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Session Information Session Title : NRP: Climbing the Olympic Hill to Better Evidence, Implementation, and Outcomes TEN KEY PAPERS Session Number : C6000 Faculty Name : Steven Ringer, MD, PhD Jay Goldsmith MD George Little MD
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Session Title: NRP: Climbing the Olympic Hill
to Better Evidence, Implementation,
and Outcomes TEN KEY PAPERS
Session Number: C6000
Faculty Name: Steven Ringer, MD, PhD Jay Goldsmith MD George Little MD
Faculty Institutions: Harvard Medical School, Tulane University, Dartmouth Hitchcock Medical Center
Faculty Disclosure Information
In the past 12 months, we have had no financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial service(s) discussed in this CME activity:
we do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.
Primary studies on physiology of transition and effect of depression
Investigations on best approaches
Evolution of educational modalities
Potential future changes
Expansion to all newbornsTen Key Papers
A hypothesis is stated
Evidence is sought using numerous search engines i.e. Pubmed, Embase, ECC library etc
Evidence includes both human and animal data (distinguishes this process from Cochrane)
8 levels of evidence
Evidence is evaluated for quality and then placed in grids either supporting or opposing the question
The data are summarized and a scientific statement with a class of recommendation is madeEvidenced Based Process
Step 1: Define existing and proposed guidelines
Step 2A: Gather the Evidence
Step 2b: Classify the Level of Evidence
Level 1: Randomized controlled trial with large effect
Level 2: Randomized controlled trial with small effect
Level 3: Prospective controlled non-randomized study
Level 4: Historic, non-randomized cohort study
Level 5: Non-controlled case series
Level 6 Animal or mechanical model study
Level 7: Extrapolation or theoretical analysis
Level 8: Rational conjecture (common practice)
Step 2c: Evaluate the Quality of Evidence
denotes key article(s)
denotes key article(s)
Citation #1Key studies
Copy and Paste Summary Table from Worksheet
Some harm was noticed when parachutes failed to open (NNH= 1)Consensus on Science statements
Parachutes should be used in all planned and unplanned jumps from altitude.
Handkerchiefs should not be used in jumps from altitudeDraft Treatment Recommendations
Relationship with training to ETT success
Specific research required
Adult ETT vs. BVMKnowledge Gaps (e.g.. ETT vs. BVM)
Class IIa: Acceptable, safe, useful (standard of care intervention of choice)
Class IIb: Acceptable, safe, useful (within the standard of care or an optional or alternative intervention)
Class Indeterminate: Preliminary research stage with promising results but insufficient available evidence to support a final class decision
Class III: Unacceptable, no documented benefit, may be harmfulClinical Interpretationof Classes of Recommendation
Newer system is more direct and clear than the previously used classes of recommendation:
Consider recent results that may guide practice in the future (What will we be doing)
Examine the papers advocating a change in education and training for resuscitation (How we teach)Session Goals
A review of the early work by Dawes, Adamsons and others examining the effects of experimental acute asphyxia on newborn Rhesus monkeys.
Central paper demonstrating physiologic response, primary and secondary apnea, effectiveness of resuscitation
Level of Evidence (LOE) 61. Physiologic effect of asphyxia
Controlled Asphyxiation by slipping saline filled rubber bag over head, tying umbilical cord, for 10-15 minutes
Placed on table at 30 degrees C.
Umbilical artery catheterized, infant monitored
Resuscitation with PPV, Oxygen, Cardiac massage as neededPhysiologic responseto asphyxia
Demonstrated the development of bradycardia and hypotension over course of experiment, recovery with resuscitation
Defined the relationship between length of asphyxia and time for recoveryPhysiologic responseto asphyxia
Adamsons, et al
Time for
recovery depends
on length of asphyxia
Adamsons, et al
Demonstrated the resuscitation before the "last gasp" (~8.4 minutes) resulted in absent or trivial cerebral damage
Resuscitation after 12.5 minutes accompanied by widespread and severe damage
Asphyxia does not end with ventilation, continued support and ongoing evaluation neededPhysiologic responseto asphyxia
The management of the baby with MSF has evolved dramatically over past 30 years. Most babies not depressed
Randomized MCT of > 2000 babies compared intubation vs. expectant care
Demonstrated lack of utility of intubation and suctioning in vigorous infants with MSF
LOE 12. Management of MeconiumStained Fluid (MSF)
Naso or oropharyngeal suctioning of MSF before delivery of shoulders compared with no suctioning, randomized trial, >2500 infants.
