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Introduction : Le choc cardiogénique (CC) compliquant l'infarctus du myocarde avec élévation de ST (STEMI) est grevé d'une mortalité élevée. Il existe des preuves limitées pour sa prise en charge, à l'exception de la revascularisation précoce.
Objectif : Nos objectifs étaient d'évaluer le pronostic et les facteurs prédictifs de mortalité précoce du CC compliquant un STEMI.
Méthodes : De janvier 2009 à août 2018, tous les patients se présentant dans les 48 heures suivant un STEMI, compliqué de CC et recevant un traitement invasif, ont été prospectivement inclus.
Résultats : La cohorte d'étude a compris 122 patients consécutifs. L'âge moyen était de 65±12 ans avec 74.5% d'hommes. L'insuffisance ventriculaire gauche était l'étiologie la plus fréquente du CC (72.1%) et des complications mécaniques sont survenues dans 8.2% des cas. Une intervention coronaire percutanée (ICP) a été proposée pour tous les patients et réalisée dans un contexte primaire dans 72.1% des cas. Une prévalence élevée de no reflow a été notée (15.6%). Des lésions multitronculaires ont été notées chez 64.8% et des ICP multitronculaires durant la procédure index ont été réalisées chez 22.1% des cas. Un ballon de contre-pulsion intra-aortique a été utilisé chez 17.2% des patients. La mortalité à 30 jours était de 58.2%. Le seul facteur prédictif de mortalité précoce était l'ICP multitronculaire immédiate (OR=4.1, IC95%: 1.1-14.5; p=0.031).
Conclusion : Malgré des stratégies de prise en charge invasives, la mortalité à 30 jours du CC post-STEMI est restée aussi élevée que 58,2%. L'ICP multitronculaire immédiate était le seul facteur prédictif de mortalité précoce.
Cardiogenic shock (CS) complicates 6–10% (1) of all ST elevation myocardial infarctions (STEMI). Its in-hospital mortality has been reduced from formerly 80% to 40-50% nowadays, however it remains the leading cause of death following STEMI (1,2), mainly because of a complex physiopathology which implicates both mechanical systole-diastolic dysfunction of cardiac pump and systemic inflammatory response syndrome (3–5).
There is only limited evidence regarding the management of CS (2), except for the proved impact of early revascularization (6,7) and the relative ineffectiveness of routine use of intra-aortic balloon pump (IABP) (8,9). Since SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial (6), few therapeutics advances have shown convincing clinical benefit (10).
Study population
From January 2009 to August 2018, we prospectively included all patients who presented within the first 48 hours of STEMI complicated by CS and receiving invasive management with percutaneous coronary intervention (PCI) and/or mechanical circulatory support. Transient (<30 min) CS or those from non-cardiac origin were excluded.
Interventional procedure
All patients were transferred to our cathlab for PCI-mediated reperfusion in primary setting, or after fibrinolysis. Fibrinolysis was indicated in patients with a stable hemodynamic status at first medical contact or when primary PCI could not be provided expeditiously (<120 min). In these cases, emergent coronary angiography was performed regardless of the ST resolution and the time from fibrinolysis administration. PCI were performed by six skilled interventional cardiologists and decision to carry out culprit-lesion-only or multivessel-PCI was at the discretion of the operator.
Emergency echocardiography was routinely performed at presentation in cathlab particularly when mechanical complications were suspected.
Patients with mechanical complications of STEMI were discussed for the optimal revascularization and surgical repair strategy by the local "heart-team" on a case by case basis.
IABP use, as the only available percutaneous mechanical circulatory support, was at the discretion of the operator.
Definitions and endpoints
The diagnosis of acute STEMI was defined according to the fourth universal definition of myocardial Infarction (11). Patients were considered in CS in front of persistent hypotension (systolic blood pressure <90 mmHg) despite adequate filling status with signs of low cardiac output and/or pulmonary congestion. CS was also considered if inotropes and/or mechanical circulatory support were needed to maintain systolic blood pressure >90 mmHg (10).
The primary endpoint of our study was to evaluate the 30-day all-cause mortality. The secondary endpoint was to determine predictors this early mortality.
Standardized definitions were used for all-cause deaths, recurrent MI, target vessel revascularization, stroke, stent thrombosis (12), and bleeding events endpoint criteria (13). Angiographic success was defined as a TIMI grade flow 3 with <20% of residual stenosis (14).
Statistical analysis
Independent groups were compared using the Student's t-test for continuous variables and Mann and Whitney's test in case of reduced effectives, whereas the chi-square test or Fisher exact test were used to compare the categorical variables. Risk factors were determined by evaluating the Odds ratio. To identify 30-day mortality predictors, a multivariate analysis using logistic regression was performed. At univariate analysis, the following variables were assessed: age, gender, cardiovascular risk factors, myocardial infarction history, chronic kidney disease history, anterior STEMI location, pre-hospital cardiac arrest, left main coronary artery disease involvement, concomitant chronic total occlusion, glycoprotein-IIbIIIa inhibitors, thrombus-aspiration, IABP use, no reflow and performance of multivessel-PCI. Patients with mechanical complications were excluded from analysis. Age, gender and variables with p<0.1 were included into a multivariable model. In all cases, p values <0.05 were considered statistically significant.
A total of 122 consecutive patients presented to our center with CS complicating STEMI during the study period. The baseline characteristics are summarized in Table 1. The mean age was 65±12 years and 75.4% were males. Smoking was the most reported cardiovascular risk factor (70.5%) and almost half of patients (49.2%) were diabetic.
A median time of 3.0 hours [IQR=1.3-5.6] between chest pain onset and first medical contact was observed in our population. CS was present from the outset in 94 patients (77.0%) and developed early after admission secondary to fibrinolytic therapy failure in 24 patients (19.7%), "no reflow" complicating PCI in three patients (2.5%) and was the consequence of a rapid aggravation of an acute ischemic mitral regurgitation despite a successful primary PCI in one patient (0.8%). Twelve patients experienced cardiac arrest (9.8%) and 13 patients (10.7%) were already intubated and mechanically ventilated before cathlab admission. According to localization, 58.2% of STEMI were anterior. At first medical contact or during transportation, prevalence of rhythm and conduction disturbances was particularly high with 20.5% of patients presenting with severe bradycardia (<30 beats per minute), 4.9% with sustained ventricular arrhythmia and 1.6% with rapid atrial fibrillation.
Fibrinolytic strategy was adopted in 34 patients (27.9%), only in one patient in a prehospital setting, using streptokinase (21.3%) or tenecteplase (6.6%), within a median delay of 52 minutes [IQR=30-125] after first medical contact. Fibrinolysis therapy failed in all cases except the particular situation of one initially hemodynamically stable patient, who developed an electrical storm and CS immediately after successful fibrinolysis, as assessed angiographically, in whom mechanical complications were ruled out, however the issue was fatal.
A median delay of 3.8 hours [IQR=1.5-7.1] was observed between first medical contact and cathlab admission. Interventions were carried out in primary, rescue and emergent setting after successful fibrinolysis in 72.1%, 27.1% and in 0.8% of cases, respectively. Angiographic characteristics as well as procedural techniques and results are summarized in Table 2. Nine patients (6 cases of mechanical complications requiring only IABP support as a bridge for surgery, 2 cases of early per-procedural cardiac arrests and one case with a long lesion and a poor distal vascular bed) did not benefited from PCI. Angiographic success of the coronary PCI of the infarct related artery was achieved in 91 patients for an overall success rate of 74.6%. Except 3 cases with complex coronary anatomy, in whom lesion crossing was impossible, "no reflow" was the main cause of PCI failure, occurring in 19 patients (15.6%) despite the use of glycoprotein IIbIIIa inhibitors and thrombus aspiration in 28.7% and 42.6% of patients respectively. The other minor procedural complications were as follows: coronary dissections (2.5%) and distal embolization (3.3%). All of them were successfully managed.
Multivessel coronary artery disease was present in 79 patients (64.8%) and PCI of non-infarct related artery was performed during the index procedure in 27 patients (22.1%) representing almost the third (34.2%) of patients and before discharge (staged revascularization strategy) in 4 patients (3.3%).
IABP was inserted in 21 patients (17.2%) of patients with a median duration of 43.0 hours [IQR=11.0-56.5].
The mean left ventricular ejection fraction was of 31.5±11.2%.
The considered etiologies of CS complicating STEMI in our series are illustrated in Figure 1. CS resulted from ventricular septal defect in 7 patients (5.7%) and from acute severe ischemic mitral regurgitation in 3 patients (2.5%).
At 30 days, overall mortality was 58.2%. Myocardial infarction recurrence, target vessel revascularization and stroke occurred respectively in 4.1%, 3.5% and 2.5% of cases (Table3). All patients experiencing mechanical complications (n=10) died, despite IAPB use in 7 cases (in whom peripheral vascular anatomy was favorable) and surgical repair in 3 cases (Figures 1,2).
IABP use was associated with non-significant increased 30-day mortality (76.2% vs. 55.4%, p=0.08).
After exclusion of patients with mechanical complications, multivariate analysis revealed that immediate multivessel-PCI during the index procedure was the only predictor of 30-day mortality (OR 4.1; 95% CI 1.1–14.5; p=0.031); while a trend was observed for the presence of a chronic total occlusion in non-infarct related artery (OR 3.5; 95% CI 1.0–12.9; p=0.055).
In Tunisia as well as in North Africa, data regarding CS complicating STEMI are scarcely reported.
The major findings of this 10-year prospective cohort-study can be summarized as follows: a) Overall 30-day mortality was 58.2% although a relatively early revascularization proposed to all patients and IABP circulatory support use in 17.2%. b) Analysis of early logistics of care showed mainly a 3.9-hour delay between first medical contact and cathlab admission. c) Left ventricular failure (72.1%) was the main cause of CS, followed by right ventricular failure (19.7%) and mechanical complications (8.2%). d) Multivessel coronary artery disease was present in 64.8% of patients and PCI of non-infarct related artery was performed in almost the third of them (34.2%). e) Immediate multivessel-PCI was associated with increased 30-day mortality in multivariate analysis.
Through this study, the early mortality appeared higher than that reported in recent publications (40 to 50%) (2). This could be due in part to the exclusion of mechanical complications in most of latter studies, which represented 8.2% of CS etiologies in our study population with a fatal outcome in all cases.
In the major CS trials (9,15,16), typical factors associated with higher mortality were older age, anoxic brain damage, lower left-ventricular ejection fraction, lower systolic blood pressure, need for vasopressor support, worse renal function, and higher serum lactate. However according to our multivariate analysis, immediate multivessel-PCI was the main prognostic predictor. Results of several reports (Figure 3) (17–25), pooled in a recent metanalysis, are consistent with this finding and do not support multivessel-PCI in the setting of CS complicating myocardial infarction (26). Previous guidelines, based on pathophysiological considerations, recommended multivessel revascularization in front of a critical or instable non culprit lesion or persistent ischemia despite culprit lesion PCI (10,14,27) and in the setting of persisting CS after revascularization of the presumed culprit lesion (28). The most notable argument was the potential to improve overall myocardial perfusion and function.
Multivessel coronary involvement represents up to 80% of patients with CS (29) and is associated with higher mortality (25,30,31). Despite these considerations, multivessel-PCI was used only in 14 to 39% of patients in a recent metanalysis of the most relevant 10 cohort studies of CS complicating myocardial infarction (26).
The CULPRIT-SHOCK randomized trial was designed to address this controversial problematic. In this trial, among patients with acute myocardial infarction and CS, the risk of death at 30 days was lower with culprit-lesion-only PCI than with immediate multivessel-PCI (32) and mortality did not differ significantly between two groups at 1-year follow-up (33). The given potential reasons for the lack of benefit of immediate multivessel-PCI were the significantly higher dose of contrast load in the second group and consequent decline in renal function although the incidence of renal replacement therapy did not differ significantly between the two groups. Furthermore, the higher dose of contrast load in the multivessel-PCI group may have also led to acute left ventricular volume overload with its potential negative effects on myocardial function and recovery. (32,33). Based on these findings, culprit-lesion-only PCI is currently recommended as the default strategy in patients with CS complicating STEMI in the recent European guidelines on myocardial revascularization (34).
The IABP, as the only available percutaneous mechanical circulatory support in our center, was used in 17.2% of cases. Among patients with mechanical complications, its insertion was possible in 70% of cases. Since 2012 and after the IABP-SHOCK II randomized trial failure to prove a prognostic benefit of IABP implantation in case of CS complicating acute myocardial infarction (8,9), European guidelines do not recommend any more routine IABP implantation, and this device should only be reserved for patients with CS due to mechanical complications as bridge to surgery (35). Among other short-term mechanical circulatory support devices that are currently available, only "extracorporeal membrane oxygenation" showed a potential benefit compared to IABP (36).
The main limitation of this observational study was the potential selection bias. The decision for or against multivessel-PCI was at the discretion of the operator. All confounding factors could not have been ruled out even after multivariate analysis. In fact, patients with refractory shock after culprit-lesion PCI could have been preferentially treated with a multivessel-PCI strategy.
In the setting of CS complicating STEMI, mortality remains high despite invasive management strategy. A better collaboration between emergency care providers should be targeted in order to reduce delays. PCI of the culprit-lesion only is actually the recommended revascularization strategy. While IABP use did not improve outcome, "extracorporeal membrane oxygenation" could be of benefit when managing this critical subset of patients.
Conflicts of interest: None
Figure 1: A. Aetiologies of cardiogenic shock after ST elevation myocardial infarction. B. 30-day mortality according to aetiology.
LV=Left Ventricle, RV=Right Ventricle, VSR=Ventricular Septal Rupture, AIMR=Acute Ischemic Mitral Regurgitation.
Figure 2: Kaplan Meier cumulative survival analysis at 30-day follow-up in patients with ST elevation myocardial infarction complicated by cardiogenic shock.
Figure 3: Overview of studies comparing multivessel versus culprit-lesion-only percutaneous coronary interventions in cardiogenic shock with respect to mortality.
*p< 0,05.
(1) Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 2009;119:1211–9. doi:10.1161/CIRCULATIONAHA.108.814947.
(2) Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic shock. Eur Heart J 2015;36:1223–30. doi:10.1093/eurheartj/ehv051.
(3) Hochman JS. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation 2003;107:2998–3002. doi:10.1161/01.CIR.0000075927.67673.F2.
(4) Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation 2008;117:686–97. doi:10.1161/CIRCULATIONAHA.106.613596.
(5) Reyentovich A, Barghash MH, Hochman JS. Management of refractory cardiogenic shock. Nat Rev Cardiol 2016;13:481–92. doi:10.1038/nrcardio.2016.96.
(6) Hochman JS, Sleeper LA, Godfrey E, McKinlay SM, Sanborn T, Col J, et al. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK: an international randomized trial of emergency PTCA/CABG-trial design. The SHOCK Trial Study Group. Am Heart J 1999;137:313–21.
(7) Hochman JS, Sleeper LA, Webb JG, Dzavik V, Buller CE, Aylward P, et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 2006;295:2511–5. doi:10.1001/jama.295.21.2511.
(8) Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. N Engl J Med 2012;367:1287–96. doi:10.1056/NEJMoa1208410.
(9) Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet Lond Engl 2013;382:1638–45. doi:10.1016/S0140-6736(13)61783-3.
(10) Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119–77. doi:10.1093/eurheartj/ehx393.
(11) Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2018. doi:10.1093/eurheartj/ehy462.
(12) Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, Es G-A van, et al. Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions. Circulation 2007;115:2344–51. doi:10.1161/CIRCULATIONAHA.106.685313.
(13) Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011;123:2736–47. doi:10.1161/CIRCULATIONAHA.110.009449.
(14) Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011;124:e574-651. doi:10.1161/CIR.0b013e31823ba622.
(15) Katz JN, Stebbins AL, Alexander JH, Reynolds HR, Pieper KS, Ruzyllo W, et al. Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery. Am Heart J 2009;158:680–7. doi:10.1016/j.ahj.2009.08.005.
(16) Sleeper LA, Reynolds HR, White HD, Webb JG, Dzavík V, Hochman JS. A severity scoring system for risk assessment of patients with cardiogenic shock: a report from the SHOCK Trial and Registry. Am Heart J 2010;160:443–50. doi:10.1016/j.ahj.2010.06.024.
(17) Zeymer U, Werdan K, Schuler G, Zahn R, Neumann F-J, Fürnau G, et al. Editor's Choice- Impact of immediate multivessel percutaneous coronary intervention versus culprit lesion intervention on 1-year outcome in patients with acute myocardial infarction complicated by cardiogenic shock: Results of the randomised IABP-SHOCK II trial. Eur Heart J Acute Cardiovasc Care 2017;6:601–9. doi:10.1177/2048872616668977.
(18) Zeymer U, Hochadel M, Thiele H, Andresen D, Schühlen H, Brachmann J, et al. Immediate multivessel percutaneous coronary intervention versus culprit lesion intervention in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry. EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol 2015;11:280–5. doi:10.4244/EIJY14M08_04.
(19) Park JS, Cha KS, Lee DS, Shin D, Lee HW, Oh J-H, et al. Culprit or multivessel revascularisation in ST-elevation myocardial infarction with cardiogenic shock. Heart Br Card Soc 2015;101:1225–32. doi:10.1136/heartjnl-2014-307220.
(20) Yang JH, Hahn J-Y, Song PS, Song YB, Choi S-H, Choi J-H, et al. Percutaneous coronary intervention for nonculprit vessels in cardiogenic shock complicating ST-segment elevation acute myocardial infarction. Crit Care Med 2014;42:17–25. doi:10.1097/CCM.0b013e3182a2701d.
(21) Cavender MA, Rajeswaran J, DiPaola L, Houghtaling P, Kiernan MS, Rassi AN, et al. Outcomes of culprit versus multivessel PCI in patients with multivessel coronary artery disease presenting with ST-elevation myocardial infarction complicated by shock. J Invasive Cardiol 2013;25:218–24.
(22) van der Schaaf RJ, Claessen BE, Vis MM, Hoebers LP, Koch KT, Baan J, et al. Effect of multivessel coronary disease with or without concurrent chronic total occlusion on one-year mortality in patients treated with primary percutaneous coronary intervention for cardiogenic shock. Am J Cardiol 2010;105:955–9. doi:10.1016/j.amjcard.2009.11.014.
(23) Bauer T, Zeymer U, Hochadel M, Möllmann H, Weidinger F, Zahn R, et al. Use and outcomes of multivessel percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock (from the EHS-PCI Registry). Am J Cardiol 2012;109:941–6. doi:10.1016/j.amjcard.2011.11.020.
(24) Cavender MA, Milford-Beland S, Roe MT, Peterson ED, Weintraub WS, Rao SV. Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol 2009;104:507–13. doi:10.1016/j.amjcard.2009.04.016.
(25) Webb JG, Lowe AM, Sanborn TA, White HD, Sleeper LA, Carere RG, et al. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol 2003;42:1380–6.
(26) de Waha S, Jobs A, Eitel I, Pöss J, Stiermaier T, Meyer-Saraei R, et al. Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 2018;7:28–37. doi:10.1177/2048872617719640.
(27) Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2016;133:1135–47. doi:10.1161/CIR.0000000000000336.
(28) Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2017;69:570–91. doi:10.1016/j.jacc.2016.10.034.
(29) Thiele H, Desch S, Piek JJ, Stepinska J, Oldroyd K, Serpytis P, et al. Multivessel versus culprit lesion only percutaneous revascularization plus potential staged revascularization in patients with acute myocardial infarction complicated by cardiogenic shock: Design and rationale of CULPRIT-SHOCK trial. Am Heart J 2016;172:160–9. doi:10.1016/j.ahj.2015.11.006.
(30) Sanborn TA, Sleeper LA, Webb JG, French JK, Bergman G, Parikh M, et al. Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 2003;42:1373–9.
(31) Wong SC, Sanborn T, Sleeper LA, Webb JG, Pilchik R, Hart D, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000;36:1077–83.
(32) Thiele H, Akin I, Sandri M, Fuernau G, de Waha S, Meyer-Saraei R, et al. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. N Engl J Med 2017;377:2419–32. doi:10.1056/NEJMoa1710261.
(33) Thiele H, Akin I, Sandri M, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, et al. One-Year Outcomes after PCI Strategies in Cardiogenic Shock. N Engl J Med 2018. doi:10.1056/NEJMoa1808788.
(34) Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2018. doi:10.1093/eurheartj/ehy394.
(35) Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012;33:2569–619. doi:10.1093/eurheartj/ehs215.
(36) Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016;42:1922–34. doi:10.1007/s00134-016-4536-8.


