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Australia / Yarra Valley / Marli Russell
About Marli Russell
Marli Russell is a pioneering range to further explore the potential of the Middleton family's site and complement the traditional Mount Mary range. Back in 2007, a year after the death of Dr John Middleton, the family embarked on what was initially known as their 'Rhône Project'. Ever-changing environmental conditions and the purchase of adjacent land inspired them to plant seven Rhône varieties. Three white grapes went in - Marsanne, Roussanne and Clairette – alongside four red varieties: Grenache, Shiraz, Mourvèdre and Cinsault.
Marli Middleton, née Russell, was the inspiration behind the label. As wife of Dr John, she was co-founder of the estate and grandmother to current winemaker Sam. These wines boast all the class, intrigue and balance of the Mount Mary wines, and are poignant recognition of Marli's enthusiasm for the younger generation to continue in the pursuit of new ideas.
About Sam Middleton
Sam Middleton is a third generation wine maker from the Mount Mary family. He holds a degree in Agricultural Science from the University of Melbourne as well as a degree in Wine Science from Charles Sturt University. His background includes employment at several significant producers including Coldstream Hills and Dominique Portet. Sam has gained experience in France working a vintage in Burgundy in 2009 and travelling extensively through other wine regions on a number of occasions since. Bordeaux is of special interest to him as a result of its role in Mount Mary's history. Growing up in the Yarra Valley alongside his father and grandfather, grapes and wine have always been a part of life. He has always demonstrated a passion for primary production and has a deep respect for this region and its unique ability to produce world-class wines.
2019 Marli Russell by Mount Mary RP2
Marli Russell
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Vancouver Knights can consider them somewhat lucky as rain and bad light helped them to win the Qualifier 2. However, a win is a win and it would have certainly boosted the confidence of the Knights.
Vancouver Knights will not have very good memories of the last match when they lost to the CWI B team. Both teams locked horns in the Qualifier 1 where the CWI B team had an unbelievable victory, reaching home on the last delivery of the match.
Chadwick Walton has been in sublime form and if Chris Gayle clicks at the top of the innings, Ben Dunk and Andre Russell have enough hitting prowess to take the team beyond 200. They also have bowlers in Tim Southee and Sheldon Cottrell who have the ability to not only stem the flow of runs but also take crucial wickets.
The CWI B team, on the other hand, has been absolutely on a roll. Justin Greaves, Shamar Springer, Sherfane Rutherford and Brandon King, all have been sensational. With the ball, Obed McCoy, Derval Green, Jeremiah Louis and Khary Pierre have also contributed handsomely.
Captain Anthony Bramble also showed signs of coming back to form in the last match. All in all, it promises to be a very hard fought encounter and worthy of the Final.
Now let's have a look at the two squads.


Corn Chowder – Crock-Pot Easy!
Home Corn Chowder – Crock-Pot Easy!
Corn Chowder is super easy when cooked in a crock-pot. Enjoy this corn chowder with bold flavors from cilantro, roasted red peppers and yellow peppers.
This Corn Chowder is full of healthy, vitamin-rich veggies and soul satisfying flavor.
Using the crock-pot frees you up to do other fun things while dinner is cooking! Frozen sweet corn is delicious in this dish, but if you can get your hands on fresh corn, that would push this Corn Chowder over the top! Inspired by a recipe I found in Cuisine At Home's Slow Cooker Menus Magazine. Made just a few minor changes. This chowder is filling and satisfying without being heavy. I hope you like it!
In large skillet over medium heat, saute mushrooms in butter until browned (about 6 minutes).
Add onion and garlic. Continue cooking for 4 more minutes.
Continuing over medium heat, stir in paprika, crushed red pepper, salt, pepper, and roasted red peppers.
Mix cornstarch in 2 cups of broth. Add to mushroom mixture.
Continue to cook until thickened.
Pour mushroom mixture into crock-pot.
Top with corn, diced yellow pepper and remaining broth -- do not stir.
Cover and cook on high setting for 2-3 hours or low setting 4-5 hours.
At end of cooking time, stir chowder.
Puree cilantro in blender with yogurt, milk, lime juice and 2 cups of the chowder until thick and creamy.
Stir this blended mixture into the crock-pot.


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Prof. Sigmund C. Shipp Gave Lecture Entitled "A Charge to Keep: Historically Black Colleges and Universities in America" at Several Institutions
Professor Sigmund C. Shipp gave a lecture entitled "A Charge to Keep: Historically Black Colleges and Universities in America" to the Washington (DC) Friends Meeting (Feb 14), Cathedral Congregations, Racial Justice Task Force at the National Cathedral, Washington, DC (Feb 21), and R.C. Nusbaum Honors College, Norfolk State University, Norfolk, VA (Feb 22). His co-presenter was Professor Gregory Gardner, Norfolk State University.
By Hunter Urban|2021-02-27T12:45:32-05:00February 27th, 2021|News|Comments Off on Prof. Sigmund C. Shipp Gave Lecture Entitled "A Charge to Keep: Historically Black Colleges and Universities in America" at Several Institutions

redpajama_set_name: RedPajamaCommonCrawl


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Does Donald Trump Have Anyone Left That He Listens To?
Ron Sachs/CNP via ZUMA
Politico writes that Stephen Bannon is increasingly isolated within the White House:
The conservative news site Breitbart has waged a nonstop campaign against national security adviser H.R. McMaster, but so far it seems to have done the most damage to someone else: Steve Bannon. A Wall Street Journal editorial earlier this week accused Bannon of using the right-wing media to go after his ideological foes, questioning his loyalty to the president and placing blame for White House dysfunction squarely on his shoulders.
….Bannon has grown more isolated without his ally Priebus in the West Wing….In June, Trump started telling aides that he suspected that Bannon was a source of negative stories, according to aides. After a slew of stories about Bannon "winning" policy wars in the White House—like Trump's decision to pull out of the Paris climate accord—the president told Bannon to "knock it off," according to the senior administration official.
Priebus at one point also warned Bannon. "You've got to get people to stop writing this shit, because people know it's you," the senior administration official said.
I've recently read that H.R. McMaster is increasingly isolated in the White House. Now Bannon is increasingly isolated. Ivanka Trump is hunkering down and avoiding politics altogether. Anthony Scaramucci was fired after ten days on the job. John Kelly is brand new, but already running afoul of a president who doesn't like being reined in. At the same time, Rex Tillerson is on the outs, Mitch McConnell is on the outs, Jeff Sessions is on the outs, and Paul Ryan is all but invisible these days.
So who's left? Who does Trump still listen to? I guess Jared Kushner is still whispering in his ear. Maybe Kellyanne Conway? Mike Pence? I'm not sure. Who's left these days who's still on Trump's good side?


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Un senyal invisible (originalment en anglès, An Invisible Sign) és una pel·lícula dramàtica estatunidenca de 2010 dirigida per Marilyn Agrelo i protagonitzada per Jessica Alba, J. K. Simmons, Chris Messina, Sophie Nyweide i Bailee Madison. Basada en la novel·la de 2001 An Invisible Sign of My Own d'Aimee Bender, la pel·lícula tracta sobre una dona jove dolorosamente retirada que, quan era petita, va dedicar-se a les matemàtiques per a consol després que el seu pare emmalaltís, i ara com a adulta, ensenya l'assignatura i ha d'ajudar els seus alumnes a superar les seves pròpies crisis. S'ha doblat al català oriental per TV3, i al valencià per a À Punt.

Per la seva actuació a la pel·lícula, Bailee Madison va rebre una nominació al Young Artist Award 2011 a la millor interpretació en un llargmetratge.

Referències

Enllaços externs

Pel·lícules dels Estats Units del 2010
Pel·lícules dramàtiques dels Estats Units
Pel·lícules del 2010 doblades al català
Pel·lícules dramàtiques del 2010
Pel·lícules en anglès
Pel·lícules de drama romàntic de la dècada del 2010
Pel·lícules basades en novel·les

redpajama_set_name: RedPajamaWikipedia


The final installment of CD Projekt Red's role-playing franchise continues to see strong performance on the Playstation 4 as it has now been confirmed that The Witcher 3: Wild Hunt is experiencing exceptional digital sales on Sony's next-gen console. The official Playstation Blog revealed late last week that The Witcher 3 managed to beat out all other titles last month in order to become the Playstation Store's top-selling title in May.
While The Witcher 3 took the top spot on the PS4, Mortal Kombat X came in second on the overall PS4 digital sales charts. The Witcher 3 actually dethroned the newest entry of the classic fighter as Mortal Kombat X held the No. 1 rank on the list in April.
Since The Witcher 3: Wild Hunt is only available on current-gen platforms, CD Projekt Red's latest release wasn't competition for opposing Playstation 3 games. Thanks to a recent PS Store sale, BioWare's Mass Effect Trilogy dominated PS3 digital sales in May.
Several games that have long held a position on the PSN sales charts are still holding their ground. Joining The Witcher 3 as high-selling PS4 games, Rockstar Games' Grand Theft Auto V and Destiny also earned spots on the list. Meanwhile, GTA V barely managed to stay in the top 20 for the Playstation 3 and Destiny has completely fallen off the sales charts for Sony's last-gen platform.
However, Bungie's online shooter was still well represented last month since House of Wolves, the second expansion for Destiny, was the most-sold DLC in May for both the Playstation 4 and Playstaton 3. The title's first expansion, was also still among the top 10 selling add-ons.
Creative survival games were also big sellers last month as both Minecraft and Terraria were seen in the top charts for the PS4, PS3, and PS Vita. The Playstation 4 edition of Don't Starve also saw a surge of digital sales in May.
Gamers will likely continue to see The Witcher 3 claim its place in the Playstation sales charts in the coming months. With CD Projekt Red's commitment to support the game over the next two years, gamers will have a reason to keep interested in The Witcher 3: Wild Hunt for quite some time. The developer also strives to improve the game through free title updates, the most recent of which was released over the weekend.
Did you pick up The Witcher 3 on the Playstation 4 last month?


