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Article Text
Objective Existing clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes.
Methods A two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013–2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance.
Results Between 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI −0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66.
Conclusion The UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.
- aortic stenosis
- transcatheter valve interventions
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Transcatheter aortic valve implantation (TAVI) has emerged as the indicated treatment option for patients with aortic stenosis who are intermediate to high-risk surgical candidates.1–3 Assessment of procedural risk is predominantly undertaken by the Heart Team, guided by multiple clinical prediction models (CPM).4 To this end, CPMs such as the EuroSCORE5 or the Society of Thoracic Surgeons (STS) mortality score6 have been used to guide estimation of procedural risk and employed in randomised controlled trials of TAVI.1–3 However, surgical-based models are known to perform poorly at predicting mortality in TAVI patients.7 8
Consequently, there have been recent attempts to derive procedure-specific CPMs using national registries; examples include the FRANCE-2 model,9 the Italian OBSERVANT model10 and the American College of Cardiology (ACC) model.11 Primarily, one is interested in using such TAVI CPMs to underpin procedure audit analyses across TAVI centres, to facilitate discussion of risk with the patient and to aid comparison of randomised trials. However, existing models have only moderate performance when applied in samples outside of their development cohorts.12 Indeed, within the UK, there is no validated CPM for predicting mortality post-TAVI,13 and heterogeneity in the variables recorded among national registries restricts the application of existing models into UK practice. As such, developing a CPM for UK-TAVI patients is vital, especially since one of the fundamental incentives for collecting national registry data is to monitor centre-level performance for audit and feedback purposes.
Therefore, the aim of this study was to develop and internally validate a multivariable TAVI CPM for predicting 30-day mortality in UK-TAVI patients (hereto called the UK-TAVI CPM), to facilitate clinical discussions around procedure risk with the patient during the consent process, and for national benchmarking/audit analyses.
The reporting of this manuscript adheres to the TRIPOD checklist for the reporting of multivariable prediction models.14 The completed checklist is provided as online supplementary material.
Supplementary file 1
UK-TAVI Registry
The UK-TAVI Registry prospectively collects data for every TAVI procedure conducted in the UK (34 centres) through a web-based interface.15 This study included data on all TAVI procedures between January 2009 and December 2014. Procedures were predominately undertaken via transfemoral access, using either the Edwards SAPIEN or the Medtronic CoreValve families of devices (with their various iterations over time), although other access routes and valve types were available. The registry records information on patient baseline demographics, risk factors for intervention and procedural details. Frailty information was only recorded within the registry from January 2013 through the KATZ Index of activities of daily living,16 the Canadian Study of Health and Aging (CSHA) frailty scale17 and an indicator of poor mobility (as defined in the EuroSCORE II model5).
Outcome and cohort definition
All-cause mortality tracking was independently obtained from the Office for National Statistics, with administrative censoring occurring on 31 May 2015; this information was used to define the binary endpoint of 30-day mortality after TAVI. Mortality information was unavailable for patients in Northern Ireland and Scotland; consequently, these patients were excluded, along with any patient in England and Wales with missing mortality information. Thus, the main development sample included all TAVI patients with 30-day mortality indication across England and Wales, between January 2009 and December 2014.
For development of the UK-TAVI CPM, we considered all variables available prior to the TAVI procedure (see online supplementary table 1 for the full list of considered covariates, with translation to the UK-TAVI Registry). Our decision to include access route as a candidate covariate was made in line with previous TAVI CPM development data sets,9 11 and represents the potential risk/complications/comorbidities associated with a non-transfemoral approach. Age and sex were always included in the model, with age being mean centred. Quadratic and cubic transformations of continuous variables were considered.
Missing data
Multiple imputation by chain equations was used to handle missing data, with this analysis generating 10 imputed data sets.18 The imputation models for each baseline covariate included the majority of other variables in the UK-TAVI Registry and the survival data (both the survival event indicator and the cumulative baseline hazard19), the latter of which was included because this was used to derive 30-day mortality indication. Prior to analysis, we checked all the imputations to ensure convergence and checked that the distributions of observed and imputed values were similar. Since multiple imputation assumes a missing at random mechanism, we undertook a sensitivity analysis of this assumption as described below.
Statistical analysis
A two-stage modelling strategy was implemented to derive the CPM (figure 1). We first derived a logistic regression model within the 2009–2014 data, considering only those variables that were observed throughout this period (ie, none of the frailty measures), using the 'majority method' of developing CPMs within multiple imputed data.20 Here, the following steps were undertaken: (1) perform backwards selection using Akaike information criterion in each of the 10 imputed data sets, resulting in 10 (potentially unique) sets of predictors; (2) extract variables that were selected in >50% of the imputed data sets; (3) given the extracted variables, fit a model in each imputed data set, then pool the estimated coefficients and SEs across imputations according to Rubin's rules.18 The Akaike information criterion for backwards selection corresponds to a P value of 0.157 for a variable with 1 df.
In the second stage, we updated this derived model using model-updating techniques within the last 2 years of data21 22 (figure 1). Here, a logistic regression model was fit to 30-day mortality within the 2013–2014 data, with the calculated linear predictor (LP) from the 2009–2014 derived model, KATZ, CSHA and poor mobility as covariates (see online supplementary methods for mathematical details). The likelihood ratio test was used to determine if any of the three frailty measures significantly improved the fit of the model, with only those meeting this criterion included in the final model. The reasoning for this second modelling step was twofold. First, it uses all available data as the foundations of the UK-TAVI CPM, while ensuring that the model is reflective of most contemporary practice/technology. Second, it provides a way of considering frailty variables within the model, which we hypothesised a priori would be important predictors of mortality,23 but were only recorded within the registry from January 2013.
Predictive performance was assessed through calibration and discrimination. Calibration is the agreement between the observed and expected risk, which was quantified by the calibration intercept and calibration slope, with reference values of 0 and 1, respectively.24 Discrimination of a model is its ability to distinguish those who experienced the outcome from those who did not, and was estimated with the area under the receiver operating characteristic (ROC) curve (AUC). Throughout, we use the term 'apparent performance' to denote the predictive performance of a model within the data set in which it was developed. As such, the apparent performance was obtained by applying the final model coefficients to each patient within the 2013–2014 data across the 10 imputed data sets and pooling performance results across imputations (using Rubin's rules18). Internal validation was undertaken using bootstrap resampling of the 2013–2014 data to estimate optimism-corrected performance (figure 1)22 25; details of this process are given in the online supplementary material. In short, the bootstrap resampling represents sampling from the underlying population to estimate in-sample optimism, which can be subtracted from the apparent model performance. These internal validation results should be treated as the primary measures of predictive performance.
R V.3.4.026 was used for all statistical analyses. Multiple imputation of the data set was completed using the mice package,27 and the package pROC was used for constructing ROC curves.28 All other codes were written by the authors and are available upon request.
Sensitivity analyses
Instead of using multiple imputation, the first sensitivity analysis (singularly) imputed all missing continuous variables using the sex-matched median of the observed values, and missing categorical variables using the mode. For the majority of categorical variables this will result in a 'risk factor absent' assumption and corresponds to a viable missing not-at random assumption. Similar modelling steps to the main analysis were then performed using this single imputation strategy. The second sensitivity analysis performed the 'majority method' of variable selection directly within the 2013–2014 data set to examine the robustness of the two-stage modelling strategy.
Between January 2009 and December 2014, up to 7070 patients were recorded in the registry. After excluding patients in Northern Ireland (n=379) and Scotland (n=193), a further 159 patients were removed due to missing life status. Hence, the development sample for the main analysis included 6339 patients (figure 2). Baseline characteristics and proportions of missing data for the main development cohort are given in table 1. The mean age of patients was 81.3 years, with 46.2% female. Most procedures were performed electively (12.5% non-elective), via transfemoral access (25.4% non-transfemoral access), and used a SAPIEN valve (56%). The proportion of missing data was low for most variables. The high percentages of missing data for the three frailty measures are due to these variables only being recorded from January 2013, after which the proportion of missing data for poor mobility, CSHA and KATZ was 1.79%, 1.65% and 11.0%, respectively.
Model development
Between January 2009 and December 2014, up to 326 patients died within 30 days of the procedure (5.14%), with this decreasing to 4.14% between January 2013 and December 2014. In univariable analysis, patients with higher (mean-centred) body mass index (BMI), higher glomerular filtration rate and indication of sinus rhythm had decreased odds of 30-day mortality (table 2). Renal failure, extracardiac arteriopathy, calcification of ascending aorta, prior balloon aortic valvuloplasty, critical preoperative status, New York Heart Association class IV, poor mobility, CSHA frailty, KATZ (per point drop from 6 points), left ventricular ejection fraction <50%, non-elective procedure and non-transfemoral access each had increased odds of 30-day mortality.
The variables selected in the final multivariable model (denoted UK-TAVI CPM) are given in table 3. The model intercept was −3.6119, with 15 variables included in the model, 2 of which were frailty measures (ie, KATZ and poor mobility). One can calculate the log odds of 30-day mortality for a new patient by multiplying each covariate by the corresponding coefficient in table 3 and summing across all variables—the so-called LP; the probability of 30-day mortality can then be obtained by transforming the LP as exp(LP)/{1+exp(LP)}. Figure 3 depicts a graphical representation of this process. For example, an 85-year-old woman with a BMI of 30 kg/m2, a glomerular filtration rate of 51 mL/min/1.73 m2 and KATZ score of 4 points would have log odds=−3.6119+((85−81.25)×0.0115)+(0.1393)+((30−27.3)×−0.0257)+((30−27.3)2×0.0011)+([51/5] ×−0.0342)+((6−4)×0.2362)=−3.3604, where [51/5]=10 (ie, floor rounding). This can be converted to a probability of 30-day mortality by exp(−3.3604)/{1+exp(−3.3604)}=0.0336×100=3.36% (dotted arrows in figure 3).
Model validation
The UK-TAVI CPM was well calibrated before and after bootstrap correction, with a calibration intercept and slope significantly close to 0 and 1, respectively (table 4); the apparent performance calibration plot is given in online supplementary figure 1. The apparent AUC of the model was 0.70 (95% CI 0.65 to 0.75), which reduced to 0.66 (95% CI 0.61 to 0.71) after bootstrap internal validation. The UK-TAVI CPM was well calibrated and had moderate discrimination across quantiles of observed predicted risk, although performance was marginally worse in the second and third quantiles (online supplementary table 2). Bootstrap-corrected performance across patient subgroups is given in online supplementary table 3.
We examined the predictive performance across each centre, which demonstrated that the majority of centres had an observed event rate similar to that expected from the model (figure 4). However, there was heterogeneity in the calibration-in-the-large, with some centres performing 'better' than expected (calibration intercept <0), and others having an observed event rate higher than that expected by the model (calibration intercept >0).
Sensitivity analyses
The first sensitivity analysis examined an alternative way of handling missing data, through a single imputation strategy. Most variables within the model derived under this approach were similar to those within the UK-TAVI CPM, but additionally included an indicator of calcified aorta, and aortic valve peak gradient (online supplementary table 4). The performance results were quantitatively similar to the main analysis model.
The second sensitivity analysis restricted the development cohort to those patients between January 2013 and December 2014 to contrast with the aforementioned two-stage modelling strategy (figure 1). The model developed under this approach included similar but fewer variables to the main analysis model (online supplementary table 5). After bootstrap internal validation, the calibration slope for 2013–2014 derived model was significantly below 1 (0.69, 95% CI 0.45 to 0.92), indicating overfitting within the smaller sample size (demonstrating an advantage of the two-stage modelling strategy). The internal validation AUC of the 2013–2014 derived model was 0.64 (95% CI 0.59 to 0.69).
This study has derived a TAVI risk prediction model for benchmarking and audit analyses in UK patients. After covariate selection, the UK-TAVI CPM included 15 variables, including 2 frailty-related measures. The model demonstrated strong calibration after correction for in-sample optimism, but only moderate discrimination. It is, therefore, of greater value in allowing comparison of risk-adjusted outcomes between centres than in aiding clinicians to provide accurate risk assessment to patients being offered TAVI.
Risk prediction in TAVI patients is an ongoing research area; the FRANCE-2,9 OBSERVANT,10 ACC11 and the herein UK-TAVI CPM each represent models derived exclusively on patients treated by TAVI and each share similar (clinically meaningful) risk factors. However, differences in the variables that are recorded across the national registries limit the ability to obtain a single generalisable model for practical use across countries. Thus, we have demonstrated the UK-TAVI CPM to be well calibrated both before and after correction for in-sample optimism, with an AUC of 0.70 and 0.66 within development and internal validation, respectively. Similar performance has been reported from the existing TAVI models within data sets similar to that in which they were developed.9–11 For example, the FRANCE-2 model had an AUC of 0.59 in a 'test' subset of the French registry,9 and the AUC within an internal validation of the ACC TAVI model was 0.66.11 However, a previous analysis of the UK registry found that the AUC of the existing TAVI CPMs was below 0.64 within the UK cohort.13
The limited discrimination of the UK-TAVI CPM means that this model is not yet ready for deployment when attempting to assess risk in individual cases. While one could question the need to use TAVI CPMs in such a capacity given the emerging evidence supporting expansion into low/intermediate-risk patients,3 CPMs are fundamental to appropriately adjust for case mix when investigating postprocedural outcomes across centres. In particular, the assessment of TAVI futility should consider multiple outcomes, including mortality, quality of life and hospital readmission, but the variability in the calibration intercept per TAVI centre (figure 4) indicates the importance of case-mix adjustment when comparing mortality rates. Consequently, the herein derived model presents an important step in facilitating appropriate adjustment for case mix when making centre-level outcome comparisons in UK patients, with similar applications undertaken within the STS/ACC Transcatheter Valve Therapy Registry using the ACC model.11
However, it is inevitable that predictive performance will decrease when the UK-TAVI CPM is applied in populations distinct to that in which it was developed (external validation),22 as observed when our group applied the France, Italian and American TAVI CPMs to the UK population.13 Since the primary aim of the UK-TAVI CPM is for national benchmarking, the main implementation of this model will be within UK patients. To this end, the split sample method of internal validation (randomly splitting the data into training and test sets) is common, but this is an inefficient use of data.25 Consequently, we applied bootstrapping methods to estimate the likely performance of the model in samples drawn from the registry. While lack of new and independent data from the UK registry meant that external validation was not possible, such an assessment of model performance will need to be undertaken by independent investigators.29 As such, we encourage the validation of our model in future extracts of the UK registry to assess temporal validation. Unquestionably, the UK-TAVI CPM should not be regarded as a static tool, and the discovery of novel predictors will be fundamental for deriving future TAVI models. The rapid development of TAVI techniques, knowledge and technology, combined with the possible expansion into lower risk patients, means the model should be continuously updated. The model needs to be maintained using contemporary extracts of the registry to avoid the calibration drift commonly observed in CPMs, such as that found in the logistic EuroSCORE.30 This would be equally applicable to other contemporary risk scores used elsewhere.
The main strength of this study is that TAVI data collection is mandatory in the UK, meaning the UK-TAVI CPM has been developed using comprehensive national data. However, several limitations need to be considered. First, since we excluded all patients from Northern Ireland and Scotland due to lack of independent mortality information, the model might not be representative of such patients. Second, this model only predicts 30-day mortality, but demonstrates the need for registries to routinely collect more wide-ranging outcomes (eg, hospital readmission, quality of life). Third, to maintain sufficient sample size, we included all data from 2009 to 2014, involving several iterations of valve types/devices. Although the modelling strategy aimed to revise the model using the 2013–2014 data, the UK-TAVI CPM will need to be updated in newer extracts to include patients exposed to only the most contemporary technology/practice. Finally, the generalisability of the model is unknown since we were unable to test the performance in independent data. Thus, we recommend independent researchers conduct future validation studies on the later extracts of the UK-TAVI Registry.
This analysis of the UK-TAVI Registry has developed a contemporary risk model on over 6000 TAVI patients. The validation procedure demonstrated that the model was well calibrated but achieved limited discrimination. Thus, the derived model has potential to be used for benchmarking analyses in UK-TAVI patients, but is not yet ready for deployment when attempting to assess risk in individual cases. Future external validation studies of the model within the UK population are required, and outcomes other than 30-day mortality might usefully be explored.
Key messages
What is already known on this subject?
Existing clinical prediction models (CPM) for mortality following transcatheter aortic valve implantation (TAVI) have only moderate predictive performance when applied to populations distinct from those in which they were developed. Additionally, frailty has been shown to be an important predictor of mortality following TAVI, with the recent recording of frailty in national registries presenting opportunities to include such measures within the risk prediction.
What might this study add?
This study presents a contemporary multivariable CPM for predicting 30-day mortality after TAVI that included 15 risk factors, 2 of which were measures of frailty. This is the first model to be derived from the UK-TAVI Registry and presents an important step in facilitating appropriate adjustment for case mix when making centre-level outcome comparisons. The validation procedure demonstrated that the model was well calibrated and moderately discriminating.
How might this impact on clinical practice?
The model has potential to be used for benchmarking analyses in UK-TAVI patients by adjusting for case mix, and could facilitate clinical discussions around risk during the consent process. However, further development is needed as more data become available, and other outcomes should be explored.
We acknowledge the National Institute for Cardiovascular Outcomes Research (NICOR) for providing the UK-TAVI Registry extract for this study.
Contributors GPM, MS and MAM made substantial contributions to the concept of the work in addition to designing and performing the analysis. GPM drafted the initial version of the manuscript. All of the authors interpreted the results, revised the paper critically for important intellectual content and approved the final version of the paper.
Funding This work was funded by the Medical Research Council through the Health e-Research Centre, University of Manchester (MR/K006665/1) and a grant through the North Staffordshire Heart Committee.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.


