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Tag: Singapore
Why Kuching should be on the radar of every digital nomad
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As a digital nomad in Southeast Asia, there's a good chance you're used to doing things the unconventional way. If that's the case, you ought to read on and learn about the place dubbed the next Chiang Mai.
We're talking about Kuching, Sarawak.
Source: appc2019.ifm.org.my
Located in the Malaysian part of Borneo, Kuching is the capital city of Sarawak, a founding partner in the nation of Malaysia. Modern yet laid back, Kuching has outstanding infrastructure yet remains very much in touch with nature.
Modern Kuching can be traced back to 1841, when James Brooke, the son of an English judge in the East India Company who happened to be sailing the Malay Archipelago, helped the King of Brunei crush a rebellion in southern Borneo.
Source: Culture Trip
As a reward, Sultan Omar Ali Saifuddin II of Brunei gave him Sarawak, a swampy and mostly jungle-covered land inhabited by notorious and very dangerous headhunting indigenous tribes.
And that's how James Brooke became the first White Rajah and the Kingdom of Sarawak was born. With the exception of the second world war period from 1941 – 1945 when it was occupied by the Japanese, Sarawak was a standalone kingdom under the White Rajahs until 1946.
At the end of the occupation of Sarawak, on 11 September 1945, the British military took over Sarawak for 7 months before handing it back to Rajah Charles Vyner Brooke.
Seeing the damage done by the Japanese, Rajah Brooke realised he no longer had the resources to develop Sarawak. He hoped that with the cession of Sarawak as a British crown colony, the British would be able to rebuild Sarawak's infrastructure and develop its postwar economy.
So Sarawak became a British colony from 1946-1963 before becoming equal partners along with Peninsular Malaya, Sabah and Singapore to form Malaysia. (Singapore later withdrew itself and became an independent nation in 1965).
Source: blogspot.com
The White Rajahs played an important role in uniting the multiple races in Sarawak. With multiple ethnicities such as Malay, Iban, Bidayuh, Chinese and Indians residing harmoniously, Kuching has become a true melting pot of cultures and is seen by many as a role model for cultural and religious harmony.
Kuching is called 'The City of Cats'. You will find cat murals and statues everywhere in the town centre. The city's obsession really stems from its name. The word 'Kucing' means cat in the Malay language.
How Kuching got its name is a mystery. Some say that when the first Rajah of Sarawak, James Brooke, arrived around 1839, he pointed to the settlement and asked a local what it was called. The local, mistakenly thought he was pointing at a passing cat and said 'Kucing' (pronounced Coo-ching).
A descendant of the passing cat that James Brooke mistakenly pointed at. Or so we like to think. 😉 Source: Aish Mann
Others claim the city was named after trees that once grew throughout the area, bearing small fruit called mata kucing, or 'cat's eye fruit', which is similar to lychee. The last theory is that the name was chosen when residents discovered short-tailed cats living along the banks of the mighty Sarawak River which flows through the city.
As you walk around the streets of Kuching, you'll feel the soul of the city in its historic buildings, vibrant street art, and warm, friendly people.
'The Early Mercers' at India Street. Source: Aish Mann
With lush rainforests and the South China Sea in close proximity, a chilled authentic vibe with all the luxuries of a modern city, Kuching is the perfect haven for digital nomads who want an idyllic environment in which to work.
So, why should digital nomads base themselves in Kuching?
We asked a few who have made the move to Kuching and here's what one said:
"After visiting a lot of tourist places, I found a peaceful and quiet place in Kuching to focus on my work. iCube is very comfortable and convenient. I can find everything I need in the nearby mall Icom Square with lots of food places and a gym. People here are very calm, kind and respectful. Everyone speaks English, so it's easy to connect with locals. It's not the case everywhere in Asia and this is a very appreciable point for me." –Virginie Sarachman, France.
The sky puts on a spectacular show almost every day at Waterfront, Kuching.
We also spoke to Melvin Liew the 'go to' guy for digital nomads in Kuching. Here's what he had to say about the gradually growing digital nomad community in Kuching.
"We saw the trend (of digital nomad arrivals) increasing when the tourism sector in Sarawak started to grow. It is essential to have a solid community and the constant improvement of infrastructure for Digital Nomads in Sarawak." – Melvin Liew, Director, iCube Innovation
Another reason for digital nomads to live in Kuching
If you're from Europe or North America, you get a 90-day visa on arrival, compared to a 30-day visa for Indonesia and a 2-week visa for Thailand.
Source: tour-borneo-malaysia.com
That means you have plenty of time to get settled in and every time you leave the country, you get a 3-month visa on your return.
Now, it may seem like Kuching is in some faraway, inaccessible land, but the truth is, you could be sipping a cold beer in the hustle and bustle of Orchard Road, Singapore in a mere 3 hours.
Singapore too sterile for you? Then you can be in downtown Kuala Lumpur in 3 hours too. The beautiful beaches of Kota Kinabalu are just 2 hours away.
Fancy something laidback? Then the city of Bandar Seri Begawan would be up your alley with direct flights from Kuching that will get you there in less than 2 hours. And the cherry on the cake is that flights to all these destinations start from just US$20!
Now, where should you stay in Kuching?
Kuching has accommodation for all budgets. Airbnb works pretty well here and you have an array of apartments/condominiums to choose from.
James from locationindependent.co.uk suggests placing yourself as close to the Waterfront area as possible. He says there really isn't an expat neighborhood but Waterfront is the most central part of Kuching and almost all the main spots are walkable from there.
Another main area is Padungan Street. It's a bit further away from the town centre but it is a lively street with some of the best food options.
If you prefer a short-term rental, we suggest you come and stay in a hotel to personally view places before renting, just to be on the safe side.
How do you move around town?
Kuching is the most pedestrian-friendly city in Malaysia, especially if you live around the town centre.
Carpenter Street.
Car or motorbike rentals are available but we recommend Grab (equivalent of Uber) and Maxim. Both apps work flawlessly around Kuching and each ride costs between US$2 – 4 if you're in the town area.
Where to stuff your face
Now that you're mobile, it's time to get some delicious food into that hungry tummy!
Lucky for you, Kuching is full of gastronomical marvels.
With numerous influences from indigenous tribes as well as Chinese, Malay and Indian cultures, you'll never run out of new things to appease your hunger.
One of the most famous dishes you absolutely have to try is Sarawak Laksa. This typical Sarawakian breakfast dish is made of a special prawn-based broth thickened with coconut milk.
A perfect, mouth-watering bowl of Sarawak laksa.
Served with a generous portion of omelette strips, crunchy bean sprouts, chicken shreds, and plump prawns as well as a squeeze of calamansi lime for extra zest and thick sambal paste on the side.
The late Anthony Bourdain called Sarawak Laksa, 'The breakfast of the Gods'.
#Laksa #Kuching Breakfast of the Gods
A post shared by anthonybourdain (@anthonybourdain) on May 28, 2015 at 6:57pm PDT
One of the best places to find a fiiine bowl of Laksa is at Chong Choon Cafe. Remember, Sarawak laksa is a breakfast dish, so it sells out by around 10 am.
Other must-try dishes in Kuching include Kolo Mee at Annie Kolo Mee or Oriental Park Cafe and authentic Sarawakian tribal food at Tribal Stove the Dyak.
A beautiful bowl of Kolo Mee.
One meal with a drink in a traditional Kuching restaurant or coffee shop should cost you no more than US$2-5. Here's a more comprehensive food guide with tips on where to find cheap eats in Kuching.
How do you pay for stuff?
You can't use US dollars to pay like in Cambodia. The currency used in Kuching is Ringgit Malaysia (RM). Although some places only accept cash, most places accept credit cards or E-Wallets.
Some of the E-Wallets you can use are GrabPay, SarawakPay, FavePay, and Boost E-wallet.
What's the internet like?
Ah yes, internet: the lifeline of a digital nomad.
Connectivity issues can be quite scary if your livelihood depends on the internet. And the Bornean rainforest doesn't exactly sound like the kind of place you can do seamless Video calls. Buut…
Don't worry, Kuching has all-around 4G coverage and you can find wifi at almost every cafe.
The 3 main service providers in Sarawak with solid coverage are Celcom, Maxis and Digi.
You can pick up a sim card at the airport for as low as US$8 and this will last you a whole month with constant coverage!
Here's a price comparison between the service providers.
Now that you're settled in and well connected, it's time to look for a place to work.
There are a number of co-working spaces available but the main curator of the digital nomad community is iCube Innovation.
