I want to get periodically every hour mdb file is it possible?
Make sure to check the thread at Microsoft website to find the right solution to your question.
Hi, I found this blog from the mention thread that will helps you in backing up your data at a certain interval of time.
Why do I suddenly see this circle/arrow with clock on icon of my BIPRA backup, and 1TB?


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Wanted: new records to break in Palaro2016
When Davao del Norte hosted the 58th Palarong Pambansa in 2015, record-breaking feats were showcased by a new breed of student athletes in the swimming and athletics category.
Can we expect more records to fall in this year's staging of the Palaro in Albay?
Last year, Luzon's best bets from Central Luzon, Southern Tagalog and the National Capital Region towed the rest of the regions and mightily showed the way. Central Luzon's Balitucan National High School alumnus, Martin James Esteban shattered the 14.44m triple jump record of Mark Harry Diones with his 15.01 meter-jump.
Likewise, NCR athletes dominated the swimming pool with their speed and determination. Swimming sensation, Maurice Sacho Ilustre mined gold in a record-breaking fashion with his performance in the200m (2:07.28 min), and 100m (57.56 s) Butterfly; 800m (8:50.34 min), and 200m (1:58.83 min) Freestyle, respectively.
Team mates Christian Sy, Andrae Pogiongko, and Drew Magbagalso shone in the 400m Medley (4:07 min) and so did Alnair Guevarra, Eman Dapat, Miguel Barlisanin the 400m Freestyle (3:41.38 min) relays. The group of Ilustre shattered the 2009 and 2014 Palaro swim records.
Long-standing records in the 50m Freestyle, 50m Backstroke and 100m Breaststroke divisions were smashed by elementary athletes Jules Katherine Ong's 28.75, Seth Isaak Martin's 30.16 and Ethan Go's 1:14.86, respectively.
Also, the 100m Butterfly best time on record was surpassed by Camille Buico, who broke by a second the 2013 record of 1:06.92 in the elementary category, .while Regina Maria Castrillo outdid her own 2014 record with a time of 1:04.41 in the secondary category.
The Visayan Islands athletes won't be outclassed as they excelled through its champions from the Western and Eastern regions. Alexis Soqueño from the Western Visayas once again defied gravity as he shattered his former record of 1.92m in the High Jump category, making 1.95m the height to beat. Meanwhile, the team of Karen Janario, Feiza Jane Lenton, Gemmalyn Pino and Lealyn Sanita, set the new time record of 4:00.09 in the 4x400m relay.
Mindanao's victors came via Efrelyn Democer and Jie Ann Calis who broke records in their respective fields. Democer's score of 42.34m in the Javelin Throw crushed the 41.27m record established by Stephanie Cimatu in 2011.
On the other hand, Calis' speed outran the records in the 3000m (10:10.16 min), 1500m (4:42.20 min) and 800m (2:12.27 min) event. Her neck-and-neck race with 2013 record-setter Angelica De Josef in the 800m event was dubbed as one of the best performances ever in Palaro history.
With preparations nearing its completion for the 2016 Palarong Pambansa, the Department of Education (DepEd) hopes that the athletes will see last year's achievements as a goal to surpass. And that the name of every worthy athlete will be etched in sports history.
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In 1999 I hung out my virtual shingle and sold my first vintage dress. It was love from the very start. The dress, the photo-taking, the research, the writing, certainly the customer—even the boxing up and standing in line at the post office—I loved it all! I would get up at 4:30 AM to begin work each day because I couldn't stand to wait any longer to get started.
Now on denisebrain's 17th birthday, I still love it just as much. Seventeen is not a young age in the world of small businesses, but it still feels as young as...as young as a teenage covergirl!


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How Do Sperm Recognize Eggs? Mechanism Finally Found
D-briefBy Breanna DraxlerApr 16, 2014 12:01 PM
It's the stuff of 3rd-grade sex ed: sperm meets egg to make baby. But, surprisingly, scientists have actually been in the dark about one crucial step: how the two sex cells recognize each other amidst the fluid frenzy in the Fallopian tubes. Now researchers have announced that they've found the missing piece of this fertilization puzzle, and that the discovery could lead to individualized fertility treatments and hormone-free birth control.
Back in 2005, researchers found the first half of the the puzzle: a binding protein on the surface of sperm they called Izumol (after a Japanese marriage shrine). In the decade since then, scientists have been searching for Izumol's counterpart on egg cells. Essentially, they'd found the plug but couldn't locate the outlet.
Today researchers at Cambridge announced they've found that outlet: a receptor protein on the surface of the egg cell. They've found it on the eggs of pigs, opossums, mice and even humans.
Protein Match
Researchers found that the only receptor protein that matched up with the sperm protein was one that had already been discovered and named. Its true purpose had just been misunderstood. The receptor had been previously known as Folr4, and thought to be part of the folate-receptor family.
When researchers put unfertilized eggs in a petri dish and blocked their Folr4 receptors, sperm couldn't latch on. And when researchers genetically modified female mice to lack Folr4, the mice were sterile.
And what's even more, the discovery also helps explain how eggs limit themselves to just one sperm invader. By studying eggs fertilized in vitro, researchers found that the Folr4 proteins had all been ejected from the surface of the cell by 30 minutes after fertilization and were floating around the membrane, no longer able to bind with the proteins on the sperm.
The Izumol protein on the surface of the sperm pairs up with the Folr4 (Juno) protein on the unfertilized egg. Once fusion occurs, the egg spits out the remaining Juno proteins to prevent multiple sperm from fertilizing the same egg. Image credit: Nature
Pregnancy on Demand
Understanding how the fertilization process starts is big news—it could lead to specialized fertility treatments as well as non-hormonal birth control. Such a crucial role calls for a name change: The researchers have now dubbed the protein Juno (in honor of the Roman goddess of marriage, or, perhaps, more appropriately, for the 2007 academy award-winning film of the same name).
A simple genetic test could determine if a woman's infertility is due to a lack of Juno proteins, allowing her to skip all the preliminary fertility treatments that won't work in her case, and cutting right to the manual injection of sperm. Likewise with contraception, knowing the critical role of this particular protein means that blocking it can render sperm powerless.
Now that scientists have found the two halves of this puzzle, which they published in Nature today, their next step is discovering what other proteins are at play when the sperm and egg actually fuse.
Top image credit: videodoctor/Shutterstock
What Decriminalizing All Drugs Means for Oregon


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A P P O I N T M E N T S
What will the sessions be like?
Initial sessions are 75 minutes long, and consist of:
Thorough intake of your health history - including a discussion of your main complaint and all relevant signs and symptoms, general diet and lifestyle habits, family health history, and medications.
Pulse and tongue diagnosis - practitioners of ancient China used palpation of the radial artery to diagnose patients, a practice which has continued to this day due to its clinical effectiveness. Tongue diagnosis includes an assessment of shape, color, moisture, and texture, and can be an indicator of internal disharmonies.
Treatment - you will be treated on your first visit, most likely with acupuncture, but other modalities may be used such as moxibustion, gua sha friction massage, Craniosacral manipulation, Tui Na style of Chinese bodywork, and/or Reiki energy therapy.
Follow up sessions are 60 minutes long and consist of:
Evaluation - the previous treatment and its effects will be discussed to see how far you have progressed in the healing process.
Pulse and tongue diagnosis - these indicators change often, and can be used over and over again to monitor your progression within the healing process.
Treatment - with acupuncture and other methods.
In some cases, there will be self-work assigned for you to engage in between treatments. This can include dietary suggestions, breathing exercises, and/or lifestyle changes. This is a way for patients to take an active role in their own healing process, and continue the effects of treatment until the next appointment.
What can acupuncture treat?
Acupuncture is recognized by the National Institutes of Health (NIH) and the World Health Organization (WHO) to be effective in the treatment of a wide variety of medical problems. It is a safe and effective way to manage both chronic and acute conditions. Below are just some of the specific conditions that can be treated with acupuncture.
Pain:
Chronic or acute back pain
Post-operative pain
Repetitive strain injuries
Migraine and headache
Gastrointestinal disorders:
Abdominal bloating
Mental/Emotional distress:
Uterine pain
Menopause management
Respiratory conditions:
Is acupuncture safe?
Absolutely. Acupuncturists are trained and certified by the Occupational Safety and Health Administration (OSHA) in clean needle technique, a practice that ensures the safety of both patient and practitioner. Only sterile, single-use needles are used and disposed of immediately after removing from the patient. The needles are hair-thin, and no longer than an inch, so there is no risk of bodily injury.
What does acupuncture feel like?
Most people don't feel any discomfort during the needling process. If a sensation is felt at the time the needle is inserted, it may feel like a soreness or slight pain; some patients describe it as an "ant sting." While the needles remain inserted, for approximately 10-20 minutes, you may feel some heaviness, radiating, tingling, or an achy sensation either around the needle or traveling up or down the affected meridian, or energy pathway. Relaxation and a sense of well-being often occur during and after treatment. Many patients fall asleep while the needles are inserted because of this sense of relaxation and balance.
© 2018 Samantha Yurkosky MS LAc
Samantha Yurkosky


