text:
Retrograde Recanalization of Chronic Total Occlusions in EuropeProcedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry
Author + information
- Received January 7, 2015
- Revision received March 20, 2015
- Accepted March 20, 2015
- Published online June 9, 2015.
Author Information
- Alfredo R. Galassi, MD∗∗ (argalassi{at}gmail.com),
- Georgios Sianos, MD, PhD†,
- Gerald S. Werner, MD‡,
- Javier Escaned, MD, PhD§,
- Salvatore D. Tomasello, MD∗,
- Marouane Boukhris, MD∗,‖,
- Marine Castaing, MSc∗,
- Joachim H. Büttner, MD¶,
- Alexander Bufe, MD#,
- Artis Kalnins, MD∗∗,
- James C. Spratt, MD††,
- Roberto Garbo, MD‡‡,
- David Hildick-Smith, MD§§,
- Simon Elhadad, MD‖‖,
- Andrea Gagnor, MD¶¶,
- Bernward Lauer, MD‖,##,
- Leszek Bryniarski, MD, PhD∗∗∗,
- Evald H. Christiansen, MD, PhD†††,
- Leif Thuesen, MD, DMSc†††,
- Markus Meyer-Geßner, MD‡‡‡,
- Omer Goktekin, MD§§§,
- Mauro Carlino, MD‖,‖‖‖,
- Yves Louvard, MD¶¶¶,
- Thierry Lefèvre, MD¶¶¶,
- Aigars Lismanis, MD###,
- Valery L. Gelev, MD∗∗∗∗,
- Antonio Serra, MD, PhD††††,
- Francesco Marzà, MD∗,
- Carlo Di Mario, MD‡‡‡‡,
- Nicolaus Reifart, MD, PhD§§§§,
- Euro CTO Club
- ∗Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy
- †Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece
- ‡Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
- §Hospital Clinico San Carlos, Madrid, Spain
- ‖Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
- ¶Interventional Cardiology - Universitäts-Herzzentrum Freiburg – Bad Krozingen, Bad Krozingen, Germany
- #Helios Clinic Krefeld, Department of Cardiology, University Witten/Herdecke, Witten, Germany
- ∗∗Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia
- ††Department of Cardiology, Forth Valley Royal Hospital, Larbert, United Kingdom
- ‡‡Policlinico San Giovanni Bosco, Turin, Italy
- §§Department of Cardiology, Brighton and Sussex University Hospitals, Brighton, United Kingdom
- ‖‖Department of Cardiology, CH de Lagny, Lagny-sur-Marne, France
- ¶¶Department of Cardiology, Infermi Hospital, Rivoli, Italy
- ##Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
- ∗∗∗Department of Interventional Cardiology, Jagiellonian University Medical Hospital, Krakow, Poland
- †††Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- ‡‡‡Augusta-Krankenhaus Klinik Kardiologie, Dusseldorf, Germany
- §§§Faculty of Medicine, Department of Cardiology, BezmiÂlem Foundation University, Istanbul, Turkey
- ‖‖‖Invasive Cardiology Unit, San Raffaele Hospital, Milan, Italy
- ¶¶¶Institut Hospitalier Jacques Cartier, Massy, France
- ###Latvian Center of Cardiology–Pauls Stradins Clinical University Hospital, Riga, Latvia
- ∗∗∗∗Hospital N.I.Pirogov, Sofia, Bulgaria
- ††††Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- ‡‡‡‡NIHR Cardiovascular BRU Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom
- §§§§Department of Cardiology, Main Taunus Hospitals, Bad Soden University of Frankfurt, Frankfurt, Germany
- ↵∗Reprint requests and correspondence:
Prof. Alfredo R. Galassi, Cannizzaro Hospital, University of Catania, Via Antonello da Messina 75, Acicastello, Catania 95021, Italy.
Background A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).
Objectives The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs.
Methods Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.
Results The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up.
Conclusions The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
Since the first report in 1990 (1), coronary chronic total occlusion (CTO) recanalization through retrograde collateral vessels remains a technical challenge in interventional cardiology, greatly improving success rates in complex CTO lesions not amenable to antegrade techniques. Over the past 5 years, different retrograde techniques have been introduced, as well as new guidewires, microcatheters, and balloons dedicated to this approach (2–6). Japan, Europe, and the United States have published initial results (7–12), followed by larger patients cohorts (13–16).
The aim of the present study was to describe practice, procedural outcome, in-hospital events, and long-term clinical follow-up after retrograde CTO percutaneous coronary intervention (PCI) performed by a large group of dedicated interventionalists who are members of the Euro CTO Club.
Study population
The European Registry of CTOs (ERCTO) is a prospective real-world registry that includes patients treated via the retrograde or anterograde approach for 1 or more CTO lesions involving major genuine coronary arteries (>2.5 mm) or saphenous bypass conduits. Data collection was carried out at 44 centers across Europe. All patients undergoing retrograde or antegrade CTO PCI at these centers between January 2008 and December 2012 were registered prospectively. There were no exclusion criteria. Retrograde CTO PCIs were included as first-attempt procedures or as procedures after prior failed antegrade attempts in the same or other sessions. The treatment indication was symptomatic myocardial ischemia and/or evidence of reversible myocardial ischemia by perfusion imaging or stress testing. Patient follow-up was performed either by a clinical visit or by a telephone interview. At follow-up, details regarding major adverse cardiac and cerebrovascular event (MACCE) occurrence, rehospitalization for cardiovascular reasons, and symptoms were collected by physicians through the revision of clinical source documentation. The study was performed in accordance with the Declaration of Helsinki.
Definitions and study outcomes
Coronary CTOs were defined as angiographic evidence of total occlusions with TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 and estimated durations of at least 3 months. Occlusion duration was divided into 3 levels of certainty, as suggested by the EuroCTO Club consensus document (17). Patients were considered to have undergone retrograde CTO PCI if a guidewire was introduced into a collateral channel that supplied the target vessel distal to the lesion (9). A procedure was defined as an antegrade CTO PCI if no guidewire was introduced into a collateral channel, as previously defined. Procedural success was defined as angiographic success (final residual stenosis <20% by visual estimation and TIMI flow grade 3 after CTO recanalization). Clinical success was defined as a procedural success without periprocedural complications. In-hospital MACCEs were defined as the composite of non-Q-wave and Q-wave myocardial infarction (MI), recurrent angina requiring urgent repeat revascularization with PCI or coronary bypass surgery, stroke, and death. Non-Q-wave MI was defined as creatine kinase-MB enzyme elevation >3 times the upper limit of normal. When new pathological Q waves, in addition to enzyme elevation, were observed on the electrocardiogram, the event was defined as a Q-wave MI. In all patients, creatine kinase and creatine kinase-MB were evaluated 6 h after the procedure and until their normalization if levels were abnormal (18,19). The complexity of CTO lesion was assessed through J-CTO (Multicenter CTO Registry in Japan) score (0 = easy, 1 = intermediate, 2 = difficult, ≥3 = very difficult) (20). At follow-up, MACCEs were defined as the composite of cardiac death, MI, stroke, and further need for revascularization. Dyspnea and angina were assessed according to New York Heart Association and Canadian Cardiovascular Society classifications, respectively, before the indexed procedure and during follow-up.
Interventional procedures
All patients received optimal intravenous hydration the days before and after PCI. Patients received an initial bolus of intravenous unfractioned heparin (100 IU/kg). The activated clotting time was monitored every 30 min to determine if an additional bolus of unfractioned heparin was necessary to maintain an activated clotting time >250 s. Upstream use of glycoprotein IIb/IIIa inhibitor therapy or bivalirudin was avoided.
Choice of CTO revascularization strategy was left to the operator's discretion. All procedures were performed via the femoral route, with double coronary cannulation and contralateral selective injection. Seven-French guiding catheters were used in most cases. Several guidewire strategies were used, including the single-wire technique, the parallel-wires technique, the intravascular ultrasound–guided wiring technique, and retrograde wiring through collateral vessels, such as simple retrograde wiring, kissing wires, the knuckle technique, and the controlled antegrade retrograde tracking (CART) and reverse CART techniques, as previously described (9,17). Only drug-eluting stents were implanted.
Statistical analysis
Clinical characteristics, angiographic features, and in-hospital and follow-up events were reported through standard descriptive analyses for large samples assumed to follow a normal distribution. Continuous variables are presented as mean ± SD and categorical variables as frequencies and percents. The Cochran-Armitage trend test was used to compare success rates between years. Student t tests and chi-square tests (or Fisher exact tests when at least 25% of values showed expected cell frequencies <5) were used for comparison regarding procedural success, except for J-CTO score, for which the Wilcoxon test was used. We tried to identify clinical and/or angiographic prognostic factors of procedural failure through logistic regression analysis among age, sex, diabetes, ejection fraction <35%, history of MI, prior coronary artery bypass grafting (CABG), prior PCI, occlusion duration (<12 or ≥12 months [the median of the likely and certain] or undetermined), occlusion length (<20 or ≥20 mm), interventionalist experience (<50, 50 to 100, or >100 retrograde CTO PCIs), and J-CTO score. Univariate analyses were performed, and multivariate Cox proportional hazards regression modeling using purposeful selected covariates was applied to determine the independent predictors of long-term MACCE occurrence. All univariate variables with p values <0.10 were included in the model. Variables judged to be of clinical importance from previous published research were included in the multivariate model-building process despite p values >0.10. The univariate model included the following clinical and angiographic variables: age, sex, diabetes, chronic obstructive pulmonary disease, ejection fraction <35%, prior MI, prior CABG, prior PCI, CTO vessel, occlusion duration, number of previous attempts, CTO length, J-CTO score ≥3, number of implanted stents, and stent length. Regarding symptom changes, McNemar's test was used to compare angina and dyspnea status before the index procedure and during follow-up. Two-tailed p values <0.05 were considered to indicate statistically significant differences for all analyses performed. Statistical analysis was performed using SAS version 9.1 (SAS Institute, Cary, North Carolina).
Baseline clinical and lesion characteristics
During the 5-year study period at the 44 centers of the EuroCTO Club, retrograde CTO PCI was performed in 1,395 patients, corresponding to 1,582 lesions. Antegrade CTO PCI was performed in 7,205 patients, corresponding to 8,007 lesions (Figure 1). Overall, 16 centers (36.4%) contributed to the 5-year retrograde experience; 5 (11.4%) started retrograde CTO interventions only in the last year of the study (2012), while the contribution of the remaining 23 centers (52.2%) in retrograde CTO PCI ranged from 2 to 4 years of experience.
The relative number of retrograde procedures increased over time, reaching 25.1% of all CTOs treated in 2012 (Figure 2). Retrograde CTO procedure volumes of ≤50, >50 but <100, and >100 were attained by 35, 5, and 4 centers, respectively, during the study period, corresponding to 530, 303, and 562 patients enrolled. Baseline patient clinical characteristics of the retrograde CTO cohort are shown in Table 1 and baseline lesion characteristics in Table 2 according to procedural success or failure. The mean age was 62.0 ± 10.4 years, and 88.5% were men. The CTO target vessel was the right coronary artery (70.4%), circumflex coronary artery (7.8%), left anterior descending coronary artery (20.3%), and left main artery or a bypass graft (1.5%). Prior failed antegrade attempts (by non-CTO-dedicated operator) were documented in 42.5% of patients, and these did not affect the procedural success rate (p = 0.97). At the time of enrollment in ERCTO, the retrograde approach was used as a first strategy in 76.2% of cases and after prior failed antegrade attempts (during the same procedure) in 23.8% of cases. J-CTO scores were statistically higher in lesions with procedural failures (p = 0.002). The presence of heavy calcification, found in 20.2% of lesions, was significantly associated with procedural failure (p < 0.0001).
Procedural characteristics, complications, and in-hospital outcomes
Table 3 shows procedural characteristics of the retrograde cases. The retrograde strategy as the first approach was more successful than after a failed antegrade approach (82.2% vs. 53.1%; p < 0.001). In successful cases, the retrograde crossing technique was CART (13.9%), reverse CART (16%), touching wires (22%), or simple retrograde wire crossing (31.2%). In the remaining cases (17%), the operator did not describe the retrograde technique used.
The retrograde route was through septal collateral vessels in 62.7% of cases, epicardial collateral vessels in 13.4% and bypass grafts in 3.9%. In 20.0% of cases, information was not available. In successful cases, drug-eluting stents were implanted, with a mean stent length of 74.3 ± 32.8 mm. The mean procedural time was 156.3 ± 63.5 min, mean fluoroscopy time 66.7 ± 36.3 min, and mean contrast volume 379.3 ± 185.9 ml. These values were influenced by J-CTO score for all 3 parameters (p < 0.001 for all), as shown in Figure 3.
Thirteen patients (0.8%) experienced in-hospital MACCEs in the retrograde CTO cohort, compared with 0.5% of patients in the anterograde group. Table 4 reports complications and in-hospital outcomes with retrograde procedures. No differences were observed in terms of MACCEs, Q-wave MI, non-Q-wave MIs, coronary perforation, or cardiac tamponade according to the collateral route used for the retrograde approach (p = NS for all). Compared with patients who underwent the anterograde approach, those who underwent retrograde PCI experienced higher rates of complications, particularly coronary perforations and tamponade (Online Table 1).
Success rates
Overall, the procedural success rate was 75.3%. This rate has increased since 2009 (73.5%, 65.8%, 73.0%, 74.7%, and 79.2% annual success rates from 2008 to 2012, respectively). Clinical success was achieved in 1,126 lesions (71.2%). Procedural success for retrograde cases related to retrograde J-CTO score and operator experience is shown in Figure 4.
