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HAPPY NEW YEAR!: About 15,000 people met in Theater Square on New Year's Eve to celebrate the start of Tallinn's European Capital of Culture. The big event was greeted by the arrival of a UFO.
TALLINN - The road to Tallinn becoming the 2011 European Capital of Culture has not always been a smooth one. The resignation of Foundation Tallinn 2011 Director Mikko Fritze gave rise to worries about the project's funding and concerns over politicians using the event as a pawn in their own gain. But, as the clock struck midnight on Jan. 1, 2011, a spectacular light show over Tallinn city centre (involving, bizarrely, aliens and a flying saucer) saw the event kick off in unique style and – for the moment at least - put an end to any doubts about the viability and importance of the European Capital of Culture for 2011.
Not surprisingly, music features heavily in Tallinn's cultural offering over the coming year. The Tallinn Music Week (March 24–26, www.tallinnmusicweek.ee) has become an important event for the promotion of all genres of Estonian music from across the world and this year – which will see musicians play in various venues across the city – will see its visibility increased. The Norwegian Punkt (April 20 - 21, www.jazzkaar.ee) festival, which sees jazz concerts followed by freeform interpretations of the music, will visit Tallinn for the first time alongside shows from legendary American saxophonist and composer Dave Liebman and ten-time Grammy award winner Bobby McFerrin. Those who are fans of more traditional music will delight at the Estonian debut of Parsifal, the last opera written by Richard Wagner (Aug. 25–28, www.opera.ee) whilst the massive Song of Freedom event on Aug. 20 (www.tallinn2011.ee) will feature rock and pop musicians from Estonia, Latvia, Lithuania, Finland, Sweden and Russia, as well as special guests from Iceland and celebrate the 20th anniversary of the restoration of independence of the Republic of Estonia.
Tuuker (Aug. – Sept. 2011, www.tallinn2011.ee) promises to be an intriguing event as it presents itself as a site-specific 'horror show' that utilizes animation, music, film and many other art-forms to examine the myths and legends of the Baltic Sea. Defying notions of genre, it very well may be one of the most interesting events of the entire program. The same can be said for Stalking Stalker, an event which will use "Stalker" - perhaps the most famous film from Russian director Andrei Tarkovski – as a creative springboard for artists working in music and visual mediums. Exploring the themes of the film and the artist's own personal connection to the work, this should provide much creative energy for the city.
Dovlatov Days in Tallinn (Aug. 25–27, www.dovlatov.ee) is an international literary festival dedicated to the 70th anniversary of the birth of Sergei Dovlatov, perhaps one of the best known Russian authors, who have resided in Tallinn. Examining his work, the event should prove a draw for fans of Estonian and Russian literature. HeadRead (May 26-27, www.headread.ee) will cast the net wider as it includes the preliminary rounds of the Poetry Slam competition; a visit from renowned British fantasy author Angie Sage and the Estonian Writers Union's autumn library tour.
And those worried that all this culture may make people a bit lazy should be glad that the SEB Tallinn Marathon (Sept. 11, www.tallinnmarathon.ee) will allow people to take in the many unique sights of the city whilst getting some exercise at the same time. And, as a breather, you can go on to enjoy the Tallinn Month of Photography in Oct. 2011 (opening events from Oct. 3–8, www.fotokuu.ee) which will see numerous exhibition spaces across the city focus upon local photographic history.
This is only a small snapshot of the varied events that will be taking place as part of Tallinn 2011 and, with the diversity of events on offer, should get the city much more visibility over the coming months. Events such as these sometimes seems easy to dismiss, especially in the light of some of the dramatic happenings behind the scenes, but former capitals of culture – such as Liverpool, UK – have seen conceptions about the city change dramatically thanks to the influx of visitors and the media spotlight. Fingers crossed that Tallinn can do the same over the coming months.
Keep checking The Baltic Times for information, news and reviews about Tallinn 2011. For the full program go to www.tallinn2011.ee.


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our roots
It all started with a secret family recipe and the love that alfajores bring to families. Argentinian culture is very family focused and mothers across the culture make homemade alfajores out of love for their families to create memories they can keep forever. I have a saying, "You have to create a mllion great stars to give a child at least one to grab on to, so they can soar higher." With each alfajor, we are creating those stars for not only children but everyone to hold on to. The opportunity that we have to taste the flavours of the world is amazing and one that I am passionate about bringing to others. Our processes have been developed over the last decade and with the thin cookies giving the focal flavour, dulce de leche or milk caramel, the center stage, this cookie-pie will be loved by many more…they just need to discover it.
Since our introduction into the market almost a decade ago, those cultures with alfajores have been enjoying a local product they relish from their childhood memories. Alfajores are no longer a "need to buy item" on those trips to see family members abroad because our customers have been able to buy fresh alfajores right here. With the ability to provide a high-quality, fresh product, we have seen the joy we have been able to give many that have moved so far away from their own roots. With this love, we value striving to work hard to give and make the best quality product.
There are many things that should be valued in life and business. I always tell my family that my heart has three parts, each part for the culture I lived in and grew to love incredibly. From each of the cultures I learned the values that we stand by and foster; integrity, honesty, respect, inclusivity, loyalty, curiosity, perseverance, supportive and hard working.

subset: commoncrawl


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The Rise and Fall of the Mass Market Paperback – Part 2
Efficiency Strikes the Distribution Business
While the mass market book book business appeared to be healthy, in the early 1990s the infrastructure of paperback book distribution was undergoing significant changes. The dramatic rise and expansion of bookstore chains like Barnes & Noble siphoned business away from wholesalers' franchises, both in cities and suburban malls. Computerized sales information enabled publishers, wholesalers and retailers to better track the performance of categories and identify winners and losers among specific books and authors. And the stunning advent of amazon.com leveraged the awesome power of the Internet to link supply and demand.
Assessing these patterns, paperback distributors began asking themselves why they needed to employ human labor when they could more efficiently and economically service bookstores and other outlets by shipping books directly to the retailers. Yes, it would mean that the human element — the guy in the station wagon who knew which towns loved historical romances and which preferred contemporary ones, which adored westerns and which were big on science fiction – would be removed from the equation. But — well, that was progress!
The big agencies pulled the plug in that summer of 1996 when whole fleets of drivers were discharged, and in the following years the wholesale distribution workforce was reduced to a fraction of what it had been in its heyday.
The Bottom Drops Out
Most publishing executives were slow to recognize the implications of the nosedive in the wholesale paperback distribution business, dismissing it as one of those occasional and inevitable shifts to which the industry had always adapted. What was the big deal? Fewer romances and other genre novels would be published, wasn't that all there was to it?
In fact, the consequences were nothing short of calamitous. The impact was felt in every sector of the publishing business, from what got written to what got published to what got read. It wasn't long before customers in west Texas or Nebraska or South Carolina discovered that many books by their favorite authors were no longer being stocked in their local stores. When customers or store owners complained, they were told to take it up with the distributor – in Vancouver or some other far-flung location reachable only by an 800 phone number.
The Rise of the Airport Model
A key result of the shift in distribution patterns was the streamlining of the way retailers ordered books from publishers. Why pick and choose among thousands of titles that might sell only a handful of copies? Wasn't it better to follow the formula that worked so well at airports, ordering only the top fifteen or twenty bestselling books by branded authors like Nora Roberts, Robert Ludlum, John Grisham and Stephen King?
As paperback publishers awoke to the new buying patterns, they were forced to choose between star authors and those whose sales performance fell below a minimum level. At first the triaging was restricted to marginal genres like westerns, but as the last decade of the twentieth century progressed the definition of "marginal" broadened to embrace every category of book that fell below an ever-stricter definition of commerciality, a process akin to the lowering of the bar in a limbo dance. Limbo indeed: authors who had made a living for years from sales of ten or fifteen thousand copies of their paperbacks were now being dropped by their publishers as the minimum sales quota increased to twenty or thirty thousand copies or more.
Like the men and women who distributed their books, a lot of authors were thrown out of work, and the grim truth finally dawned on publishing executives. It wasn't just genre titles that were affected by the seismic shift in book distribution; paperbacks of every kind were being hit by the pullback.
"What's the Author's Platform?"