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Product Overview
Warm drinks are rarely tasty, which is why colorful Bottle Coolies were invented. Just slip these insulated bottle koozies onto your longneck bottles and you can gulp chilled beer all night long!
These bottle insulators are made from 1/8" thick high-density open-cell scuba foam, and they're made to be used over and over and over again. Bottle Coolies from Quality Logo Products® are collapsible, so you can store them in a drawer or in a glove compartment when you're not using them. Each bottle jacket fits a normal-sized longneck bottle.
The even better news is that you can customize your Bottle Coolies in an ENORMOUS variety of colors. This bottle cooler sure knows how to make a splash at parties!
If we know anything about these insulated bottle holders, we know that they go fast. Don't be caught without Bottle Coolies at your next social gathering - purchase some from Quality Logo Products® today and you'll pay less AND get them faster!
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Features of Environmentally Friendly WPC Decking
Wood plastic composite Decking board is a new kind of green environmental protection decoration material. The main material of the wood plastic board is plant cellulose and lignocellulose, and the plastic is a thermoplastic polymer material. The function of the model plank is better than a real wood plank, be in so adornment building materials market more and more popular, already replaced plastic and lumber gradually.
The wood plastic for it can be used as scrap wood, corner powder and other materials to product manufacturing, waste reuse, the use of production technology is safe and pollution-free, finished products are free of any harmful substances. So it is more and more popular in many fields such as adornment course of study, furniture course of study and packaging course of study, be called the green environmental protection plank of the first selection, the extensive application is in the market of a plank of building materials.
1/ The WPC decking board features low wear and tear:
use wood plastic boards, less than the amount of ordinary wood used in the same situation. And the wood plastic composite decking board is hollow specification more, can save more production material. At the same time, the hollow plate cost is lower, the price will be more preferential. Hollow decking material also has the advantage of reducing their own weight, but also reduce the load capacity of the carrier. These are the unique advantages of wood plastic composite, ordinary wood is not able to do.
2/ The WPC decking Handle easily
common real wood plank expression needs besmear to brush paint to undertake to protect processing, still have besmeared in follow-up use a few protect paint, can affect service life otherwise. And model board does not need this working procedure after processing comes out, can use, do not need to brush lacquer, waterproof performance is very good also. Maintenance costs are much lower than for wood products.
3/ The WPC decking Life is long
the service life of model board wants than average lumber plank tall 3 to 4 times, can use 10 years to 50 years to differ more namely. Use cycle is long, the price of wood plastic board nature is higher.
4/ Wood Plastic Composite Decking board quality
A lot of people reflect model board to use the meeting after a period of time to produce be out of shape, actually, the high-grade model board won't produce be out of shape, and bearing force and compressive ability is very strong. But because model board market is more confused now, the good and bad of the businessman are intermingled, the consumer is buying a product very hard naked eye observes model board quality from the exterior, gave undesirable businessman opportunity so. Wood plastic composite if the use of inferior wood as raw materials, the production of products will not be durable, the use of very short cycle. So when everybody is buying, must buy the regular product that has a qualification certificate, or the product that chooses a famous manufacturer to produce. Although more expensive than ordinary products, but good performance, long life.
5/ Use of wood plastic composite decking board
The wood plastic composite decking board is the advantage union of real wood plank and plastic plank, defect gets improvement. So in the interior decoration industry, really furniture industry, car and boat interior decoration packaging industry, future housing construction industry and other fields are widely used, it can be used to do furniture, do the floor, do decoration materials.
The wood plastic board because have very good tenacity and rigidity, can bear all sorts of processing working procedure, and not easy chap, be out of shape, waterproof the advantage with good performance, can use all sorts of environments to use. But must look for the product of normal manufacturer when buying, can produce deformation in using otherwise, service life is short also.
Seven Trust Wood plastic composite Product has been explored in the industry for many years. It has been provided by professional manufacturers from raw materials to production processes. The quality of the products has also been recognized by many users. Now you can get a quotation and product sample by sending detailed information about the demand. look forward to your information.


