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Samanidis G, Georgiopoulos G, Bousounis S, Zoumpourlis P, Perreas K. Desfechos após inserção de balão intra-aórtico em pacientes de cirurgia cardíaca. Rev Bras Ter Intensiva. 2020;32(4):542-550
George Samanidis
Georgios Georgiopoulos
Stefanos Bousounis
Panagiotis Zoumpourlis
Konstantinos Perreas
Outcomes after intra-aortic balloon pump insertion in cardiac surgery patients
Desfechos após inserção de balão intra-aórtico em pacientes de cirurgia cardíaca
George Samanidis1, Georgios Georgiopoulos2, Stefanos Bousounis1, Panagiotis Zoumpourlis1, Konstantinos Perreas1
1 Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center - Athens, Greece.
2 Department of Cardiology, Hippokration Hospital, University of Athens -Athens, Greece.
Responsible editor: Alexandre Biasi Cavalcant
Corresponding author: George Samanidis, Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674, Athens, Greece. E-mail: [email protected]
OBJECTIVE: To assess whether preoperative versus intraoperative insertion of an intra-aortic balloon pump is associated with lower 30-day mortality or reduced length of hospital stay among patients who had an intra-aortic balloon pump inserted for cardiac surgery.
METHODS: This was an observational study of patients who had an intra-aortic balloon pump inserted in the preoperative or intraoperative period of cardiac surgery in our department between 2000 and 2012. We assessed the association between preoperative versus intraoperative insertion of an intra-aortic balloon pump and 30-day mortality in a multivariable logistic regression analysis, including preoperative New York Heart Association class, postoperative atrial fibrillation, reoperation, postoperative creatinine and isolated coronary bypass grafting as cofactors. We used a multivariate linear model to assess whether a preoperative versus intraoperative intra-aortic balloon pump was associated with length of postoperative hospital stay, adjusting for reoperation, isolated coronary bypass grafting, heart valve surgery, sex, age, cardiopulmonary bypass time, aortic cross-clamp time, preoperative patients' status (elective, urgency or emergency surgery) and preoperative myocardial infarction.
RESULTS: Overall, 7,540 consecutive patients underwent open heart surgery in our department, and an intra-aortic balloon pump was inserted pre- or intraoperatively in 322 (4.2%) patients. The mean age was 67 ± 10.2 years old, the 30-day mortality was 12.7%, and the median length of hospital stay was 9 days (7 - 13). Preoperative versus intraoperative intra-aortic balloon pump insertion did not affect the incidence of 30-day mortality (adjusted OR = 0.69; 95% CI, 0.15 - 3.12; p = 0.63) and length of postoperative hospital stay (β = 5.3; 95%CI, -1.6 to 12.8; p = 0.13).
CONCLUSION: Preoperative insertion of an intra-aortic balloon pump was not associated with a lower 30-day mortality or reduced length of postoperative hospital stay compared to intraoperative insertion.
Keywords: Intra-aortic balloon pump; Heart surgery; Ventricular dysfunction, left; Cardiac output, low; Mortality.
Intra-aortic balloon pump (IABP) is widely used as a mechanical circulatory support device to prevent and treat low cardiac output syndrome in patients with unstable ischemic heart disease, acute coronary syndrome, heart failure and those who underwent cardiac surgery. Perioperative IABP insertion may improve cardiac output by 10 - 30%, particularly in patients with preoperative low left ventricular ejection fraction (LVEF) and low cardiac output syndrome who are undergoing heart operations.(1)
The effectiveness of an IABP lies on its ability to reduce the oxygen demand of the myocardium while facilitating an increase in myocardial oxygen supply. This is achieved through a series of hemodynamic effects, which include increased diastolic pressure and decreased afterload.(1-3)In addition, IABP is indicated in high risk patients with LVEF < 30%, significant left main disease (LMD) with hemodynamic consequences (hemodynamic instability) and acute or chronic heart failure, and patients having difficulty weaning from cardiopulmonary bypass (CPB) during cardiac surgery operations difficulty.(1,4)
In this study, we evaluated the risk factors associated with outcomes after IABP insertion in patients who underwent open heart surgery. Our primary aim was to assess whether pre- versus intraoperative insertion of IABP is associated with a lower 30-day mortality or smaller length of hospital stay among patients who had IABP inserted in the pre- or intraoperative periods of cardiac surgery.
Between 2000 and 2012 7,540 consecutive patients underwent open heart surgery in our department, and IABP was inserted preoperatively and intraoperatively in 322 (4.2%) patients (Figure 1). All preoperative, intraoperative and postoperative data were recorded in our database. In all patients, IABP insertion was achieved through the left or right common femoral artery (percutaneously).
Figure 1 - Patients undergoing open heart surgery. IABP - intra-aortic balloon pump; ICU - intensive care unit; IQR - interquartile range.
This study was an observational study including 322 cardiac surgery patients who received IABP (preoperative and intraoperative). Furthermore, this study was approved by the hospital's institutional ethics committee.
The follow-up was performed in the outpatient clinic, and the first follow-up was 30 days after discharge. The second follow-up was 6 months after the first follow-up date and after one visit/year. When the patients were discharged and did not visit the outpatient clinic, then the 30-day mortality incidence was recorded after telephone contact with the patient (a mandatory process in our hospital). In addition, in our study, the median follow-up of patients was 10 (1 - 49) months.
In this study, we included patients who underwent the entire spectrum of heart operations in our department (excluding off pump coronary bypass grafting (CABG)): isolated CABG, CABG with left descending artery endarterectomy, heart valve replacement, aortic root replacement (modified Bentall operation), ascending aorta replacement and combined heart operations.
Indications and time of intra-aortic balloon pump insertion
The indications for IABP insertion (in all patients) were: cardiac index < 2.2L/min/m2, systolic pressure (SP) < 80mmHg, mean arterial pressure < 50mmHg, intraoperative transesophageal echocardiography of the LVEF < 20 - 25% and severe metabolic acidosis despite the maximal vasoactive/inotropic support (adjusted for each patient and dependent on the body surface area, pulmonary systolic artery pressure, systemic vascular resistant, central venous pressure and cardiac index).
In addition, for analysis purposes, the patients were divided into two groups:
a) Preoperative: in the operating room before patient intubation or in the cardiology intensive care unit (ICU) or catheterization laboratory.
b) Intraoperative: in the operating room after patient intubation and any time before the patient was transferred from the operating room to the ICU.
Continuous variables are presented as the mean values ± standard deviation or medians (interquartile range) for non-normally distributed variables. The categorical variables are presented as the absolute values (count) and percentages. Normality of the continuous variables was tested using the Kolmogorov-Smirnov criterion or graphically assessed through P-P plots.
Differences in continuous variables between groups of patients according to the time of insertion of IABP (i.e., mortality after an acute coronary syndrome (ACS) episode at the end of the 10-year follow-up) were evaluated through independent samples Student's t-test or the nonparametric Mann-Whitney test and chi-squared test for nominal variables.
Subsequently, logistic regression analysis was applied to evaluate the association between baseline predictors and the likelihood of developing 30-day mortality and in-hospital mortality (dependent outcome) after adjusting for various confounders. The primary endpoints were 30-day mortality and survival rate, while secondary endpoints were in-hospital mortality and in-hospital stay. The effect size (i.e., risk of primary endpoint) was reported as the estimated odds ratios (OR) and the corresponding 95% confidence intervals (95%CI). A multivariable linear regression analysis was used to predict the length of in-hospital stay based on the preoperative and intraoperative factors. In addition, Cox proportional-hazards models were used to examine the association between variables of interest and the main endpoints of the study under survival settings. Associations are presented as hazard ratios (HR) with 95%CI. Log rank tests and Nelson-Aalen curves for the cumulative hazard of death across the follow-up were also implemented in the survival analysis. In addition, a competing risk regression analysis was performed to assess the association of baseline predictors with the specific outcome of fatal cardiogenic shock based on Fine-Gray's proportional subhazard model. In detail, death from cardiogenic shock was flagged as the outcome of interest, while other causes of death (sepsis or multiple organ failure) were set as competing risks. Cumulative incidence curves estimated the probability of this type of death in the setting where other competing risks are acknowledged to exist. Multivariable regression (logistic or survival) models were built under Collett's approach: all significant univariate (p < 0.05) predictors of death were initially entered in a fully adjusted model and subsequently selected through forward and backward selection loops. Certain variables of biological interest (i.e., age and sex) were included in the final multivariable models. Goodness of fit for logistic regression models was evaluated by the Hosmer-Lemeshow test.
Statistical analysis was performed by STATA package, version 11.1 (StataCorp, College Station, Texas USA). Statistical significance was set at p < 0.05. To avoid overfitting in the final multivariable regression models, a ratio of 5 - 10 events per covariate was retained in all analyses.(2)
Preoperative details
Of the 322 patients who received IABP, 79.8% were male, with an average age of 67 ± 10.2 years old. Among the patients with dyspnea, most (65.5%) were graded as class I according to a New York Heart Association (NYHA) classification, while most patients (41.3%) with angina were graded as class I according to a Canadian Cardiovascular Society Classification (CCSC). In addition, 40.7% of the patients had a recent (< 90 days) preoperative ACS, and 19.9% suffered from LMD > 50%. The mean preoperative creatinine value was 1.3mg/dL. Furthermore, preoperative LVEF was classified into 3 categories (≤ 35%, > 35 - < 50%, ≥ 50%). The demographic characteristics and preoperative data of the study population are shown in table 1.
Table 1 - Demographic characteristics
Demographics and preoperative data
Male 257 (79.8)
Female 65 (20.2)
Age (years old) 67 ± 10.2
BSA (m2) 1.86 ± 0.19
NYHA
I 211 (65.5)
II 35 (10.9)
III 13 (4.0)
IV 63 (19.6)
0 84 (26.1)
II 29 (9)
III 9 (2.8)
Preoperative acute coronary syndrome 131 (40.7)
Left main diseases (> 50%) 64 (19.9)
Preoperative creatinine (mg/dL) 1.3 ± 0.9
Preoperative left ventricular ejection fraction (%)
≤ 35 103 (32)
> 35 - < 50 113 (35)
≥ 50 106 (33)
BSA - body surface area; NYHA - New York Heart Association; CCSC - Canadian Cardiovascular Society. Results expressed as n (%) or mean ± standard deviation.
Intraoperative details
The perioperative details are presented in table 2. Most of the patients (81.4%) had an elective preoperative status, and 91.3% of the patients received IABP intraoperatively. Overall, 61.5% of the patients underwent isolated CABG, while the other types of operations are listed in table 2. Among the patients who underwent isolated CABG, the average number of grafts was 2. Aortic valve replacement was the most frequent operation in the group of patients with heart valve replacement. Ninety patients underwent combined operations.
Table 2 - Perioperative details
Perioperative details
Preoperative patient status
Elective 262 (81.4)
Urgent 46 (14.3)
Emergency 14 (4.3)
IABP insertion
Preoperative 28 (8.7)
Intraoperative 294 (91.3)
Redo 30 (9.3)
Isolated CABG 198 (61.5)
Number of grafts 2 ± 1.1
I 15 (4.7)
III 104 (32.3)
IV 15 (4.7)
CABG with radial artery 31 (9.6)
CABG with free right internal mammary artery 45 (13.9)
CABG with LAD endarterectomy 11 (3.4)
Isolated heart valve surgery 23 (7.14)
Aortic valve replacement 11 (3.4)
Mitral valve replacement 5 (1.6)
Tricuspid valve replacement 1 (0.3)
Double and triple valve surgery 6 (1.9)
Isolated aortic root replacement (modified Bentall operation) 6 (1.9)
Other operations 5 (1.6)
Ischemic left ventricular rupture repair 1 (0.3)
Pericardiectomy 1 (0.3)
Ascending aorta replacement 1 (0.3)
Iatrogenic right atrium injury repair 1 (0.3)
Acute aortic dissection type A repair 1 (0.3)
Overall combined operation 90 (28.0)
CABG with other procedure 75 (23.3)
Heart valve replacement with other procedure (exclude CABG) 11 (3.4)
CABG with carotid endarterectomy 4 (1.2)
Cardiopulmonary bypass time (minutes) 148 ± 68
Aortic cross clamp time (minutes) 98.9 ± 44.6
IABP - intra-aortic balloon pump; CABG - coronary bypass grafting; LAD - left anterior descending artery. Results expressed as n (%) or mean ± standard deviation.
Postoperative details and follow-up data
The postoperative details and follow-up data, including the cause of death, are presented in table 3. Overall, 22.4% of patients suffered from postoperative acute kidney injury (AKI) (postoperative AKI was defined as a two-fold increase in postoperative creatinine levels in comparison to preoperative levels), and 23.6% had at least one postoperative episode of paroxysmal atrial fibrillation. Postoperative cerebrovascular accidents and amputation of the right leg were recorded in three and one patients, respectively. The median ICU and in-hospital stay was 4 and 9 days, respectively. In addition, the 30-day and in-hospital (beyond 30 day) mortality were 12.7% and 4.3%, respectively. All cause mortality during the median follow-up of 10 months was observed in 55 patients (17.1%).
Table 3 - Postoperative details, follow-up data and cause of death
Postoperative troponin value (pg/mL)
Immediate after operation 9.66 (5.2 - 17.1)
Peak value after operation 19.5 (9.1 - 44)
Postoperative maximum creatinine after operation (mg/dL) 1.5 (1.1 - 2.5)
Acute kidney injury 72 (22.4)
Postoperative atrial fibrillation 76 (23.6)
Intensive care unit stay (day) 4 (2 - 6)
In-hospital stay (day) 9 (7 - 13)
30-day mortality 41 (12.7)
Multiple organ failure 13 (31.7)
Cardiogenic shock 22 (53.7)
Sepsis 6 (14.6)
In-hospital mortality (beyond 30 days) 14 (4.3)
Multiple organ failure 4 (28.6)
Cardiogenic shock 2 (14.3)
Overall mortality 55 (17.1)
Median follow-up (months) 10 (1 - 49)
Results expressed as median (interquartile range) or n (%).).
Time of intra-aortic balloon pump insertion (preoperative versus intraoperative)
Preoperative IABP insertion was recorded in 28 patients - elective operations with preoperative LVEF < 25% and ischemic heart disease in 18 patients, emergency operations with ACS and cardiogenic shock in 3 patients, emergency operations after unable percutaneous coronary intervention (PCI) in catheterization laboratory with ACS and hemodynamic instability in two patients, emergency operations for mechanical complications due to ACS in two patients (interventricular septum rupture and free wall of the left ventricular rupture), emergency operation with left main thrombosis and hemodynamic instability in one patient, emergency operation after unable PCI in catheterization laboratory without ACS and hemodynamic instability in 1 patient and preoperative cardiac arrest in the operating room in one patient.
When the study population was divided into two subgroups based on the time of insertion of IABP, the patients with intraoperative treatment with IABP were classified in the more severe class of angina (CCSC IV) and were more likely to be treated with an emergency surgery (Table 4). In addition, the preoperative IABP group presented with smaller increases in postoperative creatinine, decreased aortic cross clamp (ACC) and CPB time and decreased length of in-hospital and ICU stays compared to the intraoperative IABP group (Table 4).
Table 4 - Comparison between patients with preoperative and intraoperative intra-aortic balloon pump insertion in terms of baseline and preoperative and postoperative characteristics
Preoperative
Age (years) 64 (11.1) 67.3 (10.1) 0.142
Sex, male 7 (25.0) 58 (19.73) 0.507
NYHA class IV 4 (16.0) 59 (22.18) 0.823
CCSC class IV 14 (56) 53 (19.9) 0.003*
Left main disease 6 (21.43) 64 (21.77) 0.967
Acute kidney injury 3 (10.71) 69 (23.55) 0.280
Left ventricular ejection fraction ≤ 35% 12 (42.86) 91 (33.58) 0.604
Redo surgery 1 (3.57) 41 (13.95) 0.119
Isolated coronary artery bypass grafting 21 (75.0) 177 (60.20) 0.124
Heart valve surgery 0 (0) 23 (7.82) 0.125
Combined operation 5 (17.86) 85 (28.91) 0.213
Postoperative atrial fibrillation 4 (14.29) 72 (24.49) 0.224
Preoperative elective status 16 (57.14) 244 (82.99) 0.001*
Preoperative emergency status 7 (25.0) 8 (2.72) < 0.001*
Preoperative creatinine (mg/dL) 0.9 (0.45) 1.1 (0.5) 0.018*
Peak postoperative creatinine (mg/dL) 1.25 (0.85) 1.5 (1.4) 0.023*
Troponin after surgery (pg/mL) 7.19 (9.2) 9.89 (12.2) 0.042*
Peak troponin after surgery (pg/mL) 12.8 (22.9) 19.9 (36.9) 0.113
CABG number of grafts 2 (1) 2 (2) 0.65
Aortic cross clamp time (minutes) 72 (53) 96 (55) 0.023*
Cardiopulmonary bypass time (minutes) 110 (55) 135 (75) 0.001*
Intensive care unit stay (days) 3 (2) 4 (4) 0.027*
In-hospital stay (days) 7 (3) 10 (6) 0.002*
30-day mortality 3 (10.71) 38 (12.93) 0.737
In-hospital death beyond 30 days 0 (0) 14 (4.76) 0.238
Overall mortality 3 (10.71) 52 (17.69) 0.349
IABP- intra-aortic balloon pump; NYHA - New York Heart Association; CCSC- Canadian Cardiovascular Society; CABG - coronary bypass grafting. p-value is derived from independent samples t-test for continuous variables or Mann-Whitney test and Chi-squared test for nominal variables.
* Statistical significance was set at p < 0.05. Results expressed as n (%) or median (interquartile range).
Interestingly, preoperative insertion of IABP was favorably associated with in-hospital stay (p = 0.02). In addition, a multivariable linear regression analysis was used to calculate the possible effect of the time of IABP insertion on the length of in-hospital stay. After adjusting for reoperation, isolated CABG, heart valve surgery, combined operation, sex, age, CPB time, ACC time, preoperative patients' status, LVEF and preoperative myocardial infarction (MI), the time of IABP insertion did not predict the length of in-hospital stay (β = 5.3; p = 0.13; 95%CI -1.58 - 12.8).
30-day mortality and in-hospital mortality
After univariable logistic regression analysis and among variables of interest, sex (p = 0.006), NYHA class (p < 0.001), postop creatinine (p = 0.004), postop maximum troponin level (p = 0.004), heart valve surgery (p = 0.012), modified Bentall operation (p = 0.016), redo surgery (p < 0.001), ACC (p = 0.006), postop atrial fibrillation (p < 0.001) and isolated CABG instead of combined operation (p < 0.001) correlated with the 30-day mortality, while age (p =0.066), preop ACS (p = 0.052) and LMD (p = 0.055) were not associated with 30-day mortality. After multi-adjustment, only NYHA class, postoperative atrial fibrillation, redo surgery, postoperative creatinine and isolated CABG determined the 30-day mortality, while the time of IABP insertion did not affect the incidence of 30-day mortality (Table 5). Preoperative status of the patients (elective, urgent or emergent) was not associated with overall mortality across the follow up of our study (p = 0.863).
Table 5 - Results from multiadjusted logistic regression models that evaluated risk factors for 30-day mortality
30-day mortality
Time of IABP insertion (preoperative versus intraoperative) 0.69 0.15 - 3.12 0.63
Age 1.024 0.975 - 1.076 0.34
Sex 1.21 0.438 - 3.32 0.71
Preoperative NYHA 1.46 1.1 - 1.95 0.01*
Reoperation 4.58 1.43 - 14.7 0.01*
Isolated coronary bypass grafting 0.155 0.052 - 0.460 0.001*
Isolated heart valve surgery 0.271 0.062 - 1.18 0.08
Postoperative creatinine 1.24 1.001 - 1.52 0.04*
Postoperative atrial fibrillation 0.092 0.011 - 0.783 0.02*
OR - odds ratio; 95%CI - 95% confidence interval; IABP - intra aortic balloon pump; NYHA - New York Heart Association. Risk factors in the final multivariable logistic regression models for outcome (30-day mortality) were selected by Collett's method as described in the statistical analysis.
* Statistical significance was set at p < 0.05.
When deaths from cardiogenic shock (n = 24) were assessed individually, only 3 parameters determined the incidence of this outcome, independently of age and sex: NYHA class (OR = 1.51; p = 0.011), type of surgery (isolated CABG versus combined surgery) (OR = 0.10; p = 0.004) and the ACC time (OR = 1.01; p = 0.047).
During the median follow-up of 10 months, 55 deaths were recorded (Figure 2A). Among numerous baseline parameters, the final multivariable model for death prediction included age (HR = 1.05; p = 0.009), sex (HR = 0.832; p = 0.606), NYHA class (HR = 1.36; p = 0.002), postop maximum creatinine (HR = 1.26; p < 0.001), postop maximum troponin (HR = 1.002; p = 0.024) and isolated CABG versus combined operation (HR = 0.213; p < 0.001). Time of insertion of IABP was not associated with the survival outcome in our study (log rank test, p = 0.374) (Figure 2B).
Figure 2 - Survival analyses. (A) Nelson-Aalen cumulative hazard estimates for the incidence of death across the follow up of our study. (B) Nelson Aalen curves for the cumulative incidence of death in our cohort according to the time of insertion of intra-aortic balloon pump. (C) Survival analyses. Cumulative incidence for death from cardiogenic shock according to the New York Heart Association classification of patients under competing risk regression analysis. IABP - intra-aortic balloon pump; NYHA - New York Heart Association.
Upon completing risk regression analysis, only the performance of isolated CABG instead of combined surgery (HR = 0.113; p = 0.003) and NYHA class (HR = 1.41; p = 0.008) (Figure 2C) predicted death from cardiogenic shock independently of age, sex and all baseline confounders. The time of insertion of IABP was not a significant predictor (HR = 0.654; p = 0.487) of death from cardiogenic shock in competing risk analysis.
In recent years, many circulatory support devices have been proposed for hemodynamic support in critically ill patients in cardiology, ICU and cardiac surgery departments. Currently, extracorporeal membrane oxygenation (ECMO), percutaneous mechanical circulatory support, left ventricular assist devices, biventricular assist devices and IABP are the most common devices for circulatory support, particularly in cardiogenic shock due acute or chronic heart disease. On the other hand, many serious and fatal complications are observed during and after placement of these devices. Intra-aortic balloon pump compared to other devices has advantages because of its placement, checking of the correct position and easier management. For these reasons, IABP can be implemented in hospitals and departments without cardiac surgery support. In addition, IABP remains a useful device in critically ill cardiac surgery patients with perioperative low cardiac output syndrome who undergo elective or emergency cardiac surgery operations. The mortality rate in cardiac surgery patients who have received IABP is high, ranging from 10 - 40%, and it is affected by decision making with regard to which patients should be placed on IABP and when, with minimum adverse effects on patient outcomes (morbidity and mortality).(5-10) Intra-aortic balloon pump placement is an additional risk factor in already critically ill cardiac surgery patients. Malperfusion syndrome, limb ischemia, cerebrovascular accidents due to peripheral vascular disease, descending and abdominal aorta calcification and IABP malposition or displacement are the most common complications after IABP insertion.
The most discussed issues with regard to IABP in cardiac surgery remain the time of insertion (preoperative, intraoperative and postoperative), age of cardiac surgery patients and type of heart operation.
As seen from many recent studies, preoperative IABP insertion has many benefits with regard to in-hospital mortality and postoperative adverse cardiac events.(6-9) Our study had comparable results with these studies, and we concluded that preoperative IABP insertion decreased in-hospital stay (p = 0.028) in our study population but did not influence in-hospital mortality (p = 0.374). Poirier et al. analyzed 46,067 patients and concluded that the preoperative insertion of IABP presented a decrease of in-hospital mortality and ICU stay, while its intraoperative and postoperative use was not clearly associated with clinical benefits.(5,6)Another recent review (9,212 patients) by Deppe et al. supports the beneficial effect of preoperative IABP insertion in high risk patients before CABG, with decreased risk of mortality, myocardial infarction, renal failure, hospital and ICU stay.(7)In 2010, a study with 7,440 patients concluded that in-hospital and risk-adjusted mortality were lower when IABP was used before (10%) than during (16%) or after (29%) the cardiac surgery.(8)This was also supported by another study in the same year, which showed that patients with cardiogenic shock complicating acute myocardial infarction who underwent PCI assisted by IABP had a more favorable in-hospital outcome and lower in-hospital mortality than patients who received IABP after PCI.(9)However, a study with 173 patients published in 2013 suggested that postoperative IABP use is more promising, showing that the cumulative 30-day mortality was 44% in the group with preoperative IABP of patients and 37% in the postoperative IABP group.(10) In contrast to the aforementioned studies, a recent study in 2014 concluded that IABP treatment commenced before or after PCI was not an independent predictor of mortality.(11) On the other hand, cardiac surgery patients are different than patients who undergo PCI; in cardiac surgery, we have prognostic scores in our armamentarium for worse outcomes (predicted mortality rates by the European System for Cardiac Operative Risk Evaluation (Euroscore) and the Society of Thoracic Surgeons (STS) score. Perhaps preoperative IABP insertion should be considered as a predictive factor in the Euroscore II or STS score for evaluating the possible benefits of preoperative IABP placement in critically ill patients.
Another major risk factor that seems to be associated with 30-day and in-hospital mortality of patients with IABP is the age of the patient. Most studies have already found that older patients have higher mortality rates. These incidents are not surprising because the number of older patients is growing, and they have more coexisting diseases (such as chronic kidney injury, peripheral vascular disease and others), which affect outcomes of critically ill patients, particularly cardiac surgery patients (independent of the need for IABP-support).(12,13) More specifically, a study in 2016 with 522 patients found that age above 70 years was an independent risk factor for mortality within 30 days.(12) In addition, in 2015, another working group of 572 patients concluded that patients older than 65 years undergoing IABP support had higher in-hospital mortality rates in comparison to younger patients.(14)In the same direction, two studies in 2015 and 2016 included advanced age as one of the most important predictors of in-hospital mortality and adverse long term prognosis.(15,16)Finally, a study with 134 elderly patients showed that patients > 80 years had higher mortality rates than those < 80 years after IABP placement.(17) After multivariate analysis in our study, we showed that age of the patients was a risk factor for survival after IABP insertion (p = 0.009). Of note, the number of older patients with comorbidities undergoing cardiac surgery operations has increased in recent years, and this directly affects outcomes of patients who have received IABP.
Currently, little data have been published about the types of cardiac operations (with IABP placement) as risk factors for 30-day and in-hospital mortality. In our study, we compared the mortality rates between isolated CABG, combined or valve replacement surgical procedures. In 2016, a study with 522 patients suggested that CABG combined with valve surgery should be identified as an independent risk factor for 30-day mortality. Among those who had that type of surgery, 47.5% died within 30 days; among those who did not have such a procedure, the mortality rate was 26.3%.(12) In 2010, another study with 136 patients requiring an IABP concluded that the "operation-specific" mortality was higher in the heart valve surgery population. More specifically, the mortality rates were 21.2%, 50% and 64.3% among those who had isolated CABG, CABG and valve surgery and isolated valve surgery, respectively.(18) In our study, after multiadjusted logistic regression analysis, we found that isolated CABG was a risk factor for 30-day mortality (p = 0.001), and it was possible that most of these patients underwent an emergency CABG operation.
This study included a small number of patients from a single department. Furthermore, the number of patients who received IABP preoperatively (compared with intraoperative) was too small to make safe conclusions. Long-term follow-up is required to demonstrate the potential benefits of preoperative or intraoperative IABP insertion in cardiac surgery patients who are already at high preoperative and intraoperative risk.
Overall, 30-day mortality is substantial in patients needing intra-aortic balloon pump insertion in the pre- or intraoperative periods of cardiac surgery. Preoperative insertion of an intra-aortic balloon pump was not associated with lower 30-day mortality or lower length of postoperative hospital stay compared to intraoperative insertion after adjusting for potential confounders.
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Cheng JM, van Leeuwen MA, de Boer SP, Wai MC, den Uil CA, Jewbali LS, et al. Impact of intra-aortic balloon pump support initiated before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from acute myocardial infarction. Int J Cardiol. 2013;168(4):3758-63.
Bergh N, Angerås O, Albertsson P, Dworeck C, Matejka G, Haraldsson I, et al. Does the timing of treatment with intra-aortic balloon counterpulsation in cardiogenic shock due to ST-elevation myocardial infarction affect survival? Acute Card Care. 2014;16(2):57-62.
Kamiya H, Schilling M, Akhyari P, Ruhparwar A, Kallenbach K, Karck M, et al. Outcome analysis for prediction of early and long-term survival in patients receiving intra-aortic balloon pumping after cardiac surgery. Gen Thorac Cardiovasc Surg. 2016;64(10):584-91.
Levi TM, de Souza SP, de Magalhães JG, de Carvalho MS, Cunha AL, Dantas JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25(4):290-6.
Cao J, Liu W, Zhu J, Zhao H. Risk factors and clinical characteristics of in-hospital death in acute myocardial infarction with IABP support. Int J Clin Exp Med. 2015;8(5):8032-41.
Schwarz B, Abdel-Wahab M, Robinson DR, Richardt G. Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation. Med Klin Intensivmed Notfmed. 2016;111(8):715-22.
Kaminski KA, Tycinska AM, Stepek T, Szpakowicz A, Oledzka E, Dobrzycki S, et al. Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock. Adv Med Sci. 2014;59(2):156-60.
Wu XP, Liu HW, Zhao XN, Cao J, Zhu P. Factors influencing outcomes of intra-aortic balloon counterpulsation in elderly patients. Chin Med J (Engl). 2013;126(14):2632-5.
Parissis H, Leotsinidis M, Akbar MT, Apostolakis E, Dougenis D. The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome. J Cardiothorac Surg. 2010;5:20.


