text:
Outcome of biliary atresia among Saudi children: A tertiary care center experience
Sinan Holdar1, Badr Alsaleem1, Ali Asery1, Abdulrahman Al-Hussaini2
1 Division of Pediatric Gastroenterology, Department of Pediatric Sub-Specialities, The Children's Specialized Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
2 Division of Pediatric Gastroenterology, Department of Pediatric Sub-Specialities, The Children's Specialized Hospital, King Fahad Medical City; College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
Date of Web Publication 27-Nov-2018
Background/Aims: Data from Western countries indicate that biliary atresia (BA) is the leading cause of end-stage liver disease in children and the most common indication for liver transplantation (LT) in the pediatric population. There is no data on the epidemiology and outcome of BA in Saudi Arabia. The main objective of our study was to understand the clinical and epidemiological characteristics and outcome of BA in the Saudi population.
Patients and Methods: We retrospectively reviewed the database of infantile cholestasis cases that presented to our center from 2008 to 2015 and identified BA cases. Data on clinical, biochemical, imaging, and histopathological characteristics were collected by chart review. The two primary study outcomes were (1) successful Kasai portoenterostomy (KPE) defined as resolution of jaundice (total serum bilirubin <20 μmol/L) and (2) survival with native liver.
Results: Over the study period, we evaluated 450 cases of infantile cholestasis. In all, 21 cases (11 males) were diagnosed with BA (4.7%). BA cases were first seen by pediatric gastroenterologists at a median age of 65 days. KPE was performed in 12 cases at a median age of 73 days. Successful KPE was achieved in four cases (33%). Five of the remaining eight cases had LT and three died before LT. Nine of the 21 BA cases were denied KPE and had primary LT at median 8 months of age. The native liver 4-year survival rate was 14.3% and the overall survival rate was 81%.
Conclusion: BA is an uncommon cause of infantile cholestasis in Saudi Arabia. Our study provides a snapshot of the epidemiology of BA in Saudi Arabia that is characterized by late referral to pediatric gastroenterologists and poor outcome without LT.
Keywords: Biliary atresia, cholestasis, Kasai, late referral, liver transplant, outcome, portoenterostomy
Holdar S, Alsaleem B, Asery A, Al-Hussaini A. Outcome of biliary atresia among Saudi children: A tertiary care center experience. Saudi J Gastroenterol 2019;25:176-80
Holdar S, Alsaleem B, Asery A, Al-Hussaini A. Outcome of biliary atresia among Saudi children: A tertiary care center experience. Saudi J Gastroenterol [serial online] 2019 [cited 2019 Jul 18];25:176-80. Available from: http://www.saudijgastro.com/text.asp?2019/25/3/176/246138
Biliary atresia (BA) is an idiopathic neonatal obstructive cholangiopathy characterized by a progressive fibrosclerosing obliteration of the large bile ducts that present uniquely in the first few months of life. Early diagnosis of BA and Kasai portoenterostomy (KPE) improves outcomes.[1],[2],[3],[4],[5],[6],[7] Data from Western countries indicate that BA is the most common cause of neonatal cholestasis (25%), the leading cause of end-stage liver disease in children, and the most common indication for liver transplantation (LT) in the pediatric population.[1],[2],[3],[4],[5],[6],[7] Successful KPE (defined as clearance of jaundice within the first 6 months after KPE) was reported in 70%–80% of the patients with BA, when performed before 60 days of age, and was associated with a 30%–40% 10-year survival with the most experienced centers in the West and approximately 60% in Japan.[8] If KPE is not performed, 50%–80% of BA cases will die (without LT) from biliary cirrhosis by 1 year of age, and 90%–100% will die by 3 years of age.[9],[10] The age at performance of KPE is one of the most important factors determining surgical outcome. If KPE is performed between 60 and 90 days of life, approximately 40%–50% of patients show bile drainage; if performed after 90 days of life, up to 25% show drainage.[2],[3],[4],[5],[6]
Data on BA in Saudi Arabia is very limited. The only available published literature on prevalence of BA indicated that BA was the cause of cholestasis in 17 of 64 neonates.[11] Data from two liver transplant centers in Saudi Arabia indicated that BA and progressive familial intrahepatic cholestasis were the leading causes for pediatric LT; BA constituted 30%–33% of the cases.[12],[13] These studies did not provide further details of the epidemiology and outcome of the BA cases. Being first in the rank of the need for pediatric LT in Saudi Arabia might indicate that BA is really a leading cause of pediatric liver disease in Saudi Arabia. Another possibility is that BA is over-represented as a cause of infantile cholestasis because LT centers are more likely to receive the severe cases that lead to advanced liver disease. We conducted this study to establish the current prevalence of BA as a cause of infantile cholestasis, to study the epidemiology, clinical characteristics, and outcome of BA in Saudi population, and to compare our results with those from the West and Far East of Asia.
Diagnosis of biliary atresia
We retrospectively reviewed our database of infantile cholestasis cases that presented to our tertiary care center in Riyadh city, the capital of Saudi Arabia, from 2008 to 2015, and identified BA cases. All infants presenting to our center with infantile cholestasis underwent extensive work-up to exclude infectious, structural, metabolic, endocrine, infiltrative, and familial causes. Inclusion criteria: We included cases of infantile cholestasis with clinical, biochemical, radiological data, liver histology, and surgical findings that were all consistent with BA. Formalin-fixed biopsies were stained with hematoxylin and eosin and examined under light microscopy by a single pathologist certified in gastrointestinal and hepatic pathology. BA was suspected when there was presence of pale stool in combination with high gamma-glutamyl transferase (GGT), infantile cholestasis (GGT > 200 IUL) and demonstration of portal tracts fibrosis, proliferation of portal bile ducts, inflammatory cell infiltration, and bile plugs in liver biopsy. The definitive diagnosis was made when cholangiography failed to show a patent biliary tree. In cases where cholangiography was not undertaken, the diagnosis of BA was confirmed by operative findings at subsequent LT.
Data on clinical, biochemical, imaging, and histopathological characteristics were collected by chart review. Data collected from each chart included demographic information, birth weight, date of onset of jaundice, date of referral, presenting signs and symptoms, diagnostic studies and laboratory values at the time of first evaluation for cholestasis, whether a Kasai operation was performed, date of Kasai operation, time to clear jaundice, postoperative course and complications after KPE (e.g., cholangitis, ascites, variceal hemorrhage), whether LT was performed, date of last follow-up, and final outcome. The postoperative medical and nutritional management was reasonably uniform during this 10-year period and included the use of fat-soluble vitamins, a medium-chain triglyceride milk formula, ursodeoxycholic acid, and perioperative intravenous antibiotics followed by prophylactic sulfamethoxazole–trimethoprim antibiotic for 3 months. Development of ascending cholangitis was an indication to give prophylactic antibiotic beyond 3 months.
Biliary atresia splenic malformation (BASM) syndrome was defined as a splenic malformation occurring together with another major malformation in infants diagnosed with biliary atresia. Clinically evident portal hypertension (PHT) was diagnosed when there was either (1) a history of a complication of PHT (esophageal or gastric variceal bleed, ascites, or hepatopulmonary syndrome) or (2) clinical findings consistent with PHT (both splenomegaly (spleen palpable >2 cm below the costal margin) and thrombocytopenia (platelet count <150,000/mL)). All children had at least 3 years follow-up after KPE.
Study outcomes
Several patients' outcomes were evaluated, including (1) successful KPE defined as resolution of jaundice with pigmented stools and serum total bilirubin level lower than 20 μmol/L; (2) failed KP defined as persistence of jaundice (>20 μmol/L) and pale stool post KPE; (3) overall survival rate (OSR) defined as starting at birth and ending at death or last follow-up; (4) native liver survival rate starting at birth and ending at death, transplant, or last follow-up.
During the study period, 450 cases of infantile cholestasis were referred to our center for evaluation. In all, 21 patients with BA were identified (11 males) which corresponds to 4.7% of the cases of infantile cholestasis.
Clinical and laboratory characteristics
[Table 1] shows the clinical and laboratory characteristics of the 21 BA cases at the time of presentation to our hospital at a mean age of 66 ± 29.2 days (median 65 days, range: 30–159 days). All the 21 cases were product of full-term gestation except one preterm baby (gestation age 34 weeks). The mean birth weight was 3 kg (range: 2–4.1 kg); all were appropriate for age except one case with intrauterine growth retardation. About 43% of the parents were consanguineous. There was no family history of BA among the 21 cases. Twelve BA cases (57%) underwent KPE at a mean of 70 ± 13.5 days of life (median 73 days, range: 50–94 days). The mean time taken from first evaluation by a pediatric gastroenterologist to performance of KPE was 13.6 ± 4.14 days (median 13 days, range: 7–21 days).
Table 1: Clinical and biochemical characteristics of the 21 patients with biliary atresia at time of presentation to our hospital
Congenital anomalies/systemic involvement
Among the 21 patients, 6 (28%) had congenital anomalies identified. BASM was diagnosed in two cases (9.5%) associated with absent tail and body of pancreas and interrupted inferior vena cava in one case. Congenital heart disease was seen in four cases (19%): ventricular septal defect in three cases, atrial septal defect in two cases, patent ductus arteriosus in two cases, and pulmonary valve stenosis in one case. Skeletal abnormality was observed in two cases: one with lumbar spine kyphosis and the other had butterfly vertebra. One case had neonatal-onset diabetes mellitus.
Imaging studies
Ultrasound was obtained in all cases. The gall bladder was reported to be hypoplastic/atrophic in 17 (81%) cases and normal in 4 (19%). The triangular cord sign was visualized in four cases (19%). Magnetic resonance cholangiopancreatography was performed in 13 cases; 12 studies showed hypoplastic/atrophic gall bladder and one study showed normal gall bladder. Hepatobiliary scintigraphy (HIDA scan) was performed for two patients early during the study period; both were nonexcretory.
Outcome of the 21 BA cases
[Figure 1] illustrates the treatment and outcome of the 21 patients with BA.
Figure 1: Management and outcome of the 21 biliary atresia cases (LT: Liver transplant; BA: Biliary atresia)
Of 12 patients who underwent KPE, 4 had successful KPE (33.3%). Those four BA cases were seen first by a pediatric gastroenterologist at a median age of 57 days (range: 40–68 days) and KPE was performed at a median age of 69 days (range: 50–73 days) by four pediatric surgeons in our center. The jaundice resolved at a median age of 18 weeks (range: 15–20 weeks). One child succumbed at age 14 months due to fulminant sepsis. The remaining three children are still alive with their native liver at a median age of 4.3 years (range: 3.8–10 years); two of them are jaundice-free. A 10-year-old girl has compensated cirrhosis with portal hypertension. A 4.3-year-old girl has been referred for LT because of decompensated cirrhosis. A 3.8-year-old girl is healthy without any complication
Eight cases failed to clear jaundice after KPE (66.6%). They were seen first by a pediatric gastroenterologist at a median age of 58 days (range: 39–81 days) and KPE was performed at a median age of 76.5 days (range: 51–94 days). Three cases died at a mean age of 7.3 months due to progressive liver failure. The remaining five patients had successful LT at a median age of 8 months (range: 6–12 months)
Post-KPE course was complicated by ascending cholangitis in seven patients (58%), one episode of ascending cholangitis each. Portal hypertension developed in two of the three BA cases surviving so far
Nine patients did not undergo KPE and had successful primary LT (43%) (at a median age of 8 months, range: 4–12 months) because of late presentation in six patients (median 90 days, range: 70–159 days) and parents' willingness in the remaining three patients
The native liver 4-year survival rate was 14.3% and the OSR was 81% after a median follow-up period of 4.3 years (range: 3.8–10 years).
This is the first local study that describes the prevalence, various characteristics, and outcome of BA in Saudi Arabia. Our study showed several important findings: first, BA is an uncommon cause of infantile cholestasis in Saudi Arabia (4.7%), when compared with 20–25% in European and North American data.[1],[2],[3],[4],[5],[6],[7],[8],[9] The high percentage (30–33%) of BA reported from the LT centers in Saudi Arabia[12],[13] likely over-represents the BA as a cause of severe liver disease leading to end-stage liver disease and need for LT. Second, an alarming feature in our data is the late referral of BA cases to pediatric gastroenterologists (median 65 days) and subsequent delay in performance of KPE (median 73 days). As a result, the outcome of BA cases in our center was poor when compared with the data from Western countries and Japan [Table 2]: the success rate of KPE was low (33%) and the short-term survival rate without LT was poor (14.3%). However, the OSR of 81% is comparable to Western data due to the success of the LT programs in Saudi Arabia.
Table 2: Series of biliary atresia published from different countries
Most of the literature on the outcome of KPE originated from Europe, North America, and Far East of Asia.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[14],[15],[16],[17] [Table 2]. Although late referral of BA cases is a problem all over the world, it is more pronounced in Saudi Arabia. These studies have identified several factors for the delay at referral: (1) lack of knowledge on the importance of an early diagnosis by pediatricians and families; (2) physicians may not recognize the importance of investigating prolonged jaundice in neonates greater than 2 weeks of age thinking it is breast milk jaundice which is very common in this age; (3) limited access to healthcare system especially by families living in the peripheries away from cities. In Saudi Arabia, after birth, a newborn is seen in the well-baby clinic at 2 months of age for vaccination and checkup, and therefore family physicians miss the opportunity of early detection of prolonged neonatal jaundice within the first month of life. Other factors that have been reported to determine the success of KPE include the following: (a) patient's age at the time of surgery, with best results (70–80% success rate) reported when KPE was performed before 60 days of age, (b) surgeon's experience as reflected by the number of KPE performed per year, and (c) occurrence of postoperative cholangitis.[1],[2],[3],[4],[5],[6],[7],[8],[9] We believe that these factors in combination were major reasons for poor outcome of KPE in our data. In addition, the wide gap between the referral date and age of surgery (median 13 days, range: 7–21 days) was another factor for the poor outcome of KPE in our study. This factor has been recognized and addressed in some pediatric liver units around the world by adopting practical protocols to accelerate the diagnostic work-up so that the diagnosis of BA can be ascertained within 5 days from admission. Another relevant strong indicator of good long-term outcome of KPE and thus avoidance of LT is the postoperative clearance of jaundice. All the successful KPE cases, except one, survived with native liver at a median age of 4.3 years (range: 3.8–10 years).
To improve the outcome of KPE, some European countries have undertaken several practical steps that included (1) awareness campaigns to alert family physicians and pediatricians about alarming signs and importance of early referral of neonatal cholestasis cases to pediatric gastroenterologists; (2) centralization of the care of BA to a very limited number of tertiary care centers to increase the case load/center/year to improve surgeons' experience;[4],[5] and (3) development of appropriate screening tests for BA.[8] A clear limitation of our study was the small number of BA patients included. Insufficient numbers of patients in the subgroups to be compared precluded a meaningful statistical analysis to determine the factors predictive of outcomes. Hence, we need a large multicenter study and a national BA registry to study the incidence of BA and to investigate the hurdles that prevent prompt referral of suspected BA cases and timely performance of KPE to enable us to make appropriate recommendations to improve the KPE outcome. Until we have enough data from a large multicenter study, efforts are needed to raise awareness of parents, general practitioners and pediatricians, for the necessity of prompt investigations of any case with prolonged jaundice (jaundice persisting >2 weeks of life) and early referral of cases with cholestasis to a pediatric gastroenterologist. On the other hand, pediatric gastroenterologists need to adopt a practical protocol to accelerate the diagnostic work-up so that the diagnosis of BA can be established within 5–7 days from admission.
In conclusion, in comparison to data from the Western countries and Japan, BA is an uncommon cause of infantile cholestasis in Saudi Arabia. Although our study's sample size is small, it gives a snapshot of the epidemiology of BA in Saudi Arabia that is characterized by late referral to pediatric gastroenterologists and poor outcome without LT during late infancy.
Sun LY, Yang YS, Zhu ZJ. Outcomes in children with biliary atresia following liver transplantation. Hepatobiliary Pancreat Dis Int 2013;12:143-8.
Schreiber RA, Barker CC, Roberts EA, Martin SR, Alvarez F, Smith L, et al.; Canadian Pediatric Hepatology Research Group. Biliary atresia: The Canadian experience. J Pediatr 2007;151:659-65.
Shneider BL, Brown MB, Haber B, Whitington PF, Schwarz K, Squires R, et al. A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr 2006;148:467-74.
Davenport M, De Ville de Goyet J, Stringer MD, Mieli-Vergani G, Kelly DA, McClean P, et al. Seamless management of biliary atresia in England and Wales (1999-2002). Lancet 2004;363:1354-7.
Serinet MO, Broue P, Jacquemin E, Lachaux A, Sarles J, Gottrand F, et al. Management of patients with biliary atresia in France: Results of a decentralized policy 1986-2002. Hepatology 2006;44:75-84.
Serinet MO, Wildhaber BE, Broué P, Lachaux A, Sarles J, Jacquemin E, et al. Impact of age at Kasai operation on its results in late childhood and adolescence: A rational basis for biliary atresia screening. Pediatrics 2009;123:1280-6.
McKiernan PJ, Baker AJ, Kelly DA. The frequency and outcome of biliary atresia in the UK and Ireland. Lancet 2000;355:25-9.
Nio M, Ohi R, Miyano T, Saeki M, Shiraki K, Tanaka K. Five- and 10-year survival rates after surgery for biliary atresia: A report from the Japanese Biliary Atresia Registry. J Pediatr Surg 2003;38:997-1000.
Chardot C, Carton M, Spire-Bendelac N, Le Pommelet C, Golmard J, Reding R, et al. Is the Kasai operation still indicated in children older than 3 months diagnosed with biliary atresia? J Pediatr 2001;138:224-8.
Karrer FM, Price MR, Bensard DD, Sokol RJ, Narkewicz MR, Smith DJ,et al. Long-term results with the Kasai operation for biliary atresia. Arch Surg 1996;131:493-6.
Abdullah AM, al Fadel Saleh M, al Madan M, el Mouzan M, Olasope B. Infantile cholestasis in the Central-Eastern Province Saudi Arabia. J Trop Pediatr 1997;43:138-42.
Khan I, Al-Shaqrani MA, Arain ZB, Al-Hebbi HA, Wali SH, Bassas AF. One hundred and thirty-seven living donor pediatric liver transplants at Riyadh Military Hospital. Results and outlook for future. Saudi Med J 2009;30:403-8.
Fayyad A, Shagrani M, AlGoufi T, ElSheikh Y, Murray J, Elgohary A, et al. Progress and outcomes of the first high-volume pediatric liver transplantation program in Saudi Arabia. Clin Transpl 2013:77-83.
Queiroz TC, Ferreira AR, ED Fagundes, ML Roquete, Penna FJ. Biliary atresia: Evaluation on two distinct periods at a reference pediatric service. Arq Gastroenterol 2014;51:53-9.
Leonhardt J, Kuebler JF, Leute PJ, Turowski C, Becker T, Pfister ED, et al. Lessons learned from the voluntary German Registry. Eur J Pediatr Surg 2011;21:82-7.
Wildhaber BE, Majno P, Mayr J, Zachariou Z, Hohlfeld J, Schwoebel M. Biliary atresia: Swiss national study, 1994–2004. J Pediatr Gastroenterol Nutr 2008;46:299-307.
Wong CWY, Chung PHY, Tam PKH, Wong KKY. Long-term results and quality of life assessment in biliary atresia patients: A 35-year experience in a tertiary hospital. J Pediatr Gastroenterol Nutr 2018;66:570-4.
Dr. Abdulrahman Al-Hussaini
Division of Pediatric Gastroenterology, Department of Pediatric Sub-Specialities, The Children's Specialized Hospital, King Fahad Medical City, Riyadh
[Figure 1]
Holdar S
Alsaleem B
Asery A
Al-Hussaini A
cholestasis
late referral
portoenterostomy


