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Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study
Giacomo Bellani1,2,
Giacomo Grasselli2,3,
Maddalena Teggia-Droghi1,2,
Tommaso Mauri3,
Andrea Coppadoro4,
Laurent Brochard5,6 &
Antonio Pesenti1,2,3
Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both negative and positive effects on lung injury in comparison with fully controlled mechanical ventilation (CMV). We wanted (1) to verify in mechanically ventilated patients if the change in transpulmonary pressure was similar between pressure support ventilation (PSV) and CMV for a similar tidal volume, (2) to estimate the influence of SB on alveolar pressure (Palv), and (3) to determine whether a reliable plateau pressure could be measured during pressure support ventilation (PSV).
We studied ten patients equipped with esophageal catheters undergoing three levels of PSV followed by a phase of CMV. For each condition, we calculated the maximal and mean transpulmonary (ΔPL) swings and Palv.
Overall, ΔPL was similar between CMV and PSV, but only loosely correlated. The differences in ΔPL between CMV and PSV were explained largely by different inspiratory flows, indicating that the resistive pressure drop caused this difference. By contrast, the Palv profile was very different between CMV and SB; SB led to progressively more negative Palv during inspiration, and Palv became lower than the set positive end-expiratory pressure in nine of ten patients at low PSV. Finally, inspiratory occlusion holds performed during PSV led to plateau and Δ PL pressures comparable with those measured during CMV.
Under similar conditions of flow and volume, transpulmonary pressure change is similar between CMV and PSV. SB during mechanical ventilation can cause remarkably negative swings in Palv, a mechanism by which SB might potentially induce lung injury.
In recent years, conflicting data have been published concerning the beneficial or detrimental effect of preserved spontaneous breathing (SB) compared with fully controlled mechanical ventilation (CMV) during acute respiratory failure [1–5]. SB has been credited with having several beneficial effects, such as improved hemodynamics [6], improved ventilation-to-perfusion matching [7], decreased ventilator-induced lung injury (VILI) [8, 9], and decreased muscle atrophy [10]. However, SB can also cause or aggravate lung injury during mechanical ventilation, as shown by experimental evidence [11–13], by mechanisms that include negative intrathoracic and alveolar pressure (causing interstitial or alveolar edema), loss of control over tidal volume (VT), and inhomogeneous regional stretch. Abolition of SB might be one of the mechanisms by which the use of neuromuscular blocking agents in the first hours after intubation may improve patient outcome [14]. For this reason, greater attention is now being paid to better understanding of the pressure across the lung (i.e., transpulmonary pressure [PL]).
While airway pressure (Paw) is usually lower during SB than during CMV, this does not necessarily translate into a lower pressure across the lung (i.e., a lower PL). By convention, PL is the difference between the pressure at the airway opening and the pleural or esophageal pressure [15]. Our hypothesis was that, for a given inspired volume and flow, and for the same mechanical properties (i.e., compliance and resistance) of the lung, the amplitude of the change in PL (ΔPL) during assisted SB and during CMV should not differ, regardless of the level of inspiratory effort, whereas the absolute value of airway and esophageal pressure should differ. To our knowledge, however, despite the major implication of understanding the mechanisms of VILI, this has not been directly verified in patients. For instance, the net effect on local transmural vascular pressures may significantly impact the generation of VILI [16]. The total PL can be divided into the pressure generated to overcome the resistance to airflow between the airway opening and the alveoli, and the pressure needed to expand the terminal airways (i.e., the transalveolar pressure). Only the latter part of the PL, which equals the product of lung elastance and volume, is dissipated across the alveolus and is commonly considered to cause VILI [17]. At the same time, the pathophysiological relevance of the pressure needed to generate the airflow across the airway will be substantially different between CMV and assisted SB, which may have clinical consequences. The absolute value of the pressure surrounding the lungs, as well as that of the alveolar pressure (Palv), will change in a positive direction related to atmosphere during controlled ventilation and in a more negative direction for increasing levels of breathing effort. Airflow generation in the presence of elevated airflow resistance may lead to an extremely high PL during both fully controlled and spontaneously assisted ventilation, but accompanied in the latter case by very negative pressure around and even inside the alveoli.
The purpose of the present study was to compare the ΔPL during spontaneous assisted breathing and fully controlled ventilation, trying to match similar conditions of airflow and volume, in a group of patients undergoing different levels of pressure support ventilation (PSV) followed by a phase of CMV. Moreover, we investigated the role of the resistive pressure in the generation of negative intrathoracic and intraalveolar pressure during spontaneous assisted breathing. Finally, we reasoned that if the transalveolar pressure is similar during CMV and PSV, then plateau pressure (Pplat) during PSV, obtained in the absence of flow and during patient's muscle relaxation, should provide similar information as during CMV. For this reason, we evaluated the reliability of the measurement of Pplat during PSV compared with that obtained during CMV.
This is a secondary analysis of data collected in a previous study, where the methods are described in more detail [18].
The protocol was approved by our institution's ethics committee (San Gerardo Hospital, Monza, Italy). We enrolled patients admitted to our general intensive care unit who were orotracheally intubated and undergoing PSV or neurally adjusted ventilatory assist with a positive end-expiratory pressure (PEEP) level greater than 5 cmH2O. Exclusion criteria were age less than 18 years, hypoxemia requiring a fraction of inspired oxygen (FiO2) greater than 60 %, presence of bronchopleural air leaks, hemodynamic instability requiring vasopressors, Richmond Agitation and Sedation Scale score less than −1, history of chronic obstructive pulmonary disease, and clinical suspicion or evidence of intrinsic PEEP. Informed consent to participate in the study was obtained (immediately or in delay, according to the institutional ethics committee's recommendations) from all patients.
Study phases
After patients were enrolled, we inserted a nasogastric tube with electrodes and an esophageal balloon. The correct placement of the esophageal balloon was verified according to the standard procedure [15]. The waveforms of Paw, esophageal pressure (Pes), airflow, and electrical activity of the diaphragm were continuously recorded using a data acquisition system (PowerLab; AD Instruments, Colorado Springs, CO, USA) at a sampling frequency of 100 Hz for offline data analysis.
The study protocol consisted of three consecutive phases. Initially, patients underwent a trial of PSV at three levels of assistance averaging 13.6 ± 3.1 cmH2O, 7.6 ± 3.1 cmH2O, and 2.4 ± 2.1 cmH2O (hereinafter defined as high, medium, and low, respectively) separated by intervals of 4 cmH2O, as previously described [19], lasting 30 minutes each in random order. During each level of PSV, at 10-minute intervals, we performed two short (2–3 seconds) end-expiratory and end-inspiratory occlusions, verifying adequate relaxation of the muscles by a return of the electrical activity of the diaphragm signal at baseline and a flat, stable plateau in the Paw waveform. After a phase of neurally adjusted ventilatory assist ventilation (not taken into account for the present analysis), patients were sedated and switched to CMV with a VT of 6–8 ml/kg and two different constant (square waveform) flow rates of 0.5 and 1 L/second. In this phase, we carefully verified the absence of SB activity by observing esophageal and electrical activity waveforms. Also in this phase, three end-expiratory and end-inspiratory occlusions were performed. Throughout the study protocol, PEEP and FiO2 were left unchanged from the clinically set values.
Signals measured and calculated
For the present study, the electrical activity of the diaphragm data and the periods of neurally adjusted ventilatory assist ventilation were not taken into account. Continuous tracings of PL were generated as Paw – Pes, where Paw and Pes are airway and esophageal pressure, respectively. As we preferred to avoid using absolute values for Pes, we always refer to ΔPL from the end-expiratory level (Fig. 1a). Analogously, a Pes decrease or increase (ΔPes) was calculated as the difference in Pes from the end-expiratory level (Fig. 1a).
Individual examples of airway and esophageal pressure tracings of pressure support breaths sampled during regular tidal ventilation (a) and one prolonged inspiratory hold (b). a For each selected breath, from the airway (ΔPaw) and esophageal (ΔPes) pressure swings we calculated the transpulmonary lung pressure (Plung) swings (ΔPL) as changes from the end expiration (dotted lines) at two time points of interest: the point of maximum ΔPL and the mean over inspiration (gray rectangular area). b Following an inspiratory hold, when the patient relaxes the inspiratory muscles, a plateau is seen in airway and esophageal pressure (arrows), whose differences from the end-expiratory level represent the elastic recoil pressure of the respiratory system and of the chest wall, respectively
The pressure generated by inspiratory muscles (Pmus) was calculated as the difference between the Pes and the theoretical curve of elastic recoil of the chest wall, which was in turn calculated by instant-by-instant multiplication of the volume signal by the chest wall elastance obtained during the phase of CMV. Palv was calculated as Paw − (flow/Raw), where Raw is the airway resistance measured during CMV and its changes (ΔPalv) were calculated as the difference between end expiration and the value of Palv at the selected time points. Finally, the changes in transalveolar pressure due to the elastic recoil pressure of the lung (ΔPL,el) were calculated as ΔPalv − ΔPes at the selected time points. At the end of inspiration, when the inspiratory flow is instantaneously zero, the transpulmonary and transalveolar pressures are equal [15]. If the VT is kept constant during spontaneous and controlled ventilation, the pressure across the alveolus must be the same.
Time points sampled and averaging of breaths
For regular VT, we sampled ten inspirations for the phase of CMV and ten inspirations for each level of PSV (attempting to identify ten breaths with a VT of a size as close as possible to those used during CMV), avoiding those parts of the tracings with a low quality of the Pes signal (e.g., peristaltic waves).
For each breath, we sampled two conditions (Fig. 1a):
The time point at which ΔPL was maximum (maximum-ΔPL)
The mean value over inspiration (mean-insp)
The values from the ten breaths sampled during each condition were then averaged, obtaining in each patient four values (CMV, PSV-high, PSV-medium, and PSV-low) in two conditions each (maximum-ΔPL and mean-insp), which were later used for analysis. After matching for the VT size, we attempted to match inspirations obtained in PSV with those with similar mean inspiratory flows in CMV. Since the matching for inspiratory flow was rather poor (see below) due to the availability of only two inspiratory flows in CMV (0.5 and 1 L/second), we performed an analysis focused only on combinations of similar (arbitrarily defined as an absolute difference <0.1 L/minute) mean inspiratory flows between PSV and CMV.
Measurement of plateau pressure
For those breaths in which an inspiratory hold was obtained, we measured plateau Paw and Pes, and static respiratory system compliance was calculated according to standard formulas during both CMV and PSV. During PSV offline analysis, we paid particular attention to avoiding those occlusions in which a clean plateau could not be identified in the Paw profile (Fig. 1b). To define a "clean" plateau, we discarded those measures in which the Paw tracing was not flat (i.e., steadily increasing or decreasing or with periodic oscillations greater than 2–3 cmH2O).