text:
Handbook of Operating Procedures
Disposition Table New
Faculty Termination
Policy Number: 133
Termination of faculty members
Date Reviewed:
Responsible Office:
Office of the Executive Vice President & Chief Academic Officer
Responsible Executive:
Executive Vice President & Chief Academic Officer
I. POLICY AND GENERAL STATEMENT
Termination of the employment of a faculty member of The University of Texas Health Science Center at Houston ("university") who has been granted tenure or termination of all other types of faculty members before the expiration of the stated period of appointment, except as is otherwise provided in Rule 31007, Section 5 of The University of Texas System Board of Regents' Rules and Regulations, or Texas Education Code Section 51.943, or by resignation or retirement, will only be for good cause shown. In cases of incompetence or gross immorality where the facts are admitted, or in cases of a felony conviction, the hearing procedures described below shall not apply, and the dismissal of the faculty member by the President will follow.
In cases of termination as a result of academic program closure or abandonment, refer to HOOP Policy 120 Abandonment of Academic Positions or Programs.
II. PROCEDURE
A. Review of Allegations and Recommendation to the President
1. The relevant dean will notify the Executive Vice President & Chief Academic Officer ("EVP/CAO") of the charges against an accused faculty member. The EVP/CAO will, in turn, notify the President.
2. If the President determines that the nature of the charges and evidence are such that it is in the best interest of the university, he or she may suspend an accused faculty member with pay pending the completion of the hearing and a final decision.
3. The EVP/CAO will review all allegations against a faculty member that involve the potential for termination. In cases of alleged incompetence, the EVP/CAO will review the allegations to ensure they are based on job performance and job-related conduct.
4. The accused individual will be informed in writing of the charges against him or her. The faculty member who is the subject of the allegations shall be given an opportunity to be interviewed and shall have the right to present a grievance, in person or through a representative, to the EVP/CAO on an issue or subject related to the allegations under review. This grievance shall be considered to be filed under this policy rather than under HOOP 127, Faculty Grievances.
5. The EVP/CAO, or another individual designated by the President if the allegations pertain to the EVP/CAO, shall take the grievance, if any, into consideration prior to making a determination whether the allegations are supported by evidence that justifies the initiation of the termination for cause process.
a. Failure to present a grievance to the EVP/CAO prior to his or her recommendation shall not preclude a faculty member from presenting an issue or subject to the special hearing tribunal in defense of charges for termination that may result from the review.
b. A faculty member under review for matters that may result in termination may only file a grievance pursuant to HOOP Policy 127 Faculty Grievances if the subject of the grievance is not involved in the review. A pending grievance may proceed only if it does not involve a subject under such review.
6. The EVP/CAO will recommend to the President whether to proceed with termination for cause.
7. If the President determines the allegations are supported by evidence that justifies the initiation of the termination for cause process, he or she will meet with the faculty member, explain the allegations and supporting evidence, and give the faculty member a reasonable amount of time, as determined by the President, to respond either orally or in writing. After receiving the faculty member's response, the President may decide not to move forward with the termination for cause process. If he or she decides to proceed:
a. A tenured faculty member who is recommended for termination on the basis of periodic evaluation must be given the opportunity for referral of the matter to nonbinding alternative dispute resolution, as required by Texas Education Code Section 51.942 and in compliance with applicable UT System and university policies and procedures for alternative dispute resolution, prior to referral of the charges to a hearing tribunal.
b. Except in cases of incompetence or gross immorality where the facts are admitted, or in cases of a felony conviction, the hearing procedures described below shall be initiated.
B. Hearings
The President will appoint a tribunal of at least three faculty members to hear the accusation, giving reasonable notice to the individual concerned.
Members of the tribunal for individual hearings will be selected by the President from a standing panel. The membership of this panel will be composed of nine tenured faculty members, with six chosen by the Interfaculty Council ("IFC") and three by the President.
1. Composition of the Standing Panel
The nine tenured faculty members shall be selected as follows:
Six elected by the IFC: two per year for three-year terms (initially assign two for one year, two for two years, and two for three years).
Three by the President: one per year for three-year terms (initially one for one year, one for two years, and one for three years).
2. Selection of the Tribunal
The President will select at least one appointee from those chosen by the IFC for membership on each tribunal. The academic rank of each of the tribunal's members will be at least equal to that of the accused individual. Members of the tribunal will select one member to serve as chair of the tribunal.
No person who accuses the faculty member may be included in the tribunal's membership.
The accused faculty member will be notified of the names of the faculty members selected for the tribunal and of the date, time and place for the hearing. Such notification shall be made at least eight business days prior to the hearing. The accused may challenge the ability of any member or members to serve fairly or objectively. The challenge from the faculty member must be made in writing to the tribunal at least three business days prior to the first scheduled meeting of the tribunal.
Each appointee who is challenged in this way must determine whether he or she can serve with fairness and objectivity. If a member voluntarily disqualifies himself or herself, the President will appoint a substitute member from the panel. The accused has no right to disqualify anyone from serving on the tribunal.
The President may request counsel from the UT System Office of General Counsel to advise the hearing tribunal.
3. Conduct
The accused has the right to appear in person at each hearing and is entitled to the selection and use of counsel at the accused's expense. If the accused is represented by counsel, the university is entitled to representation by counsel from the UT System Administration's Office of General Counsel or by a university attorney.
The accused has the right to confront and to cross-examine witnesses who may appear; the right to testify, though he or she may not be required to do so; and the right to introduce all evidence, written or oral, that is relevant and material to the defense.
A representative of the university may appear before the tribunal to present witnesses and evidence against the accused and in support of the charge. This representative has the right to cross-examine the accused (should the accused exercise the right to testify) and the witnesses offered on behalf of the accused.
The university has the burden to prove good cause for termination by the greater weight of the credible evidence.
A transcript or verbatim electronic recording of the proceedings will be kept by the university and will also be filed with the UT System Board of Regents ("Board"). The record will be made accessible to the accused.
C. Findings
The tribunal is charged with generating the following information (by a majority decision of its total membership) for consideration by the President:
written findings on the material facts,
recommendations on the continuation or the termination of the faculty member's appointment, and
supplementary suggestions relevant to the disposition of the case, if any.
The President will receive the original documentation of all the above-mentioned materials, and the accused will receive a copy. Any minority findings, recommendations, or suggestions generated by the tribunal will be delivered in similar fashion. The original record of the proceedings, including testimony and exhibits, shall also be forwarded to the President.
Within fourteen business days after receipt of the findings and recommendations of the hearing tribunal, the President will make one of the following decisions based solely on the evidence in the record of the proceedings and shall report that decision in writing to the accused faculty member. The President may:
Decide to dismiss the matter or impose sanctions short of termination. In this case, the President's decision is final, and the Board will not review the matter.
Decide to recommend termination to the Board, if the allegations are supported by evidence that constitutes good cause for termination. If so, the President shall forward the findings and recommendations of the hearing tribunal, the original transcript of the testimony, the exhibits and the President's report to the Board for its review. If the President's recommendation is not the same as the majority recommendation of the hearing tribunal, the President shall state the reasons for the President's decision to recommend termination in his or her report. The accused faculty member may, within seven business days after receiving the President's report, submit a written response to the Board. The response must be based solely on the evidence of record in the proceeding.
The Board, by a majority of its total membership, will approve, reject, or amend such findings, recommendations, and suggestions, if any, or will recommit the report to the same tribunal to hear additional evidence and reconsider its findings, recommendations, and suggestions. Reasons for approval, rejection, or amendment will be stated in writing and communicated to the accused. The decision of the Board is final.
III. CONTACTS
https://www.uth.edu/academics/
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Gold-Obsessed Man Wears 13Kg of It Wherever He Goes
By Spooky onDecember 10th, 2018 Category: News
A Vietnamese businessman has been attracting a lot of attention on Asian social media sites for his obsession with gold. 36-year-old Tran Ngoc Phuc wears a total of 13kg of gold wherever he goes, and is always accompanied by at least 5 bodyguards who make sure that no one tries to steal it.
Phuc first started making headlines in Vietnam last week after a series of YouTube videos of him showing off his massive jewellery went viral, getting several millions of views. Since then, photos and videos of him wearing his huge gold necklace, bracelets and rings have been doing the rounds on Vietnamese social media, and even on several websites in China and Thailand. While some people expressed their doubts that the jewels are real gold, most commenters wondered how he can stand walking around with so much extra weight. The businessman admitted that wearing the jewellery took some getting used to , but claimed that it was worth it as all the gold has boosted his good luck and prosperity.
World's Most Expensive Dog Jacket Is Made with 24K Gold, Costs $137,000
By Spooky onMarch 15th, 2018 Category: Animals
How much do you really love your pet dog? Enough to buy it the world's first 24K gold jacket encrusted with Swarovski crystals and black diamonds? It's "only" 137,000 and it's armored, meaning it will protect your pooch from bites and even knife slashes.
The world's most expensive dog jacket is the result of a collaboration between Doggy Armour and VeryFirstTo, the same company that brought us the ultimate holiday for James Bond fans and the world's most luxurious coloring book. The lavish canine garment is made of "Golden Textile" 24K gold Nano coated fabrics, which apparently "has the authentic values of gold itself and embraces 99.99% gold that is nono-structured". Clients also have the option to have the jacket decorated with either 20 Swarovski crystals, or 20 black diamonds.
New York Restaurant Serves $2,000 Pizza Covered in Edible 24K Gold
By Spooky onJanuary 11th, 2017 Category: Foods
Pizza has long been regarded as the food of the people; It's cheap, easy to make and tastes amazing. But that doesn't apply to all pizzas. For example, a restaurant in New York City serves a pizza that only the 1% can afford. It's priced at $2,000 and comes covered in strips of edible 24K gold.
The Industry Kitchen restaurant in New York's South Street Seaport was inspired by the nearby Financial District, which attracts the wealthy from all over the world, to create the "epitome of decadence" pizza. It's officially called 'the fance'za', but epitome of decadence sounds much more appropriate. This outrageously expensive treat consists of a black pie made with squid ink, Stilton cheese imported from England, Foie Gras and truffles from France, Ossetra caviar harvested from the Caspian Sea, edible flowers, and lost of edible 24K gold strips and flakes from Ecuador.
Artist Dubbed "Real-Life King Midas" Turns Everyday Objects Into Gold
By Sumitra onApril 2nd, 2015 Category: Art
Jewelry designer Hugh Power is being hailed as a real-life King Midas, after making it his life's mission to transform the most mundane everyday objects into opulent gold jewelry.
The Beverly Hills-based artist runs 'House of Solid Gold', a company that specializes in turning mundane objects like glasses or earbuds into luxurious gold-plated accessories that sell for tens or hundreds of thousands of dollars.
Need anything made of gold? Power's your man. He once made a gold toothpick for rap superstar Snoop Dog, because that's what you need to scoop out food from between your gold teeth, but his collection of gold accessories includes gold shoelaces ($14,995), gold earbuds (14,995), gold chopsticks ($1,695), gold glasses ($75,000) and even a gold-plated, diamond-encrusted football ($375,000).
Spanish Bakery Makes $150 Glittering Bread Using Gold Dust
By Sumitra onDecember 29th, 2014 Category: Foods
Whole wheat flour, spelt and water are the usual ingredients used to make bread, but add a touch of edible gold and you've got wealthy clients from all around the world stepping on each others' toes trying to secure a loaf of the world's most expensive bread. Made by Pan Piña bakery in the small Spanish village of Algatocin, the 'gold leaf bread' costs an unbelievable $150 per 400-gram loaf.
Pan Piña baker and co-owner Juan Manuel Moreno said that he came up with the idea for the bread after he saw the 'world's most expensive coffee' on sale at another shop in the region. So he decided to dazzle up his own bread with a dash of edible gold worth over $100 both inside and on the surface of each loaf. However, he does agree that the shiny metal does nothing to enhance flavor.
Hundreds of Treasure Hunters Hit English Beach After Artist Claims to Have Buried Gold Bars in the Sand
By Sumitra onSeptember 3rd, 2014 Category: News
Late last month, German artist Michael Sailstorfer made a surprising announcement – he said that he had buried 24-carat gold bars on the Outer Harbor beach in the town of Folkestone, in South East England, and that it was 'finders-keepers'. In the wake of this unusual news, hundreds of people have been thronging the beach, hoping to uncover at least a small portion of the hidden fortune.
The eccentric artist said that the project was his contribution to the town's art festival, The Folkestone Triennial, which began last Saturday. He named the installation 'Folkestone Digs', and described it as a unique project to get people involved in art. The event was funded by Bristol-based designers 'Situations'.
As a part of the installation, Sailstorfer hid 30 gold bars of varying sizes – 10g and 20g – in the sands of Outer Harbor. It might not sound like much, but each bar could be worth hundreds of dollars, and people get to keep everything they find. Sailstorfer encouraged people to start their search a couple of days before the festival actually started. As expected, hundreds of diggers turned up at the beach with buckets and spades, hoping to strike gold.
What Is It with Wealthy Indian Men and Solid Gold Shirts?
By Sumitra onAugust 11th, 2014 Category: News
When we wrote about Datta Phuge, an Indian businessman who owns a 3.2-kilogram solid gold shirt, we thought that his was a unique story. But it turns out there are other rich men in India obsessed with gold – like Pankaj Parakh, a businessman and local politician who celebrated his 45th birthday by gifting himself a 4-kilogram gold shirt worth over $200,000.
Pankaj is a textile magnate from the town of Yeola, near Mumbai city, who made his millions through his clothing empire. He now wants to make sure the rest of the world knows about his success. And what better way to flash his wealth than by wearing it? So he commissioned the solid gold shirt that he wore on the occasion of his birthday, last Friday.
The yellow metal shirt was designed by Bafna Jewellers in the nearby city of Nashik. The garment was then meticulously executed at Shanti Jewellers in Mumbai, by a team of 20 select artisans who spent 3,200 hours over the past two months 'sewing' the shirt.
Eat Your Food and Wear It Too – Gold-Plated KFC Chicken Bones as Jewelry
By Sumitra onJuly 2nd, 2014 Category: Art
Hard core KFC fans have come up with the perfect way to pay homage to their favorite fast food brand – by wearing gold plated KFC bones as jewelry. The idea sounds rather primitive, but I suppose the gold plating does reduce the barbaric effect to some extent.
'Kentucky Fried Chicken Bone Gold Necklaces', are made of only two ingredients – real KFC bones and real 14 karat gold. They come in two sizes – small and large. The necklaces are the brainchild of Kentucky for Kentucky, a group of people with the mission to 'engage and inform the world by promoting Kentucky people, places and products.'
Their official website states: "We're excited to introduce a brand spanking new Kentucky invention. An invention so kick-ass, it will change the jewelery game forever. We've taken one great Kentucky invention and turned it into a completely new Kentucky invention. Like Willy Wonka's Everlasting Gobstopper, we've figured out a way to make it possible to savor a single piece of Kentucky Fried Chicken forever. Forever and ever. We all win."
Gold Nugget Dubbed "Devil's Ear" Weighs 6664 Grams, Was Discovered on Friday the 13th, on a Full Moon Night
By Sumitra onJune 24th, 2014 Category: News
Miners in Russia's Irkutsk region found an oddly shaped nugget of gold on Friday the 13th, this month. The discovery scared them quite badly – especially because it happened on what superstition says is the unluckiest day of the year. It was also a full moon night, and to make matters worse, they say that the rock bore an uncanny resemblance to the devil's ear.
According to the Bodaybo town municipal administration, the gold miners (who work for the metal mining company Ugakhan) didn't immediately realise that the rock was made of gold. The sifting machine mistook it for a regular rock and discarded it. But one worker had the good sense to take a closer look, and he realized that it was in fact a large gold nugget.
Golden Baba – Indian Holy Man Tells Followers to Live Frugally But Drapes Himself in Gold
By Spooky onFebruary 19th, 2013 Category: News
His real name is Bittu Bhagat, but his fascination with gold earned him the nickname "Golden Baba". Claiming to be a living saint, this Indian holy man tells his followers to live in poverty, while he covers himself in gold clothes and accessories worth hundreds of thousands of dollars.
Golden Baba has apparently been in the sights of Indian tax officials for some time, but he also attracted the attention of the press when he made an appearance at the sacred Kumbh Mela pilgrimage with two young European beauties hanging on his arms and wearing dozens of solid gold accessories around his neck and on his hands. He looked more like a middle-aged playboy than a holy man preaching about the rewards of a simple life free of worldly possessions. But reports claim Bittu Bhagat tells his disciples they mush shun their material wealth, even their clothes, if they want to follow him, and investigators say he only accepts donations in solid gold. Formerly a simple tailor, this Golden Baba now allegedly has a fortune of several millions of dollars and travels around in a fleet of chauffeur-driven Mercedes, Bentleys and BMWs.
Gold-Obsessed Man Shows Off Solid Gold Shirt, Takes Pimping to a Whole New Level
By Spooky onJanuary 4th, 2013 Category: News
Datta Phuge, a chit fund businessman from Pimpri, India, refers to himself as "The Gold Man of Pimpri" and in order to live up to this image, he has recently commissioned a 22-karat gold shirt weighing 3.2 kilograms that's bound to make some Western rappers green with envy.
According to India Today, gold-obsessed businessmen and politicians are nothing new in India. Not long ago, a man by the name of Ramesh Wanjale was spotted wearing 2 kilos of gold, then NCP functionary Samrat Moze wore 8.5 kilograms of gold in the form of jewelry and ornaments, but chit fund Datta Phuge found a way to one-up them both. He had a team of 15 goldsmiths working 18 hours a day for over 15 days in order to finish a 3.5 kg woven gold shirt. "The gold shirt has been one of my dreams," Mr Phuge told Indian newspaper the Pune Mirror. "It will be an embellishment to my reputation as the 'Gold man of Pimpri'", Phuge said. His extravagant garment consists of 14,000 gold flowerrings, interwoven with one lakh spangles. It was assembled on a fabric base of imported white velvet, and comes with six Swarovski crystal buttons and an intricate belt, also made of gold.
Chinese Village Gives Every Villager Gold and Silver Bars
By Spooky onMarch 27th, 2012 Category: Funny, News
To celebrate the 40th anniversary of a village-owned business, Changjiang Village, in China's Jinagsu Province, has given every one f its 3,000 villagers 100-gram bars of gold and silver.
It's no secret that China has the world's fastest growing major economy, but some of its residents like to flaunt their riches anyway. Take Changjiang village, for example. This little settlement happens to own the Jiangsu Xin Chang Jiang Group, one of the top 20 private enterprise in China. It is involved in eight different industries, including electricity, chemicals and metals, and it's apparently very successful in all of them. At least that's the signal they're sending through their latest gesture of generosity. Following a promise made back in 2009, the village's party leader recently ordered over 600 kilograms of gold and silver, and handed it to every villager in 100-gram bars.
Japanese Jeweler Creates Solid Gold Christmas Tree Worth $2 Million
By Spooky onNovember 24th, 2011 Category: Art, News
For those of you who love Christmas but can't stand falling needles and cheap plastic, Japanese jeweler Ginza Tanaka has created the ultimate Christmas tree – made of pure gold and worth a whopping $2 million.
After making a 24-karat gold horse for Japan's newborn prince, and creating another tree worth $850,000, Ginza Tanaka decided to step it up even more and came up with a solid gold Christmas tree for this holiday season. Measuring 2.4 meters high and weighing around 12 kilograms, the luxurious tree is decorated with golden plates and around 60 heart-shaped ornaments, and covered with ribbon. It's the most expensive thing Ginza Tanaka has ever made, but while I do appreciate the craftsmanship and the effort that went into it, I'm not sure gold is right for such an important symbol. After all, what kind of presents are you supposed to put under such a tree, anyway?
Man Makes a Living Scraping the Sidewalk for Gold and Diamonds
By Spooky onJune 22nd, 2011 Category: Funny, News
Believe it or not, the streets of New York really are paved with gold, but you have to get down and dirty to get your hands on it. For urban prospector Raffi Stephanian this isn't an issue, just a great way to pay the bills.
Using only a Styrofoam cup, a butter knife and tweezers, 43-year-old Raffi scours the streets of New York's Diamond District searching for gold, diamonds and other precious jewels. You've probably walked on 47th Street countless times and didn't realize the riches that were right there in front of you, but don't beat yourself up about it, Raffi was probably the only one who ever thought there was something valuable on the sidewalk. And that only because he worked as a stone setter, years ago, when he found gold scraps on the floor of a diamond exchange. He realized if he could find gold inside, then people must have carried it outside, as well.
The gold and precious stones industry is a hectic one, and you can see people running from one shop to the other, from a diamond supplier to a diamond dealer, and so on, and in the process, they drop tiny valuables without even realizing it. Most of the fragments found by Raffi Stephanian were carried into the streets by diamond merchants who accidentally picked them up on their clothes or on the soles of their shoes. He also finds platinum chips, loops from broken necklaces, watches or bracelets, all of which were dropped by mistake.
Gold-Plated Barbecue Grill Is World's Most Expensive
By Spooky onJune 2nd, 2011 Category: Funny, Pics
If you have money to burn, this $164,000 gold-plated barbecue-grill made by BeefEater Barbecues should be at the the top of your spending list.
Sure, this hand-made Signature Series 6 Burner SL400 looks good has some nice built-in features like a wok burner, warming rack and roasting hood, but will it make your steaks taste better? Probably enough, and the creators of the grill themselves say they made it for people 'want to make a statement with their barbecue and have the money to burn'. 'Why would anyone want to make a statement with their barbecue?', you ask? Maybe because they just got bored of gold phones, gold-plated cars, have eaten enough gold-plated food and need something new to attract attention.
The one-of-a-kind barbecues is covered with 24 carat gold, except for the actual grilling surface, and was created for the 2008 Sydney Home Show, for an estimated $60,000. Now, the price has gone up to $164,000. Somebody better buy it soon, before the gold price rises even more.