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β-Arrestin-Dependent Dopaminergic Regulation of Calcium Channel Activity in the Axon Initial Segment
Sungchil Yang
Roy Ben-Shalom
Misol Ahn
Alayna T. Liptak
Richard M. van Rijn
Jennifer L. Whistler
Kevin J. Bender
Published - 9 Aug 2016
https://doi.org/10.1016/j.celrep.2016.06.098
Final Published version, 2.28 MB, PDF
Publisher's Copyright Statement
This full text is made available under CC-BY 4.0. https://creativecommons.org/licenses/by/4.0/
https://scholars.cityu.edu.hk/en/publications/publication(6841ce76-f0b0-4dc8-bced-ae3aab9264f5).html
G-protein-coupled receptors (GPCRs) initiate a variety of signaling cascades, depending on effector coupling. β-arrestins, which were initially characterized by their ability to "arrest" GPCR signaling by uncoupling receptor and G protein, have recently emerged as important signaling effectors for GPCRs. β-arrestins engage signaling pathways that are distinct from those mediated by G protein. As such, arrestin-dependent signaling can play a unique role in regulating cell function, but whether neuromodulatory GPCRs utilize β-arrestin-dependent signaling to regulate neuronal excitability remains unclear. Here, we find that D3 dopamine receptors (D3R) regulate axon initial segment (AIS) excitability through β-arrestin-dependent signaling, modifying CaV3 voltage dependence to suppress high-frequency action potential generation. This non-canonical D3R signaling thereby gates AIS excitability via pathways distinct from classical GPCR signaling pathways.
Arrestin Medicine & Life Sciences
Calcium Channels Medicine & Life Sciences
G-Protein-Coupled R... Medicine & Life Sciences
Axons Medicine & Life Sciences
Arrestins Medicine & Life Sciences
Dopamine D3 Recepto... Medicine & Life Sciences
GTP-Binding Protein... Medicine & Life Sciences
Action Potentials Medicine & Life Sciences
β-Arrestin-Dependent Dopaminergic Regulation of Calcium Channel Activity in the Axon Initial Segment. / Yang, Sungchil; Ben-Shalom, Roy; Ahn, Misol et al.
In: Cell Reports, Vol. 16, No. 6, 09.08.2016, p. 1518-1526.
Yang, S, Ben-Shalom, R, Ahn, M, Liptak, AT, van Rijn, RM, Whistler, JL & Bender, KJ 2016, 'β-Arrestin-Dependent Dopaminergic Regulation of Calcium Channel Activity in the Axon Initial Segment', Cell Reports, vol. 16, no. 6, pp. 1518-1526. https://doi.org/10.1016/j.celrep.2016.06.098
Yang, S., Ben-Shalom, R., Ahn, M., Liptak, A. T., van Rijn, R. M., Whistler, J. L., & Bender, K. J. (2016). β-Arrestin-Dependent Dopaminergic Regulation of Calcium Channel Activity in the Axon Initial Segment. Cell Reports, 16(6), 1518-1526. https://doi.org/10.1016/j.celrep.2016.06.098
Yang S, Ben-Shalom R, Ahn M, Liptak AT, van Rijn RM, Whistler JL et al. β-Arrestin-Dependent Dopaminergic Regulation of Calcium Channel Activity in the Axon Initial Segment. Cell Reports. 2016 Aug 9;16(6):1518-1526. Epub 2016 Jul 21. doi: 10.1016/j.celrep.2016.06.098
Yang, Sungchil ; Ben-Shalom, Roy ; Ahn, Misol et al. / β-Arrestin-Dependent Dopaminergic Regulation of Calcium Channel Activity in the Axon Initial Segment. In: Cell Reports. 2016 ; Vol. 16, No. 6. pp. 1518-1526.


Last night daughter2 made dinner. Raise your hand if you love having your college kids home? Daughter2 loves to cook plus did I mention it has been raining hard here for six days straight and it's been dark and gloomy so hunkering down at home just feels right?
Chicken piccata, honey balsamic green beans and garlic roasted potatoes. Oh my word-so delicious!
She used Giada De Laurentis's recipe for the chicken which you'll find here. A real treat and not just because I didn't have to cook it myself. The honey balsamic green bean recipe is courtesy of Paula Deen. Go here for the recipe because it's definitely a keeper. The garlic roasted potato recipe ala Nigella Lawson can be found here.
Who thinks my daughter loves The Food Network?
She might have also baked lemon cupcakes with a lemon cream cheese frosting for dessert. I did not eat a cupcake (yet!...a finger in the batter doesn't count, does it?) but hubs said they were fab.
Fyi-he did not use the word fab but that's what he meant.
Hubs does not say fab.
Who's happy they taught their daughter to cook starting way back when she was just a cute little munchkin?
Who thinks she is still a cute little munchkin?
Okay, you've convince me. I need to teach my kids to cook. It frustrates me no end to have them in the kitchen but just look at the pay off! Yum!
Lucky you! I also love the Cooking Channel. I get so many ideas there. However, there should also be a channel devoted to food channel recovery! lol!
We have had rain for 6 days in a row as well and I so know what you mean about a good home cooked meal. I can't wait till I can get my pj's on and curl up to a good movie and a hot meal. Your little cook is beautiful. Well done mamma, well done!
That looks so yummy! How sweet is she?!
She is cute! :) Good for you that they WANTED to learn how to cook. Mine never did and it´s always a little disappointing when they show no interest in cooking.
Great recipes I saved to my file! I would have had a cupcake or two! My daughter loves to bake...now cooking thats another story! Have a great weekend!
Looks like great food--even fab you might say!
YUM! I wish I had been there to enjoy sister's meal!!
I have a good recipe for chicken piccata (also from the Food Network), but Daughter#2's recipe sure sounds like a tasty one ... I'm definitely going to have to give it a try, along with the green beans (DH's favorite veggie) and the potatoes (yummy!!).
Looks delicious. And it's always better when someone else is doing the cooking.
Yum! My youngest loves to cook! Cleaning? Not so much! But he's still a cute munchkin too!
She IS cute. Can I borrow her? How did I get 5 kids, no cooks? Maybe because I'm not one myself?? :) So glad you are enjoying your time together.
This post made me laugh, and I SO identify on so many levels.
1. "Hubs not say fab" but that's what he meant.
I shall go link up w/ Kelly's Korner per your suggestion because I posted a family fave today.
Yay for having college daughters home! Double yay when they cook for their families! Mine immediately got in the kitchen when she got home too!! At least we know their husbands won't starve after they get married! Job well done, Mom!
We have one who cooks, one who takes us out and one who only eats mass quantities!!!
Oh, yes, I love when my daughter comes to visit. She's a much better cook than I am--and she enjoys it way more, too!
Dinner looks great and yes she is still a cute munchkin!
I have a son who cooks when he's home, and yes, I love it too!
Do you think the great state of NJ is ready to float away?
The weather, the workers, the weekends-oh deer!


The IESG can (and should) reject a request if another path for registration is available that is more appropriate and there is no compelling reason not to use that path.
URI Schemes", BCP 35, RFC 4395, February 2006.
RFC 4395 is not BCP 115. It is BCP 35.
Correct - RFC 4395 is BCP 35, not BCP 115. However, at the time RFC 5226 was published (May 2008), this error had not yet been reported (it was reported in Jan. 2009, and the relevant data was updated accordingly at that time).
Unassigned values are not "reserved". For bounded registries, they can be computed from the assigned/reserved values. For unbounded registries (think media types), mentioning them doesn't make any sense at all.
No change is needed. The use of "should" provides any necessary flexibility. In the IANA Considerations section of a document that sets up a registry, authors tend to indicate which values are initially "Unassigned".
registrations.  In addition, any ranges that are "Unassigned"
"Reserved", used for "Private Use", "Experimentation", etc.
Anyway, I propose to consider mentioning the norm about mandatory mentioning the Unassigned values in the registry description appropriate and useful. This would improve the work of IANA staff that will create the registries.
Changing a "should" to a "SHALL" in a BCP cannot happen through the errata. IETF consensus is needed for such a change.


ESN Group also makes cosmetics and personal care products under the brand Earth Science as well as Sarabecca perfumes and fragranced products.
Skin care with ceramides as the hero ingredient has been a mainstay of the mass market personal care sector since the 1980s when the Cetaphil product line moved out of the pharmacy and onto retail shelves.
That popular brand and Galderma, the Nestlé Skin Health subsidiary that oversees the Cetaphil brand, was in the news quite a bit a couple years back. In January 2016, Galderma received funding to help expand its North American production facility capacity by more than 20%.
The very next month Cetaphil launched a dedicated men's skin care line, as Cosmetics Design reported. "With the growth of the industry and the growing male consumer demographic, creating a line curated for their needs was the next phase in offering targeted skin care to our current fan base and to new consumers," president and general manager at Galderma for North America Miles Harrison, remarked at the time.
Ceramedx formulations include a "plant-based ceramide technology" known as Riceramide-3 Complex. Beyond that the ESN Group's new brand shifts attention to the made-without aspect of the cleanser, lotion, and cream: "These products are fragrance-free and made without parabens or petrolatum," as the press release announcing the brand launch notes.


HovText is a small freeware and open source Windows application that removes any formatting from the clipboard and it also works as a simple clipboard manager. Any text in the clipboard will be pasted as raw text without any HTML code, font size, color or layout etc. HovText remembers also the last 10 copied texts (both formatted and unformatted) and you can filter out whatever text you need with regular expressions.
A typical scenario is to copy a qoute from Internet Explorer and paste this quote into Outlook or Word. In the most cases it will paste the formatting along also and that is often inconvenient as it spoils the current formatting. Some applications has their own way of importing the unformatted text, but with HovText ALL programs has this option and it works in the same way all the times.
Another typical scenario is that you need to copy all email addresses on a webpage or if you want to grep all movie links from a web-directory, then you just apply a filter and paste this into eg. a WGET script or Outlook and so on.
Let us show an example from "almost the real life".
"genius - genius (fx a mathematical genius; it requires neither genius nor second sight to prophesy the effects of this policy on the future output of scientists and engineers); a person of superior intellectual faculties.
Let us say that we need to paste this text into Outlook (into an HTML email). Below shows a not wanted result.
Typical you wish to use the same formatting as already used in Outlook. Below shows the wanted result.
"genius - genius (fx a mathematical genius; it requires neither genius nor second sight to prophesy the effects of this policy on the future output of scientists and engineers); a person of superior intellectual faculties."


