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Nurses’ Perceptions Regarding End-of-life Care for Individuals with Non-cancer Diseases on Non-invasive Positive Pressure Ventilation-dependent: A Qualitative and Descriptive Study
How to cite this article: Ushikubo M. Nurses’ perceptions regarding end-of-life care for individuals with non-cancer diseases on non-invasive positive pressure ventilation-dependent: A qualitative and descriptive study. Indian J Palliat Care 2023;29:175-80.
Palliative care is essential for patients requiring respiratory assistance through non-invasive positive pressure ventilation (NPPV). This study aimed to describe nurses’ perception of individuals with NPPV and non-cancer terminal diseases in various clinical settings.
Material and Methods:
This qualitative and descriptive study was conducted using semi-structured interviews with audio recordings with advanced practice nurses from different clinical settings and obtained their perceptions of end-of-life care for patients with NPPV.
Five categories of nurses’ perceptions were extracted: Difficulty with an uncertain prognosis, differences in symptom management by type of disease, benefits and weaknesses of NPPV on palliative care, influence of physicians’ attitude toward palliative care and the nature of the medical institutions and influence of patient’s age in palliative care.
The nurses’ perceptions showed differences and similarities across disease types. There is a need for skills improvement regardless of disease type to minimise the side effects of NPPV. Advanced care planning based on disease-specific characteristics and age-appropriate support and integration of palliative care into acute care is needed for terminal NPPV-dependent patients. Interdisciplinary efforts, as well as the pursuit of expertise in each field, are needed to provide good palliative and end-of-life care for NPPV users with non-cancer diseases.
Non-invasive positive pressure ventilation
Palliative care services have focused on patients with advanced-stage cancer,[1,2] despite non-cancer patients accounting for two-thirds of those requiring palliative care services. Although later than other developed countries, Japan has begun to focus on palliative care for non-cancer patients.
Palliative care is more difficult for non-cancer patients because of an uncertain prognosis. Since patients with respiratory and cardiovascular diseases deteriorate gradually with repeated remissions and exacerbations, it is more difficult to predict end-of-life for these patients compared with cancer patients. The illness trajectory of these conditions has been modified by recent advances in symptom management, such as the use of ventilators for respiration and gastrostomy for nutritional management.
Respiratory failure in patients with chronic heart failure, chronic obstructive pulmonary disease and amyotrophic lateral sclerosis (ALS)/motor neuron disease is being managed with non-invasive positive pressure ventilation (NPPV). NPPV is a nasal or face mask type ventilator shown to be beneficial in improving survival rates[7,8] and has been widely used in hospital and home care settings.
There is a point where NPPV is no longer capable of providing palliation for respiratory difficulties as the disease progresses. There is a need to focus on the development of palliative care in situations where NPPV is no longer effective. A previous study showed that palliative care was not sufficiently provided for patients with neuromuscular diseases using NPPV at the end of life.[9,10] Therefore, it is necessary to understand the end-of-life care situation of NPPV users from an interdisciplinary perspective.
This study focused on nurses’ perception because nurses are experts in medical care to support patients and their families. The purpose of this study was to describe how nurses perceived the end-of-life for patients with non-cancer diseases on NPPV, to consider good palliative and end-of-life care.
MATERIALS AND METHODS
Study design and participants
This was a qualitative and descriptive study. Since this study presumed to deal with complicated issues including ethical dilemma, the subjects were certified advanced practice nurses (either certified nurses or certified nurse specialists) who had experience in caring for patients on NPPV. We excluded those who only had experience caring for NPPV users with cancer. Convenient sampling was employed and nurses from four different clinical settings in the Kanto region participated in this study: Two certified nurse specialists in gerontological nursing, one certified nurse in chronic respiratory nursing and one certified nurse in intensive care nursing.
Face-to-face semi-structured interviews were conducted with participants by one researcher and one or two research assistants. The study participants were asked to describe their experience in providing support to two or three, currently deceased, then NPPV-dependent non-cancer individuals within the past 2 or 3 years. The question items included in the interview guide are shown in [Table 1]. All interviews were recorded with a voice recorder with consent from the participants.
Years of nursing experience
|Characteristics of each patient the participants supported
|Patients’ conditions nearing death|
|Participants’ views based on their experience in caring for terminal non-cancer patients depend on NPPV|
Data analysis for qualitative data
The qualitative inductive analysis was performed in reference to the analysis of multiple case studies and based on the method proposed by Greg. The interview data were transcribed verbatim. The verbatim transcripts were carefully read and abridged and careful to not lose semantic content. Those were first analysed individually and subcategories were extracted. The categories were extracted from these subcategories according to similarity, with cross-referencing among the participants. In the qualitative analysis process, this study employed constant comparative analysis to ensure trustworthiness. The analysis was also supervised by a nurse with a master’s degree and a nurse with a doctorate degree who had substantial experience with qualitative inductive analysis.
This study was approved by the ethical committee of the author’s university (approval number: HS2016-061). All participants’ signatures were obtained to signify their informed consent after the researcher provided oral and written explanations. To ensure confidentiality, the participants were asked not to disclose the identity of the patients.
The participants were nurses in their late 30s or 40s, and their years of nursing experience ranged from 12 to 22 years. From these participants, we collected data on ten terminally ill non-cancer patients who were on NPPV until the moment of death.
|Nurse ID||Age||Gender||Qualification (Speciality)||Years of Nursing experience||Workplaces|
|1||Late 40s||F||CNS (Gerontological nursing)||21 years||Mixed care hospital|
|2||Late 40s||F||CN (Intensive care nursing)||22 years||Acute care hospital|
|3||Late 30s||F||CNS (Gerontological nursing)||12 years||Home visiting nursing station|
|4||Late 40s||F||CN (Chronic respiratory nursing)||22 years||Long-term care hospital|
|Case ID||Age||Gender||Types of disease||Disease||NPPV use||NPPV use duration||Living place|
|Before approaching death or admission|
|Case A||60s||M||Neuromuscular||ALS||Intermittent||6 months||Home|
|Case B||70s||M||Ditto||ALS||Intermittent||3 months||Home|
|Case C||70s||M||Circulatory||HF||No use||0||Home|
|Case D||90s||F||Ditto||HF||No use||0||Home|
|Case E||70s||M||Ditto||dilated cardiomyopathy||Intermittent||1 year||Home|
|Case F||60s||F||Respiratory||atypical microbacteriosis||Intermittent||1 year||Home|
|Case G||80s||M||Ditto||COPD||Intermittent||3 years||Home|
|Case H||70s||F||Neuromuscular||Muscular dystrophy||Constant||over 20 years||Hospital|
|Case I||20s||M||Ditto||Muscular dystrophy||Night only||7–8 years||Home|
|Case J||20s||M||Ditto||Muscular dystrophy||Night only||10 years||Home|
Out of ten patients, two suffered from respiratory diseases, three suffered from heart diseases and five suffered from neuromuscular diseases. There were two patients in their 20s, two in their 60s, three in their 70s and three in their 80s or older at the time of their death. All patients died in the hospital. NPPV was initiated as a standard treatment for chronic respiratory failure for eight patients; the other two patients were initiated on NPPV during an acute exacerbation. There was no specialised palliative care available to any of the patients.
Nurse’s perception of end-of-life for individuals with NPPV and non-cancer [Table 4]
Five categories were identified regarding how nurses perceived the end-of-life for individuals with NPPV and non-cancer. The categories are described in the following sections. Categories are Italic and underlined and subcategories are denoted by < >.
|Categories||Ns. 1||Ns. 2||Ns. 3||Ns. 4|
|Difficulty with uncertain prognosis|
|Difficulty in predicting whether patients recover or not||✓||✓|
|Differences in symptom management by type of diseases|
|Impression that opioids do not work well in ALS unlike cancer pain||✓|
|Limited treatment choices for patients with pulmonary diseases||✓|
|Difficulties in establishing a home care support system for patients with pulmonary diseases||✓|
|Differences between muscle dystrophy and ALS||✓|
|Benefits and weaknesses of NPPV on palliative care|
|Benefits that allow patients to be at ease and live longer.||✓||✓|
|Difficulty in taking off NPPV masks to suction the sputum and saying something to their family for patients||✓|
|Disadvantage of being restrained by mask fitting at the end of life, which increases suffering||✓|
|Influence of physician’s attitude of palliative care and the nature of the medical institutions|
|Less focusing on palliative care among the physicians in acute care hospital||✓|
|Patient pain from continued NPPV influenced by physician knowledges||✓|
|Influence of patient’s age in palliative care|
|Difficulty for patients’ parents to agree with the transition from active therapy to palliative care||✓|
Difficulty with an uncertain prognosis
This category consisted of two subcategories. <Unexpected death> was extracted from Nurses 1 and 3. Nurse 1 mentioned Case B who suffered from ALS, a male in his 70s. His respiratory condition suddenly worsened during his hospitalisation to receive respite care, and he died soon thereafter. She talked about his sudden death event stating, ‘We regret that we could not do anything for him because he suddenly died a few days after the physician explained that it was time for him to decide whether he wanted to be on tracheostomy positive pressure ventilation (TPPV)’. Nurse 3 mentioned Case G who suffered from COPD, a male in his 80s. His family member found him collapsed in the bathroom. He was transported by ambulance and pronounced dead at the hospital due to aortic dissection.
<Difficulty in predicting whether patients recover or not> was extracted from Nurses 2 and 3. Nurse 2 mentioned C ase C, a male in his 70s diagnosed with heart failure Class IV. He was admitted to the hospital due to difficulty breathing as an emergency. Intra-aortic balloon pumping was performed but could not be removed due to hypotension. He was started on NPPV, and haemodialysis was initiated due to respiratory distress and oliguria, respectively. He was admitted to the intensive care unit (ICU) for approximately 2 months and died. Nurse 3 mentioned three patients. Case E, a male in his 70s was in the late stage of dilated cardiomyopathy and had a poor response to swelling and blood pressure medication. He was admitted to the hospital as scheduled for close monitoring while his medications were being revised. Yet, his physical functions declined rapidly and he died 2–3 weeks after admission. Case F who suffered from atypical microbacteriosis was a woman in her 60s and used NPPV to help her expectorate during the daytime. She had been repeatedly in and out of the hospital for 3–4 years. The situation eventually distressed her and decided to be hospitalised. She eventually died in the hospital, although she had wanted to die at home. Nurse 3 pointed out the uncertainty of mortality stating, ‘I did not know if I should call the ambulance or not because it was uncertain whether the patients would recover or die. This would make it inevitable that they would die in the hospital’.
Differences in symptom management by type of diseases
This category consisted of four subcategories. <Impression that opioids do not work well in ALS unlike cancer pain> was extracted from Nurse 1. She has provided support for ALS patients and mentioned: ‘Unlike cancer pain, I have the impression that opioids do not work well in ALS and I believe, this was caused by the high level of anxiety’.
<Limited treatment choices for patients with pulmonary diseases> was extracted from Nurse 3. She has provided support as a home visiting nurse for patients with pulmonary diseases and mentioned the choice of treatment beyond NPPV as follows: ‘For people with pulmonary diseases, the choices regarding treatment are limited and easier to agree on among the people involved.’