text: tag:blogger.com,1999:blog-2717881364991865917.post5873573866407564932..comments2023-11-21T11:08:22.162-05:00Comments on Mamacado: Dairy Free Ice Cream Two Times a Day? Our Allergy-Friendly Beach Trip to OC, NJKathryn @ Mamacadohttp://email@example.com:blogger.com,1999:blog-2717881364991865917.post-9552264983753245172017-10-04T12:53:36.948-04:002017-10-04T12:53:36.948-04:00Yes, I totally agree with you about the less than ...Yes, I totally agree with you about the less than desirable ingredients in the Polish ice and Dole Whip. Goji seems like your best bet for sure!Kathryn @ Mamacadohttps://firstname.lastname@example.com:blogger.com,1999:blog-2717881364991865917.post-78971204170853980842017-09-29T15:01:14.959-04:002017-09-29T15:01:14.959-04:00We have gone to OCNJ the past 4 summers. We stay i...We have gone to OCNJ the past 4 summers. We stay in a place with a full kitchen. I have seen these places but not interested in the chemicals they put in the polish ice. I think I even looked at the ingredient list for Dole whips (not great). I will check out the Goji juice firstname.lastname@example.com:blogger.com,1999:blog-2717881364991865917.post-31648278554817641582017-09-29T11:30:13.380-04:002017-09-29T11:30:13.380-04:00Hi Eve - you're welcome! Yes, it's so impo...Hi Eve - you're welcome! Yes, it's so important we share our new finds with each other. That's part of why I started this blog...I found other blogs SO helpful on our food allergy journey. So, I wanted to join the conversation and hopefully help others!Kathryn @ Mamacadohttps://email@example.com:blogger.com,1999:blog-2717881364991865917.post-74755631905214589552017-09-29T11:08:34.625-04:002017-09-29T11:08:34.625-04:00We take that same trip every year & same place...We take that same trip every year & same places. I will have to check out the new Goji place. Thanks for always sharing your new finds. Much appreciated! email@example.com:blogger.com,1999:blog-2717881364991865917.post-44474858451246870112017-09-29T09:33:40.785-04:002017-09-29T09:33:40.785-04:00Thanks Diane. Yes, it's so nice to find new sa...Thanks Diane. Yes, it's so nice to find new safe treats!!Kathryn @ Mamacadohttps://firstname.lastname@example.com:blogger.com,1999:blog-2717881364991865917.post-72523759343026911492017-09-28T19:17:17.837-04:002017-09-28T19:17:17.837-04:00I am so happy little guy could enjoy all these gre...I am so happy little guy could enjoy all these great treats! 💖Dianehttps://email@example.com

