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The archaeon Methanococcus voltae encodes two pairs of NiFe-hydrogenase isoenzymes. One hydrogenase of each pair contains selenium in the active site, whereas the other one is selenium-free. The gene groups for the selenium-free hydrogenases, called vhc and frc, are linked by a common intergenic region. They are only transcribed under selenium limitation. A protein binding to a negative regulatory element involved in the regulation of the two operons was purified by DNA-affinity chromatography. Through the identification of the corresponding gene the protein was found to be a LysR-type regulator. It was named HrsM (hydrogenase gene regulator, selenium dependent in M. voltae). hrsM knockout mutants constitutively transcribed the vhc and frc operons in the presence of selenium. A putative HrsM binding site was also detected in the intergenic region in front of the hrsM gene. Northern blot analysis indicated that the hrsM gene might be autoregulated.
The transcriptional apparatus of Archaea resembles that of Eucarya with regard to the RNA polymerase composition, transcription factors and promoter structure (review: Soppa, 1999). In contrast, transcriptional regulation has been found to be more similar to that of Bacteria in many cases (reviews: Bell and Jackson, 2001; Soppa, 2001) and genome searches have yielded a high number of genes encoding regulators with characteristic helix–turn–helix motifs typically seen in bacterial proteins involved in transcriptional regulation (Aravind and Koonin, 1999). As a mode of negative regulation, classical repression has been described, i.e. competition of a negatively regulating protein for the promoter (Cohen-Kupiec et al., 1997; 1999; Bell and Jackson, 2001; Lee et al., 2003; Lie and Leigh, 2003). Alternatively, binding of regulators downstream of the promoter elements was observed, suggesting that recruitment of transcription initiation factors might occur in the presence of the negative regulator but transcription would subsequently be blocked. Some of the negative regulators are autoregulated (Bell and Jackson, 2000; Brinkman et al., 2000; Enoru-Eta et al., 2000;2002). Positive bacterial-like transcriptional regulation has also been described (Brinkman et al., 2002; Ouhammouch et al., 2003). However, not all of the archaeal transcription regulators are similar to bacterial counterparts. In a well-studied case the activator resembles a eukaryotic leucine-zipper protein and is supposed to help recruiting the transcription complex (Krüger et al., 1998; Gregor and Pfeifer, 2001). Small effector molecules were identified which are necessary for the function of regulatory proteins, either as inducer (Lee et al., 2003) or for the binding of a repressor, such as metal ions (Bell et al., 1999) or an amino acid (Enoru-Eta et al., 2000).
We have studied the transcriptional regulation of two hydrogenase operons in the methanogenic archaeon Methanococcus voltae. Methanogenic archaea gain their energy by the stepwise reduction of C1-moieties to methane (reviews Weiss and Thauer, 1993; Thauer, 1998; Deppenmeier, 2002).
Most of these organisms can use CO2, which is reduced with the help of electrons gained from molecular hydrogen by the action of hydrogenases. Two types of NiFe-hydrogenases are involved in this process. One of the enzymes transfers the electrons to the deazaflavine coenzyme F420, whereas the electron-acceptor(s) of the other type, called F420 non-reducing, are not completely known. One reaction in which an enzyme of this type appears to be involved is a terminal step of methanogenesis, the heterodisulphide reductase reaction in Methanothermobacter marburgensis (Stojanowic et al., 2003). In M. voltae a selenium-containing F420 reducing hydrogenase plays a role in the same reaction (Brodersen et al., 1999).
In this organism two isoenzymes of both the F420 reducing NiFe-hydrogenase, called Fru and Frc, and of the F420 non-reducing hydrogenase, called Vhu and Vhc, are encoded in the genome (Halboth and Klein, 1992). One enzyme of each type, Fru and Vhu, contains selenocysteine in the hydrogen activating reactive site. The corresponding isoenzymes, Frc and Vhc, have a cysteinyl residue in the homologous positions. The two NiFeSe-hydrogenases are constitutively expressed. The operons vhc and frc encoding the selenium-free enzymes are only transcribed under selenium limitation (Berghöfer et al., 1994). They are connected by a common intergenic region comprising both promoters and positive and negative regulatory sequence elements which were defined by mutational analyses employing a reporter gene system (Noll et al., 1999). A putative activator protein has been identified (Müller and Klein, 2001). The relative positions of the genes and their regulatory elements are shown in Fig. 1.
Up to now the negative regulator has been unknown. Here we report that it is a protein belonging to the LysR family of prokaryotic regulators (Schell, 1993). It is likely that the protein also regulates its own expression.
Affinity purification of a LysR-type regulator specifically binding to DNA containing a regulatory cis-element involved in the regulation of hydrogenase promoters
As a binding site for the putative negative regulator of vhc and frc transcription had been identified we attempted to purify the protein by DNA-affinity chromatography employing matrix-bound oligonucleotides which either contained or lacked the binding sequence.
Figure 2 shows the protein patterns on SDS–polyacrylamide gels of eluates from affinity columns carrying DNA either comprising or lacking the sequence required as cis-element for the negative regulation. A prominent 33 kDa protein is noticeable only in the eluate from the binding site-containing column. The protein was excised from the gel and N-terminally sequenced. Data base searches yielded a conserved sequence in polypeptides from Methanocaldococcus jannaschii and Methanococcus thermolithotrophicus annotated as LysR-type regulators (Fig. 3)
Using primers derived from conserved amino acid sequences part of the M. voltae gene was amplified and a partial sequence with high sequence identity of the derived polypeptide sequence to the homologous proteins was evident. The total gene sequence and that of the intergenic region in front of the gene was then established using a random fragment genomic library of M. voltae as described in detail in the Experimental procedures. Figure 4 shows a comparison of the derived polypeptide sequence of the HrsM protein the homologous product of M. jannaschii, and the bacterial LysR-type regulators CysB from Klebsiella aerogenes and OxyR from Escherichia coli. The archaeal sequences showed very strong similarity to the bacterial consensus, from which the two bacterial sequences deviate much more.
The HrsM protein is involved in the negative regulation of the frc and vhc hydrogenase promoters
In order to assess whether the protein was indeed involved in the transcriptional regulation of the vhc and frc operons insertion mutants were obtained in strain M. voltae V1 which contains a chromosomal uidAβ-glucuronidase reporter gene driven by the vhc-promoter preceded by the frc/vhc intergenic region (Pfeiffer et al., 1998) comprising all regulator sequences involved in the regulation of the vhc and frc promoters (Beneke et al., 1995). The obtained transformants were tested for the sites of integration of the insertion vector. As shown in Figure 5, site-specific integration was observed in different clones.
The reporter gene activity was then assayed in extracts from wild-type and mutant cultures grown with or without selenium. In the transformants with interrupted regulator genes activity was found under both conditions, whereas extracts from the V1 control strain showed only very little constitutive glucuronidase activity when the cells had been grown in the presence of selenium (Fig. 6). The spontaneous resistant mutants were also tested for glucuronidase activity in the presence of selenium. They behaved like wild-type cells (data not shown).
It is noticeable that full activity was not reached in the extracts from transformant cells grown in the presence of selenium compared to wild-type or mutant extracts after cultivation of the cells under selenium limitation. This is in line with the previous assumption that the two promoters are both positively and negatively regulated (Noll et al., 1999), as it is not expected that the positive regulation would be affected by the knockout of the gene for the negative regulator.
In order to directly show the influence on the transcriptional activity of the hydrogenase promoters RT-PCR was performed with RNA isolated from wild-type or mutant cells with primers encompassing sequences of the frcA or vhcG genes, the promoter-proximal genes in the frc and vhc operons, respectively. The results (Fig. 7) confirmed that the knockout mutant led to derepression of the hydrogenase gene transcription in the presence of selenium.
As expected, the mutation had no influence on the known constitutive transcription of the vhuG gene encoding a subunit of one of the selenium-containing hydrogenases. A control experiment with the wild-type strain V1 was also carried out separately. No change in the constitutive expression was seen in the presence or absence of selenium. Control reactions performed without reverse transcriptase yielded no products.
We attempted to directly analyse the binding properties of the HrsM protein. However, the protein eluting from the affinity column did not rebind to the vhc/frc intergenic region. The same was true for HrsM protein heterologously expressed as a histidine-tagged protein in E. coli and purified to homogeneity regardless of whether the his-tag was cleaved off (data not shown). We also attempted to obtain binding activity by adding a small molecular fraction of crude cell extracts from cells grown in the presence of selenium, which might have contained the binding cofactor(s). This approach also failed.
Indication for negative autoregulation of the HrsM protein
Because LysR-type bacterial regulator genes are frequently autoregulated, we analysed the region upstream of the hrsM gene. It is preceded by a 327 bp intergenic region which also contains a sequence with very high similarity to the putative HrsM binding site in the vhc/frc intergenic region (Figs 8). Deletion of the central oligo-dT-tract of this sequence in the vhc/frc intergenic region leads to partial derepression of the hydrogenase promoters (our unpublished results). This was an indication that the hrsM transcription might be regulated in a similar way as vhc and frc operons, which would suggest its selenium-dependent autoregulation. In order to check whether the expression of the gene was indeed dependent on the selenium supply a Northern blot analysis was performed using RNA from cells grown with or without selenite and employing a labelled hrsM probe. Figure 9 shows that the transcript indeed occurs in higher amounts in selenium-limited cells compared to those grown in medium containing selenite.
It has been known that M. voltae can adapt to selenium deprivation by derepression and activation of the transcription of the gene groups frc and vhc, encoding selenium-free isoenzymes for two types of NiFeSe- hydrogenases necessary in the reductive methanogenic energy generating pathway. Both positive and negative regulatory sequence elements were localized in the intergenic region connecting the two operons (Noll et al., 1999) and a putative activator has been described (Müller and Klein, 2001). However, the negative regulator remained elusive. Our present data show that it is a LysR-type regulator. It was purified on the basis of its binding specificity and, as predicted, a knockout mutant in the hrsM gene led to a derepression of the vhc and frc promoters. The binding site of the HrsM protein includes the dyadic sequence TNA-N7-TNA which is a classical motif of LysR-type regulator binding sites (Schell, 1993). In the present case a 6 bp inverted repeat separated by 7 bp is seen. Preliminary experiments in vitro have indicated that the HrsM protein can dimerize (data not shown). This could create a symmetric complex at the binding site, which would make the observed apparent symmetric negative regulatory action on both promoters from the central binding site in the intergenic region plausible.
The inspection of the M. jannaschii genome yielded a sequence similar to the conserved sequence in M. voltae, which the HrsM protein is supposed to recognize as its binding site. It is located in front of the hrsM homologue. However, the gene at the other end of the intergenic region in front of the M. jannaschii hrsM homologue is different. This would still allow for the assumed autoregulation of the LysR-type regulator in M. jannaschii. The hydrogenase operons encoding selenium-free enzymes of the Frc or Vhc type are not linked in M. jannaschii. Inspection of the upstream regions of these operons did not yield the conserved putative HrsM binding motif. Therefore, the function of the HrsM homologue in M. jannaschii can only be partially identical to that in M. voltae.
It is remarkable that the derepression in the hrsM mutant did not lead to the same level of promoter activity observed in the absence of selenium. This agrees well with the previous observation that the removal of the negative regulatory element by deletion also did not result in full activity of the concerned hydrogenase promoters. This observation led us to postulate additional activation of the transcription (Noll et al., 1999).
LysR regulators are supposed to have originated in the kingdom of Bacteria and to have entered Archaea by lateral gene transfer (Pérez-Rueda and Collado-Vides, 2001). The HrsM protein shows striking conservation of amino acid residues when compared to the consensus sequence of the bacterial proteins, both in the N-terminal helix–turn–helix domain as well as in the C-terminal domain frequently involved in binding of effector molecules. In comparison, the bacterial LysR-type regulators show much more variability, i.e. individual proteins deviate to a higher degree from each other and the consensus. This may reflect lesser diversification of the gene type in archaea, where LysR regulators are not abundant.
The function of LysR regulators is frequently dependent on effector molecules. Such an effector for HsrM is expected to be a signal substance possibly containing selenium, which has not yet been identified. This probably explains our finding that HsrM protein expressed in E. coli with a histidine tag and purified to homogeneity did not bind to DNA containing the defined negative regulatory sequence even after cleaving off the tag (our unpublished results). It has recently been shown that in the closely related organism M. maripaludis sulphur-containing isoenzymes of several selenoproteins are upregulated after inactivation of the selB gene (Rother et al., 2003). This gene encodes an essential translation factor for the incorporation of selenocysteine. The authors concluded that free selenium is not involved in regulation but rather a successional compound.
LysR-type regulator genes are frequently linked to genes which are under their control. These features have been thought to have facilitated their lateral gene transfer. We have indeed detected a gene that is linked to the hrsM gene by a common intergenic region and divergently transcribed. However, this linkage is not seen in the hrsM homologue in Methanocaldococcus jannaschii, a closely related methanogen. Many LysR-type bacterial regulators are autoregulated. Our finding that selenium deprivation of M. voltae resulted to an increased hrsM transcript level is in accordance with this notion. Rigorous proof will, however, need a future more detailed functional analysis of the hsrM promoter.
Strains and plasmids
The strains used in this study are listed in Table 1.
Table 1. . Strains used in this study.
Construction, source or reference
M. voltae DSM 1537
German Collection of Microorganisms and Cell Cultures (Braunschweig)
M. voltae V1
carries uidA gene linked to the vhc/frc intergenic region and driven by the vhc promoter
Four µg total cellular RNA in H2O was treated with RNAse-free DNase I (20 units µg−1 RNA) in a total volume of 20 µl for 2 h at 37°C. The DNase was inactivated by heating at 75°C for 10 min. The RNA was then used as template in a reaction employing the one-tube AccessQuickTM RT-PCR System (Promega GmbH, Mannheim) according to the manufacturer's instructions.
Transfection of M. voltae
The method first described by Metcalf et al. (1997) was applied to M. voltae with modifications: cells were grown overnight to an OD600 of 0.5–0.8. All further steps were performed in an anaerobic chamber under H2/CO2/N2 (5/20/75% v/v) atmosphere. All media and buffers used were anaerobic and contained 1 µg ml−1 resazurin as a redox indicator. One ml of the exponentially growing culture was spun down and the supernatant was carefully removed. The cells were resuspended in 300 µl 0.68 M sucrose solution for protoplasting. The lyophilized DNA used for transformation was dissolved in 25 µl 20 mM Hepes pH 7.0. 1 µl DOTAP ESCORT liposome reagent (Sigma, Munich) per µg DNA employed was added to the DNA solution and the mixture kept for 15 min at room temperature. It was then gently mixed with the protoplast suspension and was kept in the anaerobic chamber for at least 1.5 h. The mixture was then inoculated into 10 ml of growth medium without puromycin and incubated at 37°C for at least 5 h before adding puromycin or plating on 10 µg ml−1 puromycin-containing plates. Colonies formed after 5–10 days.
A genomic library in pNPAC (Fig. 9A) carrying random ∼ 600 bp Tsp 509I fragments in the Eco RI site was used in PCR reactions employing primers hvm3 or hvm5 in combination with primer pSLEcoRI-3′21 to obtain overlapping partial sequences covering the hrsM gene and adjacent sequences. The amplification products were sequenced and the total sequence obtained from the overlapping partial sequences.
Preparation of cell extracts
Extracts for the enrichment of the HrsM protein were prepared from cells grown under selenium limitation. 5 ml of an exponential culture of M. voltae were used to inoculate a 1 L culture which was grown to an OD600 of 1–2. The cells were collected by centrifugation and lysed by the addition of 10 ml H2O. The lysate was centrifuged for 30 min at 12 000 g and 4°C. The supernatant was frozen.
DNA affinity chromatography
Biotin-labelled double-stranded oligonucleotides were generated by annealing the biotin-labelled single-stranded oligonucleotide with the complementary non-labelled single strand.
In order to activate the carrier material, 2 ml of strepavidin agarose (Novagen, Madison, Wisconsin) were centrifuged at 6000 g for 1 min and washed three times in 1 ml of coupling buffer (10 mM Tris-HCl, 1 mM EDTA, 1 M NaCl pH 7.5). The biotin-labelled double-stranded oligonucleotide was bound to the pretreated material by mixing 2 ml of 50% streptavidin agarose in binding buffer, 100 µl of 50 pmol µl−1 oligonucleotide and 100 µl of 2 × binding buffer. The mixture was gently mixed for 2 h at room temperature on a rotary shaker and subsequently washed three times with 1 ml of binding buffer. The DNA agarose was suspended in 1 ml of protein binding (PB) buffer (20 mM Tris-HCl, 2 mM EDTA, 1 mM DTT, 200 mM NaCl, 10% glycerol, 0.1% Triton X100, pH 8.0) and incubated at room temperature with gentle shaking for 30 min.
Two millilitres of the DNA agarose were mixed with 10 ml of cell extract and the mixture was shaken for 20 min at room temperature. The agarose was spun out, resuspended in 10 ml of PB buffer and poured into a 1.5 × 14 cm column. The column was washed three times each with 10 ml of PB buffer containing 200 mM, 300 mM or 350 mM NaCl. The remaining protein was eluted from the column by applying four times 120 µl each of PB containing 1 M NaCl. The eluate was kept frozen at −20°C. Before use, it was desalted by spinning it through a Mobispin S-200 column (MoBiTec GmbH, Göttingen, Germany).