Regulation A+ allows startups and mid-stage companies to use equity crowdfunding platforms (such as Manhattan Street Capital) to raise as much as $50M from both accredited and non-accredited investors. Reg A+ is broken up into two tiers, Tier 1 and Tier 2. Tier 1 allows you to raise up to $20M, while Tier 2 allows you to raise from zero to $50M.
This means that start-ups and growing businesses don't need an angel investor worth millions or billions of dollars to help take their company to the next level. Regulation A+ dramatically improves the funding prospects for companies that are too small to make a regular IPO on the NASDAQ, for example, or which do not have access to a Private Placement or to Venture Capital. It completely changes the prospect of raising capital, giving start-up, mid-stage, and late-stage companies the opportunity to raise capital from many smaller, individual investors, who become owners of shares in the company. While of course, Angel investors and professional investors are encouraged to invest too.
If you set up legal Headquarters for your company in the USA or Canada then you are allowed by the SEC (Securities and Exchange Commission) to use Reg A+ to raise capital. Most companies that take this route set up a "C" Corporation in Delaware, but you can also set up an LLC or a Limited Partnership. We can introduce you to good attorneys.
If most of your investors will come from your country and few from the US, then using a Tier 1 Reg A+ can be a very good fit. The advantages of Tier 1 are that you do not have to file an Audit with the SEC and you do not have to make revenue and profit reports every six months after your offering completes. The big advantage of Tier 2 is that when you raise money from investors in US States, you do not have to satisfy the US State's Blue Sky regulations, which makes the process faster and simpler. If you will raise capital from US investors in multiple US states, then Tier 2 is the best method to use because dealing with the US states is far easier in Reg A+ Tier 2. Tier 2 offering size range is from zero to $50 mill per year.
You can list your company on the NASDAQ, NYSE, on the OTCQB or the OTCQX, or choose not to list your company at all. The SEC allows the investors in Reg A+ offerings to sell their shares after the offering. Your company can choose to lock the shares or to provide alternative forms of liquidity. The investors in a Reg A+ offering can come from anywhere in the world.
Reg S can be a good compliment to Reg D, in that Reg S allows non-US investors to invest in a US company on a similar basis to the Reg D terms, without the need to be accredited investors.
Regulation S provides an SEC compliant method for company capital offerings that are made outside the U.S by both foreign and U.S issuers. Regulation S, which was adopted by the Securities and Exchange Commission (the "SEC") in 1990, provides that offers and sales of securities that occur outside of the United States are exempt from the registration requirements of Section 5 of the Securities Act of 1933 (the "Securities Act").
Our first step is to help companies assess if Reg A+ (and in select cases, Reg D and Reg S) is a good fit for their business and funding needs. Besides conventional offerings, we also host and consult for STOs on our platform that use Reg A+, Reg D or Reg S, to be securities rules compliant offerings.
We assist companies through the whole capital raising process to achieve a successful offering. Our website technology integrates the necessary services so companies can make their offering work efficiently on Manhattan Street Capital. We provide KYC services, every investor goes through an AML check, and Accreditation Verification process if required.
We provide some services directly, others we provide by introducing client companies to specialized service providers: Specialized Marketing agencies, Legal, Broker/Dealer, Investment Banks, Underwriters, Market Makers, escrow, transfer agent, markets (NASDAQ, NYSE, OTC Markets) and auditors.
Among services that we provide through Manhattan Street Capital are; Consulting and Advisory service, Project Management, and of course Listing Company Offerings. We have developed unique proprietary AI technology that improves the process and the results of our online listing services. We are selective and we add value to the offerings that we assist with.


