|Highbankers increase gold recovery rates and process material more effectively than traditional panning.
|Suitable for various environments, from creeks to home setups.
|Enables responsible gold prospecting with options for recirculating water systems.
|A valuable tool for both hobbyists and serious prospectors.
|Compatible with various additional prospecting tools and equipment.
Highbankers: A Gold Prospector’s Best Friend
Highbankers, a crucial tool in the world of gold prospecting, have revolutionized the way prospectors extract gold. By combining a sluice box with a powerful water pump, highbankers enable efficient processing of paydirt. They are particularly valuable for working away from the water source, where traditional panning might be ineffective.
A highbanker primarily consists of a hopper for feeding material and a sluice box for gold recovery. The adjustable leg support system facilitates setup on varied terrain, making it a versatile choice for different prospecting environments. Highbankers come in various models, from portable to more substantial setups, catering to different prospecting needs.
Operation and Efficiency
Operating a highbanker involves feeding material into the hopper at a consistent rate. The sluice box, angled between 5-15 degrees, ensures efficient gold recovery. Regular sluice box cleaning and monitoring water flow are key to maximizing gold recovery.
Choosing the Right Highbanker
Prospectors should consider the size and portability of the highbanker based on their specific requirements. For instance, the Royal Manufacturing Industries Folding Sluice Highbanker offers a balance between efficiency and portability, making it a popular choice among both beginners and seasoned prospectors.
Enhancing Your Highbanker
Adding accessories like classifiers, magnets, and miner’s moss can improve the highbanker’s efficiency. For example, using a magnet to remove heavy minerals and black sand before processing can significantly increase gold recovery.
Responsible prospecting with a highbanker involves using recirculating water systems, especially in areas with water scarcity. This not only conserves water but also aligns with environmental best practices.
Safety is paramount in gold prospecting. Ensuring stable setup, careful handling of equipment, and adherence to local mining regulations are essential when operating a highbanker.
Highbankers at ProspectingSupplies.com
ProspectingSupplies.com offers a range of highbankers, including the efficient 10″ Mini Power Sluice Kit and the versatile Royal Manufacturing Industries Folding Sluice Highbanker. Their selection caters to various needs, from beginner kits to more advanced setups.
Highbankers are invaluable tools in gold prospecting, offering efficiency, versatility, and environmental consideration. Whether you are a novice or an experienced prospector, a highbanker can significantly enhance your gold recovery efforts.


text:
Police are looking into a house in Marshfield, Massachusetts.
incident at a residence in the South Shore neighbourhood.
Tuesday about 9:30 p.m
., police were summoned to a house on Gotham Hill Drive.
The Medical Examiner's Office arrived at the scene early on Wednesday
And detectives were seen combing the area for several hours.
The reason why police
to the house has not been disclosed
By either the Plymouth County District Attorney's Office or the police.
When further information becomes available, WCVB will have it.

domain: news


text:
Silk is a natural protein fibre that is weaved into the fabric to make beautiful ensembles such as the silk suits for women on the Libas website. Silk has a luxurious texture and feel, but it also keeps you warm in the chilly Indian weather, which is why it is so popular at Indian events. Libas' finest range of silk suits for ladies includes sets of silk kurtas in various styles matched with ethnic bottoms such as skirts, palazzos, pants, and so on. Straight, Anarkali, a-line, asymmetric, and front-slit silk salwar suit are available for purchase at Libas stores, online, and on the mobile app. Women's silk suits are available in a variety of colours, including white, pink, green, blue, maroon, and black. Silk suits are available in a wide range of sizes, ranging from XS to 6XL. Browse the catalogue and buy your favourite silk suits online to save money on your favourite products.
Silk Suits for Women
Silk is a natural protein fibre that is weaved into the fabric to make beautiful ensemblessuch as the silk suits for women on the Libas website. Silk has a luxurious texture and feel, but it also keeps you warm in the chilly Indian weather, which is why it is so popular at Indian events. Libas' finest range of silk suits for ladies includes sets of silk kurtas in various styles matched with ethnic bottoms such as skirts, palazzos, pants, and so on. Straight, Anarkali, a-line, asymmetric, and front-slit silk salwar suit are available for purchase at Libas stores, online, and on the mobile app. Women's silk suits are available in a variety of colours, including white, pink, green, blue, maroon, and black. Silk suits are available in a wide range of sizes, ranging from XS to 6XL. Browse the catalogue and buy your favourite silk suits online to save money on your favourite products.
Steal the Show with Silk Suits From Libas
Silk suits for women are some of the most elegant and sophisticated ethnic ensembles that have held supreme position over other traditional pieces. They can give your demeanour a unique charm while keeping the feminine grace alive. The undeniable charm, the royal texture, and versatility of silk suits make them the primary choice for sacred and auspicious occasions.
The remarkable collection of silk suits on Libas is simply breathtaking. The designs are classy and distinctive and hug your body as though they were crafted especially for you. The apparels come in vibrant colours and joyous patterns to suit your style and choices. You will definitely find something that you love on our site. So dive into the ocean of options and take your pick.
Explore the Distinctive Collection of Silk Suits on Libas
Libas’ eclectic range of silk suits for ladies and meant to make you stand out from the crowd. We assure you will find the right fit and the style. Listed below are a few of the many choice options offered here.
Anarkali Silk Suits: These suits are Libas’ best selling pieces upto date. These suit sets consist of three pieces—a kameez fitted up to the empire line that flares out dramatically into a long flowy bottom, a pair of tight bottoms and a dupatta. We offer these suits in refreshing prints and patterns like floral, geometrical, abstract and more. Some also feature heavy zari work.
- A-Line Silk Suits: These suit sets feature a knee-length kurta and a pair of palazzo pants or churidars. They come in different prints and styles. While some feature minimal embroidery, others are embellished with delicate metallic prints and sequin work.
- Straight-fit Silk Suits: These pure silk salwar suits are intricately designed with fine embroidery. You can find suits with heavy embroidery that run all over the kameez, or ones with detailed patches on selected areas, or even statement pieces with fine zari embroidery along the neck and front.
Style Your Silk Salwar Suit For All Occasions
Salwar suits are timeless. With contemporary designers adding their charm to this traditional attire, it has become a rather refreshing outfit choice. So, if you wish to achieve a stylish yet unique look, here are some styling tips.
Go for The Comfortable Everyday Look
Create an everyday look by opting for Chanderi silk or cotton suits. A salwar-kameez set would be ideal for a busy day of running errands. You can choose to add a delicate dupatta depending on your comfort and task list. Tying your hair in a tight bun or braid would be ideal. Finally, you can apply some light makeup, add a pair of stud earrings, bindi and flats and take on the day.
Get a Versatile Look for Office Events
For an office event where you wish to make heads turn, wear a contemporary silk salwar or palazzo suit. Style the outfit with a pair of kitten heels or wedges for some added comfort. Keep your makeup minimal and pin up your hair. Spitz some delightful fragrance, add a simple clutch, and you are all set.
- Make A Statement in Traditional Functions
For a traditional function like a wedding, opt for a glamourous dress. We would suggest a heavily embroidered Anarkali suit paired with high heels. Opt for a dewy makeup look and tie your hair in a French bun. Wear a pair of heavy jhumkas and a necklace depending on the neckline of your dress. Finally, wear a bindi, apply a pleasing perfume and carry a potli bag to complete the look.
Shop For Silk Suits Online On Libas
Libas’ collection of silk suits will make you fall in love with the idea of donning ethnic ensembles for just about every occasion. The designs are simply gorgeous, the fits are flattering, and the quality of all the outfits is exceptional. In addition, you can find your favourite pick in your size without worrying about the lack of variety or distinct designs. We also offer other ethnic items to mix and match, such as women's trousers, sarees, kurtis, casual dresses and more. What’s more is that these come in many different styles, designs, patterns and colours to suit your choice.
Along with such a massive product range, we also offer a fifteen-day return policy and pan-India delivery to make your online shopping experience wholesome. Our user-interface is easy to navigate and all the payment methods are safe and secure. With that said, this festive season is the perfect time for you to shop for beautiful silk suits on Libas. So sign up today and start adding your favourite items to your cart!
SILK SUITS ONLINE - FREQUENTLY ASKED QUESTIONS
Are silk suits for women in fashion?
The answer is an unquestionable 'yes!' A silk suit for women has long been popular in the fashion world, and this season is no exception. With the right styling, a silk suit set can be a great classic and stylish choice for business, festive events, or even casual winter days. These suits, available in various silhouettes and designs, provide versatile looks that will keep you on trend all year, especially in the winter. Libas brings you an exclusive collection of silk suits for women that include pretty suits made of high-quality silk in various shapes like straight, a-line, asymmetric, front slit and more. Furthermore, a silk suit by Libas comes in an array of colours, including muted hues like pastel pink, mint green, powder blue, grey and more and bold shades like maroon, navy blue, emerald green, black etc. Browse through the collection and pick your favourites today!
What styles of silk suits are best?
Shopping for a silk suit (women) can be overwhelming, with various styles. Start with the occasion you are planning to wear it to. A silk suit (party wear) is usually heavily embroidered with intricate details, sequins, mirror work, gota patti, zari and more. Furthermore, these suits come in multiple shapes and silhouettes, like the anarkali suits, straight suits, sharara suits and silk salwar suits. The suits on Libas come in a wide range of colours, from vibrant ones like red, orange, yellow and pink, to elegant green, blue, burgundy and more. The best suit for you depends on the occasion, the time of the occasion and your preference. However, you can browse the collection of uniquely designed and premium-quality silk suits on Libas and pick the best ones.
Suits for Women | Block Print Suits | Cotton Kurtis | Gota Patti Suits | Embroidered Suits | White Kurti | Designer Wedding Lehengas | Women Wedding Dresses | Chanderi Silk Suits | Mirror Work Suits | Bandhani Print Suits | Chanderi Silk Sarees | Anarkali Suits | A-Line Kurtis | A-Line Suits | Angrakha Suits | Salwars Suits | Dhoti Pants Suits | Straight Pants Suits | Churidars Suits | Sharara Suits | Party Wear Suit Set | Office Wear Suits | Cotton Suits | Party Wear Sarees | Georgette Suits | Velvet Suits | Cotton Sarees | Floral Print Suits | Sharara | Wedding Wear For Women | Designer Red Sarees | Striped Suits | Checked Suits | Black Sarees | Floral Sarees | Green Suits | Blue Suits | Pink Suits | Black Suits | Yellow Suits | Maroon Suits | White Suits | Sarees For Women | Ethnic Dresses For Women | Kurtas | Lehenga | Bottoms For Women | Ethnic Wear For Kids | Lounge Wear

