology

text: Dissections can also arise in virtually any other artery. Carotid artery dissection, for example, places patients at increased risk for stroke and may extend further into the blood vessels within the brain. Vertebral artery dissection are less common but also dangerous for similar reasons. Mesenteric artery dissection may limit the blood supply to the intestines. Renal artery dissections can decrease blood flow to the kidneys and contribute to hypertension. Peripheral arterial dissections can be found elsewhere in the arms and legs. These dissections can occur primarily due to focal traumas, underlying vascular disease, or as an extension of a larger, complex aortic dissection that tears further into these smaller branches.


title: Interventional radiology

text: Treatment of dissections depends on several factors, including the location, extent, how long it has been developing (acute or chronic) and whether it is limiting perfusion. Surgical approaches to dissections can include reconstructing the aorta, surgical bypass and surgical fenestration. Like other arterial disorders, endovascular approaches to dissection such as stent-grafting and percutaneous fenestration can be utilized, either primarily or in combination with surgery depending on the complexity of the dissection.


title: Interventional radiology

text: Penetrating aortic ulcer (PAU) is an advanced focal form atherosclerosis, most often encountered in the aorta. It starts as a small plaque in the inner-most layer of the aorta called the intima, but the inflammatory process ulcerates and penetrates through this layer into the media. While PAU is considered a distinct entity, many think this is a precursor lesion to dissection or aneurysm. Along with intramural hematoma, aneurysm and dissection, PAU is recognized as one of several acute aortic syndromes — a spectrum of related conditions correlated to potential aortic rupture. They thus have a high potential morbidity and mortality, and should at least be followed closely.


title: Interventional radiology

text: Acute or active bleeding can occur throughout the human body due to a variety of causes. Interventional radiologists can address bleeding with embolization, usually with small plastic particles, glues or coils. Traumatic rupture of a blood vessel, for example, may be addressed this way if a patient is at risk of fatal bleeding. This has revolutionized medicine and interventional radiologists commonly treat refractory nose bleeds, excessive coughing of blood, intestinal bleeding, post-pregnancy bleeding, spontaneous intra-abdominal on intra-thoracic bleeding, bleeding related to trauma and post-surgical bleeding. In some instances where severe bleeding is anticipated, such as in complex surgery or the excision of a highly vascular tumor, interventional radiologists may embolize certain target blood vessels prior to the operation to prevent major blood loss.


title: Interventional radiology

text: Transplant organs rely on healthy blood supply to survive. In some instances, the arteries that feed a transplant may narrow, typically where the donor vessel is sewn to the recipient. Interventional radiologists evaluate the blood supply of these patient's and may use balloons or stents to open narrowed vessels and keep the transplant organ functional.


title: Interventional radiology

text: The veins of the human body are responsible for returning de-oxygenated blood back to the heart. Like a rock rolling down a hill, blood flows from the highest pressure (the blood in the aorta) to the lower venous pressure (the blood in the vena cava as it empties back to the heart.) Unlike arteries, veins are thin walled and distensible, allowing them to accommodate large volumes of blood without significant changes in pressure. In fact, the venous system is so low pressure that veins have valves to keep blood from flowing backward. The motion of the human body helps pump blood through the veins- squeezing leg muscles while walking, for instance, helps push venous blood back up to the heart against the pull of gravity. Unfortunately, without this extra push some blood can sit stagnant in veins, leading to a multitude of clinical problems. The largest vein in the body is the vena cava. The superior vena cava (SVC) drains blood from the top half of the body while the inferior vena cava (IVC) drains blood from below the diaphragm. Elsewhere in the body, veins can be categorized into superficial, primarily associated with the skin and soft tissues, or deep veins, which drain muscles and organs.


title: Interventional radiology

text: Chronic kidney disease (CKD or chronic renal disease) is a condition in which there is a progressive loss of kidney function. It has numerous recognized causes and risk factors. CKD affects approximately 14% of the world population, and over 600,000 people in the United States alone. There are five recognized stages of CKD, the fifth stage is also called end-stage renal disease (ESRD) and invariably requires some form of renal replacement therapy.


title: Interventional radiology

text: Around the turn of the 20th century, breakthroughs in our understanding of renal physiology led many to believe that dialysis using artificial kidneys was a potential cure for renal disease. Over 100 years later, the only available curative, renal replacement therapy for CKD is kidney transplantation. However, many patients can live for decades utilizing dialysis.