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iPad mini 2 Backlight on, NO DISPLAYI have looked everywhere for a solution to this but have yet to find one. I have a customers iPad mini 2 here. One of my...
Answer to "Why does my computer shut down when tipped or moved?"I have seen this problem once before with a Laptop I fixed. The problem was a loose screw causing the motherboard to short out when jarred. Has your computer ever been opened or worked on? Is it a laptop or a Desktop?
Answer to "Voice Control randomly turns on"I have seen this problem before with liquid damage on the home button connectors on 5s, 6, and 6 Plus. Easily fixed with alcohol and a toothbrush. What kind of iPhone are you using?
Answer to "iPad mini 2 Backlight on, NO DISPLAY"I cleaned the board several times and found a tiny metal fiber (from what, I cannot say) laying across several IC's. Removed it and it boots up fine. Just goes to show you kids, it's not always a backlight coil ;)
Answer to "iPhone 5 will not boot"I'm sorry I haven't gotten to it until now. But yes, it is worth trying to fix. I recommend removing the Logic Board and placing it in a sonic jewelry cleaner filled with 100% fuel grade alcohol and running it for 30 minutes with the heat on low. I have fixed countless water-damaged phones with this method.
Answer to "New logic boad/mainboard install"No. Shouldn't have to activate it to use it as a multimedia device. You will obviously need to use Wi-Fi rather than LTE however.
Answer to "any one answer me please"Don't listen to James, it is probably a bad charge port. Easily fixed in almost any decent repair shop. If you would like to attempt the repair yourself the flex generally costs around $15 on ebay.
Answer to "Why do I not get a signal?"There is no antenna in the battery of your phone. Do not attempt to disassemble your battery if you do not know how it works; it would likely end poorly. Poor signal could be due to the building you are in, and/ or the coverage of your carrier. Who is your carrier? Have you attempted to look at their coverage map to see if the problem lies in the coverage?


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Cortidrenal-Slim Natural Stress Buster is an adaptogenic herbal remedy scientifically tailored to help the overstressed body and mind work toward their normal state of balance and resolve many of the biochemical changes that occur as a result of repeated, frequent exposure to stressors and cortisol. Use Cortidrenal-Slim to increase your overall weight-loss potential and help eliminate stubborn belly fat.
Benefits include:
• Balances cortisol levels*
• Decreases anxiousness*
• Helps eliminate stubborn belly fat*
• Softens the effects of daily stress*
• Recharges and regulates your adrenal glands*
• Reduces sugar and nighttime cravings*
• Enhances cognitive capacity and mental clarity*
• Alleviates mental and physical fatigue*
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.


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Model Investment ClubThe Southwest Idaho Chapter of BetterInvesting is establishing a model investment club to serve BetterInvesting clubs and members. The model Investment club will also welcome interested non-members so that they can learn about BetterInvesting and investment clubs. The model club meetings will offer training on various topics including investment topics and investment club accounting, plus presentations on invidivual stock studies. Direct support for investment clubs on investment and club management issues will also be available.
Our model investment club meets the second Wednesday of every month (except July). Meetings dates and details can be found on our Local Events page. Our meeting location is subject to change monthly. Please email Terry Monasterio at firstname.lastname@example.com to receive information about upcoming meeting locations.
We hope you will attend.


