#Waste Removal Paddington
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bigbenblog · 1 year ago
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Making Rubbish Clearance Easier - Big Ben
There are many instances in which a home owner or a property manager might require clearance service professionals and if you need a good and reputable clearance company offering a fast service for very affordable prices, call 020 3743 8686 to talk to Big Ben. Our company offers property clearance services which can benefit a whole range of individuals and we can deal with jobs of any size – from small flat clearance work to large scale house clearances and office clearance, our junk removal team are happy to help you get rid of unwanted rubbish and debris, and our workers can assist you in moving old unwanted furniture and personal effects to valuers, charity shops and recycling plants. https://emilyjenksphotography.com/how-to-plan-a-north-lake-tahoe-elopement/
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rubbishwaste · 9 months ago
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Commercial Waste Bermondsey - Rubbish Waste
What is commercial and industrial waste?
Commercial and industrial waste refer to the byproducts generated by businesses and manufacturing processes. These types of waste are distinct from residential or municipal waste and often require specialized handling due to their nature and potential environmental impact. Here's a brief overview of each:
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Commercial Waste:
Definition: Commercial waste originates from business activities, including offices, retail establishments, restaurants, and other non-industrial enterprises.
Examples: Paper and cardboard waste, packaging materials, food waste from restaurants, office equipment, and other items discarded during commercial activities.
Management: Commercial waste is typically collected by waste management services, and businesses may be required to follow specific regulations for disposal, recycling, or treatment.
Industrial Waste:
Definition: Industrial waste is generated during manufacturing, production, or other industrial processes. It can be solid, liquid, or gaseous and often contains substances that may be harmful to the environment.
Examples: Hazardous chemicals, manufacturing byproducts, wastewater from industrial processes, heavy metals, and other materials resulting from production activities.
Management: Industrial waste management involves proper treatment, disposal, or recycling based on the nature of the waste. Regulatory compliance is crucial due to the potential environmental and health impacts of industrial waste.
Both commercial and industrial waste are subject to regulations and guidelines to ensure proper disposal, minimize environmental impact, and promote recycling and sustainable practices. Many businesses are encouraged or required to implement waste reduction strategies, such as recycling programs, waste audits, and adopting environmentally friendly practices, to mitigate their impact on the environment.
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goodbyejunk1 · 3 years ago
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lukeskywaker4ever · 5 years ago
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King Pedro V 1st Trip (May 28th to September 15th, 1854): England, Part 3
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In the following days, the itinerary continued to run at an exhausting pace. When he saw the Library of the British Museum, 
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he wondered about the possibility of finding works from the old Portuguese convents: “How much wealth was not wasted in 1833, due to the disorder with which everything was done. Monastic orders were abolished, so far we are doing well; but why didn’t the nation take advantage of what it could have done?”
On 10th June, he went, with the queen, to see the reopening of the Crystal Palace, removed from Hyde Park to Sydenham, 
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in the London suburbs. 
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Under the glass vault, there were 25,000 people. An orchestra, made up of 2000 musicians, played Handel's Alleluia, and the most popular lyric singer of the time, Clara Novelo, 
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sang the God save the Queen. But it was not the music, but the building, that fascinated him. About this, he wrote: “It is 2000 feet long and its highest height is no less than 200 to 300 feet. It was made by a private company, under the direction of Sir Joseph Paxton, who, as a simple gardener, had become a celebrity for the conception of the vast plan of the Crystal Palace in Hyde Park in 1851” But he had not yet seen what he would admire. According to him, Paddington Station 
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had everything - functionality, modernity, beauty - as much as could be required of a modern work. Recalling the difficulties that Portugal was facing in order to obtain financing for the construction of railway lines, he noted that, in England, on the contrary, they “tingle capital.” Then, and with Prince Albert, he left for Windsor. The fifth - model that the kings had assembled there fascinated him: “There were introduced all the most useful applications of mechanics and all new inventions, not only those that have already been recognized as good, but also those that have yet to be proved.” According to him, kings should undertake these experiences, since they were an “example” that competed “powerfully for the progress of agriculture”. Windsor farmhouse seemed a wonder: “Everything is arranged in such a way that there is no lost material. Both excrement and urine are used in the best way to make artificial fertilizers.” In addition to the queen's hen house, he visited a vegetable garden with four orders of greenhouses and saw a steam engine that moved “all the devices designed to cut the hay, straw and oil cakes, as well as those that crush the broad beans and drain the wheat." He began to dream: “I would have liked to found an establishment of this kind, which would also do me honor. Not so much, but if God wants, I will try to imitate what can be imitated, especially the application of steam engines to agriculture.” After that he went for a horse ride, among the secular trees of the park, with Prince Albert. He was increasingly fascinated with this relative. In fact, he was increasingly fascinated with everything he observed. At the end of a ball in Windsor, D. Pedro took the time to reflect on Portuguese elites: “I take this opportunity to note the difference that exists in the education and manners of English society and ours. Here, these heroes in taverns with a mustache and a telescope embedded in the skull, whose greatest merit is to pretend to be affronted on horseback, to boast of the greatest idleness, spending their entire days between the Two Churches 
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and the Calçada do Carmo, 
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space they roar constantly. Anyway, there is education here and it is a shame to say it, among us, the upper classes are the least well created.”
Two days later, the prince was leaving London. In Oxford, 
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the vice-chancellor received the real power of the institution, the fact that his stay in the place was brief - one day - may have led him to make mistakes in the appreciation of the university, but it is also possible that the aristocratic leisure environment that was breathed there had shocked him. At St. John’s College, 
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I wanted to know what subjects were taught. They replied that "everything", something incomprehensible to someone used to think of the university institution as divided and faculties. He liked the architecture of Christ’s Church,
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but, once again, he was confused when he was told the content of the teaching. Having questioned the companion about what was taught there, he responded with a curt "yes", which surprised him. At Merton College, 
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he noticed the existence of two librarians, both crossed-eyed, which made him even more confused. Then he admired the Radcliffe Camera,
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 where, at the time, mostly books on natural sciences were kept, but he did not like the Sheldonian,
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whose faces from abroad seemed to him to be "monos". Above all, he admired the wealth of Bodleian, 
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who at the time had 500,000 volumes 
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in his estate. What the authorities did not reveal to him was the fact that it was partly formed on the basis of the very rich estate of the Bishop of Silves, looted in the 16th century by Sir Francis Drake's soldiers. But the visit was over. Dom Pedro still returned to London in time to hear Rigoletto that night.
Reflecting, already at dawn, on what he had seen in Oxford, here is what he wrote: “I noticed, by the quick examination I made of the University, that it is not in good condition; and this is, in general, the fate of all the great universities, whether the clergy or the secular arm prevails in them.” Oxford, he thought, should exhibit a more modern teaching, which shocked him, in particular, the fact that Aristotle was still seen there as an authority: “A University in the hands of the clergy, and especially that of the Protestant clergy, is an anachronism in century we live in.” He also found it negative that the institution had too many students. First, because "the crowd governs itself badly and bad examples are contagious"; second, because, in the big universities, “whoever donkey enters donkey leaves, because in them there are no coercive means capable of producing the benefit even in less able individuals.” Thirdly, because any centralization of teaching was bad. The following days passed between receptions and visits. He was received by the Lord Mayor of London, to whom D. Pedro spoke in English, and spoke in English made by himself, visited the Bank of England (which he liked), 
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St. Paul's Cathedral (which he did not like) 
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and visited to the House of Lords 
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where he heard a speech on the “question of the East”. At the end, he noted: "The viscount, Wylde, Folque, Sarmento and the brother Luis slept through the whole discussion." Then he found time to express his opinion on topics as varied as the free trade and the railways. About the first, he said: "As a result, I propose for the free trade, but, as a Portuguese, I must be somehow protectionist." About the second he wrote: “As long as we do not establish with solid bases at least one railroad, that unites us with the civilized world, as long as we have beasts that write that a railroad that unites us with Spain threatens our independence and that railroad cars cannot carry heavy weights, let us give up being anything, as we have become barbarians and thus belong only to the European continent, in fact, but not by law.”
The visits continued at a breakneck pace: to the archbishop of Westminster to whom he said “some truths that he did not like too much”, to the asylum of Bethlem, 
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which, at the time, housed 300 patients, to the painter Winterhalter, 
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who “dried” him, to the Times typography, which he liked, to Christ Hospital, 
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in his opinion inferior to Casa Pia, 
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to Greenwich, 
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registering, once again, his admiration for “that commerce, that animation, that immense navigation”, to some barracks , including Woolwich, 
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where he took the opportunity to comment on the advantages of factories being in the hands of private individuals, and to the Portsmouth Maritime Arsenal, 
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acclaimed for the “excellence of the English naval military organization.”