Source: coworker.imgix.net
They have the most up-to-date facilities if all you want to do is put your head down and get some work done.
Their packages start from as low as US$36 per month for a hot desk which is substantially lower than co-working spaces in Bali and Chiang Mai where average monthly packages cost US$100 and US$120.
Other than iCube, other interesting co-working spaces are MaGIC Sarawak and The 381 Hub.
If you'd rather work from a new location every day, we've got you covered! There are plenty of cafes around town where you can set up shop. Here's a list of some of the most aesthetically pleasing and work-friendly cafes in and around the city centre:
Tease by Jase's Tea House
Commons at The Old Courthouse
The Coffee Clinic
Kai Joo Cafe
Coffee Obsession
After-work shenanigans
We're going to give it to you straight. If you're a party animal, Kuching isn't for you. [Pro tip: You can always head to Kuala Lumpur and paint the town red there!]
Drinks and Art. What better way to relax after a long day of work? Source: Aish Mann
However, if you like to unwind and chill with a cold beer and good ambiance, there are a number of places you can try. Note, a bucket of four beers in Kuching usually costs around US$8.
Bear Garden
Drunk Monkey Old Street Bar
The Wayang
Borneo Rednecks
A stay in Sarawak isn't complete without Tuak. Tuak is a Sarawakian rice wine. You can usually find it at bars around Kuching. Try it, but be careful…
What else is there to do?
After working diligently and finishing a few months' work in a few days, you're bound to want to do some touring.
Other than a promising, laid back, and focused environment, there are plenty of activities to help you get close to nature.
When you're looking to get out of the city, you can head to sites around Kuching. Check out our articles on the magnificent caves and peculiar wildlife found in Sarawak. You can be soaking in a natural hot spring or exploring millennia-old caves in a matter of hours!
Miri is an interesting destination, more lively than Kuching, it also has the best dive sites in Malaysia. Subscribe to our newsletter to get content like this sent straight into your inbox!
All in all, Kuching is a perfect destination for digital nomads because of how gentle it is. If you're a digital nomad looking for an affordable, tranquil place to get some work done, Kuching should definitely be on your radar.
Tags Borneo, Brunei, Chiang Mai, delicious food, head, James Brooke, Kolo Mee, Malaysia, Melvin Liew, Modern Kuching, Padungan Street, Peninsular Malaya, Rajah Charles Vyner Brooke, Sarawak Laksa, Singapore, Source Aish Mann, Source Culture Trip, Southeast Asia, Thailand, White Rajahs
Sarawak's gateway city – Kuching
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Darul Hana Bedestrian bridge spanning the Sarawak river
'Sarawak's gateway city of Kuching is a quick hop from Singapore or Kuala Lumpur, loaded with heritage, culture and culinary discovery. From a Kiwi perspective, it's still an under-the-radar destination as Mike Yardley writes.
It's easy to fast become enamoured with Kuching, sweeping you up in its warm, hospitable and clingy tropical embrace.'
Read more at Otago Daily Times Online News
Tags Darul Hana Bedestrian, Kuala Lumpur, Kuching, Mike Yardley, Sarawak, Singapore
Sarawak's rich river gateway
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'From a Kiwi perspective, it's still an under-the-radar destination. Sarawak's gateway city of Kuching is a quick hop from Singapore or Kuala Lumpur, loaded with heritage, culture and culinary discovery, as Mike Yardley writes.
Tags Kuala Lumpur, Kuching, Mike Yardley, Sarawak, Singapore
SARAWAK SPREADS HER "PROMOTIONAL WINGS" TO ASIA
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Kuching – August 13th: The Sarawak Tourism Board ('STB') has added another milestone in her efforts to boost Sarawak's tourism through a collaborative effort with AirAsia and Laduni Services Sdn Bhd. to ensure that Sarawak's brand will be widely seen on selected aircrafts flying in the region.
YB Datuk Abdul Karim Rahman Hamzah, Minister of Tourism, Arts, Culture, Youth and Sports Sarawak giving thumbs up to one of Sarawak Ad Panel on AirAsia aircraft witness by Sharzede Datu Haji Salleh Askor, CEO of STB and Dato Aziz Bakar, AirAsia Board of Director.
Through this collaboration, the overhead cabin compartments of 5 AirAsia planes will be prominently adorned with visuals depicting Sarawak as a destination full of life, vibrancy and excitement, showcasing various attractions of Sarawak's culture, adventure, nature, food and festivals.
The collaboration was officiated by the Minister of Tourism, Arts, Culture, Youth and Sports Sarawak, YB Datuk Abdul Karim Rahman Hamzah at a signing ceremony held at the Kuching International Airport today.
This promotional effort on the 5 aircrafts involves AirAsia Malaysia and AirAsia Thailand, reaching out to 6 countries around Asian countries for duration of one year. Some of the key destinations include Kuala Lumpur, Miri, Kota Kinabalu, Langkawi, Johor Bharu, Kuala Terengganu, Alor Setar, Penang and Kuching in Malaysia, Bangkok, Phuket and Chiang Mai in Thailand, Chennai, Kochi and Kolkata in India, Ho Chi Min City, Danang, Hanoi in Vietnam, Medan and Jakarta in Indonesia, Phnom Penh and Siam Rep in Cambodia, Chongqing, Hangzhou, Kunming and Shenzhen in China, Bandar Seri Begawan, Brunei and Singapore.
In addition, Sarawak will also be featured in the coveted 360 inflight magazine and other digital platforms at KLIA2.
YB Datuk Abdul Karim Rahman Hamzah said: "We hope that this promotional initiative will be able to give Sarawak greater brand visibility in the region targeting the correct audience among travellers. It serves to convey not only our promotional messages but a chance to showcase our State's iconic visuals including the UNESCO World Heritage Site of the Mulu National Park, Sarawak Laksa, Tusan beach, Rainforest World Music Festivals and the Rafflesia flower amongst others."
Flight connectivity has always been a key structural challenge for the State. It is hoped that promotional efforts such as this will enhance visibility in prime catchment areas within the region.
Echoing the Minister, STB's CEO Sharzede Datu Salleh Askor said, "Sarawak tourism sees this private-public sector collaboration as a good synergy and consolidated initiative to promote Sarawak to its key target markets. Sarawak has many hidden gems that are waiting to be discovered and aircrafts are certainly one of the best platforms to boost visibility and capture tourists travelling around the Asian countries mentioned."
Sharzede added that STB is also going strongly on promotions in the digital media realm to capture air travellers who are IT savvy, many of whom tend to use Online Travel Agencies (OTAs), for their travels.
This latest collaboration follows the earlier 'Visit Sarawak Campaign' AirAsia aircraft livery, which was launched on February 2, this year. These are among STB's promotional strategy to create visibility for Sarawak in the domestic and International markets.
Tags AirAsia, Chiang Mai, Ho Chi Min City, Johor Bharu, Kuching August, Kuching International Airport, Laduni Services Sdn Bhd, Langkawi, Malaysia, Minister, Miri, Mulu National Park, Penang, Phnom Penh, Phuket, Sarawak Laksa, Singapore, STB, Tourism, Vietnam
Desaru Coast
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Key five reasons why you should go Desaru Coast fast!
I have made up my mind to head "down south" again this year after I was impressed by the development of the state of Johor when I visited the place a year ago. This round, I decided to take an in-depth travel to Desaru Coast, which spans over 3,900 acres along a pristine 17km beachfront that faces eastwards over the clear ocean waters.
I'm well prepared to share with you my exploration to this place as something new and exciting are waiting all of us there. Let's see what excite me during my trip.
The stunning Desaru Coast Hard Rock Hotel
The 365-room hotel is linked to a newly built world-class waterpark via its ground level. Overlooking the man-made beach and wave pools, Desaru Coast Hard Rock Hotel features eco-friendly themed, music-inspired elements as well as a resort-styled accommodation experience for its guests. Just trust me, you will definitely wish to visit here again and again after your first trip here. Well, if you are Johoreans or Johor residents, you can keep track of 50% discounts offer before your trip here.
The hotel rooms, at first glance might be quite similar to other typical hotel rooms, but in fact it got something make you feel it is still above your expectation as it takes everything with attention to detail (you can see umbrella, weighting machines, complimentary minibar and snack tray in your room and the guitar logo is printed on its pillow). Refill water bottle and water dispenser are available to reduce the usage of its plastic bottle. Guests will receive a personalised welcome message when switching on TV and they can enjoy a great selection of rock music.