Data are expressed as mean ± standard deviation unless specified otherwise. Analyses were performed using SPSS software (IBM, Armonk, NY, USA). Comparisons between the four study phases (CMV and the three levels of support) were performed using one-way analysis of variance (ANOVA) for repeated measures. Correlation between variables was assessed by linear regression. Mean bias and 95 % confidence intervals for agreement between measurement obtained during CMV and PSV of plateau airway pressure and ΔPL,el were calculated according to the method of Bland and Altman. p < 0.05 was considered statistically significant.
The main demographic and clinical variables of the patients are reported in Table 1. All patients completed the protocol and had data available for all study phases, except for 9.5 % of the inspiratory holds, which were discarded (see below). Inspiratory flows and VT did not significantly differ overall during the three levels of PSV and the CMV phases (Table 2), with a slight decrease during PSV-low. VT in PSV and CMV were tightly correlated (r 2 = 0.93, data not shown), but the correlation was loose for inspiratory flow (r 2 = 0.23, data not shown), suggesting that, while on average there were no differences between PSV and CMV at an individual breath level, the conditions might not be comparable.
Table 1 Patient characteristics
Table 2 Average tidal volume, inspiratory flow, and muscle pressure during the study phases
Comparison of transpulmonary and alveolar pressures during CMV and PSV
As expected (Fig. 2a), switching from CMV to decreasing levels of PSV led to a significant reduction in airway pressure (p < 0.001 by ANOVA). Simultaneously, Pmus was almost zero during CMV, and application of decreasing levels of PSV led to a progressive increase of Pmus (p < 0.001 by ANOVA) (Table 2).
a Pressures (transpulmonary pressure swings [ΔPL] on the left, shown as bars and standard deviation), versus the level of support (high, medium, or low). It shows that, by contrast with airway pressure, ΔPL swings during inspiration were similar and not statistically different between controlled mechanical ventilation (CMV) and any of the support levels. Closed symbols represent mean values during inspiration, and open symbols show maximum values during inspiration. The correlation between the value recorded during CMV and pressure support ventilation (PSV), albeit significant, was poor (b). The difference between the measurement of ΔPL obtained during CMV and PSV was explained largely by the corresponding difference in the inspiratory flow (c), as shown by the highly significant correlation. Indeed, when the analysis was restricted to the breaths with similar inspiratory flows (i.e., with an absolute difference less than 0.1 L/minute) (d), the correlation of ΔPL obtained during CMV and PSV became very tight
As a result, both mean and maximal ΔPL values were similar overall between CMV and all the levels of PSV applied, as shown in Fig. 2a (p = n.s. for both by ANOVA). The individual linear correlation between ΔPL measured during PSV and CMV was, however, quite poor (Fig. 2b), indicating a wide dispersion (Fig. 2b). The individual differences between measurements of ΔPL were well explained by the differences in flow rates between PSV and CMV breaths, as shown in Fig. 2c, indicating that the resistive pressure drop caused this difference. We thus repeated the analysis, focusing only on values (either maximum-ΔPL or mean-insp) for which the inspiratory flow was similar, defined as having an absolute difference less than 0.1 L/minute. This resulted in a tight correlation, very close to the line of identity between the ΔPL values measured during CMV and PSV (Fig. 2d). ΔPes was positive during CMV, whereas decreasing levels of PSV assistance led to progressively more negative inspiratory ΔPes, as shown in Fig. 3a (p < 0.01 for both time points by ANOVA).
The swings of esophageal pressure (ΔPes) from baseline (a), shown as mean and standard deviation, were positive during controlled mechanical ventilation (CMV) but became negative during pressure support ventilation and progressively lower for decreasing levels of support (high, medium, and low). This was the case when we considered both the mean values during inspiration (closed bars) and at the moment of maximum transpulmonary pressure (open bars). Similarly, alveolar pressure (Palv) (b), shown as bars and standard deviation, progressively decreased from CMV through the different levels of pressure support ventilation (high, medium, and low). Moreover, Palv was, on average, lower than the set positive end-expiratory pressure (PEEP) (dashed line), both as a mean during inspiration (closed bars) and at the moment of maximum transpulmonary pressure (open bars), if a low level of support was applied
Our findings were similar for Palv (Fig. 3b) (p < 0.01 for both time points by ANOVA), which became progressively lower for decreasing levels of assistance. In particular, we found a mean-insp Palv that was below the set PEEP in nine of ten patients during PSV-low, in two of ten during PSV-medium, and in one of ten during PSV-high. Transalveolar pressure (which equals ΔPL,el) was not different between CMV and any condition of PSV (Fig. 4a) (p = n.s. for both by ANOVA). Moreover, similarly to ΔPL, we found a tight correlation between ΔPL,el measured during CMV and during PSV (Fig. 4b).
The transalveolar pressure (i.e. the pressure distending the alveoli), which is caused by the elastic recoil of the lungs (ΔPL,el), was similar and nonsignificantly different between controlled mechanical ventilation (CMV) and any of the support levels of pressure support ventilation (high, medium, and low), either as a mean value (open symbols) or as a maximum value (closed symbols), during inspiration (a), shown as mean and standard deviation. The values measured during pressure support ventilation (PSV) and CMV were very closely correlated and close to the line of identity (dashed line), as shown in (b) (analysis restricted to breaths with similar inspiratory flow)
Value of plateau pressure measured during PSV
To estimate the pressure effectively distending the respiratory system and the lungs during PSV, we performed prolonged (about 2 seconds) inspiratory holds, aiming to obtain a period of zero Pmus, hence similar to CMV. Both plateau airway pressure and ΔPL,el measured during inspiratory holds performed after PSV breaths were highly correlated with the value measured in the same patient during CMV, as shown in Fig. 5, albeit a greater scatter was present for ΔPL. Mean differences and 95 % CIs were 0.35 (−2.8 to 3.5) cmH2O for plateau airway pressure and 0.38 (−2.7 to 3.5) cmH2O for ΔPL,el (Fig. 5). Similar results were found for compliance. The measurements obtained during PSV were tightly correlated with those obtained in the same patient during CMV with mean differences and 95 % CI of 3.3 (−17 to 11) ml/cmH2O for respiratory system compliance and −2 (−59 to 56) ml/cmH2O for lung compliance. In this case, the values were very close to the identity line for values of lung compliance up to 100 ml/cmH2O (plots are shown in figure E1 Additional file 1).
Tight correlation (solid line, very close to the identity, represented by the dashed line) was found between the values obtained during an inspiratory hold obtained while under controlled mechanical ventilation (CMV) and pressure support ventilation (PSV) for plateau airway pressure (Pplat) in the airways (a), static transpulmonary pressure (ΔPL,el) (b), and the respective Bland-Altman analyses (c and d), showing mean bias (solid line) and 95 % confidence intervals (dotted lines)
Our data show that, in a mixed population of patients undergoing spontaneous assisted breathing, neither transpulmonary nor transalveolar pressure changes differed between controlled and spontaneous assisted ventilation for comparable volumes and flows. When the breaths were matched for inspired volume and inspiratory flow, the values were almost identical. This was also the case in static conditions, suggesting that Pplat can be measured reliably also during PSV. By contrast, the absolute Palv value could markedly differ during inspiration, frequently becoming lower than PEEP during PSV.
A first consequence is that if SB has any role (protective or detrimental) in modulating VILI, this cannot be mediated by a pure, isolated difference in the ΔPL. Moreover, it has to be considered that only part of the PL is dissipated across the alveoli; this is called the transalveolar pressure and equals the product of lung elastance and volume. The remaining pressure determines a gradient between the airway opening and the alveoli, which yields an inspiratory flow. This gradient will be the same, regardless of the amount of pressure generated by the patient and by the ventilator, as shown by our data (Fig. 3), and it depends on the airflow profile and inspiratory Raw. For example, Yoshida et al. defined the "total alveolar stretching pressure" (PL) as Pplat + ΔPes (ΔPes being measured during inspiration), but this pressure extends across the entire lung (alveoli + airways) and is not specific for "alveoli" [11]. As a matter of fact, the increased PL in the presence of a strong inspiratory effort is associated with an increased resistive pressure [11].
These concepts are illustrated in the figure E2 in Additional file 1, which shows the respective meaning of transpulmonary and transalveolar pressure under assisted SB and CMV. For the same mechanical properties (compliance and resistance) of the respiratory system, the ΔPL will differ between controlled and SB only if flow and/or lung volume differ, and transalveolar pressure will differ only if lung volume changes. As shown by our data, in the presence of similar volumes and inspiratory flows, transpulmonary and transalveolar pressure do not differ between controlled and spontaneous ventilation, regardless of the inspiratory effort.
However, there are strong data in the literature showing that, under some conditions, SB efforts can be detrimental. In keeping with our findings, this can be explained by at least three mechanisms that do not imply a different transpulmonary or transalveolar pressure change. First, in all the pressure-targeted ventilatory modes, the control over VT is lost and, consequently, the patient might develop nonprotective VT even if airway pressures are not high. This is possibly one of the mechanisms explaining the report of Bruells et al. [20], who found a more severe degree of VILI if negative pressure ventilation (similar in some aspects to SB) was used, as compared with positive pressure ventilation. Since in this elegant experiment the VT was not controlled, it was probably higher in the negative pressure ventilation group, as suggested by the lower arterial PaCO2. In such circumstances, the ΔPL will be higher during negative pressure (spontaneous) ventilation, albeit, as emphasized before, this is simply due to the higher VT reached [15].
Second, absolute values of esophageal, pleural, alveolar, and intrathoracic pressure will be progressively lower during strenuous breathing efforts, leading, in some cases, to values below PEEP for the entire respiratory cycle, as shown by our data. The consequences of these negative pressure swings can be profound, particularly regarding the hemodynamic profile. In fact, while during CMV the resistive pressure drop does not have major physiological consequences, during assisted SB the inspiratory resistive pressure drop (unlikely to be compensated by the expiratory pressure drop of opposite sign, usually passive and driven mainly just by the elastic pressure recoil of the chest wall) causes major physiological consequences. It increases the filling of the right heart, impairs the function of the left ventricle, and causes a negative interstitial pressure in the lung, which can in turn lead to fluid accumulation in the pulmonary interstitium. Moreover, the increased cardiac output usually associated with SB [6] will necessarily lead to an increased perfusion of lung capillaries, the latter being a known factor contributing to VILI [21], even in the absence of increased vascular pressures [22]. During inspiration, the fall in pleural pressure is larger than the fall in intravascular pressure in the pulmonary circulation, explaining the increase in transmural pressure increases [23]. This increase in vascular pressure in the pulmonary circulation has been shown to favor the development of VILI [16].