Both univariate and multivariate prognostic analyses (Table 5) demonstrated that low experience and lesion complexity (measured by J-CTO score) negatively affected the final outcome (p < 0.0001). Age (per 10-year increase) was also found to be an independent prognostic factor at multivariate analysis (odds ratio: 1.19; 95% confidence interval [CI]: 1.03 to 1.34; p = 0.02).
Clinical follow-up
Among the study population, data on clinical follow-up were available in 931 patients (66.7%). These patients were more frequently smokers and dyslipidemic and showed a higher rate of prior PCI compared with those lost to follow-up (Online Table 2). The mean clinical follow-up period was 24.7 ± 15.0 months (median 23 months). Cardiac death occurred in 18 patients (1.9%), while all-cause mortality was 3.9%. MI and stroke occurred in 32 (3.4%) and 6 (0.6%) patients, respectively; the rate of further revascularization, either percutaneously or surgically, was 13%. Overall, MACCEs occurred in 127 patients (13.6%).
In comparison with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), MI (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), overall MACCEs (8.7% vs. 23.9%, respectively; p < 0.001) (Figure 5), and rehospitalization (14.2% vs. 25%, respectively; p < 0.001).
The multivariate Cox regression analysis identified female gender (hazard ratio [HR]: 2.06; 95% CI: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) as independent predictors of MACCEs at long-term follow-up (Figure 6). Compared with angina and dyspnea status before the index retrograde PCI, patients who underwent retrograde CTO PCI showed a significant reduction in symptoms during follow-up (Figure 7).
From 2008 to 2012, highly skilled CTO-dedicated operators in the ERCTO registry performed retrograde approach procedures in 16.5% of cases. The number of retrograde procedures increased in 2011 and 2012, reaching 25% in the latter year, and was associated with high procedural and clinical success (75.3% and 71.2%, respectively), low major complication rates, and good long-term outcomes.
Although favorable outcomes of the retrograde approach in CTO revascularization were recently achieved in selected centers (13–15), operators did not unanimously embrace this technique. Indeed, success depends on the operator's skill and experience. More recently, the safety and effectiveness of the retrograde PCI approach for CTO performed by independent operators in the real world were established by a scientific organization called the Retrograde Summit, which published the results of a registry conducted by Tsuchikane et al. (16). This study was conducted over 2-year period and included 801 patients with CTOs revascularized via the retrograde approach (26.6% of the CTOs treated); overall procedural and clinical success rates were 84.8% and 83.8%, respectively (16). They demonstrated that the use of channel dilator–modified strategies of the retrograde approach significantly improved the success rate, except in the case of severe calcifications at the CTO location.
The results of the present study show slightly lower procedural success (75%) than obtained by the Japanese operators (16), with a similar difference (4%) between clinical and procedural success rates. Similar results were obtained in a multicenter registry in the United States, with procedural success of 81.4% and clinical success of 79.4% (15). A possible explanation for the lower success rate in our study compared with the Japanese and American registries could be ascribed to the larger numbers of patients and operators included in the study. Furthermore, given that the retrograde technique was used also after failed antegrade attempts, its use is determinant to achieve success in those cases with unfavorable anatomy for antegrade recanalization; thus a decreased success rate with the antegrade approach is an expected finding.
In our patients, higher success rates were observed when the retrograde approach was the primary strategy adopted, compared with its use after antegrade failure (82.2% vs. 53.1%; p < 0.001). This is similar to our earlier European experience for some operators (9) and highlights how in very complex CTOs with expected antegrade low success rate, the retrograde approach might be preferable as the primary strategy in experienced hands. Indeed, a first antegrade failure may lead to higher operator and patient fatigue and increased contrast consumption or radiation exposure, which might compromise the success of the retrograde bailout strategy, the latter being the only reliable alternative way of recanalization in some very complex lesions, given the recent development of dedicated devices and wires for such a strategy.
Furthermore, the retrograde approach might be a feasible procedure when antegrade wiring seems to be very difficult because of anatomic factors (ostial CTO, absence of stump, CTO length >30 mm, presence of side branch or heavy calcification at the proximal cap, and proximal vessel tortuosity), in the presence of visible and continuous collateral vessels, healthy donor vessels, and in repeat attempt procedures after previous failures (21,22).
Among the different techniques used, the CART and reverse CART techniques were used in almost 30% of cases, as well as retrograde wire crossing (30%). The kissing wire technique was used in 22% of cases. In the remaining 17% of cases, data were missing. We had no strict rules for the selection of a particular technique, and sometimes a combination of techniques was necessary to achieve success. However, reverse CART has recently become the technique of choice by the use of a channel dilator, as pointed out in other reports (12,16). In contrast, placing an antegrade wire may be wise and in many cases helpful to target the proximal CTO cap.
In this study, we found that procedural success decreased with patient age, presence of diabetes, and history of previous stroke, probably because of underlying severe and diffuse atherosclerosis in these patients. Furthermore, age (per 10-year increase) was an independent predictor of procedural failure by multivariate analysis. In these older patients, operators might be more reluctant to perform more cumbersome procedures. In a different setting (acute coronary syndrome), Jolly et al. (23) demonstrated that procedural volume and expertise are important for PCI success and outcome, particularly for the radial approach. Thompson et al. (14) showed that in the United States, CTO experience measured by CTO-coronary PCI volume is associated with improved technical success rates, without compromising patient safety. Similarly, in this study, we showed that operators' experience was highly related to procedural success in the setting of retrograde procedures. Importantly, procedural success was associated with better outcomes.
The J-CTO score as a difficulty-grading and assessment tool
The prediction rule based on the J-CTO score was recently found to be closely associated with successful antegrade recanalization (20). We proposed the J-CTO score as an objective tool for predicting the difficulty level also for the retrograde approach and found that this score was useful for assigning procedural success in relation to operators' levels of skill for the objectively determined difficulty of dealing with these lesions. Indeed, procedural success in minimally and moderately experienced retrograde operators decreased with increased J-CTO score, in contrast to experienced operators. Furthermore, age (per 10-year increase) and increased J-CTO score were significantly associated with increased procedural failure, confirming that prediction of success should take into account these latter predictors. Interestingly, even longer procedural and fluoroscopy times were significantly related to increased J-CTO score, apart from contrast load.
Outcome after retrograde recanalization
There are several studies suggesting that successful CTO PCIs are associated with better outcomes than failed CTO revascularization procedures (24–27). Niccoli et al. (28) showed in a cohort of 317 consecutive patients that successful CTO revascularization can reduce the rate of 3-year cardiac events in comparison with unsuccessful procedures (9% vs. 26%, respectively; p = 0.008); moreover, the investigators reported a worse prognosis in patients affected with multivessel disease.
Recently, Jones et al. (29) reported in a single-center experience the long-term survival of patients with stable angina who underwent CTO PCI attempts, showing a reduction of mortality of patients with successful CTO revascularization, in comparison with patients with unsuccessful CTO PCI (4.5% vs. 17.2%, respectively; p < 0.0001). Several reasons may explain this fact, including the complications related to CTO failure, which can lead to major adverse events. Moreover, PCI failure can be a marker of disease burden and other comorbidities that might limit the vigor of CTO attempts.
A recent meta-analysis by Joyal et al. (25) addressed the outcomes of patients who underwent successful versus unsuccessful CTO interventions. Although no randomized trial was included, the investigators analyzed 13 observational studies comparing PCI with planned medical therapy. This analysis demonstrated a survival benefit for those who underwent CTO recanalization (14.3% vs. 17.5%; odds ratio: 0.56) and reductions in the need for subsequent CABG and in residual or recurrent angina.
Mehran et al. (24) reported long-term outcomes in a prospective multicenter registry, showing that successful PCI was an independent predictor of lower cardiac mortality and a reduced need for CABG. Similar results were shown by a large recent analysis of the UK Central Cardiac Audit Database, in which successful CTO PCI was associated with improved long-term survival (30).
We report the short- and long-term outcomes of retrograde CTO revascularization in a large cohort of patients, showing the safety of the retrograde approach and the good prognostic impact of attaining angiographic success in the setting of a complex CTO procedure. Considering the complexity of attempted lesions, MACCE and further revascularization rates (13.6% and 13%, respectively) were satisfactory and comparable with previous outcomes by the antegrade approach (11,26,31). Very recently, Michael et al. (32) reported the only other retrograde 2-year clinical follow-up in a small group of 41 patients, showing that although the retrograde approach was safe, it was associated with a high rate of further revascularization (45%), likely due to longer stent lengths, more complex lesions, and greater use of dissection and re-entry techniques compared with antegrade procedures. The higher rates of need for further revascularization might be explained by the limited number of patients and a success rate as low as 65.8% (32). Indeed, in our cohort, this rate was higher in the unsuccessful retrograde PCI group (23.6% vs. 8.6%; p < 0.001).
In accordance with previous studies, we found that independent predictors of MACCEs were procedural failure (24,28,33) and female sex (34). As expected, low ventricular ejection fraction and prior PCI were also associated with MACCE, and for the first time, we showed that J-CTO score was a predictor of an unfavorable long-term outcome. This might be related to the higher atherosclerotic burden and lesion complexity of patients with higher J-CTO score, requiring longer stent segment implantation.
Study limitations
As in other retrograde CTO registries, this study was limited by its observational design, in which unmeasured variables and selection bias on the part of operators toward cases may have influenced the results. Indeed, patients were treated by highly skilled, experienced operators; therefore, the results may not be generalized to less experienced operators in the real world. In addition, procedures were performed over a period when changes in operator experience and techniques occurred at different institutions. Clinical follow-up was missing in approximately one-third of the initial cohort, and the follow-up period was not homogeneous between patients (Online Figure 1). However, this registry represents the largest study reporting long-term follow-up after retrograde CTO PCI, with a median follow-up period of 23 months. To control the quality and reliability of outcome results presented, we included only centers able to provide satisfactory rates of follow-up data. Of note, patients with more comorbidities or prior PCI were more likely to be adherent to follow-up. Data regarding collateral route and crossing technique were missing in some cases. Finally, angiographic dependent and clinical outcomes were not independently adjudicated.
Our study shows that among dedicated European operators, retrograde CTO PCI is performed extensively and is associated with favorably high success and low complication rates. Moreover, successful retrograde CTO PCI was associated with favorable long-term clinical outcomes and symptom alleviation (Central Illustration).
COMPETENCY IN MEDICAL KNOWLEDGE: A retrograde approach to myocardial revascularization in patients with CTOs, when performed by experienced operators, can enhance the success of PCI.
TRANSLATIONAL OUTLOOK: More work is required to develop better criteria for the selection of patients for retrograde recanalization of coronary arteries with CTOs, on the basis of lesion characteristics.
The authors thank all the coordinators and investigators who contributed to the recruitment in the different centers.
For a list of participating centers, supplemental tables, and a figure, please see the online version of this article.
Dr. Garbo is a consultant for Terumo, Volcano, and Abbott. Dr. Di Mario has received minor research grants from Boston Scientific and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.
- Abbreviations and Acronyms
- coronary artery bypass grafting
- controlled antegrade retrograde tracking
- confidence interval
- chronic total occlusion
- hazard ratio
- major adverse cardiac and cerebrovascular event(s)
- myocardial infarction
- percutaneous coronary intervention
- Thrombolysis In Myocardial Infarction
- Received January 7, 2015.
- Revision received March 20, 2015.
- Accepted March 20, 2015.
- American College of Cardiology Foundation
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Keeping your customers safe
Applications often access more sensitive data than your SMB customers think. One thing you should encourage them to implement is a bring-your-own-device policy (BYOD) to eliminate unsecured devices from connecting to the network. This can help you monitor what applications and websites can be accessed from the network and which ones should not. Another thing you can consider offering for your customers to help them keep their data secure is a web application firewall (WAF). Check out the video below to see how Barracuda's WAF can help you.
Photo: Jaruwan Jaiyangyuen/Shutterstock.com.