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mywastecollection-blog · 5 years ago
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thewasteremovalcompany · 2 years ago
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ancientbrit · 4 years ago
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Natter #1   05/31/2020
Subject: MI MG Natter #1 2020 (another off topic) I suppose that I have always had an interest in mechanical objects As a kid, my folks bought me things that went around when you did certain things, such as light a flame under a boiler, pour sand into a hopper or pour water into a hole. Either that or I could take items from a box to build things (Meccano and Arkerecto). When I was starting at Grammar school in 1944, bikes were the big thing and I wanted to build my own - just couldn't see anything I liked that was pre-built at a price I thought I could (eventually) afford. I took on two paper routes (rounds in the UK) one in the early morning and one in the afternoon to raise the funds, but it was taking a long time. I was therefore delighted when our next-door neighbor, Walter Woodward asked me if I would be interested in helping him on Saturdays at the small engineering company he and his cousin owned This was something I had been angling for for ages and truth be told I would have worked with him for nothing, but I had to admit that the additional funds would move the bike project right along.The company specialty was a giant blow lamp that was used by the railways and was also exported to Russia where the huge soft flame was directed at rail lines to thaw frozen points.
I loved these Saturdays and learned something about gas welding, turning and threading on a lathe, forming steel tube into coils and on. All very much pleasurable to me.
Eventually, when I had amassed sufficient funds, I had the frame custom built to my specs  at “Claude Butler” and it was a thing of beauty, it really was. The ancillaries came along bit by bit over time, but the wait was worth it and it finally hit the road in 1948, the year of the first Olympics following WW2. I went everywhere on that beautiful machine, visiting Youth Hostels all over the country, cycling to school, training runs most nights and weekends and just cycling for the pure pleasure of it.
My first job after school was disappointing. I had interviewed for two jobs in London. One was with an engineering company (interview went well) The other was with an Insurance company which I knew I didn't want nor need as the first interview had been so great. I remember seeming to be a bit flippant during the interview with the insurance manager. A ten-day wait brought two letters, one from each company. I opened the engineering company's letter first, preparing to luxuriate in the good news. I was therefore gutted to see that although they were impressed they really couldn't see their way clear to taking me on, when I would be in the army, navy, or air force for my National Service stint within the year. They just couldn't afford to train me when there was a good chance that I wouldn't return to them after my discharge in three years' time. I accepted the Insurance job with regret, but it did pay - sort of - and with my first month's salary I bought my first wristwatch - an Oris from Watches of Switzerland which served me well. I still have it.
It was only a basic mechanical watch and not an automatic - they were way too expensive, but I was fascinated with their designs. All those tiny, intricate parts working together and adopting your body movements to keep the mainspring at an almost constant pressure hands-off - wonderful, especially if it was a skeleton watch with much of the face and/or back pared away so that all the working parts could be observed - working. The Oris and I moved all over Great Britain and the Middle East from Gibralter, Egypt , Iran, The Persian Gulf to Sharjah and Dubai (this was before oil was discovered) and Amman in Jordan with no problems. Following my discharge three years later I went into engineering school, following which a variety of jobs were undertaken, mostly in research which fascinated the heck out of me. Eventually, all these experiences took me to London again working on the wing design of the Lockheed C5-A, which then led me to the Lockheed plant outside Atlanta.This was a short contract to marry our wing design to the fuselage designed at Lockheed itself. When this ended Jean and I sailed home on the original Queen Elizabeth from New York.
When we arrived home, Jean presented me with a beautiful Omega Seamaster DeVille day/date watch in stainless steel, which I had seen on board and drooled over.  But the price seemed too much, bearing in mind that going through Customs at Southampton would elevate the price heavily, to a point which I couldn't afford. Jean has never given me the merest inkling of what she had paid for it, although I had a fair idea. She would also not tell me how she had spirited it through Customs either. We went through Customs together and there was never a mention of the watch. Naturally I was over the moon. This watch in stainless was ideal. I have no interest in gold watches, after all a watch is designed to tell the time and the huge extra cost for the gold is a total waste - to me anyway. My London company (CDI) had no further work in England for us, but they did have a contract to work on the Boeing 747 and so back we came. But we had only been back for a couple of months when tragedy struck!I had been to Safeway to do a weekly shop, but when I returned home my Omega hadn't made it with me. I roared back to Safeway but of course, my watch had not been handed in and I never saw it again. Even the insurers robbed me. When I sent in the claim form they came up with some cock and bull story which I accepted like an idiot. I certainly wouldn't let it go today. And so started a long period with el cheapo watches as a form of self-flagellation for allowing myself to be so taken.There were a few electronic watches and finally Jean bought me a great Seico electronic, which allowed me to split-time races, to a gnats whisker, and all whilst sitting on the bottom of the ocean had I so desired. I have worn it every day; every day that is until two days ago when the battery ran out!. Even if I could have removed the back (which I couldn't) I am sure that I wouldn't have a suitable battery. It was driving me nuts, still wearing the watch and glancing at it several times a day and seeing that it was still 10:20! So what to do? I started to look through drawers and any place I could think of that might hold another watch. These did surface but they were all electronic and of course, all their batteries were shot too.  Somewhere my old, original mechanical Oris was resting, but just where I had no idea and wasting more time didn't bring it to light. But what I did discover quite by chance was my Dad's old watch that his friends at work had given him on his 60th birthday in 1960. I know the date is correct as the back was engraved:- "To Joe from the boys of the GWTPO 19-6-60" I don't know where the Joe name came from as he was Gilbert Leonard, but then again I had collected a few myself when I was in the RAF, such as Guss and Zeke - both explainable - but some time later! The GWTPO is short for the Great West Traveling Post Office which was a special train that ran from Paddington station in London to Plymouth in the West Country, leaving London around 9 pm and arriving in Plymouth by breakfast time. Dad had run this train and others ever since he got out of the Royal Navy in 1947. This train comprised a great steam locomotive which Dad had taken me to see years earlier when I was young and impressionable - and I was. Seeing that beautiful piece of mechanical equipment with the paintwork smartly gleaming and the brass and copper all burnished, sitting there panting with a slow mist of steam emanating from various ports and oh that smell of hot oil and steam  - what more could you want? So very evocative. The engine driver so confidentally leaning out from the cab , backlit from the yellow/orange flames from the open firebox made him look other wordly as he smiled at all the mere mortals below. So evocative. The loco pulled a collection of special coaches which were set up to allow the crews to sort mail on the move. At certain stations, there would be a sort of gallows at trackside from which would be hung a sack of mail. On the side of one of the coaches would be a special net and as the train sped through the night the net would pick up the mail sack without slowing down. This system worked beautifully for years, with others running to all the different areas of the country from Lands End to John O'Groats The mail was sorted on the run and was all ready for distribution on arrival. The system was started in the Post Office's glory days when they could guarantee that a letter posted before midday would be delivered anywhere in the country by first delivery (9 am) the following day. I said first delivery as there were three deliveries every day back then. The only exceptions were deliveries to outlying Islands or places way out in the back of beyond where deliveries were by horseback frequently.
Admittedly I now have to exercise like mad once a day to wind the watch, but It started right off the bat and it hadn't run since Dad passed away at 94 in 1989. The TPO system was shut down only a few years ago when it was found to be simpler to truck mail everywhere, but to get to this stage, mailings had to be cut to a single daily delivery  and with no guaranteed delivery by first post following posting before midday the previous day either.- progress will out I suppose!
The very last run was quite an emotional affair and Dad would have loved to have been there as would I. It had massive coverage in the press and I still have newspapers of the day with the reports and pictures. Another one of those old familiar and loved functions that have gone forever. Stay safe - perhaps we will meet again in the not too distant future. YFLGordon
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the-tiesthatbind · 8 years ago
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Hull City midfielder Ryan Mason says 'it was like a bomb going off in my head' when he collided with Chelsea central defender Gary Cahill
Ryan Mason's collision with Gary Cahill left him requiring emergency surgery
Mason and Cahill came together during Hull's away game at Chelsea in January 
The Hull midfielder says the collision felt 'like a bomb going off in my head'
Mason spoke exclusively to Sportsmail's chief sports reporter Matt Lawton
The aerial collision with Gary Cahill is something Ryan Mason can recall all too vividly. 'It was like a bomb going off in my head,' he says.
But it was only five weeks ago, some three months after his accident at Stamford Bridge in January, that the full horror of what he endured was explained to him by the Hull City doctor.
'He said there was a moment shortly after I arrived at the hospital, I think maybe just after I'd had a CT scan, that I was what they call 'unresponsive',' says Mason.
