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Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention
Aggarwal B, Aman W, Jeroudi O, Kleiman NS. Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention. Methodist DeBakey Cardiovasc J. 2018;14(1):23-31.doi: 10.14797/mdcj-14-1-23
Due to advancing age and increasing comorbidities, the current population has a higher incidence of complex coronary artery disease, often without surgical options for revascularization. In this setting, hemodynamic support devices are an important adjunct in the interventionist's toolbox as they allow for a safer, more effective procedure. The following paper reviews the indications of various available mechanical support devices, highlights their clinical data and technical parameters, and offers a practical approach towards appropriate patient and device selection.Keywords
mechanical circulatory support , high-risk , percutaneous coronary intervention , cardiogenic shock , stent , coronary artery disease
Interventional cardiology has evolved tremendously in the last decade, with physicians gaining more experience and having an increasing number of tools at their disposal. As a result, complex percutaneous coronary interventions (PCI) are being performed on an older cohort of patients who have more comorbidities and more complex disease than in years past. Improvement and greater availability of mechanical circulatory support devices have made them a critical component of the interventionist's attempt at a successful outcome.
Mechanical circulatory support (MCS) devices have been used as an adjunct to PCI in two main clinical scenarios: cardiogenic shock complicating acute myocardial infarction (AMI) and technically complex high-risk PCI in the absence of overt shock.
Cardiogenic shock is the combination of tissue hypoxia and decreased cardiac output in the setting of adequate intravascular volume. There are objective clinical and hemodynamic criteria that define cardiogenic shock. Clinical criteria include hypotension (a systolic blood pressure [SBP] of < 90 mm Hg for at least 30 minutes or the need for supportive measures to keep SBP ? 90) and evidence of end-organ hypoperfusion (urine output < 30 mL/h and a heart rate of ? 60 bpm with cool extremities); hemodynamic criteria include low cardiac index (< 2.2 mL/min/m²) and pulmonary capillary wedge pressure ? 15 mm Hg.1,2
Most cases of acute cardiogenic shock occur secondary to ventricular dysfunction after AMI with or without concomitant valvular dysfunction and vasodilatory abnormalities, although in rare instances mechanical complications of AMI can lead to sudden, acute cardiogenic shock in a previously stable patient.3,4 Cardiogenic shock complicating AMI has high rates of morbidity and mortality, with 30-day mortality approaching 50%. Even though interventional techniques and pharmacology have both improved dramatically in the last 3 decades, this has not translated to meaningful improvement in outcomes for cardiogenic shock; to date, only prompt revascularization has been shown to improve mortality in this setting.1 Over the last 20 years, newer percutaneous and surgical MCS devices have become available that aid in augmenting cardiac output and decreasing afterload and ventricular filling pressure, thereby supporting end-organ perfusion acting as a bridge to myocardial recovery or transplant and providing an excellent adjunct to PCI in these critical patients with cardiogenic shock.
Coronary interventional techniques have progressed immensely since the inception of PCI 40 years ago. The availability of tools such as low-profile balloons, improved guidewires, coronary atherectomy devices, and superior stent designs that help improve deliverability have enabled physicians to perform coronary interventions in patients who would previously have been deemed untreatable. In addition, overall improvements in health care delivery have led to improved survival rates in patients with more advanced coronary artery disease to the point where revascularization can and should be performed. Furthermore, advancing age and increased comorbidities have put more patients at prohibitive risk for coronary artery bypass grafting, rendering high-risk PCI as the sole revascularization strategy for this population.5 Lastly, a large body of evidence now indicates that complete multivessel revascularization leads to significantly superior outcomes compared to partial/incomplete revascularization.6 These factors have led to the concept of CHIP: Complete revascularization for higher–risk indicated patients.
Several attributes may define a high-risk coronary intervention, although none are absolute (Table 1). These include patient characteristics such as left ventricular (LV) systolic function, end-organ dysfunction (baseline kidney disease or lung disease), clinical presentation with heart failure, and complex coronary anatomy. The goal of MCS in high-risk PCI is to provide sufficient forward cardiac output to maintain myocardial flow and end-organ perfusion and to unload the left ventricle during the procedure. This approach often requires multiple, high-pressure balloon inflations and plaque modification procedures such as coronary atherectomy and intravascular imaging. These techniques are often time consuming, lead to prolonged periods of systemic and coronary hypoperfusion, and can ultimately result in myocardial depression and circulatory collapse7—although the latter is extremely uncommon due to improved equipment that minimizes ischemic time and quickly seals occlusive coronary dissections. Despite these concerns, use of an appropriate MCS device allows time to safely perform an optimal coronary intervention in brittle, critically ill patients with advanced coronary artery disease to enable superior short- and long-term outcomes. Therefore, an MCS device should be placed prior to initiating a high-risk coronary intervention. This support enables the operator to proceed confidently with high-risk PCI without the risk of inadvertent collapse and subsequent need for emergency implementation of hemodynamic support for bailout.
An ideal MCS device should provide adequate circulatory support that increases mean arterial pressure, thereby maintaining vital organ perfusion while simultaneously reducing myocardial oxygen demand through reductions in LV pressure (afterload) and volume (preload). Ultimately, the MCS device is meant to maximize cardiac power, which has been shown to be a strong independent predictor of outcomes in patients with cardiogenic shock and severe dysfunction.8 Several percutaneous MCS devices with variable impact on cardiovascular hemodynamics are available to the interventionist (Figure 1, Table 2).9 The following is a summary of approved devices and their published trial data.
For 40 years, the intra-aortic balloon pump (IABP) has been the most widely used mechanical assist device in hemodynamically unstable patients with AMI. Mounted on a catheter and inserted through the femoral or axillary artery, the IABP displaces blood volume in the descending aorta by inflating during diastole and creating a potential space during systole that facilitates cardiac filling of the aorta. The IABP console delivers a specific volume of gas (usually helium) into the balloon with rapid entry and retrieval. The primary impact of the IABP is to reduce myocardial work and oxygen demand by decreasing the duration of the isometric phase of LV contraction. The cardiovascular changes reported with IABP can result in decreased end-diastolic aortic and systolic blood pressures of up to 30% and 10%, respectively, indicating LV systolic unloading and afterload reduction and resulting in a decrease in LV diastolic volume.10 However, the IABP provides only a modest increase in cardiac index and requires a certain level of basal ventricular function due to the lack of active cardiac support (Table 2).9 In contrast to the continuous-flow devices described elsewhere in this review, the IABP requires a stable electrical rhythm or pressure tracing for optimal timing and function.
The use of IABP in cardiogenic shock and AMI has been studied extensively. A possible benefit of IABP use was initially reported in patients receiving thrombolytic therapy for ST-segment AMI.11,12 However, the treatment strategy for ST-segment AMI has evolved over the past decades to default use of primary PCI. The use of IABP in this setting was tested in the IABP Shock II trial that included patients with AMI and cardiogenic shock. This randomized trial showed no improvement in survival with IABP either during hospitalization or at 1-year follow-up. In the realm of high-risk PCI, neither randomized clinical trials nor registry data have demonstrated benefit for routine periprocedural use of IABP.13-16
The Impella (ABIOMED) is a continuous nonpulsatile microaxial pump mounted on a 9F catheter that aspirates blood from the LV cavity and expels it to the ascending aorta. The efficient extraction of blood from the LV immediately reduces myocardial wall stress, pulmonary capillary wedge pressure, and myocardial oxygen consumption. The Impella comes in various sizes that reflect relative stepwise increases in cardiac output from 2.5 to 5 L/min, with a concomitant increase in sheath sizes up to the largest, Impella 5.0 (21F sheath), which usually requires surgical placement of an access conduit. The Impella 2.5 device was first tested and compared against conventional IABP therapy in a small randomized trial that included patients with cardiogenic shock.17 Although it did not show a significant decrease in mortality at 30 days, this trial demonstrated superior hemodynamic improvement (cardiac output and mean arterial pressure) with the Impella device in the short term compared with the IABP. A more recent randomized study comparing the larger Impella CP to IABP again showed similar findings, with no differences in mortality at 30 days and 6 months.18
The Impella device was subsequently tested in an elective high-risk PCI population against preprocedural IABP in the PROTECT-II study.19 This trial randomized approximately 500 patients with depressed ventricular function and multivessel coronary artery disease to IABP or Impella 2.5 at the time of PCI. The trial was stopped early after an interim analysis showed that it would not reach its primary end point of 30-day major adverse cardiac events. However, a subsequent post-hoc analysis revealed a lower rate of composite major adverse cardiac events with Impella compared to IABP at 90 days (40.8% vs. 51.4%; P = .029). Real-world results using adjunctive Impella technology in patients undergoing high-risk PCI were also reported in the observational multicenter USpella registry.20,21 Data from this registry substantiated the feasibility, safety, and hemodynamic usefulness of the Impella device for high-risk PCI with favorable short- and mid-term angiographic, procedural, and clinical outcomes. The FDA has approved Impella devices for use in cardiogenic shock after AMI or open-heart surgery (Impella 2.5 and Impella CP for < 4 days and Impella 5.0 for < 6 days) and for use in urgent and elective high-risk PCI (Impella 2.5 and Impella CP ? 6 hours).
Technical Considerations
The Impella device requires large-bore arterial cannulation (13F for Impella 2.5 and 14F for Impella CP) and therefore requires assessment for adequate iliac and femoral artery diameters. A fluid bolus of 250 to 500 mL of normal saline is usually given to sustain ventricular filling before initiating Impella support. For most patients, the device is removed at the end of the coronary intervention after high-risk PCI. However, if retained following the intervention (i.e., in those with cardiogenic shock), the device poses some unique challenges. Adequate positioning in the LV cavity is crucial for optimum functioning, and device migration can lead to low flow, entanglement in subvalvular mitral valve apparatus, ventricular arrhythmias, and hemolysis (Tables 2, 3). In such cases, the device can usually be repositioned at bedside with transthoracic echocardiographic guidance without the need for fluoroscopy.
The TandemHeart LV assist device (CardiacAssist, Inc.) is a continuous-flow centrifugal pump wherein oxygenated blood is withdrawn from the left atrium through a 21F inflow cannula, propelled by a magnetically driven six-bladed impeller, and delivered to the femoral artery via a 17F or 19F arterial cannula.22 The device delivers up to 4 L/min of flow and is approved for use in cardiogenic shock for short-term support ranging from a few hours to 14 days.
In studies comparing the TandemHeart device with IABP in patients with cardiogenic shock,23,24 the TandemHeart consistently demonstrated superiority in hemodynamic parameters (e.g., cardiac output, mean arterial pressure) although it showed no significant survival benefit. This device has also been used with good short-term success as an adjunctive tool for high-risk PCI.25
Technical Aspects
Although it provides significant support, the TandemHeart device has several limitations that curtail its use. One limitation is the requirement of transseptal puncture for placement of a 21F inflow cannula. Transseptal puncture is associated with longer initiation times and higher complication rates when performed by inexperienced providers, and it often requires additional imaging modalities—such as intracardiac or transesophageal echocardiogram—for adequate placement (Tables 2, 3). Other drawbacks include an increased risk of hemolysis, limb ischemia, device migration, and infection with longer support times.
Extracorporeal membrane oxygenation (ECMO) is a modified percutaneous heart-lung bypass machine that consists of a centrifugal pump, heat exchanger, and membrane oxygenator.26 This device drains venous blood from the right atrium via an 18F to 21F inflow cannula into the external centrifugal pump, where it is sent to the oxygenator. Gaseous exchange occurs through a semipermeable membrane as blood flows through the oxygenator, and the oxygenated blood is then returned to the descending aorta via a 14F to 19F outflow cannula placed in the femoral artery. Referred to as venoarterial ECMO, this system can provide cardiac flow from between 3 and 7 L/min and can potentially be maintained for weeks. Venoarterial (VA) ECMO has largely been studied in patients who have profound cardiogenic shock with respiratory failure and cardiac arrest.27,28 Small studies evaluating patients with post-STEMI cardiogenic shock have indicated higher rates of survival to hospital discharge in patients receiving ECMO-assisted PCI compared with primary PCI alone.29
ECMO holds several advantages over other MCS devices. It can be inserted quickly at bedside and provides complete cardiopulmonary support, making it especially useful in patients who are undergoing cardiopulmonary resuscitation at the time PCI is initiated. It also provides right ventricular and/or biventricular support and has the potential to support patients with concomitant pulmonary disease due to its ability to oxygenate venous blood (Tables 2, 3). Finally, since it can be maintained for longer durations, ECMO can be used as a bridge to permanent LV assist device placement or transplant in patients with persistent cardiogenic shock.
Technical Considerations
While ECMO has several benefits over the other MCS devices, it also has limitations. For example, the risk for limb ischemia is high due to large-bore arterial access; as a result, this often requires placement of an antegrade sheath in the ipsilateral femoral artery to allow for adequate distal limb perfusion. Another major disadvantage of VA ECMO is its inability to provide adequate ventricular unloading. This can lead to increased afterload, LV distention, increased myocardial oxygen demand, and an ultimate decline in myocardial perfusion. The distension can be countered with inotropes or high-dose diuretics but often requires additional support via IABP or Impella to vent the left ventricle. Due to the complexities involved with this device, its use is only recommended in experienced centers with dedicated ECMO teams that include a perfusionist.
Cardiogenic shock is a clinical continuum that varies from pre-shock/early shock (low cardiac index with SBP > 90 mm Hg) to severe shock (hypotension, end-organ dysfunction, and need for multiple vasopressors). For adequate device selection, the clinician must rapidly assess the severity of shock to determine the appropriate degree of cardiac support needed for PCI. This may require a right heart catheterization or assessment of LV end-diastolic pressure to determine cardiac output in borderline cases. Intricate preprocedural planning is paramount, as device selection should be made prior to intitiating the procedure rather than on an ad hoc basis. A team approach that involves an advanced heart failure specialist, cardiothoracic surgeon, and interventional cardiologist can be beneficial, although it may not be feasible in all cardiogenic shock patients who require immediate intervention.
The timing of device placement is critical for maximum benefit and successful outcomes. Prolonged cardiogenic shock results in end-organ (renal, liver, and cerebral) dysfunction, which can rapidly decline to a "hemo-metabolic" state that may not subsequently respond to improvement in cardiac output alone. Once prolonged periods of shock and multiorgan dysfunction have occurred, MCS devices have limited utility and impact. To address this, the concept of "door to support"—placement of MCS prior to percutaneous intervention—in patients with cardiogenic shock and AMI has been proposed and, in small studies, has shown to improve outcomes.30,31 Given our experience with these devices, we recommend rapid placement of an appropriate MCS device before coronary intervention in these patients. For high-risk PCI, most cases should be elective, and MCS should be instituted by default in the catheterization laboratory prior to initiating coronary intervention.
Before selecting MCS, one must consider contraindications and nuances involved with each device as well as individual and institutional experience. In some cases of pre-shock/early shock, it may be reasonable to start with IABP and then reassess hemodynamic response. For severe cardiogenic shock, a device with a greater impact on cardiac power should be initiated, such as the Impella, VA ECMO, or TandemHeart. Specific considerations should be kept in mind; for example, the ECMO device allows for biventricular support and can be used in subjects with concomitant pulmonary dysfunction, unlike the other described devices, and an Impella device may be the easiest and quickest to initiate due to single arterial access and a simple set-up. In the setting of cardiogenic shock secondary to acute right ventricular systolic dysfunction, the main options for hemodynamic support include Tandem-Heart ProTek Duo (CardiacAssist, Inc.), Impella RP (Abiomed), and VA ECMO.32 When right ventricular function is marginal, further deterioration may occur after initiating left-sided support due to "flooding" of the right ventricle; this should be anticipated and may require initiation of right-side support. In patients with biventricular failure, percutaneous options include VA ECMO or a combination of percutaneous right ventricular assist devices such as TandemHeart or Impella RP with an Impella CP or 5.0.
Pelvic angiography is also essential to assess peripheral arterial size and the presence of atherosclerosis and/or significant tortuosity that may complicate device placement. While the femoral artery is the default access site, the axillary or subclavian artery can be used in cases of severe femoral arterial disease.33 Obtaining arterial vascular access should be done with great precision using micropuncture techniques and/or ultrasound guidance for appropriate anterior wall cannulation above the femoral artery bifurcation. For large-bore devices (Impella, TandemHeart, or VA ECMO), preclosure of arterial access with one or two Perclose Proglide devices (Abbott Vascular, Inc.) should be strongly considered before upsizing the arteriotomy to > 8F. Additionally, a stiff 0.035-in wire such as the Amplatz Super Stiff Guidewire (Boston Scientific Corp.) or Lunderquist Extra-Stiff Wire (Cook Medical, LLC) may be inserted through a diagnostic catheter and used as a rail to overcome arterial tortuosity and ensure atraumatic delivery of a large-bore arterial cannula.32
Immaculate postprocedural care is essential to ensure safe and effective use of MCS. Training of the nursing staff and house staff physicians/intensivists is paramount to minimize complications and troubleshoot device-related issues. All MCS devices require systemic anticoagulation, and appropriate protocols should be established and strictly instituted for each device.
Once shock has resolved, or at the end of an elective high-risk PCI, early weaning or de-escalation of the MCS device should be immediately considered to minimize device-related complications from protracted dwell time. The device can be rapidly weaned in the catheterization laboratory in cases of high-risk PCI and removed prior to transferring to a nursing floor, whereas device weaning at the bedside should be slower (over hours). End-organ perfusion and cardiac output should be assessed and at a minimum level of support prior to discontinuing the device to avoid emergent repeat MCS. Additionally, the interventional physician using such devices must become facile with large-bore access closure techniques. While manual pressure can be successful in most patients, this should not be routinely used as default strategy especially for large-bore (> 10F) arterial access. In select cases or in cases of significantly diseased peripheral vasculature, surgical closure with cut-down may be considered as an alternate strategy.
Cardiogenic shock complicating AMI and complex high-risk coronary intervention are associated with a high incidence of morbidity and mortality. Percutaneous MCS devices have evolved dramatically in the last decade and have the potential to improve outcomes in these critical patients. With widespread availability of these devices, interventional physicians need to understand specific indications, contraindications, device placement, and postplacement monitoring techniques. A multidisciplinary team approach that involves adequately trained catheterization laboratory and nursing staff in addition to an interventional cardiologist, advanced heart failure physician, and/or cardiothoracic surgeon remains the cornerstone for a successful MCS program.
- Patients with anatomically complex multivessel disease and acute myocardial infarction with cardiogenic shock represent a high-risk cohort.
- Mechanical circulatory support devices act as an adjunct to percutaneous coronary intervention, enabling safe and successful coronary revascularization.
- Mechanical circulatory support device selection should be carefully individualized with continued management using a specialized, multidisciplinary team approach.
The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.References
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- Nguyen HL, Yarzebski J, Lessard D, Gore JM, McManus DD, Goldberg RJ. Ten-Year (2001-2011) Trends in the Incidence Rates and Short-Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction. J Am Heart Assoc. 2017 Jun 7;6(6).
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- Waldo SW, Secemsky EA, O'Brien C, et al. Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. Circulation. 2014 Dec 23;130(25):2295-301.
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- Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC. IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg. 2016 Aug 4;11(1):122.
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- Seyfarth M, Sibbing D, Bauer I, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008 Nov 4;52(19):1584-8.
- Ouweneel DM, Eriksen E, Sjauw KD, et al. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2017 Jan 24;69(3):278-87.
- O'Neill WW, Kleiman NS, Moses J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012 Oct 2;126(14):1717-27.
- Schreiber T, Wah Htun W, Blank N, et al. Real-world supported unprotected left main percutaneous coronary intervention with impella device; data from the USpella registry. Catheter Cardiovasc Interv. 2017 Oct 1;90(4):576-581.
- Maini B, Naidu SS, Mulukutla S, et al. Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: the USpella Registry. Catheter Cardiovasc Interv. 2012 Nov 1;80(5):717-25.
- Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation. 2001 Dec 11;104(24):2917-22.
- Burkhoff D, Cohen H, Brunckhorst C, O'Neill WW; TandemHeart Investigators Group. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006 Sep;152(3):469.e1-8.
- Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005 Jul;26(13):1276-83.
- Alli OO, Singh IM, Holmes DR Jr, Pulido JN, Park SJ, Rihal CS. Percutaneous left ventricular assist device with TandemHeart for high-risk percutaneous coronary intervention: the Mayo Clinic experience. Catheter Cardiovasc Interv. 2012 Nov 1;80(5):728-34.
- MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012 Feb;38(2):210-20.
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Just when you think alleged criminals have it all figured out, they do something stupid and mess it all up.
This is what happened to one man who spotted his own wanted post on the Great Falls/Cascade County Crimestoppers Facebook page and clicked "like"
Levi Charlies Reardon, 23, was wanted for felony forgery.
According to court records he was a suspect in a theft of a wallet and cashing four missing cheques.
He was arrested last Friday following his 'liking' mistake.
This is the latest addition to the files of suspects who have done idiotic things, ranking alongside incidents like "taking selfies with stolen items", "posting to police while leaving your Facebook location on", and snapchatting their hiding place to police.