subset: commoncrawl


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10828 Purdey Rd, Eden Prairie
Stunning Charles Cudd in Bearpath. Over $400K in modern upgrades since 2007. Many new additions include 1st flr vaulted multi-media/office/laundry/mudroom w/ expansive center island. Owners suite boasts HDWD floors, tray ceiling, new light fixtures, sitting rm w/ gas FRPLC flanked by stone, TV built-in & incredible views of the pond! Master BA enjoys 2 vanities, soaking tub & a huge W/I closet w/ a shoe island! Kitch features enameled cabinets, GRNT counter tops, under cabinet lighting, double ovens, crown molding, tons of storage, new appliances, hardware, light fixtures & built-in hutch. LL W/O is an entertainers delight w/ billiard area, floor to ceiling stone FRPLC, wains coating, new light fixtures and an exercise rm w/ a wall of mirrors. The LL wet bar features, under cabinet lighting, bev. fridge, GRNT counter-top & tons of storage. Deck off the sun porch has access to a flagstone patio/fire pit. Two-three season porches, one enjoys a built-in movie screen for late night movies!
Deck, Patio, Hardwood Floors, Tiled Floors, Walk-In Closet, Exercise Room
Attached Garage, Driveway - Asphalt, Garage Door Opener
Corner Lot, Tree Coverage - Medium
Asphalt Shingles, Age Over 8 Years
The data relating to real estate for sale on this site comes in part from the Broker Reciprocity program of the Regional Multiple Listing Service of Minnesota, Inc. Real Estate listings held by brokerage firms other than The Barry Berg Group - Coldwell Banker Burnet are marked with the Broker Reciprocity logo or the Broker Reciprocity house icon and detailed information about them includes the names of the listing brokers. The Barry Berg Group - Coldwell Banker Burnet is not a Multiple Listing Service MLS, nor does it offer MLS access. This website is a service of The Barry Berg Group - Coldwell Banker Burnet, a broker Participant of the Regional Multiple Listing Service of Minnesota, Inc.
Information deemed reliable but not guaranteed.
Copyright 2019 Regional Multiple Listing Service of Minnesota, Inc. All rights reserved.
By searching, you agree to the EULA Terms Agreement.
Listing information last updated on December 10th, 2019 at 9:20am CST.


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Today marks the end of the opportunity to weigh in on federal efforts to rollback community protections from coal ash pollution. Comments are being accepted https://www.southernenvironment.org/ccr-comments through midnight.
SELC, along with a long list of partners, submitted comments on EPA's proposal urging the agency to uphold its duty to protect clean water from coal ash pollution.
As officials at the Environmental Protection Agency seek input on their industry-driven proposal, Senior Attorney Frank Holleman attended the one public comment session held for public input on the proposal.
"Here we are today," Holleman testified, "instead of fighting pollution, having to fight the political leadership of what is supposed to be the our Environmental Protection Agency and their efforts to eliminate protections for clean water and communities in order to benefit objectives of the coal ash utilities' lobbyists and trade associations."
The EPA proposal in question would weaken coal ash protection and take rights away from citizens and give them to state agencies, which have not protected clean water from coal ash pollution. In numerous cases, including the Dan River spill in North Carolina and the massive Kingston disaster in Tennessee, state agencies were shown to be ineffective watchdogs.
The entire reason we have a national coal ash rule is that the state agencies failed to protect us from disasters like TVA's Kingston spill and Duke Energy's Dan River disaster," said Holleman.
EPA is welcoming comments on their proposal through Tuesday, May 1. For more information, and to submit your own, visit southernenvironment.org/ccr-comments.
Read PoliticoPro's coverage of the issue here (subscription site).


