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Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time.
Material and Methods
Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification.
The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17–1.72; OR 3.53, CI95% 2.95–4.2) and maternal mortality (OR 3.39, CI95% 1.59–7.22; OR 8.05, CI95% 3.34–19.41).
The caesarean section rates increased in the last years as result of increased CS in groups with spontaneous labor and in-group of multiparas with a scarred uterus. Women included in groups 1 y 3 were associated to maternal perinatal complications. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. The use of Robson classification becomes an useful tool for monitoring cesarean section in low human development index countries.
Citation: Tapia V, Betran AP, Gonzales GF (2016) Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System. PLoS ONE 11(2): e0148138. https://doi.org/10.1371/journal.pone.0148138
Editor: Rogelio Cruz-Martinez, Hospital de Especialidades del Niño y la Mujer de Queretaro, MEXICO
Received: October 15, 2015; Accepted: January 13, 2016; Published: February 3, 2016
Copyright: © 2016 Tapia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data were obtained from the SIPs (Information Perinatal Systems) of Peruvian public hospitals following approval from the Peruvian Vice Minister of Health. This data cannot be made publicly available. Other interested researchers interested in obtaining these data should contact Dr. Ernesto Gozzer, Chief of the National Institute of Health in Peru (firstname.lastname@example.org).
Funding: The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at the Department of Reproductive Health and Research of the World Health Organization have supported this analysis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Cesarean section (CS) rates continue to increase worldwide [1, 2], in both high-income and low-income countries. CS rates in Latin America including Peru rose over the period 2000–2010  and represent the region with highest increases . The worldwide rise in CS is a major public health concern and cause of considerable debate due to potential maternal and perinatal risks, cost issues and inequity in access [3, 5]. An increase in the use of CS particularly in the public sector and in low-resource settings may notably affect health services by increased rates of maternal/neonatal complications  but also in economic terms .
The main determinants of this disparity and specific reasons for the increase in CS rates in most of the world remain unclear. In order to propose and implement effective measures to reduce or increase CS rates where necessary, first, it is essential to identify what groups of women are undergoing CS and second, investigate the underlying reasons for trends. However, monitoring CS rates in a reliable and comparable manner continues to be an unmet need. Over the last decades, several CS classification systems have been created and proposed for different purposes. In 2011, a systematic review of available classifications concluded that the Robson (also known as the 10-group) classification is in the best position to fulfill current international and local needs, and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification .
In 2015, WHO proposed the Robson classification system as a global standard for assessing, monitoring and comparing CS rates . This system classifies women into one of ten categories that are mutually exclusive but totally inclusive that are based on five obstetric characteristics that are routinely collected in health facilities: 1) parity (nulliparous, multiparous with and without previous caesarean section), 2) onset of labor (spontaneous, induced or pre-labour caesarean section), 3) gestational age (preterm or term), 4) fetal presentation (cephalic, breech or transverse) and 5) number of fetuses (one or more than one) . The classification is simple, robust, reproducible, clinically relevant and prospective and thus, every woman admitted for delivery can be immediately classified into one of the ten groups based on these few basic characteristics [9, 10].
The Robson classification has gained recognition over the last decade and increasing number of facilities and countries are using it to understand and monitor their CS rates.  However, we are not aware of any analysis using the Robson classification in Peru, country which has more than doubled its CS rate at national level in 12 years from 12.7% in 2000 to 26.5% in 2012 (www.dhsmeasure.com), and it is one of the 75 countries prioritized in the Countdown to 2015 for Maternal, Newborn and Child Survival (so-called Countdown) to track and stimulate progress toward targets in MDG 4 and MDG 5 .
In public hospitals in Peru, data on pregnancy and delivery are recorded in the Perinatal Information System, a database maintained by Ministry of Health. The present study aimed to apply the Robson classification to this Peruvian database, to analyze trends in CS rates over a period between 2000 and 2010 and to identify the groups of women who, according to the Robson classification, are the major contributors to the increasing rates. In addition, we will assess variation of maternal and perinatal outcomes over time by Robson group and we expect the findings of this analysis will be able to inform the design and focus of strategies targeted to optimize the use of CS in Peru.
Materials and Methods
Setting, design and source of data
For this analysis, we included all women and their newborns from 43 health facilities in Peru included in the Latin American Perinatal Information System between 2000 and 2010. The Perinatal Information System contains information collected prospectively from time of presentation at the facility until the second or fifth day post-partum (vaginal or cesarean delivery). Data were obtained from the SIPs (Information Perinatal Systems) of Peruvian public hospitals following approval from the Peruvian Vice Minister of Health. This data cannot be made publicly available. Other researchers interested in obtaining these data should contact Dr. Ernesto Gozzer, Chief of the National Institute of Health in Peru (email@example.com).
Around 12% of the deliveries in Peru  occur in these 43 Public facilities that are located in the main town of each geographic subdivision of the country named department. These facilities are distributed among the three geographical regions in Peru, the coast, altitude and jungle. Altitude is considered when place of pregnancy and birth was over 2000 m above sea level.From the first antenatal visit until discharge of both mother and neonate, the attendant physicians or midwifes collect data in the perinatal clinical record in check-box format, which included demographic information, reproductive history, maternal characteristics, prenatal care, labor management, maternal complications during pregnancy, delivery, and the puerperium, and neonatal outcomes. Data are then entered into computer records and verified for quality control at each site.
Patient records/information was anonymized and de-identified prior to analysis and prior receiving the database in our hands.
All the variables necessary for the application of the Robson classification were available in the Perinatal Information System. The classification was constructed according to the proposed methodology [9, 2, 13–14]. The ten-group classification system is presented in Table 1. Women who could not be classified due to missing data in at least one of the variables of the Robson classification were excluded: start of labor 0.80% (4,990), presentation 0.75% (4,228) and GA 0.15% (849). Including all excludes cases (Fig 1), the total percentage of excluded represented 9.62% of the initial sample (21,531 out of 571,212).
The flowchart showing the selection of the study participants is shown in Fig 1.
Studied outcomes were stillbirth rate, low birth weight rate, incidence of preeclampsia, and maternal mortality. Stillbirths were defined as fetal deaths occurred after 20 weeks of gestation or with weights higher than 500 g. Low birth weight was defined if birth weight was below 2500 g. Other variables included were preterm birth (<37 weeks), very preterm birth (<32 weeks), newborn death, Apgar score min 1 of less than 7, Apgar score min 5 of less than 7, and need for resuscitation. Intrauterine growth restriction was defined as stunted growth of the fetus, causing his weight is below the 10th percentile expected for gestational age. Preeclampsia was defined as the presence of pregnancy-induced hypertension (systolic pressure of ≥140 mm Hg and/or diastolic pressure of ≥90 mm Hg) and proteinuria (≥300 mg/24 h) after 20 weeks of gestation. For this study, maternal mortality included deaths during pregnancy, labor and delivery and those after delivery until discharge from the hospital. Readmissions for complications or death after discharge are not recorded in the SIP under the same record so they cannot be linked. Maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100,000 live births.
Data in each group of the Robson classification system are presented in percentage for year of birth in three groups namely, 2000–2004; 2005–2007; and 2008–2010. We calculated CS rates as percentage in relation to obstetric population in each Robson group. Absolute contribution is the proportion of CS in relation to the total obstetric population, and relative contribution is the proportion of CS in each Robson group related to the total number of CS. Demographic and obstetric characteristic were determined by year of birth stratified. The chi-square test was used to calculate differences between groups for data expressed in proportions, and the Holm-Bonferroni method was used to counteract the problem of multiple comparisons. The confidence interval (CI) was defined at 95% for each variable. The Cochran-Armitage trend test was used to assess time trends in the rates of CS, setting significance at 5%. Rates of CS of Robson classifications groups were estimated according to delivery characteristics, newborn, year of birth and adverse perinatal outcomes. Estimates of crude and adjusted odds ratios (OR and aOR) with 95% CI were computed as measures of association between the variables. The adverse outcomes assessed were stillbirths, low birthweight, preeclampsia and maternal mortality. Adjusted ORs were derived through logistic regression models controlled by preeclampsia, prenatal visits, altitude and year of birth.
The trends in indications for induction and indications for CS in relevant categories of women in the Robson classification system were calculated over time (2000–2004, 2005–2007, and 2008–2010), the difference was assessed with chi square test and to adjust for multiple comparisons was used Holm-Bonferroni method. We grouped the data in three time periods to be able to assess differences and trends more easily and at the same time to be able to use all the data available for the 11 years with more power.
Significance was defined at a value of P< 0.05 for all statistical analysis.
The Universidad Peruana Cayetano Heredia (Lima, Peru) institutional review board approved the protocol. Data were analyzed using Stata software (v 10; StataCorp LP, College Station, TX, USA).
Results and Discussion
The database used for this analysis included data for 571,212 women and their newborns. A total of 11,464 were excluded because women who did not delivered in the hospital (n = 747), no data on the newborn was recorded (n = 8,098), congenital malformations (n = 1,371), data was missing for mode of delivery (n = 555), newborns characterized as birth weight outliers (birth weight higher than 3 standard deviations, n = 693), unable to classify because of missing one or more of Robson variables (n = 10,067), being the final sample size analyze 549,681 women.
Table 2 presents the characteristics of the population included in the analysis by period of time. Compared with earlier years, in the period 2008–2010 we observed less obstetric population in the coast, less educated women, less married women, more multipara women, less multiple gestations, less fetal mortality, higher BMI, more women with CS pre labor, less use of forceps/vacuum, more prenatal visits, more postpartum bleeding, less anemia during pregnancy, and more HIV infection. Malaria was lower at 2005–2010 period related to 2000–2004 (P<0.01). Gestational age between 32–36 weeks (P<0.01) and low birthweight (P<0.01) were higher in the group assessed in 2008–2010 than before (2000–2007).
The CS rate varied from 24.6% in the period 2000–2004 to 27.35% in 2005–2007, up to 30.03% during the period 2008–2010. Primary CS increased over time (18.7%, 20.8%, 22.1% for 2000–2004; 2005–2007 and 2008–2010, respectively; P<0.05). Similarly, repeated CS increased over time from 5.95% to 6.44% and 7.34% for the three groups respectively (P<0.05).
The yearly variation in the overall CS rates and by Robson group between 2000 and 2010 is displayed in Fig 2. Between 2003 and 2009 the overall CS rate increased from 23.7% to 30.4% (p<0.01). Similarly, groups 1, 2a, 3, 5, 7, 8 y 10 of the Robson classification system increased CS rates over time.
Data on CS rates for the years 2000–2004, 2005–2007 and 2008–2010 according Robson classification are presented in Table 3. CS rates of group 1 increased over time from 11.7% during 2000–2004 to 17.0% in 2008–2010 (p<0.001). Similarly, absolute and relative contributions also increased. CS rates and absolute contribution of group 2 raised over time. The main contributor between groups 2a and 2b to the overall CS rate was the group 2b. CS rates of group 2a increased over time from 24.1% in 2000–2004 to 29.9% in 2008–2010 (p<0.01). However, the absolute contribution was unchanged over time, and the relative contribution decreased in 2008–2010 compared to values between 2000 and 2007. CS rates and the relative contribution of group 2b did not change over time although the absolute contribution increased.
CS rates of group 3 increased from 5% in 2000–2004 to 6.7% in 2008–2010 (p<0.01). Similarly, absolute and relative contributions also increased. CS rates and the absolute contribution of group 4 increased up to 2005–2007 (p<0.05) and it remained unchanged during 2008–2010 (p>0.05). The relative contribution was reduced on 2008–2010. The main contributor between groups 4a and 4b to the overall CS rate was the group 4b. CS rates of group 4a increased during 2008–2010 with respect to 2000–2007. However, the absolute and the relative contributions did not changed from 2000 to 2010. CS rates of group 4b did not change either. However, the absolute and the relative contributions increased during 2005–2007 but thereafter they were reduced.
CS rates of group 5 increased from 66.3% in 2000–2004 to 71.5% in 2008–2010 (p<0.0001). The absolute contribution increased from 2005–2007 to 2008–2010. In addition, the relative contribution increased in 2008–2010 respect to values in 2000–2007. CS rates of group 6 maintained unchanged over time although the absolute and relative contributions decreased. CS rates of group 7 increased from 67.6% in 2000–2004 to 75.0% in 2008–2010 (p<0.01). The absolute contribution increased in 2005–2010 respect to 2000–2004 but the relative contribution did not change.
