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Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, Ribeiro RC, Rivera GK, Rubnitz JE, Sandlund JT, de Armendi AJ, Razzouk BI, Pui C. Risk Factors for Traumatic and Bloody Lumbar Puncture in Children With Acute Lymphoblastic Leukemia. JAMA. 2002;288(16):2001-2007. doi:10.1001/jama.288.16.2001
© 2017
Author Affiliations: Departments of Hematology/Oncology (Drs Howard, Gajjar, Ribeiro, Rivera, Rubnitz, Sandlund, Razzouk, and Pui), Biostatistics (Dr Cheng and Ms Harrison), Pathology (Dr Pui), and Anesthesia (Dr de Armendi), St Jude Children's Research Hospital, and Departments of Pediatrics (Drs Howard, Gajjar, Ribeiro, Rivera, Rubnitz, Sandlund, Razzouk, and Pui) and Preventive Medicine (Drs Kritchevsky and Somes), University of Tennessee Health Science Center, Memphis.
Context Traumatic or bloody lumbar puncture (LP) reduces the diagnostic value of the procedure and may worsen the outcome of patients with acute lymphoblastic leukemia (ALL). Little is known about the risk factors for traumatic and bloody LP.
Objectives To determine the risk factors for traumatic and bloody LP.
Design, Setting, and Patients Retrospective cohort study of 956 consecutive patients with newly diagnosed childhood ALL who were treated at a pediatric cancer center between February 1984 and July 1998.
Interventions All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy.
Main Outcome Measure Traumatic LP was defined as an LP in which cerebrospinal fluid contained at least 10 red blood cells (RBCs) per microliter and bloody LP as one in which the cerebrospinal fluid contained at least 500 RBCs per microliter.
Results Of the 5609 LPs evaluated, 1643 (29%) were traumatic and 581 (10%) were bloody. The estimated odds ratios (ORs) and 95% confidence intervals (CIs) for traumatic LP were 1.5 (95% CI, 1.2-1.8) for black vs white race, 2.3 (95% CI, 1.7-3.0) for age younger than 1 year vs 1 year or older, 1.4 (95% CI, 1.2-1.7) for early vs recent (dedicated procedure area and general anesthesia) treatment era, 1.5 (95% CI, 1.2-1.8) for platelet count of 100 × 103/µL or more vs less than 100 × 103/µL, 10.8 (95% CI, 7.7-15.2) for short (1 day) vs longer (>15 days) interval since the previous LP, and 1.4 (95% CI, 1.1-1.8) for the least vs the most experienced practitioners. Analyses for bloody LP yielded similar results.
Conclusions The unmodifiable risk factors for traumatic and bloody LP include black race, age younger than 1 year, a traumatic or bloody previous LP performed within the past 2 weeks, and a previous LP performed when the platelet count was 50 × 103/µL or less. Modifiable risk factors include procedural factors reflected in treatment era, platelet count of 100 × 103/µL or less, an interval of 15 days or less between LPs, and a less experienced practitioner.
Although lumbar puncture (LP) is generally safe, there is a risk of traumatic LP.1- 6 When LPs are difficult to perform or repeated attempts are necessary, blood can be introduced into the cerebrospinal fluid (CSF). Although the mechanism of bleeding into the CSF at the time of LP is not known with certainty, overinsertion of the needle, leading to laceration of the vertebral venous plexus as the needle hits the vertebral body, is a likely cause.7 In extreme cases, overinsertion of the LP needle can lead to CSF contamination with bone marrow and blood.8 Even when the depth of needle insertion is appropriate, the CSF can be contaminated with blood, and in such cases, the source may be the small radicular vessels along the nerve roots at the level of the LP.9 If the patient moves during the procedure, additional soft tissues may be traumatized, leading to bloody CSF.
Blood in the CSF alters the cell count, increases the protein level, and can cause false-positive culture and cytologic results, with consequent diagnostic confusion.5,10- 15 Furthermore, bacteria16- 26 or leukemic cells27 circulating in blood may be introduced into the CSF as a result of traumatic LP, thereby worsening the patient's prognosis. Traumatic or bloody LPs have been defined as those in which the CSF contains more than 200, 500, or 1000 red blood cells (RBCs) per microliter.5,13- 15,28,29 Reported incidences range from 8% to 19%, depending on the population studied and the definition used.14,30,31 Risk factors for traumatic and bloody LP have not been systematically identified.
Patients with acute lymphoblastic leukemia (ALL) undergo multiple LPs to assess central nervous system involvement and to instill intrathecal chemotherapy and are frequently thrombocytopenic. Hence, this population is an excellent group in which to study the effects of thrombocytopenia and repeated procedures on the risk of traumatic and bloody LP. We reviewed the outcomes of LPs performed on pediatric patients with ALL treated at St Jude Children's Research Hospital, Memphis, Tenn, and identified both unmodifiable and modifiable risk factors for traumatic and bloody LP. The risk of neurologic complications of LP in thrombocytopenic patients with childhood ALL, such as spinal hematoma, has been examined elsewhere.32
Nine hundred fifty-eight pediatric patients with newly diagnosed ALL were treated on 4 consecutive protocols33 between February 1984 and July 1998, for which informed consent was obtained from parents or the patient, if 18 years or older. Induction chemotherapy included prednisone, L-asparaginase, vincristine sulfate, daunorubicin hydrochloride, etoposide (or teniposide), and cytarabine, with or without methotrexate. In addition to diagnostic LP, patients underwent 2 to 12 (median, 4) LPs within 6 months of diagnosis for the administration of intrathecal chemotherapy. For each LP, the patient's platelet count, the number of RBCs per µL of CSF, and whether platelet transfusion was given were recorded. The institutional review board approved the study.
Of the 958 children treated for ALL during the review period, 2 were excluded, one because of early death before LP and the other because of intracranial hemorrhage at diagnosis with grossly bloody CSF with all LPs, which were performed to relieve pressure. The remaining 956 patients underwent 5625 LPs; 16 were excluded because no CSF results were documented. An additional 103 LPs were excluded from analyses that required a platelet count because either no platelet count was determined within 1 day of LP (n = 58) or no platelet count was documented after platelet transfusion (n = 45). Therefore, 956 patients underwent 5609 evaluable LPs, of which 5506 were associated with an evaluable platelet count.
We defined traumatic LPs as those in which the CSF contained at least 10 RBCs per microliter because this degree of blood contamination of CSF is associated with a worsened prognosis in pediatric patients with ALL and circulating lymphoblasts.27 We defined bloody LPs as those in which the CSF contained at least 500 RBCs per microliter; this degree of blood contamination causes diagnostic confusion for patients with suspected meningitis5,13,15 and possibly increased risk of introducing bacteria into the CSF when LP is performed on patients with bacteremia.22- 25 By these definitions, bloody LP is a subset of traumatic LP.
Age, race, sex, treatment era, treatment protocol, recent use of glucocorticoid or L-asparaginase, platelet count at LP, number of days since the previous LP, practitioner experience level, the traumatic or bloody status of the previous LP, and the platelet count at the previous LP were considered possible risk factors for traumatic and bloody LP. Age categories were younger than 1 year and 1 to 18 years because of the obvious differences in the unadjusted risk of study outcomes below and above the age of 1 year. Treatment era was divided into an early period (February 1984 to April 1995) and a recent period (May 1995 to July 1998). During the early period, LPs were usually performed on patients in the inpatient ward or outpatient clinic without sedation or under conscious sedation with meperidine hydrochloride and pentobarbital sodium; during the recent period, LPs were generally performed on patients under general anesthesia with propofol in a special procedure area with an anesthesiologist and dedicated staff. The effects of the ALL protocol and recent administration of glucocorticoids or L-asparaginase were also analyzed. Recent use of glucocorticoid or L-asparaginase was defined as any administration of the drug within 7 days before the LP and was categorized into 4 groups: neither drug, only glucocorticoid, only L-asparaginase, or both drugs administered. Because use of these drugs produces a hypercoagulable state, we hypothesized that the risk of traumatic and bloody LP would be decreased if performed after administration of glucocorticoid, L-asparaginase, or both.