No differences in Meconium Aspiration syndrome, need for ventilation, mortality or length of care
Routine suctioning not recommended
LOE 13. Management of MeconiumStained Fluid (MSF)
ResAir 2 was the second of two large trials, with >600 babies enrolled, randomized to 100% Oxygen or air
Study demonstrates efficacy of room air resuscitation in a full term cohort, with equal or better safety
LOE 24. Room Air or 100% Oxygen
Death within 7 days or moderate/severe hypoxic ischemic encephalopathy: 21.2% RA vs. 23.1% oxygen (NS)
No difference in growth or neurologic disability at 18-24 mo. (only 70% of population)
Cochrane Review concludes there is insufficient evidence to recommend one or the other (Lancet meta-analysis with different conclusion)Room Air or100% Oxygen?
Time Needed for Onset of Sustained Respirations
Vento et al., Biol Neonate, 2001
Relative risk of death favored RA group
Only 1302 infants included in analysis
No infants <1000 grams; few prematures
? Truly asphyxiated (entry criteria questioned)
Randomization not optimal
Only 2 studies were blinded
168 of 635 infants in RA group received cross-over oxygen100% Oxygen vsAir: Human Studies
174 of 177 deaths in developing countries
No details of causes of death
No plausible mechanism for deaths in oxygen group proposed
Entry criteria may not have selected babies who were truly asphyxiated100% Oxygen vs. Air: Human Studies
"There is insufficient evidence at present on which to recommend a policy of using room air over 100% oxygen, or vice versa, …"
"We note the use of back-up 100% oxygen in more that a quarter of infants randomised to room air."
Davis PG, Tan A, O'Donnell CPF, Schulze A: Lancet 364:2004
"The pooled analysis showed a significant mortality benefit for infants resuscitated with air (RR 0.71 [95% CI 0.54-0.94]; RD – 0.05)." Causes of death were not given. Most babies in all 5 studies were recruited from developing countries.
"For term and near term infants, air should be used initially, with oxygen as back-up if initial resuscitation fails"Meta-Analyses ofKey Human Studies
Randomized trial of infants ≤ 28 weeks- starting with low (30%) or high (90%) O2
Weaned up for bradycardia, down for high saturations
Both groups ended up in 45% oxygen, no short term differences5. Room Air or Oxygen in Prematures?
Escrig R, Arruza L, Izquierdo I, et al. Achievement of Targeted Saturation Values in Extremely Low Gestational Age Neonates Resuscitated With Low or High Oxygen Concentrations: A Prospective, Randomized Trial. Pediatrics 2008; 121: 875-80.
Escrig, 2008
Escrig, 2008
Small trial (41 infants) of RA vs. 100% oxygen as initial gas for infants 23-32 weeks
Weaned up for low saturation, and to 100% for low HR or chest compressions, down for high saturation
All RA patients required rescue, failed to meet target saturations without O2, so RA not recommended
LOE 25. Room Air or Oxygen in Prematures?
Wang et al, 2008
Randomized 610 infants 25-28.6 weeks gestation to CPAP+8 or intubation @ 5 min, multicenter
Babies deemed to need immediate intubation were excluded
Infants given mask ventilation at birth if needed, assessed at 5 minutes for need for ongoing support
CPAP by nasal prongs at 8 cm H20
CPAP infants intubated for: Unresponsive apnea, respiratory acidosis or unresponsive metabolic acidosis, need for >60% oxygen6. CPAP for Resuscitation
33.7% of CPAP group had BPD or died, vs.38.9% of intubated group, not significant
Lower risk of oxygen need or death @ 28 d, no difference in mortality, fewer vent. days
9% pneumothorax in CPAP group, vs. 3 % in otherCPAP for resuscitation
Did result in less oxygen use at 28 days, but more pneumothoraces, no difference in associated morbidities
Results suggest that starting with CPAP is appropriate, and that not all small babies need surfactant
CPAP used at 8 cm H2O, not started until 5 minutes, so less easy to generalize
LOE 1-26. CPAP for Resuscitation
Outcome evaluated in over 4100 ELBW infants
Death or degree of impairment evaluated
Not only Gestational age, but sex, exposure to antenatal steroids, singleton or multiple, birthweight have impact
LOE 17. Moving beyond Gestational age for prognosis
Halamek LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Semin Fetal Neonatal Med. 2008; (Jun)2.
