text:
Effects of Mechanical Ventilation on Release of Cytokines into Systemic Circulation in Patients with Normal Pulmonary Function
Wrigge, Hermann M.D.*; Zinserling, Jörg M.Sc.†; Stüber, Frank M.D.‡; von Spiegel, Tilman M.D.§; Hering, Rudolf M.D.∥; Wetegrove, Silke M.D.#; Hoeft, Andreas M.D.**; Putensen, Christian M.D.††
Background: Mechanical ventilation with high tidal volumes (VT) in contrast to mechanical ventilation with low VT has been shown to increase plasma levels of proinflammatory and antiinflammatory mediators in patients with acute lung injury. The authors hypothesized that, in patients without previous lung injury, a conventional potentially injurious ventilatory strategy with high VT and zero end-expiratory pressure (ZEEP) will not cause a cytokine release into systemic circulation.
: A total of 39 patients with American Society of Anesthesiologists physical status I–II and without signs of systemic infection scheduled for elective surgery with general anesthesia were randomized to receive mechanical ventilation with either (1) VT
= 15 ml/kg ideal body weight on ZEEP, (2) VT
= 6 ml/kg ideal body weight on ZEEP, or (3) VT
= 6 ml/kg ideal body weight on positive end-expiratory pressure of 10 cm H2
O. Plasma levels of proinflammatory and antiinflammatory mediators tumor necrosis factor, interleukin (IL)-6, IL-10, and IL-1 receptor antagonist were determined before and 1 h after the initiation of mechanical ventilation.
: Plasma levels of all cytokines remained low in all settings. IL-6, tumor necrosis factor, and IL-1 receptor antagonist did not change significantly after 1 h of mechanical ventilation. IL-10 was below the detection limit (10 pg/ml) in 35 of 39 patients. There were no differences between groups.
Conclusions: Initiation of mechanical ventilation for 1 h in patients without previous lung injury caused no consistent changes in plasma levels of studied mediators. Mechanical ventilation with high VT on ZEEP did not result in higher cytokine levels compared with lung-protective ventilatory strategies. Previous lunge damage seems to be mandatory to cause an increase in plasma cytokines after 1 h of high VT mechanical ventilation.
POSITIVE pressure ventilation is commonly applied in patients undergoing general anesthesia to assure adequate ventilation and gas exchange. Conventional mechanical ventilation still uses low positive end-expiratory pressure (PEEP) levels with high tidal volumes (VT
) ranging between 10 and 15 ml/kg ideal body weight. 1–4
However, positive pressure ventilation alone or in combination with preexisting lung disease may contribute considerably to lung injury, including pneumothorax, alveolar edema, and alveolar rupture. 5,6
Mechanical ventilation with PEEP titrated above the lower inflection pressure of a static pressure–volume curve and low VT
has been suggested to prevent tidal collapse and overdistension of lung regions during severe acute respiratory distress syndrome (ARDS). 7
This lung-protective ventilatory strategy has been shown to improve gas exchange and outcome in patients with ARDS. 8
Recently, Ranieri et al.9
observed higher systemic and intraalveolar levels of proinflammatory cytokines in ARDS patients during mechanical ventilation with low PEEP and high VT
when compared with a lung-protective strategy. Therefore, it has been speculated that conventional mechanical ventilation may induce release of inflammatory mediators and thereby contribute to lung injury. 10In vitro
experiments have demonstrated that mechanical stress to lung cells is associated with release of inflammatory mediators. 11,12
However, acute lung injury or ARDS itself causes an inflammation of the lungs with increased systemic and intraalveolar concentrations of the proinflammatory cytokines. 13
It is unclear whether mechanical ventilation alone or only in the presence of acute lung injury can release inflammatory cytokines into systemic circulation.
We hypothesized that, in patients with normal lungs, mechanical ventilation with high VT does not induce a release of cytokines into the systemic circulation. To test this hypothesis, we measured proinflammatory and antiinflammatory cytokines in the plasma of anesthetized patients with healthy lungs while they were mechanically ventilated with lung-protective or conventional strategies.
Materials and Methods
Approval of the Bonn University Ethics Committee, Bonn, Germany, for the study protocol was obtained, and all patients gave written informed consent before inclusion in the study.
Thirty-nine adult patients classified as American Society of Anesthesiologists physical status I or II scheduled for elective extrathoracic surgery with general anesthesia (table 1
) were eligible to participate in the study. 14
Patients with history or clinical signs of lung disease, history of smoking, age older than 65 yr, immunosuppression by drugs or underlying condition, elevated leukocyte count, or clinical signs of a systemic infection were not included in the study.
All patients received a standard premedication of 7.5 mg midazolam orally on the day of surgery. Anesthesia was induced using thiopental (4–6 mg/kg administered intravenously) and fentanyl (1–2 μg/kg administered intravenously). Thereafter, cis-atracurium (0.10–0.15 mg/kg administered intravenously) was given to facilitate tracheal intubation. Mechanical ventilation was provided with an anesthesia ventilator connected to a circle system (Julian, Dräger, Lübeck, Germany) with a fresh gas flow of air–oxygen at 4 l/min and an inspiratory fraction of oxygen of 0.30. Anesthesia was maintained with 0.5 minimum alveolar concentration of isoflurane and supplemental doses of fentanyl as required. Routine perioperative monitoring included measurement of noninvasive blood pressure, pulse oximetry, and electrocardiogram (CS/3, Datex-Ohmeda, Helsinki, Finland). End-tidal fractions of carbon dioxide and isoflurane were measured using infrared absorption capnography (Julian, Dräger). All patients received infusion of 1.5 l of crystalloid fluids during the study period to assure hemodynamic stability.
Gas flow was measured at the proximal end of the tracheal tube with a heated pneumotachograph (No. 2; Fleisch, Lausanne, Switzerland) connected to a differential pressure transducer (Huba Control, Würenlos, Switzerland). Airway pressure was measured at the proximal end of the tracheal tube with another differential gas–pressure transducer (SMT, Munich, Germany). All signals were sampled with an analog–digital converter board (PCM-DAS16S/12, Mansfield, MA) installed in a personal computer. Digitized signals were plotted in real time on the computer screen and stored on magnetic media for offline analysis. VT and minute ventilation were derived from the integrated gas flow signal.
Venous EDTA blood samples of 5 ml were centrifuged at 1,500 g for 5 min, and the plasma was aspirated and stored at −70°C. Commercially available enzyme-linked immunosorbent assays were used to measure plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF) (Biosource, Ratingen, Germany), IL-10, and IL-1 receptor antagonist (R&D Systems, Minneapolis, MN). All enzyme-linked immunosorbent assay analyses were performed with strict adherence to the manufacturers’ guidelines.
All patients remained supine throughout the study period. Baseline measurements were obtained immediately before induction of anesthesia.
After induction of anesthesia, patients were randomly assigned to receive either mechanical ventilation with VT of 15 ml/kg ideal body weight and zero end-expiratory pressure (ZEEP) (high VT, ZEEP group), a VT of 6 ml/kg ideal body weight and ZEEP (low VT, ZEEP group), or a VT of 6 ml/kg ideal body weight and 10 cm H2O PEEP (low VT, PEEP group). The ventilator rate was adjusted to maintain end-tidal carbon dioxide partial pressure between 35 and 45 mmHg. After ventilation with the assigned mode was stable for 1 h, the measurements were repeated. Thereafter, data collection was concluded and the surgical procedure was allowed to commence.
To detect differences in cytokine plasma levels between the ventilatory settings with the given two-sided parallel design at a significance level of 5% (α = 0.05) with a probability of 80% (β = 0.20) based on an estimated difference of 0.85 of the parameter’s mean SD, a minimum of 39 patients were to be studied.
Results are expressed as mean ± SD. All statistical analysis were performed using a statistical software package (Statistica for Windows 5.1, StatSoft, Inc., Tulsa, OK). Data were tested for normal distribution with the Sharpiro-Wilks W test. Ventilatory variables were analyzed using a one-way analysis of variance. When a significant F ratio was obtained, differences between the means were isolated with the post hoc Tukey multiple comparison test. Because cytokine data were not normally distributed, a two-way analysis of variance was performed after log10 transformation to permit the application of a parametric test. Differences were considered to be statistically significant at P values less than 0.05.
There were no statistically significant differences in the demographic or clinical data between patients of the studied groups (table 1
Ventilatory variables are shown in table 2
. During mechanical ventilation with low VT
, a higher ventilator rate (P
< 0.001) and a higher minute ventilation (P
< 0.001) were required to achieve the desired end-tidal carbon dioxide partial pressure range, compared with high VT