CS rates of group 8 increased from 60.3% in 2000–2004 to 67.6% in 2008–2010 (p<0.01). The absolute contribution remained unchanged, however, the relative contribution decreased. CS rates and the absolute contribution of group 9 did not changed over time from 2000 to 2010 but the relative contribution decreased. CS rates and the absolute contribution of group 10 increased over time (p<0.01). However, the relative contribution remained unchanged.
The overall cesarean rate had the highest correlation with Robson group 1 (r = 0.93, p<0.01), followed by group 3 (r = 0.90, p<0.01), group 4a (r = 0.88, p<0.01) and group 7 (r = 0.84, p<0.01).
Robson groups, selected labor characteristics, and maternal outcomes
Data on healthcare professional at delivery, use of forceps or vacuum, use of anesthesia, maternal mortality and post-partum hemorrhage by Robson group are presented in Table 4. Over 97% of women in groups 2b, 4b and 9 are attended by doctors. These figures remained unchanged between 2000 and 2010. Women in groups 5, 6 and 7 are attended by doctors in 77.8–92.5% of cases and similarly, remained unchanged over time.
During 2000–2004, women from groups 1 (33.2%), 3 (23.1%) and 4a (32%) were attended by doctors. The percentages were reduced overtime in the groups 1 and 3 but not in 4a. Midwives ranging from 46.7% and 55.3% during 2000–2004 mainly attend women from groups 1, 4a and 3 and the rates in all three groups increased over time.
During 2008–2010, midwives attended 65.3–81.9% of the deliveries in these groups. Six out of twelve Robson groups have increased the attention by midwives. Namely the groups 1, 2a,3,4a, 8 and 10.
During 2000–2004, among all Robson groups, instrumental deliveries were most used in women of the groups 1, 2a, and 5, but assisted vaginal delivery decreased with time as observed for 2005–2007 and 2008–2010. Use of anesthesia was more frequent during 2000–2004 in the Robson groups 9 (68.1%), 2b (59.1%), 6 (57.8%) and 4b (56.1%). The values were significantly reduced overtime in the groups 2b, 4b and 6 but remained unchanged in the group 9.
Robson groups and adverse outcomes
As expected, maternal mortality ratio was higher in groups 4b, 7, 8, 9 and 10 during 2000–2004. During 2004–2007, highest maternal mortality ratio was observed in the same groups except for group 8. During 2008–2010, maternal mortality was reduced in groups 7, 8 and 9. During 2000–2004 and during 2008–2010, the highest maternal mortality ratio was found in the group 10.
Post-partum hemorrhage was more prevalent in groups 8 (1.9%, 1.96% and 2.3% for 2000–2004, 2005–2007 and 2008–2010, respectively) and 2a (1.39%, 1.1% and 2.3%, respectively).
Higher rates of stillbirths during 2000–2004 were observed in the group 7, 9 and 10. The rates were significantly reduced over time up to 2008–2010. Rates for newborn deaths were higher during 2000–2004 in the groups 8 and 10, and these values were slightly reduced over time (Table 5).
Low birth weights were significantly higher in the groups 6, 7 and 8 during 2000–2004 with a trend to increase the rates with time. Intrauterine growth retardation (IUGR) was highest in the groups 8 and 10 with no change over time (Table 5). Highest rates of Apgar score<7 at first minute were observed in groups 7 (22.2%) and 9 (20.4%) during 2000–2004. These values are slightly reduced over time up to 19.2% and 17.7%, respectively for the period 2008–2010. Need for resuscitation was high in the groups 6 through 10 being highest in the group 7 (15.6%). All these figures in the last five groups of Robson showed a reduction trend over time. However, in the last period of time, the need for resuscitation continued to be high in these groups compared to the groups 1–5 (Table 5).
Increased ORs of stillbirths are observed with CS with respect to vaginal deliveries in the groups 1 and 3. Lower risks for stillbirths were observed in the groups 2a, 4a, 6, 7, 8, 9 and 10 by result of CS as compared with VD (Table 6). OR for LBW was higher associated with group 3 of Robson, and lower associated with groups 1 and 7 of Robson (Table 6). Preeclampsia was associated with CS in all Robson groups except group 4a (multiparous women without previous CS at term with single cephalic fetus in induced labor) (Table 6).
Comparing the impact of CS respect to VD, higher ORs for maternal mortality were observed in groups 1, 3, 4a and 10, whereas an OR of 0.05 (0.006–0.478, IC95%) was observed in the group 2b (nulliparous at term with planned cesarean section) (Table 6).
The main indication for induction of labor was acute fetal distress (AFD). The indication for AFD was slightly reduced from 2000–2004 to 2005–2007, but thereafter was again increased in the Robson Group 4a and 10. The indication for pre-eclampsia was reduced overtime only in the group 2a (Table 7).
Cephalopelvic disproportion (groups 1 to 5) and acute fetal distress (groups 1 to 4b and group 10) are the main indications for CS. In the group 1 of Robson, the trend is increased overtime (P<0.01). In the group 7, the indication for CS was significantly reduced over time (P<0.01). In the other Robson groups, the rates remained unchanged. The third main indication for CS was pre-eclampsia. However, the rates are lower than for fetal distress in the groups 1 to 4b. In the groups, 8 and 10 of Robson the indication of CS due to PET was higher than that due to fetal distress. Interestingly, the indication for CS in cases of PET was reduced with time in the groups 1, 2a and 2b of Robson. In the other Robson groups, no differences were observed with time (Table 8).
The 10-group classification system described by Robson was applied in the large database from the Peruvian perinatal Information system, which involved 549,681 deliveries. This database includes information of three different geographical regions in Peru characterized by differences in socio-economic status and in health facilities. For instance, in the coast were included three hospitals of category III, whereas none was included at high altitudes or the jungle of Peru.
In Peru, CS rates in 43 public hospitals have increased over a 10 year period from 25.5% in 2000 to 30.1% in 2010 well above 10–15 percent accepted as optimal rate for medically necessary cesarean delivery [3,12]. In the present study, we showed that this increase in CS rate was due to the contribution of the Robson groups 1, 3, 4a, 5, 7 and 10. Group 1 (nulliparous women with singleton cephalic full-term pregnancy in spontaneous labor), group seven (multiparas with a single breech pregnancy) and group 8 (multiple pregnancy) show the main increase overtime. During 2000–2004 the main relative contributions for CS (over 15%) were group 5, 1 and 2b respectively. This pattern was maintained during 2008–2010 being significant the increase for the group 1.
As in other published studies [15, 16] using the classification, the largest group in our obstetric populations is represented by the Robson group 3, which includes multiparous women with a singleton fetus in cephalic presentation. In our database, this represents 34.3% of the obstetric population, a similar value to the 32.3% observed in a Latin American survey . In this group 3 is observed an overall rate of 5.73% of CS (2000–2010) with a trend to increase overtime, a value lower to that described in 2004–2005 for eight countries in LA (9.9%) . It is expected these women are of low risk for CS. Another low risk group for CS is the group 1 (nulliparous with single cephalic pregnancy at term in spontaneous labor). We have demonstrated a value of CS rate of 14.0% during the 10-years period, which was lower to that observed in eight LA countries . Both groups represent 27.5% of all CS.
In a tertiary hospital in Singapore between 2000 and 2010, groups 5 and groups 1 contributed mainly to the overall increase in CS rate from 19.9 to 29.6 per 100 births in the period of 2000–2010 . In Peru, a similar pattern is observed. However, when estimating the main contributors to the CS rate in the Peruvian population, these were the groups 5 (18.9%) followed by group 1 (17.4%). Group 2b (nulliparous with planned cesarean section) has a relative contribution of 16.1% without changes overtime during the 10-years period. Fetal distress and preeclampsia could be important causes for CS, however in the present study the highest indication for CS due to fetal distress were in the groups 4a, 3, 2a and 1 ranging from 20.7% to 28.5% whereas indication for CS due to preeclampsia was higher in the group 10 (24.7%). These data suggest that reducing CS in groups 1, 2b, 3 and 5 the total CS rate may be significantly reduced in Peru. Group 1 contributed more than others to increase the overall CS rate between 2000 and 2010. This has also been observed in a previous study in Ireland . According to our present data, there is no reason to increase CS in the group 1 since indication due to fetal distress is in the order of 20% for fetal distress and 6% for preeclampsia.
Although the 10-group classification system is used broadly, our data suggest that is better a subdivision of the groups 2 (nulliparous) and 4 (multipara without uterine scar). Data revealed different behaviors between both subgroups. In addition, analyzing outcomes by Robson group may allow a more action oriented comparisons between CS and vaginal delivery. In fact, the results of the present study showed that stillbirths and maternal mortality have significantly high ORs for CS than vaginal delivery in groups 1 and 3. Since groups, one and three are at term and in spontaneous labor is expected that all women belonging in these groups must to end in a vaginal delivery. However, when women of these groups are submitted to CS, a higher risk for stillbirths and for maternal mortality are observed.
Although data from stillbirths and maternal mortality were controlled for preeclampsia in the analysis, we have also studied the association between preeclampsia and CS in each Robson group. As expected, preeclampsia was strongly associated with CS in nine of the 10 Robson groups. This is because the first line of treatment for preeclampsia is CS delivery in Peru. Patients with a history of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR = 2.5; p<0.02) . It is possible that cases of stillbirths and maternal mortality associated with CS could be also associated to preeclampsia . Robson in 2013 suggested that satisfactory CS rate in the group 1 would be around 10% and in that for Group 3, the caesarean section rate should be no higher than 3%. Clearly, CS rates for these groups in the Peruvian database are above these proposed numbers .
The Robson Classification system applied to Peruvian population may guide us through groups in which not medically justified CS may be conducted; e.g. those belonging to the groups 1 and 3 comprising pregnancies at term with a singleton in cephalic position with spontaneous labor. The fact that trend of CS in groups one and 3 increases over time suggests that reduction in CS rates could be obtained by reduction of CS in these groups, particularly because CS represents higher costs than vaginal deliveries  but also because these groups under CS deliveries are also associated with maternal and perinatal adverse outcomes. Robson classification system has been applied broadly in high- and middle-income countries [10,14]. Only three studies have been published in low-income countries [22–24]. Peru is a low-income country where reducing maternal and perinatal morbidity and mortality is a priority for the Ministry of Health. Data obtained in the present study is important since women and neonates may be at higher risk of adverse outcomes due to unnecessary cesarean sections as those related to the group 1 of Robson. However, we must to recognize that the higher risk of adverse outcome associated with cesarean delivery could be influenced by the reason for which the cesarean section was indicated and not only for the CD per se.
In countries with low cesarean rates (>15%) an inverse association was observed with neonatal, and maternal mortality rates. In countries with high cesarean rates (>15%) no association was observed with infant or maternal mortality . In contrast, our study, particularly in groups 1, 2 and 5 in which vaginal delivery should be the first choice, showed that OR for stillbirths and maternal mortality was significantly increased related to vaginal delivery.
Then, in accordance with other suggestions , this standardized classification should be used by Ministries of Health to monitor CS rates and to identify where interventions should be done to reduce the unjustified high CS rates. This classification should be used in all hospitals to be able to monitor of its obstetric practices to be sure if a CS was the right choice.
A unique feature of Perinatal Information System (SIP in Spanish) using in the study is that antenatal data are linked with birth outcome data. Therefore, SIP data is collected prospectively by clinicians in a hard-copy form. Information in the hard-copy SIP form was later entered by clerks into a database using SIP software.
In conclusion, data from Peru showed that CS rates increased over time because of increased CS in groups with spontaneous labor (groups 1 and 3) and in-group of multipara with a scarred uterus and with a single cephalic term pregnancy. Robson classification systems allow us to identify that groups 1 and 3 had increased OR for stillbirths, a maternal mortality by cesarean section than with vaginal delivery. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. However, rate of postpartum hemorrhage double from 2000–2004 to 2008–2010. In summary, use of Robson classification becomes in useful tool to monitoring cesarean section in low human development index countries.
The views expressed are solely those of the authors and do not necessarily reflect the decisions or stated policy of the World Health Organization.
Conceived and designed the experiments: VT APB GFG. Analyzed the data: VT. Wrote the paper: VT APB GFG.
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- 18. Brennan DJ, Murphy M, Robson MS, O´Herlihy C. The singleton, cephalic, nulliparous woman after 36 weeks of gestation: contribution to overall cesarean delivery rates. Obstet Gynecol. 2011; 117:273–279 pmid:21252739
- 19. Linhares JJ, Macêdo NM, Arruda GM, Vasconcelos JL, Saraiva Tde V, Ribeiro AF. Factors associated with mode of delivery in women with pre-eclampsia. Rev Bras Ginecol Obstet. 2014; Jun; 36(6):259–263. Portuguese. pmid:25099465
- 20. Ajuzieogu OV, Ezike HA, Amucheazi AO, Enwereji J. A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting. Saudi J Anaesth. 2011; 5(1):15–18. pmid:21655010
- 21. Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol. 2012 Apr; 206(4):331.e1–19.
- 22. Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth. 2013; 13:107. pmid:23656693
- 23. Sørbye IK, Vangen S, Oneko O, Sundby J, Bergjsø P. Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary hospital, northeastern Tanzania. BMC Pregnancy Childbirth. 2011; 11:55. pmid:21798016
- 24. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015 May; 3(5):e260–270. pmid:25866355
- 25. Volpe FM. Correlation of Cesarean rates to maternal and infant mortality rates: an ecologic study of official international data. Rev Panam Salud Publica. 2006; 29:303–308.
- 26. Kelly S, Sprague A, Fell DB, Murphy P, Aelicks N, Guo Y, et al. Examining caesarean section rates in Canada using the Robson classification system. J Obstet Gynaecol Can. 2013 Mar; 35:206–214. pmid:23470108


