Peptic ulcer disease
Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer. The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain and upper abdominal pain that improves with eating. With a gastric ulcer, the pain may worsen with eating. The pain is often described as a burning or dull ache. Other symptoms include belching, vomiting, weight loss, or poor appetite. About a third of older people have no symptoms. Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of cases.
|Peptic ulcer disease|
|Other names||Peptic ulcer, stomach ulcer, gastric ulcer, duodenal ulcer|
|Deep gastric ulcer|
|Symptoms||Upper abdominal pain, belching, vomiting, weight loss, poor appetite|
|Complications||Bleeding, perforation, blockage of the stomach|
|Causes||Helicobacter pylori, non-steroidal anti-inflammatory drugs, tobacco smoking, Crohn disease|
|Diagnostic method||Based on symptoms, confirmed by endoscopy or barium swallow|
|Differential diagnosis||Stomach cancer, coronary heart disease, inflammation of the stomach lining, gallbladder inflammation|
|Treatment||Stopping smoking, stopping NSAIDs, stopping alcohol, medications|
|Medication||Proton pump inhibitor, H2 blocker, antibiotics|
|Frequency||87.4 million (2015)|
Common causes include the bacteria Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs). Other, less common causes include tobacco smoking, stress due to serious illness, Behcet disease, Zollinger-Ellison syndrome, Crohn disease, and liver cirrhosis. Older people are more sensitive to the ulcer-causing effects of NSAIDs. The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow. H. pylori can be diagnosed by testing the blood for antibodies, a urea breath test, testing the stool for signs of the bacteria, or a biopsy of the stomach. Other conditions that produce similar symptoms include stomach cancer, coronary heart disease, and inflammation of the stomach lining or gallbladder inflammation.
Diet does not play an important role in either causing or preventing ulcers. Treatment includes stopping smoking, stopping use of NSAIDs, stopping alcohol, and taking medications to decrease stomach acid. The medication used to decrease acid is usually either a proton pump inhibitor (PPI) or an H2 blocker, with four weeks of treatment initially recommended. Ulcers due to H. pylori are treated with a combination of medications, such as amoxicillin, clarithromycin, and a PPI. Antibiotic resistance is increasing and thus treatment may not always be effective. Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful.
Peptic ulcers are present in around 4% of the population. New ulcers were found in around 87.4 million people worldwide during 2015. About 10% of people develop a peptic ulcer at some point in their life. Peptic ulcers resulted in 267,500 deaths in 2015, down from 327,000 in 1990. The first description of a perforated peptic ulcer was in 1670, in Princess Henrietta of England. H. pylori was first identified as causing peptic ulcers by Barry Marshall and Robin Warren in the late 20th century, a discovery for which they received the Nobel Prize in 2005.
Signs and symptoms
Signs and symptoms of a peptic ulcer can include one or more of the following:
- abdominal pain, classically epigastric, strongly correlated with mealtimes. In case of duodenal ulcers, the pain appears about three hours after taking a meal and wakes the person from sleep;
- bloating and abdominal fullness;
- waterbrash (a rush of saliva after an episode of regurgitation to dilute the acid in esophagus, although this is more associated with gastroesophageal reflux disease);
- nausea and copious vomiting;
- loss of appetite and weight loss, in gastric ulcer;
- weight gain, in duodenal ulcer, as the pain is relieved by eating;
- hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer or from damage to the esophagus from severe/continuing vomiting.
- melena (tarry, foul-smelling feces due to presence of oxidized iron from hemoglobin);
- rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis and extreme, stabbing pain, and requires immediate surgery.
A history of heartburn or gastroesophageal reflux disease (GERD) and use of certain medications can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include NSAIDs (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase and most glucocorticoids (e.g., dexamethasone and prednisolone).
In people over the age of 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by esophagogastroduodenoscopy.
The timing of symptoms in relation to the meal may differentiate between gastric and duodenal ulcers. A gastric ulcer would give epigastric pain during the meal, associated with nausea and vomiting, as gastric acid production is increased as food enters the stomach. Pain in duodenal ulcers would be aggravated by hunger and relieved by a meal and is associated with night pain.
Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the person's age. Furthermore, typical ulcers tend to heal and recur, and as a result the pain may occur for few days and weeks and then wane or disappear. Usually, children and the elderly do not develop any symptoms unless complications have arisen.
A burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion, or heartburn. Pain is usually caused by the ulcer, but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours, and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night, and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication. However, peptic ulcer disease symptoms may be different for every sufferer.
- Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening. It is associated with 5% to 10% death rate.
- Perforation (a hole in the wall of the gastrointestinal tract) following a gastric ulcer often leads to catastrophic consequences if left untreated. Erosion of the gastrointestinal wall by the ulcer leads to spillage of the stomach or intestinal contents into the abdominal cavity, leading to an acute chemical peritonitis. The first sign is often sudden intense abdominal pain, as seen in Valentino's syndrome. Posterior gastric wall perforation may lead to bleeding due to the involvement of gastroduodenal artery that lies posterior to the first part of the duodenum. The death rate in this case is 20%.
- Penetration is a form of perforation in which the hole leads to and the ulcer continues into adjacent organs such as the liver and pancreas.
- Gastric outlet obstruction is a narrowing of the pyloric canal by scarring and swelling of the gastric antrum and duodenum due to peptic ulcers. The person often presents with severe vomiting.
- Cancer is included in the differential diagnosis (elucidated by biopsy), Helicobacter pylori as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer.
Helicobacter pylori is one of the major causative factors of peptic ulcer disease. It secretes urease to create an alkaline environment, which is suitable for its survival. It expresses blood group antigen adhesin (BabA) and outer inflammatory protein adhesin (OipA), which enables it to attach to the gastric epithelium. The bacterium also expresses virulence factors such as CagA and PicB, which cause stomach mucosal inflammation. The VacA gene encodes for vacuolating cytotoxin, but its mechanism of causing peptic ulcers is unclear. Such stomach mucosal inflammation can be associated with hyperchlorhydria (increased stomach acid secretion) or hypochlorhydria (reduced stomach acid secretion). Inflammatory cytokines inhibit the parietal cell acid secretion. H. pylori also secretes certain products that inhibit hydrogen potassium ATPase; activate calcitonin gene-related peptide sensory neurons, which increases somatostatin secretion to inhibit acid production by parietal cells; and inhibit gastrin secretion. This reduction in acid production causes gastric ulcers. On the other hand, increased acid production at the pyloric antrum is associated with duodenal ulcers in 10% to 15% of H. pylori infection cases. In this case, somatostatin production is reduced and gastrin production is increased, leading to increased histamine secretion from the enterochromaffin cells, thus increasing acid production. An acidic environment at the antrum causes metaplasia of the duodenal cells, causing duodenal ulcers.
Human immune response toward the bacteria also determines the emergence of peptic ulcer disease. The human IL1B gene encodes for Interleukin 1 beta, and other genes that encode for tumour necrosis factor (TNF) and Lymphotoxin alpha also play a role in gastric inflammation.
Taking nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin can increase the risk of peptic ulcer disease by four times compared to non-users. The risk of getting peptic ulcer is two times for aspirin users. Risk of bleeding increases if NSAIDs are combined with selective serotonin reuptake inhibitor (SSRI), corticosteroids, antimineralocorticoids, and anticoagulants. The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block the function of cyclooxygenase 1 (COX-1), which is essential for the production of these prostaglandins. Besides this, NSAIDs also inhibit stomach mucosa cells proliferation and mucosal blood flow, reducing bicarbonate and mucus secretion, which reduces the integrity of the mucosa. Another type of NSAIDs, called COX-2 selective anti-inflammatory drugs (such as celecoxib), preferentially inhibit COX-2, which is less essential in the gastric mucosa. This reduces the probability of getting peptic ulcers; however, it can still delay ulcer healing for those who already have a peptic ulcer.
Stress due to serious health problems, such as those requiring treatment in an intensive care unit, is well described as a cause of peptic ulcers, which are also known as stress ulcers.
While chronic life stress was once believed to be the main cause of ulcers, this is no longer the case. It is, however, still occasionally believed to play a role. This may be due to the well-documented effects of stress on gastric physiology, increasing the risk in those with other causes, such as H. pylori or NSAID use.
Dietary factors, such as spice consumption, were hypothesized to cause ulcers until the late 20th century, but have been shown to be of relatively minor importance. Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, appear to have little effect. Similarly, while studies have found that alcohol consumption increases risk when associated with H. pylori infection, it does not seem to independently increase risk. Even when coupled with H. pylori infection, the increase is modest in comparison to the primary risk factor.
Other causes of peptic ulcer disease include gastric ischaemia, drugs, metabolic disturbances, cytomegalovirus (CMV), upper abdominal radiotherapy, Crohn's disease, and vasculitis. Gastrinomas (Zollinger–Ellison syndrome), or rare gastrin-secreting tumors, also cause multiple and difficult-to-heal ulcers.