Simulation training has increased in sophistication over the past several years
Effective simulation does not require high technology, but a commitment to "suspend disbelief" and work as a team
The use of simulation in team teaching and training is becoming the standard, is the future for NRP8.Simulation training/Debriefing
Skills needed include:
Cognitive, or content knowledge "think"
Technical, or manual skills "do"
Behavioral "think and do, as part of a team"8.Simulation training/Debriefing
2. Anticipate and plan.
3. Assume the leadership role.
4. Communicate effectively.
5. Delegate workload optimally.
6. Allocate attention wisely.
7. Use all available information.
8. Use all available resources.
9. Call for help when needed.
10. Maintain professional behavior.Behavioral skills
• Characterized primarily by passive, not active, learning opportunities
• May be primarily focused on teaching rather than learning
• Lacks realistic cues, distracters and pressures
• Unable to adequately prepare for practice in the real environment
• Clinical environment
• Places patients at some degree of risk
• Learning opportunities (cases) present randomly
• Learning limited by fast pace, production pressure, inherent high cost and other competing prioritiesTraditional learning environments not ideal
Allow learners to work through clinical challenges as best they can, then "debrief"
Learners must "suspend disbelief "
Self reflection is key componentSimulation basedtraining
• Provides structured learning opportunities with defined learning objectives
• Allows practice without interruption/interference
• Can be scheduled at times convenient to trainees and instructors
• Easily tailored to the needs of individual trainees
Can be scaled in intensity to meet the needs of learners at all levels of experience
• Allows practice of routine and rare situations
• Fosters integration of cognitive, technical and behavioral skills
• Facilitates multidisciplinary team trainingSimulation-Advantages
It isn't the sophistication of the equipment, but how it is used
As behavior is better understood, techniques and value of simulation will increaseSimulation and NRP
The construct of these sessions is critical to success
These papers will provide insight and a preview of simulation training as a standard part of NRPSimulation/Debriefing
Hypothesis: Selective and/or whole body modest hypothermia implemented in the first six hours of postnatal life in term infants at highest risk for evolving to moderate to severe encephalopathy will reduce the subsequent development of irreversible brain injury without untoward side effects.
Meta-analysis of 8 randomized trials of hypothermia to treat asphyxia and prevent brain injury
Evidence shows benefit in reduction of mortality and morbidity in term infants
LOE 19. Hypothermia for Asphyxia
Only 2 randomized studies, 50 infants
No adverse effects; no significant therapeutic effects
No recommendation for or against
2007 meta-analysis:
8 randomized studies, 638 term infants
↓ in death and ND disability in cooled patients
↑ need for inotropic support and ↓ platelets
Conclusion: Cooling reduces mortality without increasing major disability to survivors
Further trials needed to determine appropriate method9. Hypothermia for Asphyxia
Neonatal Post-AsphyxiaHypothermia RandomizedControl Trials
See NICHD Workshop: J Peds 2006; 148:170-5
(aEEG determined)
more cooled versus control infants had a favorable outcome (52% versus 34%; p=0.02) and were less likely to be severely affected (11% versus 28% p=0.03).
There was no effect in infants with severe encephalopathy and/or with seizures upon presentation.
"Cool Cap" Study
Gluckman et al Lancet 2005
Shankaran (NICHD Network), NEJM, 2004
What is the appropriate timing – Duration? When is too late?
Risk-benefit for preterm? IUGR?