The 25-year-old has also revealed he remembers the moment he suffered the head injury well
'They acted very quickly and within minutes I was in surgery. But that was a life-threatening situation and it was a shock to hear that. The doc, to be fair to him, had waited for the right moment to talk me through the accident and the operation. Any earlier and I don't think I would have had the capacity to deal with it.'
This is the Hull midfielder's first newspaper interview since a clash of heads that has left him with 14 metal plates on the right side of his skull and a scar, now concealed by his hair, that at one stage required 42 staples. A week ago, he says, he would not have had the strength to recall his experience with a journalist.
By Friday afternoon, however, he was in a hotel not far from his Hertfordshire home speaking both candidly and eloquently about an incident that had him worried he would be unable to return to anything resembling a normal life, never mind his career as a professional footballer.
This is Mason's first newspaper interview since the clash of heads that put him in hospital
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I remember the cross, the header . . . then a feeling of pure fear
'It was a big impact,' he says. 'I fractured the skull and it shattered into quite a few pieces. The plates I've had inserted will be there permanently, along with the screws. There's a big scar under my hairline. The hair is growing back on that side now, although it's still a bit thinner there. But you wouldn't have recognised me 10 weeks ago. My head was huge because of the swelling and the bleeding I suffered on the brain.
'I fractured my eye socket as well. I had to have a bit of bone removed from there and the muscle down the side of my face had to be cut during the operation. That muscle then wasted away and now I'm chewing gum constantly to build it up again.
'For quite a while the muscle wasn't attached to the jaw. I couldn't even open my mouth for the first eight weeks, never mind get a full spoon of food in there. My fiancee Rachel was feeding me grains of rice. She has been amazing. For the first eight weeks she had to live in the house without the telly on, no noise, just nursing me. It was tough.'
Hair has started to grow back on the part of his head which was damaged by the collision
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He owes so much, he says, to so many people but he knows the Hull City doctor, Mark Waller, made some critical decisions that day — not least when it came to taking Mason to the neurotrauma specialists at St Mary's in Paddington rather than the nearest hospital.
'We drove past two hospitals on the way in the ambulance,' says Mason. 'But the doc knew within seconds I'd fractured my skull and he also knew St Mary's was the best place to go. If we hadn't I probably would have been scanned and then moved there afterwards. As it was I was in surgery 61 minutes after the accident.
'I actually remember everything up until surgery. I remember the cross, the header, being on the pitch, the ambulance arriving.
'I think my thoughts were of pure fear in those seconds after the collision. A clash of heads is pretty common in football but the sheer impact of it was worrying, because it was in this temple area. It seems to be a softer part of the head. I remember being on the ground. It really did feel like a bomb had exploded in my head. It was so painful.
'The doctor explained that you go through these stages. At first on the pitch I was apparently quite aggressive. I didn't want anyone to touch me or go near my face.
'Then after maybe 10 or 15 seconds he realised what I'd done because the right side of my face was paralysed. He was asking me to whistle and I couldn't do it.
'My mum and dad were at the game, sitting in the front row. And my mum joined the doc in the ambulance. I remember bits of the journey. I think there were speed bumps in Hyde Park. But I mostly remember the tone of the voices. I could tell they were worried. It was scary.
'The closer we got to the hospital, the more the pain started to subside. It was quite strange. And then I had this out-of-body experience. It may have been just after I came out of the scan and became unresponsive. But I was looking down at myself, running up this grassy hill with Rachel, two kids and a dog.'
The next thing he recalls is waking up from a three-hour operation, 'seeing some faces'. But what he had not realised until very recently was that Michael Dawson, his captain at Hull, had told the manager he would not be returning to Humberside after the game but would stay in London until he knew his close friend and team-mate was out of danger.
“My skull had shattered into several pieces. I could tell by people’s voices it was critical”
Dawson spent the night with Mason's friends and family before returning to St Mary's the next morning, still dressed in his bright orange Hull tracksuit.
Mason was also unaware what the surgeon had told his parents, Glen and Lisa, before the operation. 'I wouldn't say 'touch and go' but there was a definite sense it was critical,' says Mason. 'Thankfully the surgeon was able to stop the bleeding on the brain relatively quickly and he then did a great job putting me back together. I've met him quite a few times now. Kevin Tsang is his name. He's been tremendous.'
Mason looks remarkably well, with a minimum of visible damage. But although he is delighted to have taken the first tentative steps this week towards a return to training, there remains some way to go before he can consider playing football again.
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'I'm still dealing with fatigue,' he says. 'And if there's a lot of noise, a lot of conversations going on, I kind of hit a brick wall and need to leave and go sleep it off.
Mason says he does recall Michael Dawson staying overnight to make sure he was safe
'Being at the training ground for three days this week, I was aware what a noisy place that is. And when I went to watch us against Sunderland, I needed ear plugs to deal with the noise of the crowd. It was amazing going back to the stadium though. It gave me this tingly feeling.
'Everything is gradually improving and the doctors are pleased with my recovery. It's all part of a process that is completely normal for what I've been through.'
His balance was a major issue. 'It was really badly affected because I had suffered damage to the inner ear,' he says. 'For the first eight weeks it was like I was on a boat the whole time, feeling nauseous and unsteady. If I stood up I'd suddenly feel dizzy and need support.
'That took a bit of time to settle down. I've been in and out of London visiting a specialist ear clinic to deal with it. But they're happy with it now. To a member of the general public it would probably be considered perfectly fine now but to come back and play professional football . . . there's still a little way to go.
'What you realise is that your body is using so much energy to repair the injury, you don't have the strength for anything else. I was in hospital for eight days and when I came home I probably slept for 18 to 20 hours a day for the first four or five weeks. Breakfast would tire me out. Just getting up to sit at the table would be exhausting. I couldn't physically do anything.
He says he is still dealing with fatigue and can 'kind of hit a brick wall'
'I remember being able to butter a piece of toast again. Rachel and I actually celebrated. It felt like a huge step. But there would be times when I couldn't hold a conversation for more than a couple of minutes. I'd have to ask people to leave the house so I could rest.'
Among his visitors, however, was Petr Cech, the Arsenal goalkeeper who suffered a similarly serious head injury when he was at Chelsea.
'He's been brilliant,' says Mason. 'I think he left it a week after the accident happened and then he chased up Rachel and was in regular contact with her, reassuring her that what I was going through was normal.
'And then he came to see us about six or seven weeks ago and everything he was describing I could relate to. Our injuries were slightly different but the process of recovery was very much the same, and to hear it from someone who has been through it, come back and had the career he has had was very encouraging.
'He's been in regular contact and has been back to see me again, and his support has been really valuable for my whole family. I can't speak highly enough of him. He's a top man.'
Before Cech convinced him otherwise he did wonder if, at 25 with that one England cap, his days as a footballer were behind him.
'For the first five weeks I was like that, for sure,' he says. 'To begin with I just felt so blessed to still be alive. To be around my family. Then I was wondering whether I could get back to any form of normality. Whether I would be able to even walk to the shops.
I was glad to be alive. Then I wanted to walk. Now I want to play
'But when I did start watching TV again I put the football on, and it was then that I started thinking I wanted to play again. Prior to that, though, I was saying to Rachel that I wouldn't be able to play again. I couldn't imagine when it would be physically possible. How was I going to run around a football pitch when I was struggling to even walk up the stairs?'
This is a far more positive Mason sitting here now. An ebullient young man who says the experience has given him a much healthier perspective on life.
'When you're very close to having your life taken away from you it would be strange if that didn't have an effect on you,' he says.
'I like to think I've always appreciated what I've got. My family, my friends. But something like this makes you realise that they're actually what really matters.
'I think it's made me a happier person. Football can be a very up and down business but I think when I return the downs will affect me less.'
When does he think that will be? 'Until I'm back I really don't know what's going to happen,' he says. 'But the surgeon said there has to be a period of six months where there is no contact. I can't drive for six months either.
'I'll just take it step by step. I'm not even running yet. This week I've just been on the bike and doing bodyweight exercises. And Hull, who have been fantastic, have assigned one of the physios to me full time.'
His former colleagues at Tottenham have been hugely supportive too, as have Cahill, John Terry and the Chelsea players.
'The Spurs lads raised some money for the Headway Charity on my behalf, and when I'm strong enough I would like to get involved and help out,' he says. 'Being able to speak to someone who has had this kind of injury can be really important, as I know from Petr. It has helped to convince me that I will make a full recovery.'
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bcwallin · 4 years ago
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Just Because It Never Happened Doesn’t Mean It Isn’t True
I’ve lost track of how many times I’ve seen the 2015 movie Steve Jobs. It’s the one that stars Michael Fassbender, not Ashton Kutcher. I’ve lost track of how many times I’ve tried to nudge my friends and family toward watching it, too. To them, it’s a movie that was seen and left behind by many in 2015; it’s no big deal. I’ve lost track of how many times my friends said they’d never watch this one pretty well-received, but otherwise, probably unremarkable movie, just because I’d seen it maybe 30 times or more. They’re concerned.