As the publishing industry entered the twenty-first century, book industry executives began requiring editors to produce elaborate profit and loss projections and other corporate-style analyses of the potential viability of books and authors. What was the sales performance of previous books? Did they "sell through" satisfactorily or did returns cross the threshold of unprofitability according to the latest formulas devised by bookstore chain number-crunchers? The mantra of "The Bottom Line" was invoked ad nauseam at every editorial committee, and editors were constantly reminded, "We can only afford to publish hits. If you can't project a big profit on a book, turn it down."
Editorial financial projections were aided by an Orwellian innovation called BookScan, instituted early in 2001 by Nielsen Broadcast Data Systems, the world's leading provider of airplay tracking information for the entertainment industry. BookScan offered subscribing publishers weekly analyses of sales by most major book retailers. Within moments, editors could access vital sales statistics on previously published books and authors, elevating performance parameters over traditional but less quantifiable values like compelling storytelling or stirring prose.
And what about the author? Was he or she attractive and mediagenic? Did he or she have a "platform" – an organizational base such as a hit television series or chain of fitness centers capable of promoting the sale of books? Was the author willing to buy large quantities of books for giveaway or resale by his or her franchise?
More and more, the importance of traditional literary criteria has taken a back seat to "The Numbers" and "The Platform." Promising but modestly successful novelists have discovered they cannot get their second or third books published, and aspiring newcomers find that they cannot sell their books at all. As for nonfiction, no matter how compelling a memoir or business guide or social commentary might be, publishers are disposed to reject it because the author was not "branded."
Faced with these grim options, authors have resorted to increasingly frenzied measures to get published. Established novelists are writing under pennames to disguise the poor performance of their earlier books, or strive to produce blockbuster "breakout" novels long on sex, violence, and plot but short on craft and characterization. Without supportive publishers to carry them while they developed their talents over four or five books, new novelists resort to gimmicky concepts with "log lines" that can be pitched like movie scripts. Nonfiction authors plump up their credentials or hire public relations specialists to burnish their images and enhance their media exposure. Others subsidize the purchase of large quantities of their own books to drive up their "numbers." Literary agents are besieged by writers frantically seeking the advantage of representation by successful dealmakers. Self-publication has soared now that electronic and print technology and Internet promotion have brought the costs of vanity books down to proletarian levels.
As much as authors would dearly love to bring back the robust mass-market paperback era, it's no likelier than a return to steam locomotives. More and more, the mass-market paperback is becoming a manifestation of blockbuster publishing, where economies of scale enable publishers to make a profit on immense shipments despite high returns. Because retail sales have shifted from racks to bookstores and the Internet, new and midlist works are increasingly being released in trade paperback.
The shift to trade paperbacks may help save midlist books. A major advantage of the trade paperback format is that it is the preferred size for print on demand reprints. "POD" takes all the guesswork out of bookselling, and the publishing industry can no longer afford to guess who will buy its products. Dismaying though it may be for old publishing hands to contemplate, the future of book distribution belongs to print on demand.
The end of the old mass-market paperback distribution system coincided with the birth of a new method of delivering books to readers. Though e-book technology has encountered innumerable obstacles, its potential to reach a vast readership is no longer seriously disputed. What sort of literature this new medium produces, and how it will make money for authors and publishers, are fascinating sources for speculation. And speculate we shall continue to do as the 21st century unfolds with its technological wonders and fascinating business model.


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State Issues Cyanobacteria Advisory for Province Lake in Effingham and Wakefield, New Hampshire
Concord, NH – A cyanobacteria bloom has been observed on Province Lake. Samples collected on 7/24/19 and 7/25/19 exceeded the State threshold of 70,000 cells/ml of cyanobacteria. Samples contained the cyanobacteria taxon, Anabaena/Dolichospermum. Sample identification was first confirmed by UNH and duplicate samples are currently being collected and analyzed by DES. The bloom appears bright green and has been spotted accumulating along shorelines. Surface blooms can rapidly change and accumulate in various locations around a waterbody. As a result, the New Hampshire Department of Environmental Services (NHDES) has issued a cyanobacteria advisory for those who use the waterbody for recreation. Please continue to monitor your individual shorelines for changing conditions and avoid contact.
NHDES monitors public beaches and public waters of the state for cyanobacteria. Once a cyanobacteria advisory has been issued, NHDES returns to affected waterbodies weekly until the cyanobacteria standards are again met. NHDES advises lake users to avoid contact with the water in areas experiencing elevated cyanobacteria cell conditions. NHDES also advises pet owners to keep their pets out of any waters that have a cyanobacteria bloom.
This advisory is not based on a toxin evaluation and is intended as a precautionary measure for short term exposure. Cyanobacteria are natural components of water bodies worldwide, though blooms and surface scums may form when excess nutrients are available to the water. Some cyanobacteria produce toxins that are stored within the cells and released upon cell death. Toxins can cause both acute and chronic health effects that range in severity. Acute health effects include irritation of skin and mucous membranes, tingling, numbness, nausea, vomiting, seizures and diarrhea. Chronic effects may include liver and central nervous system damage. Be cautious of lake water that has a surface scum, changes colors, or appears to have green streaks or blue-green flecks aggregating along the shore.
The cyanobacteria advisory went into effect on July 25, 2019 and will remain in effect until NHDES confirms that cell concentrations of the bloom have subsided.
Visit the NHDES Beach Program website for photos and more information about cyanobacteria at www.des.nh.gov/organization/divisions/water/wmb/beaches/index.htm
Updates on advisories and warnings may be obtained at www4.des.state.nh.us/WaterShed_BeachMaps/WaterShed_BeachMaps.aspx
Follow the Beaches twitter feed:
If you notice anything resembling cyanobacteria, please refrain from wading, swimming, or drinking the water. Keep all pets out of the water and contact NHDES immediately. Please call NHDES to report a cyanobacteria bloom at (603) 848-8094.
The cyanobacteria bloom on Province Lake on 7/24/19 and 7/25/19 appeared as bright green surface scums.


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Who doesn't love a push, right? Well, that actually all depends. There are plenty of Superstars who garner lukewarm reactions. This is why these performers are stuck in the mid-card or on house shows. If a babyface is getting pushed and the fans are behind it, great things happen: look at Kofi Kingston.
If a heel is getting pushed and fans believe it, the same concept applies. There are plenty of instances where WWE pushes someone, in spite of the fans' protests (looking at Roman Reigns and Batista as good examples). There are some obvious ones we can skip (they are on the verge or in the midst of pushes as we speak), but here's a look at five current superstars we want to see pushed and five we do not.
10 Do push: Ember Moon
There are rumblings that, for one reason or another, Ember Moon isn't a favorite of some in the creative process (like the big boss). If that is true, then she will have a particularly difficult hill to climb in order to get herself a push.
That said, she does have a title match at SummerSlam, so maybe she's not that disliked in the executive offices? Of course, if she loses, maybe there is some truth to the rumor? But she was wildly popular in NXT, and her finisher is one of the most exciting in WWE, regardless of division. She got burned by an earlier injury, but now is the time to push her.
9 Don't push: Lacey Evans
To be fair, Lacey Evans already kind of got her own little push in the earliest part of 2019. After getting a bit of a surprise NXT graduation, she has certainly made the most of her opportunity. That said, her push came at the expense of other superstars who were probably more deserving, or had waited their turn. Even looking at talent that could have been called up from NXT, one could make an argument that she wasn't even the best choice from the brand to jump (Shayna Baszler would have been better).
Evans has an interesting gimmick and she's played it well, but it feels as though it might have a shelf life. She got lucky and had good timing, but no more push for Evans for now.
8 Do push: Elias
Elias feels as though he has been on the verge of a push for months now. He's seemed ready to get some big programs, but nothing has truly blown up (in a good way) for him. Sure, he's involved in some good storylines now, but that doesn't really equate to a push.
No, for Elias, he needs a monster push. If nothing else, this means a great reign with one of either the United States or Intercontinental Championships. It's time to see how much more he can do as a champion, because one has to think he could, eventually, be a great champion as well.
7 Don't push: Randy Orton
Not saying that Randy Orton is getting a push, but he definitely should not be and does not need one. He is, however, getting a title shot at SummerSlam, though that may be more along the lines of a veteran wrestler working with another veteran for the sake of producing a strong match. There's nothing wrong with that.
With that in mind, however, Orton is not far off from breaking that fabled (and fabricated) record of 16 world championships. So much has been made of John Cena breaking it, or maybe Charlotte Flair... no one really mentions Orton, do they? Well, here's hoping that, at least for now, Orton isn't getting a new push any time soon. He's there if they need him, but he does not need a push.