The diagnosis is mainly established based on the characteristic symptoms. Stomach pain is usually the first signal of a peptic ulcer. In some cases, doctors may treat ulcers without diagnosing them with specific tests and observe whether the symptoms resolve, thus indicating that their primary diagnosis was accurate.
More specifically, peptic ulcers erode the muscularis mucosae, at minimum reaching to the level of the submucosa (contrast with erosions, which do not involve the muscularis mucosae).
Confirmation of the diagnosis is made with the help of tests such as endoscopies or barium contrast x-rays. The tests are typically ordered if the symptoms do not resolve after a few weeks of treatment, or when they first appear in a person who is over age 45 or who has other symptoms such as weight loss, because stomach cancer can cause similar symptoms. Also, when severe ulcers resist treatment, particularly if a person has several ulcers or the ulcers are in unusual places, a doctor may suspect an underlying condition that causes the stomach to overproduce acid.
An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on people in whom a peptic ulcer is suspected. It is also the gold standard of diagnosis for peptic ulcer disease. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis.
One of the reasons that blood tests are not reliable for accurate peptic ulcer diagnosis on their own is their inability to differentiate between past exposure to the bacteria and current infection. Additionally, a false negative result is possible with a blood test if the person has recently been taking certain drugs, such as antibiotics or proton-pump inhibitors.
The diagnosis of Helicobacter pylori can be made by:
- Urea breath test (noninvasive and does not require EGD);
- Direct culture from an EGD biopsy specimen; this is difficult and can be expensive. Most labs are not set up to perform H. pylori cultures;
- Direct detection of urease activity in a biopsy specimen by rapid urease test;
- Measurement of antibody levels in the blood (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy;
- Stool antigen test;
- Histological examination and staining of an EGD biopsy.
The breath test uses radioactive carbon to detect H. pylori. To perform this exam, the person is asked to drink a tasteless liquid that contains the carbon as part of the substance that the bacteria breaks down. After an hour, the person is asked to blow into a sealed bag. If the person is infected with H. pylori, the breath sample will contain radioactive carbon dioxide. This test provides the advantage of being able to monitor the response to treatment used to kill the bacteria.
The possibility of other causes of ulcers, notably malignancy (gastric cancer), needs to be kept in mind. This is especially true in ulcers of the greater (large) curvature of the stomach; most are also a consequence of chronic H. pylori infection.
If a peptic ulcer perforates, air will leak from inside the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to "free gas" within the peritoneal cavity. If the person stands ®, as when having a chest X-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease.
- Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistantiae. Not associated with acid hypersecretion.
- Type II: Ulcer in the body in combination with duodenal ulcers. Associated with acid oversecretion.
- Type III: In the pyloric channel within 3 cm of pylorus. Associated with acid oversecretion.
- Type IV: Proximal gastroesophageal ulcer.
- Type V: Can occur throughout the stomach. Associated with the chronic use of NSAIDs (such as ibuprofen).
Gastric ulcers are most often localized on the lesser curvature of the stomach. The ulcer is a round to oval parietal defect ("hole"), 2–4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irregular in the acute form of peptic ulcer, and regular but with elevated borders and inflammatory surrounding in the chronic form. In the ulcerative form of gastric cancer, the borders are irregular. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.
A gastric peptic ulcer is a mucosal perforation that penetrates the muscularis mucosae and lamina propria, usually produced by acid-pepsin aggression. Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows 4 zones: fibrinoid necrosis, inflammatory exudate, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis.
Prevention of peptic ulcer disease for those who are taking NSAIDs (with low cardiovascular risk) can be achieved by adding a proton pump inhibitor (PPI), an H2 antagonist, or misoprostol. NSAIDs of the COX-2 inhibitors type may reduce the rate of ulcers when compared to non-selective NSAIDs. PPI is the most popular agent in peptic ulcer prevention. However, there is no evidence that H2 antagonists can prevent stomach bleeding for those taking NSAIDs. Although misoprostol is effective in preventing peptic ulcer, its properties of promoting abortion and causing gastrointestinal distress limit its use. For those with high cardiovascular risk, naproxen with PPI can be a useful choice. Otherwise, low-dose aspirin, celecoxib, and PPI can also be used.
Once the diagnosis of H. pylori is confirmed, the first-line treatment would be a triple regimen in which pantoprazole and clarithromycin are combined with either amoxicillin or metronidazole. This treatment regimen can be given for 7–14 days. However, its effectiveness in eradicating H. pylori has been reducing from 90% to 70%. However, the rate of eradication can be increased by doubling the dosage of pantoprazole or increasing the duration of treatment to 14 days. Quadruple therapy (pantoprazole, clarithromycin, amoxicillin, and metronidazole) can also be used. The quadruple therapy can achieve an eradication rate of 90%. If the clarithromycin resistance rate is higher than 15% in an area, the usage of clarithromycin should be abandoned. Instead, bismuth-containing quadruple therapy can be used (pantoprazole, bismuth citrate, tetracycline, and metronidazole) for 14 days. The bismuth therapy can also achieve an eradication rate of 90% and can be used as second-line therapy when the first-line triple-regimen therapy failed.
NSAIDs induced ulcers
NSAID-associated ulcers heal in 6 to 8 weeks provided the NSAIDs are withdrawn with the introduction of proton pump inhibitors (PPI).
For those with bleeding peptic ulcers, fluid replacement with crystalloids should be given to maintain volume in the blood vessels. Hameoglobin should be maintained at greater than 70 g/dL through restrictive blood transfusion because it has been associated with reduced rate of death. Glasgow-Blatchford score is useful in determining whether a person should be treated inside a hospital or as an outpatient. Intravenous PPIs can suppress stomach bleeding more quickly than oral ones. A neutral stomach pH is required to keep platelets in place and prevent clot lysis. Tranexamic acid and antifibrinolytic agents are not useful in treating peptic ulcer disease.
Early endoscopic therapy can help to stop bleeding by using cautery, endoclip, or epinephrine injection. Treatment is indicated if there is active bleeding in the stomach, visible vessels, or an adherent clot. Endoscopy is also helpful in identifying people who are suitable for hospital discharge. Prokinetic agents such as erythromycin and metoclopramide can be given before endoscopy to improve endoscopic view. Either high- or low-dose PPIs are equally effective in reducing bleeding after endoscopy. High-dose intravenous PPI is defined as a bolus dose of 80 mg followed by an infusion of 8 mg per hour for 72 hours—in other words, the continuous infusion of PPI of greater than 192 mg per day. Intravenous PPI can be changed to oral once there is no high risk of rebleeding from peptic ulcer.
For those with hypovolemic shock and ulcer size of greater than 2 cm, there is a high chance that the endoscopic treatment would fail. Therefore, surgery and angiographic embolism are reserved for these complicated cases. However, there is a higher rate of complication for those who underwent surgery to patch the stomach bleeding site when compared to repeated endoscopy. Angiographic embolisation has a higher rebleeding rate but a similar rate of death to surgery.
According to expert opinion, for those who are already on anticoagulants, the international normalized ratio (INR) should be kept at 1.5. For aspirin users who required endoscopic treatment for bleeding peptic ulcer, there is two times increased risk of rebleeding but with 10 times reduced risk of death at 8 weeks following the resumption of aspirin. For those who were on double antiplatelet agents for indwelling stent in blood vessels, both antiplatelet agents should not be stopped because there is a high risk of stent thrombosis. For those who were under warfarin treatment, fresh frozen plasma (FFP), vitamin K, prothrombin complex concentrates, or recombinant factor VIIa can be given to reverse the effect of warfarin. High doses of vitamin K should be avoided to reduce the time for rewarfarinisation once the stomach bleeding has stopped. Prothrombin complex concentrates are preferred for severe bleeding. Recombinant factor VIIa is reserved for life-threatening bleeding because of its high risk of thromboembolism. Direct oral anticoagulants (DOAC) are recommended instead of warfarin as they are more effective in preventing thromboembolism. In case of bleeding caused by DOAC, activated charcoal within 4 hours is the antidote of choice. Hamodialysis maybe given for bleeding caused by dabigatran. Anticoagulants should be resumed as soon as possible for those with high cardiovascular risk because although risk of rebleeding increases, the overall mortality decreases with resumption of anticoagulants.
In Western countries, the percentage of people with H. pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80, etc.). Prevalence is higher in third world countries, where it is estimated at about 70% of the population, whereas developed countries show a maximum of a 40% ratio. Overall, H. pylori infections show a worldwide decrease, more so in developed countries. Transmission occurs via food, contaminated groundwater, or human saliva (such as from kissing or sharing food utensils).
Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century, when epidemiological trends started to point to an impressive fall in its incidence. The reason that the rates of peptic ulcer disease decreased is thought to be the development of new effective medication and acid suppressants and the rational use of nonsteroidal anti-inflammatory drugs (NSAIDs).
John Lykoudis, a general practitioner in Greece, treated people for peptic ulcer disease with antibiotics beginning in 1958, long before it was commonly recognized that bacteria were a dominant cause for the disease.