Toumpanakis and coworkers [24] imposed a resistive load on spontaneously breathing animals, causing important negative inspiratory pressure swings, and they found severe lung injury. It is worth noting that, in this model, even if the VT were not measured, this was likely normal; thus, the transalveolar pressure (product of inspired volume and elastance) was normal, but with very negative absolute alveolar and intrathoracic pressures. Similarly, Stalcup and Mellins previously demonstrated that, during asthma, negative pleural pressure swings cause alveolar fluid accumulation [25].
Finally, the pleural pressure during SB might be uneven due to the action of diaphragmatic contraction, leading to "regional" overinflation and or pendelluft, as recently shown by electrical impedance tomography [12].
In this study, we focused on PSV, a ventilatory form that (except during asynchronies) implies a relative stereotyped interaction between patient and ventilator: The ventilator delivers flow simultaneously with the patient's demand. However, patient-ventilator interaction can be more complex during other ventilatory modes allowing SB, such as synchronized intermittent mandatory ventilation, bilevel ventilation, and airway pressure release ventilation [26]. In these conditions, PL and Palv changes can be greatly amplified. As an example, while breath stacking [27] will lead to increased PL, an inspiratory effort occurring during expiration will cause a profound negative Palv.
This study has some limitations. First, it was originally designed not to specifically test this hypothesis but to evaluate the relationship between diaphragmatic electromyogram and muscle pressure. However, the data collected (Pes and Paw during controlled and spontaneously assisted ventilation) are reliable and allowed us to design this independent study. The sample size was relatively small (ten patients) and had some heterogeneity. Thanks to the crossover study design, we calculated (based on the standard deviation of PL during CMV) that the minimum detectable difference of PL between two steps was 3.6 cmH2O, with an α of 0.05 (two-tailed) and a power of 80 %.
A second limitation is that our calculations were based on a single value of Pes and on the assumption of a single compartment model. This is a simplification, since it is known that, particularly in the presence of lung disease, pleural pressure is not uniform and parenchymal compliance and resistance can have regional heterogeneities. As a consequence, our results should be regarded as "average" values for the lungs, but we have to keep in mind that, for some lung regions, PL (or transalveolar) pressures can be considerably higher (or lower). The same reasoning also applies to the end-inspiratory occluded pressure during pressure support, which represents an average of the pressures distending the alveoli.
A third limitation resides in the fact that we applied two fixed squared flow rates in CMV without a prospective match with PSV for airflow value and shape. Consequently, while VT was very similar during the two ventilation modes, airflow was not, without a systematic direction. To overcome this limitation in part, we performed ex post facto matching by focusing part of the analysis on the breaths with similar airflow values. Moreover, also based on previous data from our group [28], we did not expect that Raw would present relevant differences between these two conditions, and we assumed them to be identical.
Finally, we assumed that compliance and resistance of the respiratory system did not change between CMV and PSV, but different volume history or the use of sedation (which was difficult to avoid, however) might have affected respiratory mechanics.
We show that ΔPL under similar conditions of inspiratory flow and volume is similar between fully controlled and assisted mechanical ventilation. However, in the latter condition, the Pes and Palv can have remarkable negative swings that are in part required to overcome the airflow resistive pressure. Negative Palv values and their consequences on fluid shifts are potential mechanisms by which SB might induce lung injury. Finally, we show that by performing an inspiratory hold, it is possible to obtain a good estimate of the total pressure distending the respiratory system (or the lung) also during PSV.
Transpulmonary and transalveolar pressures do not have the same meaning.
Under similar conditions of flow and volume, spontaneous assisted breathing leads to transpulmonary pressures similar to those of controlled ventilation.
During spontaneous breathing, the pressure drop due to airflow resistance leads to negative drops in alveolar pressure.
The total elastic pressure distending the respiratory system can also be reliably measured during pressure support ventilation by means of an end-inspiratory hold.
ANOVA:
CMV:
controlled mechanical ventilation
FiO2 :
fraction of inspired oxygen
PaCO2 :
partial pressure of carbon dioxide
Palv:
alveolar pressure
PaO2 :
partial pressure of oxygen
Paw:
positive airway pressure
PEEP:
positive end-expiratory pressure
esophageal pressure
PL :
transpulmonary pressure
PL,el :
elastic recoil pressure of the lung
Pmus:
pressure generated by inspiratory muscles
Pplat:
plateau pressure
PSV:
pressure support ventilation
Raw:
airway resistance
RM-ANOVA:
repeated measures analysis of variance
SAPS II:
Simplified Acute Physiology Score II
SB:
spontaneous breathing
VILI:
ventilator-induced lung injury
VT :
tidal volume
ΔPalv:
change in alveolar pressure
ΔPL :
change in transpulmonary pressure
Marini JJ. Spontaneously regulated vs. controlled ventilation of acute lung injury/acute respiratory distress syndrome. Curr Opin Crit Care. 2011;17(1):24–9.
Yoshida T, Papazian L. When to promote spontaneous respiratory activity in acute respiratory distress patients? Anesthesiology. 2014;120(6):1313–5.
Hraiech S, Yoshida T, Papazian L. Balancing neuromuscular blockade versus preserved muscle activity. Curr Opin Crit Care. 2015;21(1):26–33.
Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988;137(5):1159–64.
Engelberts D, Malhotra A, Butler JP, Topulos GP, Loring SH, Kavanagh BP. Relative effects of negative versus positive pressure ventilation depend on applied conditions. Intensive Care Med. 2012;38(5):879–85.
Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001;164(1):43–9.
Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J. Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999;159(4 Pt 1):1241–8.
Grasso F, Engelberts D, Helm E, Frndova H, Jarvis S, Talakoub O, et al. Negative-pressure ventilation: better oxygenation and less lung injury. Am J Respir Crit Care Med. 2008;177(4):412–8.
Xia J, Zhang H, Sun B, Yang R, He H, Zhan Q. Spontaneous breathing with biphasic positive airway pressure attenuates lung injury in hydrochloric acid–induced acute respiratory distress syndrome. Anesthesiology. 2014;120(6):1441–9.
Futier E, Constantin JM, Combaret L, Mosoni L, Roszyk L, Sapin V, et al. Pressure support ventilation attenuates ventilator-induced protein modifications in the diaphragm. Crit Care. 2008;12(5):R116.
Yoshida T, Uchiyama A, Matsuura N, Mashimo T, Fujino Y. Spontaneous breathing during lung-protective ventilation in an experimental acute lung injury model: high transpulmonary pressure associated with strong spontaneous breathing effort may worsen lung injury. Crit Care Med. 2012;40(5):1578–85.
Yoshida T, Torsani V, Gomes S, De Santis RR, Beraldo MA, Costa EL, et al. Spontaneous effort causes occult pendelluft during mechanical ventilation. Am J Respir Crit Care Med. 2013;188(12):1420–7.
Yoshida T, Uchiyama A, Matsuura N, Mashimo T, Fujino Y. The comparison of spontaneous breathing and muscle paralysis in two different severities of experimental lung injury. Crit Care Med. 2013;41(2):536–45.
Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2011;363(12):1107–16.
Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189(5):520–31.
Hotchkiss Jr JR, Blanch L, Naveira A, Adams AB, Carter C, Olson DA, et al. Relative roles of vascular and airspace pressures in ventilator-induced lung injury. Crit Care Med. 2001;29(8):1593–8.
Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2014;370(10):980.
Bellani G, Mauri T, Coppadoro A, Grasselli G, Patroniti N, Spadaro S, et al. Estimation of patient's inspiratory effort from the electrical activity of the diaphragm. Crit Care Med. 2013;41(6):1483–91.
Bellani G, Pesenti A. Assessing effort and work of breathing. Curr Opin Crit Care. 2014;20(3):352–8.
Bruells CS, Smuder AJ, Reiss LK, Hudson MB, Nelson WB, Wiggs MP, et al. Negative pressure ventilation and positive pressure ventilation promote comparable levels of ventilator-induced diaphragmatic dysfunction in rats. Anesthesiology. 2013;119(3):652–62.
Broccard AF, Hotchkiss JR, Kuwayama N, Olson DA, Jamal S, Wangensteen DO, et al. Consequences of vascular flow on lung injury induced by mechanical ventilation. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1935–42.
López-Aguilar J, Piacentini E, Villagrá A, Murias G, Pascotto S, Saenz-Valiente A, et al. Contributions of vascular flow and pulmonary capillary pressure to ventilator-induced lung injury. Crit Care Med. 2006;34(4):1106–12.
Magder S, Verscheure S. Proper reading of pulmonary artery vascular pressure tracings. Am J Respir Crit Care Med. 2014;190(10):1196–8.
Toumpanakis D, Kastis GA, Zacharatos P, Sigala I, Michailidou T, Kouvela M, et al. Inspiratory resistive breathing induces acute lung injury. Am J Respir Crit Care Med. 2010;182(9):1129–36.
Stalcup SA, Mellins RB. Mechanical forces producing pulmonary edema in acute asthma. N Engl J Med. 1977;297(11):592–6.
Richard JC, Lyazidi A, Akoumianaki E, Mortaza S, Cordioli RL, Lefebvre JC, et al. Potentially harmful effects of inspiratory synchronization during pressure preset ventilation. Intensive Care Med. 2013;39(11):2003–10.
Chanques G, Kress JP, Pohlman A, Patel S, Poston J, Jaber S, et al. Impact of ventilator adjustment and sedation-analgesia practices on severe asynchrony in patients ventilated in assist-control mode. Crit Care Med. 2013;41(9):2177–87.
Pesenti A, Pelosi P, Foti G, D'Andrea L, Rossi N. An interrupter technique for measuring respiratory mechanics and the pressure generated by respiratory muscles during partial ventilatory support. Chest. 1992;102(3):918–23.
These data were previously presented and discussed at a meeting of the PLUG group (PLeUral pressure working Group, Acute Respiratory Failure section of the European Society of Intensive Care Medicine, Milan, Italy, 2015).
Department of Health Science, University of Milan-Bicocca, Via Cadore, 48 20900, Monza, Italy
Giacomo Bellani, Maddalena Teggia-Droghi & Antonio Pesenti
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
Giacomo Bellani, Giacomo Grasselli, Maddalena Teggia-Droghi & Antonio Pesenti
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
Giacomo Grasselli, Tommaso Mauri & Antonio Pesenti
Department of Emergency and Intensive Care, A. Manzoni Hospital, Lecco, Italy
Andrea Coppadoro
Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada
Laurent Brochard
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
Giacomo Bellani
Giacomo Grasselli
Maddalena Teggia-Droghi
Tommaso Mauri
Antonio Pesenti
Correspondence to Giacomo Bellani.
GB conceived the study, participated in data acquisition and analysis, and drafted the manuscript. GG participated in data interpretation and drafted the manuscript. MTD participated in data acquisition and analysis and participated in manuscript revision. TM participated in data acquisition and analysis and reviewed the manuscript. AC participated in data acquisition and analysis and reviewed the manuscript. LB participated study design and data interpretation and reviewed the manuscript. AP conceived the study, participated in data interpretation, and reviewed the manuscript. All authors read and approved the final manuscript.
The electronic supplement contains figures E1 and E2. (DOCX 190 KB)
Bellani, G., Grasselli, G., Teggia-Droghi, M. et al. Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study. Crit Care 20, 142 (2016). https://doi.org/10.1186/s13054-016-1290-9
Accepted: 08 April 2016
Controlled ventilation