6 Do push: Ali
Speaking of Orton, here's someone whose push Orton helped to abort. WWE even smartly incorporated that into the promos leading up to Kofi versus Orton, because without Orton injuring Ali, there's a decent chance KofiMania does not happen.
Now that Ali is back, however, one has to wonder if WWE will re-ignite his push. Fans were certainly getting behind the charismatic and athletic talent earlier in the year, so there's no obvious reason not to try it again, right?
5 Don't push: Buddy Murphy
Buddy Murphy can be a fun superstar to watch. He's been a bit overlooked since he jumped from NXT to the main roster, however.
In recent weeks, for one reason or another, he has found himself thrust into a major storyline. It was thought that perhaps it was Murphy that was behind the set pieces crashing onto Roman Reigns. It was not, but it was Murphy that ratted out Rowan and Daniel Bryan on SmackDown. So, will this be a footnote? Will this be part of a coming push? It could be...but here's hoping he's not getting a tremendous push.
4 Do push: Kabuki Warriors
It seemed that these two women would be the ones to take the Women's Tag Team Championships from The Iiconics, but that was not the case. This doesn't mean they won't eventually become tag champs. They absolutely should.
These two women (and Paige) absolutely deserve more. The tag titles would be just a start, to be honest. Asuka has already held a singles championship since she got to the main roster, but she didn't deserve to lose her undefeated streak when she did. Bottom line, the rest of 2019 -and 2020, for that matter- should be filled with gold for the Kabuki Warriors.
3 Don't push: Drake Maverick
This one is already happening, since Drake Maverick has been heavily involved in the 24/7 Championship storyline thus far. However, considering what the former Rockstar Spud has done since he showed up in WWE, it was a kind of odd move. Maverick may be talented and he is sure entertaining, but he really does not seem like someone who warrants a push over some of the other names on the roster.
Heck, his push even drew the ire of some other 205 Live talent, so the observation that Maverick doesn't need or deserve a push does not just come from fans, but also the locker room too. This is really not a knock on Drake, not at all. This is more an acknowledgment that there were, and are, a lot of other superstars plenty deserving of a push.
2 Do push: anyone else on 205 Live
So who do you push instead of Drake Maverick? How about anyone else on the 205 Live roster! While the 205 Live guys are all cruiserweights, they are all exceptionally skilled inside the ring. They can move, they can fly, they can wrestle, and, in case you've missed the last few WWE PPVs, they are completely capable of stealing the show.
Drew Gulak...Oney Lorcan...Tozawa...Tony Neese...just to name a few. These guys and so many others are very gifted, very entertaining, and very much deserving of a push.
1 Don't push: Charlotte Flair
Charlotte is one of the most important superstars that WWE has had over the past few years. That's an undeniable fact. She is also quickly sneaking up on her old man's celebrated 16 world championships.
In this current climate, it wouldn't be so crazy to envision an instant where it's Charlotte Flair, not John Cena, who ties and breaks that record. For one, it's Flair's own daughter. The other aspect, of course, is it would be a woman breaking it. Still, let's hope WWE doesn't do it now. The women's division is in an interesting place now, and there are a few strong women who deserve shots of their own. Charlotte can take a break for a while.
NEXT: Wrestling Royalty: 10 Things You Didn't Know About The Flair Family


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I was so excited to get this grill for the weekend. It was easy to assemble and get going. It has a great place for me to keep my bbq tools and a front rack to set stuff down so I am able to easily put things on and off the grill. We made steak and lobster tails and they could not have turned out better and it came with a cookbook to know exactly how to do it!
Pellet grills come in many different sizes with a variety of features. To take the top spot among pellet grills, the Camp Chef SmokePro DLX Grill offers the best combination of grilling space, heat control, and easy-to-achieve flavors that will create tasty meats time and time again. The grill makes cooking with pellets quick, easy, and enjoyable no matter how much skill you have on the grate.


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Back to Journals » Cancer Management and Research » Volume 10
Bone metastasis pattern in initial metastatic breast cancer: a population-based study
Authors Xiong Z, Deng G, Huang X, Li X, Xie X, Wang J, Shuang Z, Wang X
Received 30 October 2017
Accepted for publication 9 December 2017
Published 9 February 2018 Volume 2018:10 Pages 287—295
DOI https://doi.org/10.2147/CMAR.S155524
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Dr Antonella D'Anneo
Zhenchong Xiong,1–3,* Guangzheng Deng,1–3,* Xinjian Huang,1–3,* Xing Li,1–3 Xinhua Xie,1–3 Jin Wang,1–3 Zeyu Shuang,1–3 Xi Wang1–3
1Department of Breast Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; 2State Key Laboratory of Oncology in Southern China, Guangzhou, China; 3Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
*These authors contributed equally to this work
Purpose: Bone is one of the most common sites of breast cancer metastasis, and population-based studies of patients with bone metastasis in initial metastatic breast cancer (MBC) are lacking.
Materials and methods: From 2010 to 2013, 245,707 breast cancer patients and 8901 patients diagnosed with initial bone metastasis were identified by Surveillance, Epidemiology, and End Results database of the National Cancer Institute. Multivariate logistic and Cox regression were used to identify predictive factors for the presence of bone metastasis and prognosis factors. Kaplan–Meier method and log-rank test were used for survival analysis.
Results: Eight thousand nine hundred one patients with initial MBC had bone involvement, accounting for 3.6% of the entire cohort and 62.5% of the patients with initial MBC. Also, 70.5% of patients with bone metastasis were hormone receptor (HR) positive (HR+/human epidermal growth factor receptor 2 [HER2]−: 57.6%; HR+/HER2+: 12.9%). Patients with initial bone metastasis had a better 5-year survival rate compared to those with initial brain, liver, or lung metastasis. HR+/HER2− and HR+/HER2+ breast cancer had a propensity of bone metastasis in the entire cohort and were correlated with better prognosis in patients with initial bone metastasis. Local surgery had significantly improved overall survival in initial MBC patients with bone metastasis.
Conclusion: Our study has provided population-based estimates of epidemiologic characteristics and prognosis in patients with bone metastasis at the time of breast cancer diagnosis. These findings would lend support to optimal surveillance and treatment of bone metastasis in breast cancer.
Keywords: initial metastatic breast cancer, bone, molecular subtype, survival
Bone is one of the most common sites in patients with metastatic breast cancer (MBC) as 60%–75% of MBCs are firstly diagnosed with bone metastasis.1–3 Severe osteodynia, pathologic fractures, and nerve compression are the three most common symptoms of bone metastasis and are associated with poorer outcome and reduced life quality. However, there still remains a large proportion of patients who have no clinical symptom and miss detection of bone metastasis at the diagnosis of breast cancer.4–6 As most studies of bone metastasis are based on data from relapsed breast cancer, population-based studies relating to prevalence pattern and survival of patients with bone metastasis in initial MBC are still rare.
Breast cancer is a heterogeneous disease in which the biologic behavior of cancer cells and the outcomes of breast cancer patients greatly vary among different molecular subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2]-enriched, basal-like) based on the status of estrogen receptor (ER), progesterone receptor (PR), and HER2.7,8 Studies have shown that the risk of bone metastasis is subtype dependent in breast cancer.9,10 Luminal A breast cancer with positive expression of ER/PR was reported to have a higher propensity to develop bone metastasis.11 With the assessment of the gene expression of the primary tumor, studies reported that over 60% of primary tumors, which subsequently developed bone metastasis, were ER-positive/PR-positive breast cancer.12 Delpech et al further showed that the risk of bone metastasis in patients with hormone receptor (HR)-positive breast cancer was 1.66 times higher than the risk of patients with HR-negative breast cancers by developing a bone metastasis prediction model.13 With regard to HER2-enriched subtype, women with HER2-enriched cancer were less likely to have bone metastasis, compared to those with HER2-negative breast cancer.14 Although the risk of bone metastasis is different among diverse molecular subtypes of breast cancer, integration of these genes for the prediction of bone metastasis is seldom reported and outcomes among different molecular subtypes remain unclear in initial MBC with bone metastasis.
The purpose of our study is to use the Surveillance, Epidemiology, and End Results (SEER) database to assess the incidence of bone metastasis in initial MBC and to characterize patients with bone metastasis in initial MBC. Further, we would provide survival estimate and identify the prognostic factors for patients who have developed bone metastasis at the time of breast cancer diagnosis.