PICCADILLY CIRCUS UK: ISLAM WILL NOT DOMINATE……! – The Tundra Tabloids…….
PICCADILLY CIRCUS UK: ISLAM WILL NOT DOMINATE……!
There are about 200 anti-sharia activists in Piccadilly Circus and lots of press and photographers. It is a multi-racial gathering, and there are many Union Jacks on display.
Obviously, there are no Muslim demonstrators to counter, but people are showing their opposition to sharia law in Britain. The protest is very peaceful and good-spirited.
We will have some photos later on.
Steve Gash of SIOE is present, as is another English Democrat member of UKIP, Magnus Nielsen (updated).
Previous Post Previous Post TUNDRA TABLOIDS GETS MAIL FROM A SEETHING NON-MILD MUSLIM…….
Next Post Next Post 'A Time for Choosing': 45th Anniversary of Ronald Reagan Address…….


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Sakis Gouzonis gave an interview to Highwire Daze
2 February 2010 7 January 2021
Greek electronic music composer Sakis Gouzonis gave an interview to Highwire Daze.
Highwire Daze is an e-magazine based out of Los Angeles, California, USA. It was founded by Kenneth Morton and Judith Scott in September of 1990.
A big thank you goes out to Kenneth Morton, editor and publisher of Highwire Daze, for helping Sakis Gouzonis reach more listeners.
View a screenshot of this interview or read it below.
The grand artistry of Sakis Gouzonis
Interview by Kenneth Morton
Editor & Publisher of Highwire Daze
California, United States of America
Sakis Gouzonis is a composer from Greece, whose work has excited and enchanted music aficionados from all across the world. With two CD releases (First Contact and New Earth) and an impressive collection of awards he has achieved throughout his career, the electronic artistry found within the work of Sakis Gouzonis is inspiring to behold. Here is a recent interview we conducted with this talented composer…
Introduce yourself and tell me how long you have been doing electronic music -and who were some of the bands or musicians who influenced you to take on this style of music?
First of all, I would like to thank you for your interest in my music. It really means a lot to me. I am a Greek composer, orchestrator, arranger and producer of electronic music. I have been playing and writing music since I was a little boy, and I have taken part in many musical projects. However, I began to work on my own a few years ago, and my personal discography counts two albums to date. My first album, First Contact, was released internationally on 8 August 2008, and my second album, New Earth, was released internationally on 9 September 2009. My music is influenced by Jean-Michel Jarre, Vangelis, Yanni, James Horner, Danny Elfman, John Williams, Alan Silvestri and many other talented composers. I listen to a lot of different music though, and I love digging for things that are new, different and appealing.
Is there any story or concept behind the title of the CD New Earth?
We are living in a powerful and transformative time when greater light shines from the Heavens onto the Earth. This influx of light is triggering a series of inner shifts and transformations that will ultimately change our outer world. A New Earth is coming in which tears and pain will be a thing of the past. I have worked countless hours to express this change through my music.
What city are you from and what is the music scene like in Greece?
I was born and grew up in Thessaloniki, Greece. The music scene in Greece is very diverse and full of hidden treasures. All kinds of music are performed in Greece, and people of all ages and backgrounds come to the shows and support the local scene.
How easy or difficult is it to decide on a title for an instrumental piece?
Very good question. I wouldn't say it is difficult, but it is very intense. I title my instrumental pieces very carefully. I always try to find a title that reflects the theme and atmosphere of an instrumental composition using the process of elimination.
Do you participate in any other musical projects or bands outside of your solo work? If so, who are they, and what are they like?
I used to participate in other musical projects and bands as a keyboardist and orchestrator, but the last couple of years or so I have been working on my own music compositions.
Describe your music to someone who has never heard it before.
Melodic electronic music that lets you escape to some place in your mind that you have never visited before.
You have mentioned that your music is on the Myspace Christian Music Charts. How does Christianity and the teachings of Christ influence your music?
My music is an expression of my being made in the image of a creative God. The joy that I give to people has come out of experiences I have had on my own and how through them God has revealed many things. When I write a music composition or give a concert, I pray a prayer to God asking Him to guide me and help me be helpful to other people.
Any strange or unusual MySpace stories you could share with us?
A Greek man sent me a message telling me that he had a fight with singer Lyndsay Jackson, and he needed me to pass a message to her. He needed to apologize himself and ask for her forgiveness. He even gave me his telephone number in order to call him and help him out.
You have won quite a few live competitions in Greece. How exciting and nerve wracking is it to perform in these competitions?
It is very exciting and nerve cracking. I think every artist is pretty nervous before and during a music composition contest. Everybody wants to win. The adrenaline is at its peak and the atmosphere is electrified. But at the same time, it is a great way for us artists to obtain a reliable and valued response to our music from professional judges.
Outside of the competitions you have entered, have you ever performed a live set or would you want to do so in the future?
Up to now, I have given more than 900 live performances. Thousands of people of all ages and backgrounds have come to my live performances, and I personally feel very blessed. It is so great seeing so many people enjoying my music. And their comments on my live performances are very encouraging.
With your music being so cinematic, have you ever wanted to compose film scores -and what are some of your favorite film scores or soundtracks?
Yes. I would love to write music for a movie or a documentary some day. It is one of my dreams. Some of my favorite film scores and soundtracks include "My Heart Will Go On" by James Horner, "Edward Scissorhands" by Danny Elfman, "Jurassic Park" by John Williams, "Lord Of The Rings" by Howard Shore, "Star Wars" by John Williams and "Harry Potter" by John Williams.
What is it you'd like a listener to remember the most after hearing New Earth for the very first time?
I would like my listeners to remember the emotional melodies of the New Earth album, and feel stronger and happier each time they listen to it.
How close are you to writing and recording all new material?
I am currently in my home studio working on my next album. About half of the album is ready at the moment and I am very excited. There is a lot of energy and emotion in my new tracks. I am sure my fans are going to like it.
Do you have any messages for your fans all over the world and / or people now reading about you for the very first time?
Be proud for what you are. Love one another. We are all one. I hope you will check out my New Earth album by visiting my official website https://www.sakisgouzonis.com. Thank you for taking the time to read this interview.
News about Sakis #45


text:
Upgrade Specialist in Another World Vol 3 Chapter 198
"Senior, can you tell me just why we'll be going to the Northern Point this time?"
Bai Yunfei couldn't help but ask Song Lin as the two walked over to their destination.
But Song Lin only smiled in response, "There's no need to be so worried. It's for something good…"
Segueing into a different explanation, he said, "You've already become the disciple of the headmaster, so you should have the things a disciple should be entitled to. You'll be getting an even greater gift when we reach the Northern Point."
"Eh?" Bai Yunfei started, "What do you mean by that, senior?"
"Ah, well. Junior Bai, how much do you know about soul armaments?" Ignoring the previous question, Song Lin immediately asked a question of his own.
"Soul armaments? Well… what about them, senior?"
"Do you know what determines the strength of a soul armament?"
A blank face greeted Song Lin's question, prompting the senior to answer it himself.
"Well… soul armaments have several aspects, such as the tracing and the vein lines… you will come to understand that each soul armament has its own special circumstances on the inside as well as the outside. When using or even looking at a soul armament, you have to transmit your soulforce into it. You can't just let your soulforce leak into it, and neither can you let it come in waves. Your soulforce must come in a steady flow without any fluctuations and it must be efficient while bringing out the most of the soul armament's strength. The stronger the soul armament, the more these things must be focused on…"
Bai Yunfei didn't really get it, but he nodded anyways.
Throwing up his shoulders to laugh helplessly, Song Lin continued, "It's hard to explain it in a few words. I can't tell you much right now anyways. Long story short, you have to follow the shape the soul armament is in. Sense the difference in soulforce, and use them in battle to get a better understanding of how strong a soul armament is…"
"I think I got it. Thank you for advising me, senior." Bai Yunfei finally replied after a long period of silence.
Song Lin nodded, "As long as you understand. Now, let's hurry on over there."
Song Lin hadn't even finished speaking when his feet began to pick up in speed. As they traveled, Bai Yunfei remained behind him with sparkling eyes—he had already come to a sort of conclusion with himself.
"The strength of a soul armament? That must mean the attack and defense of a soul armament… In that case, I'm willing to bet there's no one that'll know better than me…"
Some time passed before Bai Yunfei realized the destination they were heading to was the very same mountain they went to for the second examination!
Seeing how Song Lin didn't even pause before entering the cave, Bai Yunfei ventured out a guess, "Senior…"
Song Lin stopped briefly to turn his head back at Bai Yunfei. He was surprised on the reason why, but then the answer hit him just as fast. Smiling, he said, "Don't feel worried; follow me in. The cave will feel different than before."
"Oh…" Bai Yunfei still didn't really understand, but he followed him in anyways.
Not much time went by before Bai Yunfei came to the startling realization that the cave was no longer exuding that same mysterious pressure like last time!!
"Wha—what's going on!?" Bai Yunfei was dumbstruck. Thinking silently to himself, he said, "Could… could the power in this cave be controlled and banished so easily?"
Turning a corner, Bai Yunfei came to a realization that the countless troves of soul armaments were gone now, leaving behind only empty platforms where they used to be. By the time they turned the corner to the six kilometer mark, the platforms themselves were gone. As Song Lin said before, the mysterious power that had been present for the test measuring aptitude in 'crafting' was completely gone without a trace…
About seven kilometers in, Bai Yunfei finally came to see a dead end in the cave itself—
—a few meters away, a stone gate, ten meters tall and five meters wide, barred the rest of the way.
Plenty of carved out rooms adorned the two sides of the cave for countless of meters. Each of the doors were closed so that Bai Yunfei wasn't able to see the interior of these rooms.
"Junior Bai, please follow me." Song Lin called out to Bai Yunfei when he realized that he was too preoccupied with looking around the place. Walking to the end of the hall, he turned to the room to the right of the giant gates.
When he entered the room, Bai Yunfei was startled to see five members already inside: the headmaster Kou Changkong, the first elder Xiao Binzi, and the second elder Huangfu Nan all sat by a circular stone table and smiled at the two of them when they entered the room. Li Tiechui and Ye Zhiqiu were both standing respectfully off to the side.
Hurriedly bowing to greet the three, Bai Yunfei said, "This student Bai Yunfei pays his respects to the master, first elder, and second elder!"
"Ah, Yunfei. Are you growing accustomed to the Western Point yet?" Kou Changkong wasn't nearly as dignified as he was during the welcoming speech back then. Right now, he looked more like a friendly old man as he treated Bai Yunfei with a warm smile.
"Thank you master for your concern, your student has adjusted quite nicely to the school already…"
"Now that you're here, let's gets started!" Cutting to the chase, Xiao Binzi spoke first.
Kou Changkong and Huangfu Nan both gave each other a glance at first, but then they nodded to each other, "Very well, let us start then!" Kou Changkong agreed.
It was an unfathomable mystery to Bai Yunfei what the headmaster wanted with him. Even when he turned to look to Ye Zhiqiu off to the side for help, Ye Zhiqiu looked as equally confused as he was.
Rather than explaining the situation, the headmaster's expression grew serious. Even more dignified than before, he waved his right hand…
Bai Yunfei could only see a flash of red light as if the headmaster was sprinkling some sort of sunlight from his hand, and in an instant, the light filled the entire room.
However, the sight that befell Bai Yunfei and Ye Zhiqiu's eyes was so stunning that it knocked them into a period of silence…
As the red light scattered throughout the room, dozens and dozens of awe-inspiring soul armaments began to appear one after another! Floating in the air side by side, they began to circle around Bai Yunfei and Ye Zhiqiu in a fluid motion!
"The earlier examination to earn a soul armament was based on your own merits. You disciples today are worthy of owning a low-grade heaven-tier soul armament, so choose one!" The first elder's calm voice shook the two stunned males out of their stupor, but even then, his words were still more than capable of keeping them in silence for a moment longer.
Heaven-tier… heaven-tier soul armaments as welcoming gifts—this was the spirit of the Crafting School!
Sparing each other a glance, Bai Yunfei and Ye Zhiqiu could both barely contain the emotions that swam through their eyes, but with time, they managed to take in a deep breath and quash the more rampant emotions in them. Soon they were impatiently moving to pick out the soul armament they wanted.
It was now that Bai Yunfei realized just what Song Lin was getting at earlier. His words from before were to explain how to measure the strength of a soul armament.
Song Lin's concerns were for naught.
For Bai Yunfei, seeing how strong a soul armament was was as easy as turning his hand over.
With all of the glittering jewel-like soul armaments, Bai Yunfei's eyes sparkled with an equally bright light as they jumped from hatchet to sword to blade to dagger and then to even the defensive-type ones.
Holding out his right hand, Bai Yunfei's hand touched at a golden dagger. As if picking an apple, the golden dagger floated down to his hands for him to take hold.
Equipment Grade: Low Legacy
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text:
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 * @file Header index
 * @author yumao<yuzhang.lille@gmail.com>
 */

