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Five ways to celebrate, but keeping it classy!
1. Slow It Down. Don't race towards the finish line. Enjoy your drinks. It may be New Years, but the faster you drink, the quicker your night will end with you feeling horrible!
2. Know Your Limit. Keep your drinks within two glasses of your limit. Try not switch between wine, beer, mixed drinks and shots (this is never a good idea). Everyone wants a good buzz, but do you really want to be throwing up in an unknown bathroom before the clock strikes midnight?
3. Act the Part. Sometimes it can be more fun to pretend that you're drunk rather than actually being drunk. You're friends don't have to know that your playing a part, but if you can pull this off you will have more fun throughout the night, while remembering everyone else's stupidity. You might even have some fabulous stories to tell your friends the next day!
4. Full Stomachs and Hydration. Munch on appetizers throughout the night if possible. Please don't drink on an empty stomach, you won't make it past the first hour. Hydrate, hydrate, hydrate. Yes, we know you aren't working out, but if you drink water while enjoying that second glass of champagne, this will help with any potential hangover the next day.
5. PARTY LIKE IT'S 2015! Most importantly, enjoy your night with the friends and family you love! New Years is all about celebrating the Good, the Bad, and the Ugly from the previous year while welcoming in the Good, the Bad, and the Ugly for the upcoming year. Because let's be honest, as much as we want the New Year to be the best year ever, there's no guarantees so let's take the good, with the bad, and HAVE A PARTY!


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Coming soon to the Raleigh North Carolina area are two new Amtrak trains. Amtrak train 74 will be in Raleigh at 3:43PM and Amtrak train 75 is in at 11:50AM. These new trains will bring the total count to six trains that offer service through the Raleigh and Cary NC area. This will also offer the area railfan the chance to see two new Amtraks through the area. The service is between Charlotte NC and Raleigh NC to offer business traverlers more choices when traveling along the crescent.
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1 Response
Hello just wanted to give you a quick heads up.
Thhe text in your article seem tto be running off the screen in Firefox.
I'm not sure if this is a formatting issue or something to do with broowser compatibility but I figured I'd
post to let you know. Thhe layout look great though!
Hoope you get the problem resolved soon. Kudos

subset: commoncrawl


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Whether you need someone for just one day, several weeks or are looking for a new team member, we can provide your patients with the excellent care they expect and deserve. We understand that running a successful practice requires the right people.
Since 1986
Dental Resource Management has been serving the dental community of central Texas through the temporary and permanent placement of pre-screened licensed qualified dental professionals. Whether you need a dentist, hygienist, clinical assistant or business staff help, we have you covered.


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Abda Kazemi
Abda Kazemi fled war-torn Afghanistan with her family at the age of three. She was the first student at her high school to attend a U.S. institution and first generation in her family to attend university. She comes from a family of seven children and was raised in east London. She attended Mayfield School where she studied law, history, economics, and theatre.
As an active member of her community and Head Girl, she logged over 450 hours of community volunteering. Abda has represented 28,000 young people in the London Borough of Redbridge for UK Youth Parliament and invited speaker John Bercow MP to her school to inspire young people into politics. Locally, she was the chairman of the Redbridge Youth Council. Besides her academic pursuits, she enjoys sports leadership and has acted as a Youth Sport Trust young ambassador, which involved being on the national steering group and speaking at a leadership conference alongside Lord Sebastian Coe.
Before her acceptance to university, she was selected as one of 150 students to be part of the Sutton Trust U.S. Programme, a social mobility organisation that provides a range of activities for state school pupils to make the right decisions about American higher education. Being part of the programme made her ambition of studying abroad possible.
Abda is a final-year student at NYU Abu Dhabi majoring in Social Research and Public Policy (SRPP) with a minor in Arabic language. During her undergraduate experience, she took advantage of the American liberal arts education by exploring courses in theatre, graphic design, computer science, economics and political science. She spent her semester abroad with the Middlebury Program in Jordan, taking all her classes in Arabic and wrote a research paper in the host language on counter-extremism efforts in Jordan.
During her university experience, she travelled to Abu Dhabi (UAE), Kathmandu (Nepal), Washington D.C (USA), Entebbe (Uganda), Kerala (India), New York City (USA), Shanghai (China), Al-Ain (UAE), Amman (Jordan) and Cape Town (South Africa) for her courses as part of her undergraduate degree. During her leisure time, she has travelled to over 15 countries on five different continents with her peers from the NYU global network.
Her graduating class consists of 263 students representing 79 countries and speaking more than 65 languages, in a student population of 1250 students from more than 115 countries who speak over 115 languages. The diversity at NYU Abu Dhabi has shaped her thinking and provided her with a global perspective.
In the shortcoming future, she has ambitions of pursuing her Ph.D. in Sociology focusing on migration in the United Kingdom.
Her mother tongue is Dari; she has native proficiency in English and professional proficiency in Arabic.
Click here for the NYU Abu Dhabi – Commencement Speech


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How to Check Soil Acidity in Your Garden
The acidity of your soil plays a role in how well your garden grows. While there are plants that are happier in more acidic soil and some that are happier in more alkaline soil, neutral soil will accommodate the widest variety of plants.
To test the acidity of the soil in your garden, here are three ways you can find out what you and your vegetables are working with.
- Buy a professional test kit. A store-bought kit usually involves digging a small hole about 2-4" deep, filling it with water and then inserting a test probe into the resulting mud. A reading of 7 indicates neutral soil. A reading of 8-14 indicates alkaline soil, while a reading of 6 or lower means you have acidic soil.
- The cabbage method. Take one finely chopped head of red cabbage. Toss it into a pot of boiling water. The water must be distilled to ensure purity and accurate results. After 10 minutes, remove the cabbage. The resulting liquid should be violet. The violet liquid should be neutral (pH of 7). Fill a clean cup with the liquid and then add two spoonfuls of dirt. If the liquid turns pink, your soil is acidic. If it turns blue or green, your soil is alkaline. And if the liquid stays purple, your soil is neutral.
- Vinegar and baking soda. Take two containers and place a few spoonfuls of soil in each. In one container, add vinegar; if it bubbles, it is alkaline. If nothing happens, add just enough water to the second container to turn the soil into a thicker liquid consistency, and then add in baking soda. If the second container bubbles, your soil is acidic. If neither container shows a reaction, then your soil is most likely neutral.
Once you know the pH of your soil, you will be able to decide how and if you want to amend your soil to make your garden a success.


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by FIBA.basketball - 2 Dec 2018 - 19110 views
Re-watch the game between MKD and Kosovo from the FIBA EuroBasket 2021 Pre-Qualifiers Second Round.
Copyright FIBA All rights reserved. No portion of FIBA.basketball may be duplicated, redistributed or manipulated in any form.By accessing FIBA.basketball pages, you agree to abide by FIBA Copyright and legal mentions.
Your suplied Email address (firstname.lastname@example.com) does not seem to be correct