The categories for time since the previous LP were 1 day, 2 to 3 days, 4 to 7 days, 8 to 15 days, and 16 days or more. Practitioners were categorized according to the number of LPs they performed in this cohort of patients with ALL (≤10, 11-50, 51-200, and >200 per practitioner). There were 230 practitioners in the least experienced group (category 1), 70 in category 2, 13 in category 3, and 7 in the most experienced group (category 4). The effect of education level (attending physician, nurse practitioner, fellow, resident) was evaluated in preliminary analyses. Attending physicians and nurse practitioners, who performed 3519 of the 5484 LPs with evaluable practitioner information, had a lower proportion of traumatic or bloody LP than fellows or residents in univariate analysis, but when experience category was added to the model, the effect of education disappeared, and therefore only the results for experience category are reported. Platelet counts from 1 × 103/µL to 100 × 103/µL were categorized in increments of 25 × 103/µL. Platelet counts higher than 100 × 103/µL comprised a single category because bleeding time and other measures of hemostasis are normal when the platelet count is above this value.34,35 The platelet count at the previous LP was considered a possible risk factor because thrombocytopenia at the previous procedure may allow persistent leakage of blood into the CSF that would be present at the subsequent LP. Platelet counts from the previous LP were categorized in the same way as platelet counts measured at the current LP.
We modeled the risk of traumatic and bloody LP by using logistic regression and included 2 types of intrapatient correlations: a longitudinal correlation and an exchangeable covariance structure that accounted for unmeasured intrapatient factors. The longitudinal correlation was modeled as a first-order Markov chain36 by including the previous LP status as a predictor variable. The model was fit by using generalized estimating equations according to the method of Liang and Zeger37 as implemented by SAS statistical software version 8 (SAS Institute Inc, Cary, NC). Because the purpose of this study was to identify risk factors rather than to test a particular hypothesis, we report odds ratios (ORs) with 95% confidence intervals (CIs). Odds ratios whose 95% CIs do not include 1.00 are associated with P<.05. All reported ORs resulted from multiple logistic regression using the risk factors as predictor variables and the exchangeable within-patient covariance structure as input to the GENMOD procedure in the SAS statistical program.
The 523 male patients (55%) and 433 female patients (45%) ranged in age from 1 month to 18 years (median, 5.5 years), 775 (81%) were white, 127 (13%) were black, and 54 (6%) were of other races (Table 1). Of the 5609 LPs, 1643 (29%) were traumatic, and 581 (10%) were bloody.
Sex had no effect on the proportion of traumatic or bloody LPs. Black race, age younger than 1 year, and early treatment era were associated with an increased risk of traumatic and bloody LP (Table 1 and Figure 1). Treatment protocol was significant in univariate analysis, but when treatment era was included in the multivariate analysis, the effect of treatment protocol disappeared (data available from authors on request). Also, there was no reduction in risk with recent use of glucocorticoid or L-asparaginase in either univariate or multivariate analysis (data available from authors on request); therefore, chemotherapy was not included in the final model. The 2 more experienced practitioner categories were associated with decreased odds of traumatic and bloody LP when compared with the 2 less experienced categories.
After adjusting for sex, race, age, treatment era, days since the previous LP, practitioner experience level, traumatic or bloody status of the previous LP, and platelet count at the previous LP, all platelet counts of 100 × 103/µL or less were associated with increased odds of traumatic and bloody LP (Table 2). When platelet counts were 100 × 103/µL or less, the odds of traumatic and bloody LP were not statistically significantly different among platelet categories. When we combine LPs performed at platelet counts less than 100 × 103/µL, the OR for traumatic LP is 1.5 (95% CI, 1.2-1.8) when compared with LPs performed at platelet counts of 100 × 103/µL or more.
Time since the previous LP had a significant effect on the incidence of traumatic and bloody LP (Figure 2). Fifty-five percent of the second LPs, which were typically performed within 1 to 4 days of the first, were traumatic and 26% were bloody, whereas only 19% of the first LPs were traumatic and 4.7% were bloody (Table 3). We evaluated the effect of the number of days since the previous LP on the risk of a subsequent traumatic or bloody LP. When an LP was performed 1 day after the previous LP, it was traumatic 75% of the time and bloody 33% of the time. The OR for traumatic LPs performed 1 day after the previous procedure compared with LPs more than 15 days apart was 10.8 and the OR for bloody LP was 7.2 (Table 3). Traumatic LP was more frequent if the procedure was performed within 15 days of a previous LP but returned to baseline thereafter (Figure 2), a trend consistent with the ORs estimated by logistic regression.
A previous LP that was either traumatic or bloody increased the likelihood of subsequent LPs being traumatic or bloody (Table 4). After adjustment for all other risk factors by using logistic regression, the OR for traumatic LP was 1.6 (95% CI, 1.4-1.9) after a previous traumatic LP compared with a previous nontraumatic LP, and the OR for bloody LP was 1.9 (95% CI, 1.4-2.5) after a previous bloody LP. The platelet count at the previous LP was also an important risk factor. The OR for traumatic LP was 1.5 (95% CI, 1.1-2.0) and the OR for bloody LP was 1.6 (95% CI, 1.1-2.3) if the platelet count at the previous LP was 25 ×103/µL or less compared with those higher than 100 × 103/µL. The ORs were similarly high for subsequent traumatic and bloody LP if the platelet count at the previous LP was 26 to 50 × 103/µL compared with those higher than 100 × 103/µL. If the platelet count at the previous LP was higher than 50 × 103/µL, there was not a significantly increased risk. If more than 15 days had elapsed since the previous LP, the traumatic or bloody status and the platelet count at the previous LP had no effect on the outcome of the current LP (data available from authors on request).
Our data suggest that the lowest risk of traumatic or bloody LP occurs in a white patient whose LP is performed by an experienced practitioner more than 15 days after a previous LP at a platelet count of more than 100 × 103/µL in the recent era with a nontraumatic previous LP performed at a platelet count of more than 100 × 103/µL. The multivariate model predicted that in this ideal setting, 9% of the LPs would be traumatic and 2% bloody. In this study, only 53 LPs were performed in this situation: 1 was traumatic and none were bloody. In contrast, the model predicts that a patient whose LP is performed in the most unfavorable conditions will have a 97% probability of traumatic and 84% probability of bloody LP. The single LP performed under these conditions was bloody.
This study evaluated an important problem with a common procedure and found modifiable risk factors for traumatic and bloody LP. In this large series, no neurologic complications of LP occurred, whether the procedure was bloody or not.32 However, traumatic and bloody LPs may indirectly lead to poor outcomes in pediatric patients with newly diagnosed ALL and circulating leukemic cells.27 Bloody LP may also be associated with iatrogenic meningitis when performed on patients with bacteremia.18,21- 23 Moreover, bloody CSF obscures the diagnosis of central nervous system leukemia at the presentation of ALL. Therefore, attempts should be made to reduce the risk of traumatic and bloody LP.
The proportion of bloody LPs observed in this study (10%) is within the range reported in other pediatric studies (8%-19%)14,30,31; however, we made several novel observations in this study. The proportion of bloody LPs was greater among infants (23%) than among older pediatric patients (10%). The increased risk of bloody LP in infants may be due to technical difficulty in performing the LP that results from the smaller intervertebral space and the shallow depth of needle insertion required to reach the thecal sac. In a previous report27 that evaluated the first 2 LPs of 546 of the 956 patients included in this study, age younger than 1 year was associated with an increased risk of traumatic LP (OR, 1.7; 95% CI, 0.8-3.5). Because of the small number of evaluable procedures, the association did not achieve statistical significance.
