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October-December 2020
Volume 23 | Issue 4
Page Nos. 383-546
Online since Monday, October 19, 2020
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Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia p. 383
Mukul C Kapoor
DOI:10.4103/aca.ACA_138_19 PMID:33109792
The association with cardiac surgery with cognitive decline was first reported in the 1960s after the introduction of coronary artery surgery. The incidence in cognitive decline was thought to be more after cardiac surgery, especially with the use of the cardiopulmonary bypass. Anesthesia and surgery are both associated with cognitive decline but many other factors appear to contribute its genesis. On-pump surgery, microembolization during manipulation of the heart and great vessels, temperature changes, pH changes, and altered cerebral perfusion, during cardiac surgery, have all been blamed for this. Postoperative cognitive decline is associated with poor clinical outcomes and higher mortality. Several studies have been conducted in the last decade to determine the genesis of this malady. Current evidence is absolving cardiac surgery and anesthesia to be the primary causes per se of cognitive dysfunction.
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Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 2: Cognitive dysfunction after critical illness; potential contributors in surgery and intensive care; pathogenesis; and therapies to prevent/treat perioperative neurological dysfunction p. 391
Severe cognitive decline and cognitive dysfunction has been attributed to patient's stay in the cardiovascular intensive care unit. Prolonged mechanical ventilation, long duration of stay, sedation protocols, and sleep deprivation contribute to patients developing neurocognitive disorder after intensive care admission and it is associated with poor clinical outcomes. Trauma of surgery, stress of critical care, and administration of anaesthesia evoke a systemic inflammatory response and trigger neuroinflammation and oxidative stress. Anaesthetic agents modulate the function of the GABA receptors. The persistence of these effects in the postoperative period promotes development of cognitive dysfunction. A number of drugs are under investigation to restrict or prevent this cognitive decline.
Covid 19 and its cardiovascular effects p. 401
Amit Rastogi, Prabhat Tewari
COVID-19 pandemic is mainly related with the pulmonary problems initially but now as the pandemic is growing it is observed that almost all organ systems of the body are affected. Up to 20-30% patients who are admitted in Covid hospitals are showing cardiovascular involvement. Severity of cardiovascular disease in a COVID-19 patient depends whether a patient is having pre-existing cardiac disease or not. Patients with pre-existing cardiac disease have more severe infection and associated mortality. Severe COVID-19 infection shows close association with myocardial damage and various arrythmias. The cardiovascular involvement occurs by either engagement directly with the angiotensin converting enzyme 2 or indirectly by the effect of inflammatory mediators which are generated as a result of viral-host response to infection. The COVID-19 disease is said to produce a wide spectrum of affliction ranging between even asymptomatic patient to Cardiovascular syndrome. Even after recovering from COVID-19 patients can reappear in the hospital with cardiomyopathies and arrythmias.
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Measurement of aortic root dimensions by transesophageal echocardiography in adult patients undergoing cardiac surgery p. 409
Wiriya Maisat, Prasert Sawasdiwipachai, Walaiporn Aroonrat, Saowaphak Lapmahapaisan
Background: Normal aortic root dimensions were established from studies from Western countries. As the body size is significantly associated with the aortic root dimensions, Thai populations may have smaller aortic root diameters. Aims: To elucidate the aortic root dimensions using transesophageal echocardiography (TEE) in adult patients undergoing cardiac surgery. Settings and Design: A retrospective cohort study including 150 patients aged >18 years undergoing cardiac surgery. Materials and Methods: Aortic root dimensions (annulus, sinus of Valsalva, sinotubular junction (STJ), and proximal ascending aorta) were measured using two-dimensional TEE. Patients with aortic-root related pathology were excluded. Results: Men constituted 60% of the study population; the mean age was 61.9 ± 12.6 years, and mean body surface area (BSA) was 1.7 ± 0.2 m2. The absolute dimensions for the annulus, sinus of Valsalva, STJ, and proximal ascending aorta were 22.3 ± 3.4, 32.6 ± 3.9, 26.4 ± 3.3, and 29.3 ± 3.1 mm, respectively, in men (12.9 ± 1.6, 18.8 ± 2.6, 15.2 ± 2.1, and 17.9 ± 2.7 mm, respectively, after adjusting for BSA) and 20.3 ± 2.2, 29.8 ± 3.6, 23.8 ± 2.6, and 27.1 ± 3.1 mm, respectively, in women (13.5 ± 2.0, 19.8 ± 2.3, 15.8 ± 2.5, and 17.0 ± 2.1 mm, respectively, after adjusting for BSA). The absolute aortic root diameters were significantly greater in men at all levels (P < 0.001). The BSA-adjusted diameters were similar for both sexes at the annulus (P = 0.076) and STJ (P = 0.076), except for the sinus of Valsalva (P = 0.010) and proximal ascending aorta (P = 0.006). Conclusion: This study reports reference values of aortic root dimensions by TEE. The body size should be considered when comparing the aortic root dimensions of Thai populations with the standard normal values.
