text:
- Research article
- Open Access
- Open Peer Review
Cause-specific neonatal mortality in a neonatal care unit in Northern Tanzania: a registry based cohort study
© Mmbaga et al.; licensee BioMed Central Ltd. 2012
- Received: 24 February 2012
- Accepted: 13 July 2012
- Published: 7 August 2012
The current decline in under-five mortality shows an increase in share of neonatal deaths. In order to address neonatal mortality and possibly identify areas of prevention and intervention, we studied causes of admission and cause-specific neonatal mortality in a neonatal care unit at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.
A total of 5033 inborn neonates admitted to a neonatal care unit (NCU) from 2000 to 2010 registered at the KCMC Medical Birth Registry and neonatal registry were studied. Clinical diagnosis, gestational age, birth weight, Apgar score and date at admission and discharge were registered. Cause-specific of neonatal deaths were classified by modified Wigglesworth classification. Statistical analysis was performed in SPSS 18.0.
Leading causes of admission were birth asphyxia (26.8%), prematurity (18.4%), risk of infection (16.9%), neonatal infection (15.4%), and birth weight above 4000 g (10.7%). Overall mortality was 10.7% (536 deaths). Leading single causes of death were birth asphyxia (n = 245, 45.7%), prematurity (n = 188, 35.1%), congenital malformations (n = 49, 9.1%), and infections (n = 46, 8.6%). Babies with birth weight below 2500 g constituted 29% of all admissions and 52.1% of all deaths. Except for congenital malformations, case fatality declined with increasing birth weight. Birth asphyxia was the most frequent cause of death in normal birth weight babies (n = 179/246, 73.1%) and prematurity in low birth weight babies (n = 178/188, 94.7%). The majority of deaths (n = 304, 56.7%) occurred within 24 hours, and 490 (91.4%) within the first week.
Birth asphyxia in normal birth weight babies and prematurity in low birth weight babies each accounted for one third of all deaths in this population. The high number of deaths attributable to birth asphyxia in normal birth weight babies suggests further studies to identify causal mechanisms. Strategies directed towards making obstetric and newborn care timely available with proper antenatal, maternal and newborn care support with regular training on resuscitation skills would improve child survival.
- Neonatal mortality
- Neonatal deaths
- Neonatal morbidity
- Birth asphyxia
- Prematurity
- Causes of death
The aim of the United Nations' Millennium Development Goal 4 (MDG4) is to reduce under-five mortality worldwide to 30 deaths per 1000 live births by 2015. Globally, an estimate of 10.6 million children under five years died in 2000 [1], declining to 8.8 million in 2008 [2] and further to 7.7 million in 2010 [3]. At the same time, methods of estimation and available sources of information for under-five mortality have improved [1–4]. However, share of neonatal deaths increased from 37% in 2000 [1, 5] to 41% in 2008 [2]. The slow decline in neonatal mortality as compared to post-neonatal mortality calls for attention and efforts to reverse this trend. Within the neonatal period an estimated 50% of all deaths are within the first 24 hours while 75% are within the first week of life [5]. Given that a large fraction of these deaths are preventable, a focus on mortality in the first week of life is important in order to accelerate the millennium goal.
Worldwide, the most important single causes of neonatal deaths are preterm birth, birth asphyxia, sepsis and pneumonia [2, 5, 6]. This reflects the mortality pattern in low income countries where neonatal mortality is high, whereas, in high income countries where mortality is low, preterm birth and congenital malformations are the leading causes of death [7]. The World health organization (WHO) estimates that birth weight below 2500 g indirectly contributes to about 15% of the neonatal mortality, ranging from 6% in high income countries to 30% in low income countries, with preterm birth and related complications being the underlying cause [8].
Tanzania is among the countries with insufficient progress towards achieving the MDG4 showing slow decline in under-five mortality rate [4]. Neonatal mortality in Tanzania is estimated to account for 28-34% of deaths in children younger than five years [2, 3, 9], with the most frequent single causes of death being prematurity, birth asphyxia, sepsis and pneumonia [2, 10].
Globally, it has been estimated that ninety nine percent of neonatal deaths occur in developing country where also vital registration is limited [5]. The UNICEF report in 2002 estimated that only 5% of Tanzanian children aged five years are registered, with marked difference in percentage between rural (3%) and urban (22%) areas [11]. A recent country survey in Tanzania reported consistently low registration rate for under-five years children (16%), of whom about half (8%) receive birth certificate [12]. Also this survey indicated the difference in the birth registration rate between rural (10%) and urban (44%) areas.
Identification of cause-specific mortality in a particular setting is important to design interventions directed to improve neonatal survival. Therefore, in order to address neonatal mortality in Tanzania and possibly identify areas of prevention, we studied causes of neonatal admission and cause-specific neonatal mortality in a cohort of neonates delivered at the KCMC tertiary hospital and admitted to NCU.
The primary study unit was the neonatal care unit (NCU) at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. As a tertiary and a referral hospital for the four regions in the Northern part of the country, the NCU at KCMC receives high risk babies delivered within the institution and referrals from other health facilities or from home. The NCU has bed capacity of 40 babies. The babies are nursed in locally made baby cots and there are heaters to keep the room as well as the babies warm. The unit has no mechanical ventilator or any continuous positive airway pressure machine. The babies receive oxygen through nasal prongs or face masks. There is no central oxygen supply; instead oxygen is usually stored in big cylinders. In addition, there are four portable oxygen concentrators. The midwives in the labour ward are responsible for the initial resuscitation of normal deliveries. Doctors from the paediatric department are called to the labour ward to attend the at risk pregnancies. Normal babies are put on the breast as soon as they recover from the birth trauma which is usually within the first four hours after delivery. Babies in the nursery rooms are either fed on expressed breast milk if the mothers are around or formula in the absence of the mothers. Feeding is given either through nasal gastric tube, syringe or cup and spoon. For neonates with feeding difficulties, parenteral feeding with either 10% or 5% dextrose depending on the gestational age is used.
The neonatal care unit has 3 nursery rooms, one for preterm babies, one for term babies with non-infectious conditions and the third is reserved for bacterial as well as viral infections. Kangaroo mother care is being encouraged in the unit and a special room has been allocated for that purpose. Two other rooms are available for stable babies who are given to their mothers and to continue treatment under the supervision of the unit nurses, pending discharge when fully recovered.
We have previously reported that approximately15% of the births within the KCMC hospital were transferred to neonatal care unit for admission [13]. Criteria for transfer to neonatal care unit were found to be low Apgar score, prematurity, birth weight <1800 or birth weight >4000 g, congenital malformation, suspected infection or risk of infection, as well as for observation in case of poor maternal outcome or poor obstetric history.
Study design and subjects
This is a birth registry based cohort study. Neonates registered in the Medical Birth Registry and admitted to the neonatal care unit at KCMC, were included. The KCMC Medical Birth Registry was established in 1999 as collaboration between Kilimanjaro Christian Medical College, Tumaini University and the University of Bergen, Norway. The Medical Birth Registry and neonatal registry were officially established in July 2000.
From July 2000 to October 2010, a total of 34087 births were registered in the birth registry, of which 5033 (14.8%) neonates were admitted to the neonatal care unit. These neonates formed our study population.
Data collection
Information from all mothers who delivered at KCMC was collected within the first 24 hours after delivery based on a standardized questionnaire as well as antenatal records. Detailed information collected for the Medical Birth Registry are described elsewhere [13].
The neonatal registry form was recorded for all neonates who were transferred for admission in the NCU. The data collection form was administered by a trained paediatric nurse who worked in a neonatal care unit. The collection of information for neonates admitted to the NCU was done during admission and finalized after discharge or death. Information collected in the neonatal registry includes child's ID-number, date of admission, reasons for admission, investigations done, management given, clinical details at discharge and death reports. The information collected from the Medical Birth Registry and neonatal registry were finally entered into a computerized database where they can be linked using the child's ID-number.
On arrival in the NCU, the baby is examined by a medical officer. Estimation of the gestational age is done using the Finnstrøm maturity score, which is a simple method for assessing maturity based on external characteristics. Tables for maturity score and transformation to gestational age are included in the KCMC Paediatric management schedule [14]. The diagnosis of birth asphyxia is based on Apgar score below 7 at five minutes and severity of neonatal condition at admission, based on the presence of convulsions within the first 24 hours. A diagnosis of infection is based on clinical symptoms and signs, evidence of focal lesions, or laboratory findings including blood cultures. Thin and thick blood slides are taken in order to rule out congenital malaria if suspected. A diagnosis of congenital malformation is based on the child's clinical presentation at admission and screening with the aid of X-ray, ultrasound scan, echocardiography and CT scan when applicable. Up to three clinical diagnoses are recorded for each neonate. The two conditions Respiratory Distress Syndrome (RDS) and Necrotizing Enterocolitis (NEC) were frequently reported as preterm complications and were mainly diagnosed clinically followed by X-ray investigation. Other preterm complications such as Intraventricular haemorrhage (IVH) may be underreported in the clinical discharge or death diagnosis reports as brain ultrasound investigation is not routinely done for preterm babies. Management of all admitted neonates follows the KCMC Paediatric Management Schedules [14]. This book was prepared by past and present paediatricians in the department by adapting the WHO guidelines for management of common illnesses in limited resource settings [15]. During the study period there was no documented change in clinical practice and management specifically for prematurity and birth asphyxia. As for neonatal infections, the department observed a high rate of staphylococcal isolates from newborns blood culture sensitive to cloxacilline and gentamycine in early 2000 also observed and recommended by Klingenberg et al., [16]. Therefore, treatment guidelines for neonatal infection changed from gentamycine and ampicilline to gentamycine and cloxacilline [14]. Surfactant treatment is not available in the neonatal unit at the moment. Therefore, babies with RDS are managed as severely preterm babies with oxygen therapy, thermal care, nutritional support, antibiotic treatment and vitamin K [14]. In addition, aminophylline is given for babies with apnoea attacks not responding to tactile stimulation.