Materials and methods
The SEER database including 18 registries accounts for 30% of the US population.15 We searched patients with invasive breast cancer between January 2010 and December 2013. Patients with only a death certificate or autopsy, as well as those with incomplete follow-up were not included in our study. Then, we excluded patients with unknown age or younger than 18; thus, 245,707 patients were included in our study. Among these, 14,246 patients were diagnosed with initial MBC and 8901 patients with breast cancer were diagnosed as having initial bone metastasis. The follow-up period was from January 2010 to December 2014.
We defined patients' related variables including age at diagnosis (18–40, 41–60, and 61–80 years), sex (female and male), marital status (married, unmarried/divorced, and unknown), race (white, black, other [including American Indian/Alaska (AK) Native, Asian/Pacific Islander], and unknown), and Hispanic origin (yes and no). Cancer-related variables included tumor grade (grade I, grade II, grade III, and unknown), laterality (right, left, and unknown), primary tumor (T) stage (T1, T2, T3, T4, and unknown), regional lymph node stage (N0, N1, N2, N3, and unknown), and molecular subtype of breast cancer (HR+/HER2−, HR+/HER2+, HR−/HER2+, triple-negative breast cancer [TNBC], and unknown). Information of local surgery was defined as surgery and no surgery, and metastasis status was categorized as bone metastasis only, multiple/other metastasis, no and unknown).
We calculated incidence of bone metastasis as the number of patients with bone metastasis at initial diagnosis divided by the number of patients in the entire cohort (bone metastasis in the entire cohort) or patients with MBC at initial diagnosis (bone metastasis in the initial MBC cohort).
Statistical methods
Rates of overall survival (OS) and cancer-specific survival (CSS) were calculated in the entire cohort and in patients with MBC subdivided based on metastasis location (bone, brain, liver, and lung). Univariate logistic analysis was used to assess significant characteristics correlated with the initial bone metastasis. Then, the significant factors (P<0.05) were included in the multivariate logistic analysis to find independently the prognostic variables for the initial bone metastasis in the whole cohort. Univariate and multivariate Cox regression models were used to analyze the association of OS with clinical variables. Survival analysis was performed by Kaplan–Meier method and log-rank test.
All data was obtained using SEER*Stat Software version 8.3.4 (https://seer.cancer.gov/seerstat/). Statistical analyses were performed by SPSS statistical software version 22. All P values were two-sided, and P≤0.05 was considered significant.
Ethical approval
Our study complied with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Patients' characteristics and the bone metastasis pattern
Exactly 245,707 patients were diagnosed with invasive breast cancer between 2010 and 2013; 3.6% of the entire cohort was diagnosed with bone metastasis at the initial diagnosis, accounting for 62.5% of patients with initial MBC (Table 1). Also, 57.6%, 12.9%, 5.1%, and 8% of patients with initial bone metastasis had HR+/HER2−, HR+/HER2+, HR−/HER2+, and TNBC subtypes of breast cancer. There was a higher proportion of HR+ breast cancer in the cohort with initial bone metastasis compared to those with initial MBC (70.5% vs 62.7%), while less patients with bone metastasis were diagnosed with HR− breast cancer compared to that in the MBC cohort (13.1% vs 18.5%). Median follow-up in the entire cohort and in patients with initial bone metastasis was 31 and 18 months, respectively.
Table 1 Incidence of breast cancer with initial bone metastasis by the molecular subtype
Abbreviations: HER2, human epidermal growth factor receptor 2; HR, hormone receptor; MBC, metastatic breast cancer; TNBC, triple-negative breast cancer.
In the entire cohort, patients of Hispanic origin (no vs yes: odds ratio [OR]=1.256, 95% CI=1.163–1.356) and of American Indian/AK Native or Asian/Pacific Islander (other) race (other vs white: OR=0.748, 95% CI=0.682–0.819) were correlated with lower odds of having initial bone metastasis, and patients with advanced T stage (T2 vs T1: OR=3.278, 95% CI=3.035–3.540; T3 vs T1: OR=6.766, 95% CI=6.175–7.413; T4 vs T1: OR=22.112, 95% CI=20.310–24.073) and lymph node involvement (N1 vs N0: OR=2.765, 95% CI=2.605–2.934; N2 vs N0: OR=2.238, 95% CI=2.050–2.443; N3 vs N0: OR=3.564, 95% CI=3.268–3.887) were correlated with significantly higher odds of developing initial bone metastasis. With regard to molecular subtype in the entire cohort of breast cancer, patients with HR+/HER2+ subtype were more likely to have initial bone metastasis (HR+/HER2+ vs HR+/HER2−: OR=1.105, 95% CI=1.027–1.187), while those with HR−/HER2− or TNBC were less likely to have initial bone metastasis compared to those with HR+/HER2− breast cancer (HR−/HER2+ vs HR+/HER2−: OR=0.700, 95% CI=0.628–0.780; TNBC vs HR+/HER2−: OR=0.520, 95% CI=0.476–0.567). Multivariate logistic analysis regarding the risk factor screening in the entire cohort or MBC cohort is listed in Table 2.
Survival of the initial bone metastasis breast cancer
The 5-year survival rate based on OS and CSS was 23.7% and 35.4% in the initial MBC, respectively (Figure 1A, B). Patients with initial bone metastasis (5-year survival rate for OS=22.8%; 5-year survival rate for CSS=33.6%) had a much better prognosis than those with initial brain (5-year survival rate for OS=12%; 5-year survival rate for CSS=20.3%), liver (5-year survival rate for OS=12.5%; 5-year survival rate for CSS=19.3%), or lung metastasis (5-year survival rate for OS=16.8%; 5-year survival rate for CSS=26.9%). Among patients with initial bone metastasis, patients with only bone metastases had a significantly better survival compared to patients with multiple metastases (bone vs multiple: median survival=37 vs 21 months, P<0.001; Figure 2A). With regard to the molecular subtype, we discovered that median survival of bone metastasis breast cancer was the shortest (10 months) in patients with TNBC and was the longest (41 months) in those with HR+/HER2+ subtype (Figure 2B). In primary bone metastasis breast cancer, local surgery could prominently prolong the survival compared to those with no surgery (surgery vs no surgery: median survival=43 vs 25 months, P<0.001; Figure 2C).
Figure 1 Survival rate based on (A) OS and (B) breast CSS in patients with initial metastatic breast cancer.
Abbreviations: CSS, cancer-specific survival; OS, overall survival.
Multivariate Cox regression model showed that patients of black race (black vs white: hazard ratio=1.202, 95% CI=1.113–1.298), in T4 stage (T4 vs T1: hazard ratio=1.270, 95% CI=1.144–1.411), with multiple metastases (bone only vs multiple: hazard ratio=0.602, 95% CI=0.568–0.638), and with TNBC (TNBC vs HR+/HER2−: hazard ratio=2.577, 95% CI=2.346–2.830) were correlated with higher risk of mortality due to breast cancer with initial bone metastasis. Patients who had their primary tumors resected had a 0.57 times lower risk of mortality compared to patients who did not accept local surgery (surgery vs no surgery: hazard ratio=0.570, 95% CI=0.528–0.615). Significant results are presented in Table 3.
Our study has firstly reported the incidence of bone metastasis at the initial diagnosis of breast cancer and has found that HR+ status, white race, young age (18–40 years), advanced T stage, and higher tumor grade are the risk factors of the initial bone metastasis. Further, we found that patients with initial bone metastasis had a better survival compared to those with initial brain, liver, or lung metastasis. Patients of old age (>40), black race, higher tumor grade, T4 stage, and TNBC were correlated with higher mortality risk, while those who underwent local surgery were associated with lower mortality risk. As our study is based on SEER database with 30% coverage of the USA population, bone metastasis incidence and survival estimates that we have reported are highly representative of the general population.