subset: commoncrawl


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Paul Dolan Vineyards Wine Club: 6 Bottle Membership Level
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In January Pensacola International Airport regained 6 percent more seat capacity over January 2012. Total enplanements for January 2013 were up approximately 3 percent over January 2012 and total passengers for the month of January 2013 reported 101,647, an increase of 4 percent compared to 97,549 in total passengers carried in January 2012. Pensacola International Airport, the 98th largest airport in the United States, connects 1.5 million passengers annually anywhere in the world through ten international hubs served by five major carriers. Over the past year, Pensacola International Airport has been fortunate with the support of the region, it has been able to add new non-stop air service to major markets. Three daily flights to Miami served by American Eagle and US Airways providing daily service to Ronald Reagan Washington National Airport. Effective March 1, 2013, United Airlines will resume daily service to Chicago O'Hare and flight schedules are uploaded in their system to begin booking your flight reservations today. Airlines: AirTran Airways, American Eagle, Delta Air Lines, United Airlines (Express Jet/Silver Airways) and US Airways (Air Wisconsin, Mesa and PSA). Hubs: Atlanta, Charlotte, Chicago, Dallas Ft Worth, Houston Intercontinental, Miami, Orlando, Tampa, Washington Dulles, and Washington Reagan National.
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The resurgent Chicago Fire offense led the team to another MLS win, besting the visiting Minnesota United 2-0 on Saturday night.
Chicago (4-4-4, 16 points) has scored seven goals in its last two games after going three matches without scoring. The surge has taken the team from well back in the Eastern Conference into a possible playoff position, albeit early in the season.
Minnesota (4-4-3, 15 points) has now played seven of its 11 on the road and dropped to 3-4-0 away from their new, Allianz Field. The loss leaves Minnesota ahead of the pace from its first two MLS seasons, but with only one win in its last six games.
It was a game nowhere near as close as the 2-0 score would indicate, as the Fire controlled play throughout and outshot Minnesota 15-5.
The second half was an uneventful 45 minutes as there were few legitimate scoring chances, but for Chicago it didn't matter as the first half was more than enough to earn a second straight win.
Chicago scored the first goal of the game in the 21st minute on a brilliant, full-field counter off a Minnesota corner kick.
A clear from the Chicago defense found Przemyslaw Frankowski behind the Minnesota defense, near midfield. Frankowski went off to the races, getting to the edge of the penalty box just as the Minnesota defense was closing in.
Undaunted, he rolled the ball into the middle where Nicolas Gaitan beat the Minnesota defense to the ball, tapped it around goalie Vito Mannone and put it home for the 1-0 lead.
The Fire doubled their lead in the 34th minute.
Aleksandar Katai took a long pass down the left side, brought it into the Minnesota penalty area and beat Mannone to the far post for the goal.


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Source: http://youtu.be/UO7H3z2Xf_E
To be up to date with the latest information in the apiculture industry to can check out our beekeeping latest news. On the other hand if you're new to beekeeping and would like to start professional apiculture today download a copy of our beekeeping for beginners ebook.
Beekeeping can either be a full time profession or an easy hobby. Yet, more often than not, what started as a hobby would become a profession. But you cannot only tell and determine yourself that you will start to do beekeeping. Before starting on any hobby or profession, you need to have adequate knowledge and understanding on the field that you're going to enter. If you have been putting off your curiosity about beekeeping for a long time, then it is about time to indulge yourself in your line of interest. Bee farming may look simple; learning the basic beekeeping lessons can get you away to a great start.
What does a beekeeper have to know?
You should have interest that is total on beekeeping to start at the right foot. You should have also agreed to share your dwelling space with the bees. There are possible risks in beekeeping that can damage you but your family too. Your focus is not only to make money by selling honey; a great beekeeper should have fire and a keen interest in rearing bees.
An apiarist should know the right place for the beehives. You need to make sure that beekeeping is enabled in your town, if you decide to place your beehives at your backyard. There are several places limited to beekeeping; you should get permission about this.
Beekeepers must know whether beekeeping supplies can be found in the area where the beehives are situated. You may never know when you need to attend a neighborhood beekeeping store; it's best that a nearby beekeeping store is not inaccessible.
Protective supplies and equipment can also be very important to beekeepers to know. Beekeepers are prone to bee stings; the outfit that is ideal must be worn during beekeeping sessions. Know the right kind of suit to choose to keep you from any potential danger in beekeeping.
Last but definitely not the least, among the beekeeping lessons you should know is that: it's not unimportant for the beekeeper to know the proper way of picking honey. All the beekeeping attempts would be futile in case you are incapable to harvest honey from your bees. The methods should be known by a beekeeper in gathering the honey in the comb; beeswax is also part of the returns in beekeeping.