Data analysis
We first coded clinical diagnoses independently depending on the presence of any diagnosis; a neonate having more than one diagnosis was recorded in different categories in order to study all causes of admission, case fatality and their contribution to total neonatal mortality. Case fatality was computed as number (percentage) of deaths within each clinical discharge diagnosis among admitted babies with the same condition.
Criteria used for case definition to identify cause-specific mortality*
Causes of death
Case definition
Search criteria for clinical diagnosis in registry
Congenital malformation
lethal congenital malformation (congenital heart, spinal bifida, congenital syndromes, gastrointestinal malformation)
− multiple congenital malformation
− congenital heart disease
− spinal bifida/hydrocephalus
− congenital syndromes or syndrome baby and deaths due to systemic conditions such as-renal failure or gastrointestinal system
Birth asphyxia
birth asphyxia, hypoxic ischaemic encephalopathy Apgar based definition
− birth asphyxia weight >1000 g or gestational age >27 weeks
− birth asphyxia and prematurity with gestational age ≥33wks and birth weight ≥2500 g or birth weight ≥ 1800 g if gestational age unknown
− hypoxic ischaemic encephalopathy five minutes Apgar less than 7
prematurity, respiratory distress syndrome in preterm, necrotizing enterocolite in preterm birth
− prematurity
− prematurity and asphyxia with gestational age < 33 weeks and birth weight < 2500 g or birth weight < 1800 g if gestational age is unknown
− respiratory distress syndrome in preterm
− necrotizing enterocolitis
− birth asphyxia gestational age <27 weeks or birth weight <1000 g
− infection with gestational age <33 weeks
neonatal infection, sepsis/septicaemia, meningitis, pneumonia
− neonatal infection
− sepsis/septicaemia
− meningitis
− pneumonia
− impetigo neonatorum
other specific causes not classified above
− neonatal jaundice
− meconium aspiration syndrome
− respiratory distress syndrome in term babies
Data were analyzed using Statistical Package for Social Science (SPSS) program Version 18.0 for Window (SPSS 18.0 Chicago Inc. III, USA). Descriptive statistics measures such as mean, standard deviation, rate and proportions were calculated.
Ethical approval
The birth registry at Kilimanjaro Christian Medical Centre obtained ethical clearance from the Tanzania Ministry of Health, Institute of Science and Technology, from the Norwegian National ethics committee and from the Kilimanjaro Christian Medical College (KCM-College) research ethics committee in 1999. Informed consent was obtained from mothers prior to the interview. The protocol for this study was approved by KCM-College research ethics committee, with certificate no. 333 of 15th July 2010.
Characteristics of mothers and neonates
Characteristics of admitted neonates
n (%)
Mean (SD)
2806 (55.8)
Birth weight
2899 (857) gm
2227 (44.2)
Birth length
47.5 (3.6) cm
4583 (91.1)
Gestational age
38.0 (3.5) wks
From labour/obstetric ward
4788 (95.1)
From home/other facilities
245 (4.9)
Mean maternal age
27.6 (6.2) years
Born by caesarean section
2468 (49.0)
Mean ANC visits
4.3 (2.0)
Low birth weight (<2500 g)
1459 (29.0)
Gestational age <37 weeks
1178 (25.8)
Below 18 years
136 (2.7)
18-25 years
1879 (37.3)
26-35 years
2450 (48.7)
Over 35 years
558 (11.1)
First born
2119 (43.6)
Single mother
60 (12.5)
Antenatal care booking
4871 (96.8)
Causes of admission
Clinical discharge diagnosis, case fatality and contribution to overall mortality in a neonatal care unit (N = 5033). Ranked according to case fatality
Case fatality
Proportion of deaths
n (%)
n (%)
99 (2.0)
52 (52.5)
Congenital malformation
111 (2.2)
49 (44.1)
1351 (26.8)
321 (23.8)
930 (18.4)
208 (22.4)
103 (2.0)
8 (7.9)
Neonatal infection
776 (15.4)
58 (7.5)
Other conditions
230 (4.6)
8 (3.5)
Neonatal jaundice
174 (3.5)
5 (2.9)
Risk of infection
852 (16.9)
11 (1.3)
LGA (>4000 g)
538 (10.7)
5 (0.9)
Normal for observation
368 (7.3)
132 (2.6)
Growth characteristics
Birth weight <2500 g
1459 (29.0)
279 (19.1)
Gestational age <37 weeks
1178 (25.8)
217 (18.4)
Case fatality
Cause-specific neonatal mortality
Single causes of neonatal death by birth weight (N = 536)
Birth weight in grams
Total deaths
500- 999
1000- 1499
1500- 1999
2000- 2499
No. admitted
Total deaths
(% ) deaths
Single causes of neonatal deaths in relation to time of death (N = 536)
Day 0-1
Day 2-7
After day 7
Total (%)
536 (100.0)
304 (56.7)
187 (34.9)
45 (8.4)
The motive of our study was to identify morbidity and causes of neonatal death of inborn neonates admitted to a neonatal care unit at a tertiary hospital in Northern Tanzania. Our main results are largely consistent with the global pattern of mortality [2, 5], with birth asphyxia, prematurity, and infection as the most important single causes of neonatal death. Our results should be interpreted bearing in mind that it includes only inborn neonates delivered at a tertiary health facility. Neonates who are admitted at a tertiary hospital NCU represent the important subgroup of neonates who have high risk of morbidity and mortality.
Overall mortality
Overall, 10.7% of the admitted neonates died in the neonatal period. This is similar to a study done in a regional referral hospital in Sudan where also only inborn neonates were included [21]. Most other studies include both outborn and inborn neonates, where in general mortality is higher [22–24]. A previous study from KCMC NCU in 2003 including both inborn and outborn neonates reported 19% neonatal mortality [16]. A study from Nigeria reported overall mortality of 25.5%; 20.3% among inborn neonates and 64.2% among outborn neonates [22]. A study from Bangladesh [23] reported 8% mortality in inborn neonates and 25.6% in outborn neonates. The variations in mortality probably reflect local and national differences in care pattern of newborn babies.
Causes-specific mortality
Our finding that birth asphyxia was the leading cause of death is consistent with a previous study from a university and tertiary care hospital in Tanzania [10]. In contrast, the global pattern and studies from university and tertiary care hospitals find prematurity to be the leading cause of death [5, 22–24]. One explanation of the high number of deaths due to asphyxia in our data may be the definition criteria for asphyxia that we used, which included some of the preterm babies. In some studies [21, 24], all preterm babies who die are classified with prematurity as cause of death. Of particular interest is the high number of deaths attributable to asphyxia in normal birth weight infants in our study (one third of all deaths) because they may represent a potential for prevention. Basic training on newborn resuscitation skills and proper newborn resuscitation immediate after birth has proved to reduce mortality among babies born with birth asphyxia up to 40% [25–27]. A recent study in six developing countries showed that training on Essential Newborn Care which includes training on basic resuscitation had no effect on early neonatal mortality. However, there was a significant reduction in the rate of stillbirths primarily fresh, most likely as an effect of resuscitation of babies who would have been misclassified as stillbirths before training [28]. On the other hand, there was no additional effect of training in the Neonatal Resuscitation Program once the Essential Newborn Care training was already in place [28]. Training on newborn resuscitation immediately after birth is highly needed in Tanzania, where only 16% of health care services reported that they offer newborn respiratory support [29].
Prematurity was the second most important cause of death. Management of premature babies requires high specialized equipment, highly trained personnel and financial support [26, 30]. In high income countries where ventilation technology and the use of surfactant have been implemented, the survival of premature babies has improved [30]. RDS is a known very frequent complication of preterm babies due to lung immaturity, and babies with RDS had the highest case fatality in our study, which is also reported elsewhere [16, 24, 31, 32]. The high case fatality in babies with RDS reflects the inadequate care of these neonates in developing countries [30, 33].
Some specific and simple measures has been identified which could be implemented to reduce deaths related to low birth weight and preterm in low income countries [27, 34, 35]. These include among others prophylactic use of steroid during premature labour, antibiotic for premature rupture of membrane, early breast feeding, treatment of infection, hospital-based kangaroo mother care, prevention of hypothermia, feeding and nutritional support. A recent meta-analysis review found hospital-based Kangaroo mother care (skin-to-skin contact) implemented within the first week of life for stable preterm and low birth weight neonates was effective and could reduce neonatal mortality up to 51% [36].
Mortality due to infection was low compared to the global pattern as well as the pattern in low income countries [10, 16, 23, 25]. The low number of deaths due to infection might in part be explained by the inclusion of only inborn neonates, since appropriate treatment of infection or suspected infection can start with a minimum of time delay after delivery.
