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We can all agree that avocado is the darling of the paleo friendly foods. It’s full of healthy fats, fibre, and vitamins; it’s satiating and calorie dense yet low in carbohydrates making it perfect for those following a ketogenic or a low-carb paleo diet; it’s accessible and, for the most part, it’s fairly affordable (depending on the season).
Forget avocado on toast! You can use avocado in dips, salads, and sauces and because of it’s shape and texture, it is one of the most popular foods for stuffing. You use the avocado flesh as part of the stuffing and use the actual fruit as a boat/bowl filling vehicle.
There are many creative ways and ingredients to stuff an avocado with – tuna being one of the most popular – and in today’s roundup, I wanted to highlight some of my favourite recipes going around. Most of these are paleo or primal diet friendly, and I’ve provided some modifications, if they’re not. If you don’t feel inspired to stuff an avocado after this post, then there is no hope for you or your avocados.
1. Tropical Tuna Stuffed Avocado
This tuna stuffed avocado recipe from A Cedar Spoon is a perfect, protein-packed lunch or snack that can be made on-the-go or at your desk at work. I love the flavours of mango, coriander (cilantro) and lime juice in this dish. They are mixed with tinned tuna, Greek yoghurt (you can use mayonnaise or coconut yoghurt for a dairy-free version) and some crunchy veggies.
2. Smoked Salmon & Egg Stuffed Avocados
This rich, creamy and tasty baked avocados recipe is from Fresh Planet Flavor. It’s ridiculously simple to make and looks mighty impressive, if you ask me.
3. Shrimp Ceviche Stuffed Avocados
If you want to lighten things up, try these gorgeous, zesty and flavourful prawn ceviche avocados from Heather Christo. You will need fresh shrimp/prawns, coriander and lime juice, and I would swap out the vegetable oil mentioned in the ingredients with healthier avocado or olive oil
4. Taco Beef Stuffed Avocados
Who doesn’t love the combination of well-seasoned grass-fed beef mixed with things like warm peppers and spiced tomato salsa? Guacamole is an obvious topping as well but in this dish from Paleo Leap, the avocado is turned into a taco shell instead. These stuffed avocados are baked but you can easily recreate this dish with raw fruit filled with cooked taco mince and salsa.
5. Salmon Stuffed Avocados
This recipe from Keto Diet App is a low-carb, satiating meal of creamy avocados stuffed with zesty lemony salmon, mayonnaise and dill.
6. Caprese Stuffed Avocado (Primal)
This recipe from Closet Cooking is absolutely beautiful. Caprese is a popular Italian salad of buffalo mozzarella or bocconcini cheese with ripe, sweet tomatoes, and basil and drizzled over with extra-virgin olive oil and, in many cases, rich balsamic vinegar. Why not serve the salad inside avocados? You can easily make this without the cheese.
7. BLT Chicken Salad Stuffed Avocados
Shredded roasted chicken, crispy bacon, leafy greens all in one dish and inside an avocado? Yes please! Ok, so this recipe from The Garlic Diaries is trying to make a lower fat version by using cottage cheese instead of mayo and turkey bacon instead of pork bacon. Totally ok if you want to try it that way. For us, fat-loving humans, a dollop of regular mayonnaise and the real-deal bacon should be just fine.
8. Crab Salad Stuffed Avocados
In this recipe from Laylita’s blog, the crab salad stuffed avocados are prepared by filling ripe avocados with a salad of crab, red onion, bell pepper, cucumber, radishes, lime juice, olive oil, and cilantro. It’s light, summery and nutritious.
9. Tart Cherry Tuna Avocado Bowls
In this quick and easy recipe, the avocado is actually scooped out, diced and mixed together with tart cherries, and healthy fats filled tuna and pecans. Tart cherries are a great source of antioxidants and contribute to a good night’s sleep. You can also use dried cranberries or fresh cherries instead. This recipe is from Love & Zest blog.
10. Scrambled Eggs & Bacon Stuffed Avocados
Eggs, bacon and avocado is a classic breakfast combo so it was inevitable that I would stumble on this decadent looking dish. Scrambled eggs (you can make these without the cheese) work perfectly as a stuffing inside avocados. Simply top with crispy bacon and serve with a green salad. Recipe from Cafe Delights.
11. Tuna Poke Stuffed Avocados
These Whole30 friendly tuna poke avocado boats are made with sushi-grade tuna fish, coconut aminos and sesame oil, as well as crunchy cucumber and macadamia nuts. Poke is a popular Hawaiian dish made with tuna or salmon, and the flavours work perfectly with creamy avocado. Recipe from Anya’s Eats blog.
12. Strawberry Salsa Stuffed Avocados
Here is another recipe from Closet Cooking, in which fresh strawberries are chopped and paired with red onion, diced jalapeños, lime and cilantro/coriander. You can serve these with or without the crumbed feta or goat’s cheese. Perfect for warmer weather!
13. Egg Salad Stuffed Avocados
Another gorgeous avocado recipe from Laylita’s blog. These are made using delicious ripe avocados and stuffing them with a salad made with hard-boiled eggs, radish, red onion, celery, mayo (and/or yogurt), mustard, lime juice, cumin and jalapeños. I love the addition of pickled red onions on top. Or you can use caviar or fish roe, if you want to be fancy.
14. Healthy Thai Tuna Stuffed Avocados
Thai food meets tuna in this healthy Thai-inspired tuna stuffed avocado dish from The Stay At Home Chef. Soy sauce can be replaced with coconut aminos and fish sauce or the wheat-free tamari sauce, and those of you avoiding peanuts can use some toasted cashew or almond nuts, or sesame seeds.
15. Sardine Stuffed Avocados
And to finish off the roundup, I am sharing another recipe from the Keto Diet App blog. This time the avocados are stuffed with creamy, tasty sardine salad. This recipe is a real superfood powerhouse with Omega-3 and mineral-rich sardines (plus, protein!), nutritious avocado, and anti-inflammatory turmeric.
I want that smoked salmon with the beautiful egg right now for lunch! YUM! Thank you for all these great ideas – they make for a fast lunch for sure!
Oh wow, so much avocado deliciousness here! I can’t get enough of avocado 🙂
Oh my! I know what I’m doing with my avocados tomorrow 😉 Such a fab round up and great photography. LOVE <3
I was just about to go and grab a snack when this popped up. Tropical tuna stuffed avo – sounds perfect! Great round up of avocado recipes, some fantastic ideas here!
Every single one of these looks amazing, but those crab stuffed avocados in particular really caught my eye and I can’t wait to try them out!
I. am. obsessed. with. stuffed avocado things!! can’t wait to give a bunch of these a try!
I really want to try those Thai Tuna Stuffed Avocados, they look so good! Thanks for compiling this , it is so useful!
I’ve never stuffed an avocado before! Clearly I am missing out!
Avocado has to be up there as one of my all time favourite foods, love this inspiration! Lots of recipes to try.
Now THIS is a killer round up! ALL THE AVOS! Yum!
These look so good! So many beautiful and bold colors. ! I would love have #4, 6 and 7, they sound amazing!
I love all the ideas! How creative! I’m really wishing I had that scrambled eggs and bacon one right now- yum!
I love stuffed avocados! I have a recipe with shrimp and mango that I really like. Now I need to try some of these! The Caprese one looks especially delicious.
I love avocados so much!
Wow all these photos are deeply stunning.
Avocados are my FAVE!!! Love this roundup!
Oh, so many ways to enjoy my beloved avocado. Thanks for the inspiration!
Every recipe in this post looks so delicious and lovely ! I can’t wait to try all of them !! YUM !!
This one fabulous recipe list! I can’t wait to try all of these! Thank you for include my recipe for Shrimp Ceviche Stuffed Avocados!
My pleasure! It’s such a fab recipe, I had to include it 🙂