She also mentioned <difficulties in establishing a home care support system for patients with pulmonary diseases>: ‘As the patient with the pulmonary disease has no visible physical disability such as paralysis, it is difficult to use home care support services under Japanese long-term care insurance system’. ‘Few facilities provide short-stay services for patients with NPPV’ and ‘It is a big challenge to establish a home care support system for those with pulmonary diseases.
<Differences between muscle dystrophy and ALS> were extracted from Nurse 4. She has provided support for patients with muscular dystrophy in a long-term care hospital mentioning, ‘Muscular dystrophy and ALS are the same neuromuscular diseases, although muscle dystrophy is different from ALS in which a tracheotomy or TPPV gives them a new life’.
Benefits and weaknesses of NPPV on palliative care
This category consisted of four subcategories. <NPPV weakness> was extracted from Nurses 1, 2 and 3. Nurse 1 mentioned that many terminal ALS patients with NPPV suffered from thirst, trouble with mask fitting and face mask-related pressure ulcers. Nurse 2 who had worked in the ICU gave us information about two patients with heart failure who used NPPV, stating, ‘Patients with heart failure expectorate a lot and removing the mask interface to suction tends to cause hypotension and arrhythmia’ and ‘NPPV may cause paralytic ileus by pumping air into the digestive organs. As medical device-related pressure ulcers are recognised as incidents in her hospital, she said, ‘the nurses put a lot of effort into preventive care such as skin care by changing the type of mask interface’.
<Benefits that allow patients to be at ease and live longer> were extracted from Nurses 2 and 4. Nurse 2 mentioned, ‘Patients with heart failure can be at ease by wearing NPPV masks. Thus, I do not think, the patient was aware that he was approaching death’. Nurse 4 had worked for long-term care hospitals and gave information on three patients with muscular dystrophy. She expressed positive opinions about the use of NPPV. ‘I think NPPV is meaningful because I do not believe that patients could have lived this long if they had only received oxygen’, and ‘It would benefit the patient more if they used NPPV at an earlier stage rather than at the end of life’.
Nurse 2 stated <Difficulty in taking off NPPV masks to suction the sputum and saying something to their family for patient>: ‘If we do not suction the sputum, the patient will suffocate, although if we do suction, the patient’s blood pressure will drop’; ‘When the mask is removed, the oxygen saturation level immediately drops; thus, the mask has to be reapplied, although I have been still wondering if he had something he wanted to say to his family in the end, even if it was painful for him to take off his mask’.
<Disadvantage of being restrained by mask fitting at the end of life which increases suffering> was extracted from Nurse 4. She said, ‘If the patients use NPPV continuously for 24 h a day with the increased pressure, it becomes more difficult for them to adjust the mask. As a result, the patient is constricted by the mask fitting and suffers more’.
Influence of physicians’ attitude toward palliative care and the nature of the medical institutions
This category consisted of two subcategories. <Less focusing on palliative care among the physicians in acute care hospital> was extracted from Nurse 2. Regarding the choice of further treatment, she said, ‘Our hospital is an acute care hospital where lifesaving is the top priority; thus, NPPV is applied as the standard treatment for most patients’. She also pointed out that palliative care was excluded in her hospital, as ‘few cardiologists in an acute care hospital think that it is better to use sedation’, and/or ‘many doctors end up not being able to use sedation due to patients’ low blood pressure.’
<Patient pain from continued NPPV influenced by physician knowledge> was extracted from Nurse 4. She mentioned, ‘I believe that whether or not further continuation of NPPV will cause more or less pain to the patients depends largely on whether the physician knows palliative care.’
Influence of patients’ age in palliative care
This category consisted of one subcategory. <Difficulty for patients’ parents to agree with the transition from active therapy to palliative care> was extracted from Nurse 4. She mentioned, ‘When NPPV-dependent patients are in their teens or 20s, it is difficult for their parents to agree with the transition from active therapy to palliative care’.
This study revealed five categories regarding the perceptions of certified advanced practice nurses. These findings showed differences and similarities across disease types. The author discussed the nurses’ perceived challenges of palliative and end-of-life care for non-cancer patients dependent on NPPV to die without sufferings in the place of their choice.
Difficulty with uncertain prognosis
One patient with ALS in this study died unexpectedly. Sudden death has been reported in ALS in multiple studies.[13-15] In addition, the participants commented that prognosis was difficult to predict in respiratory diseases due to repeated remissions and exacerbations; therefore, it was unclear when the terminal stage was. In addition, one patient with heart failure was admitted and treated as an emergency but died in the ICU. It has been reported that twice as many non-cancer patients were admitted to ICUs than cancer patients. Another elderly patient with respiratory disease died suddenly, although the cause of death was due to another disease. The prognosis of patients with non-cancer diseases, who require long-term care, is considered to be more uncertain because of the issue of multi-disease comorbidity in elderly patients. Therefore, it is necessary to promote advanced care planning (ACP) based on the disease-specific characteristics of non-cancer diseases and to conduct research to enable prognostication,[18,19] although predicting survival for terminal patients with non-cancer diseases is difficult.
Differences in symptom management by type of diseases
The nurses’ perceptions revealed differences in palliative care for non-cancer patients according to the type of disease. Although ALS and muscular dystrophy are both neuromuscular diseases, the participants pointed out that ALS is different from muscular dystrophy in that patients can be expected to survive if TPPV is attached. Moreover, neuromuscular diseases are different from other non-cancer diseases in that upper and lower limb function and swallowing function also decline. Patients are unable to put on and to take off the NPPV mask by themselves. ALS worsens at a faster rate than other diseases. Comprehensive suffering relief, including anxiety reduction, is necessary to alleviate respiratory distress in patients with ALS.
Influence of patient age in palliative care
The age of patients requiring NPPV varies. Two cases in this study were in their 20s or younger, and their parents were making the decisions instead of the patients. This may be because parents have been making decisions for their children since they were infants. It is important to proceed with ACP in accordance with the growth of the patient and with family care and education.
Influence of physician’s attitude to palliative care and the nature of the medical institutions
It became clear that the concept of palliative care was not widely popular among cardiologists working in acute care hospitals because lifesaving was their first priority. In addition, cardiologists found the risk of hypotension due to sedation to be an obstacle in its use. It is necessary to educate cardiologists in acute care hospitals and to promote palliative care. Therefore, they need to collaborate with palliative care teams to integrate palliative care into acute care.[22,23]
Benefits and weaknesses of NPPV on palliative care
When nurses provide care for patients dependent on NPPV regardless of the type of non-cancer disease, it is necessary to improve skills, such as quick suctioning of sputum and oral care, because removing the mask can cause cardiorespiratory compromise. Collaboration with clinical engineers and/or certified nurses specialised in wound care is also needed to improve the quality of care by minimising the side effects of NPPV.[5,24]
Strength and limitations
Although the number of participants was small, the terminal status of patients and valuable opinions from certified advanced practice nurses were obtained. In addition, as the participants worked in four different workplaces, the findings showed differences and similarities across disease types. Future studies on palliative care in non-cancer patients receiving NPPV need to be conducted to increase the number of participants and to achieve better data collection on a larger scale for non-cancer diseases across different settings of care.
Implications and recommendations
This study recommends the need for ACP based on disease-specific characteristics and age-appropriate support, to integrate palliative care into acute care and to improve the quality of care to minimise the side effects of NPPV. Interdisciplinary efforts, as well as the pursuit of expertise in each field, are needed to develop good palliative and end-of-life care for NPPV-dependent individuals with terminal non-cancer.
This study clarified advanced practice nurses’ perceptions: Commonalities and differences across disease types in NPPV users receiving treatment in a variety of settings. Five nurses’ perceptions were clarified: Difficulty with an uncertain prognosis, differences in symptom management by type of disease, benefits and weaknesses of NPPV on palliative care, influence of physicians’ attitude of palliative care and the nature of the medical institutions and influence of patient’s age in palliative care. The symptom management of palliative care during the terminal stage was insufficient. Interdisciplinary efforts are needed to provide good end-of-life care for NPPV users with non-cancer diseases.
The author thanks all the participants for their cooperation in this research.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Conflicts of Interest
There are no conflicts of interest.
Financial support and sponsorship
This work was supported by JSPS KAKENHI (15K11617).
- Global Atlas of Palliative Care (2nd ed). London, UK: World Health Organization; 2020. Available from: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/palliative-care/whpca_global_atlas_p5_digital_final.pdf [Last accessed on 2020 Oct 12]
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text:
MONTESANO — The business agent for the Teamsters Union withdrew its grievance against Montesano City Administrator Kristy Powell, which originally alleged various forms of harassment against three Public Works employees and two clerical staff members at City Hall.
On Tuesday, Business Agent Mike Werner with Teamsters Union Local 252 wrote to Mayor Ken Estes that they were “withdrawing the charge with prejudice.”
“We look forward to moving forward and working together to improve the working relationship between the city and the unit members,” Werner wrote.
Mayor Estes released Werner’s letter, reading it out loud to the public and his City Council members during the regular council session Tuesday night. Estes also read a press release out loud to those at the council meeting, noting that the withdrawing the grievance with prejudice “means that it cannot be brought up again.”
In July, independent investigator Jim Webber cleared Powell of allegations that she engaged in harassment, age discrimination and retaliation against city employees.
Although Webber’s report cleared Powell, it did identify more than just one “isolated incident” where Webber confirmed that Powell may have slapped an employee’s butt, put an arm around an employee’s shoulder or said an inappropriate term to an employee.
However, he says those incidents shouldn’t constitute a trend.
The union grievance was filed in April amid several investigations the city was conducting among its Public Works crew and other employees.
“It is a shame that a dedicated city employee like Kristy has been charged with this grievance and tried in the press and social media for complaints that were unsubstantiated, ” Estes wrote in his press release. “We are rapidly completing all investigations. When they are finalized we will move ahead to provide the citizens with the services that they expect. Citizens can assist us by supporting our effort rather than launching attacks in the press and on social media. It is my desire, as well as the city administrator’s, that we move forward to begin to re-establish a solid and respectful working environment in the city.”
Mayor Estes said the city was standing behind Powell, based on the independent investigator’s findings. If the union didn’t drop its grievance, then it would have had to force the issue into arbitration.
“I did nothing wrong,” Powell said Tuesday night, thanking the mayor for his support.

