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Our Activities
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- Partners
Why MediaSpace?
MediaSpace provides multimedia satellite services at an optimised cost and on an international deployment level, proposing solutions to anyone anywhere in the world. Mediaspace's infrastructure, set up from a combination of satellite and terrestrial networks, offers global solutions thanks to the MediaSpace service platform.
MediaSpace addresses the needs and requirements of Organisations and International Institutions by offering the user communities a wide range of satellite-based telecommunication solutions, filling the shortfall in efficient, adapted and affordable communication tools that are currently available. MediaSpace solutions are developed in accordance with the individual needs of each organisation's departmental field, such as education, health, local economy, culture, sustainable development, religion, cultural exchange, and more.
MediaSpace is not a proprietary system: it is the result of a collaboration between complementary partners - IT and Telecom companies, operators, business providers and Non-Profit Organisations, who have joined together to implement and operate the system and ensure its evolution. Moreover, it uses and promotes standards while answering the requirements and constraints of the users. The objective of MediaSpace was to set up a Non-Profit Alliance creating an operational framework adapted to the mission of the system and in particular to bridge the North, South, East and West with a truly global infrastructure.
MediaSpace is the result of an ESA ARTES program for application projects led by Alcatel Space. The project allowed the constortium to define a generic architecture for a service platform based on Alcatel Spaces's experience in this domain, to instantiate such architectures within a real case and then to implement the service platform in ESRIN. Results were also obtained using models and the placement of satellite systems in the telecommunication framework, as well as market analysis to establish trends and feasibility studies for worldwide services. This pilot step has been tested, implemented and validated in partnership with organisations with a truly international presence and who have different user communities; such as Non-Profit Organisations, Universities, Medical Communities, Public Institutions, Research Institutes etc.
MediaSpace Today
MediaSpace has several intrinsic characteristics that make it a possible node for a future European initiative. Primarily the user community, served by the pilot step: the system has been dedicated to shared usage by non-profit organisations, medical and teaching institutes (especially those which bridge Europe to the rest of the world), research organisations that are skill providers and consumers of fast networks, and cultural communities who can take advantage of the global network structure.
The objective of MediaSpace was to establish that a global infrastructure can efficiently support the development of incoming countries, optimising overall user costs and building a bridge of knowledge and information.
The pilot step has materialised these objectives with communities representative of the target user segment, including sites in isolated places. These user groups are listed below. They have played a major role in the establishment of the system requirements and have also validated the system in the operational phase.
Focolare Movement - a humanitarian worldwide non-profit organisation.
Communità di Sant'Egidio - a Church public lay association.
Hospital of Padova - a medical community.
APL (Aulo de Producto Lacteos) - a teaching and research organisation in the agriculture and fish environments.
Eurasiasat - a satellite operator.
Satko - an ISP and multimedia service provider.
Bagatelle - a medical community.
IAS (Institut Aeronautic et Spatial) - a research organisation in aeronautics and space technologies.
Iztech (Izmir Institute of Technology) - a study and research institute.
ANTRAK - a risk and emergency non-profit organisation.
UNESCO - a worldwide non-governmental organisation for knowledge, culture, environment and rights preservation.
On the right, a map shows all the participating user organisations, within their particular group, that have taken part in the MediaSpace pilot project.
MediaSpace's global presence currently covers Africa, North and South America, Europe and Eastern Europe and will soon be extended to Asia and Australasia.
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Not Applicable.
What services, for which use?
The MediaSpace hosting platform provides both on-line and off-line services, accessible via personalised portal pages. The portal provides each community with a secure and unified access to the services, together with management facilities and a direct access to the MediaSpace support office. The user site configurations are also reduced to a minimum, while the customised environments offer a simple and high-quality portfolio of services, which are as follows:
Network optimisation and connectivity services:
"Portal services":
Content Management services:
Interactive services:
|These service families are all provided from a hosting platform, which is the core of the system, and which supports the application servers, the management system and the uplink facilities. Each community selects its own set of services varying from low level services like connectivity or distribution to the upper level services like e-learning and e-education, (a collaborative work environment in a virtual classroom).
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Not Applicable.
One of the larger organisations that has been involved in the MediaSpace project is the Focolare Movement, having eleven user sites deployed at present.
The Focolare Movement is a worldwide, non-profit association spanning 182 countries. About four million people, representing a great variety of racial, religious, cultural, social and professional backgrounds, adhere to the goals of the Focolare and are committed to bringing about a more united world.
Focolare Movement on the pilot phase of MediaSpace
"Our organisation began using MediaSpace with great enthusiasm for the end results and services it offers. Our general impression is extremely positive and naturally our intentions are to continue using MediaSpace and increase the number of sites involved in the project." Cesare Borin, Director, New Media Office, Focolare Movement.
An example of the success of the MediaSpace project for Focolare was shown at a live event in Castelgandolfo, Rome in September 2003. The event was filmed live (in real-time) at Castelgandolfo, uplinked by DVB to the satellite using a mobile station on site, and then was finally received by the ESRIN MediaSpace service platform. The signal was then processed by the MediaSpace service platform, encoded in MPEG4, converted in IP and uplinked in DVB/ IP. The DVB/ IP signal was then split so that it could be sent to two different satellites, the first covering Europe and the second North and South America, it was then received by Focolares' sites around the world, which were installed with the Alcatel Space A9722 satellite router receiver.
The live viewing figures from this event were as follows:
The event was also simultaneously recorded and stored on the MediaSpace service platform, so that it could be streamed off-line (after the event) to their African partners, in Douala and Fontem, via satellite.
Nowadays, Focolare periodically performs this type of event.
Following this series of events involving Focolare centers throughout the world, more than 100 additional Focolare sites have requested to become users of the MediaSpace project. Subsequently a huge deployment operation is foreseen in the next few months.
Inline with Focolare's involvement, Sant'Egidio have also joined the MediaSpace project and we are presently deploying equipment and services to nine sites in Europe; in Italy, Spain, Germany, Belgium and Hungary.
The MediaSpace project started in November 2001, and this first step has been devoted to the study of user requirements, the consolidation of the system architecture, particularly with regards to the application and service layers, business strategy and switching to the operational phase. The result of which has led to the creation of the MediaSpace Alliance.
MediaSpace relies on an Alliance of European complementary partners - satellite and terrestrial operators, industrial, application/ product/ service/ business providers and ICT specialists - to build customised telecommunication solutions specifically designed for the institutional and non-profit markets needs and requirements, ensuring that its users benefit from best practice and up-to-date technologies. These firms have entered into this Alliance to foster the necessary synergy in order to provide a better unified and adapted answer to the User Communities' requirements and needs.
The MediaSpace Alliance Members have undersigned a Memorandum of Understanding, in order to establish and animate this strong cooperative relationship and to regularly meet in the frame of the MediaSpace Alliance Steering Committee.
The Steering Committee's role is, among other tasks, to precisely define the exploitation, development and promotion of the use of satellites for large bandwidth multimedia services and European technological solutions for international organisations, with respect towards deontological and ethical guidelines, as further detailed in the MediaSpace Charter.
The MediaSpace Alliance is composed of the following partners:


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Lahore : Sharifuddin Pirzada has passed away after a protracted illness at the age of 94. Inna Lilahe wa Inna Elehe Rajeune.
The Sindh High Court temporarily suspended all legal proceedings after Pirzada's death to honour his memory.
Syed Sharifuddin Pirzada (12 June 1923 – 2 June 2017) was a noted Pakistani lawyer, served as a senior advocate at the Supreme Court of Pakistan.