The fourth time Vicki's FOR SALE sign went up in her ugly old Mazda, I'd given up my beer budget and was spending next to nothing on food. Kitty was what she called it. She'd bought fake-fur seat covers, floral floor mats and butterfly decals.
I tried making love to her instead of my usual pep talk. She wriggled out of her nightie and pushed it off the side of the bed, then lay on her back and waited.
Asleep, she looked like I had broken her into several pieces and swept her under the sheet. Just a pile of naked woman with her arms and legs folded on top of each other. I thought about the price of a bus ticket compared to a tank of gas.
It felt like an act of compassion when I took the keys and closed the door behind me. She never would have sold it for what she was asking and I would send money when I could.
Amy Silver lives in Washington State with two lovely cats and a very nice human. Her stories have appeared in 400 Words, Pindeldyboz and elsewhere.


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Brad Paisley at FivePoint Amphitheatre
Brad Paisley Tickets
Country music superstar Brad Paisley will turn FivePoint Amphitheatre into one big Country Nation this Friday, 19th August 2022, as he brings the excitement of his 2022 World Tour into Irvine, California's famous venue. Joined by two of the nation's best country singers, Tracy Lawrence & Caylee Hammack, the three-time Grammy winner will perform his hit songs to thousands of spectators on a night celebrating his incredible artistry spanning over two decades. Don't miss this summer's biggest country music concert by grabbing your tickets as early as today! Secure yours by clicking on the "Get Buttons" link.
One of the most prominent names in the country music scene, the singer, songwriter, and guitar-slinger Brad Paisley rose to stardom in 1999 when his debut album "Who Needs Pictures" topped the charts. Since then, he has given his fans one hit after another by releasing 11 more successful studio albums. These albums propelled him to international stardom and enabled him to win countless awards and recognitions. The most notable of which include three Grammys, two American Music Awards, 15 Academy of Country Music Awards, and 14 Country Music Association Awards, including a highly coveted "Entertainer of the Year" distinction.
These awards are not surprising as Paisley has been dubbed by the media as "as a skilled songwriter and even better guitar player with a faultless band," "an impressive display of showmanship," "is the most consistently great performer," and "every year he manages to do something that makes it feel fresh and inspired." And this year, Brad is ready to give his fans worldwide the best concert experience of their lives as he takes his "Brad Paisley: World Tour 2022" to a whole new level.
Aside from the North American leg of his highly-anticipated tour, he will be stopping at major cities in Australia, Canada, and different European cities. These shows outside the US are his first since 2019, pre-pandemic.
This summer, Brad will be stopping at Irvine, California's BFivePoint Amphitheatre on August 19. He will be joined by the American country artists Tracy Lawrence and Caylee Hammack. Lawrence is an award-winning singer known for his most commercially successful albums "Alibis" and "Time Marches On." On the other hand, Caylee Hammack is an American country music newcomer who recently released an album in August 2020. Her song "Fooled Around and Fell in Love" with Miranda Lambert made her win the "Musical Event of the Year Award" at the 2020 Academy of Country Awards. She was also nominated in the New Female Artist of the Year category in 2021's edition of the prestigious award-giving body.
Catch these amazing artists with Brad Paisley in a memorable concert this summer.


My college boy is home for a long weekend. This makes for a glorious mixture of happiness, nostalgia, and awkwardness that many parents of first years have lived through before me. As I marvel at the adult he has already become, managing just fine without us for six weeks (well, not always fine, but mostly), I want to keep the little boy alive in my imagination. It helps that the walls are plastered with kid photos. One of my favorite pictures is one of both of my boys in front of the pellet stove, showing evidence of the thing I am proudest: I raised two boy readers.
Of course, it's not always obvious now. They are nineteen and sixteen, and their devices, along with the accompanying multimedia noise and demands, have taken over. But their foundation is made of books, and I know that will carry them through life as it has for me. Memories of reading to my older son have gotten me through this difficult time of missing him and worrying about him. But it goes deeper than that. The act of reading together is our life foundation, too, and I am grateful for it.
It isn't easy to raise boy readers, but of course most things worth doing aren't. Boys who read aren't celebrated in our culture, and at times the reaction is worse than indifference. But the ones who do will have language, and empathy, a way to learn, and a way to process emotions that others won't have. I'm here to tell you: read to your boy for his whole life!
Read to create a comforting ritual. Don't worry if he falls asleep, because you can always go back and revisit what he missed. Read him lots of women writers when he is young, such as Margaret Wise Brown and Virginia Lee Burton. Read across all cultures, showing him illustrations by Jan Brett and Kadir Nelson and Allen Say, and open up different worlds to him through the familiar sound of your voice.
Read him really difficult books aloud. He may not read them on his own, but if you read often and early enough, the ritual alone will carry you, and he will understand and grow in ways that will sustain him when he is an independent reader. Listen to books aloud in the car so you can build that enjoyment of books together. Reassure him that you will still read to him even after he is reading on his own.
Read him what he wants to hear. Does that mean you will have to read a lot of nonfiction about topics of no interest to you? Most likely! I have a strange depth of knowledge when it comes to World War II, famous diamond heists, and entry-level physics. Does that mean you will have to read terrible fiction books with licensed characters designed to sell toys? Yes. Hold your nose and do it, because you also need to let your son see how books can feed many parts of himself, both high-minded and the lowest of the lowbrow.
If you can do this, even a little bit, you will find that you will have built a house made of books with your boy. You may be lucky, as I was, to spend three years with Harry Potter and your boy every night, which is a long-term investment that results in shared themes you both can draw on forever. You may be able to navigate adolescence by reading Sherman Alexie and Chris Crutcher with your teenage boy, if you have logged the read-aloud time when he was nine and ten with Gary Paulsen. If you're truly blessed, you will have a conversation about the tropes of Clive Cussler and how entertaining guilty-pleasure books can be.
We parents want to feel close to our kids no matter their age. Books have given me an inroad to my sons' souls through the years because we spent time together learning, hearing great plots, and meeting interesting people. We still try to read aloud, although it's going to take us years to get through The Martian at this pace! And one of the highlights of my son's visit home was his asking me, "Hey, have you ever read Lysistrata? Well, you should!" So it's next on my list, because how can I turn down a recommendation like that?
Kelly Ahlfeld is the parent of two boys and librarian at the Mettawee Community School in Vermont. She likes to run and read, but never at the same time.