mechanical ventilation. Increase in ventilatory rate was associated with a reduction of inspiratory time and expiratory time (P
< 0.05), whereas the inspiratory time/expiratory time ratio remained unchanged. Peak airway pressure was lowest during mechanical ventilation with low VT
at ZEEP. In the presence of PEEP, mechanical ventilation with low VT
resulted in the highest mean airway pressure. End-tidal carbon dioxide partial pressure was lowest during mechanical ventilation with high VT
Cytokine plasma levels are shown in figures 1–3
. The response of the cytokine levels to starting mechanical ventilation was neither significantly different between the three ventilatory strategies nor statistically different after 1 h of ventilation in each individual group. Plasma levels of IL-10 remained below the detection limit (10 pg/ml) in 35 of 39 patients both at baseline and after 1 h of mechanical ventilation.
This study was designed to evaluate the effects of different ventilatory strategies on the release of inflammatory mediators into the systemic circulation of anesthetized patients who had healthy lungs. We were unable to detect statistically significant differences in cytokine release between potentially injurious and protective ventilatory strategies after 1 h of ventilation.
Mechanical ventilation is usually provided by using low PEEP levels with high VT
ranging between 10 and 15 ml/kg ideal body weight. 1–4
Based on experimental data, mechanical ventilation with high VT
has been claimed to overdistend functional lung units and contribute to direct lung damage. 6
Mechanical stress such as shear stress has been found to induce production of inflammatory cytokines in isolated endothelial, 15
and macrophage cells. 17
Experimental and clinical studies have investigated the production of inflammatory mediators in injured lungs induced by various ventilatory strategies. 9,11,12,17–20
Based on these findings, inflammatory cytokines have been implicated as contributors to ventilator-associated lung injury. 21
A recent multicenter trial of 861 patients demonstrated a reduction in mortality by 22% and lower systemic cytokine levels when VT
was reduced from 12 to 6 ml/kg ideal body weight. 22
We studied the effect of different ventilatory strategies on systemic cytokine levels during anesthesia before elective surgery. Although our patients had an essentially normal pulmonary function, previous computed tomography studies have clearly demonstrated alveolar collapse and atelectasis soon after induction of anesthesia and mechanical ventilation in previously healthy patients, 23,24
which can be prevented with a PEEP of 10 cm H2
Thus, the lung-protective ventilatory settings in this study should have prevented tidal alveolar collapse and overdistension, whereas the potentially injurious ventilatory should have not. 23
The latter has been suggested to result in shear forces with transmural pressures of up to 100 cm H2
O applied to lung cells. 26
In our patients, we did not observe consistent differences in proinflammatory and antiinflammatory cytokine plasma levels depending on different ventilatory strategies, and all levels were still within the variability observed in healthy volunteers. 27
Therefore, our findings appear to be in contrast with previous experimental 12
and clinical 9,28
observations, indicating a marked systemic inflammatory response in the presence of an injurious ventilatory strategy using low PEEP and high VT
. Variation in the systemic cytokine concentrations observed during injurious mechanical ventilation may be attributed to the difference in the design and the experimental conditions of the individual studies. Tremblay et al.12
found pronounced production of cytokines induced by injurious mechanical ventilation in animals pretreated with intravenous lipopolysaccharides, 12
whereas pressure stretching of cultivated alveolar macrophages in absence of lipopolysaccharides as an inflammatory costimulus could not induce TNF and IL-6 excretion. 17
These findings support our observation that mechanical ventilation seems to induce no inflammation in normal lungs, but may well augment lung inflammation to clinically important levels in preinjured or infected lungs. In agreement with our findings, in rats without lung injury, mechanical ventilation with VT
set at 10 ml/kg did not affect bronchoalveolar lavage fluid content of IL-1α, IL-1β, IL-6, macrophage inflammatory protein-2, and TNF when compared with spontaneous breathing, 19
whereas in a rat model with hydrochloric acid instillation–induced lung injury, mechanical ventilation with VT
of 16 ml and ZEEP resulted in a marked increase in TNF and macrophage inflammatory protein-2 when compared with VT
of 9 ml and PEEP of 5 cm H2
Unfortunately, we cannot draw conclusions on lung tissue cytokine concentrations on the basis of plasma cytokine levels. Previous studies suggest that an increase in alveolar–capillary permeability is required for translocation of mediators, including cytokines, from the lungs into the circulation. 29,30
Because inflammatory mediators cause an increase in vascular and alveolar permeability, a relevant accumulation of cytokines in the lungs should have resulted in an increased release of cytokines into the blood and alveolar fluid.
It is also important to note that we tested each ventilatory strategy only for 1 h. Experimental data have demonstrated that intraalveolar expression of TNF gene 31
and increased TNF levels in the systemic circulation 11
can be found after 1 h of injurious mechanical ventilation in lung injury models. Preliminary clinical data in patients with injured lungs indicate that maximal increase in alveolar and systemic cytokine concentrations occurs within 1 h after initiating mechanical ventilation with low PEEP and high VT
Therefore, the lack of an increase in plasma cytokines during injurious mechanical ventilation in our patients should not be attributed to a time-related component on the cytokine release. However, we did not study long-term effects of mechanical ventilation on cytokine production in healthy lungs or the effects of mechanical ventilation combined with a surgical intervention, which itself may cause an inflammatory response or even bacteremia.
General anesthesia itself has been suggested to modulate the inflammatory response during mechanical ventilation. 32
Recent experimental data suggest that inflammatory response to mechanical ventilation may be aggravated by inhalation of volatile anesthetics after 2 h. 19
Studies comparing the immune response to standardized elective surgery in patients during propofol versus
isoflurane anesthesia have revealed no differences 33
or a minimally diminished systemic inflammatory response with propofol and alfentanil when compared with isoflurane and nitrous oxide anesthesia. 34
Anesthesia in all of our patients was provided with isoflurane and fentanyl. Therefore, it is unlikely that anesthesia has a major influence on our results after a study period of only 1 h.
Our data suggest that in essentially normal lungs of anesthetized patients, short-term mechanical ventilation with high VT in the presence or absence of PEEP induces no clinical relevant increase in systemic proinflammatory and antiinflammatory cytokines. This observation is indirect evidence that mechanical ventilation seems to induce no inflammation in normal lungs, but may well augment lung inflammation to clinically important levels in preinjured or infected lungs as previously shown.
The authors are grateful to Alexandra Casalter, Department of Anesthesiology and Intensive Care Medicine, Uinversity of Bonn, Bonn, Germany, for technical laboratory assistance, and Jukka Räsänen, M.D., Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, for careful critique of the manuscript.
1. Marini JJ: New options for the ventilatory management of acute lung injury. New Horiz 1993; 1: 489–503
2. Roupie E, Dambrosio M, Servillo G, Mentec H, el Atrous S, Beydon L, Brun Buisson C, Lemaire F: Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med 1995; 152: 121–8
3. Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondejar E, Clementi E, Mancebo J, Factor P, Matamis D, Ranieri M, Blanch L, Rodi G, Mentec H, Dreyfuss D, Ferrer M, Brun-Buisson C, Tobin M, Lemaire F: Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 1998; 158: 1831–8
4. Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, Mazer CD, McLean RF, Rogovein TS, Schouten BD, Todd TR, Slutsky AS: Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome: Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med 1998; 338: 355–61
5. Parker JC, Hernandez LA, Peevy KJ: Mechanisms of ventilator-induced lung injury. Crit Care Med 1993; 21: 131—43
6. Dreyfuss D, Saumon G: Ventilator-induced lung injury: Lessons from experimental studies. Am J Respir Crit Care Med 1998; 157: 294–323
7. Amato MB, Barbas CS, Medeiros DM, Schettino G-P, Lorenzi Filho G, Kairalla RA, Deheinzelin D, Morais C, Fernandes E-O, Takagaki TY: Beneficial effects of the ‘open lung approach’ with low distending pressures in acute respiratory distress syndrome: A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med 1995; 152: 1835–46
8. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi FG, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338: 347–54
9. Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, Bruno F, Slutsky AS: Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: A randomized controlled trial. JAMA 1999; 282: 54–61