Syed Sharifuddin Pirzada was born in the city of Burhanpur, in what is today Madhya Pradesh, to parents Mir Niazi Pirzada and his wife, Fatima. His father was a noted barrister as well, serving in the Indian Civil Service at the time and posted in the state.
He was the prime advisor to General Pervez Musharraf against maintaining the status quo regarding the 1973 constitutional oath given to the judges prior to the general's coup d'état. He advised Musharraf who then later included Aziz Munshi as a law minister to seek the consent of the Chief Justice Saeeduzzaman Siddiqui for the legitimacy of his rule. Siddiqui was called upon by Musharraf earlier in October and it was made clear that the oath under the Provisional Constitutional Order shall not be administered to any judge of the court. Musharraf had agreed, later when asked by Mr. Munshi, Siddiqui refused and rejected the notion that judges of the courts be administered any other oath and that to contrary to the ones under the 1973 constitution. Later Siddiqui refused to take oath and resigned with 4 years remaining in office.
He was a highly-controversial figure amongst political and judicial circles in Pakistan due to his regular legal work in ensuring the legitimacy of Pakistani military rulers, as well as offering his services to a wide variety of entities seeking on ensuring the status quo in the country. For such reasons, he is regarded as a maverick lawyer with no firm stance on political matters. In addition, he is a member of the Pakistan Civil Service, having served as both Foreign Minister under Ayub Khan and the Attorney-General under Zia-ul-Haq.
Punjab Chief Minister Muhammad Shahbaz Sharif has condoled the death of renowned lawyer and a companion of founder of the nation Quaid-e-Azam Muhammad Ali Jinnah, Sharifuddin Pirzada.
In his condolence message, the Chief Minister has extended sympathies to the bereaved family and prayed to Allah Almighty to grant courage and solace to the bereaved family to bear this irreparable with equanimity. He has further said that the services of Sharifuddin Pirzada in the field of law will be remembered for a long period of time.

subset: commoncrawl


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Treatment of Symptomatic Severe Aortic Stenosis With a Novel Resheathable Supra-Annular Self-Expanding Transcatheter Aortic Valve System
Author + information
- Received February 18, 2015
- Revision received May 1, 2015
- Accepted May 5, 2015
- Published online August 24, 2015.
Author Information
- Ganesh Manoharan, MBBCh, MD∗∗ (gmanoharan{at}msn.com),
- Antony S. Walton, MBBS†,
- Stephen J. Brecker, MBBS, MD‡,
- Sanjeevan Pasupati, MBChB§,
- Daniel J. Blackman, MD‖,
- Hongyan Qiao, PhD¶ and
- Ian T. Meredith, AM, MBBS, PhD#
- ∗Regional Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom
- †Victorian Heart Centre, Epworth Hospital, Melbourne, Australia
- ‡Cardiology and Interventional Cardiology Services, St. George's Hospital, London, United Kingdom
- §Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
- ‖Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
- ¶Statistical Services, Medtronic, Inc., Minneapolis, Minnesota
- #Monash Cardiovascular Research Centre, MonashHEART, Monash Health, and Department of Medicine, Monash University, Melbourne, Australia
- ↵∗Reprint requests and correspondence:
Dr. Ganesh Manoharan, Cardiology Department, Royal Victoria Hospital, 274 Grosvenor Road, Belfast BT12 6BA, United Kingdom.
Objectives The purpose of this study was to prospectively evaluate the safety and clinical performance of the CoreValve Evolut R transcatheter aortic valve replacement (TAVR) system (Medtronic, Inc., Minneapolis, Minnesota) in a single-arm, multicenter pivotal study in high- or extreme-risk patients with symptomatic aortic valve stenosis.
Background Although outcomes following TAVR are improving, challenges still exist. The repositionable 14-F equivalent CoreValve Evolut R TAVR system was developed to mitigate some of these challenges.
Methods Suitable patients (n = 60) underwent TAVR with a 26- or 29-mm Evolut R valve. Primary safety endpoints were mortality and stroke at 30 days. Primary clinical performance endpoints were device success per the VARC-2 (Valve Academic Research Consortium-2) and the percent of patients with mild or less aortic regurgitation 24 h to 7 days post-procedure.
Results Patients (66.7% female; mean age 82.8 ± 6.1 years; Society of Thoracic Surgeons Score 7.0 ± 3.7%) underwent TAVR via the transfemoral route in 98.3%, using a 29-mm valve in 68.3% of patients. All attempts at repositioning were successful. No death or stroke was observed up to 30 days. The VARC-2 overall device success rate was 78.6%. Paravalvular regurgitation post TAVR was mild or less in 96.6%, moderate in 3.4%, and severe in 0% at 30 days. Major vascular complications occurred in 8.3%, and permanent pacemaker implantation was required in 11.7% of patients.
Conclusions The repositionable 14-F equivalent Evolut R TAVR system is safe and effective at treating high-risk symptomatic aortic stenosis patients. Repositioning was successful when required in all patients, with low rates of moderate or severe paravalvular aortic regurgitation and low permanent pacemaker implantation. (The Medtronic CoreValve™ Evolut R™ CE Mark Clinical Study; NCT01876420)
The prevalence of patients presenting with aortic stenosis increases with age (1,2), and untreated symptomatic patients have a poor prognosis (3–5). Transcatheter aortic valve replacement (TAVR) is now an accepted treatment strategy for patients who are considered to be high risk or unsuitable for surgery (6–11).
Despite studies demonstrating good outcomes following TAVR, challenges such as vascular access complications (12,13), the need for permanent pacemaker post-TAVR (14,15), paravalvular leak (PVL) (16,17), stroke (18,19), and procedure-related complications (20,21) still remain. Technological advancements, with conformable valve frames and more accurate valve positioning, may improve outcomes.
The Medtronic CoreValve Evolut R System (Medtronic, Inc., Minneapolis, Minnesota) (Figure 1) was designed to mitigate some of these difficulties. Detailed design characteristics have been described previously (22). In brief, this system comprises the Evolut R valve and the EnVeo R Delivery Catheter System (DCS) with the InLine sheath. The trileaflet valve and sealing skirt are made out of porcine pericardial tissue, sutured in a supra-annular position on a compressible and self-expandable nitinol frame (Figure 1A). The Enveo R DCS enables the valve to be fully repositionable and recapturable before full release by turning the delivery handle (Figure 1B). The built-in InLine sheath allows for the whole system to be inserted into a patient without the need for a separate access sheath, reducing the overall profile of the system (Figure 1C), equivalent to the outer diameter of a 14-F sheath.
The objectives of this prospective, single-arm, multicenter pivotal study were to evaluate the safety and clinical performance of the CoreValve Evolut R TAVR system in patients with severe symptomatic aortic valve stenosis who are at high or extreme risk for surgical aortic valve replacement (SAVR). The 30-day outcomes are presented in this paper.
Study design
This prospective, single-arm, multicenter study was conducted at 6 centers in the United Kingdom, Australia, and New Zealand (Online Appendix A). The study was funded by Medtronic, and the protocol was developed in collaboration with the study investigators.
The study was conducted in accordance with the Declaration of Helsinki and was consistent with Good Clinical Practice and the applicable local regulatory requirements. Local ethics committee approval was obtained, and signed informed consent was obtained from each patient who met all study inclusion criteria and had no exclusion criteria (Online Appendix B) before enrollment and before performing any study-related investigations.
The study methods included the following measures to minimize potential sources of bias:
• An external clinical event committee, comprising a cardiologist, a cardiothoracic surgeon, and a neurologist, adjudicated all serious adverse events in the study.