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Understanding mechanical ventilation is a fundamental part of intensive care and perioperative medicine. Here’s an overview of the basics of mechanical ventilation. Keep in mind that clinically, there are many more things to consider, exceptions to rules, hybrid ventilator modes, and other strategies that I will not cover for the sake of maintaining simplicity. Please leave me questions in the comments section at the bottom!
First, it’s essential to understand how a breath on the ventilator is initiated and terminated by phase variables (trigger, limit, cycling).
A trigger dictates what causes the ventilator to cycle to inspiration. Modes can also have more than one trigger.
- Pressure-triggered: the patient generates negative pressure from diaphragmatic contraction
- Volume-triggered: the patient inspires a small volume of air from the ventilator
- Flow-triggered: the patient generates a small amount of airflow into their lungs
- Time-triggered: a preset timer dictates how often the patient breathes
A limit restricts a variable before the end of inspiration.
- Pressure-limited: a pressure that will not be exceeded during inspiration
- Volume-limited: a volume that will not be exceeded during inspiration
- Flow-limited: a flow rate that will not be exceeded during inspiration
The cycling variable dictates how the ventilator “cycles” between inspiration and passive expiration.
- Pressure-cycled: after achieving the peak inspiratory pressure (PIP), exhalation occurs
- Volume-cycled: after the target volume is delivered, exhalation occurs
- Flow-cycled: exhalation occurs when the inspiratory flow rate falls below a preset threshold
- Time-cycled: purely based on time
The chest wall and the lungs are in a constant “tug-of-war” – the lungs want to collapse inward, and the chest wall wants to expand outward. These two systems work together to influence respiratory mechanics. Compliance is defined as Δ volume / Δ pressure. In other words, a stiff system (low compliance) requires lots of pressure (large Δ pressure) to drive in a small volume of air (small Δ volume). Examples of poor compliance include interstitial pulmonary fibrosis, pneumonia, acute respiratory distress syndrome (ARDS), etc.
OXYGENATION AND VENTILATION
The lungs provide oxygen (O₂) and remove carbon dioxide (CO₂) from the blood. These processes refer to oxygenation and ventilation, respectively. Oxygenation can be improved by increasing the fraction of inspired oxygen (FiO₂) and positive end-expiratory pressure (PEEP). PEEP helps maintain alveolar recruitment between respiratory cycles and is often increased concurrently with FiO₂.
Minute ventilation is the product of respiratory rate (RR or ‘f‘) and tidal volume (VT). Increasing either of these parameters will increase minute ventilation to remove more CO₂.
The inspiratory to expiratory ratio (I:E) refers to the time spent in each respiratory cycle phase. Under physiologic conditions, we usually spend 2-3 times as much time in passive expiration (I:E of 1:2 or 1:3). For example, if a patient is deeply sedated or paralyzed, they will breathe at the RR set on the ventilator. Let’s assume this is at 15 breaths/minute. That means a complete inspiratory-expiratory cycle lasts 4 seconds. An I:E ratio of 1:3 means that inspiration will last 1 second and expiration will last 3 seconds.
If this ratio changes to 1:1, then equal amounts of time are spent in inspiration and expiration. Inverse ratio ventilation occurs when more time is in inspiration than expiration (i.e., 2:1). This ventilation mode can be very uncomfortable and lead to “breath stacking” as there is inadequate time to exhale the previous VT. This can, in turn, lead to progressively higher mean airway pressures (the expiratory flow does not return to 0 L/m before inspiration) and alveolar trauma.
Now let’s talk about different modes of ventilation!
ASSIST CONTROL (A/C)
Assist control (A/C) is routinely utilized as a “rest mode” where the ventilator takes on the role of breathing (“control”). If the patient wants to breathe over the set RR, they can “assist” with ventilation. Therefore, if the patient does not trigger any breaths, the ventilator will achieve the preset minimum. For example, in the image above, the A/C mode (volume control) settings are: RR 16 bpm, VT 350 cc, FiO₂ 0.5, and PEEP 5 cm H2O.
- Volume Control (A/C – VC)
- VT is directly set. Driving pressure will vary depending on the compliance although a “maximum” pressure can be set to avoid barotrauma.
- PEEP, FiO₂, and RR can be adjusted.
- A patient-triggered breath will result in the full VT being received.
- Flow is traditionally constant and maintained until the VT has been reached (“square waveform”). A decelerating flow is seen in pressure-control, volume-guaranteed variants of A/C-VC (downsloping flow in the latter parts of inspiration). This decelerating flow pattern is also seen in pressure control ventilation (see below).
- Ventilator will cycle to expiration once VT is delivered.
- A fixed minute ventilation is guaranteed since both VT and RR are directly adjusted. To increase minute ventilation, I usually consider changing the RR first rather than increasing VT which can lead to alveolar overdistension (volutrauma).
- Pressure Control (A/C – PC)
- Inspiratory pressure is directly set. VT will vary depending on lung compliance. For this reason, as the compliance changes (resolving pulmonary edema, worsening ARDS, etc.), the VT will change unless the inspiratory pressure is adjusted. Keep this in mind for any mode of ventilation where the inspiratory pressure is independently controlled.I/E ratio determines the amount of time spent in each phase (see the above explanation).
- PEEP, FiO₂, and RR can be adjusted.
- Usually cap the peak airway pressure around 30 cm H2O.
AIRWAY PRESSURE RELEASE VENTILATION (APRV)
Airway pressure release ventilation (APRV) is a pressure-controlled mode of ventilation that I sometimes try when I struggle with hypoxemia, such as ARDS or COVID pneumonia. APRV aims to improve alveolar lung recruitment by maintaining airway pressure at designated “high” (Phigh) and “low” (Plow) pressures for a set amount of time (Thigh and Tlow). This creates auto-PEEP to improve oxygenation. Think of breathing on top of CPAP with intermittent releases of airway pressure – that’s APRV!
When changing someone from a more conventional A/C-VC mode to APRV, I determine the plateau pressure and use that as my Phigh. Typically I start with a Phigh at 25 cm H2O and Plow at 0 cm H2O. Then, I start the time spent at the high pressure (Thigh) and the low pressure (Tlow) to 4 seconds and 0.5 seconds, respectively. By keeping the Thigh >> Tlow, the lungs don’t have enough time to depressurize completely, so the alveoli stay recruited. Also, since a complete breath takes Thigh + Tlow seconds, it makes sense that 60 / (Thigh + Tlow) is equal to the release rate (the “respiratory rate” on APRV).
Exhalation occurs after the airway is suddenly decompressed upon cycling to the Plow. The time spent at this low pressure (Tlow) is often difficult to gauge. Too short, and not enough air is exhaled, leading to decreased minute ventilation. Too long, and one runs the risk of extensive alveolar derecruitment. Finally, remember that APRV is an open lung ventilation mode, meaning patients can initiate their breaths at any point.
Weaning from APRV (essentially a CPAP mode) is accomplished by progressively decreasing the Phigh and increasing the Thigh time. Once the Phigh reaches 10-15 cm H2O, I’ll switch to a more traditional weaning mode (i.e., pressure support).
In summary, one can increase the FiO₂ and/or the mean airway pressure to improve oxygenation by increasing Phigh and/or Plow. In addition, ventilation is affected by the release rate and can be improved by increasing the gradient between Phigh and Plow, decreasing the Thigh time, or increasing the Tlow time.
SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION (SIMV)
Although SIMV delivers a preset minimum number of breaths per minute, it “synchronizes” itself with spontaneous breathing initiated by the patient to avoid providing a breath as the patient is expiring. The mode of delivery can be anything (volume control, pressure control, hybrid modes).
The critical difference between A/C and SIMV is how they handle spontaneous efforts made by the patient. If the patient triggers the ventilator while on A/C, they will receive a fully supported breath (i.e., the full VT in volume control). In SIMV, they get whatever VT they can pull with predetermined pressure support from the ventilator. To a large extent, the tidal volume from a spontaneous breath is based on the patient’s respiratory strength and pulmonary compliance. If the patient is over-breathing their preset SIMV rate (i.e., VT of 450 ccs at a rate of 10 bpm), their VT can vary tremendously as the ventilator fully delivers some breaths and others are unsupported spontaneous efforts.
PRESSURE SUPPORT VENTILATION (PSV)
PSV provides just that – pressure support – with each breath spontaneously triggered by the patient who might be too weak on their own (i.e., respiratory weakness, emerging from anesthesia, etc.) In this mode, FiO₂, PEEP, inspiratory pressure, and a backup rate can be directly set. Remember that in SIMV, these same breaths would be unassisted. Like A/C – PC, the actual delivered VT depends on the patient’s pulmonary compliance. With changing compliance, this can lead to hypo/hyperventilation. Volume support ventilation (VSV) aims to solve this by automatically scaling the patient’s amount of pressure support to achieve the preset VT.
In either case, compliance should improve as respiratory strength recovers and/or pulmonary pathologies improve (less pressure to deliver more VT). For example, patients may need 15 cm H2O or more inspiratory pressure at the end of a long anesthetic to maintain a decent VT. However, after volatile agents have been weaned down and neuromuscular relaxation has been reversed, they may only need 5-10 cm H2O to achieve the same VT.
Check out the following posts I’ve written dealing with pulmonology and mechanical ventilation:
- How We Breath – The Role Of Pressure Gradients
- Hypoxic Pulmonary Vasoconstriction (HPV)
- Bronchopulmonary Segments
- Functional Residual Capacity (FRC) And Pulmonary Vascular Resistance
- Work Of Breathing – Pressure-Volume Curve Integration
- Equal Pressure Point In Lung Physiology
- Interpreting Capnograms
- Automatic Tube Compensation (ATC)
- Extubation Criteria And Failure