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Nightly Routine
Establish a relaxing nightly routine for your child before bed. This could include tidying up their toys, reading bedtime stories, taking a warm bath, and brushing their teeth.
Sleep Consistency
Children are the most rested when they have a consistent sleep schedule. Try to keep their bed time and wake time the same on weekdays and weekends.
Your child may try to delay bedtime by extending their nightly routine. Experts say you can incorporate some flexibility into their routine by allowing them to pick the bedtime story or cheery song, but it is important to establish boundaries by limiting the number of choices. To be effective, this routine should last no longer than 30 minutes. Try to leave their bedroom prior to them falling asleep.
Sleep Resistance
Some children will express resistance to going to bed. To help avoid this confrontation, use a neutral timekeeper, like a clock or a timer. This will not only establish clear expectations in an impartial and positive way, but also helps to expose your child to numbers and telling time.
Pre-K Physical Health Tips
Ages 4 and 5 can be a time of great development for your child, both academically and physically.
Playtime in Bed
Encourage your child to play with their toys on the floor of their bedroom or in another room, reserving their bed solely for sleeping. By limiting the other activities that take place on their bed, your child will begin to associate the bed with sleep time.
To help lessen the fear of the dark, parents have long relied on nightlights. Experts caution that some of the lights currently available on the market are actually too bright for a restful environment and end up inhibiting sleep. They suggest using a low-illumination nightlight and putting it in a place far away from your child's head, so that it is not directly shining into their eyes when they are lying down.
Make a family rule to turn off the television and other electronic devices at least 30 minutes prior to bedtime. Extended screen usage, especially right before bed, is often associated with bedtime resistance, difficulty falling asleep, and nightmares. Experts recommend removing the television from your child's bedroom to ensure that it is a quiet and dark environment.
Consistent Messages
It is important to send consistent messages about the importance of sleep. Try praising your child after a good night's sleep. Avoid using an early bed time as a punishment or a late bed time as a reward. To create a positive message around sleep, you can make a sticker board and reward them with a star for every night they get to bed on time.
Pre-K Nutrition Tips
Proper nutrition will support your Pre-K child's growing body and put them on track for lifelong health.


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ISN reported today, IVIS Group assisted Tesco.com in enhancing its promotions functionality to help central European customers get the best online deals.
Tesco.com recently opened e-commerce operations in Poland, Slovakia and the Czech Republic, and is working with multi-channel expert IVIS Group to create promotion-specific areas on each country's website; recognising the strong offer-led culture around grocery shopping in the region.
Online promotions are linked to those instore in real-time, so customers get the same deals however they choose to shop.
IVIS Group provides Tesco.com with product information and promotions management tools needed to customise offerings in each new local market. The Sonetto® Retail Suite houses a powerful price and promotion management (PPM) platform, while product information management (PIM) technology provides the right information on the right products to customers in a timely manner.
Continue reading here.


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Canada's Newest Thrill Ride is a Single-Rail Roller Coaster Built into a Mountain
There's a new single-rail coaster that brings riders through 4,600 feet of stunning nature.
Roller coasters are great, but for the majority of them, the scenery is nothing to write home about. That being said, flying above lines of people waiting for a seat on said coaster is still incredibly fun. A new attraction at Revelstoke Mountain Resort in Canada is bringing visitors through the surrounding forest and glades on a single-rail ride.
The coaster itself—which officially opens to the public on May 21st—reaches a speed of 27 mph and takes riders over 4,600 feet (just under a mile), including a 915-foot vertical drop. The cost for such an experience will run you $19. The best part: for the majority of the ride, there's not another person in sight. Check it out:
Erika Owen is the Audience Engagement Editor at Follow her on Twitter and Instagram at @erikaraeowen.


