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Brazilian Journal of Cardiovascular Surgery
Print version ISSN 0102-7638
Rev Bras Cir Cardiovasc vol.28 no.1 São José do Rio Preto Jan./Mar. 2013
Surgical treatment for infective endocarditis and hospital mortality in a Brazilian single-center
Tratamento cirúrgico para endocardite infecciosa e mortalidade hospitalar em centro único brasileiro
Maurício Nassau MachadoI,II; Marcelo Arruda NakazoneI-III; Jamil Ali Murad-JúniorI; Lilia Nigro MaiaIV
ICardiologist Assistant at the Postoperative Cardio Surgery Care Unit and Coronary Care Unit from Hospital de Base, São José do Rio Preto Medical School (FAMERP). Specialist in Cardiology by SBC/AMB, São José do Rio Preto, SP, Brazil
IIPost-graduation program in Health Sciences, FAMERP, São José do Rio Preto, SP, Brazil
IIITechnical Scientific Coordinator at Centro Integrado de Pesquisas - Hospital de Base /FAMERP, São José do Rio Preto, SP, Brazil
IVProfessor from São José do Rio Preto Medical School. Chief of the Coronary Care Unit and Medical Clinical Research Coordinator at Centro Integrado de Pesquisas - Hospital de Base/FAMERP, São José do Rio Preto, SP, Brazil
OBJECTIVE: We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality.
METHODS: We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP), Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis), evaluating perioperative clinical outcomes and 30-day all cause mortality.
RESULTS: In our series, 64 patients (8%) underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%), greater need for dialysis (9%) and higher 30-day mortality (17%) compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively). In a Cox regression analysis, age (P = 0.007), acute kidney injury (P = 0.004), dialysis (P = 0.026), redo surgery (P = 0.026), re-exploration for bleeding (P = 0.013), tracheal reintubation (P <0.001) and type I neurological injury (P <0.001) were identified as independent predictors for death. Although the manifestation of infective endocarditis influenced on mortality in univariate analysis, multivariate Cox regression analysis did not confirm such variable as an independent predictor of death.
CONCLUSION: Age and perioperative complications stand out as predictors of hospital mortality in Brazilian population. Cardiac valve surgery in the presence of active infective endocarditis was not confirmed itself as an independent predictor of 30-day mortality.
Descriptors: Bacterial endocarditis. Cardiac surgical procedures. Hospital mortality.
OBJETIVO: Avaliamos pacientes submetidos à cirurgia valvar em vigência de endocardite infecciosa na tentativa de identificar preditores independentes de mortalidade intrahospitalar em 30 dias.
MÉTODOS: Foram avaliados 837 pacientes consecutivamente submetidos à cirurgia valvar, no período de janeiro de 2003 a maio de 2010, em um hospital terciário de São José do Rio Preto, SP, Brasil. O Grupo de Estudo compreendeu indivíduos submetidos à intervenção em vigência de endocardite infecciosa e foi comparado ao Grupo Controle, considerando complicações clínicas perioperatórias e óbito por todas as causas em 30 dias.
RESULTADOS: Em nossa casuística, 64 (8%) pacientes foram submetidos à cirurgia valvar em vigência de endocardite infecciosa, sendo 37,5% deles com indicação de intervenção cirúrgica em múltiplas valvas. O Grupo de Estudo apresentou maior permanência em Unidade de Terapia Intensiva (16%), necessidade de diálise (9%) e maior mortalidade em 30 dias (17%) comparado ao Grupo Controle (7%, P=0,020; 2%, P=0,002 e 9%, P=0,038; respectivamente). A análise de regressão de Cox confirmou idade (P=0,007), lesão renal aguda (P=0,004), diálise (P=0,026), reoperação (P=0,026), reintervenção por sangramento (P=0,013), reintubação orotraqueal (P<0,001) e lesão neurológica tipo I (P<0,001) como preditores independentes para óbito. Embora a manifestação de endocardite infecciosa influencie na mortalidade na análise univariada, a regressão de Cox não confirmou tal variável como preditor independente de óbito em nossa casuística.
CONCLUSÃO: Idade e complicações perioperatórias destacam-se como preditores de mortalidade hospitalar em população brasileira. Cirurgia valvar em vigência de infecção ativa não se confirma como preditor independente de óbito nesta casuística.
Descritores: Endocardite bacteriana. Procedimentos cirúrgicos cardíacos. Mortalidade hospitalar.
Surgical mortality for infective endocarditis (IE), while declining in the last decades, stands out as an important cause of death in native or prosthetic valve interventions [1-3], justifying early diagnosis and appropriate antibiotic therapy as key points to the success of the treatment [4].
Clinical complications and treatment failure may suggest surgical valve replacement for IE by up to 60% of cases [5-7]. However, due to possible association between increased incidence of postoperative complications and mortality, the real benefit of early surgical intervention on IE remains doubtful [8].
In the absence of adequate treatment, IE can be fatal. Despite the medical and surgical treatment being able to modify the course of disease, mortality remains high, ranging from 17% to 36% of cases according to the population studied [9,10]. In this context, this study evaluated the mortality of patients undergoing cardiac valve surgery (CVS) in the presence of IE in an attempt to identify independent predictors of 30-day mortality in a regional referral center.
This study evaluated 837 patients admitted to the São José do Rio Preto Medical School Cardiac Surgery Postoperative Intensive Care Unit after CVS from January 2003 to May 2010. This Brazilian Hospital is a regional tertiary referral service with 540 beds for a population demand of 1.5 million inhabitants. In this research, patients were divided into two groups: (SG) study group, subjects undergoing CVS in the presence of IE; and (CG) control group, consisting of patients with CVS performed in the absence of IE. The analysis was conducted as a prospectively historical type, including gathering information on the local computer database. The constitution of SG considered the recent recommendations of the American College of Cardiology /American Heart Association for IE surgical approach [11]. This study was approved by the São José do Rio Preto Medical School Ethics Committee (6079/2010) and, because of its observational nature, the informed consent was waived.
We evaluated demographic data, clinical outcomes and complications occurred in the postoperative period, and 30-day all cause mortality. Categorical data are presented as absolute numbers and percentages, and continuous variables as mean ± standard deviation (SD) or median and interquartile, when applicable. Categorical data were compared by chi-square test or Fisher's exact test and continuous variables were compared using the nonparametric Mann-Whitney test. Survival curve was constructed to demonstrate the outcome of 30-day mortality for both groups. The Cox regression analysis was used to determine independent predictors of 30-day mortality. Hazard ratio (HR) and 95% confidence intervals (95% CI) were calculated for predictors of mortality. The analysis was performed with the SPSS software (version 20) and P value < 0.05 (two-tailed) was considered statistically significant.
In our series, 64 (8%) patients underwent CVS in the presence of IE, and 37.5% had surgical intervention in multiple valves. In the SG there was predominance of males (67%) lower body mass index (23kg/m2), greater value for European System for Cardiac Operative Risk Evaluation (EuroSCORE) (9 points), and greater cardiopulmonary bypass time (100.5 min) compared to CG (47%, P = 0.002, 24 kg/m2, P = 0.028, 90 min, P = 0.020 and 4 points, P <0.001, respectively). Table 1 shows the demographic and baseline characteristics of all groups.
The analysis of clinical outcomes demonstrated that the EG had a higher percentage of subjects with prior cardiac valve surgery (47%), higher prolonged intensive care unit (ICU) length of stay (over 14 days) (16%) and need for dialysis (9%) compared to CG (28%, P = 0.001; 7%, P = 0.020 and 2%, P = 0.002, respectively, Table 2). Consequently, patient sunder going CVS in the presence of IE had higher 30-day mortality (17%) compared to those without active infection (9%, P = 0.038).
The following variables were included in the univariate Cox analysis: age (years), male gender, body mass index (kg/m2), readmission to intensive care, diabetes mellitus, CVS in the presence of IE, multiple valve surgery, acute kidney injury, dialysis, left ventricular systolic dysfunction moderate or severe, redo surgery, reoperation for bleeding, tracheal reintubation and type I neurological injury. Table 3 shows the variables associated with 30day mortality, highlighting age (P = 0.007), acute kidney injury (P = 0.004), dialysis (P = 0.026), redo surgery (P = 0.026), reoperation for bleeding (P = 0.013), tracheal reintubation (P <0.001) and type I neurological injury (P <0.001) as independent predictors of death determined by multivariate Cox regression model. Cardiac valve surgery in the presence of infective endocarditis was a predictor of death in the non adjusted analysis (HR = 1.96, 95% CI = 1.04 - 3.70, P = 0.038, Figure 1). However, after adjustment for predictors in the multivariate model, this variable was not independent (P = 0.06).
Despite the current knowledge including prevention, diagnosis and treatment, IE remains a not rare cause of hospitalization with high morbidity and mortality [12,13]. In our analysis, we found 8% of valve-related surgery approaching to IE, percentage similar to that observed in national, North American and European casuistic [14-16]. Moreover, we confirmed high 30-day mortality (17%) for patients undergoing CVS in the presence of active infection, as recently reported by Prendergast & Tornos (ranging from 6% to 25%) [17]. However, the surgical approach in the presence of IE wasn't confirmed as an independent predictor of death in our series.
Our series of patients considered subjects with high severity disease transferred from other hospitals for surgery treatment with established diagnosis of IE, justified by the infection refractory to medical treatment. In this context, factors such as age, comorbidities, clinical presentation and surgical technique used in valve approach can influence the postoperative results [18,19]. Although there is no statistical difference between the groups in age, this variable was found as an independent predictor of 30-day mortality in patients with IE, reinforcing results of Murdoch et al. [20]. Furthermore, in contrast to data of Chirillo et al. [21], the prevalence diabetes mellitus was similar between the groups do not representing a risk factor for poor clinical outcome in patients with active IE undergoing CVS. Although evidenced greater proportion of male gender and lower body mass index in EG, these parameters were not associated with worse postoperative prognosis. The higher cardiopulmonary bypass duration in this group may reflect the greater surgical difficulty for a complete removal of the cardiac valve in patients with IE [17].
The International Collaboration on Endocarditis-Prospective Cohort Study [20] reported 17.7% of overall in-hospital mortality for patients with IE, while Wallace et al. [22] reported 15% mortality in the group undergoing medical treatment and 22% for those who underwent additional surgery. Still, the hospital mortality in patients with valvular abscess due to complications of IE has been reported as 19.2% in Brazilian patients [23]. Similarly, the present study found a hospital mortality rate of 17% at 30 days for patients undergoing CVS due to IE and prolonged ICU length of stay, probably reflecting the severity of sepsis in these individuals [24-26]. However, the anatomical location of the valve infection was similar among the groups, confirming the absence of its association with clinical complications, including mortality, reflecting results previously presented by Rostagno et al. [13].
In this context, the presence of signs of heart failure, persistent infection, acute kidney injury, thrombocytopenia, paravalvular abscess at echocardiography and need for urgent surgery are indicated as predictors of hospital mortality [27-29]. Several studies have associated renal dysfunction with worse prognosis in the evolution and treatment of IE, reporting sepsis, lesions in glomerular architecture and antibiotic toxicity as etiologic factors [22,30,31]. Results of this analysis confirmed the acute kidney injury requiring dialysis as independent predictors of hospital mortality.
This study demonstrated that reoperation, including re-exploration due to postoperative bleeding, was also a predictor of 30-day mortality. Attempting to decrease perioperative mortality for valve replacement surgery in the presence of IE, Musci et al. [32] recently proposed valvuloplasty as an effective alternative in previously selected cases, with consequent reduction in the need for reoperation and recurrent infections, but this surgical modality was not evaluated in this analysis. Besides these factors, the type I neurological injury and tracheal reintubation stood out as predictors of mortality in patients undergoing CVS in the presence of IE, in agreement with previous studies [33,34]. In this case, the manifestation of encephalopathy due to cardiovascular surgical procedure or severe sepsis, characterized by altered mental status or focal neurological deficit without evidence of impairment in anatomical imaging methods may have contributed definitely to returning to invasive mechanical ventilation and consequent high risk of in-hospital deaths.
Study limitations
Studies related to IE approach are limited by its low relative frequency, the huge variability of the population affected and their underlying risk factors, represented mostly by series of case reports or single centers experience. In our sample, due to the small number of valve involvement by IE, there was limitation in demonstrating the relationship between prognosis, native or prosthetic valve involvement and etiologic agent identified in blood cultures, a fact worsen by the wide range of pathogens involved in its manifestation, affecting the scope and statistical power to draw definitive conclusions. Further investigations are needed to evaluate whether more sensitive prognostic markers may improve the detection of high-risk patients for whom aggressive surgical valve treatment during an IE can really contribute to the reduction of in-hospital mortality.
Although hospital mortality rate for patients undergoing cardiac valve surgery due to refractory infective endocarditis remains high in the Brazilian population, the surgical approach during an active infection is not confirmed as an independent predictor of death in our series.
In this case, age, acute kidney injury, dialysis, redo surgery, re-exploration for bleeding, tracheal reintubation and type I neurological injury stand out as predictors of in-hospital mortality (30 days) in this population.
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12. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia; American Heart Association; Infectious Diseases Society of America. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111(23):e394-434. [ Links ]
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27. Revilla A, López J, Vilacosta I, Villacorta E, Rollán MJ, Echevarría JR, et al. Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery. Eur Heart J. 2007;28(1):65-71. [ Links ]
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29. Alonso-Valle H, Fariñas-Alvarez C, García-Palomo JD, Bernal JM, Martín-Durán R, Gutiérrez Díez JF, et al. Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period. J Thorac Cardiovasc Surg. 2010;139(4):887-93. [ Links ]
30. Netzer RO, Zollinger E, Seiler C, Cerny A. Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of212 cases 1980-1995. Heart. 2000;84(1):25-30. [ Links ]
31. Oakley CM, Hall RJ. Endocarditis: problems: patients being treated for endocarditis and not doing well. Heart. 2001;85(4):470-4. [ Links ]
32. Musci M, Hübler M, Pasic M, Amiri A, Stein J, Siniawski H, et al. Surgery for active infective mitral valve endocarditis: a 20-year, single-center experience. J Heart Valve Dis. 2010;19(2):206-14. [ Links ]
33. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. 2000;160(18):2781-7. [ Links ]
34. Tugtekin SM, Alexiou K, Wilbring M, Daubner D, Kappert U, Knaut M, et al. Native infective endocarditis: which determinants of outcome remain after surgical treatment? Clin Res Cardiol.2006;95(2):72-9. [ Links ]
Correspondence address:
Maurício Nassau Machado
Hospital de Base de São José do Rio Preto
Av. Brigadeiro Faria Lima, 5544 - 5º floor - Unidade Coronária (UCor)
São Josédo Rio Preto, SP, Brazil -Zip code: 15090-000
E-mail: firstname.lastname@example.com
Article received on July15th, 2012
Article accepted on September 25th, 2012
This work was developed in Cardiac Intensive Care Unit from Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil.
Some results were presented in XXXII Congress from Sociedade de Cardiologia do Estado de São Paulo, SP, Brazil.