• A data safety monitoring board provided oversight of all safety aspects of the study.
• All sites followed a standardized protocol for acquisition of echocardiographic endpoint data.
• An echocardiography core laboratory (Mayo Clinic, Rochester, Minnesota) evaluated all echocardiograms and echocardiographic study endpoint results.
• All study-related data were collected electronically, and independent full source data verification was periodically conducted at each site.
Patient selection
All eligible patients had symptomatic (New York Heart Association [NYHA] functional class ≥II) aortic stenosis defined as an aortic valve (AV) area of <1.0 cm2 (or AV index of <0.6 cm2/m2) and a mean AV gradient >40 mm Hg or maximal velocity of >4.0 m/s by resting echocardiogram. Patients with low flow/low gradient aortic stenosis were permitted if they had documented dobutamine or exercise stress echocardiography demonstrating a mean gradient >40 mm Hg or a maximal valve velocity >4 m/s and an AV area <1.0 cm2 (or AV area index <0.6 cm2/m2).
Risk assessment was determined on the basis of a Society of Thoracic Surgery (STS) score ≥8.0% or documented heart team agreement of high or extreme risk for SAVR due to frailty or comorbidities.
Primary clinical exclusion criteria were any contraindication for placement of a bioprosthetic valve, clinically significant untreated coronary artery disease, severe left ventricular (LV) function (ejection fraction <20%), end-stage renal disease, liver failure, bare-metal stent placement within 30 days or drug-eluting stent within 6 months before assessment, myocardial infarction within the past 30 days, severe dementia, or any condition that would preclude anticoagulation. Key anatomical exclusion criteria were a pre-existing prosthetic heart valve in any position, mixed AV disease (stenosis and regurgitation), severe mitral or tricuspid regurgitation, moderate or severe mitral stenosis, or bicuspid or unicuspid AV.
Multislice computed tomography (MSCT) of suitable patients was used to analyze the aortic annulus and peripheral vasculature to assess anatomic suitability. This information assigned patients to undergo TAVR via the transfemoral or an alternative access route (direct aortic or subclavian artery). Two valve sizes were available in this study (26 or 29 mm), and valve choice was determined by the MSCT-derived annular perimeter (26 mm: 62.8 to 72.3 mm; 29 mm: 72.3 to 81.6 mm), as per the manufacturer's instructions for use.
Study procedure
Before patient enrollment, the study sponsor trained all investigative teams on the study methods, procedures, and requirements. All implanting physicians were trained on the use of the investigational TAVR system through didactic and simulator sessions. Throughout the study period, any newly learned procedural techniques were disseminated to the other investigators.
The choice of performing the procedure under general or local anesthesia was at the discretion of the implanting team. Although the EnVeo DCS with the InLine sheath allows for the valve to be delivered "sheathless," implantation using standard techniques (pre-positioning of an 18-F access sheath) was allowed on the basis of the manufacturer's instructions for use. Once all arterial and venous accesses were achieved, intravenous unfractionated heparin was administered to achieve a recommended activated clotting time of ≥250 s.
The "sheathless" technique required distinct steps before advancement of the TAVR system into the patient. Once access was obtained and pre-closure sutures deployed, a 14-F 30-cm standard sheath was advanced into the patient. This access was used to cross the AV, followed by positioning of a pre-shaped stiff support wire in the LV. The manufacturer's instructions for use recommended balloon aortic valvuloplasty (BAV) before positioning of the valve. Once BAV was completed, the 14-F sheath was carefully removed, maintaining wire position in the LV. The EnVeo DCS with the InLine sheath, mounted with the Evolut R valve, was then advanced "sheathless" into the patient and implanted at the annulus. Following successful valve implantation, the EnVeo DCS was removed, and while maintaining wire position, the 14-F sheath was re-introduced. Following this, post-TAVR hemodynamics and angiographic and echocardiographic assessments were completed.
During the TAVR procedure, an electrocardiogram (ECG) was recorded at key procedural steps (pre-TAVR, pre-BAV, post-BAV, immediately post-deployment, and at completion) to prospectively assess if or when a rhythm change may have occurred.
During valve delivery, the Evolut R can be repositioned by either resheathing or recapturing to optimally place the valve. Resheathing was defined as when only part of the valve was retrieved back into the DCS capsule, and recapture was defined as when the valve was completely retrieved back into the DCS with the intent to re-cross the AV (if the valve fully migrated into the ascending aorta during deployment) or, if necessary, to completely remove the system from the patient safely. Repositioning to achieve an implant depth between 1 and 5 mm was recommended.
Following successful TAVR, the use of dual antiplatelet therapy was at the discretion of the implanting team. Generally, the best practice recommendation for the CoreValve system was used, with dual antiplatelet therapy continued for 3 months, followed by single antiplatelet therapy for life.
Follow-up evaluation included clinical assessment, echocardiography, and 12-lead ECG at discharge and 30 days, and is planned through 2 years post-procedure. Transthoracic echocardiography was performed pre-implant and at 24 h to 7 days after the implant to calculate device success. In addition, cardiac enzymes were monitored through 30 days, and creatine kinase-MB was collected if elevation in creatine kinase was detected. Modified Rankin scores (MRS) are documented at baseline, discharge, 30 days, 6 months, and 1 year, as well as at 1 and 3 months following any stroke events.
Study endpoints
There were 2 primary safety endpoints: the rate of all-cause mortality and the rate of any stroke at 30 days. The primary clinical performance endpoints were the device success rate, as defined by the VARC-2 (Valve Academic Research Consortium-2) (23), at 24 h to 7 days and the percent of patients with no more than mild aortic regurgitation at the early post-procedure echocardiogram (24 h through 7 days).
The secondary safety endpoints were: 1) the rates of the VARC-2 composite early safety endpoint, which includes death, all stroke (disabling and nondisabling), life-threatening bleeding, acute kidney injury at stage 2 or 3 (including renal replacement therapy), coronary artery obstruction requiring intervention, major vascular complication, and valve-related dysfunction requiring repeat procedure (BAV, TAVR, or SAVR); and 2) the individual components at 30 days. Secondary clinical performance endpoints included the rate of successful recapture (if tried) and valve function by Doppler echocardiography at 30 days.
Statistical methods
The analysis cohort for this report comprised all 60 patients implanted with the Evolut R transcatheter aortic valve (TAV). Baseline categorical variables are presented as percents and continuous variables as mean ± SD. Event rates are reported as Kaplan-Meier estimates.
The clinical performance endpoints of device success and the percent of patients with no more than mild aortic regurgitation were summarized with 2-sided 95% exact binomial confidence intervals. The comparisons for valve hemodynamic data (mean AV gradient and AV area) between baseline and early post-procedure were conducted using the paired t-test. All statistical analyses were performed using Statistical Analysis Systems software, version 9.2 (SAS Institute, Cary, North Carolina).
A total of 60 patients (66.7% female; mean age 82.8 ± 6.1 years) underwent TAVR with the CoreValve Evolut R system at 6 centers in the United Kingdom, Australia, and New Zealand between October 2013 and July 2014 (Online Appendix A). The study cohort included each implanter's first experience with the Evolut R System. The overall study compliance for the 30-day follow-up visit was 98.3% (Figure 2).