Editor's note: Two days after Superstorm Sandy roared into the Northeast, ravaged cities are working on cleaning up from floods, wind and fire. Millions remain without power. The storm has left at least 122 dead from Haiti to Canada. Here is the full story and below is the latest news as we learn it.
[Updated 1:40 a.m.] About 4.9 million customers remain without power in 15 states and the District of Columbia today, a CNN tally shows. That number dropped by about 600,000 in six hours.
[Updated 10:32 p.m.] New York Gov. Andrew Cuomo declares a transportation emergency Wednesday and authorizes the Department of Transportation to waive fares through Friday as an inducement to get people to take mass transit.
[Updated 8:52 p.m.] The following video shows some of the devastation in and around Seaside Heights, New Jersey, a city known in part for hosting several seasons of MTV's "Jersey Shore." A roller coaster is in the ocean, and house after house is destroyed.
The mayor of the barrier island community says residents will be shocked by the destruction when they're able to get back there.
[Updated 8:33 p.m.] The number of U.S. deaths believed to be linked to Sandy has risen to at least 56, according to a CNN tally. That's 28 in New York; nine in Pennsylvania; six in New Jersey; five in West Virginia; two in Maryland; two in Connecticut; two in Virginia; one in North Carolina; and one on the HMS Bounty in the Atlantic.
One death in Canada and 67 in the Caribbean also are attributed to Sandy. So, CNN's total death toll for Sandy is at least 124.
[Updated 7:33 p.m.] About 5.5 million customers remain without power in 15 states and the District of Columbia, according to a CNN tally. That number dropped by about 400,000 in six hours.
[Updated 7:08 p.m.] Some details on why New York's Bellevue Hospital - one of the nation's largest hospitals - is being evacuated: The building lost regular electricity service during the storm, and backup generators have been providing power since then. But people have been having to carry fuel up 13 flights of stairs because the fuel pumps that normally supply the generators are in the basement, and the basement is flooded, a source told CNN.
Officials decided Wednesday that the fuel pumps aren't salvageable. "What they realize is that their emergency generators are not continuing to work well," said Dr. Sanjay Gupta, CNN's chief medical correspondent, who was reporting from outside the hospital Wednesday.
So, rather than continuing under these conditions, with regular power service not expected soon, officials decided to evacuate the remaining 700 patients. The most critically ill patients were evacuated earlier.
The evacuation process could take a couple days.
[Updated 6:35 p.m.] Metro Transit Authority chairman Joe Lhota talks about what it will take to get the New York City subway system running. Parts of it - north of Manhattan's 34th Street - are expected to be running Thursday.
[Updated 6:11 p.m.] At least 14 people have died on the New York City's Staten Island as a result of the storm, borough President James P. Molinaro said. It's unclear how this affects the death toll in New York state, where we know at least 26 deaths have been reported.
"It's like a tsunami hit us, and this is the aftermath," Molinaro told CNN.
Molinaro said dozens of houses on Staten Island have been destroyed, thanks in part to storm surges of more than 13 feet. About 114,000 customers - two-thirds of the borough - are without power on Staten Island, he said.
[Updated 6:06 p.m.] U.S. Rep. Bob Turner, R-New York, says the fire that destroyed his house and more than 100 others during the storm Tuesday morning in the Breezy Point neighborhood was heartbreaking.
He says he left his home while the fire was burning in the area, but before it got to his house. Because roads were blocked by floodwater, it took about two hours for firefighters to reach the homes, he said.
"There was no way the engines could get through what was, at one point, 5 feet of water in the road," Turner, a resident of the neighborhood for 32 years, told CNN's Wolf Blitzer. He said he and some neighbors hope to rebuild their homes.
[Updated 5:49 p.m.] New York's LaGuardia Airport will open Thursday at 7 a.m., and airlines will be operating limited flight schedules, the Port Authority of New York and New Jersey announced on their website. The airport has been closed because of significant flooding and damage relating to Sandy.
Two other New York-area airports - John F. Kennedy and Newark International Airport - reopened Wednesday with limited service.
[Updated 5:32 p.m.] In a rare example of wireless provider collaboration, AT&T and T-Mobile have agreed to share networks in New York and New Jersey, allowing customers to use whichever network gets coverage in their areas, CNN's Heather Kelly reports.
The move could make it easier for storm victims there to get cell phone reception. Making calls across the Northeast has been difficult following Sandy, and New York and New Jersey seem to be the hardest hit. According to the Federal Communication Commission, about a quarter of cell phone towers in the 10 states were knocked out by the storm.
[Updated 5:24 p.m.] CNN's Kevin Liptak has more on the tour that President Barack Obama and New Jersey Gov. Chris Christie made Wednesday of the storm-damaged areas of New Jersey.
The helicopter tour took the president and the governor over cleanup efforts in Atlantic City and surrounding towns, including Seaside Heights, where a large pier that previously housed a roller coaster has been submerged in seawater. Later, Obama and Christie toured a makeshift shelter in the Brigantine Beach Community Center, northeast of Atlantic City, where 200 spent the night during the storm's peak on Monday night.
[Updated 4:54 p.m.] President Barack Obama, addressing reporters in Brigantine, New Jersey, after touring damaged areas of the state with Gov. Chris Christie, said he's directed his staff members and people in his administration to tolerate no red tape or bureaucratic excuses when it comes to getting storm victims the help they need.
"We will not quit until this is done," Obama said, adding that he's instructed his people to return the calls of officials in storm-damaged states within 15 minutes.
"If they need something, we figure out a way to say yes," Obama said.
Obama said New Jersey, New York, West Virginia and Connecticut "are really bearing the brunt of this incredible storm." Power companies from as far away as California have pledged to send equipment crews, he said.
[Updated 4:41 p.m.] President Barack Obama and New Jersey Gov. Chris Christie are addressing reporters in Brigantine, New Jersey, after touring damaged areas together and speaking with people in shelters.
"I cannot thank the president enough for his personal concern and compassion for our state and the people of our state," Christie said.
"[Engineers] have determined that the ties that bind the crane tower to the building are secure," Bloomberg said. "There was enormous torque when the crane fell over, and the fact that those connectors have withstood the pressure just testifies to how well they were put in and how stable that tower is.
"The next step is going to be to determine some steps as to how to begin shrinking the zone around the frozen area as we eventually get around to - probably tomorrow or the next day - tying the boom to the building so that they can then work around the top of it, and they'll have to construct another crane on top of it in order to take down this one. And that can take weeks, but once the boom is secured we should be able to minimize any destruction on the street below. But certainly that street is not going to be fully reopened until some time this weekend at the earliest."
[Updated 4:02 p.m.] Engineers have concluded that a partially collapsed crane that has been dangling for days off a under-construction, high-rise apartment building in midtown Manhattan is secure, New York Mayor Michael Bloomberg says. However, the street below won't be open until at least this weekend, he said.
The crane's arm, damaged by Sandy, has been dangling 90 stories above New York City. Police have cordoned off the area around the base of the One57 building on West 57th Street.
[Updated 3:55 p.m.] The minimum number of U.S. deaths believed to be related to Superstorm Sandy has risen to 54, based on reports from officials in affected states. The overall minimum death toll, which includes a death in Canada and 67 in the Caribbean, stands at 122.
The U.S. deaths include 26 in New York; nine in Pennsylvania; six in New Jersey; five in West Virginia; two in Maryland; two in Connecticut; two in Virginia; one in North Carolina; and one on the HMS Bounty.
[Updated 3:45 p.m.] The New York marathon will happen as scheduled on Sunday, despite the damage from Sandy, Mayor Michael Bloomberg said.
He added that New York public schools will remain closed Thursday and Friday. See the 3:17 p.m. update below for what's going on with transportation.
[Updated 3:17 p.m.] We reported earlier that limited commuter train service would resume in New York City on Wednesday afternoon - and now Grand Central Terminal has reopened, the New York Metropolitan Transportation Authority says.
A recap of other New York City-related transportation information: Limited subway service is expected to start on Thursday. New York buses were operating at full service Wednesday.
New Jersey Transit rail and light rail will remain suspended until further notice. Bus service also is also suspended, with the exception of limited service in Camden County.
Two New York-area airports - John F. Kennedy and Newark International Airport - reopened Wednesday with limited service. New York's LaGuardia Airport will remain closed Wednesday because of significant damage there.
The Port Authority of New York and New Jersey says it's waiting for electrical power to be restored to begin pumping out the Holland Tunnel. Three of seven East River tunnels have been pumped and are free of water.
[Updated 3:08 p.m.] About 6,300 people are in 76 evacuation shelters in New York City, Mayor Michael Bloomberg said Wednesday. In coming days, officials will consolidate some of the shelters, he said.
[Updated 2:50 p.m.] President Barack Obama and New Jersey Gov. Chris Christie met in Atlantic City, New Jersey, earlier this afternoon ahead of an aerial tour of damage caused by Sandy. Sandy came ashore late Monday in southern New Jersey, wiping out houses, pushing sand four blocks inland and leaving people stranded.
[Updated 2:41 p.m.] An update to the evacuation at New York City's Bellevue Hospital: The number of remaining patients who will be evacuated is about 700, and the process could take two days, a source familiar with the evacuation plan told CNN. Many critically ill patients were evacuated earlier.
The hospital's generators are on the 13th floor, but the pumps that supply oil to the generators are in the basement under 8 feet of water, the source said.
[Updated 2:12 p.m.] New York City's Bellevue Hospital will evacuate the remaining 500 patients inside, according to an e-mail from a hospital group sent to New York-area hospitals. Many critically ill patients were already evacuated, but about 500 remained. Ambulances are lined up outside the hospital in preparation, CNN's Dr. Sanjay Gupta reports.
[Updated 1:43 p.m.] The city of Long Beach, New York, says residents should evacuate if they have not already done so and not return until services such as water, sewer and power have been restored. Buses will go through neighborhoods to pick up residents and take them to shelters, according to the city's Facebook page.