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[Warning: General spoilers ahead.]
Catherine Bell has two Christmas movies this season on Hallmark Movies & Mysteries–Home for Christmas Day opposite Victor Webster, which sneak peaked in July and is now running on the network, and Christmas in the Air opposite Eric Close, which premieres Sunday night. When I spoke with Bell last month for Good Witch, we also chatted about her holiday films.
After doing successive longterm runs on JAG and Army Wives, Bell's name is somewhat synonymous with military-related projects, but now when they come around, she considers them carefully before jumping right in. "I find that I'm a little bit wary of doing the same things over and over, and if it has a military theme, I want to make sure it's something different because there are so many great stories to tell there," she says.
"When JAG ended and I got the offer to do Army Wives, my first inclination was [to say] no, not right after nine years of JAG, but IÂ read the script and it was so different and it was about the wives and the women and the family holding down the fort at home."
"[Home for Christmas Day] came about from [Jennifer Aspen] a dear friend that I've known for 20 years from acting class back in the day. She came up with the idea. She drove me to the airport one day and said, 'I've got this idea. I'll drive you and pick you up and tell you the idea.' She pitched it and I loved it."
"I have a teenage daughter right now, and going from having a little girl to having a young woman and trying to be the best parent you can along that journey, trying so hard to have her not to have to experience pain or bumps or things. I so related to that."
"While it was a military theme, and that's always so important and beautiful for me to be connected to, it was also about a woman and daughter and the challenges of letting her live her own life while preventing her from the pain she'd gone through herself."
The film has a really lovely, integral scene between Bell's character, Jane, and Anthony Konechny, who plays Tyler, the love interest for her character's daughter, Betsy (Matreya Fedor). Tyler is about to be deployed and Jane has been dead-set against the fairly sudden courtship. Before he leaves, they finally talk to each other one-on-one and Jane explains herself to Tyler.
Bell loved that scene, too. "All the scenes were so easy to act with him," she recalls. "I would just look in his eyes and the emotions would come," she says. "It's a beautiful story, I loved making that movie. It was a really great journey. The whole process of getting it made and filming it and watching it. I think I cried more than anyone else."
Christmas in the Air is rare lighter fare for Bell, and it's one of the reasons she leapt at the chance to do it. "It's kind of the opposite [of Home for Christmas Day]. It's a romantic comedy. Probably just what you want right before the holidays," she explains.
"It's With Eric Close, who is adorable. I play a personal organizer and he's a boy-at-heart toy inventor. He has two kids, I have none. We're kind of the most unlikely pair because he's a mess and all over the place, but he's cute and boyish and charming and creative and has a beautiful life force and my character needs to lighten up and loosen up ."
"They sent me the script. It was all ready to go. I sat down and read it front to back and instantly called Michelle Vicary and said, 'Yes, please. This would be just a blast.' It's literally a romantic comedy…cute, adorable, two unlikely people falling in love. We had a blast filming. I got to go to Vancouver in March/April. It was stunning, just between the snow going away and starting to warm up."
If you follow Bell's Twitter feed, you may have noticed she has a link for beautycounter.com on her page. She shares the link with her fans to create awareness of earth- and body-friendly cosmetics. "These women, their whole mission [was] to create safe, non-toxic [cosmetics]. There are so many chemicals in cosmetics that cause cancer and are endocrine- and hormone-interrupting and get in our bodies and mess up the way our bodies function," she points out.
"The laws governing that haven't changed since 1938. There's something like 1500 chemicals banned in Europe that are allowed here and they're going into the largest organ in your body, your skin. They told me about [the site] and I fell in love."
Christmas in the Air premieres Sunday at 9 pm/8c on Hallmark Movies & Mysteries. Home for Christmas Day repeats Saturday at 7 pm/6c. Both films will repeat several times through the end of the year. Here are a couple of sneak peeks.