Bone is one of the most susceptible sites for cancer metastasis, especially in breast cancer.16 Our study found that 62.5% of patients with initial MBC were diagnosed with bone metastasis, which was consistent with the previous reports.17 Several factors were suggested to be responsible for bone metastasis. As metastasis through blood plays a major role in distant metastasis in breast cancer, the rich blood flow in the bone marrow and the stream of blood from the breast to the skeleton via the vertebral–venous plexus would significantly increase the risk of cancer metastasis to bone.18 Otherwise, bone is suggested to be a large repository of growth-stimulating factors including fibroblast growth factors, platelet-derived growth factors, and bone morphogenetic proteins. These factors, released and activated in bone, could stimulate growth of tumor cells and act as a fertile ground for metastasis formation.19,20 Although bone metastasis is commonly seen in MBC, the preferential metastasis sites of breast cancer were reported to be different based on HR status and HER2.21 HR+ or HER2− breast cancers are more likely to have skeletal involvement among patients with breast cancer recurrence.22 Further, our results showed a similar pattern of cancer metastasis among patients with initial MBC as the HR+ status (HR+/HER2− and HR+/HER2+) was significantly correlated with initial bone metastasis and most (57.6%) of the patients with initial bone metastasis had a positive expression of HR. The mechanism regarding the propensity of bone metastasis for HR+ breast cancer remains unknown; however, some studies pointed out that this phenomenon may be associated with tumor dormancy.22–24 Studies suggested that dissemination of breast cancer cells takes place long before the detection of cancer metastasis and most of these disseminated cancer cells die while part of them might survive and become dormant in bone marrow.24,25 The dormant cancer cells with positive expression of HR, which are hormone responsive, could be reactivated by steroid hormone and they subsequently develop metastasis disease in bone.22
Next, we assessed the survival rates depending on OS and CSS among patients with MBC and observed that outcome of patients with initial bone metastasis was better than those with initial brain, liver, or lung metastasis. The consequences of cancer metastasis are often devastating as the cancer cells would cause tissue damage and destruction of organs with metastatic diseases.26 In breast cancer, bone metastasis is predominantly characterized as osteolytic, which causes severe pain, pathologic fracture, or nerve compression, and is considered to be less deadly compared to metastasis of brain, liver, and lung.27,28 As the cancer cells have spread widely in MBC patients, chemotherapy and targeted therapy (endocrine therapy and anti-HER2 therapy) become optimal options for cancer treatment. Patients with HR+ breast cancer, which is highly responsive to targeted therapy (endocrine therapy), as well as those with HER2+ breast cancer, which is responsive to anti-HER2 therapy, could achieve tumor remission and improved survival with endocrine therapy.29,30 Thus, the better outcome in patients with initial bone metastasis might be attributed to the higher proportion of patients with HR+ diseases. Consistently, in breast cancer with initial bone metastasis, we observed a significantly lower mortality risk for patients with HR+ or HER2+ breast cancer compared to those with TNBC, which was unresponsive to targeted therapy.
Since organ destruction resulting from cancer metastasis is the major cause of death in MBC, local surgery to primary tumor was thought to be invalid to improve cancer survival.31 Interestingly, our study showed that surgical removal of the primary tumor might improve cancer survival in newly diagnosed breast cancer with bone metastasis. Consistently, both retrospective studies and randomized trials have indicated that local surgery may improve cancer survival by lowering the tumor burden in initial MBC.32–34 A study using a cancer transplantation model in mice suggested that local surgery of the primary tumor improves survival by both reducing the tumor burden and enhancing sensitivity to chemotherapy.35 Meanwhile, the results of experimental and clinical studies were opposed the survival benefit of local surgery based on the theory that surgical removal of the primary tumor would prompt growth of metastasis by increasing the adhesion of circulating tumor cells to the vascular endothelium of target organs and inducing inflammatory cascade.31,36 Thus, the survival benefit of local surgery remains unclear in initial MBC and more well-designed studies are required to guide cancer therapy.
There are some limitations in our study. As our study is retrospective, selection bias and missing data are inevitable. Details of systemic therapy including anti-HER2 therapy, endocrine therapy, and chemotherapy are not available in our study, and the relevant biases may exist. Randomized and prospective studies with large patient cohort are required to identify the validity of surgery in initial MBC with bone metastasis.
Our study has reported the epidemiology of patients with bone metastasis in initial MBC based on a general population in the USA. Patients with bone metastasis had a superior prognosis compared to those with visceral/brain metastasis in initial MBC. Incidence and survival differences of initial bone metastasis were well described according to the different molecular subtypes in initial MBC. We also discovered that local surgery could significantly improve cancer survival, suggesting that patients with bone metastasis might consider local surgery in initial MBC.
Availability of data and material
The data of our study are freely provided by the SEER Research database (http://www.seer.cancer.gov).
Author contributions
ZX and XW designed the overall project. ZX and XH analyzed the data and wrote the manuscript. GD and XX collected and analyzed the data. XL and ZS performed the research. JW did the statistical analysis. All the authors (XW, ZX, GD, XH, JW, XL, XX, ZS) have read and approved the final manuscript. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.
The authors report no conflicts of interest in this work.
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The Beyerdynamic DT220 is a strange headphone. Nobody quite knows when production ended, but there have been ads for them dating back to the late '70's. They are studio headphones. Other than the ad, there is pretty much no information about them to be found other than a few Head-Fier's opinions.
Item InformationBeyerdynamic DT220, 4 votes
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- Ishcabible
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- 4
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- 0
- Rating:
- 3.875/5, 4 votes
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Beyerdynamic DT220
Ishcabible · May 10, 2010 · 7K
- Rating:
- 3.875/5,
Recent Reviews
Nice quality headphones for cheap
Written by andi85
Published May 15, 2012
- 4.0/5,
Pros - Sound, comfort (w/ new pads), easy to fix, it's a Beyer
Cons - Comfort (w/ old pads), narrow soundstage, only few parts available
First off, I'm not an audiophile, I'm a musician and a music lover - and my interest in HiFi stuff and headphones comes from there.
I've known those phones for years, they have been the in-store headphones of a German record chain, and apparently they simply don't break. So when I found a DT220 clean, fully working and cheap on eBay I couldn't resist.
With the old pads the sound was reasonably detailled, but rather low-mid heavy with a slightly pronounced bass. Treble sounded pretty accurate though unassuming. Anyway, a very pleasing sound, if slightly fatiguing. Also, soundstage is more or less a non-issue, it all plays pretty much within the listener's head. Still - not bad for such an old design!
The classic Beyer layout with the metal headband makes it easy to adjust the phones to the head, however, the old pads had gone extremely soft, which caused the elliptical rubber parts to exert some pressure on my ears. Not very comfortable!
Good news: Beyer still sells replacement pads for €15 a pair. I ordered them and a new cable (the dual-entry cable of the DT211/411 fits, but make sure to order sleeves with the cable!). That's what you call customer service!
With the new pads in place, it's amazing how comfortable those things are. The DT220 gets close to the classic AKGs, which fit my head perfectly. Changing the cable was a piece of cake, the screws for disassembly hide under the pads, contacts for soldering are marked, so this isn't really a big deal.
However, the pad replacement changed the sound, too. Compared to what it was before, it is now almost amazingly linear and even with a much leaner/more natural bass response. It took some time for me to get used to it - actually even some time in which I didn't listen to the DT220 at all - to forget the old sound signature.
Anyway, it changed for the better, it's less fatiguing now, sounds more natural. Isolation stayed pretty much the same I think - reasonable but nothing special.
Apparently, the impedance of my unit is 400Ω. They do work on basically everything, even my Macbook and my Sony Walkman MP3 player, but they sound a lot better with my old JVC CD deck.
If you can get them cheap, go for them. Also, they come from one of the nicest and friendliest companies I know in the audio business - so if there's a problem, they are happy to help.
You can check their impedance using an Ohm-meter. I'm surprised you can drive them using portable players, even if you had the 250Ohm version. They must be very sensitive phones.KimLaroux, May 16, 2012
Alright, my ohm meter is acting strangely, but apparently the DT220 is 400Ω. Concerning the use with the MP3 player, maybe I got ahead of myself a little. Let's say it works at a volume that is enough for home use. It wouldn't be my choice for a busy regional train etc. and it sounds better from the output of my old JVC.andi85, May 16, 2012
Decent professional monitoring.
Written by psilas
Published Sep 2, 2010
- 4.0/5,
Pros - Great flat response,well built.
Cons - Less comfort than DT-100.Ear pads a get a bit hard over time.
The Beyer DT-220 are a very solid pair of headphones and excellent for serious mixing requirements.
While the DT-100 are now the industry standard (and for good reason) I have no regrets buying 4 pairs of the DT-220 which I managed to pick up 2nd hand for £40 a pair.