Helicobacter pylori was identified in 1982 by two Australian scientists, Robin Warren and Barry J. Marshall, as a causative factor for ulcers. In their original paper, Warren and Marshall contended that most gastric ulcers and gastritis were caused by colonization with this bacterium, not by stress or spicy food, as had been assumed before.
The H. pylori hypothesis was initially poorly received, so in an act of self-experimentation Marshall drank a Petri dish containing a culture of organisms extracted from a person with an ulcer and five days later developed gastritis. His symptoms disappeared after two weeks, but he took antibiotics to kill the remaining bacteria at the urging of his wife, since halitosis is one of the symptoms of infection. This experiment was published in 1984 in the Australian Medical Journal and is among the most cited articles from the journal.
In 1997, the Centers for Disease Control and Prevention, with other government agencies, academic institutions, and industry, launched a national education campaign to inform health care providers and consumers about the link between H. pylori and ulcers. This campaign reinforced the news that ulcers are a curable infection and that health can be greatly improved and money saved by disseminating information about H. pylori.
In 2005, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Marshall and his long-time collaborator Dr. Warren "for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease." Marshall continues research related to H. pylori and runs a molecular biology lab at UWA in Perth, Western Australia.
Some believed that mastic gum, a tree resin extract, actively eliminates the H. pylori bacteria. However, multiple subsequent studies have found no effect of using mastic gum on reducing H. pylori levels.
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- "Ulcer, Diagnosis and Treatment - CDC Bacterial, Mycotic Diseases". Cdc.gov. Archived from the original on 3 December 2013. Retrieved 27 February 2014.
- Huwez FU, Thirlwell D, Cockayne A, Ala'Aldeen DA (December 1998). "Mastic gum kills Helicobacter pylori". The New England Journal of Medicine. 339 (26): 1946. doi:10.1056/NEJM199812243392618. PMID 9874617. Archived from the original on 15 September 2008. See also their corrections in the next volume Archived 5 October 2008 at the Wayback Machine.
- Loughlin MF, Ala'Aldeen DA, Jenks PJ (February 2003). "Monotherapy with mastic does not eradicate Helicobacter pylori infection from mice". The Journal of Antimicrobial Chemotherapy. 51 (2): 367–71. doi:10.1093/jac/dkg057. PMID 12562704.
- Bebb JR, Bailey-Flitter N, Ala'Aldeen D, Atherton JC (September 2003). "Mastic gum has no effect on Helicobacter pylori load in vivo". The Journal of Antimicrobial Chemotherapy. 52 (3): 522–3. doi:10.1093/jac/dkg366. PMID 12888582.
|Wikimedia Commons has media related to Peptic ulcers.|


Bloodborne Pathogen Standard
Occupational Safety and Health Administration (OSHA)
29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens
Who is covered:
The Bloodborne Pathogen Standard applies to all employees with reasonably anticipated skin, eye, mucous membrane, or parenteral contact with human blood, blood components, or other potentially infectious materials that may result from the performance of an employee's duties. Other potentially infectious materials means:
- The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood
- Any unfixed human tissue or organ (other than intact skin)
- HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV
What training is required:
Each training program must be appropriate in context and language and contain at a minimum the following elements:
- An accessible copy of the regulatory text of this standard and an explanation of its contents.
- An explanation of the epidemiology, transmission, and symptoms of bloodborne diseases.
- An explanation of the University of Minnesota's exposure control plan and the means by which the employee can obtain a written copy.
- An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials.
- An explanation of the use and limitations of methods that will prevent or reduce exposure including engineering controls, work practices, and personal protective equipment.
- Information on the types, basis for selection, proper use, location, removal, handling, decontamination and disposal of personal protective equipment.
- Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that employees will be offered the vaccination series free of charge.
- Information on the appropriate actions to take and persons to contact in an emergency.
- An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available.
- Information on the post-exposure evaluation and follow-up.
- An explanation of the signs and labels and/or color coding required.
- Name of individual to contact for further information.
When training is required:
Training must be completed within ten working days of initial assignment to tasks where occupational exposure may take place, and at least annually thereafter.
Training records must be maintained for three years from the date on which the training occurred. Training records must include the dates of the training sessions, the contents or a summary of the training session, the names and qualifications of persons conducting the training, and the names and job titles of all persons attending the training sessions.
Contact name and number:
For further information, call the Biosafety Specialists in Environmental Health and Safety, at 612-626-6002


Hare Hatch Montessori links the Montessori ethos with the requirements of the Early Years Foundation Stage (EYFS). We aim to work effectively with all children and their families, ensuring each individual has their needs acknowledged and met.
The four main aims for the EYFS:
- quality and consistency in all early years settings, so that every child makes good progress;
- a secure foundation through learning and development opportunities which are planned around the needs and interests of each individual child and are assessed and reviewed regularly;
- partnership working between practitioners and with parents and/or carers; and
- equality of opportunity and anti-discriminatory practice, ensuring that every child is included and supported.
The principles underlying the EYFS are ones with which Montessorians are very familiar and which they endorse enthusiastically. We acknowledge that every child is unique; that children learn to be strong and independent through positive relationships; that they learn and develop well in enabling environments; and that they develop and learn in different ways and at different rates.


Students in India Launch Satellites to Help Farmers, Fisherman, and the Environment
Over the next few years, India is likely to witness launch of around 20 to 25 student satellites that are specifically dedicated to environment and development in the coming decade. In last one year alone four student satellites were launched into space.
The satellites StudSat, a picosatellite conceived and created by students of Hyderabad and Bengaluru institutions, Anusat, which was launched by Madras Institute of Technology and three other satellites were launched with the aim of "environmental surveillance and early warning of disaster" such as "assessing pollution levels in the atmosphere by monitoring green house gases, carbon dioxide and water vapor.
Jugnu, a remote sensing satellite "provides data for agriculture and disaster monitoring. It can help farmers in planning crops in such way that minimizes losses and improves earnings. It has been developed by students of Indian Institute of Technology in Kanpur.
Pratham, a microsatellite, is "focused on building advanced tsunami warning systems to help poor fishermen along India‟s vast coastline.
Implications from SFG:
"Student satellites underline not only technological competence of young Indians but also their concern for environment and its implications for farmers and fishing communities who are among the poorest people. The poor and middle income groups do not have resources to foresee and secure their future. The student satellites
could act as a tool to look over potential man-made and natural
environmental threats. With government support, currently 20-25
such projects can be foreseen. If foundations, international universities and private sector players collaborate, their number, quality and capacity can go up significantly, enabling them to cover almost the entire country, and neighboring countries such as Bangladesh and Pakistan, as beneficiaries."
Implications from IFTF:
Domestic innovation and aid is important in fostering regional self-esteem


Whole class graphing activities for December!These fun set of graphing activities are a perfect way to introduce graphs to your students. This set of 4 Christmas related questions will have your students surveying, creating, collaborating and reading graphs.
There are 2 different styles to showcase the questions and choice options in. You can use clothes pins or clips for students to vote or use the editable ticket stubs and have them vote that way!
Each question has 5 different related worksheets to use around that topic. 3 are geared towards the class and 2 are ones they will need to interpret the data on and answer questions.
Super fun and engaging this set includes opportunities to compare and contrast, addition and subtraction and so much more!
Questions included in this set:
• Which ornament do you like best?
• How do you like your hot chocolate?
• What cookie would you pick?
• Which would you rather use?
Please download the preview to see one of the questions and the worksheets included. If you would like something additional please don’t hesitate to let me know and I can get it added for you!
If you want any of the wording changed please don't hesitate to let me know and I can customize it for your class!
Thank you for looking at my store. Please consider becoming a follower to be notified of new products. All new items are 50% off for the first 48 Hours.


There are few more impressive creatures than the docile, vegetarian, giant Galapagos land tortoises. No one knows how old these creatures grow in the wild, since no person has been living in the islands long enough to see one survive to its natural old age. The ones in the photo are upwards of 140 years.Weighing in at half a ton, the greatest danger they pose to you is stepping on your toe. This tranquility has not always served the giant tortoise well. In the past they were frequently attacked by invasive dogs and kidnapped by sailors for meat on their long voyages. Where once half a million giant tortoises roamed, today only a few thousand remain.
It is sad to think that the survival of this species is in our hands – the very creatures the endangered them in the first place.


When a short optical pulse propagates through a nonlinear medium, the Kerr effect leads to a phase delay which is largest on the beam axis (where the optical intensity is highest) and smaller outside the axis. This is similar to the action of a lens: the wavefronts are deformed, so that the pulse is focused (assuming a positive nonlinear index n2). This effect is called self-focusing and has important implications for passive mode locking of lasers (→ Kerr lens mode locking) and for optical damage of media (catastrophic self-focusing). For negative n2, the nonlinearity is self-defocusing.