Whole body vs. selective head? Appropriate method of re-warming?9. Hypothermia for Asphyxia: Issues
NRP has been used increasingly in the developing world over the past several years
While the basic principles are the same, the practice requires adaptation in resource-poor environments and specialized programs are under development
Often lessons learned in these settings have value in the developed world as well10. International efforts
Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K, Schutzman D, Cleary GM, Filipov P, Kurlat I, Caballero CL, Abassi S, Sprague D, Oltorf C,Padula M. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics. 2000;105:1-7
Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Lancet. 2004;364(9434):597-602.References and papers for discussion
Saugstad OD, Ramji S, Irani SF, El-Meneza S, Hernandez EA, Vento M, Talvik T, Solberg R, Rootwelt T, Aalen OO. Resuscitation of newborn infants with 21% or 100% oxygen: follow-up at 18 to 24 months. Pediatrics. 2003;112(2):296-300.
Tan A, Schulze A, O'Donnell CP, Davis PG. Air versus oxygen for resuscitation of infants at birth. Cochrane Database Syst Rev. 2005;(2):CD002273.References and papers for discussion
Escrig R, Arruza L, Izquierdo I, Villar G, Saenz P, Gimeno A, Moro M, Vento M. Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: a prospective, randomized trial. Pediatrics. 2008;121(5):875-81
Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. Nasal CPAP or Intubation at Birth for Very Preterm Infants. N Engl J Med 2008; 358:700.References and papers for discussion
Ohlinger J, Kantak A, Lavin JP Jr, Fofah O, Hagen E, Suresh G, Halamek LP,Schriefer JA. Evaluation and development of potentially better practices for perinatal and neonatal communication and collaboration. Pediatrics. 2006;118 Suppl 2:S147-52.
Halamek LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Semin Fetal Neonatal Med. 2008; (Jun)2.References and papers for discussion
Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003311
Singhal N, Niermeyer S. Neonatal resuscitation where resources are limited. Clin Perinatol. 2006;33(1):219-28.References and papers for discussion


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Trapdoor Collector Discussion Board
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H & R Officers rear sight
Posted by Don Huskins on Tuesday, 27 January 2015, at 6:25 p.m.
Thinking about adding a rear 1879 sight to my H & R Officers, I have been told that I might run in to an issue with the sight screws, original being Whitworth screw pattern and requiring a Whitworth tap set. The remedy seem to be to use a American screw pattern. Has any one attempted this or know anything about this issue?
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Posted by Steven Shavell
Review For the past 30 years, Steven Shavell has been one of the prolific and influential contributors to the economic analysis of law, the foremost intellectual movement in law in the last half century. His new book is a lucid, accessible, authoritative, critical, and comprehensive treatise on the economics of the fundamental doctrines and institutions of the law. It is at once a major contribution to scholarship, a useful reference tool, and a valuable introduction to an approach to law that no serious student of the law can any longer afford to neglect. (Richard A. Posner, Judge, U.S. Court of Appeals for the Seventh Circuit)Shavell's book provides a masterful, non-technical synthesis of the classical topics of law and economics. It is comprehensive, clear and readable. The book will be a great source both for neophytes who want to learn about this important area, and for experts who want to make sure that they are up-to-date on the latest developments. (Oliver Hart, Department of Economics, Harvard University)Law and Economics is one of the great intellectual triumphs of social science. Shavell's book offers a compelling account of the accomplishments and challenges of the field at the beginning of the 21st century. (Andrei Shleifer, Department of Economics, Harvard University)Since the 1970s, Steven Shavell has written one path-breaking article after another. Not only has he collected the insights from this large body of work under one roof here, he has added to it both by integrating it into a coherent whole, and by filling in numerous gaps in the literature. For someone interested in getting to the cutting edge of law-and-economics scholarship as quickly as possible, this book is a 'must read.' It clearly will become the authoritative treatise on the economic analysis of law. (A. Mitchell Polinsky, Stanford Law School)This book proposes an overview of the fields in the economics of law to which the author has contributed. It also covers in detail other fields and many contributions to the literature. The emphasis is on theory, but some empirical facts are mentioned...I very much enjoyed reading the book. It covers with great competence the relevant topics of positive and normative analyses of law. The book reflects the strong academic competence of the author. I recommend the book to academics and professionals. I also recommend its use for teaching the economics of law in law schools, economics departments, and business schools. (Dionne Georges Journal of Risk and Insurance 2006-12-01) Read more About the Author Steven Shavell is Samuel R. Rosenthal Professor of Law at Harvard Law School. Read more
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How to download 4dh.com videos
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|18 May 2017 by Amelia Sophia
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reliable as usual...