domain: food


Zelenskyy was “grateful” Ottawa decided to extend its military training mission, Operation Unifier, for three years, as well as provide non-lethal equipment, enhanced intelligence sharing and resources to defend against cyberattacks.
But is it enough to deter Russia from pursuing an armed conflict with Ukraine, like many western nations fear it will? Aurel Braun doesn’t think so.
“I want to emphasize that I would not be dismissive of the Canadian aid, but we have to contextualize – It doesn’t do what’s needed,” said Braun, a professor of international relations and political science at the University of Toronto.
“We are doing considerably less than we are capable of doing, and we are at the 11th hour.”
Mykhailo Honchar, a Ukrainian expert on international energy and security relations, agrees.
“Canada has an opportunity to take a more active position … including with weapon supplies,” he told Global News’ Crystal Goomansingh in Kyiv on Thursday.
“We Ukrainians hope Canada will be more active in the context of political diplomatic support, including … preventive sanctions against Russia, not reactive.”
Tension has been building between Ukraine and Russia in recent weeks, stoking fears of an armed conflict between the two countries.
Canada, the United States and European allies have been scrambling to support Ukraine in the event of an armed conflict, while threatening to impose sanctions against Russia if it moves into the former Soviet state.
Russia has denied it intends to launch an invasion, but western nations are unconvinced.
On Wednesday, Prime Minister Justin Trudeau announced Canada is extending Operation Unifier, and will be deploying 60 additional Canadian Forces members to join the roughly 200 others already on the ground training Ukraine’s security forces.
Ottawa is also boosting both intelligence sharing and support to combat cyberattacks. But it is not fulfilling one of Ukraine’s top requests right now, which is for defensive weapons.
Trudeau said Canada will send non-lethal equipment like body armour, optics and scopes. He did not elaborate when asked to provide a clear answer as to why the government has decided not to send weapons right now.
Andrew Rasiulis, a defence expert with the Canadian Global Affairs Institute, told Global News he feels Canada’s support to Ukraine is “very measured.”
“Everyone wants to prevent a conflict and the diplomatic path is currently in play, and that is everyone’s preferred option,” he said.
“It’s deterrence and dialogue, so the dialogue is on the diplomacy side, and deterrence is like Operation Unifier, where we are training Ukrainians to build up their defence force capabilities for self-defence. … Canada has put a very measured response, which puts the emphasis on diplomacy while not ignoring the deterrence side of the equation.”
But to help further deter Russia from potentially invading Ukraine, Canada must use all the tools at its disposal, Braun said.
While fulfilling Ukraine’s request for Operation Unifier to be extended and economic supports are a good start, more can be done like sending defensive weapons, he added.
“(Russian President) Vladimir Putin looks for soft targets … every time he invaded anywhere, he calculated very carefully the risks were low of an all-out conflict, he calculated very carefully the gains were larger than the costs,” Braun said.
“We in Canada need to help divert that calculation, and we’re running out of time.”
For weeks, western nations have been supporting Ukraine in anticipation of an armed conflict, while also pursuing a diplomatic solution with Moscow.
The United States and the United Kingdom have sent weapons and other military equipment to the region. Estonia, Latvia and Lithuania are also sending U.S.-made anti-tank and anti-aircraft missiles to Ukraine.
Denmark is sending a frigate and deploying F-16 warplanes to Lithuania, Spain is sending warships and could send fighter jets to Bulgaria, and France stands ready to send troops to Romania.
But one European powerhouse – Germany – appears to be hesitant on sending weapons. The country recently sent 5,000 military helmets to Ukraine, which Kyiv’s mayor dismissed as “a joke” that left him “speechless.”
“The German government is agreed that we do not send lethal weapons to crisis areas because we don’t want to fuel the situation, we want to contribute in other ways,” said German Defence Minister Christine Lambrecht on Wednesday.
Experts told The Associated Press recently they believe Germany’s position is partly rooted in its inglorious history of aggression during the 20th century.
“There’s the obvious legacy of Germany’s own militarization in Europe during two world wars that has led many German leaders to view any military response as the last resort,” said Rachel Ellehuus, deputy director of the Europe, Russia and Eurasia program at the Washington-based Center for Strategic and International Studies.
But that attitude could backfire, she added.
“The current government does not seem to grasp that sending defensive weapons to Ukraine might actually deter further Russian aggression,” Ellehuus said.
German Foreign Minister Annalena Baerbock has said Berlin takes a dim view of Russia’s behavior.
The nation is willing to consider tougher steps if Russia acts against Ukraine, such as calling into question the future of the new Nord Stream 2 pipeline meant to bring much-needed natural gas to Germany from Russia.
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Such a move against its biggest energy supplier could cost Germany, but officials believe that being a large customer of Russian gas can give it leverage, as Moscow won’t want to harm its reputation as a reliable supplier of gas, The Associated Press reported.
It might be unrealistic to think western nations will all be on the same page when it comes to addressing the Ukraine-Russia crisis, Rasiulis said.
“It’s actually perhaps preferable for the alliance to have some states like Germany, France and perhaps Canada now who are going to be the frontrunners on the diplomatic stage, and have some of the more hardline countries like the United States and Britain taking very tough stances, but also open and very much advocating diplomacy,” he said.
“I think a mix is not a bad thing. It shows there are nuances and there’s room to reduce the tension a bit when there’s dialogue taking place and even if there’s a bit of nuance in opinions, it reflects the reality in fact.”
Braun suggests if Canada increases its supports to Ukraine, it could get Germany to do the same.
“We can set an example,” he said.
“We can show that Canada is acting responsibly.”
— with files from Reuters and The Associated Press


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Last night President Cyril Ramaphosa announced the easing of restrictions under adjusted level 3 lockdown. Key among them was the sale of alcohol being allowed once again, with it permitted during the week from Monday morning until Thursday afternoon. On the back of the news, ecommerce platform OneDayOnly is focusing on its ability to deliver orders for alcohol to customers across the country in a timely fashion.
To that end, the site confirms that customers can expect deliveries to occur within a five to 10 day time frame, dependant on stock availability of course.
The company says it has learned from previous lockdowns, and its procurement team has been working with liquor suppliers ahead of last night’s presidential address.
“You may have seen communication about #supportinglocal and the #SaveSAwine initiative where we’ve stayed committed to local producers and distilleries and kept processing orders for our suppliers to help keep their financial heads above water,” notes Laurian Venter, director at OneDayOnly.
“With the announcement of another update address from our President this evening, our buying team have been working throughout the day setting up tomorrow’s store with new brands like Leopard’s Leap, Devil’s Peak and Lourensford which we are offering at up to 35% discount,” she adds.
With South Africa dependant on its liquor industry, and wine in particular, OneDayOnly is hoping South Africans will support local businesses in their efforts to remain afloat given the chaos that alcohol bans and lockdowns have caused since March last year.
“For those who supported local through our platform throughout the alcohol ban, you’ll be pleased to know that our suppliers are dedicated to prioritising their deliveries within a 5-10 working day delivery timeframe and of course, adhering to the necessary COVID-19 safety precautions,” concludes Laurian.

domain: economics


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- Free WiFi
- Parking On Site
With a stay at Black Pearl in Reykjavik (Reykjavík 101), you’ll be minutes from Reykjavik City Library and Reykjavik City Hall. This 4.5-star aparthotel is within close proximity of Reykjavik Harbour and Parliament House.
Make yourself at home in one of the 16 guestrooms, featuring kitchens with refrigerators and espresso makers. Rooms have private furnished balconies. LCD televisions with satellite programming provide entertainment, while complimentary wireless Internet access keeps you connected. Conveniences include safes and desks, as well as phones with free local calls.
Spa, Wellness & Premium Amenities
Pamper yourself with onsite massages or make use of the other amenities, which include complimentary wireless Internet access and concierge services.
Food & Drink
Take advantage of the aparthotel’s room service (during limited hours).
Business & Travel Amenities
Featured amenities include a business center, dry cleaning/laundry services, and a 24-hour front desk. Self parking (subject to charges) is available onsite.
How to Get There
From start to finish we loved our visit. Paul is so welcoming and is always at the end of the phone if ever you need anything! The apartment is small but was ideal for us as a family of 3. Our son made himself a little den in the living room to sleep In so there would have been room for another on the camp bed too! Tram stops and the beach are a stone's throw away and a lovely pub down the road serves delicious meals for all the family! Will be back!
We stayed there for about a week, and loved the fact that it was so centrally located to pretty much everything. Paulina, at the front desk, was super helpful, and friendly. Everything we asked for, they took care of and then some. I hadn’t realized I needed to make parking space reservations also, but lucked out when I got there, as they had one opening. Parking on the street is very hit and miss. There was a bit of noise in the surrounding area but nothing that we couldn’t handle. We’d definitely stay here again.
This hotel is in a great location and walking distance to many restaurants and shopping areas. Our room was clean and well appointed. We arrived in Iceland at 6 am and called the hotel, the staff went out of their way to prepare a room and call me back that my room was ready at 9:30 am. That was a big deal since we needed to rest after our overnight international flight. Also, make sure and reserve a parking space if you have a car as parking is limited in the area (the hotel staff emailed me ahead of time and asked if I wanted to reserve a space). They were excellent at anticipating our needs. For that as well as being a nice hotel, they get 5 stars.
We stayed two nights here in the 2 bedroom deluxe apartment. The apartment was tastefully decorated and impeccably designed. The quality of furniture and linen were outstanding. However, there were absolutely no views whatsoever to talk about. The view from living room and the balcony is the next building.
Also, its certainly not value for money. While the apartment was very spacious overall, the bedrooms were very small. Secondly, for an apartment meant for 4-6 people, there was just one bathroom. One has to come out of the master bedroom into the second bedroom to access the toilet!
The location of the establishment in the harbor is excellent to get onto the highway and also to walk right into town. The service at the reception was great, and they were helpful. There is no restaurant in the hotel, but it is walking distance to a bunch of restaurants/town in less than 5 minutes. They also have fantastic garage parking with very close access to the rooms. Just be sure to request parking ahead of time, as there are less than 10 spots.
The rooms are extremely clean and spacious. We had a standard suite, which was more than enough space for a family of 4. They changed towels daily and made our beds daily. I want sure what to expect, as they are labeled apartments. However, the room was cleaned daily as I would see in any nice hotel otherwise.
We were very happy with the service, the room and the location! We would definitely come back!!

domain: travel


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Vitamin B9 or folate is another name for folic acid. Folic acid is a vital vitamin that you should make sure to get enough of, since it is used for brain development, cell growth and tissue development. The cell division required to produce DNA is dependent on folic acid. The body can get folic acids from a variety of food sources. These include dark green leafy vegetables like broccoli and spinach; citrus fruits; legumes; tomato juices and fruits such as bananas, melons and asparagus. They also include poultry, shellfish and pork.
To stay healthy and strong, you should ensure you eat a balanced diet that is full of fruits and veggies. Folic acid can have a positive impact on the health of women.
Pregnant women should ensure that they consume enough folic acids in their diet. It can come either from food or a prenatal supplement. Women who have difficulty conceiving may benefit from a higher intake of folic acids. Folic acid is also known to help reduce the risk of certain birth defects, and can enhance fetal development. The mother-to-be should begin taking folic acids during her pregnancy. It is important that you only take the recommended dose by your doctor.
A folic-acid supplement taken during pregnancy can help protect your baby against neural tube defects such as cleft lip and palate, low weight at birth, poor growth, miscarriage and premature birth. Women who are trying to get pregnant and those in the first three months should take 400 mcg a day. The fourth to ninth months should take 600 mcg.