Themed Rock Star concept, all guests can be entertained by live band daily as scheduled. There is a memorabilia exhibition of the Rock Stars Collection and a Sound of Your Stay Music program in a complimentary audio experience for its guests to either enjoy creating own personalised playlist, playing a music instrument or listening to 10 specially-curated records etc at specific schedule.
Besides, a 23-acre waterfront landscaped retail and lifestyle village, offering exciting retail, restaurants, cafes and entertainment outlets are just within walking distance from the hotel.
World-class Desaru Coast Water Challenge Park
Even though the weather is hot in Malaysia, but it will not stop anybody, both young and old from exploring this newly-built theme park. Featuring more than 20 wet and dry rides, slides and attractions, this waterpark can accommodate up to 12,000 guests at one time. It is home to unique rides including the first-ever water coaster in the region and one of the biggest wave pools in the world. You will find it a great splashing time with your family and friends here.
Taking "Kraken's Revenge" as example, it brings guests to the sky through its shipwreck and throw them in fast speed to the water pools.
It creates excitement and fun with loud screaming heard everywhere inside the theme park.
Golfing Paradise – The Els Club Desaru Coast
Set in the heart of Desaru Coast, The Els Club Desaru Coast features 45-holes of golf in total, with two distinct clubs; Ocean Course, a 27-hole golf course designed by Ernie Els and Valley Course, an 18-hole golf course designed in collaboration with Els' long standing friend and major champion, Vijay Singh.
Managed by world-renowned management organisation, Troon Golf, the experience, service and condition will be of the highest order and will bring a new standard to gold in Southeast Asia, giving members and guests the assurance their experience will be first-class each and every time they play.
Complimentary shuttle bus is available for guests to The Els Club from Hard Rock Hotel. Golf lovers can definitely enjoy a nice stay with great golfing experience. For non-golfers, you can also enjoy the lush greenery view for the stunning golf course.
Special events and activities
To position Desaru Coast as a premium destination resort, a host of exciting events and activities will be held all year-long that promises great fun for whole family and create memories that will last a lifetime. Its first edition of Desaru Coast Gourmet Series, themed "A Malaysian Journey", featuring award winning Michelin Grand Chef, Emmanuel Stroobant is one of the examples that offering exclusive dining experience that took place in Dec last year for its guests. Look forward for the remaining five-series of this special curated dining program in 2019, which is partnered with Singapore's culinary event organisers, SAVOUR.
It is proud to say that I managed to sample the six-course dinner, a first-of-its-kind mouth-watering fusion flavour during my visit served by the celebrity chef Emmanuel.
Desaru Coast Gourment Series is part of "Desaru Coast Live Series", a curation of special events focusing on music, gourmet and lifestyle, which includes sports, designed exclusively for Desaru Coast with the aim to nurture it as a signature events destination.
Key Upcoming Development
Upcoming components due to open in 2019 include renowned hotels such as The Westin Desaru Coast Resort, Anantara Desaru Coast Resort Villas and OneOnly Desaru Coast. Besides that, Desaru Coast Conference Centre, a fully-equipped multipurpose venue that can host up to 1,000 participants is another key attractions for the entire development to cater to corporate functions, meetings, exhibitions and entertainment events.
Tags Anantara Desaru Coast Resort Villas, Desaru Coast Conference Centre, Desaru Coast Gourment Series, Desaru Coast Gourmet Series, Desaru Coast Hard Rock Hotel, Emmanuel Stroobant, head, Johor, Malaysia, Michelin Grand Chef, Ocean Course, retail, SAVOUR, Singapore, Sound, Southeast Asia, Taking Kraken, Themed Rock Star, Troon Golf, Vijay Singh


Twenty years ago my wife and I had visitors from New York, and their car broke down on a country road about a mile from our home. One of them panicked because there were no phone booths from which to call for help. Nebraska is a place where there can be a lot of room between one land-line and the next. Carol V. Davis of California did a residency at Homestead National Monument, and this is one of the poems that came out of it.
a creeping dawn, slow ticking toward dusk.
cicadas faint; the blackbirds half-heartedly singing.
of superstitions that squeezed them from all sides.
They camped under stars that meant no harm.
It was the silence that alerted them to danger.
its doors and blinked their eyes until daylight.
We do not accept unsolicited submissions. American Life in Poetry is made possible by The Poetry Foundation (www.poetryfoundation.org), publisher of Poetry magazine. It is also supported by the Department of English at the University of Nebraska-Lincoln. Poem copyright ©2013 by Carol V. Davis, "Animal Time," from Harpur Palate, (Vol. 13, No. 1, summer/fall 2013). Poem reprinted by permission of Carol V. Davis and the publisher. Introduction copyright © 2019 by The Poetry Foundation. The introduction's author, Ted Kooser, served as United States Poet Laureate Consultant in Poetry to the Library of Congress from 2004-2006.


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Tag: AEGIS
Report – Navy Aegis Ballistic Missile Defense (BMD) Program: Background and Issues for Congress
Posted on October 19, 2017 by Jim
Issues for Congress regarding the Aegis BMD program include the following: 1. required numbers of BMD-capable Aegis ships versus available numbers of BMD-capable Aegis ships; 2. a proposed reduction in planned procurement quantities of SM-3 Block IB and IIA missiles under the FY2018 budget submission, compared to planned quantities under the FY2017 budget submission; 3. […]
Issues for Congress regarding the Aegis BMD program include the following: 1. required numbers of BMD-capable Aegis ships versus available numbers of BMD-capable Aegis ships; 2. a proposed reduction in planned procurement quantities of SM-3 Block IB and IIA missiles under the FY2018 budget submission, compared to planned quantities under the FY2017 budget submission; 3. whether the Aegis test facility in Hawaii should be converted into an operational Aegis Ashore site to provide additional BMD capability for defending Hawaii and the U.S. West Coast; 4. burden sharing—how European naval contributions to European BMD capabilities and operations compare to U.S. naval contributions to European BMD capabilities and operations; 5. the potential for ship-based lasers, electromagnetic railguns (EMRGs), and hypervelocity projectiles (HVPs) to contribute in coming years to Navy terminal phase BMD operations and the impact this might eventually have on required numbers of ship-based BMD interceptor missiles; 6. technical risk and test and evaluation issues in the Aegis BMD program; and 7. the lack of a target for simulating the endo-atmospheric (i.e., final) phase of flight of China's DF-21 anti-ship ballistic missile. Navy Aegis Ballistic Missile Defense (BMD) Program Congressional Research Service Continue reading "Report – Navy Aegis Ballistic Missile Defense (BMD) Program: Background and Issues for Congress"
Posted in Defense, Including Radar, Missiles and EW, ENGINEERINGTagged AEGIS, Air and Missile Defense Radar
Another Accomplishment for Lockheed Martin: Intermediate Range Ballistic Missile Blocked by Aegis BMD
Yet another accomplishment was achieved by Lockheed Martin's Aegis Ballistic Missile Defense (BMD) on April 14, 2011. Aegis BMD was proven effective against intermediate range ballistic missiles. USS O'Kane (DDG-77, Arleigh Burke-class destroyer ) was used for the exercise. Here is how it worked. • Aegis BMD used AN/TPY-2 radar to track the missile • […]
Yet another accomplishment was achieved by Lockheed Martin's Aegis Ballistic Missile Defense (BMD) on April 14, 2011. Aegis BMD was proven effective against intermediate range ballistic missiles. USS O'Kane (DDG-77, Arleigh Burke-class destroyer ) was used for the exercise. Here is how it worked. • Aegis BMD used AN/TPY-2 radar to track the missile • Using a launch-on-remote function Aegis BMD system detected the threat very early in flight • A Standard Missile was fired to destroy the inbound missile • Round of applause for Lockheed Martin What does this mean for the rest of us? It means that our US Navy ships can defend themselves more effectively expanding the battle space. There are 25 Aegis BMD-equipped ships currently deployed – 21 U.S. Navy ships and four Japanese destroyers. Three additional ships are planned to become BMD-capable this year.