In a previous study from the same NCU where both inborn and outborn neonates were included one fifth of the deaths were due to infection [16]. Furthermore, the use of Gentamycin and Cloxacillin instead of Gentamycin and Ampicillin [14] introduced in the early 2000 for neonatal infections in the department may have played a role in increased survival in infected neonates. A similar change in antibiotic treatment in Nigeria resulted in a 32% reduction in mortality associated with septicaemia [25]. The routine transfer to NCU of all neonates at risk of infection or suspected infection due to premature/prolonged rupture of membrane for antibiotic prophylaxis [13], might also have contributed to low mortality due to infection in this setting. We have previously shown that babies of mothers with premature/prolonged rupture of membrane had a 2 fold risk of being transferred to NCU for antibiotic prophylaxis due to risk of infection [13].
The majority of women in low income countries do not access early ultrasound scan for screening of congenital malformation, and there are very few early terminations of pregnancies due to severe/fatal congenital malformations. Availability of management/surgery for neonates with severe congenital malformations is limited, and under the prevailing circumstances we suggest that few of these deaths could have been prevented.
Time of death
The majority of neonatal deaths occurred during the first day after admission and more than 90% within the first week of life. We found that birth asphyxia and prematurity were the major causes of death within the first 24 hours, whereas deaths related to infections were more frequent after first week. These results are similar to what has previously been observed [25, 34].
Strengths and limitations
This study used a large Medical Birth Registry with a complementary neonatal registry of neonates admitted to NCU where data are collected using standardized questionnaires. The data set contains a substantial number of neonates to be studied. All admitted neonates were given at least one discharge diagnosis and all information from the NCU could be linked to their information recorded in the birth registry. The modified Wigglesworth classification used to classify single causes of neonatal death was selected because it is simple to apply and since causes of death according to this classification have clear implications for clinical management. The classification gives the opportunity to identify areas of health care provision in need of prevention or improvement in management and care to improve neonatal survival. Since KCMC is a tertiary care hospital and included only inborn neonates, the results may not be generalized to all hospitals in Kilimanjaro or to the population.
Conclusions and recommendations
Birth asphyxia, prematurity and infection were the major single causes of neonatal morbidity and mortality. Birth asphyxia in normal birth weight babies and prematurity with low birth weight, each accounted for one third of all deaths, and some of these deaths may be preventable. First, strategies directed towards strengthening screening and identification of mothers at risk and early referral mechanisms for care and support is needed. Second, regular and continuous training of health personnel on essential newborn care to ensure basic knowledge on resuscitation skills and immediate actions needed for asphyxiated newborns should be strengthened. Care of premature babies should include in hospital kangaroo mother care for stable preterm and low birth weight babies, thermal care, feeding and nutritional support, as well as prevention and treatment of infections.
Decline in neonatal mortality might have been hampered by insufficient feedback mechanisms within the hospital or between the hospital and peripheral health facilities where patients are referred from. Therefore, all deaths occurring in the hospital whether maternal or newborn should be reviewed and discussed between obstetricians and paediatricians; the cause identified, preventive measures worked out, and feedback given to all the staff involved within the institution as well as surrounding health facilities through existing outreach programs.
Regular review of neonatal deaths using simple classifications within a particular setting will help to understand the magnitude of the problem and review the strategies for better improvement. Reviews should be directed towards identifying areas where screening, prevention and therapeutic interventions need to be strengthened.
Efforts should be done to further develop registration systems in order to collect information that can be used to understand maternal and newborn health outcomes and serve as guidance for further preventive measures.
We acknowledge the Norwegian Council for Higher education program for Development Research (NUFU) for funds support to develop and maintain the registries as well as for sponsorship support to author BTM. We thank the KCMC and KCM-College administration for authorizing use of the hospital birth registry and neonatal registry data for this study. We thank the staff of the birth registry department in Norway for ongoing supervision and technical support for the KCMC birth registry. We also thank the birth registry team, obstetrics and gynaecology and paediatric staff at KCMC for their support in data collection, and in taking care of mothers and their newborns. To our participants' mothers who delivered at KCMC during the period of data collection and their babies in NCU, we say "Thank you".
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- Mlay GS, Manji KP: Respiratory Distress Syndrome among neonates admitted at Muhimbili Medical Centre, Dar Es Salaam, Tanzania. J Trop Pediatr. 2000, 46 (5): 303-307. 10.1093/tropej/46.5.303.View ArticlePubMedGoogle Scholar
- Poudel P, Budhathoki S: Perinatal characteristics and outcome of VLBW infants at NICU of a developing country: An experience at eastern Nepal. J Matern Fetal Neonatal Med. 2010, 23 (5): 441-447. 10.3109/14767050903186285.View ArticlePubMedGoogle Scholar
- Vinod PK: The current state of newborn health in low income countries and the way forward. Semin Fetal Neonatal Med. 2006, 11 (1): 7-14. 10.1016/j.siny.2005.10.005.View ArticleGoogle Scholar
- Barros F, Bhutta Z, Batra M, Hansen T, Victora C, Rubens C, Group tGR: Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions. BMC Pregnancy and Childbirth. 2010, 10 (Suppl 1): S3-10.1186/1471-2393-10-S1-S3.View ArticlePubMedPubMed CentralGoogle Scholar
- Lawn JE, Mwansa-Kambafwile J, Horta LB, Barros CF, Cousens S: 'Kangaroo mother care' to prevent neonatal death due to preterm birth complications. Int J Epidemiol. 2010, 39: i144-i154. 10.1093/ije/dyq031.View ArticlePubMedPubMed CentralGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/12/116/prepub
Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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"What is this?" My you ask my dear readers. "A second Sexxy Saturday Cumbia post on the same Saturday?" Well, yes that is exactly what it is. This is a first I admit but I found it to be completely impossible for me to just have one post all about Halloween when there were so many brilliant tracks uploaded this week.
I wouldn't dare hold onto to all of these incredible tracks until next week. Therefore I felt it to be quite necessary to write and put together another normal SSC for those who want to hear something more. No theme goes along with this here post, except if you believe brilliance is a good theme. Then that is what it is. This post's theme is cumbia brilliance.
I dare not miss posting one of Jack Posada's consistently awesome cumbia mixes. In the past I have featured his other Cumbiambero Loco mixes. Here is his latest installement.
María & José has been somewhat quiet on the Internet these past three months or so. He returns with his new ruidoson-tribal tune.
A hot new video has been released by Oaxacan based La China Sonidera. I recently fell in love with their chill sound.
Two mixtapes came out this week that you simply must get into when you can. First up from Paris-based Pedrolito with his eclectic mix.
Dale amor a la cumbia que la cumbia te lo devuelve #37 [04.10.2012] by Pedrolito Radioglobal on Mixcloud
Followed by DRCrck, someone I haven't posted about in quite some time.
Cevillano Mixtape by Drcrck on Mixcloud
Andean Illicit took an already deep Bob Marley track and took it deeper.
Yyamil came out with this pretty dope Indian cumbia fusion. It's straightforward and really cool.
This cumbia-dub really came out beautifully by DJ Pase and Eliazz.
DJ Neber really did a number on this one, featuring a great and misleading intro.
Not stopping there, this is an equally dope DJ Neber chicha fusion with hip hop beats and vinyl scratches.
Also here is his latest dopeness (I can't wait for Skyfall).
El Lobby Sound has been keeping them coming lately. Here is his newest masterpiece.
Albert DJ Style has been experimenting a lot with La Sonora Dinamita tracks lately. I can honestly say he's doing them justice.
Ever wonder how Qechuaboi works with his Electribe's live? I have a perfect video to quench your curiosity while making you embrace his music even more.
Qechuaboi Live! – "Nunca fuí al Love Parade" from qechuaboi on Vimeo.
Cumbia Cosmonauts, the cumbieros from down under, along with Chusma Records, released this cool little promo for their soon to be released album "Tropical Bass Station" due out the 23rd of November.
For the champeta lovers out there, here is a dope mix from the deep cumbia boy Dany F!
Another beautiful transnational cumbia comes from my good friend Piper Street Sound (Matthew Mansfield).
La Estereofonica needed a good edit. Sonido Bestial is such a beast to make it happen.
Another heavy hitter in the Pa Changas collective is Enrikisimo Deejay. This new one from him is very awesome and psychedelic.
If you're looking for a relaxed cumbia mixtape then this one will surely take care of you.
New on the Caballito scene is Luci Fuerza. The song here is called El Pich and it is something really unique.
Kinky Electric Noise took the classic Moby track "Why Does My Heart" to a cumbia level with his masterful edit.
Snow Balderas returns with a banger of a new cumbia mashup.
This next track needs more love than it has been getting. It's a really cool piece from Orihuela MSS.
Rafael Aragon does it again. He takes something already really good and brings it into his own unique world. This time he took his friend and fellow Generation Bass writer, Indian Jone's track into his laboratory.
Chicha-cumbiahton is where Alejandro Cassis's head is. You simply must download this track.
I'm a little late to posting BomBomBom's new Colombian-based mix. A perfect 40 minutes if you ask me.
Yeah [email protected] is always dope. Here he takes a reggaeton classic into the realm of cumbia by mashing it with Albert DJ Style.
Well I'm very glad I was able to manage to put up these tracks for this Saturday. Otherwise if my decision was not to then I'd be haunted with that poor decision all week and be faced with too massive a post next weekend.
I hope you got your fix of cumbias here this weekend!