When a Gaussian beam with optical power P and beam radius w propagates through a thin piece (thickness d) of a nonlinear medium with nonlinear index n2, the dioptric power (inverse focal length) of the Kerr lens is
when considering only the phase changes near the beam axis in a parabolic approximation. This equation can be derived by calculating the radially dependent nonlinear phase change and comparing it with that of a lens.
The equation shows that for a given optical power Kerr lensing becomes more important for stronger beam focusing: this increases the optical intensities and even more so the intensity gradients.
|||P. A. Belanger and C. Pare, “Self-focusing of Gaussian beams: an alternate derivation”, Appl. Opt. 22 (9), 1293 (1983)|
|||F. Salin et al., “Modelocking of Ti:sapphire lasers and self-focusing: a Gaussian approximation”, Opt. Lett. 16 (21), 1674 (1991)|
|||V. Magni et al., “Astigmatism in Gaussian-beam self-focusing and in resonators for Kerr-lens mode locking”, J. Opt. Soc. Am. B 12 (3), 476 (1995)|
|||J. H. Marburger, “Self-focusing: theory”, in Progress in Quantum Electronics, J. H. Sanders and S. Stenholm, eds. (Pergamon, Oxford, 1977), Vol. 4, pp. 35-110 (1977)|
|||Y. R. Shen, “Self-focusing: experimental”, in Progress in Quantum Electronics, J. H. Sanders and S. Stenholm, eds. (Pergamon, Oxford, 1977), Vol. 4, pp. 1-34 (1977)|
See also: focal length, Kerr effect, lenses, self-focusing, laser-induced damage, Kerr lens mode locking, self-phase modulation
and other articles in the categories nonlinear optics, physical foundations
If you like this article, share it with your friends and colleagues, e.g. via social media:


- Click on the ' Edit ' menu with the mouse or press ' Alt '+' E '.
- Click on ' Preferences ' or press ' E ' to open the preferences dialog box.
- Click on, or use the arrow keys to select the ' Font ' heading underneath the ' Appearance ' category. If you cannot see the Font heading, you may need to expand the Appearance category. Do this by either double clicking on Appearance, or selecting Appearance with the arrow keys and pressing the right arrow key. (See Fig 1).
- Use the mouse, or the ' Tab ' key, to navigate to the ' Proportional ' drop down box.
- Press up or down and then ' Enter ' to choose the font you wish to use, or use the mouse and click on your chosen font. A proportional font is one in which the letters are of varying widths, like this paragraph. You can either choose Serif or Sans Serif.
- Once you have chosen the default proportional font, you can set the default size. Press ' Tab' or use the mouse to click in the size box immediately after the proportional font. Press up or down and then Enter, or use the mouse, to choose the font you want.
Depending on what proportional font type you chose, you will probably need to set the specific font you want under the relevant typeface groups drop down menu, to do this:
- Click on the drop down box next to ' Serif' and click on the font you want or press ' Tab ' until the drop down box is highlighted and then press the ' up' or ' down' arrows to select the font you want to use and then press ' Enter '.
- Click on the drop down box next to ' Sans-Serif' and click on the font you want or press ' Tab ' until the drop down box is highlighted and then press the ' up' or ' down' arrows to select the font you want to use and then press ' Enter '.
- Click on the checkbox ' Allow documents to use other fonts ' to uncheck the box or press' Tab ' until the checkbox is highlighted and then press ' Spacebar ' or make sure the box is unchecked.
- Click ' OK ' or press ' Enter ' to return to the page you were viewing.
Note: If this does not work it could be because your computer settings cannot be changed due to local IT policies - contact your local IT support for further help.


The PPT presentation – Information literacy: Necessary but not sufficient for 21st century learning (see below for the Abstract) – may be downloaded from here and needs to be downloaded to work properly.
We’ll find a home for presentations shortly.
Ivan Illich argued that the principal lesson School teaches is the need to be taught.
While this lesson may not be intentional, it is almost inevitable in an educational paradigm that is centred on teaching rather than learning (instructionism). It is also a lesson that increasingly fails to prepare our students for the world unfolding around them.
What might an educational paradigm that is centred on learning look like (constructionism), and what might it require of us, particularly in School?
In this regard, the International Baccalaureate continuum of education for 3-19 year olds is instructive. Central to the IB’s approach to education is learning through independent inquiry. Inquiry is more expansive than research and draws on a number of literacies, one of which is information literacy. Furthermore, because effective learning through inquiry requires professional collaboration between teacher and librarian, growth in the number of schools offering one or more IB Programmes is both an opportunity for librarians in schools to redefine themselves professionally, and a challenge to do so. Additionally, a continuum of inquiry-based education that stretches from age 3-19 will develop students who are better equipped for life and learning beyond school than students who are merely the product of School.
More broadly, the evolving definition of information literacy in the US reveals both an educational movement towards inquiry as well as something of the role of information literacy within inquiry, and this, like the IB continuum, is a consequence of active participation in the global conversation about the future of education. Both of these streams combine at Oakham School.
Oakham School has offered the IB Diploma Programme alongside A levels since 2001, and is currently a candidate school for the IB Middle Years Programme, which will lead to GCSEs. This affords us a unique perspective on and experience of these two educational paradigms. Additionally, since 2011 we have been drawing on the work of colleagues in the US, specifically Barbara Stripling and Carol Kuhlthau, resulting in a Framework of Skills for Inquiry Learning (FOSIL), which is both a model of the inquiry process as well as a progression of skills enabling it. As FOSIL evolves, mainly due to our deepening understanding of inquiry, but also the ongoing work of transplanting it from foreign soil, so it becomes an increasingly powerful tool for enabling inquiry, whether controlled, guided or open.
Starting from the global conversation about the future of education, we will proceed to discuss the value of inquiry to an education for the future, as well as some of the strategic and operational considerations that a shift in focus to learning through inquiry demands. Using FOSIL, we will then look at the place and role of information literacy within inquiry, paying attention to the forces driving the evolution of FOSIL. As FOSIL has emerged at the centre of a growing community of schools committed to advancing inquiry learning, we will conclude with developments to support this community through online discourse and the sharing of best practice and resources.
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The Women’s Studies Program is built on the understanding that gender is a crucial category of human knowledge and action. Women’s studies recognizes the complexity of human lives as gender interconnects with sexuality, race, class, ability, nationality, ethnicity, religion, and age in the constitution of experience and identities.
The program is at its core interdisciplinary, integrating knowledge from different disciplines to encourage critical engagement with all forms of experience from a feminist standpoint. Interdisciplinary study leads students to question frameworks, concepts, and methods, enabling them to understand better both the past and the contemporary world, while envisioning a future beyond traditional roles and inequities. By emphasizing interdisciplinarity, the program seeks to help students acquire the tools to analyze critically the societal, cultural, global, and personal issues that shape their lives and challenge them to look at these issues from multiple perspectives. It also encourages them to reflect on the ways in which knowledge is produced within different and oftentimes unrecognized systems of oppression, and to examine categories that are presented as natural and permanent in their cultural and historical context. Finally, the program strives to help its students acquire the skills of critical analysis and imagine alternatives that challenge the naturalizing of inequalities.
Women’s studies offers a major and minor as well as a wide variety of interdisciplinary courses for students. Some of these courses are listed as WMST courses. The basic introductory course is WMST 202.
Students in women’s studies, as well as the campus community as a whole, are encouraged to participate in activities sponsored by the Center for Women’s Studies, located on the lower level of East Hall. During each year, the center initiates a wide variety of educational programming, including films, discussions, and student projects, which aim to establish an open dialogue about the many ways race, class, cultural differences, and sexual orientation both interact with and shape gender roles.
Majors in women’s studies typically go on to graduate or professional school in a number of different fields or work in areas of social policy, social change, and human services.
An introduction to significant debates and texts in the field of postcolonial literatures. This course explores how the field engages with questions of race, gender, sexuality, class, caste, and migration. It considers how writers located in the global south or in the West as migrants navigate their spaces when faced with inequality and marginalization. The course examines both the legacies that empires have left and the nature of new empires that are being constructed.
Faculty Profile for Professor Julien
How do we come to be who we are? How do we tell our own stories? What can we learn from each other? What does it mean to be a human community? These are some of the questions this course invites us to consider as we discover texts written by various prominent authors from West and North Africa. The product of a complex history, this is a literature where cultures, identities, genres, and languages intersect. It gives voice to rich questions of identity and self-definition through the exploration of traditional as well as innovative forms of writing. Together, we will engage in close reading of these texts and have broader discussions on themes and concepts such as imperialism and colonialism, post-colonialism, cultural translocation, gender, race, sexuality, religion, and multilingualism. In doing so, we will encounter new ways of reflecting on questions and issues that concern us all, our self-definition, and the way we relate to others. This course is taught in English but should especially be of interest to students with some experience with the French language or in French-speaking countries. There will be the opportunity of a separate optional “Foreign Language Across the Curriculum” component. Students who successfully complete this seminar will receive credit for FREN 222 and satisfy one half of the Human Thought and Expression area of inquiry requirement.