Even if I had the capacity to push them toward trying it (“people don’t know what they want until you show it to them”), my friends, my family, and my exasperated wife would walk away saying “That? That’s the movie you can’t shut up about?” It’s the movie I’ve seen the most under quarantine (including one watch each with the two commentaries that come on the Blu Ray), and possibly the same for the before times. I’ve finished it and started all over again. I’ve played it on the subway, listening only to the audio. I’ve watched or listened to it on more than one continent, up to three times in a day. I read the interviews and watched the New York Film Festival Q&A where Kate Winslet barely gets any questions and I’ve heard Aaron Sorkin’s many different ways of saying he didn’t want a “cradle-to-grave” structure and I’ve read Danny Boyle talking about his reverence for Sorkin. I wasted 2 hours watching the supremely mediocre Jobs, because when you’re stuck in an all-consuming relationship with a movie or a piece of art or a particularly good donut shop, you want to take in every variety and idea that you can. I’m like Agnès Varda and the gleaners in The Gleaners & I; I’m trying to glean. Everything I can.
If I went in order from here, telling how I first saw the movie with my mom, then revisited it 3 years later, then got it stuck in my head like a bad song and then like a really good song, in a beginning-to-end, beat-by-beat telling with all the hit moments along the way, I would’ve learned nothing from Steve Jobs, at least in terms of storytelling. If I kept going on this navel-gazing path of pointedly telling a story in a way that’s not like all those other stories — this story goes to a different school — then I would’ve learned nothing from my feelings toward Aaron Sorkin, whose language I like quite a lot, and who spent a lot of the Blu Ray commentary asking editor Elliot Graham why different bits of his language, which he, too, likes quite a lot, were removed from the movie. My most significant memory of Aaron Sorkin is him saying “Damn it, how could this have happened?” before telling you in his Masterclass ad why you shouldn’t write that. He’s an exacting guy and he probably sees himself in Steve Jobs and Boyle sees himself in Steve Jobs and I don’t see anything of myself in Steve Jobs, but I see some of myself in Andy Hertzfeld (Michael Stuhlbarg) wearing a loose-fitting t-shirt and tying his shoes onstage while Steve Jobs (Michael Fassbender) complains about a computer not doing what it’s supposed to do.
It’s so easy to go back to the old favorites. You hold onto what you’ve already got. For so many people, if their parents showed them a movie that came out before 1985 when they were young, it’s enough to make it a classic, but for any other movie from that not-so-distant past or earlier, they’d rather not come to it for the first time. It’s like what I say every so often, which is that I don’t want to be writing; I want to have written. But that’s not really true. Being stuck inside is concerning. The world is concerning right now. If this is being read in the future, the world may be concerning then, and I hope you’re doing alright. If you’re reading this at any time, I hope you’re doing alright. Jobs didn’t care if people were doing alright, if you’d believe the movie. Jobs didn’t care how most people were doing until he’d pushed them to their lowest point, if you’d believe the book it’s based on, Walter Isaacson’s biography.
Let’s talk about the reality of the movie. Steve Jobs is a biopic. Aaron Sorkin would tell you that it’s not a piece of journalism; it’s a piece of storytelling. (What else would he tell you?) I’ve seen the fictional and the real versions of the movie — or, at least, those versions of parts of the movie, because most of it didn’t happen — because old keynotes are available on YouTube. You can watch the movie, then see how it stacks up against reality, then back again. Sorkin’s big idea with this movie is not to use a “cradle-to-grave” structure (he uses this phrase a lot); it takes place in an approximation of real time before three different product launches that the real Steve Jobs was at the center of. If you watch the B-roll, you can see that Boyle recreated the keynote speeches from those launches, at least in part, but you don’t need to watch those bits and pieces to make the comparisons. You get either a bit of rehearsal, a discussion about a detail going into the launch, or something of the like. Sorkin’s works tend to slip in the bits and the pieces that you need to get the gist of what’s going down.
The presentation of the iMac in 1998 — which Boyle, following filming in the Flint Auditorium Center and the San Francisco Opera House in keeping with history, chose a new venue to shoot in — was fascinating, but there are still the hitches of reality. Jobs walks over to the computer and then a beat and then he clicks the mouse and another beat and then the demo. In Steve Jobs, the 2015 movie, Michael Fassbender plays Steve Jobs in the turtleneck and jeans he wasn’t wearing in 1998 at the launch of the iMac and says “This is the iMac,” and he pulls the cover off in synchronization with the sounds of the lights shutting off and Daniel Pemberton’s electric score takes over the scene, and it’s not just because the exit signs are off (you see? It’s like poetry; it rhymes) that this historical retelling feels so cool. It’s Reality+ and it’s comforting.
The end of the movie is kind of like that, too, but it’s disingenuous. On a rooftop parking lot that’s not actually on the rooftop of the building they shot in, Michael Fassbender, playing Steve Jobs, reconciles with his character’s daughter, Lisa. He brings back the drawing a different actress playing Lisa pretended to draw earlier and he unfolds it from his pocket and she looks at him as the lightbulbs flash and he smiles at her onstage and she loves her dad. It’s probably because the idealized products mimic the feelings we get when we see the unveilings and announcements, unless you’ve pledged yourself to a different phone company, in which case Apple is and always has been a company full of idea hacks and copycats. But people. People are what matter. Unless you’re Steve Jobs.
It can be intoxicating listening to “Great Men” even when you know they’re not great men. I’ve watched/listened a lot to Orson Welles’s The Other Side of the Wind, a movie about a “Great Man” that was directed by a “Great Man.” It’s a movie about the making of a movie, and both movies have the same name. Whether you watch it from the outside-in (production horrors in trying to get this movie to ever be made) or the inside-out (the psychological and physical torments by a repressed alpha male played by John Huston), you see these “Great Men” put their loved ones and acolytes through their onslaughts and then, you hope, it’ll all turn into something incredible. But The Other Side of the Wind wasn’t finished by J.J. Hannaford and the other The Other Side of the Windwasn’t finished by Orson Welles, and maybe everything Welles put cinematographer Gary Graver through (cf. the making-of documentary, They’ll Love Me When I’m Dead) and everything J.J. Hannaford (Welles stand-in-ish) put Brooks Otterlake through (Peter Bogdanovich stand-in) wasn’t really worth the failed end-result. But also I like my iPhone, so I can live with the past, I guess?
One of the pieces of Pemberton’s score for the 2015 movie Steve Jobs that I enjoy the most (and there are a lot of good parts) is what he described as an orchestra tuning up, which turns into a melody. It coalesces. That music plays while Michael Fassbender, playing Steve Jobs, says “I play the orchestra,” which is to say that Steve Jobs was best at getting other people to do things right. He did this by poking and prodding people in his exacting ways, repeating ideas back to people as if they were his, creating dichotomies between “insanely great” and “bullshit.” But was anything great ever made without alienating some people involved? Besides Paddington 2? If anybody walks out of Steve Jobs thinking that the lesson is to push people because that’s how they’ll do the best, it’s not the right lesson, but it’s also not a lesson the movie fully discourages, since everything pretty much works out for Michael Fassbender’s performance of Jobs. Even John Sculley (Jeff Daniels) comes back to give him a Newton (they edit in the words to Daniels’ mouth — if you watch the movie enough times, you pick up that he’s not moving his lips when words come out) because it’s a reconciliation. I also can’t help but love the sentiment of the scene and the way Daniels says “Let’s let it go now,” because even in the less real moments, Steve Jobs is a movie starring people at the top of their game (except in the last scene).
Michael Fassbender doesn’t do an impression of Steve Jobs and he doesn’t try to look like Steve Jobs, and that’s not just because he’s not Ashton Kutcher (who was in the 2013 movie Jobs, a different movie). It’s evocative. None of this happened, Andy Hertzfeld said, according to Aaron Sorkin, as recorded on the Blu Ray commentary. But all of this happened (except for the last scene). It’s art and it’s a masterclass on how to tell a story (a. I’m not really into using that phrase; b. Damn it, how could this have happened?) that doesn’t have to be the story you thought you should tell. And then Michael Fassbender says that line, “It’s like five minutes before every launch, everyone goes to a bar and gets drunk and tells me what they really think.” It’s still not as awkward as the Bob Dylan lyrics projected on the floor and walls (added digitally in post) in the first third of the movie (did you know it’s a three-act structure?), but these are also the thoughts of a person who’s seen the 2015 movie Steve Jobs over 30 times. Boyle likes comparing the story to Shakespeare, so I’ll just say about all this, “Take in what sense thou feel.”