domain: sociology


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National Mario Day is celebrated on March 10 of every year. Mario is the game which is celebrated in the month of March. He is the plumber of the first donkey kong, which started in 1981. Mario got his own game of Luigi’s brother. Super Mario was necessary for the fictional Mushroom Kingdom of the set match. The best-selling video game made its first appearance in 1981 as the Nintendo game Donkey Jumpman of Mario. Mario is the best-selling video in the franchise of all time. Nintendo declared 2013 as the year of Luigi. It was the game at that point, Mario has a background of playing the character of climb and Mario is the game that designed Jumpman.
“Like most celebrities, of course, I adore all the Mario games.” – Josie Maran
History of National Mario Day
National Mario Day is celebrated on March 10 of every year, as Mar 10 looks similar to the game name. Mario is the name that comes from the Carpenter. But the technology part of bringing in video games is the procedure. Super Mario is 64 and was introduced at the forefront of video games. The first game of integration is the camera controlled by a player. Mario sunshine made advances in allowing spaces that have more movements. Mario and Miyamoto went on to design more games within the Jumpman character. Jumpman changed the owner of Nintendo’s house of headquarters demand that past of luck would and owner of Mario. The staff then jokingly kept the nickname of Miyamoto’s character as Mario, in the proprietor of the warehouse.
Other Celebrations on March 10
March 10 is also celebrated as
- National Pack Your Lunch Day
- International Day of Awesomeness
- National Blueberry Popover Day
- International Bagpipe Day
- National Middle Name Pride Day
- National Day of Unplugging
How to Celebrate National Mario Day
Celebrate National Mario Day by observing and playing the game. Take a day by enjoying the fun on the platform of the match. The children feel fun playing Mario games with all the characters in enemies of them. There is other fun spent the Mario game. Mario dresses up as another character from the friend like fun and knowing the series of reactions is excellent. Today is the day of spending the quality of sharing fun and unforgettable memories. Post pictures and share your National Mario Day celebrations on social media by using the hashtag #NationalMarioDay or #MarioDay.
Thank you for reading the post. You can celebrate every day with Happydays365.org and Happy National Mario Day 2023.

domain: hobby


text:
Day 8 - Friday July 31, 2009
After several extensive searches of all three rental vehicles, I concluded that my brand new GPS was lost. I am notorious for misplacing things, so I did not panic when I could not find it the previous day. In my search and disarray, Tom called the park headquarters and found it. It turns out that I left it at the Old Faithful Visitor Center two nights ago, and they took it to the Park headquarters in Mammoth Springs. The only problem is that it was 35 miles out of the way (70 round trip) from the route to our next destination in Idaho. Luckily, everyone in our car was ok with this side trip down a road we had not traveled yet. We were rewarded with a grizzly bear sighting (in the distance) and a bald eagle near the road.
My Lonely Planet Guide turned out to be valuable this trip, but it too has its flaws. We decided to stop in West Yellowstone for lunch, and the recommended restaurant was closed, and replace by another. We decided to give it a try anyway, because of its name, "Kiwi." It turned out to be a New Zealand joint run by a native. We told her about our upcoming trip, and she gave us some tips about eating out in her country. The British style fish-and-chips were excellent.

domain: geography


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Montana fire managers move wildfire danger to 'very high'
With little rain in the last several weeks, Northwest Montana fire managers have moved the wildfire danger rating to very high.
The danger rating is elevated for the Flathead National Forest, Glacier National Park, the Department of Natural Resources Swan Unit, Stillwater Unit, and Kalispell Unit, and other local state lands. Flathead County is also at a very high fire danger.
Fire managers move the fire danger rating to very high when fires start easily from all causes, immediately after ignition, spread rapidly and increase quickly in intensity. All fires are potentially serious. Direct attack may be dangerous except immediately after ignition. Fires require many resources of multiple types and potentially an incident management team.
The Bear Creek fire in southwest Montana.
Very high fire danger means that people should think twice before starting a campfire or working with heavy equipment during the heat of the day. The public should double-check that chains aren’t dragging behind vehicles and pay attention to wind and other local factors that could cause a campfire to escape.
“We’ve responded to multiple escaped campfires in the past two weeks,”
Andy Huntsberger, Flathead National Forest Hungry Horse District Fire Management Officer, said.
“Stick close to your barbecues, make sure your campfire is dead out when you leave, and make sure to extinguish cigarettes completely. Give us a hand in the coming weeks as we reach peak fire season.”
For information on how to prepare for wildfire season, contact the Community Preparedness Specialist for the Kalispell Unit of the DNRC at 406-751-2270.
The Lion Creek fire in western Montana.

domain: news


It's been quite a while since we have seen an evolution in transceiver interfaces. Does anyone remember the GBIC with its Duplex SC Interface? In 2001, Major equipment manufacturers standardized the SFP (aka Mini GBIC) for 1Gbps, and the LC Duplex Interface became the standard. Then, around 2012, the QSFP+ 40G transceiver brought us the MPO interface. Except for PON (Passive Optical Network) transceivers, which use SC Simplex connectors, the LC and MPO are the transceiver interfaces. The MPO-based transceivers (SR4, PSM4) easily break out into 4 Duplex LCs with an MPO Breakout cable. If it isn't broken, don't fix it, right?
So, what is a VSFF Connector, and why do we need them?
As their name implies, VSFF or Very Small Form Factor connectors have a much smaller footprint than the LC Duplex Interface. In fact, VSFF connectors offer 3X the density of a Duplex LC.
This density is achieved because the VSFF Duplex connector is aligned vertically. It uses the same size ferrules (1.25mm) and performs similarly to the Duplex LC.
There are two versions of this connector on the market: the SN Connector manufactured by Senko and the MDC Connector made by USCONEC. The connectors look very similar; both use a flexible boot to plug and unplug the connector. Both are aligned vertically and offer 3X the density of the duplex LC. Beware, though, they are not compatible with each other. By that, you cannot plug a Senko SN Connector into a USCONEC MDC transceiver interface or patch panel port and vice versa.
With the introduction of the QSFP-DD (Quad Small Form Factor Pluggable Double Density) and OSFP (Octal Small Form Factor Pluggable) 8-lane interfaces to support 400G and beyond, the MSA working groups have included the Senko SN and the USCONEC MDC as transceiver interfaces. The SFP-DD MSA has these connectors included for breakouts as well.
We already see transceivers on the market with either SN or MDC interfaces, and more are in development.
One compelling reason to choose a transceiver with an SN Or MDC interface is that these Duplex Connectors provide direct breakout access at the transceiver to the individual lanes. There is no need for a breakout cable or breakout cassette as required with an MPO transceiver.
From a structured cabling standpoint, these VSFF Connectors reduce rack space needed for fiber cabling. This freed-up space in the rack can be used for servers or network gear.
Which one should I choose, SN or MDC?
The answer is that either the SN or the MDC is a great choice. The good news is that your team at Approved Networks has both the SN and the MDC on our product roadmap. We recently launched our 100GBASE-SR4 QSFP28 MDC MMF 850nm 100m DDM Transceiver. It's a great solution to break out 100G to 4X25G connections directly from the transceiver.