text:
December 27, 2018
Help CWY continue making a difference one youth at a time
Because of you Canada World Youth was able to change the life of over 25,000 youth this past year.
Changing the lives of young people is now more important than ever. With four in 10 people – 42% of the global population being under the age of 25, this demographic is in desperate need of our support.
That’s why Canada World Youth is committed to continue investing in young people to pursue purposeful actions and overcome challenging experiences creating a longer lasting impact for themselves and society through our experiential learning programs.
“My internship with Canada World Youth has provided me with experiences that allowed me to build a unique skillset. I now have a second family in Peru and I plan to visit them in the future. I’m grateful for the opportunity to have lived in Peru for four months doing the work that I did, and it has changed me as a person.”
- Chelsea Currie, CWY Pathways to Indigenous Leadership Program (IAYI) intern 2018
These programs would not exist without your support.
As a member of our CWY family, you know first-hand the impact our programs can have.
On behalf of Chelsea and all the other youth you have helped us support through one of our unique CWY experiences, thank you.
This holiday season, please make a special year-end gift to Canada World Youth so we can continue to make a difference one youth at a time.
Wishing you and your family all the very best for 2019.
Canada World Youth
News Item Boilerplate
About Canada World Youth
Canada World Youth is dedicated to enriching the lives of youth aged up to 35 who want to become informed and active global citizens. CWY offers international transformative learning experiences focused on building knowledge, leadership and skills through participation in sustainable community-driven projects. For more than 40 years, 38,000 youth and 12,000 host families have participated in CWY programs, in Canada and abroad.
CWY is registered with the Canada Revenue Agency as a charitable organization (#118973999RR0001).
Source : Mary McGee, Communications Officer, Canada World Youth, 514 931-3526 # 336, firstname.lastname@example.org.
Interviews and information (photos available):
1 800 605-3526 #336
514 931-3526 # 336