subset: commoncrawl


text: TEcHNOpls 73 Posted March 31 Hi, I'm not doing much today, and yet AP has closed many times on me, seemingly at random, with no crash dialog or such. One scenario that seems preety often is when closing one of the images, or opening many at once. (memory issue?) "I'm a lumberjack and I'm OK, I sleep all night, and I work all day..." Amature camera user, Adobe avoider. Still missing: HLS improvements, Raw development with sidecars, Gradient list in gradient layer/tool. Do want: Liquefy as Layer. Share this post Link to post Share on other sites


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text: Vigilance recommended following Winnipeg law firm bombingsTragedy also strikes law office in Terrebonne, Que. July 6, 2015|Written By Glenn Kauth Police are recommending continued vigilance despite charging litigant Guido Amsel in relation to explosive devices discovered at two Winnipeg law firms in recent days.Winnipeg police have charged Guido Amsel in connection with the bombing that seriously injured lawyer Maria Mitousis. "I want you to know that we still have a lot of work to do," Winnipeg police Chief Devon Clunis said during a news conference this morning. Police, in fact, told the news conference they were investigating another scene at a Canada Post depot this morning and have issued a warning for people to watch for other incidents. The package turned out to contain only DVDs, reported the Winnipeg Free Press."Police are concerned that other packages could have been sent out to other legal counsel or justice officials who have dealt with Amsel," the Winnipeg Police Service said in a news release yesterday."Police are asking those individuals to be aware and diligent in alerting police to any suspicious packages or items that may be addressed to them."The warning follows Friday's explosion at the law offices of Petersen King on River Avenue that left lawyer Maria Mitousis, 38, with serious injuries to her hands, throat, and stomach. Police said this morning she remains in hospital and noted her condition had stabilized and she has been able to speak to officers.Police investigated a second explosive device on Saturday as well as a third at the law firm Orle Barkman and Davidson on Stradbrook Avenue yesterday.Police had earlier called the original bombing an isolated incident but have since charged Amsel, 49, with two counts of attempted murder, one count of aggravated assault, and a number of counts related to the possession of explosive devices. They are suggesting he has targeted his ex-wife as well as legal counsel who have represented either her or himself in the past.Response and support from the bar both in Winnipeg and across Canada has been overwhelming says Sofia Mizra, president of the Manitoba Bar Association. Mizra says friends and family say Mitousis is recovering very well but her injuries are quite serious.Members of the bar in the city are staying alert and looking carefully at packages before they open them, she says, noting the MBA offices were also evacuated on Friday in one of the other bomb scares.According to police, the devices discovered so far have had distinct packaging and "unique" block lettering. Due to the Canada Day holidays last week, police believe any further packages will likely emerge in the next day or so.Mizra emphasizes that issues of threats and potential violence are not new to many lawyers who are often involved in very emotional circumstances with their clients, but the situation with the bombings is obviously extreme. Lawyers and judges, particularly in the area of family law, are often on the receiving end of the anger from unhappy parties."When litigants hear something they don't want to hear, they can take matters into their own hands," she says, adding, "We have some brave lawyers in our community."According to Manitoba court records, Mitousis had represented Iris Amsel in family litigation against Guido that dates back to 2004 as well as a separate case filed in 2010 dealing with a numbered company. Mitousis is a family lawyer who had joined family law boutique Petersen King in 2014. Manitoba court records show Guido has also faced other small claims litigation matters over the years.According to the CBC, police on Sunday deployed the bomb unit as part of the their investigation to two businesses, including EuroTech Auto Body. That business is among the defendants, along with Guido, named in the lawsuit launched by Iris involving the numbered company.The incidents follow another tragic situation involving members of the legal community in Quebec. According to the CBC, lawyer Benoït Côté, 51, and notary Marie-Josée Sills, 30, died in hospital Saturday after a shooting at a law office in Terrebonne, Que., on Thursday.Côté had once represented Michel Dubuc, a man found dead in his home on Friday along with the bodies of his two sons. Côté had been facing a $1.2-million lawsuit filed by Dubuc, the CBC reported.Longueuil police spokesman Tommy Lacroix told the Canadian Press the timeline of events and motives behind the shooting had yet to be established but that autopsies were going to be conducted.[em]Canadian Bar Association-Manitoba members Laurelle Harris and Kelli Potter have set up a donation page on gofundme for those looking to support Mitousis in what will likely be a long recovery. In two days, it has raised more than $25,000.[/em]


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Haas ST10Y, Used Haas CNC Lathe
Are you looking for a CNC lathe that has live tooling? The Haas ST-10Y could be a great fit for what you need! This Haas machine is a 12″ x 16″ max capacity but just because its small size, doesn't mean it doesn't have a large capability. The machine has a 15HP vector drive and has an impressive 6,000 RPM spindle just like the Haas ST10 model. The main difference to the Haas ST 10Y is that it comes equipped with live tooling as well as y-axis travel. To find out more about this machine, refer to the Haas ST10Y specifications below or call us at 844.262.6789.
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To see more of our Haas inventory, click here!