The premiere of Calendar Girls may have made the Women's Institute the hottest story in the UK this week, but the charity's ideals of "truth, justice, tolerance and fellowship" have come under pressure in the intense media glare.
Only six of the 11 real-life WI calendar girls from Rylstone in north Yorkshire attended last week's premiere in Leicester Square. The absence of the others prompted lurid newspaper accounts of how fellowship had given way to bickering after the stunt to raise £1,000 to buy a hospice sofa was turned into a blockbuster movie starring Helen Mirren and Julie Walters.
Reports of the split in the original calendar girls group drew a frosty response this week from the organisation's head office.
"I'm afraid we can't really comment on that kind of thing," said general secretary Jana Osborne. "You would have to talk to the film's PR company about that."
Kate Hudson, a spokeswoman for Premier PR, said: "Six women decided to get involved in the movie and five didn't. Therefore the film is about the six who did. Like all films it has been dramatised - it is not a documentary." The charity has leapt on the opportunity to shed its outdated image.
Chairman Barbara Gill welcomed the "wonderful" publicity to encourage new members to join. On the night of the premiere, the national office received 50 membership enquiries . The charity's 70 federations are also busy requesting publicity materials for special screenings of the film.
Melanie Taylor, the WI's PR officer, said the charity's 230,000 members were excited by the publicity. "There are bits of the film where they poke fun at the WI's image and it doesn't reflect what we're about, but it's very tongue in cheek. The WI is what the members want and what they make it."
Taylor added the original calendar girls were true to the spirit of the WI. "It's reflective of what we do," she said. "We see a problem and we solve it."
She said she and the chairman had both read the script. "They wanted to check a lot of things with us," she said. "The scriptwriter's mother and grandmother were both members."