The range is good at 20-20,000 htz and the sound is fairly neutral,being neither too bassy nor too trebbley.
What you hear is what you get which makes these ideal for professional jobs. I have used these for day long sessions without suffering any ear fatigue which is essential.
The only downside I've found is that out of the 4 pairs I have 2 of them had rather hard ear cushions whereas 2 pairs did not. I think that over time the rubber cushions get slightly harder. Thankfully you can still get replacement parts for the 220's which includes new ear cushions.
In total, I would go for the DT-100 over the 220 due to the slightly increased comfort and broader freq range.However, for the money the DT-220 are more than decent for the studio professional, have great sound quality and will also last a long time.
dt220 Review
Written by Punnisher
Published May 12, 2010
- 4.0/5,
This is a mini review of the beyerdynamic dt220 400ohm.
Last year I stumbled upon a pair of dt220 on ebay for $75. I was unable to find information in regards to their sound but I bought them anyway. A true impulse buy. After hearing them, I bought another pair from the same seller. I could tell that I had found a special headphone, a true diamond in the rough.
The dt220 is rare and information is hard to find. There are a few pictures and specs but very little in terms of listening impressions. Luckily I have two original boxes, so here are the specs listed for my pairs:
20-200000 Hz 400ohm
102mW = 122db = 6.4 V an 400ohm 260g
There is also a 20ohm version of this headphone which I do not own.
Judging by the phrase "a quality product made in West-Germany", I can safely assume this particular headphone was made, at the latest, in the late eighties. Though it could very well be from the seventies. As said before, little is known about production timelines.
My two pairs are identical, likely bought at the same time for the same studio, as I got them from one seller. The pads are very different from modern pads. They are made from rubber and filled with foam. The drivers are comparatively small compared to modern drivers. There is also a dense foam piece that surrounds the driver, which your ear rests on. This gives the bass a very punchy feel, just like Grados. It's a nice departure from my other headphones. My pairs feature single sided entry cable, which must have been implemented after some time indicated by this awesome beyerdynamic photo featuring a dual entry cable:
This posed a problem, though. The depth of these headphones (thickness from front of pad to back of cup) is small compared to most beyerdynamics. This means that cup rotation is greatly hindered because of the cable entry/exit on top of the cups. You can even see where the aluminum cup brackets dug into the cable strain relief. Because of this limitation, the pads sat on my head at an angle which prevented a proper seal and removed what little comfort these headphones had.
To fix this I converted the headphone to dual entry using a sennheiser hd650 cable. I also removed the physical anti-rotation portion built into the cup hinge sockets and cup brackets. The result is perfect seal and the best comfort you're going to get with this headphone.
My first listen was made using a TI class-D amplifier board modified to be a headphone amplifier. This little amp works great for all my other headphones but I feel that the impedance of the dt220 (400ohm) is well beyond its capability. Not knowing this, I still enjoyed this headphone immensely. The sound was the same as using it unamped out of my iriver h320. Bass was lean, mids a bit cold and treble sounded good. They seemed ruler-flat and took about any music with stride. Though, they sounded almost horn-like with some music. This was my impression of them for months, as I had taken a break from my tube amp.
Eventually I decided to try them with my SS Millet tube amp and the difference was night and day. Many people say amplifiers make no difference, but with this headphone the difference was overwhelmingly positive and far too large to be placebo. Instead of an overall cold/flat sound, music became warmer and closer. Bass can extend extremely deep and the physical feel of kick drums is prevalent. Mids are smooth, not recessed and clearly audible. Treble is slightly relaxed but not to the point of being hard to distinguish.
Overall the sound these headphones present just works. Warm, musical, yet somehow faithful to the recording. Faithful in the way that just about anything you play will be represented accurately and pleasantly. Some headphones just can't do that.
Comfort is where these headphones fall short. Granted, these were geared towards studio monitor users so comfort may have been placed on the back burner. The main problem (with single entry models) is the limited cup rotation as stated above. Remedy this problem, and all you have left to complain about are the pads themselves.
The pads are foam coated with flexible rubber. The ear openings in these circumaural pads are rather small, which my small ears barely fit into. People with larger ears may experience untold discomfort. I can last a couple hours before I need a break.
Just beneath the main pad is a smaller pad made out of dense foam rubber. This smaller pad surrounds the driver and makes contact with your ear. This pad is interesting because its removal means loss of all warmth and bass. I believe the pad is there to limit the amount of dead air in between the driver and ear, as well as physically transmit vibrations to the ear. This gives a very punchy, physical bass experience much like supra-aural Grados. Remember, the driver in this headphone is actually very small, being around 30mm instead of beyerdynamics current 45mm. It doesn't move air quite as effortlessly.
These headphones sell for relatively cheap as far as I can tell. I got both my pairs for around $75 and I consider that a great bargain. I have even heard of them going for well under $50. At any of these prices they are a great deal. They can compete with all my other headphones.
If you want these, consider proper amplification. It's even more important with these 400ohm headphones than it is with the k702. My tube amp brought out the best in these headphones, so try to have an amp on hand with specs greater or equal to the SS Millett.
That's it.
Beyerdynamic DT220, Giant Killer? Maybe Not, However, Great In Their Own Right.
Written by Ishcabible
Published May 12, 2010
- 3.5/5,
Pros - Great all arounder, incredibly durable
Cons - Not really anything. Could be a lot more comfy.
For the TL;DR crowd, they are great sounding headphones. They can do pretty much everything well, if you don't mind a smallish soundstage. They bass extends to all but the lowest notes, electric guitars have a nice bite, vocals can be enchanting, pianos can give goosebumps if you haven't heard much better, drums are nice and impact, imo, saxophones are rendered fine, not great, however. (I've played the saxophone for 5 years, so I'm too critical on this part) Violins are rendered better than saxophones, much better. Classical is not their forte if you like a cavernous soundstage, but I was able to pinpoint instruments pretty easily. They are quick enough for most electronic, and detail is about par with my K271.
For the rest of you, a little back story before the review. I got these about two years ago. I quite honestly don't know why I got them. I had an A500 so I had no need for a closed headphone, but something about them called to me, and a $20, straight from Beyerdynamic USA, it was impossible to resist. It'd be more portable than the A500, I hoped. It's quite frankly, impossible to be bigger than them.
Three days later, they're on my front door. Excitedly, I rip open the USPS box. I start playing Death Cab for Cutie, and…brightness. There's a lot of harsh treble, so I let it burn in for a few hours while I was at school. When I came back, they seemed to be less harsh. Remember, I had a warmish (imo), colored headphone before them. The bass was kind of loose and unrefined, so I tried sticking some blu-tack to absorb some reverberations, and the bass was--or it could have been placebo--tighter and refined a good bit.
On to the review. I use a Harman Kardon receiver with a PS1 CDP and a Beogram 2402 with a cheap TEC phono stage. I'll update this when I actually have a decent source. I got a K271 the following year for, again, no clear reason except that it was $60 shipped, so I'll make a few comparisons to them too.
Where should I start…? Might as well start with Plans, since I've mentioned it in the beginning paragraphs. Starting with Marching Bands of Manhattan. The intro has always perplexed me. I never quite knew what instrument, if it was an instrument, played in the intro. Well it sounded like a synth on the DT220, and I stand by that. I listened in to the ending to make sure the bass kept up with the vocals and piano unlike my K271 unamped. The bass seems to falter a bit, but nothing major. If I listened to the song as background music, I wouldn't have noticed it.
On to I Will Follow You Into the Dark, a song I played until my fingers bled--the things we do to make a girl happy… Anyways, because of this, I know the song inside and out. What I hear is pretty good. Ben's voice is intimate, yet there is something strange about his voice. It seems colder than normal and contains less body than I'm used to. And the guitar is about 5 feet behind his voice. Strange.
"Love is watching someone die…", a quote from What Sarah Said that makes my heart hurt every time I hear it. The piano intro is another section I have learned to play for a friend, so I listen in to make sure I hear the piano when it drifts away. Gibbard's voice enters powerfully, reaches into your soul when he utters the fabled words.
Second album, a Tool album. 10,000 Days to be specific. No particular reason why I chose this album, but it is a recent album that isn't brick walled, so there's a plus. It's also pure fun to listen to.
Starting off with Vicarious, a song I like to use to test aggressiveness. The guitar intros prove a nice crunch, but somehow seem to be too polite, like the brakes are being pushed. The drums prove to make me tap my toes to follow the beat-something neither of my other two headphones could do.