export * from './header.component';

redpajama_set_name: RedPajamaGithub


text:
'A disaster waiting to happen' Portsmouth council goes ahead with unpopular 14,000 new homes plan
The council has drawn up a draft plan to meet the government's housing targets, despite branding them 'completely unattainable'
Josh Wright, Local Democracy Reporter
The Tipner West Project will create 2,000 new homes for Portsmouth (Image: Gensler/Local democracy service)
Consultation on Portsmouth's draft local plan will begin in the coming weeks, despite council leaders saying government housing targets were "neither feasible nor sensible".
A six-week consultation on the planning blueprint, which outlines how the council plans to meet its 17,700-home target, was approved by the city council's cabinet on Tuesday.
But councillors also agreed to reiterate their concerns to that "completely unattainable" requirement, saying Portsmouth was "a unique city which needed a unique solution" to its housing demand.
READ MORE: Portsmouth could finally be about to get glass recycling collections
The council is required to develop a local plan to outline its development plans and priorities for the next 15 years.
The draft version sets out six key strategic sites for development:
Tipner
The city centre
Fratton Park and the Pompey Centre
Cosham
St James's
Langstone Campus and Lakeside North Harbour
Included within this is the controversial £1bn Tipner West masterplan.
"It is considered that, through long-term redevelopment, the city centre has the potential to become a diverse, vibrant and attractive area that has the capacity to deliver a number of new homes, new business, commercial and leisure space, new cultural, social and leisure, uses and new community facilities," the document says.
"Together, this will make a major contribution to meeting the city's development needs and strengthen the identity and vitality of the city centre and its economy."
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But, despite approving public consultation on the draft local plan at Tuesday's cabinet meeting, councillors also agreed to a series of formal criticisms of the government's requirements.
Five amendments were put forward by council leader, councillor Gerald Vernon-Jackson, who, last week, described the target as "a disaster waiting to happen and completely unattainable".
They included a formal rejection of the government's 17,700-home goal, a claim it would cause "significant" environmental damage and a call for local powers to set an alternative.
Introducing the draft plan on Tuesday, cabinet member for planning, councillor Hugh Mason, said there were "a number of difficult bits in it".
"People will always be concerned about new developments and in this plan we have a large number of them," he said.
"We are faced with challenges and we need to consider the implications of the options we have in front of us."
And, responding to calls to increase affordable housing provision, he said the council had to be "realistic" and accept that the cost of land in the city would make this unviable in many cases.
Cllr Vernon-Jackson said the council had reluctantly produced the draft local plan, and said building 17,700 new homes was "just not feasible, nor sensible".
"What that would do to people's lives and to the environment is very bad," he said.
"If we are able to work together to reduce that figure, that would be great.
"The whole of this plan is driven by the government's demand that we have to be able to identify land.
"That means there has to be some very difficult decisions for us and that's why the government should reduce the target. We are a unique city and we need a unique solution".
The consultation approved by councillors on Tuesday will start "later this summer" and run for six weeks with an aim for the final draft to be completed by next spring.
Portsmouth road damage 'most likely due to lightning strike' as scene is likened to 'War of the Worlds'
Parking "worse than ever before" as Southampton fire station share pictures of vehicles blocking doors


If you're already in Australia and looking for how to stay in Australia we can assist you with the following options.
The starting point here really has to be which visa type you are currently on, either a Working Holiday Visa or a Student Visa. If you in Australia on a tourist visa we are unable to assist. It is illegal to look for work on a tourist visa.
1- Your current level of education?
2- Have you completed any study in Australia?
Having the answers to these questions is good, but as you would expect it's only part of the equation. The next stage is to find not only the right course but to examine perhaps what your future plans will be after the course has completed. The best courses to undertake are those at University level as they potentially open the door to further visas once your course has completed. There is of course a financial element to this pathway. Studying as an International Student is not a cheap option and we advise that you research potential costs with prospective institutions and for courses.
– pass a health and character test.
This visa is for 18 months to allow the student to work in Australia after they complete their degree. If you are interested in applying for the 485 Post Graduate Study Visa take our online assessment today. Because you are in Australia your consultation will be done by our local MARA agent.
Obviously during your studies you are allowed to work part time during terms time and full time during the holidays to support yourself. Many applicants on a student visa are successful in finding Sponsored Jobs In Australia.
What about going for another Student visa?
Another student visa may be an option, depending on your financial resources and previous studies. The key criteria to consider with a second student visa criteria would be the "genuine temporary entrant" criteria. You will need to be able to justify why further studies are required. For example, the visa holder completed a Cert 3 or Diploma and now wants to do a Bachelor degree. Or the new diploma course is similar to the first course and is can be an extension of your skills set.
Congratulations! You've found an Australian partner! In this instance you may be able to apply for an onshore partner visa.
If you are looking for a Partner Visa and are in Australia please take our free visa assessment. Your consultation will be carried out by our onshore MARA agent.
As you can see there are a number of ways to extend your stay in Australia and move through visa classes. We would love to discuss your options in more detail.


Rosebud, mrcane and earl.dean.smooter like this.
St_Nick, bluegrasser and earl.dean.smooter like this.
Hope you got home ok, that really really suks when that happens.
earl.dean.smooter, 2RedEyes, umbra and 3 others like this.
Good morning. Up early today. Rose, Nick I sure hope that snow melt quick. Nothing big happening here, a little yard work than in the kitchen for the day.
earl.dean.smooter, Rosebud, thegloman and 1 other person like this.
Just was outside heavy mist, and in the 50's. Good day to pick weeds. I'll be planting egg plant, peppers, tomatoes this year. Plus, I'll be putting a sativa (Train Wreck) in the white house. Looking forward to that one.
earl.dean.smooter, Rosebud, zigggy and 1 other person like this.
There's already a train wreck in the white house.
earl.dean.smooter, 2RedEyes, Rosebud and 2 others like this.
earl.dean.smooter, Rosebud, oldfogey8 and 5 others like this.
morning cane. sorry about the snow. I got to say I'm enjoying GA weather.
Burping a few jars,sure smells good !!!!
earl.dean.smooter, 2RedEyes, Rosebud and 3 others like this.
Reverse Image search is wonderful. you can instantly tell when someones pictures of a grow is stolen/fake.
Food is the one resource in this country that Should be given freely to those in need.
It only takes a few to start a movement.
I been there, and when you're hungry it just don't matter why.
I take 1 day every week to give to the less fortunate. We have it SO good and there's so many kids who are hungry and needy.
1 person can't do much but when we All do just a little a LOT gets done.
Please........Give a hand up when you can.
Always great when our lil buddies are feeling good.


text:
Q: Why do I get 'Connection refused - connect(2)' for some models? I have a rails application running for the past 90 days that suddenly stopped working.
Debugging the problem I found that I can read from the DB but not write to it. At least for certain models.
There is one model that I can save whereas all others return Connection refused - connect(2) when I attempt to save them.
They all used to work fine last month. I have no idea how to determine what the problem may be.
Unfortunately I do not have access to the actual server remotely right now so I am limited in my debugging ability.
I was able to get some non-tech people to run simple commands though that may help identify my problem. I will also be getting access tomorrow at some point.
1 Check from the console
./script/console
>> a = Post.last.clone
=> #<Post id: nil, title: "test"...
>> a.ex_id = 7
>> a.save
Connection refused - connect(2)
...
...
>> b = Story.last.console
=> #<Story id: nil, title: "test"...
>> a.ex_id = 7
>> a.save
=> true

I am not sure why this works for story and not post. This is consistent over many tests.
2 Check from mysql
./script/dbconsole -p
mysql> INSERT INTO Posts (`title`,`body`, `ex_id`) SELECT `title`, `body`, 7 FROM Posts WHERE ID = 1;
Query OK, 1 row affected (0.01 sec)
Records: 1  Duplicates: 0  Warnings: 0

And as you can see I am able to write to the table with the same credientials that Rails uses?
Does anyone know why I get connection refused in the console?