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Elan Miracle Retail Shops Multiplex Sector 84 Gurgaon +91-90157-05000
- 3000000.00 Rupee ₹
- Published date: October 11, 2018
- Gurgaon, Gurgaon, Haryana, India
Elan Miracle is a mixed used development project with the tallest iconic building, having been designed by "UHA LONDON" one of the best building designers of the world and the compliment the above we have empanelled "Design Plus" as architechs who are known for the excellence in their field.Situated in an amidst dense residenstional area been developed by names like DLF, Vatika, Bestech, Spaze etc offering approximate of over 50000 apartments.
Key Features
Project Name Elan Miracle
Possesion Under Construction
Location Sector 84 Gurgaon
Size 300 Sq. Ft.
Price 30,00,000 Lacs Onwards*
Contact No +91-90157-05000
Website http://www.setriterealtors.com/elan-miracle-price-plans-sector-84-gurgaon.html
elan miracle, elan miracle sector 84, elan miracle gurgaon, elan miracle sector 84 gurgaon, elan miracle 84, elan miracle serviced apartments, elan miracle gurgaon, elan miracle multiplex,
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Office - Commercial Space Gurgaon (Haryana) May 15, 20189200000.00 Rupee ₹
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Artificial pancreas system succeeds in maintaining near-normal glucose levels Mass. General, Boston University researchers run first clinical trial of system using 2 hormonesAn artificial pancreas system that closely mimics your body's blood sugars control mechanism could maintain near-normal glucose levels without causing hypoglycemia in a small group of individuals /le-viagra-naturel.html . The system, combining a blood glucose monitor and insulin pump technology with software that directs administration of insulin and the blood-sugar-raising hormone glucagon, originated at Boston University . Continue reading
More than 1.1 million people in the national country believed to be vulnerable to the virus will receive the vaccine, as early as April 1, the Communist Party newspaper Granma stated Friday, the AP reviews. The vaccines to end up being distributed had been donated by the WHO . USAID's Global Pulse 2010 USAID is sponsoring an on the web discussion with whoever has suggestions and or solutions to a few of the pressing global challenges, within its Global Pulse 2010, March 29 – 31, Stabroek News reports. According to the news support, Global Pulse 2010 is normally part of the strategy of the National government in reaching out to partners across the globe to go over pressing challenges within specified fields – women and women; education; partnerships; political and civil rights; global wellness; a sustainable world and entrepreneurship, trade and economic chance among other areas . Continue reading
today announced the demonstration of benefits from a Phase 2 clinical trial in non-little cell lung tumor of ARQ 197, a selective small molecule inhibitor of the c-MET receptor tyrosine kinase, at the annual conference of the European Society for Medical Oncology . Sufferers treated with ARQ 197 plus erlotinib acquired a median time to develop new metastases of 7.3 months, compared to 3.6 months for patients treated with placebo plus erlotinib. This effect was even more pronounced among patients with non-squamous cell histology, among whom the median time to develop new metastases was 11.0 months for individuals treated with ARQ 197 plus erlotinib, weighed against 3.6 months for those treated with placebo plus erlotinib. Continue reading
'The 14-time period recommended by NY State may not be good more than enough. We have a check that could display for HIV and HEP on the very day an organ is donated. These point-of-care assays are designed to significantly shorten the time to diagnosis and to lessen the costs of testing. The Centers for Disease Control and Prevention chose to implement an instant influenza check created by Chembio due to its ability to test all at once for multiple strains. Siebert says. 'In a mere 15 minutes, with just one single bloodstream sample or oral fluid sample, we can determine to an extremely high degree of precision whether an organ donor is certainly HIV-positive and whether she or he has HEP B/C. If performed before an organ donation immediately, this test would significantly lessen the chances of an infected organ being transplanted into a patient, and may deliver a total result within minutes.. Continue reading
As Gingrich gains support in polls, his plans draw attention, too Information outlets analyze GOP presidential hopeful Newt Gingrich's plan positions, including those relating to Medicare and other health issues cialis side effects . Paul Ryan's Medicare programs amounted to 'right-wing cultural engineering' . The Wall Road Journal: Gingrich Evolves On Federal Role At various moments in his profession, Mr. Gingrich has come out and only requiring that folks carry medical health insurance and increasing federal government spending for scientific research. He has backed programs run by the Education Department, which a lot of his peers would like to abolish, along with national curriculum criteria and a federal government response to climate modification. Continue reading
Arthritis drug caution advised by New Zealand experts A specialist New Zealand committee reviewing the protection of a group of arthritis drugs called COX-2 inhibitors offers reinforced UK information cautioning against their routine make use of where safe and effective alternatives are available. The Medicines Adverse Reactions Committee is advising patients who are using Celebrex, Arcoxia, Mobic and Bextra they should talk with their health care provider about alternatives if they have concerns. The Medicines Adverse Reactions Committee has discussed a rapid literature review of the chance of use of COX 2 inhibitor medicine causing increased risk of cardiovascular events /an-overview-of-cialis-vs-levitra/ . Continue reading
Bingeing, SUBSTANCE ABUSE Up At Colleges Substance abuse on university campuses is nothing at all new, nonetheless it is taking a more threatening and extreme form, with higher prices of frequent binge prescription and drinking substance abuse, and more negative implications for learners such as for example arrests and risky sexual behavior. That is the portrait painted by a fresh, comprehensive report tying a variety of recent analysis on college drug abuse together, supplemented with a few of its new survey data enchanced libido http://sildalist.org . The record by The National Focus on Addiction and DRUG ABUSE at Columbia University, argues that drug abuse isn't an unavoidable rite of passage for adults. Continue reading
Evaluation of the regulatory hurdles in European Diagnostics In a move targeted at harmonising diagnostics regulations, the European parliament amended the medical devices directive of 1993 to generate the IVD directive in 1998. The directive comprises of a number of articles that outline definitions, standards and vigilance and as from December 7, 2003, provides been enforced in the 25 European Union member claims and the four European free trade association associates namely, Iceland, Norway, Switzerland and Liechtenstein. While many regulatory hurdles have been removed with the execution of the Conformite Europeene mark, this multinational standardised mark additional allows global manufacturers to distribute their products within the EU, eliminating the need for additional quality approvals or examining eriacta 100 uk . Continue reading
We believe this last round of financing will energy the extension of the Arthrosurface system from its first generation of partial surface hemi-replacements into its following era of 'partial total joints,' said Arthrosurface President Steve Tallarida. This will continue to differentiate Arthrosurface's unique platform as we move to address a complete range of joint pathologies during surgery. .. Arthrosurface launches new product for treatment of patello-femoral disease Arthrosurface has received FDA clearance to start its cartilage surface area implant system for the treating patello-femoral disease. Steve Ek, COO, offered, That is another large market in orthopaedics that, up until now, has been ill-addressed by the prevailing medical device sector. Continue reading
Clarient introduces Mammostrat test to quantify likelihood of breast cancer recurrence Clarient, Inc. , a premier technology and services reference for pathologists, oncologists and the pharmaceutical market, announced the commercial release of Mammostrat today, a patented, novel test designed to help quantify the likelihood of recurrence of breast cancer following medical procedures and initial treatment. The Mammostrat test employs an optimal set of five biomarkers that can be identified visually on a patient's tumor specimen by using a well-established technology known as immunohistochemistry. Mammostrat is well-validated, having been studied on more than 3 clinically,000 ladies, as reported in multiple peer-reviewed journals, including Breast Cancer Research , Clinical Cancer Analysis , and the Journal of Clinical Oncology . Continue reading
Applicants in Monday's GOP debate clash on health reform, Medicare, vaccines One of the questions emerging in this primary contest is whether entitlement programs like Medicare and Public Security will still be a political 'third rail,' or if public problems about government spending have got overcome this conventional wisdom. Bush and enacted during his tenure online pharmacy . They all agreed to maintain it, but that to pay for the program, government waste materials must end. . USA Today: Rick Perry Must Be The Front-Runner: Everyone Episodes Him The emerging Republican campaign could test whether Sociable Security continues to be the 'third rail' of American politics -; that's, contact it and die -; or if strains on entitlement applications and concerns about authorities spending have changed the calculations and changed the risks . Continue reading
Researchers analysed five research to evaluate the potency of offering chemoprophylaxis to the individual and to contacts in households and childcare configurations. They found that the risk of meningococcal disease in household contacts of a patient is reduced by 89 percent if they take antibiotics that eradicate meningococcal carriage. Another way of expressing this risk decrease across a inhabitants is that about 200 household contacts need to be treated to avoid one case during the first month. The data also suggests giving preventive treatment to the individual before discharge from hospital, as at least 3 percent of individuals will still carry the virulent meningococcal stress after treatment with penicillin. Continue reading
The ongoing company plans to file an NDA in the third quarter. In a previous medical study, Captisol-enabled Melphalan fulfilled the requirements for establishment of bioequivalence to the current industrial intravenous formulation of melphalan. Spectrum assumed the duty for the pivotal clinical trial and is responsible for filing an NDA. Beneath the license agreement, Ligand received a license fee and is eligible to receive milestone payments, and also royalties pursuing potential commercialization.. Continue reading
You should, read it yourself. Nevertheless, you have the disregard the Summary as that's not the statutory law, and will not reflect what's in the Law. As you may suspect, this move may be the 'final remedy' of Monsanto, DuPont and various other seed-domination corporations who've long admitted their objective may be the complete domination of most seeds and crops grown on earth. By criminalizing the personal growing of vegetables – – therefore turning gardeners into criminals – – EU bureaucrats can finally give complete control of the meals supply to powerful companies like Monsanto. Continue reading
Furthermore, CMS proposed to increase the 25 percent rule – – which decreases Medicare reimbursements for LTCHs located within acute care hospitals that accept a lot more than 25 percent of their individuals from the host facilities – – to cover all LTCHs that accept a lot more than 25 percent of their patients in one hospital. In related news, lawmakers from both House and Senate have launched legislation that would establish certification criteria for LTCHs. THE HOME bill would set up a system to identify which severely ill patients LTCHs should accept and would define the %age of individuals at the hospitals who must meet the criteria, according to the Acute Longer Term Hospital Association. Continue reading
Citrus fruit might help lower the chance of stroke in women A study recently carried out at the University of East Anglia in Norwich, UK and posted in Stroke: Journal of the American Heart Association reveals that a compound found in citrus fruit may help lower the chance of ischemic stroke. The study showed that women who consumed high levels of oranges and grapefruit experienced a 19 % lower threat of stroke than women who didn't regularly consume any citric fruit eriacta 100 uk . Citrus flavonoids improve brain blood circulation The study looked at how a very specific subclass of flavonoids founds in citrus fruit impacted on the risk of stroke. Continue reading
We've proven our business design and are attaining significant momentum. Expanding enrollment %ages are providing a robust revenue driver to your business design.' Mr. Anderson continued, 'In the first quarter of 2014 we signed our first Medicaid strategy, which has launched in a single state already. This provides us the opportunity to demonstrate out our outcomes in a Medicaid human population, which, if successful, we expect to supply the catalyst for the program to rollout nationally. We consider Medicaid to become a significant and growing segment, as a larger part of Medicaid programs generally suffer from the results of compound dependence than in a industrial plan.' Mr. Anderson concluded, 'With our business model proven, and our consumer base established, we are focused on expansion during 2014 squarely. Continue reading


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You must be 21+ to enter and purchase products from our website. Click Enter only if you are at least 21 years of age.
Regular price
Learn to bend and stretch your way to the best version of yourself with the seminal paperback version of The East/West Exercise Book.
Note on condition: This item is a vintage find, and therefore has slight imperfections that come with age and use.