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Possible replacement for pagers as well as all those overly-priced HIPAA compliant texting apps?
How a Childhood Vaccine Reduces Risk of a Cancer | NY Times →
HiB vaccine reduces the risk of acute lymphoblastic leukemia in children. Get your vaccines; they're amazing.
ResearchKit Asthma app developer praises framework in first official blog post | 9 to 5 Mac →
I'm very excited about ResearchKit and the potential it has to revolutionize how research is conducted. It is certainly not without its problems, most notably the bias it inherently introduces by only including iOS users. The graph at the bottom of this post highlights another problem—initial excitement but precipitous drop-off in engagement. This developer had a 50% dropoff in less than a month. [1]
This graph doesn't look too different than such graphs I've seen for most apps. People try things out and only a small fraction stay engaged. Unfortunately, that introduces a huge bias when talking about research. ↩
The Next Generation of Medical Tools May Be Home-Brewed | Backchannel →
Overkill: America's Epidemic of Unnecessary Care | The New Yorker →
Atul Gawande writing with his usual, uncommon brilliance about unnecessary medical care:
Well, as a doctor, I am far more concerned about doing too little than doing too much. It's the scan, the test, the operation that I should have done that sticks with me—sometimes for years.
We're more afraid of doing too little than of doing too much. And patients often feel the same way. They're likely to be grateful for the extra test done in the name of "being thorough"—and then for the procedure to address what's found.
Much of the debate on unnecessary tests and procedures has focused on our fee-for-service reimbursement system and doctors profiting from "doing more". The two quotes above highlight what I think is a much more important pressure on physicians—we don't want to miss something. We truly want to find a cause for our patients' complaints and treat them. This is done with the notion that we are providing the best care for them. We dramatically underestimate the consequences of overtesting and overdiagnosis. It is a bias and part of the culture of medicine; we feel like we have to do something.
Right now, we're so wildly over the boundary line in the other direction [of wasteful care] that it's hard to see how we could accept leaving health care the way it is. Waste is not just consuming a third of health-care spending; it's costing people's lives. As long as a more thoughtful, more measured style of medicine keeps improving outcomes, change should be easy to cheer for. Still, when it's your turn to sit across from a doctor, in the white glare of a clinic, with your back aching, or your head throbbing, or a scan showing some small possible abnormality, what are you going to fear more—the prospect of doing too little or of doing too much?
This is the ultimate battle, both for doctors and patients. When its your health or your patient's health on the line, you don't want to fall on the side of doing too little. This is a struggle I deal with daily in trying to provide the best care for my patients.
Resident burnout – not fixed | MedRants →
Robert Centor:
Burnout generally follows a lack of control. Changing work hour rules, if anything, worsens lack of control.
The ACGME rules are not helping residents. They are not improving patient safety. They are likely impacting education.
Work hour rules, however, are accomplishing one of their most important goals–giving the public the impression that the ACGME is doing something to keep sleep-deprived residents from harming patients.
As long as they continue to accomplish this goal, I see very little changing.
Google Glass Is Finally Dead. Ish. | Slate →
Will Oremus:
"Moving even more from concept to reality" is a pretty fantastic PR euphemism for discontinuing a product, moving the team to a different division, and going back to the drawing board. While the company promises that there will be future versions of the device, it has offered no timeline.
Some consolation for Google Glass enthusiasts–Tony Fadell, previously at Apple working on the iPod and then started Nest, is reported to be taking over the project.
The most damning part of this announcement is the lack of details or timeline for next steps. If Google didn't think Glass needed serious work, the next announcement would have been plans for retail sales.
I expect Google Glass to undergo serious changes that will be on a time scale of years not months. I remain bearish on Google Glass, even in medical settings.
The dumpster fire (part 2) | Controversies in Hospital Infection Prevention →
Dr Mike Edmond boldly writing about the crisis in recruiting new ID doctors:
But ethical mentoring now requires that we have frank discussions about the relatively low pay of ID physicians with young physicians who are in the process of career discernment. I tell would-be ID physicians that they need to come to terms with the fact that they will work harder and make less money than their peers who are hospitalists. And the issue isn't just about money, it's about how valued you feel.
Many (maybe most) subspecialists maintain their generalist board certifications. Why not trade your overworked, underpaid job for shift work as a hospitalist?
Should Surgeons Keep Score? | Backchannel →
In order for surgeons to improve, they have to know how well they're doing. In order to know how well they're doing, they have to know how well their patients are doing. And this turns out to be trickier than you'd think. You need an apparatus that not only keeps meticulous records, but keeps them consistently, and throughout the entire life cycle of the patient.
Great article on the need for performance measurement and feedback. This article focuses on surgeons, but we need this everywhere in medicine. Unfortunately, as stated above, any efforts require meticulous and expansive data. This is one of the promises of electronic medical records, but we are far from that goal right now.
I would love to have a system like this for diagnostic accuracy for myself, especially as I train.
Don't Homogenize Health Care | NY Times →
Sandeep Jauhar:
We have to get smarter about how we try to improve medical care. I believe the next phase of quality improvement will be a move away from homogenizing care and toward personalizing it, perhaps with the help of genomic research. Neither the old approach, in which seemingly every patient was treated differently, nor the new one, where we try to treat them all the same, has worked well. Medicine needs another way.
A great idea except genomic medicine has almost no evidence supporting it. We have excelled at uncovering the genetic components of diseases and physiology. Unfortunately, we have not excelled (so far) at applying that knowledge to changing the practice of medicine.
A quick example, we know that opioids are metabolized with the help of an enzyme encoded by the CYP2D6 gene. We also know that this gene is highly variable in humans. We know how to detect this variability using genetic testing. We do not know what to do with this information [1]. I could have a patient's CYP2D6 profile in my hands but I would not have a precise estimate of how I should adjust their morphine dosing…because no such studies have been done.
Genomic medicine is likely part of the answer, but we are going to need the translational research first and then guidelines on what to do with that research.
…other than to tell people at the extremes (very poor metabolizers and very rapid metabolizers) they should likely avoid opioids all together. ↩
Atul Gawande responding to CIA Torture Report | Twitter →
Yesterday morning, Atul Gawande posted a series of 12 tweets detailing and condemning the medical professionals complicit in the CIA's torture of detainees. The details are appalling and the doctors' actions reprehensible.
I find it interesting that Gawande used Twitter and a tweetstorm format to publicize this important criticism. While he has over 108,000 followers, he also has access to The New Yorker and The New York Times. With 12 tweets worth of content, clearly he had enough for a longer form [1]. Perhaps this was only the first public debut of his thoughts and we will see more in the next few days in one of those prominent publications.
Maybe we need to hook him up with a tumblr account… ↩
SocialWellth acquires health app certification company Happtique | MobiHealthNews →
What? Why? Happtique never provided anything valuable.
How residency programs are training doctors to waste money | Vox →
(It's difficult to link to an article with such a ridiculous title, but here we are.)
An interesting piece written about a new JAMA study that shows residency impacts and continues to impact costs of care for physicians once they are practicing.
I initially read through the Vox article, then read the abstract from the JAMA [1] and came to the conclusion that training in a high-spending region seems to mean that you will have higher costs of care when you go out in practice (regardless of spending patterns in your region).
From the Vox article:
Residents who train in regions with high health care costs (that is, the places that err on the side of more scans and specialists) continue to practice expensive medicine decades beyond graduation — even if they move to low-cost parts of the country.
While proofing my original post, I realized that this is not what the paper says at all [2]. There is never a direct comparison made among residents trained in high-spending areas versus residents trained in low-spending areas. The comparisons (summarized in Table 2) are all made within the training spending levels.
The data (as presented) actually shows the opposite of what Vox concludes. For residents trained in regions with high health costs, their average cost patient expenditure is $9,482 when practicing in a high-spending region versus $7556 when practicing in a low-spending region [3].
The comparison we want to look at is between the high-spending trainees and low-spending trainees and their costs within their specific practice spending strata. So, for a resident trained in a high-spending region who goes to practice in a low-spending region, his average cost is $7,556 (as mentioned above). For a resident trained in a low-spending region who goes to practice in a low-spending region, his average cost is $6,882. This represents a difference of $674—not chump change—but no direct statistical comparison is made, so it is difficult to say if this is a real difference.
This data is correlational and speculative at best. It's hard to tell the direction of the effect.
Vox concludes:
The JAMA paper suggests a tantalizingly easy way to save money in American health care: train more residents in low-cost areas of the country.
While I don't think that is a bad idea, I wouldn't base huge programs to shift residency training to lower-cost regions based on this paper.
Blood, Simpler | The New Yorker →
Theranos and Elizabeth Holmes are utterly fascinating. To develop a diagnostic testing company in complete secrecy over 10 years that is now valued at $9 billion is unreal.
Speaking of Theranos' valuation:
Investors have valued the company at more than nine billion dollars, comparable to the two major diagnostic labs.
Comparable valuations, but not comparable scale of business:
Quest runs about thirty full-service laboratories around the country; it performs six hundred million tests of all kinds annually—Theranos's aim is to hit one million blood tests in 2015—and owns four thousand vehicles for picking up samples.
Valuations never make sense to me.
When I first read about Theranos earlier this year, the proposition—hundreds of laboratory tests from a few drops of blood obtained by finger-stick—seemed too good to be true. Conversely, why not? Why do we have to draw so much blood?
I am not a pathologist and definitely not qualified in any way to answer that question. I think the juxtaposition between Theranos' promise and the eventual reality is what makes it such a fascinating company. As mentioned several times in the article, transparent peer review needs to be conducted before we can fully buy into Theranos' promise. Comparison to 23 and Me is quite apt; Theranos will undoubtedly go through growing pains which will include government oversight.
I can't wait to see what happens. I would prefer, both for my patients and myself, easier diagnostic testing, but it has to live up to current standards for accuracy.
Why Google Glass still matters | mHealthNews →
Having to write stories that discuss the relevance of Google Glass are an indicator it is mattering less and less.
Postmodern public health | Controversies in Hospital Infection Prevention →
Mike Edmond:
It seems that we have entered a new era of postmodern public health. No longer are decisions being made on evidence by experts who understand the epidemiology of infectious diseases, but by politicians who pander to the the misinformed for political gain.
The guys over at Controversies in Hospital Infection Prevention have the best ongoing commentary on Ebola.
Antibiotic Hunters | Toronto Star →
Beautiful multi-media piece (reminiscent of the NY Times "Snow Fall" piece) about the urgent need for new classes of antibiotics and a few of the people searching for those compounds.
Surgeons and GPs more likely to cause car accidents than other workers | The Guardian →
Difficult to judge the validity of this study, but the results are chilling nonetheless:
For every 1,000 surgeons who drive a car, 361 made an at-fault claim in the past five years, compared with just 3.5 building society clerks, the research found.
I think about this whenever I drive home from the hospital late at night after a long day. Be safe on the road.
The future doctor: moderator, not sage | Irish Times →
Read this article and pay attention to what Bertalan Mesko and Bryan Vartabedian say. You can ignore pretty much everything in the quotes attributed to Eric Topol.
Stanford MedX to Take On MedEd with New Academy Initiative | Wing of Zock →
Very cool stuff going on with the Stanford's Medicine X. I hope to participate in the near future.


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- Sizing on this dress is true to size.
- *** This dress is asymmetrical so the front dips longer than the back.
- This fab easy to wear dress has clever rouching to the front.
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- V neckline to back but normal bra can be worn
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We are always on hand to answer any questions, on styling, fit or dress size. Not sure of your shape? Feel free to 'chat' to us or leave a message, call us on 023 8858527, or drop us a Facebook message if it's after hours...we're always delighted to help!
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* Please note that should you wish to return the dress if it does not fit, etc then you will be refunded in full (except postage cost) once the dress is received back in the same condition. Please see our returns policy page for full details.*
More in this Collection
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Norse People is the section of our website that is all about our most important assets – the people who make up this organisation. In it, we publish information about our work in the community as well as significant achievements of individuals at Norse Commercial Services.
Tricia Fuller, Group HR Director,
"We see our staff as our most important asset. Constantly investing in our national workforce at all levels, reaps rewards for clients and takes our already successful partnership from strength to strength. Our learning and development is recognised both locally and nationally at national industry award level, as comprehensive, targeted and of the highest standard. Our commitment to staff has been recognised by Investors in People status and we have excellent staff retention levels."