I would like to create my own ePub documents from scratch without a tool so that I have full control over the final result.
What is the absolute minimum set of required files to have a valid ePub file? Or, to put it in programming terms, what would an ePub "Hello, world." file look like?
And that's it! For more complex stuff, there are a number of free epub 3 samples available at https://code.google.com/p/epub-samples/.
In regards to the version 3.0 ePub I disagree and believe it should be noted that when an ePub is built as ePub 3.0 format ONLY it will not validate other than 3.0 in epubcheck. This can be achieved and tested in the terminal using epubcheck command line (which is a different question).
value of attribute "version" is invalid; must be equal to "2.0"
attribute "property" not allowed here; expected attribute "content", "id", "name", "scheme" or "xml:lang"
element "meta" missing required attributes "content" and "name"
attribute "properties" not allowed here; expected attribute "fallback", "fallback-style", "href", "media-type", "required-modules" or "required-namespace"
That displayed my argument with the industry standard is that a version 2.0 ePub CAN be built to support and function with devices that run version 3.0 and it should be coded as such for quality and validation.
I find it easier for maintenance and less annoying searching for a .opf or .ncx file in either OEBPS, OPS, OPF, etc. etc. file structures.
Not the answer you're looking for? Browse other questions tagged epub creation production or ask your own question.
How do I add a cover (and other pictures) to my ePub?
How do I build multiple ebooks using common blocks of content and styling, such as title pages and CSS?