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We find the cheapest flights to Lisbon by allowing you to search the entire month for the cheapest available deals. After checking flight estimates on different days we are the only site on the net where you can compare the best meta-search engines in seconds to discover the absolute lowest priced flights to Lisbon.
How to use our site to find cheaper flights to Lisbon?
In our search engine form you can select which airport you want to fly to Lisbon from. After you have done that simply select the 'whole month' option to see the cheapest prices to Lisbon from your chosen departure airport.
We will show you the cheapest flights found by other users in the last 15 days (please note prices are estimates and may be sold out). The more flexible you are with your dates the more likely you are to find a cheaper deal.
After you have selected your travel dates you can compare the following sites in seconds to find the cheapest deal to Lisbon:
Skyscanner flights to Lisbon - Skyscanner searches hundreds of sites for the cheapest flights - make sure you select this tab on our results page to see their offers.
Momondo flights to Lisbon - Momondo is another powerful flight search engine which compares flights to Lisbon. Use their handy price calendar to see if you can shave some more off your flight price by looking at surrounding day flights.
Dohop flights to Lisbon - Dohop is also shown on our flight results page. We recommend you see their offers too as they can often find cheaper deals than the rest.
Other sites we compare include:
Kayak Lisbon flights
Google flights Lisbon flights
Travelsupermarket Lisbon flights
Tripadvisor Lisbon flights
Fly.com Lisbon flights
and many more...
We are the only site on the world wide web where you can compare up to 10 different metasearch engines from one convenient location. We call this process meta-meta flight search and in our opinion it is simply the best way of finding the cheapest flights to Lisbon in the world.
Remember - the more sites you compare on our results page the more certain you can be that you have found the cheapest flights to Lisbon as one site will never find you the best price every time.
Lisbon can once again lay claim to the name Golden City of southern Europe. As Portugal 's capital, the city struggled through a few decades before getting a breath of fresh air by way of a modern cosmopolitan facelift. The 1990s brought a lot of change and improvements to a city already rich with history and culture.
River Tagus is now spanned by the unbelievably breathtaking Vasco da Gama Bridge, making many other regions of Portugal easily accessible. An easy connection to the rest of Europe can also be found by way of the architectural wonder of Santiago Calatrava's Gare do Oriente, the transportation hub of Lisbon. A marvel to see under the glimmer of sunlight, it is a dazzling spectacle when illuminated at night. Cross the street and you are at the 1998 World Expo's Parque das Nações.
Delve into the fascinating past with a visit to Castelo Sao Jorge, an impressively fortified castle which looms over the city since medieval times. Though greatly destroyed in the earthquake of 1755, remnant's of Lisbon 's golden age can still be seen. You'll be charmed and delighted as you stroll past inviting cafes set amidst Romanesque, Barocque and Gothic architecture.
Ancient art can be viewed at the Museu Nacional de Arte Antiga, while the Museu Nacional do Traje e da Moda offers a fascinating glimpse into the world of costume and fashion. For a captivating night at the opera, check the calendar of Teatro Nacional de Sao Carlos. You'll also be impressed by Oceanario de Lisboa, the second largest oceanarium in the world.
So what are you waiting for? find your cheap flights to Lisbon now!
Happy Searching!
Cheap Flights Finder - Lisbon Flights


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40's changed the direction of my life throw what I always wanted to do: write and share my passion for gastronomy. In this new level I did not want to be alone and the magic put on my way my partner and friend. Endless conservations around a table, a market, thematic travels and reports, made me think about showing all I have learned in this wonderful project (Platunique). My years of experience as a purchasing manager in a multinational telecom and my involvement in several companies had taught me the skills to develop this unique idea. I dedicate my daily hard work in this project to leave the best impression in each of our clients.
I still smile and feel embarrassed when I remember my days giving the news in front of the mirror and recording home videos to show an incipient communicative gift. Years later, that small talent took me to the university to study journalism, work for a journal and in a movie set learning how ephemeral publicity could be. After 7 months in Barcelona I went to Madrid, a city where I coordinate gastronomic contents, have found my new home, a friend (Edy), a project (Platunique) and a passion (gastronomy).


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An American army general, Creighton Abrams once said, "When eating an elephant, take one bite at a time." When you are just starting out, saving up for that first time home buyer down payment can feel like eating an elephant.
According to the Canadian Real Estate Association, in February 2017, the average price of a home in Canada was $519,521. With a minimum down payment of 5 percent, you're looking at saving about $26,000—almost $27,000 if you include mortgage insurance.
So how do you save $26,000 when you have student debt, current living expenses, car payments, and an active social life? It's easy to be overwhelmed by the numbers and lose sight of the goal. But with some hard work, discipline and resolve, you can save $26,000 (and more!) for that first down payment. Here are some strategies to help you show up at the bank with your down payment in hand.
If you need help saving for a down payment, or you're considering debt consolidation so you can start saving, or you're not sure what expenses to cut out, call us today at 1.800.267.2272. We can set you up with a free counselling session with one of our certified Credit Counsellors. They can help you set realistic financial goals (like saving for a down payment) and create a budget that will help you achieve them. You can also check out our free E-Learning course on Buying a Home. And if you're looking for some inspiration, consider reading Sean Cooper's Burn Your Mortgage. Sean used some of these strategies to save for his down payment. They worked so well he kept going and paid off his house in under four years.
Saving for your down payment might seem like eating an elephant. But with some planning and hard work, you might be surprised at your success.
Topics: Housing
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Our blog is all about how to spend smart while still getting the most out of life.
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Every week we release the latest news and info on a wide range of money management and debt topics, everything from rising interest rates and costs to saving for a downpayment, retirement or your next vacay. Our blog is all about how to spend smart while still getting the most out of life.


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Call Now630 590 3292
– Mary
- 18 Mar 2014
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Armond was GREAT ! Very professional and was able to accommodate all of our wants in regard to music selection ! The music was so good I couldn't stop dancing !:) we also went through him for our photobooth which made everything a lot easier considering how busy our schedules are. There was a bunch of different size photobooths we could choose from and packages. Beyond happy with his services . Couldn't have asked for a better dj !:)
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AIUB Community of Engineering Students (ACES) organized a seminar titled "BIOMEDICAL ENGINEERING: RECENT TRENDS AND SCOPES IN RESEARCH AND HIGHER STUDIES" on 30th November, 2016 at Room No. 266, FE Building, American International University-Bangladesh (AIUB). The seminar was conducted by Mr. Saiful Islam Khan (Lecturer, Faculty of Engineering, AIUB). The main emphasis of the seminar was on biomedical engineering, sharing insights and its futuristic prospects.
Prof. Dr. A.B.M. Siddique Hossain (Dean, Faculty of Engineering, AIUB) commenced the event by giving the welcome speech. He gave a brief idea about biomedical Engineering and its appliance and coherence with medical studies. Then the floor was given to the speaker Mr. Saiful Islam Khan. He started the session by discussing the main focuses of biomedical engineering and its extension in a broader perspective. After that, he shared his own experience of his research, based on biomedical engineering thus giving more ideas about its implementation. In conclusive remarks, he inspired the students of COE department to consider Biomedical Engineering as their major and the students of EEE department to consider Biomedical Engineering as their elective. He also gave guidelines how to start preparing for it.
Dr. Md. Abdur Rahman (Director & Associate Professor, Faculty of Engineering, AIUB) gave the closing speech and spoke about the opportunities of biomedical engineering in AIUB. He also pointed out that Biomedical Engineering will offer more immense opportunities in the near future. Thus he encourages the young community of future engineers to think out of the box and join in the vast world of Biomedical Engineering. Dr. Mohammad Hasan Imam (Assistant Professor, Faculty of Engineering, AIUB), Ms. Rafia Akhter (Assistant Professor, Faculty of Engineering, AIUB), Mr. Syed Muhammad Baker (Lecturer, Faculty of Engineering, AIUB & Motivator of ACES) and Ms. Shahreen Hassan (Lecturer, Faculty of Engineering, AIUB & Motivator of ACES) graced the seminar with their presence. Finally, the seminar ended with the big round of applause from the students to the speaker and students left the seminar with a new ray of hope in the field of Biomedical Engineering.


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Beatrice Bork is one of the artists exhibiting in
Small Works - Big Impressions
The Wildlife Experience in Parker, Colorado
November 17, 2007 – January 1, 2008
The Society of Animal Artists returns to The Wildlife Experience along with a premier event: the First Annual Society of Animal Artists' Small Works Exhibition and Sale, entitled Small Works, Big Impressions. The Wildlife Experience has hosted the SAA's prestigious annual touring exhibition, Art and the Animal, on several occasions since opening in 2002. This year, we will be hosting the new Society of Animal Artists Small Works Exhibition and Sale during the holiday season. This show gives visitors and collectors alike to view and purchase works of art from members of the Society of Animal Artists. The quality will be comparable to that displayed in the Art and the Animal exhibition, yet all works will be on a much smaller scale. Seasoned collectors and new collectors alike will have the opportunity to purchase works by their favorite artists at reasonable prices. A substantial percentage of the proceeds from this sale will benefit the work and missions of The Wildlife Experience and the Society of Animal Artists.
Tuesday, October 30, 2007
Small Works - Big Impressions
Beatrice Bork is one of the artists exhibiting in


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About Victoria
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Courses, Workshops and Retreats
Courses, workshops and retreats are a great way to deepen your understanding of specific aspects of your yoga practise - great if you are just starting out, an advanced yogi or somewhere in the middle. The small group setting without the time constraints of a general class means more individualised attention and more opportunity to ask questions and deepen your knowledge and understanding whilst enriching your experience of yoga. The beauty of working deeper means that the benefits are much longer lasting and can in some cases have a positive life changing impact.
In a tranquil setting these courses, workshops and retreat days offer a mini retreat where you can completely focus on having some time and space for yourself and look at your needs and well-being and explore some tools needed for healing, stress relief and health on all levels of your being.
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Gold Maple Leaf
Gold — Ask: — | Today: —
- Metal Type Gold
- Metal Content 1 oz. (31.108g)
- Weight 31.103 g
- Composition 99.99% gold
- Diameter 30 mm
- Mint Dates 1979 - present
About this Product
The beautiful gold Canadian Maple Leaf, a legal-tender bullion coin known universally for its purity, sophistication and beauty, are known and respected throughout the world because of the immaculate standards of quality mandated by the Royal Canadian Mint. With their classical beauty, unsurpassed purity, and being backed by the Canadian government, the Canadian Maple Leaf coins provide investors and collectors with coins that can be both a secure and internationally-recognized addition to a well-diversified investment portfolio.