The proportion of traumatic LPs was greater among black patients (36%) than white patients (28%), a difference that remained statistically significant even after controlling for all other risk factors (OR for traumatic LP, 1.5; 95% CI, 1.2-1.8). This difference may be the result of the greater lumbar lordosis in black patients compared with white patients, which makes optimal flexion of the spine for LP more difficult.38,39 Since most patients were either under conscious sedation or general anesthesia, any cultural differences in the response to medical interventions is not likely to play an important role in the observed effect of race on risk.
Procedures performed in the early treatment era were more likely to be traumatic or bloody (ORs, 1.4 and 1.6, respectively) than those performed during the recent era. The reduction in the proportion of traumatic and bloody LP occurred abruptly in May 1995, when several changes were implemented. Before that time, LPs were performed in the inpatient ward or outpatient clinic with no sedation or only conscious sedation; after that time, LPs were performed in a dedicated procedure area, with designated staff for procedures and general anesthesia. These changes in anesthesia practice were made to decrease patient pain and anxiety; the beneficial effect on the risk of traumatic and bloody LP was discovered only as a result of this study. There were no systematic differences in the level of training of practitioners who performed LP during the 2 treatment eras, so we attribute the effect of treatment era to these changes. Practitioner experience level was a more important predictor of outcome than education level, which suggests that practice is important to achieve optimal skill in performing LP.
The platelet count is a strong predictor of traumatic and bloody LP; patients in all categories with platelet counts of 100 × 103/µL or less had increased risk. This finding is consistent with the normal bleeding times found in patients with platelet counts higher than 100 × 103/µL. Surprisingly, the risk was not different across platelet categories once the count decreased below this threshold, despite progressively abnormal bleeding times in thrombocytopenic patients as the platelet count decreases from 100 × 103/µL to 10 × 103/µL.34,35 Therefore, in those settings in which traumatic LP is particularly undesirable and the benefit of transfusion outweighs the disadvantages, such as the diagnostic LP in a child with ALL and circulating leukemic cells, platelet transfusion for a count of 100 × 103/µL or lower is warranted. In our previous study, we found that LP was safe when performed in pediatric patients with ALL at platelet counts of 10 × 103/µL or higher,32 with no increased risk of neurologic or hemorrhagic complications, such as spinal hematoma. Therefore, to perform routine LP for administration of intrathecal chemotherapy, a platelet count of 10 × 103/µL or higher is adequate. However, if the patient has circulating leukemic cells or bacteremia, a higher platelet count is needed to reduce the risk of traumatic and bloody LP, which may adversely affect the prognosis27 and necessitate additional intrathecal chemotherapy.40
A short interval since the previous procedure is the strongest predictor of traumatic or bloody LP. The risk for both traumatic and bloody LP decreased as the interval between procedures increased. After 15 days, the unadjusted proportions of traumatic and bloody LPs were the same as those of the first LP (Figure 2). These findings suggest that blood leaks into the CSF after the procedure but clears during the subsequent 2 weeks. Furthermore, when the previous platelet count was 50 × 103/µL or lower, the risk of traumatic or bloody LP was elevated, which implies that leakage of blood into the CSF of a thrombocytopenic patient is of greater magnitude or duration than that of a patient with a normal platelet count. If bacteremia occurs after LP, when blood is still leaking into the CSF, it may increase the risk of meningitis. In fact, Gaur et al26 found that of 12 patients with Bacillus cereus bacteremia, 4 developed concomitant meningitis. All 4 had undergone LP during the week before the bacteremia compared with none of the 8 patients whose bacteremia was not associated with meningitis. Hence, if medical circumstances allow, the subsequent procedure should be performed more than 15 days after the previous LP. In patients with definite evidence of leukemia (ie, the presence of circulating leukemic cells), we now administer intrathecal chemotherapy immediately after obtaining CSF for examination with the diagnostic LP, obviating the need for repeated LP for intrathecal chemotherapy in a short period. For other patients, we delay the LP and intrathecal chemotherapy until the diagnosis of leukemia is established.
Strengths of this study include a large number of patients and LPs, a variety of practitioners who performed the procedures, and a racially diverse group of pediatric patients. To our knowledge, this study is the first to assess the effects of thrombocytopenia, repeated procedures, and (indirectly) adequate anesthesia on traumatic and bloody LP, and our findings translate directly into recommendations for patient care. Our results remain essentially the same when the analysis is limited to patients with platelet counts of 25 × 103/µL or higher and when bloody LP is defined by 200 or 1000 RBCs per microliter of CSF (data available on request from the authors).
In this study, most LPs were performed in children with ALL by using conscious sedation or general anesthesia; therefore, results should be applied with caution to other pediatric populations. However, LPs were performed by a variety of caregivers (pediatric oncologists, oncology fellows, oncology nurse practitioners, and residents); thus, results of procedures performed in other settings may be comparable. Another potential weakness of this study is the possible misclassification of the traumatic or bloody outcome of LPs. If an LP is difficult to perform and CSF is not obtained or is grossly bloody after several attempts, a more experienced practitioner may perform the procedure and obtain clear CSF. Alternatively, a traumatic or bloody LP by a more experienced practitioner may be the result of earlier failed attempts by a less experienced practitioner. A sensitivity analysis of such misclassification showed that if the outcomes of as many as 10% of LPs were misclassified, our results would change little. Another weakness is the lack of information about the LP needles used and the type of anesthesia administered and whether the procedure was difficult to perform or required multiple attempts.
In conclusion, unmodifiable risk factors for traumatic and bloody LP include black race, age younger than 1 year, a traumatic or bloody previous LP performed within 2 weeks, and a previous LP performed when the platelet count was 50 × 103/µL or less. Modifiable risk factors include procedural factors as reflected by the treatment era, platelet count, a short interval between LPs, and a less experienced practitioner.


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CG at the North Shore Academy for Home Room Heroes Breakfast Event
Mar 23, 2017
Consul General was delighted to interact with students of North Shore Academy du …
Welcome to the website of the Consulate General of India, Chicago. Our endeavor is to provide useful information pertaining to the consular, visa and other services offered by the Consulate. The website also serves as a useful gateway for obtaining information on tourism, art, culture, trade and economy of India.
We would suggest the visa seekers to plan their trips to India sufficiently in advance to give enough time for processing of their visa applications through the outsourcing agency Cox & Kings Global Services,US. The Consulate would be pleased to provide the visa seekers with any information pertaining to various places in India.
The Consulate General of India, Chicago strives hard to render timely services to the Indian nationals and Persons of Indian Origin. The Consulate would be pleased to assist visa and consular applicants in case they face any difficulties or delays in services. We look forward to your valuable suggestions and feedback through our 'Contact Us' link. We thank you for visiting the Consulate General of India, Chicago website.
Best Wishes,
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IANA reports strong third quarter 2010 intermodal volumes
Domestic volumes hit an all-time high despite container shortage
Events in the News
ProMat Show Preview 2017 Despite signs of progress, Federal Railroad Administration calls PTC implementation 'uneven' Despite sluggish volumes, IANA's Casey makes case for future intermodal growth at RailTrends Railroad leaders stress importance of trade deals KCS and BNSF team up for cross-border intermodal service to begin in December More Events NewsEvents Resource
Unwrapping the Hidden Value of a Parcel System The growth in e-commerce sales and omni-channel distribution has forced more shippers to re-evaluate the way they handle parcel shipments.All Resources
While various freight trends have seen numerous stops and starts in 2010, intermodal transportation is not one of them, according to the results of the third quarter Market Trends report from the Intermodal Association of North America (IANA).
In the third quarter, IANA stated that third quarter intermodal loadings—at 2,995,043—were up 20.3 percent year-over-year. This was ahead of the second quarter's 2,829,971 and behind the first quarter's 3,019,310.