domain: sociology


engine cranks wont start no spark from coil.have replaced crank sensor,coil,icm,starter relay,ignition switch,and pcm.when testing remote icm found #4 pin not recieving signal from ignition switch.could find no open wires all ohm tested good under hood.all bulk connectors look good no pins pushed out help.
cranks wont start no spark to coil on 1996 Ford F-150
Asked by for the 1996 Ford F-150
crank sensor?? does this have a distributor?? when you checked the coil. did the negative side toggle to fire the coil??
no.to my understanding from the limited information inthe haynes manual the icm sends that signal to the coil.but without the voltage from the ignition switch in start position it wont toggle the coil. yes it does have a crank sensor which i cant find in any wiring diagrams and it does have a di distributor with remote ignition control module
has new crank sensor new computer electronic module and distributor moduleturn switch on has 12 volt meter has 12 volts at the coil on both sides when you crank the vehicle with the key it has no fire going through this coming out of the coil or out of the distributor come on


text: Northern highbush blueberry (Vaccinium corymbosum L.) is adapted to acidic soil conditions and often grows poorly when soil pH is greater than 5.5. When soil pH is high, growers will usually mix prilled elemental sulfur (So) into the soil before planting (converted to sulfuric acid by soil bacteria) and, if needed, inject acid into the irrigation water after planting. These practices are effective but often expensive, time consuming, and, in the case of acid, potentially hazardous. Here, we examined the potential of applying micronized So by chemigation through a drip system as an alternative to reduce soil pH in a new planting of ‘Duke’ blueberry. The planting was located in western Oregon and established on raised beds mulched with sawdust in Oct. 2010. The So product was mixed with water and injected weekly for a period of ≈2 months before planting and again for period of ≈2 months in late summer of the second year after planting (to assess its value for reducing soil pH once the field was established), at a total rate of 0, 50, 100, and 150 kg·ha−1 So on both occasions. Each treatment was compared with the conventional practice of incorporating prilled So into the soil before planting (two applications of 750 kg·ha−1 So each in July and Oct. 2010). Within a month of the first application of So, chemigation reduced soil pH (0–10 cm depth) from an average of 6.6 with no So to 6.1 with 50 kg·ha−1 So and 5.8 with 100 or 150 kg·ha−1 So. However, the reductions in pH were short term, and by May of the following year (2011), soil pH averaged 6.7, 6.5, 6.2, and 6.1 with each increasing rate of So chemigation, respectively. Soil pH in the conventional treatment, in comparison, averaged 6.6 a month after the first application and 6.3 by the following May. In July 2012, soil pH ranged from an average of 6.4 with no So to 6.2 with 150 kg·ha−1 So and 5.5 with prilled So. Soil pH declined to as low as 5.9 following postplanting So chemigation and, at lower depths (10–30 cm), was similar between the treatment chemigated with 150 kg·ha−1 So and the conventional treatment. None of the treatments had any effect on winter pruning weight in year 1 or on yield, berry weight, or total dry weight of the plants in year 2. Concentration of P, K, Ca, Mg, S, and Mn in the leaves, on the other hand, was lower with So chemigation than with prilled So during the first year after planting, whereas concentration of N, P, and S in the leaves were lower with So chemigation during the second year. The findings indicate that So chemigation can be used to quickly reduce soil pH after planting and therefore may be a useful practice to correct high pH problems in established northern highbush blueberry fields; however, it was less effective and more time consuming than applying prilled So before planting.

domain: agronomy


Glover's $4,000 legal bill covered
Councillor Bill Glover will be reimbursed for nearly $4,000 in legal bills related to an integrity commissioner's investigation earlier this year.
Council voted 9-3 Tuesday night to pay the bills.
Last year, councillors voted to hire an integrity commissioner to examine Glover's actions during the electoral boundary re-drawing exercise, and the subsequent Ontario Municipal Board hearing into the matter.
The integrity commissioner, George Rust-D'Eye, reported that Glover should not have been corresponding with an expert on boundary issues later hired by the city, but he also decided against applying sanctions against the councillor.
Councillor Rick Downes said going up against Rust-D'Eye, one of the best lawyers in Ontario, required Glover to hire his own legal representation.
“A $4,000 legal fee is an unfair burden for him to carry,” said Downes during a passionate plea on Glover's behalf Tuesday night.
Downes said other city councillors at the table were responsible for the inquiry, and that it was “propogated by people who are certainly against Councillor Glover.”
Glover, who was absent from the discussion and vote, has in the past accused some councillors of carrying out a vendetta against him.
Councillor Bryan Paterson said he had not been motivated “to somehow target” Glover “to force him into legal expenses.”
“We were simply following the advice of our city solicitor,” said Paterson.
Paterson said he was going to vote to reimburse Glover just to prove there were no hidden motives behind the decision to launch an investigation.
Mayor Mark Gerretsen said he was not in favour of reimbursing Glover on an “ad hoc” basis but agreed that with the pending hiring of a permanent integrity commissioner a policy for reimbursing legal fees was needed.
“Had the report said nothing inappropriate occurred then I would agree some compensation should be made. But that's not what happened,” said Gerretsen.
The mayor also said that he believed Glover “never intentionally did anything wrong. I think his intentions were the best.”
Councillor Brian Reitzel said he opposed reimbursing Glover and that the case pointed to the need for councillors “to police yourself and take responsibility for your own actions.”
“I have nothing personal against Councillor Glover,” said Reitzel, adding that Glover was “paying the price for all of us learning a lesson.”
In his final, emotional appeal, Downes said it wasn't fair for Glover to pay the price for a process that had never been invoked before.
“Is this some kind of experiment, or is it about doing the right thing?” he asked.
“I am here to say Bill Glover is a man of integrity. He is my friend, my colleague and my equal at council. It's time to move on. And what is the best way of moving on but to practice forgiveness.”
Nine councillors voted to reimburse, including: Mayor Gerretsen, Rick Downes, Kevin George, Dorothy Hector, Rob Hutchison, Jim Neill, Lisa Osanic, Bryan Paterson and Liz Schell.
Opposed were Sandy Berg, Brian Reitzel and Jeff Scott.


text:
Memoirs We Love
You'll be swept away by these powerful true stories, from a rich tapestry of a Southern life to a brave tale of survival following a tragic accident.
Photo: Marko Metzinger/Studio D
34 of 75
192 pages; Simon & Schuster
"For much of my adult life I've been tempted, sporadically, to visit fortune-tellers, just to get their opinion on my prospects, as it were," says Larry McMurtry in Literary Life, his second memoir in the trilogy that began with Books and will culminate in Hollywood, a juicy (we hope) exposè of his screenwriting years. Whether ogling racecars with Susan Sontag or waxing skeptical about winning the Pulitzer Prize, McMurtry, now 73, is the master of the showstopping anecdote: Stumped midway through a novel, he saw an old church bus parked alongside the road near Ponder, Texas. On its side: LONESOME DOVE BAPTIST CHURCH. Writer's block, hasta luego.
— Kristy Davis

domain: artistic


text:
I am so grateful that I can continue straight away with the second instalment in the series, because otherwise I would be in big trouble. I’ve been warned before I started that there is a big cliff-hanger at the end, and oh boy, isn’t it just.
Joe Stone, a leading detective in Strategic Investigation Unit, special police task force in London, is juggling increasingly demanding career and unpredictable struggles of his personal life. The work for SIU, is all he cares about these days. After his girlfriend, Gemma, disappeared a year ago he threw himself into work, and has been receiving praise for exceptional work ever since.
In the first book of the series, Loose Cannon, he tries to solve a string of murders and assaults within the London mafia families. Everyone is a suspect, and information is hard to come by. While his commander grooms Joe to become the head of SIU in the future, he discovers the thin line between police work and cooperation with the world of crime. He learns quickly that it is better to stay on the mafia bosses’ good side in order to get results.
In Long Shot, London becomes a victim to a terrorist attack, and The Prime Minister decides to charge SIU with the task of finding those responsible for the attacks. When Joe’s friends and colleagues are the ones who are targeted by the terrorists, this case becomes more than just a regular assignment. Constantly worried about the safety of his team, Joe races against time to uncover secrets from the past, and information regarding all the high profile suspects.
Soon Joe finds himself in charge of the SIU, which proves to be not at all what he expected.
The second book in Joe Stone’s series did not disappoint. I really enjoyed reading this series, and it leaves us with a brief intro to the next story.