Quantitative estimation of LIMA blood flow between extraluminal papavarine vs extraluminal papavarine plus intraluminal vasodilator cocktail in CABG patients p. 414
Vivek V Pillai, Renjith Sreekanthan, Jayakumar Karunakaran
Objective: In this study, we aimed at a comparative quantitative estimation of the difference in LIMA blood flow between LIMAs treated with topical papaverine alone and LIMAs treated with a combination of topical papaverine plus an intraluminal cocktail of papaverine, nitroglycerine, and milrinone. Methods: Nearly 50 consecutive patients with similar demographics undergoing elective on-pump CABG were recruited for the study. After pedicled LIMA harvest, topical papaverine was sprayed on the pedicle and kept enveloped in papaverine soaked gauze. LIMA flow was then estimated. Later, intraluminal vasodilator solution of papaverine, NTG, milrinone, and heparinized blood were instilled in LIMA, and LIMA flows were estimated. Results: The mean LIMA flows with topical papaverine alone was 47.19 mL/min whereas the mean LIMA flows with topical papaverine plus intraluminal cocktail was 104 mL/min. There was a significant difference between the two flows as their mean was 56.815 mL/min and the paired t-test for significance had a P value of 0.0001. Conclusion: There was a significant difference in the LIMA flow when the LIMA had been treated with the intraluminal instillation of the vasodilator cocktail in addition to the topical application of papaverine solution. Therefore, intraluminal vasodilator cocktail of milrinone, NTG, and papaverine mixed with heparinized blood in addition to topical papaverine is a simple and effective method for LIMA preparation in CABG.
Gender difference in long- and short-term outcomes of off-pump coronary endarterectomy p. 419
Feridoun Sabzi, Atefeh Asadmobini
DOI:10.4103/aca.ACA_28_19 PMID:33109797
Background: The role of gender in the selection of the most effective method for treatment of patients with diffused coronary artery diseases remains a matter of debate. This study thus evaluated the effect of gender on long- and short-term outcomes of off-pump coronary endarterectomy (CE). Methods: This was a single-center retrospective study of patients who had undergone coronary artery bypass graft (CABG). The patients were divided into two groups, the CABG and the CABG + CE group, and further stratified into male and female. Long-term survival for each group was estimated by Kaplan–Meier analysis with log-rank testing. In addition, Cox regression analyses of each gender were also carried out to identify the predictors of the primary and secondary endpoints. Results: Overall, 25.8% of the patients were female. Diseased vessels were not statistically different in the two groups – men and women. There was no significant difference in postoperative outcomes between males and females in the CABG and CABG + CE groups. There was no significant difference in hospital mortality in the two groups between males and females. Kaplan–Meier curves show that there was no significant difference in the 5-year cardiac mortality between males and females belonging to the CABG and CABG + CE groups. Conclusion: The results of this study show that there was no significant difference in the short- and long-term outcomes of off-pump CABG and CE in both genders although women tend to carry a greater risk.
Comparison of flow-independent parameters for grading severity of aortic stenosis using intraoperative transesophageal echocardiography – A prospective observational study p. 425
S Nanditha, Vishwas Malik
Introduction: Discrepancies have been reported in grading of severity of aortic stenosis. We propose to compare Aortic valve area by continuity equation, Dimensionless Index and Acceleration time/Ejection time in patients with documented severe aortic stenosis with normal left ventricular function by TEE after induction of anesthesia. This might give use insight about the best parameter we can rely on intra-operatively for decision making. Methodology: 60 patients with severe AS undergoing elective cardiac surgery were enrolled in our study. Post intubation trans-thoracic echocardiography (TEE) was performed and above mentioned parameters was noted. Results: 96.7 % of patients continued in severe AS category when AS was measured using AVA as echo parameter. So there is 3.3 % disparity. There was disparity in 13.3% of cases when DI was considered. And there was 43.3% disparity when AT/ET was considered. Conclusion: Perioperative grading of aortic stenosis continues to be a challenge for cardiac anesthesiologists. Multiple echocardiographic parameters have to be considered. We have found AVA and DI to have less disparity compared to AT/ET.