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Dota 2 Purge plays Silencer - Replay
Silencer was picked sometimes during TI5 because of his high damage output, sometimes hard countering mid heroes, and his good teamfight presence as a carry because of Global Silence.
To play him as a core position, you need farm, then to purchase a ganking/kill tool, whether that is a Shadow Blade, or Rod of Atos, then transition into major +int utility items such as Scythe of Vice, Shivas Guard, or defensive items like Force Staff or Mek, but generally you just purchase damage items. Later pick up BkB if needed.
The dotabuff segement ends at
Match ID: 1773200506
Google +:
Purge's Dotabuff:
Dotabuff Plus:
only 360 the wait is real now
Damn comment section is silent
yes weiners
the wait for 1080p beggins
360? wtf
What happened to instant 1080p cause of pre-uploading or something?! DAMMIT
CURSE YOU!!! If you got speakers with bass hooked up to your comp you will
cry every time you hear that. Curse of the silent is great against Leshrac
i think.
welcome to the 301+ club how tough are ya
that puck got shit on so hard its not even funny
Uploaded 39 minutes ago and only 720p FailFish Kappa
I like the break aspect of silver edge for pudge games. It's nice ripping
off like 30-40 strength late game from him and being able to burst him down
with a medallion/crest
Game starts at 8:33
IDK why purge thinks phase shift shouldnt avoid damage, its pretty much the
fundamental ability which pucks entire hero survivability is based around,
hero would be trash if abilitys went through it.
I like curse of the silent as a back up to last word. When you are chasing
someone (especially early game) last word them and when it pops and they
are still running then curse them. The AOE is pretty big for curse and can
deal that little extra damage you need early game to finish someone off
that can outrun you
Getting stats over Curse of the Silent is so stupid.
why shivas instead of AC ? the extra 55 atack speed does more DPS than the
extra 25 int from shivas
game begins at 8:34
1:06:29 "It also stops Radiance, that's pretty cool."
He says, as he takes Radiance burn from the Spectre.
26:19 Why did Puck suddenly get 1400 gold?
I swear chachi always randoms brewmaster LOL
Welcome to the below 1000 club
thank you for a GREAT video. i love to play silencer mid and i kind of wish
that you went as a trip support or safe lane because i don't normally see
those and i wanted your opinion but.......thanks for the video. Much love!!
keep up the good work
Dam did purge carry his team hard
37:45 FUCK TECHIES its never a waste to fuck over a techies. 10/10 ult
everytime. Fuck techies
Rod is best for skywrath imo
Lmao Silencer hand of midas shadow blade looked exactly like a game I just
Would the puck phase shift evasion of last word apply to astral
Also nice to point out that with Shadow Blade you can search for a hero
that you know that is in a area but not sure exactly where (the enemy
jungle, for example)
damnit no 60fps!
Raise your hand if you mistook Purge's mouse pointer for your own.
I think treads are nice because you can get an extra 10 int which is good
damage, but then again, I'm just a pub scrub.
Purge you can use most invis while channeling tp and it wont break
One of the bigger things about Last Word, I think, is the vision it gives
on your target. It makes Silencer impossible to juke unless they use BKB.
Isn't that the point of Puck's phase shift??
still figuring out why silencer has a lot of silences. Purge's order.
36:30 when talking about silver edge, you forgot one important aspect: *it
gives you a disable*. Maybe weak, maybe unreliable, but still a disable,
which you constantly complained about not having.
purge I think u should midas the small creep and kill the big one for more
best enchantress world?
How about play Nature prophet?
19:56 Purge I really don't think Meepo is going to be there.
Damn that 30fps is annoying.. Great video Purge, but, dunno why you went
for 30fps upload tho. :)
play jakiro
moon shard on SB is the greatest invention ever
Aghs does not increase the duration of the ultimate anymore.
PL is also a big counter to Silencer for the same reason that Puck is
except PL is even worse. PL can completely ignore Silencer's abilities by
using his W, and then there's Silencer's lack of good AoE. Against PL,
Silencer is basically a hero that only has an ult, and no other abilities.
It's the hardest counter I know of.
aghs no longer increases duration
Just btw Purge...you don't have to shift-click your Shadow Blade when you
tp. They have this mechanic that you can always activate invis during
tp...kinda like you can use your Bounty E while tping without canceling it.
Does bloodstone work on silencer, as you die and you can still steal int?
"iiiieeeeeeehello" xD so funy
Every victory against Techies is a victory for humanity.
The advantages aren't big because he's good against almost everyone, so the
matchups don't change a lot.
Being able to dodge last word with very good timing is a good mechanic.
them fps drops...
48:38 Platemail would increase your suitability against physical by 60%
only if you had 0 armor before, since you already had 14 armor it would
increase you physical EHP only by ~32%.
Purge, what do you think about orchid on silencer?
This guy is just garbage guys he plays unranked and make mega misstakes
only go to chi long qua he is the best fucking dota 2 player this world
have ever seen remember that and actually the funniest dota 2 player this
world have ever seen
still dont understand Last word, that spell will hit you anyways what ever
you do?
The right way to do this is take mid, buy power threads then rush shadow
blade. After that gank gank gank. Next item assault cuirass. Follow up with
items depending on enemy lineup (orchid, force, atos, euls, shiva etc). But
sb and ac rush is the most important.
Got 14 win streak like that so i know what i am saying.
Slahser's way is the best way.
As for skills max 2 and 3 and ulti when possible. Then stats and 1 at the
end... if game goes that long.
6:35 look at the number of matches against storm spirit
had the midas about 10 mins longer than he should have...typical high mmr
There really should be a quick message saying 'Techies mines are here' or
something. Then you could ping out the spot
I think the Undying just heard the sound of shadow blade and got scared
Techies at minute 55: "Aaaaah! My miiiines! :((" :D
That techies was so fucking bad it hurt to watch...
why is the logo of moon duck a earth hippopotamus
puck has 550 range and silencer 600 , other way round?
purge confirmed for slahser's way fanstraight
Puck's name though.
Finish treads?
so that specter is the coach in the meepo game...... maybe not the best
coach not that i can really talk though.
purge, did you know you can shadowblade while tp'ing? i didnt see you do it
in this video, so i am just curious. i know it's not a big thing but can
really give you the edge when they dont see you the split second after the
tp finishes.
So enchantress is actually faster than luna....
Purge says lina and silencer are both viable SB builders, and i want to ask
is slark one of them?
Hey Purge. I joined your PurgerGamers Dota 2 channel a while ago because I
was hoping to find nice people to play with. I live in Eu west and I am
playing Dota since years. Only problem: EU west is crowded with russians -
so most games are f*cked before they even started. I started asking for
ppl/teams in your channel but no one wants to play they are all just
trading. Any advise? I am so fed up with russian games - can't take it
anymore. But what could I do now?
I just dont want to play with Russian trash anymore they are so bad ...
worst shit on EU west!
Should have got Manta when you sold your Midas, illusions would have done a
huge amount of damage and that would have allowed you to siege the base.
How does that Enchantress, at that level, not have a custom courier? :(
You focus on the gold and xp difference when Spectre bought back, but isn't
wiping the enemy team worth it? Even if it's not worth it for your hero
alone, it greatly benefits your team, hinders the enemy, and makes
objectives easier while they're dead. What needs to happen for a buyback on
Spectre to be worth it for the team, in your eyes?
I feel like this was a OK Aghs game :/
The way phase shift and last word interact is that puck completely avoids
all parts of it if he channels his phase shift for the full duration. If he
doesn't and cancels it (by moving e.g.) prematurely, he'll get damaged,
slowed and silenced. Makes no sense and is pretty bullshit but that's how
it works.
Concerning break: There is no mechanic disabling passive item boni anymore,
except for mkb vs evasion. SIlver edge only affects passive skills, mute
only affects active items. Silver edge does not disable radiance.
anyone notice purge always says raising ur attack speed by 45 is 45
percent??? no its just 45 ......he always says percent when its not....yeah
some things increase percentages but not attack speed
this normals game so brain damage
Gay build shadow blade lol. U shoulda rush aghanim and get 2 or more levels
of first skill then ur ult would silence do some dmg and drain enemy mana.
its like free EMP.
Break doesn't work on items, only hero abilities, not an alternative to
Goblin Techies. Turning 30 minute games into 60 minute games.
Agh's doesn't increase ult duration anymore! :(
Purge, the thing about not building silver edge first, I normally build it
on sf as like 2nd big item. I think he benefits from the strength by a
significant amount and it can be a powerful first item against un-co
ordinated teams. What are your thoughts about this?
Purge's opinion on silver's edge is pretty much my opinion on guardian
why the fuck would you rush greaves as your first item holy shit.
Early in the game u say treads aren't worth it with the attack speed you
had through other items, but y not upgrade your brown boots to Phase? The
move speed would've been great for u since you went sheep vs an Atos this
game, and the extra dmg is nice.
Spectre is a she?
Does SIlver edge stop item passives as well as ability passives?
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Baseball Prospectus has good news and bad for the Cincinnati Reds.
The site's annual PECOTA projections have the Reds improving over last season but failing to get out of the basement in the National League Central.
The Reds will win 74 games in 2018, which would be six more than last year, but still finish three games behind the Pirates.
RELATED: Reds reps talk Nick Senzel, young pitchers, 1990 World Series memories and more
The projections have the Cubs winning the division with the Cardinals and Brewers also finishing above .500 after both teams were aggressive in adding talent in the offseason.
For what it's worth, projecting the season for the Reds might be harder than some clubs considering the uncertainty regarding the pitching staff.
While manager Bryan Price has said he expects his rotation to include Luis Castillo, Homer Bailey, Anthony DeSclafani and Brandon Finnegan with a fifth starter to be determined, DeSclafani and Finnegan are both coming off of years mostly lost to injury.
PECOTA expects DeSclafani to make 16 starts with Robert Stephenson and Sal Romano getting 23 apiece.
RELATED: One on one with Reds GM Dick Williams
The projection also includes Jesse Winker getting 60 percent of the playing time in right field and 10 percent in left field with Scott Schebler getting 40 percent of the time in right and 20 percent in left.
How those things actually shake out remains to be seen.
The other projected division winners are the Dodgers, Nationals, Astros, Indians and Yankees.
Thank you for reading the Dayton Daily News and for supporting local journalism. Subscribers: log in for access to your daily ePaper and premium newsletters.
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"I'm not saying it would be easy, young Alphonse," the General said, steepling his hands in front of his face. He winked, quick enough that Alphonse wasn't sure if he'd seen. General Cameron continued, "but I hear some talents run in the family." "Sir," Alphonse said: prompt, question, and agreement. "Not so formal, young man," Cameron replied. The woman—whom Alphonse guessed to be the General's wife—brought them tea, and left the tray on the low table. Cameron watched her go, a gentle smile on his lips. "Roy Mustang was one of my staff, for the duration of his time in East City."
"Oh," Alphonse exclaimed. "I didn't—"
"No matter," Cameron told him, waving a hand. "I made sure not to impose on Mustang's work, nor on that of his management of your brother, though I did enjoy hearing the stories."
Alphonse was pretty sure he was blushing madly.
"He's a firebrand," Cameron said, a bit fondly. "Rather poetic justice, watching him deal with that sharp blade."