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TIGECYCLINE is a glycylcycline antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, the flu, or other viral infections.
This medicine is for infusion into a vein. It is usually given by a health care professional in a hospital or clinic setting.
If you get this medicine at home, you will be taught how to prepare and give this medicine. Use exactly as directed. Take your medicine at regular intervals. Do not take your medicine more often than directed.
It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or healthcare provider to get one.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
Side effects that you should report to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
breathing problems
fever or infection
high or low blood pressure
irregular heart beat
swelling of the hands or feet
unusual bleeding or bruising
unusually weak or tired
vaginal irritation or discharge
yellowing of eyes or skin
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
back or stomach pain
nausea, vomiting
pain at site where injected
trouble sleeping
unusual taste
upset stomach
This medicine may interact with the following medications:
birth control pills
certain medicines that treat or prevent blood clots like warfarin
If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.
Keep out of the reach of children.
If you are using this medicine at home, you will be instructed on how to store this medicine. Throw away any unused medicine after the expiration date on the label.
They need to know if you have any of these conditions:
liver disease
other chronic illness
an unusual or allergic reaction to tigecycline, tetracycline antibiotics, other medicines, foods, dyes, or preservatives
pregnant or trying to get pregnant
Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse.
Do not treat diarrhea with over-the-counter products. Contact your doctor if you have diarrhea that lasts more than 2 days or if the diarrhea is severe and watery.
This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.
Birth control pills may not work properly while you are taking this medicine. Talk to your doctor about using an extra method of birth control.
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Visitor mine
20 m below the ground, the museum maintains a visitor mine constructed to resemble a real mine, with a network of about 2.5 km of tunnels. Here visitors can see the impressive mining machines from close up, get an idea of the trials of day-to-day work underground, and feel like real miners for a little while.
Our soon to be opened new highlight, a simulated shaft descent, will make this impression even more life-like.
Themed tour: coal mine
Most of the visitor mine is devoted to coal mining. The actual mining activities include the creation of mine structures and the extraction of coal: an underwater tableau shows how the blind shaft, which had become flooded since its construction, was manually deepened in the 1960s. Two kinds of tunnel driving are shown: excavation with a full-face boring machine and with drilling and blasting. Coal extraction can be found at two workings with a chain coal cutter and with pneumatic picks, and in three longwall workings or faces. The first of these shows the use of a coal plough to shear off slabs of coal, combined with individual props for roof support (1950s/1960s), the second shows a shearer loader being used to cut coal, in combination with self-advancing supports (1960s/1970s). The third face fills in the technological gap between then and the present with equipment such as the double-drum shearer loader and powered roof supports. These are typical of the German coal-mining industry today, where the average length of the longwall faces is 300 to 400 m. The coal-mine themed tour also shows numerous items of equipment with logistic and safety-related functions.
Pneumatic pick
In the coal-mining industry, the pick or pickaxe, which had long been the main tool of extraction, was replaced in the 1920s by the pneumatic pick. From the mid-1950s the pneumatic pick was increasingly superseded by the coal plough and the shearer loader.
Today the pneumatic pick is only used for ancillary work.
Electric locomotive
In the complex tunnel network of an underground coal mine, many transport operations are carried out on railway tracks.
Today the locomotives are usually equipped with a diesel motor or an electric engine. In the past there were also benzene locomotives and compressed-air locomotives.
In the tunnel network of the visitor mine, which is around 2.5 km long, small electric locomotives are used for transport. One or two of these locomotives are usually to be found in the battery charging room, very close to the shaft.
Hammer drill
The pneumatic hammer drill, in use since the beginning of the 20th century, constitutes a major advance in the making of blast boreholes, which used to be laboriously drilled by hand. The drill column, which is also pneumatically driven, bears the weight of the hammer drill and generates the pressure needed for drilling. To reduce the risk of black lung disease, the drilling dust is extracted by suction or suppressed using water. These days hammer drills are used in situations where the use of a drilling jumbo is not possible or expedient.
Shearer face
On this face, the coal is cut out of the seam by a shearer loader. It represents the state of technology from the mid-1960s to the mid-1970s.
The single-drum shearer cuts the coal out of the seam as it moves in one direction, and loads it onto the scraper chain conveyor with its rake blade on its return.
The hydraulic self-advancing supports, here in the form of support props, prevent the rock from falling down. Behind the props, the rock is allowed to collapse.
Dahlbusch bomb
The first "Dahlbusch bomb" was built at the Dahlbusch mine in Gelsenkirchen in 1955. Here it was used to free three trapped miners, who could only be rescued through a drill hole.
The most famous use of a Dahlbusch bomb, known as the "Miracle of Lengede", took place in 1963. In this mining accident, ten miners who had been trapped for two weeks were rescued with the help of the "bomb" – miraculously unharmed.
A similar rescue device was used to free 33 miners in Chile in 2010.
Compressed air lamp
In coal mines the lighting has to be constructed in such a way that explosive mixtures of air and firedamp (methane) cannot be ignited.
The compressed air lamp is particularly safe in this respect. It only works if its protective glass cylinder is intact and airtight. If this is the case the compressed air drives a small turbine generator, thus producing electrical energy. If the glass cylinder is damaged, the compressed air escapes and no electricity is generated.
Mine bicycle
Mine bicycles are often used by tradesmen, who have to be able to get to their workplace at any time. Blasters, who are not allowed to use the passenger train with their explosives, also make use of bicycles. The mine bicycles are usually equipped with a second seat. The seat without pedals is most popular.
High tech underground
The visitor mine took several years to construct. In this period, the museum's miners removed 2500 m3 of rock, transported it to the surface, and excavated 100 m of new tunnels. Finally, around 27 powered roof supports, roughly 50 m of scraper chain conveyors, a double-drum shearer loader (cutting machine) and a continuous miner (tunnelling machine) were installed.
The result was a state-of-the-art longwall face, of the type generally to be found in the Ruhr today. Visitors can now see and experience a high-tech longwall face, the culmination of years of mining technology development.
Drilling jumbo
The blasting section in the visitor mine shows the state of mining technology at the end of the 1950s. The main equipment used for this is the pneumatic drilling jumbo. The rotary percussive drill can be moved by means of the boom.
Working with this drilling jumbo is less physically strenuous, as it only involves control levers. The noise exposure is high, however.
The following tasks are repeated constantly: drilling of blasting holes, blasting, removing the debris, and supporting (securing) the newly created cavity.
Plough face
The visitor mine's 80 m long plough face, in a shallow, 2 m thick coal seam, reflects the state of technology for roof support, extraction and backfilling in the 1950s and 1960s.
Individual props support the roof (the rock above the coal). A coal plough slabs off the coal from the seam and loads it onto a scraper chain conveyor. The cavity behind the face is filled mechanically with rock (pneumatic stowing). The filling material reaches the pneumatic stowing machine through a central pipeline.
Chain coal cutter
The chain coal cutter was powered by a pneumatic motor and had a chain fitted with picks – similar to a chainsaw – with which it was able to cut a groove a few centimetres wide into the coal face.
For greater stability, the machine was clamped between the roof and the floor of the tunnel. The groove made it easier to loosen the remaining coal with the pneumatic pick.
Tunnel boring machine ("mole")
Tunnelling machines are one way to create galleries in a mine.
"Full-face boring machines" are particularly effective; like the tunnel boring machine in the visitor mine, these cut a circular tunnel cross-section into the rock.
Extensive preparations are needed before such machines can be used. For example, they have to be assembled underground from individual components. This kind of tunnelling technology is therefore only worthwhile when particularly long galleries need to be excavated.
Tobias the mine horse
The mine horses were used for the transport of coal, rock and other materials. They usually remained underground for several years, and some eventually went blind. It is said that the mine horses were able to count: if more mine cars than usual were attached, the horses simply refused to move.
The last mine horse in the coal mines of the Ruhr district was called Tobias. He remained in service underground at the General Blumenthal mine in Recklinghausen until 1966.
Overhead monorail
The overhead monorail is a typical mode of transport in coal mining. It is mainly used near the working face, where no normal trains can travel.
The track of the overhead monorail is suspended from chains, so this system of transport is independent of the condition of the floor.
For shorter distances the main mode of transport used is pneumatically powered overhead railways (shunting trolleys). For longer distances, on the other hand, rope-hauled or self-propelling rail systems are more suitable, usually in the form of diesel trolleys.
Blind shaft
The floors (the different levels of a mine) are connected to each other by sloping galleries or vertical shafts. A shaft which only connects two or more floors of a mine is called a blind shaft, because it doesn't see the light of day.
In the recreated blind shaft in the visitor mine, the shaft gates can be opened and the swinging platform can be activated. When the platform has descended, wagons carrying materials can be pushed onto the pit cage, or people can enter the cage.
Themed tour: iron ore mine
The iron ore mining section shows how iron ore was extracted in northern Germany until the end of the 1970s, using the room and pillar system.
Between the rooms, part of the surrounding rock remains standing as a support.
One room shows how the ore is extracted by cutting, using a continuous miner. Three further rooms show extraction by drilling and blasting. Here self-propelling equipment is used: the drilling jumbo, the explosives truck and the loader use diesel motors to drive from one room to the next. In another room visitors can see a "part-face heading machine", which cuts out the rock with its movable cutter head.
Drilling jumbo
The drilling jumbo, manufactured by Hausherr, is equipped with a movable boom. The boom carries the drill, putting it in the right position to make the blasting holes. Blasting guidelines stipulate that these have to be around 3 m long and parallel; this is a prerequisite for a good blasting outcome, in which the cavity has the intended form and size after the blasting.
Continuous miner
The continuous miner is a kind of part-face heading machine with a flat cutting boom which can be pivoted up and down and sideways. The cutting bits are mounted on rotating chains, making it possible to cut a rectangular tunnel cross-section. The rock is transported to the discharge boom via a conveyor device. The continuous miner moves on crawler tracks.
Double lateral chain scraper conveyor
The double lateral chain scraper conveyor is used to transport the blasted rock, i.e. the debris. It is very robustly built for this purpose. It consists of a line of steel conveyor troughs in which a continuous chain belt revolves. Drivers or scrapers mounted between the two chains on the outside push the rock from the loading point towards the discharge point. The power unit with electric motor and gear mechanism is mounted on the side at the discharge end.
Joy front-end loader
The front-end loader manufactured by Joy has an "articulated steering" mechanism between its two axles. This makes it very manoeuvrable, and able to handle very tight curves. At the front end the loader has its loading bucket, which digs into the debris with considerable force as the loader drives forward, and fills with rock. The loader than drives to the unloading zone with the rock. In contrast to the continuous conveyors (belt conveyors and scraper chain conveyors) this is what is referred to as shuttle haulage.
Scraper loader
DThe scraper loader is a robust, versatile loader, which was in widespread use up to the 1960s. The rock which is to be removed is moved by a scraper bowl to the loading platform, where it is transferred by cable hoist to a scraper chain conveyor. The scraper bowl can be moved forwards and backwards by means of cables and rollers. Its weight makes it dig into the debris and fill with rock. Because of its construction, the scraper loader is also suitable for operation in places with steep gradients.
Part-face heading machine AM 50
The Alpine Miner type part-face heading machine has a cutting boom that can be raised and pivoted, with a transverse cutting head. This is fitted with bits which cut the rock out of the groundmass. A pincer-like device loads the cut rock onto a scraper chain conveyor, which ends behind the machine as a discharge boom. The crawler tracks increase the mobility of the part-face heading machine.
Unimog explosives truck
The explosives truck has a storage container at the back for loose, granular blasting material, a mixture of ammonium nitrate (AN) and hydrocarbons (C), e.g., chemical fertilizer and diesel oil, which is very safe to handle. This 'ANFO' (ammonium nitrate/fuel oil) explosive is blown into the blast holes through a hose pipe using compressed air. The compressed air needed for this is produced on the vehicle by an electric compressor. The explosives truck is equipped with a cable drum at the front to connect with an external power source.
Belt conveyor
The belt conveyor is a conveyor which is in continuous operation. It consists of a steel construction with belt rollers, over which a continuous rubber belt is moved. This rubber belt transports the rock and also serves to transmit power. The belt conveyor is less robust than a scraper chain conveyor. Thus the very coarse debris generated by blasting has to be crushed in a crusher first. The finer rock produced by the continuous miner, however, can usually be extracted straightforwardly without any further crushing.