domain: design


text:
The Rustamid (or "Rustumid", "Rostemid") dynasty of Ibāḍī
Kharijiteimāms ruled the central Maghrebas a Muslim theocracy for a century and a half from their capital Tahertin present Algeriauntil the Ismailite FatimidCaliphs destroyed it. The state's extent is not entirely clear, but it stretched as far east as Jabal Nafusain Libya.
The Ibādiyya reached North Africa by
719, when the missionary Salma ibn Sa'dwas sent from the Ibādī "jama'a" of Basrato Kairouan. By 740, their efforts had converted the major Berber tribes of Huwwaraaround Tripoli, Nafusain Jabal Nafusaand Zenatain western Tripolitania. In 757(140 AH), a group of four Basra-educated missionaries (including Abd ar-Rahman ibn Rustam) proclaimed an Ibādī imamate, starting an abortive state led by Abul-Khattab Abdul-A'la ibn as-Samhwhich lasted until the Abbasids suppressed it in 761, and Abul-Khattab Abdul-A'la ibn as-Samhwas killed. On his death, the Tripolitanian Ibādiyya elected Abul-Hatim al-Malzuzias imām; he was killed in 772after launching a second unsuccessful revolt in 768.
After this, the center of power shifted to
Algeria, and ˤAbd ar-Rahmān ibn Rustam, a Tunisian-born convert to Ibadiism of Persian origins already mentioned as one of the four founders of this imamate, was elected imām; after this, the post remained in his family, a practice which the Ibādiyya justified by noting that he came from no tribe, and thus his family had no bias towards any of the tribes of which the state was formed.
The new imamate was centered on the newly built capital of
Tahert; several Ibādī tribes displaced from Tunisiaand Tripolitaniasettled there and strong fortifications were built. It became a major stop on the newly developing trade routes with sub-Saharan Africa and the Middle East. It is described by visitors such as the SunniMuslim Ibn as-Saghiras notably multi-religious, with a significant and loyal Christianminority and a substantial number of Sunnis and Jews, and open religious debate was encouraged.
Ibn as-Saghir also describes the imām as notably ascetic, repairing his own house and refusing gifts; the citizens sharply criticized him if they considered him derelict in his duty. Religious ethics were strictly enforced by law.
The Rustamids fought the
Aghlabids of Ifriqiyya (based in Qairawan) in 812, but otherwise reached a "modus vivendi"; this displeased the Ibādī tribes on the Aghlabid border, who launched a few rebellions.
After Abdu l-Wahhāb, the Rustamids grew militarily weak; they were easily conquered by the
Ismaili Shiite Fatimids in 909, upon which many Ibādiyya - including the last imām - fled to the Sedratatribe of Ouargla, whence they would ultimately emigrate to Mzab.
Abd ar-Rahman ibn Rustamibn Bahram ( 776- 784)
Abd al-Wahhab ibn Abd ar-Rahman( 784- 832)
Aflah ibn Abd al-Wahhab( 832- 871)
Abu Bakr ibn Aflah( 871)
Muhammad Abul-Yaqzanibn Aflah ( 871- 894)
Yusuf Abu Hatimibn Muhammad Abil-Yaqzan ( 894- 897)
Yaqub ibn Aflah( 897- 901)
Yusuf Abu Hatimibn Muhammad Abil-Yaqzan, again ( 901- 906)
Yaqzan ibn Muhammad Abil-Yaqzan( 906- 909)
Wikimedia Foundation. 2010.
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Rustamid kingdom — ▪ historical state, Algeria Rustamid also spelled Rostamid (AD 761–909) Islāmic state on the high plateau of northern Algeria, founded by followers of the Ibaḍīyah branch of Khārijism. It was one of several kingdoms that arose in… … Universalium
History of medieval Tunisia — The present day Republic of Tunisia, al Jumhuriyyah at Tunisiyyah , has over ten million citizens, almost all of Arab Berber descent. The Mediterranean Sea is to the north and east, Libya to the southeast, and Algeria to the west. Tunis is the… … Wikipedia
North Africa — North African. the northern part of Africa, esp. the region north of the tropical rain forest and comprised of Morocco, Algeria, Tunisia, Libya, and that part of Egypt west of the Gulf of Suez. * * * Introduction region of Africa comprising … Universalium
Medieval Muslim Algeria — Part of a series on the History of Algeria … Wikipedia
Algeria — Algérie redirects here. For the French WWII heavy cruiser, see French cruiser Algérie. Coordinates: 29°34′24″N 2°22′23″E / 29.5734571°N 2.3730469°E / … Wikipedia
Berber people — Berbers Imazighen / ⵉⵎⴰⵣⵉⵖⴻⵏ … Wikipedia
Ibadi — The Ibadi movement or Ibadiyya (Arabic: الاباضية al Ibāḍiyyah) is a form of Islam distinct from the Shi a and Sunni denominations. It is the dominant form of Islam in Oman. There are also Ibadis in Algeria as well as Libya. [web… … Wikipedia
Muhallabids — This article deals with the governors of Ifriqiya. For other dynasties Muhallabids (disambiguation). History of the Arab League member states Arab Caliphate Rashidun … Wikipedia
Berbers and Islam — The Berbers (Imazighen) are an ethnic group that had, until recently, few links to the Arabs. They have existed in ancient Mauretania, Numidia, Ifriqiya and Tripolitania, (present day Morocco, Algeria, Tunisia and Libya respectively) for… … Wikipedia
Rostémides — الرستميون al roustoumiyoune 767 – 909 Informations générales Statut confédération Capitale Tahert Langue arabe et langues berbères Religion … Wikipédia en Français

domain: history


text:
Ben & Jerry’s is rolling into the Emerald City this summer for the second year in a row with its social media–driven Scoop Truck tour, offering free scoops of the company’s new Greek Frozen Yogurt flavors.
Ben & Jerry’s is also looking to local Seattle fans to help develop a unique, local flavor. The new campaign, “City Churned,” is the first of its kind to crowdsource a locally inspired flavor that is literally created by the city of Seattle itself.
Ben & Jerry’s is tabulating activities throughout the Emerald City, such as public transportation data, city landmarks, tweets, traffic patterns, local ingredients, and its people, to create and ultimately name a Seattle-inspired Ben & Jerry’s flavor.
For example, Ben & Jerry’s has been tracking the visibility of Mount Rainier to help decide between the ingredients Theo Chocolate and Yellow Cake Pieces. Every day that Mount Rainier is visible, it is a vote for Theo Chocolate—one of the local companies partnering with the brand to provide local ingredients.
On days when the mountain is engulfed in clouds, it is a vote for Yellow Cake Pieces. In addition to Theo Chocolate, Ben & Jerry’s is also partnering with Caffé Vita coffee to ensure the flavor is a true tribute to Seattle.
"The Scoop Truck began cruising through the streets of Seattle last summer giving away free scoops of our new flavors, and this year we wanted to do something more for our fans. There's a personality to Seattle, as in any city, that is distinctive unto itself. Some would say ‘a flavor,’" says Dave Stever, director of marketing. "We want to be able to capture the heartbeat of one of the most popular and unique U.S. cities and ultimately create a new flavor that is truly inspired by the great people of Seattle.”
Fans can also weigh in on each ingredient match-up by voting online on the “City Churned” Seattle microsite. On the site, fans can also put their creativity to the test by submitting their original ideas for the flavor name.
The campaign will conclude in mid-September with a community event where, for one day only, Ben & Jerry's will invite the community to celebrate the new, euphoric flavor of Seattle that they helped to develop.
Consumers can satisfy their Ben & Jerry’s craving via the Seattle Scoop Truck now through September 16. Fans can not only tweet the Scoop Truck to get a free scoop of the new Greek Frozen Yogurt flavors—including Liz Lemon, Raspberry Fudge Chunk, and Banana Peanut Butter—but they can also physically cast “City Churned” ballots by tossing their spoons into recycling bins listed for Caramel or Fudge.


MLS Action at SeatGeek Stadium – Chicago Fire face Philadelphia Union
Thursday’s MLS clash between Chicago and the visiting champions, kicks off at 3:00am GMT at SeatGeek Stadium.
Leaders Union are currently 12 places higher than their opponents Chicago, when the two sides meet, they will sit in first and thirteenth positions respectively.
Chicago Fire go into this fixture with 14 points secured
With two wins in a row under his belt, Ezra Hendrickson takes his Chicago team into this game full of confidence, and hopeful of another successive victory.
Also, Ezra Hendrickson knows that a run of seven losses in nine fixtures for his Chicago side, is going to be a tough run of form to change. However that is exactly what he must try to deliver. Their position is thirteenth in the League and they have 14 points, that is, 0W, 0L and 0D.
Playing at home, Chicago have won two meetings, drawn three meetings, and lost two matches.
A victory for Chicago Fire would put them on 17 points.
Maintaining their position as League leaders will be Philadelphia Union’s primary goal going into this meeting
Union will be buoyant, following a 2-1 home win against New York in their last fixture.
Also, with seven draws in nine games, Manager Jim Curtin has plenty to ponder, going into the next fixture, not least of which is how to get the wins he needs. With 29 points (0W – 0L and 0D), they currently sit top of the League.
Union’s away record is remarkable and poses a significant threat to Chicago. In the 7 games they’ve played on the road this season, they have so far won three fixtures, drawn three meetings, and lost one game.
A win for Philadelphia Union will take the League leaders to 32 points, further consolidating their position and keeping the pressure on everyone else.
Chicago Fire v Philadelphia Union – Head-to-Head.
Regarding their historical duels the recent form between these two sides has seen Union with a greater number of wins. In the last 28 meetings, they have enjoyed 12 victories, to Chicago’s nine wins. In addition, the last nine meetings against Union have resulted in five wins for Chicago. The last time they played each other in this competition was August 2021 and the score line ended up with a 1-1 draw.
For Chicago, Chris, one of their best scorers, has netted in 16 League matches this MLS Season, while Andre contributed with in 16 League fixtures this campaign for Union.
Other players of note for Chicago are Gabriel and Spencer with respectively and for Union are Joseph and Matthew Andrew with respectively.