title: Interventional radiology

text: Dialyzer technology initially outpaced the ability of clinicians to apply it to patients. In the 1920s, the first dialysis catheter was created using thin fragile glass tubes. Early methods required surgical incision to reach large vessels, which carried a large risk of major bleeding. The first somewhat permanent, reliable dialysis access, the Scribner Teflon Shunt, was invented nearly 40 years later and allowed a patient with kidney failure to survive 11 more years. As medicine and surgery have grown more sophisticated, more patients now live with chronic renal disease than ever before. The most common type of dialysis in the United States is hemodialysis, which can be performed through several types of vascular access. The arteriovenous fistula (AVF) is the preferred method. Arteriovenous fistula are created surgically by directly connecting an artery and a vein, most commonly in the arm. An arteriovenous graft (AVG) relies on the same principle but bridges the gap between the artery and vein with a medical-grade prosthetic shunt. Over time, altered flow mechanics can result in changes within the involved vessels. Vascular narrowing, thrombosis, aneurysms and pseudoaneurysms are commonly encountered complications over the life of an AVF or AVG. Interventional radiologists can use angiography to evaluate these structures (commonly called a Fistulogram) and treat dysfunctional access with angioplasty, stenting, and thrombectomy. Most patients require regular evaluation and treatment to keep their access working. When possible, AVFs are preferred to AVGs due to their relatively lower complication rate and longer patency. The Fistula First initiative works to promote physician and patient awareness about the benefits of first attempting hemodialysis through a fistula. There are a few devices (endo AVF) that are being utilized by interventional radiologists to percutaneously create fistulas in a minimally invasive fashion.


title: Interventional radiology

text: Dialysis catheters include temporary and tunneled large-bore central venous access lines placed for administering hemodialysis. When possible, these catheters are placed in the right internal jugular vein, but the left internal jugular and femoral veins may also be utilized. Temporary dialysis lines may be placed when patients are hospitalized and either too sick or at a high risk of bleeding. Permanent hemodialysis catheters are longer overall but a segment is tunneled through the skin of the chest, which lets the catheter lie flat and lowers the risk of infection.


title: Interventional radiology

text: Central venous access refers to a variety of intravenous catheters placed in patients requiring certain long-term medications. These are much smaller in diameter than dialysis lines, but are larger and longer than a standard intravenous line (IV.) Examples include Hickman catheters, peripherally inserted central cathethers (or PICCs), tunneled small bore central venous catheters, and mediports. These lines differ in where they are inserted but are all placed under imaging guidance and adjusted so the end of the catheter sits in the vena cava adjacent to the heart. These catheters are designed to deliver strong medications, such as chemotherapy or prolonged courses of antibiotics, which are either dosed too frequently to keep placing new IVs or are too irritating to small veins be injected through a standard IV.


title: Robert MacNaughton

text: Robert MacNaughton is an American actor. He is best known for his role as Elliott's brother Michael in "E.T. the Extra-Terrestrial", for which he won a 1982 Young Artist Award as Best Young Supporting Actor in a Motion Picture. MacNaughton also played the lead role of Adam Farmer in the 1983 film "I Am the Cheese", based on the young adult novel by Robert Cormier.


title: Robert MacNaughton

text: Born in New York City, MacNaughton primarily worked in the theater, both before and after "E.T.", performing with the Circle Repertory Company, where he originated the role of Buddy Layman in Jim Leonard Jr.'s "The Diviners". MacNaughton performed with Kevin Kline in "Henry V" at the New York Shakespeare Festival in Central Park. He played Hally in Athol Fugard's ""Master Harold"...and the Boys" for South Coast Repertory, and has also performed with the Long Wharf Theater and Seattle Repertory, among many others. His television appearances include Dennis Potter's "Visitors" for the BBC, "Vietnam War Story" for HBO, "Newhart", and "Amen", among other television films.


title: Robert MacNaughton

text: MacNaughton retired from acting in 2002. He then worked as a mail handler at the bulk facilities in Phoenix, Arizona, and Jersey City, New Jersey. In 2013, MacNaughton returned to acting, performing in two films, Kamal Ahmed's "Laugh Killer Laugh" (co-starring his wife, Bianca Hunter) and Damien Leone's "Frankenstein vs. The Mummy".


title: Wolters Kluwer

text: Wolters Kluwer N.V. () is a Dutch information services company. The company is headquartered in Alphen aan den Rijn, Netherlands (Global) and Philadelphia, United States (corporate). Wolters Kluwer in its current form was founded in 1987 with a merger between Kluwer Publishers and Wolters Samsom. The company serves legal, business, tax, accounting, finance, audit, risk, compliance, and healthcare markets. It operates in over 150 countries.