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The Chamber of Engineers invites you to attend the presentations of the three nominees for the Industrial Excellence Award 2017.
The presentations will be delivered by
1. Altern Ltd
2. Aviation Cosmetics Malta Ltd
3. Malta Life Sciences Park
To reserve a place please send email to
Date: Thursday 30th November 2017
Time: 18:00h
Location: Professional Centre, Gzira
The Award winner will be announced during the MEEAs 2017 which are being held under the distinguished patronage of H.E. Marie-Louise Coleiro Preca, President of Malta on Tuesday 12th December 2017 at the Verdala Palace at 18:15h. Guests will be requested to be seated on the 2nd level of the palace by 18:45h. A reception will follow on the 1st level of the palace.
MEEA Programme
Registration of Attendance
Tickets available at €15 per person (€5 will go towards the MCCF). Places are limited.
Tickets must be presented at the entrance.
Parking available in the vicinity of the Palace.
A shuttle service will be organised by the Chamber free of charge by the main gate of the Palace to the main door between 17:45 until 18:40 and later from the main door to the main gate between 22:15 until 23:00
The Chamber of Engineers is launching the 16th edition of the Malta Engineering Excellence Awards (MEEA).
We are addressing corporate and engineering companies in Malta to obtain their support for this prestigious event. The Chamber of Engineers invites you to participate in this yearly event as a celebration of achievements by the local engineering community. The MEEA showcases the excellence in engineering innovation and its positive impact on the Maltese society.
These awards are actually presented during the Chamber of Engineers annual reception which will be held under the Distinguished Patronage of H.E. Marie-Louise Coleiro Preca, President of Malta. This year the event will be held at the Verdala Palace on the evening of the 12th December 2017.
This year two awards will be presented namely The Maurice Debono Lifetime Achievement, and the Industrial Excellence Awards. During the same event, the Best Student Projects' CoE Awards will also take place. Please refer to the MEEA 2017 brochure for a better understanding of our event for this year.
The Chamber of Engineers would welcome you to participate either as an applicant for the Industrial Excellence Award, or even as sponsor for this year's edition as per the Nomination Form and Sponsorship Packages. The closing date to apply for Award Participation is now extended to 15th November 2017. I trust that you will be interested to partake in this prestigious event. Sponsorship is accepted at even later dates.
It will be our pleasure to have you as a participant to the MEEA 2017 event.
Inġ. Michael D'Amato.
Chairman - MEEA Sub Committee
Link to Sponsorship Package
Link to MEEA Brochure
Link to Nomination Form
We are addressing major corporate and engineering companies in Malta to obtain their support for this prestigious event. The Chamber of Engineers invites you to participate in this yearly event as a celebration of achievements by the local engineering community. The MEEA showcases the excellence in engineering innovation and its positive impact on the Maltese society.
This year two awards will be presented namely The Maurice Debono Lifetime Achievement, and the Industrial Excellence Awards. During the same event, the Best Student Projects' CoE Awards will also take place.
As per previous years esteemed companies have sponsored the awards and participated and obtained recognition at this event. The Chamber appreciates the financial support towards this event to maintain the precious standards. This augurs well for the profession and we look forward to a good number of sponsorships.
There are three sponsorship packages which we are sure that can fit your budget. The sponsorship can actually be settled by end of March 2018.
We look forward to your positive response.
Thank you for your support.
Click here for more info on these sponsorship packages
London Mayor Sadiq Khan said questions will need to be answered over the safety of tower blocks.He stated that "we can't have a situation where people's safety is put at risk because of bad advicebeing given or if it is the case, as has been alleged, of tower blocks not being properly serviced ormaintained," he told BBC Radio.Matt Wrack, of the Fire Brigades Union said something had clearly gone badly wrong with fireprevention procedures at the building.Firefighters would normally fight a fire in a tower block from the inside, going up the fire escape,and fighting using the internal dry-rising mains, he said, but that's not been possible in this case. –BBC Report
This incident brings to light now more than ever the importance of the proper facilities managementof buildings. In places like Malta, with its densely populated areas, Developers need to carefullyconsider the importance of life safety systems from design to execution and eventual maintenanceunder the Facilities management regime. A word of caution goes to those engineers involved in thedesign of such buildings and others in the management of such facilities. We, as Chamber ofEngineers, strongly recommend that professionals have to be extra vigilant and make sure that noone is allowed to compromise on costs both when it comes to the construction of the projects andthen when it comes to maintaining and operating them. Ethical considerations need to be lookedinto here. There cannot be cases where buildings are certified as achieving compliance to thenecessary requirements from a fire aspect to ensure proper life safety when they are not compliantjust to anticipate that a building is deemed to be ready to be occupied. Such practice would onlyendanger the lives of occupants within the development and puts Directors and Professionalsheavily burdened with the liabilities that would emanate from such actions.
We therefore encourage the Government to push forward the process of local building regulationsthat should also cover the fire safety aspects of buildings. These regulations should also induce therequirement for periodic inspections of systems within such buildings and to this effect no distinctionshould be made between residential and non-residential buildings.
The Chamber of Engineers is always ready to work with the Government and its competent entitiesas we strongly believe in the overarching principle that is core of our profession and that is ensuringconstantly public health and safety.
Inġ. Norman ZammitPresident, CoE
© 2008-12 Chamber of Engineers, All rights reserved | developed by webmalta