How Do Programmable Thermostats Work In Bay Area Homes?
Who wouldn't like to save money while sleeping or away from home? You could save a considerable amount of energy without sacrificing comfort simply by using a programmable thermostat.
Take advantage of this guide to be able to program energy-saving configurations matched to your schedule, and for your specific cooling and heating systems.
Programmable thermostats present an array of features that will make programming temperature changes a breeze. Large touch screen displays help to make navigation uncomplicated and intuitive. Program and store as many as 6 temperature changes on a daily basis. For quick temperature changes, manually bypass the programmed setting by selecting "Hold" without changing the rest of the daily or weekly programs.
It's important to match compatible programmable thermostats with HVAC systems. For example, if you have a heat pump, you'll have to have a two-stage programmable thermostat. Or else, when room temperature drops more than a few degrees below a standard thermostat's set point, the heat pump's back-up electric resistance heating powers on, and energy savings go out your window. A 2-stage thermostat stops backup heat from turning on.
Boilers and under floor heating systems have a slow reaction time. You'll need a thermostat that monitors heating performance, and automatically changes the start up time to meet the heating requirements to your scheduled program. For those who have electric baseboard heating, you'll require a line-voltage thermostat able to contrl 120-volt or 240-volt circuits. Your HVAC specialist will help you select the right thermostat for your home heating system.
Just how much energy am I going to save?
Government figures reveal that cooling and heating costs can be decreased by about 1 % for each and every degree the thermostat is lowered (heating months) or raised (cooling months) for an 8-hour time period. To illustrate, if you set back (heating months) the thermostat eight degrees during sleeping hours, and kept that very same setting during your workday (total 16+ hours), you'd save roughly 16 percent, and maybe more, heating costs in that 24-hour period.
For additional information about programmable thermostats, email or call Sandium Heating & Air San Jose and the whole metro south SF Bay Area.
Heat pumps, like other hvac systems, require require the proper operating techniques to run it's best. The combination of caring for your heat pump in the right way and setting up annual maintenance with your local hvac company can result in a system that is 10-25% more efficient than a neglected one.
Use the "auto" fan setting. This allows the thermostat to control the fan and achieve optimal performance. It is also easier on the unit than the constant turning it up and turning it down.
Change the filter once per quarter or as needed. A new filter will ensure proper airflow and put less strain on the compressor. A new filter is much cheaper than repairing the unit.
Clean the outdoor coils periodically. If dirt appears on the outside, that's your cue to hose down the outdoor coils. You should also keep plants trimmed back so they don't obstruct airflow.
Each of these checks will keep your heat pump in it's best condition for years to come, helping you avoid expensive repairs and delaying replacements.
Most of the homeowners in the Bay Area have probably had their furnace running for a few weeks now. This is about the time when the first heating bill arrives for the season. Obviously the amount will correlate to the size of the home and usage pattern. But it is worth spending some time reviewing if you feel it is excessive for the size of your home. In general if the bill is over $200 there may be opportunity to save that will have a quick payback.
There are a couple places to trim your heating bill. Firstly, if you are not using a programmable thermostat you should strongly consider it. Sometimes a furnace is left on when the house is not occupied or when it is not required to be heated. Those can be avoided if a digital programmable thermostat is set up properly. It is relatively inexpensive as a basic thermostat can be had for less than $50 from Home Depot.
Secondly, if your ducts were installed over 20 years ago you should have it checked for leakage. California Energy Commission have done a study indicating that the average leakage rate for older homes is around 30%. That means $0.3 of each dollar is spent heating or cooling your crawlspace/attic. That can be reduced greatly if the system is properly sealed. A duct leakage test can be done to analyze your current status. PG&E also has rebates from $350-$600 to encouraged homeowners to seal their ducts. In certain situations the rebate may be enough to cover the cost of sealing.
Thirdly, if your furnace is over 15-20 years old it may also be a source of inefficiency. There are modern furnaces that are rated at over 95% AFUE. A 20-30 year old furnace is probably running at 60-75% so a significant saving will be seen if it is replaced.
How would you like to dramatically slash your electricity bill as much as 85%? Superinsulating a house can significantly enhance the energy performance of an old house. These so-called deep energy retrofits achieve household energy as much as 85% by addressing all (or almost all) energy loads - space conditioning, warm water, lighting, home appliances, and plug loads - or even transportation. Energy cutbacks of this magnitude require a rigorous and extensive systems approach: The natural associations among energy, indoor quality of air, sturdiness, and thermal comfort should be honored throughout construction and designs. Passive photo voltaic design and renewable energy systems are typical during these projects.
The objectives of any house energy retrofit can be like those of a brand new green residence, however like all remodels, a big difference is basically you have to deal with a pre-existing building. Below are a few house systems with particular areas you should focus on.
With the top and bottom of the home sealed tightly and insulated, the very next prospect will be the walls. Did you know that old and outdated windows is like having a significant hole in your wall? While functioning poorly, they often leak both water and air into the house. Correctly mounted, Energy Star (or even better) windows seal off the gaps in the walls to hold out water and climate extremes.
minimum, upgrade the efficiency of warm water production by coupling the tank towards the boiler.
Warm, dry cellars and crawlspaces can extend living and space for storage. Wet cellars are the source of high humidity levels and discomfort in the summertime in old houses. They can also cause mold growth that will get distributed throughout the house. Spray foam is really a fast, efficient way to create these areas in to the conditioned space while sealing the leaks between foundation and floor framework.
If air leaks in at the bottom of the home, it leaks out at the very top, making a home cold and drafty in the winter months. A poorly insulated roof also can produce a hot house in summer time. Air-sealing is really a by-product of excellent insulation, so it's a real one-step process. Using spray foam within roof may also eliminate the requirement for roof ventilation, that is tricky in complicated roofs.
Filling empty wall cavities with cellulose is really a cheap, easy, efficient way to warm-up a classic house. Blowing cellulose into existing wall tooth decay is definitely an art, to be certain, but you will find many companies who've been doing the work for a long time. Actually, you will find now affordable methods to seek advice from infrared cameras to make certain that voids happen to be filled without disturbing the present plaster or sheathing on outdoors walls. Because siding or shingles on old houses may also normally wear out, we go ahead and take chance to set up foam sheathing around the outdoors of the home before re-siding.
Fittings, home appliances, and lighting after you have reduced your parking space conditioning and water-heating loads, the lighting, appliance, and plug load will probably be your next large energy item. A brand new Energy Star refrigerator uses 15% less energy than the usual standard model. Changing old light fittings with pin-based compact fluorescent fittings guarantees your utility bill will remain lower (as much as 30%).
When your energy consumption continues to be reduced considerably, it might be reasonable to create your personal energy with systems such as photovoltaics, wind energy, or hydro, if you possess a stream nearby. Before you slash the energy usage, though, it isn't worth the money in renewable energy sources. Conservation remains the least expensive game around.
One of the fastest growing sectors of renewable energy resource development is the wide and varied field of Geothermal Heating. No matter the type you choose to match your needs and location, a geothermal installation can be made completely sustainable and is very scalable. It is likely that the future of geothermal energy will find some aspect of it found in every home as part of a varied renewable energy package.
Boiled down to its most basic elements, geothermal energy is generated when the heat of the Earth itself (or submerged magma near reservoir cavities) is used to directly heat water. The water acts as a conduction medium, bringing the heat to another location. One may also use superheated steam to generate electricity by spinning an industrial sized turbine. The water may also be used directly to heat, as is the case in greenhouses with hot water pipes under plant benches.
Geothermically heated waters have been used for at least the last 2,000 years, maybe longer, as the Roman baths found throughout the former Empire can attest to. There was a revival of heated bathing culture in the mid- to late 19th century that saw the creation of countless "healing water" spas. By the 1920s those areas were popular enough that they needed electricity for street lamps and electricity around these often rural destinations, usually flanked by mountains.
The Geysers geothermal power station in northern California was once the site of one of the world's first geothermic power plants, though they were very inefficient. Later, when the spa fell out of fashion, the site became home to no less than 21 industrial turbine generators that make it the largest such facility in the world. Indeed, though Iceland produces more geothermal energy than the US per capita, the output of the US dwarfs the tiny, island nation.
Improvements in generator design have caused there to be a few typical designs for geothermal generators. The oldest type is called "dry stem" and simply uses the steam as it comes out in a single chamber system that turns the turbine. The more modern and efficient method of using what is called a "binary cycle" and two chambers has been very successful and many generators are switching over when they receive overhaul work. Here, either the superheated water itself or another fluid is allowed to undergo pressure changes that instantly turn it into a vapour, thus turning the turbines with each "stroke," like a combustion engine.
One of the most exciting developments in the production of geothermal power is the relatively new practice of injecting reclaimed water into spent vents or heated cavities commonly referred to as, "hot, dry rocks." The water is pumped in while it is still capped, to allow the pressure to grow. It is usually pumped in cold in the hopes that the difference between the water and the rock temperatures will cause further fissures to open up and increase the volume of the cavern to be filled. When new holes are driven in to the rejuvenated geothermal well, the site will usually operate indefinitely as long as there's available water.
Roughly one quarter of North America is capable of supporting any actively heated sites, such as those where hot springs are naturally found. The central and eastern part of the country are still able to use geothermal energy to heat and cool homes and businesses, but their options are limited to passive technologies such as the heat pump. Here, water or glycol is injected into pipes and circulated underground to exchange the heat or absence of it with the constant temperature of the ground outside. Such systems are always closed when they simply circulate underground, but may also be open systems that have intake and outtake pipes submerged deep into a nearby lake or pond.
These passive systems have the advantage of being suitable for homeowners everywhere, having hardly any moving parts that can break and quietly bringing your home to equilibrium with the ambient temperature of the Earth in your area. For those living in climates that get very cold in the winter, this can be the difference between heating your house from 50 to 70F (10-20C) rather than from a typical sub-zero base.
For those looking to investigate how to fit geothermal heat into their sustainable power system, there several organizations that provide detailed information on the topic as part of their advocacy mission.
The next century will surely see a wide expansion of the various geothermal technologies, if for no other reason than it's predicted affordability within even just a few years. As the benefits of geothermal heating and energy production become more widely known, it is certain that heat pumps will become as ubiquitous as wind turbines and solar panels.