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I don't know why Stormella decided I needed to go to the board walk. Obviously she thought it would make me not want to drink. Well I have news for her, it isn't working.
You know who liked roller coasters.
I followed behind her, trying not to be super irritated. She did pay for my all day access bracelet, which was expensive in terms of normal people.
"I'm not a big ride person but I like this one." She said as we approached a huge ride with a bunch of swings hanging off it. It was set up on the edge of the dock so the swings would go over the water.
I stayed in place, staring up at the stupid thing.
I am not riding that.
"Luke." She called, turning around once she realized I wasn't following her.
I gave her a look that reminded her about the conversation we had in the car. The one where I told her not to shout my name.
"Oh, sorry, come on princess." She called.
"Then prove it." She shouted as she turned back around, walking up to the ride guy and showing him her bracelet. She walked up to the ride, picking a seat. She turned to look at me.
I was not going to let her think I was a chicken. I marched right up to the guy, who was smirking at me, showed him my bracelet and the took the seat right beside her. We were a good ten feet apart.
The guy looked around for anyone else who wanted to ride. Most of the people here were interested in eating so it was just us on the ride.
I felt the ride slowly start to move up, bringing us up into the air. I felt my stomach do a flip. The ground was getting further away than I liked.
I looked over to see Stormella smiling at me.
"Are you gonna be okay princess?" She asked.
I rolled my eyes, just as the ride started to spin. I let out a little scream.
"Relax Luke, we'll be fine." She shouted so I could hear her over the wind.
We circled over the ocean and the dock. My feet dangling above them both. I tried not to think about that, I also tried not to think about the fact the ride was going faster. I didn't drink enough alcohol to do anything to me this morning, but the spin was making me feel like I had.
I looked back over to Stormella. She had her arms stretched out. Her hair was blowing behind her and she looked, calm.
I stretched my arms out too, feeling my stomach flip again as I noticed the ocean before me.
Relax dude. I thought to myself as I inhaled deeply through my nose, closing my eyes.
"There you go." I heard Stormella shout.
I felt a big smile stretch across my face. My mind was clear as the wind hit my face. Blowing away any thoughts I could've had about a certain someone.
Once we were back on the ground I was relieved. Although I had fun, I did not like being spun around thirty feet above ground.
"Okay, your turn." She said as we walked by a bunch of game booths.
I looked around, spotting a big rollercoaster over on the beach. I know who would've loved that.
I headed in it's direction, as I did thoughts of her filled my mind.

domain: literature


text:
Central & South Asia
People & Power
This month on Al Jazeera
person > Wael Eskandar
1 - 7
Will Sisi guarantee freedom of expression?
Egypt's new president is under mounting pressure to protect human rights.
Last updated: 29 Jun 2014 12:52 GMT
Trapped inside the fear bubble of the Egyptian military
Human rights activists show caution in criticising the Egyptian military, fearful of the uncertain political climate.
Last updated: 12 Aug 2013 11:25 GMT
The state of Egypt's revolution
Egyptian society remains polarised, two years after the start of the country's popular uprising.
Last updated: 26 Jan 2013 10:51 GMT
The struggle for Egypt's presidency
As the Muslim Brotherhood calls for a political ban against members of the old regime, who will win the power struggle?
Last updated: 14 Apr 2012 15:11 GMT
Voices from Tahrir Square
One year on from revolution, five young Egyptians recount the tumult of January 2011 and offer thoughts on the future.
Last updated: 27 Jan 2012 18:05 GMT
Egypt: A year on and still unresolved?
As protesters converge again in Tahrir Square, we ask if last year's revolution has failed to unseat the old guard.
Last updated: 26 Jan 2012 10:12 GMT
Egypt: Democracy in danger?
Protesters are taking to the streets in Egypt, demanding faster reforms.
Last updated: 09 Jul 2011 11:13 GMT
Featured on Al Jazeera
Rising tide of UK anti-immigrant sentiment
Swathes of the British electorate continue to show discontent with all things European, including immigration.
A glimpse into the universe's oldest galaxies
Astronomers have captured images of primordial galaxies that helped light up the cosmos after the Big Bang.
The photo controversy over indigenous people
Critics assail British photographer's portrayal of indigenous people, but he says he's highlighting their plight.
'We got this, Bob Geldof, so back off'
As Western stars re-release 1980s charity hit, many Africans say it's a demeaning relic that can do more harm than good.
JOURNALISM UNDER FIRE
Iraqi Kurdistan: The Middle East's next 'Little Sparta'?
Can tech companies stop ISIL?
Tanzania's Maasai prefer death to eviction
Cruelty in Jerusalem
Iran nuke deal is no bargain
UN move will embolden North Korea officials
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text:
Surface anatomy and palpation
This course covers palpation techniques focussed on soft tissues (in particular muscle). Surface anatomy is revised and palpation practice to identify soft tissue pain sources in various regions of the body. In this one day introductory course we will cover the shoulder girdle, the neck and dorsal spine, and the low back and posterior hip girdle. By the end of the day, participants should feel more confident about identifying key landmarks and palpating the superficial muscle layers in these regions.
Course led by Dr Mike Cummings
If you cancel any time up to four weeks prior to the course, we will refund your fee less £50 administration charge. Thereafter, we regret no refunds can be made. Substitution of a colleague who fulfils the criteria is acceptable. BMAS cannot be held responsible for delegates expenses in the event of cancellation by either party. In exceptional circumstances and at the Society’s discretion, course delegates may be permitted to transfer to another course.
|Surface Anatomy & palpation 2013 (BMAS member)||£150.00
|Surface Anatomy & palpation 2013 (non member)||£190.00
To continue with your booking, please click 'Continue' below.

domain: medical


text:
William shakespeare´s hamlet is a fascinating play that has undoubtedly influenced humans for ee hamlet themes madness madness is a key theme in hamlet. The theme of action and inaction in hamlet from litcharts hamlet by william shakespeare yet hamlet turns the revenge play on its head in an ingenious way:. Hamlet themes william shakespeare revenge is central to the plot of hamlet hamlet is often called an elizabethan revenge play, the theme of revenge.
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domain: artistic


The PMT test system
The photomultipliers (PMT) installed in the cameras of the
Fluorescence Detector are XP3062 with photocathode of hexagonal shape,
produced by Photonis. The standard tests on the PMTs are done at
the factory. Afterwards the HE boards (active divider + driver)
are soldered to the flying leads of the PMT. The test system in
Roma was designed to test the complete unit PMT+HE.
The system allows simultaneous test of 24 PMTs. For each PMT the high
voltage dependence of the gain, the linearity as a function of the
incident light intensity, the sensitivity and the uniformity of the
photocathode response are measured.
A measurement of the spectral sensitivity using narrow band
filters was also done.
The matrix of 24 hexagonal PMTs to be tested
Back view of the matrix of 24 PMTs.
The divider and the driver are mounted on the two small round
Front view of the 24 PMT matrix with light mask as mounted
inside the test box
The test box with the light sources and filter system
A Xe lamp and a blue emitting LED were used as light sources
Neutral attenuating filters and narrow band filters were
used, mounted on automatized wheels


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RollingStone magazine were lucky enough to watch an edited footage from The Force Awakens! Read on for the highlights of their coverage.
Adam Driver on delivering a speech to Darth Vader’s melted mask:
“When someone sets the scene for you, it’s always very funny. The idea that in this reality, Darth Vader is real.” And now, one of the most promising actors of his generation has a large supply of dolls of himself. “I’m set for Christmas presents for the next 10 years,” Driver says.
Daisy Ridley is planning her future, and takes a very grounded approach for a new upcoming star.
While the others plunge on with their careers, Ridley is planning to study psychology at university, a break she hopes will help keep her grounded in the face of sudden intergalactic fame. “I think I’ll be OK,” she says. She goes silent, then repeats herself. “I don’t know. I think I’ll be OK!”
Mark Hamill’s plans to maintain low profile were troubled by Harrison Ford.
But his first reaction to Lucas’ news, delivered at a lunch during a Star Wars convention, was to enter a “state of shock.” He realized he had mixed feelings. “We’re all in a great place and we’ve all done it before,” he says. “There was a beginning, middle and end. You have to think about all the aspects, ’cause if you wanna maintain a low profile, this isn’t the best way to do it!” He found himself hoping that Ford wouldn’t do it. “I said, ‘The ace in the hole is, Harrison’s not gonna do this. Why would he?’ So that’s our escape clause. You know, if I’m the only one, I’ll look terrible – but if he doesn’t do it, I don’t have to do it.”
And finally the Rolling Stone was able to attend an editing session.
Back at Bad Robot, I am permitted to watch Abrams editing the movie for precisely 20 minutes. That adds up to maybe a minute or two of actual footage. So I can confirm that there is a space battle in the film, featuring X-Wings and TIE fighters and something like a Death Star. There is a lightsaber duel, where Kylo Ren is unmasked, revealing an intense-looking, unscarred Driver. There is a weapon that the filmmakers, at least, refer to as a “Sunsucker.” I see a churning energy device on the ground of a planet that sends a massive, lavalike beam upward – Sunsucker or not, it looks scary.
Remember those flags?
The flags are designed to drive superfans nuts with references to the earlier movies, but Abrams tells Guyett that too many of them allude to the first of Lucas’ prequels: “I don’t want to be too about podracers,” he says. “I’d rather come up with our stuff.”
For the full story go to RollingStone

domain: entertainment


accubond BC ?'s
changed the scope on my 7mm AM this week, now my shooting is 800 yds or less, and it seems it has always shot high using the 160 accubonds, by about 1/4 MOA. so today I shot at 630 yds, 44 degrees, 29.5 BP, this load chrony'd 3430 fps a week ago in simular temps. so today I shoot 3 shots and shot 1 was 2 moa high, I contributed this to a cold bore shot, now the next 2 were just under 1 moa high. so my ? is, have any of you ran the numbers on a nosler 160 accubond to find out what actual BC it is, if I change the BC in my programs from the published # of .531, to .620, then my chart comes very close to matching my trajectory. thanks for any input
Born to Hunt, Forced to Work!