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Home » Biography » Gary Dell'Abate
Gary Dell'Abate
Posted on Apr 28, 2021, Pranav Bajracharya
Early Life and Bio
Nationality and Physical Stats
Personal Life: Relations
Gary's Net Worth
Gary Dell'Abate is an American radio producer who is well-known for his work as an executive producer in the radio show, 'The Howard Stern Show' since the year 1984. Likewise, he is also immensely popular for his autobiography, 'They Call Me Baba Booey' which is a book that was published on 2 November 2010. His nickname 'Baba Booey' stuck onto him since the day he mispronounced Baba Looey which is the fictional Mexican burro and McGraw's sidekick from the 'Quick Draw McGraw Show'.
Full Name Gary Patrick Dell'Abate
Date of Birth 14 March, 1961
Place of Birth Brooklyn, New York City, United States of America
Ethnicity Italian-American
Mother's Name Ellen Cotroneo
Father's Name Salvatore Dell'Abate
Siblings Steven Dell'Abate (passed away 1991)
Body Physique Average
Eyes Color Dark Brown
Education Adelphi University
Wife / Girlfriend Mary Dell'Abate Caracciolo
Children Lucas Dell'Abate
Jackson Dell'Abate
Net Worth $15 million (estimated)
Gary Dell'Abate's full name is Gary Patrick Dell'Abate was born on 14 March 1961 in Brooklyn, New York City, United States of America to a mother whose name is Ellen Cotroneo, and to father whose name is Salvatore Dell'Abate. His mother worked as a food demonstrator at Macy's New York and his father worked as a salesman for the American ice cream company, Haagen-Dazs. He was born and raised alongside his brother whose name is Steven Dell'Abate.
Unfortunately, his brother tested positive for HIV-AIDS and passed away in the year 1991. Gary stated that he was aware of his brother's condition but he did not know how harmful the disease was. Besides this, he is currently 60 years old with the zodiac sign of Pisces.
Gary Dell'Abate holds an American nationality and he descends from Italian-American ancestry. He is a Christian and he practices Christianity as his religion. In addition to this, he belongs to the white ethnicity.
Gary Dell'Abate stands at a height of 5 feet and 9 inches (1.75m/175cms) tall and weighs around 90kgs (214lbs). He has an average body physique with a pair of dark brown colored eyes and black colored hair.
You might want to check out about Tamron Hall.
Unfortunately, there is no information available regarding Gary Dell'Abate's schooling years so it is assumed that he completed his schooling at some local schools in Brooklyn. However, for further studies, he studied and completed his education from the Adelphi University which is a private university located in Garden City, New York. During his time in the university, he was also awarded the Richard F. Clemo award in his senior year.
Gary Dell'Abate is currently married to his wife whose name is Mary Dell'Abate Caracciolo. Her exact profession is unknown but it is known that they tied knots in the year 1992. Whereabouts regarding their marriage location and date are currently unknown and it is also assumed that they were involved in a relationship for a very long time prior to their marriage. Besides this, they were blessed with two sons whose names are Lucas Dell'Abate and Jackson Dell'Abate.
Gary Dell'Abate's professional career as a producer began in the year 1974 when he helped in the production of the show, 'The Uncle Floyd Show'. Since then, he has appeared as a producer, a segment producer as well as an executive producer in numerous television series, television shows, and television movies like 'U.S. Open Sores' in the year 1989, 'The Howard Stern Radio Show' in the year 1998, 'Howard Stern' in the year 2005, and 'For What It's Worth' in the year 2013. His most remarkable work came in the year 2006 when he worked as a producer as well as an actor for over 500 episodes of the comedy talk-show television series, 'Howard Stern on Demand'.
You might want to check out about Liz Cheney.
Gary Dell'Abate earns from his professional career as a producer and he is one of the most successful producers in the industry. He has done a lot of hard work and has kept a lot of effort in his work which is appreciated by the audience. As of the year 2021, he has an estimated net worth of around $15 million.
Gary Dell'Abate is active on social media platforms. His official Instagram account (@robertabooey1) has over 145 thousand followers but the account has not been verified by Instagram yet. Moreover, he has over 405 thousand followers on his official Twitter account (@robertAbooey).
For more interesting news and updates about your favorite celebrity, please stay connected with us at Celebsgraphy.
Gary Dell'Abate
Felisha Terrell
Genevieve Gallen
Josha Stradowski