Time to get some wings. Wings for Marie and 10,000 Days is next. The guitars drifting from left to right is entrancing. Keenan's voice is wonderfully deep and raspy, in a good way. The thunder in 10,000 Days proves itself by making me jump out of my seat when it suddenly crashed when I least expected it to.
"Incomprehensible words"--best description of Rosetta Stoned my friends and I can come up with. We joked that if you could understand every single word, you are God. Sadly, I am not. The DT220 misses about half the lyrics, sadly. What is incomprehensible, however, is involving gibberish. Guitars are yet again, exciting.
I'll admit I'm not the biggest classical fan, so I'll do my best to describe the DT220's performance in classical music.
New World Symphony by Dvorak-The opening trumpets shine, but seem hazy at the same time. Same with the clarinets, but seem to be more upfront. Flutes, for some reason, seem to sound much clearer than the trumpets and clarinets. Violins are just amazing though. They are rendered pretty nicely compared to the trumpets. And to get off topic about the instruments, I found it laughable how obvious it sounded when a person in the audience stood up and left the room. Anyways, yeah, sorry I can't give much of a description here. I'll be sure to update this at once.
IT'S ELECTRIC! BOOGIE WOOGIE…Yeah no. Sorry about that, so tempting. A couple random Chemical Brothers songs for this portion, and a Shpongle song.
Galvanize, a song we all know. Really popular when it came out. This song the first song I've heard sibilance in. The intro made me jump out of my skin for some reason. Bass is nice and impact, synth is pretty nice too. You might notice how short this portion is. I couldn't stand the sibilance I heard. I also hear some unfavorable distortion.
Hold Tight London, a less popular song. This song, however one of my favorites by the Chemical Brothers, mainly the way the soundstage is all over the place and makes use of both channels really nicely. The vocals have an eerie, almost ghost-like attribute to them that makes the song impossible to pause.
Private Psychadelic Reel, another of my favorites by the duo. It escapes how the wall of synth manages to climb up your back at approximately 2 minutes into the song. The repetitive nature of the song would make one think it gets boring, but the DT220 has the great ability to make the song involving. The section at approximately 3:30 is also amazing. The tunnel of sound that forms about 5 feet away from your face is just jaw dropping. The DT220 does electronic. And pretty decently at it.
On to jazz.
Dave Brubeck's Take Five is a nice example showing that the DT220's forte is not jazz. I have heard a Selmer Super Balanced Action many times. The DT220 fails to replicate the sound nearly as well as I expected it to considering it's a monitor headphone. Perhaps I'm being too hard on it, but I have standards. Yes, it plays the song well. Not as well as my K271, however. Still decent though. There is a fuzzy element in the sound that leaves me wanting more however. The tone is just off…
Well, there's a quick and dirty review of the rare on Head-Fi DT220. Hope you guys liked it! This goes without saying, but all this is in my opinion. Oh, and one more thing. These really hurt my ears after about two hours.
Update, addressing Punnisher's review, if you can sew pads the same dimensions out of leather, that would probable increase comfort a good bit. I tried some pad rolling with a baffle, and sadly, any pads other than the DT220's killed the sound.The velour K271 pads made the sound too thick, and the A500 pads sounding tunnely. Please resist the temptation to make the pads too thick. It will kill the sound. Ideally, maybe a centimeter thicker than the original pads to improve comfort, but this is just a speculation. I haven't made pads for them yet. I'll make some in a few weeks and report my findings. And while Punnisher has the 400ohm version, I have the 20ohm version.
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A recent story going around both the media and the EMS blogosphere with much fervor is the assault on the sensible policies of American Medical Response by Jackson, MS City Councilman Kenneth Stokes. You can read the initial story as reported by WLBT and a follow up story as reported by WAPT, both media outlets in Jackson, Mississippi.
The Assault
His call for responders to disregard scene safety has sparked reaction across the nation from responders and non-responders alike.
Scene safety has been built into the EMT/Paramedic curriculum in every scenario. There is good reason for this. After all, if the rescuers become victims, who does that benefit? Your victim count has increased and you are no closer to preserving life than you were by staging a block away.
The fact is that we encounter and assume a number of risks in our daily everyday duties. We have found ways to reduce some of those risks but these dangers are still real nonetheless:
- Disease – We expose ourselves to disease on a daily basis. Yes there is Body Substance Isolation (BSI) that helps to reduce that risk, but there are still plenty of opportunities for exposure especially when we are the first healthcare providers making contact with a patient
- Motor Vehicle Accidents – We perform our duties in one of the most hostile workplaces ever… the back of a moving vehicle. Yes, we have training and there are seat belts that can help us to reduce that risk. The training that we receive often does not meet the demands placed on operators and most of the safety restraint systems were designed for passenger vehicles in the 50's
- Physical Health – The physical demands of this job are immense. With the growing girth of America and the continuous reduction of resources we are doing more with less and paying for it in injuries
- Mental Health – The mental and emotional demands placed on us is possibly one of the greatest threats we face. We don't do enough to reduce that risk and it often leads to broken homes, mental trauma, and emotional imbalance to the point where we are no longer able to function in society as others would
Instituting a staging policy pending the securement of the scene by law enforcement on calls where a violent crime has been reported is sensible of any agency. Adhering to that policy is sensible of any provider.
As it turns out, from the video report below, Councilman Stokes really has no say over the policies or the contract with AMR who is the agency he demanded the policy change from:
Councilman Kenneth Stokes is in fact a dullard when it comes to the purpose and capabilites of not only EMS, but apparently also of himself.
The Unacknowledged Truth
Non-responders though have a slightly different view. From their viewpoint if they are injured, they want help and they want it now. At first glance of the subject most of them agree with Kenneth Stokes. They want to call 911 and have who they need arrive, and not park a block away waiting for someone else.
Usually after further conversation with non-responders, and the highlighting of certain aspects from the scenario, more often than not their viewpoint changes as they better understand what the actual role and capabilities are of EMS. This is yet another indicator that we fail when attempting to effectively communicate with the public. When it comes to what EMS does and is capable of, they are the uneducated masses and we need to make their education a priority so that when it comes to understanding EMS they are not dullards like Kenneth Stokes.
We owe them the gift of education in the very least.
Other Takes
Here are some other takes on the same subject from around the blogosphere:
- Kelly Grayson shined the light on the initial story
- Rogue Medic has a well researched post on the topic and the man
- EMS Garage discussed the issue with a little bit of ranting on the side during Episode 105
- Medic Trommashere wrote an open letter to the instigator in question.
- Justin Schorr looks at the issue from a different perspective


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What is the normal battery life for this device, using daily for reading only?
This is for the most current Kindle, "A single charge lasts up to four (4) weeks, based on a half hour of reading per day with wireless off and the light setting at 13. Battery life will vary based on light settings, wireless usage. Audible audiobook streaming over Bluetooth will reduce battery life", that is pretty standard across devices. So, 14 continuous hours. I don't know how old your device is, but it will lose some capacity over time.
I think the Kindle 4th Gens worked out to 21 hours
Battery life diminishes over time so any numbers you find are for a brand new device.
One good afternoon on a hot car seat in the sun could easily knock it down 75%.
Here is why they die:
If all else fails, Amazon is 24/7 at https://www.amazon.com/contact-us
NOTE: I do NOT speak for or represent Amazon in any fashion. This is a customer to customer forum.
Disclaimer: I have examined any sites I provide links for and have determined them to be safe but I make no promises about safety, content, ads served or anything that might make you clutch your pearls in horror. Use discretion clicking on links provided by total strangers such as myself.


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Paris Appearance Week saw the admission of Hedi Slimane's Celine, area the artist didn't aloof bead the emphasis aloft the E, but gave the absolute characterization an overhaul. And while shoppers may adulation addition adventitious to snag a Slimane creation, critics weren't so affectionate to his collection. Slimane, no drifter to controversy, airtight back, adage that abrogating reviews, which addressed the show's abridgement of diversity, the credible change of Slimane greatest hits, and complete adjournment of the brand's history, may accept been artlessly phobic.
"It's actual black and I still feel like they're talking about addition else," he said of the criticism. "The spirit of the appearance was ablaze and joyful, but today, animation and aloofness are actuality questioned in fashion," he said in an email, Fashionista reports. "It's accessible that there is a hasty subtext of abeyant phobia there."