subset: commoncrawl


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College Scholarships for Children of Fallen Military
College Scholarships for Children of Fallen Military
As students return to school and their normal routines, please help Children of Fallen Patriots Foundation (Fallen Patriots) identify Gold Star scholars who need college scholarships. Thanks to the generosity of corporations such as YBC, Yesterday Business Computers, and Southpoint Capital Advisors, Fallen Patriots now has more scholarships opportunities and needs the media's help to identify families in need.
Nearly 20,000 dependents have been left behind by troops killed in the line of duty over the past 35 years. Unfortunately, this number continues to grow. Because of this, Fallen Patriots has recently joined in partnership with Tragedy Assistance Program For Survivors (TAPS) to better serve families of fallen armed forces. Under the agreement, Fallen Patriots and TAPS will offer students and families in their respective databases the opportunity to be connected to additional resources by providing consent to have their information shared with the other organization.
"We believe one of the best ways to honor our fallen heroes is to invest in the future of those they loved most – their children," notes David Kim, co-founder and CEO of Fallen Patriots. "A college education is the key to a bright future for any child and the generosity of our supporters is making those hopes and dreams come true," he adds.
Fallen Patriots helps bridge a $32,000 funding gap between government assistance programs and the cost of a four-year degree. As 63% of surviving spouses report having trouble making ends meet earning less than $50,000 per year, the vision of Fallen Patriots is to extend peace of mind to Gold Star families in all 50 states, in all branches of the military.
HOW TO ENROLL: It's easy and takes less than 5 minutes! Visit: https://www.fallenpatriots.org/enroll-a-student
Since 2002, Fallen Patriots has provided approximately $22.7 million in total assistance to over 1,140 scholars. We are determined to assist every child left behind, but we need the media's help to find them all. There is currently no central database to track Gold Star children.
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My name is Alexandros Angelidis, I'm a creative based in London interested in one-off and custom made pieces, whether its clothing, products or works of art.
I'm currently studying Product Design in Central Saint Martins but I continue to create pieces independent of my studies.
I work against the trend, appreciate aesthetics but do not sacrifice functionality for them. My work ethic is to ''go get what you want, waiting will not bring anything'', backed up by a one-man-show mentality I have built a wide portfolio spreading in many different creative directions. The work method I rely on is the materialisation of ideas and challenging the process between the physical and non-physical state of things.
My interests vary from conceptual art to physical science such as engineering.
Most of my current work is formed around the human, its body and its interaction with the surrounding world, such as my first solo exhibition ''The World As We Know It'' at the European Court of Justice (Luxembourg).


text:
Richdeep Gill, MD, Harshdeep Mangat, BSc, David P Al-Adra, MD, Haili Wang, MD FRCSC, Xinzhe Shi, MPH, Cliff Sample, MD FRCSC. University of Alberta
Objective:As laparoscopic surgical procedures increase in complexity, surgeons may find themselves with the laparoscope opposite to their laparoscopic instruments, thus creating the paradoxical viewpoint. We assessed whether surgical task performance in the paradoxical viewpoint would be improved by digitally altering the image or by changing the camera orientation.
Methods: 61 laparoscopically naïve operators preformed a Peg Transfer task using a trainer box according to the FLS (Fundamentals of Laparoscopic Surgery) program. In the first "round" naïve operators were block randomized to perform the Peg Transfer task either in the standard view (camera aligned with operator) or the paradoxical view (operator and camera in opposite 180o positions). In the second "round", naïve operators were positioned in the paradoxical view and block randomized to having the monitor image as paradoxical (unchanged) (n=19), or altered by being digitally-flipped (mirror) (n=22) or inverted (camera upside down) (n=20). The Peg Transfer task consisted of grasping and transferring 6 small plastic objects in 5 min (300 sec). Scoring was based on total time = time to completion (max 300 sec) + penalty time (50 sec per peg not completed). We also assessed number of completed peg transfers in the allotted time.
Results: In the first "round", average total time to perform the Peg Transfer task using the standard view was 215 ± 20 sec, which was significantly less (P<0.001) than that for the paradoxical view at 563 ± 13 sec. The group utilizing the standard view completed 5.6 ± 0.2 peg transfers, which was significantly greater than the paradoxical view group that completed 0.7 ± 0.3 peg transfers (P<0.001). In the second "round" (with all naïve operators in the paradoxical viewpoint) the total time for the paradoxical image, digitally-flipped (mirror) and inverted image were 561 ± 12 sec, 449 ± 25 sec and 259 ± 37 sec, respectively. The total time for the inverted image was significantly less than both the paradoxical image and digitally-flipped image (P<0.001). The total time for the digitally-flipped image was also significantly less than paradoxical image (P<0.05). The group with the paradoxical image completed 0.8 ± 0.2 peg transfers, which was significantly less than both the digitally-flipped (mirror) and inverted view groups (P<0.05). The group with the digitally-flipped image completed 2.8 ± 0.4 peg transfers, which was significantly less compared to the group with the inverted image that completed 5.1 ± 0.4 peg transfers (P<0.05).
Conclusions: This is the first study to demonstrate that when in the paradoxical viewpoint, altering the image on the video-monitor, either by digitally flipping or inverting the image, can improve surgical task performance.
Session: Poster
Program Number: P178
View Poster