text:
Wind Mobile Founder Says Rogers-Shaw Merger Will Bring Higher Wireless Prices
Former Wind Mobile founder, Anthony Lacavera, says he was "disappointed" to hear about the Rogers-Shaw merger this week.
Shaw acquired Wind Mobile in late 2015 and turned it into Freedom Mobile, part of a $1.6 billion deal.
Speaking to Postmedia from his home in Toronto, Lacavera said, "The oligopolies are so strong in Canada," adding, "I was disappointed. It's just so unfortunate that the country I love is dominated by these oligopolies and does not have a competitive market."
Lacavera said the Rogers acquisition of Shaw will result in increased prices and weaker customer service. "I think that prices most definitely are going to go up," he said, noting the wireless picture would turn back to a consolidated picture before Wind Mobile entered the picture.
He also took issue with the fact Rogers mentioned in its press release it would not raise Freedom Mobile prices for at least three years.
"I think it's very telling (that) right in their press release, they felt the need to say that," Lacavera said to Postmedia. "I think in a normal competitive market, you would never have to say something like that, because of course, if there's a competitive market, prices are not going to go up."
While Lacavera noted his disappointment from the news, he also shared some positive takeaways, specifically mentioning the deal would benefit the advancement of 5G networks and make Canada competitive on the world stage. Canadians will most likely need to pay higher prices to access 5G.
He also praised the Big 3 for their business practices, when it comes to the wireless industry. "The decisions that they make, to limit competition, to stifle innovation, to keep prices high and keep competitors out, those are smart business decisions," he said, referring to Rogers, Telus and Bell.
Ultimately, regulators are to blame, says Lacavera, for failing to enforce spectrum allocation policy back in 2007, related to governing disputes and cell tower sharing.
"Let's figure out how to create a policy framework that encourages competition but resolves some of the shortcomings of the old policy," stressed Lacavera. "At the same time, let's create a mechanism for enforcement. That is the most important thing. Just enforce the policy," he added.
Other articles in the category: Rogers
Rogers-Shaw Deal Expected to Net Hedge Funds Over $200 Million: Report
Rogers' proposed $26 billion takeover of Shaw Communications, if successful, could deliver a $216 million payday to 12 hedge funds that bet on it — reports Reuters. The controversial and heavily contested merger has a January 31 deadline. With the Federal Court of Appeal rejecting the Competition Bureau's appeal of the merger on Tuesday, Rogers and...
Shaw Tells MPs: Telus and Globalive Working Together Like 'Geppetto' and 'Pinocchio'
MPs on the House of Commons' industry and technology committee on Wednesday expressed concerns about the impact of Rogers' proposed $26 billion takeover of Shaw Communications on jobs, competition, and affordability in Canada's telecommunications sector (via The Globe and Mail). During another hearing on the long-embattled merger just a week before its January 31 deadline,...
Rogers Price Increase Coming for Customers on Older Infinite Plans
Rogers has started notifying some customers on older Infinite plans their bills are going up. According to iPhone in Canada reader Rob, his latest January Rogers bill statement included a blurb about a price increase set to take place in March, 2023. The heading "Changes to your Wireless Plan Rate" then explains the monthly service […]