"He...yes," Alphonse managed, catching up with the General's words in time to realize that the firebrand wasn't Edward, but Mustang. Alphonse smiled, at that, feeling a little better.
"Now, then," Cameron told him. "We need to pull some strings. I understand you had a perfect score on the National Alchemist Exam? That was...1910?"
"Yes, sir," Alphonse replied. "I'm assuming I'll need to retake it—"
"No need. The scores stand for ten years, if you scored above a certain percentage. More fail the practical, by not having something the military can use. Letting the scores stand is a way to prevent all of them from packing the headquarters every year." Cameron's eyes glinted. "I suspect it's also a way to get out of the paperwork required to grade those exams."
"It was rather difficult," Alphonse said. "I'd be relieved to not have to do that part again."
"Rather difficult!" The General chortled. "Yes. The annual review processes are a regular event, and that might be...Well, I shall make some calls. Are you familiar with the explosives and obstacle range, just north of the city?"
"Vaguely, sir."
"Be there tomorrow morning, at eight. Do you have a place to stay?"
Alphonse thought of Gracia, and nodded. "I'm pretty sure I do."
Gracia was cleaning up the last of the meal when Alphonse came down the stairs. She glanced up, a plate in one hand, and gave him a brilliant smile. "Thank you for tucking her in," she said. "She misses both of you so much, sometimes."
"I was surprised she even remembered me," Alphonse admitted. He'd been away from Central ever since...well, he decided, long enough that he'd figured most children would forget him. And not being a suit of armor anymore... "Children have longer memories than adults realize," she replied, and her expression darkened, for just a minute. Alphonse covered the pause by assisting her with the rest of the cleanup, and soon they were sitting in the living room over cups of hot chocolate.
"Brother got the assignment at the last minute," Alphonse began, between sips. "He was supposed to head to the North, but then he called and said he'd changed his plans."
"That was my fault. I meddled," Gracia said. "It was Roy's..." She flushed. "I mean, the General's birthday. I made Edward keep him company, since..." Her voice trailed off, and she stared down into her cup for a second, before smiling gamely. "They were assigned two days later."
"I doubt the General's birthday had anything to do with it," he said, and ran his finger across the edge of the mug. It said, World's Best Daddy. He felt his stomach twist with a sudden visceral ache.
"I think...Edward decided to go on that trip because I pushed him to keep the General company," Gracia replied. She sighed, and bowed her head. "I'm sorry, Alphonse. If I hadn't, then at least—"
"Ms. Gracia," Alphonse protested. He wondered if this was going to be an eternal refrain for him, explaining to everyone. "Brother is going to go where he wants to go. He's not very good at taking orders. Don't think you pushed him into anything he probably didn't already want to do."
"I suppose." Gracia smiled, and glanced at the time. "The guest bedroom's ready for you. You're going to need to be awake early to make it to the testing grounds by eight."
"I usually wake up at dawn," Alphonse said, and shrugged. "I missed enough. I don't like missing anything, now."
"Mm," Gracia replied, and it reminded Alphonse of Mustang's noncommittal responses. He wondered if it meant the same thing when Gracia made that sound. She stood, and collected their empty cups. "I'm awake about that time, to start getting Alicia ready for school. I can drop you off before I take her to school."
"You don't have to..." Alphonse stood, as well. He was now just a few inches taller than her, but still not as tall as Hughes had been. Somehow, he'd expected that when he was human again, he'd be looking up at Gracia. It felt odd to see her head tilted back to smile at him, when he felt so young—and yet so old—in comparison. "But I would really appreciate it," he finished.
"Anything, Alphonse," she replied, patting him on the shoulder. "You only have to ask."
He nodded, and something must've shown on her face, because she paused, her eyebrows raised.
"I'm just nervous," Alphonse said. "I don't think I'll sleep much tonight."
"You'll do fine," Gracia said, and laughed. "There's no way you couldn't."
"I wish! But I—"
"Alphonse," Gracia chided. "Don't worry so much."
He felt rather presumptuous, hearing the words spill from his lips. "I could say the same to you, Ms. Gracia. We'll find out what happened. I promise."
"I know you will," Gracia whispered, and kissed him on the cheek. "Good night, dear."
The explosives and obstacle range was a fifteen-acre plot of land occupied by trees, obstacle courses, and several old stone buildings whose roofs had long since caved in. Mostly the area was used for small explosives and boot camp. The entire area was ringed by a foot track for morning runs. Alphonse's boots crunched on the winter leaves, echoing dully on the tarmac before landing on frost-covered grass on the other side.
Ahead across a broad field he could see General Cameron, looking patrician and reserved, leaning on a cane. There were five others with him, also in military dress. Alphonse pulled his gray cloak closer about him, and shivered as the wind hit the back of his neck. Not for the first time he wished he'd had it made with a hood.
The group turned to look at Alphonse as he approached, and General Cameron gave him a slight smile.
"Alphonse Elric, these officers perform the annual reviews for National Alchemists." He introduced each in turn, and Alphonse nodded nervously, giving each person—two men, two women—a polite smile. The fifth person was Generalissimo Thayer, who grinned broadly but said nothing, his hands in his pockets.
Cameron cleared his throat, and leaned heavily on the cane for a second, then began walking towards the middle of the training grounds. They passed the stone buildings, and Alphonse halted.
"I could do it here, if that's okay," he told them, having an idea already of what he might do. He'd been up most of the night worried about it, remembering his brother's stories about the original test, and the annual evaluations after that.
"I'm going to give you the standard speech, young man," one of the men said. He was in his fifties, with graying hair at the temples. He rocked back on his heels, grinned at the other examiners, and began reciting a series of warnings and explanations that were obviously long-since burned into his memory. Most of it involved the requirements of checking their materials before beginning, and various other notes of safety.
Some of which, Alphonse noted, were probably due solely to Edward's more gloriously destructive maneuvers over the years. He caught the phrase, 'don't destroy anything you can't repair in one day,' and nearly smirked. When the man finished, Alphonse blinked, and nodded.
"Yes, sir," he said, hoping they didn't quiz him too hard. He'd caught most of it, but... His stomach felt queasy.
"What's your radius?" One of the women asked, digging a notepad from her pocket. She looked at Alphonse expectantly, and he eyed the three buildings with a judicious eye.
"Just stand back there," he said, waving in the direction of a low bunker used for storing obstacle course items.
The group moved back, and several more got out their notepads, ready to observe. Alphonse waited until General Cameron and the others had moved to a point about two hundred feet away. He took a deep breath, raised his hands before him.
He brought his palms together with a solid slap.
Dropping to his knees, he put his hands on the ground and pushed.
The shockwave tore across the ground, beaten winter-grass whipping in the underground force. A wave of light spread out in a half-circle, threads of blue and silver. A second later the three buildings exploded upwards. The tall flag over the main grounds rippled violently, one of its tie-downs ripped from its mooring. Stones and rocks and broken rotting wood arced into the air, smashed and scattered into the molecules of their origin.
For a second, everything seemed to hover, and Alphonse clapped his hands again. He spread them, palms out, pressed his hands to the ground, and pulled.
The pebbles and splinters came flying back, as another wave of blue light spread from the farthest points of the half-circle to come rushing back at Alphonse. The buildings settled back down into themselves, even the collapsed roofs returning to their original shrunken positions. The tie-down on the large banner whipped, metal shrieking as the hook caught and held.
Alphonse regarded the buildings with a careful eye. Standing, he wiped off the knees of his pants while the examiners approached him. General Cameron looked thoughtful, while Generalissimo Thayer was laughing about something one of the examiners had said.
"Well, young man," Thayer said when they reached Alphonse. "I see you have more in common with your brother than meets the eye." His gaze jumped from Alphonse's sandy brown hair, to the gray cloak, and the black jeans and gray overcoat underneath. "Other than the same taste in footwear," he added, and chuckled.
"Yes, sir," Alphonse said, not really sure how to take the man. He offered a small smile, and Thayer's chuckles grew.
"Any questions?" Thayer looked around at the examiners. The one who'd given Alphonse instructions stepped forward.
"You have impeccable control over the process of deconstruction and recreation," he commented. "But your control over the blast radius is questionable."
Alphonse thought for a second, looking around. "The flag," he said. He clapped his hands, knelt, and pushed. The wave of light this time was nearly gunshot thin; the flag splintered and ripped. Alphonse raised his hands and waited, still crouched before them.
General Cameron coughed. "You can put it back, now, Alphonse. I think you've proven your point."
"Yes, sir." Alphonse tossed a quick smile at Cameron; a clap, flash, and a moment later the flag's ribbons were solid, waving gently in the midwinter breeze. He came to his feet.
"Good enough?" The examiner looked around, and the other three nodded.
"One more question, Alphonse Elric," Generalissimo Thayer said. The smile lines disappeared from his face, replaced by a grim look that belonged on the battlefield. "What's your purpose, in all this?"
To find my brother, Alphonse thought...but is that all? If he's dead, then...He frowned, considering it for several moments before answering cautiously, "I'm here for the people."
Thayer's eyebrows went up, and he stared at Alphonse for a long time. The others waited, unmoving, though the winter breeze caught their coats and the flag snapped a few times as the breeze picked up. Finally Thayer nodded.
"We'll notify you with our decision, General," the head examiner told Cameron. The four saluted, and as a group, left the grounds, Generalissimo Thayer in their lead.
"Alphonse," Cameron said, and sighed. He leaned on his cane for a moment, staring up at the flag. Then he seemed to come back to himself, and he smiled distantly. "My car is waiting. Would you like to join me for lunch? I go there everyday, and I'm sure any messenger will be sent there first."
"That's generous of you, sir," Alphonse said.
"Ah, but I know you alchemists," Cameron said, and his eyes twinkled in the early morning sunshine. "I expect equivalent trade."
"Yes, sir," Alphonse replied, soberly, tensing.
"That is to say, offer me your arm, young man, I'm not nearly as spry as I used to be." Alphonse offered his support, and together the two slowly made their way to Cameron's waiting driver and car.
"This is the officer's club," Alphonse said, surprised. He opened the door, helping General Cameron from the car.
"That's right," Cameron said, leaning on his cane but walking with an amazing quickness now that he was back on even ground. Inside, a young lady took their coats, and a middle-aged gentleman welcomed Cameron by name and led them to a table near the back. Cameron slid into his chair with a grateful sigh. "It's good food...and it's warm. I'm afraid I'm not up to long cold mornings, these days."
Alphonse nodded, aware that he'd been handed a menu but the General hadn't been. It was pretty clear the General was a regular, and from the looks and smiles from the staff, one of the staff's favorites, as well. It wasn't surprising, given the man's elegant yet congenial manners.
They spoke little, and Cameron seemed to be content watching the late morning crowd while Alphonse pondered his choices. Picking something at random that he'd never had before, he gave his order to the waiter. Alphonse settled his napkin in his lap, clasped his hands, and waited.
"The Generalissimo was wrong," Cameron said, in a conversational tone, but he looked amused. "There is much in your appearance that is like your brother, but far less in temperament."