It’s like music. It’s like music that has awkward lines (“I got over the Mac and Woz and Sculley the same way you get over your high school sweetheart; build a new one.”) and that feels like a stage play that had cutaways layered onto it, but not as many cutaways as the 2013 movie Jobs’ incessant need to show people applauding the genius of Jobs, its hero. The more you watch the movie, the more it feels preordained, because that’s how everything is supposed to happen (it doesn’t matter if I come to a satisfied conclusion about why watching Steve Jobs a lot is therapeutic — my wife will still be exasperated). Steve Jobs, the 2015 movie where Kate Winslet takes no prisoners and Michael Stuhlbarg breaks your heart, is my comfort movie, even though it’s an insanely tense movie where your worst nightmares of claustrophobia are filled with quick-paced dialogue and one-upmanship that feels a lot less clever when you start to notice how crafted it feels. But you barely notice it because of how amazing everybody is (except in the last scene — but Fassbender uses his lower teeth like a well-tuned instrument when he says “I’m poorly made”). It’s my comfort movie. I’ve accepted I’m alone in this. For those considering, there are two options the character Steve Jobs offers on one of his computers: “buy it or don’t.” I doubt my disinterested friends are still reading, but I’ll let it go now. Must be time.
Originally published on The Sundae
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the-lady-bryan · 5 years ago
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HP AU Idea: “The Wizarding World” game simulation.
Inspired by the Red Dwarf episode "Back to Reality". (If you haven't watched the show - holy mother of Cloister you are MISSING OUT ON A SMEGGING FABULOUS SHOW! If you're in the US, it is totally worth the $6.99/mo for Britbox. Also, it's got Classic Doctor Who on there, too so, y'know, that's also worth it. Moving on....)
Note: For anyone familiar with the episode - Totes not going to bother with the fascism world because I honestly have no interest in it. But the Red Dwarf simulation game machines? Fucking genius. The tech that ran them? Dude played Wormtail so of my brain ran off in a weird direction after remembering that.
Now on with the idea....
Modern world (like, our world) but a bit more advanced. And no, I haven’t spellchecked any of this garbage.
M-Corp, the leading game developer in the world, has unveiled the next greatest thing! Move over common Virtual Reality/Altered Reality and make room for Fully Simulated Living! Want to be a pirate? You and all your friends can sign up and play the Pirates of the Caribbean Experience! Want to go on an epic quest to stop evil and bring about the dawn of a new age? Well get eight of your best friends together for the fully immersive War of the Ring! Fight monsters, save elven maidens, and build a kingdom! Or be a tiny little thief and a band of dwarves. Whatever your heart desires. Or are you more of a spacefaring espionage kind of guy? Well in that case you'll want to sign up for the Red Dwarf Experience and play as Arnold J. Rimmer (just be careful not to end up playing the prat version all the way through like the beta tester did...)
"You haven't truly lived until you've died! But don't worry, you can always play another game!"
There is one game though.... one game that hasn't left the beta testing. And no one at M-Corp thinks it ever will. It was the first game they tried to make with the new tech, before all the bugs had been worked out and the safeguards had been put into place. They had stopped sending people into the game ten years ago when some of the beta testers hearts just... stopped. Coroners couldn't figure out what happened or why. Aside from mild dehydration the programmers who had volunteered to help test the game they had made just... died. James Potter and Lillian Evans were the last casualties of M-Corp's biggest failure to date... and they couldn't just unplug people either. The last person they did that to... Well... To this day he still believes he's a wizard who rebelled against the Dark Lord, the villain of the game and insists he needs to destroy some enchanted locket. Beta Tester Reginald Blackmoor was never the same after experiencing "The Wizarding World" game.
And so they have to wait for the testers characters to die in the game and hope that whatever had happened to Potter, Evans, and a handful of others, doesn't happen again.
Seventeen years ago a team of hackers made it known that they had a theory, but couldn't test it out unless they were plugged into what the underground and pirating circles called "The Lost Game". A game so deadly it literally killed people who played it. So of course, adrenaline junkie and all around smart ass known only as "Son of Prongs" and his right and left hand, "Bookworm" and "Garbage Disposal" had to do everything they could to get into this impossible game.
It was crazy. It was unethical and honestly not in the company's best interest... but when the offer was made it was M-Corp's desperation that drove them to accept.
It's been 16 years since the three hackers were plugged in immediately following the download of data from one of their hardrives directly into the game. During that time they lost quite a lot of testers, especially in the last three years. The first of the mysterious deaths had been beta tester Cedric Edwards. The next was Bartholemew Tenant. Unlike most of the mysterious deaths, he seemed to have died of absolute fright while in the machine. The deaths afterwards were rather... steady. Then, one day, there was a mass system failure and they lost half the tester and programmer team. Some they were able to pull out before the cascading feedback could turn them to vegitables. As this was happening, many of those unaffected would give pained grunts or twitch in their stations. One young man spontaneously combusted right in his seat. Thankfully they were able to put him out before it spread to others, but the man did not survive.
Of those who had been brought out of the game during the system failure and survive, it was... unsettling to watch them in the recovery rooms. Many kept freaking out and demanding to know "where is my wand!" while others kept shouting at them about being something called a "mudblood" or somesuch.
One man, part of the original team with James Potter and Lillian Evans sat in silence. Periodically he would reach up to his throat and then look at his forearm in disbelief. When he finally did speak, while staring down at a name badge with a picture of himself on it, only 20 or so years younger, his voice was quiet and slightly uncertain. "My name. It is... Steven Prince?" "Yes, Mr. Prince." "And I... have been inside of an illusion-" "A simulation." "A simulation. For twenty years." "Yes." "And all this time, my family did not wonder where I was?" "You signed a NDA and a waiver. M-Corp is not responsible for-" "There is no Dark Lord." "No. There is not. Magic is not real. You cannot break the laws of physics by saying a few words here and there." "What... Lily. Was Lily real? Is she here, too?" "Your fiance.... died, Mr. Prince. Sixteen years ago. We do not know how or why it happened. She and design specialist James Pot-" "I believe I understand, thank you." And he has not said anything since.
It's a full year after the event the survivors of the system failure call "The Battle of Hogwats" before the game is finally, finally shut down and those still plugged in are able to be removed. Most of those removed during the "Battle of Hogwarts" have regained their memories and attempted to assymilate back into the real world. Many still have trouble and some, such as Remmy Wulfric, are in and out of institutions. One man, the lead project developer who had been able to leave the game before most of them, Brian Dumbledore, never recovered and is a permanent resident in the same wing as Reginald Blackmoor. This was after he was found robbing corner stores dressed in outrageous wizard costumes from the halloween stores, and demanding they hand over all the lemon sherberts "for the greater good". It was all over the news. And clips from security cams made it to youtube, where he further made it to fame on "World's Dumbest" styled funny clip shows.
The last three to emerge from the game are "Son of Prongs" "The Bookworm" and "Garbage Disposal". The three of them have no idea where they are or how they got there. According to one of them, he was just about to get married to the love of his life, Ginny Weasley.
And that's when the three of them are handed each a suitcase and the original hard drive with written instructions and are escorted to a recovery facility.
It doesn't help that one of the first people they saw was the Care Tech, Peter Paddington, who went around to make sure everyone's nutrition sacks were refilled and their fluid lines still clear and running correctly. And, when the need arose, dealing with "waste disposal". It wasn't Peter's fault that his best mate James decided to sneak in a cameo into the game for him since his mind couldn't handle the load of the simulation. Otherwise he would have been in there with him and their other best friends.
Anyway, in recovery the three hackers open their suitcases to find clothes and notebooks and a disk each with the words "watch me alone". Once the three of them have gotten their memories back, or rather, convinced others they have gotten their memories back and are released, they follow the directions written in one of their journals in a code that they recognize as having been used during the "horcrux hunt" - which they now know never happened. They find a storage locker and after doing some snooping they learn that it's been paid up every month automatically from a bank account bearing the name "Sybil Trelawney". It was a code name, according to Bookworm's notebook, that they used when talking amongst themselves about their theories about The Lost Game.