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Beautifully Handcrafted and Uniquely Embossed Game of Thrones Leather Journal
BEAUTIFUL JOURNAL THAT WILL LAST FOREVER
?Made by gifted artisans using handcrafted techniques passed down through many generations.
?Beautifully soft and durable black colour leather journal (No Faux or PU leather used)
?A lovely distressed vintage style with a gorgeous, real leather scent
?Handmade and embossed with a unique and decorative sigil of the house and their motto.
?It is a truly unique and wonderful gift for a friend or to treat yourself to as a special keepsake.
TREE-FREE PAPER & NO BLEED THROUGH
?120 sheets/240 pages (counting both sides) of blank, off-white paper
?Hand-crafted with Recycled Cotton paper, perfectly complementing the leather
?Tree-free and Acid-free means you're purchasing a product that is environment-friendly
?Easily detachable paper binding which can be replaced when full
?120 gsm paper thickness means it's beautifully soft to write and draw on, use any pen without any ink bleeding through
ONE SIZE THAT SUITS ALL
?Ideal Size For Multiple Uses
?Large 8" x 6" for home and office use
?Easy for handwriting, drawing or sketching
?Compact for carrying in your bag
?Artists Sketchbooks, Scrapbook or Poetry Work
?Daily Notepad or Bullet Journal
?Food Planner and Grocery Lists
?Travel Diary or Thought Book
?Weight Watchers Records
?Appointment RemindersA Unique Leather Journal to Treasure and Enjoy !!

domain: artistic


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Chilean Cranberry Bean Stew Recipe
- A Rancho Gordo Recipe
- ½ pound dry Rancho Gordo Cranberry or Marcella beans picked over and rinsed
- ½ pound pumpkin or hard winter squash, cleaned and cubed about 2 cups
- Salt and freshy ground black pepper
- 1 small bunch fresh basil, stems removed
- 2 Tbsp. vegetable oil
- 1 small onion, chopped
- 1 garlic clove, minced
- ½ tsp. sweet paprika
- ½ tsp. ground cumin
- 2 ears of corn, kernels removed about 2 cups
- 1 Tbsp. butter
- Rancho Gordo New Mexican Red Chile Powder
1. Cook the beans in plenty water until tender, 1-3 hours. Add the pumpkin, ½ tsp. salt, a few basil leaves, and more water if needed. Cover and cook over medium heat for about 20 minutes or until the pumpkin is soft.
2. Meanwhile, in a large skillet over medium heat, warm the oil. Add the onion, garlic, more basil leaves, paprika, and cumin, plus more salt and pepper. Fry until the onion is soft and fragrant, about 7 minutes.
3. Add the corn to the pumpkin and beans: cook until tender, about 5 more minutes. Stir in the onion mixture into the pumpkin-corn mixture and add the butter. Taste and adjust the seasoning. Garnish with fresh basil and chile powder, if desired.

domain: food


Asset management reaches new heights with drone technology
November 23, 2016IM&E manufacturers will soon be using drones to perform visual inspections, capture videos, and obtain sensors readings.
The potential benefits to the industrial manufacturing and equipment industry are staggering. Think of the possible time and cost savings that could be achieved by using remote-controlled cameras to relay images of machinery on an off-shore oil rig, in a remote desert location, or high atop a vertical cliff. Field technicians monitoring equipment performance could obtain valuable viewpoints and details—all without risk to personnel.
A picture is often worth a thousand words. That’s the case with the IM&E industry. Monitoring performance and conducting preventive maintenance are critical to expanding the lifecycle of industrial equipment. This is particularly true of mission-critical equipment that just can’t be allowed to fail, such as generators, security systems, and oil drilling and mining equipment. Beyond photographic images, drone technology can also supply infrared and X-ray images to detect structural issues or dangerous leaks in an environment potentially unsafe for humans.
Infor understands the challenges IM&E manufacturers face and provides solutions to help manage preventive maintenance with greater ease, speed, effectiveness. Last week, Infor announced a partnership with Drone Aviation Corp. to create Infor's new Drone Enterprise Asset Management Solution (DEAMS). This new solution is designed to solve industry challenges by enabling safe, efficient asset management and maintenance, and will take asset maintenance to a whole new level.
Infor and DAC believe that applying tethered drone technology to even small enterprise asset management (EAM) projects can have a significant impact on the success of an asset. With a tethered drone's ability to perform functions like perch-and-stare, video capture, and laser scanning, the drone can replace many of the dull, dirty, and critical services of inspection and compliance.
By combining the cutting-edge, patented tethered drone technologies of Drone Aviation Corp. with the Infor Enterprise Asset Management system, private and public sector customers are now able to benefit from the flexible capability of drone technology to efficiently and safely inspect buildings, oil rigs, power stations, railways and other linear and nonlinear assets.
Thanks to the flexible flying capability, drones or unmanned aircraft systems (UAS) can extend beyond the typical constraints of asset management to capture high-quality images and footage that provide complete visibility. By using emerging technologies to manage infrastructure assets, organizations can achieve greater value in maximizing product lifecycles and institute a preventative maintenance plan that can prevent costly downtime.
Drone technology has quickly standardized and proven reliable since it was first introduced to the market, and today the technology is more affordable and effective than previous techniques in capital-intensive public sector environments.
The partnership between Infor and Drone Aviation helps automate the core business processes that provide enterprise organizations with integrated asset and maintenance management solutions. DEAMS delivers an inspection and maintenance management approach that can produce actionable business insights and improve a business' decision-making processes. Drone Aviation's tethered drones have advanced imaging cameras including stabilized thermal, that can zoom in to show the smaller details of an item being inspected, and they can be safely operated for hours with power and data being securely transmitted through the tether to the operator on the ground.
"Our vision for drone technology has always extended beyond the physical hardware itself, seeing the drone as a critical extension of the network where its sensors are capable of capturing and relaying critical data and information to its users in real time. Through our partnership with Infor and the creation of the DEAMS solution, we are realizing that vision and helping enterprise customers across a wide array of industries harness drones to meet their many unique asset management challenges," said Jay Nussbaum, chairman and CEO of Drone Aviation. "Infor's expertise in data analysis makes them an ideal partner in the development of this unique end-to-end solution."
Infor DEAMS uses Infor ION®, a purpose-built middleware, that processes the data collected by the drones' onboard sensors and integrates it with Infor EAM and maintenance, repair, and overhaul (MRO) applications. The data can also be analyzed with easy-to-use analytics to produce accurate information about the asset life, allowing for quicker and more effective decision-making.
Learn more about this new tethered drone-based asset management solution.