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Manage your AvMed account online by using www.avmed.org. AvMed is one of the oldest and largest nonprofit healthcare management organizations in Florida. It provides Medicare Advantage coverage in Broward and Miami-Dade counties, Individual & Family coverage in Orlando, Gainesville, Jacksonville and southern areas of Florida and Employer Groups in more than 30 counties across the state.
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22 Sep 2018
From cinnamon to turmeric, this autumn's shades are straight from the spice markets. Just don't call it brown.
Left: Gregory Peck in London, 1966
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Five Girls (Signed)
Photography - Haskins, Sam
Price: $450.00
New York: Crown Publishers, 1962. First edition Folio. Clothbound volume in dustwrapper. Early work by Haskins captures the youth freedom and exuberance of the early 1960's through tasteful black and white images of these five delights. A handsome near fine copy in dustwrapper that is torn and chipped in several places with tape mends visible. This copy, though, has been SIGNED by Haskins and dated in 2009. A book seldom found signed or inscribed. Near Fine Cloth (Item ID: 26472)
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- By This Author: Photography - Haskins, Sam
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Hi, it looks like you're new. Welcome to Voat!
Voat is a censorship-free community platform where content is submitted, organized, moderated and voted on (ranked) by the users.
Users can earn a percentage of our ad-revenue share for the content they submit.Take a tour
Archived Followed a link from SBBH to reddit. Found this in the comments. (imgoat.com)
submitted ago by Caesarkid1
[–] AndrewBlazeIt 2 points 36 points 38 points (+38|-2) ago
Lots of VERY depraved folks there!
This is coming from Reddit. The website that will tell you it's okay to shoot heroin and have sex with a 7 year old as long as the 7 year old consents.
[–] Womb_Raider 0 points 1 points 1 points (+1|-0) ago
To be fair, we do have Aged greycloud and hecho. Pretty depraved.
[–] AndrewBlazeIt 0 points 0 points 0 points (+0|-0) ago
Does hecho even post anymore?
[–] RageAgainstTheAmish 1 points 1 points 2 points (+2|-1) ago (edited ago)
I rub my nipples and get a chub every time i hear trumps voice 😩😭🌊 especially when talking about the wall and how awful obama was
Oh baby im so depraved.
Trumps my bae
[–] Caesarkid1 [S] 0 points 6 points 6 points (+6|-0) ago
lol those were good times for sure.
[–] lordbeatlejuicethe1 4 points 19 points 23 points (+23|-4) ago
[–] cool_and_froody 0 points 17 points 17 points (+17|-0) ago
Couldn't be more proud.
Keep fighting the good fight Voat.
[–] ninjajunkie 0 points 7 points 7 points (+7|-0) ago
[–] Reed_Solomon 0 points 7 points 7 points (+7|-0) ago
It's funny how redditors coming to voat en masse would be like a microcosm of the migrants coming to Europe.
[–] Caesarkid1 [S] 0 points 13 points 13 points (+13|-0) ago
Except in this case the migrants fear the natives.
[–] Reed_Solomon 0 points 13 points 13 points (+13|-0) ago
which is how it should be.
[–] EloquentOgre 0 points 3 points 3 points (+3|-0) ago
Except here, the natives aren't censored and castrated.


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City services are not free.
In an 8:1 vote Tuesday, the Stephenville City Council voted against waiving a $512 building permit fee for the construction of a single-family dwelling at 727 W. Frey Street.
Habitat for Humanity requested the waiver, but City Administrator Mark Kaiser said he would "consistently recommend" that the council not waive permit fees.
Kaiser said such requests are fairly common and approving the waiver would mean the city would be giving away inspection services and city time.
He said requests for waivers are fairly common, and there have only been a few occasions the city has approved such requests. Specifically, he said fees were waived when the Boy Scout huts were constructed by local tax-exempt, volunteer-based social service organizations.