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Journey of the Kookaburra limited edition print 3/20 FRAMED
The kookaburra represents my mother's totem from South Australia.
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Darmian hints at Man Utd exit: I really miss Serie A
The full-back has made only three league appearances this season and was the subject of interest from Napoli, Inter and Juventus last summer
Manchester United full-back Matteo Darmian has hinted at a move back to Serie A, admitting he misses Italy.
The 29-year-old was signed from Torino in 2015 but has struggled to establish himself at Old Trafford, particularly falling out of favour under Jose Mourinho.
He has made just three appearances for the Red Devils this season and featured only eight times in the Premier League last term with the Portuguese boss favouring the likes of Antonio Valencia and Ashley Young as wing-backs.
Speaking to Gazzetta dello Sport , Darmian said: "I must say, I really do miss Serie A and Italy now.
"I know that I am at one of the best clubs in the world and I am proud to be at Manchester United, but I do miss Italy. I love my country."
Despite his lack of game time in England, Darmian was a regular member of Italy's international squad in their failed World Cup qualification campaign for the 2018 tournement in Russia.
However, he has not features for his country since former Manchester City boss Roberto Mancini took charge.
Darmian continued: "Returning to play for Italy is my objective. Roberto Mancini hasn't called me up yet, but I hope he will in future."
The United right-back had to watch on as Italy came second in their Nations League group, finishing as runners-up to Portugal but beating Poland.
Juventus and Inter were linked with a move for Darmian in the summer and Napoli confirmed that they made a bid for him .
They failed to meet United's demands, although the Reds still signed 19-year-old Diogo Dalot in the same transfer window for £19 million ($24m). Dalot has started the last two league games at right-back against Arsenal and Fulham, and Mourinho beleives the defender could claim the spot for the next 10 years , further cementing Darmian's lowly position at the club.
The Reds have had a turbulent season with Mourinho often criticising his players in the press and enduring a very public fall-out with record signing Paul Pogba.
A 4-1 win over Fulham on Saturday has steadied the ship, but they travel to Valencia on Wednesday before a tough trip to in-form Liverpool next weekend.


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"Finally, I suspect that it is by entering that deep place inside us where our secrets are kept that we come perhaps closer than we do anywhere else to the One who, whether we realize it or not, is of all our secrets the most telling and the most precious we have to tell." Frederick Buechner
Friday, September 11, 2009
9/11/01: There are no words
It is incomprehensible to me, still.
Eight years later, and I still can not take it all in: the memory of the images. The sounds. The smells.
I don't know why it is, exactly, but I am always caught by surprise and taken up short by the enormity of sadness in my heart. There are no words - no prayers - no sound I can make.
I simply lift my eyes and my heart to the heavens.
Later this evening, I will give the benediction at the 9/11 Memorial here in Chatham. This town lost 13 people.
I pray I will find some words for those who have gathered - the parents, the wives the children - to remember their loved ones who died that day, nine years ago. To offer some words of hope and solace and peace.
Right now, there simply are no words. Only the numbers "9/11". Only memories of what is still incomprehensible.
In moments like these, perhaps it is best to simply let music and poetry carry our prayers. Our sadness. Our fears. Our hopes.
In this clip, Leonard Slatkin Conducts the BBC Orchestra on September 15 2001 in honor of those who lost their lives a few days prior. The visuals are from BBC's 'Last Night of the Proms' and ABC's 'Report from ground zero.
I offer it as my meditation on the 9th Anniversary of "9/11", with thanks to Marcia.
Because, there simply are no words.
Because it is still incomprehensible.
5 comments:
- altar ego said...
My first association with this piece of music is from the movie Platoon. Then, as now, it evokes the basic question of an ancient mystery: the why of needless and senseless loss. The faces in this reflect what I think you describe: a stunned, incomprehensible response to what has taken place. You are right, it is still incomprehensible. It still stuns and leaves speechless. It still breaks the heart and tears at the soul. If there is any comfort perhaps it is that we are joined together in our sadness, our loss, our heartbreak and interruption of breath, just as this day interrupted life. There are no words. Only deep, stirring sadness.
- Fri Sep 11, 09:02:00 AM
- Brother David said...
How someone could harbor such evil, such hatred, and could perpetuate such misery on other people is incomprehensible Madre Lizabet.
We will never understand. That kind of malevolence is a cancer. Best to be cut out and sent into oblivion, where it hopefully could not affect us again.
I only wish for us all that George Bush and his administration had not been in office. They returned evil for evil in their own unspeakable ways, and we shall all pay for it for the rest of our lives.
- Fri Sep 11, 02:31:00 PM
- Doorman-Priest said...
I alwayd loathed that music before. Now it can reduce me to tears.
- Fri Sep 11, 03:58:00 PM
- Mary-Cauliflower said...
Today I've gone about my business, sitting in a lot of meetings taking notes, writing "Sept 11, 2009" at the top of the page several times. And I've been in a shiteful mood while at the same time feeling half conscious. Because of course today is the anniversary of the day that an unimaginable and seemingly endless cycle of evil was unleashed. Oh yeah...funny how that can slip our minds.
My word is "untembl"
- Fri Sep 11, 09:09:00 PM
- Fran said...
Thank you. Oh that music.
- Fri Sep 11, 10:09:00 PM


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HOTT3D at the Mining Indaba 2013 – SHELL & DELOITTE
The HOTT3D team were commissioned by Shell and Deloitte to create a corporate platform for their exhibits at Mining Indaba 2013. Work began on these designs well before the end of 2012 due to the proximity of the event to the start of the new year. The late release of the final floorplan by the organizers meant a redesign of Shell in the new year. Both booths were full custom exhibition designs. Both stands utilized interactive features such asRead More


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Have you heard of Heir?
Well you should have.
Heir is a five piece alt-pop band from Leeds, who have been playing music together for a few years, after meeting as students in Leeds. I was invited by a friend to the gig, I was agreeably surprised by the band. Very involved with the audience and making sure everyone enjoyed their evening, you cannot dislike them. Apart from their instrumental skills and their undeniable charisma and humour, the band isn't scared to demonstrate their vocal capacities with a combination of powerful harmonies and hooks.
Even if you aren't specially into their music, they manage to make you want more by putting their own twist on modern pop music, influenced by The Eagles to The 1975 and Glass Animals. Releasing two BBC backed singles they have since gained support slots with Lawson, Honne, The Dunwells and Karima Francis and been featured on national radio, be prepared to hear more from them.
Their debut EP When The Lights Went Out gave them the opportunity to have their first headline tour across the UK and Europe, which is probably my favourite of theirs. The band isn't only talented, but they also have their fanbase to support them, cheering and making the room full. The band even played a completely new song for us which made for a delightful preview at this gig. It's a yes from me.
Ste on guitar and Harry on bass are flawlessly framed by Sam Perry's keys. These were underlined by the unrelenting and powerhouse of a drummer, Sam Newham. However, what really stood out from the night was the backdrop that these combined efforts created for Tom's light and emotive vocals which were superbly complimented by heart-warming harmonies.
Sarah Ashford-Brown
Image: Bandcamp