The Carver School Committee unveiled a historical marker at Carver Elementary School in Decatur today.
Carver Elementary School is the first school in Alabama to be named after Dr. George Washington Carver. Dozens of people came out to witness the unveiling. Some of them were students who went to the school.
Several teens with Decatur Youth Services also came out to see the new marker and shared what this means to them and the community.
Meagan Green said, “It means a lot because it can’t ever be torn down, which is a really big thing, and also because it was once a place where people could come and study, which is really big because we want everyone to achieve in Decatur.”
Carver Elementary school opened in the late 1800s.
- Locals to honor MLK in annual Day of Service
- Completing your census report means more federal funding for Alabama
- Anonymous donation provides Morgan Co. Sheriff’s deputies with life-saving device


I have a new USP tactical .45 that has the adjustable target sights. I would like to have a set of night sights installed here sometime soon. I would like to hear from those that have done the same and if you went with the adjustable night sights or the fixed and why? There doesn't seem to be alot of options for the tactical in sights or holsters. Thanks.


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Additional Book Information
Series: NYRB Poets
Publication Date: April 2, 2013
An Invitation for Me to Think
by Alexander Vvedensky, edited and translated from the Russian by Eugene Ostashevsky, additional translation by Matvei Yankelevich
Winner of the 2014 ALTA National Translation Award
“Pussy Riot are Vvedensky’s disciples and his heirs. Katya, Masha, and I are in jail but I don’t consider that we’ve been defeated…. According to the official report, Alexander Vvedensky died on December 20, 1941. We don’t know the cause, whether it was dysentery in the train after his arrest or a bullet from a guard. It was somewhere on the railway line between Voronezh and Kazan. His principle of ‘bad rhythm’ is our own. He wrote: ‘It happens that two rhythms will come into your head, a good one and a bad one and I choose the bad one. It will be the right one.’ … It is believed that the OBERIU dissidents are dead, but they live on. They are persecuted but they do not die.”
— Pussy Riot [Nadezhda Tolokonnikova’s closing statement at their trial in August 2012]
“I raise[d] my hand against concepts,” wrote Alexander Vvedensky, “I enacted a poetic critique of reason.” This weirdly and wonderfully philosophical poet was born in 1904, grew up in the midst of war and revolution, and reached his artistic maturity as Stalin was twisting the meaning of words in grotesque and lethal ways. Vvedensky—with Daniil Kharms the major figure in the short–lived underground avant-garde group OBERIU (a neologism for “the union for real art”)—responded with a poetry that explodes stable meaning into shimmering streams of provocation and invention. A Vvedensky poem is like a crazy party full of theater, film, magic tricks, jugglery, and feasting. Curious characters appear and disappear, euphoria keeps company with despair, outrageous assertions lead to epic shouting matches, and perhaps it all breaks off with one lonely person singing a song.
A Vvedensky poem doesn’t make a statement. It is an event. Vvedensky’s poetry was unpublishable during his lifetime—he made a living as a writer for children before dying under arrest in 1942—and he remains the least known of the great twentieth-century Russian poets. This is his first book to appear in English. The translations by Eugene Ostashevsky and Matvei Yankelevich, outstanding poets in their own right, are as astonishingly alert and alive as the originals.by Alexander Vvedensky, edited and translated from the Russian by Eugene Ostashevsky, additional translation by Matvei Yankelevich
Vvedensky is a marvel: a poet too little known in Russia, and not known at all in the English-speaking world, is revealed as a major 20th-century world poet—wonderful, wonderfully strange, and haunting. The alchemical translation, with its shifty rhymes and non-rhymes, intense images and absent logic, knits and unknits reality before the reader’s eyes, walking not a line so much as a live wire.
—From the Judges Citation for the American Literary Translation Association’s National Translation Award for Poetry
...it's high time that more readers pick up on [Vvedensky's] work to break language, to crush understanding so that what is beneath and beyond it can smuggle its miracle into our event-hemorrhaging lives.
Unlike the Symbolists, his aim is neither to create an aesthetic paradise nor to suggest or build a bridge to another world—Vvedensky's is an aesthetics of martyred aesthetics, of not knowing, of the defeat of "poetry" in the service of truth.... His poetic sensibility combines the Russian Symbolist concern for transcendence, God, and "other worlds," with the Futurist orientation toward syntactical and semantic deformations that draw attention to the artifices of language.
—Thomas Epstein, The New Arcadia Review
Skirting oblivion, impossibly present, Vvedensky now even exists in English where he rubs shoulders with contemporaries he never knew, echoing the metaphysical side of Laura Riding, the phenomenological bent of Gertrude Stein, and the grammatical play and befuddling repetition of both.
—Matvei Yankelvich, Poetry Daily

domain: library


Ashli Babbitt’s family filed a wrongful death lawsuit on Friday against the U.S. government, alleging a Capitol Police officer was negligent and did not have legal justification to shoot and kill her during the Jan. 6, 2021, attack on the Capitol.
The lawsuit asking for $30 million, brought by the conservative group Judicial Watch on behalf of Babbitt’s family, takes aim at the officer who shot Babbitt, Michael Byrd, along with the Capitol Police for negligent supervision and training.
The Justice Department declined to bring charges and the Capitol Police cleared Byrd, who has since been promoted to captain. The Capitol Police is not named as a defendant in the lawsuit, which was filed in U.S. District Court for the Southern District of California.
Babbit was a pro-Trump rioter and Air Force veteran who stormed the Capitol. Byrd fatally shot her as she tried to climb through a broken window into the Speaker’s Lobby, an area that abuts the House floor, as members were evacuating.
The suit claims Byrd breached several standards of care including the safe use of a firearm, the assessment of imminent threats, use of force levels, the use of warnings and obtaining timely, appropriate medical aid.
“Had Lt. Byrd adhered to these standards, he would not have fired, and Ashli would be alive today,” the suit states.
Byrd, the suit claims, used his firearm in a negligent manner because he unholstered his gun before he saw Ashli and before any “expected, prudent, and lawful discharge,” the suit says, quoting a Capitol Police directive. He also failed to keep his unholstered weapon at “low ready” rather than point his gun at more than three people on the other side of the Speaker’s Lobby doors, the lawsuit states.
He didn’t diligently assess the appropriateness of using deadly force against Babbitt and did not give proper warning that he was going to fire, the lawsuit states.
Other law enforcement officers on the scene were accused of acting negligently in the suit. Sgt. Timothy Lively, Officer Kyle Yetter, Officer Christopher Lanciano, and CERT officers Steven Robbs, Don Smith, Brandon Sikes, and Mike Brown “owed Ashli a duty to act as reasonably prudent officers to protect her from harm.” Jason Gandolph, a House Sergeant at Arms employee, also owed Babbitt that duty, the lawsuit states.
Byrd’s history of shortcomings on the department were brought up as reasons the department is responsible for negligent supervision, discipline and retention of Byrd. The suit makes note of when he left a loaded Glock 22 in a Capitol Visitors Center in 2019 and when he failed to meet his firearms qualifications, as well as an off-duty shooting incident that was not justified and a use of force matter that was originally sustained.
“The Capitol Police, Capitol Police Board, and ultimately Congress, as Lt. Byrd’s employer, breached their duty to Ashli to use reasonable care in the supervision, discipline, and retention of Lt. Byrd by retaining, promoting, and even allowing Lt. Byrd to serve as incident commander of the House chamber on January 6, 2021 despite multiple, serious warnings about his dangerous and/or otherwise incompetent behavior,” the lawsuit states.