They find computers inside, and it's Bookworm who has to operate them because neither Son of Prongs or Garbage Disposal remember how. When she loads the first one from her own suitcase, it's got all three of them in the shot. And they're all in the storage locker. They seem to be having some sort of argument between them. "No, I'm telling you, that game changes people! Look! Reginald Blackmoor came out honestly believing he was some... some wizard named Regulus Black!" "so it made him insane. Honestly Ronny anything that messes with the human psyche and perception-" "Then explain how he managed to kill the pub owner by just pointing a stick at him!" "The pub owner was old and his medical records showed-" "Yeah?! What about the strange deaths, huh?! For fuck's sake, Henry's mom died because of that game! Don't you two want to know how or why?!" "Of course I want to know! The fuckers covered it up and said it was something else but I KNOW it was that stupid game!" "Then what are we waiting for? We've tested the program over and over. We know it works. If we can just get it and ourselves in there-" "We've tested it in a controlled environment, Ronny. That's not the same as uploading our patch to the M-Corp servers. There's every chance that it would be corrupted the moment we're plugged in. We may even lose ourselves like Blackmoor did." "Fuck off, Jane. It's Henry's project, so it's Henry's decision."
The second disk, from apparently Ronny's suitcase is the three of them again. This time laying out the plan. "If we can just get to your mom's fiance... he has an editic memory. We can use that." "The day Steven Prince willingly helps me is the day hell freezes over. He hates me, and you know it." "Why though?" "Fuck if I know." "Maybe he's just pissed that you're proof someone else got to your mom first." "dude." "What? I knew a guy like that. Right bastard he was. Made his girlfriend give her kid to her ex, even though the dude was a fuckin meth dealer." "That's horrible!" "Steve isn't THAT bad. Besides, she didn't even know who my dad was. Do you know how many dudes were at that frat party? Now enough about my dead mom's sex life and back to the plan..."
The last disk, from "Henry's" suitcase is Henry looking frantic and addressing the camera. He looks like he's in the offices of M-Corp. Behind him on cots are Jane/Hermione/Bookworm and Ronny/Ron/Garbage Disposal. Henry/Harry/Son of Prongs keeps running a hand through his hair and green eyes keep darting to a screen off camera. "Something's wrong. We plugged in Trelawney to upload the patch and... it looked normal. But... we're twenty minutes till plug in time and the data's corrupted already. I've tried to edit the code but whatever is in this game is vicious and intelligent. It's got tendrils everywhere. It's rewriting code at a rate I can't keep up with. I'm trying to write up a new function. If it works, then whatever this thing is... we'll be able to trap it on the hardrive, and then destroy it. We promised to anylize the code after we shut down the game from the inside but... that won't be possible without infecting other systems. But... there's more. I hacked into the personel files. I needed to see what... how my mom really died. Nothing. But when I looked through old surveilence footage I found something. Just before she died she was... glowing. Her and that James Potter bloke. So I dug through more files. It's strange. Everyone that died had something weird happen to them or near them just before they kicked it. I can't explain it... Just in case we don't make it, or somehow our minds are lost or, god forbid we end up like that Blackmoor bloke, whatever you do, don't hook that harddrive up to anything. Destroy it. And if possible, destroy the game, too. I think one of the original programmers did this but I can't be sure until we get inside."
Voldemort, it turns out, is a self-replicating virus (hence horcruxes and the problem of never actually being able to get rid of Voldemort completely) created by disgruntled computer programer Thomas Marvin Riddle who was fired from the project by Brian Dumbledore after he threatened to destroy a co-worker's career if she didn't lie and give him credit for her work.
Life goes on. The entire Wizarding World game is covered up and the equipment broken down. But there's a problem still... small groups of former beta testers and programmers who lived through the experience start meeting up in "support groups". None of them can really get over what happened to them. Especially when some of them start noticing they have had strange things happen around them... almost like bouts of accidental magic.
Henry, Jane, and Ronny run a message board under the names Potter, Granger, and Weasley. Their memories of their lives before the game never returned. They destroyed the harddrive without looking at it. Unfortunately for everyone involved, it did change them physically... and made them all real witches and wizards.
And unfortunately.... disgruntled programmer Thomas Marvin Riddle had a pirated game station hidden in the basement of his home and the harddrive wasn't able to catch quite everything linked to the Voldemort Virus...
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localbrisbaneplumber · 7 years ago
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Blocked Drain Brisbane - Hydro Jetting Made Simple
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Different Ways of Waste Disposal
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viralhottopics · 8 years ago
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Sickening, gruelling or frightful: how doctors measure pain | John Walsh
The Long Read: Suffering is difficult to describe and impossible to see. So how can doctors tell how much it hurts?
One night in May, my wife sat up in bed and said, Ive got this awful pain just here. She prodded her abdomen and made a face. It feels like somethings really wrong. Woozily noting that it was 2am, I asked what kind of pain it was. Like somethings biting into me and wont stop, she said.
Hold on, I said blearily, help is at hand. I brought her a couple of ibuprofen with some water, which she downed, clutching my hand and waiting for the ache to subside.
An hour later, she was sitting up in bed again, in real distress. Its worse now, she said, really nasty. Can you phone the doctor? Miraculously, the family doctor answered the phone at 3am, listened to her recital of symptoms and concluded, It might be your appendix. Have you had yours taken out? No, she hadnt. It could be appendicitis, he surmised, but if it was dangerous youd be in much worse pain than youre in. Go to the hospital in the morning, but for now, take some paracetamol and try to sleep.
Barely half an hour later, the balloon went up. She was awakened for the third time, but now with a pain so savage and uncontainable it made her howl. The time for murmured assurances and spousal procrastination was over. I rang a local minicab, struggled into my clothes, bundled her into a dressing gown, and we sped to St Marys Paddington at just before 4am.
The flurry of action made the pain subside, if only through distraction, and we sat for hours while doctors brought forms to be filled, took her blood pressure and ran tests. A registrar poked a needle into my wifes wrist and said, Does that hurt? Does that? How about that? before concluding: Impressive. You have a very high pain threshold.
The pain was from pancreatitis, brought on by rogue gallstones that had escaped from her gall bladder and made their way, like fleeing convicts, to a refuge in her pancreas, causing agony. She was given a course of antibiotics and, a month later, had an operation to remove her gall bladder.
Its keyhole surgery, said the surgeon breezily, so youll be back to normal very soon. Some people feel well enough to take the bus home after the operation. His optimism was misplaced. My wife came home the following day filled with painkillers. When they wore off, she writhed with suffering. After three days she rang the specialist, only to be told: Its not the operation thats causing discomfort its the air that was pumped inside you to separate the organs before surgery. Once the operation had proved a success, the surgeons had apparently lost interest in the fallout.
During that period of convalescence, as I watched her grimace and clench her teeth and let slip little cries of anguish until a long regimen of combined ibuprofen and codeine finally conquered the pain, several questions came into my head. Chief among them was: Can anyone in the medical profession talk about pain with any authority? From the family doctor to the surgeon, their remarks and suggestions seemed tentative, generalised, unknowing and potentially dangerous: Was it right for the doctor to tell my wife that her level of pain didnt sound like appendicitis when the doctor didnt know whether she had a high or low pain threshold? Should he have advised her to stay in bed and risk her appendix exploding into peritonitis? How could surgeons predict that patients would feel only discomfort after such an operation when she felt agony an agony that was aggravated by fear that the operation had been a failure?
I also wondered if there were any agreed words that would help a doctor understand the pain felt by a patient. I thought of my father, a GP in the 1960s with an NHS practice in south London, who used to marvel at the colourful pain symptoms he heard: Its like Ive been attacked with a stapler; Like having rabbits running up and down my spine; Its like someones opened a cocktail umbrella in my penis Few of them, he told me, corresponded to the symptoms listed in a medical textbook. So how should he proceed? By guesswork and aspirin?
There seemed to be a chasm of understanding in human discussions of pain. I wanted to find out how the medical profession apprehends pain the language it uses for something thats invisible to the naked eye, that cant be measured except by asking for the sufferers subjective description, and that can be treated only by the use of opium derivatives that go back to the middle ages.
When investigating pain, the basic procedure for clinics everywhere is to give a patient the McGill pain questionnaire. Developed in the 1970s by two scientists, Dr Ronald Melzack and Dr Warren Torgerson, both of McGill University in Montreal, it is still the main tool for measuring pain in clinics worldwide.
Melzack and his colleague Dr Patrick Wall of St Thomas Hospital in London had already galvanised the field of pain research in 1965 with their seminal gate control theory, a ground-breaking explanation of how psychology can affect the bodys perception of pain. In 1984, the pair went on to write Wall and Melzacks Textbook of Pain, the most comprehensive reference work in pain medicine. It has gone through five editions and is currently more than 1,000 pages long.
In the early 1970s, Melzack began to list the words patients used to describe their pain and classified them into three categories: sensory (which included heat, pressure, throbbing or pounding sensations), affective (which related to emotional effects, such as tiring, sickening, gruelling or frightful) and lastly evaluative (evocative of an experience from annoying and troublesome to horrible, unbearable and excruciating).