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The Untouchable DJ Mensah releases two new singles off his upcoming album which is set to be out few days from now.
These latest releases, dubbed, "DanceFloor" features the current top High Life artiste Bisa Kdei, and "Say I Do" featuring Ghana's top rapper Sarkodie
Just like the title, DanceFloor with multiple award winning musician Bisa Kdei is a danceable song which doesnt just have a party groove, but carries a message that will put you in the mood of moving your feet. Highlife meets the street.This is an instant hit
"Say I Do" from Sarkodie is a love song, and this time, the rapper is telling the world how ready he is to tie the knot with his special someone. Another masterpiece.
Check out both songs from below and dont forget to share. You got it here first.
DJ Mensah Ft Sarkodie – Say I Do [Download]
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best feet forward:
how to measure your baby's feet
When your baby starts taking their first steps outdoors, it's time to get shoe shopping. The simplest way to get your baby's shoe size right is to take them to a shop with a qualified shoe fitter, but if that's going to be tricky for you we also have some advice on measuring at home.
what should i expect?
There may well be tears and tantrums, but you shouldn't worry if your baby gets upset having their feet measured. The fitter should have loads of experience, and will be completely used to measuring not-entirely-happy children. It's best to go for shoes with plenty of support to hold your baby's feet in, for example with buckles or Velcro fastenings.[1]Plastic designs are better left on the shelf as they can make your baby's feet sweat, leading to the possibility of fungal infections.
how can i measure my child's feet?
For home measurements, there are a few options you can try out from drawing around your little one's foot or even painting - though these can be tricky to keep your little one still and messy if you choose to go down the paint route.
Alternatively, you can download and print our handy measuring guide. You may still have to contend with a wriggly little one, but with clearly marked sizes it hopefully shouldn't take you too long.
what about width?
Depending on who you buy your shoes from, the widths will either be classed as narrow, medium and wide, or sized from D to H – with D being the narrowest, H the widest and F the average. You'll be able to get a reasonable idea of whether your child has particularly wide or narrow feet just from looking. If you're not sure, start with a medium size. It's important that your child has a bit of wiggle room, and that the shoes will fit over socks.


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Northern California Restaurant Month Events
California's northern region is home to many popular foodie destinations—San Francisco, Napa Valley, Berkeley, to name a few—but it also boasts lesser-known locales in the centre of agricultural hubs. Discover new hotspots or treat yourself to a multi-course meal at your favourite restaurant with these special January deals in the northern third of the state, listed north to south.
Mendocino County Crab, Wine & Beer Festival
January 20–29
Mendocino celebrates Restaurant Month with a weeklong seafood festival that celebrates the county's local fisherman, winemakers, and brew masters. The 10-day Mendocino County Crab, Wine, and Beer Festival features dozens of events, like the family-style crab and cioppino feeds, gourmet crab-themed dinners, crab and wine pairings, crab fishing adventures, a wine competition, and the popular Crab Cake Cook-Off.
Yuba-Sutter Restaurant Week
January 23–29
Located in the Sacramento Valley, Yuba-Sutter County's local ingredients play a huge role at the region's restaurants—something you can taste for yourself in late January. You'll find special menu items created specifically for Yuba-Sutter's Restaurant Week, the region's first-ever California Restaurant Month event. One spot to try: The family-friendly Dancing Tomato Caffé makes creative comfort food with a focus on supporting local farms.
El Dorado Epicurean
All month
El Dorado County celebrates the annual California Restaurant Month tradition throughout January with plenty of culinary adventures along its bountiful Gold Country backroads. The El Dorado Epicurean Collection of Culinary Adventures is a monthlong celebration packed with exclusive seasonal offerings from innovative chefs, wine-pairing specials, farm tours, vineyard hikes, cooking demonstrations, and discounts on local accommodations.
Taste of Yolo Restaurant Week
January 22–28
Yolo County will showcase its farm-to-table culinary chops with a special Taste of Yolo menu at participating restaurants from January 22–28. The restaurants will feature ingredients from Yolo's backyard, such as fresh organic produce, olive oil, meats, nuts, honey, locally crafted wine, and beer. Look for special items on participants' menus—each restaurant will offer something new made from locally sourced ingredients.
Dine Downtown Sacramento
January 12–22
The growing foodie destination of Sacramento will highlight the best local fare during its 12th annual Dine Downtown Restaurant Week program. For 10 days, more than 30 restaurants will offer three-course meals for $35. Plus, Sacramento adds a feel-good element to your night out: One dollar from every Dine Downtown meal is donated to food literacy programs—just $4.11 provides a week of food literacy education for one child.
Vacaville Restaurant Week
January 13–21
Situated halfway between San Francisco and Sacramento, Vacaville is an easily accessible destination for foodies and families. Enjoy a week of discounted pricing and specialty menus during Vacaville's Restaurant Week January 13–21. The area is proud to boast its diverse dining options, with favourites like Buddha Thai Bistro—where chef Joey Jaraba's spin on classic Thai dishes earned it a spot on Yelp's top 100 places to eat in the U.S. in 2015.
Napa Valley Restaurant Week
January 22–29
The Michelin-rated restaurants and farm-to-table practices make Napa Valley a must-go epicurean destination. And during Napa Valley Restaurant Week, visitors can experience the area's legendary food and wine at a more wallet-friendly rate. With multi-course prix fixe menus for lunch ($20) and dinner ($36 or $46), you'll have the chance to try the latest culinary hotspots or revisit old favourites. Get the best of both worlds with a $46 three-course menu with wine pairings at high-energy TORC, or stop by Charlie Palmer's Harvest Table for a $20 two-course lunch that features produce from the restaurant's adjacent garden.
Sonoma Valley Culinary Excellence Month
All month
With participating restaurants, wineries, and olive oil and cheese producers, it should come as no surprise that Sonoma Valley boasts an entire month of offerings, so you have time to taste the best of the region. This is Sonoma's first time participating in the January event, which is good news for wine country visitors—this is your chance to try some of the area's world-class cuisine at a discount.
Suisun Waterfront Restaurant Week
January 20–29
The seventh annual Suisun City Historic Waterfront Restaurant Week will return January 20-29, with participating restaurants offering prix fixe menus for breakfast or lunch (two courses) or dinner (three courses). Whether you want Greek, Italian, Mexican, Thai, or American cuisine, Suisun City's got it. After December 30, menus from participating restaurants can be downloaded from Suisun's website.
Downtown Benicia Restaurant Week
January 21–28
Charming downtown Benicia, about an hour northeast of San Francisco, celebrates with a week of deals: a dining "passport" offers a 15% discount at participating restaurants January 21–28. Stop by First Street Café to try its famous Dungeness Crab & Artichoke Sandwich, served open-face with fresh Roma tomatoes and melted Jack cheese. (It was featured in Bon Appétit magazine.)
Stockton Restaurant Week
January 20–29
Taste your way through Stockton's best restaurants during Stockton Restaurant Week, when fixed-price meals can be found throughout the city. Local deals make it affordable to eat out multiple times throughout the 10 days. Grab a $10 lunch at the modern American Centrale Kitchen and Bar, Mediterranean-Italian Mezzo, or small-plate- focused Midgley's Public House (plus many more). Or take advantage of the $15–$25 dinners offered at other participating restaurants.
Berkeley Restaurant Week
January 19–29
Berkeley's best restaurants will offer special prix fixe menus for lunch (starting at $20) and dinner (starting at $25) during its Restaurant Week January 19-29. The epicentre for California Cuisine has no shortage of incredible food to try at all times of the year. Participants for 2017 include the healthy-meets-gastronomy Mission Heirloom, all natural sushi and Japanese AKEMI, and German slow food purveyors Gaumenkitzel.
Oakland Restaurant Week
January 19–29
Just over the San Francisco-Oakland Bay Bridge, this hot foodie destination will offer two weekends of deals during Oakland Restaurant Week. More than 100 restaurants are offering prix fixe deals at $20, $30, $40, and $50 dollars. Sample the salami, pasta, and gelatos at Lungomare—they're all made in house—or order the B&B Signature cocktail (with house barrel-aged white corn whiskey) to accompany your hearty steak at Bourbon & Beef.
San Francisco Restaurant Week
January 18–29
Recognized as one of the top dining destinations in the world, San Francisco Restaurant Week features dining deals at more than 125 restaurants across 26 neighbourhoods. With special two-course menus for lunch ($15 and $25) and three-course prix fixe dinner menus ($40 and $65), set out to find a new restaurant or revisit a favourite to enjoy special multi-course menus exclusive to California Restaurant Month. You can get up-to-date info on participating restaurants—including a menu preview—on the SF Restaurant Week website or Facebook page.
Eat Tri-Valley
All month
The Tri-Valley area—comprised of Pleasanton, Livermore, Dublin, and Danville—is just 45 minutes east of the Golden Gate Bridge. The "Sunny Side of the Bay" is worth exploring for its restaurants and cafes, peaceful Livermore Valley wine region, and craft beer trail with more than 20 breweries. Throughout the entire month, the Tri-Valley area will offer discounted meals and California Restaurant Month specials. Check the website for participating eateries.
Downtown San Jose Restaurant Week
January 16–26
Order from the prix fixe menus in the urban heart of Silicon Valley, where innovative chefs feature specials made with local produce. During San Jose's Restaurant Week, your meal will help to support feeding the hungry through Martha's Kitchen—for every prix fixe meal sold, Sysco will donate $1 to the cause. San Jose's range of restaurants makes it appealing to dine out more than once this week: from Farmers' Union, a comfy tavern with sustainable fare, to Nomikai, a trendy lounge serving Asian fusion.
Find more dining deals with our Restaurant Week guides on Central and Southern California.