Built in 1766 ACE by Sultan Haider Ali of Mysore, the fort – named after Haider's son, Tipu Sultan – is one of the best preserved in Kerala. It sits in the heart of the town, reminding everyone of what Palakkad meant to its erstwhile ruler and to those who captured and lost it many times over. Mornings and evenings bring a crowd of fitness enthusiasts who walk or jog around the granite fort that holds a Hindu temple within. It is believed that several forts built during Haider's reign had carvings of the Hindu God Anjaneya or Hanuman, who was worshiped by warriors of that era. The Kote Anjaneya temple is located at the eastern entrance of the fort.
The Tamil brahmins of Palakkad migrated to the state during the 14th century and continued to come in till the 18th century. They settled in different parts of the town within agraharams or villages that they built, some with over 100 homes strung together. Palakkad's Kalpathy agraharam is the first Brahmin village to be notified as a heritage site in the state and is famous for its Chariot Festival, which is held annually, for three days. The festival sees deities from various temples being mounted on chariots that roll through the streets to assemble at the main temple of Sree Vishwanathaswamy in Kalpathy.
About 10 km from Palakkad lies Malampuzha Garden, which includes a dam and the famous Yakshi (female spirit) sculpture built by Kanayi Kunhiraman. A canal flows through the middle of the garden with bridges hanging over it. The ropeway gives one a great view of the garden, which is illuminated at nights, on weekends and public holidays.
Palakkad is also a good place to shop for traditional Keralite garments or cottons and silks. The many street side shops here offer savouries such as deep-fried lentil vadas or hot banana chips fried in coconut oil. Renowned for its medicinal oils and massages, Kottakal Ayurveda has shops and branches operating in and around Palakkad.
The high mountains surrounding the region make the monsoon beautiful but quite ferocious. Avoid the scorching summers too. The best time to visit Palakkad is December when the place experiences mild, cool weather. The nearest airport is in Coimbatore.