Posted in Defense, Including Radar, Missiles and EWTagged Lockheed Martin, NAVY, AEGIS, Aegis BMD, Ballistic Missile Defense System, Bethesda, DDG-77, Intermediate Range Ballistic Missile, Md, Missile Defense Agency, remote AN/TPY-2 radar, shipboard, SPY-1 radar, trajectory, USS O'KANE1 Comment on Another Accomplishment for Lockheed Martin: Intermediate Range Ballistic Missile Blocked by Aegis BMD
GAO REPORT OUTLINES AEGIS ASHORE CHALLENGES
Posted on December 30, 2010 by Val
Missile Defense Agency officials say that developing the Aegis Ashore program would not incur high risk, the Government Accountability Office contends "a certain degree of uncertainty remains," according to a new GAO report. The Dec. 21 GAO report, a series of briefing slides, outlines "acquisition management for the European Phased Adaptive Approach" and "near-term development […]
Missile Defense Agency officials say that developing the Aegis Ashore program would not incur high risk, the Government Accountability Office contends "a certain degree of uncertainty remains," according to a new GAO report. The Dec. 21 GAO report, a series of briefing slides, outlines "acquisition management for the European Phased Adaptive Approach" and "near-term development risks." Aegis Ashore is the land-based component of the administration's proposed "phased adaptive approach" to defending US forces in Europe from ballistic missile attack. The briefing slides include several pages on Aegis Ashore, and additional slides on the planned Standard Missile 3 Block 1B interceptor, the Terminal High-Altitude Area Defense system, and other related topics. MDA says developing Aegis Ashore "is not a high risk since it's based on the existing Aegis [Ballistic Missile Defense] system," the report states, adding that the 3.6.1 version of Aegis BMD "is currently in service on BMD-capable cruisers and destroyers." However, "while Aegis BMD has demonstrated performance at sea, a series of changes are required to modify it for use on land with Aegis Ashore," says GAO. Changing existing Aegis BMD technologies that would be used for Aegis Ashore "may reduce their maturity in the context of the new Aegis Ashore program, and new features will require testing and assessment to demonstrate their performance," the report adds, noting that MDA plans to conduct ground and flight tests of the system before it is deployed. Additionally, "there are dependencies on next-generation versions of Aegis systems that are still in development," according to GAO. Developing Aegis Ashore includes changes to the Aegis ship's deckhouse and software operating system configurations, the report states, adding that of the 32 components of the integrated Aegis Combat System architecture, "only 11 of these will be reused for Aegis Ashore; the remaining 21 will need to be suppressed or otherwise disabled."
Posted in Defense, Including Radar, Missiles and EWTagged technical training, short courses, NASA, Applied Technology Institute, ATI Courses, Professional Development Short Courses, AEGIS, Aegis Ashore, Ballistic Missile Defense, GAO
LOCKHEED TO PROVIDE AEGIS COMBAT SYSTEM FOR AUSTRALIA
Lockheed has been awarded a cost-plus-fixed-fee performance incentives contract for post-critical design review (CDR) Aegis combat systems engineering to support the Australian Government. The Australian Government has selected the Aegis combat system for its air warfare destroyer (AWD) program.. Under the $197m foreign military sale, Lockheed will provide combat systems engineering, computer program development, technical […]
Lockheed has been awarded a cost-plus-fixed-fee performance incentives contract for post-critical design review (CDR) Aegis combat systems engineering to support the Australian Government. The Australian Government has selected the Aegis combat system for its air warfare destroyer (AWD) program.. Under the $197m foreign military sale, Lockheed will provide combat systems engineering, computer program development, technical manuals, ship integration and test. The company will also design and build an Aegis weapon system (AWS) based on the US Navy AWS Baseline 7 phase I to support the AWD program. The US Naval Sea Systems Command is the prime contractor and work will be carried out at the company's facilities in US and Australia. The contract also includes options that, if exercised, would bring the cumulative value to $211m. Work is expected to be complete by December 2014.
Posted in Uncategorized, Defense, Including Radar, Missiles and EWTagged technical training, short courses, Applied Technology Institute, ATI Courses, Professional Development Short Courses, Lockheed Martin, AEGIS
Standard Missile Pushes Forward
Posted on July 28, 2010 by Jim
ATIcourses offers several courses on missile defense and combat systems. This defense news should be of interest to ATI course students. STANDARD MISSILE NAVAL DEFENSE FAMILY (SM-1 TO SM-6): Variants of the SM-2 Standard missile are the USA's primary fleet defense anti-air weapon, and serve with 13 navies worldwide. The most common variant is the […]
ATIcourses offers several courses on missile defense and combat systems. This defense news should be of interest to ATI course students. STANDARD MISSILE NAVAL DEFENSE FAMILY (SM-1 TO SM-6): Variants of the SM-2 Standard missile are the USA's primary fleet defense anti-air weapon, and serve with 13 navies worldwide. The most common variant is the RIM-66K-L/ SM-2 Standard Block IIIB, which entered service in 1998. The Standard family extends far beyond the SM-2 missile, however; several nations still use the SM-1, the SM-3 is rising to international prominence as a missile defense weapon, and the SM-6 program is on track to supplement the SM-2. These missiles are designed to be paired with the AEGIS radar and combat system, but can be employed independently by ships with older or newer radar systems. AEGIS is the primary anti-air warfare defensive weapons system on board American Ticonderoga Class Cruisers (CG-47) and Arleigh Burke Class Destroyers (DDG-51), as well as foreign air defense ships including Japan's Kongo Class destroyers, Korea's KDX-III Class destroyers, Norway's Fridtjof Nansen Class frigates, Spain's F-100 Alvaro de Bazan Class frigates, and Australia's Air Warfare Destroyers If you enjoyed this information:
Posted in Defense, Including Radar, Missiles and EWTagged AEGIS, STANDARD MISSILE, Ticonderoga Class Cruisers (CG-47)
Arleigh Burke Class DDG 108 Named for Wayne Meyer, a former ATI instructor
An Arleigh Burke Class DDG 108 was named for Wayne Meyer, a former ATI instructor. Rear Adm. Wayne E. Meyer is also known as the father of AEGIS. After he retired from the Navy in 1985 he taught several professional development classes on Combat Systems Engineering for ATI based on his many years of systems […]
An Arleigh Burke Class DDG 108 was named for Wayne Meyer, a former ATI instructor. Rear Adm. Wayne E. Meyer is also known as the father of AEGIS. After he retired from the Navy in 1985 he taught several professional development classes on Combat Systems Engineering for ATI based on his many years of systems engineering experience with the AEGIS combat System. Wayne E. Meyer passed away on Sept 1, 2009, and did not get to see this ships' commissioning, which bears his name, but his legend as 'father of Aegis" is well known
DDG 108 Wayne E. Meyer
DDG-108 has been named in honor of Rear Adm. Wayne E. Meyer. DDG-108 Rear Adm. Wayne E. Meyer is a Flight IIA variant of the Arleigh Burke class guided missile destroyer and incorporates a helicopter hanger facility into the original design. The ship can each carry two SH-60B/R helicopters. Guided missile destroyers operate independently and in conjunction with carrier strike groups, surface action groups, expeditionary strike groups and replenishment groups. On August 22, 2008 the USS WAYNE E. MEYER (DDG 108) received its homeport letter and will homeport in San Diego, CA. The ship is scheduled to set sail from Bath late summer 2009. The location and date for the ship's commissioning has yet to be determined, but it will most likely occur in the fall of 2009 [versus the originally planned January 2009]. Until DDG 108 is commissioned, its formal title is Pre-Commissioning Unit WAYNE E. MEYER (DDG 108). Once commissioned, the title will change to USS WAYNE E. MEYER (DDG 108). The Pre-Commissioning Unit administration support facility is located at 590 Washington Street in Bath, Maine. The term PCU, or simply "PRECOM Unit" or "Unit," also refers to the PCU support facility that houses the offices for the crews of each PCU currently under construction in Bath. For the purposes of the entire Pre-Commissioning process, think of the "PRECOM Unit" or "PCU" as the actual ship in Bath. Click here for more info
Rear Admiral Wayne E. Meyer
As of mid-2008 Rear Admiral Meyer operated a consultancy with offices in Crystal City, Virginia. He chairs and serves on numerous Panels and Committees chartered by various DOD civil and military officials. He has served on the National Ballistic Missile Defense Advisory Committee for the past seven years, serving as its Chairman for the past three years. He also gives numerous speeches besides reviewing and editing articles, essays and books. Rear Admiral Wayne E. Meyer, retired in 1985 as the Deputy Commander for Weapons and Combat systems, Naval Sea Systems, Naval Sea Systems Command and Ordnance Officer of the Navy.