The mean STS score and logistic EuroSCORE were 7.0 ± 3.7% and 20.5 ± 12.5%, respectively. The most prevalent STS factors at baseline were chronic lung disease in 26 (43.3%), atrial fibrillation or flutter in 22 (36.7%), and prior coronary artery bypass grafting in 17 (28.3%) patients. At baseline, 68.3% of patients had NYHA functional class III or IV symptoms, with 41 patients (68.3%) considered to be frail (Table 1).
Procedural outcomes
The majority of cases were performed under general anesthesia (63.3%), with transfemoral being the predominant TAVR access route (98.3%) (Table 2). The EnVeo DCS was advanced sheathless using the InLine sheath in the majority of cases without difficulty. Pre-dilation of the native AV was performed in 96.7% of cases, and a 20-mm balloon was used in 60.3% of cases. The Evolut R TAVR system was advanced to the native AV annulus in all patients without difficulty.
The 29-mm valve was implanted in 68.3% of patients, and post-implant dilation was performed in 21.7% of cases. Valve repositioning was successfully performed 22 times in 15 patients by either resheathing or recapturing to optimize valve position (Table 2). There were no instances in which the valve needed to be completely retrieved, and there was no valve-related dysfunction requiring a repeat procedure. One patient required a second Evolut R valve implantation due to the first valve being deployed supra-annularly, causing marginal aortic migration of the valve upon full release and resulting in severe PVL. This patient was discharged without complication, with a 30-day echocardiogram showing mild PVL.
Clinical outcomes
There was no death or stroke observed up to 30 days (Table 3). Symptom relief post-TAVR was observed, with 76.3% of patients improving by at least 1 NYHA functional class and 39.0% improving by at least 2 NYHA functional classes from baseline to 30 days. No patient had coronary occlusion, annulus rupture, or ventricular perforation during TAVR.
Major vascular complication was observed in 5 patients (8.3%). Two patients required access intervention following TAVR: 1 patient experienced a dissection of the right common femoral artery, treated successfully with angioplasty with no further sequelae, and the other had a failed percutaneous closure device leading to bleeding and hematoma, treated with blood products and left femoral artery stenting. Access groin hematoma was noted in the other 3 patients, with 2 requiring blood products.
Life-threatening or disabling bleeding was observed in 3 patients, occurring at the access site, permanent pacemaker site, or induced by the endotracheal tube.
At 30 days, a new permanent pacemaker implantation was required in 11.7% of patients. Six patients had third-degree atrioventricular block, and 1 had second-degree atrioventricular block post-procedure. All permanent pacemaker implants occurred between 1 and 5 days post-TAVR. Pre-procedure ECG abnormalities were present in 4 patients: 2 had first-degree atrioventricular block, 1 had right bundle branch block (RBBB), and 1 had both RBBB and first-degree atrioventricular block. When the depth of implant was reviewed, the average depth for those who received a pacemaker (left coronary cusp [LCS] 9.4 ± 3.1 mm; noncoronary cusp [NCS] 8.1 ± 3.5 mm) was significantly deeper than that of patients who did not receive a new pacemaker (LCS 4.3 ± 2.5 mm; NCS 3.3 ± 2.5 mm; p < 0.0001 for both comparisons).
The VARC-2 overall device success rate was 78.6% post-procedure (Table 4). In 5 patients, the effective orifice area (EOA) could not be determined to calculate the patient-prosthesis mismatch (PPM).
Echocardiographic outcomes
The Evolut R TAV effectively reduced the mean AV gradient from 49.1 ± 13.0 mm Hg at baseline to 9.2 ± 3.9 mm Hg early post-procedure (p < 0.0001). The AV area was also significantly improved from 0.6 ± 0.2 cm2 at baseline to 1.9 ± 0.5 cm2 early post-procedure (p < 0.0001). Figure 3 shows valve hemodynamics through 30 days. Mild or less PVL occurred post-TAVR in 96.6% of patients; 2 patients had moderate and none had severe PVL at 30 days (Figure 4).
This prospective, multicenter, first-in-man study has demonstrated that the resheathable Medtronic CoreValve Evolut R TAVR system is safe, with good clinical performance at treating high-risk symptomatic patients with severe aortic stenosis. No death or stroke were observed up to 30 days, and the overall VARC-2–defined device success rate at 24 h to 7 days post-procedure was 78.6%, with 93.2% of patients having mild or less PVL. The PVL improved at 30 days, with 96.6% having mild or less, 3.4% having moderate, and none having severe PVL.
Although study design, patient selection, and TAVR experience may differ, the 30-day mortality and stroke rates observed in this study compare favorably to those reported in other studies using first-generation (10,11,24,25) or next-generation (26–29) devices. Despite patients in this study having an STS score of 7.0 ± 3.7%, the absence of primary clinical events at 30 days may in part be due to the use of MSCT (for sizing and assessment of coronary ostia), careful adherence to best practices learned from global use of the Medtronic CoreValve device, appropriate patient selection, the self-expanding nature of the TAVR system, and the resheathable feature of the Evolut R system.
Stroke, coronary occlusion, annular rupture, and LV perforation during TAVR significantly affects patient outcomes post-TAVR. The low stroke rate observed in this study is consistent with that reported (0% to 4%) from other studies (26–29). Female sex, use of the balloon-expandable TAVR system, previous bioprosthetic AV, and low-lying coronary ostia are risk factors for coronary occlusion (30). Severe annular calcification, the use of a balloon-expandable TAVR system, and aggressive post-dilation are associated with annular rupture (31,32). None of these complications were observed in this study.
Device success, as intended by VARC-2, requires a composite of: 1) absence of procedural mortality; 2) correct position of a single prosthetic valve; and 3) intended performance of the prosthetic valve (no PPM mean valve gradient <20 mm Hg or peak velocity <3 m/s, and no moderate or severe prosthetic regurgitation). Failure to meet any 1 of these 3 parameters will categorize the device a failure. The device success rate for this study was lower than expected (Table 4) and was driven predominantly by the presence of calculated PPM in 9 patients. The challenges with calculating PPM are recognized, especially when transthoracic rather than transesophageal echocardiography is used to measure LV outflow tract diameter. Furthermore, these data were not available in 5 patients, further affecting the device success rate. Importantly, the mean EOA at 24 h to 7 days and at 30 days was good (1.9 ± 0.5 cm2), with low mean gradients of 9.2 ± 3.9 mm Hg and 8.1 ± 3.3 mm Hg, respectively.
Repositionability and safety
Repositioning with the Evolut R was performed 22 times in 15 patients safely and without difficulty to optimize final valve implant position. Repositioning in these 15 patients enabled an average final implant depth of 5.9 ± 3.4 mm for NCS and 6.3 ± 4.1 mm for LCS. The ability to resheath and reposition in turn contributed to the overall good clinical outcomes, with no death or stroke, low to moderate PVL rates, and low permanent pacing rates observed in this study.
The novel distal portion of the capsule (containing the crimped valve [Figure 1B]) expands to facilitate valve resheathing and recapturing of a partially released Evolut R valve, which reduces friction and mechanical stress encountered during repositioning, thereby reducing agitation of friable native valve tissue and potentially contributing to the absence of clinical stroke observed.
Permanent pacemaker implantation
The rate of permanent pacemaker implantation was 11.7% in our study. The rate of permanent pacemaker implantation post-TAVR with the CoreValve device ranges between 11% and 40% (33,34) and for the Edwards SAPIEN between 3% and 8% (35). More recently, the multicenter ADVANCE II (CoreValve Prospective International Post-Market Advance II Study) study, investigating the effect of best practice on rhythm disturbances with the CoreValve device, reported pacing rates of 13.3% (36). Similar low rates of pacing were also observed with other new TAVR devices (27–29); however, the Lotus system reported a pacing rate of 28.6% (26). Although the cause is multifactorial, pre-existing RBBB (37), final device depth, and oversizing are suggested triggers.