[These verses] doth, as it were, take our hands, and lay them upon Christ's breast, and let us feel how his heart beats and his bowels yearn towards us, even now he is in glory – the very scope of these words being manifestly to encourage believers against all that may discourage them, from the consideration of Christ's heart towards them now in heaven.
Cited from: The Works of Thomas Goodwin, Vol. 4, p. 111.
Cited from: The Works of Thomas Goodwin, Vol. 4, p. 100.
Below is a moving selection from the forward to The Banner of Truth's Edition of Thomas Goodwin's book "The Heart of Christ" written by Michael Reeves that he posted over at The Theology Network.
hearten and encourage believers to come more boldly unto the throne of grace, unto such a Saviour and High Priest, when they shall know how sweetly and tenderly his heart, though he is now in his glory, is inclined towards them.
Goodwin shows that in all his glorious holiness in heaven, Christ is not sour towards his people; if anything, his capacious heart beats morestrongly than ever with tender love for them. And in particular, two things stir his compassion: our afflictions and – almost unbelievably – our sins.
The focus is upon Christ, but Goodwin was ardently Trinitarian and could not abide the thought of his readers imagining a compassionate Christ appeasing a heartless Father. No, he said, 'Christ adds not one drop of love to God's heart'. All Christ's tenderness comes in fact from the Spirit, who stirs him with the very love of the Father. The heart of Christ in heaven is the express image of the heart of his Father.
All then, that God works upon you savingly, from first to last, is a discovery of Christ, some way or other, in you. It is either the knowledge of his person, or it is a conformity to him, or it is dispositions suited to what you know of him; working upon us, and operations of God upon us suitable to what is in him; and this I call the sum or substance of our religion.
A Puritan Theology (Grand Rapids, MI; Reformation Heritage Books; 2012) p. 332.
Quoted from: Goodwin, Glory of the Gospel, in Works, 4:346.