Posted in Defense, Including Radar, Missiles and EWTagged a former ATI instructor, AEGIS, Wayne Meyer

redpajama_set_name: RedPajamaCommonCrawl


CI SONO VOLUTI 5 ANNI, DIVERSI MAC DISTRUTTI, E NON SI SA ANCORA QUANTE LICENZE ADOBE CRACCATE, MA CI SONO RIUSCITI. E' IL FONT DEFINITIVO, REALIZZATO DA GOOGLE E MONOTYPE, CHE INCLUDE ANCHE UN CENTINAIO DI ALFABETI E SI CHIAMA NOTO A.K.A. NO TOFU CHE SONO – A DETTA LORO – QUEI RETTANGOLINI BIANCHI CHE TI ESCONO QUANDO NON C'E' UN DETERMINATO CARATTERE NEL FONT.
DA OGGI PUOI SCRIVERE ANCHE IN FENICIO.
QUI PUOI SCARICARE TUTTO IL PACCHETTO OPPURE IL SINGOLO FONT, LA LICENZA E' OPEN SOURCE E PUOI CONTRIBUIRE ANCHE TU AL PERFEZIONAMENTO DEL PROGETTO.
COME DICEVAMO CI SONO CENTINAIA DI LINGUE E ALFABETI. DAL CHEROKEE ALL'EBRAICO ANTICO, DAL SAMARITANO AL TAMIL.


Nine days later, Ji Hao transformed into an extremely thin beam of golden light, flashing across the sky.
He reached to five-hundred-thousand kilometers high from the ground and could move a hundred thousand miles within the blink of an eye. He didn't fully activate his power, but his moving speed was already more than ten times faster than his earlier moving speed when he had his fiery wings activated.
Besides, Ji Hao couldn't activate his fiery wings anymore. The Gold Crow bloodline contained in his body had been burned out thoroughly by the essence sun fire, and by now, Ji Hao was a completely pure-blood human being. Not even the thinnest, last little bit of Gold Crow bloodline remained in his body.
The magic he was casting now was called 'Flowing sunlight flying magic.' He created this magic himself when he made the breakthrough. His body had transformed into a sphere of fiery light, in a vague state that was in between the state of pure light and tangible human body. With a single thought, he could fly to tens of thousands of miles away. His moving speed was astonishing fast, but his flying was completely silent.
The sun shone on the entire world, but did that sunlight ever make any sound when it dazzled across the world? This flying magic created by Ji Hao was the same; it was incredibly fast, yet wouldn't make even the slightest noise. When he flashed across the sky, only a thin golden beam of light could be seen, and within a twinkling of an eye, he would fly far, far away.
Flying as fast as he liked for around a quarter of an hour, Ji Hao abruptly stopped.
This flying magic allowed him to fly surprisingly fast, but also allowed him to stay perfectly still. The flying speed of his was indeed amazing and completely traceless, yet it was extremely easy to control. The conversion between motion and static was natural without any difficulty. Ji Hao sensed the great sun power surrounding him, and couldn't help but laugh out loudly.
He looked into the inside of his body with his primordial spirit power. With the sun power, Ji Hao saw that on the edge of his primordial spirit, which was now faint golden in color, nine water-clear streams of Yu Yu's Qi of Dao had been quickly and flexibly rotating and hovering like fishes swimming in the water. Clearly, his cultivation had improved to another level.
Among the nine streams of Qi of Dao was an enormous seed of Dao, that seemed to contain such mysteriousness, and was only faintly visible. Every time the seed of Dao turn faintly visible, thin streams of Dao of the sun would merge with the nine streams of Qi of Dao, and afterward, Ji Hao's cultivation would be improved by a little bit.
Looking carefully, Ji Hao's body was now suffused by a mist-like, purely golden sun power. That power had been rotating and was a unity, no longer separated by Magus Acupoints like before.
The Sun power contained inexhaustible warmth, and as it rotated, meridians and Magus Acupoints contained in Ji Hao's body had been changing strangely. His meridians, Magus Acupoints and other 'paths' inside his body that could allow power streams to flow through had been slowly 'melting' within the sun power. When all meridians and Magus Acupoints inside Ji Hao's body disappeared, and the inner space of his body became a boundless void, that would be the time for him to break into the level of Divine Magus.
What surprised Ji Hao was that the inner surfaces of his body were all thickly covered with golden patterns. These patterns could be seen even on the finest cells of his body. These patterns came from the essence sun power that contained the great Dao of the sun.
He had already accomplished the first turn of the Mysterious Cultivating-Method with Nine Turns. As a benefit brought to Ji Hao by the first turn, his physical strength grew hundred percent greater than before, along with the explosive force he could generate, his agility, pliability and defensive power.
Apart from all these, Ji Hao's body had been through some kind of magical transformation when he broke into the level of Magus King, and his power was turned into sun power. Neither did Yu Yu nor the scriptures he read in Magi Palace mention this kind of a transformation.
When Ji Hao was younger, he made a trade with the mysterious man with his Mantra Dan with Nine Secret Words. Back then, the mysterious man gave him two drops of spirit blood that came from a dragon and a phoenix. The two drops of spirit blood merged with Ji Hao's body but only slightly improved his physical strength and purified his soul. However, the moment he broke into the level of Magus King and a great amount of essence sun fire surged into his body, Ji Hao suddenly felt the dragon spirit blood and phoenix spirit blood in his body speedily rise and grow with the help of the magical creative and nourishing power contained in the essence sun fire. At last, the two drops of blood managed to expand and strengthen to the equal extent as his own spirit blood.
After that, spirit blood from a dragon and a phoenix mixed together with Ji Hao's own spirit blood and became a new bloodline. Ji Hao could not tell for sure about what it exactly was.
Ji Hao's physical body became extraordinarily, even unreasonably tough and powerful, while his primordial spirit, which had shrunk quite a lot in size after being purified by the essence sun fire, had become especially powerful and clear. By now, his primordial spirit looked just like a statue made from colored glaze and was nearly tangible.
In terms of physical strength, Ji Hao had taken countless precious herbs, powerful medicines, swallowed countless meat of fierce beasts, and with the help of those multicolored-flames in his lower abdomen, Ji Hao's physical strength was as great as an ordinary Magus King's physical strength when he was still a Senior Magus.
According to Ji Hao's estimation based on the comparison between himself and the other Magus Kings and Divine Magi he knew, after he became a Magus King, his physical strength could be as great as the physical strength of some peak-level Magus Kings from those large clans. But in fact, after the unexpected expansion of the dragon and phoenix spirit blood and the perfect Integration of the dragon and phoenix spirit blood and Ji Hao's own spirit blood, Ji Hao's physical strength now should have reached to the level of ordinary two-star Divine Magi!
Moreover, he had accomplished the first turn of the Mysterious Cultivating-Method with Nine Turns. This allowed the explosive force he could generate, his agility, pliability, defensive power and his physical strength to rise by a hundred percent. This made Ji Hao's body as tough and strong as the bodies of ordinarily three-star Divine Magi!
"Old man, how did this happen?" Ji Hao floated in the air, pondered for a while, then finally threw out the question in his spirit space.
Staying silent for a long while, the mysterious man's impatient, mumbling voice came from his spirit space, "It's a good thing anyway, why do you have so many questions? All in all, just like when you woke up all your meridians and Magus Acupoints back then, don't mention this to anybody, not even your Shifu!"
"Your Shifu is indeed a reliable man, but the two brothers of his…If you don't want to be sneakily captured by them, if you don't want them to peel you, pull out your tendons, drain your spirit blood and turn you into magic pills, do not mention this to anyone… never, ever mention it to anyone! Not even a single word about this!" The mysterious man warned Ji Hao seriously, "Even though you're under my protection and not even they can see through your true body condition, you still can never tell this to anyone. If you do tell anybody…an unknown disaster would come to you!"
"Can I know why?" Ji Hao only felt that a bone-deep coldness surge up from his heart, subconsciously as he asked further.
Remaining silent again for a long while, the mysterious man responded with a bland tone, "Nothing too big. The dragon-kind, phoenix-kind and humankind were one unity. Someday, the bloodline split and derived into three different kinds. The dragon-kind attained the great physical strength, the phoenix-kind attained the soul power, and the humankind attained wisdom and the great reproductive ability."
"Now, you have done no more than trace to the beginning and attain the most original trace of the bloodline. This is not a big deal in fact. But after all, it won't do you any good if you let the others know." said the mysterious man in a low voice, "Not only this, even for those things in your lower abdomen, don't mention anything about them to anyone either."
The mysterious man stopped talking, while Ji Hao stayed in shock for quite a while. He then quickly reached his spiritual power to his lower abdomen.
In his lower abdomen, the number of those five-colored flames had grown to nine, and by now, these nine flames had been flipping and merging quickly. Ji Hao somehow felt that this change happened only because these flames had absorbed enough amount of essence sun fire.