You dont have to be a linguistic genius to see there are shortcomings in this range of terms. For one thing, some words in the affective and evaluative categories seem interchangeable theres no difference between frightful in the former and horrible in the latter, or between tiring and annoying and all the words share an unfortunate quality of sounding like a duchess complaining about a ball that didnt meet her standards.
But Melzacks grid of suffering formed the basis of what became the McGill pain questionnaire. The patient listens as a list of pain descriptors is read out and has to say whether each word describes their pain and, if so, to rate the intensity of the feeling. The clinicians then look at the questionnaire and put check marks in the appropriate places. This gives the clinician a number, or a percentage figure, to work with in assessing, later, whether a treatment has brought the patients pain down (or up).
A more recent variant is the National Initiative on Pain Controls pain quality assessment scale (PQAS), in which patients are asked to indicate, on a scale of 1 to 10, how intense or sharp, hot, dull, cold, sensitive, tender, itchy, etc their pain has been over the past week.
The trouble with this approach is the imprecision of that scale of 1 to 10, where a 10 would be the most intense pain sensation imaginable. How does a patient imagine the worst pain ever and give their own pain a number? Some men may find it hard to imagine anything more agonising than toothache or a tennis injury. Women who have experienced childbirth may, after that experience, rate everything else as a 3 or 4.
I asked some friends what they thought the worst physical pain might be. Inevitably, they just described nasty things that had happened to them. One man nominated gout. He recalled lying on a sofa, with his gouty foot resting on a pillow, when a visiting aunt passed by; the chiffon scarf she was wearing slipped from her neck and lightly touched his foot. It was unbearable agony.
A brother-in-law nominated post-root-canal toothache unlike muscular or back pain, he said, it couldnt be alleviated by shifting your posture. It was relentless. A male friend confided that a haemorrhoidectomy had left him with irritable bowel syndrome, in which a daily spasm made him feel as if somebody had shoved a stirrup pump up my arse and was pumping furiously. The pain was, he said, boundless, as if it wouldnt stop until I exploded. A woman friend recalled the moment the hem of her husbands trouser leg snagged on her big toe, ripping the nail clean off. She used a musical analogy to explain the effect: Id been through childbirth, Id broken my leg and I recalled them both as low moaning noises, like cellos; the ripped-off nail was excruciating, a great, high, deafening shriek of psychopathic violins, like nothing Id heard or felt before.
It seems a shame that these eloquent descriptions are reduced by the McGill questionnaire to words like throbbing or sharp, but its function is simply to give pain a number a number that will, with luck, be decreased after treatment, when the patient is reassessed.
This procedure doesnt impress Professor Stephen McMahon of the London Pain Consortium, an organisation formed in 2002 to promote internationally competitive research into pain. There are lots of problems that come with trying to measure pain, he says. I think the obsession with numbers is an oversimplification. Pain is not unidimensional. It doesnt just come with scale a lot or a little it comes with other baggage: how threatening it is, how emotionally disturbing, how it affects your ability to concentrate. The measuring obsession probably comes from the regulators who think that, to understand drugs, you have to show efficacy. And the American Food and Drug Administration dont like quality-of-life assessments; they like hard numbers. So were thrown back on giving it a number and scoring it. Its a bit of a wasted exercise because its only one dimension of pain that were capturing.
Illustration: Matthew Richardson
Pain can be either acute or chronic, and the words do not (as some people think) mean bad and very bad. Acute pain means a temporary or one-off feeling of discomfort, which is usually treated with drugs; chronic pain persists over time and has to be lived with as a malevolent everyday companion. But because patients build up a resistance to drugs, other forms of treatment must be found for it.
The Pain Management and Neuromodulation Centre at Guys and St Thomas Hospital in central London is the biggest pain centre in Europe. Heading the team there is Dr Adnan Al-Kaisy, who studied medicine at the University of Basrah, Iraq, and later worked in anaesthetics at specialist centres in England, the US and Canada.
Id say that 55 to 60% of our patients suffer from lower back pain, he says. The reason is, simply, that we dont pay attention to the demands life makes on us, the way we sit, stand, walk and so on. We sit for hours in front of a computer, with the body putting heavy pressure on small joints in the back. Al-Kaisy reckons that in the UK the incidence of chronic lower back pain has increased substantially in the last 15 to 20 years, and that the cost in lost working days is about 6 to 7 billion.
Elsewhere the clinic treats those suffering from severe chronic headaches and injuries from accidents that affect the nervous system.
Do they still use the McGill questionnaire? Unfortunately yes, says Al-Kaisy. Its a subjective measurement. But pain can be magnified by a domestic argument or trouble at work, so we try to find out about the patients life their sleeping patterns, their ability to walk and stand, their appetite. Its not just the patients condition, its also their environment.
The challenge is to transform this information into scientific data. Were working with Professor Raymond Lee, chair of Biomechanics at the South Bank University, to see if there can be objective measurement of a patients disability due to pain, he says. Theyre trying to develop a tool, rather like an accelerometer, which will give an accurate impression of how active or disabled they are, and tell us the cause of their pain from the way they sit or stand. Were really keen to get away from just asking the patient how bad their pain is.
Some patients arrive with pains that are far worse than backache and require special treatment. Al-Kaisy describes one patient let us call him Carter who suffered from a terrible condition called ilioinguinal neuralgia, a disorder that produces a severe burning and stabbing pain in the groin. Hed had an operation in the testicular area, and the inguinal nerve had been cut. The pain was excruciating: when he came to us, he was on four or five different medications, opiates with very high dosages, anticonvulsive medication, opioid patches, paracetamol and ibuprofen on top of that. His life was turned upside down, his job was on the line. The utterly stricken Carter was to become one of Al-Kaisys big successes.
Since 2010, Guys and St Thomas has offered a residential programme for adults whose chronic pain hasnt responded to treatment at other clinics. The patients come in for four weeks, away from their normal environment, and are seen by a motley crew of psychologists, physiotherapists, occupational health specialists and nursing physicians who between them devise a programme to teach them strategies for managing their pain.
Many of these strategies come under the heading of neuromodulation, a term you hear a lot in pain management circles. In simple terms, it means distracting the brain from constantly brooding on the pain signals it is getting from the bodys periphery. Sometimes the distraction is a cunningly deployed electric shock.
We were the first centre in the world to pioneer spinal cord stimulation, says Al-Kaisy. In pain occasions, overactive nerves send impulses from the periphery to the spinal cord and from there to the brain, which starts to register pain. We try to send small bolts of electricity to the spinal cord by inserting a wire in the epidural area. Its only one or two volts, so the patient feels just a tingling sensation over where the pain is, instead of feeling the actual pain. After two weeks, we give the patient an internal power battery with a remote control, so he can switch it on whenever he feels pain and carry on with his life. Its essentially a pacemaker that suppresses the hyperexcitability of nerves by delivering subthreshold stimulation. The patient feels nothing except his pain going down. Its not invasive we usually send patients home the same day.
When Carter, suffering from agonising pain in the groin, had failed to respond to any other treatments, Al-Kaisy tried his new combination of therapies. We gave him something called a dorsal root ganglion stimulation. Its like a small junction-box, placed just underneath one of the bones of the spine. It makes the spine hyperexcited, and sends impulses to the spinal cord and the brain. I pioneered a new technique to put a small wire into the ganglion, connected to an external power battery. Over 10 days the intensity of pain went down by 70% by the patients own assessment. He wrote me a very nice email saying I had changed his life, that the pain had just stopped completely, and that he was coming back to normality. He said his job was saved, as was his marriage, and he wanted to go back to playing sport. I told him, Take it easy. You mustnt start climbing the Himalayas just yet. Al-Kaisy beams. This is a remarkable outcome. You cannot get it from any other therapies.
The greatest recent breakthrough in assessing pain, according to Professor Irene Tracey, head of the University of Oxfords Nuffield Department of Clinical Neurosciences, has been the understanding that chronic pain is a thing in its own right. She explains: We always thought of it as acute pain that just goes on and on and if chronic pain is just a continuation of acute pain, lets fix the thing that caused the acute and the chronic should go away. That has spectacularly failed. Now we think of chronic pain as a shift to another place, with different mechanisms, such as changes in genetic expression, chemical release, neurophysiology and wiring. Weve got all these completely new ways of thinking about chronic pain. Thats the paradigm shift in the pain field.
Tracey has been called the Queen of Pain by some media commentators. She was, until recently, the Nuffield Professor of anaesthetic science and is an expert in neuroimaging techniques that explore the brains responses to pain. Despite her nickname, in person she is far from alarming: a bright-eyed, enthusiastic, welcoming and hectically fluent woman of 50, she talks about pain at a personal level. She has no problem defining the ultimate pain that scores 10 on the McGill questionnaire: Ive been through childbirth three times, and my 10 is a very different 10 from before I had kids. Ive got a whole new calibration on that scale. But how does she explain the ultimate pain to people who havent experienced childbirth? I say, Imagine youve slammed your hand in a car door thats 10.