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Southern African News Features SANF 12 No 8, February 2012
More flood threats for southern Africa
by Joseph Ngwawi
Southern Africa should brace for more heavy rains and possible flooding until the end of the 2011/12 season as weather experts warn of more approaching tropical cyclones that could pummel the eastern part of the region between February and April.
Despite a late start to the season, most of southern Africa has received heavy rains since late December 2011, resulting in flooding in several countries.
Southern African Development Community (SADC) weather experts have predicted normal to above-normal rains for most of the region from January to the end of the season largely because of the continuing effects of the 2011 La Nina phenomenon.
This is the opposite condition to El Ninő, caused by a warming of waters in the western Pacific Ocean that impacts on the weather over a quarter of the earth’s surface, bringing drought to southern Africa.
According to the latest update from the SADC Climate Services Centre published in February, more heavy rains are forecast during the coming two months, particularly along the eastern part of the region.
“The February to April 2012 rainfall projections for most of SADC including the island states are still for persistent heavy rains. However, portions with greater chances of normal to above-normal are confined more across the eastern portions of the region,” the centre said.
It said while tropical cyclone Giovanna, which had threatened to bring heavy rains and flooding to low-lying areas along the eastern coast of the region, had now changed course and was no longer a threat for mainland SADC countries, it was still a threat over southern Madagascar.
Two other tropical cyclones are developing east of Mauritius headed towards southern Africa and could make landfall during the coming month, the weather experts warned.
“As tropical cyclone Giovanna has re-curved southeast-wards off Madagascar, another series of tropical cyclones is evolving over the Indian Ocean well east of Mauritius, and trundling erratically toward the region,” the experts said.
Officials say flooding from the two storm systems claimed at least 40 lives and displaced several thousands in Mozambique. Major highways between the capital, Maputo, and northern parts of the country were destroyed, raising fears of food shortages in affected areas.
The number of people directly affected by the torrential rains, high winds and flooding brought by the two storm systems is estimated at 119,000, according to the Mozambique news agency, AIM.
Other SADC countries that also experienced flooding this year include Angola and South Africa. Most countries in the region have activated contingency plans to mitigate against the impact of floods.
Mozambique began releasing water from the Cahora Bassa Dam on the Zambezi last year with people living along the lower Zambezi basin and in the Buzi, Save and Pungue basins being relocated. The Zambezi River Authority (ZRA), a body set up by Zambia and Zimbabwe to manage Kariba Dam, was forced to open the spillway gates of Lake Kariba early to release pressure on the dam wall. The gates, which are usually opened in early February, were opened on 3 January while people living downstream were advised to evacuate their homes.
Namibia has prepositioned essential commodities and relief tools as part of their contingency plans, especially in the Caprivi Region, which is prone to floods.
sardc.net Southern African News Features offers a reliable source of regional information and analysis on the Southern African Development Community, and is provided as a service to the SADC region.
This article may be reproduced with credit to the author and publisher.
SANF is produced by the Southern African Research and Documentation Centre (SARDC), which has monitored regional developments since 1985
Comments and queries regarding the page itself, contact the Web Applications Developer.

domain: news


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Harry Wilson‘s two goals against Chester caught the eye on Saturday, and the youngster is now set to sign a new-and-improved contract at Liverpool.
Wilson was one of the standout players as the Reds dismantled their lower-league opponents 7-0 at the weekend, kicking off pre-season in style.
The Welshman took both of his first-half goals expertly and was an influential figure throughout his 45-minute runout.
Jurgen Klopp is now weighing up whether or not to keep Wilson in his squad next season or loan him out for the campaign, with 12 Championship clubs keen on acquiring his signature.
Saturday’s evidence suggests the Liverpool manager may opt for the former, and news of his latest contract extension is proof that Klopp thinks highly of him.
According to Goal‘s Neil Jones, “the 21-year-old will this week sign a new long-term deal on improved terms, as the club looks to reward his impressive progress in recent months.”
Wilson only agreed his current contract six months ago, but Liverpool clearly see the improvements made and want to make sure his long-term future is nailed down.
He enjoyed a highly impressive loan spell at Hull City between January and May, scoring seven goals and registering four assists in just 14 appearances for the Championship side.
Wilson’s next chance to shine comes on Tuesday evening, as the Reds take on Tranmere Rovers in another friendly at Prenton Park.
Klopp will always pick players on merit rather than reputation, and if he feels his young forward will be a better option than a potential new signing he won’t hesitate in using him.
The Wales international’s versatility, work rate and eye for goal make him an ideal Klopp player—whether he can find a consistent level at a club of Liverpool’s stature is perhaps the biggest stumbling block.
It is easy to forget that Ryan Kent signed a new contract last summer before being loaned to Freiburg, though, so it doesn’t necessarily signal a definite change in Wilson’s current role.


Last week, PFAW’s Paul Gordon pointed out that Senator Mitch McConnell’s ongoing campaign to obstruct President Obama’s judicial nominees had resulted in not a single new judge since Republicans took over the US Senate. If there’s been no movement it certainly hasn’t been for lack of need. The number of judicial vacancies has risen from 40 to 51, and the number of judicial emergencies has doubled from 12 to 24. Yet up until recently, Senator McConnell hasn’t seen fit to allow a vote on a single nominee.
But lest anyone think that Mitch McConnell hasn’t been paying attention to the judicial vacancy crisis or the Americans who pay the price when their cases are delayed or relocated, today everything changed: today Senator McConnell allowed a vote on … one judicial nominee!
Surely, Senator McConnell’s name will now be listed along with the great senate leaders of our history because he finally brought himself to allow a vote on one, single, solitary nominee. Just look at those numbers!
Truly, Senator McConnell, your willingness to move heaven and earth to do—literally—the least you could possibly do to put partisanship aside and perform the duties you’re paid for is an inspiration to us all.
Let’s give you a round of applause. You earned it.


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Did you know that this vast expanse of land, known as the Tularosa Basin, has attracted people for over 10,000 years? From atlatls to missiles, the glistening gypsum dunefield of White Sands has witnessed the steady advancement of human history, technology, and engineering. For thousands of years the people have called this place home.
Over 10,000 years ago the first people came to White Sands National Park in search of food, water, and shelter. In more recent times, Spanish explorers and miners came to the basin in pursuit of salt, gypsum, and other resources. Ranchers also took advantage of the expansive grasslands in the basin until the bombing of Pearl Harbor during World War II, which caused the U.S. Military to see the value of using the basin for scientific research and technological development.
Each generation of visitors to the Tularosa Basin and White Sands National Park have left their mark. Today visitors can experience some of the most iconic historic places associated with the basin’s rich history. These places include the park’s historic district, which is listed in the National Register of Historic Places, as well as the historic Lucero Ranch on the western shoreline of Lake Lucero. Visitors interested in learning more about the Tularosa Basin’s military history can also visit the White Sands Missile Range Museum and Trinity Site, the place where the first atomic bomb was tested in 1945.
Stories passed down from one generation to the next capture the park’s rich history and the many accounts of people who have worked here. These stories include the legend of La Pavura Blanca and firsthand accounts of what ranching life was like on the range in the early 1900s. Park rangers also tell their stories about being employees for the National Park Service and what it is like to work at White Sands National Park.
Scenery that is never the same twice, colorful sunsets, and the brilliant night sky is an inspiration to many different artists worldwide. Did you know that White Sands National Park has been the backdrop for many feature films, music videos and commercials? The bright white sands, blue skies, and picturesque mountains provide the perfect setting for commercial filming, photography, and various other art forms.
Last updated: December 27, 2019

domain: travel


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Alfred Classics for Students: Burgmüller, Heller & Schumann, Book 2
Item is available as a recurring order
To automatically re-order this item before you run out, select the recurring order option during checkout.
The literature found in the Classics for Students series provides a sequenced course of progression for the pianist who wants to play music of substantial quality. The wide variety of moods, technical features, and colors included in this collection will aid in the development of technique and musicianship and provide hours of personal enjoyment.
- At the Brook, Op. 47, No. 8 (Heller)
- Ave Maria, Op. 100, No. 19 (Burgmüller)
- Cradle Song, Op. 124, No. 6 (Schumann)
- Dusk, Op. 138, No. 3 (Heller)
- Étude in B-flat Major, Op. 125, No. 13 (Heller)
- Fantasy Dance, Op. 124, No. 5 (Schumann)
- The Hunter, Op. 138, No. 4 (Heller)
- Little Romance, Op. 68, No. 19 (Schumann)
- Norse Song, Op. 68, No. 41 (Schumann)
- Restlessness, Op. 100, No. 18 (Burgmüller)
- The Storm, Op. 109, No. 13 (Burgmüller)
- Tarantella, Op. 100, No. 20 (Burgmüller)
- Tolling Bell, Op. 125, No. 8 (Heller)
- Waltz, Op. 124, No. 4 (Schumann).