"We are two different people," Alphonse pointed out.
"Of course." Cameron pursed his lips, and leaned forward. "Are you aware of the purpose behind General Mustang's assignment to Hyle?"
"Only the barest bones, sir. My brother called me the night before he left, and again from Hyle, before he left for Soswell. General Mustang was supposed to find out what had happened to two National Alchemists."
"That's right," Cameron confirmed. He settled back in his chair, and studied Alphonse for a long moment. "This doesn't seem to surprise you."
"I know General Mustang has been given demanding assignments in the past," Alphonse answered, picking his words carefully. "And with my brother going along, I figured there must be some danger involved."
"Or would be," Cameron said in a low undertone, "once those two started their first argument."
Alphonse choked on a laugh. "I see you're fully aware of their...working relationship."
"My office was down the hall from General Mustang's, in East City," Cameron said, and arched a quick eyebrow, come and gone in amused solidarity. "I heard the doors slamming often enough, usually followed by a young man's voice complaining bitterly as it passed my door."
"Oh, gracious, I'm so sorry, sir, I had no idea," Alphonse sputtered. He knew he should've done more to get Edward to stop ranting, so many times, but sometimes it was just easier to let Edward get it out of his system right away. "Brother can be—"
"Colorful," Cameron said. "I think that was the word my secretary used. Which prompted a rather colorful reaction from the then-Colonel Mustang and a bit of a sulk, too, I believe." He winked at Alphonse. "They are too wise to woo peaceably."
Alphonse blinked.
Cameron shook his head, waving one hand good-naturedly. "It's just an expression. Regardless, as I've been able to gather, Major General Mascroft recommended General Mustang be assigned the duty. There is nothing on record of animosity between the two men, but it's wise to be aware of one's...benefactors."
Alphonse caught the merest hesitation, and nodded firmly. Cameron gave him a long look, and Alphonse lifted his chin, just a degree.
"Yes, young man," Cameron said, recognizing and answering the unspoken question.
"Sending a General to track down two Alchemists seems like overkill," Alphonse said, emboldened by Cameron's affability. "Wouldn't that normally be for someone more..." He shrugged, not sure. "Administrative?"
"Depends on the situation," Cameron said. He leaned back as their lunch was delivered, and thanked the waitress with a smile. When she'd departed, he was silent for a moment, cutting his steak gracefully but not eating right away. "If there's suspicion of the Alchemist leaving his or her post without permission, a General is a more efficient option."
"Sir?" Alphonse held his fork and knife, and the engraved bumps on the handles were enough to remind him he really wasn't in Reisensburg, but at the Officer's Club in Central, having lunch with a Major General. Yet, at the same time, that was still an egg, a biscuit, some ham, and some kind of sauce that he hadn't known but it smelled delicious. He took a long pause, trying to inhale the scent as unobtrusively as possible.
"A General has the authority to judge and order a sentence carried out, on the spot, without need for a military tribunal. This is relatively rare, however, and most of the time an administrative investigator is sent. A General would normally only be sent in times of war when time is an issue," Cameron mused. "Although the rumors of arms smuggling—"
"War?" Alphonse flushed, realizing he'd interrupted, and hastily shoved a bit of egg and sauce into his mouth. Then he stopped, and had to grin outright, lips tightly sealed. It was exquisite. While the General spoke, Alphonse chewed very slowly, drawing each taste out as long as possible.
"I hope not. Drachma has often smuggled arms over the borders, supplying those who would incite unrest." Cameron frowned slightly, noting Alphonse's careful and steady eating, then seemed to understand, and chuckled. "Yes, the food here is always excellent."
Alphonse nodded enthusiastically, his attention divided between Cameron's words and the scents and smells of the meal he'd ordered. He made a note to find someone who could cook it for him in Reisensburg. Maybe with a little practice Winly could figure out the recipe. They certainly wouldn't let Edward—
The memory of the night before came rushing back, and the food turned to ashes in his mouth. Alphonse chewed methodically, and forced his attention solely onto the General. Anything was better than the lurking knowledge that he'd never be able to convince his brother to try this meal, that he'd never get to tell Edward about seeing Gracia and Alicia, that he'd never... He sighed, staring down at his half-eaten meal.
"Alphonse?" Cameron's voice was gentle.
"Just..." Alphonse gave the General an apologetic look. "I only found out yesterday evening. And it doesn't seem real, then I remember...and..."
"Yes," Cameron said, softly. "There are no easy losses."
Alphonse nodded, and pushed the second egg-and-biscuit around on the plate. "I'm sorry, sir."
"No need to apologize," Cameron said, and his voice thickened for a moment. He coughed, and sat up straighter, taking another bite of his own meal, but without much enthusiasm either. "The real question is about Mustang's...about the circumstances."
Alphonse nodded, and pushed his plate away. He settled his hands in his lap, sensing this was the bulk of Cameron's information. "I know that General Mustang had as much control over his alchemy—if not more—than my brother."
"Of course," Cameron said. "Ignoring that, there are several other details that have come to my attention. I don't know whether they are coincidence or significant, but you should know them. If you're heading into a trap, I prefer you be armed with as much knowledge as possible."
"Are you sure General Mustang worked for you?" Alphonse narrowed his eyes at Cameron. "It doesn't seem like he picked up much of your style. He never warned Brother and me ahead of time."
"Would your brother have listened?"
"I concede your point, sir," Alphonse had to say, using one of Mustang's favorite jibes. He smiled, though, and the General only shook his head and sighed.
"General Mustang has many enemies, and many more who are simply jealous of...his intelligence, his charisma..."
Cameron turned in his seat, his back to the wall, and his eyes were sharp as he watched the dining room. They were far enough in the back that all sounds reaching them were muffled, but Alphonse thought he recognized some of the same watchful attitude that Hughes sometimes displayed.
"And more importantly, though the young man plays the role of a fun-loving, lazy playboy...he does have a temper," Cameron continued. He glanced sideways at Alphonse. "Was that your take on the General?"
"Not really, sir," Alphonse admitted. "Oh, we heard plenty from his staff, about this girl or that...but I never actually saw him with anyone. But I didn't pay a lot of attention to that, then, so... But personally—" He dropped his voice to a conspiratorial whisper. "—I think his jokes about women wearing miniskirts in the military were just to make First Lieutenant, I mean, Captain Hawkeye see red."
"She has good aim, that one." Cameron's murmur seemed noncommittal; he raised his eyebrows as if prompting Alphonse.
"Colonel— I mean, General Mustang..." Alphonse grew bolder. "...He protected us. And I'm guessing that your telling me all this means you knew of it."
"Very good," Cameron murmured. "You should finish your Eggs Benedict. The chef here is one of the best. No matter what has happened, or may have happened, life is too short to miss out on such pleasures for any longer than one has already." His eyes were sharp, though, and the answer was clear for Alphonse to read: I knew, and I supported him.
"Do you still..." Alphonse left it hanging, for the General to interpret.
"As much as I can," Cameron said, though whether he meant his knowledge of Mustang's actions or goals, Alphonse wasn't certain. Cameron shifted, glancing at Alphonse's plate. There, his meaning was clear.
"Yes, sir," Alphonse said, and began eating again.
"The bottom line," Cameron continued, in that same conversational tone, "is that few would be stupid enough to attack General Mustang outright. Despite his useful masks, no one with any intelligence is ignorant of his skills with his alchemy. And the Fullmetal Alchemist is even more powerful, in his own right."
Alphonse nodded. "That's what bothers me. General Mustang didn't spend all those years protecting us to..." He shrugged, abashed. "Get sloppy, I guess."
"Sloppy," Cameron mused. "No, that word only applies to the General when he wants you to think that."
"Perhaps someone else wants us to think that," Alphonse said, frowning.
"Perhaps." Cameron glanced across the room, his expression reserved, his tone wary and low. "Two Alchemists, disappeared without a trace, and only brought to the attention of the Generalissimo very recently. Within a day of General Mustang's arrival in Hyle, their absences were explained by the convenient excuse of missing paperwork. The next day, General Mustang dies in a conflagration in Soswell."
"The timing," Alphonse said, and realized that if Hawkeye knew of these details, he'd been right in his assessment of her reasons for insisting on her assignment. "My brother wasn't supposed to be there. He didn't give me the details. He said only it was last-minute." Actually, what Edward had mostly done was chortle wickedly about going over Mustang's head, and how he was going to laugh himself silly when Mustang found out.
"The General's enemies may not have been counting on that," Cameron said, and sighed. "Which is the part that saddens me the most, to lose both..."
"That's the reason for the fire," Alphonse murmured, staring down at his meal. "It destroys everything in its path, and leaves little evidence."
"Assuming you could catch either of those two off-guard," Cameron said. He nodded to someone across the room, waving languidly with a long-fingered hand. "I believe we have news."
Alphonse looked up to see Farman heading their way, a large brown envelope under his arm. Farman waved off one of the waitresses as he approached, saying something Alphonse didn't catch. The waitress brightened, throwing a smile towards Alphonse, and Farman continued towards them.
"Alphonse, General," Farman said, and accepted the chair Cameron pointed to.
"I thought you were leaving immediately," Alphonse said, his eyebrows raised. He was pretty sure he'd achieved the watch, and to hell with Edward's response when he found out. Alphonse could always turn in the watch later and be done with it. His stomach tightened. "Is there news? Did—"
"If your brother had ever followed military timelines," Farman drawled, "you two would just be getting to Liore by now." He grinned broadly. "Captain Hawkeye's been moving faster than a steam locomotive the past twenty-four hours. We leave in two hours."
He dropped a manila envelope on the table. It thumped metallically, and Alphonse reached for it with hands he was surprised to see were shaking.
He undid the clasp and slid out the sheet of paper, eyes scanning it quickly. Flipping the envelope upside down, a silver watch slid out into Alphonse's waiting palm. He studied it, flipping it over, then open and closed several times before hooking the chain on his belt loop and pocketing the watch. Alphonse looked up to see Farman frowning at the letter from the Generalissimo.
"Halmos," Farman said. "What kind of an Alchemist's title is that?"
Alphonse chuckled. "It's one given by someone who knows a fair bit of trivia," he said, but refrained from finishing his other suspicion out loud: it's a title chosen by someone with a dry sense of humor, too.
Farman arched an eyebrow at Alphonse.
"Halmos is the symbol at the end of a mathematical proof," Alphonse explained. "It means that what you've attempted to prove...has been." He plucked the sheet from Farman's fingers, folded it neatly, and stuck it in the inside pocket of his coat.
"Good luck, young knight," Cameron said. "I look forward to hearing your report."
Hawkeye, Fury, and Thompson were waiting at the train station when Farman and Alphonse arrived. Hawkeye regarded Alphonse with a long look, and he noted that her eyes didn't widen when her gaze dipped down to see the silver chain, hooked to his belt loop and disappearing into his pocket. She'd known, he realized.
He straightened his cloak, giving Hawkeye a shy smile that soon turned confident under her appraising gaze. Behind them, the train whistled, pulling into the station. Smoke belched from its engine and the wheels screamed as the train slid to a halt.
"Well, Halmos," she said. "Glad to have you along."