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Rating: NNNNN
Fayoum Region, Egypt -- I'm standing in the Valley of the Whales (Wadi Al-Hitan in Arabic), where you can find the fossilized remains of long-extinct marine creatures. The ancient whales and sharks lived some 40 to 50 million years ago.
For a full day, I and my four desert adventure-seeking companions let loose in the mammoth Saharan sandbox. We temporarily leave the city and our professional personas behind like the cloud of dust trailing our 4WD as we follow a desert ranger's vehicle into the Sahara.
This desert habitat is located in the Fayoum region, Egypt's best-known site for fossils. The two-hour drive on the path from the Wadi Rayan Protected Area flashes by in a Cairo minute.
Faces press against the car windows. Hearts pound. We see but can't believe the sweeping desert vistas and creamy beige sandstone formations of fantastic abstract shapes.
"I am not in outer space. I am not dreaming," I remind myself after a pinch or two.
With endorphins cranked high, we spill out of the vehicle and sprint toward the giant golf balls of sandstone strewn around the desert plateau, said to have been formed by erosion and the winds of time.
Since eco-tourism in the Fayoum region isn't fully developed, we're virtually the only souls at the site. I'm astounded to walk in the vast bed of sand surrounded by rising cliffs, territory famous for the fossils of the sea-serpent-like Basilosaurus isis (incorrectly identified and thus named the "king of reptiles"). The Basilosaurus, known to grow up to 60 feet long, was an ancestor of the modern whale, the king of all animals in size and in the food chain during the late Eocene period.
One of many Kodak moments comes when we spot some reddish-orange loose fossil stones, and desert ranger Mohamed beckons us to help him carry the petrified bones and reassemble the Basilosaurus.
Wannabe paleontologists, we delicately lay the pieces down to fit into the puzzle of Basilosaurus vertebrae peeking out from under the sand. Assembled bones are usually roped off, but we can come as close as a few centimetres to admire the exposed fossils in the raw.
Soon after I ask about any evidence of sharks, Mohamed uses his X-ray vision or, more likely, his inside-out knowledge of the area to pick up a Y-shaped shark's tooth from the rubble of fossils, shells and stones. I hold the artifact of my greatest fear in the palm of my hand, impressed. For a predator, it's shockingly minuscule with an innocuous pointy tip.
Mohamed is a friendly, gentle soul who understands our feelings of elation as we frolic in the open-air museum of the desert. After his oft-repeated Arabic-English phrase "Yalla, let's go, guys!", he graciously allows us to linger a while longer, not minding the brewing sandstorm. Though he gives us some freedom to enjoy our moments away from rules and responsibilities, Mohamed draws the line when it comes to preserving the beauty of the desert.
When I ask politely in my Canadian way if we can keep a few tiny souvenirs, he replies in his serious yet playful Egyptian manner: "Don't ask me. I don't own the desert." Not everyone follows the rules, Mohamed laments. Overzealous tourists have pilfered the site for "personal souvenirs" over the years.
I don't go home with a prehistoric shark's tooth, but seeing one is enough.


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18140 Woodview Lane, Fredericktown, OH 43019 US Knox County Home
18140 Woodview Lane, Fredericktown, Ohio
Spacious Ranch Located Near Knox Lake
Property Details
Listing Information
- Bedrooms: 3
- Baths: 2
- Partial Baths: 1
- Lot Size: 1.567
- Style: Ranch
- Garage: 2 Car
- Heat Source: Electric
- Schools: Fredericktown
More Information
Property Description
Spacious country ranch located near Knox Lake just off of route 95, the setting is a gorgeous 1.567 acre treed setting, the floorplan is attractive and includes 3 bedrooms and 2 ½ baths, a super huge living room with lots of natural sunlight and hardwood flooring, cabinet filled kitchen that includes the major appliances, a nice adjoining dining area, convenient main level laundry room, master bedroom features a private bath plus a walk in closet, semi finished lower level with game room plus extra storage space, attached 2 car garage with circular drive, covered rear deck/patio, this is an outstanding property especially for only $100,000.
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Property information deemed reliable but not guaranteed and should be verified.
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Raymarine MFD Displays and Equipment
Octopus Electrical Service can custom design your instrument layout and fit Raymarine systems to your vessel. Intergrated Boat systems are becoming more and more popular. The below link will take you to Raymarines site for detailed information on all raymarine products. PLEASE CONTACT US FOR PRICING email@example.com
Victron Energy
Octopus Electrical Service custom fit all Victron Products to vessels from 10ft- 200ft. We can design the best power control systems for your inverters and solar charging requirements. The link below will take you to the Victron Energy Site. FOR detailed information PLEASE CONTACT US FOR PRICING firstname.lastname@example.com
Trojan DEEP Cycle Batteries
These are REAL deep cycle batteries.
With over 85 years of experiance, Trojan Battery Company is the worlds leading manufacturer of advanced deep-cycle batteries, to deliver superior power for MARINE, golf and utility vehicle, renewable energy, vechicle applications. Choose the global leader in deep-cycle batteries - Trojan Battery. ------ FOR detailed information PLEASE CONTACT US FOR PRICING firstname.lastname@example.com
Why lithium-iron-phosphate ?
As these batteries have improved over time we can now supply a Lithium LiFeP04 battery with the same usable capacity as Lead acid AGM/GEL Deep cycle batteries for about 30% more than what the AGM/GEL batteries cost, but the lithium units will last a lifetime, instead of 2 to 4 years as with the AGM/GEL units. Also as a bonus they are 1/4 the size and 1/4 the weight
Octopus has installed over 50 battery banks into boats over the last 5 years and we have not had one problem with any battery to date.
As a example a 400 amp hour bank of deep cycle AGM/GEL Batteries would cost around 58,000 Baht and of this only 200ah is usable (weight 140Kg)... Now a 200AH usable Lithium bank would cost 75,000 Baht (weight 22kg) and this includs the BMS system as well.
Other Advantages Very little volage drop from full to 90% empty 20% faster charge times 2000 plus Cycles and after this you still have 80% of the orginal capacity, then after 10,000 cycles you have 70% left of the orginal capacity 1/4 the weight and 1/4 the size BMS included will work with existing charging systems in 95% of boats
Lithium-iron-phosphate (LiFePO4 or LFP) is the safest of the mainstream li-ion battery types. The nominal voltage of a LFP cell is 3,2V (lead-acid: 2V/cell). A 12,8V LFP battery therefore consists of 4 cells connected in series; and a 25,6V battery consists of 8 cells connected in series. Rugged A lead-acid battery will fail prematurely due to sulfation: • If it operates in deficit mode during long periods of time (i.e. if the battery is rarely, or never at all, fully charged). • If it is left partially charged or worse, fully discharged (yacht or mobile home during wintertime). A LFP battery does not need to be fully charged. Service life even slightly improves in case of partial charge instead of a full charge. This is a major advantage of LFP compared to lead-acid. Other advantages are the wide operating temperature range, excellent cycling performance, low internal resistance and high efficiency (see below). LFP is therefore the chemistry of choice for very demanding applications. FOR detailed information PLEASE CONTACT US FOR PRICING firstname.lastname@example.com
BEP Electrical Equipment
All of the company's products are designed to easily integrate into simple or comprehensive electrical systems. The world's finest boat, emergency vehicle, and RV manufacturers are recognizing the requirement for quality electrical systems and are specifying our products as original equipment. The challenge, and our promise, is to leverage the deep product understanding in each of our companies with coordinated product development, an ABYC Certified technical sales team, and an industry-leading customer service and support group.
Czone and Equipment
Digital Switching Let CZone do the thinking! The CZone digital control & monitoring network simplifies installation of electrical systems through the replacement of complicated, cumbersome wiring. CZone replaces switch and fuse panels with state-of-the-art, robust interfaces and light NMEA 2000 network cable. It provides a sophisticated solution via automation of the control and monitoring issues required by today's complex on-board and in-vehicle systems. CZone allows the user to control multiple circuits with "One Touch", dramatically simplifying operation. With control potentially available at any point in the NMEA network, fingertip control is available anywhere around the boat or vehicle, through the dedicated CZone screens, iPad , remote keyfob or through the navigation MFDs of our integration partners. PLEASE CONTACT US FOR PRICING email@example.com
FCI Watermakers
Intuitive engineering guarantees the longevity, durability and performance of every FCI Watermakers unit. Our system design optimizes the flow of water, while industrial-quality materials employed throughout the reverse osmosis unit ensure robust operations. Take a look at the features that make an FCI watermaker the world's finest. PLEASE CONTACT US FOR PRICING firstname.lastname@example.com
Blue Sea Systems
Blue Sea Systems, products are designed to easily intergrate into simple or comprehensive electrical systems. Ideal for Battery managment, Cicuit protection,and pamels
Lumitec L.E.D Lighting
Living Lumitec is, simply, a passion for the water and a love for boating. For boaters, avid fishermen, sailors, divers or anyone who lives the marine lifestyle, getting out there in the open waters feels like taking a deep breath. Connecting with the forces of nature, putting the stress of daily life in your wake and charting your own course both day and night, that's Living Lumitec!
All of our featured and listed products can be purchased and fitted by Octopus Electrical Service. We can supply and fit some of the most cutting-edge marine products on the market today. Our range includes products from some of the best marine brands from around the world. Contact us for a free no-obligation quote on any of our products and services.