text:
Neo: The Bullish Flag Awaits Resolution
#NEO
While many retail traders had been focused on crazy gains showcased by various DeFi tokens, Neo (NEO) has been doing very well, having gained 160% in the past year against USD, 52.4% in the Bitcoin (BTC) market, and even outgunned the surging Ethereum (ETH) by 3.5%.
YTD NEO chart
This was largely inspired by the newly emerged expectations around Neo3, the third version of Neo Foundation's proprietary blockchain that's supposed to introduce file storage as well as the digital/decentralized identity to the network. This year, the Chinese blockchain project has also incorporated the cross-chain interoperability solution in collaboration with Ontology, and also participated in the creation of Flamingo Finance together with Binance, consequently dipping its toes in the DeFi waters, which is obviously one of the reasons behind its positive performance in the marketplace.
As of this writing, NEO is priced at $18,39, having gained 2% in the past 24 hours and 8.16% over the last week, though it has dropped by 12.8% against USD and as many as 30.1% in comparison to BTC in the past month, but that should be blamed on the retracement that followed the bull rally, and Bitcoin's resurgence on the back of the news about PayPal inclusion.
The continuation pattern starts to play out
The weekly chart demonstrates that NEO is currently finalizing the first major retracement of the minor uptrend that stems from this year's low at $3.79 that had been hit during the market collapse in March.
1-week NEO/USDT chart
Neo had briefly peaked at $26, upon which the retracement kicked in and took the price all the way to $16 in a series of two large dumps that went throughout the entire cryptocurrency market. Nevertheless, the buyers have defended the support at $16 really efficiently - this level had also been tested multiple times during the initial breakout, which further proves its fortitude.
At the close of this week, NEO is traded above the open of the first candle that began the consolidation, thus increasing the likelihood of forming the bullish engulfing pattern that usually opens up the rally, which, in its turn, should resolve the bullish flag formation to the upside and continue the uptrend, unless the sellers apply an insurmountable pressure at $24, thus forcing the price action into the double top reversal pattern.
There is also a possibility of NEO going into consolidation between $16 and $20, but that would be determined by the behavior of MACD that has its moving averages now closing either for a bearish crossover or the rejection. But given the reigning bullish sentiment throughout the market, the indicator is likely to go for the rejection and the resumption of movement to high extremities. The Accumulation/Distribution indicator is now approaching the apex of the symmetrical triangle, the resolution of which to the upside will confirm NEO's bullish intentions.
Our NEO price prediction is that the 20th altcoin will gain at least 32% in the next 30 days as a part of the resolution of the bull flag, and then take out the resistance at $24. The good entry point for a long play would be at $19.1 - supposed close of engulfing candle, or more conservative at $21.5 - the breaking point of previous resistance.
Author: Alex Paulson for Crypto-Rating.com
Neo Explodes to the Upside After Successful Break
Neo Bullish On All Fronts This Summer
NEO Is a Step Away From the Explosive Zone
NEO Has Its Target Set on 50 EMA
NEO: Cup & Handle Turned Bearish Spike Pattern
NEO: The misleading rally in January
NEO Price Forecast for November 2019
NEO moves to new blockchain - NEO 3.0


text:
namespace draco {

// This class encodes a given point cloud based on the point cloud compression
// algorithm in:
// Olivier Devillers and Pierre-Marie Gandoin
// "Geometric compression for interactive transmission"
//
// In principle the algorithm keeps on splitting the point cloud in the middle
// while alternating the axes. For 3D this results in an Octree like structure.
// In each step we encode the number of points in the first half.
// The algorithm uses quantization and does not preserve the order of points.
//
// However, the algorithm here differs from the original as follows:
// The algorithm keeps on splitting the point cloud in the middle of the axis
// that keeps the point cloud as clustered as possible, which gives a better
// compression rate.
// The number of points is encode by the deviation from the half of the points
// in the smaller half of the two. This results in a better compression rate as
// there are more leading zeros, which is then compressed better by the
// arithmetic encoding.

// TODO(hemmer): Remove class because it duplicates quantization code.
class FloatPointsTreeEncoder {
 public:
  explicit FloatPointsTreeEncoder(PointCloudCompressionMethod method);
  explicit FloatPointsTreeEncoder(PointCloudCompressionMethod method,
                                  uint32_t quantization_bits,
                                  uint32_t compression_level);

  template <class InputIteratorT>
  bool EncodePointCloud(InputIteratorT points_begin, InputIteratorT points_end);
  EncoderBuffer *buffer() { return &buffer_; }

  uint32_t version() const { return version_; }
  uint32_t quantization_bits() const { return qinfo_.quantization_bits; }
  uint32_t &quantization_bits() { return qinfo_.quantization_bits; }
  uint32_t compression_level() const { return compression_level_; }
  uint32_t &compression_level() { return compression_level_; }
  float range() const { return qinfo_.range; }
  uint32_t num_points() const { return num_points_; }
  std::string identification_string() const {
    if (method_ == KDTREE) {
      return "FloatPointsTreeEncoder: IntegerPointsKDTreeEncoder";
    } else {
      return "FloatPointsTreeEncoder: Unsupported Method";
    }
  }

 private:
  void Clear() { buffer_.Clear(); }
  bool EncodePointCloudKdTreeInternal(std::vector<Point3ui> *qpoints);

  static const uint32_t version_;
  QuantizationInfo qinfo_;
  PointCloudCompressionMethod method_;
  uint32_t num_points_;
  EncoderBuffer buffer_;
  uint32_t compression_level_;
};

template <class InputIteratorT>
bool FloatPointsTreeEncoder::EncodePointCloud(InputIteratorT points_begin,
                                              InputIteratorT points_end) {
  Clear();

  // Collect necessary data for encoding.
  num_points_ = std::distance(points_begin, points_end);

  // TODO(hemmer): Extend quantization tools to make this more automatic.
  // Compute range of points for quantization
  std::vector<Point3ui> qpoints;
  qpoints.reserve(num_points_);
  QuantizePoints3(points_begin, points_end, &qinfo_,
                  std::back_inserter(qpoints));

  // Encode header.
  buffer()->Encode(version_);
  buffer()->Encode(static_cast<int8_t>(method_));
  buffer()->Encode(qinfo_.quantization_bits);
  buffer()->Encode(qinfo_.range);
  buffer()->Encode(num_points_);

  if (method_ == KDTREE) {
    buffer()->Encode(compression_level_);
  }

  if (num_points_ == 0) {
    return true;
  }

  if (method_ == KDTREE) {
    return EncodePointCloudKdTreeInternal(&qpoints);
  } else {  // Unsupported method.
    fprintf(stderr, "Method not supported. \n");
    return false;
  }
}

}  // namespace draco

#endif  // DRACO_COMPRESSION_POINT_CLOUD_ALGORITHMS_FLOAT_POINTS_TREE_ENCODER_H_

redpajama_set_name: RedPajamaGithub


In 2016, Ohio-based federal agencies and laboratories received a federal R&D investment of $2.4 billion. They leveraged that investment via their technology transfer efforts to address societal needs, promote economic development and growth, and enhance U.S. competitiveness. From defense to life sciences to energy to agriculture, Ohio-based federal agencies and labs are meeting the technology transfer mission envisioned by Congress.
To learn more about, and connect with, Ohio's FLC member laboratories, visit FLC Business. The web-based, searchable database displays laboratory profiles with information such as contacts, areas of expertise, laboratory history, website links, and more.


OKLAHOMA CITY — As the crowd showered him with a raucous standing ovation, Russell Westbrook turned to the Portland Trail Blazers bench and gave a little wink.
A drive and kick to set Paul George up for a 3 made NBA history: A 10th consecutive triple-double, breaking Wilt Chamberlain's mark of nine straight set in 1968.
It looked like a long shot for Westbrook, needing five assists in the final eight minutes, but with a quick flurry of setups, he was up to nine with four minutes to go. On a pick-and-pop with George, Westbrook hit his All-Star teammate in rhythm, and the rest was, well, history as the Thunder topped Portland 120-111.
The triple-doubles didn't end there, though. Westbrook returned the favor a few minutes later, hitting a deep 3 set up by George, giving him his third career triple-double with 47 points, 12 rebounds and 10 assists, featuring 15-of-26 shooting and 8-of-13 from 3.
It's the second time this season teammates have recorded triple-doubles in the same game (LeBron James and Lonzo Ball) and the ninth time in NBA history.
Westbrook finished with 18 points, 14 rebounds and 11 assists in 37 minutes. It's his league-leading 23rd triple-double of the season. He had two previous streaks of seven straight triple-doubles — both in his MVP-winning 2016-17 season — but finally passed Michael Jordan and himself last week, then caught Chamberlain on Saturday against the Rockets, before setting the new mark on Monday.


text:
Sub Dub Micromachine est un groupe de metal industriel allemand, originaire de Berlin. Débutant comme groupe de post-punk à partir de 1997, sous le nom de Halmakenreuther, le groupe se reforme sous le nom actuel en 2000.

Biographie
Le groupe est formé en 1997 sous le nom de Halmakenreuther. En 2000, il se compose de Kirk de Burgh (Knorkator), H-Beta (B. Crown) et de Marcello Goldhofer (Die Skeptiker) et devient Sub Dub Micromachine. Le nom fictif de Kirk DeBurgh est visiblement inspiré par le personnage de James T. Kirk de Star Trek, et du chanteur irlandais Chris de Burgh.

Le groupe se popularise grâce à plusieurs chaînes de radio sur Internet comme ChroniX Aggression qui jouent fréquemment leurs chansons. En 2002 sort leur premier album, Rabautz!. En 2008, le groupe publie son deuxième album Auferstanden! au label Black Cookie. En 2013, le groupe annonce sur sa page Facebook être en train de travailler sur un troisième album.

Style musical
Le groupe en tant que tel est largement influencé par des groupes comme Korn ou Fear Factory en pratiquant un style qui utilise aussi des instruments électroniques et qui varie au niveau du chant entre des growls s'approchant du death metal, un chant mélodique s'approchant du rock 'n' roll ou même de la country sinistre et un chant parlé s'approchant du rap ou nu metal. Les chansons du groupe sont principalement en anglais, mais il y a aussi quelques exceptions allemandes traitant des sujets divers et souvent provocants. Bien que l'apparence du groupe ressemble plus au style gothique ou EBM, leurs spectacles sont plutôt inspirés de Rammstein en utilisant des projeteurs de films, des lasers, des masques ou des éléments pyrotechniques. Ce genre de spectacle s'appelle l'apparence 'Cyber Warrior. Par contre, ces concerts remarquables sont assez rares, vu que le groupe ne donne des concerts et ne publie des CD que très irrégulièrement et n'est resté connu que dans le underground du genre, malgré deux albums et plusieurs clips vidéo professionnels.