A curfew will be in effect from 7 p.m. Wednesday to 6 a.m. Thursday.
[Updated 1:27 p.m.] Two more storm-related deaths have been confirmed in Pennsylvania, bringing the U.S. death toll to 50. A total of 118 people have died from the storm, including 67 in the Caribbean and one in Canada.
[Updated 1:24 p.m.] About 5.9 million customers are without power in 15 states and the District of Columbia, according to numbers compiled by CNN from local power providers.
[Updated 1:21 p.m.] Coastal towns say damage from Superstorm Sandy was much worse than what Hurricane Irene did last year, and cleanup will cost multiple millions of dollars, CNNMoney reports.
[Updated 1:11 p.m.] President Barack Obama has arrived in New Jersey to tour the storm-damaged area, according to reporters traveling with the president.
[Updated 1:02 p.m.] Four more storm-related deaths have been reported in West Virginia; 48 deaths are now reported in the U.S. 116 people have died in all, from the Caribbean to Canada.
[Updated 12:52 p.m.] The death toll from Superstorm Sandy in New York has risen to 26, Gov. Andrew Cuomo said Wednesday.
[Updated 12:47 p.m.] New York expects the federal government to cover the vast majority - or potentially all - of emergency response costs for Superstorm Sandy, Gov. Andrew Cuomo said Wednesday. "We expect the federal government to pick up the lion's share of those costs as they did with Hurricane Irene, as they normally do," he said. Meanwhile, the cost to the private sector cannot yet be calculated, but will be in the billions of dollars, he said.
[Updated 12:23 p.m.] Limited commuter rail service on Metro North and the Long Island Rail Road will begin at 2 p.m. Wednesday, and limited New York City subway service will begin Thursday, New York Gov. Andrew Cuomo said. There will be no service for now in Manhattan below 34th Street.
[Updated 12:15 p.m.] Virginia National Guard soldiers used boats to help residents of Mears, Virginia, who were stranded by high water on Tuesday.
[Updated 11:50 a.m.] New Jersey is putting off Halloween. Gov. Chris Christie signed an executive order today postponing celebrations until Monday.
"I've taken this action to minimize additional risks to lives and the public safety as we begin the process of rebuilding and recovering from Hurricane Sandy," he said, calling the postponement "a commonsense and necessary step."
[Updated 11:21 a.m. ET] The U.S. Navy is moving three amphibious landing ships toward the coastline of New York and New Jersey in case there is a request for their assistance, Navy officials said Wednesday.
[Updated 11:20 a.m. ET] A good indication on why it will take awhile to get New York City transportation up and running.
[Updated 11:09 a.m. ET] The remnants of Superstorm Sandy are now multiple centers of circulation across the lower Great Lakes region, the National Weather Service says in its 11 a.m. ET advisory.
Gale warnings remain in effect for portions of the Great Lakes. There are flood warnings and watches still in effect for northern New England. Areas of the mid-Atlantic states still have flood warnings in effect and well as portions of Great Lakes shorelines.
Winter storm warnings and watches remain in effect for the central Appalachians.
[Updated 10:46 a.m. ET] JetBlue reports service is gradually returning to airports affected by Sandy.
[Updated 10:42 a.m. ET] The U.S. Coast Guard has sent airboats normally used for ice rescues in the Great Lakes area to the East Coast to assist in shallow water rescues. Read the Coast Guard's Wednesday update.
[Updated 10:30 a.m. ET] Residents from New York's other boroughs took a long, cold walk into Manhattan this morning as some businesses reopened but transportation options remained severely limited.
"I left my house at 6:45 a.m. and I'm still walking," Queens resident Elizabeth Gorman told CNN a couple of hours later. "I think it's faster to walk. It's crazy here. I don't know what to do, I have to get to work.
"It's sort of like the transit strike a few years ago," added the 40-year-old, who was one of thousands walking across the Queensboro Bridge. "Happy Halloween."
[Updated 10:12 a.m. ET] More than 19,500 flights have been canceled as a result of Sandy, according to flight tracking site FlightAware.com. More than 7,000 Tuesday flights were canceled, FlightAware figures show. By 9 a.m. Wednesday, more than 2,800 Wednesday flights and more than 480 Thursday flights had been canceled. Read more.
[Updated 9:59 a.m. ET] A CNN satellite truck was just what people needed to charge their cellphones in Manhattan.
CNN Meteorologist Rob Marciano told us that sat-truck engineer Ken Ryan set out power strips for residents and passersby. "He does it whenever he is in a disaster zone for people to charge their phones," Marciano said.
And Ryan's not alone. He's following the practice of another truck operator he saw in a hurricane-hit area years ago, and we know our colleague Chris Stewart is doing the same thing in New Jersey.
"Even though I'm in a truck, I'm still here on the street where there's no power or lights," Ryan said. "I can't help with a lot of things, like get the power back up or power up their computer, but I can help them keep their phones charged."
[Updated 9:57 a.m. ET] See some of the damage Superstorm Sandy did in Toronto from CNN affiliate CTV.
[Updated 9:36 a.m. ET] President Obama will resume campaigning for Tuesday's election on Thursday with stops in Green Bay, Wisconsin; Boulder, Colorado; and Las Vegas, a campaign aide tells CNN. Follow the campaign on the Political Ticker.
[Updated 9:34 a.m. ET] U.S. stocks open mixed after being shut down for two days because of Superstorm Sandy. The Dow rises 21 points. Check CNNMoney for market updates.
[Updated 9:30 a.m. ET] This is what the Jersey Shore looks like after the hit from Sandy. The photo was provided by the New Jersey governor's office.
[Updated 9:18 a.m. ET] The Port Authority of New York and New Jersey says it's waiting for electrical power to be restored to begin pumping out the Holland Tunnel.
[Updated 9:04 a.m. ET] Superstorm Sandy's powerful winds uproot a tree in a Huntington, New York, backyard – as captured in this astounding video.
[Updated 8:59 a.m. ET] About 9,000 people across 13 states spent Tuesday night in 171 Red Cross-operated shelters, the agency tells CNN.
[Updated 8:56 a.m. ET] New York City police used helicopters to rescue people stranded in flooded homes on Staten Island.
[Updated 8:52 a.m. ET] About 25% of cellular towers are damaged in states hit by Superstorm Sandy, the Federal Communications Commission says. The situation could get worse before it gets better, FCC Chairman Julius Genachowski said.
On its official Twitter account, the FCC linked to a Wall Street Journal story carrying quotes from Genachowski in a conference call.
About a quarter of broadband and cable customers are without service, the story says. A "very small number" of 911 call centers lost power, but calls were rerouted to other centers.
The FCC urges people to limit nonemergency phone calls in stricken regions, and to use text and social media to let loved ones know you are OK.
[Updated 8:49 a.m. ET] New York's LaGuardia Airport is still closed this morning, but other airports are resuming limited services. CNN's Richard Quest looks at how Sandy has affected travel.
[Updated 8:44 a.m. ET] About 12,000 National Guard personnel are assisting Sandy relief efforts across 13 states and the District of Columbia this morning.
This morning, about 12K #NationalGuard members support #Sandy response efforts in CT, DC, DE, MA, ME, MD, NC, NH, NJ, NY, PA, RI, WV & VA.
[Updated 8:27 a.m. ET] A look at the snow from Sandy. Click below.
And what the remnants of the storm looked like this morning.
[Updated 8:22 a.m. ET] Thirteen people have been arrested in New York, and most of them are charged with looting Tuesday in the wake of Superstorm Sandy, CNN affiliate WABC reports.
Much of the looting took place on Coney Island. People ripped their way through damaged storefronts to grab "anything that wasn't nailed down," WABC's Sandra Bookman reports.
The precinct that covers the area had been forced to evacuate in the flooding.
[Updated 8:04 a.m. ET] The effects of Sandy are still being felt far to the west of where the storm made landfall Monday. The Coast Guard in Milwaukee, Wisconsin, is warning people to stay away from Lake Michigan on Wednesday, with 14- to 18-foot waves expected this morning, according to a report from CNN affiliate WTMJ.
[Updated 7:43 a.m. ET] Much of Maine is under a flood watch today. The National Weather Service says the watch is in effect until 2 p.m. An inch or more of rain could come today, on top of what Sandy already brought.
[Updated 7:31 a.m. ET] While the storm did billions of dollars in damage in the Northeast, communities much farther south were not spared. An official in Florida's Indian River County says Sandy caused $12 million in beach erosion there. "This is the worst I've seen since the 2004 hurricanes," county coastal engineer James Gray says in a report from CNN affiliate WPTV.
Meanwhile, in Kitty Hawk, North Carolina, roads were washed out and torn up by the surf generated by Sandy.
"It looked like a big bomb hit and nobody could really get away from it," Kitty Hawk resident Evan Briggman told CNN affiliate WAVY.
[Updated 7:17 a.m. ET] A fire is burning on a barrier island in Mantoloking, New Jersey, according to Patrick Cook, a police officer in Brick Township, near the island. Cook said officials could not get to the island to fight the fire or even assess damage as sand and storm debris were blocking access.
[Updated 7:09 a.m. ET] The death toll from Superstorm Sandy now stands at 108, with 40 in the United States.
[Updated 7:01 a.m. ET] Early Wednesday morning, at least 6.2 million electric customers across the eastern United States were still in the dark from the effects of Superstorm Sandy.
[Updated 6:50 a.m. ET] Superstorm Sandy has left at least 39 people dead in the United States, and at least 107 across its entire path, according to figures provided to CNN.
Here is the breakdown: New York, 22; New Jersey, 6; Pennsylvania, 3; Maryland, 2; Connecticut, 2; Virginia, 2; West Virginia, 1; HMS Bounty replica, 1.
The storm has also caused one death in Canada, and earlier it left 67 dead in the Caribbean.
[Posted 6:30 am ET] The remnants of Superstorm Sandy were continuing to weaken over Pennsylvania this morning, the National Hurricane Center said. The storm had "no discernible center of surface circulation," forecasters said in their 5 a.m. ET update. Gale warnings were in effect for portions of the Great Lakes and winter storm warnings and weather advisories remained for portions of six states - Pennsylvania, West Virginia, Maryland, Tennessee, Kentucky and North Carolina.
Mayor Bloomberg now endorses President Obama, General Colin Powell endorses President Obama and of course President Bill Clinton who presided over the best economy for America endorses President Obama. And now Gov Christi praising President Obama for immediately responding to help the people of NJ and other states hit by hurricane sandy. Gov Cuomo praising President Obama and FEMA responses to NY.
It is obvious to me that this problem is exclusively caused by Obama. Obama, Doomburg- and the little mario coomo jr- all democrats- all ignoring the people in need- worrying about campaigning and marathons. Obama came into NJ for a state sponsored photo op- spending who knows how much his trip that could be used for relief. then Obama jumps on plane spending millions more- flying to Las vegas to campaign and have a good time. On TV people are shown, to be dieing in the street- while Obama ignores them.