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Oil Flow Meters
Product Description
With our wide expertise in this present sector, our organization is capable of manufacturing, supplying and exporting a superior quality assortment of Oil Flow Meters. Appreciated among our valuable clients, these are precisely designed in various application areas including petroleum, petrochemical & process control industries. The manufacturing of the provided range is completed at our processing unit by selecting optimum quality raw material, updated machine and contemporary techniques. Our quality analysts perform various quality parameters on Oil Flow Meter to ensure optimum performance.
- Easy to install
- Rust resistance
- Excellent flow rate
Contact Us
No. 47, Bhagirath Industrial Estate, Part-1, Nagarvel Hanuman Road, Amraiwadi, Ahmedabad, Gujarat, 380026, India
Phone :+918068342584


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Organic Lavender Puppy Shampoo
Extra-delicate luxury for extra special pups. Lather your dog's delicate skin with this extra mild organic lavender formula. Natural goodness with a limited ingredient list that will relax even the most anxious puppies. Also recommended for dogs with skin allergies.
• Extra mild shampoo designed to be safe and gentle for a puppy's sensitive skin.
• Formulated with Organic Lavender to calm puppies during baths.
• Leaves skin moisturized and fur feeling soft and fluffy.
• Made with 90% certified organic ingredients.
• No soap. No parabens. No sulfates. No artificial fragrances or dyes. No petroleum based ingredients.
• Made in the USA
Purified water, Coco Glucoside 818, K+ Oleate, K+ Cocoate, Decyl Glucoside 2000, Vegetable glycerin, Organic Seaweed Extract, Organic, Lavender EO, Potassium sorbate, Xanthan gum, Citric acid.


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Restive Kashmir: Centre has given up, President only ray of hope, says JD(U)
| Updated: Aug 23, 2017 11:20 IST
New Delhi, Aug 22 (ANI): Accusing the Centre of inaction in pacifying situation in the violence-hit Kashmir, the Janata Dal (United) on Monday said President Pranab Mukherjee is the only ray of hope in the nation, as the Bharatiya Janata Party (BJP) government has given up as far as the Valley's situation is concerned. "Even as 45 days have passed on, the situation in Kashmir is still restive, and the Centre is doing nothing to pacify it," JD(U) leader Ajay Alok told ANI. "The President is the last ray of hope left in the nation. Only he can give a warning to the Centre. Because, the Centre has given up, they are just talking, but nothing is being done on the ground. Kashmir its under fire for the past 45 days," said Alok. "I would like to ask the BJP government that it made a lot of promises at the time of general elections, and now what is it doing? You forget Kashmir and speak of Balochistan. The nation is now in strange condition," he added. The Union Home Minister, while referring to the recent violence in the Kashmir Valley, urged the youth to pick up books and not stones. "Some people in order to serve their selfish motives are forcing the innocent children and youth of Kashmir to pick up stones... Is this not playing with their future? I want to tell those having such nefarious intentions not to encourage the innocents to pick up stones," said Singh at a function in Lucknow on Sunday. "These children are innocent and citizens of India...If there is a problem or difficulty, it cannot be solved through demonstrations, it can be resolved only through mutual dialogue," he added. Singh also lashed out at Pakistan and accused it of involvement in nefarious activities against India. (ANI)


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Hasselblad front protective cap for H and XCD series lenses
The Hasselblad 67 mm Front Lens Cap For H Series Cameras is easy to put on and take off your lens. Lens caps protect your lens from scratches, fingerprints and the elements when the lens is not in use. It's always good to have a spare in your camera bag, too.
67 mm
Attachment Method
Center Pinch
To be the first to review this product simply fill out the form to the left and let us know how you feel about this product!
To estimate the freight on this item simply enter the destination postcode and the desired quantity and click the "estimate" button.
Get Free Shipping on all orders! No minimum spend! Items are dispatched from our Melbourne Warehouse within 24 Hours*
Shop with peace of mind knowing all items sold @ C.R.Kennedy & Co are backed by genuine manufacturers warranty.
Place a Click and Collect order online and pickup from your nearest warehouse.
C.R. Kennedy is Australia's leading importer and distributor of photographic equipment. Our head office and main warehouse is located in Melbourne with branch offices and warehouses in Adelaide, Brisbane, Cairns, Perth and Sydney.
All rights reserved.
We pay the store, you take the goods the same day.
Choose how you pay - weekly, fortnightly or monthly.
Up to $1,000 interest free always or up to $1,000 with 6 months interest free.
Accepted here:
*A $6.00 monthly account fee applies. Pay your balance by the due date (the end of next month) and we'll waive the fee. See full Ts & Cs


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Nicer Dicer
Delevery All Over pakistan
Contact Number:03231075915
#NicerDicer #Price #Pakistan #Karachi #Lahore #Peshawar #zipperpk #Justdialshop
Genius Nicer Dicer Plus in Pakistan
Genius Nicer Dicer Plus
At Zipper.pk, If you're not feeling well and tired under-taking the wearisome and tedious tasks of slicing, dicing, and chopping, then possesses the answer for you because of the Nicer Dicer Plus. Currently say cheerio to the standard strategies of slicing, cutting and dicing and takes this procedure to a replacement level with this multiple Nicer Dicer Plusmachine. This new product is going to be positive your new room companion that produces the entire method of preparation easier. The Nicer Dicer Plus is accompanied by an oversized 1.5-liter capability instrumentality. This instrumentality comes in very handy significantly for storing several fruits, nuts, and alternative edible things. All you would like to try to is to press the lid of the slicer to start out cutting the food. The Nicer mechanical device and comes with 5 differing types of steel grills that facilitate to chop the ingredients in a very range of the way and designs. With the assistance of those completely different cutting extensions, users will cut the edible things in eleven completely different strategies.
Nicer Dicer Plus
The utile Nicer Dicer Plus is accustomed cut and divide the ingredients into four and eight components. Every cutting grill can permit you to chop the food into the completely different and distinctive ways that. This slicer is in the course of an obsessive grating device. This device is specifically designed potatoes, carrot, and cucumber. currently, you are doing not got to peel and cut the carrot into tiny items on every occasion you would like to create bowls of the dish as a result of the exact same purpose is accomplished by the employment of Nicer Dicer Plus.
The best factor regarding the Nicer Dicer Plus is that it comes with the airtight lockup lid. This airtight lockup lid makes it attainable to lock the crispness and freshness of food for the longer period. This versatile slicing machine is an excellent room companion for busy moms, housewives, victuals building, hotels and preparation dependent personnel.
Nicer Dicer Plus Review
utile manual slicing, dicing and chopping machine
Equipped with sharp stainless-steel blades
made up of highest quality food grade plastic
is used as knowledgeable grade chopper and mixer
aggregation is extremely straightforward
Disassembling is additionally on the straightforward facet
Safe to use
Rust Resistant end
1500 mil instrumentality
Safe for dishwasher
Genius Nicer Dicer Plus Instructions
withdraw strips and cubes
withdraw slices
For fruits or tomatoes
withdraw cubes
Protection Holder
Pressing unit
Cutting prime and cutting base
skilled peeler
withdraw shreds
Crisper container (POLYSTYRENE PS)
Why Choose Zipper.pk?
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Beginning on November 16, the DKC will offer Sunday night hours from 7PM-9PM. As we experiment with this new time slot, we will be holding tutorials in different locations. Check the DKC (ITCC 408) for posted locations on Sunday nights.
When available, tutors will accept walk-in tutorials, in addition you can book an appointment on this Web site.


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In addition to the wonderful ambiance and profusion of adult beverages, the food at the Tortilla Factory is also well-regarded. Owner/operator Chad Flaum describes it as 'Southwestern with a Mexican twist,' and it draws from Native American and Sonoran influences, combining the simplistic nature of their ingredients with modern cooking techniques. To protect the integrity of the recipes, the freshest ingredients are always used. Favorite entrees include green enchiladas, old town tacos, the red chile pork chop and the tasty grilled salmon. Complimentary homemade tortillas, with different flavors nightly, distinguish the Tortilla Factory from 'so-called' competitors.
When new offers are available from this business.


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$ 135.00
Because we believe in love at first sight. . . Our classic heart-cut Blue Topaz floats inside a Sterling Silver setting. An open design which allows light to illuminate the stone.
Heart-cut Blue Topaz with Sterling Silver floats on a 14k Gold Endless Hoop
Earring is approximately 3/4" in length (including hoop)
For additional Stone options, please contact the studio
Hand-crafted in Los Angeles, California
Designed to mix or match. How will you wear yours?
Stay up-to-date on all the studio news + upcoming events


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Precision Waterjet Cutting Services
Stainless Steel • Aluminum • Copper • Zinc • Hardwood
Stone • Granite • Glass • Ceramic • Acrylic • Composites
Does your business need precision cut parts?
Do you need a dozen, a hundred or thousands?
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Do you need a vendor to produce prototypes?
Call us. Our OMAX CNC waterjet cutting machine is available for contract cutting jobs. We're experienced in working with a wide variety of materials for a broad range
of applications.
Applications for Waterjet Cutting
• Mechanical parts, gears, tracks, flanges
• Assembly frames
• Decorative pieces
• Signs, letters, logos, symbols
• Custom counter top and floor inlays
Parts can range in size from less than a square inch
up to 60" x 120".
For questions or to receive a quote:
Contact P&L Specialties:
E-mail- email us: email@example.com
Call (707) 573-3141 x-113
• Sorting & Reception • Crush Pads • Destemmers • Pumps • Catwalk • Cellar & Vineyard • Punch Down • Food • Wastewater
• Services • Products • What's New • About P&L • Contact Us • Home
Website by Wavemaker