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8 thoughts on "Baby: Sex, Names & Guessing Games"
di says:
looooooooove the name. i wanted to name stella jade but angel said no because he knew a girl he didnt like with that name! lol i also couldnt name her olivia or penelope or any other name i liked because of that same reason!i think he was just making it up =)
you could name your next one giada alessandra! then you get to use all the names!
di says:
how do you pronounce giada?
Abuelita Castaneda says:
We're very excited about the baby girl or boy! We're going to love this baby soo much! Can't wait to meet baby! Love your picture, mommy looks very healthy and happy!
Looks like baby is happy too, playing around with her little arms and feet.
Love you, take care!
Jackie says:
How exciting a Girl!! I love the names. I also love Giada De Laurentiis I watch her show Everyday Italian I love it.
Castaneda 5 says:
Well don't buy too much pink! I've known a couple of people who thought it was a girl and it turned out to be a boy! Maybe Mika is right! lol
Sonia says:
Michelle- I know… you're right.. it could still turn out to be a boy. A girl I used to work with was told it was a girl so, of course ALL of her shower gifts were pink… then the baby was born… and it was a BOY!! So, for now, I'm telling Mom to only buy colors that are neutral… yellow, green & orange… besides they're spring colors so they'll be perfect anyway!
De Lly Dilettante says:
That's a nice name. Congratulations. Also, have a Blessed Christmas and a Happy New Year!
jmisgro says:
Pretty name and nice belly!!! You are lucky that you do not have to name her after your husband's mother like they do here in Sicily. Our oldest is named after her grandmother, Caterina. Since we lived in the US then we named her Catherine. We got lucky it's a pretty name!
I better get knitting!!