Something seemed to be hiding inside these nine-colored flames. It was nothing else but this magical thing that allowed Ji Hao to limitlessly absorb energies, life forces, and powers contained in the beast meat, magical medicines and all kinds of precious and rare herbs that he had swallowed, and to improve his body condition and physical strength.
That so-called Bu Tian Bu Lou Magic Spell, which was given to Ji Hao by the mysterious man, seemed to be a disguise now. That spell didn't have any actual effect; what was effective was nothing else but this nine-colored flame itself.
While Ji Hao was wondering, Zhu Rong Long's voice suddenly came from the front.
"Earl Yao, we found a big thing, and we brought it over! You have to be careful, don't let this animal hurt you!"
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Iran's Only Female Olympic Medalist Rumored to Have Fled to Netherlands
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January 2014, VOLUME 133 / ISSUE 1
Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants
Srinivas Bolisetty, Anjali Dhawan, Mohamed Abdel-Latif, Barbara Bajuk, Jacqueline Stack, Ju-Lee Oei, Kei Lui, on behalf of the New South Wales and Australian Capital Territory Neonatal Intensive Care Units' Data Collection
OBJECTIVE: Not many large studies have reported the true impact of lower-grade intraventricular hemorrhages in preterm infants. We studied the neurodevelopmental outcomes of extremely preterm infants in relation to the severity of intraventricular hemorrhage.
METHODS: A regional cohort study of infants born at 23 to 28 weeks' gestation and admitted to a NICU between 1998 and 2004. Primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years' corrected age defined as developmental delay (developmental quotient >2 SD below the mean), cerebral palsy, bilateral deafness, or bilateral blindness.
RESULTS: Of the 1472 survivors assessed, infants with grade III–IV intraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay (17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I–II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs 12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), and deafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). After exclusion of 40 infants with late ultrasound findings (periventricular leukomalacia, porencephaly, ventricular enlargement), isolated grade I–II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs 12.1%). Isolated grade I–II IVH was also independently associated with a higher risk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidence interval 1.22–2.46).
CONCLUSIONS: Grade I–II IVH, even with no documented white matter injury or other late ultrasound abnormalities, is associated with adverse neurodevelopmental outcomes in extremely preterm infants.
extremely premature
intraventricular hemorrhage
neurodevelopmental outcomes
ACT —
BSIDII-MDI —
Bayley Scales of Infant Development-II Mental Development Index
GMDS-GQ —
Griffiths Mental Developmental Scale General Quotient
IVH —
MDI —
mental developmental index
NICUS —
Neonatal Intensive Care Units database
NSW —
PVL —
periventricular leukomalacia
ROP —
retinopathy of prematurity
Cranial ultrasound is routinely used in identifying cerebral abnormalities in premature infants. Grade III and IV intraventricular hemorrhages, cystic periventricular leukomalacia, and late ventriculomegaly are all known predictors of adverse neurodevelopmental sequelae in these infants.
We reviewed neurodevelopmental outcomes among 2414 extreme preterm infants. Infants with grades I and II intraventricular hemorrhage had increased rates of neurosensory impairment, developmental delay, cerebral palsy, and deafness at 2 to 3 years' corrected age.
Cranial ultrasound is the most readily available and commonly used imaging technique for the diagnosis of cerebral lesions in preterm infants. Intraventricular hemorrhage (IVH) is the most commonly recognized cerebral lesion on ultrasound in extremely preterm infants.1 Papile classification is commonly used to grade the severity of IVH.2 Grade III–IV IVH and other lesions noted on ultrasound including periventricular leukomalacia (PVL), porencephaly, and ventriculomegaly are well documented to be associated with adverse neurodevelopmental outcomes.3–7 However, the true impact of lower-grade IVH on the neurodevelopment of these extreme preterm infants has not been well described. IVH originates in the germinal matrix, which is the source of future neuronal and glial cells in the immature brain. The germinal matrix that initially surrounds the whole fetal ventricular system in the previable gestation gradually involutes to reside over the body of the caudate between 24 and 28 weeks' gestation and at the level of the head of the caudate nucleus between 28 and 32 weeks' gestation. It is therefore logical to suspect that even smaller hemorrhages within the germinal matrix at this gestation may have an impact on the future neuronal and glial cell migration within the immature brain.
We therefore undertook this study to investigate the long-term neurodevelopmental outcomes in relation to the severity of IVH in a large cohort of extremely preterm infants admitted to any of the 10 NICUs within New South Wales (NSW) and the Australian Capital Territory. We hypothesized that preterm infants with any grade of IVH have poorer neurodevelopmental outcomes compared with those without IVH.
This was a retrospective cohort study using prospectively collected data from all 10 tertiary NICUs in NSW and the Australian Capital Territory (ACT). The study included all infants born between 23+0 and 28+6 weeks' gestation and admitted to the NICU between January 1998 and December 2004. Infants with major congenital malformations and those who died before an ultrasound was obtained were excluded. A full description of the NSW and ACT neonatal service organization and networking and the validity of the Neonatal Intensive Care Units (NICUS) database has been described.8,9
In NSW and ACT NICUs, cranial ultrasound is the standard screening test used to detect IVH and other cranial pathologies for all preterm infants born before 32 weeks' gestation. The standard policy in the network is to perform head ultrasounds during days 1 through 4 of life, days 10 through 14 of life, and 4 to 8 weeks of age and at 36 to 40 weeks' corrected age. The interpretation of the head ultrasound was based on the reports of radiologists and/or neonatologists at each hospital. Papile classification is used to grade the severity of IVH on ultrasound.2 Porencephalic cysts are defined as parenchymal lesions corresponding to grade IV intraventricular hemorrhage. PVL refers to the ischemic brain injury affecting the periventricular white matter in the boundary zones supplied by terminal branches of both the centripetal and centrifugal arteries. Encephaloclastic porencephaly refers to the late development of extensive echo-dense and cystic lesions involving the periphery of the cerebrum. Interobserver reliability and accuracy in interpreting cranial ultrasounds in NSW and ACT has previously been validated and reported.10 Overall agreement among the reporters was found to be 88%. Multirater agreement for individual grades of IVH found in this report were as follows: normal ultrasounds, 78%; grade I, 45%; grade II, 41%; grade III, 38%; and grade IV, 70%. Intraobserver reliability ranged from 78% to 90%.10
For all preterm infants of <29 weeks' gestation, the standard practice among the NICUs in this region is to perform a neurodevelopmental assessment by a developmental team at 2 to 3 years of age, corrected for prematurity, including the administration of the Griffiths Mental Developmental Scale General Quotient (GMDS-GQ) or Bayley Scales of Infant Development-II Mental Development Index (BSIDII-MDI). Follow-up assessment results are included in the NICUS database.
Data for this study extracted from the NICUS Data Collection included all relevant clinical information, hospital outcomes and follow-up information at 2 to 3 years of age, corrected for prematurity. The primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years' corrected age. Moderate neurosensory impairment was defined as the presence of developmental delay (GMDS-GQ or BSIDII-MDI between 2 and 3 SD below the mean), moderate cerebral palsy (able to walk with the assistance of aids), or deafness (requiring amplification with bilateral hearing aids or unilateral/bilateral cochlear implant). Severe neurosensory impairment was defined as developmental delay (GMDS-GQ or BSIDII-MDI ≥3 SD below the mean), severe cerebral palsy (unable to walk with the assistance of aids), or bilateral blindness (visual acuity of <6/60 in the better eye).11
Statistical analyses were performed by using Predictive Analytics SoftWare Statistics (version 20; IBM SPSS Statistics, IBM Corporation, Armonk, NY). Multivariate analysis using logistic regression models adjusted for significant clinical characteristics were performed to determine the relationship between the study groups (no IVH, IVH grade I–II, and IVH grade III–IV) and neurodevelopmental outcome. In multiple group comparisons, where appropriate, χ2 for larger contingency table, analysis of variance, or Kruskal-Wallis tests were used to test for between group differences. A no-IVH group was used as controls for all subsequent post hoc 2-group comparisons. All P values were 2-sided, and the significance level was not changed when multiple comparisons were performed.
The study was approved by the South Eastern Sydney Illawarra Area Health Services Northern Hospital Network Human Research Ethics Committee.