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is an online magazine with a staff of Catholic homeschoolers and homeschool graduates dedicated to merging spirituality and creativity with a diverse array of content and subject matter. Through a series of unexpected events this past June, your lately errant blogger became the Editor-in-Chief of this worthy enterprise. Hopefully this goes some ways in explaining my tardiness in putting up fresh posts for the masses (along with an ER trip for repeated and extremely painful kidney stones and later on, a strained wrist...but I digress!).
I plan on trying to rectify this in the coming weeks, but for now, I feel that is my obligation to assure you all that I have not been lounging in a hammock in the Caribbean with an umbrella drink in hand, soaking up the sun in the company of Sean Connery. If that were so, you would have every justification to bring Pearl to Tyburn and make hang her up by the thumbs.


text:
Home Audience For U & Me A Training Institution that's Going Places, while Breaking New Ground!
A Training Institution that's Going Places, while Breaking New Ground!
"Vision is perhaps our greatest strength… it makes us peer into the future and lends shape to the unknown."—Li Ka Shing, a businessman from Hong Kong.The story behind how the founder of Koenig Solutions came up with a radical business model, to turn a struggling training and certification institution into a profit churning multi-city entity, may interest many existing or wannabe entrepreneurs. In 2000, when the dotcom bust hit the IT industry, entrepreneurs running the IT training and certification businesses also felt the heat.The options were either to quit and save themselves from further losses; or to tie a knot at the end of the rope, hang in there, and look for opportunities in the middle of the crisis.
Rohit Aggarwal, founder of Koenig Solutions, chose the second option and decided to not only stand firm in the face of this onslaught but also emerge out of it stronger. Driven by his vision to make a success out of his hard-hit IT training certification business, he decided to explore new options and innovate around the existing set of resources.Supported by a team of dedicated professionals, including the current general manager, Sandeep Dhawan, he decided to downsize and focus only on the profitable niches. On analysis, the team discovered that,occasionally, foreign students attended courses at Koenig. The company saw an opportunity to make extra bucks by bundling travel and hospitality with its core teaching and training offerings.
This was an experiment that worked well for Koenig. The team bundled a hotel tariff in the course fee, and began making money on commissions from the hotel where the students would stay. "Although it was a miserly sum of Rs 200 per day, it seemed like a princely sum to us in those days," recalls Aggarwal. The first student who opted for this courseplus-hotel package came from the UK in 2002. "He was happy with our solution and agreed to become our referral in the UK. This encouraged us. Foreign students started coming in regularly, albeit in small numbers. Since these students saved a lot of money compared to training in their own country, they were quite happy," he adds.
At that time the team felt that if the institution could get 10 students every month, it would be a great achievement. This target was achieved in 2004. "Soon the true potential of offshore training started to dawn on us. We set a target of 100 students per month, which we achieved in 2009. We are now targeting 1,000 per month, which is to be achieved in the next few years," shares Aggarwal.
FOSS certifications: Trend-spotting
Since Koenig Solutions has been in the business of FOSS and Linux certifications and training for over 15 years, we requested Aggarwal to share a few details regarding the demand that exists in this domain, and the factors that are propelling this demand.
Aggarwal observes that there is a growing demandfor FOSS skills. "Keeping this trend in view, we have progressively increased our training portfolio for FOSS and we plan to further enhance it in the coming year (e.g., with Zend PHP certification)." RHCE remains the most sought after certification in FOSS. LPI certification (which is now supported by Novell) is also gaining popularity, besides MySQL/PHP skills, which are also in demand, he adds."We have been offering training on Red Hat Linux since 2004. As of today, we also offer training on Novell(SUSE) Linux, Solaris, Ubuntu, LAMP (Linux, Apache,MySQL, PHP) and LPI certifications. Our training and certification on Linux and open source technologies has been growing by 50 per cent, year-on-year, and we expect this trajectory to continue."
Blending tourism with training
Initially, Koenig's business idea was to save costs for its customers. Tourism was not a significant aspect of its value proportion. But in 2004, based on the feedback received from its customers, who liked this unique blend of tourism and study, it decided to strengthen this aspect.Going forward, some students remarked that Delhi was not the ideal place to study because of its traffic, noise and summer heat. This prompted the team to open a centre in Shimla. Then another centre came up in Goa, in 2005.
Talking about the key factor that has helped shape the Koenig growth story, Aggarwal says: "The success of our business depends upon ensuring that our customers have a hassle-free stay in India. We have developed strong relationships with reliable and customer-oriented vendors and hotels in India, and most of our customers recommend India as a tourist destination to their friends and colleagues."
Surmounting challenges But success didn't come easy to the team. Aggarwal recapitulates those days when, compared to western standards, the institution's infrastructure and facilities were ramshackle, with even computers being obsolete. But there were a few things that kept Koenig ticking. "The trainers and staff kept going with full motivation. The students liked the concept of the 'one-on-one' training that was imparted,and also the abundant attention that they received from the administrative staff."
Over the years, Koenig improved its services. "Thefacilities and computers became state-of-the-art and comparable to the best in the world," says Aggarwal.
A business model that may grow, dramatically!
Offshore training is a novel business idea that Koenig has pioneered in India, claims Aggarwal. He feels that the concept has the potential of evolving into a full-fledged industry. He explains: "We are diverting clients from other countries to India and, in the years to come, this will be another business on par with today's call centres, BPOs and other ITES (ITenabled services)."
Aggarwal takes pride in several other innovations that Koenig has come up with over time. "The concept of 'oneon-one' training and the holiday-cum-training are the key innovations. Apart from this, we constantly upgrade our facilities and innovate in the HR processes (which are critical to retain the best IT talent) to meet international standards. In fact, as of today, our students prefer Koenig primarily because of quality. Cost is a secondary consideration."
For budding entrepreneurs who wish to set up a training and certification business, Aggarwal has a few words of advice: "Focus on quality. Far too soon, service providers fall into the trap of seeking short-term profits, thus compromising on the quality of their core offerings. Though there is no dearth of training providers, there is a virtual vacuum for businesses that deliver superior quality that's beyond their price point. So businesses that are paranoid about quality will always do well."
"A service provider determined to 'wow' the customer and continuously innovate to meet the customers' latent needs cannot but be successful in the long run," he asserts. And, we agree!
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The author is an executive editor at the EFY Group. Apart from writing on subjects like entrepreneurship, IT for businesses, she loves to read on a range of topics, which include religion and spirituality. She likes to read 'meaningful' fiction, too.
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madhu March 5, 2010 At 2:57 PM
Great article..it shows how a simple integration can impact the business in greater way…