A: heh, that's funny, had the same issue today.
My problem was that one of my models was tied to ElasticSearch which was not running.
So you should probably look in this direction ( any external connections )

redpajama_set_name: RedPajamaStackExchange


text:
The Omelette
Children Used For Drug Carriers, Reporter Lara Logan Sexually Assaulted, and...
Children Used For Drug Carriers, Reporter Lara Logan Sexually Assaulted, and Flyers Finally Beat Tampa Bay Lightning
By Dennis Bakay at 6:00 am on Wednesday February 16, 2011
The Omelette Wednesday February 16, 2011
Parents Arrested For Using Children As Drug Mules
Yesterday Philadelphia Police arrested the parents of two children who were used as drug carriers. They discovered 7 pounds of marijuana in the backpacks of a 9 and 10-year-old. In total, five people were arrested in the bust.
Reporter Lara Logan Was Sexually Assaulted in Egypt
Lara Logan, a top reporter for CBS was sexually assaulted in Egypt in the hands of a mob. Logan was in Cairo's central Tahrir Square on Friday, the day Hosni Mubarak resigned, and was separated from her crew in the crowd, the US television network said in a statement. Perhaps, this assault was planned by Pro-Mubarak supporters in order to discredit the movement. Either way, it's a disgusting and vile attack. On a side note, some sites are mispelling Logan's first name. Her name is not Laura Logan, but Lara Logan.
Flyers Knock Off Tampa Bay Lightning in Shoot-out
The Flyers have finally defeated the Tampa Bay Lightning this year. They were 0-3 against Tampa heading into last night's game. All it took was a Timo Kimonen goal int he7th round of the shootout to secure the 4-3 victory.
children drug carriers
Dennis Bakay
flyers beat tampa
flyers lightning
lara logan
lara logan assaulted
lara logan egypt
laura logan
reporter assaulted
reporter raped
reporter sexual assault


Article from The Week UK, June 23, 2018 - available to read here.
Welcome to the first of a series of blogs and articles from Bates teacher Charlotte Schuman! If you'd like to know more about Charlotte, you can check out her profile page here or drop her a message here.
Really?! Oh… so that's why I always looked so fabulously intellectual and educated when I wore glasses….! (Actually, I looked a lot like Nana Mouskouri (sorry Nana!) and that's why I decided to try the Bates Method).
After a couple of false starts and half-hearted attempts to improve my vision with a few lessons, it was several years later that I managed to improve my vision all by myself over a matter of weeks, with the help of Bates' book: Better Eyesight without Glasses - Eureka! Wow! All of a sudden, I could see people's faces again as I walked down the street; I could see sunlight sparkling off the parked cars, and going out at night without glasses was no longer so, well…dark and blurry! And yet - I was still "highly educated".
This sudden return to clarity was such a revelation to me that I decided to train to teach the Bates Method, so that I could help others who might also be wandering in the dark, so to speak, as I had been doing, for ten long myopic years. That was twelve years ago, and I have since established a busy practice as a teacher of this extraordinary and still absolutely revolutionary method of eyesight improvement.
But as it happened, I didn't know this dubious detail and I actually didn't start to become short-sighted until I'd finished my studies and was working abroad.
That's the thing: it's not just about being "highly educated"; many of my clients, found, as I did, that their vision first deteriorated while working in an office, in a "real" job.
So what aspects of studying for an education in school or at a tertiary institution, or working in an office job have in common?
And, is it possible to be "highly educated" or office bound, and still have good vision?
The answer, and it's an encouraging one, I'm pleased to say, is YES!
But how? As the scientists so brilliantly deduced (perhaps they could have referred to Bates' findings, to save themselves the time taken to carry out all of those complicated experiments), is that "spending a long time in the classroom" or spending a lot of time in an office, necessarily means that you are spending less time outdoors, and thus are missing out on valuable natural light.
Anyway! The fact is that the eyes need natural light to function well over the long term, so if you're spending a lot of time studying or working indoors, try to take as many breaks as you can outdoors in natural light, and go outdoors as much as possible on weekends and evenings in your spare time.
There is also another, totally avoidable factor which can lead to vision problems such as myopia, and which is related to spending long hours indoors studying or working - and that's the topic of my next blog!
In the meantime - slap on a hat, put away the shades, (bought with cash you probably earned indoors), and embrace the sunlight - your eyes will thank you for it.


text:
Article Tag - "IBPA"
Independent Articles
IBPA is Proud to Announce the Newest Benjamin Franklin Digital Awards Honorees »
(PRESS RELEASE) FOR IMMEDIATE RELEASE June 24, 2016 Contact: Joanne Kenny IBPA Member Benefits Liaison 310-546-1818 (Manhattan Beach, CA) The definition of "book" continues to expand, and the Independent Book Publishers Association (IBPA) honors and encourages the field's innovators with its unique digital book awards program: the Benjamin Franklin Digital Awards (BFDAs). The most recent …
"Late Night Conversation" with IBPA Executive Director Angela Bole »
(PODCAST) In this special Late Night Conversation podcast, IBPA Executive Director Angela Bole talks about the IBPA, camaraderie within the indie community, the importance of each diverse voice within the publishing world, and much more. CLICK FOR ACCESS
IBPA Launches a Cloud-Based E-Learning Platform Exclusively for Members »
(PRESS RELEASE) Introducing a brand new IBPA member benefit! Today, IBPA is pleased to announce an innovative new member benefit: a cloud-based e-learning platform that integrates social media techniques — including chatting, posting comments, blogging, and sharing materials — with quality content vetted especially for IBPA members. We think you're going to like it! Over the next few days, all …
Six Director Candidates, Chosen by IBPA's Board Nominating Committee, Will Stand for Election to the IBPA Board on March 22 »
(NEWS) As announced on December 10, 2013, IBPA's Board Nominating Committee has been busy reviewing applications for the IBPA Board of Directors. Over thirty (30) applications were received for six (6) available seats. After vetting all candidates, the Board Nominating Committee named the following director candidates to stand for election to two-year terms (2014-2016) on …
IBPA Names Deltina Hay as New Board Chair »
(PRESS RELEASE — Manhattan Beach, CA) New media offers indie publishers opportunities to reach a wider audience, says new IBPA chair Deltina Hay The Independent Book Publishers Association (IBPA) named publisher, author, new media expert and IBPA board member Deltina Hay as its new board chair in an announcement made May 29 at the Benjamin …
Don't Trust Mom When It Comes to Book Cover Design »
By Tamara Dever, TLC Graphics A book's cover and spine have a great deal to do with whether potential buyers investigate further. A good cover design can be critical to your book's sales success. This is true even for those not planning to sell in traditional bookstores. Every aspect of creating your book affects your …
10 Reasons Why Authors Should Embrace Twitter »
Stephanie Chandler discusses ten reasons why authors should use Twitter to increase their followers and get more mileage from their blog posts. IBPA is pleased to welcome Stephanie Chandler as our guest blogger. Stephanie will be speaking at IBPA Publishing University 2013 in Chicago April 26-27 on Niche Know-How: Marketing and Promotion Strategies for Reaching …
IBPA Introduces the Benjamin Franklin Digital Awards »
PRESS RELEASE (Manhattan Beach, CA) The Benjamin Franklin Digital Awards (BFDA) will honor achievement in electronic book publishing by individuals and organizations of all sizes, including publishers, developers, designers, manufacturers, institutions, and technology leaders. The Independent Book Publishers Association (IBPA) is proud to announce the launch of the new Benjamin Franklin Digital Awards for digital …