Best Resume Format For Teaching Job Free Downloads Resume Format Word Aurelianmg is just one of the many collections of Sample Resume Reference that we have on this website. We have a lot of Sample Resume Template or Cover Letter Template and any other things concerning in this website. We're not just providing info about , but , you can get a lot more reference to create your Resume and Cover Letter as well. So , don't forget to keep visiting Vcuregistry.org to get the latest update about Sample Resume Format , Cover Letter Sample , Sample Resume Template and more.
Best Resume Format For Teaching Job Free Downloads Resume Format Word Aurelianmg was posted in April 4, 2018 at 7:18 am. Best Resume Format For Teaching Job Free Downloads Resume Format Word Aurelianmg has viewed by 39 users. Click it and download the Best Resume Format For Teaching Job Free Downloads Resume Format Word Aurelianmg.
Resume Awards and Certificates, Recent Free Resume Download In Word Format was posted May 23, 2018 at 6:40 am by Vcuregistry.org . More over Recent Free Resume Download In Word Format has viewed by 2427 visitor.
Resume Awards and Certificates, 2018 Resume For Retail Management Position was posted May 14, 2018 at 10:33 am by Vcuregistry.org . More over 2018 Resume For Retail Management Position has viewed by 2673 visitor.
Resume Awards and Certificates, Fresh Template For Cover Letter And Resume was posted March 23, 2018 at 7:47 am by Vcuregistry.org . More over Fresh Template For Cover Letter And Resume has viewed by 3331 visitor.


text:
IKBA
Mojo Stumer
Michael Jay Wallin
For over thirty years, Stewart Senter, Inc Builders has been building and renovating luxury homes. Our workmen and subcontractors are the industry's finest. No project is too large or too small. We work with the best known architects and take great pride in our quality, craftsmanship and competitive prices. Contact us for a no-obligation consultation on your next building project.
Mr. Brodsky's entrepreneurship was evident as far back as 1970. At that time, he founded his first company, Medical Arts Office Services, Inc., a bookkeeping service for hospital-based physicians. Just three years later, under his direction, the Company became the first to offer computer-automated billing and management services for this market. His innovative leadership was further evidenced when he developed the first program for hospital-based physicians to submit claims electronically to Blue Cross/Blue Shield, Medicare and Medicaid. This business became the forerunner of what is today known as Sandata Technologies, LLC, one of the nation's premier providers of advanced computer, telephony and internet-based technologies for the healthcare industry. Mr. Brodsky is Chairman of Sandata Technologies, LLC, the largest processor of home care claims in the United States.
Lands End at Sands Point © 2016

redpajama_set_name: RedPajamaCommonCrawl


Test Cases for Pen :- It is a very favorite question of interviewer, they use to ask this one to every one during interview.
So here i am writing few good positive and negative cases.
Positive Cases :- 1). See if the different components(the barrel, cap, unscrew-able head, refill, spring etc) of the pen are fitting perfectly.
2). Test the dimension of the pen, its shape and size should be ergonomically designed so as to result in a comfortable writing experience.
3). Test by writing on a piece of paper, see if you can write smoothly.
4). Test if you can carry the pen in your shirt pocket using its cap. The cap extension should be firm enough to grip the pocket.
5). Verify whether it is ink or ball point and color of ink accordingly.
6). Verify whether the pen tip is covered by a suitable cap or not.
7). Test the pen by writing different angles of use.
8). Test if the pen is usable with different brands of simillar refill.
9). Check Whether you are able to hold the pen easily.
10).Soak the refill upward and then write on a paper.
Negative Cases :- 1). Rub the pen ball on hard material and then write.
2). Try to write on paper with bit force to check if it damages the paper.
3). Through the pen in the water and then write up again.
4). Remove the cap of a pen and keep it in a pocket to check whether there is any leakage of ink.
5). Drop the pen from remarkable height to check whether it is getting damage or not.
This is a very informative website, I'll recommend it to my friends to check out, keep the good contents coming! If you ever need help to register a business, let us help, we are the best singapore company incorporation assistant out there, accounting company now!
We won't going to get the well done as correlation with different nations that have more choices and strategies of current training so we should need to proceed onward and receive the real and innovative ways.
Pen is an important thing for us to start our writing career. In this blog we will read about different quality and structured pens. We use pen in https://www.professionalletterwriting.net/letter-explaining-low-gpa/ work as well as in every field to write something. SO this is a best blog.
This is what I was looking for so long.I did not know how to make test cases and test plans but your post resolved my testing queries http://www.manualwriting.net/our-manual-writing-services/help-with-writing-a-training-manual/.Thanks a lot.


Sylvie was raised by a family of Stoats and subsisted exclusively on organic woodland matter until she discovered the urban world in her late teens. Now she is a veritable human 'bridge' for people to cross from their domestic settings into The Glade.
Faze is master of all things that no-one else seems to be doing and largely responsible for making you have a good time at our events. He also spent 7 years balancing on the tip of a stick deep in the Tiger Forest, and he's come back to pass on his insights into feeling good.
Whenever we are dreaming big, Aphra is the welcome voice of reason amongst the chaos and helps herd resources so we can walk our talk. You may often find her behind the scenes at our events weaving magic. She is also in charge of 'soft things'.
Does he create problems or does he fix them? We're still not sure which he does more of. As the founder of TWP Al spends most of his time pretending he knows whats going on and trying to get what's in his head, working in the 'real' world.
Patricia has spent much of her professional life courting the invisible bonds between social beings, and shepherding the intangibles of organisational life. From time to time she floats into our meetings and gently re-shapes our organisational intentions.
From his creative and fertile nursery of a brain, Steve grows and harvests pixels, he then plants them to create nice looking things. He also helps to stop us from being really confusing when we want to show you things.
Eska is 7 months old and is in charge of the company finances. Not really (she is currently 7 months old though). Beloved daughter of Aphra and Al, Eska and her generation are the reason we plant trees.
If we want to find a fairer/better way of doing what we're doing, Tim normally has a good idea of how we can do it. It's like he was a monastic some sort of temple of social enterprise for most of his life. He guides us when we need to do something difficult.
Darren is like the lovechild of a mountain goat and an influential artist. You'll often find him up a ladder rigging stuff up, talking about dimmer switches or going at a piece of timber with a 9' grinder. What a legend.