text:
Troubled Waters
Public Art (Murals)
Shawn Michael Warren was born in Chicago, IL, and currently resides in Los Angeles, CA. He received his BFA at the American Academy of Art in Chicago and also studied at the Florence Academy of Art in Florence, Italy. His work is a reflection of the experiences and narratives surrounding black history and culture. His intent is to create works of art that depict the underrepresented. From unknown parts of history to contemporary topics, his work is used as a means to educate, ignite thought-provoking conversations about societal issues that plague us as a collective people and evoke empathy, conviction, compassion and beauty. Warren's work brings attention and awareness to events and individuals (past and present) that have affected and shaped cultures and civilizations throughout the world. His most notable creation, "In a Promised Land . . . ", received critical acclaim for bringing life to the tragic history of the Greenwood Community in early 1920s Tulsa, Oklahoma, home to the wealthiest black community in America: "The sublime beauty of Warren's painting style combined with the absence of blood and gore makes the subject matter accessible, so that people linger and look closely at the scene of destruction and emotional upheaval" (Kate Lewis, in the Rapidian).

redpajama_set_name: RedPajamaCommonCrawl


Steeped in tradition and embracing the future.
Where lawn bowling and socializing mix well near the base of Mont-Royal in the heart of Montreal. Drop by for some friendly instruction on the game or sample some of our ambiance.
In August 1901 three Scottish immigrants namely James Brown, James Baillie, and James Rodgers investigated the procurement of sand, turf, and equipment needed for the development of a bowling green. They drew up an open letter to the Westmount public advertising the proposed club and on September 6 at a public meeting a provisional committee was appointed to get the project off the ground.
The first formal meeting at the Club took place on May 28, 1902 with the election of a Board of Directors who were empowered to arrange for a clubhouse to be built at a cost not exceeding $500. The opening ceremony of the club took place on Saturday June 28, 1902.


text:
Home Scores Bracket Rankings Stats Video History Champ Info
NCAA.com | May 3, 2015
2015 DI NCAA Championship selections
Top-seed Notre Dame was one of eight at-large bids, the rest of the field is composed of automatic qualifiers.
INDIANAPOLIS --The NCAA Division I Men's Lacrosse Committee announced the field for its championship tournament Sunday.
Full Release | Interactive Bracket | Printable Bracket
The following conferences and their representatives received automatic qualification:
America East Conference: University at Albany
Atlantic Coast Conference: Syracuse University
Big East Conference: University of Denver
Colonial Athletic Association: Towson University
Big Ten Conference: Johns Hopkins University
The Ivy League: Yale University
Metro Atlantic Athletic Conference: Marist College
Northeast Conference: Bryant University
Patriot League: Colgate University
Southern Conference: High Point University
The top 14 teams have been placed in the bracket, while the remaining four teams will compete for the chance to advance to the round of 16. Those games will take place Wednesday, May 6 with High Point traveling to Towson and Bryant playing at Marist.
The remainder of the field was selected at large: Brown University, Cornell University, Duke University, University of Maryland, College Park, University of North Carolina, Chapel Hill, University of Notre Dame, The Ohio State University, University of Virginia.
All Division I round of 16 games will be televised on ESPNU or ESPN2 on May 9 and 10. The quarterfinal games will also all be televised on ESPN2 or ESPNU on May 16 and 17.
The Division I semifinal and championship games, and the Division II and III championship games, will be held at Lincoln Financial Field in Philadelphia on May 23-25 and hosted by Drexel University.
The Division I semifinals will be televised live on ESPN2 starting at 1 p.m. Eastern time, May 23. The championship game will be televised live on ESPN2 starting at 1 p.m. Eastern time, May 25.
Best face-off guys returning for the 2020 men's lacrosse season
TD Ierlan, Kyle Gallagher, Gerard Arceri and Conor Gaffney are some of the best college lacrosse face-off men to watch in the 2020 season.
College lacrosse teams with the most national championships
Here are the college lacrosse teams who have won the most NCAA DI men's lacrosse championships from 1971 to today.
When does the 2020 men's college lacrosse season start?
The 2020 men's lacrosse season will begin the weekend of Feb 1. Find all you need to know for the upcoming season.


Diskpart failed to extend the volume is common problem. Then what to do? Find a partition tool take the place of Diskpart is good. In this article, I recommend you try AOMEI Partition Assistant Server Edition and take examples to tell you why.
When Diskpart failed to extend the volume?
When you extend volume by using Diskpart.exe, please don't be surprised if you receive a warning message: "The volume you have selected may not be extended. Please select another volume and try again."
Diskpart command is a Windows built-in partition resize trick. You can use it to perform like converting basic disk to dynamic disk, converting MBR disk to GPT disk, creating/deleting a partition, extending partition, etc.
Although Microsoft improved the functions of disk manager in Windows Vista, Windows 7, Windwos 8/8.1 and Windows Server 2008(R2), Windows Server 2012(R2) and you can shrink or expand a volume with disk management on these Windows operating system. The fact is many people still use Windows XP and Windows Server 2003 nowadays. And you cannot do those partition operations with Windwos built-in disk tool on XP and Server 2003. Good news is Microsoft also provides a command line-diskpart.exe.
Why Diskpart failed to extend the volume?
Diskpart differs from many command-line utilities because it does not operate in a single-line mode. Instead, after you start the utility, the commands are read from standard input/output (I/O). You can direct these commands to any disk, partition/volume.
Why? There are several reasons: Diskpart command is not able to extend volume if it is FAT, boot/system partition, and no existing unallocated space. It only supports NTFS file system, extension only supports data volume, if it was the dynamic disk you want to extend, it should be only simple volume or spanned volume. And if you want, you can find more limitations of using Diskpart to optimize partition.
How to solve the question when Diskpart failed to extend the volume?
How to solve the problem to easily extend volume? If you don't want to upgrade your operating system, that means insist on using Windows XP or Windows Server 2003, I suggest you don't waste your time on Diskpart.exe. Instead, find a professional third-party disk partition tool is a good choice.
AOMEI Partition Assistant Server Edition, which offers amazing features to perform best disk volume management for Windows Server 2003(R2), 2008(R2), 2012(R2), Windows SBS 2003, 2008, 2011 and Windows XP/Vista/7/8/8.1 (All improving package, both 32 & 64 bit OS).
Because this article focus on Windows Server 2003, and system partition is the partition needs to be extended volume most often. So I take how to extend system partition on Windows Server 2003 as an example to explain how AOMEI Partition Assistant Server Edition works next.
First of all, download the Server Edition to install. Run the program, the main window shows disk partition information in detail.
Second, right click F: drive(because it is large enough), and select "Allocate Free Space" option. In the pop-up window, type a free space value, select partition C(system partition) from the drop down menu. Then click "OK" to return the main screen.
Third, the changes can be previewed in advance on the main interface. There are three pending operations: resize partition, move partition, move and resize partition. Operating these three operations respectively is also OK. But to save time, so choose "Allocate Free Space". Now, click "Apply" button to apply these pending changes.
Another way to quickly extend the volume is choosing "Extend Partition Wizard" from the left wizard panel.
Once you click it, there will be a pop-up window as the following picture. The first method is to expand system partition, the second method is to expand any partition. More detail please visit here.
In summary, if Diskpart failed to extend the volume, you can turn to AOMEI Partition Assistant. It is a powerful and easy-to-use all-in-one partition software. AOMEI Partition Assistant Server Edition supports both Windows OS for home and Server. What's more, the highlight is that there is no data loss when the process of resizing partition. It is a a highly-efficient partition magic to help you optimize computer performance very well.


The main project aims to develop a common understanding and framework for applying open innovation platform thinking in the Baltic Sea Region. This will be done in cooperation with leading BSR regions. During the main project innovation platform network in the BSR is used as a concrete test bed for this common policy framework and the network will be developed further in several BSR regions particularly for solving major public sector development challenges. Platform-based development will be activated in parallel with innovation policy actions by BSR Stars High-level group. The major outcome will be an operational open innovation platform network in the BSR that is able to attract public sector, companies and universities in concrete co-creation activities.