Hélène M. Julien is professor of French and Women’s Studies. With a specific focus on contemporary French literature and literature from North Africa and its diaspora, her research explores the ways in which personal and collective selves find their voices in relation to history, memory, gender, race, sexuality, and culture.
Religions of Resistance: Gender, Sexuality and Performance in the Caribbean
Studies African-derived religions and practices in the Caribbean, particularly the ways in which they constitute anticolonial and decolonial perspectives and practices. By exploring texts drawn from cultural studies, religious studies, literature, theatre and anthropology, students will develop an analytical framework through which to examine concepts such as syncretism and hybridity, ritual and bodily performance, and the construction of gender and sexuality. Key concerns in this course are the empowerment of women and people of diverse gender and sexual identities in religious contexts, black identity in the Caribbean and beyond, and the creation of new spaces for marginalized voices to be heard.
Explores gender from a variety of angles, and in tandem with race, ethnicity, class, religion, sexuality, and other markers of identity. Students develop vocabulary and tools to speak and think critically about oppression, patriarchy, social change, and common assumptions about the world and people around us. A primary goal is to explore both the forces that feed into inequality and discrimination, and ways to resist, challenge, and overcome those forces. Students explores issues ranging from bodies, work, families, identity, politics, medicine, history, and the media, as well as the ways in which feminist movements around the world have addressed these topics.


Liturgical readings are available here.
The long story about Susanna from the Book of the prophet Daniel shows that God is just, he acts justly, and grants a just outcome. It is already the name Daniel that makes one think of justice, since the very name means: God makes justice.
The story, however, offers a deeper meaning to ponder. Susanna is a model of the people of Israel that resists temptations of the pagans, remaining faithful at any cost.
The two elders who sin are emblematic of any human sin. All starts with their looking, continues with their preparation of a plan and it ends with deliberation and action. This logic of sin, however, is not stringent and there is an escape route.
- Live in God’s presence: Sin has its origin in human nature, but it only develops if we forget that God is with us.
- Resist: Stand firm in temptations. God rewards those who are faithful to him.
Jesus in the gospel is more than Daniel. He also encounters a woman in a somewhat similar situation, but this woman is guilty. Yet, Jesus proves to be much more than a defender of an innocent person. He even forgives sins. He cares not only about the external response to the prescriptions of the law, but especially about the answer of the heart.


SemaphoreHandle_t xSemaphoreCreateCounting( UBaseType_t uxMaxCount,
Creates a counting semaphore
and returns a handle by which the newly created semaphore can be referenced.
must be set to 1 in FreeRTOSConfig.h, or left undefined (in which case it will
default to 1), for this RTOS API function to be available.
Each counting semaphore require a small amount of RAM that is used to hold the
semaphore's state. If a counting semaphore is created using xSemaphoreCreateCounting()
then the required RAM is automatically allocated from the FreeRTOS heap.
If a counting semaphore is created using xSemaphoreCreateCountingStatic()
then the RAM is provided by the application writer, which requires an additional
parameter, but allows the RAM to be statically allocated at compile
time. See the Static Vs
Dynamic allocation page for more information.
Counting semaphores are typically used for two things:
In this usage scenario an event handler will 'give' a semaphore each time
an event occurs (incrementing the semaphore count value), and a handler
task will 'take' a semaphore each time it processes an event
(decrementing the semaphore count value). The count value is therefore
the difference between the number of events that have occurred and the
number that have been processed. In this case it is desirable for the
initial count value to be zero.
Note the same functionality can often be achieved in a more efficient way
using a direct to task notification.
In this usage scenario the count value indicates the number of resources
available. To obtain control of a resource a task must first obtain a
semaphore - decrementing the semaphore count value. When the count value
reaches zero there are no free resources. When a task finishes with the
resource it 'gives' the semaphore back - incrementing the semaphore count
value. In this case it is desirable for the initial count value to be
equal to the maximum count value, indicating that all resources are free.
The maximum count value that can be reached. When the semaphore reaches this value it can no longer be 'given'.
The count value assigned to the semaphore when it is created.
If the semaphore is created successfully then a handle to the semaphore
is returned. If the semaphore cannot be created because the RAM required
to hold the semaphore cannot be allocated
then NULL is returned.
void vATask( void * pvParameters )
/* Create a counting semaphore that has a maximum count of 10 and an
initial count of 0. */
xSemaphore = xSemaphoreCreateCounting( 10, 0 );
if( xSemaphore != NULL )
/* The semaphore was created successfully. */
Copyright (C) Amazon Web Services, Inc. or its affiliates. All rights reserved.


Wednesday June 13, 2018
It has proven nearly impossible for the Kenyan government to quickly close the third largest refugee camp in the world. Meanwhile, fewer people have chosen to return to Somalia so far in 2018, compounding the issue.
"Many of the inhabitants fled Somalia because of political instability in the '90s and have settled in Dadaab's camps after decades in Kenya," explains Neil Turner, our country director in Kenya and Tanzania. Some of Dabaab's inhabitants were born in Kenya and have never set foot in the country their parents or grandparents fled.
Neil Turner, NRC country director in Kenya and Tanzania
In 2011, when a devastating drought and famine hit Somalia, 100,000 additional refugees arrived. Supplementary camps were set up to accommodate them. At that time, the Dadaab population soared to around 480,000 as it became the world's largest refugee camp. Today, the Dadaab refugee complex consists of four refugee camps. The population is mostly Somalian, with a small number of refugees from Ethiopia, South Sudan and The Democratic Republic of the Congo.
The Kenyan government's desire to close down Dadaab
In 2016, the Kenyan government announced in that it would close Dadaab. A year later, the high court in Kenya ruled that a closure would violate the country's constitution. Turner explains that it was not necessarily the Kenyan government's intention to close Dadaab, but to send a message "that the status quo from the Kenyan government's perspective was not acceptable and that the UN refugee agency (UNHCR), in particular, should do more."
But the announcement still spread uncertainty among people in the camps.
The Kenyan government and UNHCR run a voluntary return programme for Somali refugees in Kenya. The number of refugees returning to Somalia through this programme increased through both 2016 and 2017.
"The number of refugees returning to Somalia increased because of the government's signals that Dadaab would be closed, and the uncertainty this caused among refugees," Turner says.
A decrease in voluntary returns to Somalia in 2018
Two years later, life goes on in the four remaining refugee camps. It is unlikely that Dadaab, one of
the world's largest refugee camps, will close any time soon.
"Practically, how does that happen", Turner asks.
Over 75,000 Somalian refugees have returned to Somalia through the voluntary return programme in the past three years. Around 33,000 returned in 2016 and a further 33,000 in 2017.
Most of the Somalis who return are the people who arrived after the 2011 drought. "They have more recent links to Somalia, while the people who arrived three decades ago are less likely to return as they have settled in Dadaab," Turner says.
Compared to previous years, the number of people returning to Somalia in the first four months of this year has decreased. "Our assumption is that those people who, for whatever reason, might join the voluntary return programme have already done that," Turner explains.
Returning to internal displacement in Somalia or going back to Dadaab
The refugees who travel back to Somalia face many barriers in a country not yet ready for a mass return of refugees. The Kismayo district in Somalia and the capital, Mogadishu, are the areas where most returnees end their journey. Many might ultimately become displaced again.
The Somalian refugees who return to the Kismayo district without having lived there before, face difficulties in getting land, housing and property. Some may end up leaving for Dadaab a second time. For the ones who return to Dadaab, it is almost impossible to get renewed refugee documentation. Without documentation, people have no right to food, shelter and healthcare.
Harsh rhetoric, but working to find solutions in practice
With almost 500,000 registered refugees living throughout Kenya, lasting solutions, such as livelihood opportunities, are needed to improve the situation.
A new refugee bill creating a more conducive environment for refugees to work and travel was approved by the Kenyan Parliament in June 2017. However, it was not agreed to by the President and has been returned to the legislature. Meanwhile, Kenya is part in the Comprehensive Refugee Response framework (CRRF), working to find lasting solutions in displacement, such as resettlement, integration or return. A CRRF pilot was initiated in late 2017.
Turner explains that the general perception of the Kenyan government's policy is that they are very strict on refugee matters, but "when you look below the rhetoric, you find that actually quite a lot is possible."


Robert R. McCormick’s maternal grandparents, Katherine Patrick (1831-1894) and Joseph Medill (1823-1899), laid the foundation of a media empire. In 1855 Joseph Medill purchased a 1/3 interest in the Chicago Tribune newspaper and formally incorporated the Tribune Company six years later. He purchased a controlling interest in 1874 and took over the company.
Medill wielded great power in Chicago. When the Chicago Tribune offices, and most of downtown Chicago, were obliterated in Chicago’s Great Fire of 1871, Medill borrowed a printing press. The next morning’s edition boasted: “Cheer up…Chicago shall rise again!”
Robert R. McCormick ushered in a new era when he laid the cornerstone of a new printing plant in 1920. President of Tribune Company since 1911, he expanded Tribune business ventures by forming WGN radio in 1924 and building the iconic Tribune Tower in 1925. WGN-TV joined the company in 1948.