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Sen. Cynthia Villar, chair of the Senate Committee on Agriculture and Food, assured that bigger funds are coming to boost further performance of the livestock, poultry and dairy in the country.
"I have filed a bill whose enactment will see a big leap in the allocation of funds for these food sources in the country," Villar said during the March 27 silver anniversary celebration of the Philippine Carabao Center (PCC) held at its national headquarters and genepool, Science City of Munoz, Nueva Ecija.
Senator Villar served as guest of honor together with city Mayor of Manila Joseph Ejercito Estrada represented by his administrator Atty. Ericson Alcovendaz who delivered his greetings and message to the agency and the public.
She said there is too much bias in favor of rice, corn and coconut production which is about 40 percent of the Php 107 billion budget of the Department of Agriculture for 2018. Yet, the livestock, poultry and dairy industries contribute about 33 percent of the food being made available to the country's needs.
"I will see to it that the 'Livestock, Poultry and Dairy Development Law' will be enacted this year," Villar told the appreciative audience in attendance to the PCC anniversary celebration. "It will mandate the allocation of one-third of the DA's budget for the livestock, poultry and dairy industries," she added.
Villar said that 35% of the livestock and dairy industries are private-sector led and is already progressive. She said there is need to support the remaining 65% represented by backyard livestock, poultry and dairy farmers.
"I have approached them for the giving of more funds to support these industries, but all that I got were promises. So, I thought of filing of this bill which I will push for its passage," Villar said.
She encouraged and challenged the PCC to continuously extend its programs and services, including its technical-know-how to the Filipino families engaged in carabao farming.
"Nakasalalay po sa inyo Philippine Carabao Center ang pag-asa ng mga batang pamilyang Filipino na makainom ng gatas upang sila'y maging matalino at mahusay at makapagdadala ng ating bansa sa mga susunod na henerasyon. Patuloy ninyong palaguin ang dairy industry at tulungan ang ating mga magsasaka sa agrikultura," she said.
Villar also urged the involvement of smallholder dairy farmers in the various feeding and nutrition programs of the government.
A day before the anniversary celebration, PCC Executive Director Arnel del Barrio presented to the public the PCC-developed "Philippine Dairy Carabao" breed, which was a product of crossbreeding and continuous backcrossing which marked the towering achievement of the PCC in its genetic improvement program (GIP).
He said this breed, which is of 93.75% riverine blood is very much adapted to hot and humid weather conditions, is resilient to climate change, and higher in milk yield which would be very much profitable for dairy farmers.
Only a few countries in the world have produced their own breed of dairy buffaloes.
Also presented during are PCC's new mascots "Kalaboy" and "Kalagirl". They were earlier seen in the PCC motorcade and devotional thanksgiving on March 26.
Among the other sharing and inspiring activity-sessions held during the PCC month-long celebration included #Millenial Goals: Life Views & Unleashing Potentials in the Workplace, Silver Fun Run, Palarong Pinoy Sports Fest & Picnic party, Cheesecake and Sushi making, "Oh Yeah, On the Catwalk", and "Say Grace" Social Etiquettes 101.
It also included the innovative session of "Launching of iREB Client Dashboard: A business tool for Carabao Family Business Owners."
One of the invited pillars Dr. Libertado Cruz, former Executive Director of PCC, gave his appreciation to the long efforts of the agency.
Dr. del Barrio, on the other hand, received from TUV-SUV ISO 9001:2015 Quality Management System and 14001 Environmental Management System certification which is an additional breakthrough of the agency.
This was followed by the signing of a memorandum of agreement (MOA) on training-related activities between PCC and Agricultural Training Institute (ATI).


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Abhijit Sawant rocks the Stage on K for Kishore
The contest is getting fierce in K for Kishore.. Get ready for a mindblowing musical week, as Abhijit Sawant makes his presence in the episode.
Are you looking for some great songs, music and nostalgia? Look no further. Just tune in to K for Kishore the coming weekend, Friday, January 25 th,at 9.00 p.m and relive the memories of these songs that have been etched in our minds. To add to the nostalgia, the show has ample sprinkling of anecdotes from those who knew and loved Kishore Kumar in his lifetime. So wife Leena Chandavarkar Ganguly, Bappi Lahiri, Sudesh Bhosle and 'the little girl' who was a part of the late singer's troupe, Bela Sulakhe reveal the little known things about the eccentric singer in the absence of an indisposed Amit Kumar. Yes, Amit will be missed in this episode!
The teams broke up into duets with Apoorva (he seems to be getting tons of mails from women admirers from all over ) and Kshtij, Vinod Seshadri and Chetan Rana, Chintan Bakiwala and Arnab forming the 3 teams in the first round. The solo numbers that were sung too had the audiences and judges asking for more. Apoorva's heart rendering of Geet gata hoon main… Kshitij's Tum bin jaoon kahan… Vinod's Yeh kyaa hua… Chetan's flawless rendering of Saanson se nahi, which was the best performance to say so, Arnab's Roop tera mastana…and Chintan's Dream girl…
This episode has another surprise for the viewers. Abhijeet Sawant, the first Indian Idol, makes his presence in the episode .He pepped up the environment with his energetic rendering of the all time popular number from film Don Khaike paan Benaras wala. Like Milind Ingle before him, has Abhijeet too entered the show as yet another Challenger? Stay tuned to find out.
Before the start of the round, the large hearted judge Bappi Lahiri announced that he would gift one of his lucky gold chains to the best singer of the round. Perhaps, it was the very idea of bagging a heavy gold chain from Bappi's neck had all the singers belting out their songs with newfound energy and zing!
those hardcore Kishore Kumar fans who have participated in the
Challenger participation, stay tuned to find out who among the viewers
will soon become the part of the show as Challenger participants.
K for Kishore, every Friday & Saturday at 9.00 p.m is getting in to interesting rounds. There's loads of singings, masti, magic, memories of evergreen Kishore Kumar only on Sony Entertainment Television.
ALSO READ: Karishma Sawant: Yeh Rishta Kya Kehlata Hai has changed my life


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text: Helene Posted December 22, 2010 Share Posted December 22, 2010 After over half a decade as "Ballet Talk", we are returning to our original name, "Ballet Alert", named after Arlene Croce's fictional New York City Ballet cast alert phone tree. Our new board URL is: www.balletalert.invisionzone.com Our logo is "red"; hopefully this will distinguish us more visually from Ballet Talk for Dancers. carbro, our patient registrar, fields many registration attempts that are meant for BT4D. A lot of what you see on the screen are actually graphics that will take a bit of effort to change, and we will clash a little bit for a while. The amazon.com box disappeared from the header at the top of each page next to the logo before this change happened, and I'm working on trying to reinstate it. (The code that amazon.com is providing has changed, which may be the root of the issue.) I've done some preliminary testing, and so far, old links from emails, bookmarks, and URLs embedded in posts are being redirected to the new URL. I wasn't forced to re-log in after the change. and to the kind folks who host our software for making the move as seamless as possible. I haven't tested everything -- I'll continue to poke -- and if you are having problems or see anomalies, please post them here or send us email via the "Contact Us" link at the top of the page. Link to comment


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The Sugar House
Known to many in the neighborhood as the Sugar House, this long-standing sugar refinery closed its doors in 1984. The Pennsylvania Sugar Refining Company was the last independent producer to fight the giant Sugar Trust early in the 20th century; it later became the Pennsylvania Division of the National Sugar Refining Company in 1942. Its story began with John Hilgert, a Bavarian immigrant, building a smear house at 5th and Girard in 1868 where molasses was refined. His son Charles moved the refinery to the foot of Shackamaxon Street in 1881, where, despite multiple owners, legal problems, and short periods of disuse, it remained for over a century until closing.
During the first half of the century, the Sugar House's presence in the neighborhood and the city as a whole expanded—while it employed about 40 men throughout the 1880s, by the 1950s it employed over 1500 men and women. During World War II, it produced a whopping 408,000 tons of refined sugar. According to a former employee turned chronicler of the company named Dan Gutleben, it was the increasing demand for sugar by America's allies during World War II that caused the plant, situated in a predominantly white neighborhood, to begin hiring African Americans. Nevertheless, this racial integration did not seem to last long, as Connie Galiczynski, who worked there in 1951, recalled that employees were all white by then.
At a time when many people stuck to their own ethnic parishes, she remembered the factory being the place where people of different cultural backgrounds and neighborhoods would interact. 'If you wanted a fresh kielbasa, you could ask the lady from Port Richmond to bring one to work…Once I asked Mary from South Philly to pick me up a hot sausage," she recalled, "I took it home and cooked it. I thought the smoke would come out of my husband's ears." She described the sexual division of labor at the plant: women worked at the conveyor belts performing functions like packaging while men worked as machinists. When the Sugar House closed in 1984, 600 men and women lost their jobs.
Today the Sugar House refinery is being remade into the Sugar House casino, which is slated for completion in the fall of 2010. It serves as another typical example of urban adaptive re-use: an industrial waterfront structure re-purposed for the entertainment/service driven economy. Whereas nearby Penn Treaty Park was partly industrial space appropriated by and for the community, local neighborhood activists like the Fishtown Civic Association and Casino-Free Philadelphia, who fear the deleterious effects of a casino in the neighborhood have opposed the building of the casino.
Yet the story of adaptive reuse extends much further back than the last few years. According to the Kensington History Project, the space "had a Spermaceti Whale Oil Works built atop an eighteenth-century shipyard, built atop a British Revolutionary War Fort, built atop Native Indian implements." From 2008 to 2010, an archaeological dig as part of a federally mandated historical review of the site turned up hundreds of Native American artifacts – some from long before the area was occupied by the Lenni-Lenape Indians encountered by William Penn, such as an arrowhead from circa 1500 BCE. Though the digs did not verify the remains of sites like British Redoubt #1, a loyalist British fort during the Revolutionary War, and Bachelor's Hall, an 18th century gentlemen's club, a large amount of evidence points to their former existence on the 22-acre casino site. In fact, it may well have been the building of the sugar refining company on the site in 1881 and its later expansions that destroyed potential artifacts.
- Galiczynski, Corinne. 2010. Telephone interview with author. June 2, 2010.
- Gates, Kellie Patrick. "SugarHouse work could go to Phase III." February 19, 2008. http://planphilly.com/node/2736
- Gutleben, Dan. "A Record of the Behavior of the Men and Machines in the Pennsylvania Sugar Refinery, 1868-1960."
- Jack Frost Sugar Refinery. Stuart Paul Dixon, Workshop of the World (Oliver Evans Press, 1990). http://workshopoftheworld.com/fishtown/frost.html
- Milano, Ken. "History of the Pennsylvania Sugar Company - Jack Frost." http://kennethwmilano.com/page/Encyclopaedia/PennsylvaniaSugarCompanyJackFrost/tabid/205/Default.aspx
- "The Kensington Screw Dock & Spermaceti Works" Kenneth W. Milano, (March 28, 2008). http://section106.wordpress.com/category/kenneth-w-milano/
1037 N. Delaware Ave