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A go-live for a new product is always a rewarding experience. Months of development and QA capitalize on the first customer adopting the product and its subscribers starting to use it. A "switch" in a load balancer -of some sort- is flipped and traffic starts flowing through your newly deployed solution. Engineers are happy that months of hard work is finally getting some real mileage. Sales is happy that revenue will be recognized soon. Professional Services are making travel reservations for the location of the next customer. And then …
And then all hell breaks loose. Stability issues that the QA process had missed are identified. Corner case scenarios that no-one could think off are run into and expose holes in the design or implementation. Customer issues are hard to reproduce in your own lab, so as to investigate and fix, requiring you to hack tests in a language you haven't touched since ages ago. You pound at code with undocumented memory allocator settings. You find yourself reaching for the ancient scriptures, trying to troubleshoot and nail down an issue. You're analyzing data from the now live systems in real-time, trying to gauge the magnitude of the problem, identify whether it's a software or an integration issue. You find yourself working at post-midnight hours and still waking up at 06:00 am. You try to figure out workarounds till the hard at work developers manage to fix the underlying problems. You come up with aggressive acceptance test plans that optimally balance between the need for quality and quick turnaround. You operate under pressure, the customer requesting an immediate workaround in order not to rollback to the previously installed solution.
We have very good news. Both actions against the problem work as planned. This means that the highest priority issue of the customer is now solved.
You grab a cold beer. You can feel the lack of sleep creeping in your aging bones and mind, yet can't really sleep. You remember a similar crisis a couple of years ago, with another product and another customer back at the time, you smile and think that I'm still not too old for this shit.
[Dedicated to Angie, Nikos, Petros and everyone else hard at work during the last 3 days; couldn't have done it without you team]


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Have you ever wondered what it would be like to spend a whole semester as an exchange student in Oldenburg, Germany, studying at the Carl Von Ossietzky Universitat? Then follow along with Michele's blog as she explores this historic city over the Spring Semester! Join her on this adventure into the heart of Europe as she discovers new foods, new places, and new people!
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Let the Right One In (2008)
Oskar, an overlooked and bullied boy, finds love and revenge through Eli, a beautiful but peculiar girl.
Oskar, a bullied 12-year old, dreams of revenge. He falls in love with Eli, a peculiar girl. She can't stand the sun or food and to come into a room she needs to be invited. Eli gives Oskar the strength to hit back but when he realizes that Eli needs to drink other people's blood to live he's faced with a choice. How much can love forgive? Set in the Stockholm suburb of Blackeberg in 1982.
In the suburb of Blackeberg in Stockholm, the twelve year-old Oskar is a lonely and outcast boy bullied in school by Conny and two other classroom mates; at home, Oskar dreams on revenging the trio of bullies. He befriends his twelve year-old next door neighbor Eli that only appears during the night in the playground of their building. Meanwhile, Eli's father is a serial-killer who drains the blood of his victims to supply Eli, so she doesn't have to kill. Eli advises Oskar to react to Conny fighting back; however, he soon discovers that she is a vampire and he feels fear and love for the girl.
- Twelve year old Oskar (Kåre Hedebrant) is so wimpy that he's constantly picked on by the other boys at his school, especially Conny (Patrik Rydmark) and his two friends, Martin (Mikael Erhardsson) and Andreas (Johan Sömnes). Out of fear, Oskar never fights back. In the evenings, however, he sits in the courtyard rehearsing knife attacks on his tormentors. One evening, Oskar notices a new girl about his age and her father moving into into #15, the apartment next door to his. Oddly, the first thing they do is to cover the windows with cardboard. What Oskar doesn't know is that Håkan(Per Ragnar) is not Eli (Lina Leandersson)'s father... he is her renfield... and Eli is a vampire. It is Håkan's job to bring Eli fresh blood, which he gets by killing other humans. First he anesthetizes them with halothane, then he strings them up by the feet, slits their necks, and catches the blood in a jug, leaving the bodies to be discovered the next day. Unfortunately for Eli, Håkan is having problems securing blood for her. On his first kill after moving into the new apartment, he either lost or forgot the jug filled with blood. Consequently, Eli is beginning to get hungry.
One evening, as Oskar is in the courtyard stabbing a tree in lieu of his tormentors, he notices Eli watching him. She's not very friendly, as she tells him right off that she can't be friends with him. The next evening, they run into each other again in the courtyard. Oskar notices that Eli is not wearing a coat even though it's the dead of winter in Stockholm. What's more, she's not even cold. And she smells bad. Still, Oskar shares with her his Rubik's cube and shows her how to work it. After Oskar has gone inside, Eli goes hunting. She waits in the shadows under a bridge. When two neighborhood friends, Jocke (Mikael Rahm) and Lacke (Peter Carlberg), part company, and Jocko walks under the bridge, Eli calls out, "Help me!" Thinking that the little girl has fallen, Jocko picks her up. Suddenly, Eli latches onto him and bites his neck. Gösta (Karl-Robert Lindgren), a friend of the two men, sees everything from his apartment window. By the time he is able to stumble into the Sun Palace Cafe and get help, however, Jocko's body is gone (Håkan has already covered up the killing by tossing the body into a pond), but they do find Jocko's blood in the snow. The next morning, Oskar finds that Eli has solved the Rubik's cube and left it in the courtyard. When they meet there later in the day, Eli is a bit more friendly, taking the time to explain to Oskar how she went about solving the puzzle. She also smells better, but it's odd that she cannot remember her birth date when Oskar asks. Since Eli doesn't know her birth date, she doesn't celebrate her birthdays and gets no presents, so Oskar offers her the Rubik's cube.
The next day at school, Oskar stays after class to copy the symbols for Morse code from the encyclopedia. On his way home, he is confronted by Conny and his two friends. When Conny orders Oskar to show him what he copied from the encyclopedia and Oskar refuses, Martin grabs Oskar and Andreas begins to whip his legs with a stick. As an added measure, Martin slaps the stick against Oskar's cheek, gashing it. Oskar later tells his mother that he fell during recess. But when Eli asks what happened, he tells her the truth. Eli tells him that he must start to fight back. If so, they will stop tormenting him. If they don't stop, Eli promises to help him. Oskar shares with Eli the Morse code that he copied from the encyclopedia. That night, they practice tapping on the wall that separates their apartments. The next day at school, Oskar signs up for the weight-lifting program. Later, he takes Eli to a candy store and offers her a piece. At first, she refuses; then she tries one. Oskar finds her heaving on the sidewalk around the corner. He hugs her. Eli asks him whether or not he would still like her if she wasn't a girl. "I guess so," Oskar replies, not quite understanding what Eli is asking.
As the friendship between Oskar and Eli deepens, Håkan starts feeling a bit jealous. He tries again to obtain blood for Eli. This time he preys on a student alone in the weight-lifting room, but he is interrupted when Matte (Christoffer Bohlin)'s friends come to pick him up. Knowing that he is trapped and about to be discovered, Håkan pours acid on his face so that he can't be identified. When Eli learns that Håkan has been taken to a hospital, she shows up asking for her father. The desk clerk tells her that Håkan is on Level 7, so she climbs up the outside of the building until she gets to his window. Håkan lets her in and offers her his neck. After Eli drinks his blood, Håkan falls to his death. Eli returns to the apartment building and taps on Oskar's bedroom window, asking to be let in. Oskar is almost asleep but he tells her to come in. Eli crawls into bed with him, and Oskar notices that she doesn't have any clothes on. He asks her whether she'd like to go steady with him, and Eli replies "I'm not a girl." That doesn't seem to bother Oskar, so they decide to go steady. The next morning, Eli returns to her own apartment, but she leaves a note for Oskar that reads, "To flee is life; To linger is death. Your Eli."
One afternoon on a school outing to a local pond for some ice skating, Conny, Martin, and Andreas again confront Oskar with a warning that they are going to push him into an ice hole. This time, however, Oskar stands up for himself and takes a swipe at Conny's head with a stick, causing his ear to bleed. At the same time, two younger students gone off to pee behind some trees notice a body frozen in the ice. The police are called, and the body is cut free. Later that afternoon, after school is out, Oskar brings Eli to a basement room at the school. When Eli asks why they're there, Oskar pulls out a knife and cuts his palm, offering to mix bloods with her. Watching Oskar's blood drip on the floor, Eli can no longer stand the hunger that she's experiencing now that Hakan is not providing her with blood. She falls to the floor and begins to lap up Oskar's blood.
The body stuck in the ice is identified as that of Jocko's. Jocko's drinking buddy, Lacke (Peter Carlberg) and his girlfriend Virginia (Ika Nord), try to convince Gösta to tell the police what he saw the night that Jocko was murdered. During the discussion, however, Lacke defends his closeness with Jocko by pointing out that Virginia is "cold", Consequently, Virginia storms off. Lacke follows her to the subway where Eli jumps on her. Fortunately, Lacke is able to kick Eli off before she kills Virginia. Unfortunately for Virginia, Lacke's save only means that Virginia is doomed to become a vampire. She notices the change the next morning when she opens the blinds and quickly closes them again. That evening, she visits Gösta's apartment looking for Lacke, but she is viciously attacked by Gösta's cats. Later, in the hospital, Virginia realizes that she's been infected with something and decides that she doesn't want to live. She asks the doctor to open the blinds to her room. Immediately, she is consumed in flames.
A wimp he might be but Oskar is not a dummy. He has figured out that Eli is a vampire and confronts her. Knocking on the door ot her apartment, he is let in to see that there is no furniture and that Eli smells bad again. When Eli comes to his apartment and asks to be invited in, he stalls, asking her what would happen if he didn't invite her in. Eli steps inside and begins to bleed from various places on her body. Oskar relents and invites her in. Eli explains that she drinks blood because she has to. Apparently, Oskar understands, as he allows Eli to shower and put on one of his mother's dresses. As Eli dresses, Oskar peeks in the door and notices that Eli has a horizontal scar across her public area and no evidence of a vaginal slit. [NOTE: In the novel, Eli was born male and castrated at age 12 by the vampire that turned him.] When Oskar's mom comes home, Eli immediately scampers across the window from Oskar's apartment to hers, even though it's two stories up.
The next morning, Oskar finds a note from Eli asking him whether he wants to meet her that evening. Lacke has somehow traced Eli to her apartment. He breaks in and finds her asleep in the bathtub. Because he can't see in the dark, he rips open the cardboard covering the windows. Oskar, who was in the apartment waiting for Eli to wake up, screams "NO!" giving Eli sufficient time to jump on Lacke and drink his blood. After feeding, Eli thanks Oskar, but informs him that she must go away. That night, Oskar looks out the window to see Eli moving.
The next day, Oskar gets a call from Martin, asking whether or not he's going to be at swimming practice that afternoon. Martin also tells Oskar that he thinks Oskar was right to stand up to Conny. That afternoon, while Oskar is in the pool, someone starts a fire in the trashbin out back, forcing the attendant to leave the pool area unattended. As Martin distracts Oskar, Conny, Andreas, and Conny's big brother Jimmy (Rasmus Luthander) enter the pool area. Jimmy orders everyone else out of the pool. When they are alone with Oskar, Jimmy gives Oskar an ultimatum... either stay under water for three minutes or have one of his eyes poked out... Oskar's eye for Conny's ear. Then Jimmy grabs Oskar's hair and pushes him under. A minute passes. Suddenly, feet can be seen skimming on the surface of the water, followed by Jimmy's severed head, and then Jimmy's severed arm. An almost drowned Oskar is pulled from the water by Eli, who has just slaughtered three of Oskar's tormentors, leaving the fourth sobbing on the side of the pool.
Epilogue: Oskar sits on a train. Snow is falling outside. A large basket sits in front of him. From inside the basket comes a rapping. Oskar raps back in Morse Code, "P-U-S-S", Swedish for "kiss". [Full synopsis by BJ Kuehl]