Along with a 20.3 percent annual gain in total intermodal loadings, IANA said that the four major intermodal categories it tracks were also showed gains. Domestic containers—at 1,162,460—were up 13 percent. International containers—at 2,011,775—were up 28.1 percent (marking the second time since the second half of 2006 that international topped domestic containers. All domestic equipment—at 1,591, 227—was up 11.7 percent, and trailers—at 428,767—were up 8.5 percent (trailers have been down 19 of the last 23 quarters).
"Intermodal activity, particularly from the international-driven side, is somewhat of a leading indicator as to what the expectations are for the economy," said Tom Malloy, IANA Vice President of Member Services, in an interview. "A driver for intermodal's continued momentum is the optimism—and confidence—by supply chain managers in bringing materials in from overseas."
The Market Trends report supports this view, noting that the resurgence of international intermodal is primarily due to stronger container import volumes. But even with international container volumes up nearly 30 percent in the third quarter, IANA said they are still well below peak levels from the third quarter of 2006 as seasonally-adjusted third quarter international volumes are 11.7 percent below peak levels.
Domestic volumes for the third quarter, according to IANA, hit an all-time in the third quarter, with the report stating that domestic container shipments continuing to outpace the overall economic recovery in conjunction with intermodal shipments gaining share over other modes of freight transportation.
"Domestic activity is off the charts right now, especially for domestic containers of North American origin and termination, and are up over previous high points from 2008 and 2006," said Malloy. "This is a good story. Had there been more containers [available] there likely would have been increased domestic container activity. This means equipment managers are doing a much better job of managing load-to-load churn, which is key for the companies that own them, the manager that runs them in order to maximize revenue opportunities for these pieces of equipment on an annual basis."
IMC Performance: Intermodal Marketing Companies largely saw percentage gains on an annual basis in the third quarter, with intermodal loads—at 286,035—up 12.3 percent, and total loads, including highway which was down 7.9 percent at 144,284, up 4.6 percent at 430,859.
IMC intermodal and highway revenue—at $669,111,766 and $194,770, 436—were up 13.8 percent and 5.1 percent, respectively. Total revenue—at $843,083,202—was up 9.0 percent. Average revenue per intermodal load—at $2,339—was up 1.3 percent, and average revenue per highway load—at $1,345—was up 14.1 percent.
About the Author
Jeff Berman, Group News Editor Jeff Berman is Group News Editor for Logistics Management, Modern Materials Handling, and Supply Chain Management Review. Jeff works and lives in Cape Elizabeth, Maine, where he covers all aspects of the supply chain, logistics, freight transportation, and materials handling sectors on a daily basis. Contact Jeff BermanSubscribe to Logistics Management Magazine!
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Article Topics
Container · IANA · Intermodal Association of North America · Tom Malloy · Trailers ·5 Supply Chain Trends Happening Now 2017 Warehouse/DC Equipment Survey: Investment up as service pressures rise View More From this Issue


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Framing Labor Cost Per Sf
I have always done my own framing but work is starting to pile up and I'm looking to sub out the framing. What ranges should I expect to get for framing cost per sf. (floors, walls, sheathing, roof sheathing) Scheduling is not working in my favor at the moment so I have to bring in an outside crew. Looking to have them do a second story over an existing ranch house with a flat roof. Only half of the second floor is being framed into living space, the other section will just be to build a pitched roof over the old flat roof. House footprint now is 1800sf.
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Foundation for Endangered Languages
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FEL XIII: Endangered Languages and HistoryThis page last updated: 13 December 2009 Programme | Visa and travel information | Accommodation | Conference Proceedings [русский] Post-conference updatesConference resolution (in English and Russian) Photos (photos of the conference participants and environment) OrganisersThe Foundation for Endangered Languages, in association with the Academy of Sciences of Tajikistan, the Institute of Ismaili Studies, London UK, and The Institute of Humanities, Khorog The Foundation for Endangered Languages, in association with the Academy of Sciences of Tajikistan, and The Institute of Humanities, Khorog Programme: see the Draft ProgrammeVenueInstitute of Humanities, Academy of Sciences of Tajikistan, Khorog Tajikistan. See below for travel and visa information. Important Dates
Conference themes:Endangered languages are often the remnants of old nations and civilizations. Many of these languages have been widely used in vast territories for centuries before giving way to more powerful and influential languages over a period of time for various social, economic, literary, political, and natural reasons. It is often precisely in the endangered languages of minorities and indigenous peoples that scholars seek answers to the historical developments of nations, their values and ethics, agricultural activities, habitat, way of life, migration patterns, arts and crafts, religious traditions, archaeological findings, etc. Endangered languages can serve to legitimise the sovereignty of the dominant nations, or to reaffirm their identity and authority over the territory, often at the expense of other languages. In the process, the endangered languages themselves may be strengthened or weakened as the past of the nation becomes a bone of contention. History also has value in the life of a community and can foster and promote a sense of identity among its members, thus perhaps playing a crucial role in the preservation or revitalisation of the endangered languages. The conference will discuss the complex interaction of Endangered Languages and History and how the study of history can encourage the preservation and promote the revitalisation of endangered languages. The following are some of the aspects of this interface which could be discussed at the conference, certainly not an exclusive list:
The languages of the conference: English, Russian and Tajik. Abstract and papers will be accepted in any of these languages. PresentationsEach presentation at the Conference will last twenty minutes, with a further ten minutes for discussion and questions and answers. Keynote lectures (by invitation only) will last forty-five minutes each. Visa and travel information: see the Visa and travel information pageAccommodation: see the Accommodation information pageFees
The fee includes conference fee, accommodation, food, travel to Khorog by road, an excursion to the Badakhshan region, the conference proceedings. The fee also includes annual membership of FEL. Note: The fee does not include expenses in Dushanbe. The local organising committee can arrange booking hotel in Dushanbe on request. The price will range from US$50-US$150. The fee can be paid by one of these methods:
International bank account number: GB95 CPBK 0890 0250 0734 56 About the organisers


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Over the years Green Care NGO has been operating from a small two room office in the Bui division in the North West region of Cameroon. With our fast growing activities and staff there has been an urgent need to grow and move to a larger location. Green Care has recently acquired a site to construct a new office that will be a used as an agroforestry training center. This will give Green Care the ability to expand their reach to the whole North West region of Cameroon. Green Care will therefore be able to train many communities in agroforestry and environmental best practices. Major progress has been made in the last few months with the complete design of the building, and receiving approval from the local council to start construction. The first stage of this project has been completed as of the 28th of May 2012 thanks to many volunteers. This is including an American Peace Corps, a British Engineer, many local villagers from Shisong and Kumbo, along from the traditional head of Shisong "Shufai Wang". The first stage of this project has become a reality thanks to the support and funds we have already received from Global Giving. The ability to complete the next stage of this project is mainly hindered at present by lack of finance. It is a common hope that funding can be raised to enable Green Care to continue to fulfill the needs of the community and grow as a regional training center.
The new Bui Division Agroforestry training center will have many different aspects in its entirety. The building will be equipped with a large library and a small internet café, a conference room/training room, a sanitary room for honey production, a personal office for Green Care staff, two bathrooms (in which all waste will be recycled), and a storage room. With this new building we will be able to hold workshops on agroforestry and environmental best practices, along with HIV/AIDS awareness, computer classes, continue with an environmental education club in collaboration with a local Shisong school, and also have workshops with individuals with disabilities.
We would like to thank you in advance; it is a true honor to have this opportunity to have our goals reached. This new office will enrich the lives of everyone involved, mostly the grass root villagers, and the entire North West region of Cameroon.
Thank you,
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Hey Ballston! I'd like to introduce you to a new exhibitor who will be joining us for the the last market of the season on October 8th -- April Alayne!
April has been drawing since I could hold onto a brush. And it shows! Her favorite things to draw are people and ideas. She also enjoys doodling cute characters or personifying otherwise everyday objects. April's inspiration from emotions, colors and movement. Basically life.