The aromatics are fuller, more forward, ripe and with exotic elements. Intense, softer, smoother, with decent complexity and a length tinged with brioche.
High-toned, fresh, some green fruit notes. Good density, not too fat – even a touch of grapefruit. For a 2003 this is very attractive and quite fresh.
An assemblage of 5 different parcels. Pale colour. The nose is very nice, a little citrussy with perhaps the merest whiff of aniseed. Piercing fruit and quite nice acidity. The finish is relatively short, but this is a lovely wine.


text:
Q: Worker thread unable to update the UI on Motorola V3 I'm working on a J2ME application that should be ported to different vendors phones. So far, the application is working fine, except on the Motorola V3 (this is the only Motorola phone I have tried).
The problem is that when I start a new Thread, and when the thread tries to update the graphics (by calling repaint()), the graphic system is stack.
Some useful info:
- I'm obtaining the display in the constructor of the Midlet, and reusing it during the application lifespan.
- There is only one class extending Canvas. Every drawing happens here. When I want the graphics repainted, I call the repaint() method, either from the UI thread or from another Worker thread. As far as I know, every thread can access the UI without problems.
- I tried a fix where, in the beginning of the app, I take the name of the running (UI) thread and store it for later use. Before repaint() is called, I check if the current thread's name equals to the UI thread's name. If it odes, then I do repaint(), else I do:
display.callSerially(new Runnable() {
    public void run() {
        repaint();
    }
});

Can you point to me any specifics in the Motorola's implemenation of J2ME? How can I solve this problem with threads updating the UI?
Thanks,
Zlatko

A: Unlike Swing, the MIDP user interface APIs are thread-safe. This means you don't have to use callSerially to force things to run on the UI thread. There are reports that callSerially doesn't work well on some Motorola devices, so your best bet is to just call repaint by itself.
Note that repaint is just a suggestion to the system to do the repainting. If you want to force the repaints to occur immediately, you have to call the serviceRepaints method.
A good discussion of MIDP UI event handling can be found here.

redpajama_set_name: RedPajamaStackExchange


text:
Четвертий сезон Футбольної ліги був останнім, в якому змагання проходили в одному дивізіоні. Сандерленд уперше став чемпіоном. На початку сезону Сток Сіті залишив Футбольний альянс і повернувся у лігу. Дарвен теж перейшов із Альянсу, але пропустив 112 голів і зайняв місце на дні таблиці.

Турнірна таблиця

Результати матчів

Примітки

Посилання
 rsssf

Футбольна ліга
Англія
Англія

redpajama_set_name: RedPajamaWikipedia


1. This is a new Evertale Game account (Level 1, Magic value 0) with summon stones. The account only used for checkin in game everyday, 100% safe and won't get you stuck in the storyline.
3. After login the account, summon the storyline SR card first, then the lottery draw.
4. Data interoperable on IOS/Android platform.
1. We will send account Restore code to you by email or live chat, please check photo below to read how to use restore code.
2. 2000 and 3000 stones currently in stock, delivery in 10mins. 4000 will be on sale at April 8th, we accept pre-order now!
Developed by ZigZaGame and released on March 21st 2019, Evertale is basically a combination of Pokémon and Final Fantasy, which launched for IOS and Android platforms. In this gameplay, you play a role as a monster trainer called" Crestbearer" and your mission is to save the world of Erden, which is currently suffering from a curse known as Pandemonium. You'll begin with a single sword-wielding party member, but will soon fill out your team with monsters and other warriors. The way of filling out your team is by constantly catching monsters and then battle alongside the monster to level it up, eventually evolving it when it becomes powerful enough. There are over 180 monsters for you to catch, train and evolve. Monster balls are indispensable items to catch masters. But Monster balls can be only purchase with Soul Stones.
Evertale Soul Stone play an essential role of in-game currency. We 5Mmo.com offer an easy way to get cheap Evertale Soul Stone Account that is Evertale account. Evertale Account service is not to sell some real account to you for gaming; it's just an account that full of Soul Stone. Use our soul stone to buy more powerful monsters balls and conquer stronger monsters, train them and put them into battles to fight for you. Hope you can end this age-old curse once and for all.


Looking for ideal Silver Pure Acrylic Pedestal Washbasin Manufacturer & supplier ? We have a wide selection at great prices to help you get creative. All the PMMA Stone Resin Pedestal Washbasin are quality guaranteed. We are China Origin Factory of Stone Resin Silver Column Basin. If you have any question, please feel free to contact us.


text:
Funeralhomes Simi Valley CA 93099
Seeing how much he's missed gives him the resolve necessary to go through some difficult ordeals to get himself resurrected. End-of-life expenses are a driving factor behind many families' decisions to pursue cremation instead of traditional burial. What is left after the cremation process is basically dry bone fragments and the quantity of these usually vary from 2kg to 3kg depending on the deceased size. Black families go to a black funeral home," McKinney said, shrugging. "It's just always been that way." Funeralhomes Simi Valley 93099.
You are upright in all you have done for us.. True is the sentence you have given, in all that you have brought down on us. Japanese Journal of Religious Studies, Vol. 27, No. 3/4, Mortuary Rites in Japan (Fall, 2000) , pp. 297-334 In January, David Bowie's passing was also marked across Capitol Hill Be ready for more and what could be a nearly perpetual state of pop culture mourning fueled by art and creativity, social media, marketing, and good old fashioned nostalgia at the scale of an increasingly interconnected planet.
Cremated remains may not be checked through as regular baggage. The cremated remains should be transported in a temporary plastic or cardboard container that will pass through screening procedures. Great Sermon!. amen brothers and sisters arent we lucky to have a saviour that can... You can print off the detailed funeral checklist to help you organize the process and ensure clear decision-making. The state of great comfort and extravagant living. Burial Plot Simi Valley CA
The funeral director is there to help you every step of the way. Our Perth based funeral directors are available 24 hours a day, every day of the year to assist you in your time of need. Another environmental concern is that traditional burial takes up a great deal of space. In a traditional burial, the body is buried in a casket made from a variety of materials. The FBI has arrested an 18-year-old man on suspicion of conspiring to launch acts of terrorism against government buildings in Maricopa and Pima counties. In fact, the law requires me to allow you to BYOB. Costco and Wal-Mart sell very reasonably priced nice caskets on their websites.
We don't just rent apartments. From the moment you walk through the front door you'll feel the comfort and security that makes our residents happy to call us home. Cremation costs can vary greatly and are dependent on many factors. The location of the deceased, competition in the market, access to crematories and a firms level of overhead all play a part in determining cremation costs. For Steve Torrance, being a funeral director means helping families celebrate a life, not just mourn a death. Simi Valley 93099 She started her Ask a Mortician series, together with the Order of the Good Death — a web forum she founded for death professionals, academics and artists to promote the open discussion of death and dying — as a platform to spread her conviction that we need to drastically change the way we confront death, which she feels is weighted down by denial. Thank you for taking me step-by-step through the things I could and would need to do. The professionalism and dignity which you provided to me gave me comfort and closure that I will never forget. Federal authorities are moving forward with illegal export cases at a time when luxury auto manufacturers are pressing to take advantage of the demand for high-end cars in China. Other big car reveals this week at the show include the Nissan Maxima, Chevrolet Malibu, Focus RS, Kia Optima, Jaguar XF, Chevrolet Spark, Scion iM hatchback and 1A sedan. My beautiful FREJA died on 9.11.15 after a short battle with melanoma CANCER. Can't bear to go on but I have to for her sisters sake. God shall wipe all tears from their eyes; and there shall be no more death, nor crying, neither shall there be any more pain: for the former things are passed away. Instead, the business you receive will come from funeral homes and sometimes cemetery associations. reading this impressive piece of writing to increase my experience.
There is a thin line between sadness and anger, and he broke that line quickly with our entire family. Making it to where instead of spending that hour remembering my precious grandmother, I spent my time seething in anger and fighting back hot tears filled with crazy. It will be ready to ship in 3 business days or less. Be sure to consider time for delivery. Scott checked into Koyuk at 4:13pm and has not yet checked out. A sudden death is always the most stressful experience that can happen to anyone especially when it is one's spouse. I could not have expected more, you were expeditious, courteous and kind and I cannot thank you enough for the attention that you gave to me, it took a load off my shoulders. On the day of a funeral in the house, Vada is supposed to be watching her but Grandma gets up and walks into the funeral - and starts singing at the top of her voice. Overlooking Llanelli with views of the Gower where it meets the sea, Llanelli crematorium provides a natural place for families to hold a dignified service of their choice. I have passed my National Board Exam with sucess. The M.A.T.S. program was the keystone to this success. I would like to thank you for the production of this program and making it available for students to use. Wooster Funeral Home and Cremation Services (Pauls Valley): (405) 238-7574 Why are you nominating this member for a badge? Please explain briefly or provide a link to support your nomination. We offer services to the four state area with locations in Grove and Jay. Lawson's Funeral Home is best known for accommodating the most intimate of settings within our spacious chapels, or offering Services in the most unique places. While individually this may not take much room, combined with other burials, it can over time cause serious space concerns.
David W. Bickel, age 66, passed away at home surrounded by family on Sunday, June 26, 2016 Dave was a true intellectual, writer, learner and artist. Harald Heine - bass guitar, backing vocals (1993-2016) Here are two other passages which clarify what this burning is: Funeralhomes Simi Valley California 93099 Copyright © 2016 McGan Cremation Service LLC. All Rights Reserved. Website by CFS All participating funeral homes offer you the opportunity to honor your loved ones with Living Tributes, the unique new Internet service that preserves a life story for future generations.
In a later episode, Homer is getting dressed for his wedding anniversary when he pulls out the program for Grimes' funeral. I know it was just fun to him, or some perverse pleasure, but it was deeply damaging to me. He couldn't understand my fear and enjoyed pursuing me. A physical examination and completed medical health form are also required for acceptance. Already pre-arranged with another firm? In New York State,both revocable and irrevocable pre-paid trusts are 100% commutable by law and can be transferred to another funeral home at any time. Funeral service has traditionally been a male-dominated profession. It also has been a "family" profession, with firms being passed down from one generation to the next. Please be advised that due to staffing limitations, we will only be able to offer the Simply Cremation Plan for deaths that occur in La Crosse County.
Burial Plot Funeral Home Supplies