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Hi all!
Our course ends with an exam, consisting of essay (deadline 4.05), written quiz (was conducted in February) and team project presentations (taking place on May, 7th at 10AM).
Official exam days are: Tue 22.05 at 14:00 and Fri 25.05 at 8:15 (põhieksam). Last chance is Fri, 1.06 at 8:15 (järeleksam). All exams will be held in room T-321 upon advance registration according to university rules.
You SHOULD NOT attend an official exam if and only if all of the following is true:
1) you have successfully defended your team project on May, 7th (all teams passed, ÖKOTrans A, trreid B, Liikluinfo.ee Mobile C, Tiim4 C)
2) you have submitted you essay on time (Roger, Tanel, Antero, Lauri, Dea, Aleksandr, Raimond, Jaan – are OK)
3) and you passed the test with at least E (Lauri, Raimond, Roger, Dea, Tanel, Martti, Mihkel, Antero, Kaarel, Kristian, Signe, Jaan – are OK).
Good luck!


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10 Inspirational 2019 Chevy Silverado Features – Chevrolet, colloquially Called Chevy and the Chevrolet Division of General Motors Company, is the American automobile division of the American Producer General Motors (GM). Louis Chevrolet and ousted General Motors founder William C. Durant began the company about November 3, 1911 as the Chevrolet Motor Car Company. Durant employed the Chevrolet Motor Car Company to acquire a controlling stake in General Motors using a reverse osmosis occurring on May 2, 1918 and steered back himself into the GM presidency. Right after Durant's second ousting in 1919, Alfred Sloan, with his maxim"a car for every purse and purpose", could pick the Chevrolet brand to turn into the quantity leader at the General Motors family, selling mainstream automobiles to contend together with Henry Ford's Model T in 1919 and over-taking Ford as the best-selling vehicle while in the United States from 1929.
0d 2019 Silverado 2019 Chevy Silverado 1500 2500 2016 Chevrolet Silverado Rally, Source : resumeopinions.club
Chevrolet-branded autos are sold in most automotive markets globally, In Oceania," Chevrolet is symbolized with its Australian subsidiary, Holden, having came back to the region at 2018 following a 50-year shortage together with the launching of this Camaro and also Silverado pickup vehicle. Back in 2005, Chevrolet was re launched at Europe, chiefly selling vehicles built by GM Daewoo of South Korea with all the tagline"Daewoo has grown up enough to become Chevrolet", a movement suspended generally Motors' effort to build a international fresh across Chevrolet. With the re introduction of all Chevrolet into Europe," GM intended Chevrolet for a mainstream worth manufacturer, while GM's traditional European standard-bearers," Opel of Germany, along with Vauxhall of uk would be moved . But, GM reversed that movement around in late 2013, declaring the new could be pulled from Europe, together with the exclusion of the Camaro and Corvette at 2016. Chevrolet automobiles will probably last to be marketed from the CIS countries, including Russia. After normal Motors fully acquired GM Daewoo in 2011 to build GM Korea, the last using the Daewoo automotive brand was discontinued at its own native South Korea and succeeded by Chevrolet.
0d 2019 Chevy Silverado New Next Chevy Silverado Spy Shots, Source : resumeopinions.club
Silverado 2019 Concept Hot News Chevrolet Silverado 2500 2019 Specs and Review, Source : alohadreamcars.com
2019 Silverado Hd Price and Release Date 2018 2019 Car Release Date Lovely 2019 Chevy, Source : microclass.org
2019 Gmc Sierra 1500 2019 Chevy Silverado 1500 Interior Gmc Sierra Denali 2019 Fre Plus, Source : autocarsreview.club
In united states, Chevrolet produces and sells a wide selection of vehicles, from sub-compact vehicles to medium-duty commercial trucks. As a result of prominence and name-recognition of Chevrolet as a member among General Motors' global marques, Chevrolet, Chevy or Chev can be used sometimes as a synonym for General Motors or its own particular products, 1 example being the GM LS1 motor, commonly known from the name or some variant thereof of its progenitor, the Chevrolet smallblock engine.


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|"Olive Drab". This colour, although in the 1-GP-12b, didn't appear in the 1-GP-12c standard, but was still in apparent use, as late as Oct. 1970.
|1-GP-12b: 5-13
|Hue: 31 Sat: 49 Lum: 57 Red: 73 Green: 68 Blue: 48
|In additions to combat vehicles, this colour is also used for some ground support equipment and airfifield moble support equipment (fuel trucks, aircraft 'mules', etc.). Compare this to the 503-321 in the RCAF/CAF/Cdn Army, portion of this colour guide. According to David Klaus's "IPMS Color Cross-Reference Guide", FS34082 is a the closest match (but poor), further saying it should be darker & more yellow. Tom Rae notes that this colour has been observed to weather to a blue or brown, dependng on the sun and paint manufacturer
|1-GP-12c: 503-321
|Hue: 39 Sat: 226 Lum: 44 Red: 90 Green: 88 Blue: 03
|Commonly alluded to as 'Forest Green', this is used either as an overall colour or as part of a camouflage scheme.
|Hue: 49 Sat: 41 Lum: 76 Red: 89 Green: 95 Blue: 67
|Between the 1970's and the adoption of SCAPP, this was a part of the camouflage pattern for all Cdn Army vehicles, except the Leopard tank. David Klaus's IPMS Color Cross Reference Guide, puts FS34079 as a very close match.
| 1-GP-12b: 3-212
1-GP-12c: 503-319
|Hue: 50 Sat: 230 Lum: 31 Red: 49 Green: 65 Blue: 01
|Overall colour used on all non-combat CF vehicles, since unification, such as various utility vehicles. It's been suggested that FS34058 with a gloss finish, may be a good match.
|Dupont: 1753 (Gloss)
|Hue: 96 Sat: 82 Lum: 00 Red: 51 Green: 72 Blue: 51
|This 'medium green' is one-third of the NATO camouflage scheme. FS34441 has been suggested as a very good match for this colour..
|Lt. Field Green
|Hue: 49 Sat: 41 Lum: 76 Red: 89 Green: 95 Blue: 67
|Referred to as 'Dk. Brown'. According to David Klaus's "IPMS Color Cross-Reference Guide", FS30118 would be a good match,
|1-GP-12c: 504-107
|Hue: 24 Sat: 54 Lum: 95 Red: 125 Green: 105 Blue: 78
|This colour appeared as part of the standard CF camouflage,in the early 1970's, along with Greens 5-13 and 503-319, Black 512-301, as well as Earth 504-107. According to David Klaus's IPMS Colour Cross-Reference Guide, FS20400 is a good match, but with a matt appearence. Tom Rae has noted that, when 'fresh', this tended to have a slightly browner tinge, to the basic colour.
|Khaki Sand
|Hue: 22 Sat: 108 Lum: 153 Red: 204 Green: 167 Blue: 121
|This appears to be the overall colour of the vehicles serving in Operation APOLLO in Afganistan. The FS number was matched to several well-lit photos, similar to the one in the photo section.
|FS595: 33531 (Sand)
|Hue: 21 Sat: 84 Lum: 181 Red: 214 Green: 193 Blue: 170
|Matt black. As pointed out in the IPMS Canadian Colour Guide, it weathered to a dark grey, under service conditions. A gloss black is the overall finish used for Staff Cars.
| 1-GP-12b: 1-201
1-GP-12c: 512-301
|Hue: 160 Sat: 00 Lum: 00 Red: 00 Green: 00 Blue: 00
"SCAPP" Colours - produced in the former-West Germany for the refinishing of all Canadian Army equipment, Due to the toxic nature of the paint formula, these colours were only applied when the vehicles were scheduled for Depot Level maintenance
|Bronzegrun (Bronze Green). According to David Klaus's "IPMS Colour Cross-Reference Guide", FS34094 is a near match. I've been told, ROCO brand paints (from Germany) have exact matches for the SCAPP camouflage colours.
|Hue: 49 Sat: 41 Lum: 66 Red: 77 Green: 82 Blue: 58
|Lederbrun (Leather Brown). According to David Klaus's "IPMS Colour Cross-Reference Guide", FS30051 is a good match, but should be a bit darker.
|Hue: 6 Sat: 75 Lum: 69 Red: 97 Green: 57 Blue: 50
|Teereschwarz (Tar Black). According to David Klaus's "IPMS Colour Cross-Reference Guide", FS37030 is an exact match.
|Hue: 200 Sat: 2 Lum: 64 Red: 69 Green: 68 Blue: 69