Adherence to guidelines for the treatment of hospitalized elderly patients with community-acquired pneumonia (CAP) has been associated with improved clinical outcomes. This study evaluated the cost-effectiveness of adherence to guidelines for the treatment of CAP in an elderly hospitalized patient cohort.
Data from an international, multicenter observational study for patients age 65 years or older hospitalized with CAP from 2001 to 2007 were used to estimate transition probabilities for a multi-state Markov model traversing multiple health states during hospitalization for CAP. Empiric antibiotic therapy was classified as adherent, over-treated, and under-treated according to 2007 Infectious Disease Society of America/American Thoracic Society IDSA/ATS guidelines. Utilities were estimated from an expert panel of active clinicians. Costs were estimated from a tertiary referral hospital and adjusted for inflation to 2013 US dollars. Costs, utilities, and transition probabilities were all modeled using probability distributions to handle their inherit uncertainty. Cost-effectiveness analysis was based on the first 14 days of hospitalization. Patients admitted to the intensive care unit (ICU) were analyzed separately from those admitted to the ward. Sensitivity analyses with regards to time frame (out to 30 days hospitalization), cost estimates, and willingness to pay values were performed.
The model parameters were estimated using data from 1635 patients (1438 admitted to the ward and 197 admitted to the ICU). For the ward model, adherence to antibiotic guidelines was the dominant strategy and associated with lower costs (−$1379 and −$799) and improved quality of life compared to over- and under-treatment. In the ICU model, however, adherence to guidelines was associated with greater costs (+$13,854 and + $3461 vs. over- and under-treatment, respectively) and lower quality of life. Acceptance rates across the willingness to pay ranges evaluated were 42–48 % for guideline adherence on the ward and 61–64 % for over-treatment on the ICU. Results were robust over sensitivity analyses concerning cost and utility estimates.
While adherence to antibiotic guidelines was the most cost-effective strategy for elderly patients hospitalized with CAP and admitted to the ward, in the ICU over-treatment of patients relative to the guidelines was the most cost-effective strategy.
Pneumonia is one of the leading causes of death in the United States, and a leading cause of hospitalizations is community-acquired pneumonia (CAP) [1, 2]. Hospitalizations are increasing for infectious disease-related problems in the elderly, particularly for pneumonia [3, 4]. For these reasons, the treatment of elderly patients hospitalized with CAP is a major component of health care spending in America and an important public health issue.
Clinical practice guidelines have been developed to guide antibiotic choice in hospitalized CAP by the Infectious Diseases Society of America and the American Thoracic Society (IDSA/ATS) . Clinical practice guidelines are becoming more common across multiple medical disciplines. They are generally formed from evidence-based reviews by experts in their field and promulgated by national or international professional societies in an effort to disseminate best practices and improve patient outcomes. There is evidence to suggest that adherence to guidelines may improve mortality and time to clinical stability (TCS) in CAP [6, 7]. Adherence to the 2007 IDSA/ATS guidelines improves mortality, length of stay (LOS), and TCS in elderly patients hospitalized with CAP .
Cost effectiveness research will be a critical part of healthcare spending and intervention evaluation in the future of American healthcare. It is incumbent upon practitioners to not only deliver medical care with good clinical outcomes, but also to consider those interventions that most efficiently use scarce healthcare resources. The cost effectiveness of practice guideline adherence has been evaluated and found to be cost-effective in a variety of medical conditions [9–12]. The cost effectiveness of adherence to antibiotic guidelines in CAP has only been evaluated in a limited number of studies [6, 13, 14]. This study was performed in an effort to determine the cost-effectiveness of adherence to IDSA/ATS antibiotic guidelines for the treatment of CAP in hospitalized elderly patients (age ≥ 65).
This study is a retrospective study utilizing patient and outcome data from the Community Acquired Pneumonia Organization (CAPO) International Study Cohort, which is an international, multicenter observational study of patients hospitalized with CAP . Data were abstracted from the database from June 1, 2001 to January 1, 2007 for all patients age 65 years or older and included data from 43 centers in 12 countries including North America, South America, Europe, Africa, and Southeast Asia (see Arnold et al.  for details concerning the patient cohort used in this study and the 'Availability of Data and Materials' section). The study was approved by the Human Subject Protection Program Institutional Review Board at the University of Louisville. Additional approval was obtained from the local internal review board for each participating hospital. Patient consent was waived due to the retrospective and observational study design. The initial antibiotic regimen for each patient was evaluated and categorized as adherent, over-treated, or under-treated according to the 2007 IDSA/ATS guidelines as previously described [5, 8]. Patients were stratified into ICU or ward admission status based on their initial admission orders. A patient was considered clinically stable on the day they were switched to oral antibiotics from intravenous antibiotics; ATS criteria for switching to oral therapy were used . A small number of patients were admitted with oral antibiotics as their initial therapy; these patients were considered clinically stable upon admission. Baseline characteristics of the cohorts of interest were compared using chi-square or Fisher exact for categorical data, as appropriate, medians were compared with Kruska-Wallis test, and probabilities compared using Gray's test for difference between cumulative incidence curves .
A 14-cycle Markov model was constructed modeling the four possible states in which a patient could exist during the 14 day observation period (Fig. 1). Each cycle is a 24 h period during the patient's hospitalization. Patients admitted to the hospital (state 1) remained in this initial state until they either reached clinical stability (state 2), were discharged (state 3), or died in the hospital (state 4). Patients who reached clinical stability remained in that state until they were subsequently discharged. Patients initially admitted to the ICU were assumed to remain in the ICU until they died or reached clinically stability, after which they were transferred to the ward. Prior to reaching clinically stability patients were on intravenous medication, after which they were placed on oral medications.
Conditional transition probabilities for each possible transition from state i to state j (see Fig. 1) at time t ∈ [1, 14] were estimated based on the cause-specific transition hazards α ij (t). Non-parametric estimates of the transition hazards were based on the number of individuals making the i → j transition at time t divided by the number of individuals in state i just prior to time t (i.e., the number 'at-risk' of making the i → j transition). Non-parametric estimates of the conditional transition probabilities were then obtained using the Aalen-Johansen estimator with the R package msSurv [18, 19]. Parametric estimates were obtained by first fitting time-dependent Cox regression models to each of the possible transition hazards outlined in Fig. 1. These estimates of the transition hazards were then used to obtain estimated transition probabilities for an individual with a given covariate profile using the R package mstate . The covariates (in addition to adherence to antibiotic guidelines) used in the parametric models were disease severity (pneumonia severity index (PSI) risk class ≥4 vs. <4), presence of multilobar pneumonia, pleural effusion, altered mental status, tachypnea (respiratory rate > 30 breaths/min), hypotension (systolic blood pressure < 90 mm Hg), receipt of antimicrobials within 8 h of admission, pneumococcal vaccination, blood cultures obtained within 24 h of admission, and whether oxygen assessment was done . All covariates were dichotomous, and the parametric transition probabilities were based on the most frequently occurring value for each covariate. Daily transition probabilities (the probability of making an i → j transition from time t to t + 1) were obtained from both parametric and non-parametric estimates and compared to ensure validity. The daily transition probabilities from the parametric multi-state model were modeled as continuous beta distributions in the Markov model based on the estimates and standard errors from the parametric model.
The antibiotic decision making was modeled using three comparators: Adherent, Over-treated, and Under-treated . The multi-state Markov process followed the decision making nodes. ICU admissions and ward admissions were analyzed in two separate models. Cost-effectiveness analyses, probabilistic sensitivity analyses, and a Monte Carlo microsimulation with 10,000 patients were performed. For conciseness only results from transition probability estimates based on the parametric models are reported, however substantive conclusions based on the non-parametric estimates did not differ. "Adherent" was considered the base case comparator, against which the over- and under-treated groups were compared.
Our model required cost and utility estimations for the following unique states: ICU admission status (over-treated, adherent, and under-treated), ward admission status (over-treated, adherent, and under-treated), ward clinically stable (over-treated, adherent, and under-treated), discharge status, and death. Costs were adjusted according the US consumer price index to 2013 US dollars. Average daily hospital costs for a day in the ICU were dynamically modeled, with mean daily costs ranging from $5132 on ICU day one to $3825 for day eight and thereafter (c.f. medical costs reported in Table 4 in Dasta et al. , adjusted to 2013 US dollars). The daily ICU costs were modeled with a gamma probability distribution with parameters κ and θ estimated from reported standard deviations of cost data by Dasta et al.  Mean daily ward costs for treatment of CAP were estimated to be a static cost of $1060 per day (c.f. Table 3, column 'Simple Pneumonia' in Kaplan et al. ). Daily ward costs, like ICU costs, were modeled with a gamma probability distribution with parameters based on standard deviation estimates reported by Kaplan et al.  The initial antibiotic regimen of each cohort was retrieved from the CAPO database. Daily antibiotic costs were estimated based on average wholesale prices (year 2013 value) of each antibiotic obtained from the University of Louisville Hospital (Additional file 1). The daily cost of each respective antibiotic regimen in our database was calculated and averaged for our unique states described above. Admission status antibiotic regimens were intravenous, while patients in clinical stability by definition were on oral medications. Patients initially admitted to the ICU were assumed to transfer to the ward upon reaching clinical stability. The cost associated with each state was the sum of the hospital charges for the location of treatment (ICU or ward) and daily estimated antibiotic costs.
Utility estimations were obtained based on a survey (Additional file 2) administered to an expert panel survey of six CAPO investigators. Each expert was polled independently. While the executive director of CAPO assisted in convening the expert panel, he was not involved in the eliciting of utilities and was blinded to specific utility assessments. The demographics of the expert panel survey were as follows: 50 % male; one Fellow, four Assistant Professors, and one Professor; mean age 43.5; mean years of clinical practice experience was 18. All respondents were currently practicing in the US. Each survey respondent was asked to estimate the utility associated with the following states in the context of a standard gamble: ICU admission, ward admission, and ward clinically stable. Utility was defined as an estimate of relative quality of life on a scale of 0 to 1, with 0 being death and 1 being at home. It was assumed that the utility of each state would be independent of the antibiotic adherence classification. The utility estimates were modeled with a beta distribution, with shape parameters based on the standard deviation of the expert panel survey results.
Probabilistic sensitivity analyses were performed for the hospitals costs and utility estimates, since they were modeled as probability distributions. Sensitivity analyses of the fixed daily drug cost estimates were estimated in a 3-way analysis across ranges $1 to $100 in 20 intervals. Strategy dominance was evaluated across willingness to pay ranges from $0 to $1000, in 20 intervals. This range was based on the generally used threshold of willingness to pay of $100,000/QALY. Since our model cycles corresponded to days, rather than years, a willingness to pay range of 0 to $1000 per quality-adjusted life day corresponds to 0 to $365,000 per QALY .
TreeAge Pro 2015 (Cambridge, MA) software was used for all cost-effectiveness analyses.
There were 1635 patients identified age ≥ 65 whose initial antibiotic regimens could be classified; 1438 of these patients were admitted to the ward and 197 were admitted to the ICU. Patient demographics for the ICU and Ward patients according to antibiotic regimen are summarized in Table 1, while the number and percentage of patients on various antibiotic regimens is given in Table 2.
The estimated daily transition probabilities for both the parametric and non-parametric multi-state models are given in Additional file 3 (ward) and Additional file 4 (ICU). The lines represent the probability of making a transition from one state to another on sequential days. The parametric model estimates were based on the covariate profile corresponding to the most frequent value for each covariate. For the ward and ICU models these were PSI risk class ≥4, absence of multilobar pneumonia, pleural effusion, altered mental status, tachypnea, and hypotension, antimicrobials not received within 8 h of admission, no pneumococcal vaccination, and both blood cultures obtained within 24 h of admission and oxygen assessment done. For the ward model the parametric and non-parametric estimates agree fairly closely, with the parametric estimates appearing smoother in the over-treated case. For the ICU model again there is fairly good agreement between the parametric and non-parametric estimates, though the parametric model generally had higher estimated transition probabilities to clinical stability/discharge status and lower transition probabilities to in-hospital mortality. Note that for both ICU and ward models once an absorbing state (discharge and in-hospital death) is reached the probability to remain in that state is one.
The daily transition probabilities from the parametric model based on the given covariate profile were used to build the Markov model for analysis. The proportions of patients occupying the four unique states in the Markov model over time are represented in Fig. 2. Daily cost and utility estimates for each state are given in Table 3. Per stage and cumulative cost estimates for both models are presented in Fig. 3, demonstrating decreased daily and cumulative costs for the adherent cohort relative to the over- and under-treated cohorts in the ward model. However, in the ICU model the over-treated cohort had decreased costs compared to the adherent and under-treated cohorts. Per stage and cumulative utility estimates are presented in Fig. 4, demonstrating increased utility in the adherent strategy in the ward model and the over-treated strategy for the ICU model.
The cost effectiveness analysis results for the ward model are summarized in Table 4. The adherent strategy was the dominant cost-effective decision in this set of patients. Patients treated with an antibiotic regimen that was adherent to the recommendations of the 2007 IDSA/ATS guidelines experienced lower costs and increased utility compared to patients treated with an over- or under-treatment regimen. On average, total hospitalization costs were $1379 and $799 less in the adherent group compared to the over- and under-treated groups, respectively.
The cost effectiveness analysis results for the ICU model are summarized in Table 5. The over-treatment strategy was the dominant cost-effective decision in this set of patients. Patients treated with an antibiotic regimen that was in excess of the recommendations of the 2007 IDSA/ATS guidelines experienced lower costs and increased utility compared to patient treated with an adherent or under-treatment regimen. On average, total hospitalization costs were $13,854 and $3461 more in the adherent group relative to the over- and under-treated groups, respectively.
Sensitivity analyses are summarized in Tables 6 and 7. The over-treatment strategy remained the dominant strategy across all of the ranges in the sensitivity analyses for drug cost estimates in the ICU model. In the ward model, the adherent strategy was dominant across all variations in ward oral drug costs, but partially dominant across variations in ward intravenous drug costs.