Robert created a vast newsprint manufacturing empire to make Tribune Company a self-sufficient corporation. It included Tribune Company’s Canadian timberlands that supplied wood to their Thorold, Ontario and Baie Comeau, Quebec paper mill, and 12 ships that transported rolls of newsprint to offices of the Chicago Tribune and New York Daily News.
Throughout his life, Robert staunchly defended the First Amendment to the US Constitution, paying particular interest to the rights of Freedom of Speech and Freedom of the Press. As Chairman of the American Newspaper Publishers Association’s Committee on Freedom of the Press in 1928, his legal skills helped him defeat a Minnesota gag law. Eventually the U.S. Supreme Court ruled the law unconstitutional.
Robert firmly believed:
“The newspaper is an institution developed by modern civilization to present the news of the day, to foster commerce and industry, to inform and lead public opinion, and to furnish that check upon government which no constitution has ever been able to provide.”
—Robert R. McCormick
First Division Museum
Jan: ClosedFeb: Fri-Sun, 10am-4pmMar-Apr: Tue-Sun, 10am-4pmMay-Oct: Tue-Sun, 10am-5pmNov-Dec: Tue-Sun, 10am-4pm
Click for McCormick Museum Hours
Garden Tips & Tastes
See entire events calendar »


Bitcoin Studies: Finding Nakamoto Satoshi【11】——The global consensus requires an official consense
Updated: Dec 12, 2022
ZWS(Zhu Weisha), a Famous Chinese Entrepreneur
Bitcoin started as an air phase with only cost and no price, and the air-to-value transition is commonly thought of as pizza day on May 22, 2010. Then, it was the beginning of peer-to-peer commodity exchange, and after that, Bitcoin represented the value of the commodity. The first bitcoin trading platform, M.T.Gox (Mentor), started trading bitcoins on July 17, 2010. Note: Previously, bitcoins only represented commodities; once changed bitcoins with fiat currency, it meant that bitcoins officially became a medium of exchange and had the characteristics of money.
11.1 Measure of money
Currency represents assets, and assets have standards for measuring assets, which we will discuss later. The currency itself also has a standard of measurement. Just like a ruler has a tape measure, a caliper, and a ruler, they are suitable for different scenarios. We compare bitcoin to fiat and gold because their use cases are the same. The difference between them is that gold is history, fiat currency is the present, and bitcoin is the future.
Money itself can be an asset, but not all assets are money. Likewise, money itself is not necessarily an asset.
What is currency?
Many objects have represented the medium of exchange, such as shells, stones, metals, and paper money. Even certain strings of numbers are now described as currency. As a currency, there are quality issues. There are different indicator systems for measuring the quality of a currency. There are four most important indicators, and we can use these indicators to analyze a currency.
Currency has four characteristics: universality, Stability, Settle-easily, and popularity. Assets do not have all four of these characteristics.
Universality: Bitcoin is a super-sovereign currency, more universal than fiat money.
The country restricts the circulation of fiat currency because each country has its fiat currency. The scope of Bitcoin circulation is almost unrestricted, and only a few countries have nominal restrictions because the Internet is free. But the circulation of Bitcoin is hindered by its volatility, which is the same as gold. Therefore, Bitcoin is as unsuitable as gold as a standard for direct transactions. And experiments with blockchain stablecoins have opened our eyes to new possibilities.
Stability: Bitcoin's Stability has run for 13 years without significant failures, and there is no problem with time-tested Stability. 91% are mined out, and 97% are mined out by the end of the 5th cycle, i.e., 2027, which means there is only a 3% maximum risk in terms of Stability. It can almost be said to be negligible from the view of over-issuance. Except for technical Stability, quantity stability does not exist in terms of over-issuance. Quality stability cannot be falsified. Trust stability is trading Transparent.
Four indicators of stability：
1. Stable technology, will not die out.
2. Stable quantity, the total number can be known.
3. Stable quality, can't be faked.
4. Stable trust, transparent transactions and books.
Readers can compare gold and fiat currencies with four Stability by themselves, which I won't discuss here. The conclusion is that both flaws are unchangeable, and Bitcoin is superior to both. Although Bitcoin also has flaws, they are not unimprovable, and therefore Bitcoin is the most suitable medium of exchange and monetary representation in modern times.
Settle-easily: Compared to the fiat currency of clearing and settlement, bitcoin has no problems; there is a barrier to payment. This barrier also affects popularity. We classify such problems as popularity issues, analyze them one by one, and propose solutions or directions for each. And gold is wholly inapplicable at this point.
Popularity: measured by consensus or users. Bitcoin is not a global consensus, as we will discuss later. It is a flaw of Bitcoin that cannot be solved by technicians alone.
11.2 Popularity of Bitcoin in the Blockchain Circle
Popularity is the biggest weakness of Bitcoin, which is divided into in side and outside the blockchain circle. First, look at the status quo of Bitcoin in the blockchain, and then see if there is a way for one hit to win. Popularization within the circle is easy, and every bit of progress lays the foundation for popularization outside the circle.
11.2.1 The necessity of popularity in the blockchain circle
According to Figure 1, the website "Zhihu," as of February 4, 2021, had 345,505,547 bitcoin addresses. However, due to centralized exchanges, each of which has many users, Binance reached 120 million account holders, with a 20% growth in 2021. Binance does not allow American customers to open their accounts, but Coinbase, a U.S. company, can allow Americans to open accounts. It will have 56 million registered users in 2021. There are reportedly 25.2 million people in the U.S. holding bitcoin. (1) That means 30-50 million bitcoin holders on all Exchanges. It represents about 25% of the entire cryptocurrency circle. Bitcoin has a lot of room to grow in the cryptocurrency circle itself.
Figure 1 the number of bitcoin addresses on the chain
Figure 2 shows the distribution of the number of bitcoin addresses on the website "Zhihu," with 49% of the addresses holding less than 0.001. Due to the bitcoin change, most addresses are not owned by independent people. However, we need to consider the possibility that there are independent users with 0.01 bitcoins. Holding 0.01 bitcoins is also equivalent to $200, the price of a hard wallet, so it is likely to be owned by someone other than an independent person. This way, the number of independent coin holders on-chain could be 10 million. Most people are motionless for a long time or rarely trade. A conservative assumption is that there are 40 million people holding bitcoins on-chain and off-chain. The average person has 0.5 bitcoins.
Excluding the large "whale" addresses that don't move, the average retail user holds less than 0.2 bitcoins. Thus, 0.2 is a tiny psychological number for a retail investor, and the price is too high for a small retail investor to buy. The cost of Warren Buffett's stock in the U.S. is $440,000 a share, and the Buffett effect has affected the psychology of the core Bitcoin team. It is considered normal to have a high price. For small retail investors, who would buy it? Warren Buffett's stock was never considered a currency, his target is fund managers, and the world only needs a few thousand people. In fact, Buffett only needs the consensus of "money," Bitcoin is used as a currency and requires not only a consensus of money but also a consensus of people. Insiders are the best source of consensus. Do a little research to know the views of retail investors: Bitcoin is too expensive.
Figure 2 Distribution of the number of on-chain positions in bitcoin
11.2.2 The easiest way to popularize within the circle
Earlier, I mentioned a solution to this problem in "Establishing a Bitcoin Prize and a Satoshi Nakamoto Prize." According to Satoshi Nakamoto, moving the decimal point requires at least a 5-digit shift. Moving it six places is best. Also, set up a bitcoin Foundation with a portion of the transaction fees. However, this point has been said many times, which will be discussed later. It is needed to make up for the bitcoin consensus. Also, it benefits the popularity of bitcoin in the cryptocurrency circle. The Bitcoin community advocates natural evolution, which is suitable for the old era when a wine is not afraid of deep alleys. Now it's the information age, the laws of the market have changed, and adapting to the market is the constant law.
Dogecoin's success lies in being cheap, adapting to the market psychology, and marketing efforts, including the endorsement of Musk. Dogecoin will have more than 132.6 billion coins issued by September 2022, and the coin price on September 28 is $0.062. Bitcoin's decimal point shifted six places to the right; one bitcoin can become 100,000, all more than three times more expensive than dogecoin. The most exaggerated is the ShiBcoin price of $0.00001091; the market capitalization is 6 billion dollars, and it has no content or decent market activity; it just captures the psychology of people. It is more than Ethereum Classic (ETC) $3.72 billion, more than the old Bitcoin copycat Litecoin (LTC) $3.71 billion, and more than DeFi's leading Uniswap (UNI) $4.7 billion. That's psychology. If bitcoin is split off and the price drops, the number of people will increase.
Bitcoin will also go all the way up, so the most extensive application is not payments are transactions, and that's where Metcalfe's Law plays a key role. Increasing the number of people in the circle is one of Bitcoin's most significant pain points. This time drop, the market didn't follow PlanB's model because his model is based on a four-year halving rule that doesn't include Metcalfe's law, just as every time the stimulus effect wanes, a simple halving stimulus is no longer enough. Every four years, the halving cycle is on the long side, and making a significant improvement at the low point of the halving process will disrupt the steps of short sellers.