domain: medical


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Photo By: Elin Chow
A central point of the coastal province of Krabi, Thailand, Ao Nang is a small resort town consisting of a main street, which is dominated by a wide range of restaurants, shops, massage centres, pubs, and other amenities that are specifically targeted at tourists. The town main beach, Ao Nang Beach, serves as a departure point for long-tailed boats to several of its surrounding beaches and nearby islands. Ao Nang, a simple and small town with everything at your fingertips.
Ao Nang has no shopping malls or supermarkets, but there are plenty of lively convenience stores, roadside stalls and other small shops selling mostly similar things from beach wear, bags, clothing and even shoes. Do not be surprised to find differences in prices for same items in different shops. So be prepared to bargain for the lowest price if you are intending to do some shopping at the Ao Nang walking streets.
For us, we did not managed to bring back anything home from these shops. We bought some souvenirs like keychains and fridge magnets from a roadside stall near our resort. The roadside stalls are undoubtedly the best place where you can get some really cheap souvenirs.
A vast majority of the shops are lined neatly along the beachfront road, with minority of them tucked away down the side alley, off the main beach road.
We were really surprised to find that most of the restaurants in Ao Nang not only employed a large number of Indian employees, but also included several Indian cuisines in their menu. While strolling down the streets, we were constantly harassed by some of these Indian staffs standing on the pavement, as they tried hard to lure us into the restaurants which they are working for. It was such an annoying and unpleasant experience!
Seriously, why would we want to eat Indian food in Thailand? We should be trying out a mountain of Thai cuisines in Thailand instead! Unfortunately, we could not find many restaurants that serve only Thai food on the streets. Most of the restaurants in Ao Nang generally serve a mix of Thai/Indian, Thai/Italian or Thai/Western cuisines. That also explained why we decided to dine in at our resort most of the time.
Daytime in Ao Nang tends to be quiet and relaxed. As most people go off on tours and island-hopping trips in the day, thus the streets are not overly crowded. Night-time in Ao Nang is busier, especially on the main beach road, with its concentration of shops, bars and restaurants. This is when most people return to rest and relax after a tiring day trip. As such, the streets will be more bustling after the sky falls dark.
Tuk Tuk are the fastest and easiest way to navigate around Krabi, hence I would really recommend taking one of these rather than a taxi. Furthermore, they are plentifully available everywhere, especially along the main beach road, at a flat rate of 30 baht per passenger and 60 baht for single passenger for trips around the town.
Alternatively, you might want to hop on a Songthaew (shared pick-up truck/taxi) to get around and explore Krabi. Songthaew are color coded according to destination, so make sure you double check with the driver before boarding one.
Songthaew services generally runs to and from Ao Nang beach and krabi town everyday, with designated stops along Ao Nang beach main road. Even so, you are free to hop on and off almost anywhere you like.
Located right across the road is Ao Nang beach, which offers an amazing sunset view. So do not forget to catch a sunset at the beach while you are in Ao Nang, Krabi.
While strolling back to our resort, we happened to chance upon a group of ladyboys parading along and handing out flyers along the main beach road every night, trying to attract and bring in more customers to their cabaret show. If you are keen, you may find any 'lady' who you think is pretty and snap a keepsake photograph with her for free.
We got most of our essentials like sunblock lotion, snacks and bottled mineral water from the 7-Eleven underneath our resort. This is the ultimate convenience of staying with Aonang Cliff Beach Resort.
We love the fact that Ao Nang is a small beach town that is not so packed with tourists. It was very easy to navigate around the town by foot.
Although food and accommodation are slightly more expensive, everything is still reasonably priced in Ao Nang. The absence of raucous nightlife makes Ao Nang an ideal place for relaxation, especially for people who prefer peace and tranquility.
Be sure to follow me on my Facebook or Twitter to get the latest updates on my travel adventures! Also, do not forget to share my blog posts with your family and friends if you find them helpful. In the meantime, you might also want to check My Wanderlust page for some of my other travel adventures.

domain: geography


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Police officers found five automatic weapons inside the cab of a truck that crashed near the intersection of Ingraham Street and Grand Avenue on May 6. Inside the Dodge pickup, police found several automatic weapons and equipment including an AK 47, AR 15, an Uzi and a handgun. Police identified the man as 36-year old Jason Hilliard. He also carried plastic bags, duct tape, several flashlights and a baseball cap with the letters CIA on it.
No details of the crash were immediately available but crash left the truck with a dented front bumper. Police verified the driver was not intoxicated.
Police allegedly tried to get Hilliard medical attention but he fought back, prompting officers to subdue him with a tazer, according to a statement from San Diego police department spokesperson Mònica Muñoz.
Hilliard was taken to the hospital. That’s when he alerted officers about the guns, according to Muñoz. Hilliard is now in federal custody.
“Its not that unusual for people to stockpile weapons in their home,” Muñoz said. “It turns out that some of the guns he had were illegal to own in the first place.”
Check out the May 14 issue of the Beach & Bay Press for more information.

domain: law


The same old story… I’m from the Government and here to help you…!
You know folks, when it comes to real estate in this country the Federal government’s Housing and Urban Development (HUD) Department never ceases to amaze us.
I thought I’d share this video Brian Steven and Frank Garay that explains it all. Click on the image below to see the video and then let me know what you think.
In the Mean Time…?
Make it a Great Day…!
Ed Favinger, Broker CRS, GRI, SFR, CDPE 916-203-1260 firstname.lastname@example.org


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"I spoke with the players individually and even before I became a manager. My relationship with them is good and I enjoy working with them. You saw on Sunday their attitude was at a high level.
"In training and on the pitch I think Chelsea can be very proud of these players. They are very professional and have a good attitude, I don't see one problem so far.
"But look, I don't think anyone is happy from this situation. The situation has happened but nobody in the club was happy. But it has happened and this is football, it is not the first time it has happened.
"But we need to adapt to it as soon as possible, and I think all of us, the players and the management have done that and we are looking forward to improving our quality of football, that is our goal.
"I am very happy with their attitude, even from the injured players, they all want to play.
Grant has spoken to most of the players, both individually and as a group, and he has been heartened by the reaction so far. But he knows that in a squad of 25, he knows there will always be someone who is a unhappy.
Grant added: "It has been much better than I thought and I am sure it will be much better from now. When you have 25 players in the squad it sometimes happens that one or two are not happy.
"For the moment, I have not seen that. I am a very positive person - I like to think about the positive things the players can bring to Chelsea.
"I know some will not be happy because I know it cannot be 100% happiness."

domain: sports


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domain: entertainment


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Facebook executive Mike Vernal, who supervised search and developer products at the social networking giant, announced his departure from the social media giant to join venture capital firm Sequoia Capital. The social networking site said the product team will continue to be run by their individual leaders and that it is not planning to replace Vernal.
Vernal was important to Facebook
Vernal, who worked for the social media giant for eight years, directly reported to CEO Mark Zuckerberg. Vernal joined Sequoia as a partner, and there, he will invest in early-stage startups. Vernal, who was the vice president of search, local and developers’ products, announced his departure on Monday afternoon.
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In a statement, the Menlo Park, Calif.-based company said, “Mike Vernal has been an integral part of the Facebook team. While we’re sad to lose him, we’re happy for him to take the next step in his career and wish him all the best.”
At Facebook, Vernal helped the social networking site’s efforts to turn its search function into more of a resource for people to find public posts on current events and not just a place to find profiles of friends.
The news of Vernal’s departure came just a week after Facebook’s annual developer conference in San Francisco. The conference drew about 2,500 attendees to hear about the company’s 10-year vision, which is focused on artificial intelligence (AI), chatbots and virtual reality.
Not an easy decision to make
In an interview with Re/code, Vernal said it was not easy to come to this decision, especially when Zuckerberg laid out a grand vision at the developers’ conference which included things like Internet-beaming drones and towers and connecting humans inside virtual reality.
“The company is so mission driven, and that mission is so good that it’s hard [to leave],” he said. “It’s a pretty exceptional place with pretty exceptional leaders.”
Vernal told the website he has interest “across a lot of industries” and didn’t particularly tell about the verticals he will pursue at Sequoia. Since the departure of Michael Goguen, a longtime partner who left last month after a former exotic dancer filed a lawsuit alleging abuse and breach of contract, Vernal is the first partner to be added to the firm. Goguen invested in later-stage growth companies.
Vernel is not new to investing in companies; he has done a sort of angel investing in the past – something he calls investing in “friends and friends of friends.”