31 July 2020
Ministers have announced an extension to the Government Co-Funded Payroll Scheme (CFPS) until March 2021. The scheme, which was introduced in April, was due to end on August 31, but will now be phased out from September 2020 until March 2021. From September the subsidies received by businesses for each employee will be gradually reduced.
The Minister for Economic Development, Tourism, Sport and Culture, Senator Lyndon Farnham, said: “This is a significant extension of the payroll scheme, which is a more substantial scheme than most jurisdictions worldwide, and gives greater flexibility and support to employers, employees and the self-employed.
“The extension to our payroll scheme will help to maintain the protection of jobs throughout the winter months. We are also fulfilling the government’s commitment to avoid a cliff-edge end to financial support. It is essential to provide businesses with the certainty of a continuing subsidy, to allow them to plan ahead as trading adapts and the economy begins to recover.”
The Minister for Treasury and Resources, Deputy Susie Pinel, said: “As well as extending the scheme, we are also lowering the detriment test from 30% to 20%. This means businesses will only need to show a 20% reduction in income and it will allow more businesses to qualify for support. This will aid economic recovery and share financial support across a wider business base, as subsidies reduce and economic activity returns.
“There will be no change to eligibility, but businesses will be able to claim for new or different employees, if those employes are Entitled or Entitled to Work, or they can hire people who are Registered if they were on any payroll in March. Funding for the scheme has been confirmed by the Treasury until at least the end of December and, subject to approval of the new Government Plan by the States Assembly, until March 2021.”
From August 2020, in order to be eligible to claim under the scheme, businesses will be required to return to broadly normal trading patterns (in line with health advice) and will not be able to remain closed if safe to open, or artificially restrict revenue to make them eligible for CFPS.
This scheme will have cost an estimated £93 million by the end of August. This is significantly below the initial £138 million estimate. The gradual tapering of the scheme until March next year will cost approximately another £26-£53 million, bringing the estimated total cost of the CFPS to between £108 million and £137 million.
In considering the future of the scheme, Ministers have had to balance the need to make prudent use of public money with the importance of giving certainty to business, and of avoiding a sudden end to financial support. The certainty provided by a guaranteed employee subsidy until March 2021 will allow businesses to plan for future trading conditions.
Ministers will continue to monitor the CFPS and will be open to amending the scheme if a change in the prevalence of the virus in Jersey impacts on public health restrictions and associated trading.
The subsidy will operate in the following way from September 2020 to March 2021:


MOZA Slypod Professional Monopod Motorized Movement Digicam Slider Correct Place & Pace Management Lengthen Out 520mm Most Pace 40mm/s with Pan and Tilt Head & Tripod
(as of May 11,2022 09:58:15 UTC – Particulars)
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【Highly effective&Sturdy】 This 3-in-1 monopod is manufactured from sturdy and lightweight carbon fiber supported by a strong foldable tripod base designed to assist the Slypod Professional on any floor. The clever mechanical design supplies Slypod Professional with maintenance-free efficiency, defending the built-in transmission system from wind, sand, and mud


text:
THE U.N. AT 50
THE U.N. AT 50; Carter Fosters Rwanda Peace Effort
Published: October 23, 1995
Former President Jimmy Carter said yesterday that he has agreed to convene a conference with the active participation of Tanzania, Uganda and Zaire to try to prevent "further humanitarian tragedies" in Rwanda and Burundi.
At a news conference with the presidents of Uganda and Zaire, who are attending the 50th anniversary meeting at the United Nations, Mr. Carter said the date and place of the conference are still to be determined. He added that the leaders of Rwanda and Burundi had agreed to the conference, although Burundi said it has to conduct consultations at home.
Hundreds of thousands have died in ethnic slaughters in the area and more than two million people are refugees. Mr. Carter declined to specify what the conference would do or discuss.

domain: sociology


text:
Standard scenic pushes on Big Area of Hawaii are plentiful. Actually, virtually every push on the wonderful isle can be viewed as scenic. Some of the most used scenic pushes demand a four-wheel push to get into the whole drive. Hire businesses concentrate in vehicles only for this specific purpose, Big Island photographers and most may be leased by the hour on the Big Island.
Onomea Bay Panoramic Get
That is among the most used scenic pushes on the Big Island. That slim, rotating road goes through beautiful water forest terrain with wonderful bubbling revenues apparent from the road. That journey also allows you to see the collapsed Onomea Arc and the Tropical Botanical Garden.
Sequence of Craters Road Panoramic Get
That uncommon scenic push offers see of lava woods and a sizable petro glyph field. The journey lasts about two hours and is entirely on paved roads.
Kahinahina Panoramic Get
This can be a wonderful push, but involves four-wheel push due to the issue of the soil road in some areas. The whole journey lasts about seven hours. You are able to choose between two different paths. The large road, Kahinahina Road, empties onto Seat Road and the lower road, Mana Road, comes out near Waimea. Equally paths offer extraordinary views distinctive to this wonderful scenic drive. Hiking paths and rest parts is found all over the route.
Crater Edge Panoramic Get
That three-hour push circles the wheel of the Kilauea Volcano while moving through Hawaii's Kau Leave and a tropical water forest!
Mauna Loa Panoramic Get
That seventeen mile extended, rambling push goes along a paved path as you vacation up the side of the world's biggest pile, Mt. Mauna Loa. You'll see magnificent lava runs, wonderful vista views, and organic Hawaiian landscapes. That scenic push stops at the Mauna Loa Climate Observatory, in which a scenic hiking trailhead is situated for the bold to walk to the mountain's summit.
Kumukahi Lighthouse Panoramic Get
That serene scenic push goes from Honolulu Landing to Kumukahi Lighthouse. It travels for six miles on slight soil highways and takes the typical scenic driver two hours to complete. That scenic push offers magnificent views of both flora and fauna discovered just on Hawaii.
The Kaalaiki Top Road Panoramic Get in Ka'u
That 15 mile expand of paved and well-maintained soil road goes between Pahala and Na'alehu on the Big Island. It includes magnificent views of woods, vegetation, wildlife, and the sparkling blue sea 2,000 feet under you.
Mauna Kea Summit Panoramic Get
That 43-mile extended journey takes visitors to the summit of Mauna Kea. After at the very top, you can go to the astronomical observatories situated nearby. On a definite time, that journey provides views of the neighboring Hawaiian Islands! That scenic push goes across a wide selection of Hawaiian areas from Rain Forests to the sparsely livable summit of Mauna Kea. The journey may possibly involve four-wheel push to attain the summit.
Road To The Ocean Panoramic Get
That scenic push involves four-wheel push to attain the secluded pockets of natural sandy beaches which are produced as a result of volcanic activity. You ought to arrange for a four-hour push to traverse the six miles of rugged terrain.
Every trip to the Big Area includes a minumum of one magnificent scenic drive. The scenic pushes on The Big island of Hawaii offer countless photo options and boundless potential for creating one-of-a-kind memories accessible just in Hawaii.

domain: geography


VdA | View firm profile
On 23 December 2020, the Portuguese Government enacted Decree-Law no. 106-/2020, approving the transitional regime applicable to the provision of financial services by United Kingdom based entities. The regime enters into force on 1 January 2021 if, on that date, no agreement (or equivalent decision) has been reached between the European Union and the United Kingdom of Great Britain and Northern Ireland, regulating the matters covered therein (“Decree-Law”).
The Decree-Law approves several important novelties in this regard, namely the following:
PROVISION OF INVESTMENT SERVICES AND ACTIVITIES AND ANCILLARY SERVICES IN PORTUGAL
•Credit institutions and investment firms authorised in the United Kingdom to provide ancillary services and investment services and activities, operating in Portugal under the right of establishment and the freedom to provide services, may continue to provide such services to investors in the Portuguese territory after the end of the transitional period provided for in the exit agreement, which at this moment corresponds to 31 December 2020 (“Expiry Date”).
•For this purpose, interested entities shall, within 3 months from the Expiry Date, submit to the CMVM (Comissão do Mercado de Valores Mobiliários) the elements contained in Annex I to the Decree-Law, indicating if they intend to (i) terminate the existing agreements; or (ii) request authorisation to maintain their activity in Portugal.
•Entities who intend to request authorisation to maintain their activity in Portugal shall submit such authorisation request to the competent authority within 6 months from the Expiry Date.
PROVISION OF SERVICES IN RELATION TO COLLECTIVE INVESTMENT UNDERTAKINGS IN PORTUGAL
•Management entities authorised in the United Kingdom to provide services relating to collective investment undertakings (CIUs) and operating in Portugal under the right of establishment and the freedom to provide services may continue to provide those services to investors in Portuguese territory after the Expiry Date.
•After the Expiry Date, credit institutions, payment institutions and electronic money institutions established in the United Kingdom and operating in Portugal under the right of establishment and the freedom to provide services may execute agreements or carry out new transactions in Portugal relating to taking deposits, granting credit, payment services and the issue of electronic money, only if they have obtained prior authorisation from Banco de Portugal under the regime applicable to third country entities.
•However, entities covered by the preceding paragraph are still entitled to perform the necessary acts for the execution of (and compliance with) the agreements relating to such services or activities which have been concluded up to the Expiry Date. This provision shall also apply to the provision of services of an ancillary or instrumental nature to a pre-existing master agreement entered into by a client resident in Portugal and which do not constitute new operations or new agreements.