Monitoring of limb perfusion after vascular surgery in critical limb ischemia using near-infrared spectroscopy: A prospective observational study p. 429
Tanveer Singh Kundra, Ashwini Thimmarayappa, Sunder Singh Subash, Parminder Kaur
Background: Intra and postoperative perfusion monitoring should be used in critical limb ischemia patients undergoing vascular surgery to improve outcomes and reduce costs. While a pulse oximeter can be applied on the affected limb to monitor the arterial saturation of the limb, thus reflecting flow in that limb, we need to focus on other important parameters like muscle oxygen consumption and regional blood flow for a good outcome. Near-infrared spectroscopy (NIRS) can be used in such patients to monitor regional and tissue oxygenation. Methodology: In this prospective observational study, 30 adult patients undergoing infra-inguinal bypass were recruited. All these patients were given combined spinal-epidural anesthesia. In addition to routine monitoring, a pulse oximeter and NIRS electrodes were applied on the affected limb. rsO2, limb spO2, and Doppler signals were noted before the induction of anesthesia (baseline) and postoperatively at 0, 6, and 12 h. Improvement in rsO2 and limb spO2 values after surgery was noted and fall in these values was evaluated. Pearson correlation between rsO2 and limb spO2 was assessed. The data was analyzed using repeated-measures ANOVA. Results: Pearson correlation between rsO2 and limb spO2 was r > 0.8. Two patients had a fall in rsO2 in postoperative period, which co-related with a fall in limb spO2 and decreased/absent Doppler signals. Conclusion: NIRS represents a noninvasive and reliable means to monitor limb perfusion in patients undergoing vascular surgery for rest pain.
Tracheal extubation of anesthetized pediatric patients with heart disease decreases the incidence of emergence agitation: A retrospective study p. 433
Tatsuya Kunigo, Yuko Nawa, Yusuke Yoshikawa, Michiaki Yamakage
Background: Emergence agitation for pediatric patients after general anesthesia is one of the postoperative complications. The relationship between consciousness at tracheal extubation and emergence agitation is not clear. Aim: The aim of the present study was to determine whether tracheal extubation of anesthetized pediatric patients with heart disease by propofol decreases the incidence of emergence agitation. Settings and Design: This was a retrospective case-control study conducted at a children's hospital. Materials and Methods: Pediatric patients with heart disease aged 0-14 years who underwent cardiac catheterization under general anesthesia by propofol between October 2014 and September 2018 were enrolled. The incidence of emergence agitation by anesthetized extubation was compared with that by awake extubation. Statistical Analysis Used: Logistic regression analysis was performed. Results: Anesthetized extubation was performed in 202 patients and awake extubation was performed in 56 patients. The incidence of emergence agitation was significantly lower in patients who underwent anesthetized extubation than in patients who underwent awake extubation (25.2% vs. 69.6%, P = 0.000). In logistic regression analysis, anesthetized extubation [odds ratio (OR): 0.075, 95% confidence interval (CI): 0.034-0.165, P = 0.000] and older age (OR: 0.808, 95% CI: 0.728-0.897, P = 0.000) were associated with a decreased incidence of emergence agitation, and preoperative anxiety (OR: 2.220, 95% CI: 1.060-4.660, P = 0.03) was associated with an increased incidence of emergence agitation. Conclusions: Tracheal extubation under anesthesia by propofol decreases the incidence of emergence agitation in pediatric patients with heart disease.