title: Wolters Kluwer

text: Jan-Berend Wolters founded the Schoolbook publishing house in Groningen, Netherlands, in 1836. In 1858, the Noordhoff publishing house was founded alongside the Schoolbook publishing house. The two publishing houses merged in 1968. Wolters-Noordhoff merged with Information and Communications Union (ICU) in 1972 and took the name ICU. ICU changed its name to Wolters-Samsom in 1983. The company began serving foreign law firms and multinational companies in China in 1985. In 1987, Elsevier, the largest publishing house in the Netherlands, announced its intentions to buy up Kluwer's stock. Kluwer merged with Wolters-Samsom to fend off Elsevier's take-over bid and formed Wolters Kluwer. The merger made Wolters Kluwer the second-largest publishing house in the Netherlands.


title: Wolters Kluwer

text: After the merger, Wolters Kluwer began expanding internationally with the purchase of IPSOA Editore, Kieser Verlag, Technipublicaciones and Tele Consulte in 1989. By the end of the year, Wolters Kluwer expanded its presence to Spain, West Germany and France. The company also launched LEX, its legal information system, in Poland. In 1989, 44% of the company's revenue was earned in foreign markets.


title: Wolters Kluwer

text: The following year, Wolters Kluwer purchased J. B. Lippincott & Co. from HarperCollins. The company acquired Liber, a Swedish publishing company, in 1993. The following year it established its first Eastern European subsidiary, IURA Edition, in Bratislava, Slovakia. The company acquired Jugend & Volk, Dalian, Fateco Fîrlag and Juristfîrlaget, Deutscher Kommunal-Verlag Dr. Naujoks & Behrendt and Colex Data in 1995. Wolters Kluwer was operating in 16 countries and had approximately, 8000 employees by the end of that year.


title: Wolters Kluwer

text: In 1992 Spain was added to the countries where the company has a presence. “Wolters Kluwer España” directed by Miguel Guibelalde, institutional director of the company.


title: Wolters Kluwer

text: In 1994, Wolters Kluwer expanded its US legal business by acquiring Prentice Hall Law & Business from Simon & Schuster. In 1995, Wolters Kluwer acquired CT Corporation. The following year, it purchased CCH Inc., a tax and business materials' publisher, for $1.9 billion. The purchase assisted in expanding the company's business in Asia because of CCH Inc.’s involvement in Australia, New Zealand, Japan, Singapore, and Hong Kong. It also purchased Little, Brown and Company’s medical and legal division that year. John Wiley & Son's legal division was purchased in 1997. Waverly, Inc., Ovid Technologies, Inc. and Plenum Publishing Corporation were acquired in 1998 with the intention of developing Wolters Kluwer’s medical and scientific publishing industry.


title: Wolters Kluwer

text: In 2002, Wolters Kluwer sold Kluwer Academic Publishers to the private equity firms Cinven and Candover Investments. (It is now part of Springer). The company established its first three-year strategy to deliver sustained value to customers and shareholders in 2003. The New Delhi Wolters Kluwer Health office opened in 2006. In 2017, Wolters Kluwer Education was sold to Bridgepoint Capital. In September 2008, Wolters Kluwer acquired UpToDate, an evidence-based electronic clinical information resource. The following month, the company received a multi-year contract to provide prescription and patient-level data to the United States Food and Drug Administration. In 2009, Wolters Kluwer was named the “Best Place to Work” in Spain by the Great Place to Work Institute.


title: Wolters Kluwer

text: Wolters Kluwer acquired FRSGlobal, financial regulatory reporting and risk management firm in September 2010. The acquisition enabled Wolters Kluwer to provide financial organizations comprehensive compliance and risk solutions. The company acquired SASGAS, a financial reporting software solutions provider, to the foreign and domestic bank market in China in October 2011. That December, Wolters Kluwer acquired Medknow, an open access publisher. Also in 2011, Wolters Kluwer sold its pharmaceutical industry-related Marketing and Publishing Service division to Springer Science+Business Media, which led to a workforce reduction at its facility in Ambler, Pennsylvania, eventually leading to the site's closure in 2013.


title: Wolters Kluwer

text: In 2012, Wolters Kluwer acquired Acclipse, an accounting software provider, and Finarch, an integrated finance and risk solutions. The company's health division tested technology to identify and treat sepsis that December. Wolters Kluwer acquired Health Language, a medical terminology management provider, in January 2013. In May 2013, it acquired Prosoft Tecnologia, a Brazilian provider of tax and accounting software. The company acquired CitizenHawk, an American online brand protection and global domain recovery specialist, in September 2013. That month, Wolters Kluwer acquired Svenson, an Austrian regulatory reporting solutions provider. The acquisition enabled both companies to assist Austrian banks and insurance companies in meeting national and international regulatory requirements.