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The Australian's Ean Higgins must be gratified at the way he and his colleague Christian Kerr have got AusAID bureaucrats ducking for cover, equating the paper's anti-BDS beat-up for general "media attention":
"The Australian can reveal that earlier this year senior AusAID officers secretly considered blocking a $580,000 grant destined for Professor [Jake] Lynch's Centre for Peace & Conflict Studies (CPACS) at the University of Sydney. Documents obtained under Freedom of Information show then AusAID assistant director-general Rebecca Bryant said she feared approving the grant might 'compound' media attention surrounding BDS, even though the proposed research program had nothing to do with the international boycott campaign seeking improved rights for Palestinians." (Academic hints at link between BDS campaign and rejected research grant, Ean Higgins, 27/12/13)
Curious this. If concern about attracting the attention of the media over BDS was really a factor in considering whether to fund CPACS, one really has to ask whether the likes of Rebecca Bryant and her colleagues at AusAID actually read or listen to the media. If they do, they'd know that neither Fairfax nor the ABC are campaigning against BDS or its supporters. Which leaves only Murdoch. And if their concern is attracting the attention of Murdoch operatives such as Higgins and Kerr, why not say so?
Now as you may remember, BDS supporter Professor Lynch had himself applied for a grant from the Australian Research Council (ARC) which only became problematical when, in May, then opposition foreign affairs spokeswoman Julie Bishop announced that a Coalition government would ensure 'no grants of taxpayers' funds are provided to individuals or organisations which actively support the BDS campaign'.
Well, it transpires that Professor Lynch's grant has been rejected by the ARC, and he has his suspicions that the present government has something to do with it:
"This year Professor Lynch submitted an application to the federally funded Australian Research Council for $290,000 to study the work of journalists in South Africa, Nepal, Australia and Britain. The ARC recently rejected the application. 'It could be, of course, that it was simply adjudged not quite good enough by the assessors,' Professor Lynch told The Australian. 'But the Bishop statement, and the earlier evidence that AusAID... improperly took my support for BDS into account, leaves me with suspicion that this has happened with the ARC too. I have a verbal agreement with the National Tertiary Education Union (NTEU) that they will launch a Freedom of Information request to see if there is any correspondence showing a possible link'." (ibid)
We look forward to the result of the NTEU's FoI request.
Finally, in a Higgins/Kerr piece (of work), you know you're never going to get the Israeli organ grinder himself, but any of his local monkeys - no problem:
"Labor MP Michael Danby, a fierce opponent of BDS... said the ARC would have made its decision based on academic rigour. 'Jake Lynch is not a very highly regarded academic, he's just basically an ex-BBC journalist'." (ibid)


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"Tiny prints, thanks! The service that way provided to be able to give me options to personalize the invitations was more than I expected and also to have your team to proof read is more than awesome :) Though I ended up going with the stock colors and layouts, it was nice to see that when I reached out to your design team, they gave me some alternative options, very quickly!! Thanks for making this a great experience and I look forward to my next order! Best, JT"
"My baby shower invitations arrived a day before they were expected & the quality is great! Looks just as it did on the proof online."
"The paper is of very high quality. I used the standard paper. The reason I love this invitation is the simple modern design. The white print is very easy to see and the blue color is very refreshing. I also love the pocadots on the back of the paper. Very high class, reflecting the elegant baby boy shower I am hosting with my mother and 3 sisters for my daughter. I received the invitation 5 days before I expected, which gives me ample time to address 48 envelopes. I am definitely using Tiny Prints for all my custom invitations. Am delighted with the quality and service."
"I was beyond happy and amazed with the customer service and product. For some reason I wasn't able to place my order online, so I called. Not only did the representative place my order, she made a correction which I hadn't caught. The invites came quicker than expected, and they are beautiful. I've recommended this company to everyone and will use them forever."
"They changed the baby shower to baptism and the result was amazing! very happy with the finished product and the quality!"


The new “Strictly” season is back on the BBC, but it’s Strictly Come Dancing every day of the year for Lynette Boyce and her family, for whom dancing well and truly runs in the blood. For over 40 years members of the Boyce family have been wowing audiences and judges with their ballroom dancing prowess. Between them they have won numerous championship awards. Continue reading ““Strictly Come Dancing” is in their Blood”
With dance numbers apparently in decline you may be surprised to learn that Sequence Dancing is probably the most popular form of traditional ballroom dancing in the UK with good regular attendances at local clubs and classes. So, what exactly is sequence dancing and what makes it different? Continue reading “A Brief Guide To Sequence Dancing”
Linedance as we know it today has evolved way beyond its original roots in country and western dancing. Forget the image of cowboy hats and “yee-ha” as these days linedancing is accompanied by a wide variety of music styles, both new and old. As long as it has a regular beat, you can linedance to it! Continue reading “Linedance Fun in Torquay”
What is it about Latin American dancing that makes it sound so glamorous, especially the tango? For me, mention ”tango” and I can immediately picture couples dancing under foreign skies in a close embrace on warm, dusky evenings to sultry sounding music. OK, so I might be getting a bit carried away. And this is where I must admit that as a novice I get quite muddled as I struggle to tell the difference between ballroom tango and Argentine tango. Continue reading “Ballroom Tango and Argentine Tango?”
It’s that time of the year again where our Saturday nights and living rooms are transformed into a sea of celebrity dancing. Yes, Strictly Come Dancing will be back on our screens before you can say ‘X Factor versus Strictly ratings war’.
Dancing of all types certainly seems to have had a resurgence in recent years and programmes such as Strictly and Got To Dance have helped fuel the flames. But why has it become so popular? What inspires anyone to take to the dance floor?


text: Apink started the North American tour in Vancouver on January 5, followed by Dallas, San Francisco and Los Angeles. Jobros the one where the band gets back together shirt. In the same month, the group received the Bonsang award at the Seoul Music Awards and Disk Bonsang awards ceremony at the Golden Disk Awards.   On January 24, the group invited to attend the KKBOX Music Awards was held in Taiwan.  On February 25, the group released a music video for the Japanese song “Brand New Days”. The song was also chosen as the opening theme for the anime Rilu Rilu Fairilu ~ Yousei No Door ~.  The group also performed at the Asian Film Awards on March 17.  On April 2, Apink held a mini-concert called Pink Memory Day “in Singapore.  On April 19, the group released the single” The Wave “, with the lyrics written by Park Cho-rong to celebrate the 5th anniversary of its founding and issue a photo book entitled “Girls’ Sweet Repose.

domain: artistic


text:
New Japanese budget airline ZIPAIR (ZIPAIR Tokyo Inc) headquartered at the Tokyo Narita Airport launched operations with its first cargo flight in the first week of June. The first flight flew with cargo from Tokyo, Japan to Bangkok, Thailand.
Due to the ongoing Coronavirus pandemic and lockdowns, the airline started its cargo operations and delayed the planned Narita-Bangkok passenger flight services. Zipair was scheduled to start passenger operations on May 14th, but the plans were postponed as international passenger flights were banned by Thailand.
The cargo flight from Narita airport carried 13 tonnes of daily commodities to Thailand and returned with 17 tonnes of electronic components from Bangkok, Thailand.
Zipair has plans to start passenger flights from Tokyo to the following destinations in 2020.
|South Korea||Seoul||Incheon International Airport|
|United States||Honolulu||Daniel K. Inouye International Airport|
As of March 2020, ZIPAIR has a fleet of 2 Boeing 787-8 planes leased from Japan Airlines.
ZIPAIR Passenger flight Cabin Design
In end of 2019, ZIPAIR unveiled their passenger cabin design. The cabin is sleek and looks classy.


Sig’s 1-6x24mm TANGO6 optic will top off a variant of the Heckler & Koch G28E rifle to serve as the Army’s new SDMR, replacing legacy accurized M14 rifles. (Photos: Sig Sauer)
The Army has announced that Sig Sauer’s 1-6x24mm Tango6 optic has been selected to equip the service’s new Squad Designated Marksman Rifle.
The Tango6 series scope, as selected for a 6,069-unit SDMR requirement, will include a flat dark earth aluminum main tube, 762 extended range bullet drop compensation illuminated front reticle and a red horseshoe dot for daylight target acquisition.
“It’s truly an honor to be selected as the official optic for the Squad Designated Marksman Rifle, and it is very humbling to once again earn the trust of the US Army through this selection,” said Ron Cohen, Sig’s president and CEO, with the news coming a year after the company’s big win in the Army’s Modular Handgun System competition.
“Sig Sauer is committed to providing the highest quality equipment for the military that surpasses expectations in durability, accuracy, and performance, so they have tools they can rely on for every mission requirement in the defense of freedom,” Cohen said.
Typically sold in a black finish commercially, the Army’s version of the optic will have an anodized aircraft grade aluminum main tube with a FDE coating.
Other features of the optic include a locking illumination dial, Power Selector Ring throw lever, and a laser-marked scope level indicator for mount installation that Sig bills as being six times more accurate than a typical bubble level.
The Army is moving to adopt some 6,000 Heckler & Koch G28E rifles as the service’s new SDMR platform, replacing modified M14 rifles used for the purpose over the past decade, Military.com reported. While the same 7.62x51mm-caliber rifle, when classified as the M110A1 Compact Semi-Automatic Sniper System uses a Schmidt & Bender 3-20 power variable scope, Army officials said the SDMR variant, meant for use at the squad-level, would use an optic geared more towards close-quarters battle.
“What we are looking at would be in the realm of a 1-6, variable-power illuminated reticle,” Daryl Easlick, the small arms deputy for the Lethality Branch at Fort Benning’s Maneuver Center of Excellence told Military.com in March. “The concept would be if I am doing anything under 50 meters or even 100 meters, I am on one power and I can execute those tasks that I would normally do with a [close combat optic] very well.”