domain: literature


text:
Design: Prague 012
Prague is a magical city and Charles Bridge is a magical place. This photo shows this wonderful place also in magical light, during a spectacular sunrise. On the left, you can see the characteristic dome of the Baroque Church of St. Francis of Assisi. The silhouette of the medieval Old Town Bridge Tower (Staroměstská mostecká věž) dominates the right side of the picture.The products are manufactured and dispatched by reputable third-party companies. The items can be shipped to most countries in the world. Payments are handled securely by the third-party company. For your purchase, Amazing Czechia receives a small commission, which helps to maintain and grow this site.


text:
Our flour mill plants include all types of flour milling machines, ie. flour sifters, grain equipment for production of e.g. fine white flour or organic wholemeal flour. will be able to make healthy, organic wholemeal flour, grits or high class flour. The plants can be designed for wholegrain milling, wheat flour, rice flour, rye or...
more details ↠
Please feel free to give your inquiry in the form below. we will reply you quickly!

domain: food


text:
It takes some serious confidence to wear full-look crimson. Step up: Beyoncé. While others would only accessorise with the bold shade, Queen Bey wore head-to-toe red Alessandra Rich for a date night with her husband Jay-Z.
Out wining and dining together in the States, the couple celebrated Valentine’s Day in the traditional way. Think: rose petals, candles, wine and presents. Styled by Zerina Akers – the curator and founder of the Black-founded business platform, Black Owned Everything – Bey took a moment to pose in front of a white backdrop for her fans. In a scarlet leather belt, mini skirt, shades and matching pumps, Bey looked like the powerhouse that she is. And dangling from her wrist? An Alexander McQueen Story Shoulder bag.
Last September, Bey served up some executive realness in Alessandra Rich. Pictured against a run-of-the-mill brick wall, Beyoncé’s look couldn’t have been more opposite. Wearing a cropped tweed jacket and matching mini skirt, the multi-award winning singer accessorised in a crystal-encrusted chain choker and coordinating hoops. Slipping on some dazzling shades, Queen Bey completed her outfit in a pair of Rich’s hot pink satin pumps.

domain: celebrity


text:
TAS OPEN HOUSE 2019 – 2020
TAS Open House 2019 – 2020 took place yesterday afternoon, August 5, 2019, and it was a success! We gladly welcomed parents to our school as a way for them to get to know the classroom teachers, administrators, and fellow parents. In addition, parents learned what is expected of students in their academic classes and how they can support students at home.
The College Readiness Workshop with our College Counselor, Mr. Phillip Wenturine, was also a highlight of the event. What we loved most was to see many parents sign up for PTA and start getting more involved in the school community. This year’s Open House surely proved to be the start of a wonderful school year ahead.

domain: news


text:
The death of the Turkish military in Syria in early February is not a reason for military assistance to the North Atlantic Alliance Ankara. At least, such a problem was not raised during the meeting of NATO defense ministers.
This was reported to the TASS news agency by a source working in the diplomatic mission of one of the Alliance states in Brussels.
He explains this by saying that Turkish soldiers died during a military operation on foreign territory, so it does not fall under the scope of Article 5 of the NATO Charter. The death of the military did not occur during the attack on Turkey, so it cannot count on other countries of the Alliance entering the conflict. According to the diplomatic worker, Ankara is well aware of this, and therefore they did not begin to raise this issue there. At the same time, he added that many European NATO members do not agree with the policy of Turkey in the Middle East.
Another source of TASS from the NATO military believes that the Turkish army is one of the most combat-ready in the Alliance. She is able to independently cope with the Syrian government forces. True, the concern is the possibility that Ankara’s active actions in Syria could cause its military clash with Iran or Russia.


text:
Alamo city commission majority fires police chief three days later
District judge dismisses TRO…
It took approximately five months for the city of Alamo to fire its police chief, Baudelio Castillo, but Monday (May 20) the hammer finally fell after state District Court Judge Marla Guerra ruled in the city’s favor the previous Friday, thereby throwing the matter back in the city’s hands.
Last Dec. 17 (2018), Castillo’s attorney, Francisco Rodriguez, filed a petition/request for a temporary restraining order, trying to put a halt to the city’s attempt to fire his client. State District Court Judge Keno Vasquez signed it, and the five-month delay began as each side filed countless motions and counter-motions as the case was moved. One response to a plea, alone, dated March 22, 2019, took up 226 pages of space.
Mayor Diana Martinez, Commissioners Robert De La Garza and Maria Del Pilar Garza vs. Commissioners Trino Medina and Pete Morales led to Castillo’s undoing.
Read the entire story on the e-Edition of our newspaper. http://www.etypeservices.com/Advance%20News%20JournalID455/

domain: law


The search engine giant Google has a tradition of hosting its developer preview event every year and now the company has officially announced the date of its upcoming Google I/O 2023 event. So let’s get into the article to check out the date of the event and the expected announcements.
It is officially announced that Google will be hosting its Google I/O 2023 event on May 10th and it is also confirmed that the event will be limited in-person audience and the same will be live-streamed for free to viewers across the globe. If you are interested then you can register for the event now and it is free.
Registered people will get updates on the conference’s schedule and content, along with relevant developer news via email. The event will be available to view live or on-demand, sessions. It will be available to those who don’t register as well but they might not get updates.
Google is expected to announce the first beta version of Android 14 during the event and the company may launch its Google Pixel 7a smartphone as well. The company will also announce new features across its applications and services. We can also expect the announcement of Google Bard which is the artificial intelligence powered tool of the company. The company will be launching its first ever tablet as well.
So let’s wait for the event and we recommend you to stay tuned with us for more updates from the world of technology.
Read interesting news, reviews as well as tips & tricks on TechnoBugg website, and stay updated with the latest happenings of the tech world on the go with Technobugg App. Also follow on Google News and join our Telegram channel for the latest updates.


text:
Kampala- Aga Khan University Hospital is poised to expand its footprint in East Africa after acquiring land from government to build aspecialised health facility in Kampala.
The 60-acre piece of land, which is part of the former Nakawa-Naguru Housing Estate, will host a teaching hospital.
The facility will serve as hospital and a health training institution for the Aga Khan University located on Gadaffi Road in Old Kampala, which trains doctors, nurses, midwives and allied health professionals.
The hospital will have specialties in cardiology and cardiothoracic surgery, cancer, women and child health, neurology and minimally invasive surgery; and advanced diagnostic equipment such as MRI and CT scanners and nuclear medicine, a statement released by the Aga Khan Development Network (AKDN) yesterday indicated.
President Museveni and His Highness the Aga Khan are expected to attend the event where the project will be formally announced at the ground-breaking at Nakawa in Kampala on Thursday.
According to AKDN, the first phase of constructing the university teaching hospital will start in 2017 and be completed in 2020 at a cost of $100 million (about Shs350 billion).
“At that point, it will have 150 beds. Thereafter, it is expected that it will add capacity over time, and could eventually reach 600 beds,” the statement added.
“It will provide Ugandans with access to world-class care when they need it and where they need it, preventing unnecessary suffering due to delays or unavailability as well as the expense and disruption of seeking care abroad,” the statement added.
It is expected to be equipped with specialised cardiac operation theatres, intensive care units and radiation therapy equipment. As a tertiary hospital, the hospital in Kampala will provide the most advanced types of care and be capable of diagnosing and treating the most complicated cases.
“Upon completion of construction, the hospital will begin educating specialist physicians in surgery, internal medicine, paediatrics and obstetrics and gynaecology. Four additional disciplines will be added thereafter,” the AKDN indicated.
The University also plans to expand its existing nursing and midwifery programmes through its School of Nursing and Midwifery in Kampala, where 539 students have earned degrees so far.
The hospital will join the Aga Khan University Hospital in Nairobi as one of the only hospitals in sub-Saharan Africa to meet rigorous international quality standards.
Lands Minister, Daudi Migereko, told Daily Monitor yesterday that the lease and terms for the lease will depend on the progress of the project. “They are supposed to build a teaching hospital and that is what we expect to see at the end of the five years,” Mr Migereko said.