11.3 Popularity of Bitcoin outside the blockchain circle
Popularity outside the currency circle has three issues: ease of use and security of wallets; lack of official consensus; larger bitcoins holdings in the hands of Satoshi Nakamoto.
11.3.1 Ease of use exceeds the security and convenience of banks to be widely popularized
The issue of ease of use.
This issue is no longer a problem for centralized cryptocurrency Exchanges. The current crisis is the credit of Exchanges, and the current solution is to incorporate regulation. The easiest way is to bank account custody. The disadvantage is going back to the old way of centralization. This kind of problem belongs to the second layer application of bitcoin, and now it seems that both the centralized technology of the cryptocurrency exchange and blockchain technology for the second layer are flawed. Satisfying the regulatory authorities the blockchain circle is dissatisfied, and the meet circle, does not meet the requirements of the regulatory authorities. Popularity must solve two good problems and simultaneously solve the payment defect so that the Internet enters the WEb3 era. Web3 calls for new second-tier technologies. For this, you can refer to the solution provided by literature (2), which provides ease of use and security that exceeds that of banks.
11.3.2 Bitcoin requires official consensus
This problem is caused by history. The Bitcoin idea originated from cypherpunk and has a natural tendency to rebel against the government. Creating their cliques is not destined to succeed. The 2000s saw the emergence of several reality-oriented digital currencies, making Satoshi Nakamoto from the small circle of thinking to face the public. The market is finally recognizing Bitcoin's leading thinking and the ingenuity of its design. However, with the anonymous method, even if there is a reason for the publicity of the ledger, there is a solution in the design, and they are destined to be unwilling to cooperate with the government. How to cooperate? The community may not support the initial talk of working with the government.
The Bitcoin consensus is incomplete compared to gold. Gold is the global consensus, with 17.2% held by official holdings in 2011. (3) Literature (3) Statistics the total number of gold held by central banks of various countries. Currently, there are reports that the total number of official gold holdings reaches about 20%, but no accurate statistical report has been seen. a large amount is still privately held. The number of official bitcoin holdings is unknown, and it's part of the official hand from confiscated, and the market increased part of it.
Humans have used gold as money for thousands of years. The state-issued fiat currency, starting with the Chinese Song dynasty, issued Jiaozi, whose currency depreciated at a rate similar to today's fiat money in purchasing power, with less than a hundred years left with less than a few percent of the purchasing power. Finally, paper money did not become popular. Gold due to the defect of liquidity; the silver note was generated. The U.S. dollar was the equivalent of a silver note, giving rise to The Bretton Woods system. The lack of Acceptance capacity of the dollar led to the breakup of the system. The whole Bretton Woods establishment and disintegration was similar to the China Song dynasty Jiaozi initiated by the private. In the beginning, there was credit, then the rich merchants broke faith, the official intervention, the Jiaozi gradually without the nature of the silver note, that is, without the asset endorsement or a small amount of asset endorsement, and today's fiat money is the same. Of course, the fate of fiat money is the same. Because human nature is the same. (4)
The flaws in the design of the gold standard, and the lack of computer technology at the time, Like the Song Dynasty, the gold standard is not suitable for modern economic development. Nevertheless, It has become the mainstream view in the economic circle. Allowing Keynesianism to exploit the loopholes. Actually, Keynesianism is a quick fix but has regulators treating it as a multivitamin. One inflation and financial meltdown after another declared the bankruptcy of various theories of monetary issuance and regulation. Let's compare the dollar to a Ponzi scheme. Which are a convincing story, to begin with, and so is the U.S. dollar, which promises to pay its debts with taxes. Then the Ponzi scheme was also a trustworthy payment at the beginning. In fact, the original story has long been unreliable. It relies on borrowing the new to repay the old. As long as the chain continues, it will keep turning. Likewise, the dollar debt, can U.S. taxes be repaid? The later stage of the Ponzi scheme is the rise in the geometric progression of debt. The same is true for the U.S. dollar right now.
Bitcoin makes up for gold's liquidated flaws and makes it possible for us to return to the digital gold standard, i.e., the Bitcoin standard. However, as a global consensus, Bitcoin lacks the official Part, and the consensus is incomplete. To be like gold must be complemented by official recognition. The bitcoin standard, in particular, is simply impossible to do without official recognition. Is it that official involvement is centralized? Gold officially has about 20%. Is gold centralized? This is because some people do not distinguish between the Bitcoin system and Bitcoin. Assuming that the official controls the Bitcoin system, it also needs to control the global computing power. It is useless to control any party alone. If you can’t even control the system, Bitcoin can’t even control it. which can refer to the description in the fifth chapter of the literature (2). liquidated core is open and transparent, acting according to available rules, and there is certainty about the outcome expected. See section "10. The Significance of Satoshi Nakamoto's Nobel Prize" for a description of the machine's credibility. In the next section, we describe how we could use Bitcoin to save the U.S. dollar.
11.4 The Chosen Son Satoshi Nakamoto
New resources are needed to resolve historical debt, and this resource is not used to draw numbers on a computer but to pay off the debt with real money. The value of Bitcoin is converted from the electricity cost, which rises geometrically. Only it has the potential to outpace the growth of U.S. Treasuries. It just so happens that Satoshi Nakamoto has more than 1 million bitcoins.
11.4.1 Helping cypherpunks realize their dreams
Also, Satoshi Nakamoto has over 1 million bitcoins in his possession, close to 5% of the total, and he has never communicated this to the market. It's a bombshell for the market, and it doesn't know what the future holds. He is a one-person decision, and the level of terror exceeds the decision-making mechanism of the Federal Reserve.
Cyberpunk has a quote, "advocating widespread use of strong cryptography and privacy-enhancing technologies as a route to social and political change." There are 25.2 million Americans who hold Bitcoin, (1) half of the global holdings. If Bitcoin is good, that is America's good. Today it's time for Satoshi Nakamoto to realize the ideal of "social and political change" and fill in the missing Part of the consensus blank.
How do? Satoshi Nakamoto Donates No Less Than 1.1 Million Bitcoins, which becomes the reserve currency. The foundation is laid for it to become a commodity price ruler after 120 years. Lays the groundwork for the Bitcoin standard and the foundation for a strong dollar. Retirement of credit-based coins without asset backing, making the dollar a stablecoin for bitcoin. Thousands of households issue their currencies based on the bitcoins in their hands; see the next section for details on how to do this.
11.4.2 The failure of algorithmic stablecoins sounded the death knell for fiat currency
Related stablecoins attempts such as DAI and USDT have pioneered the way. The technical means are available, and the experiments are successful. Blockchain is the laboratory of contemporary finance, and understanding the blockchain looking back at the operation of the fiat currency, is very clear; where are its defects? If finance becomes a science like physics, there has to be a financial laboratory like a physics laboratory. All the formulas of physics have to be experimentally proven. Obviously, sociology is more complex than physics, and there are more uncertainties than physics. The solution is to use the ecological simulation approach, and any blockchain project is self-formed ecology, a simulation of social and financial ecology. Creative failure is not a significant loss. The failure of the algorithmic stablecoin is a wake-up call for fiat currency. Fiat currency is the unfulfilled tax backing, and this backing is uncertain. Algorithmic stablecoins are equity endorsements, and this equity is not as reliable as state taxes. Algorithmic stablecoins have one regulating factor, quantity regulation, which adjustment is based on the algorithm. The fiat currency has two regulators, a quantity and an interest rate. But the rule behind it is not even an algorithm; the decision-making process is based on unreliable data, which is similar to deciding by slapping the forehead. Suppose the algorithmic stablecoin has a bailout; will it collapse? The collapse of the algorithmic stablecoin lies in the fact that the equity behind it is much higher than its value. Three hundred million dollars now reflects Luna's equity value, which was 60 billion before the collapse; how much is it overvalued? Let the masters of the financial markets hunt is destiny; the United States is not afraid of hunting because it can have infinite over-issuance. Inflation will show up gradually, which is what the latter government can do. We are all in the middle of a Ponzi scheme that fiat currency; the funny thing is, knowing that I've been deceived has no way out. Satoshi Nakamoto saw this and came up with Bitcoin to find a way out. The following section, "Realize the Solutions of Bitcoin Dollar Standard," is one way to do this.
The death knell of fiat currency has sounded with bitcoin. No matter how fiat currency wanted to stay on the stage, it took only a few hundred years from the rise to the fall of the historical stage, which is the same as the fate of his ancestor "Jiaozi" in the Song Dynasty. The natural growth of Bitcoin does not require operation. Satoshi Nakamoto can wait for it; Bitcoin can wait for it, and wait for the world comes to him; this is also a natural event. It is God's choice; everything is at the timing.