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- Genre RPG
- Region Worldwide
- Languages Multilanguage
- Singleplayer Yes
- Multiplayer Yes
- CO OP No
- Release Date 29 Jan, 2015
About This Game
Important note: Heroes III – HD Edition content is based on the original 1999 game: The Restoration of Erathia.
Do you remember all those sleepless nights spent fighting Black Dragons and Archangels, Demons and Necromancers? Were you a true fan of Heroes® of Might & Magic® III? We have great news for you!
The most popular Heroes® title of all time is back in HD! Fifteen years later, rediscover the epic tale of Queen Catherine Ironfist, as she re-embarks on her critically acclaimed quest to unite her ravaged homeland and re-conquer the kingdom of Erathia.
Forge the destinies of mighty and magical heroes, leading fantastic and ferocious creatures in a game that still stands today as the landmark opus of the Might & Magic: Heroes’ franchise.
Heroes® of Might & Magic® III is a turn-based strategy game, originally released in February 1999.
• A new HD experience: re-live the Heroes® III in HD, a true craftsmanship which offers players updated graphics, with wide screen compatibility.
• Enjoy the critically acclaimed Heroes® III gameplay, with 7 exciting campaign scenarios, around 50 skirmish maps, a local multiplayer mode and a map editor.
• A new online multiplayer lobby: Now Steamworks compatible, Heroes® III offers an online multiplayer lobby, where you can share your experience with the Heroes III community.
- CPU: Intel Core2 Duo E4400 @ 2.0 GHz or AMD Athlon64 X2 3800+ @ 2.0 GHz (or better)
- GPU: nVidia GeForce 8800GT or AMD Radeon HD2900 (256MB VRAM or more with Shader Model 4.0)
- RAM: 2 GB RAM
- OS: Windows 7 SP1, Windows 8, Windows 8.1 - both 32/64bit versions
- Other: Windows-compatible keyboard and mouse required * This product does not support Windows® 98/ME/2000/NT4.0 * Windows XP and Vista are not officially supported for this title although they may run the game properly.

domain: entertainment


text:
The travel destination in the shape of the Valsugana offers the great deal of the lakes that are located in the Trentino region of the country named Italy which is the mouth-watering for the tourists and travelers. It allows you to do the hiking with the help of the large mountains and the taking of the fresh air while being surrounded by the natural beauty wonders of the country named Italy. The beautiful picture of the still waters, amazing view of the lake side beaches and the small size thermal spa town that have the things can attract the large number of tourists and travelers of the world.
Sunrise at Lake Caldonazzo:
As the matter of the fact, the visit of this lake would turn out to be magical for you and for the people who are considered to be near and dear ones. You would come across many people who would say that the sunrises at this lake appear to be magical with the surrounding mountains offering the perfect view. It is worth noticing truth that this lake provides you an opportunity to get the early morning view with the beautiful sunrise. As and when the sun gets to its peak at the mountain, the golden glow throws the beautiful spark around the area which has to be quite lovely and mouth-watering. For the many people who come to explore this lake, it is the magical thing and the unmatchable view to be explored for the purpose of doing something good with life. You can have the relaxing and comfortable environment while being surrounded by the peaceful lake with the sunrise taking its place.
Lake of Levico:
It has been the 2nd largest lake along with the lake of the Caldonazzo which is the warmest lakes of Southern Europe in the region of the Valsugana, the beautiful part of the country named Italy. This is the lake which has the total area of the 1 square kilometer along with having the high level of the depth in the shape of the 38 meters. As the matter of the fact, the shores of this lake have been featured by the things called woods that would offer you the opportunity to engage in the activity of the walks in the shape of the picturesque. It has been observed by the tourists and travelers that the lake Levico has been the perfect place if you want to engage yourself in the activity of the fishing. You would be able to get the sight of the wide range of the fish species which are the part of the waters that surrounds this beautiful lake.


text:
Fish tank temperature probe
How many programmers does it take to change a light bulb? None, that's a hardware problem.
For all your bananapiano needs
Grab the latest edition of the official Raspberry Pi magazine, The MagPi, today!
Free resources to teach, learn and make with Raspberry Pi
The Raspberry Picademy is a free professional development experience for teachers
Get monthly updates for educators from the Foundation's education team
The MagPi is now the official Raspberry Pi magazine - and the price starts at free!
Community events to share knowledge, learn new things, and meet other Pi enthusiasts
A new funded programme for creative 16-21 year olds
Free Raspberry Pi weather station kits for schools around the world
Raspberry Pi's professional development course for teachers held at the Google Garage venues
The second generation Raspberry Pi
The final revision of the first generation Raspberry Pi
A cheaper, smaller, low-power spin of the Raspberry Pi 1 Model B+
Prototyping board for the Raspberry Pi compute module
The official Raspberry Pi case
The official and recommended universal USB micro power supply for Raspberry Pi
The official and recommended universal USB WiFi dongle for Raspberry Pi
Sensor board and LED matrix add-on board used in the Astro Pi space mission

domain: hobby


text:
Everyone expected the ER patient load to go up as the number of people with affordable (or any) insurance goes down, but the fact that some people with insurance actually prefer the ER for routine pediatric care over their PCPs isn’t exactly common knowledge.
There’s a new piece in the Washington Post about the “non-urgent” patient load handled in pediatric emergency rooms that’s a must-read. Everyone expected the ER patient load to go up as the number of people with affordable (or any) insurance goes down, but the fact that some people with insurance actually prefer the ER for routine pediatric care over their PCPs isn’t exactly common knowledge.
The article is based off of a study in Ambulatory Pediatrics, which found that not only were parents choosing to skip the PCP visit altogether, but some PCPs were actually referring them to the ER. The analysis was based off of data collected from 31 families who visited the pediatric emergency department for non-urgent care between the hours of 8:00AM and 4:00PM on weekdays over a period of four weeks.
The fact that data was collected at only one hospital is a limiting factor, so it would be interesting to see additional research that included multiple facilities around the country. Studies like this can be helpful — when they are not viewed by the professional community as “finger-pointing”- at a time when the country is considering a healthcare system overhaul. I don’t think pediatricians are at fault, but I take exception to responses from professionals (such as the one interviewed for the Post article) who try to boil the matter down as convenience for parents. “Convenience” is becoming a necessity, not a choice — and the current economy only increases this fact. Most parents work and simply cannot afford long waits or referrals.
Our current healthcare system encourages referrals in primary care. The ER, on the other hand, is one-stop shopping. What are your thoughts?
On the technology side, Siemens has announced that it will introduce a new CT scanner, the Somatom, to the market in the first quarter of 2009 at a lower dose of radiation. This could make things easier on kids - they wouldn’t have to hold their breath, and they’d be in and out quickly.
A German company, MBR Optical Systems, has also recently announced a product called Haemospect, which is a hand held, non-invasive blood and tissue analyzer. You can read the press release here and see the product description here. The device was presented last week at Medica 2008 in Düsseldorf, but I don’t see a device approval in the FDA database at this point. However, it may be on its way.
That’s the news for this week. Have a happy and safe Thanksgiving, everyone!

domain: medical


COLUMBUS, Ohio – The Buckeyes’ (11-7) win streak was halted at seven games as they fell to Wright State (9-10), 3-0, on Tuesday night.
- Trey Lipsey had a lead-off single in the bottom of the first inning and Marcus Ernst was walked with one out on the board, but both were stranded.
- Tyler Pettorini hit a two-out single in the bottom of the second inning, followed by Josh McAlister drawing a walk, but the Raiders got the final out on a fielder’s choice to keep the game scoreless.
- The Buckeyes turned a double play to wrap up the top half of the third inning, keeping Wright State off the board.
- The Raiders took a 1-0 lead in the top of the fifth inning after a solo homerun.
- In the top of the eight, Wright State scored on an Ohio State error to get ahead by two, 2-0.
- Kade Kern singled to left field and advanced to second on a Raider error, but he was stuck there as the next two Buckeyes flied out.
- An RBI single in the ninth gave the Raiders a 3-0 lead, which was the winning score after the Buckeyes went down in order in the home half.
Buckeyes by the Numbers
- Lipsey, Kern and Pettorini each had one hit.
- Starter Gavin Bruni fanned four and allowed only one hit in 3.1 scoreless innings of work.
- Jonah Jenkins (3-1) took the loss on the mound. He struck out three and gave up one run on four hits in 3.1 innings pitched.
- The Buckeyes host Toledo tomorrow night at 6:00 p.m., before opening Big Ten play with a three-game series at Indiana March 24-26.


Disclosure of Position Reclassifications
Please note that our disclosure of Position Reclassifications are now centralized and available on Open.Canada.ca.
Disclosure of past Position Reclassifications
On February 25, 2004, the government announced the mandatory publication of information concerning the reclassification of occupied positions in the Public Service of Canada.
This page provides information on the reclassification of occupied positions by department and agencies on a quarterly basis.
The rules and principles governing the reclassification of occupied positions are outlined in the Guidelines on reclassification. With these guidelines deputy heads have the framework for exercising their authority for the reclassification of existing positions.
Some of the reasons that the duties of a position might change, causing the position to be reclassified are:
- changes to departmental/program mandate
- managers reorganize in response to external conditions that increase or decrease available resources
- managers reorganize to make more efficient and effective use of their financial and human resources, such as technology innovations, changes in employee competencies
- managers reassign work among their existing human resources to increase productivity, such as in response to vacancies that require temporary or permanent reassignment of work
- settlement of a classification grievance
Reclassification of occupied positions in the Public Service of Canada is an important and necessary management option. However, when contemplating changes to a position that may result in reclassification, management must endeavour to ensure the proper, effective and efficient use of public money. The cost implication associated with upward reclassification must be known, transparent and support accountability for classification decisions.
Government-wide position reclassification departmental websites – Information on these websites will be updated every three months, starting in October 2004.
Please note that information that would normally be withheld under the Access to Information Act or the Privacy Act does not appear on this web site.
Fiscal year 2017-2018
Fiscal year 2016-2017
Fiscal year 2015-2016
- Date modified:


text:
Los Angeles, CA
Friday, November 15th, 2013 at 8:00pm
REZUREX (US) + ANGELSTRIFE (GER)
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text:
Review: How High We Go in the Dark - Sequoia Nagamatsu
Genre: Literary Fiction, Sci-Fi, Short-Stories
Published: Bloomsbury Publishing, January 18th 2022
My Rating: 4/5 stars
“It’s strange how the discovery of an ancient girl in Siberia and viruses we’ve never encountered before can both redefine what we know about being human and at the same time threaten our humanity”
Blurbing a book to be “Station Eleven meets Cloud Atlas” guarantees two things for me: first, an immediate addition to my most-anticipated-list. Second, a high likelihood of disappointment that comes with being compared to giants… Somehow, Sequoia Nagamatsu managed to subvert that second expectation, and completely live up to my hype with his melancholic collection of tales of loss and connection.
It all begins when a grieving archaeologist unearths the subject of his deceased daughters research; the body of a girl, and the virus that killed her ages ago. From there on out, we follow this virus, now dubbed “the Arctic Plague” as it multiplies and fans out across the globe. Through a mosaic of stories, touching but never quite overlapping, we witness its effects on a variety of people spread out over both distance and time.
There are few books that live up to Station Eleven for me, but the way Nagamatsu captured the sorrowful, contemplative and intimate atmosphere of his post-pandemic world completely warrants that comparison to me. Nagamatsu proves himself a skilled wordsmith, with a particular eye for those small, quiet moments of human connection and intimacy, amids a world filled with insecurities. When it comes to the themes discussed in this book (grief, “moving on” and the desire to hold on to what you have, against the knowledge you may lose it all), that is the best way to tackle them, in my opinion. As a medical professional, these scenes resonated deeply with the way I witnessed and experienced this pandemic, and I have nothing but praise for the author for capturing this so perfectly.
My only critique of the book may be in part due to the marketing, as it’s presented to be a “novel”, while I felt it to be more of a short-story collection. This impacted my expectations going into it, and my overall enjoyment of the book as a whole. Throughout the first few chapters, this was a 5-star read for me, and I kept hoping the story would somehow loop back to those first protagonists once more, so I could see their story developed a little more. Had this choice been made, this would’ve probably been my perfect book. (Had the novel been about just the protagonists of 30,000 Years Beneath a Eulogy, City of Laughter andThe Scope of Possibility, that would’ve probably been perfect to me)
Instead, each chapter introduces a new set of characters, and although the lines all touch on each other, they never completely converge. As a set up to a short- story collection, that would’ve been perfect to me, but since I went in with the expectations of a novel I felt the connections to be a little to slim for my taste.
Overall: an ambitious and deeply impressive work of fiction that never sacrificed its sense of intimacy with its wide scope. I have a feeling this will be one of “The Great” of 2022, that will stick with me for a long time after to come.
Many thanks to Bloomsbury Publishing for providing me with an ARC in exchange for an honest review. It truly felt like an honour to read this one early.
How High We Go in the Dark is set for release on January 18th 2022 in both US and European territory.

domain: library


The Houston Chronicle’s Live Updates blog documents the latest events in the coronavirus outbreak in the Houston area, the state of Texas and across the U.S. with a focus on health and economic impacts.
The Houston Chronicle’s ongoing coverage is available to subscribers. Subscribe now for full access and to support our work.
Resources on COVID-19 and Texas’ reopening: Use our interactive page to track the spread of cases through Harris County and the rest of Texas. For a detailed look at our state, check out the Chronicle’s Texas Coronavirus Map. To get regular updates on our coverage, sign up for our coronavirus newsletter.
Total coronavirus cases:
• 1,227,435 cases in Texas, including 21,782 deaths.
• 265,249 in the Houston region, including 4,042 deaths.
• More than 13.5 million in the U.S., including 267,987 deaths. Click here to see a U.S. map with state-by-state death tolls and the latest coronavirus case counts.
• More than 63.1 million in the world, with more than 1.4 million deaths. More than 40.4 million people have recovered. You can view the worldwide totals here.
Latest updates from today:
11:22 a.m. The Houston Society for the Prevention of Cruelty to Animals is in “dire need” of pet food donations for a Dec. 5 touch-less, drop-off food drive that will benefit Northwest Assistance Ministries, according to the organization.
The Houston SPCA has helped provide nearly 170,000 pet meals for those in need during the pandemic so far.
— Rebecca Hennes
10:28 a.m. Nearly all students in Liberty ISD were required to report back to their classrooms Monday morning after the district canceled its online learning option, joining other Houston-area school districts that have canceled virtual learning amid unprecedented rates of failing.
In a letter, Superintendent Cody Abshier said families that did not want to send their students back to campuses for face-to-face instruction would need to either homeschool them, transfer to a district that still provides virtual learning or enroll them in a private school.
“Our decision to suspend remote learning is based on many factors, with the single biggest issue being the tremendous learning gap that we are seeing between face-to-face students and remote students,” Abshier wrote.
— Shelby Webb
10 a.m. Houston and other major Texas metros registered strong home price gains in October as buyers sought houses that often serve double-duty as a workplace, according to a CoreLogic report. However, the gains in most Texas cities fell short of the U.S. increase.
— Katherine Feser
9:38 a.m. The U.S. imported more crude and petroleum products than it exported in May and June as the pandemic crushed global demand for oil.
After becoming a net exporter for seven straight months between October 2019 and April 2020, the U.S. briefly returned to net importer status. U.S. net petroleum imports averaged 939,000 barrels per day in May and 675,000 barrels per day in June, according to the Energy Department.
— Paul Takahashi
9 a.m. European regulators may approve a coronavirus vaccine developed by drugmakers Pfizer and BioNTech within four weeks, the EU’s drug agency said Tuesday, according to the Associated Press. The time frame could mean the shot is rolled out first in the United States and Britain.
The European Medicines Agency plans to convene a meeting by Dec. 29 to decide if there is enough safety and efficacy data about the vaccine for it to be approved, the regulator said.
Read the full Associated Press story here.
8:15 a.m. The number of Texans enrolling in health insurance plans on the Affordable Care Act exchange so far is up 17% from last year. Roughly 383,000 people in the state have enrolled since the beginning of November.
The reasons for this jump are likely pandemic-related, experts say.
— Gwendolyn Wu
7:45 a.m. In a report issued before Thanksgiving, the White House Coronavirus Task Force called on Texas to step up its pandemic response by reducing maximum occupancy indoors and conducting mass weekly testing.
“Texas continues to be in a full resurgence and mitigation efforts must intensify,” the Nov. 22 report says. “The silent community spread that precedes and continues to drive these surges can only be identified and interrupted through proactive, focused testing.”
Gov. Greg Abbott has focused his message on treatment. His office did not respond to a request for comment late Monday on the White House recommendations.
–Benjamin Wermund and Jeremy Blackman
7:30 a.m. Texas added another 29,225 COVID-19 cases Monday, bringing the statewide total from 1,198,017 to 1,227,435.
This makes 101,427 newly reported cases since last Monday. Another 189 deaths brings the statewide fatality count to 21,782.
The statewide 7-day average for new cases is 16,296 today, up from Friday’s 15,125.
The Houston region’s count is 265,249, up 6,207 from Friday. Harris County reported 3,646 new cases since Friday, 72 of which were more than 14 days old, and is now at 191,513 cases total. There were 17 newly reported deaths in the Houston region since Friday, making the death toll 4,042.
The positive test rate statewide is now at 11.33 percent, up from Friday’s 10.3 percent.
Statewide, there were 8,900 patients hospitalized for lab-confirmed COVID-19, up from Friday’s 8,518.
– Stephanie Lamm


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Dr. Laurence Sloss, MD generally accepts new patients. You can see Dr. Sloss' profile to make an appointment.
Dr. Laurence Sloss, MD is a cardiology specialist in Brookline, MA. Dr. Sloss completed a residency at Massachusetts General Hospital. He currently practices at Doctors Sloss Vinch Cardiology PC and is affiliated with Beth Israel Deaconess Medical Center. Dr. Sloss is board certified in Cardiovascular Disease.
- Boston Children's Hospital, Fellowship Hospital — 1973
- Massachusetts General Hospital (Cardiovascular Disease), Fellowship Hospital — 1972
- Massachusetts General Hospital, Residency Hospital — 1968
- Massachusetts General Hospital, Internship Hospital — 1967
- Stanford University School of Medicine, Medical School — 1966
- California Institute of Technology, Undergraduate School — 1961
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Doctors Sloss Vinch Cardiology PC1101 Beacon St Ste 703S, Brookline, MA 02446 (617) 738-6878


The WS31 VHF FM Manpack set was first introduced in 1948. The picture shows the MK2 version set complete with headset, microphone assembly & Whip aerial. The WS31 was really a copy of the American SCR-300-A and covers 40-48MHz. This gives 41 channels 200kHz apart four of which (Channels A,B,C&D) are compatible with the slightly earlier 88 Set, made for use in tropical conditions.
WS31 MkII with headgear and Satchels Signal
These early FM sets paved the way for most later British radios to employ FM for short range VHF operation. The circuitry was relatively advanced for its day with the MK1 version having an automatic squelch circuit. However this circuit was removed during workshop refurbishment and was not provided on the MK2. This mod helped the user become more aware of weak transmissions, with the intention that operators would if possible, re-locate to a better radio site!
The set was powered from dry batteries 90+60+4.5 Volt and ran about 300mW of RF output. The working range is given as 3-5 Miles which would appear to be under open field conditions!
The headset plug employs a novel feature allowing an officer to plug into the stackable plug and monitor traffic or pass messages over a Net. This can be compared with the dual sockets available on later Larkspur and Clansman series radios.
The set which is tropicalised and splash-proof has a dual conversion receiver. with IF of 4.3 and 2.515MHz . The circuitry employs 15 B7G Valves plus three in the Squelch (later removed). The receiver local oscillator is also used as master oscillator for the transmitter. Operating at half the required signal frequency it is followed by a separate frequency doubler. DC output from the receiver discriminator is used in the Automatic Frequency Control (AFC), which compensates for slight inaccuracies in tuning or circuit instability. The capture range of the AFC is approximately 50kHz.
The WS31 Mk1 has a Magnesium alloy case and top cover, which although much lighter (22 1/2 lbs) proved to give inadequate protection. The MKII has a steel case weighing in at 31lb including battery. The MOD’s philosophy on the weight of equipment made soldiers comfort a secondary consideration!. It was to be many years before awkward and heavy General Service carrying frames were replaced by lightweight alloy items and fabric packs.
The WS31 does not cover any frequencies currently covered by UK amateur licences. Accordingly the set is now mainly of interest to collectors and exhibitors of military equipment.
Barry G8DXU Copyright SARS 2016