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eCommerce (also known as 'electronic commerce') refers to business conducted online. At one time, the term included only web businesses such as Amazon and Travelocity that transferred a real world paradigm – buying books or booking flights — to the Internet. But heading into the second decade of the 21st Century, practically all business is conducted online in some way and eCommerce includes a wide range of subject matter, whether it's downloading an app, clicking on an adword at a blog, licensing content from iStockphoto, or purchasing a legal form. In fact it's hard to imagine a business without some eCommerce element. In this section we look at all of the legal issues affecting eCommerce 2.0.
If you want your website to succeed — whether you are creating a simple two-page online shop for a local jeweler or a thousand page site for a Fortune 500 company — you'll need to understand basic legal and business principles. This section provides the basics for developers and those who contract for website development with a focus on contracting, intellectual property and the patchwork variety of website related laws and regulations.
Many sites post "terms and conditions" somewhere on the site. Do you need them, too? If you have anything more than a small, information-only site, you probably do, covering topics like copyright, returns, and limiting your liability.
If your site sells products, you may need notices regarding credit card use, refunds, and returns (known as "transaction conditions"). For example, you might want to announce that your business will accept returns up to 30 days after purchase.
You may also want to include disclaimers — statements that inform customers that you won't be liable for certain kinds of losses that might incur. For example, you may disclaim responsibility for losses that result if pottery breaks when a customer ships it back for return.
If you are gathering information from your customers, including credit card information, you should post a privacy policy detailing how this information will be used or not used. Yahoo!'s privacy policy ( http://privacy.yahoo.com) is a good example of a broad, easy-to-understand policy.
You can check out other policies by typing "privacy policy" in a search engine. Pick and choose the elements that apply to your site. Whatever policy you adopt, be consistent, and if you are going to change it, make an effort to notify your customers of the change.
If your site provides space for chats or postings from the Web-surfing public, you'll want to limit your liability from offensive or libelous postings or similar chat room comments. There are three things you can do:
Regardless of what your site does, you should include notices regarding copyright and trademark — for example "Copyright © 2006 RichandAndrea.com" or "Cyzuki is a trademark of Cynthia Lloyd."


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Tru Stockholm is taking place on 9 and 10th March at the Monster.se offices in Stockholm, Sweden. Here is a round-up of the content realted to the event. I'll add new posts to the bottom of the lists as and when I find them.
I created a blog for the event on posterous and will include some of the links to that in this list.
Swedish Metro reports on the unconference
Andy Headworth rounds-up day one – Day one from the #Trustockholm recruiting unconference.
My view on day one – Learning together at #trustockholm
Photos from day one from Social Honesty in their Facebook album
Jorgen Sundberg gives his slant on day one (as a Swede now living outside of the country) – Social recruitment at #trustockholm
My post on humanising the sourcing/application process – Time to humanise the application process
My post: The global recruitment challenge for Sweden
Article on Internetworld (Sweden) – I have translated the page using Google Translate – How to recruit you in to social media
Andy Headworth does a great job summing up day two and the whole falvour of the event (check out the picture captions) – Day 2 and my overall thoughts on #trustockholm social recruiting unconference
Stefan Liden provides his thoughts on Tru Stockholm – read the article in Swedish – and here is the Google Translate version – How will social media change the recruiting landscape and the way we look for a job
My post for UK Recruiter – The Swedish Recruitment challenge
Bill Boorman on why job seekers will always go to a job board first – Why jobseekers will always use job boards first #trustockholm
Mattias Gronborg explains why he attended the unconference and what he got out of Tru Stockholm – Unconference #Trustockholm
Stefan Rizvi reflecting on #trustockholm Swedish recruitment challenges
Rob van Elberg talks relocation recruitment
Torgil Lenning on the need for Swedish recruiters, HR and candidates to embrace HR
Jorgen Sundberg reflects on day one of #trustockholm
Gordon Lokenberg talks recruiting and augmented reality
Ralph Sijl gives his thoughts on #trustockholm
Thanks to some great snappers at the event (I am not including myself, by the way!):
Great set of pictures from Oscar Mager
220 (yes, you read that correctly) great pictures from Sara Headworth
My pictures of getting there and setting up
And some of my pictures of day one
Oscar Mager has produced a great Animoto of his pictures from Tru Stockholm
Guess who is the monster – video by Oscar Mager
Also by Oscar – video of augmented reality Pacman – which Gordon Lokenberg demonstrated to kick off Tru Stockholm
Fron the content track – delegates describe Tru Stockholm in one word


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American Academy of Pediatrics (AAP)
This website provides information on a range of child health issues, including vaccines and immunization. The AAP is dedicated to improving the social, mental, and physical health and well-being of children.
Author: American Academy of Pediatrics
» Visit website (English)
(Located at www.aap.org)
Resource types: Website
Diseases/vaccines: Not disease/vaccine specific
Topics: Organizations and coalitions
Regions: North America and Europe


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Sayedah Sharifa
I have been fortunate to visit Sharifa daughter of Imam Hassan, and last time there was an hall in which to pray in, now it is literally only the Zarih. So you pray Salaat under the skies – my kind of Salaat.
For those who are not well, ask in the name of Sharifa that they are healed.
We didn't wait around, we got off the coach with our rucksacks and went straight to Baynul Haramain to say Salaam. I knew I was going to see Imam, my mind had acknowledged the fact that I was in Karbala, but I don't think my heart had fully accepted it. So upon arriving and seeing the majestic gold dome, all I could say was Thank You. Thank you for everything.
BH was really quiet especially when it was so close to the 10th day. But there were still processions going on – today was Shah Qasim's procession.
We thought that we would get back just in time for our room to be ready. Apparently, the group was too efficient this time, and they were wondering where we had gone.
Maghrib was once again under the starts – in BH.
We planned this so we would be able to listen to Dua Kumayl, however, they never recited it. After Ziyarat Ashura there was nothing. Once again I have missed Dua Kumayl in Karbala, inshallah I will be invited again and will be able to experience this wonder.
Ziyarat Ashura was on point though, when people were facing Imam Hussain and recited the following together, gives you goosebumps thinking about it:
Peace be upon you, O Aba-`Abdullah
and upon the souls that gathered in your courtyard.
Peace of Allah be upon you from me forever
as long as I am existent and as long as there are day and night.
May Allah not cause this (visit) to be the last of my visit to you (all).
Peace be upon al-Husayn,
upon `Ali ibn al-Husayn,
upon the sons of al-Husayn,
and upon the companions of al-Husayn
We figured that there was no Dua Kumayl because of the processions that were coming out and you wouldn't be able to hear. Shah Qasim decked in green and young boys following him, puts the picture in your head of what happened on that day – he really was ready to die for the Imam of his time despite being young.
Due to the rush, we figured it would be hard to go inside, and thought the best time to go was at a quieter time where we could engulf ourselves in the scent of the Imam Hussain and Abu Fadhil without being pushed from all sides and decided to call it a night.


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Managing for the Bigger Picture
with Kurt Reinhart
Target audience: Executive
"I just wish my manager acted like they owned the business and…" You fill in the blank. Having a manager with an entrepreneurial mindset is a common request by owners, particularly as they grow the business. The bad news: You cannot simply motivate a manager to become entrepreneurial. The good news: It is possible to introduce entrepreneurial best practices into their skill set.


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As I work with and choose leaders, there are key aspects that are important to consider. Years ago, my mentor, Dr. Gordon Stephens talked about three areas: Character, Competencies and Chemistry. I also heard the first three, plus one additional, Culture, in a conference with Andy Stanley at Northpoint Community Church a few years ago.
There are three more C's, I would like to add to the list along with some key questions in this blog post. This will assist us as we are choosing staff or appointing leaders on our board, business and other volunteer service areas.
When choosing leaders so much of it has to do with:
- Character
These are people whose values and beliefs are not just talked about they are lived out in their lives. They have integrity, honesty and strength of who they are in their everyday decisions and interactions with people. A few years ago my Mother gave me a birthday card with me sitting on my Grandpa Pifer's lap when I was about 18 months old. He was one of my heroes growing up along with my Dad and my other Grandfather. The card was surrounded with three words: Honesty, strength and integrity. Words of character lived out in these men's lives were modelled for me. I also want to be known as a leader of godly character.
Key Question: Is this person growing in and known for Christ-like character and integrity?
- Calling
For some, this might be passion since it is such a popular word in our daily culture. Calling is much deeper because passion can run out when the going gets tough. A called person is persevering, they are focused. They have been designed uniquely by God to fill the needs and develop the area of responsibility they have been assigned. Calling is multi-dimensional. It involves a person's choice, their energy, skills, makeup and giftedness coming together in a God-given desire to contribute and serve the cause of Christ with clear commitment. This goes beyond moving somewhere for a job or comfortable ministry. Fulfilling a calling can be painful, inconvenient. The motto of the called person, "If I can't do this I die; I am willing to pay the price."
Key Questions: Is this person called to this role or do they see this as just another job? Are they willing to pay the price?
- Chemistry
This aspect is important because you want a person you are introducing to fit, contribute, and have a vital role in strengthening your team. Will they click with the other team members and mix well to assist the staff to move ahead to pursue the organization's vision, mission and goals? Find out how they react under pressure from others and whether they are an explosive mix or when added to the team they contribute to a healthy environment. Will adding them produce a synergy of relationships?
Key Question – Will they add to the mix of the team or will they disrupt and cause unnecessary tension and an explosion?
- Culture
When hiring someone you need to consider the culture they are coming from and the culture they are coming to in your decision. Do they understand what you do as an organization? What are the traditions of that business or institution? Traditions, develop in new and older organizations. We all have them. Will this person be able to fit into the current culture? Will they match up with the mores, shared beliefs and practices of the team?
In the church setting do they line up with the doctrinal statement, philosophy of ministry, vision, mission and ministry priorities set out by the Pastor and Elders' board? Attitudes also have to be taken into account along with their skills, education and expertise. One thing you have to question is whether their qualifications, educational training and experiences stretch our current culture to align us for greater mission effectiveness and growth.
Key Questions – Will they be able to adapt, learn and grow in our culture? Will they also stretch us to have a healthier staff culture?
- Competencies
These are the skills and the abilities that people bring to the position to fulfil the requirements of a given job. Look at their experience and education. Find out who they have worked under to determine where their strengths and skills have benefitted others. What have been their strengths and accomplishments in serving previous organizations? What have they done? In recent years one of the most important factors to consider is the Emotional intelligence (EI) or relational intelligence of a person as a competency.
Key Question: Do they have the skills, abilities, training and emotional intelligence to get the job done?
- Cognitive Abilities
As we seek staff members, we want them to be able to think, research, develop strategy, set goals, tactics and adapt while being in alignment with the mission and vision of the organization. Does their knowledge puff them up? Are they still teachable? Are they "lifelong learners" who have a submissive attitude rather than one of pride or superiority? Just because a person is an expert in one area does not make them an expert in every field. That is why good leaders will have smarter people around them to complete and improve their team IQ. Those using their knowledge will also demonstrate wisdom in their tasks and interactions with others. It is not about the educational degrees a person possesses but how much they have applied their education and experience to life. In other words are they "know it alls" or are they wise?
Key Questions: Do their knowledge, experience and education translate into wise living? Are they still teachable?
- Christ-Centeredness
The last aspect as I am looking for leaders is a Christ-centered or God-focused life. Who is the centre of their life? Who motivates them? What is the purpose of their life? Do they have strong Biblical values? Tough questions, but if we are to have the right people on our teams we need people who definitely have Jesus Christ as Lord of their lives especially in the church. Christ must be the centre as the Apostle Paul relates in Galatians 2:20. Faith in Christ produces faithful people who are available to the work, ministry and perform not for themselves but as servants of Jesus Christ. If Christ is indeed Lord, their attitudes are different as well. They pulse with the life of Christ, and it is contagious to others around them. Christ-centered leaders leave self-centred leaders in the dust.
But what about business leaders making choices about people. Sure people who have Jesus Christ should bring an advantage to your company. If this is not the case for you. What are the values demonstrated by a potential hire? Where do their beliefs come from? Why do they make the choices they make? Who are they following and why? Getting to these questions determine who is really the master of their life. You do not want someone self-absorbed but someone who is other focused.
Key Questions: Who is at the centre of this person's life? Does their talk, attitudes, actions and habits demonstrate a Christ focused life?
If you have further questions. Let me know. If I can coach you with some tools or help in your search for the right staff people in your church or organization I will be glad to assist or direct you to the right people.
For now, I hope the seven C's of hiring will help you in the search for the right people for your team or organization.