10. Tremblay LN, Slutsky AS: Ventilator-induced injury: From barotrauma to biotrauma. Proc Assoc Am Physicians 1998; 110: 482–8
11. Chiumello D, Pristine G, Slutsky AS: Mechanical ventilation affects local and systemic cytokines in an animal model of acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 160: 109–16
12. Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS: Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 1997; 99: 944–52
13. Suter PM, Ricou B: Cytokines and lung injury, Acute Lung Injury. Edited by Marini JJ, Evans TW. Berlin, Springer-Verlag, 1998, pp 41–53
14. Saklad M: Grading of patients for surgical procedures. A nesthesiology 1941; 2: 281
15. Iba T, Maitz S, Furbert T, Rosales O, Widmann MD, Spillane B, Shin T, Sonoda T, Sumpio BE: Effect of cyclic stretch on endothelial cells from different vascular beds. Circ Shock 1991; 35: 193–8
16. Vlahakis NE, Schroeder MA, Limper AH, Hubmayr RD: Stretch induces cytokine release by alveolar epithelial cells in vitro. Am J Physiol 1999; 277: L167–73
17. Pugin J, Dunn I, Jolliet P, Tassaux D, Magnenat JL, Nicod LP, Chevrolet JC: Activation of human macrophages by mechanical ventilation in vitro. Am J Physiol 1998; 275: L1040–50
18. von-Bethmann AN, Brasch F, Nusing R, Vogt K, Volk HD, Muller KM, Wendel A, Uhlig S: Hyperventilation induces release of cytokines from perfused mouse lung. Am J Respir Crit Care Med 1998; 157: 263–72
19. Kotani N, Takahashi S, Sessler DI, Hashiba E, Kubota T, Hashimoto H, Matsuki A: Volatile anesthetics augment expression of proinflammatory cytokines in rat alveolar macrophages during mechanical ventilation. A nesthesiology 1999; 91: 187–97
20. Muscedere JG, Mullen JB, Gan K: Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 1994; 149: 1327–34
21. International Consensus Conferences in Intensive Care Medicine: Ventilator-associated Lung Injury in ARDS. Am J Respir Crit Care Med 1999; 160: 2118–24
22. The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–8
23. Rothen HU, Neumann P, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G: Dynamics of re-expansion of atelectasis during general anaesthesia. Br J Anaesth 1999; 82: 551–6
24. Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G: Re-expansion of atelectasis during general anaesthesia: A computed tomography study. Br J Anaesth 1993; 71: 788–95
25. Neumann P, Rothen HU, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G: Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand 1999; 43: 295–301
26. Mead J, Takishima T: Stress distribution in lungs: A model of pulmonary elasticity. J Appl Physiol 1970; 28: 596–608
27. Dugue B, Leppanen E: Short-term variability in the concentration of serum interleukin-6 and its soluble receptor in subjectively healthy persons. Clin Chem Lab Med 1998; 36: 323–5
28. Stüber F, Wetegrove S, Schröder S, Wrigge H, Zinserling J, Hoeft A, Putensen C: Release of cytokines by low-PEEP high tidal volume ventilation in patients with ALI [abstract]. Am J Respir Crit Care Med 1999; 159: A457
29. Tutor JD, Mason CM, Dobard E, Beckerman RC, Summer WR, Nelson S: Loss of compartmentalization of alveolar tumor necrosis factor after lung injury. Am J Respir Crit Care Med 1994; 149: 1107–11
30. Gullo A, Berlot G, Viviani M: The role of adult respiratory distress syndrome in the multiple organ dysfunction syndrome. Acta Anaesthesiol Scand Suppl 1996; 109: 70–3
31. Takata M, Abe J, Tanaka H, Kitano Y, Doi S, Kohsaka T, Miyasaka K: Intraalveolar expression of tumor necrosis factor-alpha gene during conventional and high-frequency ventilation. Am J Respir Crit Care Med 1997; 156: 272–9
32. Galley HF, DiMatteo MA, Webster NR: Immunomodulation by anaesthetic, sedative and analgesic agents: Does it matter? Intensiv Care Med 2000; 26: 267–74
33. Pirttikangas CO, Salo M, Mansikka M, Gronroos J, Pulkki K, Peltola O: The influence of anaesthetic technique upon the immune response to hysterectomy: A comparison of propofol infusion and isoflurane. Anaesthesia 1995; 50: 1056–61
34. Crozier TA, Muller JE, Quittkat D, Sydow M, Wuttke W, Kettler D: Effect of anaesthesia on the cytokine responses to abdominal surgery. Br J Anaesth 1994; 72: 280–5
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text:
|Emily said these shoes were "just obnoxious |
enough" to push me through taper week.
|3 week taper |
By the time transition closed, I had done all of my last minute chores and was sitting on the beach with the wife and friends waiting for the cannon to fire. I decided to have a short warm-up swim and was surprised how tough it was to move through the surf. I hit the beach in time to hear last call for the starting line. Fortunately, there wasn't a lot of time for the anxiety to set in.
2.4 Mile Swim 1:13:26
|Big thanks to Larry from All American Swim|
for setting me up with the Huub wetsuit
After a few seconds, I thought somebody would call the fight. I really thought this couldn't be the way it was planned. It wasn't swimming, it was survival. I would get punched, kicked, or grabbed every stroke but there was no time to pause. A missed stroke meant getting dunked or swam on, over, or through. I "survived" the first lap and hit my feet to find calf cramps when I tried to push through the knee deep surf onto the beach. After making my way across the timing mat, I heard a guy say 35 minutes was his slowest first lap. I rejoiced. I ran down the beach 10-20 yards and back into the water I went, making a bee line for the red buoy. From my observation, this made the swim a bit longer, but I didn't have to wait in the que to get back to the straight-line path, and I didn't have to take another trip through the scrum until I hit the turn buoy. I didn't think that I was swimming directly into the current, and I probably spent a bit more time heading out than I planned. I actually was able to enjoy the swim to the next corner, and then I hit the swarm again. I fought my way back to the beach and stood up to find my calves cramping again. No worries, at least I was out of the water.
Transition One 5:13 (passing 145 athletes in T1, transitions matter!)
112 mile Bike 4:59:34 (Click for Garmin data)
|I can't believe my seat is too high.|
The ride was uneventful except for 3 encounters.
I happened upon a pace line of 4 guys a few miles before the bridge. I easily caught and passed them while maintaining my watts, but they immediately repassed. I went through the dance of sitting up and falling out of the draft zone only to lose a ton of ground. I just kept getting passed by folks. I could not pedal. So I elected to disregard the "drop back" rule and get to passing again. When I caught back up to the paceline, I passed a little more assertively and shook them off.
|Here's a little water for the Fam. |
Thanks for enduring the support duties!
Lastly, on the final leg of 79, I got caught up with a guy riding with power at a similar pace as me. We would pass each other only to slow down in the head wind and get repassed. I fought with him for a while before ultimately deciding to ride legal and sit behind him. When I would accidentally enter the draft zone, I would make a pass, and he would let me lead for a while before repassing and repeating the same dance again. This whole exchange dropped my power as I was soft pedaling a lot to ride legal, but I felt like it was a better option than trying to out ride him on the home stretch.
|How about that 1.0100 Variability Index?|
Transition Two 1:56 (7th fastest T2 overall!)
26.2 mile Run 3:24:39 (click for Garmin Data)
First, I made sure I was breathing 8 step cycles. Basically, I would inhale for four steps and exhale for four steps. I wasn't forcing it, I was just aware of it. I knew if I was breathing harder, I was working and it was way too early to work.
Secondly, I talked. I talked a lot. I talked to the aid station volunteers, spectators, and other athletes. I was really surprised to find the other guys didn't want to visit with me very much. So I just tried to be encouraging. Every time I passed someone I tried to make a joke, compliment them somehow, or remind them we were actually doing the IRONMAN!
|Early in the marathon, feeling good enough to float!|
|Feeling less good going out for loop 2|
My run nutrition goal was to take water and ice at every aid station and Gu as often as I could stomach it. I found about every second aid station to be perfect up to the last 10k. After the 10k mark, I took one last Gu/water and ran it in. I know I got down 7 that I can remember, but I am betting it was closer to 9 or 10. That is a lot more than what I took for B2B.
|Pretty even pacing overall. You can see mile 15 where I ran out of ice, |
and you can tell the last 2 miles, I fell off my average pace 45-50"
Overall, 140.6 miles 9:44:48 9th M30-34, 85th OA (click for official results)Accelerate 3 set me up with sweet power pacing guidelines, and even though I didn't spend my 205 watt average power allowance, I think I made the right, conservative decisions to score a fast bike split and protect a solid run split. Really, the marathon couldn't have gone better. I ended up with a ~2 minute positive split and didn't really fall off pace until the last 5k. My nutrition was spot-on with no GI issues. I also feel like I managed the heat as well as I could.
Next up is IM Cabo!
|This is my "finish strong face"|
|Hi Mom! at the end of Loop 1|
|Just out of T2. Accelerate 3 rarely has me do brick runs, and |
I can honestly say I never once thought that I should've ran more bricks during the marathon.
|One day I will qualify that shaka.|