Fluid responsiveness to passive leg raising in patients with and without coronary artery disease: A prospective observational study p. 439
Varun Suresh, Manikandan Sethuraman, Jayakumar Karunakaran, Thomas Koshy
Introduction: Hemodynamic stability and fluid responsiveness (FR) assume importance in perioperative management of patients undergoing major surgery. Passive leg raising (PLR) is validated in assessing FR in intensive care unit patients. Very few studies have examined FR to PLR in intraoperative scenario. We prospectively studied FR to PLR using transesophageal echocardiography (TEE), in patients with no coronary artery disease (CAD) undergoing major neurosurgery and those with CAD undergoing coronary artery bypass grafting (CABG). Methods: We enrolled 29 adult consenting patients undergoing major neurosurgery with TEE monitoring and 25 patients undergoing CABG. After induction of anesthesia, baseline hemodynamic parameters were obtained which was followed by PLR using automated adjustment of the operating table. Clinical and TEE-derived hemodynamic parameters were recorded at 1 and 10 min after PLR following which patients were returned to supine position. Results: A total of 162 TEE and clinical examinations were done across baseline, 1 and 10 min after PLR; and paired comparison was done at data intervals of baseline versus 1 min PLR, baseline versus 10 min PLR, and 1 min versus 10 min PLR. There was no significant change in hemodynamic variables at any of the paired comparison intervals in patients undergoing neurosurgery. CABG cases had significant hemodynamic improvement 1 min after PLR, partially sustained at 10 min. Conclusion: Patients undergoing CABG had significant hemodynamic response to PLR, whereas non-CAD patients undergoing neurosurgery did not. A blood pressure–left ventricular end-diastolic volume combination represented strong correlation in response prediction (Pearson's coefficient 0.641; P < 0.01).
Transesophageal probe placement increases endotracheal tube cuff pressure but is not associated with postoperative extubation failure after congenital cardiac surgery p. 447
Stephanie J Pan, Stephen Z Frabitore, Angela R Ingram, Khoa N Nguyen, Phillip S Adams
Context: The concomitant use of cuffed endotracheal tubes (ETT) and transesophageal echocardiography (TEE) probes increases ETT cuff pressures (CP), which may contribute to mucosal ischemia and perioperative complications such as failed extubation. Aims: To assess changes in ETT CP after TEE insertion in patients of different age groups undergoing congenital heart surgery and examine the relationship between ETT CP and postoperative extubation failure. Settings and Design: Single-center quality improvement project. Subjects and Methods: ETT CP was measured with a manometer following intubation and again after TEE insertion. Tracheal perfusion pressure was then calculated and postoperative extubation failures were recorded. Statistical Analysis: Chi-square testing, Fisher's-exact testing, one-way analysis of variance testing or Kruskal–Wallis testing with Dunn's pairwise, and student's t-test or Wilcoxon rank-sum testing were used to analyze the data. Results: Median ETT CP increased significantly after TEE insertion in each age group, with infants showing a smaller magnitude of increase (+2 [1-6] cm H2O, P < 0.001) than adults (+12 [8-14] cm H2O, P = 0.008) (intergroup comparison P = 0.002). Five patients (9%) failed extubation, all of which were infants. Within the infant subgroup, no significant difference existed between failed vs successful extubation regarding ETT CP during bypass (15 ± 1 vs 16 ± 2 mmHg, P = 0.206) or tracheal perfusion pressure pre-bypass (34 ± 9 vs 38 ± 11 mmHg, P = 0.518), during bypass (20 ± 9 vs 22 ± 6 mmHg, P = 0.697), or post-bypass (42 ± 9 vs 41 ± 9 mmHg, P = 0.923). There was a significant difference in cardiopulmonary bypass duration (151 ± 29 vs 85 ± 32 min, P < 0.001). Conclusion: Factors beyond intraoperative ETT CP likely play a larger role in postoperative extubation failure.
Relationship between transesophageal echocardiography-derived pulmonary artery systolic pressure measurements and early morbidity in patients undergoing coronary artery bypass grafting p. 453
Hariharan Subramanian, Satyen Parida, Chitra Rajeswari Thangaswamy, Ashok Shankar Badhe, BV Sai Chandran, Sandeep Kumar Mishra
Context: We studied the relationship between intraoperative transesophageal echocardiography-derived (TEE-derived) pulmonary artery systolic pressure (PASP) measurements with early morbidity in on-pump coronary artery bypass grafting (CABG) surgery. Aims: The objective of the study was to assess whether TEE-derived elevated PASP is independently predictive of significant morbidity. Settings and Design: Prospective observational study in a university hospital. Materials and Methods: Around 54 patients who underwent CABG under cardiopulmonary bypass (CPB) were divided into two groups; with PASP ≥35 mmHg and PASP <35 mmHg, assessed by intraoperative TEE. Outcomes studied were poor coronary revascularization, postoperative arrhythmias, myocardial infarction, respiratory failure, intra-aortic balloon pump use, pacemaker dependence, significant inotrope use, prolonged intensive care unit stay, and the total length of stay in the hospital. Mortality analysis was not a part of this study since expected sample sizes were low. Results: Patients with PASP ≥35 mmHg had a higher risk of respiratory failure, increased inotrope use and prolonged hospital stay, although multivariate analysis failed to demonstrate an independent association of PASP with these outcomes. Diabetes mellitus (DM), peripheral vascular disease, low cardiac output and elevated mitral annular E/e' ratio were significantly associated with higher pulmonary arterial pressures. Multivariate analysis showed that PASP was independently associated with higher mitral annular E/e' ratio. Conclusions: Our study, therefore, suggests that higher PASP may predict higher left ventricular filling pressures, and although elevated PASP ≥35 mmHg may be associated with DM; peripheral vascular disease, lower intraoperative cardiac output, postoperative respiratory failure, higher inotrope use, and delayed hospital discharge, it is not an independent predictor of any of these variables.