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WHAT IS VASCULAR TESTING?
Vascular testing evaluates the blood vessels. These blood vessels, called arteries and veins, transport blood through your body. Ultrasound testing is used frequently in vascular testing. An ultrasound machine and special probe are used. The probe creates high frequency sound waves. The sound waves travel through the body, bounce off structures, and return to the ultrasound machine producing a picture. The sound waves also carry important information about blood flow. This kind of ultrasound, called Doppler, shows how well blood flows through the blood vessels. Some vascular tests use a Doppler probe and blood pressure cuffs to look for blockages in the blood vessels.
WHY DO I NEED VASCULAR TESTING?
Your provider may order a vascular test if they suspect that you have a blood vessel disorder. There are many different types of blood vessel disorders. The most common disorder of the arteries is a clogging or blockage. This is called atherosclerosis. Atherosclerosis can occur in almost any artery in the body. The signs and symptoms of atherosclerosis vary and depend on the location of the blocked arteries. There are also many disorders of the veins. One type of vein disorder is blood clots. This is called deep vein thrombosis. Deep vein thrombosis occurs most frequently in the veins of the leg. This is a serious disorder and may require immediate medical treatment. Another disorder of the veins is venous disease. Venous disease, sometimes called venous insufficiency, occurs when the vein walls become weak and blood flows backward in the legs. This can cause leg discomfort, leg swelling, skin color changes, and leg sores.
HOW IS VASCULAR TESTING PERFORMED?
Vascular tests are performed by sonographers and specially trained vascular technologists. Depending on the type of test being performed you may be asked to change into a gown. The tests are usually performed while you are lying on a bed on your back. Some vein tests may be performed while you are standing or in an upright position. If you are having an ultrasound test, the sonographer will place a small amount of gel on the ultrasound probe and place it on the area being evaluated. If you are having a vascular test to evaluate the arteries in your legs the sonographer will use several blood pressure cuffs. The cuffs inflate at different levels to obtain blood pressures readings and Doppler information. Vascular studies can be performed in as little as 15 minutes. Some vascular studies take as long as 1 1/2 hours to complete.

domain: biology


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The PM has announced her new cabinet which forms part of NZ's most diverse parliament in history
Michael Wood has been appointment minister for workplace relations and safety in the new Labour Government, as part of Jacinda Ardern’s recently announced cabinet.
Wood has a trade union background and has emphasised the importance of workers’ rights, including the role Fair Pay Agreements will play in ensuring decent work and wages.
However, Wood is keen to make sure that the benefits of union membership are not so easily passed on to non-unionised workers.
Union membership has dropped significantly since employment law changes in the early 1990s, from around 42.9% of wage and salary earners in 1991 to 17.2% in 2017.
Wood said that unions needed to be “dynamic and attractive enough” to increase their own membership.
The president of The Council of Trade Unions Richard Wagstaff said Wood comes to this role with a depth and breadth of experience as a union organiser.
“He knows first hand the challenges that working people in Aotearoa face. He is a compassionate, hard working, committed individual, whom we are confident will show clear decisive leadership to ensure that this is the best place to work in the world,” said Wagstaff.
Wagstaff said Wood is expected to act swiftly on:
Safer sick leave
As per their election promise, Labour will increase sick leave to 10 days. This will be put into law in their first 100 days in office, enabling people to take sick leave from the first day of work.
Sherridan Cook, partner, Buddle Findley, told HRD that some employers may not like this policy because employees might treat sick leave like annual leave.
“Employees might see it as another five days a year that they can take,” he said.
“If an employer suspects an employee is not actually sick it can be a difficult thing to prove.”
Fair Pay Agreements
Wagstaff said now is the time for implementation of Fair Pay Agreements, including the passing of legislation in line with the Framework for Fairness principles “for a good FPA law and the Joint Working Group recommendations”.
Read more: PM’s pregnancy to ‘smash gender boundaries’
Making work safe
This involves increasing funding to WorkSafe, reviewing the Health and Safety at Work Act, ensuring there are elected Health and Safety representatives in all workplaces, ensuring there are better protections against psychosocial harm and empowering working people to keep their work safe under the law.
Assistant National Secretary at E tū, Annie Newman, added that Wood has a bright future, as he has continually put workers at the very heart of his political life by emphasising the need for equality in the workplace.
“Michael truly believes that all workers deserve a fair share of the economic cake and wants them to have a voice in decision-making that affects them,” said Newman.
“He has worked in Parliament for many years and is a vocal supporter of working people, including low-paid and migrant workers, as well as those in the service sector.”
Ardern’s ministry appointments come after New Zealand elected its most diverse parliament in history in a landslide win on October 17.
Women will be making up 43% of the wider Ardern administration, while eight members of the new 20-person cabinet are women.
Moreover, five members of the cabinet are Maori, three are Pasifika, and three are LGBTQ. Nearly half (47%) of the new parliament is made up of women.
In fact, Nanaia Mahuta - who will become the minister of foreign affairs - is the first woman in the nation’s history appointed to hold the portfolio.


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Some Helpful Hints for Planning your Colorado Dude Ranch Vacation
Overnight Guests, as well as Disc Golfers and Trail Riders may find helpful hints.
Check In & Check Out
Here is our riding profile and waiver form: https://www.sundancetrail.com/waiver/ We are requesting guests to complete it before arrival. This helps us to pick the right horse for you.
- Summer Dude Ranch
Check-in Sunday 2PM or Wednesday 2PM.
Check-out Saturday around 12 PM
- Fall, Winter and Spring
Check-in is 2PM.
Check-out is before 12 PM
Our lifestyle is relaxed and very casual, but you will be most comfortable if you follow these general guidelines.
- long pants/jeans preferred
- long sleeve shirts
- some folks find bicycle shorts under their jeans most comfortable
- sports bras can make trotting and cantering easier
- either riding/cowboy boots, light hiking shoes or tennis shoes (No deep-tread hiking boots or loose fitting tennis shoes)
- cowboy hat or sunscreen for ears, neck and nose
- stampede strings for your hats are HIGHLY recommended!
- stampede strings hang from the inside brow band below the chin — keeps hat attached to you in a breeze, so hat does not fly away and SPOOK the horses behind you! Can be found in most Country-Western clothing stores or in our Trading Post here.
- riding helmets are available here
- you are welcome to bring your own saddle and/or helmet if you prefer
- hiking boots, hiking shoes or tennis shoes (NOT cowboy boots),
- sunscreen and a hat, wide-brimmed or cap
Everything else requires:
- jeans or shorts
- sunscreen (we can’t repeat this enough)
- swim suit
- sun glasses (high altitude sun is rough on eyes)
- Summer evenings can be cool – a jacket, sweat shirt or sweater
- Fall, Winter & Spring can be unpredictable, with as much as a 40 degree difference between afternoon high and night low temperatures. Dress in layers.
- Washers and dryers are available for guest use every day after 5PM – (yes, mom, you can go home with clean clothes!)
Other Items to Bring Along:
- Water Bottle — Dehydration is a common malady at altitude, bring your own or buy one from our Trading Post and drink several quarts a day, especially in the summer
- Hand lotion – our air is dry
- We now have a retail liquor store on the property, and a variety of soda pop, beer, wines and spirits available on the ranch. You do not need to BYOB, but are also welcome to if you wish.
- Guest suites have small refrigerators.
- We make trips to town daily, and will be happy to have staff pick up other needed items.
You do NOT need to bring:
- Your hair dryer – every bathroom has one.
- Your banjo, accordion or bagpipes.
Did you notice that we didn’t list watches or cell phones or pagers? You won’t need them here — let your cell phone work exclusively as a camera!
We are happy to accommodate your special diet needs. Please notify us well in advance of these needs, and we will be happy to write our menu with you.
If you have a fussy eater, we will be happy to have a variety of simple “kid-friendly” foods available. Notify us in advance, and we will have your child’s favorite foods available when you arrive.
We are pet friendly! Dogs and Horses are welcome here! Details are outlined here.
You can see the National Weather Service 7-Day Forecast here.
|Our Historical Weather:||Jan||Feb||March||April||May||June|
|Avg. High Temp||40°F||45°F||50°F||60°F||69°F||80°F|
|Avg. Low Temp||13°F||18°F||23°F||32°F||42°F||51°F|
|Avg. High Temp||85°F||83°F||75°F||64°F||50°F||43°F|
|Avg. Low Temp||56°F||54°F||45°F||34°F||23°F||17°F|
Mountain weather means dressing in layers. Remember the temperature will drop 30 degrees when the sun goes down at night!
Mail, Verizon cell service, limited Wifi available.
However, “bringing work” with you, or being “on-call” for work is HIGHLY discouraged.