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green mountains - Blog - RCP Network 2020-05-28T05:21:33Z https://rcpnetwork.org/blog/feed/tag/green+mountains Chittenden County Uplands Conservation Project Celebrates 10,000-Acre Milestone https://rcpnetwork.org/blog/chittenden-county-uplands-conservation-project-celebrates-10-000- 2018-07-10T18:15:19.000Z 2018-07-10T18:15:19.000Z Hallie Schwab https://rcpnetwork.org/members/HallieSchwab

With the protection of a 428-acre town forest in Richmond, Vermont earlier this year, the Chittenden County Uplands Conservation Project (CCUCP) surpassed the threshold of 10,000 acres of land conserved since the partnership's founding in 1999.

The Chittenden County Uplands occupies an expanse of land between the Champlain Valley and the Green Mountains in one of the most densely populated regions of Vermont. This priority corridor situated between the Mount Mansfield State Forest and Camel's Hump State Park abounds with outdoor recreational opportunities and is home to breeding populations of moose, black bear, fisher and other wildlife.

CCUCP coordinator Bob Heiser emphasized the critical role that the partnership's early mapping and prioritization work played in laying a foundation for an impressive array of conservation projects, including a beloved community skiing area in the Bolton Valley Nordic and Backcountry, land owned by the Vermont Youth Conservation Corps, portions of the Long Trail and the Catamount Trail, and most recently, the Richmond Town Forest.

A nationally-competitive grant from the US Forest Service Community Forest Program helped the Town of Richmond purchase the property for use as a town forest. Additional financial support came from the Vermont Housing and Conservation Board (VHCB), the Richmond Conservation Fund, the Open Space Institute, and the Conservation Alliance. "The fact that the Richmond Town Forest was part of this larger landscape initiative and a longtime priority for a diverse group of partners was key to the project's ability to attract investment from a wide range of funding sources," Heiser explained. A conservation easement co-held by Vermont Land Trust and VHCB will permanently protect the forest and the public's access to it.

Heiser noted that Richmond Town Forest land was one of eight prominent properties in the region that helped to galvanize local residents and conservationists to form the Chittenden County Uplands Conservation Project in the first place, so the fact that this project put the RCP over the 10,000-acre mark has special resonance for the partnership.

Read more about the Richmond Town Forest.

Photo by Olivia Wolf


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Crowdfunding Marine Reserves: Inspirations from a Squid and a Wise Man
LoaTree is a proud sponsor of the Aldebaran and the Green Coconut Run's journey. For the next few months, we'll be blogging about their adventures down the Californian, Mexican and South American coasts. The following are excerpts from a recent blog post from the Aldebaran and it's crew.
Just as we were enjoying our latest culinary invention, a "chili-mango-ahi roll," we saw Four Arrows, aka Don Jacobs, paddling out to Aldebaran. It's not every day that we see a 70 year old man paddling out to our sailboat, thin frame and sinewy muscles bronzed from sunshine.
Four Arrows is no ordinary man, however. He is a Native American of the Lakota tradition, a university professor and author of books covering dozens of topics. His expertise ranges from riding wild stallions, applied hypnotherapy, and his academic focus, curriculum for balanced education. He lives here in Chamela Bay, partly because it is the best place for him to battle his 7ry old lymphoma cancer. After being given just 2 yrs to live, he's beating the cancer on a rigorous diet of coconut water, sunshine, organic whole foods, and a lot of exercise.
We had contacted Four Arrows to learn about his latest achievement: how he is setting up a grassroots marine reserve with Kickstarter funds for a local fishing cooperative, just south in a town called Arroyo Seco.
The younger fishermen were naturally very skeptical. But the older fishermen started telling stories of how the fish used to be bigger and closer to shore. Nowadays they had to go offshore many miles to find sizable fish, which is dangerous with their single outboard pangas. By the end of the meeting they raised their hands and voted to consider the idea further.
They flew in a fisherman from Cabo Pulmo, a famous protected area in southern Baja, to tell the Arroyo Seco fisherman about the experience of creating a marine reserve: "It has transformed our lives," said the fisherman from Cabo Pulmo.
The fisherman continued: "The fish have come back, because the big fish in the reserve have millions of babies more than the small fish. We also have new opportunities in tourism, which is great for our children – more options for work keeps them around." Having heard the testimonial, the Arroyo Seco cooperative approved the idea! Now they just needed the $26,000 for biological and social assessments, required for a National Marine Area designation.
Four Arrows took on the fundraising task […]. This innocent act – of connecting our love of eating seafood with the protection of the ocean – was an unplanned stroke of brilliance.
Here was the missing link key which helped us define our own voyage.
As we had begun the Green Coconut Run, a sailing voyage from California to New Zealand, our dream was to enjoy the wild beauty of the ocean: surfing and diving in remote places. As young professionals in environmental and health fields we also wanted to visit marine reserves and help support them – somehow.
Here in Chamela Bay, enjoying ahi sushi and listening to Four Arrows, we realized that if we can connect appreciation of the ocean – through surfing, fishing, diving and sailing- to efforts like this community led marine reserve, we can help preserve the ocean.
Will our grand kids be able to enjoy seafood as we do? Scientists say that pollution and overfishing may cause the collapse of many fisheries by mid century. One of the most important solutions suggested is to expand the small network of marine protected areas, which currently cover less than 1% of coastal areas. Marine reserves give fish safe havens in which to breed and grow to full size and fecundity.
When we consider the ocean a 'resource,' we will continue to abuse it. When we consider the ocean a 'relation' – the fish and corals as our brothers and sisters – then we love and protect it.
Most existing reserves have been designated by governments in complex bureaucratic affairs. It is no wonder their creation has been slow. In comparison, the proposed Arroyo Seco marine reserve, measuring 16 square km and including a complete mangrove area, was developed in nine months with the support of local community. Official designation is expected in under a year with less than $35,000 invested.
This is the power of the Grassroots reserve effort: it is community led, it is relatively small and attainable, it is crowd-funded, and it is fast.
The science behind protected areas is well documented, and says that reserves are beneficial for both ecology and fisherman. A network of small marine reserves, located in important habitats every 50 miles, would make a vast improvement to fisheries and the ocean's health.
The capstone to improve our relationship with the ocean will be to shift our attitude. Four Arrows put it eloquently:
"When we consider the ocean a 'resource,' we will continue to abuse it. When we consider the ocean a 'relation' – the fish and corals as our brothers and sisters – then we love and protect it."
We have been moved by many moments on this voyage, only the latest [being] the most brilliant display of bioluminescence, snorkeling through a galaxy of tiny stars. Two days later, we found a "magic log" in the middle of the ocean with dozens of turtles, small sharks, and schools of fish.
These experiences make it easy to see what Four Arrows is talking about. But even on a mundane beach, looking out at the horizon of the vast ocean, who doesn't catch a glimpse of this awesome power and beauty?
Raising anchor and continuing our voyage south, we contemplated our fishing poles with new eyes – ever grateful for the offerings from the sea. We also contemplated our tasks ahead: to dodge hurricanes and lightning as we sail to Panama in the storm season; to find (and share) amazing experiences that move us; and in so doing, do our part to promote a growing network of marine protected areas. Because now we know that it is possible.
Catch the full story here.
Want to contribute to the Green Coconut Run, jump on the boat, or sponsor their efforts? Visit www.GreenCoconutRun.com or hashtag #GreenCoconutRun. Ahoy!!
All content and photos courtesy of Aldebaran Green Coconut Run.