domain: sports


text:
By Kelly Laycock
Have you been on our website lately? We’ve got lots of great resources available to our members through the password-protected Members’ Section. Here is a sample of some of our most popular legal research subscriptions.
An authoritative and comprehensive source for legislation, cases, commentary, forms, precedents and current events. Check out the following useful CCH guides:
Canada Law Book’s Criminal Spectrum database includes several criminal law textbooks, the Canadian Criminal Cases, a comprehensive collection of full-text unreported decisions, Weekly Criminal Bulletin case summaries, topical indexes, a case citator and search templates.
Another great database from Canada Law Book, DART has digests of judgments from the Western provinces dating back to 1980, plus a number of subject indices.
The Law Society Library’s agreement with LexisNexis Canada Inc. gives access to all law firms of 10 members or less, some conditions apply.
Published by Canada Law Book, the online version of the popular O’Brien’s Encyclopedia of Forms is a comprehensive source of Canadian legal forms and precedents. It includes thousands of regularly updated legal documents that can be customized to individual needs. The Law Society currently subscribes to the following online volumes:
New to the Law Society Library, rangefinder is a tool to help lawyers and judges find criminal sentencing ranges in seconds instead of hours. Click a few tags that describe the kinds of cases you’re looking for and rangefindr tells you what kind of sentences were imposed in those cases. One more click and you can review the judgments themselves. Try it out!
Ask one of our reference librarians:
Call 306-569-8020 in Regina

domain: library


text:
Yes, I do love to travel. I enjoy seeing the beauty of our country - meeting and talking to people. Flying is great for trips to other countries or when we just don't have time to drive. My favorite is still "The All American Road Trip". I like the planning - spending hours on Googlemaps and RoadsideAmerica.com. Ya just never know what's around the next bend in the road.
This trip will be much shorter than our last one - only about 4,000 miles as compared to 9,200 on the last trip! Every day for the last couple of weeks we've made additions to our map. I just keep finding things that need to be seen.
We aren't taking the MotorHome this time - we'll be driving my Third Brother's Honda Insight - great gas mileage. I only hope he doesn't find a moose head (or was that a steer?) or something similar (he really did find one on the last trip). Yes, we brought it home in the SUV - thought for a while we might have to tie it on the roof! Traveling with a "collector" is really interesting - especially when he collects just about everything!
Ken will be staying home to keep things under control - except for Bodacious the Beagle - he just can not be controlled.
Check back for some pictures as we travel up the east cost about as far north as we can go. On into Nova Scotia and Halifax - then over to Quebec before we begin a new route south. Might even find a few Frank Lloyd Wright houses along the way.

domain: travel


text:
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domain: design


text:
I was having a hard time finding an affordable bed canopy for my daughters room. So I decided to make one myself and for just $5.00 you can make this beautiful bed canopy! You will never guess what I made it out of - head on over and take a look!
INDOOR window box for girls room, too cute...The simplest way I to make this is..purchase a simple plastic window flower box from your local garden supply store. Cover the front, bottom and side with fabric (a hot glue gun ). Colour choices, flowers etc are yours. Add a " brick " of floral styrofoam so that flowers etc can be pushed into it. It should be light weight and easy to hang.

domain: artistic


text:
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domain: finance


text:
MEERBUSCH, August 14, 2019
Top seed Pedro Sousa opened his title bid at the Tennis Open Stadtwerke Meerbusch on Wednesday with a 6-3, 7-5 second-round win over ITF-entry Karim-Mohamed Maamoun of Egypt.
In front of about 500 spectators at the GWR Büderich, the World No. 148 from Portugal broke his opponent’s serve five times, winning 52 per cent of the total points played to secure victory in one hour and 25 minutes.
“Although he showed some weaknesses in the second, he will remain one of the top contenders for the title here,” Yonex Tennis Base coach Marius Meiszies commented on Sousa’s performance.
Up next for the 31-year-old from Lisbon will be young Spaniard Javier Barranco Cosano, who defeated Julian Lenz from Germany 7-5, 6-2.
Pedja Krstin, third seed of the €46,600 ATP Challenger clay-court event, also booked his spot in the third round. The 24-year-old from Serbia remained untrobled in his 6-1, 6-4 win over German wild card entry Lucas Gerch. Krstin finished the encounter after one hour and 15 minutes and will next meet Facundo Mena from Argentina.
Jan Choinski edged past Spanish veteran Daniel Munoz de la Nava, winning 6-2, 6-4. The No. 7 seed representing Great Britain capitalized on four of his 11 break point chances to advance after one hour and 35 minutes. Choinski will next face 10th favourite Aslan Karatsev of Russia.
Carlos Taberner fought past No. 4 seeded Frenchman Tristan Lamasine, rallying 6-7(4), 6-4, 6-2. The 22-year-old from Spain sent down six aces, winning 70 per cent of his first-service points to prevail after two hours and 33 minutes. Taberner set a third-round clash with Germany’s Benjamin Hassan, 16th seed of the tournament.


text:
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text:
Architectural colour and power: a case study of the Summer Palace, Beijing (1750-1912)
Item statusRestricted Access
Embargo end date20/07/2024
Although for the Chinese authorities, colour, and in particular architectural colour, has always been a crucial way to exercise influence, classify hierarchies, and maintain national and international order, the significant relationship between Chinese architectural colour and political power has long been being neglected by theorists and historians. This thesis addresses this omission. The power-oriented use of colour was continually exercised from the Shang Dynasty (ca.1600-1046 BC) to the Qing Dynasty (1636-1912), although the meanings of specific and related colours changed and evolved as they were continuously renewed in response to changes in the social context and the appearance of new knowledge. This thesis focuses on the Summer Palace in Beijing(1750-1912), which witnessed how the Qing Empire went from its apogee to its collapse. The Palace is a microcosm of the Qing Empire constituted by over 3,000 buildings, which were purpose-built for the imperial court, including religious temples, royal residences, and the naval academy. All these buildings were constructed to perpetuate the supremacy and legitimacy of successive sovereigns. Accordingly, the thesis investigates how the colour of these buildings demonstrated and implemented imperial power, laying particular emphasis on four integral perspectives: politics, religion, the imperial family, and the military. The aim of the thesis is to answer three questions: why were specific colours chosen by the Qing Monarchs for the Palace; how did these colours express and exercise power; and what kind of social-political results were produced by successive colour schemes? The thesis offers a new way of understanding architectural colour in the Chinese context and particularly during the Qing Dynasty, when architectural colour was employed in the service of authority. It was a practical technique for the expression of monarchical power that functioned in many dimensions, ultimately as a web of power relations. In exploring the importance of architectural colour in the historical context, the thesis will also shed light on both the use and interpretation of colour in contemporary architectural practice in China.


text:
Murder By Association
by Gary Starta
As Boston’s most lethal serial killer jeopardizes the city’s anniversary celebration, CSI Detective Stanford Carter desperately fights for forensic clues to nail the perp. But the “Plunger” after stabbing his victims through the heart, leaves only Tarot cards as evidence. The mayor demanding an arrest is also keeping a secret. Soon, something even more dangerous threatens the city. Carter must find out what it is before it steals his sanity and the life of the woman he loves.
Praise for Starta
“Reading a Gary Starta book is a pleasure and a heart pounding adventure. No matter which book by this author you choose you will be thoroughly entertained. I suggest you try all he has to offer.”
“I can honestly say there are a hand full of authors that wins my support one hundred percent. Gary Starta is one of those authors. He has a writing proficiency that is impeccable and never predictable. An author that does his research to ensure a gripping and believable reading experience.”
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domain: literature