text:
Since the 1500s, the finest fabrics of the highest of
quality have been made here, thanks to the textile
arts that have been passed down from generation
to generation. Figli di De Martini’s range of products
includes precious damasks, satins, and silks
for upholstery and interiors, and pure linen towels
with macramé, “ajour”, or “gigliuccio” handmade finishes.
Figli di De Martini also weaves linen cloth for
curtains and clothing and rich plaids (light woolen
blankets), stoles, scarves, cloaks, and sweaters in
cashmere and silk.
Damaschi e Tessuti di Lorsica


voltage controlled LFO micromodule
Warning: Last items in stock!
Delivery time: up to 10 working days
μLFO 3340·A is a voltage controlled low frequency oscillator. The micromodule is based on AS3340 integrared circuit. Its typical use is for generating periodical control signal for modulating e.g. VCO pitch, VCF cut-off frequency, or VCA gain.
• 4 independently accessible waveforms:
triangle, saw, inverted saw, pulse
• voltage controlled PWM
• 3 rate control inputs with different sensivity
• 5Vpp output signal with adjustable
• DC shift
• control voltage range normalized to
• 0V ÷ +5V
• LED indicator
• +12V, −12V power supply
• reverse voltage protection
Manufacturer: Syntaxis, Poland


text:
Chair and Associate Professor of Chemistry & Biochemistry Kelly Neiles, along with colleagues at St. Mary’s College of Maryland, have accepted an invitation from the Howard Hughes Medical Institute (HHMI) to participate in an Inclusive Excellence Learning Community. The award includes $30,000… Find Out More
Recent St. Mary’s College art and art history alumnae Brooke Lamplough ’19 and Cecelia Marquez ’18, along with Tristan Cai, assistant professor of photography, were included in the exhibition “New Photography II” at the Academy Art Museum in Easton, Maryland. Running from August 1- October 7, 2020… Find Out More
Assistant Professor in Art History Emily Casey has received a short-term fellowship from the Program in Early American Economy and Society at the Library Company of Philadelphia to conduct research for her book project, "Hydrographic Vision: Imagining the Sea and British America, 1750-1800."
The… Find Out More
Tibetan Buddhist monks from Drepung Loseling Monastery will construct a Mandala Sand Painting from Monday, Oct. 21, through Thursday, Oct. 24, in Daugherty-Palmer Commons on the St. Mary’s College of Maryland campus.
From all the artistic traditions of Tantric Buddhism, that of painting with… Find Out More
Professor of Art Sue Johnson's work has been selected for the exhibition, “Contested Spaces: Harnett Biennial of American Prints” at the Harnett Museum of Art, University of Richmond Museums, Richmond, Virginia. Juried by Carmen Hermo, associate curator, Elizabeth A. Sackler Center for Feminist Art… Find Out More
Professor of Art Carrie Patterson organized “The Shaping of America: A Painter’s Perspective” art exhibition on display now at AnnMarie Sculpture Garden and Arts Center in Solomons, Maryland. The show opened on September 27 and runs through October 26, with an evening reception on October 11 from 5… Find Out More
St. Mary’s College of Maryland Provost and Dean of Faculty Michael Wick announced two awardees of the Steven Muller Distinguished Professorships: Susan Goldstine, professor of mathematics, has been named the Steven Muller Distinguished Professor in the Sciences, and Lisa Scheer, professor of art,… Find Out More
Effective July 1, St. Mary’s College of Maryland Professor of Art History Joe Lucchesi began tenure as chief reader for College Board's Advanced Placement® Program (AP®) Art History course and exam. In that capacity, he is responsible for overseeing the standard-setting and scoring of AP® art… Find Out More
For eight weeks this summer, eight students and their faculty mentors participated in the annual St. Mary’s Undergraduate Research Fellowship (SURF) program. SURF provides students opportunities to engage deeply in independent research, laboratory, and creative work across disciplines, including… Find Out More


text:
With regard to David Tusing's report Abu Dhabi's Peter Rosalita on his viral 'America's Got Talent' journey: 'I was watching others on YouTube, now I'm watching myself' (June 8): good luck on your journey, Peter. So very proud of you. You have the gift of a golden voice.
Elvie Iwakeim, Larnaca, Cyprus
Pakistan's fifth deadly train crash in three years
With regard to Ben Farmer's article Overnight death toll in Pakistan train accident rises to 63 as more bodies found (June 8): all the more tragic that this is not the first such train accident in Pakistan of late. My condolences to the bereaved families.
Elize van Wyk, Dubai
Coping with grief by helping others
With regard to Ramola Talwar Badam's report Covid-19: Indian expat who lost eight relatives in 22 days backs aid campaign (June 8): this story was a grim read. Covid-19 has created so many complications in people's lives. Besides the emotional toll of losing loved ones, the death of family members, especially earning members, affects practical matters like finances. There are many layers to grief. And while time does help, these are irreparable losses.
It's commendable that so many philanthropic organisations are helping ease the burden on those affected by Covid-19 – and that this lady, Juhi Khan, with such a heavy burden of grief is trying to help others.
K Ragavan, Bengaluru, India
Indian citizens in crises bail out one another
In reference to Taniya Dutta's report Indian government takes back vaccine distribution from states in new push against Covid-19 (June 7): in the midst of the immense human suffering due to the pandemic, there are instances of human and institutional initiatives and co-operation that need to be applauded.
Many private sector companies in India are arranging with local municipalities to vaccinate all their employees. Some are also vaccinating the families of the employees and associates like the distributors of the company. In Mumbai, a Citizen’s Forum has decided to procure 8,000 doses to vaccinate free of charge all residents, maids, drivers and slum dwellers in the vicinity. They are visiting families door-to-door to register the names and ages of potential recipients of the vaccines.
The Sikh community in Delhi rendered a fantastic yeoman service by opening oxygen clinics when there was a desperate shortage of oxygen in the city. Such instances of human beings helping one another in distress are heartening. At a time when governments and institutions are under severe pressure due to the pandemic, ordinary citizens should pick up the gauntlet.
Rajendra Aneja, Dubai


Plain Suiting waistcoat trouser dress Fabric 147 cm M1585
This fabric has a slight give and would be suitable for jackets, trousers, blazers and more.
70% Polyester, 30% Viscose,
Sold By the meter.
Multiple orders of the same fabric will be sent as a continuous piece.
10cm x 10cm Approx
If you require a sample, please select from the "length" option above.
Please order a sample to avoid disappointment.
Machine wash at 30 degrees.
Do not bleach
Iron on a low heat.
No tumble dry.
We recommend testing a small piece first.
A NOTE ABOUT COLORS:
We put a great deal of effort into taking images which represent the colours as closely as possible,
however the appearance of colours will always vary slightly from one computer screen to another.


This article is one in a series that have been released in conjunction with Wayne's book, 101 Projects for Your Porsche 911. The book contains 240 pages of full color projects detailing everything from performance mods to changing your brake pads. With more than 650+ full-color glossy photos accompanying extensive step-by-step procedures, this book is required reading in any Porsche 911 owner's collection. See The Official Book Website for more details.
It's almost unbelievable that the early 911s did not ship with a stock front mounted sway bar. The front sway bar is probably the best suspension improvement that you can perform on your 911. The sway bar adds stiffness to the suspension by coupling the spring effects of one side with the other. The sway bar acts as a torsion bar that resists suspension displacement across the width of the car. When one side of the car starts to dip, the sway bar (connected to the other side) acts to pull it back up. Through this coupling effect, the car maintains an increased stiffness and reduces side-to-side sway.
Up until 1973, almost all 911s appear to have shipped from the factory with the mounting tabs for the bulkhead mounted sway bar. In 1974, the sway bar was mounted below the body and integrated into the front suspension (see Pelican Technical Article: Replacement of Sway Bar Bushings and Brackets). Some racers prefer the through-body setup that was used on the early cars. You can install this through-body bar on the later cars with a set of aftermarket mounting brackets.
For 911s with the mounting tabs already installed, the attachment of the sway bar is a snap. For those without these mounting tabs, you will have to drill the holes required for the installation of the aftermarket bracket. You may also have to install the u-tabs onto the a-arms of your car if it didn't come with them installed. Most cars will have a cover attached to the sway bar mount on the inside of the fender. If your car has this cover, then simply remove it and the sway bar installation becomes a bolt-in process.
The first step in installing the sway bar is to obtain all the parts that you need. For this installation, you will need a sway bar kit with drop links, a u-tab mounting kit, the sway bar mounting kit for the bulkhead, and new bushings for both the bar and the drop links. You will also need a 1" hole saw to drill the hole for the sway bar in the bulkhead, if your car doesn't already have this hole.
You can choose to install the stock 19mm Porsche sway bar setup, or you can opt for an aftermarket setup. The stock original Porsche sway bar kits are still available, however, they can be quite expensive. A good aftermarket kit is the Weltmeister sway bar kit. Available in sizes 16 mm , 19 mm, and 22 mm, the right sway bar for your task can easily be fitted to your car. I suggest that you use the stock 19 mm size sway bar if you are planning on driving the car on the street, or the thicker 22 mm if you plan to do some racing. The Weltmeister bars also offer adjustability along the torque-arm of the bar, which means that you can lower or increase the rate of stiffness in only a few minutes.
The first step is to install the u-tab kit on your 911 front suspension arms. Jack up the front of the car and remove both the left and right wheels. Most 911s without sway bars did not come with these tabs installed. Check your a-arms before you order the kit, though, as some did sneak out of the factory with the tabs attached. Drill a hole in the a-arms exactly perpendicular to the top surface of the a-arm. This hole should be located 5 1/8" from the center of the ball joint. Make sure that this distance is equal on both sides of the car. Fasten the u-tab kit to the a-arm using the hardware supplied in the kit. If you have access to a welder, then these tabs can be welded instead of bolted-on.
The next step is to create the holes required for the sway bar to fit through the chassis. It is recommended that you use the improved sway bar mounting bracket available from Weltmeister (part no. SB-1955). This bracket mimics the factory-welded plate that was installed with cars outfitted with factory sway bars. The kit includes a template for drilling the holes in sides of your chassis. Make two photocopies of the template and tape it onto the inside fenders of your car, according to the directions in the kit. There should already be a depression in your chassis where the mount is to be located, so you shouldn't have too much trouble placing it in the correct position.
Drill two of the three small holes that are used to mount the adapter. Once these two holes are drilled, you will want to bolt the adapter plate to the car in order to use it as a template for drilling the remaining holes. For ease of drilling, mount the adapter plate to the outside surface of the fender well. You will have to reach around into the inside of the front trunk of the car in order to fit two bolts into the plate. With the adapter plate mounted to the outside face of the inner fender, you can now use the adapter to guide your drill for the large center hole, and the remaining mounting hole.
Once you have the adapter mounted to the outside of the fender, use the third hole in the adapter plate to guide yourself, and drill through the chassis. Then, using the 1" hole saw, drill the large center hole through the chassis. Repeat the same procedure for the opposite side.
After you have all of the holes drilled, the sway bar can be assembled on the car. File down any of the edges that might stick out of the chassis sheet metal from the holes that you drilled. Make sure that you use new bushings at the mounting points near the fender well, and also use new drop link bushings. Remove the adapter plates from the outside of the fender, and place them on the inside of the car, using some masking tape to temporarily hold them in place. Then insert the sway bar into the chassis. Place the bushings onto the bar, and then attach the outside mounting plates to the sway bar on each side. Finally, bolt the arms to the ends of the sway bar, and attach the drop links to the u-tabs on the a-arms. Make sure that the drop link clears the brake line and the strut before you reattach the wheel.
If you are going to be using your car for racing, then a wise upgrade might be a set of adjustable drop links. These allow you to dial your front suspension for greater balance, or to adjust the sway bar in case the track on which you are racing only banks in one direction.
When you put your car back on the road, you will feel a remarkable difference, particularly when making quick turns. You will wonder why the factory never installed these as stock equipment in the first place.
This photo shows the inside fender well and the stock early 911 sway bar installed. Use a new bushing at the bulkhead, and also new drop link bushings when you are installing the bar. Also make sure that the nearby brake lines and shocks don't have any opportunity to make contact with the sway bar mechanism. Check the bar for clearance both when the car is elevated, and when it's resting on the ground.
This is what the inside of the fender looks opposite to the sway bar mount. The nuts shown here are welded in from the factory. If your car doesn't have this these mounting nuts and bracket already installed, then you will need to install the aftermarket bracket which has these nuts integrated into its construction.
Shown here are the u-tab kit and the aftermarket inner bulkhead mount from Weltmeister. The u-tab kit contains the necessary hardware to mount the tabs to the 911 a-arm. The bulkhead bracket consists of heavy gauge sheet metal with three encapsulated nuts on the rear.
On the left is a picture of a factory 911 a-arm with the u-tab already installed. If your a-arms are missing this u-tab, then you will need to install the kit onto the a-arms, as shown on the right. Install the sway bar into the car first, so that you can double check the location required for the u-tabs. Make sure that they are in the same location on both sides of the car.