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From the desk: Comments on Fed hike and NZ GDP numbers
Bevan Graham, AMP Capital, 15 June 2017
Two key pieces of economic news out this morning with the US Fed raising its benchmark interest rate and March-quarter GDP growth numbers for New Zealand released. Watch the video for my thoughts.
Click here to watch the video.
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We create holidays and educated-led and wildlife group tours to over a hundred locations worldwide. The Lifestyle Residence Design Collection are award successful stylish, contemporary designs excellent for open plan living. With excellent inclusions and distinctive options, these houses are perfect for family dwelling. If luxurious houses are extra your type, our Prestige Collection range supply the highest quality inclusions and massive trendy properties. Think alfresco kitchen and eating, spacious bedrooms and premium finishes.
Creating your dream residence from the bottom up is exciting. Building a home that is completely yours provides you the unique alternative to mould our designs to reflect your fashion and taste. Our Studio M Selection Centre makes customising your new dwelling easy, convenient and quite a lot of enjoyable. Studio M showcases our in depth range of product selections, for each the interior and exterior, including designs to customize your kitchen, bathroom and lighting. Our Lookbook is another great resource that highlights the totally different inside design types on supply, inspiring you to make your own home a house.
Interior design has become the subject of television exhibits. Within the United Kingdom (UK), well-liked interior design and adorning applications embrace 60 Minute Makeover ( ITV ), Changing Rooms ( BBC ), and Selling Houses ( Channel 4 ). Famous interior designers whose work is featured in these applications embody Linda Barker and Laurence Llewelyn-Bowen In the United States , the TLC Network aired a preferred program known as Trading Spaces , a show based mostly on the UK program Altering Rooms. As well as, each HGTV and the DIY Community additionally televise many programs about inside design and decorating, featuring the works of a variety of interior designers, decorators, and residential enchancment experts in a myriad of projects.
All of the packages we reviewed are 3D design software. This means you can see your finished dream home in each SECOND, which is flat and looks like a blueprint, and 3D, which has textures and colours to give you an thought of what the final product will look like.
For a room that functions as an extension of personal area, the items had to be work-, relaxation-, and sleep-pleasant. Plus, Laxmi has a robust Indian aesthetic, so we chose modern designs with traditional silhouettes. The slatted back and open sides of the couch, the rust-coloured carpet, and light cotton curtains perfectly complement the teak end. And together, they create an enhanced sense of space.


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Mini-Model Congress is a student-run government simulation held at our school every June. We have 2 half-day preparation sessions followed by the actual day-long conference. This year, Mini-Model Congress was held on Thursday, June 14, 2018. This year, 105 students participated in Mini-Model Congress : The conference was comprised of 5 committees : The topics debated ranged from the Russian …
Summer Fun for Primary Pupils
It was with joy that primary children marked the end of the school year with the traditional 'kermesse'. At last the moment had come to show family and friends their carefully choreographed class dances. It was a time to have fun with friends in the sunshine and enjoy water fights and games. After a splendid afternoon of fun, families and …
Enjoying a sushi workshop
Some EBI students had the chance to have a sushi lesson with our high school Maths teacher, Mrs Kim. They experienced the preparation, tasting and presentation of sushi and enjoyed it very much! Thank you Mrs Kim!
Variety Show – Learn more about it!
TICK-TOCK ! Saturday June 2nd – 18.00 Sunday June 3rd – 17.00 SPECTACLE CARITATIF SALLE DES FETES STUDENTS : 3€ – ADULTS : 5€ Vente des tickets dans le bureau de Mme Jourdet
We are in the headlines!
Un article consacré à L'Ecole Bilingue Internationale est paru hier dans le journal La Montagne.
Geography fieldtrip – March 2018
The 8th, 9th, 10th and 11th graders spent the morning visiting the water supply plant "L'usine d'eau potable du Val d'Allier" in Cournon. We learnt about the process which two-thirds of Clermont-Ferrand's agglomeration's water follows from its extraction in wells along the banks of the Allier River, fitration in the plant, storage in reservoirs to the tap. Fieldword is an …


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5 Reasonably Priced and Elegant Watches Presented at Baselworld 2019
You don't need to sell one of your legs to look classy!
9 responses
The tutima is clearly superior and amazing. I wish it didnt have the crown guard things. Only detail I don't like.
Is this ANOTHER bracelet with zero micro-adjustment?
Are we all now expected to accept this? We have already seen it become normal to wear watches on the hand (as in the headlining photograph for this very article). Is "understanding how a watch fits" to become arcane knowledge, like using a shaving brush or a manual choke in a car?
JD, agree 100%. It is the most expensive on the list, though, so we should expect it to be superior – but that movement…wow.
Yes, the Tutima looks to be the most desirable of these even given the price and that annoying, and rather inappropriate, crown guard. I wonder if the enamel is low temperature enamel, though? In none of the reviews that I have seen is it described as grand feu, so I suspect it is the rather cheaper, easier – and presumably less resilient – modern alternative.
@Ian E
To me the actual visual quality is much more important. For example, FPJ Chronometre Bleu's dial is lacquer rather than enamel, but it's no less stunning than the best enamel dials I've seen.
Irrespective how pretentious I attempt to be, my inner redneck keeps head-butting me, when I look away from the two-tone (Tudor). There can be little doubt that two-tone is the next fad, but (to me at least) little presents an air of elegance, as much as a 'sharp dressed man' (notably the one in the dark grey suit) – sporting a dark dial two-tone watch.
Setko EUR 1,950…a bargain? I think we lost the meaning of the words…
I think bargain or not is not only determined by the price alone…


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Healthcare legislation for 2018 session
What bills were introduced? Did they make it to committee, sub-committee, House, Senate, Governor, law?
MotherBoard is supporting decision makers who are committed to creating an accessible, affordable and dignified health care system that works for all - rather than spending time and resources blocking access and pandering to fears.
Learn about Virginia's Medicaid and FAMIS programs for children, pregnant women and adults. You can also get information about health insurance options available through the Federal Marketplace. 855-242-8282 Facebook: @coverva
Naral is building political power for pro-choice Virginians and working to ensure every Virginia woman can make the personal reproductive decisions that are best for herself and her family, without stigma or political interference. Contact: firstname.lastname@example.com, 571.970.2536 Facebook page Twitter: @NARAL
Senior Services of Southeastern Virginia
The nonprofit Senior Services is the leading regional agency for a wide variety of programs and services for seniors. It also does advocacy on some issues. There are at least three programs that help seniors with health care access:
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text:
Are you overpaying your dentist?
Are you paying the correct amounts to your dentist's office?
Insurance can be confusing, and dental insurance is no exception. Even though the total costs of dental care can be lower than other services like healthcare, dental claims can accumulate to thousands of dollars. That's why it's important to make sure that you're getting the most out of your dental coverage, by paying the correct amounts to your dental provider. We'll list a few keys to help you keep your dental costs in check.
Make sure a claim is filed
Properly check your EOB
Avoid paying up front
Question any claim discrepancies
Save money with a claim review
Make sure that dental claims are filed
If you have a dental insurance plan and are receiving services from your dental provider, then you need to make sure that claims are filed with your dental plan. This is usually taken care of by the dentist's office, but some patients wonder how they can make sure a claim has been filed.
Usually the easiest way to determine a claim has been filed is to see if you've received an Explanation of Benefits in the mail. While claims processing can take a few weeks, you should normally receive an EOB in the mail from your dental carrier anywhere from two to four weeks after your services have been performed.
If you don't receive an EOB, you can either call the carrier or your dentist's office to inquire about the claims filing. Once you'e verified a claim has been filed and processed, then it's on to the next step to review the claim's processing.
Properly checking your EOB will help you pay the correct amounts
Once you've received your EOB in the mail, you'll want to properly review it for key pieces of information. An Explanation of Benefits contains several pieces of important information that you should review for accuracy for the services and procedures that you received. It's good to have an understanding of your insurance plan's benefits in order to make sure the charges have been processed correctly.
It's very important to compare your EOB to the billing statement you receive from the provider. You'll want to make sure that the patient responsibility at the bottom of the EOB matches the amount a provider is billing you.
If the provider bill is higher than what an EOB is showing for the patient payment amount, you should question this with your dentist and show them a copy of your EOB. Often any discrepancies can be worked out once all the information has been given to the dentist.
Avoid paying providers until claims have been finalized
Another important consideration is the timing of provider payments. It's often recommended to avoid paying providers up front before you know what your total patient cost will be after insurance has been processed. This way you can avoid any overpayments, which would cause you to have to request a refund.
Many times, an Explanation of Benefits will be received in the mail before you get a bill from the provider. This can help you compare the information once you receive both the EOB and the provider bill to make sure the information matches up.
However if a provider sends a bill and asks for payment before you receive an EOB, you can often request to delay payment until insurance has been processed and you are notified by a completed EOB.
Don't be afraid to question certain charges or ask for a claim to be refiled
As you review your Explanation of Benefits, be sure to keep your eye out for anything that doesn't look right. Sometimes a charge may be overlooked, or a wrong procedure code can be filed.
It's important to review the claims information to verify the charges were processed correctly. Don't be afraid to ask your dentist about any charges or information that does not appear to be correct.
Often, if an error is found, the dental office can work with you and the carrier to get the information corrected. Taking a little time to review your claims info can save you money.
Reviewing your dental claim info can save you money
Although it can take a little time and some basic understanding, it is not hard to make sure you're paying the correct amounts to your dentist.
By reviewing your EOBs for discrepancies and comparing charges to your provider bill, you can identify any potential errors that might cost you if overlooked. Then you can rest easy knowing that you're getting the most out of your dental benefits and not overpaying the dentist.
Find dental plans for your dentist