text:
Get ready to embrace fall InStyle! R&B Diva Beyoncé covers of the famed fashion magazine everywhere. Looking flawless in a bronze and gold star-embellished mini-dress, Bey opens up about an eclectic amount of topics, ranging from her guilty pleasure of MTV’s Jersey Shore to plans of a possible career transition into motherhood:
“When you’re young —18 or 19 — you have the energy and drive. That’s the time to work as hard as you can. Now I’m a woman, and because I gave it my all, I can focus on my marriage. I can decide I want to have kids. I can be the mother I want to be and dedicate myself to my children,” she states in her cover story.”
While Beyoncé toils with the possibility of motherhood, she also touches on her opinion of women with little to no female friends:
“I am a girl’s girl. Women who don’t have female friends scare me. I love my friends, and I love sitting with them and listening to their stories.”
While her latest album 4 continues to blaze the charts as fans wait in anticipation for what this dynamic vixen may do next, the “Party” singer has this to say about last year’s break from living life in the fast lane:
“It was great to be a wife and travel with (my husband). I had to turn down great things. I did it for my sanity, my life, my relationships, my nephew, my husband, my sister and my friendships. I deserved to give myself time to focus on things besides performing, filming and recording.”
Read more of Beyonce’s compelling interview in the September issue of InStyle hitting newsstands soon. In the meantime, click the link to take a look at some of the behind the scenes footage: Beyonce’s In Style Photo Shoot.
Props: Nicole Bitchie


text:
The current Agreement will expire January 14, 2016. Accordingly, be advised that a call for contract proposal changes is now in order. All such proposals are to be submitted on contract proposal forms which can be obtained from your steward or via the District Lodge 142 website:
When submitting more than one proposal, please use separate forms.
Contract proposed changes must have your name, signature, IAM Book number and be received in the District 142 Office no later than December 31, 2015 for consideration.
With best wishes, I remain
Sincerely and fraternally,
Otha “Mac” McSwain, Jr.

domain: law


Causality and Generalizability: Identifiability and Learning Methods
This PhD thesis contains several contributions to the field of statistical causal modeling. Statistical causal models are statistical models embedded with causal assumptions that allow for the inference and reasoning about the behavior of stochastic systems affected by external manipulation (interventions). This thesis contributes to the research areas concerning the estimation of causal effects, causal structure learning, and distributionally robust (out-of-distribution generalizing)
... methods. We present novel and consistent linear and non-linear causal effects estimators in instrumental variable settings that employ data-dependent mean squared prediction error regularization. Our proposed estimators show, in certain settings, mean squared error improvements compared to both canonical and state-of-the-art estimators. We show that recent research on distributionally robust prediction methods has connections to well-studied estimators from econometrics. This connection leads us to prove that general K-class estimators possess distributional robustness properties. We, furthermore, propose a general framework for distributional robustness with respect to intervention-induced distributions. In this framework, we derive sufficient conditions for the identifiability of distributionally robust prediction methods and present impossibility results that show the necessity of several of these conditions. We present a new structure learning method applicable in additive noise models with directed trees as causal graphs. We prove consistency in a vanishing identifiability setup and provide a method for testing substructure hypotheses with asymptotic family-wise error control that remains valid post-selection. Finally, we present heuristic ideas for learning summary graphs of nonlinear time-series models.


text:
My personal message to you
I have been involved in sport all my life, from playing Rugby up County Level, to Karate and Thai Kickboxing. I bring that passion into all my sessions, unless you are dedicated to a specific sport, training should be varied to keep it interesting.
As a personal trainer I concentrate on three main things. Client experience, trainer-client relationship and results. I recognise that every client is different and should have a tailor made training program to allow them to reach their goals.

domain: hobby


text:
A week ago Friday, I stopped to watch President Trump’s inaugural address. Halfway through, I was almost expecting machine guns to open up and blow him to bits. How dare he say things like this, when we’re all supposed to be caught up in the moment:
But for too many of our citizens, a different reality exists: Mothers and children trapped in poverty in our inner cities; rusted-out factories scattered like tombstones across the landscape of our nation; an education system, flush with cash, but which leaves our young and beautiful students deprived of knowledge; and the crime and gangs and drugs that have stolen too many lives and robbed our country of so much unrealized potential.
This American carnage stops right here and stops right now.
But, in fact, he’s right. We are a troubled nation, and the first step in fixing the troubles is acknowledging that they exist.
The next day, I dug up Obama’s address from 2009, and replayed Trump’s version. There were telling similarities: both Presidents were representing themselves as a break from the past and a new direction. But Obama was polite and circumspect, like a politician, while Trump was blunt and forceful, like a new CEO brought in to resurrect a failing corporation.
* * *
Enough with the posturing, already.
Many fewer people showed up to witness Trump’s inauguration in 2017 than Obama’s in 2009. The weather was worse this year; Trump is another white guy; many in the northeast United States, within 200-300 miles of Washington, supported the other candidate. Perhaps some people even imagined that machine guns might open up in the middle of the inaugural address.
But then the new Administration waded into the issue to challenge what seemed an obvious truth. It doesn’t accomplish anything and just makes them look petty.
Similarly, the President of Mexico, perhaps riled by some of President Trump’s statements, cancelled his planned visit. Trump responded:
The President of Mexico and myself have agreed to cancel our planned meeting scheduled for next week. Unless Mexico is going to treat the United States fairly, with respect, such a meeting would be fruitless, and I want to go a different route.
No, you didn’t mutually agree: he cancelled. If he hadn’t, the meeting would still be happening. Don’t pretend otherwise.
* * *
Yesterday’s Daily News featured a graphic of the Statue of Liberty weeping in response to President Trump’s executive orders on immigration. “Trump needs to read the inscription on the statue,” someone remarked at the restaurant where my wife and I were having lunch.
A century ago, the ‘huddled masses’ and ‘wretched refuse’ came to America under their own power. They saved their money and paid for their own passage. They knew there were hardships and dangers, and that they would have to adapt to their new land, not the other way around.
It would be one thing if people organized a charitable endeavor to bring refugees into the United States. The government’s role in this would be issuing visas for entry and nothing more. Congress could authorize some quantity of refugee visas to be paid for by the taxpayers, but that would be it. The charities running the operation would be responsible for transportation, providing a place for the refugees to stay when they arrived, and acclimating them to life in the United States.
But that isn’t what’s happening. The government is funding, at taxpayer expense, the arrival of these refugees. There are religious organizations, functioning as government contractors, doing the work.
We didn’t do this a century ago. Why do we feel the need to do it now? What national interest does it serve?
Alas, I didn’t get the memo.

domain: sociology


We are a husband and wife team - Fahmy and Erliana, hell bent on lessening our contribution to the landfills by mending your loved garments one piece at a time. Based in Singapore, our business ethos is centered around mottainai, which means to waste nothing. Largely influenced by Japan's aesthetics and values, we make aprons and lifestyle products. We also specialise and teach the art of boro, an ancient method of mending and repairing old or torn garments to prolong its use. We strive to make all our products with minimal waste and sustainability in mind, as well as re-using fabric remnants in our boro mending craft.