Seton Hill residents and Baltimore Gas and Electric Co. yesterday settled their bitter two-year dispute over the appearance of a new electric substation in the historic neighborhood.
The compromise design requires BGE to completely rebuild an existing brick compound, spending at least $3 million more than required by a plan presented to the Baltimore Planning Commission last month and fiercely opposed by area residents.
"I'm not jumping up and down for joy," said Mico Milanovic, a member of the Seton Hill Community Association. "But it's life; you gotta make compromises."
Residents began protesting when BGE announced it would turn an empty brick compound just north of St. Mary's Park into an electric substation.
The company has owned the structure, a roughly triangle-shaped arrangement with approximately 18-foot-high walls, for more than three decades and has always said it might become a substation, said BGE spokeswoman Linda Foy. For years, the space inside the walls remained vacant, until BGE decided it needed another station to serve its clients.
But residents, disgruntled about the aging site, said that if BGE wanted to install the station in Seton Hill, it should tear down the walls and create a more welcoming design. A mixed-use area, making space for shops, would be optimal, they said.
BGE balked at the suggestion of a mixed-use area - an extremely expensive endeavor - and spent two years meeting with residents to find a way to spruce up the walls in a manner that would be affordable and acceptable to the community.
Last month, city Planning Commission Chairman Peter Auchincloss issued the sparring parties an ultimatum: They had one month to find a mutually acceptable design.
"If in a month people do not come in here hugging, kissing and singing 'Kumbaya,' then this chair will design the wall," he said at the time. "And believe me, I don't use a crayon real well."
"Kumbaya" did in fact burst from a compact disc player at yesterday's Planning Commission meeting, and Auchincloss did bring his crayons, eliciting laughs just before the commission approved the compromise design.
"It's been a process, but I think it's been a good one, and one with a good outcome," said Milton Branson, government relations representative for Constellation Energy. It's still to early to estimate the total cost of the new design, he said.
The walls will be torn down, and walls built of red brick.
Decorative metal fencing will top much of structure.
A number of 6-foot-wide brick pilasters will jut out a few inches from the face of the walls, creating a varied appearance.
A brick house meant for equipment will go inside the station and will be affixed to one outside wall. The structure will have a metal roof and ornamental windows. Wall-mounted light fixtures will be installed on the outside of the compound.
Varying patches of landscape will be created. Some greenery will remain against the street curb, while some will be planted alongside the brick site.


text:
Q: WiX Burn: Reading LaunchTarget from Registry I'm new with WiX, and I'm trying to have my Bootstrapper launch my installed application when it completes. To accomplish this, I'm using
<Variable Name="LaunchTarget" Value="path_to_exe"/>

However, it is not easy for me to get the path to the executable. The reason for this is because I'm using <Chain> to install some pre-requisites and then an msi that actually installs my exe.
So to do this, the msi is writting the path to a known location in the registry, and then the bootstrapper reads it and uses it.
The problem is that when the bootstrapper reads the registry, the msi hasn't run yet, so it is unable to run the executable at the end.
Here's my WiX, if it helps:
<?xml version="1.0" encoding="UTF-8"?>
<Wix xmlns="http://schemas.microsoft.com/wix/2006/wi" xmlns:bal="http://schemas.microsoft.com/wix/BalExtension" xmlns:util="http://schemas.microsoft.com/wix/UtilExtension">
    <Bundle Name="My Installation" UpgradeCode="a8964402-f3fc-4878-aafd-31ecda6b685e" Version="1.0.0.0">
        <BootstrapperApplicationRef Id="WixStandardBootstrapperApplication.RtfLicense">
            <bal:WixStandardBootstrapperApplication LicenseFile="EULA.rtf"
                                                    ThemeFile="theme.xml"
                                                    SuppressOptionsUI="yes" />
        </BootstrapperApplicationRef>
        <Chain>
            <PackageGroupRef Id="NetFx40Redist"/>
            <ExePackage Id="OpenSSL" SourceFile="pre-requesite.exe" />
            <MsiPackage Id="myInstall" SourceFile="mySetup.msi" />
        </Chain>
        <util:RegistrySearch Root="HKLM"
                             Key="Software\myProgram"
                             Value="myEXEPath"
                             Variable="myEXEPath"
                             Result="value"
                             Format="raw" />
        <Variable Name="LaunchTarget" Value="[myEXEPath]"/>
    </Bundle>
</Wix>

So, in short, I'm trying to have the RegistrySearch run AFTER the MsiPackage installs. Can this be done? If not, what alternatives do I have?
As I side note, if I manually fill in the registry value before installation, everything works fine. This means that besides the order things are running in, everything is working fine.

A: RegistrySearches run during the Detect operation.  Custom BAs could run Detect after Apply, but that's not really an option since you're using the WixStandardBootstrapperApplication.
Lucky for you, WiX v3.9 added support for running the LaunchTarget already elevated, with the requirement that the path to the target .exe be in the registry under HKLM. So you would do this:
<BootstrapperApplicationRef Id="WixStandardBootstrapperApplication.RtfLicense">
    <bal:WixStandardBootstrapperApplication LicenseFile="EULA.rtf"
                                            ThemeFile="theme.xml"
                                            SuppressOptionsUI="yes"
                                            LaunchTargetElevatedId="MyAEEId" />
</BootstrapperApplicationRef>
<ApprovedExeForElevation Id="MyAEEId"
                         Key="Software\myProgram" Value="myEXEPath" />

Edit:
It looks like you are required to set LaunchTarget as well.  Why doesn't your bundle know where it will be?  You can just put in gibberish for LaunchTarget (WixStdBA will try the registry location first), but can't you use built-in variables and/or MsiProperty elements to locate the exe?

redpajama_set_name: RedPajamaStackExchange


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text:
Кизилжа́р () — село у складі Цілиноградського району Акмолинської області Казахстану. Входить до складу сільського округу Кабанбай-батира.

Населення — 521 особа (2009; 293 у 1999, 283 у 1989).

Національний склад станом на 1989 рік:
 казахи — 100 %.

У радянські часи село називалось також Октябр.

Примітки

Джерела

Посилання
 На Вікімапії

Населені пункти Цілиноградського району
Села Акмолинської області

redpajama_set_name: RedPajamaWikipedia


text:
Nearly 40 cats in faeces-caked cages removed from Yishun flat
REMOVED: The cats were found housed in cages, many of which were caked with faeces. PHOTOS: CAT WELFARE SOCIETY
Authorities remove nearly 40 cats in cages from flat in Yishun
Judith Tan
She might finally be able to sell her flat.
For years now, the housewife, who wanted to be known only as Madam Seow, 63, had wanted to sell her three-room unit at Block 207, Yishun Street 21, to move into a bigger one with her three-tier family.
But every time potential buyers and their real estate agents went to view the fourth-storey HDB flat, they were turned off "almost immediately''.
"They emerged from the lift into the bad smell coming from the flat just in front of the lift," said the grandmother.
"No one wants to live in that kind of environment," she added.
BAD SMELL
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Singapore passport remains second-most powerful in the world
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Madam Seow and her family have been living with the stench from the neighbour's flat for the last few years.
"It is extremely bad. I could smell it even from my bedroom and the kitchen," she told The New Paper.
She said that all the neighbours kept their doors and windows shut throughout the day and night.
Residents of the block have been complaining to both the Agri-Food & Veterinary Authority of Singapore (AVA) and the Housing Development Board (HDB).
Yesterday morning, officers from both agencies raided the flat after seeing its condition the night before. (See report )
The flat owner, Mr Roslani Ahmad, 63, is unemployed and has been keeping cats in cages inside the flat since 2000.
Nearly 40 cats, in cages caked in faeces and with cockroaches crawling around them, were removed by the authorities yesterday.
A 56-year-old neighbour, who lived at the end of the corridor, said he could smell the stink from his flat more than 100m away.
The stench was so strong that even residents on the first storey could smell the cats' excrement.
Mrs Chong, who lives on the first storey, said the stench permeated to the back, where the playground is.
Mr Roslani, who was present during the raid, told Channel NewsAsia (CNA) earlier in the day that the cats were brought home by his daughter, now 33, and that he has had cats in his flat since 2000.
Even at 1pm, after the cleaners from the Town Council had cleaned the flat and its surroundings with disinfectant, there was still a lingering smell of cat pee and poo.
When the TNP team knocked on the door of Mr Roslani's unit at 3pm, some cockroaches fell on the ground and skittered across the floor.
Still, no one came to the door.
They emerged from the lift into the bad smell coming from the flat just in front of the lift. No one wants to live in that kind of environment.
- Madam Seow, 63, on how it was almost impossible to sell her flat
Owner could not be contacted: AVA
In a statement to the media, AVA said it received public feedback on "smell nuisance from a unit at Block 207, Yishun Street 21, in September 2015".
"We tried on numerous occasions to establish contact with the unit owner but we were unsuccessful.
"We finally established contact on the night of Feb 24, and we were granted access to the unit," its spokesman said.
The 39 cats found in the unit were surrendered to AVA during a follow-up visit yesterdayand they were found to be in poor condition.
The cats are under AVA's care and being assessed by its veterinarians.
"We are currently investigating the case for failure in duty of care and possible animal cruelty. Once our investigations have concluded, we will work with our re-homing partners such as Cat Welfare Society (CWS) to find homes for the cats that are assessed to be suitable for rehoming," he said.
A spokesman for CWS said they believe this is a case of hoarding and not one of abuse, although some of the cats are sick.
In a statement on its Facebook wall, CWS said that its volunteer assisted to sterilise some cats in the unit in 2010, but the situation was nowhere near what was discovered yesterday.
"When the case resurfaced recently to authorities due to neighbours' feedback on odours, we tried to make contact with the family, together with AVA and HDB, to no avail," CWS said.
"The sudden evacuation (yesterday) means plans will need to be made ASAP (as soon as possible) to find placements for these cats who are flu-stricken and require recovery," it added.
SingaporeanimalsUncategorisedYishunAVAhdb
Read articles by Judith Tan