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Han Han has spoken out on the issue of Google. His latest blogpost: "I am Just Speculating" is on this very topic. Roland Soong has translated it into English. (The original has already been "password protected" on Han's sina blog):
2016: The number of Internet users in China drops down to 1 million. All websites are merged into a single website. It does not matter what URL you enter because you will be sent to that website. The updates are based upon the People's Daily. In the same year, the Internet industry disappears in China. This directly or indirectly causes 5 million people in Internet-related industries to lose their jobs. The disappearance of e-mail means that the previously closed but now revived Postal Office hires 100,000 of them. 4.9 million people still have no jobs. At the same time, almost 1 million Fifty-cent Gang members lose their jobs. The Fifty-cent Gang members complain that they worked like dogs for their whole lives and now they don't even get pensions.
2016: The People's Daily wrote: An industry was sacrificed in return for the stability of the nation, but it was worth it.
2016: The 1 million jobless Fifty-cent Gang members have no other skills and therefore could not find new jobs. They could not make feed themselves. Several tens of thousands of Fifty-cent Gang members gather in Beijing. During Children's Day, 150,000 Fifty-cent Gang members sit down in front of the government building to conduct a silent hunger strike. They ask the government to arrange jobs for them, give them credit for their prior work, and grant them public service worker status retroactively. The People's Daily writes that the government never had the job position of Internet commentator. Therefore, all those Fifty-cent Gang members wrote on their own. The Fifty-cent Gang members are unable to show any labor contact to prove that they had an employer-worker relationship with the government.
The spokesperson for the Fifty-cent Gang members say that they were underground agents who had done great work on behalf of national stability.
The government gives the Fifty-cent gang members three days to leave Beijing or face arrest. People's Daily writes that if one praises the government, one should not apply pressure on the government. Praising the government cannot be a condition for obtaining money. Praises should be uncompensated.
2016: The Fifty-cent Gang members continue the hunger strike. The citizens say that they support the hunger strike by the Fifty-cent Gang members fully. But they do not provide any food to them and they block all channels of bringing food. Also, they will make sure that the Fifty-cent Gang members continue on their hunger strike.
The next day, Minister of Culture Yu Qiuyu visits the scene of the hunger strike and reads the "Tearful advice to the Fifty-cent Gang." The Fifty-cent Gang members say that Yu Qiuyu's speech is too profound for them to understand.
2016: The Fifty-cent Gang is accused of the crimes of illegal assembly, illegal march, illegal demonstration, attacking the government, violent resistance against the law, smearing the government, endangering public security, disrupting social order, spitting in public, etc. The organizers are arrested. But the government says that they will be lenient towards blind followers who don't know the truth and offer them an opportunity to reinvigorate themselves: they give 50 cents to each of them to feed their hunger.
comments on the scene: Fifty-cent Gang members see fifty cents and break out in tears.
2016: The Fifty-cent Gang crisis is peacefully resolved, once again showing the ability of the Party and the government to maintain stability. The Fifty-cent Gang leader tells the CCTV reporter on camera: "I am so sorry about before."
More articles about Han Han are here on CDT.


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Sir Nemo
A chess addicts road to mastery...
Monday, May 27, 2013
Results: UPDATE
Ok so the tournament results have been posted and my new rating is
! That's a jump of
rating points in one tournament! I'm quite pleased with this result and look forward to my future progress as a player. I have a strict study plan set up for when I finish with this certification course. For a list of tournaments that I will be participating in next:
1st Annual Summer Solstice Showdown, June 22 - 23, 2013 [
Albuquerque/Rio Rancho Open, June 29th-30th, 2013 [
I'll keep you posted as the time nears for each of these tournaments :]
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Sir Nemo
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Sunday, May 26, 2013
Tournament Results!
Well today was the day of the Denver Memorial Day Weekend G/30. I was up bright and early and ready to play some chess! I was really nervous going into this tournament being that it was my first in 5 years. I didn't let the nerves psyche me out, however, and I performed quite well! I beat an 1858, 1557 and 1550 and lost to a 2078 and a 2000, giving me a score of 3.0/5.0 which was good enough to win my section and a hefty $60 for my efforts!
Here's a list of my opponents and the score by round:
Jules Carter
(1134P) vs.
Isaac Martinez
Daniel Herman
(1557) vs.
Jules Carter
Jules Carter
(1134P) vs.
Mark A. Jimenez
Buck Buchanan
(2000) vs.
Jules Carter
Tim Kohler
(1550) vs.
Jules Carter
Now I must study for a certification for work so I'll be back in about a month or so! If you need to find me, you can leave a comment here or write to me on chess.com :D
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Sir Nemo
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Wednesday, May 22, 2013
Here we go again!
Well it's been YEARS since I've last made an appearance here and I must say loads of things have happened and changed in my life. I want to get it off my chest that this post will be about my return to chess after 5 years of not playing. I will give my story and what I plan for the future of this blog...
Where has Sir Nemo been? Oh man, I've been all over the damn world. Jumping from hobbies and obsessions like I was changing underwear. My last post was May, 2009. As some of my loyal readers remember, I had started dabbling in poker and I had a somewhat newborn I was learning how to take care of. I was also engaged to my son's mother and had plans to get married...
Well, things didn't work out with me and Brandon's mom. It ended on pretty bad terms and I won't go into much detail about it but the outcome was a major plus for me, as it meant I got my son the majority of the time. This happened in late May of 2009. Shortly after, I quit playing chess so I could focus on poker and really start to take it seriously. In June, 2009, I was invited to move to Austin, TX to live at the SNGIcons mansion with all the big name online tournament players at that time. I learned a lot about poker and I was on my grind. I managed to build up a quite impressive bankroll of around $8.5k in 6 weeks but I had also developed another 'hobby'. It's not something I'm proud of but let's just say I spent a good portion of my winnings on it and nearly cost me my life. I moved back home to Albuquerque, NM nearly empty handed... I believe I had $500 to my name when it was all said and done. I had hit rock bottom. No motivation, no ambition. Nothing. I was an unemployed father who lived with his parents, with a child of his own. I thank the good Lord my parents were there to help me raise my son as I would not have been able to do it on my own.
After a period of a couple of months, I was at a friends house and was watching him and one of my brothers playing a video game on the XBOX 360 called Call of Duty. I hadn't played a video game since Quake III Arena and this game looked appealing to me. I went out and purchased a console and the game and was quickly obsessed with yet again another useless game. I got damn good at the game and started competing on Major League Gaming's Game Battles website. After about a year, I had reached the #1 spot for best 1v1 sniper back when the Game Battles had the sniper ladders. I held that title for 6 months before I was bumped from the top. I started making YouTube videos of my gameplays and montages of my best clips. I was so hooked and looking back on it, it was [
] a complete waste of my time and life... I say almost, because there was something really great that happened because of my video gaming that will always be important and relevant for the rest of my life. I'll get to that next...
One evening some friends I knew in real life and myself were playing some Call of Duty: Black Ops when one of our friends invited one of his friends and his friend's ex girlfriend into our party. Now if you've never played a video game in your life you won't understand what it's like when a girl joins a game or lobby. All the horny geeky guys go goo-goo and do their best to try to get her to talk to them. I wasn't one of those guys as I typically viewed gamer girls as how girls view gamer guys... fat, ugly, full of acne and generally smell bad. I had asked my friend who invited her what she looked like and he had said she was fat and ugly. To be fair, his friend (who was her ex) was present when he said this to me.... Anywho, I digress... After a few months went buy of all of us playing together and me never really talking to her aside from making her laugh every now and then and vice versa, the gang decided to meet up at the annual Comic Con in Albuquerque. Normally, I wouldn't go to a Comic Con... but the actors from The Boondock Saints were going to be there and since that's one of my all-time favorite movies I just had to be there. Turns out, she was going to be there and even showed up at my house to pick me up with one of our mutual friends. That was the first time we met in person. We really hit it off and started talking daily. I don't want to get all mushy so I'll sum it up by saying that we quickly fell in love. She's my best friend and there's not a single person on this planet that understands me better than her. Shortly after getting together, she got pregnant and 9 months later our beautiful daughter was born.
During this time, my new loves in my life completely motivated me and gave me the ambition I needed to be a real man and get off my ass to find work. When all was said and done, I managed to get a job up in Denver, Colorado as a Penetration Tester. If you don't know what that is, it's a politically correct way of saying 'professional hacker' or 'hacker for hire'. This is by far the best job I've ever had and I'm damn grateful for having it. You can check out my main site at http://www.daftandcurious.com for random articles and tutorials on infosec stuff. Life is good now, and I will continue to make it better from here on...
Now we can get to the chess! w00t! Up until about a month ago my hobbies still consisted of lots of Call of Duty. I love the game, what can I say. However, my problem was that I was getting too damn frustrated all the time and would often let it effect my emotions outside of the game. I had to stop. I've always said that chess was my passion, and thus here we are. I started playing again about a month ago. I dabbled in a few games on chess.com on my old sir_nemo account and quickly realized that I had much to remember. But the fire was re-ignited and it was game on! I started going through whatever books I still had from 4-5 years ago and I quickly got back up to speed; nearly to the point of where I left off before I quit playing.
I've created a new chess.com account so that I could start fresh. I've also played a few slow games on my old FICS account (SirNemo) and have won every one of them. I will update the sidebar with my current stats once I've finished posting this.
There are a couple of tournaments coming up that I will be participating in:
May 26 - Denver Memorial Day Weekend G/30+5s
June 22-23 - 1st Annual Summer Solstice Tournament
June 29-30 - Albuquerque Open
I also plan on starting the 7 Circles again on July 15th. I've dabbled a little with the CT-ART program and got a 100% on the problems with difficulty level 10. I know this is not that impressive of a result as I'm sure most of you can do that by now, but the fact that my tactical abilities are still present after 5 years of not playing really shocked me.
I will let you guys know how the May 26th tournament goes this weekend. As we all know, I usually go into a tournament overconfident and wind up playing terribly. Lets see if the mature version of my prior self can overcome this obstacle and prevail finally!
Until next time!
- Sir Nemo
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Jon Stewart's Final "Daily Show" Was An Emotional Rollercoaster
After 16 years of "The Daily Show," Jon Stewart's jokes and sarcastic political remarks came to an end last night on Comedy Central. The late-night talk and news satire television show aired Monday through Thursday every night featuring guests from celebrities to politicians, and Jon Stewart's jokes made viewers laugh around the world. Jon's long opening monologues about current headlines sparked laughter his satirical remarks about poltical figures made even the politicians themselves laugh.
But last night, the show had its final hoorah, with Jon Stewart saying (as if nobody knew), "Guess what? I've got big news. This is it." And with it, some of Stewart's political and celebrity targets joked back, with Wolf Blitzer "wishing" Stewart a fairwell saying, "Screw you, Stewart," and Bill O'Reilly calling Stewart a "quitter."
Last night wasn't all jokes and laughter, however. Jon Stewart shed some tears when Stephen Colbert thanked him for the opportunities he provided him. (If you didn't know, Colbert started his career on "The Daily Show" as a correspondent, and then moved to his own show, "The Colbert Report.") Colbert said to Stewart, speaking on behalf of all the people he's helped, "We owe you, and not just for what you did for our careers … we owe you because we learned from you."
So what's next for Jon Stewart now that's he's left "The Daily Show?" Will he fill the void in his schedule? Standup, directing, producing or even spending more time with his family are among the possibilities. Closing out his show, we know for certain it wasn't a "goodbye" as the comedian said, "Rather than saying goodbye, or goodnight, I'm just going to say: I'm gonna go get a drink."