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06 March 2021 Tacoma (Washington, USA)
Video Games Live
Symphony Tacoma - Pantages Theater
Program Info: Video Games Live™ is an immersive concert event featuring music from the most popular video games of all time. Joined by Symphony Tacoma, they perform along with video footage and music arrangements, synchronized lighting, solo performers, electronic percussionists, live action, and unique interactive segments to create an explosive entertainment experience! This show will feature some of the best music and video clips from the most popular games past and present, including Mario™, Zelda™, Halo®, Final Fantasy®, Warcraft®, and more.
Whether it is the power and passion of the more recent blockbusters or the excitement of remembering the sentimental classics you played growing up, Video Games Live™ will truly be a special concert to remember. Even if you have never played a video game, you have never heard or seen an orchestral performance quite like this!


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Way back on February 16th, before the Steelers released half their roster, PFT previewed franchise tag season.
With just a couple days to go before Monday’s deadline to apply the tag, I wanted to take a look back at where things stand. The initial projection had 19 tags applied, a record number.
Now it looks like we could hit 20 or more. Here’s what was predicted, and what has happened since.
Well, that section went pretty well. Finley signed a long-term deal, but none of these players are going anywhere.
We said on February 16 the next 11 players were tough calls, but ultimately would get the franchise tag. Here’s what we think now.
10. Matt Prater, Broncos kicker. (Not a lot of news here, but Prater is still a good bet for the tag.)
13. Wes Welker, Patriots wide receiver. (Welker is still viewed as likely to get the tag.)
16. Stevie Johnson, Bills wide receiver. (There have been conflicting reports on Johnson. This remains up in the air.)
17. Josh Scobee, Jaguars kicker. (Scobee remains a strong candidate for the tag.)
We’ll probably get three or four wrong in that section.
The Near Misses
These were the players we predicted would not get the tag after some consideration.
1. Arian Foster, Texans running back. (Foster remains likely to get the highest tender as a restricted free agent.)
4. Michael Bush, Raiders running back. (The Raiders chose to tag someone else. More on that soon.)
5. Dwayne Bowe, Chiefs wide receiver. (Now we expect Bowe to get the franchise tag.)
7. Paul Soliai, Dolphins nose tackle. (Soliai is not expected to get tagged.)
8. Vincent Jackson, Chargers wide receiver. (Chargers G.M. A.J. Smith could still pull a surprise, but we’ll stick with our prediction.)
The Stanford Routt signing changed the dynamics in Kansas City, but otherwise these predictions look good.
The Guys we missed
We overlooked these players in our first primer.
1. Tyvon Branch, Raiders safety. (In our defense, we did say Branch was a better candidate for the tag than Michael Bush. We should have given G.M. Reggie McKenzie more credit. Branch has been tagged.)


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CLEVELAND, Ohio — With a necktie wrapped around her wrists, the first woman to accuse Anthony Sowell of rape climbed through a third-floor window to a rooftop in East Cleveland to get away from him.
The woman, three-months pregnant, yelled until neighbors spotted her on that July 1989 morning. Sowell was convicted a year later. The crime was so vicious that state parole officials refused to release Sowell early from of a 15-year prison sentence.
The attack and his subsequent prison sentence give insight into Sowell, a former Marine who struggled with drugs and alcohol for years and is now accused of preying on women.
"He choked me real hard because my body started tingling," the woman told police. "I thought I was going to die."
Over the years, prison officials kept coming back to her words and injuries as they considered him for parole. Often, they gave the same reason for denial: "The serious nature of the offense."
Despite the seriousness of the attack, Sowell did not get sexual-offender treatment while in prison, even though he made a request for it, according to parole records and interviews.
Sowell is being held in City Jail on a rape warrant after a woman accused him of raping her and choking her with an extension cord in September. Detectives are also trying to determine if he killed six women whose bodies were found decomposing Thursday and Friday in and around his home. Police arrested him Saturday about a mile from his Imperial Avenue house.
The victim in the latest case, who knew Sowell, said he offered to split four bottles of malt liquor with her. She entered Sowell's home and went to the second floor, which was empty except for a chair, a blanket and an extension cord, police said.
The woman told police that after drinking for a while, Sowell became upset, punched her in the face and began choking her with the cord. He raped her as she passed out, the woman said.
All the bodies have been identified as black females, and five died by strangulation, according to police. The last died of unknown causes. The coroner's office is trying to determine their identities.
Detectives are focusing the investigation on missing persons in Sowell's neighborhood and will expand it to other unsolved homicides with similar causes of deaths.
Sowell had shared the duplex with his stepmother since 2005, when he was released from prison after serving 15 years for raping a 21-year-old woman in East Cleveland.
Parole records show that Sowell was seldom in trouble while behind bars between 1990 and 2005. In fact, Sowell did not have any major rule infractions while in prison, a spokeswoman said. He was given four verbal warnings for minor violations. Sowell also did not have a juvenile record in Cuyahoga County, a spokeswoman said.
The East Cleveland rape that landed him in prison mirrored the latest attack, according to police and court records. It began at 6 a.m. on July 22, 1989, when police showed up at a motel on Euclid Avenue and Lee Road in East Cleveland. The woman was waiting for her boyfriend, and she feared officers were going to raid the motel.
Sowell was there, as well, and lured the woman to his car and told her that her boyfriend would want her to stay with Sowell until after the officers left. Sowell drove her to his home -- a third-floor apartment on Page Road in East Cleveland.
Once inside, Sowell threw her on his bed, choked her and repeatedly raped her.
When she tried to leave, Sowell tied her hands with a necktie, wrapped a belt around her feet and stuffed a rag in her mouth. He threw her on the bed and began pacing up and down the stairs.
He later came back into the room and fell asleep on the bed. The woman got her feet loose, spit out the rag and crawled out the window, onto the roof and screamed for help. She feared opening the squeaking door would wake Sowell.
"He told me that he was going to kill me, and I believed him," the woman told police.
Sowell pleaded guilty to attempted rape charges. The victim, along with county prosecutors, opposed early release of Sowell from prison each time it was considered.
A parole official noted in 1993 that Sowell "stated he was denied sex-offender program participation." It also said the "inmate does wish to participate in sex-offender programming."
A prison spokeswoman said Monday that "we have no record of participation or completion of sex offender treatment." Sowell took other courses aimed at controlling his violent temper, such as "Living without Violence," "Cage your Rage" and "Positive Personal Change."
He also took the 12-step Alcoholics Anonymous program, "Adult Children of Alcoholics" and "Drug Awareness Prevention." The records show Sowell drank heavily and used drugs before to his arrest.
From 1978 to 1985, Sowell served in the Marines. He was honorably discharged, according to parole records.
Repeated attempts to reach the victim of the 1989 attack were unsuccessful. A message left at Sowell's attorney in the case was not returned late Monday afternoon.

domain: law


text:
Wednesday, May 25, 2011
Pia Toscano wearing House of Harlow 1960
Pia Toscano attended the ceremony honoring Simon Fuller as he received a star on the Hollywood Walk of Fame.
The singer accessorized her look with a House of Harlow 1960 textured wrap ring.
House of Harlow 1960
celebrities wearing house of harlow 1960
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domain: celebrity