Does the endotracheal tube cuff pressure increases with transesophageal probe insertion? p. 460
Deepak Prakash Borde, Swati Pande, Balaji Asegaonkar, Sujit Khade, Antony George, Shreedhar Joshi
Context: The cuff pressure (CP) of the endotracheal tube (ETT) exceeding 30 cm of H2O results in reduced perfusion of lateral mucosa of trachea leading to complications. As the posterior tracheal wall is in contact with the esophagus, there is a possibility that the insertion of transesophageal echo (TEE) probe may compress the tracheal wall and increase CP. Aims: This study was aimed to assess the impact of TEE probe insertion on CP in adults undergoing cardiac surgery. Settings and Design: Prospective observational study of 65 patients at tertiary care level hospital. Subjects and Methods: After balanced general anesthesia, patients were intubated with high volume low-pressure ET.TEE probe was then inserted with gentle jaw thrust. CP was measured by standard invasive pressure monitoring device at four points: T1 at baseline before TEE probe insertion; T2 maximum CP noted at TEE probe insertion; T3 at 5 min post TEE probe insertion; and T4 at post-TEE exam. Statistical Analysis Used: CP was compared between pairs of time points (T1 vs. T2; T1 vs. T3; and T1 vs. T4) using Mann-Whitney U test. Factors predicting CP >30 cm of H2O at T4 were assessed by backward stepwise regression. Results: CP (mean ± S.D.) at T1, T2, T3, and T4 was 22 ± 3, 38 ± 10, 30 ± 6, and 30 ± 7, respectively. CP increased significantly from T1 to T2 (P < 0.001), T1 to T3 (P < 0.001), and T1 to T4 (P < 0.001). There were 26 patients (40%) with CP >30 cm of H2O at end of TEE exam (T4). On multivariate analysis baseline, CP (T1) >20 cm of H2O was significantly associated with CP >30 cm of H2O at end of TEE exam with Odd's Ratio (OR) of 8.5 (1.76–41.06, P = 0.008). Conclusions: To conclude, the CP increases significantly with TEE probe insertion in 40% of patients exceeding a safe limit of 30 cm of H2O. The monitoring and optimization of CP is advisable.
Effect of dexmedetomidine on pulmonary artery pressure in children with congenital heart disease and pulmonary hypertension p. 465
Muralidhar Kanchi, Devdas Thomas Inderbitzin, Kadam Naina Ramesh, Pujar Venkateshauarya Suresh, Shreesha Shankar Mayya, Shanthi Sivanandam, Kumar Belani
Background: This study was undertaken to determine the effects of dexmedetomidine on pulmonary artery pressure (PAP) in children with congenital heart disease (CHD) and pulmonary hypertension (PH) undergoing cardiac catheterization with and without a planned intervention during monitored anesthetic care using midazolam and ketamine. Materials and Methods: Children (<18 years) with known CHD and PH who were scheduled for cardiac catheterization and interventional procedures were included in the study. The procedures were performed under monitored anesthesia. After obtaining baseline PAPs, an intravenous (IV) infusion of dexmedetomidine (1 μg/kg) was given for over 10 min. During infusion, heart rate (HR), blood pressure (BP), respiratory rate (RR), and peripheral arterial oxygen saturation (SPO2) were recorded every 2 min until completion of dexmedetomidine infusion, 15 min later, and when the procedure was completed. In addition, pulmonary artery systolic and diastolic pressures, and mean pulmonary artery pressure (MPAP) were recorded and the pulmonary artery systolic pressure (PASP)/systolic blood pressure (BP) ratio was calculated. Results: All children tolerated the procedure without adverse events. The HR decreased significantly over time during dexmedetomidine infusion. The changes in systemic systolic BP and PAPs were not significantly different from the baseline value at all points of measurement as was the ratio between the systolic pulmonary artery and systolic systemic BPs. Conclusions: Administration of dexmedetomidine in a dose of 1 μg/kg over 10 min did not significantly alter the PAP in children with CHD and PH. There was a decrease in the HR that was not clinically significant. The children tolerated dexmedetomidine without adverse events.