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Quantitative Echocardiographic Determinants of Clinical Outcome in Asymptomatic Patients With Aortic RegurgitationA Prospective Study
Author + information
- Received September 10, 2007
- Revision received October 11, 2007
- Accepted October 18, 2007
- Published online January 1, 2008.
Author Information
- Delphine Detaint, MD,
- David Messika-Zeitoun, MD,
- Joseph Maalouf, MD,
- Christophe Tribouilloy, MD,
- Douglas W. Mahoney, MS,
- A. Jamil Tajik, MD, FACC and
- Maurice Enriquez-Sarano, MD, FACC⁎ (Sarano.maurice{at}mayo.edu)
- ↵⁎Reprint requests and correspondence:
Dr. Maurice Enriquez-Sarano, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Objectives The purpose of this study was to define the link between aortic regurgitation (AR) quantitation and clinical outcome in asymptomatic patients with AR.
Background Quantitative American Society of Echocardiography (QASE) thresholds are recommended for AR assessment, but impact on clinical outcome is unknown.
Methods We prospectively enrolled (1991 to 2003) 251 asymptomatic patients (age 60 ± 17 years) with isolated AR and ejection fraction ≥50% with quantified AR and left ventricular (LV) volumes using Doppler-echocardiography.
Results Survival under medical management was independently determined by baseline regurgitant volume (RVol) (adjusted hazard ratio [HR] 1.22 [95% confidence interval (CI) 1.08 to 1.35] per 10 ml/beat, p = 0.002) and effective regurgitant orifice (ERO) (adjusted HR 1.52 [95% CI 1.19 to 1.91] per 10 mm2, p = 0.002), which superseded traditional AR grading. Patients with QASE-severe AR (RVol ≥60 ml/beat or ERO ≥30 mm2) versus QASE-mild AR (RVol <30 ml and ERO <10 mm2) had lower survival (10 years: 69 ± 9% vs. 92 ± 4%, p = 0.05) independently of all clinical characteristics (adjusted HR 4.1 [95% CI 1.4 to 14.1], p = 0.01) and lower survival free of surgery for AR (10 years: 20 ± 5% vs. 92 ± 4%, p < 0.001, adjusted HR 12.9 [95% CI 5.4 to 38.5]). Cardiac events were considerably more frequent with QASE-severe versus -moderate or -mild AR (10 years: 63 ± 8% vs. 34 ± 6% and 21 ± 8%, p < 0.0001). Independent determinants of cardiac events were quantitative AR grading (QASE-severe adjusted HR 5.2 [95% CI 2.2 to 14.8], p < 0.001; QASE-moderate adjusted HR 2.4 [95% CI 1.06 to 6.6], p = 0.035), which superseded traditional AR assessment (p < 0.001) and LV end-systolic volume index (ESVI) (adjusted HR 1.09 [95% CI 1.03 to 1.14 per 10 ml/m2], p = 0.002), which superseded LV M-mode diameters. In QASE-severe AR, patients with ESVI ≥45 versus <45 ml/m2 had higher cardiac event rates (10 years: 87 ± 8% vs. 40 ± 10%, p < 0.001). Cardiac surgery for AR reduced cardiac events in patients with QASE-severe AR (adjusted HR 0.23 [95% CI 0.09 to 0.57], p = 0.002).
Conclusions Echocardiographic quantitation of AR severity and ESVI provides independent and superior predictors of clinical outcome in asymptomatic patients with AR and ejection fraction ≥50% and should be widely clinically applied. Patients with QASE-severe AR and ESVI ≥45 ml/m2 should be carefully considered for cardiac surgery, which reduces cardiac events risk.
In patients with aortic regurgitation (AR), symptoms of heart failure (1–3) and reduced ejection fraction (EF) (3–5) are major determinants of outcome definitely indicating aortic valve replacement (6). However, in asymptomatic patients with preserved EF, predictors of survival after diagnosis are uncertain (7–9). These uncertainties stem from low mortality rates in young and healthy populations enrolled in natural history studies (7–9), contrasting with those observed in clinical practice (3), or from lack of a specific measure of AR severity (10). Hence, high-risk groups among asymptomatic patients with AR and left ventricular (LV) EF ≥50% are poorly defined, so that surgical indications remain unclear and are rarely applicable on the basis of current clinical guidelines (6).
However, recent guidelines endorsed by American and European cardiology societies noted limitations of standard qualitative AR assessment (11,12) and LV assessment by diameters (13,14) and emphasized importance of quantitative measurements. These guidelines provided quantitative American Society of Echocardiography (QASE) thresholds for AR grading (10) and recommended LV volume quantitation (15) for improved LV assessment (16,17). However, the role of quantitative echocardiographic measurements in predicting outcome of asymptomatic patients with AR is unknown. For this purpose, we prospectively enrolled asymptomatic patients with AR and EF ≥50% in whom we quantified AR and LV volumes at diagnosis with Doppler echocardiography to analyze outcome according to quantitative AR grading. We hypothesized that quantitative echocardiographic measurements (specifically QASE AR grading) independently predict clinical outcome and define high-risk patient subsets.
Study design
The study design was approved by institutional review board to: 1) prospectively enroll patients with AR in whom the authors quantified regurgitation and LV volumes at diagnosis; 2) have patients forming this cohort clinically managed by their independent physicians (with all information available); 3) complete all off-line echocardiographic measurements in a secure database; and then 4) record all deaths, cardiac events, and aortic valve surgeries during follow-up by their independent physicians. This design was chosen to minimize investigators' interference with patients' management, limit healthy participant bias by not requiring mandatory follow-up appointments (3,7), and ensure baseline data completion before clinical events' ascertainment. The study was designed in 1990 to 1991 (18), enrolled the first patient in 1991, and was continued with consecutive enrollment of all eligible patients examined by the authors. The American Society of Echocardiography guidelines (10), in which we (M.E.S) participated actively, were prepared later, but are in complete agreement with the present study's approaches.
Study population
After oral consent, patients were consecutively and prospectively enrolled by investigators between 1991 and 2003 if they were asymptomatic and their AR was: 1) at least mild by standard color-flow imaging (19); 2) pure (no stenosis) and isolated (no other valve disease); and 3) evaluated with quantitative echocardiography for AR degree and LV volumes. Exclusion criteria were: 1) symptoms at diagnosis (7); 2) aortic dissection or ongoing endocarditis; 3) functional AR due to hypertension; 4) associated aortic systolic gradient ≥20 mm Hg; 5) concomitant mitral valve, congenital (other than bicuspid valve), or pericardial disease; 6) previous valve repair or replacement; and 7) EF <50% (6,20). No exclusions were based on gender, age, cardiac rhythm, or treatment received.
Clinical evaluation and management
Patients were evaluated and treated by their independent physicians, who were provided with all results of Doppler echocardiography. Diagnosis of congestive heart failure was based on Framingham criteria (21). Atrial fibrillation was diagnosed by electrocardiogram. Comorbid conditions were evaluated with validated Charlson index (22). Follow-up was collected in 2006 and 2007 after closure of enrollment and of all baseline data collection procedures. Causes of events and deaths were established by review of medical, coroner, and autopsy records or death certificates.
Doppler echocardiography
AR assessment
Comprehensive Doppler echocardiography was performed (23). The AR was prospectively assessed quantitatively and qualitatively. The AR quantitation used 3 validated methods, eventually averaged to calculate both regurgitant volume (RVol) and effective regurgitant orifice (ERO) area (85% of patients had ≥2 of 3 methods of quantification). These methods were quantitative Doppler based on aortic and mitral stroke volume measurement (18,24), quantitative 2-dimensional echocardiography on the basis of LV and mitral stroke volume (15,24), and proximal isovelocity surface area method analyzing proximal flow convergence (25). The QASE guidelines regarding AR grading (10) define regurgitant volume <30 and ≥60 ml/beat and ERO <10 and ≥30 mm2 as thresholds for, respectively, mild and severe regurgitation. Thus, QASE-severe AR was defined as regurgitant volume ≥60 ml/beat or ERO ≥30 mm2, QASE-mild AR required both regurgitant volume <30 ml/beat and ERO <10 mm2, and QASE-moderate AR was larger than mild (regurgitant volume ≥30 ml/beat or ERO ≥10mm2), but not reaching QASE-severe criteria. The AR qualitative assessment also prospectively graded AR in 4 grades and measured jet-width to LV outflow tract-width ratio (19) by color flow imaging measured from parasternal long-axis views (10).
LV assessment
The LV end-diastolic and end-systolic volume indexes (ESVIs) and EF with Simpson disk method and LV mass were measured as recommended by the American Society of Echocardiography (15). The LV diameters by M-mode echocardiography were measured as absolute values and normalized to body surface area.
Statistical analysis
Data are presented as mean ± SD or percent. Group comparisons used analysis of variance or the chi-square test, as appropriate. The outcome end points were survival, survival free of AR surgery, and cardiac events (defined as cardiac death, congestive heart failure, or new episode of atrial fibrillation) under medical management. The entire follow-up after diagnosis under medical and surgical management was used to assess the impact of surgery on outcome with a time-dependent term in Cox proportional hazard models. Event rates with Kaplan-Meier method were expressed as estimated ± SE and compared with the log-rank test, and linearized rates of first events were estimated. Time to events was analyzed by Cox proportional hazard with calculation of unadjusted and adjusted risk ratios. Adjustment in multivariable models used age, gender, comorbidity score, and EF in models not using ESVI. Comparisons of outcome predictors (quantitative vs. traditional) used the concordance index (26); p < 0.05 was significant.
Baseline characteristics
The 251 patients enrolled in the cohort were followed for a total of 8.0 ± 3.8 years (>5 years in 188 patients, and >10 years in 82 patients; complete up to death or 2006 in 97%). All had organic aortic valve disease—due to degenerative disease (with valve thickening, annular enlargement, and central defect) in 140 patients, bicuspid valve in 60 patients, dystrophic disease (with thin leaflet, annular enlargement, with or without valve prolapse) in 19 patients, rheumatic disease in 6 patients, chronic endocarditic lesions in 6 patients, and miscellaneous causes in 20 patients. Baseline characteristics are presented in Table 1. Regurgitant volume and orifice widely ranged from 7 to 212 ml/beat and from 3 to 100 mm2, respectively. Groups displayed by QASE grade (10) in Table 1 involve 18% QASE-mild, 43% QASE-moderate, and 37% QASE-severe. As usually noted (7,9,27), severe AR showed male predominance, a trend for younger age, lower diastolic blood pressure, and larger LV volume and mass. Jet-width ratio grading was mild (<25%) in 18%, moderate (25% to 64%) in 74%, and severe (≥65%) in 8% of patients. Vasodilator therapy ≥6 months during medical follow-up included angiotensin-converting enzyme inhibitors in 100, calcium-channel blockers in 51, and angiotensin-receptor blockers in 31 patients.
Survival and cardiac surgery after diagnosis
During follow-up, 33 deaths occurred under conservative management with survival 93 ± 2% at 5 years and 78 ± 4% at 10 years. Cardiac surgery was performed in 81 patients: 1 for aortic dissection and 80 for AR. Indications for surgery for AR were occurrence of symptoms in 38, LV dysfunction or enlargement in 17, aortic aneurysm in 11, infective endocarditis in 3, and physician and/or patient preference in 11 patients. The 10-year rate of surgery for AR was 36 ± 4%. Thus, for the combined end point of survival and freedom from surgery for AR, 113 events (33 deaths, 80 surgeries) occurred with a rate of 50 ± 4% at 10 years.
Univariately (or after adjustment) qualitative assessment of AR in 4 grades, with jet-width ratio as a continuous or categorical variable, showed no significant association to survival (all p > 0.15). Conversely, quantitative AR measurements were associated with survival after diagnosis univariately (RVol adjusted hazard ratio [HR] 1.17 [95% confidence interval (CI) 1.05 to 1.30]/10 ml, p < 0.01; ERO adjusted HR 1.50 [95% CI 1.16 to 1.86]/10 mm2, p < 0.01) and in multivariable analysis as continuous variables or as QASE-severe AR grading (adjusted HR 4.1 [95% CI 1.4 to 14.1] compared with QASE-mild AR, p = 0.01) (Table 2). Stratified by QASE-AR grading, survival under conservative management was lower in QASE-severe versus QASE-moderate and QASE-mild AR (at 5 years, 82 ± 6% vs. 95 ± 2% and 98 ± 2%, respectively, p = 0.05) (Fig. 1). Adjusting additionally for vasodilator therapy use, QASE-severe AR remained independently associated with higher mortality (adjusted HR 6.7 [95% CI 2.2 to 23.2], p = 0.02). The QASE-moderate compared with QASE-mild grading showed a trend for higher mortality (adjusted HR 2.1 [95% CI 0.8 to 6.7], p = 0.13). The LV end-systolic diameter (absolute or normalized to body surface area) was univariately associated with survival (both p < 0.04), and ESVI showed a trend of association (p = 0.12), but both were no longer significant after adjustment for quantitative AR assessment (all p > 0.30).
In QASE-severe versus QASE-moderate and QASE-mild AR, surgery for AR was more often performed (at 10 years, 72 ± 6% vs. 24 ± 5% and vs. 0%, respectively, p < 0.0001), so that the rate of survival free of surgery for AR was lower in QASE-severe AR (at 10 years, 20 ± 5% vs. 57 ± 6% and 92 ± 4%, respectively, p < 0.0001; adjusted risk ratio 12.9 [95% CI 5.4 to 38.5] for QASE-severe AR and 4.0 [95% CI 1.7 to 11.8] for QASE-moderate AR vs. QASE-mild AR, both p < 0.001) (Fig. 2,Table 2). In patients with QASE-severe AR, linearized yearly mortality rates were markedly lower after AR surgery (1.7% [95% CI 0.8 to 3.1]) than under conservative management (3.4% [95% CI 1.9 to 5.6]), but the time-dependent mortality reduction did not reach statistical significance (risk ratio 0.64, p = 0.38).
Cardiac events
Under conservative management, 67 patients incurred cardiac events (cardiac death, congestive heart failure, or new atrial fibrillation) with 5- and 10-year rates of 27 ± 3% and 39 ± 4%, respectively. All measures of AR severity, traditional (qualitative 4-grade classification, jet-width ratio continuous or categorical) or quantitative (RVol, ERO), were univariately predictive of cardiac events (all p < 0.01). However, in models with quantitative AR grading, traditional AR assessments were no longer significant in predicting cardiac events (all p > 0.23). Comparison of outcome prediction involving traditional AR assessment demonstrated superiority of QASE-grading for predicting cardiac events (all p < 0.001). The RVol and ERO remained predictive of cardiac events after adjustment in multivariable analysis (Table 2). Stratified by QASE grading, cardiac event rates were considerably different (Fig. 3). In multivariable analysis (Table 2) adjusted for age, gender, comorbidity index, and LV ESVI, QASE-severe AR (adjusted risk ratio 5.2 [95% CI 2.2 to 14.8] p < 0.001 vs. QASE-mid AR) and QASE-moderate AR (adjusted risk ratio 2.4 [95% CI 1.06 to 6.6], p = 0.035 vs. QASE-mild AR) were independently predictive of cardiac events, even after adjusting for vasodilator use.
All measures of LV end-systolic enlargement, traditional (LV diameter absolute or body surface area normalized) or volumetric (ESVI), were univariately predictive of cardiac events (all p < 0.01). However, in models with ESVI, traditional measures lost significance in predicting cardiac events (both p > 0.09). Comparison of outcome prediction involving LV end-systolic diameter (absolute or body surface area normalized) demonstrated superiority of ESVI for predicting cardiac events (both p < 0.002). Baseline ESVI was predictive of cardiac events univariately (adjusted HR 1.09 [95% CI 1.03 to 1.14]/10 ml/m2, p = 0.002) and in multivariable analysis (adjusted HR 1.23 [95% CI 1.03 to 1.46]/10 ml/m2 or 2.4 [95% CI 1.3 to 4.3] for ESVI ≥45 ml/m2) (Table 2). Stratified by ESVI categories (<45, ≥45 ml/m2), 10-year cardiac event rates were considerably different overall (31 ± 5% vs. 74 ± 8%, p < 0.001) with progressively increasing rates in combination with stratification using QASE AR grading (Fig. 4).