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"Slimane doesn't assume decidedly absorbed in acclamation the banal issues in a woman's life. His appearance is not actuality to break your problems. Save your problems for your therapist. His designs are about his vision. They are not welcoming. They abide abaft the clover rope. They are the afterwards afterwards party," Robin Givhan wrote in the Washington Post.
Critics compared him to Donald Trump, adage that his designs didn't abode the needs of women in their accustomed lives. Why the Trump comparisons? The apple seemed divided, with one accumulation adage that a characterization that was already acclaimed for creating accouterment for women by a woman (in this case, Phoebe Philo) had been taken over by a man. And at atomic this time around, the man showed actual adolescent women in actual abbreviate dresses. He additionally focused in on American appearance reporters, adage that it was that specific accumulation that acid in on the actuality that he had taken over a position captivated by a woman.
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"The comparisons to Trump were opportunistic, rather adventurous and absolutely comical, aloof because the women in my appearance were chargeless and nonchalant," Slimane wrote in response. "They are chargeless to dress as they wish."
The artist is demography the criticism in stride, however, calling it "unhoped-for publicity" and an archetype of the French spirit. Celine, he says, is a best of nonconformity and freedom.
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Who will look after your crate-washer?
Our machines are low maintenance. However, low maintenance does not mean no-maintenance. Any machine needs regular care if it is to perform at its best and our crate-washing machines are no different.
Who will look after your crate-washer?
In my experience, having one person in charge of running the machine, making sure it is cleaned daily and weekly, will mean it can run for massively long hours with no breakdowns. It's that simple.
The process is not just about the cleaning of the products. The crate-washing machine itself needs to be washed and sterilised regularly. When there's ever an issue with hygiene (at worst this might mean a product recall), it always comes back to when the machine was last sterilised.
How often this needs to be done depends on the product, the type of pollution and the running hours of the machine. A machine running two shifts a day for seven days will require a different cleaning regime to a machine running only for half a day a week.
Some factories use different temp workers each day to operate the crate-washing machine. This situation means no-one is responsible for taking care of it. I have seen this happen with seasonal machines that are rented. If nobody is in charge of taking care of the machine, it can lead to breakdowns and interruptions to product cleaning. This can be devastating in a short season. However, it is completely avoidable. Even in seasonal operations, it is still vitally important to have someone responsible for the machine's care.
I have a client who bought a machine from our company 12 years ago. The client has a designated worker who is responsible for making sure the machine is properly cleaned every week. The worker keeps a record of the cleaning of the machine, which operates five days a week, eight hours a day, for the last 12 years. It has had no breakdowns and minimal running costs. I do regular services and notice that the machine looks as good as new, inside and outside.
To achieve this, I recommend that when the machine is installed, I meet and discuss the care requirements with the designated person in charge. Then for the next two to three services, I will do the service with that person. Although workers may constantly change on a daily basis, the person in charge should always be there to brief the new crew on how to operate the machine. Most machines need to be cleaned every night, have a chemical wash to remove scale monthly, and checks to make sure the heating works and the pump is running properly.
By following a simple care routine, you can ensure that your cleaning and sterilising is of the highest standard.


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ReMix: Skies of Arcadia "Coding Angel" 3:08
By Jason Covenant
Arranging the music of one song...
"Gilder's Theme"Skies of Arcadia (Sega, 2000, DC), music by Tatsuyuki Maeda, Yutaka Minobe
Posted 2019-09-09, evaluated by Liontamer
Happy 20th North American Birthday to the Sega Dreamcast! Just three months older than us :)
To celebrate we've got not one, not two, but THREE Dreamcast ReMixes for you, starting with this Arcadia Legends Erasure-esque synth-pop vocal jam from Jason Covenant (Jason Miller); album director Darkflamewolf writes:
"Those who know me know that I'm a die-hard fan of Jason Covenant and pretty much anything he does is gold to me. I adore his voice and singing in every track he's done. He's been primarily on the compo scenes more than he is submitting remixes to OCR directly, but I took note of his unique style right away. His track was the last one delivered (not counting the sudden last-minute submission rework by Deedubs) and was a nice capstone to a completed album tracklist. He met and exceeded my expectations I had for him when I sought him out for this album."
Mastering engineer Rotten Eggplant adds:
"The lyrics and the composition here is amazing, and turned a song I didn't care for much in the original OST into a song I thoroughly enjoy listening to."
Vocals have a processed sound to them, but it's on the subtle side & (more importantly) works well with the genre, which channels synth-pop & a bit of indie-pop, at least for me. Lyrically, as a software developer, I can only say that C confuses me too, and even as an atheist, a coding angel with an omnipotent, omniscient IDE does sound like a game-changer. Eclipse doesn't strike me as Heaven's IDE, particularly ;) Thematic comparisons to Jonathan Coulton's classic "Code Monkey" seem relevant, though Covenant goes for a less overtly-goofy vibe. I've got a soft-spot in my heart (brain) for upbeat synth-pop, and Jason's done a great job transmogrifying the source into a sweet, tightly-packaged example of such; good stuff, enjoy!
on 2019-09-10 10:05:59
Very well-done vocals!
on 2019-09-08 01:07:05
What did you think? Post your opinion of this ReMix.
Sources Arranged (1 Song)
- Primary Game:
Skies of Arcadia (Sega, 2000, DC)
Music by Tatsuyuki Maeda, Yutaka Minobe
- Songs:
- "Gilder's Theme"
Tags (9)
- Genre:
- Dance, Pop
- Mood:
- Energetic, Happy
- Instrumentation:
- Electronic, Singing, Synth, Vocals: Male
- Additional:
- Lyrics > Lyrics: Original
File Information
- Name:
- Skies_of_Arcadia_Coding_Angel_OC_ReMix.mp3
- Size:
- 5,286,798 bytes
- 0918e8452a1df0f7ff723f97ae9cf553
- Bitrate:
- 221Kbps
- Duration:
- 3:08
C just confuses me
How I wish I could code
Progress has slowed
Free of errors I see,
How you comment so clearly
My programming...
Angel, coding Angel,
Debugging my broken heart with your perfect functions
Angel, coding Angel, using Heaven's IDE
I wish that I could write,
lines the way that you do,
I would write for you...
Angel, coding Angel,
Debugging my broken heart with your perfect functions
Angel, coding Angel, using Heaven's IDE,
Using Heaven's IDE
Arcadia Legends
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Nicola Frost
Year of Call: 2009
Email Address: email@example.com
CJSM: firstname.lastname@example.com
Telephone: 0117 928 1520
Nicola is an Accredited Mediator – Civil & Commercial Mediation (Bristol ADR Group).
"I was really impressed with how understanding you were and also how direct and honest you were."
"My client loved Nicola because she was feisty but fair."
"You did an excellent job for my client in difficult circumstances. Thank you."
"Tenacious!" (judge)
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"I think your skeleton [argument] is beautifully written and presented."
Academic qualifications
- LL.B (Hons) (First Class) – Bristol Law School, UWE Bristol
- BVC (Very Competent) - Bristol Institute of Legal Practice, UWE Bristol
- Inner Temple Exhibition and Duke of Edinburgh Scholar
- Inner Temple Keble Advanced International Advocacy Scholar
Professional qualifications & appointments
- Accredited Mediator – Civil & Commercial Mediation (Bristol ADR Group)
Professional bodies
- Family Law Bar Association
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Direct Access
Nicola Frost is qualified to accept instructions directly from members of the public and professional clients under the Direct Public Access scheme.More Information
Hague Convention appeal clarifies 'anticipatory retention' point says Nicola Frost
Nicola Frost, writing for Family Law Week, explains the implications of a Hague Convention decision. The CA unanimously held, "anticipatory retention" is a con...Read more
3PB Family Barrister Nicola Frost provides an insightful summary of Re: MM (A patient) [2017] EWCA Civ 34
3PB Family Barrister Nicola Frost provides an insightful summary of Re: MM (A patient) [2017] EWCA Civ 34, an appeal from the Court of Protection in which the a...Read more
3PB Family Barrister Nicola Frost summarises AB (Surrogacy: Domicile) [2016] EWFC 63
3PB Family Barrister Nicola Frost provides an insightful summary of AB (Surrogacy: Domicile) [2016] EWFC 63, an application for parental orders in relation to t...Read more


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