text:
D- Day beaches tour
D-DAY BEACHES TOUR
Immortalised in classic movies such as The Longest Day and Saving Private Ryan, the Normandy Landings was one of the most dramatic conflicts in the Second World War. On 6 June 1944, allied troops stormed the beaches of Normandy in the largest seaborne invasion in history, aiming to liberate France from German rule.
To this day, the beaches are popular destinations for tourists and for travellers looking to pay their respects and commemorate the events of D-Day. There are memorials, cemeteries and museums in the towns surrounding the beaches.
Our accommodation partner Booking.com has thousands of brilliant places to stay available to book online. Whether you’re looking for a hotel, a B&B, an apartment or even a houseboat, you’re sure to find something to suit you. Visit our Booking.com page for more information.
Day 1: UK - Caen
From the UK we have 3 routes to France, sailing from Newhaven to Dieppe and from Dover to our ports in Dunkirk or Calais, with all 3 offering easy access to Caen.
Once you arrive in Caen you may begin to notice that much of the city still bears the scars of heavy bombing during the Second World War. Head to the Museum for Peace, widely regarded as one of the best World War II memorials around, and set the scene for the next few days.
After the museum, take a short drive to Pegasus Bridge, where the invasions began with a glider attack, and visit the museum there before exploring the beach at Ouistreham, which was codenamed Sword Beach on D-Day and was the site of British troops landing under heavy fire. Overnight in Caen.
Day 2: Caen - Bayeux
Begin your second day by driving 13 miles north to Juno Beach, which is where exiled French general Charles de Gaulle famously arrived ashore following the landings as the first French soldier to set foot in mainland Europe since 1940. From there, you can head to Mulberry Harbour in Arromanches, where allied ships disembarked on an artificial port, commemorated in the Musée du Débarquement.
Longues-sur-mer and Gold Beach saw some of the fiercest fighting during the conflict and you can still see the 2 150mm artillery guns in their concrete casements to this day. Later, drive inland to Bayeux, the first town to be liberated after D-Day. Visit the War Cemetery, with almost 5000 graves from 10 countries including Great Britain, and explore the conflict through photos and personal accounts at the Musée Mémorial de la Bataille du Normandie. Overnight in Bayeux.
Day 3: Bayeux - Utah Beach
Travel the 13 miles from Bayeux to Omaha Beach and you may be struck with a sense of familiarity. Omaha Beach was the setting of the famous opening scene in Saving Private Ryan, where 40,000 American troops landed and were instantly under fire.
There is a memorial on the beach to the lives lost during the conflict, and an American cemetery nearby, the largest of its kind in Europe. Follow the coastline another 28 miles toward Utah Beach, stopping off at Pointe du Hoc, where you can see huge deep shell impact craters and ruined bunkers. Utah Beach is also home to another Musée du Débarquement, where you can see a genuine B26 Marauder aeroplane which fought in the battle.Overnight in Bayeux.
Day 4: Bayeux - Dunkirk
While not part of the D-Day landings, Dunkirk was also the scene of a heroic and famous military operation during the Second World War. Operation Dynamo involved the safe evacuation of over 300,000 allied troops. Visit the Dunkirk War Museum on your way back to port and learn more about this famous evacuation, and why the huge scale of it guarantees it will forever be remembered as a miraculous success against colossal adversity.
Take the 4 hour, 257 mile, drive from Bayeux to Dunkirk and you can sail back from our Dunkirk port, or drive an extra 27 miles to Calais and sail from our port there.


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Kendrick Oliver & New Life Jazz Orchestra @ Shalin Liu SAT 8 FEB benefit for NMYO
Wow, these guys can swing! Here’s a great way to help support student musicians and have fun doing it. From their concert page:
Award-winning conductor Kendrick Oliver and his youthful, vibrant and energetic 15+ piece orchestra (including a vocalist) will light up the stage for a night of infectious sound. New Life Jazz Orchestra has been selling out concert halls and turning heads throughout the jazz scene since its inception in 1995 while Oliver was a student at Berklee College of Music. Respected throughout the jazz community, New Life Jazz Orchestra has appeared at a host of high profile events including the Boston Beantown Jazz Festival, Atlanta Jazz Festival, Tanglewood Jazz Festival, and opened JVC’s prestigious Newport Jazz Festival.
This evening will be nothing less than a swing, sing, stomp, and shout experience!
Don’t take their word for it. Check out the videos, below. (Tickets & info here)


Take a quick look at a cars for sale section in any magazine or website and in the description of many small hatchbacks you’ll find the phrase ‘peppy’. But what does it really mean to be peppy? The dictionary would have you believe that peppy means “full of or characterized by energy and high spirits” and that’s probably correct but to save on words it could just have a photo of the new VW Polo TSI. What makes the second Polo variant available in NZ so lively is a new engine that’s low on displacement but very high on pep. Car and SUV took a closer look at the little Polo to solve the riddle of how less can really be more.
When the new Mk V Polo first touched down in NZ it was sold exclusively with a 1.4-litre 63kW engine, now it’s being offered with an all-new 1.2-litre unit. The new engine carries a $3k premium over the larger 1.4 motor but it’s money well spent because it must be the peppiest 4-cylinder in town. Using turbocharging to produce 77kW of power and a healthy 175Nm of torque the new engine is responsive and engaging. It suffers very little turbo lag and offers maximum torque from low in the rev range (1500 to 3500rpm) so it doesn’t need to be pushed hard. The TSI Polo will dash to 100kph in well under 10 seconds and has the mid-range punch to match much larger engines. But Grandmothers shouldn’t be scared off, the engine is well mannered at slower speeds and is never fierce on boost. With the pint-size engine and lightweight body the Polo also returns an impressive fuel economy of just 5.3l/100km combined.
With no manual option available in NZ the Polo TSI is fitted exclusively with a 7-speed DSG gearbox. It’s a modern piece of kit that changes seamlessly and gives a high-tech edge to the overall driving experience. Having seven ratios gives the smart gearbox a flexibility to either work through them rapidly keeping the Polo in its peak power band or focus on economy and get into a higher gear early. There is a sports mode available that keeps the engine in a lower gear and changes up later. There is also a sequential changing option on the gearshift for manual changes but steering wheel paddles are not available, even as optional equipment.
It would be a shame to have such an advanced powerplant but then be let down by average handling dynamics and luckily that’s not the case for the Polo TSI. It does have a suspension setting that’s more focused on comfort than sporty intent, which may disappoint teenage boys borrowing mum’s car. There is some torque-steer off the line for the heavy-footed but once up to speed there’s a tenacious level of grip on offer.
The only area where there’s a noticeable departure from the mild sporting feel is in the Polo’s steering which, while precise, is very light and uncommunicative. However, this is understandable considering the Polo’s target market and the fact that it’s not being pushed as a performance model. Overall, dynamically the Polo TSI is a well balanced all rounder that feels equally capable on twisting open roads as it does on regulation suburban duties.
The level of cabin refinement during driving is excellent with few engine sounds, no wind noise and only minimal tyre noise entering the tranquil cabin. Most road bumps and dips don’t disturb occupants and with the front seats pushed back it’s easy to feel like you’re in a larger, more expensive car.
In terms of visual styling the Polo sits wider and lower than the previous model and has received the new VW corporate front grille. Slightly enlarged in every direction it still retains the look of a mini Golf but has nicely chiseled, mature lines. The wide gaping air intake denotes a sense of purpose and there are some classy touches like L-shaped rear lighting and colour coded wing mirrors with integrated turn signals. There’s a general feeling of quality to the Polo exterior with its ultra-bright paintwork, tight shut-lines and four doors that close with a reassuring thud. Some subtle chrome trim at the front and badging at the rear distinguish the TSI variant. Our tested vehicle had the optional 17-inch ‘Boavista’ wheels that dressed the Polo up smartly and never looked oversized (16-inch as standard).
In the cabin, quality is at the forefront with texturised soft touch plastics that would be at home in a vehicle twice the price. The Polo’s dashboard is conservatively styled in charcoal with silver accents, it looks great and all switchgear is thoughtfully laid out. There is good storage for small items and a handy fold-down centre armrest. The seats are height-adjustable, supportive and finished in a thick well-stitched cloth. Interior space is fairly good for a B-segment vehicle with front occupants well catered for in terms of shoulder and legroom. With four adults in the car the front seats will need to be pushed forward to give the rear seat enough leg room for longer journeys, head room is ample all around. Luggage capacity is 280-litres in the hatch expanding out to a capacious 952-litres with the rear seats folded to create a flat loading floor. The hatch floor can also be lowered or used to hide away items. Standard interior equipment includes climate air-con, cooled glove box, single disc CD stereo, heated electric mirrors, leather-covered steering wheel and hand brake, electric windows and a full size spare wheel. Overall, the Polo has raised the bar on interior build quality for entry-model cars with and shows that the VW Group’s commitment to style and refinement filters all the way down to its lower ranks.
The Polo also has its bases well covered in regards to safety. It’s picked up a 5-star NCAP safety rating and comes equipped with an electronic stability control programme, ABS brakes, traction control and an electronic diff lock. There are front, side and curtain airbags ready to go and a passenger airbag deactivation feature for child seats.
So what’s the verdict on the Polo TSI? Well, it would be hard to match it in the small-hatchback segment. Its engine is a marvel and can offer a sporting drive when required while still being timid enough to appeal to all. It has clean-cut contemporary styling, a high quality interior, comfortable ride and is just fun to drive. Priced at $31,500 it occupies the high end of this segment and is around $6k more than the Ford Fiesta or Honda Jazz. But you’re getting the latest technology and exemplary build quality, for many that will be worth the extra money. If you’re in the market for a small hatch and want to see exactly how it should be done, check out the Polo TSI.
What we like:
- Excellent engine and gearbox package
- Interior quality
- Fun to drive
What we don’t like:
- Vague steering
- Conservative exterior styling
Words and Photos: Adam Mamo
To find out more about the Polo TSI, see below for specifications or click here to visit the VW NZ website.
Other reviews of interest:
Volkswagen Polo TSI (2010) – Specifications
Engine, gearbox, electrical system (77 kW)
Cubic capacity, litres/cm 3 1197
Max. output, kW(bhp) at rpm 77 @ 5000rpm
Max. torque, Nm at rpm 175Nm @ 1550 -4100rpm
Gearbox, standard 7-Speed DSG
Fuel consumption, litres/100 km combined 5.3
CO 2 emission, g/km 124 – Euro 5
Safety and Security
ESP (electronic stability program), ABS braking system (ABS), Traction Control System (TCS) and Electronic Diff Lock (EDL)
Airbags for driver and front passenger
Front passenger airbag deactivation
Curtain airbag system for front and rear passengers
Side airbags at the front
Safety optimised front head restraints
ISOFIX mountings on outer rear seats for child seats
Anti-theft ‘Plus’ alarm system
Turn signals with integrated in door mirrors
Wheels and Suspension
Alloy wheels, 16″ Cartagena 215/45 tyres
Headlights — Halogen
Electrically adjustable and heated door mirrors
Green-tinted heat insulating windows
Front fog lights, with fixed cornering light
Climatic air conditioning
Steering wheel with height and rake adjustment
Leather covered gear lever and hand brake lever
Leather covered multi-function steering wheel
Central locking with radio remote control
Front centre armrest with storage box
Multi function display
Electric windows, front and rear
Floor mats front and rear
Glove compartment with cooling function
Seats and upholstery
‘Livon’ fabric upholstery
Front seats with height adjustment
Drawers under front seats
4 x 20 watts, 6 loud speakers (4 at front, 2 at rear)
RCD310 Radio CD system, single CD and AUX-IN multimedia socket
Warranty and Assistance
3 year / unlimited km mechanical warranty, 12 year anti-corrosion warranty
3 year Volkswagen Roadside Assistance
Long-life underseal including wheel arches