But the city has done a lot to assist Habitat's housing ministry, according to Kaiser. He said almost $8,000 in demolition, mowing and clean up fees were waived when the organization purchased the property.
"There is no lack of (city) support on Habitat endeavors," Kaiser said.
Kaiser said the estimated value of the property, which is currently under construction, was listed as $32,000, and the city and other local taxing entities will be delivered property tax revenue.
Betty Chew, director of community development, said Habitat had not yet paid the permit fee, but the organization was aware they would be required to do so if it was not waived by council vote.
In the end, Doug Svien was the only council member who voted against denying the waiver.


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Base History Tour
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Madness is the fourth studio album by American rock band Sleeping with Sirens. The album was released on March 13, 2015 through Epitaph Records. The entire album was self-produced by Sleeping with Sirens with John Feldmann. The album is the band's first release following their departure from Rise Records in 2014. It's also the first record to feature guitarist Nick Martin who replaced former guitarist Jesse Lawson. Madness was preceded by lead single "Kick Me" as well as a string of digital singles released in the days leading up to the album's release. The album continues the band's progression to a more pop rock sound, but retains some post-hardcore influences on tracks.
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Russia Profile.ORGСредняя оценка: 4.2. Добавлено 1 отзыв о работе.
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RUSSIA PROFILE.ORG is an English-language information service and community platform featuring a daily updated website and a monthly magazine, geared towards a wide range of people with a professional interest in Russia. Russia Profile's aim is to offer its readers the most comprehensive and concise view of business, economic, political and cultural trends and processes underway in Russia. Our target audience includes foreign businessmen and top managers working in the Russian market, as well as journalists, government agencies, academia, etc. around the world.
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There is no easier way to applesauce up a basal accouterments than by throwing on a brace of fun earrings, whether baby and aerial or blatant and festive. Earrings are offered in all styles and amount ranges from artisan emblem pieces to affordable and chichi appearance pieces, so it's no admiration that accepting one's aerial broken feels a bit like a rite of passage. Finding the appropriate abode to assurance your aerial to is the acute aboriginal step. Check out this annular up of the best places for ear piercings.
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It is important to agenda that the laws in Minnesota apropos "body art" became added acrimonious in 2010, and you should be accustomed with them afore visiting the called stop. Amateur can still get ear piercings in the affiliate or alien ambit of their ear, but alone with actual identification (which may accommodate a bearing affidavit for some shops), affectionate accord and accompaniment by a ancestor or acknowledged guardian. For added details, advertence this advertisement from the Minnesota Department of Health.
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An Uptown institution, Saint Sabrina's has an unparalleled reputation for both acute and tattooing. With a affable and knowledgeable staff, apprehend to allocution about what you want, get a bright compassionate of afterwards affliction and accept a best experience. The boutique does a array of anatomy piercings, so be able for added images and adornment to be on display. Saint Sabrina's will do ear piercings up to a 10 barometer on amateur with affectionate consent, and accurate IDs for both the accessory and ancestor are required. For adolescent children, agents will accommodate an binding consultation, and may accomplish a 24-hour cat-and-mouse aeon at their discretion. Acute starts at $23 and does not accommodate the amount of jewelry.
Related: Best Places For Facials In The Twin Cities
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Enchanted Retreat Day Spa582 Prairie Center Drive, Suite 230BEden Prairie, MN 55344(952) 942-0600www.enchantmentretreatdayspa.com
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3014 Lyndale Ave. S.Minneapolis, MN 55408
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Defiant Boom and Caffeine Bar mixes achievement art (of a sort) and caffeine by acceptance assemblage a advanced row bench into abounding of its boom appointments. The boutique additionally offers a array of anatomy acute services, including ears, adjustable with the Minnesota regulations mentioned above. Defiant acerb encourages assemblage to analysis its experience online. Read up on the artists' portfolios for reviews to aces an artisan you'll be best adequate with back accepting your aerial pierced. Going for the aboriginal time? Feel chargeless to accompany some moral abutment and amusement 'em to a cup of coffee afterwards.