The lower pacing rate in this study could be attributed to: 1) the redesigned delivery system (with resheath and recapture capability) enabling more accurate positioning; and 2) the modified, more conformable nitinol frame design resulting in a more uniform outward force and reduced stiffness at the inflow portion of the valve, thus potentially reducing trauma to the conduction system as compared with the CoreValve system. Of the 7 patients who received a permanent pacemaker through 30 days, 4 had pre-existing conduction abnormalities and all had significantly lower final deployment depth as compared with the study average.
Paravalvular leak
Moderate to severe PVL post-TAVR is associated with a poor prognosis (38,39). Potential causes include suboptimal positioning, undersizing, and eccentric calcification. A more conformable frame, MSCT-based sizing, and repositionability may mitigate some of these challenges, as observed in this study. The observed rates for PVL mild or less (96.6%) and moderate (3.4%) with the Evolut R compare favorably to the CoreValve (mild or less: 91%; moderate to severe: 9%) (11), and appear similar to SAPIEN S3 (mild or less: 96.6%; moderate: 3.4%) at 30 days (29).
Hemodynamic performance
Aortic valve pressure gradient and valve area were significantly improved following Evolut R TAV implantation (Figure 3). Absence of PPM at the early post-implant echocardiogram (in 55 evaluable patients) was 83.6%. Despite the challenges and inconsistency with deriving these data, they appear to be better than that reported in the Reprise II (60.7%) (26) or the PARTNER (40% to 56%) (40) studies. This may, in part, be due to the supra-annular function of the Evolut R valve. Furthermore, the mean gradient and EOA at 30 days for the Evolut R were equivalent to those reported for the CoreValve bioprosthesis in the CoreValve US Extreme Risk (8.7 ± 4.2 mm Hg and 1.86 ± 0.56 cm2) (25) and High Risk (8.9 ± 3.9 mm Hg and 1.95 ± 0.56 cm2) (11) studies.
Vascular complications
The rates of major vascular complications (MVC) (8.3%) and life-threatening bleeding events (5.0%) are consistent with rates reported for the CoreValve system. The CoreValve Extreme Risk (25) and High Risk (11) studies reported MVC rates of 8.2% and 5.9%, respectively, and life-threatening bleeding events of 12.7% and 13.6%, respectively. Patients with MVC in our study had a slightly higher body mass index when compared with those who did not (28.2 ± 5.0 kg/m2 vs. 26.8 ± 4.8 kg/m2; p = 0.53), which may have contributed to the access-related events.
Study limitations
This was a first-in-man study of the use of the Evolut R TAV in patients at high or prohibitive risk of SAVR. The study size was relatively small, with a short (30-day) follow-up. Longer-term follow-up to 2 years is planned. Although all patients had MRS assessments pre- and post-TAVR, formal neurological assessments were not performed unless a change in MRS was observed. The absence of clinical neurological events may also be in part due to the small study numbers. Larger studies are required to further evaluate clinical outcomes.
This study confirms the clinical safety and performance of the next-generation Evolut R repositionable TAVR system in treating high-risk or surgically inoperable symptomatic aortic stenosis patients. Future studies will further help to validate the favorable outcomes observed in this study.
WHAT IS KNOWN? High-risk or inoperable patients with symptomatic severe aortic stenosis are increasingly treated by TAVR; however, challenges such as death, stroke, paravalvular leak, and need for permanent pacing exist.
WHAT IS NEW? TAVR with the 14-F–equivalent, repositionable Medtronic Evolut R system results in reduced event rates.
WHAT IS NEXT? Larger studies are required to evaluate and confirm the findings of this small pivotal study.
The authors would like to thank Jane Moore, MS, ELS, an employee of the sponsor who, under the direction of the authors, drafted the methods and results sections and prepared all tables and figures to meet journal requirements. The authors would also like to thank the clinical study management team of Charles Boldt, MS, and Kelly Hendrickson, MS.
This study was supported by Medtronic, Inc. Dr. Manoharan has received consultant fees and honoraria from Medtronic, St. Jude Medical, and Boston Scientific. Dr. Walton serves as a proctor and advisory board member for Medtronic. Dr. Brecker has received consultant fees from Medtronic and Boston Scientific. Dr. Pasupati serves as a consultant and a proctor for Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr. Blackman has received consultant fees and honoraria from Boston Scientific and Medtronic. Dr. Qiao is an employee and shareholder of Medtronic, Inc. Dr. Meredith has received consultant fees and honoraria from Boston Scientific and Medtronic; and has received proctor fees from Boston Scientific.
- Abbreviations and Acronyms
- balloon aortic valvuloplasty
- delivery catheter system
- left ventricle
- Modified Rankin score
- multislice computer tomography
- New York Heart Association
- patient-prosthesis mismatch
- paravalvular leak
- surgical aortic valve replacement
- Society of Thoracic Surgeons
- transcatheter aortic valve
- transcatheter aortic valve replacement
- Received February 18, 2015.
- Revision received May 1, 2015.
- Accepted May 5, 2015.
- 2015 American College of Cardiology Foundation
- ↵
- Lindroos M.,
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- Heikkila J.,
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- Rosenhek R.,
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- ↵Manoharan G. Multicentre clinical study evaluating a novel resheathable self-expanding transcatheter aortic valve system. Paper presented at: Transcatheter Therapeutics; September 13, 2014; Washington, DC.
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Barclays Plc will stop offering wealth management services in about 130 countries by 2016 and cut jobs in the unit as part of an effort to rein in costs and boost profit, the Financial Times reported on Wednesday, citing the British bank.
Barclays announced plans in April to restructure its wealth business so it works more closely with retail and corporate banking divisions. Further details on the wealth strategy had been expected.
The bank appointed Peter Horrell as the wealth and investment management unit's chief executive on Monday. Horrell has held the position on an interim basis since May.
Source : Reuters


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How to Fight Terrorists Without Being Bullied By the World: Step One. Don't Be All "Jewey" About It
Step Two. Check to see if you're really not Jewish. Are you sure you're not even a teensy little bit Jew? Just a schmear of Jew in you? See Step One.
The jets bombed the bejeebers out of them. The ground forces invaded. They at long last suppressed the terrorists, who had conducted a long campaign of suicide bombing and planting bombs, and put an end to any notion that the terrorists and their sponsors would be granted their own state.
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2008 has been a memorable, quotable year in games –and these are the top 10 fellows in the media spotlight (in no particular order, since, hey – they're all heavy-hitters and you can decide the order in our IGN forums). These are the biggest faces in the industry – constantly in front of a microphone, under the glare of the lights and the flash of the camera bulb, selling the games to you, to your parents and to the media itself.
Cliff Bleszinski
Company: Epic Games
What He Worked On in 2008: Gears of War 2
'CliffyB' is no more – the media chewed him up and spat him back out like a piece of shrunken, grey, flavourless chewing gum. Cliff Bleszinski is reborn the game developer he once was. He still draws a crowd; mostly because he has a smirk and a diamond earing. He's also grandiose and sellable and has something missing from the gaming industry – sex appeal. But he's also a bright guy – reiterated through his no-nonsense (well, a little nonsense) approach to talking shop. Hype for Gears 2, which is in the can now, was ramped up by his initial quote 'Bigger, better, more badass', which set the tone for the rest of his media campaign.