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Life Is Strange: True Colors - Playstation 4
A bold new era of the award-winning life is Strange begins, with an all-new playable lead character and a thrilling mystery to solve! Alex Chen has long suppressed her 'curse': the supernatural ability to experience, absorb and manipulate the strong emotions of others, which she sees as blazing, colored auras. When her brother dies in a so-called accident, Alex must embrace her volatile power to find the truth - and uncover the dark secrets buried by a small town. Pre-order to receive the Alex Outfit Pack. Expand your wardrobe with four exclusive outfits for Alex, with unique designs that celebrate Valkyrie, the feline fury of the record store, and the other cats of Haven Springs, available to pre-order customers at launch.
- The truth will hurt - Discover the shocking secrets behind your brother's death in an emotional roller-coaster of an adventure
- Feel everything - change fate and change lives with the psychic power of empathy
- Forge deep relationships - build trust with the townsfolk - and embrace friendship or romance with Ryan and Steph
- A truly personal story - Make tough decisions and choose your own future. Freely roam the streets, stores, and hidden spaces of Haven Spring and meet unforgettable characters


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|William Blake in youth, drawn by Catherine
Blake died in such poverty and obscurity that his burial in Bunhill Fields was largely unnoticed and on borrowed money, nineteen shillings for an unmarked grave, the body nine feet down, stacked on top of three others, and eventually followed by four more. The headstone was erected later and only approximately in the areas they were buried.
He married Catherine Sophia Boucher on the 18th August 1782 at St Mary's in Battersea. Friends said they lived their married life in 'uninterrupted harmony' though there were stories of Blake upsetting his wife by planning, perhaps not entirely seriously, to "add a concubine to his establishment in the Old Testament manner." The poet "gave up the project because it made Mrs. Blake cry." Their friend Thomas Butts liked to recount how he came across the pair of them sitting naked in their garden at Lambeth reciting passages from 'Paradise Lost' in character as Adam and Eve.
Catherine made the most of the time she spent with her husband because, as she once told some visitors who came looking for him "I have very little of Mr. Blake's company. He is always in Paradise." On his deathbed in 1827, "one of the very last shillings spent was in sending out for a pencil," with which he then proceeded to draw a portrait of his wife "Stay, Kate! Keep just as you are -- I will draw your portrait -- for you have ever been an angel to me." "Just before he died "His Countenance became fair," wrote a friend later, "His eyes Brighten'd and He burst out into Singing of the things he saw in Heaven." Even death did not separate them, according to contemporary accounts she "saw Blake frequently after his decease: he used to come and sit with her two or three hours every day …he advised with her as to the best mode of selling his engravings." When she died witnesses said she was "calling continually to her William, as if he were only in the next room."


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Covid-19 relief for Shipowners and Service companies
Dear valued customers, partners and friends,
The Covid-19 (Corona) Virus has forced all of us into Situations where doing "business as usual" raises too many dangers. Ports are locked, travel is prohibited and generally attendances on Board are not welcome, not to endanger the health status of the entire Crew onboard. These brave souls are the last defense line which stands between us and the foggy bottom of a global disaster.
In these days we have to wipe away all the business politics and fence fights and start to take care again of our Maritime Business, which might result in testing new paths, exploring the unknown and showing mercy to others which are not in the situation to have a choice.
Therefore, the Management of Ranger Navigational Rental has decided to discount every Rental equipment by 45% for the next 2 months, irrespective if it is a new customer or an already recognized and valued customer.
All items which are shipped from our Warehouse are disinfected prior shipping.
This relief program is valid until 2020-06-01 and subject to may be prolonged.
Existing Premium Service contracts remain unaffected.
Ranger Navigational Rental
-The Management-


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Goldstone defends himself
Richard Goldstone writes in the Guardian to defend his report into alleged atrocities by both sides in the Gaza conflict. He says that it would have been hypocritical of him to speak out about violations of international law and impunity for war crimes around the world and then not to criticise Israel for its attacks on Gaza, just because he is Jewish.
Our blogs are written by Amnesty International staff, volunteers and other interested individuals, to encourage debate around human rights issues. They do not necessarily represent the views of Amnesty International.


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Customer Reviews
Thanks for having your friend get this to me. This worked amazing. I'd say my knee pain is about a 2 out of 10 now from a 7, but it's only been 3 days, so there's still some time to get it to 0.
I was pleasantly surprised that this oil worked as fast as it did. I've started developing some numbness and pain of my feet over the past 6 months and my orthotics weren't enough to relieve the pain. I used this oil twice a day on my feet and the pain went from an 8 out of 10 to a 2 out of 10. I'm going to start using it more frequently to see if I can get to 0, but I can definitely feel the difference.
This is my first review, but I've got to say, this works really well for lower back pain. I was massaging it on my lower back because I started getting back pain from lifting weights. It was working pretty good, but a friend told me that I should put it under my tongue instead. My back feels so much better now. I'm not using Motrin at all anymore. My only gripe is that I would recommend putting instructions in the box, so people know different ways it can be used.
I tried the tea which was nice and calming, but I started having more difficulty sleeping. My girlfriend gave me some CBD gummies and they worked really well. I know the doctors who founded the company so, I decided to ask them about CBD. They gave me a bottle to try and I was hooked. I am a bit biased because I like them, but this oil really works. I even use it on my feet at night. Buy It. Buy It. Buy It.
It worked for me.


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A Word Cloud Red Kangaroo design made up of various species of Australian mammal and marsupial.
White t-shirt available in either a Men's (unisex) Gildan Softsytle round neck t-shirt or a Ladies Stanley Stella Organic Tshirt in either a V neck or round neck.
Please note this item will be custom made so please allow up to 28 days for delivery and possibly slightly longer if shipping outside of the UK. Please check sizes expecially if ordering a ladies fit which may be smaller than you would normally buy.
RED KANGAROO Word Cloud Tshirt


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Ballet is one of the world's most beautiful and revered art forms. Adults and children alike will love building on a foundation of basic movements set to beautiful music as they grow their strength and abilities. While it can be challenging at the higher levels, this traditional dance form is a pleasure to learn for all ages. Students who take ballet classes build self-control, body awareness and self discipline as they learn to master increasingly technical moves.
Classical Ballet
Event Details
Event Times: 7:00pm - 9:30pm
Dress Code: Casual
Registration: $10
Main Auditorium, 60 Gaven Rd Maudsland, QLD


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google-site-verification: googleccd898ae249d53e6.html
We are needed now. Some information received as recently as yesterday includes the following:
We can speed things up in order to guarantee a rapid resolution, all with our intent. It is intent that creates here.
It is our intent. We must intend the removal of the controllers. All of them.
We have united, our voice has been heard, we have anchored the light. It builds now and as it increases, those not on the same "wavelength" are pushed away. The dark exits.
This can be accelerated with our belief and continuous effort. The conclusion is inevitable, the timing is not.
There is a cloud of our light and as it builds, it pushes the dark away, taking its place. The dark does not resonate with our light, and this, this cloud of light, is what heralds our new earth.
Think of it this way. Every pebble creates a ripple in the pond. Those ripples all reach the edge of the pond, regardless of the size of the pebble tossed in. Change the size of the pebble into something larger, something like a boulder, and the reach is the same. The ripples will still reach the edge of the pond. Yet, the force and speed with which this occurs increases dramatically.
Each evening, before sleeping, just think: "It's time for you to go." Intend their exit in whatever way works for you and direct that intent towards whatever dark controlling element, institution, activity, organization or being that feels right. You'll know.
If you wake up feeling a bit achy, it's because you've engaged in some determined effort. It was not physical effort, another part of you was engaged in the dreamscape. Yet you awaken as a physical being, and the effort extended is felt here. We begin our multi-dimensional awareness now. Cool, isn't it?
Perhaps this song shared below will help. Maybe they just need to know how to go? That's why we're here.
Let's do this.
I love you with all of my heart. It is an honor to stand beside you as we assist in the liberation of this beautiful planet.
With appreciation for all that you are,
Words of One Volumes I, II and now III are getting all 5-star reviews! Read them all, for insight into this 2020 year. Both Kindle & paperback editions of all 3 are available now. (click here)
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Much obliged.
bob mencel
12/8/2020 08:13:14 am
Hello Sophia; I wanted to thank you from the bottom of my heart for all you do. the tide is turning , Please keep up the good work. Best regards, Bob.
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July 2023