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Women Build 2018
During National Women Build Week we invite local women to devote at least one day to help families build strength, stability and independence through housing. The week is meant to spotlight the homeownership challenges faced by women. Habitat and Lowe's encourage all women to volunteer—no construction skills or experience in Habitat builds necessary.
This is a hands-on project where our volunteers (men and women) will be engaged in construction and landscaping for a single family home in Middleton NH. Volunteers from throughout southeastern New Hampshire will be coming out to spend a day improving the lives of others. Along with the help of these volunteers and Lowe's, we will be completing a home in Rochester on May 5 and 12.
This year, Lowe's donated nearly $2 million to Habitat for Humanity to support the 2018 National Women Build Week, which is set to take place in 300 communities nationwide.
Food and water are being donated by a variety of local businesses, including Lowe's of Rochester, Domino's Pizza of Rochester, Fresh Vibes Cafe, and Hannaford of Rochester. Thank you so much for your support!
If you would like to join us please send an email to Karen at email@example.com or call 603-433-9555.
For more information about Women Build Week please visit the National Women Build website.


text: TV / VideoMark and Mindy: 'NCIS' Juggernaut Squashes Tuesday Night CompetitionMixed bag for newbies 'The Mindy Project,' 'Vegas'By Anthony Crupi|September 26, 2012 ShareBy Anthony Crupi|September 26, 2012 Share The networks on Tuesday night presented a Whitman's Sampler of new and returning series, and while the ever-popular varieties were predictably gobbled up, some novelty flavors were nibbled and discarded. According to Nielsen live-plus-same-day data, CBS got the night started with some sweet ratings candy, drawing 20.5 million viewers and a 4.1 rating in the 18-49 demo with the 10th season premiere of NCIS. After finishing the 2011-12 campaign as the most-watched scripted program on TV, NCIS showed no signs of slowing down, torching the 8 p.m. time slot in total viewers and finishing one-tenth of a ratings point behind NBC's The Voice in the battle for the demo. Starring Mark Harmon, the older-skewing NCIS (median age: 59.3 years) bested The Voice in the reach department by nearly a 2-to-1 ratio (20.5 million to 11.6 million), but trailed in the dollar demo (4.1 vs. 4.2). NCIS' Left Coast spinoff NCIS: Los Angeles also put up some garish numbers, beating all comers at 9 p.m. with an average delivery of 16.7 million viewers and a 3.4 in the demo. On Fox, returning champ New Girl got the Grover Cleveland treatment, landing nonconsecutive slots at 8 and 9 p.m., the better to lead into the network's two new comedies. Unfortunately, the Zooey Deschanel vehicle appeared to slump without its customary Glee support, drawing 5.35 million viewers and a 2.8 rating at the top of the night and 5.18 million viewers and a 2.8 at 9 p.m. When compared to its blockbuster year-ago premiere (10.3 million viewers/4.8 rating), New Girl's time slot debut was down 42 percent in the demo. In what promises to be one of the more closely observed time slots in prime, New Girl edged NBC's Go On in the demo by one-tenth of a point but fell short on reach by a margin of some 1.7 million viewers. With lukewarm support at the top of the hour and facing a tough crowd at 8:30 p.m., the Fox sitcom Ben and Kate had a soft launch, delivering 4.21 million viewers and a 2.1 in the demo. And while the highly anticipated Mindy Kaling series beat NBC's The New Normal by a spread of four-tenths of a ratings point (2.4 to 2.0), The Mindy Project did not enjoy a strong opener. When compared to the premiere numbers notched by the year-ago time slot occupant Raising Hope, TMP dropped 2 million viewers and was off by 23 percent in the demo. The 9-10 p.m. comedy roadblock will be at full capacity as of Oct. 23, when ABC airs the season premieres of Happy Endings and Don't Trust the B—- in Apt. 23. At 10 p.m., it was a glass-half-full/empty scenario for CBS, which bowed its slick period drama Vegas to a not-inconsiderable 14.9 million viewers, blowing ABC's Private Practice (6.45 million) and NBC's Parenthood (4.85 million) off the map. That said, Vegas averaged a 2.5 in the 18-49 demo, which marks CBS' lowest-rated Tuesday night drama debut since the one-off Century City premiered in 2004. When compared to Unforgettable, which premiered in the 10 p.m. slot a year ago to 14.1 million viewers and a 2.9 rating, Vegas was up 6 percent among total viewers and down 14 percent in the demo. On the whole, CBS dominated the night, averaging 17.4 million viewers and a 3.3 in the demo. The resurgent NBC finished second (7.1 million/2.7), while Fox took third in the demo with a 2.5 and fourth in total viewers (4.85 million). ABC ranked No. 2 in total reach (9.12 million viewers) but finished fourth with the under-50 set (2.0). Sharehttp://adweek.it/2kECgn5 copy Adweek Adweek


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Home Audio
If you're having a new home built, this is the perfect time to think about multiroom audio. Did you know one of the smartest trends to hit the home building industry is a multiroom audio system? Not only does it increase the value of your new home, it enhances your quality of life by providing music instantly at your fingertips. Choosing a home audio system is as easy as picking out your cabinets—and a lot more fun than choosing the color of your carpeting. Make music part of your life. All the sound. None of the clutter.
Mobile FX has perfect products for all your home audio needs. We carry intercoms, 7.1 home theater products and an array of in-wall, in-ceiling, and outdoor speakers.
Imagine having the ability to listen to your favorite CD collection in the master bedroom while at the same time having the football game playing through the speakers on the deck by the BBQ. All of our options are cosmetically pleasing, user friendly, and priced less than the competition. We can fill your home without emptying your wallet. We carry home products from quality manufacturers including Russound, Pinnacle, Onkyo, Denon, Monster Cable and many more. Upstairs, downstairs, the garage, the bathroom, the kitchen, and weather resistant outdoor speakers are a must in your new home. You won't believe how far your money goes.


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SourceBottle, a free online resource that's designed to help journalists, bloggers and PR pros, is now available in North America. The platform helps journalists and bloggers find sources, while also giving PR pros an opportunity to help gain brand awareness on behalf of their clients. Continue reading


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by Ed Riley
Chase Grimmett, a Running Start student who was a top graduate in Rochester High School's 2012 senior class, carries a clear vision of what he wants out of life.
As a high school student he played varsity football, basketball, and baseball and had the potential of attending several universities on scholarships based on his athletic skills. It is, however, academics that hold his passion and what he believes is the key to his success in life. He is now a second-year Centralia College student with plans to work in marine biology.
Grimmett will attend Western Washington University to study marine biology next fall and plans to focus on coral reef ecology.
Marine biology is the perfect career for Grimmett: he is passionate about the environment and is an certified scuba diver with deep water and cave dives in Hawaii and the Pacific Northwest to his credit.
"Finishing my associate degree at Centralia College makes a lot more sense financially. Besides, the college has the advanced science classes I need for my degree in marine biology. And the Environmental Science department has amazing instructors who are experts in their fields," Grimmett said. "The support I've received from the faculty has been incredible, they have really helped guide me in the direction I need for my degree."
In fact, Grimmett was accepted and offered partial scholarships to attend Oregon State University, the University of Oregon, and Western Washington University. Grimmett puts it this way, "The scholarships would have only paid for about 40 percent of my tuition; my family would have had to come up with the rest. That's an incredible amount of money. I don't want my family to go into debt for my education." With two scholarships from the Centralia College Foundation to help pay the way, his overall college costs will be much more manageable.
Grimmett also has his family to thank for his recognition of the importance of education and his career direction. His mother works for the U.S. Fish and Wildlife department tracking endangered species, and his father is an instructor for special needs children.
In what little spare time Grimmett does have, he enjoys hiking and backpacking, and he takes lessons in Tae Kwon Do, and he still manages to work part time. Through his hard work and dedication, coupled with a clear vision for what he wants, he is certain to realize his dreams.