His status is reinforced by the impact of things like his on-camera greetings and forewords for new Gears 2 footage, as well as his genuine passion for all things gaming – and for his fans.
Memorable 2008 Quote:
"You tell people what you do for a living and they're like, 'Oh, you play video games for a living.' No, I play a game that's not as fun as it should be, that's broken, until it's no longer broken. Then I give it to other people to have fun with."Fun Fact: Clifford doesn't make games, he makes dreams.
Shigeru Miyamoto
Company: Nintendo Co. Japan
What He Worked On in 2008: Wii Music / Wii Fit / Mario Kart Wii
Everybody's favourite Japanese dude (outside of Masaki 'Hard Gay' Sumitani, perhaps) has been in the spotlight on and off this year, promoting his own bittersweet brand of offbeat gaming experiences. Being the figurehead for gaming innovation is never easy – expectations clearly weigh on his shoulders at all times and fans are as eager to play his work as they are critical of his ultra-light mainstream releases, which are becoming more and more frequent.
Still, Miyamoto still manages to sell us on his passion for creativity and accessibility time and time again. Whether or not you agree with his idea of where gaming should head, expect to see Miyamoto-san back in this list in 2009.
Memorable 2008 Quote:
"My attitude is that obviously for 30 years now I've been making games and for the vast majority of time I've been making the type of games that the loyal Nintendo fans enjoy.Fun Fact: Secretly, Shigeru is growing and training a clone of himself to increase the output of core games necessary to sate the demands of ravenous Nintendo Fanboys.
Those are the types of games that my career is based on and we're going to continue to make those types of games. In fact, we have many of those types of games in development right now."
Denis Dyack
Company: Silicon Knights
What He Worked On in 2008: Too Human
We could retitle this entry 'The People vs. Denis Dyack' – but that'd be cruel and unusual. In reality, Dyack had a year of ups and downs; on the upshot, he finally sent Too Human to market, a full nine years after being originally unveiled. 'Grats! On the downside, Dyack spent far too long listening to the shrill whine of venomous forum users and it finally broke the poor guy, sending him into a defensive tailspin that saw him making ridiculous 'them-or-us' statements and opening himself up to a tidal wave of abuse.
A lesson learned, then: even if you win an argument about games on the internet, you still lose – because you're arguing about games on the internet.
Memorable 2008 Quote:
"I feel Too Human is a great game, likely to be better than most that will come out this year. I certainly feel it is the best game we have ever made. I also believe the press and gamers alike will believe this. This puts me in the "For" camp.Fun Fact: He just wants to fit in and be loved.
I know there are many who feel strongly in opposite camp. I also would ask you to stand up and say "Against"."
Mark Rein
Company: Epic Games
What He Worked On in 2008: Unreal Tournament 3
Mark Rein is a powerful figure in the eyes of PC gamers; he, arguably alongside Gabe Newell – who almost made our list – is at the fore of new gaming technologies in the industry and his comments about the future direction of Epic Games and the industry in general have profound and lasting implications. This year, Rein vehemently defended the Xbox 360 platform for their developments, citing cost issues and profit margins as being core factors behind the PC as a secondary market.
Rein has also recently been in the spotlight for denying rumours of the acquisition of Epic Games by Legendary Pictures – the company producing the Gears of War movie. This comes off the back of rumours that both EA and Microsoft made advances on the company.
Memorable 2008 Quote:
"You are able to buy a PC that's as powerful as the Xbox 360 long before the 360 generation is finished. So people, calm down. If we give conflicting views and say things that are negative, it's because we care about it and we want it to be strong, and we're going to work to make it strong.Fun Fact: Mark divides his time between overseeing core engine development and fighting for his right to dance in a small town that has outlawed rock music.
Relax, take a breath... PC gaming will be fine."
No. Sorry, that was the plot for Footloose.
Peter Molyneux
Company: Lionhead
What He Worked On in 2008: Fable II
Peter Molyneux, captain of industry and champion of the sciences, finally released Fable II this year to wide praise. But the road to release was paved with incredible media exposure – talk of AI dogs, deaths in the virtual family, orphaned kids, evildoers and the potential for absolute moral complexity within Fable II's Dickensian setting. But the beauty of Molyneux's media exposure certainly rests with his amazing claims that your dog would revolutionise Fable 2's interface. Full stop.
It didn't, of course – that was just grand hyperbole. But his excitement for the game was tangible and delicious –audiences responded and the game has since sold its tits off. Speaking of tits, here's the perfect quote to segue into, summing up Molyneux's offbeat public persona in 2008:
Memorable 2008 Quote:
[On Fable II's sex] "It's you Americans. There's something about nipples you hate. If this were Germany, we'd be romping around naked on the stage here."Fun Fact: Molyneux was once held hostage by a tribe of Zulu warriors and was forced to dig his way to freedom using the disc from an unsold copy of Black & White 2.


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Tutorials for creative minds
TrappCG is the New revision of Traptcg.com. The tutorials on TrappCG will be complete projects. This direction is to teach not only the tools of each software, but also to develop the skills and Imagination to create your own projects. Each project will be broken down into multiple videos.
Programs covered: Autodesk 3D Studio Max, Blender, Adobe Photoshop, Adobe Illustrator, Adobe After Effects
Recent Resources posts
Vector Drawing
Introduction To Adobe Illustrator
Download 6 Part Tutorial Series:
Part 1:Introduction to Adobe Illustrator
This tutorial will cover:
• Introduction to starting a new Adobe Illustrator file for vector drawing.
• Introduction to Adobe Illustrators Interface and customizing the layout for any project.
• Importing an image into Adobe Illustrator and setting it up as a reference layer.
• Work with the Vector Pen tool to draw parts of the reference image
• Use Vector Pen tool to draw vector lips.
• Use Vector shapes to draw the right vector eyeball.
• Work with sold colors and Gradient colors.
Part 2: Vector Drawing and brushes
This tutorial will cover:
• Learn to copy and past vector objects
• Vector draw the left eyeball
• Work with brushes to vector draw the eye lashes
• Create a custom brush in Adobe Illustrator
• Change settings on brushes
Part 3: Create Custome Brushes
This tutorial will cover:
• Create vector hair using custom made vector brushes.
• Learn to use masks in Adobe Illustrator.
Part 4: Highlights and shadows for shape
This tutorial will cover:
• Vector draw the highlights and shadows to form the shape of the face.
• Use masks in Illustrator to control the highlights and shadows.
Part 5: Create a painted look
This tutorial will cover:
• Use Effects to add blur to create a softer painted vector look for your vector art.
• Use masks in Illustrator to control hard edges of the blur effect.
• Add more shadows and highlights to bring more detail to the face.
Part 6: Create a Magazine Cover
This tutorial will cover:
• Create a new Adobe Illustrator document with two Art Boards.
• Learn what Art Boards are in Adobe Illustrator.
• Create two different magazine covers featuring the vector drawing you created.
• Work with the Type tool in Adobe illustrator.
• Learn how to Conform type to a shape using the Area Type Tool.
• Learn how to type along a Path using Type on a Path Tool.
• Learn how to Create a type box.
• Convert type to an editable vector shapes using create outlines option.
• Learn how to use Twirl and other vector distortion brushes.
• Learn how to change settings on the distortion brushes, like brush size, strength, direction and more.
• Use Adobe Illustrator spell check.
• Learn how to save as a PDF doc to send to clients.
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January 1, 2030
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Geeks! Hey… over here! Yeah, we have a podcast thing we want you to listen to. This week we are talking about the creator of email, the death of a video app, zombies, Neil Gaiman, and the exploration of game worlds.