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Plea to Working Moms: Stop Putting Off What Makes You Happy Because You're Convinced It's Selfish
Last week I attended a double memorial service at Arlington National Cemetery to celebrate the lives of a pair of close family friends who played a pivotal role in my life growing up. This dynamic duo was full of life, energy, and always shared an open invitation to drop all your worries, grab a beer and float your cares away in their beautiful backyard pool. Still madly in love in their eighties, it felt fitting to lay them to rest as a couple after losing them both over the course of last year.
As always, death invites reflection and contemplation into our lives. In this case, here are two life lessons I took away from my most recent dance with what will inevitably happen to each of us.
When navigating one's way through the professional world, it's practically mandatory to seek out the humans who are card-carrying members of the wisdom, experience and perspective club. You know them as mentors. And if you're fortunate enough to have some good ones in your life, then you know the immense R-E-L-I-E-F that comes from tapping into the perspective of those who have already figured out what matters in life.
It makes me want to exhale just thinking about it.
I would argue that the same need exists, but is often overlooked, in your personal life as well. We all need access to elders—the grandmothers, grandfathers, family friends and neighbors who are wise enough to know that nobody goes to their grave wishing they'd spent more time on their to-do list.
This couple taught me that work can wait, family comes first and there's nothing better than sitting around the pool with a stiff drink laughing and talking with the people you love.
When it comes to your own life, you probably don't need any more friends your own age because you likely can't even keep up with the ones you already have. I say, aim older!
Make an effort to surround yourself with people who can reduce your tendency to lose your mind over your colleague's micromanaging ways, your son's obsession with dirt, or your daughter's inability to clean her room.
For example, the other day I was complaining to my 93-year-old grandfather about once getting seasick on a cruise ship and he told me it was OK—that he was seasick the entire time he was on an aircraft carrier fighting the Japanese during WWII, and he made it through.
Excellent point, my friend.
The most shocking revelation during my trip to Arlington National Cemetery was the sobering reality that one day we'll all end up in a box. That's right— just like my strong neighbor, whom everyone called "The King," and his wife, a benevolent mother to four boys—you're working your way toward the same destination.
You in a box.
So, my question to you is this: If dead in the ground is your ultimate destination, then why wait another day to be happy? Why stay in a job that makes you miserable? Why hang out with friends who bring you down? Why yell at yourself all day long for not being a better mother, when deep down you know you're doing a damn good job?
One day it'll all be over and your never-ending to-do list, spotless volunteer record at your son's school, and relentless efforts to do, accomplish and be more will be rendered useless.
The people you love will be standing around your box singing "Amazing Grace," and wouldn't you RIP a lot easier knowing that you arrived at your happy place long before you arrived in your final resting place?
Stop putting off what makes you happy because you've convinced yourself it's selfish. It's not. It's your life and you've only got one shot.
My hope for you is that you'll show up to your box knowing you figured out what mattered most in life and went after it with gusto without holding yourself back along the way.
Why wait to learn these lessons later in life when you can learn them now?