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Scenic Technologist
The Department of Theatre at Michigan State University invites applicants for a position as Specialist- Teacher, Scenic Technologist. This is a one-year fixed term (with possible renewal), annual year (12-month) appointment at the rank of academic specialist in teaching commencing July 1, 2019, or August 1, 2019. Salary competitive and commensurate with experience.
Candidates should be proficient in modern scenic and prop construction including, but not limited to accurate development and interpretation of working drawings, planning and facilitating, carpentry, welding (MIG and TIG), and tool maintenance. In addition, the candidate should have excellent time management skills, be familiar with commonly used software packages (MS Office, Vectorworks or AutoCAD computer drafting), knowledge of automation and rigging practices, and have experience working with and leading student crews. The Scenic Technologist will participate in departmental production activities, lead load-in and strikes of electrics, audio, and media equipment, and serve as the Technical Director of Summer Circle Theatre productions each year (including installation and strike). The successful candidate will be a collaborative member in a production environment with faculty and student designers and technicians. They will mentor/supervise student technicians and have the opportunity to teach practica and labs in scenic technology as well as courses in the University's Integrative Studies in the Arts and Humanities. Continued work in the professional field is encouraged.
The Scenic Technologist will also be responsible for enforcing MSU shop safety policies and procedures, maintaining accurate shop inventory records, assigning tasks to student employees and volunteers, and maintaining a safe and productive working environment.
Michigan State University's Department of Theatre is a vibrant organization offering a BA, BFA (acting, design, and stage management), MFA (acting and design) and Minors in Dance and Musical Theatre. The department presents four-five major productions each academic year and three in the summer. The production season reflects the University's values of cultural diversity and inclusion, using theatre to explore the human effect upon the global environment. http://theatre.msu.edu/
The College of Arts & Letters recognizes that only an academic and organizational culture, which actively seeks out and strengthens diverse voices and perspectives among its members, results in true excellence. We are an equal opportunity / affirmative action employer. The College of Arts & Letters is particularly interested in candidates of all backgrounds who are committed to the principle that intellectual leadership is achieved through open access and pro-active inclusion. The Department of Theatre has a strong institutional commitment to diversity in all areas and encourages candidates from underrepresented groups including the LGBTQIA community. We favor candidates who can contribute to the College of Arts & Letters' distinctive educational objectives, which promote interdisciplinary perspectives, intercultural understanding, and values diversity and inclusion as essential to achieving excellence.
MSU is an affirmative action, equal opportunity employer. MSU is committed to achieving excellence through cultural diversity. The university actively encourages applications and/or nominations of women, persons of color, veterans and persons with disabilities.
MSU enjoys a park-like campus with outlying research facilities and natural areas. The campus is located in the City of East Lansing, adjacent to the capital city of Lansing. The Lansing metropolitan area has a diverse population of approximately 450,000. Local communities have excellent school systems and place a high value on education. The University is proactive about its obligations under the ADA, and provides individual accessibility plans to students and employees with disabilities. Michigan State University is proactive in exploring opportunities for employment for dual career families, both inside and outside the University, and respects all family forms. Information about MSU's dual career support can be found at http://miwin.msu.edu/. Information about WorkLife at MSU can be found http://worklife.msu.edu/. Information about the Academic Advancement Network can be found http://aan.msu.edu/. Information about MSU Diversity and Inclusion Initiatives, including the Diversity Research Network can be found http://www.inclusion.msu.edu/.
The College of Arts and Letters employs 250 full-time faculty with 3300 undergraduates and 175 graduate students enrolled in 24 majors, 38 minors, and 9 graduate programs that are housed in 8 departments and 22 research centers and interdisciplinary programs. These include such outstanding programs as African and African American Studies, American Indian and Indigenous Studies, Jewish Studies, the Center for Gender in a Global Context, and the Center for Interdisciplinarity. The College also has a vibrant mentoring program at the College and Departmental levels. It works closely with MSU's five international centers that receive Title VI funding and is also a long-time leader in international education sponsoring 70-80 programs each year. In 2016, faculty of color made up 25% of the College faculty and students of color made up 28% of its entering undergraduate class.
Bachelors -Technical Theatre or related field
Applications must be submitted electronically to the Michigan State University Human Resources web site http://careers.msu.edu/. Qualified applicants should submit a) a cover letter b) current curriculum vitae c) a statement of teaching philosophy that highlights your alignment with some of our desired qualifications d) a written summary of your experience with diversity in the classroom and/or in your past or planned research endeavors, any experience mentoring diverse students or community outreach initiatives, and an explanation of how you will advance our goals of inclusive excellence and the names and e) the names, phone numbers, and email addresses of 3 potential references.
For more information, contact the Chair of the Search Committee, Angie Wendelberger, firstname.lastname@example.com or 517-884-7785 or for more information about the Department of Theatre go to theatre.msu.edu. Persons with disabilities have the right to request and receive reasonable accommodation.
Michigan State University has been advancing the common good with uncommon will for more than 160 years. One of the top research universities in the world, MSU pushes the boundaries of discovery and forges enduring partnerships to solve the most pressing global challenges while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.


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Welcome to The Jafflong's new website! We are currently busy building all the features to make this site as informative and useful as possible.
In the meantime, you are most welcome to join us on our facebook site at: www.facebook.com/jafflong for all the current news. We'll be linking Facebook and this site very soon.
As always though, if you have anything that you'd like to see on on, please feel free to let us know.
Contact us on: 01322 293 858 | 01322 277 457
email: firstname.lastname@example.com
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Course ListingFashion Marketing & Management
Published June 1, 2016
Student Learning Outcomes
See ge.artinstitutes.edu/programoffering/3275 for program duration, tuition, fees, and other costs, median debt, salary data, alumni success, and other important info.
Program Courses
Program Electives
Note: The Art Institute of San Antonio (a branch of The Art Institute of Houston) reserves the right to alter the sequencing of classes. Some courses are offered on a rotating basis. Students should consult their Academic Advisors and/or Department Chair when creating their course schedules to ensure they are following the recommended sequence. Students must meet all co/prerequisites for courses.