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Once there was a beautiful young maiden. Here is how her story goes.
* * *
Long ago, there lived a young woman of surpassing beauty. Many rich and powerful men vied with one another for her hand, each offering greater gifts than the last, so that her father was quite bewildered which of their offers to accept. But while he deliberated, the matter was cut short: for in the dark of the night one suitor more daring than the rest broke into their home, and stole the maiden quite away. This suitor carried the maiden to his hidden home, deep in the darkest part of the taiga. There he wooed her with gifts and music, with fair words and fine verses and rich gowns sewn all over with precious stones; but she would not accept him, and each day she demanded only that she be returned to her home. When she had rebuffed him for the hundredth time, her suitor grew angry: he locked her into her room, and swore that she would not leave until she consented to his suit. But still she denied him, until the fury of his failures turned the young man's brain.
Seeing her resistance continue, the suitor became convinced that the beautiful maiden must have had some secret lover, whom she preferred to him. He suspected everyone, and not entirely without reason: for the other suitors had not ceased to search for her, and their servants and soldiers were prowling from village to village. So her captor gathered around himself a band of silent and merciless men, and he decoyed these agents of the other suitors deep into the taiga, and there he hanged them from the branches. Soon his suspicion grew so deep that he saw in every stranger or traveller a thief come to steal away his prize; and so he hanged them, one and all, until the woods around his hidden home were full of corpses swaying in the winds. As the fame and the horror of the place grew, legends began to circulate through the far towns that the most beautiful women in the world was being held prisoner there, deep in the pinewoods. Many a gallant young man rode off in search of her, fancying himself a lover or a hero. All of them ended their days choking in the hangman's noose.
That night, when the Hangman came for the two thousandth time to demand her hand in marriage, she told him that her heart had softened towards him, and that she longed for him to enter her chamber and sing to her as he used to do. He unlocked the door – and as he stepped inside the maiden cast around his neck a noose woven from her gowns of silk and cloth-of-gold, the other end of which hung down over the room's rafters; and her sister and her sister's suitor rushed in behind him, and all three of them pulled the rope until the Hangman was lifted from the floor, kicking and gasping until he breathed his last. Then they gathered all the wealth which he had given her and they fled out of the taiga, and they did not stop until they reached their father's house. Her sister married the last of her suitors, and they lived in wealth and happiness until the end of their days, but the maiden herself had resolved never to marry: instead, she entered into a temple devoted to the Sage of Gold, and in time she became a great priestess and physician, as famous for her skill and wisdom in her old age as she had been for her beauty in her youth.
After their deaths, the three of them passed into legend: and today the Golden Maiden, the Brave Sister, and the Faithful Suitor are revered as quasi-deific figures, prayed to by would-be lovers and all who find themselves crossed in matters of the heart. As for the woods where the Hangman once lived, it remains a place of appalling ill-omen. Those who enter it often do not come out again; and those who do often speak of seeing corpses dangling from the branches, corpses which could not possibly be the remains of those killed by the Hangman all those years ago. Some say that it is the descendants of his murderous band who still lurk there, practicing the same grim customs which he first taught them; others assert that it is the Hangman himself, so far-gone in evil and madness that even death could not hold him, who now roams the woods with a tattered silken noose around his neck, or else that the ghosts of his victims prowl the forests, dragging others to the same horrible deaths as themselves. Few are so curious as to be willing to risk their lives to discover the truth.
* * *
The Sage of Gold, you will recall, is primarily revered by the Serpent Folk. This means that his cult has something of an image problem. People may respect the Serpent Folk, but they don't like them, and they certainly don't like going into whole temples full of them. There's only so many lines of hissing, heavily-robed serpent-men that you can walk past before you start to feel like a mouse which has accidentally wandered into the snake enclosure at the zoo.
As a result, the legend of the Golden Maiden has been a gift to the cultists of the Sage of Gold. Whenever an unusually attractive young person with a knack for healing comes to their attention, the cultists of the Sage lose no time in producing any number of spurious genealogies and family trees 'proving' that the individual in question is a direct descendant of the Brave Sister and her Faithful Suitor, and proceed to offer them all kinds of encouragements and inducements to follow the example of their famous ancestress the Golden Maiden and join the cult of the Sage of Gold. These beautiful young healers are called the Golden Ones, and the cult values them very highly indeed: they form the public face of the religion, one to which people tend to react much more positively than all those creepy serpent-men. After all, the Golden Maiden is one of the most popular folk-heroes in the region.
In game terms, the Golden Ones are the closest thing that ATWC has to the 'healer-priests' of D&D tradition. Like most things in the Wicked City; they come with a whole load of baggage: the cult they serve is run by the same serpent-folk who control the city's drug trade, most of whom find the current situation so profitable that they're not at all keen on rocking the boat. But the brighter Golden Ones usually work out that they're basically being exploited for PR value, and the braver ones sometimes even decide to do something about it. They're good-looking, they're articulate, they're medically trained, and they're absolutely adored by the common people. It's not a bad package for a would-be revolutionary.
* * *
The Brave Sister Would Be Proud of Me: Playing a Golden One requires Intelligence 11, Wisdom 11, and Charisma 13; they need to be bright enough to cope with a rigorous medical education, and pretty enough to persuade people that maybe they really are the descendents of the Golden Maiden. Game information is as follows:
Golden One Summary Table
- You can only use simple weapons, and cannot use shields, or any armour heavier than heavy leather (+3 AC).
- You gain a bonus to all your to-hit rolls equal to half your level, rounded down.
- You gain 1d6 HP per level.
- Your beauty, self-confidence, and air of untouchable holiness makes it very hard for people to bring themselves to hurt you. When fighting intelligent enemies, you may add your Charisma bonus (if any) to your AC.
- You have a disturbingly complete knowledge of human anatomy, which you can use to your advantage in combat. When wielding a dagger-sized or smaller bladed weapon (knife, scalpel, etc) in melee against a living target with more-or-less human anatomy, you gain a damage bonus equal to half your level, rounded up.
- You are a highly skilled healer. Each day, you may care for a number of people equal to your level; as long as you are able to check up on them every few hours, giving them medicine and dressing their wounds, they will regain an extra 3 HP per day in addition to whatever they would normally recover. If you focus your entire attention on caring for a single patient for an entire day, they regain a number of extra HP equal to three times your level. If more than one Golden One is tending to the same patient, these bonuses stack.
- You know a wide range of cures for diseases and poisons. After inspecting someone suffering from a poison or disease, you can spend one hour preparing a medicine which permits them a new FORT save to shake off its effects, with a bonus equal to your level. You may only attempt this once per patient.
- You can perform amazing feats of battlefield first aid. If someone takes a fatal injury, then you have a number of rounds equal to your level to attempt life-saving treatment. If you get to them in time, then spend one round performing emergency first-aid and make a Wisdom roll; if you succeed, they immediately regain 1d6 HP. If this isn't enough to save their life, then they die for real.
- You can identify almost all drugs, poisons, and medicines by smell. Especially obscure ones might require an Intelligence roll.
- You are attractive, eloquent, and widely believed to be descended from a popular folk-hero. You gain a +1 bonus on reaction rolls (in addition to any bonus from your Charisma), and all your followers gain an additional +1 bonus to morale.
- Between your good looks, your ancestry, your eloquence, and your habit of saving people's lives, people just really like you. Any ordinary people you meet should be assumed to be friendly, helpful, and well-disposed towards you unless they've got a strong reason to behave otherwise. This isn't mind control - they won't die for you, or tell you their deepest secrets - but you'll always be given the best seat at the concert, the last slice of cake, the first warning that the guards are coming, and so on. If you're really trying to push your luck with what this will let you get away with, the GM may call for a Charisma roll.
Golden One Summary Table
Hit Points
To Hit Bonus
Fortitude save (FORT)
Reflex save (REF)
Willpower save (WILL)
Starting equipment: Beautiful clothes, bag of medicinal herbs, medical instruments (scalpel, forceps, etc), golden icon of the Sage of Gold, 1d6 copies of a cheaply printed book telling the story of the Golden Maiden (illustrated with woodcuts), impressive-looking documents 'proving' that you are a lineal descendent of the Brave Sister, 3d6x10 sp.


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Sammond, Nicholas. "Meeting in the Archive: Comix and Collecting as Community." Feminist Media Histories 4.(2018): 96–118.
Added by: joachim (7/8/18, 12:05 AM) Last edited by: joachim (7/8/18, 12:25 AM)
|Resource type: Journal Article
Language: en: English
Peer reviewed
DOI: 10.1525/fmh.2018.4.3.96
BibTeX citation key: Sammond2018
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|Categories: General
Keywords: Archive, Fandom, Gender, Underground Comics, USA
Creators: Sammond
Collection: Feminist Media Histories
Views: 3/370
|URLs http://fmh.ucpress.edu/content/4/3/96
This paper examines the holdings of several archives that house women's and queer comix. It considers the logics of comix creation, distribution, and collection, and their relationship to the formation of communities. Situating its analysis in relation to the reparative turn in queer history and arguments about queer utopianism, the paper considers these comix, most of which were produced and purchased from the 1970s to the 1990s, against the often libertarian, and misogynist, and better-known, underground comix of that era by figures like Robert Crumb, Spain Rodriguez, and S. Clay Wilson. It asks what sorts of relationships we might discern between the contents of women's and queer comix and the communities they represented and contributed to, and how archives of those comix inflect our understanding of that shared and contested history.