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"Music To Make Your Ears Smile!"
Home Page
About Ed Austin
Contact Us
"One Man Band"
Upcoming Performances
"GREATEST HITS!" Vol. 1
About Ed Austin
Since the 1970's
Ed Austin
has developed a reputation as one of the hardest working musicians at the
Jersey Shore.
With an extensive repertoire of songs from from the 50's through today,
can entertain audiences of all ages.
A multi-instrumentalist,
Ed Austin
started playing in bands in high school. After attending Glassboro State College he worked throughout the tri-state area, playing guitar and bass in several successful bands. On his off nights he would frequently perform around the Point Pleasant area as a solo singer/songwriter and became popular for his interactive approach with audiences.
As the entertainment business changed in the mid 1980's,
Ed Austin
became one of the first musicians in the area to embrace the new technology that would enable him to become a
"One Man Band".
Using professionally recorded background tracks, playing electric guitar and incorporating harmony vocals, Ed can produce the authentic sound of a full band.
Ed Austin
is also a recording artist for
Lucky Star Records
and an award winning songwriter. Since 1999 he has released five CDs as a solo artist and recorded three benefit CDs with
Ed Austin and Friends"
A respected arranger and recording engineer, Ed continues to produce demos and CDs for local musicians.
In addition,
Ed Austin
is well known in the area as a music instructor, teaching guitar, bass, piano, banjo, ukulele, harmonica, mandolin and music theory. He maintains a full schedule of students at
Clarizio Music Studios
in Point Pleasant, NJ.
Ed Austin
has achieved a milestone that few musicians will ever see. In 2011 he performed his
Gig at the Broadway Bar and Grill
in PPB, NJ
where he has played weekly since 1993! Many musicians would be happy to play 1,000 gigs in their entire career...and Ed has played that many in the same corner of his hometown bar. At last count,
Since 2012, Ed (in his alter ego as Mr. Staunton) has taught Music at
St. Peter School
in Pt. Pleasant Beach, NJ, where he also directs the Children's Choir,
"The Singing Saints".
Ed Austin's motto is simple:
"Find a job you love and you'll never work a day in your life!"
Content copyright


text: Tes SEN North 2019 will contain a range of free-to-attend special features which have proved their popularity in previous years at the Tes SEN Show in London. The opening Keynote Panel Debate will feature eminent educationalists from the SEN sector and is designed to ensure that visitors can immerse themselves in the latest thinking around policy and practice. The exhibitor-led workshops will enable visitors to find out about how new products and services can be applied in day-to-day practice. The Parent, Carer & Teacher Forum will provide a vital safe space for parents, carers and teachers to exchange tips and learn to work collaboratively. SEN North TeachMeet will take place after Day 1 of the show to allow you to discuss your challenges and solutions with your peers. Visitors will be able to able to return to their schools, inspired with new ideas to put into practice.


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BIC has met every contract cost, schedule, and performance requirement for every contract we have been awarded: Without Exception!
Birmingham Industrial Construction has over $30 million in contracts over the past three years, including every major construction discipline, from small repair projects to large building renovation and new construction.
Our main focus is Military installations and for the past three years we have completed sixty five percent of our projects at Maxwell AFB and Keesler AFB.
BIC was awarded an IDIQ contract during the Alabama tornado recovery mission. BIC hauled and installed over 200 temporary housing units to families who lost their homes during the tornados.
Some of our clients are: CSC APPLIED TECHNOLOGY GROUP, ITT SYSTEMS CORPORATION, US NAVY, USACE, FEMA, UNITED STATES AIR FORCE, UNITED STATES ARMY, DEPARTMENT OF HOMELAND SECURITY, DEPARTMENT OF VETERANS AFFAIRS, AIR NATIONAL GUARD.
SATOC/USACE - Minor Construction & Renovation/Repairs South AL - Ft. Rucker, AL.
IDIQ/SATOC - USACE - Ft. Rucker, AL.
IDIQ - GSA - Miscellaneous Repairs and alterations. Alabama
MACC - NASA - Stennis Space Center, MS.
IDIQ - NASA - Marshall Space Flight Center, Huntsville, AL.
IDIQ / MATOC - Department of Veterans Affairs - Location 3, Alabama.
IDIQ / SATOC - US Army - Support of Mobile District of North Alabama Region Construction.
IDIQ - Air National Guard - General Contracting and Repairs.


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We're back by popular demand! In our recent survey on www.gargoylesreawakening.com, we received numerous requests to revive Fan of the Week as a way to celebrate the individuals who make up our fandom. Well, you asked and we listened. Starting this month, Fan of the Week lives again!!
In the tradition of keeping the Gargoyles fandom alive, we bring to you the Gargoyles Fan of the Week. During this week, we will feature a fan whose artwork, fanfiction, merchandise collections, or anything else that demonstrates their love of all things Gargoyles!
A long hiatus really allows one to appreciate the fandom and it seems only right to return with the King of Gargoyles himself, Greg Bishansky. Whether he's organizing a Gathering, rallying the troops to support a Real Gargoyles movie, providing useful tips on how to contact Disney to release Season 2 Part 2, or simply sharing his wealth of knowledge from various resources, GregXB is a forerunner and deserves nothing short of a standing ovation. He's been with the fandom since the beginning and we're lucky to have him. Congratulations, Greg


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For those students who are planning on studying in Canada September 2015, they will want to take a look at one of Canada's smaller universities, Grant MacEwan University. Grant MacEwan is situated in Edmonton, Alberta and has a credit transfer agreement with the University of Alberta for their Engineering Students.
According to the Canadian University Report 2013 put out by Canada's prestigious Globe and Mail, Grant MacEwan ranked first place among 15 small universities for most satisfied students.
A small university can be a great place to start your undergraduate programs. These universities are often affiliated with larger, research intensive universities and often have credit transfer agreements.
These universities offer smaller classrooms; better professor/student ratio and homework help programs from both professors and peers; much to the benefit of the student. For the international student making that transition from homeland to studying in Canada, a smaller campus is often the place to study. Additionally, these universities are fully equipped with state of the art facilities as are the larger universities.
The table below shows the rankings for these small universities.
If you are considering studying in Canada next year, contact your Grant MacEwan University representative in Pakistan at Alberta Rose Education Centre for assistance and further information.


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Samsung Behold 2 :: Phone Flashes - Goes Through Boot Screen And Then Screen Turns OffApr 13, 2010
Tried rooting so I started off flashing r8 of bh_man's 1.6 rom. Went through the setup, odin turned blue to pass and I let the phone run past the android system and then the screen turned off.
Thing about it is that the phone is still being detected by the computer and odin. It's like my phone is on a screen lock but not responding to when I push unlock.
Ive tried every custom rom and each one does the same. I try to go back to stock and most of the time the program closes, when it doesn't I try to flash it and it goes through the process but goes on forever. One time I let the timer go on for 2 hours and it was still on 5/9 completed.


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Relive the aerial dogfights and naval clashes of the Battle of the Philippines Sea, thanks to stunning color footage. It is a visual record of the battle that underlined U.S. superiority in the Pacific.
After a disastrous start, Admiral Chester Nimitz's island-hopping campaign across the Central Pacific has gained momentum and led his men to their largest and most important target yet: Saipan in the Mariana Islands. The nearly month-long battle on this island featured mountain sieges, Banzai attacks, white-knuckled dogfights, and escalating tensions between the U.S. Army and Marines. Color combat footage and testimony from the soldiers who were there bring this seminal moment of the Pacific War to life.
Access even more free Smithsonian Channel full episodes and documentaries online through participating TV providers.
Find out if your television provider carries Smithsonian Channel.
Don't panic! It's simple to upgrade to the latest version of one of these browsers:
Don't panic! To get the best possible experience on smithsonianchannel.com we recommend you upgrade your operating system.
For the best possible site experience, please use Chrome for Android.
Add username "SmithsonianChan" on Snapchat for fun and fascinating facts. We'll be sharing spontaneous photos and videos as inspiration strikes.


text:
British Telecom's profits got up by 71% as its broadband market increased in the last twelve months. £1.7 billion is the magical number of sales registered on 31st of March. During the fourth quarter BT managed to increase their profits by an enormous 97% to approximately £495 million. The bad news is very small in numbers as it is in percentage - only 6% decrease in sales, which means something a little more than £5 billion, was lost. In this case, BT still has some issues with its services.
Ian Livingston, who is the chief executive at British Telecom, said: "We have delivered profits and free cash flow ahead of expectations for the year." BT is continuing to firmly make its way in the broadband market by issuing incredibly affordable packages. This strategy helped the telecommunication companies to add more than 250,000 customers in the fourth quarter alone.
Technology is what kept the prices down and the energy-saving Home Hub 3 router is one of the steps BT made to ensure the best connections for wireless networks.
"We have consolidated our position as the leading provider of broadband in the UK with our highest quarterly share of DSL broadband net additions for eight years," added Ian Livingston. Mr. Livingston believes that BT will continue this path and increase its profits even more.
Another step taken by BT towards improving its services and getting more profits represents its plan to extended the Infinity package, making the fiber broadband faster and more reliable. The current speed for this package is 40Mbps, but 2012 will bring double that speed to current customers' delight. According to Mr. Livingston even Openreach revealed an increase in its copper lines this year. The tone of Ian Livingston's voice was optimistic and progress appears to remain on BT's agenda.


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Submissions for DocPoint 2016 open on May 4th. The submission period will end on October 1st, with the final programming decisions being made by November 1st. Films can be submitted at www.docpoint.info/en/submissionform.
As a non-competetive festival, the DocPoint programme consists of yearly changing themes. The festival mainly screens feature length films. Submission if free of charge.
To learn more about the submission process as well as rules and regulations, please visit www.docpoint.info/en/submissions.
15th edition of DocPoint takes place on January 25th – January 31st 2016. The programme will be published in the beginning of January.