Ten-year rates of atrial fibrillation were 14 ± 7%, 14 ± 4%, and 19 ± 7% in QASE-mild, QASE-moderate, and QASE-severe AR, respectively (p = 0.02). If patients with atrial fibrillation as the only cardiac event are excluded, 61 patients had cardiac events (cardiac death or heart failure), with 10-year rates of 18 ± 8%, 29 ± 5%, and 65 ± 8% in QASE-mild, QASE-moderate, and QASE-severe AR, respectively (p < 0.001). These events were predicted independently by QASE-severe AR (adjusted HR 5.9 [95% CI 2.3 to 18.3], p < 0.001) and ESVI ≥45 ml/m2 (adjusted HR 2.2 [95% CI 1.2 to 3.9], p = 0.01), with borderline effect of QASE-moderate AR (adjusted HR 2.3 [95% CI 0.95 to 7.0], p = 0.065). Of note, ESVI ≥45 ml/m2 is similarly predictive of atrial fibrillation (adjusted HR 2.9 [95% CI 1.6 to 5.1], p = 0.02) and heart failure (adjusted HR 3.4 [95% CI 1.2 to 9.2], p < 0.001).
The effect of age on outcome was analyzed by stratifying patients age <50 and ≥50 years at diagnosis (Fig. 5). Whereas mortality was minimal below age 50 years irrespective of AR severity, QASE grading was predictive of mortality after age 50 years (Figs. 5A and 5C). Only 9 patients incurred myocardial infarction during follow-up and none died, so that the age–mortality link is unlikely to be related to coronary disease. Notably, QASE-severe AR was similarly predictive (p = 0.84) of a high risk of cardiac events irrespective of age (Figs. 5B and 5D).
With the entire follow-up in models with time-dependent surgery for AR, patients with QASE-moderate AR showed no significant reduction of cardiac events after surgery (p = 0.92). Conversely, for QASE-severe AR, surgery for AR was associated with marked reduction of cardiac events (linearized yearly rates 11.2% [95% CI 7.9 to 15.3] under medical management decreasing to 2.3% [95% CI 0.9 to 5.0] after surgery, adjusted risk ratio 0.23 [95% CI 0.09 to 0.57], p = 0.002). Also in patients with ESVI ≥45 ml/m2, surgery for AR was associated with marked reduction of cardiac events (linearized yearly rates 14.9% [95% CI 10.2 to 21.0] under medical management decreasing to 2.9% [95% CI 1.3 to 6.0] after surgery, adjusted risk ratio 0.22 [95% CI 0.08 to 0.62], p = 0.004). If patients with atrial fibrillation as the only cardiac event are excluded, surgery for AR markedly lowered the event rate (0.16 [95% CI 0.05 to 0.47], p < 0.01).
The present prospective cohort demonstrates the impact of quantitative echocardiography on the clinical outcome of asymptomatic patients with AR and EF ≥50%. The RVol and ERO are powerful independent predictors of outcome, and patients with QASE-severe AR (RVol ≥60 ml/beat or ERO ≥30 mm2) incur excess mortality, cardiac events, and lower survival free of surgery for AR. Additionally, baseline ESVI ≥45 ml/m2 independently predicts cardiac events. These quantitative measures supersede predictive power of traditional variables (jet assessment and LV diameters), underscoring their importance to clinical decisions. Patients at high risk of cardiac events display a marked reduction of risk after cardiac surgery for AR (risk almost 5 times lower) so that surgery should be considered in patients with QASE-severe AR and ESVI ≥45 ml/m2.
Rationale of the study
Patients with AR and symptoms or reduced ventricular function are at higher risk of cardiovascular death (6). In previous smaller prospective studies (7–9), defining high-risk subsets among asymptomatic patients with preserved LVEF was challenging. Indeed, these series observed only a few deaths (average mortality 0.4%/year) (7–9), contrasting with clinical practice in which patients are older (closer to 60) and mortality of asymptomatic patients with AR is higher (2.8%/year) (3), close to our present series. Thus, clinical guidelines are based on data involving low mortality and cardiac events and on inconsistent LV markers of clinical outcome (6). Recommendation of LV diameters, particularly end-systolic diameter ≥55 mm, for class II indications of surgery is poorly substantiated (6). In our study, only 3 (1.2%) had such diameters and 95% had both LV end-diastolic diameter <70 mm and end-systolic diameter <50 mm, which represents a contra-indication (class III indication) for surgery by clinical guidelines (6). Conversely, 44 (17.5%) of our patients had both QASE-severe AR and ESVI ≥45 ml/m2 and were at high risk. Therefore, traditional LV indexes used in AR are quite insensitive. Emerging clinical tools by quantitative echocardiography, measuring absolute AR-degree (RVol or ERO) and total LV consequences of AR (LV volumes) raised new hopes. These tools were developed in physiologic studies (18,24,28), codified by guidelines of the American Society of Echocardiography (10,15), and endorsed by major American and European cardiac societies, but their impact on clinical outcome was unknown. In view of insensitivity and prognostic inferiority of traditional tools (LV diameters) for detecting high-risk patients (6), the present data are essential in managing asymptomatic patients with AR and preserved EF, among which high-risk subsets can now be identified and aggressively managed.
Quantitation of AR
The link between AR degree and outcome might seem intuitive, but reports of "severe" AR with very low mortality (7,8,29) cast doubts on such a link, which was never analyzed, probably because traditional AR assessment has serious limitations (11,12). Quantitative methods (10) provided encouraging risk stratification in other valve regurgitations (30). Ancillary questions regarding potential superiority of quantitative assessment and specific thresholds proposed by QASE grading (18,24) required outcome data. The present study fills these gaps of knowledge and shows that QASE AR grading strongly predicts outcome in asymptomatic patients with EF ≥50%, is more sensitive, and supersedes traditional measures of AR severity, providing essential support for quantitative assessment. A QASE-severe AR defines patients at notable risk of mortality, cardiac events, and with lower survival free of surgery for AR, genuinely justifying the severe label. Hence, for patients in whom surgery is not indicated by clinical guidelines (6), quantitative echocardiography identifies those at high risk of poor outcome under medical management and improved outcome with surgery and is particularly important and relevant.
We averaged 3 methods of AR quantitation for simplicity of presentation. Methods correlate with r ≥ 0.90, and all predict cardiac events similarly, so that in clinical practice measuring all methods is not always indispensable to optimize feasibility. In mitral regurgitation, ERO carries the most predictive power (30), but in AR, ERO measuring lesion severity and RVol measuring volume overload (24) are equipotent for outcome prediction and complementary.
Quantitation of LV volumes
Patients with LV dysfunction complicating AR incur high mortality (3), even after surgery (5). However, in patients with "normal" EF, LV dysfunction development is rare (7,29). Disagreement on ventricular indexes predicting outcome (3,7,8,29) reflects LV diameter's shortcomings as a measure of LV remodeling (13). The ESVI was assessed in a small angiographic series examining only post-operative outcome (16,17). Our study provides new information with echocardiographic ESVI predicting clinical outcome and superseding LV diameters. Despite "preserved" EF, higher ESVI (≥45 ml/m2) independently predicts more cardiac events within each AR grade. This result reconciles previous discordant data (3,7,16,17,29,31,32) and, by normalizing to body size, is equally applicable to men and women, avoiding gender-bias from non-normalized LV dimensions (14). Thus, quantitative echocardiography provides comprehensive determinants of outcome and is essential for clinical management of asymptomatic AR.
Clinical implications
Quantitative echocardiography defines prognosis in patients with AR and should be encouraged and generalized (10,15). The RVol and ERO should be measured at diagnosis; patients reaching thresholds (≥60 ml/beat, ≥30 mm2, respectively) have severe AR and, with ESVI ≥45 ml/m2, are at risk for poor outcome. Considerable post-operative outcome improvement is a strong incentive to consider surgery. Patients with either (but not both) quantitative criteria (QASE-severe AR or ESVI ≥45 ml/m2) should be carefully monitored for progression of AR or LV remodeling (33).
Patients <50 years incur minimal mortality. Thus, studies enrolling mostly young patients observed few deaths, and their suggestion that symptom-based decision-making is sufficient in AR (34) might be biased. In our series, cardiac events were similarly frequent with QASE-severe AR in young and older patients. Thus, QASE-severe AR and ESVI ≥45 ml/m2 should lead, even in younger patients, to consideration of surgery.
Study limitations
Our study was restricted to patients with preserved EF. Lack of association of EF with outcome does not obviate prompt surgical consideration in patients with low EF who are at high risk (3,5,6,20). The link between AR and atrial fibrillation might be disputed, but our data show that after exclusion of patients with atrial fibrillation as the only cardiac event, our results are unaffected and AR quantitative grading and ESVI predict outcome. In comparing outcome implications of quantitative and jet-based data, it is important to account for jet direction and AR etiology. However, jet-width ratios were not different when stratified by QASE-grading according to jet eccentricity (all p > 0.31) or AR etiology (all p > 0.17). For prediction of outcome, jet-width ratio impact was not improved by focusing on central jets, and individual variables such as pressure half-time or aortic arch were not independently predictive of outcome (all p > 0.11), confirming the superior outcome predictive power of quantitative versus qualitative AR grading.
Loss of follow-up might bias the estimation of outcome but was minimal in our study. Series analyzing outcome with data mining risk overfitting (35). Examining few prospectively predefined variables obviates overfitting, which is unlikely here.
Vasodilator treatment of AR is disputed (36,37) and inconsistently used, and we cannot draw conclusions regarding subsets in which vasodilators might be beneficial.
The present prospective study shows that quantitative echocardiography provides independent and superior predictors of clinical outcome in AR and should be routinely performed. Asymptomatic patients with EF ≥50% but QASE-severe AR (RVol ≥60 ml/beat or ERO ≥30 mm2) and ESVI ≥45 ml/m2 are at a high risk of mortality and cardiac events. Cardiac surgery for AR, which markedly reduces this risk, should be carefully clinically considered.
This study was supported in part by the grant HL 64928 of the National Institute of Health. Drs. Detaint and Messika-Zeitoun were supported by a grant from "the French Federation of Cardiology."
- Abbreviations and acronyms
- aortic regurgitation
- ejection fraction
- effective regurgitant orifice
- end-systolic volume index
- left ventricle/ventricular
- quantitative American Society of Echocardiography
- RVol
- regurgitant volume
- Received September 10, 2007.
- Revision received October 11, 2007.
- Accepted October 18, 2007.
- American College of Cardiology Foundation
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text:
I want to tell you a story about how my little daughter is teaching me to be daring. No far in the time, one of these days I were walking with her to pick up her brother. She has been so rebel since she started school days (the different language must be affect us!)
Well, she started to say that she wanted ice cream, I said to her that I couldn´t give her the ice cream that I haven´t, but she wanted an ice cream. Then she stopped to walk. I was so stressed because I must to be in time to pick up her brother, but I decided to be calm. I decided be patient and wait. But she was all the time angry, asking for her ice cream. Then, when I saw that I was starting to be really late, I started to walk with the hope that she would follow me.
When I looked back with my fingers crossed…she was following me! I was worrying with the time but I smiled her, and in this way, we walked to the bus stop. She was always behind me walking slowly, so slowly…
When we must cross the road, she continued asking for her ice cream, but she gave me the hand. I felt so good. For a short time, when we arrived to the curb, she dropped me hand.
We were arriving when she started another time to stop and saying that she didn´t wanted to walk more. I sat and try to speak with her but was impossible…Once again, I started to walk watching my back, and she followed me at a short distance when I heard a shout.
When I looked to the shouts I saw a big woman in a Bus service car, who was shouting to Me. Yes, to me. All the street was looking to me. A perfect day. I didn´t believe it, why? I tried to understand her, She said that I must take to the girl, and that I was a bad mum, and she may throw herself to the road. She shouted me that while she drove the car with aggressiveness for park.
Let me tell you that I am very impulsive, too much. Suddenly I found myself responding with naturalness: Hey !, you are wrong, my daughter its only four years old but she isn´t crazy!
Sometimes I would not be myself. This was one. The big woman started to swell and become red, so much that at one point I thought it would explode. Luckily, she had already parked. Then she start to shout me in a very high level. She said me all type words less beauty. Then I saw my girl she was sad. I decided be daring.
I don´t know how I went to the car and I asome her window and told her: I don´t like that you are doing. Work with our children don´t entitle you to shout us or insult us. If I wanted I would give you problems because of this, but I don't, because I'm not like you, I do not like to do harm to others. Then I took my daughter´s hand and we went to pick up my son.
I was scared. When we were going to cross the zebra crossing, already of turned, a car brake in dry. Was she another time. She made signs us of we can cross. I refused. Then she goes away doing all type of gestures. I breathe relieved. But I was worried I am not confident with this type of things. I confess that I am a bit cowardly, and I have fears that I do not understand.
My little was so nervous this day. All the day was so active, crying for all, and angry with me. The next morning wasn´t better. So it was, that I ask for help in the childcare, and send messages asked for help to my Spanish friends. I´m lucky. They answered me that I must to try to speak with her. They were in true. I was speaking with her about a lot of things. She start to speak a lot of things so fast. In one moment she asked me, mum we are going to pick up Juan to the bus stop? Yes we are go to pick up him.-I answered to her.
-Are you bad mum- said her looking me with her big eyes- You are, because the big woman said that.
-Did you believe it? – I asked her
– She said it mum, am I bad?-she told me.
-No, Elena you are good, but sometimes you make things wrong, like me-I heard me answered
-why said her that you were bad?- I was in a trouble, I didn´t not how answered her, she was asking for confidence- Because she didn´t know nothing about us but she has a big bad mouth and when she open it start to shout to the others.
-I want to see her- said my little daring girl- I want to see the Bigbadmouth
When we arrive to the bus stop I was so scared and uncomfortable, but she was so calm. When we saw the car, my little Daring tell to me- I want to see the Bigbadmouth mum, Is she in the car?
I was so scared and say to her- I don´t know Elena, but I don´t want to go if you go perhaps I will be there.
Ok, mum I´m going-she is only four years old but in this moment she seemed to be a giant. when I saw her walking with step decide I only could thought in the Bigbadmouth shouting me another time for being separately of my daughter and I ran behind her to be close to her. We stopped at one step of the car´s door. This day the Bigbadmouth had in his face a big blacks glasses, and a hat. And she only looked the cellular. She looks a normal woman, no more strong than me, she was embarrassing of herself, (was evident!).
I started to feel better, daring to the life, and very proud of my little daring girl.
We repeat this situation another day. And I felt more better. I was not more angry, I have not fear and I was very granted to my daughter.