Keystone XL is a proposed 1,700 mile pipeline that would bring 700,000 barrels of tar-sands oil per day from Alberta, Canada, to refineries on the Gulf Coast of the United States. The pipeline would be a $7 billion extension of an existing pipeline that runs from Alberta to Illinois and Oklahoma.
Those in favor of the pipeline argue that this project will create tens of thousands of US jobs and tap into one of the biggest oil reserves in the world, slashing our dependence on oil from overseas.
Environmentalists point out that the processes used to extract tar-sands are far more damaging to water and land resources- as well as emit more greenhouse gases- than methods used to extract conventional oil. Environmental groups also cite the existing pipeline's abysmal record of leaks and spills. As for jobs, the projected number of jobs created by the pipeline is said to have been greatly exaggerated, with some estimates suggesting it could kill more jobs than it creates, and at most 50 long-term jobs will be created (involving pipeline maintenance only). Keystone opponents also note that the oil to be sent through the Keystone XL pipeline is not destined for U.S. markets. TransCanada (the company behind Keystone XL) has publicly admitted that most– if not all– of the extracted and refined oil would be exported to overseas markets. In addition, TransCanada will be allowed to export domestic oil in addition to the newly extracted and refined oil which will raise gas prices in the United States.
The State Department, which must review the project because it crosses an international border, issued an Environmental Impact Statement in late August of 2011, and it was assumed by many that the Obama administration was well on its way toward approving the pipeline until activists called out President Obama on the project during campaign rallies and events across the country. In addition, field hearings on the project elevated concerns from Nebraska residents about the pipeline's proximity to the state's Ogallala aquifer, which supplies drinking water to 1.5 million people. Less than a week after the White House protest in early November, the State Department said it was ordering a new route for the pipeline, delaying the administration's decision until after the 2012 presidential election.
In June of 2013, during his long-awaited speech climate change, President Obama said he would approve the pipeline only if it "does not significantly exacerbate the problem of carbon pollution."
As those in favor and opposed to the pipeline awaited the release of the State Department's final environmental assessment, the review process itself came under intense scrutiny because the firm contracted by the agency to prepare it- Environmental Resource Management (ERM)- had worked on another TransCanada project during the period covered by their conflict of interest disclosure statement, and "had worked for TransCanada, ExxonMobil and other fossil fuel companies that have a stake in the Canadian Tar Sands." While the State Department's Inspector General's office has launched an investigation into the contracting process, the final supplemental EIS was released to the public on January 31, 2014.
The final environmental impact statement concluded that, even though crude extracted from the oil sands produces 17 percent more greenhouse gas emissions than the average barrel of crude currently used in the United States (and 2 percent to 10 percent more than the heavy crude it would replace at Gulf Coast refineries), and even though bitumen, the substance that is extracted from tar sands, is more difficult to clean up than lighter crude in the event of a spill, the proposed Pipeline would be unlikely to impact global greenhouse gas emissions because TransCanada would likely ship the crude to US refineries by rail anyway.
Beginning on February 5, the State Department opened a 30-day comment period, and other federal agencies began a 90-day period to weigh in.
Environmental groups are rallying supporters to protest the pipeline during the public comment period, declaring that "even the oil-industry written, sham FSEIS couldn't deny that Keystone XL does have an impact on carbon pollution."
Once the State Department issues its decision, other agencies have 15 days to object, and if that happens, President Obama will make the decision whether to issue the permit.
You can submit comments to the State Department before March 7, 2014.
Members of the public are encouraged to submit comments to regulations.gov.
Kristen Milhollin also contributed to this article.


Wondering if you should buy your own gym equipment to exercise at home or simply pay for a gym membership?
First, let's all run the numbers. The average price of a gym membership is $50 per month. That ends up costing you $600 per year. Over the course of five years, you will end up paying around $3,000!
Contrary to popular belief, you don't need to spend this kind of cash when purchasing your own equipment. If you're still unsure, consider these added benefits of a home gym.
When you don't hold a gym membership, you don't have to worry about random fee increases or jumping through hoops if you need to cancel your membership or put your membership on hold.
Being told that there are certain times a day that you can't work out, such as late nights, weekends, or holidays, can be inconvenient and strenuous on your schedule. When you decide on buying your own gym equipment, you can feel free to work out early on Sunday mornings, at 3am, or whenever you want to sneak a workout routine into your day.
When you visit a public gym, you inadvertently expose yourself to a wide range of germs. You might catch a cold, contract an infection from the shower room floor, or subject yourself to a number of germs and illnesses from members who frequent the facility.
When you work out in the comfort of your own home, there are no loud TVs, music, or the sound of multiple people working out around you. This can all be detrimental to your personal workout program. When you work out at home, you can choose where your workout equipment is placed and the environment that you want to work out in.
Working out at home means that you can spend more time with your family. There's no need for expensive sitters and a drive across town. Now you can work out when it's convenient for you and go right back to your family's activities when you're finished, all without leaving the comfort of your own home.
One of the best things about working out at home is that it can literally be done in your skivvies! You don't have to worry about impressing other members with your expensive gym attire, which can add hundreds to your yearly gym cost.
Waiting for equipment to become available during the busier times at the gym can completely derail your workout plans for the day. At home, you can use any machine whenever you want!
Sometimes working out in front of others can be embarrassing and stressful. It's difficult to focus on your own self-improvement when you are surrounded by large numbers of people. At home, you have no reason to feel self-conscious and nothing to distract you from your own workout goals.


European Union data protection rules should be based on hard data and analysis, rather than the emotions stirred up by politicians, Slovakia's deputy prime minister said in an interview with EURACTIV Slovakia.
Peter Pellegrini is Slovakia's Deputy Prime Minister for Investments and Information Technology. During the country's EU Council Presidency, he is in charge of the cohesion agenda and the Digital Single Market. He spoke to Zuzana Gabrizova from EURACTIV Slovakia.
There are many proposals on the table related to the EU's digital agenda, which is under your responsibility. What would the Slovak Presidency consider a success by its end inDecember?
In this area, the Slovak Presidency is more focused on the technical work and the successes will be coming through during the Maltese Presidency. But this cannot lower our ambition. Different proposals have been put forward at different levels.
In case of the geo-blocking, we would like to at least agree on the general approach. We would also like to start the trialogue on the definitive removal of roaming charges in order to meet the July 2017 deadline. The EU eGovernment Action Plan could make its way into the Council conclusions. Considering this, a Bratislava declaration on eGovernment defining clear goals for the EU member states would be considered our most significant achievement. The aim is to gradually converge towards the 'one time, last time' principle and towards making the public services of one country available to the citizens of another by 2020.
Where will agreement be toughest to achieve?
The agreement on the ability to use pre-paid data services abroad was concluded rather quickly. Regarding geo-blocking, there is a broad understanding that there is no place for discriminating against someone based on the payment method or the simple fact they live somewhere where the vendor refuses to sell.
Finding a compromise between removing discrimination and preserving the rights of suppliers, who are either not technically able or cannot arrange delivering abroad, will take a long time.
The free flow of data is another huge issue. In this case, there is no specific proposal, but this is the future. We see this as one of the freedoms. Thanks to the development of modern technology, states, institutions and organisations will have an enormous amount of data.
The age of the Internet of Things (IoT) is dawning. Connected vehicles, smarts meters and various other sensors will all transmit data. On the one hand, this could span new applications and create new jobs. On the other hand, we need to talk about protecting personal data. Nowadays they are being protected at the national level. The question is to what extent the national authorities are willing to transfer some of their competences to the European level.
We do have a broad agreement on roaming charges. Now, the important thing is to monitor wholesale prices between operators, so that they can appropriately safeguard the operation of the service infrastructure and, once the roaming surcharges are over, not increase their prices.
If the EU wants to be competitive on the global scale, it has to take decisions quickly, not only react after the fact.
How can we regulate such a dynamic domain without hindering innovation?
The European Union has to find a certain framework. It should evaluate data and specific consumer behaviour and only intervene if we identify a problem. We can no longer look at regulation with this presumption of guilt, as if something bad was coming and we were impeding development.
There has to be a flexible way to respond to any deficiencies that arise in the market or if consumer protection and health of citizens are compromised. Europe has to learn to manage society based on hard data and analysis, not based on emotions stimulated by politicians.
For all the things that are currently being dealt with, having a proper infrastructure is fundamental. The deployment of high-speed broadband networks requires investment. Where should this investment come from?
Without state-of-the-art digital infrastructure Europe has no chance of succeeding in a competitive global market. Many countries have already announced when they will start building 5G networks. The EU also needs to harmonise the 700 MHz spectrum. We have it on the table. I hope we will be able to come up with an agreement with the European Parliament on whether it is going to be freed up in 2020 or in 2022. Of course, it is relatively late. The way member states auction their frequencies has to stimulate the frequency owners to build infrastructure.
Frequencies are the new gold for both the state and the operators. Governments could demand the highest price and generate more money for the state budget. But on the other hand, this would drain so much money from private sector that it would not be able to build the infrastructure in a short period of time. As states, we must agree that we prefer investment and rapid construction, even at the cost of lower state revenues.
With 4G, we have focused on coverage based on the density of the population. At the onset of the IoT, in the case of autonomous cars, our concern must be the percentage of covered area. If a car is to drive from one city to another, it requires countrywide coverage.
Even in Slovakia, there is a struggle between telecommunication companies and the state. They don't really like state or municipal investments, they claim they create competition. If this is the case, then the private sector should guarantee coverage of "X" percentage of an area by the year "Y". If not, then the state must intervene because there are areas that will never be commercially attractive.
Cohesion policy is not one of the priorities during the Slovak Presidency, but it is an important topic. What can we do in this field?
I don't want the debate on the Cohesion Policy to slip into a polemic between net payers and net beneficiaries. We are all members, we all make budget contributions. It was the Union itself that decided to show solidarity with the less-developed regions. Slovakia could become a net payer, but this does not mean changing our attitude. There is no need to discuss whether the Cohesion Policy is an added value for Europe, the results are self-explanatory. We need to discuss its future beyond 2020 and its current situation.
And what is the current situation?
We have a complicated bureaucratic system including an unpredictable multilevel system of controls focused on processes and papers, not on results. It needs simplifying.
This simplification should be applied during this programming period without radically altering the entire system. That includes expense reporting or controlling on outcomes rather than the process itself, especially if we trust the beneficiaries. These are often municipalities.
We are expecting a lot from the high level group of the European Commission. We also have some practical remarks issued by the Committee of the Regions. I believe that under the Slovak Presidency we will be able settle on clear conclusions. These could serve as the basis for the Cohesion Policy after 2020.
Should the extent of the programming be considered, too, as suggested by the Committee of Regions? For example, if the goal is increasing employment, should recipients of funds be given a free hand in deciding how to respond to local circumstances?
Flexibility is certainly legitimate, yes, because every region is unique. I also think we should not have strictly enforced instruments to achieve the various priorities and we should trust the locals. There is no need to steer everything from the top, we need a balance.
What is your view of the debate over whether the new financial instrument, the so-called Juncker Plan comes at the expense of traditional structural and investment funds?
The development of infrastructure of national significance has an added value for all Europeans. We need to keep the balance between the interests of the state and of the local governments. Nobody is right by definition.