Decision making, management, and midterm outcomes of postinfarction ventricular septal rupture: Our experience with 21 patients p. 471
Samarjit Bisoyi, Usha Jagannathan, Anjan K Dash, Raghunath Mohapatra, Debashish Nayak, Satyajit Sahu, Pattnaik Satyanarayan
Context: Ventricular septal rupture (VSR) is a dreaded complication following myocardial infarction. Surgical repair of VSR is associated with significant early mortality. Variable outcomes in terms of early mortality and midterm functional status have been reported from different centers. Aims: In our study, we attempt to review the experience of decision making and surgical repair of postinfarction VSR, and to analyze the factors contributing to the early mortality and midterm outcome after repair. Materials and Methods: It is a retrospective study. Data were summarized retrospectively by frequencies and percentages for categorical factors, and means and standard deviations for continuous factors. Multivariate logistic regression, odds ratios, 95% confidence intervals, and P value were calculated for different variables to determine their independent effect on operative mortality. All surviving patients answered the EQ-5D Health Questionnaire. Results: Preoperative renal failure, left ventricular dysfunction (moderate and severe), and Killip class (III and IV) were significantly associated with early mortality after surgery. Small residual ventricular septal defect (VSD) was not found to affect the midterm quality of life. Conclusions: Early surgical repair benefits the patient by preventing early end-organ damage. The renal failure left ventricular dysfunction (moderate and severe) and Killip class (III and IV) adversely affect early outcomes after surgery. Small residual ventricular septal defect (VSD) does not affect the midterm quality of life.
Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia p. 477
Gladdy George, AV Varsha, Madhu Andrew Philip, Reshma Vithayathil, Dharini Srinivasan, FX Sneha Princy, Raj Sahajanandan
Objectives: del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC). Materials and Methods: This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC. Results: There was no difference in cardiopulmonary bypass time (P = 0.516) and clamp time (P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable (P = 0.344) (P = 0.40). The incidence of clamp release ventricular fibrillation (P = 0.207) was similar. The creatine kinase-MB isotype levels for the CABG patients were comparable on all 3 days (P = 0.104), (P = 0.106), and (P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation (P = 0.186), ICU days (P = 0.931), and postoperative complications (P = 0.354) were comparable. There was no 30-day mortality or postoperative myocardial infarction in both the groups. Conclusion: DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.
Cardiothoracic surgery during COVID-19: Our experience with different strategies p. 485
Sarju Ralhan, Rajesh C Arya, Rama Gupta, Gurpreet S Wander, Rajiv K Gupta, Vivek K Gupta, Suhani Bagga, Bishav Mohan
Background: An acute respiratory disease (COVID-19), caused by a novel coronavirus (SARS-CoV-2,), has been declared a pandemic by WHO. A surgery on COVID-19 patients not only involves a risk of spread of the disease but also there is a serious concern for the patient's surgical outcomes and resources requirement. Aim: The retrospective study is aimed to provide a protocol for pre-operative testing of SARS CoV-2 using RT-PCR in the patient undergoing cardio-thoracic surgeries. Material and Methods: To analyze the impact of pre-operative testing of SARS- CoV-2 using RT-PCR in the patient undergoing elective cardio-thoracic surgeries. The patient who underwent surgical interventions during the COVID-19 lockdown period was divided into two phases. Phase I (without COVID-19 RT-PCR testing) and Phase II (with pre-operative COVID-19 RT-PCR testing). The retrospective comparison between the two study groups was done using Student t-test, Mann–Whitney U, and Chi square (χ2) test depending upon the clinical variable to be analyzed. Results: During the early phase (phase I), 26 patients underwent cardio-thoracic surgery without COVID-19 RT-PCR test. Whereas, during phase II, all patients were tested for COVID-19 using RT-PCR, preoperatively and a total of 64 surgeries were performed during this phase. One patient planned for CABG was positive on RT-PCR for COVID-19 and was sent to the quarantine ward. The difference in the pre-operative hospital stay between two groups was found to be statistically significant and a significant decrease in the number of PPE kits used, during the phase I. Conclusion: All asymptomatic patients should be tested for COVID-19 using RT-PCR prior to cardio-thoracic surgeries not only to contain the disease but to avoid potential implications of COVID-19 on the perioperative course, without added financial implications.