text:
Steephill Independent School and Pre-School
'Pupils are at the heart of everything we do'
- Steephill Independent School
- Off Castle Hill, Fawkham, Longfield, DA3 7BG
- 01474 702107
- email@example.com
We have a Breakfast Club from 7am - 8am every morning, where children are offered a combination of cereal and toast.
The Early Bird club is a facility open from 8am to 8.45am for those children who need to be in school before the gate is opened at 8.45am.
No booking is required as these facilities are available every day.
The Homework Club is open from 3.30pm to 5.30pm (6pm on arrangement). Tea can be ordered which consists of a sandwich, fruit and a drink.
These clubs are run by school staff and activities may also include outside games as well as indoor, but as the name implies older children are expected to do some homework!


text:
Kombizz Kashani [kombizz]
Member Page View Count: 36K +
Total User Views: 100K +kombizz kombizz
My name is Kombizz Kashani. I was born and brought up in Iran, a beautiful country that is full of history. I started taking photos at an early age of my life with a Lubitel, a Russian twin lenses camera. Most of my photos in those days were black and white. It was a very nice camera that my parents gave me when I was 15 years old. I always loved to see images. I remember that I would spend time in the library for hours and hours looking at the different photos in Life Magazine, National Geographic and other photographic journals and books. Also I always loved nature, and the different patterns made in it. I remember because of my Entomology studies, I would spend hours in the laboratory looking into microscopes at those beautiful and perfect structures that God created in those different tiny flowers, plants, tiny nematods, animals and insects. Then after I finished university in Iran, I left to do on my M.Sc. in California, the Golden State. There I was witness to even more of the beauties that nature held in each different moments of time. I remember I was always walking and trying to absorb all the scenes in my mind and memory as well as recording them on film. I forgot to say that I received another precious gift from my parents. That was a Canon camera with a fixed lense G-III QL17. Then after I finished my studies, I returned to Iran for work. I consider myself an artist photographer. At present I have a lovely Minolta Dynax 7, Mamiya 7II with few lenses. In February 2008, I was delighted to be one of the Amateur UK Photographers short-listed in the Sony World Photography Competition Cannes 2008. I have a vast numbers of printed photos, slides and thousands of negatives which all are archived in many folders. I love to share my observations through my photos with those people who love and appreciate. I make beautiful photographs out of ordinary things rather than ordinary photographs out of beautiful things. Photography is a record of my living, for anyone who really sees.
Country: US