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How do I dispute a car insurance claim adjuster's report?
Free Car Insurance Comparison
Secured with SHA-256 Encryption
UPDATED: Nov 2, 2016
It's all about you. We want to help you make the right coverage choices.
We strive to help you make confident insurance decisions. Comparison shopping should be easy. We partner with top insurance providers. This doesn't influence our content. Our opinions are our own.
- If you disagree with your claims settlement, ask to speak to a manager
- If you don't get anywhere with a manager, you can get a repair estimate from a mechanic or an independent adjuster
- As a last resort, you have the option to take a car insurance company to court
Disputing a car insurance claim adjuster's report is your right and it can be as simple as getting an independent report and submitting it, or as complicated as hiring a lawyer and bringing the claim to court.
In between these two extremes, there are other things you can do such as hiring a third party adjuster or going over the adjuster's head and contacting the claims manager.
In the article that follows, there is more specific information provided regarding how to dispute a claim adjuster's report. Also, be sure to use the free tool on the top of this page to get a free car insurance quote comparison!
Getting Independent Reports
The final say as to the amount you should be paid for a car insurance claim does not have to rest solely with your insurance company. Be aware that some insurance companies will try to convince you that you do not have a choice.
They may make you feel like you have to follow what their adjuster said in the report, but this is not the case. You have a right to dispute the adjuster's report and you have the right to get independent reports as well.
There are many independent auto mechanics, not affiliated with an insurance office, which can be hired to give you a report. This is the first step and the cheapest route you can take.
Make sure you are hiring a professional. Your cousin who fixes cars on the side, no matter how knowledgeable, will not be considered a professional by the insurance company.
Allow the person you hire to look over the damage to your vehicle and give you a written report with a dollar amount required to fix the vehicle. Then send this to your insurance company via certified mail.
If this does not work, you can go a step above hiring a professional mechanic and hire an independent insurance adjuster.
Though you may not be familiar with independent adjusters, it is actually a very competitive business and you will be able to find many choices in your area, just by going online or looking in the yellow pages.
Independent or private adjusters are able to use their expertise not only of vehicle repair but of the insurance industry itself to help you get the settlement you deserve. This is more costly when hiring an independent mechanic but usually yields better results.
Free Car Insurance Comparison
Secured with SHA-256 Encryption
When Independent Reports Don't Work
If you have gone the route of hiring someone to do an independent report and your insurance adjuster will not change the report, it is time for the next step.
– Step One
First of all, you should contact the supervisor or manager that is over the claims adjuster giving the manger the same independent reports you gave to the adjuster.
Sometimes, simply speaking with a manager will result in your claim being adjusted. Some insurance companies make you do the work, but when you reach a manager, they are willing to make changes.
– Step Two
If this is unsuccessful,you can contact your state insurance office. Every state has a government office that regulates the insurance industry of the state. Almost every state insurance office has a complaint department as well.
You can file a complaint and the office will investigate your claim along with comparing it to complaints filed against the same company.
If the company has a history of problems, your complaint will be investigated more vigorously and may save other people from having a bad experience with the same company. This may take awhile so you need to be patient but it is worth it to get the claim you deserve.
– Step Three
The last step in disputing a car insurance adjuster's report is to file a lawsuit. This should only be done if you have tried every other option.
Taking an insurance company to court is costly. If you win the suit, the insurance company will be required to reimburse you for your expenses, but if you don't win you will be out the money for the court expenses and your claim still will not be adjusted.
Some insurance companies will settle with you just to save the expense of going to court.
Finding a Trustworthy Company
A major factor in disputing a claim is working with an insurance company that it reputable and that you can trust. To find an insurance company, you can use our free online comparison tool.
This type of tool allows you to receive rates and quotes from top companies so that you can find a reputable company you will be able to work with when a claim needs to be filed. Just enter your zip to start!
Free Car Insurance Comparison
Compare quotes from the top car insurance companies and save!
Secured with SHA-256 Encryption


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Having a backyard at home is valuable because you have room to enjoy fresh air.
Because housing is not cheap now, small houses are the main choice, and the backyard is not as large as a farm.
Decorating this area requires knowledge and information.
In short, the backyard is usually called an area located behind a house that still has land.
The size depends on what you have, but the main feature is the open area while you still have enough space to plant trees or flowers.
Backyard decoration will be part of the landscape and exterior design.
Want to make the page look beautiful.
Look at some of these beautiful backyard designs. . .
Related Posts
Popular Designs
Interesting Ideas..
Fresh Entries
© 2020 AlbertoPrieto.org. All Rights Reserved.


text:
We're still putting together the job specification for this role. But what we can tell you is that we're looking for quantum engineers with a diverse range of experiences to build on our initial team!
About Oxford Quantum Circuits
At Oxford Quantum Circuits, we're creating the core of the quantum revolution to solve some of humanity's most significant challenges. We are developing technology using the power of quantum to do things which have never been achieved before, from enabling life-changing drug discoveries to developing new battery technologies.
We are developing the world's most scalable quantum computer for the real world impact. We're doing this using state-of-the-art, innovative, superconducting quantum hardware spun out of the world-renowned University of Oxford.
We're looking for innovators, technical wizards and creative ninjas to join us on this exciting journey.
We'd love to hear from you!


text:
The LG Aristo 2 has launched on MetroPCS a small, no nonsense phone that can be had for as little as $60 (or even for free). Thats how much the original cost a year ago. Note that this phone was supposed to show up on T-Mobile as well, but theres no sign of it yet.
Anyway, the sequel keeps the 5 720p display, though its an IPS panel this time around. Youre still looking at Android Nougat, but with a bit more RAM its 2GB now. The storage is the same at 16GB (9GB user accessible, you better use that microSD slot).
The camera department is largely unchanged a 13MP/1080p camera adorns the back, the front gets a 5MP/1080p camera. The selfie camera can unlock the phone thanks to facial recognition, but theres a fingerprint reader on the back if you prefer that.
The LG Aristo 2 works on MetroPCS LTE network and sports Wi-Fi calling. The battery is relatively small 2,410mAh but the estimated talk time is a solid 17 hours.
Lets go over the price once again. The phone costs $140, but the carrier offers an instant $30 discount. On top of that, theres a $50 mail-in rebate. Oh, and if you trade in an old device (and get an unlimited LTE plan), you can have the new Aristo for free. For more, head over to MetroPCS.
Probably should went with Oreo if they want more sales. Because this phone right here will never ever get a major android update
Why do you even react, it's cheap for a reason.


text:
By Max Gough | Senior Account Executive
The reason we do things is more important than the things we do.
Within the first week of joining Akili, the first thing that struck me was the cast of characters around the office and the culture of individual empowerment. Obviously, friends and family have asked "so, what are the people/culture like at Akili?", etc. In all candor, I was struggling for the right phrase that captured this entourage…then it hit me! "Band of Brothers."
Similar to the acclaimed movie Band of Brothers, the plot soon had little to do with the Normandy invasion but quickly evolved into a mission of passion; an unsuspecting group, bonded by a higher purpose, not simply to survive the day.
Similar to the first principle in the book Good to Great, "First Who, Then What," beginning in 1992, Akili's CEO, Shiek Shah has carefully crafted a group of people who share two very similar DNA traits; a passion for ethical reasoning and raw analytical talent. Focused more on the reason they do things rather than the things that they do, this Band of Brothers (and sisters!) has for 20 years, experienced record growth and unquestionable customer loyalty.
Here at our Headquarters in Las Colinas, I often wonder if our fellow tenants ponder about the cast of characters dressed in everything from business attire to shorts and flip-flops (okay, it's about 90% shorts and flip-flops) and wonder "what the hell is Akili all about?!" Don't let the hoverboards, loud laughter and casual environment fool you, my friend. Because behind those doors are some of the most highly respected and sought-after SAP and Anaplan professionals in North America. When it comes to disciplined thought and disciplined action that's driven by a unified passion of "why" not "what," "Band of Brothers" perfectly describes this entourage called Akili. I hope one day to call it home.


text:
Stay on target
Researchers have studied the impact of music on the human brain for centuries.
But only recently has anyone considered how harmonized sounds affect the maturation of cheese.
Students at Switzerland's Bern University of the Arts (HKB) teamed up with local cheesehouse Käsehaus K3 and the city of Burgdorf for a unique culinary art experiment.
Led by Michael Harenberg, director of studies at Sound Arts HKB, students tested eight semi-hard cheese wheels—kept in special wooden boxes, each with different music styles. A ninth sample—the scientific control—aged in silence.
The eclectic tracklist featured five diverse genres:
- Ambient: Yello – "Monolith"
- Classical: Wolfgang Amadeus Mozart – "The Magic Flute"
- Techno: Vril – "UV"
- Rock: Led Zeppelin – "Stairway to Heaven"
- Hip-hop: A Tribe Called Quest – "Jazz (We've Got)"
Left to ripen for about six months, the dulcet cheese wheels were then put to the test by a "star-studded" panel of judges, including Burgdorf Mayor Stefan Berger, insect cook Andrea Staudacher, artist Celia Sidler, and gastronomic entrepreneur Benjamin Luzuy, among others.
The group claimed they could discern clear differences, not only in laboratory analyses, but also in terms of taste. (Cheeses that were played hip-hop music, for instance, were described as slightly sweet.)
"For chefs like me, these results are fascinating," Luzuy, the "Jamie Oliver of Western Switzerland," said in a statement. "This opens up new avenues for us in terms of how we can work creatively with food in the future."
The project has already made international headlines, and the HKB and Käsehaus K3 are now exploring ways to develop their new acoustic approach to cheesemaking.
"We really did not expect such a response, particularly from the international media," according to HKB Director Thomas Beck. "This inspiring idea provides a great opportunity for our university to be seen as a place of learning for creative and committed students guided by dedicated and innovative teachers."
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