She uses a personal example to explain the way perception and circumstance can alter the way we experience pain, as well as the phenomenon of hedonic flipping, which can convert pain from an unpleasant sensation into something you dont mind. I did the London Marathon this year. It needs a lot of training and running and your muscles ache, and next day youre really in pain, but its a nice pain. Im no masochist, but I associate the muscle pain with thoughts like, I did something healthy with my body, Im training, and Its all going well.
I ask her why there seems to be a gap between doctors and patients apprehension of pain. Its very hard to understand, because the system goes wrong from the point of injury, along the nerve thats taken the signal into the spinal cord, which sends signals to the brain, which sends signals back, and it all unravels with terrible consequential changes. So my patient may be saying, Ive got this excruciating pain here, and Im trying to see where its coming from, and theres a mismatch here because you cant see any damage or any oozing blood. So we say, Oh come now, youre obviously exaggerating, it cant be as bad as that. Thats wrong its a cultural bias we grew up with, without realising.
Recently, she says, there has been a breakthrough in understanding about how the brain is involved in pain. Neuroimaging, she explains, helps to connect the subjective pain with the objective perception of it. It fills that space between what you can see and whats being reported. We can plug that gap and explain why the patient is in pain even though you cant see it on your x-ray or whatever. Youre helping to bring truth and validity to these poor people who are in pain but not believed.
But you cant simply see pain glowing and throbbing on the screen in front of you. Brain imaging has taught us about the networks of the brain and how they work, she says. Its not a pain-measuring device. Its a tool that gives you fantastic insight into the anatomy, the physiology and the neurochemistry of your body and can tell us why you have pain, and where we should go in and try to fix it.
Some of the ways in, she says, are remarkably direct and mechanical like Al-Kaisys spinal cord stimulation wire. There are now devices you can attach to your head and allow you to manipulate bits of the brain. You can wear them like bathing caps. Theyre portable, ethically allowed brain-simulation devices. Theyre easy for patients to use and evidence is coming, in clinical trials, that they are good for strokes and rehabilitation. Theres a parallel with the games industry, where theyre making devices you can put on your head so kids can use thought to move balls around. The games industry is, for fun, driving this idea that when you use your brain, you generate electrical activities. Theyre developing the technology really fast, and we can use it in medical applications.
Illustration: Matthew Richardson
Pain has become a huge area of medical research in the US, for a simple reason. Chronic pain affects over 100 million Americans and costs the country more than half a trillion dollars a year in lost working hours, which is why it has become a magnet for funding by big business and government.
Researchers at the Human Pain Research Laboratory at Stanford University, California, are working to gain a better understanding of individual responses to pain so that treatments can be more targeted. The laboratory has several study initiatives on the go into migraine, fibromyalgia, facial pain and other conditions but its largest is into back pain. It has been endowed with a $10m grant from the National Institutes of Health to study non-drug alternative treatments for lower back pain. The specific treatments are mindfulness, acupuncture, cognitive behavioural therapy and real-time neural feedback.
They plan to inspect the pain tolerance of 400 people over five years of study, ranging from pain-free volunteers to the most wretched chronic sufferers who have been to other specialists but found no relief. The idea is to find peoples mid-range tolerance (theyre asked to rate their pain while they are experiencing it), to establish a usable baseline. They then are given the non-invasive treatments such as mindfulness and acupuncture and are subjected afterwards to the same pain stimuli, to see how their pain tolerance has changed from their baseline reading. MRI scanning is used on the patients in both laboratory sessions, so that clinicians can see and draw inferences from the visible differences in blood flow to different parts of the brain.
A remarkable feature of the assessment process is that patients are also given scores for psychological states: a scale measures their level of depression, anxiety, anger, physical functioning, pain behaviour and how much pain interferes with their lives. This should allow physicians to use the information to target specific treatments. All these findings are stored in an informatics platform called Choir, which stands for the Collaborative Health Outcomes Information Registry. It has files on 15,000 patients, 54,000 unique clinic visits and 40,000 follow-up meetings.
The big chief at the Human Pain Research Laboratory is Dr Sean Mackey, Redlich professor of anaesthesiology, perioperative and pain medicine, neurosciences and neurology at Stanford. His background is in bioengineering, and under his governance the Stanford Pain Management Center has twice been designated a centre of excellence by the American Pain Society. A tall, genial, easy-going man, he is sometimes approached by legal firms who want him to appear in court to state definitively whether their client is or is not in chronic pain (and therefore justified in claiming absentee benefit). His response is surprising.
In 2008, I was asked by a law firm to speak in an industrial injury case in Arizona. This poor guy got hot burning asphalt sprayed on his arm at work; he had a claim of burning neuropathic pain. The plaintiffs side brought in a cognitive scientist, who scanned his brain and said there was conclusive evidence that he had chronic pain. The defence asked me to comment, and I said, Thats hogwash, we cannot use this technology for that purpose.
Shortly afterwards, I gave a talk on pain, neuroimaging and the law, explaining why you cant do this because theres too much individual variability in pain, and the technology isnt sensor-specific enough. But I concluded by saying, If you were to do this, youd use modern machine-learning approaches, like those used for satellite reconnaissance to determine whether a satellite is seeing a tank or a civilian truck. Some of my students said, Can you give us some money to try this? I said, Yes, but it cant be done. But they designed the experiment and discovered that, using brain imagery, they could predict with 80% accuracy whether someone was feeling heat pain or not.
Mackey finally published a paper about the experiment. So did his findings influence any court decisions? No. I get asked by attorneys, and I always say, There is no place for this in the courtroom in 2016 and there wont be in 2020. People want to push us into saying this is an objective biomarker for detecting that someones in pain. But the research is in carefully controlled laboratory conditions. You cannot generalise about the population as a whole. I told the attorneys, This is too much of a leap. I dont think theres a lot of clinical utility in having a pain-o-meter in a court or in most clinical situations.
Mackey explains the latest thinking about what pain actually is. Now we understand that pain is a balance between ascending information coming from our bodies and descending inhibitory systems from our brains. We call the ascending information nociception from the Latin nocere, to harm or hurt meaning the response of the sensory nervous system to potentially harmful stimuli coming from our periphery, sending signals to the spinal cord and hitting the brain with the perception of pain. The descending systems are inhibitory, or filtering, neurons, which exist to filter out information thats not important, to turn down the ascending signals of hurt. The main purpose of pain is to be the great motivator, to tell you to pay attention, to focus. When the pain lab was started, we had no way of addressing these two dynamic systems, and now we can.
Mackey is immensely proud of his massive CHOIR database which records peoples pain tolerance levels and how they are affected by treatment and has made it freely available to other pain clinics as a community source platform, collaborating with academic medical centres nationwide so that a rising tide elevates all boats. But he is also humble enough to admit that science cannot tell us which are the sites of the bodys worst pains.
Back pain is the most reported pain at 28%, but I know theres a higher density of nerve fibres in the hands, face, genitals and feet than in other areas, Mackey says, and there are conditions where the sufferer has committed suicide to get away from the pain. Things like post-herpetic neuralgia, that burning nerve pain that occurs after an outbreak of shingles and is horrific; another is cluster headaches some patients have thought about taking a drill to their heads to make it stop.
Like Irene Tracey, Mackey is enthusiastic about the rise of transcranial magnetic stimulation (Imagine hooking a nine-volt battery across your scalp) but, when asked about his particular successes, he talks about simple solutions. Early on in my career, I used to be very focused on the peripheral, the apparent site of the pain. I was doing interventions, and some people would get better but a lot wouldnt. So I started listening to their fears and anxieties and working on those, and became very brain-focused. I noticed that if you have a nerve trapped in your knee, your whole leg could be on fire, but if you apply a local anaesthetic there, it could abolish it.
This young woman came to me with a terrible burning sensation in her hand. It was always swollen; she couldnt stand anyone touching it because it felt like a blowtorch. Mackey noticed that she had a post-operative scar from prior surgery for carpal-tunnel syndrome. Speculating that this was at the root of her problem, he injected botulinum toxin, a muscle relaxant, at the site of the scar. A week later, she came up and gave me this huge hug and said, I was able to pick up my child for the first time in two years. I havent been able to since she was born. All the swelling was gone. It taught me that its not all about the body part, and not all about the brain. Its about both.
Main illustration by Matthew Richardson
This is an edited version of an article that appears on Mosaic. It is republished here under a Creative Commons licence.
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from Sickening, gruelling or frightful: how doctors measure pain | John Walsh
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