text:
Although fans were excited to see Cee-Lo Green and Goodie Mob back together, the true star of the set was Jean Sok, a one-legged dancer from Cirque du Soleil's Michael Jackson The Immortal World Tour. Dressed as a soldier, Sok gave a truly powerful performance and left a lasting impression on viewers.
Clad in white Adidas tracksuits, the hip-hop foursome (Cee-Lo Green, Khujo, T-Mo, and Big Gipp) then surprised the audience by launching into the Beastie Boys classic, "(You Gotta) Fight for Your Right (to Party!)," as a tribute to Adam "MCA" Yauch, who lost his battle with cancer earlier this month.
In other Billboard Music Awards news, Katy Perry picked up the Spolight Award for matching Michael Jackson's record of five No. 1 singles on the Billboard charts off a single album.
Teenage Dream spun off the No. 1 Hot 100 hits "California Gurls" (featuring Snoop Dogg), "Teenage Dream," "E.T." (featuring Kanye West), "Firework" and "Last Friday Night (T.G.I.F.)." The singer nabbed yet another No. 1 this year, with "Part of Me," the first single off the special edition album Teenage Dream: The Complete Confection.
Perry, who brought her 91-year-old grandmother to the awards show, debuted her new single, "Wide Awake," live on the BBMA stage. The track was written for her upcoming 3-D film Katy Perry: Part of Me.
Meanwhile, Taylor Swift was honored as Billboard's Woman of the Year, with actress Zooey Deschanel presenting the country crooner's award for her chart-topping records, sold out concerts and for being, well, adorkable. Swift was actually named Billboard's Woman of the Year in October 2011, but why not celebrate it twice?
Billboard also honored the life of music legend Whitney Houston, who passed away in February 2012. Musicians John Legend and Jordin Sparks were on hand to perform a medley of Houston's greatest hits. Sparks, who starred oposite of Houston in her last film "Sparkle", performed Houston's seminal single, "I Will Always Love You." Houston's daughter, Bobbi Kristina, accepted the Billboard Millennium Award on her mother's behalf.
"I just really want to say thank you to everyone who supported us through it all," she said. "Not just when it was good, but when it was bad too ... Thank you so much for showing that much love, because she deserved it."
Hosts Ty Burrell and Julie Bowen, the stars of ABC's "Modern Family", also paused for a moment of silence for the recent passing of Bee Gee Robin Gibb.
Singer Natasha Bedingfield paid tribute to disco legend, Donna Summer, who also lost her battle with cancer just last week.
On a lighter note, Alicia Keys honored Stevie Wonder with the Billboard Icon Award. The duo performed a medley of Wonder's hits, "Higher Ground" and "Overjoyed." But before getting off the stage, the pair had one more surprise in store. With a little encouragement from Wonder, who recently celebrated his 62nd birthday and had one wish for the soulful songstress, Keys belted out the chorus of Jay-Z's "Empire State of Mind."
The Billboard Music Awards were held in Las Vegas, but since when has there been an inspirational song about Sin City?
Note: Adele won 12 awards, but you would have never known that after watching the Billboard Music Awards, so luckily, we have the full list below.
Top Artist: Adele
Top New Artist: Wiz Khalifa
Top Male Artist: Lil Wayne
Top Female Artist: Adele
Top Duo/Group: LMFAO
Top Billboard 200 Artist: Adele
Top Hot 100 Artist: Adele
Top Digital Songs Artist: Adele
Top Radio Songs Artist: Adele
Top Touring Artist: U2
Top Social Artist: Justin Bieber
Top Streaming Artist: Rihanna
Top Digital Media Artist: Adele
Top Pop Artist: Adele
Top R&B Artist: Chris Brown
Top Rap Artist: Lil Wayne
Top Country Artist: Lady Antebellum
Top Rock Artist: Coldplay
Top Alternative Artist: Coldplay
Top Latin Artist: Shakira
Top Dance Artist: Lady Gaga
Top Christian Artist: Casting Crowns
Top Billboard 200 Album: Adele '21'
Top Pop Album: Adele '21'
Top R&B Album: Beyonce '4'
Top Rap Album: Lil Wayne 'Tha Carter IV'
Top Country Album: Jason Aldean 'My Kinda Party'
Top Rock Album: Coldplay 'Mylo Xyloto'
Top Alternative Album: Coldplay 'Mylo Xyloto'
Top Latin Album: Romeo Santos 'Formula: Vol. 1'
Top Dance Album: Lady Gaga 'Born This Way'
Top Christian Album: Casting Crowns 'Come To The Well'
Top Hot 100 Song: LMFAO Feat. Lauren Bennett & GoonRock 'Party Rock Anthem'
Top Digital Song: LMFAO Feat. Lauren Bennett & GoonRock 'Party Rock Anthem'
Top Radio Song: Pitbull Feat. Ne-Yo, Afrojack & Nayer 'Give Me Everything'
Top Streaming Song (Audio): Adele 'Rolling in the Deep'
Top Streaming Song (Video): Nicki Minaj 'Super Bass'
Top Pop Song: LMFAO Feat. Lauren Bennett & GoonRock 'Party Rock Anthem'
Top R&B Song: Kelly Rowland Feat. Lil Wayne 'Motivation'
Top Rap Song: LMFAO Feat. Lauren Bennett & GoonRock 'Party Rock Anthem'
Top Country Song: Jason Aldean 'Dirt Road Anthem'
Top Rock Song: Foster The People 'Pumped Up Kicks'
Top Alternative Song: Adele 'Rolling In The Deep'
Top Latin Song: Don Omar & Lucenzo 'Danza Kuduro'
Top Dance Song: LMFAO Feat. Lauren Bennett & GoonRock 'Party Rock Anthem'
Top Christian Song: Laura Story 'Blessings'


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India’s wheat output dented by heatwave, could limit government stock building
A heatwave in northern and central India at a time the crop is ripening is threatening to damage grains and dent the country’s wheat production for the second straight year.
The reduction in production amid a drop in inventories to the lowest level in 6 years may force the world’s second biggest producer of the grain to allow imports after banning exports last year.
“Winter hasn’t ended yet, but during the day temperatures rise like summer,” said Rameshwar Chowdhury, who has planted wheat on six acres in the Niwai village in the northwestern state of Rajasthan.
“We are irrigating fields to limit the impact, but beyond that we can’t do anything.”
The maximum temperature in some wheat-growing areas jumped above 39 degrees Celsius for a few days in February, nearly 10 degrees Celsius above normal, according to weather department data.
Higher temperatures would lead to early maturity of the crop and grains could be shrivelled, like they were last year, said Chowdhury.
India recorded its highest ever maximum temperature in February and the weather office has warned the country is likely to experience another heatwave in March, especially in the key wheat-producing central and northern states.
A heatwave in March could further harm the crop, which has already been showing signs of stress, said another farmer, Gopilaal Jaat.
In 2022, a heatwave in March curtailed India’s wheat production to 100 million tonnes against local consumption of 103.6 million tonnes, estimates the U.S. Department of Agriculture’s Foreign Agricultural Service.
India last month estimated wheat production in 2023 could rebound to a record 112.2 million tonnes, but trade bodies are less optimistic due to the heatwave.
“Higher temperatures in March can trim output by 4 to 5 million tonnes. We are estimating production of around 106 to 107 million tonnes,” said Pramod Kumar S, president of the Roller Flour Millers’ Federation of India (RFMFI).
Global and Indian trade houses are even more bearish and forecasting a far bigger drop in production.
“We trimmed the estimate to 103 million tonnes from 109 million tonnes,” said a New Delhi-based dealer with a global trading firm, adding production could fall to around 100 million tonnes if temperatures remain above normal in March as forecast by the weather department.
Lower production would keep wheat prices WHE-ATDEL-NCX above the government’s buying price and encourage farmers to sell to private players, the dealer said.
State purchases fell by 53% in 2022 to 18.8 million tonnes, pushing up local rates and forcing the government-backed Food Corporation of India (FCI) to release 5 million tonnes of the grain from its reserves to cool prices.
But the sales, which are ongoing, would halve the government’s stocks at the start of the April-March marketing year to 10.2 million tonnes, the lowest in six years, estimates USDA.
To replenish stocks, the government is aiming to procure about 34 million tonnes from farmers in 2023.
“The government will do everything to ensure food security and to keep prices under control. It can even allow imports if needed,” said Kumar of RFMFI.
Source: Reuters (Reporting by Rajendra Jadhav; Editing by Raju Gopalakrishnan)

domain: agronomy


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The lush cushion-cut amethyst in this 14k rose gold pendant necklace commands attention. A halo of brilliant round diamonds provides a luminous finish. Adjustable cable chain length delivers a just-right fit.
The item you've selected is exceptional and deserves special attention. Please phone a diamond and jewellery expert and they will help you complete your order.