text:
In a recent Google update, Google Places pages have been entirely replaced by new Google+ Local pages. 80 million Google Place pages worldwide have been automatically converted into 80 million Google+ Local pages.
What does this mean for searchers?
From a searchers perspective when searching for a business across Google properties (Maps, Mobile, Search) they will now see the Google+ local page whereas previously they would have been directed to a Google Places page.
Below is a before and after view of a search for a restaurant in Washington, DC.
Before: Google Places View
After: New Google+ Local View
What does this mean for business owners?
At the moment business owners will still manage their local listing through the existing Google Places platform – nothing with change from the backend.
The conversion to Google+ local pages will happen for all places pages regardless of whether they have been claimed by business owners or not. The new Google+ Local pages will be indexed by Google (unlike Google Places pages), so this is a great opportunity to gain more visibility. If you have not yet claimed your business listing, it is essential that you do this asap so you can make sure that your correct business information and branding is on the listing.
The appearance of a 'local' tab within Google+ accounts, gives Google+ users the functionality to perform local searches within their account.
Users searching for your business within Google+, will see your local listing regardless of whether you have Google+ account. However, by not having a Google+ account you could be missing out on a great opportunity to develop followers, message them and interact with them.
When users go to the Local tab in Google+ they are shown a personalised local home page, which shows a mixture of recommended places, places from your circles, top reviewers and a selection of type of places e.g. pubs, restaurants. If your Google+ page is in a user's circle, has been +1'd or reviewed by someone in their circles then the chances of appearing in the personalised search results increase.
New Features in Google+ Local
The Google+ Local pages are more visually appealing that the old Google Places pages. The old static places pages have given way to the new dynamic Google+ Local pages. They allow businesses to socially interact with their users. Some of the new functionality of the pages are:
- The integration and free availability of Zagat reviews (its entire archive across categories). Google's star ratings are being replaced by the Zagat 30-point rating scale (for user reviews as well).
- The Google/Zagat merger from almost a year ago is finally surfacing. The traditional 5 star ratings as they have been upgraded to the Zagat 30 point system as part of the local reviews. One of the most promising features could be the search functionality within the Local tab. The layout is a near exact replica of Yelp as users can enter in exactly what they are looking for as well as the city in which they are looking.
- The integration of Google+ Local pages across Google properties (search, Maps, mobile)
- Integration of a circles filter to find reviews/recommendations from friends/family/colleagues
Is Google+ Local good for SEO?
The new Google+ local pages open the doors for businesses to actively engage with their potential customers. This is an exciting time for local businesses, giving them the platform to excel in local search.