We determined changes in the dominant strategy proportion over a range of willingness to pay values in the probabilistic sensitivity analysis. Since the model measured daily cost and utility estimates, a conversion factor was used and we varied the willingness to pay across a range from 0 to $1000 per quality-adjusted life day, corresponding to 0 to $365,000 per QALY . The over-treatment strategy remained the dominant strategy in > 60 % of the iterations in the ICU model across all levels of willingness to pay, while the adherent strategy remained the dominant strategy in the Ward model (Fig. 5).
Differences in length of stay were the most important determinants of cost in the models, particularly in the ICU. The dominant strategy of over-treatment in the ICU was associated with lower overall length of stay (median = 11 days) compared to the adherent and under-treatment strategy (median = 14 days for both). ICU length of stay varied greatly for the three strategies: over-treatment (median = 4 days), adherent (median = 12 days), and under-treatment (median = 8 days). Length of stay did not vary quite as much in the ward model: adherent (median = 8 days), over-treatment (median = 10 days), and under-treatment (median = 9 days).
The most important finding in this work is that adherence to the IDSA/ATS guidelines regarding empiric antibiotic therapy for elderly patients hospitalized with CAP was cost effective compared to non-adherence in non-ICU patients, but was not the most cost effective strategy in ICU patients. Elderly patients admitted to the ICU with CAP who were treated with an antibiotic regimen in excess of the IDSA/ATS guidelines had lower costs and increased quality of life compared to those treated with an adherent regimen.
The cost effectiveness implications of adherence to treatment guidelines has been evaluated in a limited number of settings, finding that in general, adherence to treatment guidelines is cost effective. Adherence with guidelines for sarcoma treatment was cost effective in a recent study from two European regions . Adherence to guidelines has also been shown to be cost-effective in such diverse fields as intrauterine insemination and hepatitis B therapy [10, 11]. A study from Japan has shown the adherence to guidelines for gastric ulcer therapy is cost effective in that country . Consensus treatment and practice guidelines have the potential to not only standardize care and disseminate best practice measures throughout complex healthcare systems, but also may offer cost effective strategies that are of particular importance in the current era of health care utilization reform.
Adherence to guidelines for the treatment of CAP has been associated with improved outcomes. An analysis of the same CAPO data used in this study found adherence to guidelines improved mortality, LOS, and time to clinical stability in elderly patients hospitalized with CAP . However, the previous study did not separate patients on the basis of admission to the ICU or ward. Nonadherence to guidelines was associated with in-hospital mortality in studies of both community hospitals and tertiary teaching hospitals [25, 26]. These findings of improved outcomes in both hospitalized and outpatient settings with adherence to antibiotic guidelines have been replicated [27–29]. Nonadherence rates were higher in patients treated by non-pulmonary specialists in one study . The cost implications of adherence to guidelines in hospitalized patients with CAP have not been studied as extensively. One study from Europe evaluated the cost-effectiveness of adherence to Spanish guidelines for the treatment of hospitalized CAP in non-ICU patients of any age . This study found that adherence to the guidelines was the dominant cost-effective strategy compared to non-adherence. To our knowledge, this study is the first to evaluate the cost-effectiveness of adherence to guidelines in an exclusively elderly population with CAP in a multi-institutional setting, stratified by admission to the ICU or ward. Additionally, this study accounts for the stochastic nature of a hospital stay by estimating conditional transition probabilities directly from the data using the Aalen-Johansen estimator. This is an improved method by which to estimate cost and utility changes during a hospitalization course, as one is able to estimate daily, conditional changes in the probability of transitioning between states rather than averaging the transition probabilities over the course of an entire hospitalization, thus providing more precise estimates of cost and utility changes.
While the finding that adherence to IDSA/ATS guidelines was the dominant strategy in ward (non-ICU) patients was expected and is consistent with a previous report, it was surprising to find that over-treatment was the dominant strategy in ICU patients . A close analysis of the state occupation probabilities used to build the model suggests the likely explanation is the accelerated time to clinical stability in this cohort of patients, which under our assumptions led to a reduction in ICU LOS for these patients. Daily ICU costs were the dominant driver of total costs in this model. Drug costs, which are a direct consequence of empiric antibiotic therapy choice, are miniscule compared to the daily cost of a stay in the ICU, which is measured in thousands of dollars per day. Thus, any large cost benefit from an antibiotic choice in relationship with the IDSA/ATS guidelines would likely be driven by a reduction in ICU and overall LOS rather than a reduction in daily drug costs. In the CAPO cohort, ICU LOS was shorter in patients who were treated with an over-treated antibiotic regimen compared to an adherent strategy. By hospital day 5, only 43 % of over-treated patients initially admitted to the ICU remained there, while the percentage of patients treated with an adherent regimen remaining in the ICU was nearly twice that (71 %) (Fig. 2). This led to dramatic reductions in daily and cumulative costs, and subsequent improvements in utility for the over-treated group. The marginal (unadjusted) 14-day mortality rate was higher in the over-treated group (18 %) compared to the adherent group (14 %) (Table 1), though differences in adjusted mortality rates were smaller (4.1 % vs. 2.4 %, respectively, Fig. 2). Overall, the lower costs associated with quicker transfer from the ICU to the ward made the over-adherent treatment strategy the most cost effective.
From this analysis, one cannot draw a conclusion of direct causation regarding the implementation of an overly-broad antibiotic regimen and the reduction in ICU LOS, although there certainly seems to be a strong association between an over-treatment strategy and a decreased ICU LOS that leads to reduced hospital costs. One potential explanation is the possibility that the patients in the over-treatment cohort were over-triaged to the ICU compared to adherent and under-treated patients and thus were more likely to leave the ICU earlier, independent of initial empiric antibiotic coverage. However, the initial demographics of our ICU patients suggest that the three antibiotic groups were relatively similar (Table 1). Pulmonary severity indices were not significantly different across the antibiotic groups, nor were the differences in comorbid conditions such as cancer, congestive heart failure, COPD, renal, or liver disease. Though the sample size for the ICU was small, over-treated patients did have a significantly higher probability to reach clinical stability by day 7 (Table 1), and in particular patients that received both a macrolide and a quinolone in addition to a β-lactam. Interestingly, another recent study of hospitalized CAP patients from three world regions found an elevated risk of mortality associated with ICU patients prescribed flouroquinolones relative to macrolides . However, this study did not investigate whether the combination of a flouroquinolone with a macrolide provided any additional benefit, nor did it investigate time to clinical stability or length of hospital stay. These findings suggest that strategies to reduce ICU LOS may include aggressive empiric antibiotic regimens that can be later tailored to more targeted therapy guided by clinical response and microbial laboratory findings.
The findings in this study were robust over a wide range of sensitivity analyses performed. Sensitivity analyses of model parameters in multi-state Markov models are a critical component of the evaluation of model findings, as the model predictions are only as good as the parameters used to build the model. Antibiotic costs were estimated from a single local institution (University of Louisville Hospital), thus a valid criticism would be the external validity of these cost estimates to other hospitals. Sensitivity analyses found that the dominant strategies were robust over a wide range of daily antibiotic costs, thus suggesting that these findings have external validity to other institutions. Utility estimates are also quite subjective. We attempted to control for this using an expert panel of CAPO investigators who are familiar with the care of elderly patients with CAP. Modeling the utility estimates as a probability helps to account for this variability in the probabilistic sensitivity analysis. State occupation probabilities were available for the entire 30 day hospital course for our study cohort. We limited our model to an analysis of only the first 14 days, reasoning that hospitalizations beyond 14 days for CAP in the elderly likely were the result of complex, confounding factors and associated comorbidities that were unaffected by the initial empiric antibiotic coverage. Sensitivity analysis, however, did confirm the cost dominant strategies remained the same for models analyzed > 14 days.
The results reported here are based on the adjusted transition probability estimates based on the parametric models. However, conclusions based on the non-parametric estimates were similar, with adherence being the dominant strategy for the ward and over-treated the dominant strategy for the ICU. If the setting of the Markov model was extended to include post-discharge utility, then the difference in unadjusted mortality between the adherent and other antiobiotic groups might have a greater impact on the cost-effectiveness analysis. The most salient difference between the adjusted and unadjusted models was the reduced probability of mortality and increased probability of discharge and reaching clinical stability in the ICU for the adjusted model relative to the unadjusted estimates (Additional file 5).
The findings in this study must be considered with consideration of the shortcomings. Decision analysis models are only as strong as the parameters used to build them. While every effort was made to develop the model with realistic parameters, limitations arise in estimating transition probabilities, cost and utility estimates, and perspective of the model. Baseline differences in the clinical risk factors among the three groups, including PSI score and age, clearly have an impact on estimates of in-hospital mortality and discharge rates. While attempts were made to limit their effect on the model using adjusted transition probability estimates, differences in clinical pathways, practice, and resource utilization among the participating institutions and their effects on the clinical outcomes measured in this study cannot be discerned. An additional limitation is the assumption that patients transitioned out of the ICU once they reached clinical stability. This may not necessarily be the case, as patients may require longer stays due to deterioration of other comorbidities or other reasons. However, on average patients who reach clinical stability sooner should also leave the ICU earlier, so the observed differences between antibiotic treatment classes should be relatively robust. Finally, the estimated transition probabilities for over-treated patients in the ICU were based on only 28 patients, and require independent validation of the finding that this treatment regime was most cost-effective for these patients in the hospital setting.
A second limitation of the model is how patient utility estimates were obtained. The sample size of expert opinions (six) was limited and only from US institutions. While the experts were independently polled and we have no reason to believe there responses were subject to bias, an alternative method for obtaining a consensus (e.g., the Delphi method) might be preferable. Co-morbidities were not factored into the utility estimates both to simplify the data collection and because we felt this was not directly related to CAP/CAP therapy. Finally, using expert opinions to model patient-centric utilities is less desirable than patient-based estimates. While expert judgments concerning utilities should be used sparingly, it became pragmatically difficult to elicit utilities from patients and a data source does not exist in which the specific utilities we needed were present. A superior approach would be to estimate utilities based on appropriate patient questionnaires, perhaps as part of a prospective study to include post-discharge outcomes. While we did not have the resources to obtain such data as part of this study, future research will definitely take this into consideration.
Third, the CAPO data used in this study does not contain cost data, and external references and data were used to model both hospitalization and antibiotic regimen costs. While it may prima facie seem inconsistent to model costs from two different sources, we elected to use data from Dasta et al.  in addition to Kaplan et al.  for two reasons. First, the data from Dasta et al. suggests that ICU costs are not constant, rather they change over time. Hence these data are uniquely appropriate for use in a Markov model, in which one can capture these differences and make more accurate inferences about differences in costs based on how many days are spent in the ICU. Second, the data from Kaplan et al. only provides estimates of the total hospitalization costs for patients initially treated for CAP in the ICU. Thus these estimates capture both costs in the ICU and in the ward, and an average cost per day calculation from the Kaplan data would be "contaminated" with time spent on the ward. Hence it is a less fit estimate for daily ICU costs compared to the Dasta et al. data. Lastly, costs were estimated based on US institutional rates but applied to international data. However, since the results were consistent across sensitivity analyses for costs and willingness to pay thresholds, we feel the conclusions are relatively robust to any regional variation in costs.
Finally, the conclusions here are based on the short-term utility and cost-effectiveness for CAP patients during their hospital stay. Since we did not have direct data concerning post-discharge mortality and quality of life for this cohort of patients, we did not attempt to model long-term cost-effectiveness. While we have no evidence to suggest that post-hospitalization outcomes are different among the treatment cohorts in this study, we acknowledge that it is a limitation of the model that it incorporates only a fraction of the life-expectancy for these patients. However, our multi-state modeling approach is easily extendable to prospectively collected data on patients discharged after hospitalization due to CAP [32–35]. For example, one could model the post-discharge outcomes as additional states within the Markov model, tracking transitions between occurrence of various co-morbidities, re-hospitalizations, and mortality. The multi-state model can also be coupled with causal inference approaches to assess the effect of various interventions/treatment regimens on outcomes of interest. For example, such models have been fit in other disciplines to evaluate whether partial versus full time sick leave and having a cooperation agreement is helpful in reducing sickness absence from work . In a similar fashion, a multi-state model coupled with causal inference approaches may form the basis of active, prospective evaluation of antibiotic choices and the cost-effectiveness of adherence to recommended guidelines. Patient quality of life would then be ideally collected using appropriate designed patient questionnaires. As a final thought, such studies would also need to take into consideration the effect of antibiotic regimen on antimicrobial resistance. The societal costs of antibiotic over-treatment pressures on the development of antimicrobial resistance are hidden costs to the over-treatment strategy that must be considered.
In conclusion, this study found the adherence to IDSA/ATS guidelines in elderly patients hospitalized with CAP was cost-effective for patients admitted to a non-ICU setting. For patients admitted to the ICU, over-treatment relative to adherence to IDSA/ATS guidelines was associated with decreased ICU and overall LOS; subsequent to these LOS reductions, over-treatment was the most cost-effective strategy in these particular patients. The prospective evaluation of empiric antibiotic treatments in CAP and the resulting cost implications of these choices remain to be determined.
The CAPO database is owned and maintained by the Division of Infectious Diseases at the University of Louisville (see http://caposite.com). Permission was granted to access the data by Dr. Julio Ramirez. The specific data used in this study is available upon request from the authors.
The authors gratefully acknowledge the work of the CAPO investigators in compiling and maintaining the CAPO data base. The authors also acknowledge the constructive comments from the Associate Editor and two reviewers, which helped improve the quality of this manuscript.
JAM and GNB conceived of the project and supervised the research. MEE, GNB, and JAM conducted the statistical and cost-effectiveness analysis. FWA and LAP compiled the antibiotic usage and daily cost data. JAR helped supervise the research and contributed to the clinical interpretation of the results. MEE drafted the manuscript, and all authors read and approved the final version of the manuscript.