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'Queen and the Duke' Bowie Mercury 'Under Pressure' Illustrated Art Printby Eye for London Prints
'Under Pressure' Illustrated Art Print
This is an interesting 'upside-down' print.
Who do you love more? Freddie or David...or both? If thinking about it puts you literally 'Under Pressure'...this is the print for you!
Maybe you can turn it around every week!
The song was played live at every Queen concert from 1981 until the end of Queen's touring career in 1986.
"Under Pressure", evolved from a jam session that Bowie had with the band at Queen's studio in Montreux, Switzerland. It was credited as being co-written by the five musicians. The scat singing that dominates much of the song is evidence of the jam-beginnings as improvisation.
However, according to Queen bassist John Deacon (as quoted in a French magazine in 1984), the song's primary musical songwriter was Freddie Mercury – though all contributed to the arrangement.
Brian May recalled to Mojo magazine, in October 2008, that, "It was hard, because you had four very precocious boys and David, who was precocious enough for all of us. David took over the song lyrically. Looking back, it's a great song but it should have been mixed differently. Freddie and David had a fierce battle over that. It's a significant song because of David and its lyrical content."
Fine art Giclee Prints on Xpression smooth 300gsm thick paper available. (I love this, as the archival inks enhance the colours, on light texture) Reminds me a bit of the texture of concrete. (see last photo for Giclee texture ref)
Good to know:
- All prints dispatched within 7-8 working days.
- Shipping: Within UK : Royal Mail First class (1-2 Days Delivery after dispatch)
- If you want an expedited shipping, please message me for courier options.
- Rest of the World: 15-25 days after dispatch delivery by Royal Mail Tracked.
- International Shipping: Sometimes if deliveries were attempted and unsuccessful, the package is returned to the PO. Please look out for a delivery note.
- The prints are not framed. Please be aware that colours may vary slightly from what you see on your screen, depending on your monitor settings.


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I've just returned from a rather awkward and unpleasant visit to the optician…
Let me start by saying this is the same optician I've used for the last four years. I don't think we would ever be capable of being friends, but I don't have to like someone to "work with them". That's what being professional is all about. It's only once a year, so before now I've never felt the need to go elsewhere. That has probably changed now.
Issue 1:
It looks like the site maintenance is complete and from my perspective the DNS changes have gone through.
If you go to the homepage and see a message called "Site Maintenance" in the "Site News" section, it means you are being directed to the new server. If you don't see that it means you are still being directed to the old server and you won't be able to read this.
I guess it will take a few hours for the DNS changes to propagate. Last time I moved the site it took a couple of days to complete for everyone.
Just a quick heads-up to you folks…
On Saturday I'll be transferring my website and blog to a new server. It's with the same hosting company, so hopefully the DNS changes will not be too drastic.
The site is already in place on the new box and it seems to be working fine, so on Saturday morning I will do a backup of the MySQL databases and transfer them to the new machine, then initiate the DNS change.
The last time I did this, which was between different hosting companies, there were some issues in some geographical regions for a couple of days, but most people were seeing the site as normal within about an hour.
Note. If you happen to post on the forum or comment on a blog post during Saturday, it might be lost depending on the timing. Also, my email address my go wonky for a little while…
Fingers crossed…
While I was at BGOUG I went for swim each morning before the conference. That got me to thinking, perhaps I should start swimming again…
It's been 4 weeks since I got back from the conference and I've been swimming very morning. It was a bit of a struggle at first. I think it took me 2-3 days to work up to a mile (1600M – about 9M short of a real mile). Since then I've been doing a mile each day and it's going pretty well.
I get asked a lot of questions about Oracle! I find it amazing how often people will fire a question to a forum or social media and wait for response, rather than try the thing out for themselves. My response is often, "What happens if you try it?". In some cases, their response to that is, "I don't want to risk it on my production environment".
Yesterday I was making a small config change to some test WebLogic domains. The change required a restart, so that's what I did. The domains didn't start up properly…
Being the last person to change the config, it was obviously something I had done that had broken them. I did the usual stuff of checking the log files and noticed some messages about not being able to write to a swap file. I did a "df -h" and noticed the mount point for the WebLogic installation was full. A quick bit of clean-up and everything started up fine.
So the moral of this story is one of the following:
For quite some time I've had a specific policy on how I use social networks.
If Google were to characterise me based on my YouTube views, they would probably list me as some major conspiracy theory junkie. I watch a lot of conspiracy theory rubbish on YouTube, but for me it is light entertainment. I find it amusing to see how they try to present a bunch of random nonsense as science. Watch any of this stuff and you will hear the same types of phrases again and again…
Yesterday I was informed about someone stealing my content again. I take a pretty hard line to this these days. I used to be a little unsure about how to approach it, but now I just hit them with a DMCA take-down notice straight away. I've not got time to explain to everyone and their dog about copyright law…
So the current thief has nicked 35+ of my articles. I went to the WordPress.com DMCA Notice page and they say the usual stuff, except that you have to file a separate notice per blog post. All other services I've encountered allow you to post a single notice, listing all the offending posts. Not WordPress.com! (see update below)
I recently read the news that LogMeIn have stopped their free service. I'm not a big user, but it's handy to get into family PCs so I can sort stuff for them without having to talk them through things.
As I was reaching for my credit card to pay the yearly fee for LogMeIn, I noticed people speaking in the comments about alternative products, so I decided to give TeamViewer a go before parting with my cash.
The result is, it's fine. If you are a casual user of LogMeIn like me, you might want to consider trying TeamViewer out before parting with your cash.
Note. I don't have a problem with paying for software, I do it all the time, but if there is a free solution for something I only use on occasion, I'm probably going to go that route.
Captain Support…


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OOS 2019 Bird Walk Series
We are just now gearing up for our 2019 Bird Walks! Keep an eye on this page for more info as we add field trips in each of our supported regions. More coming SOON! (more…)
We are just now gearing up for our 2019 Bird Walks! Keep an eye on this page for more info as we add field trips in each of our supported regions. More coming SOON! (more…)
February22 – March 1, 2020
*** $400 from each registration will go to support the OOS conservation fund ***
Ecuador has the highest bird species diversity per square kilometer on the planet and offers some of the best birding in South America. Short distances to drive, good tourist infrastructure, and wonderful lodges and other facilities for birders – including a multitude of hummingbird and anpitta feeder stations, make Ecuador perhaps the most obliging destination on the continent!
Trip Price is only $4900
Double occupancy, excluding international airfare(Domestic flights included)
To register or for more information: Please email firstname.lastname@example.com
A deposit of $1000 per person is due upon registration and final payment is due by Sep. 15, 2019.
You must be an OOS member to register. Join Today!
For complete tour info, check out the itinerary below, or click here!
Alvin Miller, a local Amish young man, was the recipient of first prize from our annual membership drive, Zeiss Conquest HD 8×42 binoculars. Since I was the closest board member to Arvin, I was tasked with delivery of the bins.
Friend Su and I were out birding, were close to Millersburg, so decided to make delivery.
When we arrived at the address, we realized that we had chased a Harris's Sparrow at this Amish farm many years ago. After checking old records we found that the bird showed up on 1/27/2007 and stayed until 5/3/2008. It had been a very cold and snowy winter so far. Only 3 of us showed up for our annual Castalia trip so we decided to stay local and chase this rarity. Over 400 birders came to see this bird!
The amazing thing about this story is that the young boy who found this rarity, among a flock of White-crowned Sparrows, was ALVIN MILLER. He is now a hard-working young man. When we showed up he had just returned from work and was totally surprised. He knew nothing about the drawing since he did not see any ads for the membership drive or has internet access. He was just renewing his membership to continue with OOS. (Out of respect for the Amish, we did not request a photo.) After reminiscing with him about the Harris's Sparrow, seeing his smile, we said our goodbyes and went on our way.
Then, on February 18, OOS Treasurer Bruce Miller was honored to present Joy Alcalde with the 2nd Place prize from our annual membership drive!
Joy won a new pair of Vortex Optics Diamondback 8×42 binoculars. She was ecstatic to have won! She said the time could not have been any better as she will be leaving for a trip to Key West and is going to Dry Tortugas National Park! She is hoping these new binoculars will help her spot a Sooty Tern!
Congratulations, Joy! We hope these binoculars reward you with some great views of the birds for many years to come!
Third and fourth prizes were sent to Don Hollenbaugh and Ronald Baker via U S Mail.


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Chocolate Brown Removable Leather Hat Band
Chocolate Brown Removable Leather Hat Band
$ 17.00
Our genuine leather hat bands are the perfect add-on to your felt Gigi Pip hat. The chocolate brown band is complete with a brushed gold pin to ensure the band stays on your hat. Available in sizes 57 S/M and 59 M/L, make sure to order the hat band size that matches your felt hat size!
A great match with our Scottie.
Want to add another band to your collection? Check out our Leather Chain Hat Band.
Take a look at our all our Accessories.
More in this Collection
Back To In Stock


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So, Harley Quinn fans, we have some good news and we have some bad news.
The good news is that Margot Robbie will definitely be back as Harley at some point next year. The bad news is that not even she knows what film it'll be in.
(At least we're not the only ones confused, then.)
Chatting to The Wrap recently, Margot confirmed that she'll be back "in fishnets, wielding a baseball bat" next year. Apart from, that she's clueless.
When asked if her next role as Harley will be for one of the DCEU's standalone Joker movies, Margot replied: "Your guess is as good as mine at this point, I don't know."
Fortunately for Margot, her on-screen lover is also in the dark about what the plans for the Joker are, as Jared Leto recently admitted he was "a little confused" by everything.
Rumor has it that there are actually three Joker-related movies in the works over at Warner Bros, two with Jared Leto on board and one origin story separate from the DCEU.
"There are a couple of things happening in the DC world," Jared confirmed last week, adding that he was "excited" to see what comes from the other projects.
"I love the Joker. He's a great character and really fun character to play. But it's a big universe and when you play the Joker, there's no ownership there.
"You have the honor of holding the baton for a little while and then passing it off."
From: Digital Spy