Cool, eh? Yeah, we think so too, so what are you waiting for… hit play!
And don't forget to leave us a review on iTunes or Stitcher!
Thanks, you're our favorite listener!
Ray Tomlinson – RIP – Dead at 74 (Inventor of email)
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With both of our boys (Ethan now 4 and Logan now 2), we were lucky in that going to bed and sleep was never a constant battle but, I can remember during the tougher phases feeling a bit like I was going to break at times due to the lack of sleep. There was a time when we found ourselves in a phase of sharing our bed every night. And there was a time when we had to pick our youngest son up from his grandparents because he'd woke up at 2 o'clock in the morning and just outright refused to accept that he needed to go back to sleep. There were also times when I would feel consumed with Mum-guilt because my baby would wake up at night crying and we'd struggle to settle him back off to sleep.
But then I expect that at some point that's pretty much the same sort of story for all parents of babies. I just feel very thankful that it didn't take us too long to be able to establish good routines and find an approach that meant the sleepless nights weren't too much of a long term thing.
The first thing we made sure was that we were consistent and that we set a bedtime routine. The importance of routine was proven to us when our first son was quite young and we didn't quite realise how much a change to his normal routine would affect him whilst we were on holiday. Whilst away we let him stay up a bit later and also come into our bed with us. Naively we thought he'd be fine going back into his own bed when we were home again. But of course, he wasn't and what followed was quite a hard bedtime battle phase. So ever since then we've tried to keep to a good routine when it comes to going to bed;
When it came to getting our boys to settle in their beds after they'd moved into the own rooms we found a starlight mobile to be a bit of a lifesaver. It plays calming music and also has lights that shine a relaxing light show. It automatically shuts off after 20 minutes or so which we found brilliant because it meant that we didn't have to keep going into their rooms like we would have had to with a wind-up cot mobile.
My boys also have a teddy each that they've had from birth which they find so much comfort in and sleep with every night. They both slept with dummies and Ethan gave his up at 3 (Logan still has his). And we used sleeping/grow bags with them both too for bedtime. I really like the sleeping bags because they are so much safer than loose covers are and also pretty good for when they are a bit older and can stand up it's far harder for them to attempt to climb out of their cot with them on.
I believe that trying controlled crying is only recommended for babies who are a bit older. I personally wouldn't have used it when my little ones were really little, but when it came to settling Ethan into his own room and teaching him that bedtime meant bedtime, controlled crying really worked for us.
I know that people have different opinions on controlled crying, but for it was about teaching our boys that we have to go to bed at night. The way that I look at it is that it's a bit like taking them to school I guess - we wouldn't take either of our boys out of school just because they cried. We'd comfort them, reassure them and then come back at the end of the day. I think when it comes to bedtime routines and babies, there's probably no wrong way or right way to approach it other than finding something that works for everyone. Babies need to sleep but equally, parents also need their rest and their sleep to be able to give their children their best the next day.
I'm definitely not a baby sleep expert, but this is just what worked for us. We still have the odd night of the boys waking up or not wanting to go to bed. But on the whole it's not too bad, the only thing that we're really dealing with at the moment is the 6 am wake up calls! I hope this has been helpful, I'd love to hear your top tips for settling your baby/getting them to sleep through if you have any.
Alex is the founder of the popular family lifestyle blog, Bump to Baby.The blog covers motherhood, family travels and adventures and Alex's passion for home interiors.


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"…and it's a long December and there's reason to believe maybe this year will be better than the last." – Counting Crows
During this time, Pam has had to deal with moving for the 5th time in as many years and 2 more moves to look forward to over the next year. She has had to deal with her own personal version of "
During this same time, aside from the normal trials and tribulations of military duty, I have traveled through 14 countries on 3 continents, trained in the snow, endured the stifling desert heat, experienced thunderstorms of biblical proportions, and witnessed brutal and indiscriminate devastation wrought by both man and nature.
And yet, there have been moments of spontaneous joy along with heartfelt outpourings of love and kindness, the nature of which can only be born out of tribulation. Coinciding with the heart-rending tragedy that continues to permeate this region of the world where so much of my past year has been spent, were extraordinary moments of compassion and kindness; spontaneous and heartfelt demonstrations of caring and generosity and overwhelming occasions of camaraderie and sharing.
How then do we weigh these blessings against the magnitude of heartache, loneliness, and sorrow of being separated from family, or can we? I think now, that even though they all must be taken as pieces that create the whole, one cannot be weighed against the other. They are of different genres and should not even be competing on the same field for my emotions. While we have to accept all the challenges that life brings us, they are only things to be endured, things which add contrast and texture to the moments we cherish in life.
As the end of this year approaches, I find myself separated from my wife and family by half a world. While all the reasons that I find myself desert purgatory are just as valid as they ever were, there are days when I just don't care, days when I just miss my wife and when I yearn for home. During these times, Pam and I will commiserate with each other through our hardships. We will put aside all the noble and honorable reasons for our tribulations and allow ourselves a short time of self-pity because duty and honor aside, being apart from your loved ones through this time of giving and sharing just plain sucks.
Tomorrow though, the world will seem just a little brighter as we wake up one day closer to being together again. Our contributions and sacrifices will mean just a little bit more as this fledgling bastion of freedom progresses that much further through its infancy and we will see if we can find just a little more strength and perseverance from some untapped reserve to help push us through the final stretch. So while it has been both a long year and a long December, with the end of our mission right around the corner, there is reason to believe that maybe this year will be better than the last.


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Sunday, June 25, 2017 10am
James Cassara, Guest Speaker
A continuation of a talk presented last year, artist and arts educator James Cassara will explore the intersection between creativity and the "real world", looking at ways in which we can sustain and nurture the creative spark in a world that often seems far too busy and chaotic. This will be an interactive experiment; a pair of canvases will be set up during the service, with open invitations to come down and add your own individual ideas to what James has begun. For some it may be the first time in years they've applied paints-which will be provided-to a surface beyond the walls of their house. Plans for the completed works are still be to determined but they will find a home that appreciates and supports them. Come ready to be gently nudged out of your safety zone! Click on title to continue.
Service: Sustaining the Creative Spark (audio only)
Sunday, June 25, 2017 10am


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Have you heard that coconut oil is bad for you? Have you been avoiding all saturated fats thinking that they are evil and will raise your cholesterol?
I felt the same way for a long time, but lately research has been coming out saying somewhat the opposite. Some saturated fats actually have beneficial health properties that can INCREASE your high density lipoproteins (HDL); or the GOOD fat.
Here is a great article from ACE on this very subject:
Have you tried coconut oil? What are your favorite ways to use it?


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JBL LE15A, complete 8 ohm recone kit.
Now you can recone your JBL LE15A woofer yourself and save.
This recone kit comes with everything you need to recone your
JBL LE15A, cone with foam surround, spider, edge wound
aluminum voice coil, dust cap, gaskets, lead wires, centering shims, glue and instructions.
The voice coil, spider, cone and lead wires come pre-glued and attached to make
installation very simple.
Speaker reconing is not rocket science. The hardest part about reconing speakers is
centering and setting the voice coil to the proper depth. We have set the depth for you and
your kit comes with centering shims to align the coil perfectly every time.
30Hz - 2.5kHz
The voice coil has the correct polarity, the same as the original LE15A kit. When positive voltage is given to the negative terminal, the cone will move out in a forward motion.
Item Code:: JBL-LE15A-Recone-Kit
Not yet rated
Click here to write a review and share your thoughts with others.