Check out her amazing illustrations, artwork and jewelry designs at the FINAL market of the season on Saturday, October 8th.
Tuesday, September 27, 2011
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The Historic Review Commission of Pittsburgh has scheduled the following hearings in the East Carson Street Historic District for 1 p.m. on Wednesday, Nov. 2, following Internal Business beginning at 12:30 p.m.
2205 East Carson Street, Carnegie Library of Pittsburgh, owner and Loysen and Kreuthmeier Architects, applicant, for infill of basement windows, installation of metal louvers, etc.
1611 East Carson Street, 17th Street Partners, L.P., owner, and AT&T Mobility, applicant, for installation of cellular antennae screening.
1601-1605 East Carson Street, 16th & Carson Street Partners, owner and applicant for changes to previously approved roof deck plans.
1401 East Carson Street, John Vetere, owner and applicant, for installation of a tw0-story roof deck.
The Historic Review Commission of Pittsburgh meets in the First Floor Hearing Room, 200 Ross Street. The meeting is open to the public. Contact Sarah Quinn with Questions and comments at 412-255-2243 or firstname.lastname@example.com.


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text: Here's What Those Bumps In The Sidewalk Are ForTom McParland2/09/17 11:02amFiled to: SidewalksInfrastructureConcreteAccesibilityMobility45176EditPromoteShare to KinjaToggle Conversation toolsGo to permalink The next time you walk down a sidewalk and come to a street crossing, you may notice some strange bumps and patterns in the concrete. I always thought these were for water drainage or extra traction. I was wrong! The real reason is much more complex and fascinating. Advertisement In short, it's to help people with disabilities get around a little easier. The following video is from the UK's Royal National Institute of Blind People, and it gives an amazing explanation of not only why these patterns in the concrete exist, but also how the various patterns allow people with limited or no sight navigate the city safely.The integration of sidewalks and roadways in a major city is a massive undertaking for engineers who must take into account all kinds of populations, and how people with varying abilities will interact with the environment. My wife is a wheelchair user and we have traveled all over the globe. I can tell you from experience that the littlest details such has a flush curb cut (where the sidewalk meets the road) and an easy transition from one surface to another can either make a city easy to get around or a hazard.Those who don't live with a disability, whether it be a mobility impairment or blindness, may never notice this complexity. But it's necessary to design an infrastructure that promotes the safe transportation of all people. Advertisement (H/T to ttyymmnn!)Recommended StoriesBlind Man Sues McDonald's For Right To Use Drive-Thru Without A CarWhat Happens When The Airline Breaks Your WheelchairHow A Blind Mechanic Sees The WorldTom firstname.lastname@example.com is a contributing writer for Jalopnik and runs AutomatchConsulting.com. He saves people money and takes the hassle out of buying or leasing a car. Reply451 repliesLeave a reply


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COLUMBUS -- A gay soldier who was booed during a GOP primary debate last year after asking a question about homosexuals serving in the military has joined an effort to place a gay marriage amendment before Ohio voters.
Stephen Snyder-Hill and his husband, Josh, will serve on the steering committee for Freedom to Marry Ohio.
"I've been in the military for 24 years of my life fighting for everybody else's freedom except my own," Snyder-Hill said during a press conference near the Statehouse Friday. "The military's been very supportive of everything that I've done, because it's been a good story. It shows that gay soldiers are no different than straight soldiers and we can do just as good of a job."
The Columbus couple plan to assist in an effort to overturn a 2004 constitutional amendment that blocked the state from recognizing gay marriages and civil unions.
Gay marriage advocates have proposed amending the constitution to allow two consenting adults the freedom to marry, regardless of their gender. The proposed amendment also includes language allowing churches to refrain from performing such ceremonies.
The issue would require upward of 380,000 valid petition signatures to qualify for the general election. Backers on Friday declined to comment on how many signatures they have gathered to date, nor would they commit to the November ballot.
On Friday, Snyder-Hill described the challenges of serving in the military as a homosexual and the need to change Ohio's constitution to recognize committed gay relationships.
"Everybody sacrifices a lot when we serve our country," Snyder-Hill said. "Gay people have sacrificed so much more, because just to be able to serve our country, they've had to lie and make up fake pictures and fake names. It's just ridiculous. That's why we really feel like we need to fight this fight."
Marc Kovac is the Dix Capital Bureau Chief. Email him at email@example.com.


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"Murphy was an optimist!"
How's dinner? November 10, 2008 10:05 pm
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Meanwhile, Serb soldiers in eastern Croatia grudgingly surrendered their weapons and uniforms, completing the demilitarisation of Croatia's last Serb-held region. The process is considered a key step in the re-establishment of Croatian government rule over an area that Serb rebels had controlled for almost five years. AP - Vienna
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{"id":12414,"sku":"ROB-12414","name":"Clamping Hub - 1\" Bore (Threaded)","description":"
These threaded aluminum clamping hubs are perfect for standard applications that need shafting or tubing 1\" in diameter secured safely. These clamping hubs have a 1\" bore, an outer diameter of 1.31\", four 6-32 tapped holes, and one ¼-20 x ½\" machine screw for tightening.<\/p>\n\n
Actobotics<\/a> is a robotics building system based around extruded aluminum channels, gears, precision shafts, and ball bearings. Thanks to the two standardized hole patterns, nearly all Actobotics components can be intuitively connected together. The wide range of components makes building complex electromechanical prototypes or finished projects a reality.<\/p>\n\n Dimensions:<\/strong><\/p>\n\n Documents:<\/strong><\/p>\n\n\n


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I'm not in good shape, and I don't know if I ever will be. I do enjoy several physical activities, though. One of those activities is walking. It started a few years ago for me. I had gone down to part-time and I was looking for things to do on my days off. I decided to get into walking. Now, I go for at least one walk a week. The town I live in is pretty nice, even if it is dull activity-wise.
As I walk, I find that I need music to help me along. I don't know why, though. Maybe it's because the beat propels me along, or maybe it's because it inspires my writing, or maybe it's my homage to the idea of the movie montage, but music has always helped me as I walk.
I would now like to talk about some of my favorite songs to listen to when walking.
I'll start off with a track by a woman who has consistently acted in energetic ways throughout her career. That woman is Madonna.
Her self-titled album from 1983 is loaded with powerfully danceable tracks that can really get you moving. The track that I find most suitable for walking is "Think Of Me". The beeping that starts off the track leads into a great synth-line and then those vocals kick in. The song is physical in that, to my ears, it entitles a lot of walking in and out of the lives of Madonna and her lover. As I walk, I can get the top half of my body into the act as well, swinging my head back and forth and making movements with my hands like waves and pointing gestures. I can get the whole operation moving with her music. There are plenty of other Madonna tracks that could go here, but this is what came to mind.
The next track I can think of has a different beat to it, but is great for walking to nevertheless.
It comes off the album "Come As You Are" by Peter Wolf.
The track is a James Brown-sounding track called "Thick As Thieves". The instrumental section provides a great charge to the feet, with a wailing horn section and a bass line that can charge through you like an electrical current.
The song has aspects of walking as well. The track is about Wolf's distress with people who want to take him for all he has...His money, his soul, his life. I think the first verse can really get your walk going:
"Butchers walking down the street,
(Thick as thieves, thick as thieves!).
Thinking I'm a piece of meat,
(Thick as thieves, thick as thieves!),
Like to hang me on a hook,
Cut me up and call the cook,
Keep them bastards 'way from me,
I'm getting sick of thieves!".
Constantly moving to get away from all the disturbances in your life...Sometimes that's what I'm about when I'm walking. When you get down to it, though, aren't we all trying to get away from our disturbances?
The next track that comes to mind as great for walking is the song "Tip Of My Tongue" by The Tubes.