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In marking the 20th anniversary of the International Year of the Family (IYF), Parenting in Africa Network (PAN) and its partners recently hosted a Regional experts’ meeting at the Hilton Hotel in Nairobi, Kenya, whose theme was “Restoring families as the Pillar of Development in Africa”. The meeting brought together over sixty (60) participants, drawn from 9 countries in Africa. They included representatives from CSO’s, Regional and International NGO’s, Government Departments, Academia, the Private sector, Policy Makers, Family Services Practitioners, individuals and a representative from the African Union AU - Committee of Experts on the African Charter on the Rights and Welfare of the Child.
Outcomes: A call to action: http://parentinginafrica.org/d2/index.php/topics/89-a-call-to-action-iyf-20 (kindly follow link to endorse/comment and read a detailed background of the call) was developed in the regional meeting, ahead of the 20th Anniversary of the International Year of the Family on 15th May, (and the 10th anniversary of the Plan of Action - PoA - on the family in Africa).
The Plan of Action calls on Member States to “develop national capacities to reduce poverty at the family level and to increase the income per capita and GDP” (p.10). It also aims at guiding African Union Member States in designing, implementing, monitoring and evaluating appropriate national policies and programmes for the family on the basis of their specific requirements and needs.
Reflections on Africa's Indigenous knowledge on Parenting: indigenous parenting practices of different communities in Africa (2014): Enjoy PAN’s (recently launched) studies showcasing forgotten indigenous parenting studies, of 4 African countries, through the following links:
Source: Parenting in Africa Network (PAN)
3 December 2012 - Betty Nalukwago had kept her illness a secret from her children. It was only Jessica Semambo, now a worker of Phoebe Educational Fund, a non-governmental organization that cares for the elderly, who knew what was ailing her mother.
10 November 2012 - EDITORIAL. A survey commissioned by the government shows that about 247,000 families countrywide are embroiled in different types of conflicts that risk breaking them up.
6 November 2012 - It is tough mothering albinos with other disabilities; but as Geoffrey Namukoye reports, Joyce Salirwa keeps her spirits up, and her hope alive.
Children depend on parents to provide a stable environment. However, when parents start favouring one child over another, the less fovoured get less perplexed and will ask where they went wrong.
There are consequences for all those who engage in unprotected sex. However, teenagers are particularly at risk, mostly because they use effective contraception less consistently than adults. No surprises, then, that the reduction or delay of sexual involvement among young people has become a major priority for policy-makers motivated by concerns about sexually transmitted infection and unintended pregnancy.
Parents with children serving prison sentences have been requested to visit them more frequently and contribute towards their rehabilitation process.
Nearly fifty per cent of the street children in the major urban centres in the oil producing region of South Sudan appear to have been forced onto the streets due to the abuse of their rights, cruelty and a lack of parental care.
Families headed by youths aged 15 to 24 are on the rise, a study conducted by the Institute of Economic Affairs has revealed.
"Child's right in a Modern Society" was the title of the lecture delivered on November 18, 2010 at the Odundun, Townhall, Ile-Oluji, by Chief Makanjuola Esan, former Attorney-General of Ondo State in 1994-1996 and pioneer A-G of Ekiti State, 1996-1997. The lecture was delivered as part of activities marking the 20th Coronation Anniversary of His Royal Majesty, Oba S.S. Adedugbe, FNSE, The Jegun Olu-Ekun and Paramount Ruler of Ile-Oluji Kingdom.
Selection of documentaries on key Child Rights issues in Africa from various sources.


The culprit in many cases is your home’s air ducts. Whether it’s the age of your home, a recent pesticide treatment, or other lifestyle factors, air ducts eventually accumulate dirt, debris, allergens, and – if moisture is present – mold, which releases spores into your home’s living spaces.
If you suffer from these symptoms, you should identify their specific root issues with a professional indoor air quality assessment. With your assessment complete, you’re ready for targeted air duct cleaning services that address your air ducts’ biggest issues.
When you evaluate potential air duct cleaners for your home, confirm that their services match the following expectations:
- Double-check that you know what is going to be cleaned and what won’t. Air duct cleaning services vary widely depending on the size of the system to be cleaned, the system’s accessibility, your climatic region, the company’s air duct cleaning technology, and the level of contamination.
- Air duct cleaning services may range between (though not always) $450 and $2,000, depending on the above factors.
- Your air duct cleaning should cover all of the following parts: the supply and return air ducts and registers, grilles, diffusers, heat exchangers, heating and cooling coils, condensate drain pans (drip pans), fan motor, fan housing and the air handling unit housing. Failure to clean one dirty component results in the recontamination of your entire system.
- Ensure your air duct cleaning company agrees to clean all components in your system and is qualified to do so. Some cities require that air duct cleaners have appropriate licenses and certifications, so confirm their qualifications before they begin.
- Check that your air duct cleaning company has the right tools for the job. Typically, air duct cleaners use specialized tools to dislodge dirt and other debris from the ducts, and then use a high-powered vacuum cleaner to draw the debris out.
- Educate yourself beforehand if you want chemical biocides or sealants inside your systems. Some air duct cleaning service providers claim that these chemical treatments or sealants control mold growth or prevent dirt buildup in ducts, but such practices haven’t been fully researched. No matter your decision, any sealants should only be applied after a full system cleaning.
With these air duct maintenance and cleaning tips in mind, act today to relieve your indoor allergy or asthma symptoms with a proper indoor air quality assessment and air duct cleaning.
If you’re looking into air duct cleaning services, choose an air duct cleaning company you already trust. On Time Experts helps relieve your home respiratory symptoms with air duct cleaning that keeps your house tidy and your home comfortable.


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4.8out of 3,000+ reviews
Pennsylvania Average Cost of Car Insurance Rates (2022)
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On average, car insurance rates for drivers in Pennsylvania are $200 per month, and $2394 per year. The average rates make Pennsylvania the 28th most expensive state in the country for car insurance rates and 12% less expensive than the national average.
Keep in mind that average auto insurance costs are determined by factors other than location. Based on your driving history, credit score, age and marital status you should be able to find insurance quotes and discounts so that your monthly payment is less than the averages cited here.
Insurify's comparison tool will help you make sure you're getting the best possible quote based on your needs and location. You can have peace of mind you're not paying any more than the average price in your state, and customers save $48 per month on average.
Insurify analyzed car insurance rates in the twenty most populous cities in Pennsylvania and has selected the following providers and quotes as the best rates for drivers in Pennsylvania.
For drivers in Pennsylvania, it's important that you evaluate all of your potential insurance options to ensure you are finding the best rate. Based on internal Insurify data, here are the average cost of car insurance rates for drivers in the top 10 cities in Pennsylvania.
|City||Avg. Monthly Rate|
Compared to other states––where they could pay average rates over twice as much––Pennsylvania teenagers spend a reasonable $349 per month on car insurance. People in their 20s reduce their monthly rates by over $100 as they get more driving experience under their belts.
Are you in your 30s, 40s, or 50s? You'll save a minimum of $25 a month compared to the average monthly cost for Pennsylvania drivers. Those drivers approaching retirement and beyond get the best deals. As a category, they drive less often and for fewer miles, and their rates reflect that.
|Age||Avg. Monthly Rate|
Men and women pay almost the same in Pennsylvania. There's a $7 difference between them, which can be attributed to the fact that women are statistically safer drivers and therefore cost less to insure.
|Gender||Avg. Monthly Rate|
Married Pennsylvania drivers pay an average of $20 less for their monthly premium when compared to their single counterparts.
Financial advisors and other experts point out that marriage adds stability, a higher net worth, and even tax benefits. At $20 per month, you can add up 240 more reasons a year to tie the knot.
|Marital Status||Avg. Monthly Rate|
Pennsylvania has a no-fault system, which means drivers file with their own insurance company after an accident. The law requires $15,000 in bodily injury liability per person and $30,000 per accident, $5,000 in property damage liability per accident, and $5,000 in personal injury protection (PIP) per person per accident. To protect your car itself, you'll need comprehensive and collision coverage.
Since the state allows insurance companies to use credit score as a rating factor, Pennsylvanians with excellent credit pay a little less than folks with poor credit. By the way, excellent credit starts at an 800 score. Why do folks with average and good credit pay more than those with poor credit? Drivers in those categories can afford more expensive cars and higher levels of coverage.
|Credit History||Avg. Monthly Rate|
"Safety first" is not just a mantra that saves lives. It also saves money. Common sense tells us that the safest drivers will pay the least, and safe drivers qualify for "good driver" and "accident-free" discounts. But what if your record is less than perfect?
Drivers with a speeding ticket in Pennsylvania should expect their monthly rate to increase marginally —plus fines. Drivers with an at-fault accident on their insurance record should expect to see monthly rates increase by around $20. Accidents happen, but driving safely and keeping a clean record are the best ways to avoid rate hikes. Remember, violations and accidents will stay on your insurance history for years to come. Still, you can still take a defensive driver course to reduce your monthly payment.
|Driving History||Avg. Monthly Rate|
Eastern Pennsylvania still outpaces the western part of the state, but altogether the population continues to grow. That means no matter which half you call home, your streets will soon be a tad more congested, and car insurance becomes a greater necessity if you want to avoid accidents or other scrapes.
Here's your chance to try Insurify 's rating tool and compare up to 10+ real quotes in less than two minutes. Unlock savings and discounts as you find the coverage you deserve at a price you can afford.
Use Insurify for all of your car insurance comparison needs! Compare and connect directly with the top insurance companies to find the best rates as well as the most personalized discounts and coverage options. Insurify’s network includes over 200 insurance companies throughout the U.S. who can work with you to get you the right auto insurance policy at the cheapest price. See All Auto Insurance Companies
There are many different factors that go into the how expensive your car insurance is. That said, some of the reasons why you could be paying so much for your insurance include: living in a state with high minimum insurance requirements, being a young or new driver, committing past traffic offenses like at-fault accidents or DUIs, and having a low credit score.
Auto insurance costs will vary between locations and insurance carriers, depending on the county Pennsylvania. Insurify analyzed the latest data for the five most populous cities in Pennsylvania to find you the cheapest quotes in each of these metropolitan areas.
The way to find the carrier with the best auto insurance ratings in Pennsylvania and save on your insurance premiums is to compare quotes from all companies in your area. Use a car insurance quotes comparison site like Insurify to compare up to 10+ real quotes for your specific driver profile and unlock savings and discounts. Rates can fluctuate greatly based on whether you're a safe driver or a high risk one, but you should never overpay. Insurify provides the cheapest car insurance quotes and companies in your area in just a few seconds.
During the past three years in the United States, national premium costs have risen an average of 4.5 percent annually. In states where quotes have risen, this figure has been 7.8 percent; and in those where rates have fallen, prices have decreased by approximately 6.0 percent. Individual rates by state will of course vary depending on the driver’s history and a multitude of factors.
The car insurance quotes displayed are based on an analysis of Insurify’s database of over 40 million quotes from 500 ZIP codes nationwide. To obtain representative rates, Insurify’s data science team performs frequent comprehensive analyses of the factors car insurance providers weigh to calculate rates including driver demographics, driving record, credit score, desired coverage level, and more.
Insurify’s analysis also incorporates the Insurify Composite Score (ICS) assigned to each insurance provider. The ICS is a proprietary rating that weighs multiple factors reflecting the quality, reliability, and health of an insurance company. Ratings used to calculate the ICS include Financial Strength Ratings from A.M. Best, Standard & Poor’s, Moody’s, and Fitch; J.D. Power ratings; Consumer Reports customer satisfaction surveys and customer complaints; mobile app reviews; and user-generated company reviews.
With the above insights and ranking methods, Insurify is able to offer car insurance shoppers insight into how various insurance providers compare to one another in terms of both cost and quality. Note, actual quotes will vary based on unique attributes including the policyholder’s driver history and their garaging address.