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Getting Started RPI2/3
You can find images to download at Manjaro-ARM site in the DOWNLOADS section.
You should be able to extract the zip file by right clicking in the .zip file and clicking in "Extract", "Extract Here" or any variants of these using your file manager.
For windows, there are plenty of tools to help with extracting zip files if the built-in file manager does not work. 7zip is an example.
For Linux command line:
unzip Manjaro-ARM-[Edition]-[Device]-[Version].zip
By design, the image is made so that installation is simple. All that is required is dumping the image to the sdcard. To do this with Linux:
sudo dd if=Manjaro-ARM-[Edition]-[Device]-[Version].img of=/dev/[device] bs=4M
There are tools and GUIs that can make this process a little easier such as Etcher and instructions for those are included with the respective software
Cleanup and First Boot
Once you have the image on the SDCard, you should be able to put the card into your RaspberryPi and plug it in. If everything worked correctly, it should boot to the Operating System. Depending on the edition you have installed, this could be a simple TTY login or a graphical desktop environment.
Resizing the partitions
Since 18.09 this is now done automatically on the first boot of the device. The device will boot, and reboot just before the login screen would appear. When it's booted to the login screen, the filesystem has been resized to fill out the remaining space on the SD card.
Once completed, the script will prompt you to reboot the device. Once the reboot has finished, you should see that the available space has been completely filled with the root '/' partition and the filesystem has been resized to match.
There are 2 users by default on the image.
root and
Passwords are as follows:
root. Password:
manjaro. Password:
Cleaning up
There are no necessary post-installation steps for the raspberry pi. Creating new users and setting passwords can be done but these steps are not required.


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The Ultimate Guide To Residential Flats Gurgaon2 BHK Low Budget flats in Gurgaon Jaypee has contested the NCDRC buy over the grounds the settlement among the prospective buyers and business entails a penalty of Rs ten for each sq. foot, which the commission missed.
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The ruling adds to your woes of the real estate property developer that is in the middle of insolvency proceedings. Jaypee is among many distinguished builders that have delayed the shipping and delivery of flats while in the Countrywide Capital Region, locking lakhs of money paid out by typically middle-class homebuyers.
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Vatika INXT is prepared with not only homes and also with streets, parks and energy backup to speedy Web and clean vegetables.
The allottees have also claimed the authority wrongly projected the scale from the flats inside the publicity brochure.
After the return of flats in the sooner schemes DDA experienced claimed which the problems with them were dealt with.
2 BHK Apartments Depleting drinking water concentrations, weighty visitors, significant pollution amounts and expanding need for electric power are just a few of its issues.


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Alaska 4th of July Fireworks 2018
Alaska is a state located in the northwest extremity of the North American continent.
Juneau is the capital while Anchorage is the largest city.
Other big cities in Alaska include – Fairbanks, Badger, Sitka, Wasilla, Palmer, Seward.
Every year, July 4 – the Independence Day of United States is celebrated in with grand fireworks across the state.
In the city of Anchorage there is a big Independence Day celebration accompanied with firework at the Eagle River. Similarly in the city of Juneau, firework display is at the Marine Park.
In Fairbanks, Fourth of July Fireworks take place at the Pioneer Park and 4th of July Celebrations here include lots of entertainment, military ceremony, Air Force fly-over, and much more.
In Wasilla, 4th of July Fireworks take place over Eagle River and Big Lake.
Below you can find Photos & Videos of Alaska 4th of July Fireworks.
Alaska 4th of July Fireworks Display Photo 2018 :
Alaska 4th of July Fireworks Display Videos 2018 :
Alaska 4th of July Fireworks Display Live Telecast / Streaming 2018 :
In Alaska, you can watch the Fourth of July Fireworks 2018 LIVE on local TV Channels.
Juneau – KTOO-TV, KJUD
Anchorage – KTUU-TV, KTBY, KYES-TV, KAKM, KTVA, KYUR
Fairbanks – KATN, KJNP-TV, KFXF, KUAC-TV, KTVF
Live Streaming and Webcast of Alaska 4th July Fireworks 2018 will be available on websites of these TV channels and other popular news portals of Alaska.