During the study period, 2701 extremely preterm infants (23–28 weeks; gestational age) were registered in the NICUS database, and 133 infants died before head ultrasound screening (Fig 1). Of the survivors, 152 infants had major congenital malformations and were excluded from the study. Another 2 surviving infants who did not have ultrasound examination were excluded. The study population comprised 2414 infants of whom 819 (33.9%) were diagnosed with IVH, 515 (21.3%) grade I–II IVH and 304 (12.6%) Grade III–IV IVH. Of these, 446 infants died. Infants with III–IV IVH had a significantly higher mortality rate (62.2%) compared with I–II IVH (15.7%) and the no-IVH groups (11%).
Profile of study group from admission to follow-up assessment. *P < .05, **P < .01, ***P < .001. F/U, follow-up.
Of the 1968 survivors, 1472 (74.8%) infants were assessed at 2 to 3 years of age, corrected for prematurity. Of these, 1043 had no IVH. Grade I, II, III, and IV IVH was found in 232, 104, 56, and 37 infants, respectively. Table 1 compares infants who were followed up with those lost to follow-up. Infants lost to follow-up had less neonatal morbidity compared with infants who were followed-up.
Comparison of Infants Followed Up and Lost to Follow-Up
Perinatal characteristics of the IVH and no-IVH group are summarized in Table 2. Pregnancy-induced hypertension, antenatally detected intrauterine growth restriction, and antenatal steroids were significantly associated with a lower incidence of IVH. Caesarean delivery (with or without labor) is associated with lower incidence of IVH. Outborn infants (delivery outside a tertiary perinatal center), male gender, and low Apgar scores were associated with a higher risk of III–IV IVH.
Perinatal Characteristics and Morbidities Among 1472 Infants
Major morbidities including chronic lung disease, postnatal steroid therapy, patent ductus arteriosus, necrotizing enterocolitis, sepsis and severe retinopathy of prematurity (ROP) were significantly more common in infants with IVH of any grading. Pneumothorax was associated with higher incidence of Grade III–IV IVH. Compared with no-IVH infants (Table 2), significantly more IVH infants had abnormal 6-week ultrasound findings including PVL, porencephalic cyst, and hydrocephalus (ventricular dilatation >97th percentile). In particular, these cerebral abnormalities were found in 64 (69%) of the grade III–IV infants.
Neurodevelopmental Outcomes at 2 to 3 Years, Corrected for Prematurity
Higher rates of moderate-severe neurosensory impairment were seen with increasing grades of IVH, being 12.1% for no-IVH (n = 1043); 21.1% for Grade I (n = 232); 24% for grade II (n = 104); 41% for grade III (n = 56) and 46% for grade IV (n = 37). After exclusion of ultrasound abnormalities including PVL, porencephalic cyst, and ventricular enlargement, moderate-severe neurosensory impairment rates were 17.6% for isolated grade I (n = 205); 20.9% for isolated grade II IVH (n = 91); 36.8% for isolated IVH III (n = 19), and 40% for isolated IVH IV (n = 10). The comparable rates of impairment for grades I and II and for grades III and IV allow grouping into 2 IVH groups, grade I–II and III–IV, for subsequent analyses. Thus, infants with III–IV IVH had the highest rate (43.0%) of moderate-severe neurosensory impairment (Table 3). Infants with grade I–II IVH were twice as likely to have a moderate-severe neurosensory impairment (22.0%) compared with the no-IVH group (12.1%). Infants with grade I–II IVH had a significantly higher rate of cerebral palsy than the no-IVH group (10.4% v 6.5%. odds ratio [OR] 1.72, 95% confidence interval (CI) 1.11–2.67). Both IVH groups had higher incidence of hearing loss in comparison with no-IVH group.
Neurodevelopmental Outcomes of 1472 Infants at 2 to 3 Years' Corrected Age
After controlling for confounding factors by multivariate analysis (Table 4), the adjusted OR for moderate-severe impairment for infants with I–II IVH was 1.61 (95% CI 1.14–2.28) compared with no IVH, and for III–IV IVH, it was 3.81 (95% CI 2.30–6.30). Small for gestational age, male gender, PVL, chronic lung disease, and ROP independently predicted significant adverse outcomes. In view of the high incidence of hearing loss in grade I–II IVH, multivariate analysis was repeated with the exclusion of infants with isolated hearing loss. Grade I–II IVH remained an independent risk factor for moderate-severe neurosensory impairment (adjusted OR 1.45, 95% CI 1.003–2.112, P = .048).
Multivariate Analysis to Determine Independent Factors Associated With Moderate-Severe Neurosensory Impairment
Of the 336 grade I–II IVH, 40 had other ultrasound abnormalities including PVL, porencephalic cyst, or late ventricular dilatation detected at 6-week ultrasound. Table 5 shows the neurodevelopmental outcome of 296 "isolated grade I–II IVH" stratified by gestation. Moderate to severe neurosensory impairment was significantly higher in I–II "isolated IVH" compared with no IVH in both 23 to 25 weeks' gestation (24.3% vs 18%) and 26 to 28 weeks' gestation groups (15.5% vs 10%), representing a consistent 5% impairment rate difference between no-IVH and isolated IVH grade I–II infants (Table 5). After multiple logistic regression analysis controlled for male gender, small for gestational age, chronic lung disease, and ROP, variables that were found independently significant from Table 4, moderate to severe impairment was still significantly increased for isolated I–II IVH.
Moderate-Severe Neurosensory Impairment in Isolated Grade I–II IVH Group in Comparison With No-IVH Group After Exclusion of Other Ultrasound Abnormalities
Our regional study of a recent and large sample of 1472 very premature survivors revealed that presence of IVH, even for grade I–II, was associated with poor neurodevelopmental outcomes. Moderate-severe neurosensory impairment was significantly higher in the I–II IVH group than the no-IVH group (22% vs 12%). After excluding other ultrasound abnormalities including PVL, porencephaly, and ventricular enlargement, it was 19% and 12%, respectively, representing a 7% impairment rate difference between no-IVH and isolated IVH I–II infants. After adjusting for confounding perinatal variables, isolated grade I–II IVH remains a significant independent risk factor associated with poor outcomes (adjusted OR 1.73, 95% CI 1.22–2.46). It is noteworthy that a 5% increase in the neurosensory impairment rate persisted even when the infants were stratified by gestational age, indicating that the presence of isolated grade I–II IVH can be associated with poor outcomes. There was a relatively high incidence of hearing loss in grade I–II IVH, which could have contributed to the adverse neurosensory outcomes. However, even after excluding infants with isolated hearing loss, grade I–II IVH remained a risk factor for increased neurosensory adverse outcomes.