How Can I Use What I Learned in 9th Grade to Make Next Year Count?
Can you remember how you felt when school started last fall? There was so much to learn…the layout of a new school building…how to study for harder classes…how to meet and get along with all sorts of new people…which activities were right for you and how to get involved…how to manage your time with so much going on…. Well, in just a few weeks, your first year of high school will be behind you and you may be wondering just what the whole thing meant…how you've changed and what you've learned. Most importantly, you are wondering how to use this self-discovery as you move on to 10th grade.
Self-discovery means taking a long, honest look at what you've learned and the ways in which you have grown. You can begin by looking in the mirror. In what ways is the reflection you see different from the person you saw in the mirror last year? Physically, emotionally, and intellectually, you have changed in many ways and are closer to becoming a young adult than you were when you finished eighth grade.
You now have new interests, teachers, counselors, and classmates that were not a part of your life a year ago. If you were enrolled in a standard ninth grade curriculum, you now know more about math, English, science, foreign language, and the world around you. Your parents may be giving you more freedom to manage your time and make some choices about your social life (dating, curfew, allowance, etc.). All of these things indicate that you have matured a bit and are ready to take on new interests, new courses, new activities, new relationships, and new responsibilities.
How can I put my academic strengths and interests to work in 10th grade?
Though you will have to follow an established course of study in high school, taking the courses (English, math, science, social studies, foreign language, fine arts, etc.) required for high school graduation, you probably have a greater sense now of which courses you like most and the ones that you learn easiest.
If you are eligible for honors level classes, take them. Join clubs and teams that will allow you to build on what you learn in class and interact with teachers or coaches and peers who share your interests and can help you learn more about certain subjects or activities. Engage in career exploration activities offered at school or search for opportunities to find out more about your certain career fields.
What social skills will I need in 10th grade?
Remember that character always counts! (Character: those positive qualities that distinguish you from others as an individual and attract others to you…those things about you that determine your reputation.) If you practice good manners, make wise social choices, and give attention to developing good character, you will be fine.
Remember, also, that you are an individual. The most important social skill you will ever have is to be true to yourself. In other words, don't compromise your values and integrity in order to be popular.
It's okay if you are shy. You will meet people who like and understand your personality…people who will accept you as you are.
If you are a leader, learn what makes for good leadership and follow those who demonstrate the traits that you admire in a leader.
If you are popular, never use your popularity to exclude or devalue others. Respect for others is a reflection of self-respect. There is something of value in everyone and showing respect is not an option; it is a requirement for healthy relationships with others.
What can I do to help me remember what I learned during my freshman year?


NEW YORK (AP) — A sprawling storm closed schools, snarled travel and threatened homeless populations Wednesday with snow and cold stretching from the Midwest to the East Coast and with heavy rain in the South.
Snow fell in New York City, and schools in several parts of the U.S. closed amid predictions for messy afternoon commutes. Philadelphia closed city offices as of 1 p.m. and put a "code blue" into effect, putting extra teams out to encourage homeless people to get into shelters. New Jersey's governor declared a state of emergency with up to 4 inches of snow expected before turning to rain Wednesday night.
Tourists who made it into the Washington area before the storm hit were unbothered.
Farther west, snow forced Minneapolis and St. Paul schools and scores of other districts in Minnesota and Wisconsin to cancel classes.
Heavy rains caused problems in parts of the Deep South. Flood watches and warnings cover the northern parts of Alabama, Mississippi, and Georgia, and nearly all of Tennessee is at risk for floods.
A "potent and cold" low pressure system was expected to drop up to 3 inches (8 centimeters) of snow on the outskirts of Las Vegas starting Wednesday night and continuing into Friday morning, the National Weather Service said.


When you are charged with a crime, society tends to view you in a negative light, regardless of the outcome of the case. Our criminal defense firm, however, takes a very different approach. We base our mission on the ideal that each accused person is innocent until proven guilty. With this principle serving as the foundation of our work, our attorneys work tirelessly to defend clients charged with criminal matters ranging from minor misdemeanors related to drug possession to felony charges for homicide.
Regardless of the charges against you, we will work aggressively to defend you in a court of law.