The song has a walking quality to it...Actually, more like a strut. The horns, guitars and synths work together to create a blue-eyed soul piece that can accompany walking well. The song itself isn't about walking, though...It's actually about something far more risque, but I can imagine lead singer Fee Waybill strutting through town in order to get to what the song is about. Let's just say that, if this were the 80s, it would probably involve a woman who looked like this:
It was the style of the 80s, so please don't knock it, alright?
Now the horns come in again for a song with a more nihilistic bent to it.
It's the title track of Oingo Boingo's 1982 album "Nothing To Fear".
The type of walk that goes with this is a walk of apocalypse. Have you ever had one of those days where everything about you says "People are Hell...The buildings are Hell...Everything is Hell"? I've had days like that, and I've walked with eyes furrowed and looking straight ahead. I can feel a sense of anger within myself. It eventually subsides, but I can hear it mimicked in Danny Elfman's hyper-kinetic vocals and the group's instrumentation. Danny is sounding like the town crier for the coming darkness...I occasionally feel that way, too, but more often than not, I usually sound like the village idiot.
On a lighter note, I think that "Once In A Lifetime" by Talking Heads is a great track for walking to.
Of course, the walking is best demonstrated in the video for the song. In the video, David Byrne looks like Jerry Lewis' arty younger brother as he's preaching a strange sermon about a man's expectations of the world.
Throughout the video, with the use of visual effects, we see lots of Byrne clones walking around in a rather bizarre manner with affectations of The Monkey done in a rather slow way. I don't walk like that, though. My walk for this song is done in a confident manner. I listen to this song, and there's a refreshing feel to it that can be reflected in my steps. Your mind-set can not only define your day, but your walk as well.
As explored in previous articles, mind-set can help define your age as well. A movie about age provided me with the next song on my list. From the movie "Cocoon" came the track "Gravity" by Michael Sembello.
In the movie, the song is used as a background for a sequence that shows the older actors engaging in the behaviors of the younger, from playing in toy stores to dancing the (then) current steps. These people are able to walk again in a sturdier manner than their ages may suggest.
Sometimes I feel a little too old as well, but a song like this can get my blood flowing as I walk around the blocks.
My town is pretty nice, and I can connect walking, a restaurant in my town and a song all at once.
In 2006, on a day off, I was walking around town with one of my mix discs. The track I was listening to was "The Lucky One' by Laura Branigan.
Branigan's tracks always had a great charge to them that inspires my walking. The rhythm gets me to moving like I'm in a montage from an 80s movie. This song has those qualities. You listen to this and you're out and about, striving to meet the challenges of what's going on and trying to keep your head above water. That's how it's always felt for me whenever I've been out and about. On this particular day that I was listening to this track, I was walking all about, up this street, down that one, across near the fire department building. I then went to the local Subway restaurant.
I always read on other message boards how people connect food to memories, and this is the restaurant I connect to this memory. It wasn't a big day...Nothing important happened. It was just an average day, lifted by an above-average sandwich and a superb song by a wonderfully talented singer. Why did she have to die? Why couldn't a mass murderer or a rapist have died in her place? You know, someone who actually deserved to die? Ms. Branigan didn't deserve to die...I wish she was still around. She could probably be making some pretty good music today if she lived.
These are 7 tracks that I feel are great for walking to. One track for each day of the week. Burn them together and see what you can do with your walking.
Have a good day!
The Sounds Of My Footsteps
Here are some of my favorite songs to listen to when I'm walking.
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finally! looks very cool!
You wake up in a dark alley, not knowing anything. What has happened anyway? You struggle after the truth and answers. Answers you want to know in the darkness and fear, which makes your heartbeat race like violent blows against your head. Where do "they" come from? What has happened? Are you just turning insane? The time is up; you can't stay there reading your smses forever. It's time to head out and find the answers. Cry of Fear is a singleplayer modification of Half-Life 1 which brings you the horror you've always been afraid of. It's a total conversion of Half-Life 1, which means it uses NO Half-Life 1 content or other peoples' files. It's all made exclusively by the developers. It also uses new gaming styles that you will rarely find in Half-Life mods, such as advanced cutscenes and other stuff that will be revealed at a later date.
there should be some pretty epic battles. can't wait for may 20th then!
Looks like the police forces of Sweden found a real interest in Simon's book. Their emotions allowed the hordes of darkness to grow even more in numbers. And now, the fate of the world shall be decided in a fictional enviroment...
Well, that or it's just one badass survival mode. Awesome job as always Team Psyskallar. There are not enough games with survival mode these days, I am sure it's gonna be lots of fun. Also, congratz on giving birth to something even WORSE then the Sawrunner. Well done... You mangificent bastards.
ok at least ad a law rocket launcher (1 or 2 shots max) so we can take out the tallers with out losing most a squad.
Looks cool. Also, co-op seems near impossible. Me + friend can't even get past the first street. I know it was designed for four players, but it's a bit, well, you knwo... too much
Type in console "difficulty 1", it's possible with two people.
Me and my friend were able to beat the co-op without affecting the difficulty. It's just fine. The first levels were preaty easy to get past. Some levels we kept dying on, but after a few tries, we beat them.
It is possible , but you need to knows some "tactics" and probably play SP to get hang of it a bit. I will give you a "golden" tip: Do not kill every monster you see in Co-op. You will just waste too much health and bullets. Better run past them. Though you can do as Gonzo says if you want Co-op to be easier and don't want to play SP.
Haha well I did not finish SP all the way through, watched walkthroughs instead. I'll keep running past them in mind, though.
Time attack? Pretty neat. Any chance of a boss player vs all type game in the future? That would be fun.
Definitely makes me want to go online and wreak havoc! But I'm surprised by the list of servers out there; none existing.
The story I guess is:
The police run in before Simon even finish writing the book and somehow the police get stuck into it. As the book isn't finished, there are no ending for them. What they really can do is survive until the times over and Simon suicide.
Only registered members can share their thoughts. So come on! Join the community today (totally free - or sign in with your social account on the right) and join in the conversation.
Here's our trailer for the upcoming patch!
Buy Cry of Fear t-shirts here: Teampsykskallar.spreadshirt.se
Get the Cry of Fear soundtrack here: Cdbaby.com


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KIRKLAND, Wash. — A Kirkland woman is facing charges of stalking and trespassing after allegedly trying to scale a security fence at former American Idol runner-up Clay Aiken's home on April 3, the Kirkland Patch reported.
According to the website, 57-year-old Barbara Jean Saylor scaled a security fence and looked into Aiken's windows at his North Carolina home. She was ordered to leave the property, and only did so after police had been notified.
Aiken decided to press charges against Saylor, the Kirkland Patch website reported, saying the woman has done similar things in the past. She was arrested by Chatham County sheriff's deputies and is scheduled to appear in a North Carolina county court April 24.


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5 Perfect Protein-Packed Gym Snacks
The muscle-building ideal is 25 to 40 grams of protein, half before and half after your workout. Bring these convenient snacks to the gym to fuel growth.
14-22 grams protein
66-100 calories
Wrap one of these standbys in a piece of bread. Four slices of chicken or turkey provide 14 grams of protein, while half a can of tuna has nearly 22 grams.
19 grams protein
232 calories
They're still incredible after all these years. Hard-boiled eggs are most convenient, but it's also easy to scramble a few in the a.m. and scoop them into a microwavable container. Don't sweat the fat: It's healthy and filling.
About 17 grams protein
333 calories
Refresh and rebuild at the same time. A study in the Journal of the American College of Nutrition shows that chocolate milk may be the ideal postworkout beverage for building muscle.
24 grams protein
110 calories
This milk-derived product continues to rule the gym. Mix it with milk instead of water if you want a bit more protein. Try Nitrean; it has whey isolate for quick absorption, and casein, which is digested slowly.
Ready to boost your post-workout shake? Then click here for the best ways to Blend the Ultimate Smoothie.
15 grams protein
80 calories
Greek-style yogurt is a lifter's dream: It's easy to carry and packed with protein. Skip yogurts with fruit and sugar; to add flavor, drop in a few berries or nuts.