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Volkswagen is planning to sell more electric cars in the US and wants to build a massive electric car charging network across the country.
The German automaker will spend millions of dollars on building out the country's underdeveloped charging infrastructure. Electrify America, a VW subsidiary, has recently announced their plans to install EV charging stations at more than 100 Walmarts in 35 states by 2019. The news came a few days after Porsche, which is owned by VW Group, announced it wants to build 500 of its own EV charging stations across the country.
The Walmart charging stations are part of a broader Electrify America plan to build 2,000 chargers at 500 charging stations all over the country by mid- 2019. Mark McNabb, president and CEO of Electrify America said that the owners of electric cars needed "a convenient, reliable and fast turnaround in recharging their vehicles," and according to the company, Walmart is the perfect partner for Electrify America "to bring electric charging services to EV owners who value their time."
Both VW and Porsche will spend billions of dollars on rolling out new electric models in the years to come. Only a few months ago, Porsche announced it would double its investment in plug-in hybrids and pure EVs by 2022 to more than $7.5 billion. The Mission E, their first electric vehicle, is considered as one of the first real competitors to the Tesla Model S and Porsche claims their Mission E would be able to charge in only 15 minutes. A second EV, based on the Mission E Cross Turismo concept, is planned to debut in 2020.
According to TheVerge.
Volkswagen is planning to sell more electric cars in the US and wants to build a massive electric car charging network across the country.


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|An unidentified trooper in what almost certainly appears to be the uniform of the British South Africa Company Police. While very
small in this photograph this trooper appears to wear the lion badge associated with the Company Police on his sleeve.
The reverse of the card has a small slip of blue lined paper glued to it with the name of "Mrs. Shaw" inscribed on it. One might
assume that this Mrs. Shaw was the intended recipient of the photograph.
Eventually renamed the British South Africa Police the unit served during the two wars with the Matabele (1893 and 1896/97), during
the founding of Rhodesia, during the Anglo-Boer War and later in Tanganyika during World War One. It later would become the
senior regiment of the Rhodesian armed forces.
Cabinet Photograph
Fitz G. Foreman/Salisbury Studio - Photographer
Stanley Avenue, Salisbury, Mashonaland
c. 1895


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• Caught in the Crosshairs of time!
• Old-man Clint and an aged Kate have finally tracked down PROJECT COMMUNION. But even with help from two of Kate's Young Avengers teammates, liberating the FROG KIDS will prove more difficult than the sharpshooters ever imagined.
• Meanwhile, in the present, Clint finds himself estranged from Kate, and pays a visit to another Hawkeye--his big brother Barney!
Rated T+
The flashbacks were some of the least compelling parts of the last volume of this series, and the flash-forwards now are proving to be even worse - both because you know they are essentially meaningless and will be wiped away in no time, and because Ramon Perez's style in those jumps lacks the wow-factor of his usual art. Read Full Review
All-New Hawkeye #3 brings the series' first arc to an end, and despite there being plenty of action and a couple of intriguing twists, I couldn't help but feel let down. The creative team did however give us some dramatic moments between the two characters, with a cliffhanger that is sure to leave readers returning for more. Read Full Review
The art for the flash-forwards continues to be atrocious, and the character shilling for both Kate and America Chavez is groan inducing, but at least the Clint Bashing has been reduced this issue, so yeah, giving it a four, which is actually an improvement over the previous issue.


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"ChopBlock Vol.1" By INFINIT ESSENTIALS brings you 20 Lo-Fi chops with a mixture of old school and new school. Inspired by Bryson Tiller,PARTYNEXTDOOR, and Tory Lanez.
24-Bit WAV
All Tempos Included
20 WAV/Files
20 Melody loops
44.1kHz/24-Bit Quality
100% Royalty-Free
- CAN NOT DOWNLOAD: Some probably encounter the following error: This site can't be reached ...sundryfiles.com's server IP address could not be found. DNS_PROBE_FINISHED_NXDOMAIN. In this case, please use Google DNS and you will get rid of trouble.
- If downloaded file can not be extracted (file corrupted...), please make sure you have downloaded the file completely and don't use Winzip, it sucks! We would recommend using The Unarchiver.
- By reason, the App does not work and can not be opened. Mostly, just Disable the Gatekeeper, and you get rid of troubles.


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Living room designs become the basic theme for any house, colors are the most important in decorating a living room, it can be make a big change instantly in short time for any interior. Selecting a living room's color combination is a major hurdle when designing a home. Generally people like a light themed living room design with some specifically selected areas or corners. For contemporary houses we see a lot of cream and white colored living room designs which include a light flooring, white walls, white furniture especially sofa sets with white leather upholstery and a white ambient lighting.
These are few ideas for red white living room designs. White is the more subtle while red is intense and the combination of these two colors works really well. Most of the rooms when featured use two colors such as black and white, but the best color contrast is white and red. Blue and White Living room designs are also a good contrast but to give a more smart and classy and bold look to your living room the red and white is a killer combination. As shown in the images below for living room designs you surely would agree that red and white really make your living room stand out.
If you try to design your living room with red and white themes, I think it is a good idea, white is considered to be subtle, and red to very intense. Both these colors seem a good combination to realize your luxury interior white and red theme design. The result of this red-white design is an elegant and stylish decoration in your living room. One thing is certain, you can choose what colors dominate in the terms of use, people have asked a lot of thought into the design of red and white room.