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text:
Stones In Water
Roberto was only a 13 year old going to an American western film when his world changed, and not for the better. Since Roberto lived in Venice, Italy during the time of World War II, he might not have been able to see another American film again. He was excited to see that they hadn’t yet stopped showing American films in Italy, so he decided set out with his two friends, Samuele and Memo as well as Roberto’s older brother, Sergio, who invited himself to tag along. They could not have anticipated what was coming next.
Roberto decided to skip lunch so that he’d make it in time for the start of the movie because it was in a different town. When he arrived, the movie had already started but not much time had gone by. Not long after he arrived, German Soldiers started streaming down the aisles taking all of the boys. There were only boys in attendance as girls did not tend to like western films. The soldiers took them on a train, and the boys became separated from Sergio. Samuele was faced with a challenge, since he had a Jewish name. He could have been tortured or killed if the soldiers found out that he is Jewish. Roberto suggested to Samuele that he state his name to be the Christian name “Enzo” to protect him from harm. Roberto handed Samuele his St. Christopher cross. They were on their own now. They didn’t know whether they would make it back home.
This book appeals greatly to historical fiction readers, but can suit many other book preferences.
is a lively book that contains many happy and sad moments. The persistent character of Roberto shows how giving up is not a choice in life or death situations. As I drew farther into this action-packed book, I started to feel for Roberto as he journeyed through hard times.
makes you realize that life could change in a flash, for better or worse. I would highly recommend this book to people who love a good, yet sad book.

domain: library


text:
Need to test but lack motivation? This article aims to resolve 5 major uncertainties... more »
his is the third edition of one of the best books on MySQL. The subtitle of the book is... more »
You’re a programmer. Have you ever wondered how multiplayer games work? From the outside it... more »
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Discover best practices and the most useful tools for building the ideal integration architecture.


text:
Monorail cranes vary in size and shape depending on their intended use. Generally, they are smaller devices used in tight spaces, usually in indoor locations. Often, they may take the place of a conveyor belt.
The safe operation of a monorail crane design has some impact on the design of a monorail system. Engineers need to be concerned with the operational safety of the monorails they design. To that end, engineering drawings should include some or all of these factors: maximum lift design load, safety, impact, or load factors used, maximum angle or load due to side pull, method, and locations of labeling stating maximum capacity, warnings, etc.

domain: design


text:
Steve Antony has written and illustrated several picture books, including The Queen’s Hat and Please Mr Panda (the first book in his award winning Mr Panda series). He also illustrated Tim Minchin’s When I Grow Up and a cover of the Famous Five. Steve lives in Swindon, England, and is Patron to Swindon Libraries Children’s Services. Visit him online at www.steveantony.com
A delightful picture book about the wonders of all the fun you can have inside AND outside, by the award-winning Steve Antony, author of the bestselling Please Mr Panda. BLIP spends all day plugged into her computer, playing games and having fun. But when there is a POWER CUT, Blip goes down the stairs and out the front door, where she discovers playing games and having fun . . . OUTSIDE. Isn’t it wonderful to be UNPLUGGED? By Steve Antony, winner of the Oscar’s First Book Prize, nominated for the Kate Greenaway Medal and shortlisted for the Waterstone’s Children’s Book Prize.
Storytime and Drawing Fun with Steve Antony
|Event Time||Age Range||Event (Click Link to see further information)|
|Sunday 21 Oct 2:30pm||3 to 6||Storytime and Drawing Fun with Steve Antony|


- 2023 Innova Crysta gets new squarer grille and bumper with chrome finish that goes down to the bumper
- Side and rear profile of the MPV are same as of the 2022 model, there are no changes in the interior too
When Toyota launched the Innova Hycross in December 2022 many assumed that it’s the end of the current Innova Crysta. But Toyota decided to put the Innova Crysta on sale along with Innova Hycross. Temporarily Toyota discontinued the Innova Crysta to launch the 2023 model of the MPV with little changes.
2023 Toyota Innova Crysta
Now the 2023 Innova Crysta has started to arrive at dealerships. Here we’ve got the first look of the MPV and we noticed some small changes. The 2023 Innova Crysta gets squarer grille and new bumpers. There’s a chrome finish on the grille that goes down to bumper. Well this is the only major change on the 2023 Innova Crysta.
Side view of the MPV is same as of the 2022 model. The Innova Crysta continues to get age-old MPV profile. Mid-spec variants will ride on 16-inch single-tone alloy wheels while 17-inch dual-tone alloys will be on offer on top variants. Just like the side profile there are no changes at the rear as well.
In the above image one can see the upright tailgate, roof spoiler and bumper that has been carried out from 2022 model of Innova Crysta.
The interiors of the car are too same as before. The 2023 Innova Crysta gets same 8.00-inch infotainment and wooden finish on dashboard. These images are of the GX variant that doesn’t get wooden dashboard finish and automatic air conditioning. Both these features start from VX variant only.
Top variants of the Toyota Innova Crysta continues to get 8-way powered driver seats, Apple CarPlay, Android Auto, automatic climate control and captain seats in the second row. If we talk about safety then there are up to seven airbags on offer along with stability control, reverse parking sensors/camera, hill start assist and ISOFIX child mounts.
Under the hood the Innova Crysta gets 2.4-litre diesel engine that is now RDE and E20 compliant. This engine puts out 150 PS and now it will get 5-speed manual transmission that sends power to rear wheels. G, GX, VX and ZX are the four variants that will be on offer with the 2023 Innova Crysta. The MPV’s base price is expected to be around ₹18 lakh (ex-showroom). It rivals the Kia Carens and Mahindra Marazzo in its segment.
Image Credit – Zigwheels