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Science has proven that meditation increases immunity, decreases pain, increases positive thinking, decreases depression, increases social connection and emotional intelligence and decreases anxiety and stress. It also makes you more compassionate, feel less lonely, and improves your ability to regulate your emotions. Meditation also increases your grey matter, increases focus and creativity, improves your ability to multitask, and even improves your memory. So meditation is pretty good then.
To those who know me, it's probably no surprise that I meditate, and moving in to my final semester at university, full of deadlines and uncertainty, I suspect I'll be doing a lot more of it.
The 'brand image' of meditation is evolving but some still see it as an activity that involves sitting crossed-legged, robed, chanting in a foreign language. Far from being annoyingly metaphysical, one application – Calm – is setting out to break the misconception.
I had a chat with Michael Acton-Smith, one of Calm's founding pair, to find out more…
Michael, where did the inspiration for Calm come from?
Alex Tew, my co-founder, has been a life long meditator. I was initially dubious as I thought there were religious and 'woo woo' connotations but as I researched more I began to appreciate the science behind it.
Calm is about breaking down the misconceptions of meditation and about making it more relatable. We want to demystify this valuable practice and make it accessible and understandable to all.
A few years ago we had the chance to buy Calm.com and that was the first step in creating an exciting and important new brand. We felt there is an awakening in the West of people who want to understand and develop their minds.
Calm's audience is 'anyone with a mind', and our mission is to make the world a happier and healthier place.
And how is that mission progressing?
Very well. We have over 4 million downloads and are adding about 10,000 new users every day. The feedback we get from users is awe-inspiring and humbling.
We have many plans to expand the brand and bring Calm into all aspects of someone's life, but the app is the heart of the business. Some ideas include Virtual Reality, clothing, music, and community events around the world.
Lots of meditation practitioners talk about disconnecting from technology and re-connecting to people and nature. What's the relevance of meditation in the digital age?
These devices we carry with us everywhere are super powerful and valuable but we need to learn to become masters of them rather than slaves. For many people their relationship with their phone is mindless and it's causing a great deal of stress, distraction and anxiety in the world.
I don't feel being a technological company has hindered Calm's success. There are 2 billion smartphones in the world and it is the smartest way to connect with a huge audience. The technology is not at fault it is our relationship with it that matters.
And what does meditation, and Calm, mean to you, Michael?
I started meditating a few years ago and I have observed many benefits in my life. When I discover something I'm passionate about I love turning it into a business and sharing it with the world.
Calm is a very exciting journey that I believe will not only be a successful business but more importantly will help bring a little more peace, perspective and equanimity into the world.
17 Nov 2016about podcast contact


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The Ministry of Information Technology and Telecommunication (MOITT) Pakistan in efforts to auction off the remaining 4G spectrum among the telcos of Pakistan, has hit a snag. As per the news pouring in, an overwhelming majority of telco operators shall not be taking part in the auction. It has been reported that three of the total four possible bidders will not be participating for various reasons.
Telenor, Zong and Jazz have been reported to not participate in the upcoming auction, leaving Ufone as the only potential bidder for the 4G spectrum. The Ministry of Information Technology and Telecommunication Pakistan had initiated the relevant processes and measures to auction off the auction of 10MHz block in 1800MHz band in March of 2017. The base price had been set at 295 million dollars.
Also Read: Next Phase of 4G Spectrum Auction in March 2017
However, despite the best efforts, the auction does't seem to be a possible success. As stated earlier, many of the uninterested parties have various technical reasons for not participating in the upcoming auction. For example, Telenor acquired 10MHz block from 850MHZ band only in August 2016. They have just launched their 4G services and currently and have no reason to aim to expand their 4G spectrum.
Similarly, Jazz has only recently merged with another telecom operator, Warid which had its own 4G Spectrum. Thus Jazz already has a sufficient presence in the 4G domain without having to acquire additional spectrum.
The reasons for Zong's non participation have yet to be confirmed.
Also Read: Ufone Doubles The 3G Spectrum, Rings Trouble For The Competitors
The only telecom operator that remains available to take part in the bidding is Ufone. There are reports suggesting that the PTA is vigorously pursuing Ufone to take part in the bid. Ufone is a subsidiary of Etisalat, a company based in the United Arab Emirates (UAE). However, there seems to be no compulsion for Ufone to acquire 4G Spectrum as they are currently improving their existing infrastructure.
The 4G auction of the remaining spectrum is largely believed as a political concern for the ruling quarters to show this achievement in their last budget.
The first auction in Pakistan was held online in which telecom operators sent bids using the secure portal provided by PTA. Zong and Mobilink/Jazz each gained the 10MHz of 3G spectrum in 2100MHz band. Telenor and Ufone managed to acquire the 5MHz of 3G spectrum in 2100MHz band, each. Zong was likewise able to win the 10MHz 4G spectrum in 1800MHz band. Warid hadn't participated in the auction, however, later along with Telenor, was able to get the 4G spectrum.
As Mobilink/Jazz got the 4G functionality after it has acquired Warid, Ufone now remains as the only company which doesn't offer the 4G spectrum.


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On Fri, 2006-02-10 at 16:52 +0100, Alexander Terekhov wrote: > Rui Miguel Silva Seabra wrote: > > [... "monopoly" ...] > > William M. Landes and Richard Posner: > > ----- > A property right is a legally enforceable power to exclude others > from using a resource, without need to contract with them. So if A > owns a pasture, he can forbid others to graze their cattle on it
Yes, we all know that. But contrary to grass & cows, people can copy digital content ad aeternum without loss of the source. This fundamental difference establishes quite good boundaries. Like why copyright isn't property. In property, if I equally share a land with you, each of us has half a land. In idea expressions, if I share an idea with you, each of us has an idea. Its like the christian miracle of bread & fish. Rui
Description: This is a digitally signed message part
_______________________________________________ Gnu-misc-discuss mailing list email@example.com http://lists.gnu.org/mailman/listinfo/gnu-misc-discuss


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High interest rates on your credit cards and loans. If having bad credit score indicate that your using your credit
card to much and cannot pay the credit on due date. If you're approved with bad credit score you will pay more
interest rate over time than you would if had better credit score.
Credit and loan applications may not be approved. Having bad credit score is not good record on you because if
you want to apply for new credit or loan it will denied because of your bad credit. You may find it hard to apply for
new credit or load in the future.
Difficulty getting approved for an apartment. Many people don't realize landlords check credit before approving a
rental application. Having bad credit can make it much more difficult to rent an apartment or house. If you find a
landlord who will rent to you despite your low credit score, you may have to pay a higher security deposit.
Security deposits on utilities. Utility companies – electricity, phone, and cable – check your credit as part of the
application process. If you have a bad credit history, you may have to pay a security deposit to establish service in
your name, even if you've always paid your utility bills on time. The security deposit will be charged upfront before
you can establish service in your name.
You can't get a cell phone contract. Cell phone companies check your credit too. They argue that they're
extending a month of service to you, so they need to know how reliable your payments will be. If your credit's bad,
you may have to get a prepaid cell phone, a month-to-month contract where phones are typically more expensive,
or go without one at all.
You might get denied for employment. Certain jobs, especially those in upper management or the finance
industry, require you to have a good credit history. You can actually be turned down for a job because of negative
items on your credit report, especially high debt amounts, bankruptcy, or outstanding bills.
Employers check your credit report and not your credit score. They're not necessarily checking for bad credit, but for items that could affect your job performance.
Difficulty starting your own business. Starting new business need money to help funds their startup. A bad credit history can limit the amount of your able to borrow to start new business, even having solid marketing plan to
That's why there are credit repair Company to assists us in making our credit score from having bad
credit to good credit.