Anesthetic consideration for patients with micra leadless pacemaker p. 493
Sathappan Karuppiah, Richard Prielipp, Ratan K Banik
MICRA, miniaturized leadless single chamber pacemaker, is inserted directly into the right ventricular myocardium via transcatheter approach. We present a case of a 66-year-old patient with a Micra pacemaker scheduled for kidney-pancreas transplant. The patient is pacemaker dependent. The preoperative cardiology consult did not comment on the need of reprogramming. One hour prior to the surgery, the anesthesia team was unable to locate the pacemaker on the chest wall. The Medtronic hotline was called, and the caregivers learned that the particular pacemaker is buried within the ventricular wall and is not responsive to an external magnet. Thus, the case was delayed and a cardiac electrophysiology team was contacted to reprogram the pacemaker to VOO (fixed ventricular pacing) mode. We suggest that the pacemaker can pose perioperative challenges due to its novelty, paucity of report, and guidelines.
Coronary cameral fistula and its complications: A case report p. 496
Renu Upadhyay, Aseem Gargava, Vishal Prabhu, Manjula Sarkar, Jitendra Homdas Ramteke
Coronary cameral fistulas (CCFs) are rare arteriovenous malformations that may be congenital or acquired. The presentation of CCFs varies from asymptomatic in early age to symptomatic and start of complications upon aging. Although percutaneous closure with embolization can also be done, surgical closure of CCFs is a gold standard of treatment. We present the case of a 20-year-old patient with a fistula connecting right coronary artery and the right atrium, along with aortic valve endocarditis and congestive cardiac failure.
Two patterns of the "crossed swords sign" for the accurate diagnosis of diverse mitral valve regurgitations p. 499
Kazuto Miyata, Sayaka Shigematsu
The "crossed swords sign," demonstrating the divergent jet, is visualized on 2-dimensional color Doppler imaging and indicates complicated mitral regurgitation (MR). We describe the cases of two patients with varying patterns of the crossed swords sign. In the first patient, the crossed swords sign was detected during the holosystolic phase. In the second patient, the direction of the MR jet changed according to the phase of systole: The crossed swords sign was formed by two regurgitation jets during different phases of systole. The crossed swords sign implies two patterns and is useful for the accurate diagnosis of complex MR.
Iatrogenic intramural hematoma of the ascending aorta complicating inadvertent arterial cannulation during central venous catheter placement. A case report and review of the literature p. 502
Mafdy Basta
Aortic injury during central venous catheter (CVC) insertion is a rare but serious complication. This presentation describes a case of iatrogenic intramural hematoma of the ascending aorta complicating inadvertent arterial cannulation of the right subclavian artery during attempted Port-A-Cath insertion at the right subclavian vein. Various strategies for the prevention and management of aortic injury during CVC placement are discussed. In this case, the hematoma was managed surgically and replacement of the ascending aorta was undertaken under deep hypothermic circulatory arrest.
NIRS: So near yet so far (From the brain) p. 505
Suman S Kandachar, Anbarasu Annamalai
Cerebral oximetry is touted as a magic wand to detect cerebral hypoperfusion. Inability to completely exclude extracranial oxygen however is a limitation. Variation in scalp vascularity can magnify the limitations of relatively short emitter–detector distances. The combination of brain ischemia and cutaneous hyperemia, as is the situation during anaphylaxis and anaphylactoid reactions, can be associated with a paradoxical increase in cerebral oximetry values. This could compromise the quality and accuracy of care delivered. We report the association of red man syndrome with exaggerated cerebral oximetry values.
Post-surgical unilateral left pulmonary edema after mitral valve replacement – A diagnostic challenge p. 508
Saipriya Tharimena, AV R Naidu
Unilateral left pulmonary edema due to inadvertent surgical occlusion of left superior and inferior pulmonary veins is not only an exceedingly rare complication of mitral valve surgeries but also a diagnostic challenge in the postoperative recovery unit. Described here is a case of a 38-year-old male who developed progressively worsening unilateral left pulmonary edema after mitral valve replacement on postoperative day-1. The diagnosis was mostly by the exclusion of multiple possible differentials and was confirmed during reexploration surgery.