domain: news


VG Jeff, Cong Yoyette Take Oath
Re-elected Negros Occidental Vice Governor Jeffrey Ferrer and 4th District Representative Atty. Juliet Ferrer were solemnly sworn into Office by Judge Aireen Bonghanoy of MTCC Bago City this afternoon.
La Carlota City newly elected Mayor Rex R. Jalando-on and re-elected SP member Julius Martin Julius Martin D. Asistio were among those who came to show their support to the power couple.
Among the priority projects of Vice Governor Jeffrey and Cong. Yoyette in La Carlota City were the construction of school buildings for La Carlota City College and Senior High School, Dona Hortencia Salas Benedicto National High School, farm-to-market roads such as the Sitio Bugcos FMR, barangay halls, and La Granja and Guintubdan roads. They are also instrumental in the establishment of hemodialysis center in the city.
Along with the City Government of La Carlota, the Ferrer couple are working towards the construction of the La Carlota Circumferential Road intended to divert traffic away from the city proper and spread development to the countryside.
Photo from the FB Page of Hon. Jeffrey P. Ferrer
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Vascular air embolism is a potentially life-threatening event that is now encountered routinely in the operating room and other patient care areas. The circumstances under which physicians and nurses may encounter air embolism are no longer limited to neurosurgical procedures conducted in the "sitting position" and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center. Advances in monitoring devices coupled with an understanding of the pathophysiology of vascular air embolism will enable the physician to successfully manage these potentially challenging clinical scenarios. A comprehensive review of the etiology and diagnosis of vascular air embolism, including approaches to prevention and management based on experimental and clinical data, is presented. This compendium of information will permit the healthcare professional to rapidly assess the relative risk of vascular air embolism and implement monitoring and treatment strategies appropriate for the planned invasive procedure.
INTRAOPERATIVE vascular air embolism (VAE) was reported as early as the 19th century, in both pediatric and adult practice. Well over 4,000 articles have been published during the past 30 yr alone, providing ample resonance to the ubiquity and seriousness of this vascular event. Perhaps the most striking feature accumulated during this period is the myriad of clinical circumstances in which VAE may present itself, a result primarily of the increased technological complexity and invasiveness of modern therapeutics. Most episodes of VAE are likely preventable. This article provides a systematic review of the pathophysiology and clinical presentation of this acute phenomenon, as well as an in-depth analysis and algorithms for favorable methods of detection, prevention, and treatment.
Vascular air embolism is the entrainment of air (or exogenously delivered gas) from the operative field or other communication with the environment into the venous or arterial vasculature, producing systemic effects. The true incidence of VAE may be never known, much depending on the sensitivity of detection methods used during the procedure. In addition, many cases of VAE are subclinical, resulting in no untoward outcome, and thus go unreported. Historically, VAE is most often associated with sitting position craniotomies (posterior fossa). Although this surgical technique is a high-risk procedure for air embolism, other recently described circumstances during both medical and surgical therapeutics have further increased concern about this adverse event. Conditions during which air embolism has been documented have substantively broadened, and much of the credit is owed to Albin et al. 1–4for their description of the pathophysiology during a variety of surgical procedures. Not only does the historic modus operandi of a gravitational gradient remain a concern, but we must now as well be suspicious of VAE during modern procedures where gas may be entrained under pressure, both within the peritoneal cavity or via vascular access. Hence, it is imperative for anesthesiologists to be aware of the causes of VAE, its morbidity, diagnostic considerations, treatment options, and adoption of practice patterns that best lead to the prevention of this potentially fatal condition.
The two fundamental factors determining the morbidity and mortality of VAE are directly related to the volume of air entrainment and rate of accumulation. When dealing simply with air being suctioned by a gravitational gradient, these variables are mainly impacted by the position of the patient and height of the vein with respect to the right side of the heart. Experimental studies have been conducted using several animal models to assess the volume of VAE necessary to provoke circulatory collapse. Lethal volumes of air entrained as an acute bolus have been concluded to be approximately 0.5–0.75 ml/kg in rabbits5and 7.5–15.0 ml/kg in dogs.6,7Translating such data into the adult human would be difficult, if not for some parallel confirmation from the clinical literature. From case reports of accidental intravascular delivery of air,8,9the adult lethal volume has been described as between 200 and 300 ml, or 3–5 ml/kg. The authors of these reports suggest that the closer the vein of entrainment is to the right heart, the smaller the required lethal volume is.
The rate of air entrainment is also of importance, because the pulmonary circulation and alveolar interface provide for a reservoir for dissipation of the intravascular gas. As early as 1969, it was shown by Flanagan et al. 10that a pressure decrease of 5 cm H2O across a 14-gauge needle (internal diameter of 1.8 mm) is capable of transmitting approximately 100 ml of air/s. This rate of entrainment easily exceeds lethal accumulation if not terminated immediately. Such data highlights the risk of catastrophic VAE in many vascular procedures performed in patients, because the luminal size is well within the diameter of commonly placed hardware. If entrainment is slow, the heart may be able to withstand large quantities of air despite entrainment over a prolonged period. As shown by Hybels,11dogs were able to withstand up to 1,400 ml of air over a several-hour period.
Both volume and rate of air accumulation are dependent on the size of the vascular lumen as well as the pressure gradient. The risk of VAE is also present under circumstances that prevent the collapse of veins even at modest decreases of pressure relative to that in the venous system (surgical dissection). Not only negative pressure gradients but also positive pressure insufflation of gas may present a serious VAE hazard. Injection of gas (or liquid–air mixtures), such as into the uterine cavity for separation of placental membrane or for a variety of laparoscopic procedures, poses a risk for VAE.
Early animal experiments indicated that VAE increases microvascular permeability.12Embolization of the right ventricular chamber has been shown to induce pulmonary hypertension related to the release of endothelin 1 from the pulmonary vasculature.13The microbubbles formed due to turbulent flow in the circulation precipitate platelet aggregation and the release of platelet activator inhibitor. This, in turn, may lead to systemic inflammatory response syndrome.14
These physical and chemical responses may cause injury to the pulmonary capillary network, leading to pulmonary edema.15–20Another mechanism of lung injury includes toxic free radical damage. An argument has been made to attenuate pulmonary edema with high doses of steroids such as methylprednisone.21
Several pathophysiologic pathways may be elucidated after a substantive volume of air or gas entrainment. Which pathway is manifested is greatly dependent on the volume of gas accumulated within the right ventricle. If the embolism is large (approximately 5 ml/kg), a gas air-lock scenario immediately occurs. There may be complete outflow obstruction from the right ventricle as failure from the inability to decompress the tension of the ventricular wall. This rapidly leads to right-sided heart failure and immediate cardiovascular collapse. With more modest volumes of VAE, the embolism may still result in significant right ventricular outflow obstruction, with an attendant decrease in cardiac output, hypotension, myocardial and cerebral ischemia, and even death. Even if the cardiac output remains above that required for adequate perfusion, the embolism may nonetheless impart significant and even lethal injury. Air entrainment into the pulmonary circulation may lead to pulmonary vasoconstriction, release of inflammatory mediators, bronchoconstriction, and an increase in ventilation/perfusion mismatch.
Vascular air embolism may have cardiovascular, pulmonary, and neurologic sequelae. The spectrum of effects is dependent on the rate and entrained volume of VAE, as well as other two additional factors: whether the patient is spontaneously breathing, yielding negative thoracic pressure during respiratory cycle with facilitation of air entrainment, or under controlled positive-pressure ventilation. An informative summary of the common relation between clinical presentation and acute embolism volume is presented in figure 1.
Cardiovascularly, tachyarrhythmias are common, and the electrocardiogram demonstrates a right heart strain pattern as well as ST–T changes. Myocardial ischemia may be observed, and in animal studies, peaking of the P wave is seen in the earlier stages. Blood pressure decreases as cardiac output falters. Pulmonary artery pressures increase as a consequence of increased filling pressures and reduction of cardiac output. The central venous pressure measurements also increase as a secondary effect of right heart failure, and jugular venous distension may be noted. As hypotension increases, shock ensues.
Pulmonary symptoms in awake patients include acute dyspnea, continuous coughing,22urgent complaints of breathlessness,23lightheadedness, chest pain, and a sense of “impending doom.” The common response of gasping for air as a consequence of dyspnea forces a further reduction in intrathoracic pressure, frequently resulting in more air entrainment. Pulmonary signs of VAE include rales, wheezing, and tachypnea. During anesthesia with respiratory monitoring, decreases in end-tidal carbon dioxide (ETco2), and both arterial oxygen saturation (Sao2) and tension (Po2), along with hypercapnia, may be detected. Invasive cardiac monitoring commonly increases pulmonary airway pressure.
The central nervous system may be affected by VAE by one of two mechanisms. Cardiovascular collapse secondary to reduced cardiac output (from output obstruction, right ventricular failure, or myocardial ischemia) rapidly results in cerebral hypoperfusion. In mild form, acute altered mental status presents, but focal deficits related to cerebral hyperemia and cerebral edema leading to frank coma quickly follow. Second, direct cerebral air embolism may occur via a patent foramen ovale, a residual defect that is present in approximately 20% of the adult population. Mental status changes postoperatively should raise the suspicion of cerebral ischemia secondary to air embolism in at-risk individuals.
Improvements in monitoring such as measurement of ETco2and end-tidal nitrogen (ETn2) have helped to confirm VAE as a relatively common event during surgical procedures. The breadth of clinical circumstances in which air or gas embolism poses a substantial risk became ever more appreciated. Recent technological advances whereby air is delivered by positive pressure within the abdominal cavity or via vascular access further increase the risk of VAE. It is no longer safe to presume that lack of a negative-pressure system eliminates potential embolism. Common surgical procedures with risk for VAE24–64are listed in table 1. The gravitational gradients may exist not only during surgery, but whenever the vasculature is introduced to relative negative pressure (i.e. , suction effect). Table 2summarizes nonsurgical clinical incidents documenting gas embolization.65–76Relatively novel etiologies include air embolism during eye surgery, home infusion therapy in children,68placement of deep brain stimulators,37,38lumbar puncture,73contrast-enhanced computed tomographic imaging,71,72and radial artery catheterization.67
Gas embolism may occur not only in an anterograde venous course, as is most typical, but also via epidural spaces, via tissue planes, and in a retrograde fashion either arterially or by venous channels. Such paths may result in air found in unusual compartments—not simply via the vena cava to the heart and into the pulmonary circulation. An excellent visual example is provided by a case report by Alper et al. 77After penetrating chest wound trauma and documented tension pneumothorax, the 8-yr-old patient was noted by brain computed tomographic imaging to have massive air densities within the cerebral circulation. It was unclear whether the air found its way there by passage via the pulmonary veins or by direct injury to the greater thoracic arterial vessels. There are also numerous reports of a patent foramen ovale permitting air directly to the cerebral circulation.27,78–82
What can we learn from the voluminous reports of air/gas embolism? First, the clinical conditions do follow certain simple patterns, and appreciation of may alter our plan of procedure, suggest additional monitoring, or make preparations for early intervention. The clinical procedures listed in table 3can be highlighted as air embolism risks. Of surgical procedures, neurosurgical cases remain the highest risk as a consequence of the following:
Elevated positioning of wound relative to the heart
Numerous large, noncompressed, venous channels in the surgical field—especially involving cervical procedures and craniotomies that breach the dural sinuses
Such elements may occur in other surgeries in which patient positioning yields a similar gravitational threat (lateral decubitus thoracotomy, genitourinary surgeries in the Trendelenburg position) or a high degree of vascularity (tumors, malformations) or compromised vessels (trauma) are present. The potential for VAE is commonly not considered in laparoscopic surgery and cesarean delivery, despite the reported incidence risk of greater than 50% during each surgical procedure (table 1). Indeed, each procedure has been associated with intraoperative death as a direct consequence of air embolism.83–87The risk of air embolism during cesarean delivery seems to be a frequent finding when investigated by ETn2or Doppler ultrasonography, although in some cases, the presence of abnormal Doppler signals may reflect turbulent venous return rather than air embolism.51The period in which risk may be highest is when the uterus is exteriorized.88Patient positioning to reverse Trendelenburg seems not to reduce the risk.51During laparoscopic surgery, evidence points to the prerequisite of inadvertent open vascular channels through surgical manipulation as a risk for VAE rather than simply a complication of insufflation.89–90
Detection of Vascular Air Embolism
Before the inclusion of multimonitoring technologies, the clinical diagnosis of VAE was dependent on direct observation of air suction in the surgical field, deduction from clinical events, or postmortum discovery of air in the vasculature or heart chambers. More recently, we rely predominantly on our real-time monitors, some of which are standard, and several specifically used for the purpose of detecting VAE. In general, the monitoring devices that are used should be sensitive, easy to use, and noninvasive. The selection of monitoring device should be predicated on the surgery performed, the position of the patient, the expertise of the anesthesiologist in using the device, and the overall medical condition of the patient.
The detection of an ongoing episode of VAE is a clinical diagnosis, taking into consideration the circumstances under which clinical alterations occur. There are specific circumstances where the diagnosis of VAE should be considered immediately in the differential diagnosis:
Any unexplained hypotension or decrease in ETco2intraoperatively in cases that are performed in the reverse Trendelenburg position or in situations where there is exposure of venous vasculature to atmospheric pressure
Patients undergoing insertion or removal of a central venous catheter who report shortness of breath during or shortly after completion of the procedure
Patients undergoing cesarean delivery who have sustained hypotension and or hypoxia not explained by hypovolemia alone
There are few randomized case–control studies that have assessed the efficacy and the benefit of any monitoring for VAE. Nevertheless, incorporation of certain devices has approached a relative standard of practice. Hence, it would be difficult to demonstrate their benefit in a controlled investigation. In table 4, specific monitoring modalities are listed in the descending order of sensitivity (in ml/kg if established) and specificity of VAE detection, but not necessarily their utility or popularity.91
This instrument is currently the most sensitive monitoring device for VAE, detecting as little as 0.02 ml/kg of air administered by bolus injection.92,93It permits detection not only of venous macroemboli and microemboli, but also paradoxical arterial embolization that may result in ischemic cerebral complications. Notwithstanding, transesophageal echocardiography (TEE) has been said to be almost too sensitive, detecting virtually any amount of air in the circulation, most leading to no adverse sequelae. The counter argument is that the presence of any volume of air should alert the anesthesiologist to institute prophylactic measures, reducing the risk of further entrainment. Cardiac anesthesiologists frequently use TEE for intraoperative patient monitoring and also for detecting residual air when the patient is being weaned from bypass.
The major deterrents to TEE are that it is invasive, is expensive, and requires expertise and constant vigilance that may limit its use by a noncardiac anesthesiologist. A report by Himmelseher et al. 94in Germany noted the use of TEE as standard of practice in only 38% of patients undergoing intracranial procedures, compared with near uniformity of use of precordial Doppler ultrasound.
Precordial Doppler Ultrasound
The precordial Doppler is the most sensitive of the noninvasive monitors, capable of detecting as little as 0.25 ml of air (0.05 ml/kg).95The Doppler probe (typically a 2- to 5-mHz device) can be placed on either the right or the left sternal border (second to fourth intercostal spaces) or, alternatively, between the right scapula and the spine.96We have had good success in both adults and children using these landmarks. The probe is placed along the right heart border, to pick up signals from the right ventricular outflow tract. Generally, the positioning is confirmed by an injection or “bubble” test (injection of an air-agitated 10-ml bolus mixture of 1 ml or less of air in 9 ml saline). The bubble test is helpful in positioning the Doppler probe especially in obese patients.
The first discernible evidence of VAE is a change in the character and intensity of the emitted sound. The “washing machine” turbulent resonance of normal blood flow passing through the right cardiac chambers abruptly is superimposed by an erratic high-pitched swishing roar. Although it is generally easy to appreciate the audible transition, the anesthesiologist must pay close attention to the sounds throughout the case. With greater air entrainment, a more ominous “drum-like” or “mill wheel” murmur develops, signaling cardiovascular decompensation. The sound volume at which this device is used should be at a level appropriate to hear the audio signal above the din of the other operative instrumentation, and preferably kept constant throughout the period of use. Major impediments in the use of this device include sound artifacts during concurrent use of electrocautery, prone and lateral patient positioning, and morbid obesity. The combination use of a precordial Doppler probe along with a two-dimensional echo image may improve detection.97
Transcranial Doppler Ultrasound
Contrast-enhanced transcranial Doppler has been shown to be highly sensitive in the detection of a patent foramen ovale and has been used as a screening tool for patients undergoing high-risk procedures. The sensitivity of this method has been shown to increase with the use of the Valsalva maneuver.98In comparison with TEE, contrast-enhanced transcranial Doppler has shown a sensitivity of 91.3%, a specificity of 93.8%, and an overall accuracy of 92.8%.99
Pulmonary Artery Catheter
A pulmonary artery catheter is a relatively insensitive monitor of air entrainment (0.25 ml/kg),91,95being inferior to the precordial Doppler and far too invasive for a patient who has no other comorbidities requiring its use. The pulmonary artery catheter is of limited ability to withdraw air from its small caliber lumen. The use of the pulmonary artery catheter is thus restricted to those patients who have significant comorbidities that may benefit from its use as a monitoring tool for cardiac output or mixed venous saturation. Volk et al. 100have demonstrated the utility of an 8-MHz probe introduced through the central venous catheter in pig studies to improve upon VAE detection and have claimed a 0.5-μl sensitivity.
Not routinely available on all anesthesia monitors, ETn2is the most sensitive gas-sensing VAE detection method, measuring increases in ETn2as low as 0.04%.91,101It has been shown that changes in ETn2occur 30–90 s earlier than changes in ETco2.102The sensitivity compares to or exceeds that of ETco2during large-bolus VAE but may be less sensitive during slower entrained volumes.103Unfortunately, not all anesthetic monitors have the capability to measure ETn2, and this method is not useful if nitrous oxide is used as a carrier gas. The presence of ETn2may also indicate air clearance from the pulmonary circulation prematurely, and the method is limited by hypotension.102
End-tidal Carbon Dioxide
The ETco2monitor is the most convenient and practical American Society of Anesthesiologists monitor used in the operating room, and critical importance must be paid to this monitor for a high-risk case.
A change of 2 mmHg ETco2can be an indicator of VAE. Therefore, the “low”-level alarm should be adjusted to detect even this small decrement, especially in high-risk procedures.104Unfortunately, ETco2monitoring is not very specific, and its reliability in the event of systemic hypotension is difficult to assess. In addition, in spontaneously breathing patients, this monitor may become unreliable during periods of upper airway obstruction, mouth breathing, and variations in respiratory rate or obstruction of the gas analyzer port by mucus or condensation.
A change in oxygen saturation is a late finding of VAE and typically requires a severe physiologic disturbance because patients often are exposed to a high fraction of inspired oxygen during surgery. Transcutaneous oxygen and carbon dioxide are on the lower end of the sensitivity measurements.
Vigilance of the Anesthesiologist
As part of the comprehensive anesthetic management, timely anticipation of VAE during critical portions of a procedure is as vital to patient well-being as any detection device. For example, observing the absence of oozing venous blood from bone during removal of a craniectomy flap is indicative that the venous pressure at that level is less than the atmospheric pressure and poses a potential VAE risk.
The sensitivity of the esophageal stethoscope has been shown to be very low in detecting a mill wheel murmur (1.7 ml · kg−1· min−1).105
Alterations in the electrocardiogram rank low in sensitivity for VAE detection. Changes are seen early only with rapid entrainment of air, and generally reflect an already compromised cardiac status. Peaked P waves are the first change seen on a 12-lead electrocardiogram in animal studies. In humans, ST–T changes are noted first, followed by supraventricular and ventricular tachyarrythmias.105
For routine surgical procedures where there is a low to moderate risk of venous air entrainment, such as spine procedures, abdominal explorations, and thoracotomies, the anesthesiologist should rely on vigilant monitoring of hemodynamic status, ETco2, ETn2if available, and close visual inspection. During surgery that imposes a clear risk due to anticipated elevation of the surgical site with respect to the heart, laparoscopic procedures with anticipated vascular bleeding, or vascular abdominal cases (cesarean delivery), precordial Doppler ultrasound should be strongly considered in the anesthetic plan. It is the most cost effective, most easy to use, and least invasive of the sensitive monitoring devices. The use of transcranial Doppler or TEE requires special expertise and has not been demonstrated to provide significant additional clinical benefit over precordial Doppler.
Improvements in technical capabilities have led to a dramatic decline in use of the sitting position in neurosurgical and orthopedic surgery. Alternative positioning such as prone or “park bench” provides adequate surgical conditions. Additional medical issues may impact on patient positioning. One such comorbidity is the patient with a documented right-to-left cardiac shunt via a patent foramen ovale. There seems to be an increased risk for a paradoxical embolus in the sitting position, although this has not been observed to lead directly to an increase in stroke or overall morbidity compared with nonsitting positions.106
Although near elimination of the sitting position has resulted in a substantial decline of catastrophic embolism, other perioperative scenarios continue to pose substantial threats of VAE. Common examples include the following:
Insertion and Removal of Central Venous Access Catheters.
It is common to use the Trendelenburg position during the insertion of central venous catheters in the jugular or subclavian veins. Nevertheless, even using optimal positioning and techniques, air embolism has been reported65in the interventional radiology literature at an incidence of 0.13% (15 episodes in 11,583 insertions). The criteria for confirmed VAE were such that only substantial volumes would have met the threshold: the hearing of audible suction or visualization of right ventricular air on fluoroscopy. One of the 15 patients died as a result of the embolism. In the authors’ case series, the complication was commonly noted during insertion of a tunneled catheter through a peel-away sheath.65This technique is frequently used in the operating room for insertion of hemodialysis access or the placement of portacaths. In such a scenario, it is common practice to stop ventilation during insertion of the finder needle to decrease the risk of a pneumothorax, especially with the subclavian site. Holding ventilation also reduces the negative intrathoracic pressure during the expiratory phase that may induce a suction effect, promoting VAE. Similarly, increasing right atrial pressure during the tunneling phase of catheter insertion may also minimize the risk of air entrainment.
Regarding placement and removal of the popular temporary, nontunneled catheters, it is important for providers to understand that the conditions that can increase the risk of air embolism include fracture or detachment of catheter connections,107,108failure to occlude the needle hub or catheter during insertion or removal, dysfunction of self-sealing valves in plastic introducer sheaths, presence of a persistent catheter tract following removal, deep inspiration during insertion or removal (increases the magnitude of negative pressure within the thorax), hypovolemia (reduces central venous pressure), and upright positioning of the patient (reduces central venous pressure). Removal of the catheter should be synchronized with active exhalation if the patient is cooperative. If the patient is on mechanical ventilation, one can apply positive end-expiratory pressure. The Valsalva maneuver has proven to be superior to breath holding for increasing central venous pressure and may be beneficial to reduce the incidence of air entrainment in awake and cooperative patients.109Protective sheaths may aid in limiting contamination but seem to have limited value in prevention of VAE.110
Based on case report data, hospital safety-driven approaches toward development of protocols of central line care have been developed.111,112The protocols emphasize incorporation of the Trendelenburg position during placement and removal of a central venous catheter. There are clinical situations where it may not be possible to have the patient in a Trendelenburg position for the duration of the procedure, as in the presence of increased intracranial pressure. In such circumstances, one may recommend transient Trendelenburg position during insertion of the guide wire or the catheter after the vein has been identified by the finder needle, and/or raising the legs by keeping pillows under the knees to increase the venous return and pressure in the right atrium. Debate exists as to whether the Trendelenburg position is necessary during catheter removal.113,114Careful attention toward occlusion of the entry site may be most important.
The anesthesiologist must be aware that surgery in the head-up position places the patient at risk for VAE. This may occur during craniotomy or spine procedures. However, the risk for VAE may also occur during shoulder surgeries and other procedures near the head and neck. In such situations, the propensity of incurring a negative gradient between the open site veins and the right atrium can be decreased by increasing right atrial pressure via leg elevation and using the “flex” option on the operating table control.
The traditional 15° left lateral tilt position during cesarean deliveries creates a gradient between the right side of the heart, which is at a lower level than the uterus, thus encouraging air embolism.51To counteract this, investigators have studied various positioning changes. In one report of patients undergoing cesarean deliveries, institution of a 5° reverse Trendelenburg position was correlated with a VAE reduction from 44% to 1% in a series of 207 patients.52Subsequently, data from one study comparing 5°–10° reverse Trendelenburg position found that the incidence of VAE is not affected.53
The physiologic changes that occur during various patient positions must be anticipated, and strategies to minimize the negative gradient between the entraining vein and the right atrium must be adopted. Routine use of the Trendelenburg position or other methods of positioning (leg elevation) is recommended during insertion and removal of central venous catheters. Regarding positioning for cesarean delivery, conflicting data exist to recommend any alterations in positioning from common practice.
An increased incidence of VAE has been reported in patients with a low central venous pressure, which enhances the negative pressure gradient at the wound site compared to the right atrium. Hence, a well-hydrated patient reduces VAE risk. It has been proposed to maintain the right atrial pressure between 10 and 15 cm H2O, depending on the elevation of the patient.81A useful maneuver is to zero the right atrial pressure at the level of the right atrium (fifth intercostal space in the midaxillary line) and then increase it to the level of the surgical site to assess whether a negative or positive gradient exists.
Regarding hydration, optimizing volume status should be adjusted to prevent wide gradients between the right atrium and the entraining vein, which may be guided by measurement of central venous pressure, along with other parameters of volume assessment such as respiratory variations in systolic blood pressure and urine output.
Use of Military Antishock Trousers
The use of military antishock trousers during surgery has been shown to increase right atrial pressure in the sitting position. It is possible to reliably sustain the right atrial pressure above atmospheric pressure by maintaining military antishock trouser pressure greater than 50 cm H2O.115The benefits of using military antishock trousers must be weighed against the risks of decreasing vital capacity, hypoperfusion to intraabdominal organs, and potential compartment syndromes.
Although the use of the military antishock trousers suit has been shown in one study to reliably elevate the right atrial pressures, its routine use in high-risk patients cannot be fully justified.
Use of Positive End-expiratory Pressure
The application of positive end-expiratory pressure (PEEP) has been controversial. Studies have demonstrated the safety of PEEP,115,116and over wide ranges of positive pressure.117Several investigations have shown it to be beneficial for prevention of VAE in both animal models and humans, but other reports suggest that PEEP potentially increased the risk of paradoxical air embolism,115a fact exacerbated by a sudden release of positive pressure.118Additional data suggest that application of PEEP does not reduce the incidence of VAE but leads to increased cardiovascular disturbance in the sitting position.119Therefore, the role of PEEP during procedures at risk for VAE seems mixed. Because there are no definitive data to support the use of high PEEP (> 5 cm H2O) as a prophylactic measure, and in some cases the risk of VAE increases, PEEP should be used with caution and used to improve oxygenation rather than as a means to minimize VAE.
Avoidance of Nitrous Oxide
Experimental and clinical investigations have demonstrated that in the presence of VAE, anesthesia with inhaled nitrous oxide in oxygen–air permits lower volumes of delivered venous gas to more rapidly exacerbate the hemodynamic effects of the embolism.120–123This adverse effect is independent of whether the embolism occurs during open or laparoscopic procedures. In patients undergoing neurosurgical procedures in the prone position, there are data to suggest that nitrous oxide may actually be well tolerated.124Nonetheless, nitrous oxide can dramatically increase the size of the entrained volume of air, being 34 times more soluble in blood than nitrogen.
It is also unclear, after a gas embolism has been diagnosed and the patient has been treated with 100% oxygen, at what point it is safe to begin nitrous oxide. Despite some data suggesting that air washout takes place within a relatively brief period of time (60 min),125others suggest that nitrous oxide may be a problematic even if administered more than 2 h after institution of pure oxygen ventilation.126
Although without uniform consensus, there is ample data to discourage the use of nitrous oxide in any high-risk case. Any theoretical benefit nitrous oxide may contribute is unlikely to outweigh its potential adverse effects on VAE. In moderate- or low-risk procedures, the benefits of this agent should be weighed against the possible risks, and appropriate monitoring should be used.
The diagnosis and subsequent management of VAE relies not only on a high index of suspicion, but also on newer sophisticated monitoring devices that enable early diagnosis and treatment before catastrophic cardiovascular collapse occurs. Principal goals of management where VAE is strongly suspected include prevention of further air entry; a reduction in the volume of air entrained, if possible; and hemodynamic support.
Prevention of Further Air Entrainment
Upon suspicion of VAE, the surgeon should be informed so as to immediately cover the surgical field with saline-soaked dressings, thus preventing further entrainment of air. The surgeon should then be asked to assess and to eliminate any entry site. The tilt of the operating table should be adjusted to lower the likely source of air entry and eliminate the negative air pressure gradient. For procedures below the level of the heart (i.e. , lumbar spine, laparoscopy), placing the patient in a reverse Trendelenburg position, if tolerated, should be efficacious at reducing air entrainment.
If cranial surgery is being performed, air entrainment can be reduced by transient jugular venous compression, which by virtue of increasing venous pressure may identify open dural sinuses and result in retrograde flow. Jugular venous compression has been shown in both animals127,128and humans129–131to be effective in limiting the entry of air into the chest and the right atrium from sources in the face and head by increasing distal venous pressure, including the pressures recorded from incompressible veins such as the dural sinuses in humans.132A direct consequence of this technique, and hence a severe limitation, is increase of intracranial pressure, thereby reducing cerebral perfusion. Additional concerns include direct carotid artery compression resulting in a decrease in cerebral blood flow and possible dislodgement of atheromatous plaque, venous engorgement leading to cerebral edema, and carotid sinus stimulation causing severe bradycardia.
Institute High-flow Oxygen
To maximize patient oxygenation during the period of cardiovascular instability, nitrous oxide should be discontinued, and the patient should be placed on 100% oxygen. This has the additional benefit of aiding elimination of nitrogen and reducing embolus volume. Clinical experience suggests that air may not clear rapidly after VAE and may remain susceptible to augmentation by nitrous oxide if reinstituted.126
Reduce Embolic Obstruction
It may be possible to relieve the air-lock in the right side of the heart either by placing the patient in a partial left lateral decubitus position (Durant maneuver),133or simply placing the patient in the Trendelenburg position if the patient is hemodynamically unstable. Recent literature has questioned the Trendelenburg position as a favorable placement to optimize hemodynamics.134The use of the traditional left lateral position has been found not to be beneficial in improving hemodynamic performance in canine studies. In fact, the concept of repositioning the patient at all during a suspected episode of VAE has been challenged in an animal study by Geissler et al. 135These investigators demonstrated that dogs in the left lateral position experienced no benefit during induced VAE, despite definitive relocation of air into the more nondependent portions of the heart. There are no data in humans, however.
Cardiopulmonary Resuscitation and Chest Compressions
Rapid initiation of cardiopulmonary resuscitation with defibrillation and chest compression has presumptively demonstrated efficacy for massive VAE that results in cardiac standstill.136Even without need for cardiopulmonary resuscitation, the rationale behind closed-chest massage is to force air out of the pulmonary outflow tract into the smaller pulmonary vessels, thus improving forward blood flow. In canine studies, cardiac massage has been shown to be equally beneficial as left lateral positioning and intracardiac aspiration of air,12and there is substantiated clinical evidence of its efficacy.137
Aspiration of Air from the Right Atrium
Although intuitive, the success rates of appreciable aspiration of air during VAE are far from ideal. Multilumen catheters or Swan-Ganz catheters have been shown to be ineffective in aspirating air, with success rates between 6% and 16%.138–143The best available device probably is the Bunegin-Albin multiorifice catheter (Cook Critical Care (Bloomington, IN), with success rates as high as 30–60%.139–141The catheter (polyethylene, 5.8 French, 14-gauge size), can be inserted via the antecubital vein the subclavian or internal jugular veins, guided by either a chest x-ray or an electrocardiogram lead that has been attached to the catheter (point of large negative P complex), positioned 2 cm distal to the superior vena caval–right atrial junction.143
In one of the earliest case reports, Stallworth et al. 144reported withdrawing 15 ml of air from the right heart percutaneously in a case of venous air embolism, resulting in prompt hemodynamic improvement. This volume of air, 15–20 ml, has been the average amount that has been reported aspirated with a variety of devices during the past several decades. Currently, there are no data to support emergent catheter insertion for air aspiration during an acute setting of VAE-induced hemodynamic compromise.
The available literature discussing the hemodynamic treatment options in cases of VAE is limited. Clinical VAE increases right ventricular afterload, resulting in acute right ventricular failure and a subsequent decrease in left ventricular output. The logical management would be to optimize myocardial perfusion, relieve entrained air as possible, and provide inotropic support of the right ventricle. Jardin et al. 145used dobutamine in 10 patients with VAE-induced hemodynamic dysfunction treated and observed an increase in cardiac index and stroke volume while decreasing pulmonary vascular resistance. Dobutamine was started at 5 μg · kg−1· min−1, and the dose was increased by 5 μg · kg−1· min−1every 10 min until the desired effect was achieved. Archer et al. 146have described management of VAE with ephedrine.
The use of norepinephrine in the management of hypotension secondary to pulmonary embolism was studied in a canine model.147Norepinephrine titrated to a modest increase in blood pressure produced significant improvement in ventricular performance without increasing pulmonary vascular resistance or compromising either renal blood flow or function.
Hyperbaric Oxygen Therapy
There have been numerous case reports and case series illustrating the potential benefits of hyperbaric oxygen therapy (HBO), especially in the presence of cerebral arterial gas embolism. The passage of the air into the pulmonary arterial circulation has been related to both the amount and the velocity of air infused or entrained. Animal data suggest that the lung acts as a physiologic filter, which becomes overwhelmed above 0.4 ml · kg−1· min−1.148
The physiologic derangements and the therapeutic interventions have been nicely detailed in two review articles.149,150The proposed mechanisms of benefit of HBO are believed to be due to a reduction in the size of the air bubbles secondary to accelerated nitrogen resorption, and increased oxygen content of the blood. The size of the bubbles is inversely proportional to the ambient atmospheric pressure and, as the pressure increases to more than 1 atm, the bubble size shrinks.151Prospective trials demonstrating efficacy are lacking, however.
The optimal time from the occurrence of VAE to the start of therapy (range, 5–29 h) is also unclear. In a retrospective study of patients with venous or arterial embolism receiving HBO from 1980 to 1999 (86 patients), Blanc et al. 152noted that the benefits of HBO were clearly defined if this therapy was instituted within 6 h after the occurrence of venous air embolism. However, no benefit was noted in the arterial embolism group regardless of time to intervention. The authors concluded that HBO was ineffective if the embolism directly enters the cerebral circulation inducing ischemia. Although time may be a factor in the success of HBO, there have been case reports of benefits using delayed (> 6 h) HBO therapy.153Its use has proven effective independent of the cause of the embolism, and the number of sessions have varied anywhere from one154to nine (during nephrolithotripsy).155The decision to pursue delayed HBO has been dependent on the amount of air entrained and the persistence of clinical signs. The risk of transportation of an unstable patient to a hyperbaric facility must be carefully considered.
There has been substantial interest in the use of fluorocarbon derivatives in the management of the complications of VAE, particularly those of cerebral ischemia. All of the studies demonstrating benefits have been in animal models; human data are lacking.
Fluorocarbons are thought to enhance the reabsorption of bubbles and enhance the solubility of gases in blood. Studies conducted by Spiess et al. 156in the 1980s demonstrated the fluorocarbon FP-43, which has 100,000 times solubility for oxygen, carbon dioxide, and nitrogen compared with plasma, would absorb air that was introduced into the circulation. This compound showed promising results in reducing the neurologic complications arising secondary to cardiopulmonary bypass and attributed to systemic air embolism.157Infusion of FP-43 in dogs has also been shown do reduce the cardiovascular complications of coronary air embolism.158Alterations in pulmonary artery pressure, arterial carbon dioxide tension, right ventricular stroke work index, and shunt fraction secondary to VAE are reduced by FP-43.159In a more recent study, the use of the perfluorocarbon emulsion (OJSC SPC Perftoran; Moscow, Russia) decreased the bubble clearance time by 36%.160
The optimal management of VAE is prevention. Even after significant VAE, the greatest risk to the patient is continued entrainment of air. Preventive measures such as reducing the pressure gradient through repositioning, irrigating the field with fluid, intravascular volume loading, and use of moderate levels of PEEP remain important. Recognizing procedures at risk for VAE and planning the appropriate level of monitoring and management algorithms are key to patient safety (fig. 2).
The authors do not recommend routine continuous jugular venous compression in the initial management of VAE during cranial procedures. However, it may be considered on an emergent basis situations where high volume and rapid entrainment of air occurs. Compression of the external jugular vein for anterior scalp procedures is logical, but the majority of neck and scalp incidences of air embolism occur via the posterior venous complexes.
Attempts at aspiration of air from the right atrium seem prudent if a catheter is in place, and it is probably the only management strategy with demonstrated clinical efficacy. For catastrophic VAE with cardiovascular collapse, use of ionotropic support and, if necessary, cardiopulmonary resuscitation are standard measures that also may have a beneficial action in clearing residual air embolism. There is little evidence to support special patient positioning as a means to enhance air dispersion. If paradoxical cerebral air embolism occurs in a patient with stable hemodynamic and respiratory status, the consideration of HBO therapy is appropriate.
Vascular air embolism is a potentially life-threatening event that is increasingly more common in situations other than surgery performed in the classic sitting position. Clinicians must be aware of this silent but dangerous entity that can occur during many seemingly routine operative procedures and interventions. Unfortunately, there remains a paucity of prospective, controlled trials to assess various preventative and treatment options.
Vascular air embolism may be detected by ETco2monitoring, and precordial Doppler ultrasound should be used in moderate- to high-risk patients undergoing high-risk procedures. Emphasis is given to the prevention (hydration, positioning) and prompt recognition of this event and to the use of all available tools (fluids, positive ionotropic agents) in the management of cardiovascular complications.
The use of invasive monitoring devices such as TEE and central venous catheters should be dictated by the presence of comorbidities, rather than as a primary tool to manage VAE. The use of hyperbaric oxygen is indicated depending on the severity and duration of the embolic sequelae, the presence of arterial embolism, and the availability of such a technique. Use of perfluorocarbons is an exciting new concept but has yet to be validated in humans.

domain: literature


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The 135-year-old Peak Tram, one of the world’s oldest and most famous funicular railways, has transformed itself from an essential mode of transport into one of Hong Kong’s most popular tourist attractions.
Prior to COVID-19, the tram drew more than six million people annually.
Peak Tram passengers can enjoy panoramic views of Victoria Peak (known as The Peak), Hong Kong’s skyline, and Victoria Harbour. The Peak is a major destination combining the landmark Peak Tower, shopping, dining, attractions, and woodland walks.
“The Peak Tram has served Hong Kong citizens since 1888, from the first-generation steam-powered Peak Tram, which could accommodate 40 passengers, to the sixth-generation, state-of-the-art Peak Tram, which can now accommodate 210 passengers,” says May Tsang, general manager at The Peak Tramways Company. The funicular railway rises 396 meters above sea level along a 1.4-kilometer track with a gradient of 4 to 25.7 degrees.
The Peak Tram’s popularity was one of its challenges as demand created long queues. Last August, the Peak Tramways Company completed a HK$799 million upgrade, boosting the ride’s capacity and cutting wait times. In addition to introducing the larger tram cars—along with revamping the boarding platform to improve capacity, comfort, and accessibility—the project embraced entertainment in five engaging zones.
“The new-look Peak Tram offers visitors a multitude of sensory experiences, and ushers in a vastly improved passenger experience all around,” explains Tsang.
The new entertainment and art installations greet visitors, build anticipation, add storytelling in the queuing and waiting areas, and facilitate better throughput.
Australian artist Lindy Lee’s Eye of Infinity sculpture shimmers with starry lighting at the Central terminal entrance. The Beating Heart installation breathes new life into the Peak Tram’s existing historical haulage equipment display. Projection mapping and lighting effects conjure the illusion that the machinery is again pulling the tram up the mountain. A short film shows how the tram’s technologies have evolved.
Guests can climb aboard one of the first wooden tram cars at An Icon is Born. Once Upon a Tram charts key moments in the history of Hong Kong and the Peak Tram through a scrolling digital timeline (in English and Traditional Chinese). Go Wild At the Peak is a wraparound hyperreal video experience that immerses guests in The Peak’s fauna and flora. The mesmerizing sequence previews The Peak’s diverse wildlife from dawn to dusk. Dreamlike 3D digital animations play across floor-to-ceiling LED screens for eight minutes. Each show is timed and synchronized to the tram’s timetable.
Strategy Behind the Content
Design and production company Sarner International was a consultant on the project, helping deliver the experiential entertainment and media content, which was designed and produced remotely during the pandemic. Sarner collaborated with Squint/Opera to create the immersive digital media. “Audio System Consultants (Asia) Ltd delivered the hardware and our partner on the ground was Dino Tech Ltd,” explains Alex Prescott, lead designer at Sarner.
Sarner’s managing director Ross Magri says the project struck “a fine balance between doing something that is an attraction in its own right, but not overtaking what visitors go to The Peak for.”
The immersive displays entertain, but, “primarily for the client, it’s all about getting footfall through,” Prescott says. The team had to be mindful that the exhibits didn’t impede that process. The dynamic displays help to manage queues by pulsing visitors through the terminals and are designed to slow them from rushing onto the tram.
Vadim Charles, creative director at Squint/Opera, says one of the challenges was to produce a close-to-final experience before the LED walls and ceilings were built on-site and available for testing. So, Squint recreated everything in its Virtual Twin platform and simulated various crowding conditions to understand how the experience might be affected by different visitor numbers. This insight influenced the animations for Go Wild at the Peak; flying and climbing animals were ideal because they could be easily seen by visitors on the upper LED panels.
The immersive media enlivens the venue while being sympathetic to the Peak Tram’s heritage. It also allows for flexible content, such as highlighting special events.
“We have worked hard to integrate technology and engaging interactivity, giving passengers an immersive Peak Tram-themed experience at all guest touchpoints,” Tsang says.
“The reason for all this effort is that we put our visitors at the heart of everything we do. With every question we asked ourselves—and every challenge and design consideration that came up—we circled back to how we could better serve passengers and bring more joy and fun to everyone riding on the Peak Tram.”
Benefits that Produce Visitors
Now that Hong Kong is open again to visitors worldwide, the Peak Tram is ready to welcome an increasing number of visitors. “The expanded Central terminus with five entertainment zones will help to reduce passenger waiting times by over 70%. People no longer need to wait for over 90 minutes outdoors to get on the tram. They can stay in the covered, temperature-controlled queueing and waiting areas and learn about Hong Kong’s culture, history, and nature,” Tsang says.
Tsang praises the Peak Tram’s partners and team for achieving the colossal redevelopment. “With a brand-new passenger experience, enhanced technology, and a spectacular experiential journey on the new tram cars, the Peak Tram can proudly take its place amongst the world’s best tourist attractions.”


Syrris Asia Syringe Pump video – Ideal for Flow Chemistry
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Designed specifically for flow chemistry, the ultra smooth Asia Pump is extremely chemically resistant and is rated to 20 bar (300 psi). This compact microfluidic module offers two independent flow channels, each with an integrated pressure sensor and a flow rate range from 1.0 μL to 10 mL/min.


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Rain Without Thunder
Original Release Date: Jan 1, 1993
It's the year 2042 and the threat is real: women are going to prison for terminating their pregnancies.
When a girl and her mother are sentenced to life behind bars for fetal murder, an investigative reporter is determined to reveal the truth behind the convictions.
Through a series of disturbing interviews with family members, a dedicated defense attorney, the prison's peculiar warden and other female inmates, the reporter exposes shocking accounts of government tactics used to search out suspects and ultimately convict them.
- Betty Buckley
- Ali Thomas
- Frederic Forrest
- Jeff Daniels
- Director: Gary Bennett
- Writer: Gary Bennett
- Executive Producer: Rick Callahan
- Executive Producer: Michael R. Mihalich
|Time Warner Cable||WIS||121|


Commissioners' decision to rename Lower Valley highway angers family
El Paso County Commissioners' decision Monday to rename the Manuel F. Aguilera Highway in the Lower Valley infuriated the family of its namesake, a former Texas Department of Transportation engineer.
The Commissioners Court voted 3-2 to begin changing the name of the road that will connect the new Tornillo-Guadalupe Port of Entry to Interstate 10. Commissioners Carlos Leon and Andrew Haggerty voted against changing the highway's name.
A proclamation was approved by the Commissioners Court in 2003 to name the highway after Manuel F. Aguilera, who at the time was the Texas Department of Transportation's Deputy District Engineer. He worked for TxDOT for 37 years, he said.
Aguilera, 73, was raised in the Tornillo-Guadalupe area, graduated from the University of Texas at El Paso and contributed to the construction of several major thoroughfares in the county, such as the Spaghetti Bowl in Central El Paso. He also served in the U.S. Army.
County Judge Veronica Escobar said the purpose of changing the name had nothing to do with Aguilera or his family, but is an effort to best market the new port of entry.
Escobar is proposing to change the name to Avenida de las Americas or Paseos de las Americas.
"It's not so much that he is not a worthy individual or he has not been a part of a larger group of public servants who made this a reality. It was about creating a symbolic name that maximizes the investment that the taxpayer has made both in the roadway as well as the port of entry," Escobar said.
Escobar said she hopes the port of entry increases tourism and border trade.
Aguilera and his family attended Monday's Commissioners Court meeting to oppose the renaming of the road. Aguilera said his biggest concern is the impact that the name change will have on his reputation.
"In El Paso, when something like this happens, there are really negative thoughts, 'what did he do that they took the name off?'," Aguilera said. "It's not the name on the road, but it's my reputation."
Attorney Mark Rosales, Aguilera's son-in-law, said the Commissioners Court made a promise that the highway was going to be named after Aguilera.
"To now strip it and take it away would be in fact a dishonor," he said.
But Escobar said the naming of the roadway was not a promise and the Commissioners Court can't make promises for future courts.
Flor Rosales, Aguilera's daughter, said the name change is not fair and "it seems capricious."
"Here we are all these years later and now they are going to change it. Maybe the bridge itself could be named something with the international flavor that Judge Escobar wants. Leave the highway signage, it does not make sense to tear that down," she added.
Escobar said there is a street name after Aguilera in the city already.
Manny Aguilera Drive is located near Joe Battle Boulevard, between Edgemere and Pebble Hills boulevards on the East Side.
The county's public works department will solicit input from the rest of the Commissioners Court and transportation experts to find a new name for the Tornillo highway. A new name has to be approved before the county gives the $20 million road to TxDOT for maintenance in about three weeks.
The Aguileras did not rule out legal action against the county.
In another action Monday, the Commissioners Court unanimously approved to rename Miguel Teran Park in far East El Paso to Agua Dulce Park.
Teran, a former county commissioner, was not present at the meeting.
Escobar said she contacted him about the renaming of the park at 15371 Kentwood.
"He obviously was not happy, but he said he would not have any comment, he would not be here and he would not object," she said of her conversation with Teran.
According to El Paso Times archives, the park was named for Teran in 2008 after residents presented a petition with hundreds of signatures to the Commissioners Court. At the time, Teran was a member of the Commissioners Court.
The Commissioners Court in 2012 approved a policy in which "no property belonging to El Paso County shall be named for living persons," unless the person makes a significant contribution to the development of a public property or the facility is near a street or area that is already named for a living individual by another government organization.
Aileen B. Flores may be reached 546-6362.


Posted Dec 16, 2012By
The Nuggets, who now have played an NBA-high 18 games on the road, played with a lot of energy, ran the court from the opening tipoff to the final horn and thumped the Kings 122-97. It was the most points scored and the largest margin of victory this season for the Nuggets, who play the San Antonio Spurs in Denver on Tuesday.
The Golden State Warriors (12-9) beat the Memphis Grizzlies (9-10) 108-82 at FedExForum in Memphis, Tenn. on Saturd
Reserve forward Xavier Henry scored 12 of his 21 points in the fourth quarter, Pau Gasol had 20 points and 10 rebou
The Golden State Warriors (8-5) take on the Portland Trail Blazers (11-2) at Oracle Arena in Oakland, Calif., on Sa
The Golden State Warriors led by double digits throughout much of the first half, but the Memphis Grizzlies came on
The Golden State Warriors (6-3) take on the Utah Jazz (1-9) at Oracle Arena in Oakland, Calif., on Saturday, Nov. 1
Golden State Warriors have something to prove as they take on one of the most talented teams in the West and the fa


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What is a controlled vocabulary? A controlled vocabulary is a set of selected words or phrases that are used to aid in the search of organization, and therefore the ability to search and retrieve information. Synonyms and words that could be spelled different ways are often redirected to the 'authorized' term, assuring that search results are accurate. Controlled vocabularies are often hierarchical in structure. Meaning the authorized word can often be linked to broader or narrower search terms. Basically using a controlled vocabulary helps you to be precise in your search. Example.....
What is MeSH? MeSH is the controlled vocabulary thesaurus of the NLM (the National Library of Medicine). The NLM uses MeSH to index the articles found in the MEDLINE and PubMed databases. It is also used in the descriptions of items cataloged by the NLM such as books, documents, and images. Since the NLM covers all areas or medical and health care using MeSH terms in your search can be very helpful.
CINAHL headings are based on MeSH but with additional headings added.
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From Boats to Brokers
From the Dutch East India Company to Wall Street, the stock market has a long and storied history.
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Understanding how capital gains are taxed may help you refine your investment strategies.
Preparing for the eventual distribution of your assets may not sound enticing. But a will puts the power in your hands.
Take the long view - 5 tips for staying on track even during volatile times

domain: finance