TSUKUBA, Japan—A new walking, talking robot from Japan has a female face that can smile and has trimmed down to 43 kilograms (95 pounds) to make a debut at a fashion show. But it still hasn’t cleared safety standards required to share the catwalk with human models.
Developers at the National Institute of Advanced Industrial Science and Technology, a government-backed organization, said their “cybernetic human,” shown Monday, wasn’t ready to help with daily chores or work side by side with people—as many hope robots will be able to do in the future.
“Technologically, it hasn’t reached that level,” said Hirohisa Hirukawa, one of the robot’s developers. “Even as a fashion model, people in the industry told us she was short and had a rather ordinary figure.”
For now, the 158 centimeter (62.2 inch) tall black-haired robot code-named HRP-4C—whose predecessor had weighed 58 kilograms (128 pounds)—will mainly serve to draw and entertain crowds.
Developers said the robot may be used in amusement parks or to perform simulations of human movement, as an exercise instructor, for instance.
HRP-4C was designed to look like an average Japanese woman, although its silver-and-black body recalls a space suit. It will appear in a Tokyo fashion show—without any clothes—in a special section just for the robot next week.
The robotic framework for the HRP-4C, without the face and other coverings, will go on sale for about 20 million yen ($200,000) each, and its programming technology will be made public so other people can come up with fun moves for the robot, the scientists said.
Japan boasts one of the leading robotics industries in the world, and the government is pushing to develop the industry as a road to growth. Automaker Honda Motor Co. has developed Asimo, which can walk and talk, although it doesn’t pretend to look human.
Other robots, like the ones from Hiroshi Kobayashi at the Tokyo University of Science and Hiroshi Ishiguro at Osaka University, have more human-like faces and have been tested as receptionists.
But demands are growing for socially useful robots, such as ones that can care for the elderly and sick, said Yoshihiro Kaga, a government official in the trade and industry ministry.
“We want this market to grow as an industry,” he said.
The robot shown Monday has 30 motors in its body that allows it to walk and move its arms as well as eight motors on its face to create expressions like anger and surprise.
In a demonstration for reporters, the robot waddled out, blinking, a bit like an animation figure come to life, and said, “Hello, everyone,” in a tiny feminine voice while its mouth moved.
The demonstration didn’t all go smoothly. The robot often looked surprised, opening its mouth and eyes in a stunned expression, when the demonstrator asked it to smile or look angry.
Its walk was also not quite ready for the Paris Collection, partly because its knees are permanently bent. It has sensors in its feet but lacks the sensitive balance of a real human.
The big challenge in creating HRP-4C was making the parts small enough so it looks female, especially its thinner legs, said Shuuji Kajita, who leads the institute’s humanoid research group.
“But this is just the first step,” he said.


text:
Jennifer Knapp’s meteoric rise in the Christian music industry ended abruptly when she walked away and came out publicly as a lesbian. This is her story—of coming to Christ, of building a career, of admitting who she is, and of how her faith remained strong through it all.
At the top of her career in the Christian music industry, Jennifer Knapp quit. A few years later, she publicly revealed she is gay. A media frenzy ensued, and many of her former fans were angry with what they saw as turning her back on God. But through it all, she held on to the truth that had guided her from the beginning.
In this memoir, she finally tells her story: of her troubled childhood, the love of music that pulled her through, her dramatic conversion to Christianity, her rise to stardom, her abrupt departure from Christian Contemporary Music, her years of trying to come to terms with her sexual orientation, and her return to music and Nashville in 2010, when she came out publicly for the first time. She also talks about the importance of her faith, and despite the many who claim she can no longer call herself a believer, she maintains that she is both gay and a Christian.
Now an advocate for LGBT issues in the church, Jennifer has witnessed heartbreaking struggles as churches wrestle with issues of homosexuality and faith. This engrossing, inspiring memoir will help people understand her story and to believe in their own stories, whatever they may be.
Bursting quickly to stardom in the Christian music world shortly after her college conversion, singer-songwriter Knapp disappeared abruptly from the public eye in 2004. Here, she offers a comprehensive memoir spanning her earliest childhood in the 1970s to her 2010 return to performing from self-imposed exile. The book seems designed to explain her seclusion, which she chalks up to physical exhaustion from her brutal tour schedule and the emotional strain of coming to terms with herself as a lesbian. Her memoir suffers from uneven pacing, alternating between catalogues of activities and long reflections on her emotional state. While she does paint a bleak portrait of the constant scrutiny and moral nitpicking contemporary Christian musicians face, her retelling of events seems to place blame for problems outside her own actions. The book will appeal to fans seeking insight into Knapp's work and to others hoping for an insider view of Christian music. Some readers might find the issues raised, such as Christian hypocrisy, doubt, and homosexuality, unhelpfully unresolved.


text:
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The Award database is continually updated throughout the year. As a result, data for FY23 is not expected to be complete until September, 2024.
Download all SBIR.gov award data either with award abstracts (290MB)
or without award abstracts (65MB).
A data dictionary and additional information is located on the Data Resource Page. Files are refreshed monthly.
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SBC: BERTEC CORP Topic: NIA
Falls are a significant source of early morbidity and mortality in the aging population, yet the neurological,sensory, and motor changes that lead to increased fall risk often escape early identification and intervention. Vital signs are commonly used in clinical settings to assess the cardiovascular system (blood pressure, heart rate), immune system (body temperature), and the respiratory system ...STTR Phase II 2019 Department of Health and Human ServicesNational Institutes of Health
Compatibility between Brain-Computer Interface and High-Efficiency Augmentative and Alternative Communication SystemsSBC: Prentke Romich Company Topic: NIDCD
Compatibility between Brain-Computer Interface and High Efficiency Augmentative and AlternativeCommunication Systems: Phase II ABSTRACT Brain-computer interfaces (BCI) enable text production for people who cannot move, but have only simple communication interfaces and are not widely used. Augmentative and alternative communication (AAC) systems are widely used and give efficient and precise commun ...STTR Phase II 2019 Department of Health and Human ServicesNational Institutes of Health
SBC: Integrated Biotherapeutics, Inc. Topic: NIAID
Project Summary Bacillus anthracis (Ba) is a Gram-positive spore forming bacterium that is listed as an agent of highest concern (Category A) by NIAID and CDC. Ba is easy to grow, and its spores can be formulated into highly stable powder form and disseminated as aerosol or used to contaminate food or water. In 2001, letters laced with powdered anthrax spores were mailed to several US politicians. ...STTR Phase II 2019 Department of Health and Human ServicesNational Institutes of Health

domain: medical


text:
Blackjack Strategy Tips – Figure out how to Conquer the Dealer at Blackjack Online
Blackjack, originally Uno and Black Jack, can be an American version of the traditional European card game called 21. The name blackjack originates from both cards dealt out in the overall game: one for you, and something for the house. The goal is to get the most for your money by making the best possible bet when cards are dealt. It really is considered a popular game, that can be enjoyed online or offline.
Strategy plays a large role in winning at blackjack. When playing against a real deck of cards, your strategy will undoubtedly be dependent on the cards that you have been dealt. In the same way, blackjack strategies be determined by the betting pattern you have chosen. One of the common and simple blackjack tactics is the Ace-King-Queen-10-valued card combo. This strategy can be used with any palm of cards, but particularly well with the initial two cards.
Some players would rather bluff, by showing that they have more cards than their opponent, which is often verified by looking at the hand signals used. Bluffing is really a risky strategy, however, because in the event that you choose the best cards to bluff with, your opponent may have causes to suspect it. If the cards that you pull another card from are already in your hand, then you don’t have to bluff; however, if the cards that you draw aren’t in your hand, then you must know how to handle your own cards if you wish to win at blackjack. Some typically common bluffing techniques include showing that you have more cards than your opponent.
Another common form of blackjack bluffing occurs when members bet utilizing the dealer’s cards, which are usually marked having an ace, a queen, a king, or a ten on the face. Following the dealer reveals his cards, some other competitors can call out “Ace!” followed by the number that was shown on the cards. The dealer next calls out “Queen!” accompanied by the number that was revealed on the card.
Online blackjack players sometimes make an effort to deceive the casinos by revealing significantly less than full hands. This is possible when playing in small casino networks where in fact the house edge (the difference between just how much a casino pays to obtain all its cards in a game and just how much it pays to obtain one card out) is lower. If the online player is aware that the dealer will fold early in a game (because the casino makes more profit from bets that win), he might call with a hand worth that reveals more cards compared to the casino has available to engage in with.
Blackjack can be very difficult to engage in at online casinos, when there are numerous card players. In a live life casino where there are many players, a single mistake will set you back the whole blackjack! Because of this , blackjack players who would like to win at blackjack online should not bet large amounts of these bankroll on any single video game. If you’re new to online blackjack games, it is advisable to start out by betting low amounts of your bankroll on any video game and then build up to larger bets as you enhance.
Some online casinos offer exclusive “quick draws” where in fact the dealer will package four cards and immediately call, producing a four-card draw. Participants who bet small amounts should realize that quick draws are faster than traditional draws and therefore give you a better chance of winning. Another benefit of these quick draws is that if the dealer will get an Ace or Queen out and about, you need to use this to quickly raise the bet to a greater amount, as a result defeating the dealer and increasing your chances of winning.
In a multi-table game like the Texas Hold’em, there is always the option of making a multi-table bet. In these multi-table games, it is usually legal to place two bets on each of the two tables – one additional card for each bet in a multi-table video game. When you make a multi-table bet, always remember you are betting on each table rather than on just 스포 플러스 카지노 one card in a particular hand. It is best to play defense than to try and win big money with a single bet.

domain: hobby