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I had a hair transplant twenty years ago and now I shave my head. I have approximately 120 donor scars at the back and sides of my head and 120 round hair plugs on top. This might make for the most unique scalp in the land but it's not the sort of notoriety I enjoy.
I intend to keep shaving my head in the future but yearn for a natural bald look, so Iwant my hair transplant reversed. I understand it is possible to have the hair plugs put back in the donor area and I am trying to find the right hair loss doctor to perform the surgery.
In the mean time, can you recommend the surgeon/surgeons most likely to give the best result? I live in the UK but am prepared to travel to Belgium, Turkey, or the US. I did manage to contact one of your recommended doctors and he said he could achieve a 6/10 (more or less) look of normality at the donor site and 8/10 on top where the old plugs are removed.
I have done hours of research on this site and could probably do more but I thought it wise to ask since it is possible i might miss something.
In looking at your hair transplant photos, I first want to say that I’m sorry that this has happened to you. Clearly this is a case of very old work.
Regarding hair transplant repair, there are certainly options, but there is no way to reverse a hair transplant completely and make it look like a “virgin” scalp. This is most likely why our recommended surgeon is working with you on developing realistic expectations by giving you a 6/10 and 8/10 ratio, which is still a dramatic improvement. Keep in mind that removal of the old hair plugs will leave scarring. They can be redistributed to the donor sites and in the right hands will most likely improve your overall appearance. But it won’t be perfect. But getting an evaluation in person with an elite surgeon is extremely important.
In my opinion, I strongly suggest contacting a few elite physician members of the Coalition of Independent Hair Restoration Physicians as many of them specialize in repair work. In the UK, I would recommend an in person consultation with Dr. Bessam Farjo or Dr. Nilofer Farjo of the Farjo clinic.
It would be wise to research and consult with several physicians to see what they can do for your case.


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Amp up your decor with this "The Old Guitarist" print by Pablo Picasso.
- Picasso's "The Old Guitarist" lends a sense of nostalgia.
- White and silver mist matting provides a polished look.
- Satin black wood frame adds classic appeal.
- Dry-mounted paper prevents rippling.
- 16.2"H x 12.6"W
- Vertical display
- Attached hanging wire
- Artist: Pablo Picasso
Promotional offers available online at Kohls.com may vary from those offered in Kohl's stores.

domain: design


Note: Your Quotation Request will be directed to
The WL-SC-UV-3 from NKT Photonics is a Laser with Power 3 W, Wavelength 390 to 2400 nm, Output Power (Pulsed) 3 W, Pulse Width 6 ps, Repetition Rate 40 MHz. More details for WL-SC-UV-3 can be seen below.
9.2 µm - 10.9 µm, CO2 Laser for Laser Processing Applications
1047 nm Passive Q-Switched Laser for Marking & Spectroscopy Applications
532 nm Green Microchip Laser for Biophotonics & Instrumentation Applications
Let us know what you need, we can help find products that meet your requirement.
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Daugaard May Change Travel Plans to GOP Convention
PIERRE, S.D. (AP) - South Dakota Gov. Dennis Daugaard may be changing his plans to attend the National Republican Convention in Florida because of a pending hurricane.
Daugaard is scheduled to leave Monday for the convention in Tampa. But officials in that state are now preparing for the arrival of Tropical Storm Isaac, which is expected to be elevated to hurricane status later this weekend. Officials have pushed back major convention activities to at least Tuesday.
Tony Venhuizen, the Governor's press secretary, tells a local Sioux Falls radio that state officials are now "evaluating" plans for Daugaard to leave Monday. He says there may need to be changes made in the travel schedule.
Daugaard's wife, Linda, and Venhuizen, who is also his son-in-law, will accompany the governor on the trip.


The boyband is recording in LA.
The debut single from One Direction will be released on Sunday 13 March.
The boyband, Zayn Malik, Louis Tomlinson, Harry Styles, Liam Payne and Niall Horan,who came third in XFactor, is currently in Los Angeles recording material.
Radio DJs from IN DEMAND announced the news on their Twitter feed starting a six week countdown to the release.
The news that One Direction are already in the studio suggests 2011 could see a whole host of releases from 2010's X Factor finalists. Winner Matt Cardle is busy recording his debut album and Cher Lloyd is also in LA recording.


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Inspired by man’s micromoments in life, Brindlemutt’s products are catered to every man’s needs in his life’s journey by using unique blends of essential oils and scents which soothes both body and soul.
A man’s life is built up of many layers representing different stages of life which are all intricately weaved together, making up the man. It is this quality web that creates depth of character in man, and it is an idea that Brindlemutt embodies when creating its scents.
Like the unique brindle hound that has survived through battle and proven its strength in the rough environment, Brindlemutt represents individual patterns of brown on the fur coat of hounds selected for survival. Like its name, our soap has been through the cycle of its life and each finished product has emerged triumphant from all other recipes and initial ideas we’ve had. Our selected scents are made up of all-natural ingredients and have no added preservatives or synthetic products. Born from the environment, Brindlemutt is safe to return to the environment once it is used.


I need a little help folks. I stumbled across a good deal on a Sako AV in 375 H&H. Turns out the stock isn't correct for the rifle, and the recoil lug wasn't seated against anything in the stock. Of course, I didn't realize this until I hit the range and three rounds drove the tang into the stock, splitting off pieces of fiberglass. Dis-assembly shows I need a few parts to make it whole again...
Does anybody know where I can find front and rear action screws (never seen those bend before) and maybe an AV magazine box? Right now there's an AIII mag box, and it's a little tweaked so the rounds won't feed reliably. I don't know if the AIII box is any different than the AV (Murphy?), but factory ammo completely fills it lengthwise, and if there are any other options, I'd prefer a little more room.
I've already tried Numrich and they don't have what I need. Brownell's has action screws but no mag boxes. I'd prefer to buy locally, but I'm willing to go outside if necessary.