11.4.3 There can only be one global currency consensus
The currency standard is just like the scale, China has an inch, a ruler and zhang. But this scale is the Chinese consensus; the world's scale is kilometers, meters, millimeters, and micrometers. This consensus is the global consensus. Two sets of standards will be popular in one place, but there is only one global consensus. Money through natural selection, gold became the global consensus; digital gold only Bitcoin exists for this opportunity of global consensus. The following section will analyze the various assets competing with Bitcoin.
Bitcoin is the work of the Chosen One. Another giant compared to Satoshi Nakamoto is the American industrialist Henry Ford. Streamline is the foundation of modern industry, as if it were simple, influencing and driving the rapid progress of our times. Bitcoin is the foundation of contemporary finance and will affect the next era. They are both extraordinarily well-integrated and visionary. In 1921, Henry proposed the creation of an energy-based currency that could form the basis of a new monetary system, and the article was published on the front page of the New York Tribune on December 4, 1921.（5） Very coincidentally, Bitcoin is also an energy currency. The proof-of-work (POW) model dictated that energy-backed Bitcoin and this proof-of-work mining method was heavily criticized for its supposed energy consumption. This criticism ignores Bitcoin’s ability to accelerate the transition to renewable energy, the use of wasted energy. Because of technological progress, the mine with the lowest cost wins.
11.4.4 Deciphering the mystery of Bitcoin's halving design
At this point, you can understand why it mined Bitcoin half in the first cycle. This coin distribution mechanism is very irrational. I was critical at first. If Satoshi Nakamoto mined out bitcoins to prepare to fill the consensus puzzle, The distribution mechanism of this kind of mining is reasonable. I wouldn't say I liked his height, and through continuous learning, only after understanding the Bitcoin principle. I realized that Satoshi Nakamoto's mind and far-sightedness are beyond the comprehension of ordinary people of my generation, and only the Chosen One with a mission can do it.
11.5 Depreciation is the consensus of the market on fiat currency
The financial turmoil that started in 2007 actually changed more than just finance. The world's sense of insecurity and uncertainty is on the rise. Bitcoin in 2009 was one answer to this insecurity. Financial turmoil not only destroys financial bubbles but also destroys the credit behind the currency.
11.5.1 The commonality of air currency and fiat currency is to squander credit
The most interesting part of the blockchain is that it lets us clearly look at aircoins and asset coins. We will describe the difference between the two later. If the consensus of aircoins keeps value growing, it is possible to complete the conversion to an assetcoin. Otherwise, aircoins do not have a cohesive consensus and cannot form an asset value because the initial investor trust is squandered. It is how fiat money is, constantly squandering people's trust, saving money is devalued, which is the market consensus, driving people to spend immediately, risk borrowing and participating in the orgy of capital, bear the evil consequences of letting capital devour you, all the hard-earned wealth floating away with the wind. Henry said, "It is well enough that people of the nation do not understand our banking and monetary system, for if they did, I believe there would be a revolution before tomorrow morning.”(5) This is a chronic illness associated with how the Federal Reserve works and the fractional reserve system of banks. Good thing we have bitcoin, with its 100% margin stablecoin and related lending experiments.
11.5.2 Bitcoin is the reserve currency of blockchain ecology
There are two successful experiments with blockchain, one with Bitcoin and the other with stablecoins. These are also great experiments for future monetary systems. The success of asset-backed stablecoins and the failure of algorithmic stablecoins indicate that aircoins are unreliable, and endorsed assets determine the fate of stablecoins. In the blockchain, an asset that can act as an endorsement is a reserve currency. Bitcoin is already a blockchain ecological reserve currency, experiments are always going on, and the ecology is growing. Bitcoin has a long growth period, which means a long life. From the 132-year growth period to speculate the maturity period, Satoshi Nakamoto has a thousand years of consideration. Experiments with blockchain stablecoins also confirmed the verifiability of asset endorsements. Everyone is questioning whether stablecoins are 100% backed by reserve currencies. It is how the blockchain differentiates the quality of various stablecoins. Fortunately, the collapse of algorithmic stablecoins proves asset endorsements are good. Why does it need to be proven? That transparency is not enough.
11.6 Add the official consensus promotes the sharp rise of Bitcoin
Bitcoin price is demand dictates; narrative promotes demand. Once the Federal Reserve and Satoshi Nakamoto were in contact, many banks rushed to follow suit. It would cause the value of bitcoin to rise dramatically, thus making it increasingly expensive for slower-reacting banks to buy. The logic of bitcoin is the logic of venture capital investment, and early buying a tiny bitcoin is the smartest thing to do. It is the same approach that Satoshi Nakamoto told everyone in 2009, and he physically practiced it. It is the significance of Please come out of Satoshi Nakamoto; it is good for Bitcoin holders. Satoshi Nakamoto simply showing up is a bear; he must shine. It is how the upward inflection point comes about.
I have studied all the traces of Satoshi Nakamoto, deciphered almost all the Quizzes, and I judge that after 13 years of cultivation, Satoshi Nakamoto will fill this blank. It will tell everyone how to achieve the Bitcoin standard. So we help Satoshi Nakamoto to rich ideas and gather the power of the social elite to complete the mission of changing the world. That's the power of community.
Achieving the Bitcoin standard is for the next section, and it's a method that people haven't seen yet and are familiar with. It's not at all new to those familiar with blockchain. We've just changed the scenario. What works in a blockchain lab will also work in a larger scenario.
The complete consensus has to include the official, just like gold. In this regard blockchain, people have to break down their thought barriers. In the next section, we will express that gaining official recognition is the key to the Bitcoin standard.
Satoshi Nakamoto: Male, then 33-34 years old, prodigy, American, lives on the West Coast, and is a cypherpunk. No shortage of money. Freelancer. There is no Satoshi Nakamoto among the deceased Satoshi suspects. He has excellent programming and product design skills and an understanding of the community. Good life, with a good moneymaser and schemer. Satoshi Nakamoto has a deep knowledge of finance. Influenced by the Austrian school of economics. Philosophically inclined to natural evolution and prefers to live free and easy. The founder of cryptoeconomics. The Chosen One with a mission.
News The Political 03 May 2022
2. Web3.0 Chainless Financial Platform White Paper
Hong Kong Yuxing Technology Company (8005)
3. Gold reserve
Gold holders 2011 100% (171,300)
Use Holding (tons) roportion
Jewelry 84,300 49.2%
Gold investment 33,000 19.26%
Central bank 29,500 17.2%
Industrial applications 20,800 12.14%
Unknown 3,700 2.2%
4. Ford's Centennial Prophecy: An Energy-Based Form of Money


A vertebra consists of two parts: an anterior segment, or the vertebral body; and a posterior part, or the vertebral (neural) arch.
- Identify the parts of a vertebra
- The vertebral processes can give the structure rigidity, help it articulate with ribs, or serve as muscle attachment points.
- When the vertebrae are articulated with each other, their bodies form a strong pillar for the support of the head and trunk, and the vertebral foramina constitute a canal for the protection of the spinal cord.
- Two transverse processes and one spinous process are posterior to the vertebral body.
- Two superior and two inferior articular processes articulate with the adjoining vertebrae. They allow for a small degree of movement in the spine, but greatly strengthen it.In between every pair of vertebrae are two apertures, the intervertebral foramina, one on either side, for the transmission of the spinal nerves and vessels.
- process: An outgrowth of tissue or cell.
- vertebral arch: The posterior part of a vertebra through which the spinal cord passes.
When articulated together the vertebrae form a strong yet flexible structure that encloses the vertebral foramen, or opening, where the spinal cord sits. It also provides a base for numerous muscle attachments and articulations with other bones.
The strength and flexibility of this structure is generated by the structure of the individual vertebrae. Comprised of bone and cartilage, the configuration of a vertebra varies based on its location within the body, although there are common features associated with those of the upper region.
A typical vertebra of the upper region of the spine consists of two regions:
- The anterior vertebral body which is the point of articulation between the vertebrae.
- The posterior vertebral or neural arch that encloses the spinal cord.
Located between each pair of vertebrae are two laterally located openings:
- The intervertebral foramina that facilitate access to the spinal cord for nerves and vessels.
- The intervertebral discs that act as ligaments between the vertebral bodies.
The vertebral arch is formed from two, short, thick processes called pediments that extend posteriorly from the lateral sides of the vertebral body, before joining together at the midline with the laminae.
Oblique view of cervical vertebra: The parts of a human vertebra.
There are seven processes that project from a typical vertebra.
Four articular processes originate from the joint between the pedicles and laminae, two point superiorly and two point inferiorly. They interact with the zyhapophysis, a socket for the articular processes, of the adjacent vertebrae to make the spine more stable and to facilitate a small degree of articulation.
A single spinous process projects backwards and downwards from the center of the vertebral arch and it serves as a major attachment point for muscles and ligaments of the back.
The two transverse processes project laterally from the join between the pedicle and lamina and also serve as an attachment point for muscles and ligaments of the back. The transverse processes articulate with the ribs in conjunction with the vertebral body.