Nasal prongs seem pretty popular for lots of things these days. So how about their use in kids. There's a couple of papers out there on its use in the paralysed patient and Dr Andrew Weatherall is here to splice them together.
Isn't it supposed to be the kids who stuff things up their noses? Have we just seen them do it so often we started wondering about the possibilities ourselves?
Let's assume not. It's more a case of people finally getting around to testing things out on kids when they've been running with them in adults for quite some time. This time it is THRIVE and that ever so desirable feature of endless maintenance of oxygen saturations while we get around to the ensnorkelling we've planned.
In principle that makes plenty of sense. The normal kid is more likely to rapidly desaturate than the normal adult. Physiology is pretty insistent on that. Plus we know people find paediatric intubation tricky so dropping the stress by avoiding the slide of the plethysmograph tone down that digital scale is probably a worthy pursuit.
So how about we look at two papers examining just this issue – does THRIVE employed in the little people stop those saturations from … not thriving??
The routine went something like *induction of anaesthesia* –> pre-oxygenation by doing that whole bag-mask ventilation bit –> the mask disappeared and THRIVE was added or nothing was added –> start the stopwatch.
You'll note that, like the other paper we'll mention, this is not about patients who are spontaneously ventilating. That's a completely different thing.
In this group though the period of the saturations staying up was longer. Across the age groups the extension in apnoeic time was 86.8 seconds (0-6 months), 88.7 seconds (6-24 months), 129.5 seconds (2-5 yeas) and 169.2 seconds (6-10 years).
Right, lock it up. Everyone should have nasal prongs. All the time. It'd stop peanuts ending up there too.
It's worth noting that the preoxygenation here was all about face-mask ventilation with a good seal. They added THRIVE after that bit and started the clock. This is not entirely surprising because we know that nasal prongs compromise seals in adults and that's only more likely with kids.
So if you were thinking that you should set up those nasal prongs from the before time zero, you need to think again. THRIVE for preoxygenation is not something tested here, and you shouldn't assume it'd be better than good face-mask technique.
Well not really because the cut-off was 'twice the previously noted time to desaturation'. So they tested that they could reach the 'double or nothing' limit, but didn't test the full extension. In the THRIVE groups the average saturation when they stopped the clock was 99.6%.
So I guess be reassured that it was likely to be really a heck of a lot of time.
For this study there was a lot of basics being done well. Throughout apnoeic oxygenation they weren't doing things like airway instrumentation, suction, intubation or, I assume, anything much beyond chatting about the weekend and watching the clock. They did jaw thrust, a basic manoeuvre likely to optimise the impact of THRIVE. So maybe we should remember that all those things we are also interested in were not part of the picture.
What if you didn't make your cut-off '2 times the other cut-off we knew about'? How long could you go?
Well a Swiss crew with no interest in being neutral on the topic I guess have done a study comparing low flow nasal oxygen (0.2 L/kg/min) with THRIVE at either 100% or 30% FiO2 with 20 in each group. And they found … (wait for it…..) 100% THRIVE prolongs apnoea time.
OK there wasn't much suspense there really.
Except again it was more subtle, and again cut-off matters. They had a cut-off to terminate on the basis of desaturation, but another at 10 minutes (as in 'it's 10 minutes and I'm bored let's stop because those saturations are still great') and the 3rd cut-off was if the transcutaneous CO2 hit 65 mmHg.
In the THRIVE 100% group no one desaturated, 4 hit 10 minutes and the other 16 had their nasal prongs ditched when they breached the CO2 target. This actually accords with the other paper where they also found that THRIVE doesn't achieve ventilation and removal of CO2 in kids.
But at the end of this paper you still can't say how long apnoea might be extended, at least when it comes to those saturations staying up.
1. Pre-oxygenation was with face-mask ventilation. Again.
Again the nasal option had no role in the preoxygenation phase. They went with face-mask ventilation until the expired oxygen was 90% or above. Then they started the clock with the chosen nasal prong option going.
2. The other airway things done at the time were … none.
Yep. Once again this was just about the oxygen and the stopwatch. Nothing else was going on.
I mean this could be a visual metaphor for the need to appreciate their is still colour not just black and white when it comes to THRIVE or it could just be pretty, you choose.
So let's imagine that we've actually got that paediatric patient in front of us. Maybe one who needs to get intubated before we get them out of wherever 'in front of us' is.
Let's agree that maintaining oxygenation throughout is a good and noble goal. It's not the only goal of course. We'd also like to make sure we make good choices around number of attempts, and for some patients (say the patient with intracranial pathology) we need to think about ventilation.
And we don't have evidence that pre-oxygenation is aided by having THRIVE in place.
So assuming we're going to do things standard to modern paediatric RSI like face-mask ventilation for a bit before we get going. There is at least a bit of a question about whether THRIVE adds a huge amount.
What it undoubtedly adds is the confidence that saturations will stay up. That is something that lots of practitioners, particularly those not regularly intubating kids would find immensely reassuring.
There is a couple of caveats to keep in mind though.
There's a risk to be aware of with THRIVE that those saturations staying interminably up might encourage tunnel vision on persisting with intubation when it's not working out. It's not too hard to imagine the scenario where the tube hasn't passed straight down, but those saturations are OK so you persist a bit longer, and a bit longer, and now long enough that the airway is becoming traumatised and suddenly you've created a problem.
So this might be a cognitive challenge to have planned for in advance – how do you keep yourself to a limited number of attempts before re-evaluating and going to plan B (or C)? Do you make it a personal process or have others in the crew hold you to a maximum number of attempts or maximum duration of looking?
After all, THRIVE is going to get you to 10 minutes probably. But if you're still conducting open negotiations with the glottic structures at 10 minutes, oxygenation is not the airway problem that should still be at the front of your mind. While you're there, you might have to think about re-dosing anaesthetic agents too.
And the other key patient group is that one where intracranial pathology is an issue. Letting the CO2 rise for some patients is not a good plan because your TBI patient (as just one example) doesn't need those cerebral vessels dilating and the intracranial pressure going up. For those patients, a step back to face-mask ventilation, or potentially placing a supraglottic airway, to re-establish an ability to exchange CO2 is probably a better option.
So THRIVE might be great for some things. But whether it's clinically better than an approach to the airway where really excellent pre-oxygenation is routine and good practices around face-mask ventilation are established seems like a line ball call.
I mean it's still way better than a piece of Lego up the nose. But it remains an adjunct to the basic stuff, not a replacement.
Riva T, Pedersen TH, Seiler S, et al. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) for oxygenation of children during apnoea: a prospective randomised controlled trial. BJA. 2018;120(3):592-99.
We're always interested in other thoughts so feel free to drop a comment.


Drink craft beer and explore Gastown pubs!
You'll begin your craft beer adventure in the heart of Vancouver's oldest neighbourhood. Led by a knowledgeable and passionate guide, you'll stroll through cobblestone streets, learn about the nefarious characters that founded Gastown and enjoy the neighbourhood's captivating stories and picturesque landmarks.
Your tour includes visits to three craft beer pubs where you'll enjoy VIP seating, an appetizer and more all while sampling a variety of British Columbia's best craft beers. Wine is available as an alternative at each stop for those who are not fans of craft beer.
Visit to 3 of Vancouver's best craft beer pubs.
Your choice of beer or wine at each pub.
Appetizer at one of the stops.
A behind the scenes brewery tour with an introduction to the brewing process.
Season: This tour is available year-round.
Meeting location: Inside Waterfront Station at 601 West Cordova St, conveniently located by the downtown hotel district.
You will be walking approximately 1 kilometre.
Minimum age of participation is 19 years and you must hold valid photo ID.
Minimum group size is 4. Maximum group size is 14 (You'll receive at least 24 hours notice if the tour minimum is not met).
Gratuities for your guide and driver are not included but are greatly appreciated and may be offered at the end of the event.
Whether you are looking for fun things to do in Vancouver or a unique gift, the Gastown Craft Beer Pubs Walking Tour is the ticket!