Membres
 Kirk DeBurgh - chant, guitare
 H-Beta - basse
 Marcello Goldhofer - batterie, percussions

Discographie

Notes et références

Liens externes

Groupe allemand de metal industriel
Groupe musical allemand des années 2000

redpajama_set_name: RedPajamaWikipedia


text:
Video of a Safety Drill aboard Radiance of Seas while in Drydock
There's a heightened probability of a fire or other type of emergency aboard ship when it's in drydock, due to the types of construction work being done and the addition of flammable material aboard. Just like at sea, the crew needs to be ready and have everyone trained. Dealing with an emergency in drydock is much different than doing so at sea. For that reason they need to practice emergency drills not only for the crew, but also for all the contractors aboard who aren't used to being aboard a ship. In this video, Christopher Bean, Chief Safety Office aboard Radiance of the Seas, shows us an emergency drill being run during the drydock in Victoria (BC).
Labels: Radiance OTS, Royal Caribbean
Video from Radiance of the Seas' Drydock Showing New Staterooms Being Added
In this video for Radiance of the Seas' drydock, project manager Brett Vitols, shows us some of the work being done to add 15 staterooms and suites to the ship. The new accommodations will be all types from a Family Suite to staterooms for single travelers.
Video under the Hull During the Drydock of Radiance of the Seas
The main reason for a ship to go into drydock is to do work on the hull under the waterline. In this video, Jim Dixon, the manager of marine operations during Radiance of the Seas' drydock, shows us some of the projects being carried out under the ship while it is in the Victoria Shipyard.
Video of Maintenance on the Azipod Propulsion System aboard Radiance of the Seas
To work on many parts of the Azipod propulsion system, the only way to do it is when the ship is out of the water. During a scheduled drydock, such as this one for Radiance of the Seas, work on the propulsion system is a major item on the "to do" list. It also gives us a chance to see exactly what the units look like. During this drydock they are doing a routine replacement of the thrust bearings, and more unusual, they are also replacing the propellers blades with a new more fuel-efficient design.
Video of Radiance of the Seas Getting New Pool Deck
Royal Caribbean's Radiance of the Seas is still in drydock at Victoria, BC, and the latest video update from the ship shows the pool deck being replaced with a covering called "future teak." Area revitalization manager Denise Pedersen Key-Tielebein says the project is behind schedule due to the weather, but they are working to get back on track by June 9.
Video of Independence of the Seas Moving away from Oil Tank Explosion at Gibraltar
Royal Caribbean's Independence of the Seas was docked adjacent to an oil tank today (May 31, 2011) when welding on the tank apparently caused it to burst into flames at approximately 3:47pm, injuring 12 passengers on the ship. Independence retracted the gangway and immediately moved a safe distance away.
Amateur video below shows the scene shortly after the explosion.
Earlier photos showed the ship docked immediately adjacent to the tank with its stern well to what would be the left of the tank in this video. As the video progresses you can see the ship moving farther away.
The ship did continue on its itinerary, which was a 14-night cruise which departed Southampton on May 28. At 7:40pm, this evening, local media reported that the flames spread to a second tank, causing evacuation of the port offices.
In the second video, below, there is a short clip that says it was shot approximately 30 seconds after the explosion, before Independence could move, and you can see the close proximity at the time of the blast.
Labels: Royal Caribbean
Video of Construction of Samba Grill on Radiance of the Seas
The refit of Radiance of the Seas is well under at the Victoria Shipyard in British Columbia. In this video, Jurgen Bailom, Royal Caribbean's Fleet Hotel Director of Revitalizations, show the construction of the new Samba Grill, the Brazilian steakhouse, in space formerly occupied by the Seaview Grill.
Touring Celebrity Silhouette under Construction at Meyer Werft
Celebrity Cruises President Dan Hanrahan toured the almost-complete Celebrity Silhouette at the Meyer shipyard in Papenburg (Germany). The ship is being readied for delivery in mid-July. The 122,000-ton vessel is the fourth in the Solstice-class line.
The ship was floated out of Meyer's covered building dock on Sunday, May 29, 2011. We have photos of the float out on the Cruise News Daily website.
Labels: Celebrity, Celebrity Silhouette
Weekly Video Cruise News Summary May 28, 2011
This week's news headlines from the cruise industry, via Cruise News Daily, includes items about MSC Opera returning to service, a crew member overboard from Celebrity Eclipse, Italian shipbuilder Fincantieri's labor negotiations to ease its financial troubles, Carnival announcing plans to homeport in Boston, refurbishment work on Norwegian Dawn, Maasdam and Radiance of the Seas, interviews with P&O's executives about Adonia, special arrangements Princess makes for passengers traveling with service animals, the Greek government cannot remove the wreckage of Sea Diamond, and Xanterra Hotels closing on their purchase of Windstar Cruises.
Labels: newscast
▼ May 29 - June 5 (9)
Video of a Safety Drill aboard Radiance of Seas wh...
Video from Radiance of the Seas' Drydock Showing N...
Video under the Hull During the Drydock of Radianc...
Video of Maintenance on the Azipod Propulsion Syst...
Video of Independence of the Seas Moving away from...
Video of Construction of Samba Grill on Radiance o...
Touring Celebrity Silhouette under Construction at...


Simplified AIM design and new group messaging inject energy into a longtime communicator.
Anyone who has been around computers for any length of time has or has had an AIM instant messaging account. In fact, it's still our primary IM provider here at PCMag. But the official AOL client, which is also accessible from other services like Digsby and Trillian, had gotten bogged down with "feature creep," making for a complicated interface that offers no end of social, music, and video capabilities. Until now.
PCMag talked with the man behind the revamp, AOL's Jason Shellen, in advance of today's release. Shellen's company, Thing Labs, was purchased by AOL specifically to pump new blood into AIM.
"AOL told us they'd love some startup-minded folks to give AIM a refresh," said Shellen. "AIM had been bringing people the OMG and LOL, and TMI for years and years, but the product kept getting patchwork updates and the feature set grew and grew. We thought we should give a trim, slim update to the AIM client and make great group conversation. There are some cool whiz-bang features too."
AIM has a new cursive brand logo, and the buddy list now looks totally different. It's larger, and conversations appear to the side of the contact list, rather than in separate small windows. Conversations look something like the speech bubbles used on the iPhone for text messaging. If a contact sends a link to a video or image in your chat, it can play right in the AIM software. In addition to entries for individual contacts, you can create permanent group entries, which let you send a message to everyone in the group at any time. You can also find and join public chat groups.
"Adding members to a group chat is just as easy as selecting from your friend list," said Shellen. "You can imagine that this is quite a lot of fun, not just on the desktop, especially with images being shown inline, videos being shown inline. It's incredibly social and fun. It's the private place to share what you've always wanted. But it becomes even more fun if you're on your iPhone or Android phone."
The AIM client also incorporates news feeds from AOL properties like Huffington Post, TechCrunch, and Engadget. Your Facebook, Twitter, and Instagram social notifications can also appear in the AIM client.
The new AIM, like Windows Live Messenger, now supports offline messages, too, meaning that if someone IMs you while you're not online, you'll see the message on whatever device you next access AIM. File sharing is improved, too, replacing earlier AIM's direct connect capability, and uploaded images are now displayed in the buddy list. Status updates now have a Twitter-like "follow" and "follower" model. You can mute groups, and sound preferences have been reduced to the minimum: just one—on or off.
The Web version of AIM has also been revamped. Shellen says it now looks more like a true Web app, or a full Web version of the installed software. Both will launch at preview.aim.com starting today. Versions for Windows, Mac, Android, and iPhone (pending Apple approval) will be available.


Looking to clean up in business without getting your hands dirty? Well, Executive Business Maintenance Franchise (EBM) is the franchise for you.
Executive Business Maintenance is not another janitorial company. EBM is a sales, marketing and customer service provider to businesses and janitorial companies.
The EBM uses sales and marketing strategies to target companies that require janitorial and maintenance services. Then, they design a customized maintenance program to meet the client's needs and match the client to one of the highly-qualified janitorial firms from their pool of service professionals. Best of all, EBM helps franchise owners build their own businesses.
The Executive Business Maintenance franchise program gives you the opportunity to be your own boss with a qualified and caring team to back you up. The services you sell and coordinate are part of a huge market for commercial cleaning. EBM is looking for dedicated individuals to assist them in taking the EBM concept to the next level. They are sure you will find the work to be rewarding, professional, and worthwhile.


text:
PathGuide Technologies & Jensen Distribution
PathGuide Technologies & Jensen Distribution 2015 AIM 2015 AIDC (Non RFID) Case Study Competition Participant The Business and Technical Challenge Jensen is a wholesale distributor of hardware and sundries located near Spokane, Washington. Their 570,000 square foot distribution center stocks 65,000 line items and serves eleven western states. In 2008, Jensen was using a home...
Patrizia Pepe Fashion Impinj Case Study Customer: Patrizia Pepe, a fashion brand of Tessilform Spa that was established in 1998, has a presence throughout Europe, the Middle East, and Asia. With collections for women, men, and young girls, Patrizia Pepe offers a complete fashion look including a wide range of accessories, from...
Pelling - Automatic Identification of Rotogravure Cylinders with 2D Barcodes
Pelling used DPM's for identifying, tracing and stocking of rotogravure cylinders in a warehouse facility. Download the case study to learn more....
Pharmaceutical Shifts Towards UHF RFID for Savings
Pharmaceutical Shifts Towards UHF RFID for Savings Alien Technology Corporation The pharmaceutical industry in the United States dispensed more than $260 billion worth of prescription medications in 2008, and in the global marketplace the total is more than twice that amount. Distributing regulated pharmaceuticals is done through a complex supply chain...
This document has been assembled to satisfy ISO requirements for references in the ISO/IEC 15424 document. The AIM Plessey, Anker and MSI Codes archive document, which is a compendium of four historical documents and a research paper, will be that reference. This document could also serve as a definitive reference for manufacturers who wish...
Plugging Profit Leaks in the Apparel Sector
Impinj-2009...
PMMI - Brand Protection and Product Traceability Executive Summary
When purchasing products from a store or pharmacy consumers look for assurance that the products they select will be safe for consumption. However, as brand manufacturers continue to source from an evergrowing list of ingredient and material suppliers, the question, "Is this product safe?" becomes a growing concern. In order to allay these...
Public Review | AI (8009) 02 Cumulative Time-Temperature Exposure Indicator
The GS1 Application Identifier 8009 with AIM Sensor Descriptor Type 02 is used with a common type of colorimetric temperature sensor, Time-Temperature Indicators (TTI), which integrate the cumulative exposure. The progressive sensor color change on the barcode label is used as a proxy to forecast the remaining viable life (safe...
QR Codes: Why They're Here To Stay
QR Codes: Why They're Here To Stay Bert Moore Editor Despite competing offerings and nay-sayers, QR Codes are still the most viable option for marketers. The headline for the July 2011 Editorial read: Mobile: Are Bar Codes Becoming Obsolete? The conclusion was that maybe they are. But the editorial concluded that, at some point...