domain: hobby


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"I was staring at it and knew whoever was there knew I was looking" - Witness Recalls Sighting of Spaceship Over Texas
A very brief testimony of a UFO sighting from all the way back in 2003 in the Dallas area has just been submitted to MUFON (case 102698). I thought it had some interesting details that match other more well-documented reports, and so wanted to share:
I was at my house
A solid orange orb was seen hovering and then disappearing in the daytime sky over Dallas last month, according to footage uploaded to YouTube. Another similar UFO appeared alongside it, but it's harder to see in the video, which you can check out below. However, consider muting it if you don't like foul language!
"We saw a metallic object falling straight down... It looked like it was tumbling" - UFO Reported Over Dallas Area
An intriguing report of a supposed "chem trail" and falling, perhaps even crashing "metallic object" over the Dallas area was submitted to NUFORC (case 147700):
We were at Arby's between 12:30 pm and 1:00 pm when we saw a chem trail in the sky pretty high up, and from the top of it we saw a metallic object falling straight down. We watched it until we could no longer see it. My sister thought it was a weather balloon, but I did not. It went down in a straight line, but it looked like it was tumbling, and it looked metallic.
In my opinion, "chem trails" have never been proven to exist or not exist, so I'll leave it up to you all to be the judge on this report overall. The "tumbling" metallic object is probably the more important thing to focus on, however, as it's the harder sighting to explain! As always, share your thoughts and theories in the comments below, or on Facebook, Twitter, or Instagram!
April 29th, 2019 Update: A new report of a triangle UFO over Austin on April 27th at 9:25 PM has been submitted to MUFON (case 99976):
Two friends and I saw a giant brown boomerang shape in the sky. No lights, no sound, it just glided across the sky slowly. It moved like a low cloud across the sky. A few minutes later I was looking across the pool in the direction where the ufo had gone and there were two orbs of light. I kept looking until the lights started bouncing and all the sudden the ship blasted into space like in the movies. It left tracers of rainbow neon light behind it.
TexasUFOs and other online outlets have received multiple triangle UFO reports. Here are a few recent triangle UFO sightings to share as an example. Over the last several days, witnesses in Dallas and Montgomery, Texas (the cities are within a few hours drive of each other) have spotted a V-shaped object or craft of some kind. The Dallas witness claims the UFO made a loud rumbling noise that shook their house and suggests it could be top-secret military. Check out the recent reports below as well as a real-time triangle UFO map:
April 24th, 2019 at 8:29 PM in Montgomery:
V Shaped array of lights, moving fluidly through sky
April 26th, 2019 between 11 and midnight in Dallas:
Black/dark grey triangle UFO reported
What do you think of triangle UFOs in general, and these recent cases? Are aliens invading the Lone Star State? Is the government performing top-secret military exercises or even participating in a top-secret war above our heads? As always, you be the judge! Let me know what you think in the comments, or on Facebook, Twitter, or Instagram.
If you've ever seen a triangle UFO, help solve this mystery and report your sighting!
"This s-shaped shiny Chrome object had a black spot on the top" - Bizarre UFO Encounter Reported in Irving
A very intriguing and detailed testimony of an S-shaped UFO over the Dallas area has been submitted to TexasUFOs by a witness named Drew, who was driving a truck for a concrete company he worked for during the encounter:
I drive a truck for a concrete company that is located across the street from DFW Airport. Last Summer around 2 p.m. I noticed an s-shaped object hovering around 100 feet off the ground about a half a mile away on the DFW Airport property. This s-shaped shiny Chrome object had a black spot on the top curvature of the s like a window and it hovered around a hundred feet off the ground for about 2 minutes and one area but the craft was moving back and forth from north to south north to south Non-Stop it would never go all the way around it would just make that one continuous motion north to south and south to North and it would never wobble it stayed up right. I showed it to my co-workers who were standing outside and he said it was a balloon and I told him it couldn't be a balloon because one reason is a would not release a balloon that size on the airport property because a plane could hit it and secondly if it was a balloon it would be wobbling around and floating off this object stayed stationery in spot continuously making the motion I described then after about 2 minutes it shot up about quarter mile and stopped again and did the same thing for about 2 minutes I was walking towards my managers office to show him and by that time I looked up and it was up by clouds and I could barely see it. This was not a balloon I've seen dozens of balloons released in the air and and seen them float away this object had control over its movement and made the same continuous move it Non-Stop. We have had a lot of construction going on around DFW airport for the last couple of years. So I'm wondering if that was an observation craft to see what was going on around the airport but that is just mine personal opinion of what happened. have no evidence other than my testimony because at my work it is against company policy to have cell phones while driving are CDL vehicles in my phone was in my personal vehicle at the time
Oddly enough, S-shaped UFOs have been seen before; check out these photos from other similar sightings below:
Have you seen a UFO or alien? You are not alone! This site is updated with the latest UFO sightings and alien and paranormal news from Texas and all over the world.


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Welcome to Honda Racing Corporation
This weekend the WorldSBK riders will be back in action after the summer break, taking part in two days of testing at the Algarve International Circuit in Portimao (Portugal) on 24-25 August. With Leon Camier still recovering from successful surgery to his left shoulder, the Moriwaki Althea Honda team will… read more.
After sealing the 2019 MXGP world championship at Imola last weekend, Team HRC now head to Sweden looking for more success at the beautiful Uddevalla facility, located an hour north of Gothenburg. Tim Gajser wrapped up his title three rounds early but he can still set more records and put… read more.
The 2019 season continues at full pace as Marc Marquez and a recovered Jorge Lorenzo reunite at round 12. The 5.9km long Silverstone circuit is the longest on the MotoGP calendar and has hosted a number of memorable races since its debut in 1977. Newly resurfaced for 2019, the new… read more.
After sealing his third world motocross championship title in Imola, Italy last weekend, Team HRC’s Tim Gajser has signed up to race the 2019 Monster Energy Cup, held at the Sam Boyd Stadium in Las Vegas, Nevada on October 19th. Having won races all around the globe this year, Gajser… read more.

domain: sports


text: Junior Boys, Jessy Lanza @ Phoenix Concert Theatre 4/10/2016 Tiana Feng April 10, 2016 Canadian, Concerts, Electronic, Electropop, Music 788 Last night, Junior Boys and Jessy Lanza ended their two month tour together in Toronto at the Phoenix Concert Theatre. In a haze of fog, Jessy Lanza sang her signature chill and flirtatious electronic tracks earning her some new fans who were lucky enough to be early. Her set included favourites from her 2013 album Pull My Hair Back including “Fuck Diamond” and “Kathy Lee”. The rest of her set focused on new songs which included “VV Violence” from her upcoming album Oh No. Lanza brought a long a drummer which brought more power to her set. “Once you play in Birmingham, Alabama you can play anywhere,” Jeremy Greenspan said in reference to the relaxed mood that the band played in, which continued in the foggy atmosphere of the venue. Fans were treated to tunes old and new including 2011s “Banana Ripple”. The band kicked off their set with a cover of “Some People Are Crazy” by Britain’s John Martyn. Live guitars added to the lush sound of the dance tracks. The climax of the set was the new “In the Morning”. The audience got into a dance trance until the very end of the set. The electronic veterans still know how to seduce a crowd.

domain: entertainment


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- Homebuyer Workshop
- 25.08.2011 - 25.08.2011
A Homebuyer Education Workshop will be held on Monday, Aug. 25 at the R.C. Irwin Library from 1 to 5 p.m. Topics include: budgeting and credit, getting a mortgage loan, shopping for a home, etc. For more information, please call the Tunica Community Development Coalition at 662-363-5990.
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County claims as of Feb. 2, 2015 The claims docket approved...
Board cuts monthly expenses by $120,000 per month County administrator...
A Whole New World Tunica Academy students...
Fire departments, co. utility in cash crunch Budget and cash flow...
Old Man Winter takes residence in Tunica Area schools took a snow...

domain: finance


300 Thread Count Solid Duvet Cover Sets
A luxury way to brighten up your bedroom decor with a 300 Thread Count Duvet Cover Set. An affordable luxury that drapes beautifully on the bed. These 300 thread count duvet cover sets of premium long-staple cotton are "sateen" because they are woven to display a lustrous sheen that resembles satin. Coordinate with our Hotel Collection Sheets and Bed-skirts!
Our 300 Thread Count Hotel Collection Duvets are available in Twin, Full/Queen, King/California King.
Each set includes a duvet cover with matching pillow shams (one with Twin).
Black / Grey (Solid Black Duvet with a Grey Inlay Inset Border)
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The first OnePlus Watch update promises to fix some of its biggest problems
- The OnePlus Watch is getting some much-needed improvements and bug fixes.
- The company has also promised to roll out Always-on display and other features in the future.
The OnePlus Watch didn’t really get off to a good start. Reviews of the wearable were largely unfavorable owing to inaccurate activity tracking, lack of marquee features at launch, GPS dropouts, and more. It seems OnePlus has taken note of many of these problems in the latest update now rolling out for the device.
This is the first OnePlus Watch over-the-air update with firmware number B.40. It will initially roll out to devices in the US and Canada, followed by other countries in the coming days.
The changelog of the latest OnePlus Watch update shows that the company has pushed out improvements to things like GPS, fitness tracking, notifications, and more. It even squashes some known bugs. However, you might not be too happy with it since some previously missing features have still not landed.
OnePlus says it’ll push out the Always-on display functionality, remote camera control, all 110 workout modes, and other attributes in a future update. There’s no word on when this update will land, but reports suggest it could release around mid-May.
Meanwhile, you can view the complete changelog for the latest update and features promised for the future below.
OnePlus Watch B.40 update changelog
- Improved GPS performance
- Improved accuracy of activity tracking (walking and running)
- Optimized heart rate monitoring algorithm
- Enabled notification app icons for the most frequently used apps
- Improved raise-to-wake function
- Optimized notification syncing algorithm
- Fixed some known bugs
- Improved system stability
OnePlus Watch upcoming features
- Always-on Display feature
- Remote camera control of Android smartphones (Android phones running on Android 6.0 Marshmallow and above) from OnePlus Watch
- 12-hour time format
- Four languages: German, Italian, Spanish, and Polish
- All 110+ workout modes
- AI watch face