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This Fund Manager Rating is based on the Citywire Long Only ratings methodology
Citywire Ratings are rewarded for risk adjusted outperformance of benchmarks we select independently More information on how Ratings are calculated
About Clive Smith
Based in the firm’s Sydney office, Clive Smith is a portfolio manager for Russell Investments. Smith’s responsibilities include researching Australian fixed income managers as well as managing Russell’s Australian fixed income and cash portfolios. Prior to joining Russell, Smith worked with TOWER Asset Management (Aust) Limited for eight years and for four years as a money market and fixed interest dealer for Westpac Investment Management Limited in Sydney. Smith is a member of the CFA Society of Sydney and a senior associate of the Financial Services Institute of Australasia.
Citywire Rating: Not Rated
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Month by Month Performance


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(CBS) How does Sofia Vergara keep that amazing bikini body with all the curves in the right places?
The 37-year-old Emmy-nominated "Modern Family" star says she is "addicted to sugar," but sucks on lollipops to curb her craving for much worse.
"My problem is desserts. I am obsessed with desserts," she told Shape magazine.
"I am sure it's not good," she said of those darn lollipops, "but it's better than ordering tiramisu, which is what I really want to do."
More seriously, Vergara told Shape that she keeps a solid diet and exercise regimen that includes that Tracy Anderson dance method.
"I am not very obsessed with dieting and working out, but I always do it," she said. "I try to do everything in moderation. With age, I realize I have to do it more and more, unfortunately."
Vergara said she is lucky that her television character is supposed to be curvy.
"People expect... a woman to be a little more voluptuous. So they don't expect you to be really thin," she told Shape. "So it's easier for me. I don't really have to keep myself. Because I have to fill all those outfits, you know. They want to see Gloria like a voluptuous woman."
On "Modern Family," Gloria is the sharp-witted, hot-tempered wife of "Married with Children" alumni Ed O'Neill.
But in real life, Vergara has not always been as lucky.
In 2000, she secretly battled thyroid cancer and eventually had her thyroid gland removed, according to an interview with Health.com.
"When you go through something like this, it's hard, but you learn a lot from it," she told them. "Your priorities change. You don't sweat the small stuff. And it had a good ending."
Vergara currently has an Emmy nomination for Outstanding Supporting Actress in a Comedy Series.

domain: celebrity


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We did it! And Yeah, we did it!
Since 2012, Christmas with Rudi International has been a great opportunity for the children and the whole Lac Vert community to gather, rejoice and to have fun, enjoying the time together. We are really humbled to see God using us to bring some joy to this community which is comprise of people affected by war in the region. Last year, we had a great celebration with over 300 kids. See details!
In 2013, with your support, we have been able to reach even more and more people. We were able to involve the whole community, the celebrations taking two days! We gathered three separated groups on Dec 24th and the big celebration with everyone on Dec 25th. It was actually a special and unique opportunity in the area where parents are not able to offer anything on this special day for their kids. We are thankful to you for allowing us to bring this in the community.
The day before Christmas
On December 24th, we were able to organize an art workshop, focused on the 32 kids enrolled in our education program. This workshop was led by our youngest and new volunteer Daniel and it was a great opportunity for the kids to open up their minds to develop their artistic side. Both boys and girls were admitted in this workshop. A cocktail was served at the end.
“We are drawing the Holy Family, representing the little Jesus, Marie his mother and Joseph his daddy. Daniel explained us that story and I can now explain to others how things went the day Jesus was born in Bethlehem without even referring to the Bible”, commented Marko (13 years old), one of our sponsored kids.
The second group, in a separate classroom, was formed by 20 youth (aged 15 to 26 years old, young men and women). All of them were from the community, some have been to school, and others haven’t got the chance to be at school. This workshop was led by our own Arsene Tungali and he talked about their role as young people in the development of their community. The discussions were really interesting and good resolutions came out. They all agreed to take active part in activities aiming to help the Lac Vert community go forward. A cocktail was served at the end.
The 3rd group was focused on women, 27 mothers attended. The workshop was directed by Mama Jeanet, our volunteer, a great women who is directing the “Encourage Mothers” program, our new program focused on the mothers in the community. They celebrated Christmas on their own, talking about their role as women to support their families, building strong families. They could sing, dance and forget a little bit their problems, focus on Christ whose birth date was celebrated.
At the end, the youths and women received a small package (rice, soap, beans, kitchen oil, etc), to make sure they celebrate Christmas on the next day while we will be feasting with the kids on the following day.
See more photos at http://www.facebook.com/rudiinternational
Friends, know that we couldn’t do this without your support. Your contributions and support did work perfectly and we are really thankful to have you with us. We are working on making the change one step at a time. With you, we are building a strong, motivated community as we are developing specific programs that touch every generation: from working initially with the kids, young adult (first in Goma but now in the Lac Vert community as well) and women.
Do not hesitate to be part of this, just use our Online Donations page.
The Christmas day, the big and open celebration
December 25th was the D-day and we were excited to see it happen. Our volunteers were ready and have been working on it the whole week before, making sure we have everything in place (football materials, bottle of water for different activities, bananas and the kitchen for food). Specifically for this day, we were happy to have new volunteers joining us, supporting us on the ground. And we were really happy to have the 20 young adults who attended the workshop with Arsene to be willing to serve alongside with those coming from Goma. Their commitment confirmed to us that our work is fully supported by the community and the young adults did receive very well the message.
On that day, so much exciting activities were organized. The kids were already present at the school compound waiting for the team coming from Goma (10 kms away). The football teams that were selected to play were already there waiting for the new football that we had to bring for them before the match can start. Three local teams played and we had one winner who received a gift from Arsene Tungali.
Other activities followed, conducted by our volunteers (Serge and Blaise leading the team) and the Santa we brought from Goma to entertain the people at Lac Vert. The celebrations took place from 10am to 5pm and at the end, we served a public meal to over 300 kids who attended.
Blaise Ndola, one of our core volunteers noticed: “I think this year, the kids were much motivated because I saw that some of them could even remember what we did last year. Throughout the various activities, I was glad to see some of them remember the specific activities we had last year after Arsene asked the question and gave a gift to everyone who had a correct answer. This shows me that they really care and enjoy the time they pass with the Rudi team.”
The celebration was a huge success and one of the mothers (note that some mothers were curious and came to see how their kids were enjoying and having fun) could comment with tears of joy on her face that she couldn’t hide:
“I was there and could notice how the kids were on the line waiting to be served. After being served, I watched my two kids eating a full plate of rice, beans, potatoes and a cup of juice that were given to each one of them. I couldn’t have such meal to give them at home but thanks to Rudi, they celebrated Christmas with much joy. May God bless you and your work.”
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