text:
jballallen.com
Jim's Blog
Baseball>
Commentary>
NPB games, news of July 10, 2019
Baseball / Commentary / News
The horror. The horror.
Kris Johnson throws seven scoreless innings and drives in the tie-breaking run, and still the Carp can't win. They have now lost 11 of their last 12, with one tie mixed in there. That 11-game losing streak is the franchise's longest since 1999.
The Carp of darkness
Just when it seemed like it was safe for the Carp to go back in the water, reliable Kyle Regnault relieved Kris Johnson with a one-run lead in the eighth and simply couldn't get the third out.
After walking six batters in his first four innings in Japan, Regnault (4-1), had walked 16 over his next 37-1/3 innings. After giving up two singles to open the inning, the Dragons gifted him an out with a sacrifice. An intentional walk to Dayan Viciedo loaded the bases and allowed for a force out at home on the next play.
Then the wheels came off. Atsushi Fujii battled drew a walk on a 3-2 count, but Yota Kyoda didn't swing at any of Regnault's four pitches and that was the ballgame.
Enny Romero had been on the hook for the loss after allowing one run on three hits and no walks over seven innings. With the lead in hand Raidel Martinez avoided giving up the tying run in the top of the ninth thanks to a nifty fielding play at first base by Dayan Viciedo that ended the game.
Giants 4, Tigers 1
Hanshin's Randy Messenger (3-7) lasted a season-low two innings, while allowing four runs and four Yomiuri relievers saved the day after starter Nobutaka Imamura (3-1) ran into trouble in the sixth at Koshien Stadium.
The game's highlights are HERE.
Swallows 7, BayStars 2
Rookie Yakult lefty Keiji Takahashi allowed two runs over six innings, and relievers Kazuki Kondo (3-1), David Huff and Scott McGough helped the hosts cruise at Jingu Stadium against DeNA.
Lions 7, Hawks 3
Tsuyoshi Wada (2-2) game crumbled in the fifth inning on solo homers from the bottom of the Seibu order. The lefty issued a two-out walk and surrendered a single before leaving the mound with stiffness in his leg.
His relief, right-hander Masayoshi Tanaka, surrendered a two-run triple to Shuta Tonosaki, and the Lions iced the game in the seventh inning on back-to-back home runs from Hotaka Yamakawa and Takeya Nakamura.
Buffaloes 7, Eagles 6, 10 innings
Yuma Mune singled in the go-ahead run in the 10th inning off Yuki Matsui (1-5) after the Eagles sent it to extra innings by tying it in the eighth off Tyler Eppler. Brandon Dickson (2-0) worked a scoreless ninth to earn the win and finished the game off with a scoreless 10th to close it out.
Given the way relievers are used these days, a case could be made for the same pitcher to earn a win AND a save in the same game. Certainly, Dickson earned one of each, by winning it in relief and then saving it. He did what is normally the job of two pitchers. He deserves double credit.
Marines 5, Fighters 0
The opener-happy Nippon Ham Fighters got opened, with Yuki Karakawa throwing a scoreless first for Lotte, followed by three goose eggs from Chen Kuan-yu (1-0) at Zozo Marine Stadium.
Toru Murata (0-1) was tasked with going through the Marines lineup twice, but surrendered three runs, one earned in his 3-2/3 innings on the mound as the Fighters fielders made four errors in the game.
Seibu spends to keep up with the SoftBanks
In a bid to reclaim it's golden age, the Seibu Lions have revealed the team has spent about 18 billion yen, roughly $160 million, to upgrade its facilities surrounding MetLife Dome, their 40-year-old park just across the border from Tokyo.
The Sankei Sports story is HERE.
The article suggests the new indoor training facility will be the largest in NPB, and will be open so that fans can watch as players work out. The project also expands the number of dorm rooms on site from 20 to 28, expanded physical training space, more meeting rooms and includes a new merchandise shop.
The Lions last year won the Pacific League for the first time in 10 years, although they lost in the playoff to the SoftBank Hawks, who since 2010 have won either the league or the Japan Series in six seasons since.
The Hawks have invested heavily in their minor league and rehab facility in Chikugo, Fukuoka Prefecture, and their efforts have been rewarded this season with a sizable PL lead despite missing a number of their best players.
The Lions won the PL seven straight seasons from 1982 to 1988, another five time from 1990 to 1994, but only six times since. Since 2010, the Hawks have won five pennants, the Nippon Ham Fighters two, and the Lions and Rakuten Eagles one each.
Hawks' Yanagita, Imamiya not ready for early return
The SoftBank Hawks will be without star center fielder Yuki Yanagita and starting shortstop Kenta Imamiya through July 26 at least, following their withdrawal from this weekend's All-Star Game series.
Players picked for their league's All-Star team who fail to appear are prohibited from playing in their team's first 10 games after the All-Star break. The Hawks are scheduled to play their 11th game after the break on July 27 at home against the Orix Buffaloes.
Yanagita suffered a muscle tear behind his left knee on April 7, while Imamiya was deactivated on June 22 after spending much of the season with left hamstring issues.
Both were voted onto the PL squad by fans. Some have called for the 10-day suspension to only be applied to those selected in the fan ballot, since an opposing manager could select a rival team's star who is nearly fit for duty to keep him out of action for 10 more games.
Seibu Lions closer Tatsushi Masuda and Hawks outfielder Yurisbel Gracial were chosen as replacements.
Stewart sees 1st game action
Carter Stewart Jr, the eighth pick in MLB's 2018 amateur draft, took the mound in his first game since arriving in Japan over a month ago.
The 19-year-old right-hander allowed a leadoff double against the first batter he faced but retired the next six and left after two innings and 24 pitches in a practice game between SoftBank's third team and corporate league club Mitsubishi Motors Kyushu.
He touched 151 kph (93.8 mph) when he struck out the opposing cleanup hitter to end the first inning.
According to the Nikkan Sports, Stewart said he was excited and nervous, but was able to throw at about 90 percent of full strength at the Hawks' minor league park, Tama Home Stadium.
All NPB teams are required to enter a farm team in either the Eastern or Western league. Third teams are a different breed that play independent minor league teams, corporate league and university teams.
Kawasaki to coach in Taiwan
Former major league utility infielder Munenori Kawasaki, who has put his playing career on hiatus since developing a nerve disorder, is reportedly going to coach on a three-month basis this summer with the Wei Chuan Dragons according to the CPBL Stats website.
Tags: all-star, Carter Stewart
Previous PostNPB games, news of July 5, 2019
Next PostLions' Mori top of the pops
sports editor for a wire service in Tokyo
Hotaka Yamakawa and the art of 1st team survival
Japan's left-side story
Pingback: Carter Stewart Pitches in First Japanese Game Action | Burly's Baseball Musings
Latest tweets from JBallAllen
Tweets by @JballAllen
NPB games, news for July 15, 2019
Cleanup man bats 2nd, world survives
NPB news for July 14, 2019
Tigers return all-star fire at Koshien
Lions' Mori top of the pops
Carter Stewart Pitches in First Japanese Game Action | Burly's Baseball Musings on NPB games, news of July 10, 2019
Burly on NPB games, news of June 21, 2019
Nicolas Hu on NPB games, news of June 16, 2019
Sunday Notes: Griffin Canning Has an Artistic Thumb Print – Baseball My Life on Well-traveled Rhodes
William Brooks on Matt Murton's wild ride
Notification based on the Specified Commercial Transactions Act
Relief: long, middle, late and extras…
Starting Pitchers Game Scores
Interview with Hiroki Kuroda on Sept. 6, 2014
Links to Japanese baseball resources
Links to my stories in Japan Times and elsewhere
NPB batter of the month candidates
NPB park adjustments since 2011
NPB pitcher of the month candidates
NPB WAR and… Win Shares 2013-2016
Team relief rankings
Copyright 2019 - OceanWP Theme by Nick, Specified Commercial Transactions Act: https://jballallen.com/about/notification-based-on-the-specified-commercial-transactions-act/