text:
Tojice (Duits: Tojitz) is een Tsjechische gemeente in de regio Pilsen, en maakt deel uit van het district Plzeň-jih.
Tojice telt 89 inwoners.

Gemeente in Plzeň-jih


text:
Japanese Box Office, March 12-13
posted on 2011-03-21 22:29 EDT by Egan Loo
Doraemon drops to #2; Gantz , Macross Frontier , Ashita no Joe stay on charts
Doraemon: Shin Nobita to Tetsujin Heidan - Habatake Tenshi-tachi , Yukiyo Teramoto and Shinei Animation 's remake of the 1986 film Doraemon: Nobita to Tetsujin Heidan ( Doraemon : Nobita and the Platoon of Iron Men), dropped from #1 to #2 in its second weekend. It earned the equivalent of US$1,959,036 on 261 screens for a total-to-date of US$8,384,832.
The first film in Shinsuke Satō 's live-action adaptation of Hiroya Oku 's Gantz action manga fell from #5 to #7 in its seventh weekend. It earned US$373,339 on 223 screens to add to its total of US$38,589,007.
Macross Frontier: Sayonara no Tsubasa , the second anime film based on Shoji Kawamori and Satelight 's Macross Frontier science-fiction series, dropped from #8 to #9 in its third weekend on Kogyo Tsushinsha's chart. (It dropped from #7 to #8 on Box Office Mojo's chart.) It earned US$272,034 on 28 screens for a gross-to-date of US$4,361,068.
The live-action film version of Asao Takamori and Tetsuya Chiba 's classic boxing manga Ashita no Joe dropped from #10 to #13 in its fifth weekend with US$158,815 on 192 screens. It now has a gross-to-date of US$12,124,367.
The live-action film adaptation of Mainichi Kaa-san is no longer listed on either chart. The new #1 and #3 films are the live-action drama spinoff SP Kakumei-Hen and Disney's 3D animated film Tangled .
Sources: Kogyo Tsushinsha, Box Office Mojo
This article has a follow-up: Japanese Box Office, March 19-20 (2011-03-28 13:51)
follow-up of Japanese Box Office, March 5-6


Remington has expanded its selection of shotshells to include a new line featuring Barnes Sabot Slugs.
The Remington Premier Expander line will come in both 2 ¾" and 3", for 12 and 20 gauges. The Barnes all-copper tipped Expander slug is engineered with six cutting petals that deploy at impact, to help down game more quickly. The entire Remington Premier shotshell line will feature its ballistics listed on its packaging, so customers know exactly what they're purchasing just by looking at the box.


The PM-128-E is a 3.5 digit LCD panel meter..The unit can be set to work with either a 5V DC or 9V DC power source.It will perform with either a common ground or an isolated ground and is supplied with easy to use jumper points so the end user can easily set the measurement range required. Construction is very professional, implementing SMT technology.
A great quality, accurate display.
The PM-128-E is a 3.5 digit LCD panel meter.
The unit can be set to work with either a 5VDC or 9VDC power source.
It will perform with either a common ground or an isolated ground and is supplied with easy to use jumper points so the end user can easily set the measurement range required.
Construction is very professional, implementing SMT technology.
The display is a standard Grey LCD & has Black numbers.
Primary section - approx. 2 5/8" (66mm) wide, 1 5/8" (42mm) high & 3/4" (19mm) deep.
Secondary section - approx. 2 3/4" (70mm) wide, 1 1/4" (32mm) high & 1/4" (7mm) deep.
Total height - approx. 1 5/8"(42mm), 2 3/4" wide (70mm) & 1" (25mm) deep.


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You are trying to execute a Java plugin as a macro. Please read the description how to install the plugin: giovanilicalciosc.com It can segment objects from 3D images where 3D objects are labelled on their outline, like cells labeled on their membrane, as shown in the. 2D feature point-tracking plugin for the automated detection and analysis of particle trajectories as recorded by video imaging in cell biology.
6 Mar - 2 min - Uploaded by Cheng Ian How to take area measurements of cells using ImageJ One thing I notice with this method is. 28 Mar - 1 min - Uploaded by Erica Warkus How to Count Cells in 3D using ImageJ (Fiji) - Duration: MiketheMichael 8, views. Outline Area of Specific Cell Density. Hi All, I am trying to automate the detection of cell clusters based upon my specified cell density. Optimally. Cell Outliner, Find cell edges using marked seed points. Best suited to identify round cells with edge pixels either lighter or darker than the cell. Difference of.