Warren Mayor Jim Fouts faced increased pressure from other local politicians to resign Tuesday after the public release of new audio recordings of a man who sounds like the embattled mayor making crude and disparaging remarks about African-Americans and older women.
On Monday, the blog Motorcity Muckraker published recordings of a man who sounds like Fouts using the N-word to refer to African-Americans and saying "blacks do look like chimpanzees."
"I was watching this black woman with her daughter, and they looked like two chimps," the man says on the recording.
U.S. Rep. Sander Levin, four state lawmakers and three county commissioners who represent Warren called on Fouts to resign in a joint statement released Tuesday morning.
"We have listened to the audio tapes with the voice we recognize of Mayor Jim Fouts," Levin and the Warren politicians said in the statement. "These comments are hateful. They are racist and disparaging of women."
The statement was signed by Levin, state Sen. Steve Bieda, Reps. Henry Yanez, John Chirkun and Patrick Green and Macomb County commissioners Andrey Duzyj, Veronica Klinefelt and Marv Sauger, all of whom are Democrats.
"We believe that it would be best for the people of Warren for Mayor Fouts to resign, and we call on him to do so," the coalition of Democrats said.
Fouts did not return a message Tuesday seeking comment. Fouts has repeatedly denied he's the man on the recordings, claiming someone has manipulated recordings of his voice to splice together the audio.
In a Facebook post Tuesday, Fouts claimed he still has a voter mandate to serve.
"There is tremendous effort to force me out immediately by slander, by character assassination, lies, and by out right condemnation of me," Fouts wrote. "This is an attempt to reverse the 2015 election results when I won with 85% of the vote."
At the Detroit Economic Club on Tuesday, the Big Four regional leaders took turns taking swipes at Fouts, with Detroit Mayor Mike Duggan questioning the legitimacy of Fouts' story that the audio recordings are fraudulent.
"If that were true, somebody engaged in fraud," said Duggan, a former Wayne County prosecutor.
Fouts should report the recordings to the Michigan State Police and agree to have his voice tested to prove the recordings are phony, Duggan said.
The man on the recordings published by Motorcity Muckraker also made sexual comments about older women, saying they're "dried up, washed up, burned out."
"I'm not interested in any old ugly hag," the man on the recording said.
Motorcity Muckraker did not disclose the source of the recordings.
The new recordings surfaced a month after Macomb County Executive Mark Hackel released a separate recording he obtained from an unnamed source of a man who also sounds like Fouts saying developmentally disabled people are "not even human beings."
The man on the tape complained about having to meet with "a group of retards."
"This is one of the worse things about being mayor," the man said. "This is the bottom of the barrel ... I don't want to be around them, and I wish them well in a cage."
Hackel, a former county sheriff, said he doesn't buy Fouts' story that a political enemy manufactured the audio recordings to paint him as a bigot.
"That has got to be the most absurd thing I've heard in my 30 years in law enforce as a defense for what that mayor said," Hackel said.
Joe DiSano, who served as Fouts' political consultant from 2003 to 2013, said Tuesday that he heard Fouts use the N-word and once witnessed the mayor dance around his office at City Hall like a monkey to portray black voters in Detroit. DiSano said the incident occurred in the spring of 2013 during a conversation about the Detroit mayor's race that year, when former Detroit Medical Center CEO Mike Duggan, who is white, was running for mayor.
"He was talking about his belief that African-American voters never would vote for a white guy," DiSano said Tuesday. "The N-word was casually dropped a few times."
Duggan, who moved back to Detroit from Livonia to run for mayor, went on to defeat Wayne County Sheriff Benny Napoleon for the mayor's office in 2013.
On Monday, Duggan joined the chorus of those saying Fouts needs to resign if the tapes are authentic.
If Mayor Fouts said those disgusting things, he has to go. The tapes are sickening. It's hard to believe anybody could say those things.
DiSano said Fouts' behavior has become an impediment to progress in Warren.
"I think it's an enormous black eye on the city of Warren and its ability to conduct business while he's mayor," DiSano said.


text:
5 reasons you need to think about electric cars
November 10, 2014 Jon Evans , IoT
Electric vehicles are hitting the world's roads and with government support behind them these things are the future of environmentally friendly road transport.
Combustion engine vehicles generate huge quantities of pollution, and developed economies create more than their fair share. The US transportation sector accounts for around 30 percent of US global warming emissions "an order of magnitude more than most countries", says UCSUSA.
Electric greens
Europe's new Clean Power for Transport directive means member states must create an infrastructure to support electric vehicles. In the EU, cars emitted an average of 135.7 grams of CO2 per kilometer in 2011, which the EU hopes aims to reduce to 95 grams/km per by 2020.
To illustrate government commitment, the UK is working deploy around 155,000 recharging points to support the 1.55 million electric vehicles expected to be on UK roads by 2020. "The development of an infrastructure capable of supporting increasing vehicle numbers is essential," say the Society of Motor Manufacturers and Traders (SMMT). Similar schemes are rolling out worldwide.
This means electric vehicles will be enabled on our roads, prompting analysts to predict some big numbers. For example, Navigant expects sales of PEVs and all-electric cars to reach 1.75 million with hybrid vehicles achieving 2 million per year by 2020.
While electric vehicles won't be ubiquitous for a few years yet, rapid infrastructure deployment means most enterprises should begin to think about how -- and why -- they make sense to their business.
1/ Green(er) transportation
A February PwC survey showed 46 percent of 1,344 chief executives in 68 countries see climate change as one of their top three concerns. "More and more businesses are seeing climate change for what it is - a risk issue, a resilience issue and a business opportunity," PwC partner, Jon Williams told the Reuters Global Climate Change Summit. Enterprises are already adopting electric cars -- Orange recently reached a deal with Renault to extend its fleet of electric vehicles.
Governments across the planet want to get more electric vehicles on our roads as they can reduce vehicle emissions by up to 68 percent. There are some who argue that making these cars imposes their own environmental costs, but the overall impact remains a reduction in emissions.
2/Batteries are improving
The cost of manufacturing and recycling of the expensive lithium ion batteries (big versions of the batteries used in phones) used in current electric vehicles is high. These batteries easily disposed and take huge amounts of energy to recycle. That's bad news for the environment but there's plenty of research taking place that should improve this, car range should climb while the batteries themselves grow greener. Projects include:
Researchers at Uppsala University have created batteries using alfalfa and pine resin instead of cobalt or nickel – and their solution claims to enable recovery of 99 percent of the Lithium.
Researchers at Nanyang Technological University (NTU) School of Materials Science and Engineering have developed a rapid charging battery that can charge up to 70% capacity in two minutes and full capacity in five minutes. This should be available within two years.
Stanford University researchers, including former Energy Secretary Steven Chu, developed a battery that could give an electric car 300 miles between each charge.
3/ They're getting cheaper
You can find vehicles from a range of brands, including BMW, GM, Nissan, Tesla, Toyota and many more, but these things have a cost that prohibits wide adoption.
This is changing, fast. China has woken up to the impact of climate change -- Chinese car manufacturers produced 11 times as many new energy vehicles in August 2014 as they did in August 2013 because of new government incentives. Foxconn (which makes iPhones for Apple) is now working with China's BAIC Motor Corp. to manufacture a sub-$15,000 pure electric car. In the US, GM is developing its own affordable electric vehicle.
Two-wheel transportation is another alternative. Navigant Research claims worldwide sales of e-motorcycles will grow from 1.2 million vehicles annually in 2014 to 1.4 million in 2023, while sales of e-scooters will grow from 4.1 million to 4.6 million. Yamaha will introduce its own electronic two-wheeler next year, while Toyota's iRoad has already won critical acclaim. The bottom line? As electric vehicles are more widely deployed their cost will fall.
4/ Running costs
There are significant cost savings to be made in electric vehicle deployment, particularly if used in combination with other solutions, such as car sharing schemes. In one example, an electric car sharing scheme at Duke University generated those taking part around $370 per month savings in car payments, gas, parking charges and insurance. This suggests significant potential savings for enterprises running larger fleets.
Electric vehicles aren't confined to personal use, of course, electronic bus manufacturer, Transtech, claims one of its vehicles can save a school district around 16 gallons of fuel a day for over $10,000 in savings per year. Toyota in Japan already runs its own innovative consumer-focused car sharing scheme.
Exploring the disruptive potential, a University of Delaware scheme sees the institution's fleet of vehicles doubling up as emergency fuel storage cells for the local utility firm when not in use. Each vehicle earns around $110 per month under the scheme. Nissan is using electric vehicles as part of disaster and emergency response with its experimental emergency response system. These latter notions suggest that electric cars could earn at least some of their keep.
5/ Intelligent solutions
As connected vehicles hit the road, electronic vehicles will benefit from smartphone like telematics and connected intelligence to augment driving experiences. We've talked about some of the opportunities of connected cars before -- everything from personalized entertainment to reduced running costs and better road safety, but as vehicles morph into becoming integrated electronic devices, there is a growing opportunity for them to become as integral and personal to you as your smartphone -- your vehicle becomes your intelligent assistant.
That's before you even mention the chance for fleet monitoring, group insurance reduction and asset management, of course.
Jon Evans
Jon Evans is a highly experienced technology journalist and editor. He has been writing for a living since 1994. These days you might read his daily regular Computerworld AppleHolic and opinion columns. Jon is also technology editor for men's interest magazine, Calibre Quarterly, and news editor for MacFormat magazine, which is the biggest UK Mac title. He's really interested in the impact of technology on the creative spark at the heart of the human experience. In 2010 he won an American Society of Business Publication Editors (Azbee) Award for his work at Computerworld.