Stuck for ideas of what to watch next? Browse our selection of genres and decades to find hidden movie gems or rediscover old time classics.
From thrilling page turners to beautiful novels, we present you books and authors similar to the ones you love. Enjoy our recommendations – from bookworms for bookworms.
If you share our passion for music, have a browse through our list of genres and discover unmissable artists and songs from the past 50 years. You’ll find a bit of old, a bit of new and a bit of something you probably have never heard of before.
Whatever type of game you’re looking for, you’ll surely find one that tickles your fancy here. Choose your next favourite from one of our wonderful articles and get playing!
If the Bill & Ted movie creators were to take on paranormal documentaries, it would probably turn out like ‘Ghost Adventures’, or what I like to call ‘Zak and Nick’s Excellent Ghost Adventures’. These two and technician Aaron, certainly do go to some really creepy locations around the world to investigate. Sometimes it’s hard to focus on the gravity of a situation when one of them is shouting out “Dude, something just touched my arm!” or “Bro, I’m like totally freaking out right now!”
Whether you’re a believer or not, the show is quite entertaining and you’ll certainly wonder about their provocative tactics. Zak Bagans (distant relation of Frodo and Bilbo?) has a habit of challenging any potential spooks by yelling insults and then when they take the bait he whines like a baby – “man, something just touched my back, it’s burning!” Nevertheless, they do capture some pretty cool stuff on camera and audio so that approach seems to work for them. If you can’t get enough real world spooky stuff you’ll enjoy these other series like ‘Ghost Adventures’.
‘Ghost Hunters’ is one of the original ghost investigation shows, and the inspiration for many others. The Atlantic Paranormal Society (TAPS) members Jason and Grant are plumbers by day but lead investigators for the team by night, in this docu-soap style show, and early episodes often showed behind the scenes glimpses of the team’s personal interactions and conflicts.
The TAPS team seem to take a more professional approach in terms of equipment, scientific proof and openness to debunking some stories. Each episode usually starts with an interview with their client and ends with a debrief outlining their findings via camera and EVP audio. There are definitely some bumps, pushes and shuffles in the night too.
This is the UK version of ‘Ghost Adventures’ where the team go to various locations and investigate alleged hauntings. The show is hosted by Yvette Fielding who usually works with a medium to establish a connection with spirits and reveal the story of the location.
Unfortunately, the show earned a bad reputation as Derek Acorah was exposed as a fake for pretending to be possessed and researching locations beforehand. Though the real mystery is how he got away with it for so long, since he was never great at acting. Even if you’re not a believer, watch the early seasons of the show to see Derek in all his hilariously hammy glory.
Josh Gates leads his team around the world in search of the truth behind supernatural mysteries such as Bigfoot, banshees and werewolves. If you love travelling, learning about other cultures and are addicted to all things paranormal, then this is the show for you!
Josh sounds like loveable Muppet, Fozzie Bear, as he narrates the show and goes about his adventures, and you can’t help imagining how cool it would be if he was joined by Kermit, Gonzo and the gang too. Alas, his human team seem to have fun anyway, as they use the standard night vision and thermal equipment to document findings to varying levels of success.
Not all paranormal documentaries require investigations, some of them just retell people’s experiences and can be just as spooky. For more tv series like ‘Ghost Adventures’ watch the following shows.
I’m a sucker for this show that features real people who have experienced truly spooky stuff and then reconstructs the footage with actors. It’s sometimes cheesy but always compelling, and some of the stories are terrifying, particularly the ones about demonic entities and bad spirits. Even if you don’t believe in ghosts, you’ll probably still find the stories enjoyable.
This show is similar to ‘Paranormal Witness’, but relies more on actual real life video footage taken by investigators who have tried to help families deal with their hauntings and scary experiences. To differentiate itself from the competition, it’s also comes from the (sometimes tenuous) angle of animals being haunted, as they are apparently more sensitive to the presence of spirits.
Hosted by the self-proclaimed ‘Happy Medium’, Kim Russo, this show takes celebrities back to the place of their paranormal experience. The celebrities are varying levels of famous – some of them you’ll struggle to identify – but some of the stories are quite gripping and Kim channels information from their dead friends and family, which could be true ability or Google, though the celebrities seem impressed by how detailed her insight is. The Nadine Velazquez and Fairuza Balk episodes are the most shocking.
The internet is full of paranormal documentaries, you can’t go far without finding another one lurking around the next search engine corner. If you love the style of ‘Ghost Adventures’, check out their hosts other shows, Nick Groff’s ‘Ghost Stalkers’, or Zak’s ‘Paranormal Challenge’. If you’re a fan of popular culture, you might like ‘Celebrity Ghost Stories’ and ‘Celebrity Paranormal Project’.
Do you have any recommendations to add to my list?
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The Reel Queer Film Series at Bradbury-Sullivan LGBT Community Center presents a free community screening of The Year We Thought About Love, a documentary about a daring LGBTQ youth theatre troupe. The screening will be followed by a talk back facilitated by Kim Ketterer, Youth Programs Manager at Bradbury-Sullivan LGBT Community Center.
“The Year We Thought About Love” goes behind the scenes of one of the oldest queer youth theaters in America, with our camera crew slipping into classrooms, kitchens, subways, and rehearsal rooms with this fearless and endearing troupe. Boston-based True Colors: OUT Youth Theater transforms daily struggles into performance for social change. With wit, candor, and attitude, our cast of characters captivates audiences surprised to hear such stories in school settings. Our film introduces a transgender teenager kicked out of her house, a devout Christian challenging his church’s homophobia, and a girl who prefers to wear boys’ clothing even as she models dresses on the runway. When bombs explode outside their building, the troupe becomes even more determined to share their stories of love to help heal their city.
Awards and Reviews:
Best Documentary, Southwest Gay & Lesbian Film Festival
"Laughter—that’s the constant power that drives "The Year We Thought About Love," a film about an LGBTQ youth troupe out of Boston." After Ellen
"Alive, bold, and beautiful...The Year We Thought About Love is a vital story for every youth educator and theatre practitioner to see. The strength of this film is its complexity: featuring stories of many LGBTQ youth from the vantage points of school, home, community, and peer relationships—and providing illustrations of young people’s strength, beauty, and love—all in the process of making a play." Youth Theatre Journal
BJ KJ FOTOS
522 W Maple St
Allentown, PA 18101
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Dwayne Johnson’s 2008 divorce “did a number” on him.
The 47-year-old actor tied the knot with Lauren Hashian, 35, in Hawaii in August and admitted he was hesitant to wed for a second time following his split from Dany Garcia more than a decade ago.
“My divorce did a number on me.”â€” Dwayne Johnson
He told WSJ. Magazine: “My divorce did a number on me. I wasn’t fearful of getting married again, there was just some hesitancy. But Lauren was incredibly patient: ‘I love you, you love me, we have this amazing life together – no presh.'”
Although Dwayne and Dany – who have daughter Simone, 18, together – didn’t divorce until 2008, they split up some time before, and when Dwayne met Lauren he was instantly smitten.
He said: “Within 30 seconds, I thought, ‘Wow, this girl’s stunning.’ At the time, I was going through my breakup with Dany, and [Hashian] was just coming off a big breakup, too. Ironically, when you’re not looking for something, the power of the universe kind of takes over.”
Dwayne and Lauren went on to have two daughters, Jasmine and Tiana Gia, together, and he previously spoke about how “lucky” he felt to have found love again with Lauren.

domain: celebrity


This device brings you a whole new style with the OMNI Board system being themost comprehensive board that included in Vaporesso mods, guaranteeing a consistent vaping experience. As the foundation of every mod, it is geared towards both new and veteran vapers.
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We never thought we'd see the day that all the Star Wars characters would line up for a group photo, but low and behold they managed it without bloodshed. This epic poster features almost every character in the Star Wars saga from 1977 up to the present day. A must have nostalgic poster for the sci-fi obsessive. Official merchandise.
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Remember Palestine-06-16-2012 from Press TV with Lauren Booth featuring Gilad Atzmon.
As convoys and flotillas are being increasingly blocked from entering Palestine, activists look increasingly to the Boycott Movement as a way to pressure Israel. Most recently, the Co-operative Group decided to no longer engage with any supplier of produce known to be sourcing from the Israeli settlements. This was a great achievement for activists who have campaigned for this kind of boycott for years in the face of government’s refusal to act in compliance with international human rights norms.
This month campaigns were also held against the Habima Theatre Company performance as part of the Globe’s Shakespeare festival. This boycott was called in response to the Palestinian call to boycott all Israeli cultural institutions which “continue to serve the purposes of the Israeli colonial and apartheid regime”. The protest at Habima’s performance was covered by most of the UK’s major news outlets drawing attention to Israel’s human rights violations.