The Admin Console is an Enterprise only application that gives you control over the management and settings of the Alfresco environment.
You'll find help text on the Admin Console pages to assist you with setting up your Alfresco repository.
About the Alfresco Admin Console The Alfresco Admin Console is a standalone console for managing the administration of the Alfresco repository.
Launching the Admin Console The Admin Console runs externally to the Alfresco user interface and therefore you launch the application independently. This allows you to run the Admin Console without the need to run Alfresco Share or Explorer.
Admin Console: System Summary The System Summary page shows an overview of the status of the Alfresco repository, including the general system information, subsystem status, clustering settings, the current authentication chain, and details of which AMPs are applied to the system.
Admin Console: Consoles The Consoles section on the Admin Console contains pages for administering models, tenants, and workflow definitions and property bundles at runtime in the repository.
Admin Console: Email services The Email section on the Admin Console contains pages for configuring email servers.
Admin Console: General settings The General section on the Admin Console contains pages for managing your Alfresco license, viewing information about the repository, and the system settings.
Admin Console: Repository Services The Repository Services section on the Admin Console contains pages for setting the Activities feed, the clustering tool, setting which workflow engine is in use, enabling replication, enabling and setting the search service, and controlling the Subscription and Transformation services.
Admin Console: Support Tools The Support Tools section on the Admin Console contains the page for exporting the system information to a ZIP file.
Admin Console: Directories The Directories section on the Admin Console contains the page for defining authentication of Alfresco users and groups, including access to external directory services and setting up authentication chains.
Admin Console: Virtual File Systems The Virtual File Systems section on the Admin Console contains pages for setting up access to Alfresco from the CIFS and FTP protocols.
Starting the Activiti workflow console Alfresco provides the Activiti workflow console for managing Activiti based workflows and process definitions.
Customizing the Alfresco Admin Console The Alfresco Admin Console displays the most common Alfresco administration activities. You can customize the Admin Console to show different options, properties, and layout, or you can create completely new pages.


text:
Q: Closing an open excel workbook in C# There is one issue that I have been having, and I am trying to fix it because if the program crashes (the excel file stays open in the background), or the user has the excel workbook already open the program will crash because it is unable to open an already opened workbook.
Was trying to counter this issue by using the method from this question : C#: How can I open and close an Excel workbook?
But much to my dismay no success.
With this setup I get an error at wb.Close(true) saying I cannot use an unassigned local variable. To me it kind of makes sense, but I don't see how that is the case. It's not like an if statement where if the condition isn't met it doesn't jump in the loop. The try block will always execute.
Excel.Workbook wb;
try
{
    wb = exApp.Workbooks.Open(@file);
}
catch (Exception)
{
    wb.Close(true);
}

I also tried this way :
Excel.Workbook wb = new Excel.Workbook();
try
{
    wb = exApp.Workbooks.Open(@file);
}
catch (Exception)
{
    wb.Close(true);
}

but this time, I get a error: 80040154 Class not registered on the line Excel.Workbook wb = new Excel.Workbook(); when running the program. again... don't know why.
Any help is greatly appreciated.

A: Try this:
Excel.Workbook wb = null;
try
{
    wb = exApp.Workbooks.Open(@file);
}
catch (Exception)
{
    if (wb != null) wb.Close(true);
}

A: You want finally instead of catch. A finally block will always execute, whether there is an exception or not. Even if there isn't an Exception thrown, you still want to close the workbook to clear up the resources.
Something like this should be what you need.
Excel.Workbook wb = new Excel.Workbook();

try {
    wb = exApp.Workbooks.Open(@file);
    //More code...
}
catch (Exception ex) {
    // Do any error handling you need/want to here.
}
finally {
    // If there's a way to determine if the workbook is open, try that first.
    wb.Close(true);
}


Adapted from Born to Build (Gallup Press, May 2018).
People will ask you throughout your life, "Where do you work?" and "What do you do?" They never ask you, "What are you building?"
When conversations change to "What are you building?" you will change, and so will the world.
Well-meaning and important global institutions, scientists, academics and politicians have never fully understood the rare gift to build something -- a God-given natural talent that many are born with -- that to some degree, you yourself possess.
An innovation has no value until an ambitious builder creates a business model around it and turns it into a product or service that customers will buy.
An innovator is first and foremost a creator, an inventor -- a problem solver with a deep passion for improving something. Innovators are thinkers.
A builder is different from an innovator. A builder creates economic energy where none previously existed.
Builders can start very young. When an 8-year-old puts a lemonade stand on a corner, they create new economic energy on that corner -- goods and services are exchanged for the first time at that place.
Years ago, a 14-year-old could take on an existing newspaper delivery route with 25 papers and boom it to 100 papers. This young builder created economic energy that wasn't on that route before. Believe it or not, U.S. GDP actually ticked up a little when that paper route quadrupled.
Builders also create goods and services that customers didn't even know they wanted or had ever imagined. Builders create demand.
When Google or Apple was launched or the first commercial airplane took off in 1914, there was no inherent demand for any of their products or services. Nobody said, "Gee, I wish I had a device in my pocket on which I could search everything humans have recorded since the beginning of time instead of going to a library."
Or, "It would be so cool to fly through the air in a metal tube at 400 mph rather than ride to my destination on my horse."
Or, "I wish someone would invent plumbing and electricity rather than using candles and kerosene -- and going to the toilet outside."
Economists and well-meaning thinkers often look at a weak or declining economy and conclude, "We have a declining economy because demand is weak or because there is no demand at all." A more insightful observation is, "There is no demand because there aren't enough builders who create demand." Without builders, there is no demand, no growing economy and hence, no good jobs.
There was never an inherent demand for cars, flight, TV, video, indoor plumbing, electricity or the internet, or Starbucks or Amazon -- somebody had to take a good idea and build it into something big. And when people do that, they create economic energy that wasn't there before -- as well as new good jobs and all the things that build a growing economy.
Maybe you could build a small or medium-sized business. Or build a huge business -- one with $10 million or $10 billion in sales. They all count and add up to the sum total of the world economy. We need hundreds of thousands of small and medium-sized businesses. All societies need organizations of all kinds continuously starting up and booming -- or they can't develop.
You could also build a small, medium or jumbo nonprofit. Nonprofits create economic energy too. They boost GDP and create real jobs and real growth in cities and states.
Builders from Andrew Carnegie to J.P. Morgan to John D. Rockefeller to Henry Ford famously created historic economic energy through steel, electricity, trains and cars. They transformed America and the world because they created customers that didn't previously exist. They had a gift to envision, create masses of customers and change how we live. They also made very big bets -- they would sometimes bet everything they were worth. Extreme builders will, a few times in their life, bet it all.
Every institution in the world -- even nonprofits, schools and churches -- has customers. Builders are born with a gift to know how to create demand for those customers -- market disruptions that offer a better way to live.
But creating a big booming enterprise or nonprofit organization won't happen with just one gifted builder. There is a fragile ecosystem around effective builders.
Gallup has found that there are three key players in the development of any organization, whether it's a new enterprise, a new division within a company or a nonprofit. We call them the "three alphas": the alpha Rainmaker, the alpha Conductor and the alpha Expert. When this combination exists in an organization or on a team, the likelihood of it breaking out and booming grows exponentially.
An alpha Rainmaker has unusual drive and persistence -- rare grit. Obstacles and failure actually increase a Rainmaker's determination. An enterprise virtually never works without this player.
An alpha Conductor has management ability. This is the operations person or manager who knows how to get all players on the team -- or in the "orchestra" -- to work together seamlessly. This person holds the whole organization together.
Born to Build -- which Gallup is releasing today -- and the assessment included with it were created to help you decide how building plays into your life and career. They will help you answer the question "Am I an alpha builder?"
You were born to do this. Whether you are an alpha Rainmaker, an alpha Conductor or an alpha Expert, there are no limits to what you can build.


text:
Solar Struggle
Z-Software GmbH	 2012
This is an arcade action space shooter where the player takes control of one of the nine space ships and experiences a thrilling story of a young pilot in 11 missions or asserts herself/himself against tons of enemies in the skirmish mode. The whole game world is in 3D, but the action takes place on a 2D plane which makes the action and controls really easy. It features: thrilling story in 11 missions; challenging skirmish mode; 9 different ships; 36 Steam achievements. Till the year 2016, the budgets of all the government space programs have been reduced to a minimum. To forward the space exploration, a private group of companies started comprising the Consortium. The Consortium was able to demonstrate amazing success within a few decades. It quickly assumed a monopoly position in the development and production of space equipment. During this time mankind overcame the differences it had and united to a world government in 2087. The armed forces of the former governments joined to serve as police and security forces of the new world government. The first success of the new world government was the establishment of a permanent mars colony in 2094. The Consortium took actively part in. Today it's the year 2169. Mankind has long since penetrated to the farthest corners of the solar system. A gold rush has set up mining colonies whereever it has been possible to mine raw materials. The Consortium has thus developed into the largest economic power in the solar system. It controls a large part of all mining operations and earns revenue from the sale of ships and technology to the colonies. But the general prosperity also attracts individuals who seek to enrich at the expense of the honest workers. The huge distances between the planets make it extremely difficult to the Military to retain control. Therefore, unfortunately, again and again tragic events are happening. Here begins the story of the young pilot who nearly escapes death while his convoy was attacked.
Screenshots/Video	 ISO Demo 537MB (uploaded by Molitor)
Desura Digital ISO Demo (provided by starlord & upped by Scaryfun) 469MB


Identifying specific contents in uncommon pipes is easy with Specialty Pipe Markers. When you need to label contents in ducts, electrical, conduit, and medical systems, choose Specialty Pipe Markers. Specialty Pipe Markers are available in a large variety of colors, sizes, messages, and materials to meet your specific pipe identification needs.
With Specialty Pipe Markers you can inform others about voltage, the direct of duct supply air, natural gas in medical pipes, and more. Keep others informed and safe by identify specific pipes with Specialty Pipe Markers.