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When the Eureka City Council unveiled a proposed Final Solution to the Homeless Problem at its Dec. 16 meeting, too many people showed up. Council Chambers had only enough room to accommodate around 200. Attempting to solve the problem, the mayor announced that down the hall there was a different, separate room where the extra attendees would have to go.
The different, separate room, known as Room 207, had its drawbacks — it was smaller and a ways distant from the meeting itself. Instead of watching the City Council do its business in person in council chambers, all of the "extra people" would have to make do with a single TV screen.
It was perhaps fitting that once city staff proceeded to discuss various proposals for extermina... — er, accommodating — Eureka's homeless population, the favored 'solution' involved herding them into a makeshift tent city on the Bayshore Mall's dodgy north parking lot.
Well, something had to be done. Whipping the council into a froth of Home-No-Phobia was Police Chief Andy "Ugg Boots" Mills, who recited the usual script of scary labels: They're mentally ill. They drink booze. They have dogs and criminal histories and *gasp!* shopping carts!
(Subliminal message: Residents who live in fixed-address houses aren't really a problem because they own lots of neat stuff, have to pay the cable bill and thus are more easily coerced by the Police State.)
Next up and wielding a PowerPoint slideshow to seductive effect, a planning department guy showed the council how it could cram 250 tents into Bayshore's abandoned northern lot, accommodating a population of around 300. Under this tantalizing proposal, the city would herd homeless dudes off the waterfront and out of the greenbelts, gulches and various backyards, and into an organized space.
Ah, but there's a catch.
As explained in a city-commissioned report prepared by Focus Strategies, it is the singular objective of the city to "reduce the number of homeless people in the community."
As any 10-year-old will tell you, logically, the number of homeless Eurekans can be "reduced" in one of two ways: One way being to provide them with actual housing, in which case one's "homeless" status vanishes.
The other way involves ... well, basically, turning them into fishbait.
Welcome to Camp Tsunami! Pitch your tent, park the shopping cart and stick around a while (read: until the next shaker). Then, adios.
Instantly clear to anyone who's ever driven down Broadway with its dozens of signs declaring certain death in all points west in the event of an offshore temblor, Camp Tsunami is now the World's Deadliest Parking Lot Homeless Camp.
Emphasizing the importance of "site control," the planning guy stressed to the council the importance of Camp Tsunami's gates and fence.
Hey, if Mother Nature's next 7.2 is gonna get the job done, you gotta have a sturdy fence in place!
The poet Robert Frost once wrote, "Good fences make good neighbors."
In the case of Camp Tsunami, "Good fences make good shark bait."
Can eat a pretty balanced and fulfilling diet consisting of nothing but Costco samples.
Or, if plated sit-down meals are more your style, we hear the Rescue Mission's fried chicken dinners are awesome.
Both are free.
You ever get nostalgic for the 1950s? Do you ever yearn for a time when such pesky issues as "gender equality" and "diversity" remained firmly, angrily — indeed, hatefully — stuffed in the closet?
Do you ever wish you could travel back in time — to experience a world before everything was LGBTQ-this, and gender-studies-that?
Thankfully, such a place still exists. To get a glimpse of the world in all of the gender-bigoted glory of yesteryear, one need look no further than the campus of Arcata's own Humboldt Segregated University.
Oh sure, gender-neutral access to bathrooms and locker rooms may be a protected legal right in California's K-12 school system, where any dude can express gender equality by waltzing into the girls' bathroom, or by lurking furtively around the showers of the cheerleaders' locker room.
But staying true to its white-bread, Eisenhower time-warp, HSU's on-campus student housing is still segregated according to outmoded sexual "norms," its housing website helpfully informing visitors that this housing wing over here is for Jane, while that one over there is for Dick, and bathrooms "are not co-ed," just like in the awesome, pre-Stonewall good old days.
In other words, we don't care how YOU choose to identify yourself. You wanna live on-campus at HSU? Well then you're gonna have to pull down your Levi's.
Gee, doesn't it just make you and your buddies Biff and Franky want to jump in the jalopy and cruise over to the malt shop so you can sexually harass girls dressed in poodle skirts?
As this column goes to press, we're working to confirm whether HSU faculty and staff are still pecking away on manual typewriters and dialing rotary telephones.
But what we can tell you for now is that although HSU makes a couple of token gestures to the 21st century — two WHOLE bathrooms and one ENTIRE locker room having been designated gender-neutral — the rest of the campus remains securely ensconced within the confines of repressive, phobic, Happy Days-era tyranny.
Never mind the warnings from HSU's own Eric Rofes Queer Resource Center, which designates gender-specific bathrooms as dens of harassment and violence against those who aren't gender normative.
When it comes right down to it, gender equality in public education pretty much terminates your senior year of high school.
Separate but equal, anyone? Well then, welcome to Humboldt Segregated University. Leave your gender-equality at the campus border, thanks.
Someone needs to pitch a new reality show to the History Channel. Alternating almost exclusively, as it does, between shows about quirky pawn shops, World War II documentaries and the exploits of various species of junk merchant, the channel is missing out on a big opportunity.
And it happens to be right in our backyard.
They could pull off a low-culture trifecta by launching a show called Nazi Pawn Shop. Internet auction site eBay forbids sales of Nazi memorabilia, positing that profiting off a stormtrooper's combat-tested bayonet might be, oh, a tad insensitive.
But if what you're after is that special Luftwaffe ribbon or SS infantry Iron Cross, a certain Eureka pawn shop has got you covered.
Pawn Stars, eat your heart out.
Curiously, the swastika-laden fare on offer at Eureka's Mein Kampf-approved junk shop haven't raised any red flags at the Eureka Police Department. By law, EPD receives daily inventory of all items traded by every pawn shop within city limits.
But let's not let something so silly get in the way of ratings gold.
—— Ryan Hurley
Ryan Hurley is a Eureka-based attorney. Follow him if you dare: @BuhneTribune.


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Teaser: Dragonfly by Leigh T Moore
Jun 3, 2013
Postado por Ali Kiki �s June 03, 2013
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Ali Kiki is a reader, writer, reviewer, blogger, and photographer. Sometimes she is a pirate or maybe she is always a pirate. Located in Portland, OR she enjoys exploring the city and finding new unique places. As an avid reader since childhood, you can usually find Ali devouring a book or stalking the bookstagram hashtag in her lovely apartment surrounded by books and Funko pops. Ali has been blogging since 2006 and she created Dazzled by Books in 2012.


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ESAS Trade is the exclusive
representative of a socks manufacturing factory in South Asia. Since
1992, we have been producing sports and dress socks for export markets
for Europe, Australia, New Zealand and Central America. For the last 6
years, our line of sport socks, TOTAL Comfort Socks, has become the
leading sport socks producer and exporter for Europe.
We have over 600 socks knitting machines comprising of Savio Matec, Conti, N G, Lonatie sports socks machines and Double Cylinder Machines Bentley, Uniplet and E-Model which are capable of producing high quality sports socks to meet any required specs and standards. We can customize the socks with your logos and colors to reflect your brand needs.
Quality Control
Once the manufacturing process started, our trained QC teams follow strict quality control procedures. All finish products then undergo final inspection and check for logos, labels and design faults. In addition, visual inspections are conducted thoroughly for product dimensions and any holes.
Wholesale Organic Products and wholesale directory. We have wholesale sport socks and wholesale dress socks.


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Soggy Weekend; Dry and Cooler Monday
Good afternoon folks! A few thunderstorms are developing along the ridgelines this afternoon as expected, however our previous forecast for increasing shower coverage on Thursday will likely not play out as planned. The models hint at a slight reduction in coverage compared to today, so we are going with another round of isolated thunderstorms for Thursday afternoon, instead of the previously forecasted scattered thunderstorms. The front is still expected to swing through early in the day Friday, with showers dotting the landscape till the late morning hours and picking back up again Friday evening. Showers will continue overnight into Saturday and as the front stalls across the region, deep moisture from the south moves in, allowing widespread showers and thunderstorms to develop. Flooding will not be an issue, but this rain will certainly put a damper on your outdoor plans Saturday and Sunday is not looking any better. A second front passes through the area early Monday, ushering in sunny skies and near normal temps, which is something we have not enjoyed for over a week!
Thursday brings us another muggy day with a mixed bag of sun and clouds after midday, due to isolated thunderstorms popping up across the region. Temps are likely to be the same as Wednesday, perhaps a degree or two cooler, as they push into the mid 60's - low 80's depending upon elevation. Coverage increases slightly Thursday night, with more mostly cloudy skies overhead, holding temps to the upper 50's for most of the region.
Friday through Sunday will be our most active days and rainfall totals over the 72 hour period will tally up to 2 - 3" depending upon location. Roughly a half inch of rain will fall on Friday and into the wee hours of the morning on Saturday, with up to an inch of rain falling on both Saturday and Sunday. There may be a break in the action during the early - mid afternoon hours on Friday, but coverage is expected to increase overnight into Saturday, becoming widespread by Saturday afternoon. Thunderstorms will attribute to most of the expected rainfall totals and it seems the best window for thunderstorm development is Saturday afternoon. Sunday offers up another round of light - moderate showers around the noon hour, taking till the late evening hours to wind down to isolated coverage. Temps go from the mid 60's - upper 70's Friday to the upper 50's - low 70's by Sunday. Overnight lows generally will be in the mid 50's - low 60's Friday and Saturday, but are expected to cool down to the mid 40's - low 50's Sunday night under clearing skies.
Monday into the middle of next week offers up sunshine and temps that are more seasonal, rising to the low 60's - mid 70's depending upon elevation. This fair weather may extend into the late next week, so if you need to cut, dry and bail hay, next week provides us a good window.
Our next discussion will come out Friday afternoon and focus on the ongoing rainfall, the breakout of thunderstorms on Saturday and the upcoming dry spell next week.


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Baring, Stagecoach drivers raise over £3,000
for The Children's Hospital, Sheffield.
3 of the 21 Stagecoach Yorkshire, Holbrook depot, drivers pose with their calendars.
The Childrens Hospital, Sheffield, have been presented with a cheque for over £3,000 raised after group of drivers posed (tastefully) naked for a calender.
Story & pic


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FLATBUSH, Brooklyn (WABC) -- One person was killed and another was injured when a violent fight broke out in the lobby of a Brooklyn building.
A fight between two groups of men was reported in a building in the 500 block of Ocean Avenue in Flatbush early Friday morning.
Police say a man with a machete slashed a 23-year-old man in the arm.
Another man then opened fire and fatally shot a 24-year-old man in the back and leg. The victim's identity has not yet been released.
No arrests have been made and the investigation is ongoing.


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Contact Us
If you need time to relax, unwind and escape the everyday strains and stresses of modern day living, why not indulge in some top to toe pampering in our comfortable & relaxing boutique day spa. Feel free to get in touch using any of the methods below.
139 Wakefield Road, Huddersfield, West Yorkshire, HD5 9AN
Opening Hours
Sun – Mon: CLOSED \ Tuesday: 9am – 3pm \ Wednesday: 9am – 5:30pm
Thursday: 9am – 8pm \ Friday: 9am – 5:30pm \ Saturday: 9am – 3pm