Volume price discounts are only available for orders placed on this website.


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Doha bank qsc SWIFT Code
How to find Doha bank qsc SWIFT Code?
You can easily find Doha Bank Qsc SWIFT Code. Doha Bank Qsc has branches in various states of India. You can see above list of states of India where this bank is present. Select anyone of them and you can see the list of districts of that particular state where the branch of this bank is present. Then it will show you list of all cities of that district where the branch is present. Select the branch of the Doha Bank Qsc to find its IFSC Code, Contact No, Doha Bank Qsc MICR Code, Doha Bank Qsc SWIFT Code, Doha Bank Qsc BIC Code. Doha Bank Qsc has branches in more than 1 states in India. You can find SWIFT codes of all the branches of Doha Bank Qsc here. Doha Bank Qsc has in total 1 branches in India.
Doha bank qsc SWIFT Code
You can select any of the above state and find the SWIFT Code of your branch. Doha Bank Qsc SWIFT Code is used for various purpose like National Electronics Fund Transfer (NEFT) Transaction, Immediate Payment Service (IMPS) Transaction, Real Time Gross Settlement (RTGS) Transaction. Doha Bank Qsc SWIFT Code contains 11 characters.


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Miesha Tate didn't head to New York intent on retiring at UFC 205, but it didn't take long for her to decide her heart simply wasn't in fighting any longer.
"I just knew after like the first exchange that I just didn't want to do it anymore," Tate told MMAjunkie. "So it was just kind of one of those things that just like stuck it out, but I knew I had a lot more to give, and I just didn't give it.
"I don't know. It's just one of those things. It's kind of odd, to be honest. But yeah, just lacking a little bit of the competitive edge to want to punch people in the face."
Tate, who was already scheduled to be a guest fighter at this week's UFC Fight Night 101 event in Australia prior to her abrupt retirement, faced rising contender Raquel Pennington at UFC 205, which took place earlier this month at Madison Square Garden.
It was Tate's first fight since losing her title to Amanda Nunes at UFC 200, and the former champ hoped it would help propel her back to another crack at the belt. Unfortunately, once in the cage, Tate said she simply felt she didn't have what it takes to compete at the sport's highest level.
"I went in there, but I just couldn't pull out of myself what I needed to really make the fight winnable," Tate said.
Tate announced her retirement in the cage following the announcement of a decision loss to Pennington. But two weeks later, she prefers to use a different term in discussing her decision.
"I prefer the term 'transition' – just transition into, like, more promoting events," Tate said. "I'm still going to be involved. Actually, you might see more of me now."


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Columbus, GA - The Lady Lions fall in second round of the tourament againt Mars Hill 0-3 at the Hughston Clinic Invitational this afternoon, hosted by Columbus State. This round seemed to be a little harder from the first match againt Armstrong State losing in straight three sits. Even though the Lady Lions lost 0-3 they never gave up fighting through every point. The Lady Lions fell in the first set 11-25, the second 14-25, and played a harder third set only losing 19-25.
Senior Erica Burnham lead the Lady Lions with 6 kills, 2 assists, and 11 digs. While Senoir Brittany Scarbrough leading the way with 16 assists, 2 kills, and 3 digs, also Junior Abby Bradford lead right behind Kodie Patterson with 10 digs and 3 kills. Another Freshman on the team Bethany Winston had the best hitting percentage at .300 with 3 kills and 3 digs.
The Lady Lions have fallen 0-2 in the tournament and will face Columbus State at 4:30 p.m. this evneing to rap up the tournament. Emmanuel falls to 0-2 for the season.
For more EC lions news, please visit: www.goeclions.com


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According to reports released by phone designer, users can turn their attention to pictures of a prototype Nokia smartwatch. The graphic artist has worked to reproduce a revelation that depicts a glance screen style UI. This demeanor is expected to be responsible for saving battery life. Nokia's collaboration with Microsoft suggests that the company plans to take significant strides for marking their presence with wearable technology. Continue reading
Samsung Video ads illustrates the Galaxy Gear smartwatch as an astounding revelation
Just previously, Samsung announced the Galaxy Gear smartwatch which initiating the developing concept of wearable technology. This innovation provides a brief overview of whether wearable technology can flourish the improvement towards technological advancements.
The revelation can be simply connected to the respective Galaxy smartphone. This can be done by pairing it with Bluetooth and it progresses in providing absolute functionality of an Android device without even having to touch your handset.
Bringing the innovation to the market, Samsung has taken an alternative approach towards marketing the product. Samsung has managed to conceptualize this revelation as it was seen in one's mind in the past.
Apple's rumoured iWatch to be announced in second half of 2014, will be available for $149-$229 [Rumors]
According to a report which has been released out by the Taiwanese trade publication DigiTimes, it is regarded that the iWatch will be officially announced in a year's time from now. Over the year previously there have been several reports citing the arrival of this wearable gadget and now presently we have lowdowns that highlight that the new innovation will be unveiled in the second half of 2014.
Based on current itemizations, it is reported that the iWatch wwill be priced between $149 and $229 and ODM Inventec, the Taiwan-based contract manufacturer will be bestowed with sixty percent of iWatch orders. This is the estimation released by an CIMB Group. Additionally, this growth is expected to drive about nineteen percent of Inventec's profits in 2014. Continue reading


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Antibiotic Use in Farm Animals
Antibiotic use in farm animals has been a common practice since the 1940s. While there has been a decrease in the use of antibiotics for humans, little is being done to reduce the practice in animals, raising concerns of antibiotic resistance. In fact, the Interagency Task Force on Antimicrobial Resistance found that the extensive use of antimicrobial drugs has resulted in an epidemic of antibiotic resistance.
Approximately 80% of antibiotics are used in meat and poultry, used to promote growth or prevent disease. Humans who are exposed to antibiotic treated meat and poultry are at risk for two concerning reasons:
- Potential presence of superbugs in meat and poultry
- Migration of superbugs in the environment where they can cause genetic immunity to antibiotics to other bacteria that can make people sick.
The threat to public health is so great that agencies such as American Medical Association (AMA) and World Health Organization (WHO) called for a significant reduction in the use of antibiotics for animal food production. Experts have concluded that there is a connection between antibiotic use in animals and the loss of effectiveness of these drugs in human medicine. The most dramatic of which came as a result of FDA approval of fluoroquinolones–a class of antibiotics that includes Cipro (ciprofloxacin), which has been used in poultry production since 1995. By 1999 nearly 20% of chicken breasts sampled contained ciprofloxacin-resistant bacteria Camplobacter (C. coli). After a lengthy fight in the courts, the FDA banned use of the drug in 2005, at which point nearly 30% of C. coli found in chicken breasts were ciprofloxacin resistant; by 2010, resistance to ciprofloxacin had declined to 13.5%
Although the use of fluoroquinolones (Baytril, enrofloxacin) have been banned in the United States, it is common practice overseas.
The Quinolone Vigilance Foundation urges consumers to inquire about antibiotics in meat and poultry that they purchase.
Related Links:
- Food Safety News: USDA Looking at Antibiotics Claims on Meat Labels
- PBS Frontline: The Trouble With Antibiotics (free online video documentary)
- USDA Department Of Economic Impact: Restrictions on Antibiotic Use for Production Purposes in U.S. Livestock Industries Likely To Have Small Effects on Prices and Quantities
- USDA Agricultural Marketing Service: Certified Responsible Antibiotic Use
- USDA Economic Research Service: Economics of Antibiotic Use in
U.S. Livestock Production (pdf)