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"Protecting Research Subjects in the Digital Age: Lessons Learned the Hard Way"
2010-2011 Ethics Grand Rounds are sponsored by the Ethics Core of NC TraCS Institute, the UNC Office of Human Research Etihics, and the Center for Biomedical Ehtics (and other units when topics are appropriate). Talks will be the 3rd Thursday of every month from 12:00-1:00 in Room 219, Brinkhous-Bullitt. These events are headed up by Dr. Gail Henderson (firstname.lastname@example.com | 843.8268).
When |
Sep 16, 2010
from 12:00 PM to 01:00 PM |
Where | TraCS conference room #219, Brinkhous-Bullitt second floor |
Contact Name | Gail Henderson |
Contact Phone | 843.8268 |
Add event to calendar |
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Monday, October 26, 2009
The ONeal and Henson Family
I had such a wonderful time working with the ONeal/Henson family! It was another gorgeous day in Springfield as we set out on our adventure to capture some family photos. We walked around Nathanael Greene and Doling Park on Saturday, and we could not have asked for a better Fall day to take pictures. The day was incredible, and lucky for us the fall colors were still hanging on. Here is a sneak people of my shoot with the ONeal/Henson family. I hope you enjoy them, because I had a great time taking them!
Wednesday, October 21, 2009
Jon and Courtney
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Awesome Powered PA Speaker!
The Yamaha MSR250 powered PA speaker offers up plenty of power for your investment, not to mention awesome sound and a host of features. The 250-watt MSR250 features a 10" woofer, 1" HF compression driver, plus built-in Level and 2-band EQ controls. Its lightweight enclosure is made road-tough, and can be placed where it will be heard best, thanks to its integrated pole-mount bracket. Thanks to its versatile ins and outs, this speaker can even accept inputs from two sources. If you want clean power, really simple transport, and amazing sound out of your portable PA system, take a look at the MSR250!Yamaha MSR250 250-watt Powered PA Speaker at a Glance:
- Made for Heavy-duty use
- First-class portable power
- Versatile two-channel in configuration
- Ferrofluid cooling
- Asymmetrical cabinet design
Asymmetrical cabinet design
Sound bouncing around inside a speaker cabinet can have a significant effect on the sound that comes out. The biggest problem is standing waves that commonly occur between parallel surfaces. Standing waves can interfere with and color the speaker's output, thus degrading sound quality. The standard solution is acoustic insulation material inside the cabinet, which does help, but it doesn't address the underlying problem of cabinet geometry. Yamaha has gone the extra mile in designing the MSR250 cabinets, employing a one-of-a-kind configuration that eliminates parallel inside surfaces and therefore the root cause of standing waves. Acoustic insulation is also applied to effectively deaden the space inside the enclosure. Elimination of unwanted sound inside the cabinet means that optimum sound can be delivered to where it counts the most: your audience.
Ferrofluid cooling
Any technology that involves power also involves heat, and this can result in compromised performance if heat generation is not effectively controlled. The current driving a speaker generates heat in the voice coil that, in extreme cases, can cause the speaker to burn out. But even if the speaker doesn't actually burn out, that heat still results in inefficiency and non-linearity that degrade overall performance. As the power and heat increase, the resistance of the voice coil increases as well, causing power compression, a loss in acoustic out that reduces the system's dynamic range. This problem is overcome in the MSR250 by placing an cutting-edge ferrofluid in the voice coil gap, where it serves to conduct heat away from the voice coil with much greater efficiency than air. The results are smooth, natural frequency response and dynamics plus stable performance even under heavy use.
Excellent portable power
The MSR250 delivers the ideal blend of power, performance, features, and portability for an exceptionally wide range of jobs. A newly designed class D amp delivers 250 watts of clean, dynamic power via a high-performance 10" cone woofer and 1" titanium-dome compression driver that match up perfectly for smooth, uncolored response from 55Hz to 20kHz. The woofer has an oversized 2.5-inch aluminum voice coila size you'd normally see on a 15" woofer that contributes to outstanding sound and durability. With all this power and performance the big surprise is how light and manageable this cutting-edge powered speaker is.
Versatile two-channel In configuration
For extra In flexibility the MSR250 features dual input channels, each with it's own low and high equalizer controls and level control. The signals from the two inputs are mixed and delivered via the MSR250 speakers plus the rear-panel line out connector, allowing useful linking to other speakers or audio devices for simple system expansion. Input 1 has balanced XLR and phone jack connectors that accept microphone or line in, and input 2/3 is actually a mixing input in its own right with phone jack and two pin jack connectors.
Made for heavy-duty use
Although it's lightweight and simple to handle, the MSR250 is exceptionally durable and will take the tweakiest tours in stride. It's also designed to be used in a bunch of situations, including normal upright and wedge-style floor monitor operation. There's also a built-in pole-mount receptacle for useful stand mounting.
Yamaha MSR250 250-watt Powered PA Speaker Features:
- Type: 2-way powered speaker
- Crossover frequency: 4kHz (LF, HF: 12dB/oct.)
- Overall frequency response: 55Hz-20kHz (-10dB)
- Max SPL: 116dB (1m on Axis)
- Dimensions (W x D x H): 13-1/2" x 21 1/2" x 11 3/4"
- Weight: 31.1 lbs.
- LF: 10" Cone
- HF: 1" V.C. compression driver
- Enclosure type: Bass-reflex
- Material: Polypropylene
- Suspension/mounting: 35-36mm pole socket
- Amp class: Class D
- Out power: 200W at 1kHz
- Max Power: 250W
- Input/output connectors: Input 1: XLR-3-31/1/4" balanced; Input 2/3: 1/4"/RCA-PIN (unbalanced); Link Out: 1/4" unbalanced
- Level control (inputs 1, 2/3)
- EQ: 2-band
- Power On indicator: Green LED
- Clipping indicator: Red LED
- Power consumption: 40W


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EAT : Diets are made to go "on" and "off of", and if you're like most people—who want to be fit, lean, alert and healthy—you don't want to diet. You want to eat naturally and normally, in a way that helps you have the body and lifestyle you deserve to enjoy. In EAT, Dr. Ian Smith has created a blueprint for you. It's a flexible and intelligent plan you can follow every day, in every situation—eating out, working late, traveling, cooking for the holidays—and that will urge your body to perform at its peak. You'll drop any excess pounds you need to lose. You won't worry about what you "can" and "can't" eat, but will listen to yourself and eat smart.Dr. Ian's Ten Simple Rules for Good Eating tell you what the experts know:--Follow the Rainbow: if you eat color, you're getting vitamins and minerals in the right package--Carb Heaven: don't ban carbohydrates—or any nutrient group!--The Whole Truth About Whole Grains: they may not be what you think they are, and you should be eating them all the time--Feel Full Fiber: it's magic at every meal--Protein Bonanza: all proteins aren't equal--Spicetopia: 5 of the tastiest and healthiest spices in the world--Size Matters: how to portion, and secret calories you don't know about--You are What You Drink: the miracle liquid and drinks that can wash out good eating--Unearthing the Organic Truth: it's not always healthier--The Power of Snacks: they can help you lose weight! Cut to the chase with Dr. Ian's EAT Plan at the end of each chapter, or become your own expert by reading from start to finish. Either way, EAT is not about denial. It's about permission….to live, to fuel your strong body, to eat!
Category | Subject | |
Health & Fitness | Weight Loss |


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Lyrics Depot is your source of lyrics to House Of Wonders by Insane Clown Posse. Please check back for more Insane Clown Posse lyrics.