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But much has changed on Crete – and throughout the Mediterranean – since then. Today, the people of Crete still eat a lot of olive oil, but their intake of whole, natural foods has gone way down, as has their physical activity. The island’s new staples are meat, cheese, TV, and the Internet. Today, more than 60% of Crete’s adult population – and an alarming 50% of its children – are overweight.
It’s estimated that over 50% of people are deficient in Vitamin D worldwide[*]. Although Vitamin D doesn’t play a major role in whether or not you are in ketosis, it is responsible for regulating immunity, inflammation, hormones and helping with electrolyte absorption[*][*] — all factors important for weight loss and overall health. Additionally, studies support the direct benefits of vitamin D for weight loss[*][*][*]. You can check your Vitamin D levels with a simple blood test and then supplement accordingly. When supplementing, choose Vitamin D3 as it is the form that’s best absorbed by your body[*][*].
I've spent years tackling subjects from urban health to medical marijuana to behavioral science—both as a city reporter for my hometown public radio station in Tulsa, Okla., and as a freelance writer. Now I cover health and food at Consumer Reports. My hobbies include tinkering with computer code and watching trashy TV. Follow me on Twitter: @catharob.
Take calorie deficit breaks. If nothing else seems to work, then try taking intermittent diet breaks every two weeks or so. Recent research found that obese men who took 2 week breaks from being in a caloric deficit lost more fat than the men who maintained a calorie deficit. This means that keto dieters may benefit from taking intermittent calorie deficit breaks as well. To implement a diet break, simply follow the ketogenic diet for two weeks while you maintain a calorie deficit. After those two weeks, calculate what you need to eat to maintain your bodyweight, aim to eat that many calories, and repeat — recalculating your calorie deficit after each calorie maintenance phase. Researchers hypothesize that this method of dieting helps keep your metabolism from slowing down, allowing you to burn more calories while you are in a calorie deficit.
Metagenics MCT Oil provides over 90% caprylic (C8) and capric (C10) acid triglycerides. Emerging science suggests that medium-chain triglycerides (MCT) may benefit the body in numerous ways. MCT may help support cognitive health and certain cognitive processes, and pre-clinical research suggests that MCT may benefit mitochondrial function. MCT supplementation temporarily increases levels of ketones, which may serve as an alternative energy source in the brain and in muscle. Supplementing with MCT at multiple meals during the day may aid reductions in body weight and body fat, especially in those with an increased body-mass index (BMI).†† MCT may also help to temporarily increase satiety and reduce food intake, and may temporarily enhance fat oxidation as compared to common long-chain fats.*
I have always been what most would consider a “big girl”. In January 2018, I weighed 180 lbs, which is quite overweight for a woman my height. I wasn’t always this weight though. In my teenage years, I weighed only 140 pounds and I felt much healthier and happier. I strived desperately over the years to get back to this weight. But with a stressful and busy work life, I struggled... continue here https://bit.ly/mydietplantoday
However, this diet is gaining considerable attention as a potential weight-loss strategy due to the low-carb diet craze, which started in the 1970s with the Atkins diet (a very low-carbohydrate, high-protein diet, which was a commercial success and popularized low-carb diets to a new level). Today, other low-carb diets including the Paleo, South Beach, and Dukan diets are all high in protein but moderate in fat. In contrast, the ketogenic diet is distinctive for its exceptionally high-fat content, typically 70% to 80%, though with only a moderate intake of protein.
hey Julius, love your blog and dirtyweights.com … im two weeks into keto and really seeing some great results..but i would liek to know what is the optimal calorie intake and macro split ishould be doing. im 31, 6 feet 2, at 195 lbs. ive put on muslce for the past year and want to burn body fat from what i am now (approx 21% fat) to ideally 15% or lower in next 6 weeks. what would you suggest?
As for the type of MCT oil to take, I prefer the more expensive C8 (caprylic acid) oil over those containing both C8 and C10. Avoid cheaper versions containing C6. Even a 1 to 2 percent concentration of C6 can contribute to GI distress. If you want C12 (lauric acid) for its anti-microbial and anti-inflammatory activity, add coconut oil to your diet, which is less expensive and more versatile than MCT oil.
In 2017, Drs. Kevin Hall and Juen Guo published a meta-analysis of controlled feeding studies that compared diets of equal calorie and protein content with variations in carbohydrate and fat content. By designing the study in this way, the researchers could finally find out whether restricting carbs or limiting calories is more important when it comes to weight loss.
Coconut oil contains MCT’s, but only in relatively small quantities. C8 MCT (Caprylic Acid) comprises roughly 6% of coconut oil, and C10 (Capric acid) is usually around 9%. These two forms of MCT are particularly valuable because they take far fewer steps to convert to caloric energy than the other saturated fat forms found in coconut oil. Coconut oil is great, but if you really want to benefit from the fast acting fuel of MCT’s, choosing Onnit MCT oil is the way to go.
Consuming Onnit MCT oil isn’t just good for humans, it’s good for orangutans! Palm oil, the leading constituent in most MCT oils, is typically harvested from native palm forests, contributing to the destruction of some of the last remaining habitats for orangutans. So enjoy our super premium MCT oil and send a karmic high five to the great red ape.
In the short term, you may lose a modest amount of weight over a year span and are likely to keep it off it you continue to eat following the diet. (6) If eating in the Mediterranean style prompts you to consume more fruits and vegetables, you’ll not only feel better physically, but your mental health will get a lift, too. Research shows that people who eat more raw fruits and veggies (particularly dark leafy greens like spinach, fresh berries, and cucumber) have fewer symptoms of depression, a better mood, and more life satisfaction. (36)
One of the ways to do this that is yielding promising results in research is the ketogenic diet. In a 2017 study evaluating the ketogenic diet in the management of diabetes, researchers showed the diet had the potential to decrease blood glucose levels, the rudimental key to minimizing the occurrence and diagnosis of diabetes. This was further supported in a study evaluating the long-term effects of the ketogenic diet in obese patients, offering similar results in its ability to lower blood glucose levels, as well as decreasing total cholesterol and triglyceride levels.
I’ve been doing keto for a month now. Cheated on Sunday to hopefully reboot this diet because I’ve only lost 3lbs. I’ve been within my carbs and doing everything right. Somehow just not loosing weight. I’ve lost 50lbs before just eating healthier so I don’t understand why this isn’t working for me? If anyone has any advice it would be helpful, I’m trying to stick this out for my mom so she stays healthy but it suck not loosing. I’m 26 and 219lbs so I have plenty of fat to loose.
Want even more inspiration? Sign up for our Fresh Fridays newsletter. Our bi-weekly e-newsletter delivered right to your inbox celebrates the Mediterranean Diet and its remarkable health beneﬁts. Each issue includes delicious recipes that will remind you just how easy it is to enjoy beautiful, simple, economical, and easy-to-ﬁnd Mediterranean foods.
Just remember that all olive oil is not created equally. Unfortunately, most commercial manufacturers that are trying to ride the health hype on olive oil have rushed to the market with all kinds of fake olive oils, which are imitations and inferior products. The problem is these oils aren’t always harvested or processed properly, which can kill many of their delicate nutrients and turn some of their fatty acids rancid or toxic.
The polyphenols in extra virgin olive oil act as antioxidants to rid the body of free radicals that would otherwise damage cells, or even lead to cancer. A study found that drinking olive oil inhibited colon cancer at various stages of the disease. So why not use it to fend off cancer to begin with? This is not to say that you should skip those recommended colonoscopies after age 50, but go ahead and add olive oil to your daily regimen as a preventative measure.
While many brands use harsh chemicals and non-organic coconuts to create MCT oil, we've crafted a patented USDA Certified Organic process to produce the world's first certified organic MCT Oil. We only offer the highest quality organic and non-GMO products to our customers, and are committed to supporting our coconut suppliers in following sustainable farming practices. Upon harvest, the creamy white meat of the coconut is scooped from the shell by hand, then cold-pressed to create the Nutiva Organic Virgin Coconut Oil. To create Nutiva Organic MCT Oil, we slowly chill the virgin coconut oil to separate the solid fats, leaving MCT Oil.
To maximize the benefits of olive oil, Palinski-Wade mixes six servings a day with other ingredients scientifically proven to blast belly fat — including lean protein (which helps keep belly-fat hormones low) and dairy (rich in an amino acid that speeds the release of ab fat). On the olive oil diet plan, you’ll also enjoy berries, greens, beans, potatoes, and other plant foods that come packed with belly-fat-fighting antioxidants.

domain: food


Although my effort to compare my antennas at home was a noble one, it still needed to be pointed out that switching back and forth between my antennas to see where my WSPR spots were being received, wasn’t the most accurate. Propagation, QRM, QRN can all change from one moment to the next. Though I may get a ‘general’ picture of how well my signal was being received, in order to get an accurate A/B picture, a simultaneous transmission needs to occur from both antennas. In addition, all the other parameters must be equal; i.e. feedline, power, environment. I can certainly control some of these items, but the tools I had been using thus far, WSPRlite, QRP Labs U3S, and my radios, do not allow for a simultaneous transmission on two antennas. If you program two of any of these options to transmit at the same transmit rate, there’s no guarantee that they will transmit on the same cycle.
Enter the W6LVP 3 Band 2 Channel WSPR Transmitter…
A big thank you to Larry, W6LVP for offering this device for such comparisons!
In the back, there are 2 female BNC connectors, and a simple LED light & toggle switch on the front that activate the unit & select the band. The unit is powered by a 12v power supply with barrel connector. That’s one downside to using the WSPRlite is the fact that it requires 5 volts to power – not a huge deal since you can generally power it from your cell phone, but I’ve noticed that the 5 volt power requirement has caused folks to use dirty power sources. The unit will run on 20/30/40m, and is preprogrammed with all the necessary info (Callsign, Grid Locator, etc). Transmitting at half a watt – It will transmit automatically from both antenna ports on every other cycle. Larry hasn’t started commercially making this unit yet, and not sure if there are any plans to, but it has certainly solved one problem I was having with A/B comparisons! Thank you Larry.
Hope to put this device to use for the first time testing out the Link Dipole vs Elevated 1/4w vertical. Two antennas that have a permanent home in my arsenal. There’s something particularly appealing to me when it comes to monoband antennas, they may be a pain to deal with for a band hopper, but the performance, bandwidth & simplicity is unrivalled. I always enjoy going portable & putting up full size antennas. Something I rarely have the opportunity to do at home. Honestly, if I could have a monoband antenna up in the air for every band… well you get the idea!
More later on the W6LVP 2 ch. WSPR transmitter!


Our Students > Knitting Project
Knitting at the Village School :: March 2012
The 2nd-6th grade classes just finished an 8 week knitting cycle. New knitters were first introduced to a special peg loom, a great tool for developing students' visual-motor skills. Mastering the wrapping pattern and then working through a whole ball of yarn, each child made a new scarf. After learning the loom, students move onto making their own knitting needles, sharpening the tips of wood dowels, and then patiently sanding them smooth. With the new needles, students refine their technique and remember the "push, wrap, pull and lift" process, while creating a simple scarf.
As their skills develop, 4th-6th graders were given new projects, such as working on circular needles, and making a hat or a small bag, which included learning to read a knitting pattern. Another favorite is fingerless mittens. The most challenging project is knitting 2- needle mittens.
We use 100% New England wool yarn, from Bartlett Yarns, in Harmony, Maine. The 2nd–3rd graders used solid, light colors, which are best for seeing stitches. Older students use multicolored yarn dyed by Lynn.
When knitting, the children find the determination and patience to see projects through to the end. It's purposeful work, allowing the children to settle their bodies, but still have very active, focused minds, with subtle fine motor movements. It was a special treat one Tuesday afternoon, when Dick Hyland came in and played guitar during knitting time.
Lynn Anair leads and teaches the knitting program, which takes place each winter at the Village School. Children continue to knit throughout the year, and get great pointers and advice from Lynn, who is an accomplished spinner, dyer and knitter herself. The children can also always go to Lynn in the After School Program, anytime, for knitting help.
Here are some of our student knitters and their finished projects: