text:
Convertible cribs are structures that make up compact modular furniture, which converts and adapts to the different stages of your baby as it grows.
It covers the different needs of the various stages a baby passes through while growing. The convertible baby cribs can be transformed into a junior room with a bed, a small table, and a study area.
Below are some of the common advantages of a convertible crib that you should keep in mind before purchasing one.
Adjustable bed height
Almost all cribs have at least two height options. Some have third or fourth gear. The height of the bed board can be adjusted according to the height of the baby, which makes the convertible baby crib more convenient for the mother to use.
The anti-bite strip is located on the upper edge of the side rail and is a smooth plastic strip. It prevents babies from eating the side rails so that they can swallow wood chips and paint.
The anti-bite strip is usually fixed on the side rail and is also of much importance in keeping the baby safe.
Note: Every parent wants the best products for their baby. For the reason, you should learn the best convertible cribs review
A convertible crib can be used for a long time
Some cribs can be converted into a toddler bed, daybed, and full-size bed with additional side rails and other accessories. These ways to extend your cribs lifetime sound attractive.
After two or three years, when your baby no longer needs the crib, do you still like this style?
If you tend to buy a convertible crib, it’sits best to buy the parts you need to change at the same time because the model changes frequently. These parts may not be available in the market when you need them.
Some convertible cribs have drawers underneath the slat for the purpose of keeping various items. Some drawers are mounted directly on the bed frame, while others are separate drawers with wheels.
If you like this feature, you should check the drawer material. If it is made of thin fiberboard, then you have to pay attention since most of these drawers cannot bear much weight.
Decoration can be done once
Another advantage of convertible cribs is that you always have everything to match with. You will only have to decorate the room once before the baby arrives!
There is a wide variety of designs and colors. You will always find that ideal room or color that you are looking for for your baby.
Most convertible cribs on the market have casters. Convenient to push the crib. For safety reasons, there should be two casters that can be locked.
The prices of a convertible crib can be considerably higher than that of a traditional crib. Taking into account all the other furniture that is purchased independently, bed, and bedside table, it can be seen as a long-term investment.
Your baby will grow, and, in this temporary context, this crib also evolves into a new use. A crib always has a practical function since it covers such an important need in the baby’s life.

domain: design


- This event has passed.
RAeS Webinar: Unmanned Air Mobility – Hype or Hope
25th June, 2020 @ 11:00 am – 12:00 pm BST
The Aerospace Technical Network is linking up with Aerospace, Defence, Security and Space (ADS) to hold a joint webinar discussing an emerging and very popular Urban Air Mobility (UAM) industry.
As a new branch of the aviation industry, the UAM industry makes a lot of promises to all stakeholders, yet it is imperative to understand all the pros and cons of what the new technology can offer and be able to differentiate between the promises made and the real potential outcomes.
The webinar will provide a general introduction to UAM, will cover a UK perspective of how we see the sector developing as well as conclude with an open debate on the challenges that need to be addressed to realise market potential.


text:
01 July 1996
Echocardiographic assesment of the right ventricular systolic and diastolic function in children with atrial septal defect before and after surgeryBożena Werner, Marek Pleskot, Andrzej Walawski
Med Sci Monit 1996; 2(4): CR437-440 :: ID: 499917
We assessed systolic and diastolic performance of the right ventricle in 34 children with atrial septal defect before and at 7-10 days, 6 months and 1 year following the surgery. The evaluation of the right ventricular systolic function was carried out by the measurements of the ejection fraction based on TAPSE measurement. In order to evaluate diastolic performance we analysed the following parameters of tricuspid valve flow: velocity of early diastole (E wave) and velocity in late diastole (A wave), the E and A velocity ratio, acceleration and deceleration time of maximal E wave velocity. The mean values of the ejection fraction in all the studied groups did not reveal statistically significant differences as compared to the control group. It suggests normal systolic performance in children before and after the surgery. In children with ASD II we found increased velocities of E wave and A wave with the maintained vE/vA ratio. It may be indicative of increased preload. In children assessed a few days and six months following the surgery we found normal E wave velocity, higher A wave velocity than in healthy children with subsequent reduction in the vE/vA ratio. E wave velocity normalisation may be related with elimination of the shunt while higher A wave velocity may be due to increased contractility of the atrium persistent after the surgery. In children assessed one year after the surgery the mean E and A velocities did not differ from those in healthy children. Measurements of E wave ascent and descent times did not reveal statistically significant differences between the patient group and the control group which, along with the velocity measurements, suggest normal right ventricular performance in all the studied groups.
Keywords: right ventricular performance, atrial septal defect, Echocardiography
01 June 2023 : EditorialEditorial: Infectious Disease Surveillance Using Artificial Intelligence (AI) and its Role in Epidemic and Pandemic Preparedness
Med Sci Monit 2023; 29:e941209
05 Jun 2023 : Clinical ResearchComparison of Texture and Color Enhancement Imaging with White Light Imaging in 52 Patients with Short-Segm...
Med Sci Monit In Press; DOI: 10.12659/MSM.940249
05 Jun 2023 : Laboratory ResearchComparison of Composite Resin (Duo-Shade) Shade Guide with Vita Ceramic Shades Before and After Chemical an...
Med Sci Monit In Press; DOI: 10.12659/MSM.940949
02 Jun 2023 : Database AnalysisThe COVID-19 Crisis and the Incidence of Alcohol-Related Deaths in Poland
Med Sci Monit In Press; DOI: 10.12659/MSM.940904
01 Jun 2023 : Clinical ResearchRoot Canal Numbers and Configurations in 1080 Permanent Canine Teeth in 270 Saudi Subjects Using Cone-Beam ...
Med Sci Monit In Press; DOI: 10.12659/MSM.940472
Most Viewed Current Articles
13 Nov 2021 : Clinical ResearchAcceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...
Med Sci Monit 2021; 27:e932788
30 Dec 2021 : Clinical ResearchRetrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...
Med Sci Monit 2021; 27:e935379
08 Mar 2022 : Review articleA Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...
Med Sci Monit 2022; 28:e936292
01 Jan 2022 : EditorialEditorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...
Med Sci Monit 2022; 28:e935952

domain: medical


text:
Denver may be the capital and by far the most populous city of Colorado. Inhabitants on the point out are appropriately known as "Coloradans", although the archaic expression "Coloradoan" remains in use.
Small Testosterone on account of Andropause is a treatable and reversible male wellbeing condition. You needn't Allow Low T impression your self-esteem, your perform lifestyle or your romantic associations.
This Web page is actually a repository of publicly available facts and isn't intended to kind a physician-client partnership with any unique. The material of this Web page is for informational functions only. The knowledge offered on this Web-site isn't meant to go ahead and take place of your own physician’s tips and is not meant to diagnose, address, heal, or avoid any condition. Discuss this info along with your individual medical doctor or Health care supplier to determine what's good for you.
Urologists have extensive familiarity with, and capabilities in, a variety of surgical techniques for innate and acquired conditions of the reproductive and urinary techniques and their connected structures.
Colorado's freight railroad network is made up of 2,688 miles of Course I trackage. It is integral to the U.S. economic climate, staying a essential artery for the movement of Power, agriculture, mining, and industrial commodities in addition to general freight and created solutions amongst the East and Midwest as well as the Pacific Coastline states.
The western slope has significant summer season temperatures much like These discovered around the plains, though the winters are typically marginally cooler due to deficiency of warming winds widespread for the plains and Front Array. Other regions from the west have their own personal distinctive weather.
house/sexual wellness center/sexual wellbeing a-z list/testosterone therapy to take care of ed index/testosterone therapy to deal with ed article/come across a neighborhood health practitioner/neighborhood means broomfield,co he has a good point Erectile Dysfunction: Testosterone Substitute Therapy
Most compounded goods have not been through arduous clinical testing for either security or efficacy. There are also considerations concerning their purity, potency, and excellent.
Colorado's large Rocky Mountain ridges and eastern plains supply wind electricity opportunity, and geologic exercise during the mountain areas offers prospective for geothermal electric power enhancement.
The hormone is The important thing as well as the receptors they perform upon would be the locks. Bio-equivalent hormones in good shape flawlessly inside the lock, and unlock each of the beneficial effects of hormones, browse around here and when dosed properly, as While using the BioTE® system, have minimum to no Uncomfortable side effects. Synthetic hormones, nevertheless, slot in the lock, but don't transform the lock and release quite a few untoward Negative effects.
Will you be getting difficulties during the Bed room? Before you change to drugs for erectile dysfunction, get examined for Testosterone Deficiency. ED products improve blood movement, rendering it much easier to have interaction in sexual exercise, but it doesn't restore hormone equilibrium, potentially leaving you prone to many healthcare problems for example hypertension, diabetic issues, and in many cases coronary heart attack and stroke.
Tev Tropin includes multi-dosage vials which you mix with bacteriostatic water to activate. Refrigeration in between usage is often demanded. Blended and unmixed vials need to be refrigerated.
Together with these and other federal agencies, Colorado has abundant Countrywide Forest land and 4 Countrywide Parks that add to federal possession of 24,615,788 acres (ninety nine,617 km2) of land in Colorado, or 37% of the total location with the point out. In the 2nd half from the 20th century, the industrial and repair sectors have expanded tremendously. The point out's economic system is diversified which is notable for its concentration of scientific analysis and large-engineering industries. Other industries include things like food stuff processing, transportation machines, equipment, chemical solutions, the extraction of metals for instance gold (see Gold mining in Colorado), silver, and molybdenum. Colorado now also wikipedia reference has the biggest annual production of beer of any point out. Denver is a vital economic center.
Bio equivalent hormones are non-synthetic, plant-primarily based hormones which have been identical biologically to human hormone. The top analogy to differentiate bio similar from artificial hormones should be to look at the hormones and also the receptors they activate (many countless numbers inside our bodies) to be a lock and key.

domain: geography


text:
Cast: Akshay Kumar, Amy Jackson, Lara Dutta, Kay Kay Menon, Yograj Singh, Rati Agnihotri, Pradeep Rawat and Kunal Kapoor.
Rating: 1.5/5 stars
Another Prabhudheva film is out in the market, promising an original script and full-on entertainment for the masses. But the reality is no where close to what is being promised by the makers of ‘Singh Is Bliing’.
The script of this Bollywood action-comedy might not be a rehash of any superhit film down South, but the fact is ‘Singh Is Bliing’ doesn’t have any story and mindless events are put together to make this 140 minute long drama.
It’s high on slapstick comedy and clumsy jokes which try hard to tickle the funny bone of the audience from start till the end, but fail to do so. For a change the female protagonist in the movie is much stronger and smarter than her male counterpart.
The film opens in a Punjabi village, Bassi Pathana, where the head of the family is searching for his lost 50 thousand rupees, which his son Raftaar Singh (Akshay Kumar) has stolen so that he can go out and have a good time with his friends by singing, dancing and prancing around like a useless fellow.
While Raftaar’s father (Yograj Singh) is irritating, his mother (Rati Agnihotri) is over-protective, whose one eye always twitch whenever she tells a lie to protect her son and Raftaar has inherited the same habit.
Our handsome hero Raftaar is introduced on the silver screen with the song ‘Tung Tung Baje’, where he shows his hard side by performing some stunts and his love for animals reflects the soft side of his personality.
Raftaar loves to kill his time in trivial pursuits in the village and therefore his papaji decides to pack him off to Goa to work for his old friend (Pradeep Rawat), who owns a casino in Mandovi.
Cut to Romania. A weapon dealer (Kunal Kapoor) is having a meeting with other mafias and they are deciding their territories to carry on their business smoothly. Now the director introduces the beautiful and tough Sara Rana, daughter of the the weapon Lord, riding a horse. Things between Sara and son of a mafia Mark (Kay Kay Menon), turn ugly when he acts fresh with her and is then forced to apologise in public.
This fuels Mark’s anger who decides to take revenge from his father for forcing him to apologise and Sara, for rejecting and insulting him publicly.
Sara’s father then asks her to leave the country and she lands in Goa to find her long-lost mother. Sara is introduced to Raftaar by his boss, who asks him to be with her 24*7 and take care of her till the time she is in the country.
Now comes a twist in the story. Sara speaks English and our Raftaar doesn’t even understands ‘E’ of the foreign language. Enters Emily (Lara Dutta) in the story, who is hired as an interpreter to help the two communicate. Apart from doing her job, she is a sleepwalking champion who loves to seduce men and take them to a silent place just to hurt their private parts with a coconut.
Over-smart Emily, adds to all the confusion by taking liberties and changing the meaning of messages being conveyed by Sara and Raftaar to each other.
This confusion makes Raftaar believe that Sara is in love with him (Same old Bollywood formula which has been overused so many times now).
Series of silly events follow between Sara, Raftaar and Mark and the film thankfully reaches to its end.
Just like his every other film, Prabhudheva gives a guest appearance in this flick also, only to pee on Raftaar. A very kiddish attempt by the filmmaker to make the intelligent audience laugh. His direction in ‘Singh Is Bliing’ has nothing great to boost off.
After ‘Singh is Kinng’, Akshay Kumar is back as a sardar again and does similar stuff to make the audience laugh. I fail to understand why does Bollywood mostly portrays sardars as ‘gaon ka gawar’, who doesn’t understands even basic English, want to marry a ‘firangi ladki’ and love to dance and prance uselessly. Akshay has good comic timing and the actor could have done better if the baseless script would have given him some scope.
For a change the heroine in the film, Amy Jackson, is more than a pretty face in the flick. Apart from showing off her perfectly toned body in a bikini, our martial arts queen also fights with goons and does some coll stunts.
Mark’s one-liners like – “Easy is boring” and “I am too good” – can actually piss you off after initial few minutes. Kay Kay Menon is a good actor who has over-acted in ‘Singh Is Bliing’.
Lara Dutta looks like an old, ‘chashmish’ aunty. The otherwise gorgeous heroine would not want to remember this role for a long period because in the name of comedy, she does frivolous stuff in the movie.
When you expect the least, there breaks a song in the movie to add to the gibberish drama. Music by Meet Bros Anjjan, Manj Musik and Sajid-Wajid is however decent.
Leave your brain at home and go with the sole purpose to kill some time watching double meaning, silly jokes to enjoy Prabhudheva’s ‘Singh Is Bliing’.

domain: entertainment


text:
Retail is fundamentally a simple business. Buy products for one price and sell them for a higher one, sufficient to cover your costs and make a profit. And because it’s simple, retailers have just got on with it. If they’ve run into difficulty, they’ve sorted it out.
But the pace of change in the retail world means a new approach is needed. High street retail needs help, and retailers can’t do it alone - they need central, and particularly local, government to play their part in reviving the sector.
The collapse of Woolworths alone left gaps on more than 800 streets, many of them secondary and tertiary parades. And while the best Woolies stores have been snapped up, many remain empty.
At Retail Week we devised our Manifesto for the High Street to highlight the challenges facing the high street retail sector. It is coming up against unprecedented competition, not just from out-of-town stores but also the internet. Because shoppers can now buy almost anything from the sofa, local shopping areas need to be inviting places where people want to go.
For councils, it makes sense to work with retailers. Run-down shopping areas are the most visible sign of an area’s economic decline. Small steps - such as running events in a shopping street, or making parking cheaper or easier - can make a big difference.
These long-term trends aren’t going to go away. They’re going to accelerate. The pressure is on everyone involved in our shopping streets to consider what they’re doing to give them a sustainable future.
Tim Danaher, editor, Retail Week

domain: sociology


Ari moved to the United States when he was 5 years old from Russia, and spent most of his childhood playing sports in the backyard of his small Iowa hometown. He probably picked up most of his English from watching Iowa Hawkeyes' games on TV.
Ari graduated in May 2013 from the University of Missouri School of Journalism.
Prior to joining Action News 5, Ari was part of the KOMU-TV sports team in Columbia. He won two Mid-America Emmy Awards in the category of student production, along with a national and regional RTDNA Mark of Excellence Award in television sports reporting.
After a short stint as a freelance sports reporter in Cedar Rapids, Iowa at KCRG-TV, Ari came to the Bluff City excited to cover the Grizzlies, Tigers, and everything else the Mid-South has to offer.
Ari loves golfing, playing pickup hoops, hip hop music, and sushi. Not necessarily in that order. Mostly, he loves talking sports, so join the discussion on Twitter @AriA1exander or e-mail him at firstname.lastname@example.org.


text: I really liked this one. I did the same colors on the home, but did a checker pattern running vertically, and lined the crest, sponsor, and maker logos all along it. On the clash, I replaced the maroon with navy and did pinstripes with light blue sleeves. On the alt, I tried some new stuff. I did green with the yellow from the lion. It’s in the same pattern as the home, and only the lion is on the crest.

domain: artistic


text:
Hello! We or DL are trying to revive the server... Games you might have heard of or play: Fortnite Rocket League Standoff2 (Mobile) Pubg Mobile Are the ges we play, and We are looking for players
Similar servers you may like
Check out these cool gaming servers! Meet some awesome people and talk about anything gaming.
Looking For Gamers
! - http://discord.army

domain: game


text:
Louis Vuitton Sac Chasse is a must-have for any collector. This extra large bag has two carrying methods, by hand with its leather top handle, or with its long canvas shoulder strap. Several compartments make this bag easy to use as a weekend travel bag or as its true purpose – a hunting bag! This large bag has one side with an open slot pocket under the flap and a large zip compartment, the other side boasts two flat pockets under the flap along with a large open compartment. Crafted out of lovely Monogram coated canvas with leather trim, this piece is luxurious and functional!
This bag is in ‘As New Condition’ with very light sign of use
50×38 x 20 cm
Made in France.
Comes with Box, Dust Bag Key and Lock.


text:
Adam In Depth Patient Reports - imagepageSearch Health Information
D and C
D and C (dilatation and curettage) is a procedure in which the vaginal canal is gently held open with a speculum, and the cervix is dilated (widened) with a metal rod. A curette is then passed through the cervical canal into the uterine cavity where endometrial tissue is scraped away and collected for examination.
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Senior Physician, Massachusetts General Hospital.


Netflix has released a new behind-the-scenes video in “The Sea of Tranquility,” a sci-fi thriller starring Doona Bae (“Sense8” and “Kingdom”) and Gong Yoo (“Round 6”).
Production will launch on the platform on December 24.
The series is based on the eponymous short film by Choi Hang-yong, who directs the episodes. Park Eun-kyo signs the script.
Set in 2075, when depletion of natural resources devastated Earth, the tale follows the story of an elite team sent on a special mission to an abandoned research station on the moon.
Also in the cast are Lee Joon, Kim Sun-young, Lee Mu-saeng, Lee Sung-wook and others.
Make sure you watch:


text:
Perioperative myocardial ischemia occurs in 20-40% of patients at risk for cardiac morbidity and is associated with a ninefold increase in risk of cardiac morbidity.
In a prospective, double-blinded, clinical trial, we studied 190 patients with or at risk for coronary artery disease in two study groups with a 2:1 ratio (clonidine, n = 125 vs. placebo, n = 65) to test the hypothesis that prophylactic clonidine reduces the incidence of perioperative myocardial ischemia and postoperative death in patients undergoing noncardiac surgery. Clonidine (0.2 mg orally as well as a patch) or placebo (tablet and patch) was administered the night before surgery, and clonidine (0.2 mg orally) or placebo (tablet) was administered on the morning of surgery. The patch or placebo remained on the patient for 4 days and was then removed.
The incidence of perioperative myocardial ischemia was significantly reduced with clonidine (intraoperative and postoperative, 18 of 125, 14% vs. placebo, 20 of 65, 31%; P = 0.01). Prophylactic clonidine administration had minimal hemodynamic effects. Clonidine reduced the incidence of postoperative mortality for up to 2 yr (clonidine, 19 of 125 [15%] vs. placebo, 19 of 65 [29%]; relative risk = 0.43 [confidence interval, 0.21-0.89]; P = 0.035).
Perioperative administration of clonidine for 4 days to patients at risk for coronary artery disease significantly reduces the incidence of perioperative myocardial ischemia and postoperative death.
SIXTY million Americans have cardiovascular disease, and 1 million/yr die. Approximately 100,000 of the 400,000 patients/yr in the United States who undergo cardiac surgery and 1.5 million of the 30 million who undergo noncardiac surgery have perioperative cardiovascular morbidity at a cost exceeding $20 billion annually.1,2Perioperative myocardial ischemia is a potentially avoidable risk factor associated with a ninefold increase in cardiac morbidity before hospital discharge and a twofold greater long-term (2-yr) risk.1,3,4Reduction in perioperative myocardial ischemia reduces mortality.4
Prophylactic β blockade administered perioperatively reduces the incidence of myocardial ischemia4and death in patients at risk who undergo noncardiac surgery.5,6Clonidine, an α2agonist, reduces the incidence of myocardial ischemia in patients who undergo vascular7and cardiac surgery8but has not been shown to reduce the incidence of a hard outcome such as death.
The current study tests the hypothesis that clonidine administered prophylactically reduces the incidence and severity of perioperative myocardial ischemia and has long-term survival benefits.
Materials and Methods
This study was approved by the Committee for Human Research, University of California, San Francisco, and was performed with written informed consent from all patients. Two hundred two patients at risk for coronary artery disease and scheduled to undergo noncardiac surgery at the San Francisco Veterans Affairs Medical Center consented to this randomized, double-blinded, placebo-controlled clinical trial. Procedures were followed in accordance with institutional guidelines.
Criteria for the Study
Inclusion criteria required that patients were (1) scheduled for elective noncardiac surgery; (2) able to sign informed consent before surgery; and (3) had either definite coronary artery disease (as indicated by previous myocardial infarction, typical angina, or atypical angina with electrocardiogram changes indicative of ischemia in response to exercise or scintigraphic evidence of a myocardial perfusion defect) or presence of the risk factor of previous or current vascular surgery, or presence of at least two of the following risk factors: age 60 yr or older, hypertension, smoking within a year, serum cholesterol 6.2 mm (240 mg/dl) or greater, or diabetes mellitus. Duration of the patient having the risk factor was not included as a criterion.
Exclusion criteria included (1) unstable angina in the month before surgery; (2) uninterpretable Holter electrocardiogram secondary to left bundle-branch block, cardiac pacemaker dependency, or marked resting ST-segment and T-wave abnormalities that precluded electrocardiogram ST-segment interpretation; (3) preoperative use of clonidine, α methyldopa, or tricyclic antidepressants; (4) symptomatic aortic stenosis; (5) systolic blood pressure less than 100 mmHg; and (6) refusal or inability to give informed consent. All patients scheduled, who qualified under the inclusion and exclusion criteria, were approached for consent. Surgery included major vascular, intraabdominal, orthopedic, neurosurgical, intrathoracic, head and neck, and plastic procedures.
Study Drug Administration
Randomization was performed by computer in a 2:1 ratio before the study was initiated, and the statistician and the pharmacist held the code. The 2:1 ratio was chosen by a previous statistician, and no one conducting the study was aware of this choice. No stratification or balancing techniques were used. All study drug was provided in a blinded fashion by the hospital pharmacist to the nurse caring for the patient who administered it. Patients in the clonidine group received a 0.2-mg oral tablet of clonidine (Catapres; Boehringer Ingelheim, Ridgefield, CT) and a 7.0-cm2transdermal patch of clonidine (Catapres-TTS-2; Boehringer Ingelheim) the night before surgery. This patch provided continuous systemic delivery of 0.2 mg/day. Because a therapeutic plasma concentration of clonidine is achieved 48 h after initial application of the transdermal patch, the patients also received an oral loading dose of clonidine, 0.2-mg tablet (Catapres), 1 h before surgery as premedication. Patients in the placebo group received an oral placebo tablet and an inert transdermal occlusive skin patch the night before surgery and an oral placebo tablet 1 h before surgery. The patch was removed on postoperative day 4. No control of postoperative medication was attempted after removal of the patch. No patients were given clonidine after the perioperative period because of this study.
After preoperative history and physical examination, standard laboratory testing, and 12-lead electrocardiography were completed, three-channel Holter electrocardiographic monitoring was begun 12 h before surgery and continued for 7 days after surgery.
All patients were monitored with standard clinical monitors. Blood pressure, heart rate, and oxygen saturation were recorded with a computer. A standardized anesthetic was used for all cases including midazolam (≤ 50 μg/kg intravenous), sodium thiopental (≤ 5 mg/kg intravenous), fentanyl (≤ 5 μg/kg intravenous), isoflurane, oxygen, and, if appropriate, nitrous oxide. Muscle relaxation was obtained with vecuronium or succinylcholine. Reversal of neuromuscular blockade was produced with glycopyrrolate and neostigmine.
Hemodynamics were managed by protocol. All limits were predefined, and the anesthetist was provided with a written list of the limits and protocol requirements. A research coordinator observed all anesthetic cases to ensure protocol adherence. Hypertension as defined by systolic blood pressure 30% of preinduction values or greater was treated with increases in isoflurane in 0.25% increments every 3 min up to a level of twice the minimum alveolar concentration (MAC). If this therapy was unsuccessful, a 50-μg intravenous fentanyl bolus was given and could be repeated. If persistent hypertension was observed despite increases in anesthetic concentration, 0.1–0.5 mg/kg esmolol followed by infusion for tachycardia and hypertension or nitroprusside could be started for increased peripheral resistance. Hypotension as defined by systolic blood pressure 30% of preinduction values or less was treated with decreases in isoflurane in 0.25% increments. Fluid boluses were used for low preload, and 0.1-mg phenylephrine boluses were used for low peripheral resistance. Hypotension with heart rate below 45 beats/min was treated with intravenous injection of 5 mg ephedrine. Tachycardia as defined by heart rate 30% of preinduction values or greater was treated with increases in isoflurane in 0.25% increments up to a level of twice the MAC, then 50 μg intravenous injection of fentanyl, and then intravenous injection of 0.1–0.5 mg/kg esmolol followed by an infusion. Bradycardia as defined by heart rate 30% of preinduction values or less was treated with decreases in 0.25% isoflurane and, if persistent, intravenous injection of atropine up to 1 mg.
Postoperative pain was controlled with patient-controlled analgesia with morphine, unless the patient was allergic, with a starting dose of 1 mg/injection, a lockout of 6 min, no basal rate, and no limit. Inadequate analgesia was treated by increasing dose and lockout. Patients who requested an epidural catheter were given one, and it was maintained with morphine infusion. Patients receiving epidural narcotics were not included in the total narcotic calculations.
Patients were monitored using a three-channel AM Holter electrocardiogram recorder (series 8500; Marquette Electronics, Milwaukee, WI) preoperatively, intraoperatively, up to 7 days postoperatively, and at least 12 h after the study drug was discontinued. The technique and outcome definitions were identical to those of our previous studies.1,4Three bipolar leads (CC5, CM5, and ML electrocardiographic leads) were recorded using silver–silver chloride electrodes. Lead resistance was tested daily, and faulty leads (resistance greater than 5 kΩ) were replaced. The effect of patient positional variation on electrocardiographic morphology was measured before the study in the supine, upright, and left and right lateral decubitus positions.
Holter electrocardiographic data were analyzed for ST-segment deviation (Marquette Laser Holter Analysis System SXP software version 5.8; GE Marquette Medical Systems, Milwaukee, WI) indicative of ischemia after all abnormal QRS complexes were excluded, such as ventricular ectopic beats and beats with conduction abnormalities. The ST segments were trended continuously in three leads for the duration of the tape. The baseline ST-segment level was defined as the average ST segment during a stable period (usually 15–60 min) preceding each ischemic episode. All possible ischemic episodes were reviewed independently by two investigators blinded to patient randomization and clinical course. Disagreements were resolved by consensus, and if consensus could not be reached, a third blinded investigator, unaware of the other two assessments, evaluated the data.
Electrocardiographic ischemic episodes were defined as reversible ST-segment changes lasting at least 1 min and involving either a shift from baseline (adjusted for positional changes) of 0.1 mV or greater of ST-segment depression (with slope ≤ 0) or a shift from baseline of 0.2 mV or greater of ST-segment elevation at the J point. ST-segment depression was measured 60 ms after the J point, unless that point fell within the T wave, in which case it was shortened to a minimum of J plus 40 ms. Holter analysis was corrected for positional variation by taking the maximum shift noted by positional changes. If positional changes during Holter setup caused 0.05 mV of baseline shift, the criterion for ischemia was increased by 0.05 mV. This technique decreases the sensitivity of Holter electrocardiographic detection of ischemia because more episodes fail to make baseline; however, it makes the results more specific. The following parameters were measured as indications of severity of each episode: (1) duration, (2) maximum ST-segment change, (3) total area under the curve (defined as the integral of ST-segment depression in mV vs. time), and (4) heart rate (at 5 and 10 min before onset of an episode, at onset, at maximum ST-segment change, at offset, and at maximum heart rate during an episode).
Ischemic episodes were divided into separate time periods by the duration of effect of the topical clonidine administration. The periods include before surgery, day of surgery until postoperative day 3 when the patch was removed, days 4 and 5 when withdrawal phenomena might be most evident, and day 6 or more when withdrawal phenomena would subside. These periods were chosen during study design.
Holter electrocardiographic data were analyzed for the occurrence of dysrhythmias using validated Marquette Laser Holter Analysis System software version 5.8. Ventricular and supraventricular ectopic complexes were identified and counted as isolated, bigeminal cycles, couplets, and runs. The beats in each run, the beats in the longest run, the rate of the longest run, the beats in the fastest run, and the rate of the fastest run were calculated. Minimum, average, and maximum heart rate values were calculated. Totals of each variable were calculated for the preoperative day and each postoperative day.
Twelve-lead electrocardiograms were obtained preoperatively and daily for the first 7 days after surgery, on the 10th and 14th days, weekly thereafter, at discharge from the hospital, and whenever clinically indicated (by shortness of breath, chest pain, or syncope). All electrocardiographic data were analyzed by two investigators unaware of clinical data. New Q waves were identified by Minnesota codes I1 or I2. Persistent changes in ST segments and T waves were identified by Minnesota codes IV or V.9
From 1 h before surgery until 1 h after surgery, the systolic, diastolic, and mean arterial blood pressures and heart rate were recorded continuously. Episodes of hemodynamic abnormality were defined as 5 min of sequential recordings exceeding the following limits: systolic blood pressure less than 80 mmHg or greater than 180 mmHg; diastolic blood pressure less than 50 mmHg or greater than 100 mmHg; and heart rate less than 40 beats/min or greater than 100 beats/min.
Measurements of Creatine Phosphokinase and MB Isoenzyme
On postoperative days 1, 3, and 5, blood samples were analyzed for concentrations of creatine phosphokinase (CPK) and MB isoenzyme (CPK-MB), with additional samples analyzed if clinical condition or electrocardiographic changes suggested myocardial ischemia or infarction. CPK concentration was determined using the Kodak Ektachem (Rochester, NE) technique, and CPK-MB concentration was determined using an Abbott (North Chicago, IL) IMX immunoassay at the San Francisco Veterans Affairs Medical Center laboratory. A CPK-MB isoenzyme concentration of 0.83 mm (or 50 U/l) was chosen as the threshold for evidence of myocardial infarction.1
Serum Catecholamine Measurements
Blood specimens for serum dopamine, epinephrine, and norepinephrine were collected at screening, an hour before surgery, immediately after surgery, and at postoperative day 1. Blood specimens were drawn and were immediately centrifuged (5,000 rpm for 15 min), and the serum was stored at −80°C. All catecholamine analysis was performed by Unilab Corporation (Tarzana, CA) using high-performance liquid chromatography.
Blood specimens for clonidine concentrations were collected on postoperative day 2 and immediately centrifuged (5,000 rpm for 15 min), and the serum was stored at −80°C. Clonidine concentrations were measured by gas chromatography mass spectrometry (Quest Diagnostics, Teterboro, NJ).
Adverse Cardiac Events
All definitions of adverse cardiac events were defined by protocol and were similar to those definitions in our previous study.4The primary endpoints for the perioperative trial were defined as the incidence4and severity4of myocardial ischemia occurring while on the study drug (preoperative and postoperative days 0 to 3), detected using Holter electrocardiographic monitoring. Safety endpoints were validated by two investigators blinded to patient study group. Long-term follow-up consisted of review of the medical chart and a phone interview. Patients who could not be contacted by phone were sent a letter; if the letter returned unanswered, the social security death registry, medical charts at the San Francisco Veterans Affairs Medical Center, and the Internet were searched. Death certificates were obtained for all deaths. Patients were considered alive until the time of the last contact, and then if they were not dead at the time of the last contact, they were censored at the time of last contact. There was no assumption of being alive or dead; subjects were only treated as alive or dead at a time point if it could be verified.
Assessment of Analgesia
Adequacy of analgesia was assessed by visual analog scale. Patients marked on a 0–10 scale corresponding to their pain while at rest. Zero represented no pain, and 10 represented the worst pain imagined. Total use of morphine during each 24-h period was recorded. Patients not receiving adequate analgesia had their dose of morphine increased and the lockout interval increased. Patients who received epidural morphine infusions were excluded from the patient-controlled anesthesia morphine use calculations.
Power analysis was performed before study initiation. The study was designed to have 80% power to detect a 50% reduction in the incidence of perioperative myocardial ischemia detected by Holter electrocardiogram during postoperative days 0–3. Previous work demonstrated that the incidence of myocardial ischemia using this definition of Holter electrocardiographic ST-segment analysis in patients with these risk factors is 40%.1,4All analysis was two-sided, with P = 0.05 as the level of significance.
Analysis was performed by intention to treat. No exclusion or censoring were permitted except in the secondary analysis regarding perioperative β blockade or epidural use. No interim analysis was permitted. All analysis was prespecified except for the analysis excluding patients who received β blockade or epidurals. We used the analysis plan from our previous study of atenolol with similar outcome variables.4Continuous variables were analyzed using parametric (Student t test) and nonparametric (Wilcoxon rank sum test) techniques. Two-way repeated-measures analysis of variance was used where appropriate. Continuous variables are presented as mean ± SD. Proportions were compared using the Fisher exact test (two tailed). Treatment group perioperative myocardial ischemia incidences were compared for both the entire studied population (n = 190) and the subset of patients free of perioperative β blockers (n = 178). Survival analysis was performed using the Kaplan-Meier method; log-rank and Wilcoxon tests were computed to assess homogeneity between the treatment strata. The interaction of the three variables of clonidine, ischemia, and 2-yr survival were tested using multivariable logistic regression. These variables were chosen from their significance in previous studies.4A general search for predictors of mortality was not performed. No other models were tested and no corrections were made for multiple comparisons because 2-yr mortality and perioperative myocardial ischemia were predetermined independent outcome variables. All analyses were performed using SAS (Statistical Analysis System) software (version 6.12; SAS Institute, Cary, NC).
A total of 202 patients consented and were randomized, but 12 patients were withdrawn before surgery. Ten patients had the surgical procedure canceled for unrelated reasons, and the patients were withdrawn from the study. Three patients had systolic blood pressures between 80 and 90 mmHg on the morning of surgery. Two of these patients continued and one withdrew from the study after surgery was canceled. One patient developed chest pain preoperatively, surgery was canceled, and the patient was withdrawn from the study. Demographic information for the 190 patients who completed the study is listed in table 1. The emphasis in all tables is on comparison of percentages rather than the numbers of patients. There were no statistically significant differences in population characteristics between patients randomized to the treatment groups.
Intraoperative hemodynamics were similar in the two groups (table 2), with the exception that the placebo-treated patients (clonidine, 25% vs. placebo, 48%; P = 0.01) had more intraoperative hypertension (systolic blood pressure > 180 mmHg). The requirements for pharmacologic management of hemodynamics (table 3) were similar, with the exception that more patients in the placebo-treated group received intraoperative β blockade (clonidine, 7% vs. placebo, 19%; P = 0.03). Clonidine-treated patients had significantly lower minimal, maximal, and average heart rates (table 4) than placebo patients.
Clonidine blood concentrations on postoperative day 2 averaged 0.53 ± 0.29 ng/ml versus 0.005 ± 0.03 ng/ml for placebo (P = 0.0001). There was no statistical difference in pain scores on the visual analog scale (clonidine, 3.5 ± 2.8 vs. placebo, 3.5 ± 3.1; P = 0.997) or in morphine (MSO4) use (clonidine, 66.5 ± 6.5 mg vs. placebo, 63.2 ± 8.9 mg; P = 0.77). Overall, there was a statistically significant increase in concentrations of serum epinephrine (P = 0.05) and norepinephrine (P = 0.001) with time (table 5). In addition, clonidine reduced concentrations of serum epinephrine (P = 0.05) and serum norepinephrine (P = 0.002) but not serum dopamine (P = 0.64) (table 5).
The incidence of perioperative myocardial ischemia, defined by 1 mm of ST-segment depression lasting at least 1 min on Holter electrocardiographic monitoring, was reduced in patients treated with clonidine compared with those receiving placebo preoperatively, on the day of surgery, and on postoperative days 0–3. The preoperative incidence of myocardial ischemia was 0 for clonidine patients versus 5% for placebo patients (P = 0.04; table 6). The incidence of myocardial ischemia on the day of surgery and postoperative days 0–3 was 14% among clonidine patients versus 31% for placebo patients (P = 0.01; table 6). In addition, even after removing all patients receiving preoperative β blockade (clonidine, 11; placebo, 1), the incidence of ischemia analysis results remained virtually unchanged (tables 6 and 7). No significant difference was noted in severity of ischemic episodes between clonidine- and placebo-treated patients (table 8).
There were no differences in the incidence of perioperative in-hospital clinical events (table 9) or CPK-MB release (table 10). Thirty-day mortality was reduced in patients assigned to the clonidine group (1 of 125 [0.8%]vs. 4 of 65 [6.2%]; P = 0.048; table 9). In long-term follow-up, the incidence of postoperative death was reduced in patients given clonidine (fig. 1) (relative risk [RR]= 0.43 [confidence interval (CI), 0.21–0.89]; P = 0.035 by Fisher exact test [table 9] or RR = 0.45 [CI, 0.24–0.84]; P = 0.012 by log-rank test). Nineteen of 125 (15%) of the patients died in the clonidine group and 19 of 65 (29%) in the placebo group died within 730 days after surgery (P = 0.035; table 9). A two-variable model with both myocardial ischemia and clonidine demonstrates significance (P = 0.025). Assignment to the clonidine group (RR = 0.70 [CI, 0.50–0.97]; P = 0.03) reduced the risk of mortality. However, the occurrence of a single episode of myocardial ischemia did not significantly affect mortality (RR = 1.28 [CI, 0.85–1.85]; P = 0.22). Intraoperative hypertension was not a significant risk factor for mortality. Eliminating all of the patients who were taking preoperative β blockers had no effect on the 30-day (clonidine, 1 [0.9%]vs. placebo, 4 [6.3%]; P = 0.04) and 2-yr (clonidine, 18 [16%]vs. placebo, 18 [28%]; P = 0.03) mortality results. Removing all of the patients who received preoperative or intraoperative β blockers resulted in a loss of significance for the 30-day (clonidine, 1 [0.9%]vs. placebo, 1 [1.9%]; P = 0.60) and 2-yr (clonidine, 18 [17%]vs. placebo, 14 [27%]; P = 0.12) mortality results. Eliminating all of the patients who received an epidural had no effect on the 30-day (clonidine, 1 [0.8%]vs. placebo, 4 [6.6%]; P = 0.03) or 2-yr (clonidine, 18 [15%]vs. placebo, 17 [28%]; P = 0.02) mortality. Differences in postoperative medical therapy with clonidine, β blockers, calcium channel blockers, nitrates, or angiotensin-converting enzyme inhibitors did not differ between the two groups (table 11).
The current trial demonstrated that prophylactic perioperative administration of the α2agonist clonidine significantly reduces the incidence of perioperative myocardial ischemia and postoperative mortality in patients who have or who are at risk for coronary artery disease and undergo noncardiac surgery. In previous trials, prophylactic β-blockade reduced the incidence of death after noncardiac surgery.4–6The current trial demonstrates similar efficacy for prevention of death with a drug in a different pharmacologic class. Clonidine provides an alternative therapy for prevention of cardiac morbidity in patients with or at risk for coronary artery disease who undergo noncardiac surgery.
The treatment effect we observed is similar in magnitude to the reduction in risk with atenolol prophylaxis.4,5It is less effective than the 90% reduction in risk observed with bisoprolol; however, those patients started β blockade at least 1 week before and continued 30 days after surgery.6In the atenolol study, β blockade was started in the preoperative area just before surgery and continued for 7 days.4,5In the current study, clonidine was started the night before surgery and continued for 4 days. Prophylactic anti-ischemic therapy before surgery prevents perioperative ischemic events and reduces risk of death.4Early initiation of anti-ischemia prophylaxis is probably superior to immediate preoperative administration because it prevents ischemia in the period before surgery.
The current study demonstrated improved 30-day and 2-yr survival in patients with or at risk for coronary artery disease who received prophylactic clonidine therapy. Two studies of prophylactic clonidine therapy have demonstrated a reduction in the incidence of perioperative myocardial ischemia in patients undergoing noncardiac surgery. In a randomized trial of 61 patients undergoing noncardiac surgery, Ellis et al. 10found that clonidine reduced enflurane requirements, intraoperative tachycardia, and myocardial ischemia (1 of 28 clonidine patients vs. 5 of 24 placebo patients; P = 0.05), but those effects were short-lived. The incidence of postoperative myocardial ischemia (6 of 28 clonidine patients vs. 5 of 26 placebo patients) did not differ between the two groups. No effects on myocardial infarction or mortality were observed, and no long-term follow-up was performed. A randomized trial in 297 patients undergoing noncardiac surgery demonstrated that clonidine reduced the incidence of perioperative myocardial ischemic episodes from 39% (59 of 152) to 24% (35 of 145) (P < 0.01).7No significant differences in myocardial infarctions or mortality were found. No long-term follow-up was performed. Clonidine has been studied in patients undergoing cardiac surgery with mixed results, and it cannot be recommended.8,11–14A meta-analysis of the 28 English-language studies published between 1980 and 1999 found 7 that could be included.15The pooled odds ratio was 0.49 (95% CI, 0.34–0.71) for the prevention of myocardial ischemia. Subgroup analysis revealed that clonidine reduced the incidence of myocardial ischemia in patients undergoing both cardiac and noncardiac surgery. α2-Agonist therapy with mivazerol has been shown to reduce myocardial ischemia16and may reduce mortality17but it is not clinically available. Dexmedetomidine has been shown to be a coronary vasoconstrictor when given by rapid intravenous infusion in dogs.18No studies have been published that clarify its effects on the incidence of perioperative myocardial ischemia in humans.19Currently, the only clinically available α2-agonist therapy that has been shown to reduce the incidence of perioperative myocardial ischemia and reduce mortality is clonidine.
It is clear that all patients identified with or at risk for coronary artery disease who undergo surgery should be considered for anti-ischemia prophylaxis with either β blockade or α2agonist. Unfortunately, this study does not indicate which therapy is superior. Patients treated with α2-agonist therapy still experienced tachycardia, which may lead to myocardial ischemia.20β Blockade more effectively prevents tachycardia and may be superior for ischemia prophylaxis. β Blockers also have multiple effects not related to control of heart rate, including platelet effects, antiarrhythmic effects, and the control of blood pressure, which may affect perioperative outcome. Preventing central release of catecholamines may have multiple effects separate from the pure effect on heart rate. It is unknown whether combined β blockade and α2-agonist therapy will be superior to either agent alone by blocking both release and effects of catecholamines or will result in an increased risk for side effects. The current study does not have significant power to detect an added benefit of coadministration of α2-agonist therapy to β blockade.
How could a therapy applied for only 4 days affect 2-yr mortality? A single episode of perioperative myocardial ischemia detected by Holter electrocardiographic monitoring has been shown to increase the risk of 2-yr mortality in previous studies.3,4Reducing the incidence of episodes of perioperative myocardial ischemia reduces the risk of 2-yr mortality.4Two separate studies have demonstrated that perioperative administration of a drug that reduces the incidence of myocardial ischemia reduces the risk of 2-yr mortality.4,21The long-term benefit of short-term perioperative therapy has been shown in the current study and with β blockers.4,5,21Prevention of episodes of myocardial ischemia reduces the incidence of subsequent episodes of ischemia that may develop into a pattern of unstable angina and subsequent myocardial infarction. Prophylactic anti-ischemic therapy prevents the initiation of a chain of events leading to myocardial infarction and death. Perioperative anti-ischemia therapy with atenolol or clonidine reduces the overall mortality by reducing the incidence of ischemic events. Therapies that reduced the incidence of perioperative ischemic episodes are associated with a reduction in mortality after surgery. The current study clearly demonstrates a significant difference in 30-day and 2-yr mortality using a prophylactic anti-ischemic therapy.
This study has limitations. Because study patients were enrolled at a Veterans Affairs Medical Center, significant numbers of women were not available for inclusion. Results may be slightly different when prophylactic clonidine therapy is used in women with or at risk for coronary artery disease. Despite this limitation, women at risk for cardiac morbidity should receive anti-ischemia prophylaxis. This study used a single dose of clonidine (0.2-mg oral tablet and Catapres-TTS-2 patch). Higher doses may have reduced the risk even more but may have greater side effects. Only a single clonidine concentration measurement was performed on postoperative day 2. This concentration may or may not be representative of the average concentration during administration. After the oral dose or at the end of the duration of effect of the patch, the concentration may have been different. Prophylactic administration of clonidine to patients may cause hypotension preoperatively. Three patients experienced systolic blood pressures between 80 and 90 mmHg just before surgery. This hypotension responded to fluid administration; however, patients with critical aortic stenosis or who are hypotensive (systolic blood pressure < 110 mmHg) should not be given prophylactic clonidine therapy without careful medical supervision. This study used CPK-MB isoenzyme concentrations to detect biochemical evidence of myocardial injury. Concentrations were determined on postoperative days 1, 3, and 5 and when clinically indicated to optimize the detection of myocardial injury. If a larger number of CPK-MB measurements were taken or troponin I or troponin T were used, more evidence of myocardial injury may have been evident. Using CPK-MB did not affect the results of the study because the test was used for both randomized groups. The trend toward more patients in the clonidine group having a history of preoperative β blocker use does not change the results because exclusion of these patients from the analysis has no effect on the results.
The cost of prophylactic perioperative anti-ischemic therapy with either clonidine or atenolol is trivial compared with the cost of managing the perioperative myocardial infarctions and deaths incurred by not using prophylaxis. This study demonstrated that prophylactic therapy with the α2agonist clonidine reduces incidence of myocardial ischemia and postoperative death and has efficacy similar to that of β-blocker therapy. Clonidine anti-ischemia prophylaxis provides an alternative therapy to prophylactic β blockade for patients undergoing noncardiac surgery.
The authors acknowledge Dennis T. Mangano, Ph.D., M.D., Ischemia Research and Education Foundation (IREF), San Francisco, California, for his inspiration in conducting this study. The authors thank statisticians Ping Hsu and Shirley Wang, IREF, for their evaluation of the results of this study.


text:
by, Madalyn Johnson & Adrianne Hutto, Web Editor & Staff Writer
On Friday, Nov. 13, the college hosted their annual Quadchella, which provided an opportunity for the MC community to unwind from the hectic semester while getting to listen to an artist chosen by the student body. Although Quadchella did not take place on the quad this year, the event still lived up to its promises of delivering quality, live entertainment to Manhattan College.
The artist chosen to perform at Quadchella 2020 was the promised act for SpringFest 2020, the lead singer of The Fray, Isaac Slade. Student Engagement planned to set up the event as a webinar so students could interact and take away more from the event besides just live music.
“He’s going to be performing some of his songs and we’re going to be doing a panel of all different questions about his career and his background and some like fun facts about him in between each song that he sings,” Gianna Gaudio, a graduate assistant for student engagement, said.
Besides working to ensure a fun experience for students, Student Engagement purposely timed the event late into the fall semester. The office wanted participants, regardless of if they were on campus or back home, to come to the event and enjoy live music right before a Thanksgiving break that would drive students out of campus until 2021.
“I think that overall, you know, the climate right now did play a role,” Shannon Ortega, the Student Engagement coordinator, said. “We try to stagger out events so that as students were trying to figure out what their schedule was, whether they were on hybrid mode or fully remote, just allowing students to kind of gain understanding for their schedules and so that was a driving factor in terms of staggering events this year.”
The Manhattan College class of 2020 was in the back of the minds of administrators when organizing the event. Due to their senior year being cut short last spring, the class was deprived of experiencing many important events like SpringFest, and so the school wanted to invite them back to give them another chance to experience some fun.
“We wanted to make sure that they were able to be invited back for something fun on campus because they did miss out on that opportunity, so that’s why we thought it was extra important to extend that invite to them so that they felt that they were welcome back,” Gaudio said. “We told them that they would be welcomed back for an event this year because they had missed out, so we want to make sure that that was a priority.”
Student Engagement reflected on how there are many benefits to hosting an event with a popular artist online.
“We saw this play out with what was said from last week with Cody Ko,” Ortega said. “A lot of students that log in are home and remote, so with a normal Quadchella, you’re usually on campus so that’s really kind of your experience with your friends. But now you can incorporate your friends at home or your sister or, you know, your siblings because you’re home.”
Several students coordinated the webinar as Slade performed many early 2000 favorites. Among the group of coordinators was Student Body President Shannon Gleba, who perceived this year’s Quadchella as a success, thanks in large part to the proactive efforts of Student Engagement during an unprecedented semester. “Student Engagement took the reins on communicating with Isaac’s manager and planning the event,” Gleba said. “Isaac said it was his first time doing a virtual concert like this, and I feel like it went super well and like he, as well as MC, had fun.”
Besides being a part of the webinar, Gleba is a senior who watched what would be her last Quadchella at Manhattan College. She reflected on how pleased she was to see Slade play in her final Quadchella experience.
“I really enjoyed my time at Quadchella this year,” Gleba said. “It is crazy to think this will be my final one at MC, but I am thankful we had such an amazing artist like Isaac Slade to close it out.”
Freshman Katie Gilmartin got to experience Quadchella for the first time this year. It was Isaac Slade himself who influenced Gilmartin to check out the virtual event. Although Gilmartin was well aware that Manhattan annually hosts Quadchella, she came into the experience not knowing what it was going to be like.
“I honestly didn’t know what to expect, I figured it would be a bit like an online lecture,” Gilmartin said. “It turned out quite nicely, though, with both music and a Q&A with the Fray. It was moderated by a couple students, who served as great hosts.”
Gilmartin supports how student engagement viewed virtual Quadchella as an interactive way to include a variety of people into the live show, not just MC students on campus.
“I’m a commuter student, so sometimes there are events that I miss out on due to a hefty commute home or an event being too late in the evening,” Gilmartin said. “The virtual setting worked well, it allowed me to participate from the comfort of home. Also, I was able to share the event with my family; I’ve got two younger sisters in high school, and it was such a treat to share Quadchella with them.”
But like most, Gilmartin mentioned she would have preferred an in-person event, if it were possible this year.
“There’s something special about sharing an experience with other listeners around you, all tuned in to the performer, collectively appreciating the music and having a good time,” Gilmartin said.
From a senior’s standpoint, the annual concert being held online was as enjoyable as it could have been given the circumstances. Senior Kerry Brosnan shared how this year’s atmosphere changed her perception on her last Quadchella in comparison to the others she’s attended.
“Definitely not as engaging as previous Quadchellas where we’re all on the quad together, and eating from food trucks and just generally having fun on a Friday,” Brosnan said. “Quadchella usually signifies the end of the summer season, so having it now was different from years past. In-person events are generally better because there’s a more exciting atmosphere and physically seeing a performer is more captivating.”
Brosnan was still grateful Student Engagement and Student Government have been continuing the hard work to organize these types of virtual events that feature amazing talent.
“Given the current circumstance, it’s great that we’re able to have events even if it is through a virtual format.”
Editor’s Note: Shannon Gleba is Quadrangle writer

domain: news


text:
Aliases for SLPI Gene
External Ids for SLPI Gene
Previous GeneCards Identifiers for SLPI Gene
This gene encodes a secreted inhibitor which protects epithelial tissues from serine proteases. It is found in various secretions including seminal plasma, cervical mucus, and bronchial secretions, and has affinity for trypsin, leukocyte elastase, and cathepsin G. Its inhibitory effect contributes to the immune response by protecting epithelial surfaces from attack by endogenous proteolytic enzymes. This antimicrobial protein has antibacterial, antifungal and antiviral activity. [provided by RefSeq, Nov 2014]
GeneCards Summary for SLPI Gene
SLPI (Secretory Leukocyte Peptidase Inhibitor) is a Protein Coding gene. Diseases associated with SLPI include trichomoniasis and urogenital tuberculosis. Among its related pathways are Metabolism and Biosynthesis of the N-glycan precursor (dolichol lipid-linked oligosaccharide, LLO) and transfer to a nascent protein. GO annotations related to this gene include enzyme binding and endopeptidase inhibitor activity.
UniProtKB/Swiss-Prot for SLPI Gene
Acid-stable proteinase inhibitor with strong affinities for trypsin, chymotrypsin, elastase, and cathepsin G. May prevent elastase-mediated damage to oral and possibly other mucosal tissues


text:
This Vegan Salted Caramel Cashew Nut butter is our most popular nut butter so far! We think it deserves a place in nut butter heaven – but I guess we’re biased but we can guarantee it will have you reaching back for more every-time! All natural ingredients with just, cashew nuts, coconut sugar and sea salt, that are blended to brilliancy to create a silky smooth vegan treat.
To enjoy this Vegan Cashew nut butter you can just simply swirl it into your smoothie or porridge. Being high in vegan protein it is a great addition to any vegan snack or meal; healthy or a bit Norty!
Want to know a Norty secret? Straight from the jar with a spoon is how we like this nut butter best; the bigger the spoon the better!

domain: food


Recently, WhatsApp has become one of the most popular chat applications that most people use on a daily basis. Not only used for chatting, this one application can also be used to send various photos, videos, or certain documents. But how do you send long videos via WhatsApp? Here’s the explanation.
Using Google Drive
To be able to send long videos through this famous chat application, you can take advantage of services from Google, namely Google Drive. But before sending it, it would be nice if you uploaded the related files first to your Google Drive account with a few easy steps to do.
If you don’t have the Google Drive application, then download it first on the PlayStore or AppStore. Then open Google Drive and click the plus “+” icon on the home screen. After clicking on it, the “Upload” option will appear and click again. Only then select which large video to send.
Wait for the upload process to complete. After successfully uploading, open the video and tap the menu button which is a dot. Then select “Copy Link” or “Copy Link”. The next way to send long videos via WhatsApp is to open the chat application and select the desired contact or group. Paste the link then click send.
Using Video Compressor
Not only using Google Drive, but even sending videos with a long duration can be compressed first. One application that can be used in this way is Video Compressor. For that, it’s a good idea if you download it on the PlayStore or AppStore. When the download process is successful, open the application and select “Select Video”.
Decide which video to compress. After selecting, click “Compress Video”. When tapping it, you will be presented with a choice of “High Quality”, “Low Quality”, or “Custom”. You can choose as you wish. The next way to send long videos via WhatsApp is to wait until the process is complete, then “Share” to the intended contact.
Actually, this third method is not much different from using Google Drive. It’s just that here you use a media application called Youtube, which in fact is more widely used to upload videos. For that, you have to do some easy steps. First of all, please look for the video to be sent first on the Youtube application.
Or if the video doesn’t exist, you can upload it yourself. Wait for the upload process to complete. After that, tap the “Share” or “Share” button. Then a link will appear which you want to share, choose WhatsApp. Select the contact or group to send the video link to. Just copy the link, then click the green send button.
Split Video Into Two or More
If you don’t want to upload videos like the Youtube and Google Drive methods or don’t want to edit them first, then the only way is to divide the video into two or more. The way to send long videos via WhatsApp is to install an application called SplitVideo then share the video according to the required duration.
Who doesn’t know the famous chat application called WhatsApp? Thanks to this one application, most people can carry out their routines, especially communicating very smoothly. The steps for sending long videos discussed above can also be used as an alternative for sharing important information through this chat application.


Welcome everybody to another great Episode of GamerHusbands Radio.
In this episode we go over a little bit of what we have been
playing and the latest DLC for Gears of War 2. Then we dive into
the Love Sack, and answer questions from ItsAJackal21 and XGC
Drake. And as always we wrap things up with our shout outs and
evictions. So enjoy this episode of GHR!


|국가/구분||United States(US) Patent 등록|
|미국특허분류(USC)||137/62539 ; 137/59616 ; 251/636 ; 251/325|
|발명자 / 주소|
|출원인 / 주소|
|인용정보||피인용 횟수 : 4 인용 특허 : 1|
When a Hydraulically operated valve is used to control the operation of a hydraulic elevator, it is required to do so in a manner such that as the elevator cab approaches a floor level in either direction, it is first decelerated through a transition cycle and after that moved slowly a short distance through a creeping cycle to the floor level where it stops. In the up direction, an extra heavy load cuts the transistion time and adds objectionably to the time needed for up leveling. The compensating valve of the invention is interposed in the hydraulic l...
A compensating valve device mountable in a housing for modification of the flow of hydraulic fluid in a hydraulic circuit wherein a hydraulic fluid supply to the housing has a pressure in excess of ambient pressure, said valve device comprising a valve body having mounting means for positioning the valve device on said housing a valve chamber in said body, a valve stem reciprocatably mounted in said body, said stem having a piston at one end responsive to pressure of said hydraulic fluid, means forming a cavity in said stem adjacent the other end having ...


text:
Collectors museum double record album frame joann for frames 11645728 are best with possibility of vinyl record damage with lp album frames with newest 2250 zps987c1e6a. These are some benefits and may still be a wonderful variety.
9 tips of record album frames in this short article to aid your detailed the job with ease.
You might also like
Record album art paint pour liquitex pouring mediumgolden for best frames
Record album lp frame display featuring white matting juke box throughout recent frames 3039ccb907fe3844409e214a8c46e136
Precious past picture frame in coral para la casa pertaining to creative record album frames 943ff0f2ef3ac3d86620f53fe8cfbc49
X recordlp frame in inch standard style and color of regarding best record album frames il fullxfull 786628438 ru1i
Making vinyl record frame out of dollar picture inside creative album frames
Vinyl album black aluminium record cover sleeve display double inside best frames a2ba4aaa b17a 4620 a89f ce27cf6cd5fa
Record album frames set of throughout creative e15088d6 b1b1 4c27 9fe0 7b41a415be0e 1 67a9cccfbcac965243930cef8c56e075
Wall art hangings ikea for different record album frames hovsta frame medium brown 0638252 pe698802 s5
Frame my collection on twitter check out our new double record with creative album frames cczzurruuaamerv
Possibility of vinyl record damage with lp album frames with newest 2250 zps987c1e6a
Lot of record album frames new in wrap ship with lot of 100 record album frames new in
X recordlp frame in inch standard style and color of inside recent record album frames il fullxfull 786628520 s5dn
Collectors museum double record album frame joann for frames 11645728


text:
You'll hit the road in Medina, United States of America, with big smile on your face when you choose your rental car via CarRentals.com.
Swap wings for wheels once you touch down at Jamestown Regional Airport. Cars are available for rent at Avis Jamestown - Jamestown Airport, 30 miles away at 1600 21st Avenue Northeast Jamestown Municipal Airport.
If a day on the road strikes you as an alluring idea, consider traveling to Carrington. It's located 40 miles from Medina. Carrington City Park and the CrossRoads 18 Hole Golf Course have to be at the top of your list here. Putnam House shouldn't be missed either. Ashley is one more noteworthy day trip location just 60 miles away. Upon arriving, you won't regret swinging by the McIntosh County Heritage Center and Ashley Jewish Cemetery. If that's not enough, why not also go to McIntosh County Courthouse?
One of the best activities to do in North Dakota is to cruise past its lovely rolling hills.
Would you like to experience more of the region? 95 miles away, Forman is a great road trip destination. Another possible option, Flasher is located 95 miles out of the city.
Whether you want to visit the top tourist attractions or you'd rather get off the beaten track, your rental car can take you there!

domain: travel


A new report reveals that 91 per cent of trust leaders are worried that unless politicians have a full, frank and open national conversation about the severe pressures facing the NHS, we risk damaging public trust and faith in the NHS
When you step back and look at the bigger picture it becomes strikingly apparent that we are at a point of political and social flux, and a time of considerable uncertainty for the NHS and public services more generally.
Against the hazy backdrop of a potential general election – the third in five years – and the all-consuming polarised debate about the country’s relationship with the EU, the NHS is seeking to address big questions about how it remains sustainable and meets the needs of the public in future years.
The NHS, rightly, remains our national religion. There continues to be strong public support for the founding principles of the NHS – free at the point of use and universal service.
The current government has placed the NHS at the top of its domestic priorities. And trusts have welcomed increases in funding compared with other public services and an ambitious plan for the next decade.
But it would be wrong to assume that the NHS is “sorted”. While welcome, the £20.5bn funding settlement committed by the last government does little more than to cover rising costs and demand.
There’s a lot of catching up to be done to recover performance. Worryingly, the most recent British Attitudes Survey showed that overall satisfaction with the NHS had slipped to the lowest level in a decade amid lengthening waiting times and staff shortages.
These worries reflect those of NHS trust leaders.
The NHS faces a triple whammy of rapidly rising demand – 9 per cent over the last three years alone – against over 100,000 vacancies across the NHS and the need to recover from the longest and deepest funding squeeze in NHS history
In our latest The state of the NHS provider sector report, it is telling that 91 per cent of trust leaders are worried that there hasn’t been the full, frank and open national conversation about the severe pressures facing the NHS and how much these constrain what it can deliver.
These pressures are well known. The NHS faces a triple whammy of rapidly rising demand – 9 per cent over the last three years alone – against over 100,000 vacancies across the NHS and the need to recover from the longest and deepest funding squeeze in NHS history.
Current performance levels have slipped to the worst levels in a decade, and the approach of surviving off the goodwill of dedicated and hard-working NHS staff is simply unsustainable.
Trust leaders are warning that the neglect of other critical areas of public expenditure are ebbing away their confidence in delivering the ambition of the NHS long-term plan.
This includes a built-up £6bn backlog maintenance bill, of which £3bn is safety-critical, and years of funding restraint in an adult social care sector on the verge of collapse, as well as vital public health and prevention services, which should be at the heart of future service delivery.
Only 29 per cent of trust leaders are confident of making the necessary progress towards “system working” in the next 12 months, while more than half don’t believe the necessary support is in place to properly join up working between GPs and hospital and community care.
The uncomfortable truth is that despite the enduring power of the universal NHS offer, despite the superhuman effort at the frontline and despite the range of positive achievements we can point to, including a long-term plan with worthy aspirations, overall, the NHS is not currently performing as well as it needs to.
This is not a source of pride for anyone that works in the NHS.
Honest debate needed
Unless politicians level with the public about what the NHS can deliver and how quickly, we risk damaging public trust and faith in the NHS.
A trust leader recently told me that we are “not anywhere near” having the sort of conversation we need about the choices and challenges ahead, while another leader decried the quality of political discussion about the service and social care as an “embarrassment”.
It’s an uncomfortable debate to have. The government wants to be seen as an effective steward of the NHS.
NHS England and Improvement want to lead the service effectively. And frontline leaders want to provide outstanding care to every patient.
But we need greater realism about how much the NHS can deliver, and how quickly, given where we currently are and the challenges we face.
We need greater realism about how much the NHS can deliver, and how quickly, given where we currently are and the challenges we face
We have to ask difficult questions about growing demand and an ageing population. If our health and care system is already struggling when we are at the beginning of the demand bulge, what will it look like in five, eight, 10 years’ time, when we’re in the middle of that bulge?
In this uncertain pre-election period, we know that the NHS remains at the heart of public concern and affection. Make no mistake the NHS will be as important in the next election as any other.
Research from the King’s Fund shows, despite Brexit, concern for the NHS has not gone away and continues to cross traditional political divides. It is still the second most important issue after Brexit as cited by 43 per cent of respondents.
These findings also indicate that the funding settlement has had little effect on public concerns about workforce and funding concerns on the back of growing waiting times and slipping performance.
It is time that patients, NHS staff and taxpayers got honesty, realism and transparency about what the NHS needs to meet the challenges of tomorrow.
- Community services
- Foundation Trust Network (NHS Providers)
- Integrated care
- NHS funding gap
- NHS long-term plan
- Older people’s services
- Patient experience
- Public health
- Social care
- Staff wellbeing
- Sustainability and transformation plans (STPs)
- Waiting lists


text:
Now showing items 11-20 of 33
School snacks containing animal source foods improve dietary quality for children in rural Kenya
Provision of a snack at school could help alleviate the micronutrient malnutrition that is common among schoolchildren in developing countries. The Child Nutrition Project was designed to compare the efficacy of three ...
Neonatal nutrition and later outcomes of very low birth weight infants at Kenyatta National Hospital
Background: Extensive research in developed countries has established that very low birth weight (VLBW) infants are particularly vulnerable to the effects of early nutritional deficiencies. There is, however, little ...
Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation.
Animal source foods (ASF) can provide micronutrients in greater amounts and more bioavailable forms compared to plant source foods, but their intake is low in many poor populations. However, the impact of ASF on micronutrient ...
Neonatal nitrition and later outcomes of very low birth weight infants at Kenyatta National Hospital
(University of Nairobi, 2007-06)
A total of 296 episodes of bacteremia due to Enterobacter occurred in 281 patients with cancer between 1972 and 1986. The majority of these episodes were caused by Enterobacter cloacae. Seventy-four percent of the patients ...
The contribution of very low birth weight deaths to infant mortality
BACKGROUND: Infant mortality remains high in many developing countries in which the contribution of deaths among infants born very low birth weight (VLBW) may be considerable. This contribution has however not been ...
A tribute to professor Edward George Kasili
(University of Nairobi, 2009-12)
No abstract available
Rickets in Rural Kenyan Preschoolers: Case report
Clinical rickets has not been reported previously in Embu district, Kenya. Baseline clinical assessments performed for a nutrition intervention study in preschool children (n=324) identified 28 cases of rickets (8.6% of ...
Comparison of blood smear microscopy to a rapid diagnostic test for in-vitro testing for P. falciparum malaria in Kenyan school children
OBJECTIVE: To compare the diagnostic performance of microscopy using Giemsa-stained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. DESIGN: ...
Child nutrition in developing countries
Malnutrition permeates all aspects of health, growth, cognition, motor and social development of young children in developing countries. More than 50% of deaths in these children can be attributed to malnutrition, most ...

domain: literature


text:
TDR tables £211m offer for Ask
Ask Central, the restaurant chain, was today the subject of a rival takeover approach valuing the firm at an “extremely attractive” £211 million.
The proposal from TDR Capital, the private equity group, is considerably higher than a bid already agreed by Ask with The Restaurant Group, the Caffe Uno owner.
Ask said today that a firm approach from TDR was likely to be forthcoming in the next two weeks. It told shareholders who have not already voted on the original offer from The Restaurant Group to take no action in the meantime.
It added: “Shareholders should be aware that the board of Ask Central considers that an offer at this level would be extremely attractive.”
The new offer is from the same group that trumped


text:
(value not set)
- 25 Aug 2004
"Super I/O" is a class of I/O controller integrated circuits that began to be used on personal computer motherboards in the late 1980s, originally as add-in cards, later embedded on the motherboards. A super I/O chip combines interfaces for a variety of low-bandwidth devices. The functions provided usually include:
A super I/O chip may also have other interfaces, as for a joystick or infrared port. By combining many functions in a single chip, the number of parts needed on a motherboard is reduced, thus reducing the cost of production.
- A floppy disk controller
- A parallel port (commonly used for printers)
- One or more serial ports
- A keyboard and mouse interface.
The original super I/O chips communicated with the central processing unit via a connection with an Industry Standard Architecture (ISA) bus. With the evolution away from ISA towards use of the Peripheral Component Interconnect (PCI) bus, the Super I/O chip was often the biggest remaining reason for continuing inclusion of ISA on the motherboard.
Modern super I/O chips use the Low Pin Count (LPC) bus instead of ISA for communication with the CPU. This normally occurs through an LPC interface on the southbridge chip of the motherboard.
Companies that make super I/O controllers include Fintek, ITE, SMSC, United Microelectronics Corporation (UMC) and Winbond Electronics Corporation. National Semiconductor used to make them but sold that business to Winbond in 2005.


text:
From NCPR Blogs:
The U.S. Department of Agriculture has been heavily promoting its organic programs lately, particularly its increased support for organic farming in the new farm bill: "Consumer demand for organic products has grown exponentially over the past...
There was a lot of pride and excitement in the North Country agricultural community when "one of our own" was named Farmer of the Year by the Northeast Organic Farmers Association – New York chapter. Brian Bennett and his wife, Ann, have been...
A new study out this week in the journal PLOS one finds organic milk has more omega-3 fatty acids, which are good for your heart, than does conventional milk. As NPR's Allison Aubrey reported on All Things Considered Tuesday night: The researchers...
Food coops (and bulk buying clubs before them) were really the pioneers of whole food and local food and healthy food eating in most places. Now we have the mega-chain Whole Foods, and most supermarkets carry organic fruits and vegetables and...
News stories tagged with "organic"
by Todd Moe
Mar 19, 2008 — The number of Community Supported Agriculture programs in New York is growing. But how do these farmers stay connected? As part of our series, "Local flavor: growing, cooking and eating locally," Todd Moe talks with the Northeast Organic Farming Association's Abby Youngblood. She's coordinating the new statewide CSA Network. Go to full article
by Julie Grant
Mar 12, 2008 — More companies are importing organic products from China and other countries. But contaminated pet food, tainted toothpaste, and unauthorized antibiotics in fish have been imported to the U.S. from China. Now, some people are concerned about organic foods from China. Julie Grant reports. Go to full article
Feb 08, 2008 — New York's first ever panel on organic farming held its inaugural meeting this week in Albany. The Organic Advisory Task Force will help state Agriculture Commissioner Patrick Hooker create programs and policies to take advantage of the growing demand for organic food. Sue Rau is the only North Country representative on the task force. She spoke with David Sommerstein about its first meeting. Rau manages the North Country Grown Cooperative, which distributes produce from more than 20 local farms. She also runs her own certified organic farm in Norfolk. Rau says when she started farming 20 years ago, there was no local market for organic fruits and vegetables. Go to full article
by Julie Grant
Feb 07, 2008 — Organic used to be on the fringes of mainstream culture. Not any more. Ever since the National Organic Standards went into effect five years ago, organic foods have become big business. Sales of organic products now total about $20 billion a year in the US. But that quick growth spurt is coming with some growing pains. Julie Grant reports. Go to full article
Jan 29, 2008 — Chefs are always dreaming up the next big dish. Lately, it's been trendy for restaurants to showcase locally-grown farm products and meat from livestock that's been raised on a pasture instead of in a feedlot. But Rebecca Williams reports just because something's hot in the kitchen... it doesn't always mean a better payoff for farmers. Go to full article
Sep 10, 2007 — For several years, agriculture officials in New York have been pushing hard to make the connection between Upstate farms and downstate markets. A Jefferson County farmer has launched his own effort. Steve Winkler of Lucky Seven Livestock in Rodman has created a new label called "Certified Natural New York." He's distributing pork, lamb, beef, and chicken from 40 farms around the state, including about a dozen in northern New York, to stores like Wegmans and Whole Foods in metropolitan areas. Winkler told David Sommerstein "Certified Natural New York" ensures meats are produced under certain guidelines. Go to full article
by Todd Moe
Jul 26, 2007 — The New Land Trust in Saranac is sponsoring the First Annual Bee-Fest, August 3-5. The New Land Trust is a 287-acre site that's been practicing ecological land management in Clinton County since 1978. Todd Moe spoke with the Trust's Damian Gormley and Jeff Cochran about organic farming, developing their bee populations and educating the public about the phenomenon know as "Colony Collapse Disorder." Go to full article
by Brian Mann
Apr 28, 2006 — Tonight at the Keene Central School, the group Adirondack Harvest will host the screening of a new film called "Three Farms." The documentary focuses on the daily work and rituals on three organic farms, one in Keene Valley, another in Willsboro, and a third in Keeseville. Photographer Ben Stechschulte, who spends part of each year in the Adirondacks, made the film over a period of years. He spoke with Brian Mann. Go to full article


text:
Illinois Appellate Practice Manual 2022 edition published
I’m very pleased to announce that the 2022 edition of my book Illinois Appellate Practice Manual is now available from Thomson Reuters here.
This treatise is a comprehensive and practical guide to civil appellate practice in Illinois. It provides straightforward answers to common appellate practice questions that practitioners are likely to encounter in the course of an appeal, while also providing historical background, analysis, and citation to relevant authorities.
The publication covers the entire range of issues relevant to a civil appeal in Illinois courts, including considerations of issue preservation in the trial court, post-trial motions, appeals to the Illinois Appellate Court, and appeals and original proceedings in the Illinois Supreme Court.

domain: library


text:
Netflix has revealed the first look at Superman actor Henry Cavill as Geralt of Rivia for the new TV series coming to the service in 2019.
The test footage was posted on Netflix’s Twitter account. It doesn’t show much – the in-costume Cavill walks towards the camera, grimaces a bit, and takes a swig from a beer bottle. Still, it’s the world’s first look at not only Geralt of Rivia, but The Witcher Netflix series as well.
The new streaming series is based on the original books by Andrej Sapkowski rather than the popular games by CD Projekt RED – who just released their latest game in The Witcher universe, Thronebreaker: The Witcher Tales, which is a standalone RPG in the style of the Gwent card game rather than an open-world RPG like The Witcher 3: Wild Hunt.
Sapkowski isn’t a fan of the games, in fact he’s currently demanding that CD Projekt RED pay him $16 million for continued use of his characters. The Netflix series is part of a direct deal with the author, so shouldn’t face the same trouble.
You can check out the costume test with Henry Cavill as Geralt below. It’s pretty on-point for the books, although of course there are plenty of people complaining about it on Twitter.
Get your first look at Henry Cavill in The Witcher! pic.twitter.com/1O2eWS1MkP
— Netflix US (@netflix) October 31, 2018
The show itself has attracted its fair share of controversy already, such as after the suggestion that Ciri wasn’t going to be played by a white actress. This turned out to be false, but it obviously didn’t stop people from complaining about the casting choices.
The Witcher Netflix series will premier on the service in 2019, and presumably the first trailer will release sometime soon.


text:
Blood & Pigment is 4 years old! On November 8th, 2018, we published our first article on this blog! The blog’s birthday seemed a good time to create an “About Us” page to satisfy the SEO gods. Read on to find out a little more about the blog and the team behind the blog, and then enjoy some blog stats at the end of the article (available for a limited time only).
Blood & Pigment has been creating content for Blood & Plunder players since 2018. Joseph Forster started the blog but was soon joined by Guy Rheuark (writer and video contributor, and editor). Dan Carlson (writer, audio editor, and video contributor), Brian Longoria (graphics specialist), and Jason Klotz (technical wizard & SEO consultant) have since joined the team. We launched our YouTube channel in 2020 where we publish videos on a variety of Blood & Plunder topics.
The Blood & Pigment Team
Living in wargaming wasteland of Oregon, Joseph grew up playing board games of various types. Joseph backed the original Blood & Plunder Kickstarter in 2016 and has been enthusiastically playing Blood & Plunder ever since. Looking to help grow the Blood & Plunder community, Joseph started the Blood & Pigment blog in 2018. Joseph continues to contribute research and design for some more recent Blood & Plunder products, including Fire on the Frontier. Joseph stays busy as a musician, piano technician, and father of 5 little gamers.
I am Guy Rheuark and I help Blood & Pigment with videos and the occasional article. I’ve alway been passionate about history and gaming and Blood & Plunder is a great combination of those interests. I am responsible for most of our ‘Homebrew’ articles, and I encourage players to tinker with what they enjoy playing.
Painting and modeling is also a passion of mine, and Blood & Plunder is a great platform for that.
I manage Seamons Quality Sails, and worked with our artist to make scale hand quilted sails for Firelock Games ships.
Feel free to contact me on social media, or email me at email@example.com
Joining the blog in 2019 with his article about the Pirates’ Faction from No Peace Beyond the Line, Dan is our local in-game sea-faring expert. His unique writing style and passion for the game’s Pirate Factions add a colorful yet piratical flair to his works. Residing in Texas, he leads a local group of players that play games of Blood and Plunder on a weekly basis.
Dan joined at the tail-end of No Peace Beyond the Line and wasted no time in sailing for the Pirates and the Dutch. He keeps busy going to different Renaissance Fairs, pirate-themed video games, and movies. He is also a writer both for the blog and pirate-themed short stories. If he’s not enjoying those pastimes, he can be found boarding other people’s vessels with Enter Ploeg or figuring out how to bring his beloved 6th Rate Frigate (his favorite ship) into as many games as possible.
Dan maintains an Instagram account for all his Blood and Plunder hobby work and can be reached via private message from that account: https://instagram.com/pigment_member_dan?igshid=YmMyMTA2M2Y=
Brian brings a lot of graphics and social media expertise to the team. He designed our logos, graphic style, and was instrumental in bringing our YouTube channel. Also residing in Oregon, Brian enjoys several games and is always painting minis of one kind or another!
A veteran with over 30 years of gaming experience. Starting down the road to gaming with D&D, it was quickly followed by the BATTLETECH miniatures game. Over the years his hobbies have exploded into more games than he cares to mention. He’s owned and operated a hobby store and designed/contributed to a number of games over the years. He loves Oak & Iron and Blood & Plunder and continues to spend waaaay too many hours on them both. Jason is also the owner and chief contributor of TimberAndSail.com an Oak & Iron blog. He helps with Blood & Pigment primarily as a technical consultant and SEO guru.
Blood & Pigment’s Mission
Our mission is to create content that will help Blood & Plunder players to more fully enjoy the game and draw more people into playing Blood & Plunder. We all enjoy Blood & Plunder to the fullest and we love working hard making content we hope will help others enjoy the game as well.
We aim to cover both the tabletop combat (blood) part of Blood & Plunder along with the painting and crafting half (pigment) of the hobby. We’re still in the planning stages of opening the Bloody Pig pub as our HQ.
Our Content Focus:
- Ship Guides & Reviews
- Nation & Faction guides
- Strategy & Tactics guides
- Terrain & Building reviews
- List Building Tips/Suggestions
- New product previews
- Painting Showcase and Guides
- Battle Reports
Our Current Content Focus
With Raise the Black coming out, there should be an increasing number of new players getting into Blood & Plunder. We have been trying to adjust our content creation to be more helpful to these new players. We just released an updated Getting Started with Blood & Plunder article and we’re currently working on a quick start video for learning to play Blood & Plunder, articles with some advice on selecting your first ship(s) and building your first forces, On YouTube we have a full review of the Raise the Black Kickstarter video in the works, and we’ll be continuing our Ship Building video series.
Our Social Media
If you don’t get enough Blood & Plunder content here on the blog, you can follow us on the various social media sites:
- Blood & Pigment Facebook Page
- Blood & Pigment Instagram
- Dan’s Blood & Pigment Instagram
- Blood & Pigment Twitter
We recently bit the bullet and started a Patreon. Building and maintaining a blog and YouTube channel takes a lot of time and effort and, unfortunately, a good bit of money! If you enjoy our content and support our mission, we would be super thankful for any doubloons you can pledge to help support our efforts. We sure appreciate it!
Four Years of Blood & Pigment
With four years behind us, let’s look at some fun blog stats.
- Posts – 344
- Views – 248,208
- Visitors – 80,369
- Total Words – 87,920
- Source Countries for Traffic – USA, United Kingdom, Canada, Germany, Netherlands, Sweden, Australia, Denmark
- Most-visited article – Getting Started with Blood & Plunder (10,000+ views)
- First Post – Welcome to This Blood & Plunder Blog
Our YouTube channel is only two years old but we’re making progress!
- Videos – 77
- Subscribers – The 800
- Most Views – The Battle of Hudson’s Bay (1.8K)
- Total Views – 37,790
- Total Time Watched – 3,741 Hours

domain: hobby


text:
Sorry, but specific product you requested is not currently available. Hopefully you can find another option below.
Shell is knitted in one piece to the armholes. Sizes x-small to x-large, finished chest measurments 34, 37, 40, 43, 46 inches. Finished Length: 20 inches.You can also view all Knitting Pure and Simple Summer Sweater Patterns.
We provide endless possibilities for you including yarn, knitting gifts, needles, kits, sale yarn, free knitting patterns, and more!Jimmy Beans Wool is Your Local Yarn Store... Online!


NIO has taken the wraps off its all-new midsize electric SUV, the ES6, as the latest vehicle to join the Chinese automaker’s rapidly expanding lineup.
The unveil came on Saturday during its annual ‘NIO Day’ at the Shanghai Oriental Sports Center.
The high-performance long-range SUV, which features 4.7-second 0-62 mph acceleration and a range of more than 315 miles, will go on sale in June at a starting price of 358,000 yuan ($52,000).
According to the automaker, the ES6 “expands the design language of the NIO product line with a stylish and sporty exterior plus a refined, high-tech interior.”
The ES6, which joins the EP9 supercar and full-sized ES8 SUV in its all-electric lineup, will be offered in Standard and Performance versions, with customers able to now pre-order the vehicle through the NIO app.
Nearly 10,000 of the NIO ES8 SUVs, meanwhile, have been delivered, with upgrades to the latest 84 kWh battery system to become available in the second half of next year.
NIO also confirmed that its major service systems, including NIO House, NIO Service and NIO Power, will also all be upgraded.
“We are committed to redefining the user experience and creating a community centered around our users, enjoying life and growing together,” said company founder, chairman and CEO William Li.
“The ES6 launch and the NIO Day have set another NIO community milestone.”