The GFS computer model continues to have a colder look to it as it is suggesting the storm to track mote to our south. This would be the best potential for accumulating snowfall to our area.
On the flipside, the Canadian model is showing a warmer solution, bringing the rain/snow line right through central Kentucky. This scenario would bring little to no snow accumulations to the area.
In conclusion, we are still three days away, and while all the data is showing a storm in our area, I don't know what the future track will be. Stay tuned for all the latest updates!


Each chalet is rated out of 10 in the following categories: style, character, location, service, facilities, rooms, food and value for money to give you an in-depth look into what each property offers.
We'll start with Swiss ski resorts that come with chocolate-box appeal, and chalets in popular villages such as Zermatt and Verbier, just like AlpenHouse, go a long way to making those picture-perfect ski holiday dreams a reality. Prices in Switzerland might be higher than anywhere else in Europe, but along with the weighty price tags come some of the world's most luxurious lodgings. Check out our best-in-class chalet in Switzerland to see what we mean.


A grieving daughter has told of her disgust that her father's grave was left to crumble after work carried out by a funeral parlour.
Linda Street, from Northumberland Avenue, Whitley, is distressed after concrete in a surround of the grave began falling apart.
Her father Gordon Cross was 70 when he died from cancer in 2004 and he was buried at Reading Cemetery and Crematorium in Caversham in February that year.
The Co-operative Funeral-care in Southampton Street, Katesgrove, laid the concrete but has not repaired the grave since weeds began to appear in May this year.
Mrs Street, 55, who suffers with a slipped disc, ordered the concrete covering with a cross filled with stone chippings to make the grave easier to maintain, and paid £172.50 for the work last December.
She said: "I went to visit the grave on Father's Day a month later to put some flowers on dad's grave. I saw there were a number of large weeds coming up around the cross.
"I called the Co-op and they suggested I pull out the weeds or put weedkiller down. I refused as I had paid money to have this work done properly, and this defeated the point.
"I went down to the grave in the summer and the concrete seemed like too much sand had been added to the mix and phoned again asking when this would be repaired.
"They said they had lost contact with the stonemason and they showed me some pictures they had taken of the chippings removed and the slabs of concrete were all broken.


Ever since I was a kid I used to watch the Passion Play here in Cavite City during the Lenten Season. It is called here in the Philippines as Senakulo. It is derived from the Spanish word Cenaculo. It is a Lenten play that depicts the events of the Old and New Testament that is related to the life, suffering, and death of Jesus Christ. It is traditionally performed on a stage. There is usually a painted cloth or paper backdrop called telon. It usually takes up to eight days from Palm Sunday up to Easter Sunday. In modern times like the one that is being performed here in Cavite City, it is done in the streets. It takes about 8 to 10 hours to finish. According to some of my old relatives the Passion Play here is a depiction of the 14 Stations of the Cross. From when Jesus Christ entered Jerusalem up to his Resurrection. It takes about 8-10 hours for it to finish. According to some old people here that I was able to talk to. The Passion Play started here in the late 1970's. I was also able to talk to one of the Apostles in the stock photos and he said that during that time the Roman soldiers were all portrayed by Retired US Navies, Armies, and Air force personnel. Also all the participants in the play are all volunteers. Some of them do it as a form for penitence while others do it as a form of a vow or oath. There are a lot of people who watch the Passion Play done here every year. It has been a tradition for us to watch it during the Lenten Season. It is usually done here on Holy Tuesday. Also There are other places here in the Philippines that also does that Passion Play and almost everything is the same except for the people who portray the characters.
A few weeks ago one of my men (magbobote) brought me a box full images of stock photos. I asked him were he got the box of stock photos. He said that he got the photos in a dumpster near our area. When he was looking for some scraps and junk to be sold at my junkshop he found the box and took a look at it. He then found that there were some images of stock photos and he decided to bring it to me. He thought that I might be interested because I asked them to look for some old pictures. While I was skimming the photos. I noticed a bunch of religious photos that was included in it. I then collected all the religious pictures and I found out that all of them were related and that they were all pictures of Passion Play or Senakulo. At first I thought that the pictures were taken from the late 60's or early 70's. After I got the religious photos of the Senakulo, I showed it to my mom. She skimmed the pictures and found that she knew one of the Apostle in the stock photo. I asked her to call him and maybe I could show it to him to get some more information. I was then able to talk to the man and he said to me that the pictures were from the early 1980's because that was the time when he became an Apostle in the Passion Play. we also talked for a bit and he said that during that time they not only performed here in Cavite City but they were also invited to other municipalities in the province of Cavite. They were not paid and they do it for free and voluntarily. He also said that there was a sense of pride and joy whenever people watch and appreciate the things that they do.
The Photo above shows the Roman Soldiers who arrested Jesus Christ and also the ones who accompanied him until his crucifixion. As you can see people at that time really did worked hard to portray themselves as Roman Soldiers. Having stock photos of it is a good remembrance to show to the younger generations in order to inspire them. They even have complete weapons and armor to make it look realistic. I still remember getting scared when I was a kid when seeing them because of how they carried themselves a Roman Soldiers that depicts them as the ones who made Jesus Christ suffer.
the picture above shows the person who portrayed Jesus Christ and the persons who portrayed his Apostles. According to the friend of my mom the background was the door of our old church. And this particular photo was taken before they started the Passion Play. To bad the picture has some water damage.
The photo above shows the different participants for the said Passion Play. Some have minor roles while others have major ones. But all of them give and sacrifice a portion of their time to practice and make the Passion Play a memorable one.
The pictures above shows the procession of Jesus Christ from his last supper to his crucifixion. It also show the streets of Cavite City form the early 80's and in one of the pictures you can see the old house and the old cinema. Today both are demolished.
The last two pictures above shows the preparation before Jesus Christ is crucified and after. I still remember that this was the most emotional part of the Passion Play and some devotees even cry whenever they see this part.
All in all the pictures are a great reminder of this tradition that up to this day is still being held not only in Cavite City but other places in the Philippines as well. The pictures also shows the devotion of the people here to their faith. I hope that this tradition will still be experienced by the future generations and that this old religious pictures of the Passion Play be a reminder of how the people of the past used to devote their time and energy to make it a production that will be remembered.
Salamat po sa information sir.