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You can respond to this article at http://www.anaesthesiacorrespondence.com
Perioperative transoesophageal echocardiography: past, present & future
Article first published online: 12 MAR 2012
Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland
Volume 67, Issue 4, pages 343–346, April 2012
How to Cite
Greenhalgh, D. L. and Patrick, M. R. (2012), Perioperative transoesophageal echocardiography: past, present & future. Anaesthesia, 67: 343–346. doi: 10.1111/j.1365-2044.2012.07103.x
- Issue published online: 12 MAR 2012
- Article first published online: 12 MAR 2012
Transoesophageal echocardiography (TOE) has transformed the lives of cardiac anaesthetists. Whilst historically respected by their peers, they always remained in the shadow of the cardiac surgeon. The surgeon has always been able to detect aortic atheroma just by feeling the aorta, pronounce on left ventricular function by looking at the right ventricle, and assess the adequacy of mitral valve repair, despite cardioplegia-induced asystole. If the anaesthetists wanted TOE to play with and use for teaching that was fine, but acquiring images of what the heart was actually doing in real time was irrelevant.
Over time, the magic wand of TOE has brought about a transformation in which the cardiac surgeon and anaesthetist now work as a team of equals in assessing the patient intra- and postoperatively. In our institution, the cardiac surgeons have changed so radically that they will now not operate without reliable peri-operative TOE. They (and we) also require that TOE is available postoperatively to assess the patient with unsatisfactory haemodynamics who has not responded to simple corrective measures.
Many studies report changes in either surgical or medical management as a result of peri-operative TOE. Changes to the surgical plan have been reported in up to 27% of cases before bypass, and in 2% after bypass. There is a significant incidence of new findings that have been missed in the preoperative assessment [1–5]. The audit of Skinner et al., in this issue of Anaesthesia, shows that despite what appears to be an adequate work-up, intra-operative TOE unearths new findings in 6% of cases and changes the surgical plan in 68% of these: 4% of cases overall . Interestingly, 50% of Skinner et al.’s new findings were unrelated to the listed pathology. We find it disturbing that in 46 patients who had had a pre-operative echocardiogram, and who had unexpected new intra-operative TOE findings, the discrepancy was due to an error in the pre-operative study in 20 (44%). Errors were defined as either an inadequate pre-operative echocardiogram dataset, or misinterpretation of the images. In a further 14, limitations of transthoracic echocardiography (TTE) accounted for the discrepancy. Like Skinner et al., we too have experienced patients who have been misdiagnosed or in whom disease progression has changed the findings. Examples of this include significant aortic stenosis discovered during routine coronary surgery, and significant tricuspid regurgitation discovered during routine mitral repair surgery.
It is important to remember that TOE almost always gives clearer images than TTE. This is particularly the case in a patient with poor TTE windows. It is also worth mentioning that it is easier to get good quality TOE pictures, particularly the transgastric views, in an anaesthetised patient than in one undergoing conscious sedation. Transthoracic echocardiography is generally regarded as superior for assessing the aortic valve gradient as Doppler alignment is easier to achieve. It is accepted that intra-operative TOE underestimates the severity of mitral regurgitation, and this assessment should be done by TTE or TOE pre-operatively. However, intra-operative volume loading plus vasopressors to increase systolic pressure has been shown to reflect the true degree of regurgitation. Mitral regurgitation can also be underestimated pre-operatively by TTE under resting conditions or when sedated for TOE [7, 8]. Ideally, TTE should be performed with exercise as this is more clinically relevant.
Then there is the consideration of consent, or lack of it, upon which both Skinner et al. and Klein et al. touch. Can one commit a patient, for example, to lifelong warfarin therapy or a potential re-operation in the future, by adding a valve replacement without counselling? Should we be telling patients pre-operatively that in the event of a new discovery, we will do what is necessary, or should we give them the option of being woken up without undergoing the additional procedure – a decision that has clinical, psychological and financial implications? Patients may also have preconceived ideas about their procedure and unanticipated changes to surgery might impede their attitude to recovery. Such issues could largely be avoided by performing pre-operative TTE or TOE in every case. However, Skinner et al.’s findings suggest this will not entirely resolve the problem, and there is cost associated with performing pre-operative echocardiography in every patient.
Peri-operative TOE is now undertaken in the majority of centres in the UK, Europe and the USA. Until recently, category-1 indications for intra-operative use were limited to valve repair, congenital lesion repair, hypertrophic obstructive cardiomyopathy, endocarditis and aortic dissection. Coronary artery surgery for patients with poor ventricular function was a category-2b indication . Recent recommendations from both European and American bodies have indicated that TOE should be used in all elective and emergency cardiac operations unless contraindicated and have upgraded the use in coronary artery surgery to 2a [10–12]. The results of Skinner et al.’s study, and the other studies mentioned, further support its routine use in all cases where there isn’t a contraindication, because of the common occurrence of significant new pre-bypass TOE findings that influence the surgical plan. It is notable that in both Skinner et al.’s and Klein et al.’s studies, TOE was utilised in only 40–45% of cases, and was presumably largely restricted to the then category-1 and -2a indications. We suspect that re-audit in 2012 would reveal far higher rates of use.
In addition to pre-bypass diagnosis, TOE provides assistance after bypass. It provides a rational basis for decision making during weaning from bypass, chiefly the need for inotropes and vasopressors, intra-aortic balloon pumps, and volume replacement. It allows assessment of the adequacy of surgery, including adequacy of valve repair, prosthesis performance and paravalvular leaks in valve replacements, and wall motion abnormalities in both on- and off pump coronary artery surgery.
In our opinion, the increasing age and comorbidity of patients undergoing valvular and revascularisation procedures makes TOE an invaluable asset as part of our monitoring armamentarium. It allows us to fill the patient optimally and relate optimal function to a value of central venous or pulmonary artery pressure that we can then use on the intensive care unit. This is particularly important in hypertensive patients and those with ventricular dysfunction, whether systolic or diastolic, in whom venous pressure does not reflect intracardiac volume [12–15].
Transoesophageal echocardiography is the investigation of choice on the cardiac intensive care unit (and general units are catching on) as a diagnostic tool for the haemodynamically unstable patient; a category-1 indication. It is invaluable in determining the cause of haemodynamic failure and it has taught us much we did not previously realise. Among other things it has taught us to appreciate the fragility and afterload sensitivity of the right ventricle, that left ventricular outflow tract obstruction is common and can occur in otherwise normal hearts, and that hypovolaemia can occur in the presence of a high central venous pressure [16–18]. The pulmonary artery catheter, although out of favour, should not be discarded just yet: TOE provides an assessment of filling that can be related to the pulmonary artery pressure but using TOE to measure pulmonary artery wedge pressure may be inaccurate . Transoesophageal echocardiography allows targeted early re-operation for cardiac tamponade, while decreasing the number of unnecessary re-operations for medical causes of hypotension. This has implications for both patients and trust finances, the latter important in the present climate [13, 20]. The development of a disposable probe designed for 48 hours of continuous use will, we think, be very helpful for the development of TOE as a ‘routine’ monitor on intensive care units.
Accurate diagnosis is essential if the patient is to receive the correct operation the first time and avoid further surgery later. Pre-operative misdiagnosis results in modification of surgery, often without consent. Whilst the traditional role of the anaesthetist is not as a diagnostician, we have become exactly that. Anaesthetists now make decisions during the procedure that result in changes to the operative plan. It is imperative that one can back up findings that lead to a change of surgery with objective evidence of training and experience; this is a governance issue. Changing surgeons’ minds when they have planned a procedure is not an easy task and it is not undertaken lightly!
The introduction of real-time three dimensional (3D) TOE is a significant addition to the diagnostic armamentarium. In assessing the mitral valve there is no doubt that it adds valuable information, especially for the surgeon who can understand the pictures! In transcutaneous aortic valve implantation and Mitraclip® insertion, the spatial assessment that 3D TOE allows is invaluable. Quantification of regurgitation and localisation of residual regurgitation after valve repair or replacement are areas in which 3D is superior to 2D. The role of 3D echocardiography in evaluating the left ventricle has not been as widely accepted, though evidence shows it is more accurate and removes some of the geometrical assumptions behind 2D assessment . Three dimensional assessment of the left ventricle is time-consuming and requires sequential beat analysis with ventilation interrupted during acquisition, but it provides more reproducible and accurate assessment of left ventricular volumes and ejection fraction than 2D. Right ventricular volume reconstruction with TTE and TOE shows promise, but is not yet readily available for TOE. Though 3D equipment is more expensive, the cost may decrease with time and more widespread use. Further training in 3D echocardiography is required, even for 2D experts. Current recommendations are that 3D TTE and TOE should be routinely incorporated into assessment of the mitral and aortic valves, including all interventional procedures on either valve, and for left ventricular volume and ejection fraction assessment .
This leads us on to the importance of training. Miller et al. published a study emphasising the need for training, showing that it improves accuracy of reporting regardless of the sonographer’s base speciality . We now have a UK examination in peri-operative TOE which was instituted in 2003 as a result of collaboration between the Association of Cardiothoracic Anaesthetists (ACTA) and the British Society of Echocardiography (BSE). There is also a European examination which ACTA has set up with our European counterparts, EACTA . In addition, there is collaboration between ACTA, BSE and the Intensive Care Society to institute a formal training programme and examination for intensivists . Training competencies are in the process of being agreed upon, and accreditation will be based on TTE with basic and advanced levels.
In every case, there is a balance of risks to be assessed. The risk of major complications, notably perforation of the oesophagus, is between 1:1000 and 1:10 000. No deaths have been reported from this in the literature to date. Minor complications, e.g. sore throat and odynophagia, are common and can be minimised by using a laryngoscope for placement [26–29]. A recent study by Tan et al. demonstrates that there is a significant increase in tracheal cuff pressure after insertion of the TOE probe and recommends routine monitoring of cuff pressure after insertion . The only absolute contraindication to a TOE in many clinicians’ eyes, ourselves included, is an oesophagectomy !
In summary, cardiac anaesthetists have developed the use of TOE both in theatre and the intensive care unit. They provide a diagnostic service and training. Peri-operative TOE should compliment accurate pre-operative work up, but should not be a replacement for it. Nevertheless, disease does progress; it is thus inevitable there will always be a small minority in whom new findings occur at surgery. In our opinion, peri-operative 2D and 3D TOE should be used in all cardiac surgical cases, unless strongly contraindicated.
No external funding and no competing interests declared.
- 9American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 1996; 84: 986–1006.
- 10American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 2010; 112: 1084–96.