Our findings add to the growing number of studies from different populations reporting similar concerns with isolated low grades of IVH.12–15 The EPIPAGE study from France involving 942 preterm infants of <32 weeks' gestation born in 1997 found that isolated grade I–II IVH occurred in 16% of infants and was associated with a 5.5% risk of cerebral palsy at 2 years' corrected age.13 When other ultrasound abnormalities were included, the rates of CP increased to 8.1% for grade I IVH and 12.2% for grade II IVH. Patra and colleagues from United States, in an institutional study of extremely low birth weight infants born from 1992 to 2000, reported that the 104 infants with isolated grade I–II IVH had a significantly lower mean mental developmental index (MDI) score than the 258 infants with a normal cranial ultrasound (mean 74 vs 79). They had significantly higher rates of low MDI <70 (45% vs 25%; OR 2.00), major neurologic abnormality (13% vs 5%; OR 2.60), and neurodevelopmental impairment (47% vs 28%; OR 1.83) at 20 months' corrected age, even when adjusting for confounding factors.14 Vavasseur and colleagues from Ireland demonstrated that infants with grade I–II IVH in the 24 to 26–week and the 27 to 29–week groups had significantly lower MDI and PDI scores. However, no significant difference in scores was noted in the 30 to 32 weeks' gestation subgroup.15 Similarly, another recent institutional study from Austria by Klebermass-Schrehof and colleagues showed abnormal neurodevelopmental outcomes up to 5.5 years in preterm infants <32 weeks' gestation with grade I–II IVH.16
Despite these publications, there is generally less appreciation among clinicians of the neurodevelopmental impact resulting from lower grades of IVH. This is probably because of a high baseline of adverse outcomes noted in very premature infants even without IVH, and it requires a large sample size to appreciate a relatively small increase in impairment risks compared with no IVH. For example, in our 979 no-IVH infants without any ultrasound abnormalities, the baseline impairment rate was 11.6% and 18% in the 23 to 25 weeks' gestation high-risk subgroup. The NICHD Network showed that nearly 30% of the 1473 <1000-g infants cared for in 1996–1997 with normal cerebral ultrasounds had either CP or low MDI <70 at 2 years' corrected age.17
A number of studies reported IVH-related adverse outcomes extending into school age and beyond. In a study of preterm infants weighing <1000 g at birth, the Victorian Infant Collaboration Study Group reported at 8 years that no-IVH was associated with cerebral palsy rates of 6.7%, with no rise in association with grade I IVH (6.4%) but a marked elevation to 24% with grade II IVH.18 A population-based national study from the Netherlands involving preterm infants with a gestational age of <32 weeks and/or a birth weight <1500 g reported that the risk of needing special education for adolescents with grades I–II IVH increased twofold compared with those without IVH.19 Lowe and colleagues in 1990 found that VLBW infants <1501 g with grades I–II IVH performed less well at 5 to 6 years of age than at 1 to 2 years of age because specific visual motor and tactile perceptual skills are difficult to assess at 1 to 2 years of age.20
The mechanism of brain injury in isolated grades I–II IVH during early gestation may result from impaired cortical development. The germinal matrix is a source of neuronal precursor cells at 10 to 20 weeks' gestation after which it is a source of glial precursor cells that are in the process of migration to cortical regions at about the time very low birth weight infants are born. These cells give rise to oligodendroglia, the absence of which may affect myelination, and astrocytic precursor cells, necessary for cortical development. It is suggested that when a small IVH occurs at a relatively early period of gestation, it may affect the neuronal migration and result in excessive brain injury.2,21 Grades I–II IVH can also cause lesions in the head of the caudate nucleus as well as destroy cells that would otherwise migrate to the subcortical structures such as amygdala and the thalamus. Therefore, functions served by the subcortical areas may be negatively affected in low-grade IVH.22 Indeed, an MRI study of 12 uncomplicated IVH infants, 7 grade I, 4 grade II, and 1 grade III, found that the cortical gray matter volume was reduced compared with the 11 no-IVH infants.23 There are also several more determinants that may not be picked up by the ultrasound imaging. These include associated white matter injury, brainstem and hippocampal hypoxic injury, and cerebellar hemorrhage or ischemia.24
There are limitations to the study. This is a retrospective review, and grading of IVH and other ultrasound abnormalities were based on clinical information collected in the database and not under a prospective research protocol. It can be argued that a higher incidence of adverse outcomes in grade I–II IVH, even for some no-IVH infants, was probably due to white matter injury, which is not readily identified on ultrasound. The retrospective nature of the study would not allow us to determine the interobserver reliability and accuracy of ultrasound reporting. Second, studies of IVH grading reliabilities have generally showed good results for higher grades of IVH or the absence of IVH, but less so for grade I and II.10,24–26 For example, the interobserver agreement in the Eunice Kennedy Shriver National Institute of Child Health and Development network report ranged from 48% to 68% for grade I–II IVH, which was not dissimilar to the previous data from 151 infants from our region10 showing an overall κ of 70% to 77%. Considering the likely blurring of grades between lower IVH grades, we analyzed all 336 grade I and II infants as a group and found that low grades of IVH are also associated with increased risk of adverse outcomes.
Our neurodevelopmental follow-up rate was ∼75%. However, those who were lost to follow-up in our region had fewer perinatal risk factors and less early neonatal morbidity compared with assessed infants. The ultrasound imaging in our NICUs is generally restricted to sagittal and coronal views through the anterior fontanel. It is not a standard practice among the NICUs to obtain mastoid views to improve the detection of any cerebellar or posterior fossa lesions. Paneth and colleagues found cerebellar lesions in 28% of preterm infants at autopsy. However, the importance of these lesions remains uncertain.27 Finally, neurodevelopmental follow-up in our network is performed by a team including a developmental pediatrician, neonatologist, and/or psychologist certified to perform Griffiths and Bayley assessment. As a part of the case review, they are, however, aware of the child's ultrasound findings and the NICU course from the hospital discharge summary. We acknowledge the theoretical possibility of bias, but given that standardized objective measurement tools are used for neurodevelopmental assessment of these infants, we postulate that any bias of the developmental evaluators that might have been attributed to the positive findings in our study is negligible.
We found that even lower grades of IVH can adversely influence long-term neurodevelopmental outcomes in extremely preterm infants. In light of these findings and similar reports from various other populations, we suggest a more cautious approach by clinicians in counseling these families and highlight the importance of regular long-term follow-up and screening for adverse neurodevelopmental outcomes in this population.
We thank the directors, the NICUS members, and the audit officers of all tertiary units in supporting this collaborative study: NICUS, Dr JenniferBowen (Chairperson), Barbara Bajuk (Coordinator), Sara Sedgley (Research Officer); Centenary Hospital for Women and Children, Associate Professor Zsuzsoka Kecskés (Director), Dr Hazel Carlisle, Lyn Barnes; John Hunter Children's Hospital, Dr Paul Craven (Acting Director), Dr Chris Wake, Dr Rebecca Glover, Lynne Cruden, Alissa Argomand; Royal Prince Alfred Hospital, A/Prof Nick Evans (Director), Dr A/Prof David Osborn, Girvan Malcolm, Dr Ingrid Rieger, Shelley Reid; Liverpool Hospital, Dr Jacqueline Stack (Acting Director), Dr Ian Callander, Kathryn Medlin, Kate Marcin; Nepean Hospital, Dr Vijay Shingde (Acting Director), Dr Basiliki Lampropoulos, Mee Fong Chin; The Children's Hospital at Westmead, Professor Nadia Badawi (Director), Dr Alison Loughran-Fowlds, Caroline Karskens; Royal North Shore Hospital, Dr Mary Paradisis (Director), A/Prof Martin Kluckow, Claire Jacobs, Glynis Howard; Sydney Children's Hospital, Dr Andrew Numa (Director), Dr Gary Williams, Janelle Young; Westmead Hospital, Dr Mark Tracy (Director), Dr Melissa Luig, Jane Baird; and Royal Hospital for Women, A/Prof Kei Lui (Director), Dr Julee Oei, Dr Lee Sutton, Diane Cameron. We also thank the infants and their families and the nursing and midwifery, obstetric, and medical records staffs of the obstetric and children's hospitals in NSW and the ACT.
Address correspondence to Srinivas Bolisetty, MD, FRACP, Division of Newborn Services, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, 2031 NSW, Australia. E-mail: Srinivas.Bolisetty{at}sesiahs.health.nsw.gov.au
Dr Bolisetty conceptualized and designed the study, coordinated and supervised data analyses, and reviewed and revised the manuscript; Dr Dhawan contributed to the initial concept and design of the study and to analysis and interpretation of data and drafted the initial manuscript; Dr Abdel-Latif contributed to the initial concept and design of the study and contributed substantially to data analysis and review of the initial draft of the manuscript; Ms Bajuk contributed to the initial concept and design of the study, acquisition of data, and critical review of the manuscript; Dr Stack contributed to the initial concept and design of the study and critical review of the manuscript; Dr Oei contributed to the conception and design of the study and the analysis and interpretation of data; Dr Lui contributed to the initial concept and design of the study, assisted with data analysis and interpretation, and assisted with critical review of the manuscript; and all authors approved the final manuscript as submitted.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
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Home » Communities » Kiwirrkurra
Kiwirrkurra is in the "tali" (sandhill) country of the Gibson Desert in the far north of the Ngaanyatjarra Lands, approximately 850km west of Alice Springs and 180km west of Kintore. The community is in the Shire of East Pilbara in Western Australia but the closest neighbouring community is Kintore / Walungurru, in the NT. All Kiwirrkurra residents are Pintupi-speaking people, though many have close family ties with the residents of other Ngaanyatjarra communities.
In the early 1980s Kiwirrkurra was established as an outstation to help facilitate the Pintupi people's desire to return and live on traditional homelands. In 1984 the Pintubi Nine became the last known group of traditional Indigenous Australians to make contact with Western society. The family of nine had lived a traditional nomadic life in the desert until they entered Kiwirrkurra to be reunited with their extended family. Many of the group and their descendants still reside in the community.
Kiwirrkurra Community became affiliated with the Ngaanyatjarra Council in 1988. Kiwirrkurra is built on a clay pan, a low-lying area with poor drainage. In 2001 extensive flooding forced the evacuation of the entire population to Kintore, then Alice Springs, and finally to Morapoi Station 2000km south-southwest of Kiwirrkurra. 18 months later the residents were able to move back to Kiwirrkurra, having gained native title over 42,900sq km of their land in the meantime.
The community has a health centre, a store, a Ngaanyatjarra Lands school, women's centre and an art centre. WDNWPT (Purple House) also provides a renal dialysis service from the Health Centre.