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Friend's Email:
Subject: I have found a DVD that I think you would enjoy
|Twin Peaks - The First Season
Special Edition
Actors: Kyle MacLachlan, Michael Ontkean, Mädchen Amick, Dana Ashbrook, Richard Beymer
Directors: Caleb Deschanel, David Lynch, Duwayne Dunham, Lesli Linka Glatter, Mark Frost
Genres: Indie & Art House, Drama, Television, Mystery & Suspense
UR 2001 5hr 36min
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Movie Details
Similar Movies
Similarly Requested DVDs
Movie Reviews
Art collides with television
thomas s davies | Astoria, NY United States | 10/02/2001
(5 out of 5 stars)
"Twin Peaks rates as one of the most singularly innovative additions to network telelvision. David Lynch's obsession with making the everyday middle-american world beautifully strange (the word "awe" with its horrific element intact is useful here) and Mark Frost 's (St Elsewhere) quirky writing meld seamlessly in this soap opera that exposes to much beneath its surface. The episodic nature of television often strains to create new episodes that maintain sturdy characters while repeatedly playing the same scenario over and over. In this case the characters are superficial, common and quirky. But rather than falling into the dull routine of love triangles and deceit (although TP has these in abundance) Lynch and Frost immediately disrupt quiet american life with a murder--a dead prom queen, Laura Palmer, floats up to Pete Marshall shattering his early morning fishing routine. The town is cast into chaos. FBI agent Dale Cooper, played perfectly by Kyle MacLachlan, enters the town wide-eyed and appreciative of its tranquil simplicity. Using holistic methods, Cooper unravels the black underbelly that provides the illusion of innocence. Playing between superficial soap opera moments and some of the most horrific and surreal moment ever shown on TV, Lynch and Frost use the weekly format to delve deeply into the dark forces and evils which exists within beauty. And the show is ultimately beautiful in its raw exploration that reveals fear is always obliterated by love--not justice or truth. The show's inteligence survived its first season by hiding behind the murder mysery of Laura Palmer. Lynch and Frost planned to leave this mystery unsolved indefinitely in order to explore all corners of Twin Peaks. Unfortunately, the network forced the team to rush towards a solution in the second season fearing that ratings were dropping because viewers needed closure (actually Twin Peaks was losing the soap opera element as they realized the world of Twin Peaks was more complex and real than most prime time viewers were prepared to patiently stomach). Without its central nexus and Lynch leaving to complete Wild at Heart, the show floundered until Lynch's return. However, the show snapped back into brilliance following Lynch's return. But it was too late. The show met the same fate of all brilliant American network shows that shined too brightly before its time--it was cancelled. The team put together a final TV movie that "ended" the show in the manner it began. Lynch followed it with a dreamlike prequel in the theaters called Fire Walk With Me (a creepy mantra pulled from Laura's phantom killer). All of this if assembled adds up to a work of visual art that was way ahead of its time and dismissed as quirky and silly--but its rough end was probably caused by people expecting to be entertained by quirkines, but kept safe from the show's more awesome yet brutal spectacles. Still the entire work (if one can find it all and watch it in order) stands as a challenge to network programming need for dumbed-down product. First time viewers and skeptical fans should bravely revisit this fragmented masterpiece."
Truly remarkable television
Mark Twain | 07/13/2003
(5 out of 5 stars)
"In the spring of 1990, the ABC network treated it's viewers to a most unusual viewing experience; the David Lynch and Mark Frost creation "Twin Peaks". A hybrid murder/mystery, primetime soap opera, darkly funny comedy and super- natural thriller...Twin Peaks was all of these and yet at the same time none. It would use what on other shows would be clichés to create a richly woven tapestry so original, thought provoking and emotionally truthful that it re- defined what television at it's best could truly be. At times it was hilarious and absurd, other times it was heart-wrenching in it's honesty of human emotion and suffering, and still other times it was deeply chilling and disturbing with images you can't easily shake off days after...and sometimes it was all these things at once. There had never been anything even remotely like it on TV before and (so far) nothing like it since. It's influence can be seen in countless other programs...but only elements, no one has achieved the true artistry that "Twin Peaks" had. Being a mid-season replacement series, the whole of it's first season was only 7 episodes and had much of America asking the question "Who killed Laura Palmer?". The series' was set in the fictional, northwestern town of Twin Peaks, where the murdered body of local homecoming queen, Laura Palmer is found on a beach wrapped in plastic. This event sets the stage for the arrival of FBI agent Dale Cooper (Kyle MacLachlan) and the subsequent investigation as to the identity of her killer. It is this investigation that will uncover the quiet trappings of this small mountain town to reveal dark secrets hidden within and and even darker things lurking without. He will encounter a remarkable cast of characters, all with their own personal agendas."Twin Peaks" was and still remains groundbreaking television of the first order. It was stylistically cinematic, each episode looks very much like an hour long feature film with an equally impressive soundtrack presentation. It was incredibly well written (with so many quotable lines the mind boggles at them all) with fabulous characters, a wonderful sense of humor and a shadowy (and sometimes very scary) sense of mystery. The large ensemble cast of MacLachlan, Michael Ontkean, Piper Laurie, Sherylynn Fenn, Laura Flynn Boyle, Peggy Lipton, Miquel Ferrer, Ray Wise, Joan Chen and far too many more to list here are all uniformly excellent in their respective rolls.For "Twin Peaks"' debut on DVD, Artisan Home Entertainment has put together a very nice set featuring episodes 1 thru 7 (unfortunately the 2 hr. pilot is missing due to rights issues, originally owned by Warner Bros. it is now owned by Paramount). The packaging is a slick fold-out design with transparent slip case, much like the design of Fox's X-Files box sets. 4 discs are included.With only 2 episodes per disc, these transfers are mastered at a very high bit rate and the results are stunning. Having been used to the soft, grainy picture afforded by the previous video versions of the series, I was quite unprepared for the unbelievable picture quality delivered on this release. These new high definition, re-mastered transfers are breathtaking, with colors rendered perfectly (the green opening titles nearly leap off the screen). Blacks are solid with excellent shadow detail, flesh tones are accurately reproduced and the show's red color schemes have never looked better (without a trace of bleeding). No digital artifacts are present and I never noticed any signs of edge enhancement, all in all an incredible job. The same can be said for the sound presentation here, you can choose between Dolby digital 5.1 surround and 2.0 surround or (in a first for any television DVD product) DTS digital surround. These are very good mixes, the DTS surround being the best. The surround elements are reserved mostly to ambient sounds and Angelo Badalamenti's brilliant music, dialogue is placed mostly in the center and is clear and intelligible. This is television and not a Hollywood action spectacular so don't expect reference quality surround use, but a detailed sound mix perfectly suited to the show. Badalamenti's score is especially well presented here.I would suggest to first time viewers to try and get hold of the pilot episode. Although it has an alternate ending filmed as a possible "closed" ending for European markets, it is actually an uncut version of Cooper's dream in episode 2. You can also purchase an import DVD of the pilot from Amazon.com which is the original broadcast version, the video and audio is not as pleasing as on the set reviewed here but still it is acceptably good. Artisan has included a booklet with the season 1 set explaining the events of the pilot but I would suggest viewing it if possible before viewing ep.1 thru 7. With each show being a day in the investigation, viewers will likely be lost without the events of the pilot to start from. Overall a very impressive set from Artisan. If you missed this extraordinary show before, don't miss it this time. And please hurry up with Season 2."
Twin peaks definitely out on DVD Summer 2000 (region 2)!
Zanda | England | 12/14/1999
(5 out of 5 stars)
"Twin Peaks, mega mega tops. Probably one of the best series ever. Downside is that the VHS quality is very very poor. I have received an e-mail from Artisa (the production people) and they say they WILL be releasing it on DVD in Summer 2000 (earlier in the States). If you only buy one thing next year, make sure it's Twin Peaks."
Twin Peaks DVD in November 2000
thomas s davies | 06/05/2000
(5 out of 5 stars)
"Have just been informed that Artisan Entertainment (artisanent.com) will be releasing the entire Twin Peaks series on DVD in November 2000. Mysticism... Humor... David Duchovny in drag. David Warner on TV. David Lynch with a hearing aid! And Harry S. Truman! Peggy Lipton! Diners! The owls are not what they seem!"


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Nelson Mandela Bay Municipality has installed a cost effective TOA TS-780 Conference System with a built-in Digital Recorder.
TOA began developing conference systems in 1978. Over the years, we have accumulated a wealth of experience and achievements that have earned our company an excellent reputation for providing highly reliable systems that are easy to use. At TOA, we will continue to offer a full product lineup to support the smooth management of conferences.
Features of the System are…
・Plug-and-play system.
・Up to 64 units can be attached to a single Central Unit.
・System expandable to 192 units by connection of 3 Central Units.
・Test function allows connections to be accurately verified.
・Conferences can be recorded onto SD card or external recording device.
・Built-in feedback suppressor for more efficient reduction of acoustic feedback.
・External equalizing capability.
・Compact and stable hardware design.
The installed system consists of TWO Chairman Units and FIFTY EIGHT Delegate Units.
The system is integrated with a TOA Public Address System consisting of the TOA A-2000 Mixer Amplifier and TOA SR-H2S Slim Line Array Short Throw Speakers.


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We are thrilled to announce a recently completed website redesign for Seaside Sisters, a speciality stylist company for women and men, located in Stuart, Florida.
Seaside Sisters moved from a template website to a custom WordPress CMS platform. This gave us the ability to properly apply on-page SEO and the analytic tracking needed to monitor site performance, while also giving us the flexibility to create a beautiful site design for their company.
Seaside Sisters is the premier fashion stylist company in Martin County. Their clients hire the sisters to boost their self-confidence, perform a closet audit, or style them for an important event. Spouses can purchase gift certificate for their services, giving a unique and thoughtful gift for the holiday season.
If you're interested in taking your marketing in a new direction, contact us for a complimentary consultation!


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Is A Borrowell Loan Right For Me?
June 27, 2017
In addition to providing credit scores for free, Borrowell is in the business of offering unsecured personal loans.
Somewhat ironically, we're a lender that wants to help Canadians get out of debt, not into more of it.
And that's a good thing! We believe that when used responsibly, Borrowell loans can be a great way to improve your financial well-being. Our goal is to be fully transparent about when a Borrowell loan makes sense (and also when it might not be the best option).
When Borrowell's loans make sense 👍
- If you are able to save money with us as compared to your current debts (e.g. you need to pay off high-interest credit cards)
- If you currently juggle multiple payments and want to consolidate these into one convenient payment
- If you want to get out of debt on a schedule, with no early repayment fees
- If you don't want to secure your loan against your house or another asset (all of our loans are unsecured)
- If you are planning on making a major purchase or incurring an expense with a credit card and would prefer an alternative
When we might not be the best option 👎
- If you receive a rate from us that is higher than your existing borrowing options
- If you don't receive a loan amount from us that meets your needs
- If you are currently not employed or make less than $20,000
- If your credit score is currently below 660 (but we have lots of tips to help you improve!)
- If you enjoy visiting a branch and doing paperwork! 😉
Interested in learning if a Borrowell loan makes sense for you?
First, start by getting your credit score for free. If you have an Equifax credit score above 660, just click 'Loans' to view your personalized loan options. There is no risk or obligation with seeing what you qualify for.


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I'll just assume that you are following me on Instagram, but if you haven't, it's @eeked. I'm not really fancy, so yes I hope that will convince you to head on over, I guess not. Well, you should because that is where I'm most active, which means you'll be getting lotsa timely info about ma lyfe - oh, you can also follow me on Snapchat (@eeked) while you're at it.
October was intentionally a huge month for me, but I guess it didn't went as amazing or HUGE as I expected it to be. However, there were many extraordinary things that happened; one of which I celebrated my birthday with Benefit and the other is that I am featured on Women's Health Malaysia - October 2015 issue, under the Beauty section (yeah, like where else will I be). I've been a fan of the magazine ever since it was launched and a friend that I used to work with became the editor - it's one of the only magazines that I would think is worth the money spent. You can tell, that they actually put a huge amount of effort writing and curating content for their readers - they have a good humour too!
Back to my feature, I talked a lot about myself and why I do what I do today. I mentioned about the importance of doing the things you love - and how everything that I liked when I was much younger played a role in resulting to what I do at work today. I also spoke a little about my background as a singer/performer in musical plays, and have been trained since age 10. So, being on stage and being infront of camera is something that comes super natural to me. I love that feeling when I'm on stage, looking down at thousands and thousands of people feeling happy and smiling - it gives me an assurance and an affirmation - that is how I measure my achievement. Hence, today I came out with my own thing, so I get to be whatever I want to be and at the same time making people happy :)
If you want to catch a little more about the article, they are out on the news stands - October 2015 issue!