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On November 8 – Vote Yes for Regional Transit
News | October 27, 2016
Regional Transit will improve our quality of life. The regional transit plan will connect residents to 23 colleges, 310 schools, 22 hospitals, 100+ grocery stores, 410+ parks, 47 libraries and to entertainment and cultural opportunities throughout the four counties.
Ecology Center Joins Coalition Calling for Policy Reform to Eliminate Childhood Lead Exposure
News | October 25, 2016
While the Ecology Center has been working to end childhood lead exposure in Michigan for years, this National Lead Poisoning Prevention Week we joined a coalition of over fifty groups calling for federal agencies to act boldly to eradicate lead exposure on a national scale.
Just Released: Updated Lead Report
News | October 13, 2016
The Ecology Center, in coalition with other health and environmental groups, demand that the state government end childhood lead poisoning. We've known about the dangers of lead for years, and we've failed as a society to mount a response scaled to the size of the problem.
Ecology Center Wins Grant for Dearborn Recycling Program
News | September 28, 2016
The Dearborn Education and Action on Recycling program (DEAR) seeks to use Dearborn's schools as agents of community and environmental change by reducing the amount of contamination in Dearborn's recycling system.
Coal Tar Sealants Pollute Local Waterways and Increase Risk of Cancer
News | September 28, 2016
Coal tar sealants cover a vast majority of driveways, parking lots and playgrounds. They are meant to extend the life of the asphalt underneath. Unfortunately, these sealants contain a hazardous chemical that is a known carcinogen.
Washtenaw County Leaders Support Regional Transit Ballot Proposal
News | September 28, 2016
Ann Arbor City Council, Washtenaw County Commission, Ann Arbor/Ypsilanti Chamber of Commerce, the Huron Valley Area Labor Federation, Ypsilanti Downtown Development Authority and Ypsilanti Library Board have endorsed the regional transit millage on the Nov. 8th ballot. Vote YES!
Green Up Your School Lunch
News | August 31, 2016
The EPA estimates that a child bringing a brown bag lunch to school every day throws away about 67 pounds of waste each school year. Learn how to tweak school lunch preparations to prevent the creation of tons of trash and keep chemicals of concern out of your child's lunch.
Investment in Transit Can Reduce Energy Burden for Low Income Households
News | August 25, 2016
It's undeniable. The energy burden is larger for low income households in the United States, and transportation costs play a big role.
What in the World Is Going on with Ann Arbor's Recycling Facility
News | August 9, 2016
On July 7, 2016, the City of Ann Arbor evicted ReCommunity, the long-time operator of its materials recovery facility (MRF), for safety violations at the City's facility. Since then, City actions have sowed confusion throughout the community about recycling.
Cultivating Care in Our Food System
News | July 26, 2016
Did you know that on average, a hospital spends 1 to 7 million dollars annually on its food and beverage purchases? That is tremendous purchasing power. Tremendous purchasing power equates to a tremendous opportunity to make a difference.
A Transit Future for Our Region
News | June 29, 2016
The long awaited RTA Master Plan draft was released to the public on May 31st. The intention of the plan is to connect transit service between Washtenaw, Oakland, Macomb, and Wayne counties, enabling ease of travel between the counties and connecting to existing local service.
Ending Lead Poisoning in Michigan
News | June 18, 2016
On June 10, 2016, Rebecca Meuninck, deputy director for the Ecology Center, was appointed to the Governor's Child Lead Poisoning Elimination Board. The Ecology Center strongly advocated for this Board and we were thrilled the Administration agreed and that Rebecca was appointed.
Breast Milk, Babies' First Perfect Food
News | May 24, 2016
What about the many other toxic chemicals we hear about every day entering our bodies from our environment? Medical associations and researchers agree: the benefits of breastfeeding are so vitally important that they outweigh potential risks from environmental toxics.
Transit is an Environmental Issue
News | April 27, 2016
Many people talk about public transportation as an issue of access, mobility, safety, and economic development for people and businesses in Southeast Michigan. These issues are critical to our region, but public transportation has significant environmental advantages as well.
Think Global, Eat Local: Beans!
News | April 27, 2016
One food that has never gone out of favor and is a staple in kitchens the world over is dry beans. Better yet, dry beans are grown in Michigan! The state is the second largest dry bean producer in the U.S.
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Description: Drum kit - Pearl Drum Set for Sale
Pearl set 4 piece Wood-fiberglass IN GREAT SHAPE, the toms are 12",13" and the floor 16" and a bass of 22". The snare is TAMA 13x5.5" Mighty Hoop. The snare and toms have Evan heads, the snare (genera dry on top/ remo ambassador bottom) and the toms have (evans G2 top/ remo pinstripe bottom) the bass drum (Emad). Ohh I almost forgot all toms and snare have remo muffles (internal) on them. Cymbals are not included.
All hardware included, or can be split as needed by buyer.
Any questions shoot me a message or call at 954 4658157
Thank you
PRICE IS NEGOTIABLE (Asking for $550)


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April 15 (1:30pm), 16 (8:00pm) & 17 (3:30pm), 2011 – Hemmens Theatre
Stephen Squires, conductor | Jodie De Salvo,piano | Ollie Watts Davis, soprano |
Leon Williams, baritone | Elgin Choral Union
From the iconic Rhapsody in Blue to the popular and controversial Porgy and Bess, Gershwin was a champion "mixmaster," bringing the sounds and vibrancy of American cultures to the concert stage. Stephen Squires, celebrating his 20th Season as the ESO's Associate Conductor, presents some of the most loved Gershwin moments!
This program is available as part of the 2010-2011 GRAND, POPS or FRIDAY MATINEE Series.
Stephen Squires


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Chapter 2. What Business Are You In?
Every web business tracks key performance indicators (KPIs) to measure how well it's doing. While there are some universally important metrics, like performance and availability, each business has its own definitions of success. It also has its own user communities and competitors, meaning that it needs to watch the Web beyond its own sites in different ways.
Consider, for example, a search engine and an e-commerce site. The search engine wants to show people content, serve them relevant advertising, then send them on their way and make money for doing so. For a search engine, it's good when people leave—as long as they go to the right places when they do. In fact, the sooner someone leaves the search engine for a paying advertiser's site, the better, because that visitor has found what she was looking for.
By contrast, the e-commerce site wants people to arrive (preferably on their own, without clicking on an ad the e-commerce site will have to pay for) and to stay for as long as it takes them to fill their shopping carts with things beyond what they originally intended.
The operators of these two sites not only track different metrics, they also want different results from their visitors: one wants visitors to stay and the other wants them to leave.
That's just for the sites they run themselves. The retailer might care about competitors' pricing on other sites, and the search engine might want to know it has more results, or better ones, than others. ...
Get Complete Web Monitoring now with O'Reilly online learning.
O'Reilly members experience live online training, plus books, videos, and digital content from 200+ publishers.


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Over a decade ago, Nick Friedman used and old beat up cargo van and started hauling junk. Nick co-founded College Hunks Hauling Junk, now a multi-million dollar national franchise. This success set off a chain of dominos, as Nick became not only an entrepreneur – but a dominant speaker, author, and TV personality as well. Nick has been on Millionaire Matchmaker, The Pitch, House Hunters, Jobs That Don't Suck, and Below Deck. Check out this gregarious entrepreneur and learn from his sound business advice!
BUFF Take Away: Don't delegate your vision, culture and hiring * Work on your business not in your business * Take action * BONUS, Enjoy your business!
BUFF Highlighted Charity: Goodwill.org
BUFF Coupon Code for AxiomV.com Fundraiser: buff071
Contact Nick Friedman: CollegeHunks.com | CollegeHunksFranchise.com | EffortlessEntrepreneur.com | NickFriedman.com


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Organ-specific diseases include diseases such as Hashimoto's thyroiditis and coeliac disease, in which specific organs (in coeliac disease, the lining of the small intestine) are attacked by the immune system.
Systemic diseases can affect any part of the body and several systems at once, including multiple organs. Diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis are systemic diseases.
The distribution of the auto-antigen largely determines the manifestations of the disease.
In non-organ-specific autoimmune diseases, there is often an overlap of autoantibody profiles and clinical features in an individual. A patient presenting with some features of SLE and some of scleroderma is said to have an overlap syndrome.
It is also possible for an individual to have two different autoimmune diseases (e.g. thyroid disease and rheumatoid arthritis) simultaneously. This happens far more frequently than would be expected by chance.
Similarly, there may be clustering of autoimmune diseases within the same family. This phenomenon can be explained partly by the underlying genetic basis of these diseases. However, this does not account for one person developing pernicious anaemia while a sibling develops Hashimoto's thyroiditis.
Detailed descriptions of individual autoimmune diseases are available in specialist books. A small selection is listed below.
Thermo Scientific: Helping scientists meet the challenges they face in the lab or in the field every day.


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DetailsAncol & Dufan is Still a Favorite Recreational Site
( Photo : Suparni / Beritajakarta.com)
Taman Impian Ancol, North Jakarta is still a favorite recreational site by residents to spend vacation time. Even, during this long holiday, the management side also gives ticket prices promo to the visitor.
"Taman Impian Ancol and Dufan is still a favorite recreational site for the tourist," said Corporate Secretary of PT Jaya Ancol, Gaby Tulangow, Saturday (5/7).
According to Gaby, entrace ticket to Dufan is only sold at Rp 350 thousand and has been adapted to the investment and the maintenance as well as operating costs of maintenance to ensure all rides go well and smooth.
"Visitor just pays Rp 35o thousand to play various rides in Dufan. We also give other promos such as motorcycle with STNK photo copy is only Rp 140 thousand for once entry during this long holiday," she expressed.
According to her, promos includes annual pass system with once payment for free-entry per year in Ancol as much as Rp 330 thousand, Samudra Rp 150 thousand and Atlantis Rp 190 thousand.
For Saturday (5/7), as many as 43 thousand people have flocked to Ancol. It is decreasing than first day of holiday, which was 88 thousand and 99 thousand on second day.
Reporter : Suparni | Translated by : Nugroho Adibrata
Source : http://www.beritajakarta.com/