House Of Wonders Lyrics
Artist: Insane Clown Posse
Album: Forgotten Freshness
(Violent J)
So there you are you're sittin' there just kinda chillin'
A richie boy you look a little bit like Dylan
The 90210 bitch with the funny hair
So I'm gonna change a few things around here and there
Start with your eyes I pluck 'em both out your head
And pull your balls out your sack and stick 'em there instead
Then I snap off your toes and stick 'em in your nose
And pull the hair out your head until your skull shows
You're almost ready, gotta fix you for the show tonight
But your lips, man, to me, they just don't look right
They could be a little fatter, even more
So fuckin' fat that your lip is draggin' on the floor
Tie your tongue into a knot and stretch it out
And tack a sign on it, tellin' what you're all about
Set you up, 'cuz now you're ready, so open up the door
'Cuz at the House of Wonders, you're the freak show
(Chorus x 2)
Carnival thrills
Carnival shows
Carnival excites you
Carnival kills
(Ahh, ooh, ahh, ohh)
Another freak show for the jugga-lugga-lo
So there you are, come on in, chickie, wow! Ain't you a pretty?
I think I'll start with the sillicone that's in your titty
I'll pull it out and put it in your forehead and cheek
So now, you look like the elephant bitch freak
Don't try to run, chickie-poo, I'm just gettin' started
I'll beat your head in with a brick until you're half-retarded
Remember that ugly girl you laughed at at the prom?
Don't try to laugh now, bitch, you look like her mom
You came to do the starin', but it's you they're starin' at
I'll stuff you full of chili-cheese dogs to make you fat
Then I'll stretch your fuckin' lips and stick 'em in your ear
So all that evil shit you talk, only you can hear
I shave you bald, and glue your titty on the top
And then I spit on your nipple until you drop
Hey! Almost ready? Jumpsteady, open the door
'Cuz at the House of Wonders, you're the freak show
(chorus x 2)
"Oh, oh, oh my God!!!!!
"Oh, oh, oh my God!!!!!
"Oh, oh, oh my God!!!!!
"Oh my God!!!!!"
(chorus until end)
Insane Clown Posse Lyrics
Insane Clown Posse Forgotten Freshness Lyrics
More Insane Clown Posse Music Lyrics:
Insane Clown Posse - First Day Out Lyrics
Insane Clown Posse - Headless Boogie Lyrics
Insane Clown Posse - Hey Vato Lyrics
Insane Clown Posse - How Many Times? Lyrics
Insane Clown Posse - Murder Rap Lyrics
Insane Clown Posse - Piggy Pie Lyrics
Insane Clown Posse - When I Get Out Lyrics
Insane Clown Posse - Witching Hour Lyrics


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Ignoring some of the negative comments, we had a full safety briefing plus information about the Southern Right whales before we embarked. We managed to see a mother and baby... read more
To put simply: if you ignore the fact that the staff know very little about whales, they are clearly just there to exploit the tourists; that the health and safety procedures are at best haphazardand seeing whales comes as more of a surprise to the staff as it does to the tourists, then this is the best whale cruise you... More
Booked for 9am. Boat arrives at the dock at 9.30am with customs! We waited in the queue till 10.30am and then decided to get a full refund. Should have trusted the recent reviews. All other companies were booked out so not totally surprising. I wonder why customs were on the boat for 60 minutes!
Ignoring some of the negative comments, we had a full safety briefing plus information about the Southern Right whales before we embarked. We managed to see a mother and baby whale but they were quite far away and you needed binoculars (which we didn't possess unfortunately). We left and returned on time. Refreshments were crisps and bottled water or soft... More
The trip departed an hour late because the previous trip was delayed. The sea was very choppy and it was very difficult to move about safely. I was knocked off my feet by a fellow passenger and was lucky not to be hurt. There was little information given about what was happening or about the whales. I travelled on the... More
Our family took the boat trip to see whales on the 14th of October. We were scheduled to be the first boat trip that morning, it turned out that they had an earlier trip, which returned 30 minutes late and we left 40 minutes after schedule. Before getting on the boat a staff member gave an explanation on what to... More
Excursion of 2 hours to see whales with 13 friends, ten friends sat at the top of the boat. That day the waves measured 2.5 m in height. During our tour the captain was in the cabin accompanied by two young ladies to whom wanted to impress, so he made the boat sailed very quickly, that made that people sat... More
Four of us went on a lunchtime cruise on 8 September. The weather turned rough very quickly, less than halfway through the cruise, with waves hitting us a cross the bow and the wind picking up. The staff closed most of the plastic covers for the openings, not that it did much good, but inexplicably left out the one where... More
The information we had from a number of sources was that whale numbers are down by about two thirds across South Africa this year. No idea why though. That equated to only 30 whales in Walker Bay rather than the normal 90+. Hermanus Whale Cruises was not our first choice but we ended up there with lots of Japanese tourists.... More
Okay, we did see whales, pretty close too. What I did not like was the lack of organization and education involved. I have been on several whale cruises, staffed by people who clearly love whales and want to educate you about them. The operators gave a short presentation, mostly stressing the sex life which I guess he thought would be... More
4 of us went on a recommendation. Having seen whales from the shore we were keen to see them closer up. Everyone had to choose their own life vest in a haphazard, scrambling unsupervised manner. This is important as the turbulant seas were at times violent and many were wearing ill fittings lifejackets, paying mere lip services to safety. There... More
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The Thunderdragon is one of the rising stars of conservative blogging- but being a youngster within blogging tempts one to ask the question upon what basis can one criticise anyone else's views given their more extensive experience of life. The Thunderdragon provides some thoughts as to what those answers should be in a guest post here. His answer is interesting- and basically takes the form of a suggestion that whilst he accepts his limited experience compared to those who are his elders, he still thinks that the perspective of someone young deserves to be heard. As a twenty six year old blogger I am tempted to agree with him: but I think there is something else worth adding to his comments.
It isn't merely the quantity of experience that can furnish someone with an aid to understanding politics, but also the quality of that experience. Knowledge and experience are related but they are not neccessarily equivalent. To take a simple example there are plenty of seventy year olds who have less understanding than I do of economics, the science of a changing situation than I do, partly because they have never studied calculus. There will be plenty of 18 year olds with a better understanding than mine because they studied economics for longer than I did. It is not merely experience but the type of experience that matters as to whether you understand politics.
What kind of experience furnishes you with the ability to understand politics- that is the kind of question that we could spend a thousand years debating. Obviously reading vast numbers of books about history and analyses of the past helps. Obviously working in political organisations furnishes you with another kind of wisdom. Watching films and absorbing culture allows you another kind of valuable perspective, as does understanding the sciences and social sciences like economics furnishes you with another perspective. The problem is that no one of these competing experiences is enough really to sort out the whole of politics- but each allows you to have an understanding. As throughout life the more of those experiences the more you can understand- but it does depend on the type of experience you have. Watching football matches, despite the fact that is what I'm doing right at this moment, won't furnish you with much direct knowledge of politics but there are many activities which will.
Because it isn't the quantity as much as the quantity of quality experience that matters- if like the Thunderdragon, myself, Matt Sinclair or Vino Sangrapillai you have spent a long time thinking about these matters your views matter and you can even teach sometimes those who are older than you. It is also worth remembering that fetishising experience over intelligence is also a failing- a canniness and ability to think logically matters as well- training in various arts and sciences can help in that. In the end, we are all in the position where we are losing and old or young the real moment when you can tell that you have lost the ability to transmit experience into useful knowledge is the moment at which you beleive yourself not to need to learn.
August 29, 2007
Wisdom from Babes
Posted by Gracchi at 7:34 pm DiggIt! Del.icio.us
Labels: blogging
1 comments:
- Vino S said...
That's an interesting and thoughtful post. I agree with you that, because the experience of one particular person, even over a long lifetime, is limited, then attaining the age of 70 or 80 may still not give someone enough experience to know what a wide variety of political and economic situations are like. This is where I suppose theory comes in. Those who have learnt economics or read history may thus be able to bring in ideas from outside their own personal experience to broaden their perspective.
- Thursday, August 30, 2007 7:20:00 am
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