Whether you have a layover, overnight sleepover or you are just quickly passing through, our Nelson Airport Guide is a great place to start planning your visit. Here, you'll find information on services and facilities available inside the airport – including details about airport lounges, WiFi, mobile charging points, lockers, 24-hour food options, nearby hotels, and everything in between.
To help you plan your layover or overnight sleepover, here is a quick run-down about what to expect during your time at Nelson Airport.
The small, brand new terminal at Nelson Airport opened in October 2018 and handles domestic routes. Amenities are limited to a cafe, a to-go kiosk, a convenience shop, and free WiFi. For added comfort while you wait, Air New Zealand passengers may have access to its lounge. See Airport Lounges in the airport guide below for location and access information.
The airport closes nightly, so it is not possible to spend the night here. For uninterrupted sleep, nearby hotels offers shuttle service. See our Airport Hotels section below for more info.
To see more options there is a list of hotels near Nelson Airport on Tripadvisor that can be sorted by price, distance, traveller rating and popularity.
Free WiFi is available at Nelson Airport for one hour. Connect to 'Nelson Airport free SPOT' and follow instructions.
ATMs / Cash Machines – Need cash? ATMs are available. Fees may apply, so be sure to check your bank's fee schedule and your daily withdrawal limit if you are travelling internationally. You may also want to notify your bank of your travel plans. Locations: main terminal.
Baby Care Facilities – A Parents Room is available which includes baby changing facilities. Location: corridor adjacent to the bathrooms.
Baggage Trolleys – Need a hand with your luggage? Baggage trolleys are available in the main terminal.
Children's Play Area – Yes, there is an outdoor play area for children.
Conference Facilities – A small meeting room is available for hire in the main terminal.
Duty Free & Shopping – Duty Free shopping is not available. The only shopping option is The Nelson Store, selling magazines, lottery tickets, and more.
Food & Drink – At the time of writing, no 24-hour options are available. Two (new) options are available: Sublime offers coffee and small treats • Wayfair offers larger range of food and drinks including alcoholic beverages.
Family Services – Baby changing facilities and a children's outdoor play area are located in the main terminal.
Medical Services – Customer Service Officers, located by the departure gate, have Automated external defibrillators (AED) and basic first aid training for emergencies.
Walking Track – A 5.75km walkway circles the airport perimeter. The track starts at the recreational car park, where cars can be left for up to 3 hours. Pets and bicycles are not permitted on it.
The airport is open 5:00AM – 10:30PM (Mon – Fri), 5:00AM – 8:00PM (Sat) and 5:30AM – 10:00PM (Sun).
As of January 2019, Nelson airport is served by the following airlines: Air New Zealand • Air2There • JetStar • OriginAir • Sounds Air.
Car rentals are available at the airport, and counters are available in the terminal. Companies include: Avis • Budget • Europcar • Hertz • NZ Rentacar • Thrifty.
Super Shuttle operates fixed rate transfers from the airport to Nelson. Bookings can be made online or over the phone.
Several area hotels provide airport transportation service to their guests either for a fee or as a courtesy. Here are a few hotels offering airport shuttle service: Grand Mercure Nelson Monaco Apartments • Greens Motel Nelson • Saxton Lodge.
Taxis are available in front of the airport at the designated taxi rank. Nelson City Taxis is the only company with a taxi on rank.


Its pretty simple. As soon as you hit the brakes Third Brake light will flash at 20Hz.
And after 3 seconds Third Brake light will be Steady on.
Why Pulsing Third Brake Light ?
Because This will help get the attention of the drivers following behind you.
Even when your in bumper to bumper traffic.
DO NOT CONNECT THIS CIRCUIT TO YOUR MAIN BRAKE LIGHTS. Any type of flashing light on the main brake lights is prohibited and illegal. Use this circuit at your own risk and be aware that the possibility exists to be stopped by law enforcement if you implement this circuit in your vehicle.
This entry was posted in Digital Electronics. Bookmark the permalink.
Why bother with the flashing when you're so close to the cinematic rate of 24Hz?
To really make it visible, as an emergency flasher ought to be, it shouldn't be more than 3Hz to 5Hz.
Yes agreed. But I like the look when its flashing at 22Hz. Its more like a strobe. heh heh heee.
With say 3 of the unused pins, you could make the flash rate switch selectable (or strap-able) to cater for 8 rates from 3 Hz up.
To make it really easy, you coud go in equal steps like 3Hz, 6Hz, 9Hz, 12Hz, 15Hz, 18Hz, 21Hz, or something similar.
Just suggestions of course, not meant negative in any way.
Thank you very much for the suggestions. Im currently working on interfacing HT1632 display driver. So I i'll edit this project little later.
hello pasanlaksiri, I'm interested in this project, and before I begin, I want to ask if the circuit is ok. I ask this because in the pictures, I see that there are other components. Thank you and hope you do not mind.
The only extra component is ULN2003 current sinking chip. You can test the cct with one LED connected to 7th pin of the MCU across some resistor like 180ohm or so.
ok. I will try to realize the proposed scheme.
'll let you know if I succeeded or not.
Hello.I don't see pics and code.thanks.


You are a refugee and look for a job? You are a customer of the "Jobcenter" or the "Agentur für Arbeit"(Employment Agency) and would like to work in Germany?
In the six week course ("Maßnahme" – educational activity) KONTUR will survey your German language skills. You will assess your qualifications and how to make the most out of your competencies and knowledge. Also you will get important information's about working in Germany (job market, job-seeking, the German social insurance system, and more).
Besides the courses with the whole group you will also learn in small groups, get an individual job coaching and individual advisory. If you need help, you will be supported in writing job applications.


Six London friends, whose lives and work are overshadowed by a demanding film producer, flee the country for a weekend to escape his clutches. Safely ensconced in a hotel in Amsterdam, the uneasy equilibrium that has existed between them is joyously exposed as the alcohol starts to flow. John Osborne's funny and moving account of friendship won the Evening Standard Best Play of the Year Award in 1968. The play was revived by the Donmar Warehouse, London, in September 2003.


text:
mysql -u root -p agenda

-- mostra os bancos
SHOW DATABASES;

-- criar um banco
CREATE DATABASE agenda;

-- obs.: 1 row affected: sucesso!
-- usar um banco
USE agenda;

-- criar uma tabela simples
CREATE TABLE contatos (
    nome     VARCHAR(50),
    telefone VARCHAR(50)
);

-- mostrando a estrutura da tabela
DESCRIBE contatos;

-- excluir uma tabela
DROP TABLE contatos;

-- mostrar as tabelas existentes
SHOW TABLES;

-- "reset"
DROP TABLES IF EXISTS contatos;
CREATE TABLE contatos (
    nome     VARCHAR(50),
    telefone VARCHAR(50)
);

-- tabela mais "sofisticada"
CREATE TABLE contatos (
    codigo   INTEGER     PRIMARY KEY AUTO_INCREMENT,
    nome     VARCHAR(50) NOT NULL,
    telefone VARCHAR(50)
);

-- inserindo dados
INSERT INTO contatos VALUES (
    DEFAULT,
    'IFRS',
    '32338603'
);

INSERT INTO contatos (telefone, nome) VALUES (
    '32338603',
    'IFRS'
);

INSERT INTO contatos (telefone, nome) VALUES (
    '88223344',
    'Teste 1'
), (
    '44555553',
    'Teste 2'
);

-- consultando (query)
SELECT * FROM contatos;

SELECT nome FROM contatos;

SELECT * FROM contatos
         WHERE codigo = 1;

SELECT * FROM contatos
         WHERE nome = 'IFRS';

SELECT * FROM contatos
         WHERE nome LIKE 'I%';

SELECT * FROM contatos
         ORDER BY nome;

SELECT * FROM contatos
         ORDER BY nome DESC;

SELECT * FROM contatos
         ORDER BY codigo DESC
         LIMIT 1 OFFSET 1;

-- excluir registro
DELETE FROM contatos;

DELETE FROM contatos
       WHERE codigo = 1;

DELETE FROM contatos
       WHERE codigo IN (2,4,6);

-- atualizar um registro
UPDATE contatos SET
    telefone = '99992222'
    WHERE codigo = 1;

redpajama_set_name: RedPajamaGithub


text:
Amatersko prvenstvo Francije 1964 v tenisu.

Moški posamično

 Manuel Santana :  Nicola Pietrangeli  6-3, 6-1, 4-6, 7-5

Ženske posamično

 Margaret Smith :  Maria Bueno  5-7, 6-1, 6-2

Moške dvojice

 Roy Emerson /   Ken Fletcher :  John Newcombe /  Tony Roche 7–5, 6–3, 3–6, 7–5

Ženske dvojice

 Margaret Smith /  Lesley Turner Bowrey :  Norma Baylon /  Helga Schultze  6–3, 6–1

Mešane dvojice

 Margaret Smith /  Ken Fletcher :  Lesley Turner Bowrey /  Fred Stolle  6–3, 4–6, 8–6

Viri

1964
1964 v športu


FPN values strategic alliances with other strong institutions and expertise networks, both locally and internationally; these assist in the challenge of preparing students for the labour market. Over the next years a focus will be on contributing to regional initiatives, such as the development of Sciences in South Limburg and the forming of the Health Campus Randwyck, with Brains Unlimited (ultra high field imaging facilities) and TMFI (The Maastricht Forensic Institute) as relevant elements. FPN will also further intensify its successful collaboration with clinical institutes in the context of health and well-being. The FPN strategy is in close synergy and is mutually supportive of the UM strategy "Inspired by Quality".