An unusual case of uninterrupted inferior vena cava with accessory hemizygous channel: An incidental finding in a child p. 512
Gaurav Agrawal, Anupam Das, Gaurav Gupta
Azygos or hemizygous continuation of inferior vena cava (IVC) is diagnosed in the presence of intrahepatic interruption of IVC. We report a case of a 4-year-old, male child presenting with a history of poor weight gain. A detailed evaluation of the child revealed a diagnosis of hemizygous continuation of uninterrupted, but severely obstructed, IVC. This incidental finding has rarely been reported in the literature.
Aortic cannula tip dislodgement: A rare complication p. 515
Aseem Gargava, Manjula Sarkar, Sanjeeta Umbarkar, Amruta Shringarpure
Cardiac surgery involves use of cardiopulmonary bypass which usually requires a circulatory circuit containing numerous cannulae and tubings draining from major vessels (like superior and inferior vena cavae) and returning it back to the systemic circulation (via the aorta, femoral artery, axillary artery etc). Establishment of this circuit not only requires good surgical skills for technical procedures but also requires stringent vigilance and awareness about the working of these disposable items. Surgeons concentrating in the technical aspect might miss out on the minor manufacturing defects in these disposable items and anesthesiologist as well as perfusionist can contribute in this aspect by including systematic precheck of these items to avoid complications in future. In this case report, we would like to discuss a simple case of mitral valve replacement where during aortic decannulation the metallic tip got dislodged and thus got migrated to the abdominal aorta. This is a rare complication which none of us were expecting. By prechecking the various components of the cardiopulmonary bypass circuit, this complication was expected to be avoided.
Metastasizing leiomyoma obstructing the right ventricular outflow tract p. 518
Miguel Ruben Abalo, John Carey, Oscar Aljure, Yiliam Rodriguez-Blanco
A very loud systolic murmur was identified during a pre-operative evaluation of a 51-year-old woman for an elective hysterectomy. The TTE showed a 4.7 cm intracardiac mass obstructing the RVOT. The patient was scheduled instead for resection of the mass. Before anesthesia induction, the surgical team and perfusionist were prepared to initiate CPB in case of circulatory collapse. After induction of general anesthesia, the patient became hypotensive, requiring vasopressor support. She recovered and was then successfully placed on CPB. The mass was removed without incident, and a TEE confirmed resolution of the RVOT obstruction. The patient did well post-operatively.
Recurrent unilateral hemorrhagic pleural effusion: A rare manifestation of thoracic endometriosis syndrome p. 521
Neeti Dogra, Ankur Luthra, Rajiv Chauhan, Ritika Bajaj, Kalla Prasad Gourav
Unilateral recurrent pleural effusions are commonly encountered in critical care practice. Relevant clinical history, physical examination, radiology, and diagnostic thoracentesis usually identify the cause of pleural effusion in most cases. Thoracoscopy or video-assisted thoracic surgery may be required in selective cases. We report a case of 32-year-old female with recurrent unilateral hemorrhagic pleural effusion that was the presenting feature of thoracic endometriosis syndrome.
Intraoperative transesophageal echocardiography: A complement to 18F-fluorodeoxyglucose positron emission tomography-computed tomography in localizing pacemaker lead endocarditis p. 524
Soumya Sarkar, Rajarajan Ganesan, Bhupesh Kumar, Harkant Singh, Rajender Basher, Ashwani Sood
DOI:10.4103/aca.ACA_9_19 PMID:33109819
Lead endocarditis (LE) is a serious complication of permanent trans-venous pacing. Localizing LE may be challenging with conventional imaging modalities. 2-deoxy-2-[fluorine-18] fluoro-D-glucose positron emission tomography–computed tomography (FDG PET/CT) has recently emerged as a promising tool in the diagnosis of LE particularly in cases with normal echocardiographic imaging findings and/or negative blood culture. However, this technique is associated with some drawbacks. Knowledge of these drawbacks and correlating its limitations with other imaging modality is essential for the echocardiographer while evaluating such patient. We report a case where transesophageal echocardiography was complementary to FDG PET/CT in the diagnosis and localization of vegetation over pacemaker leads during intraoperative period.
INTERESTING IMAGE
Left ventricular pacemaker wire through patent foramen ovale p. 528
Nicholas Suraci, Saberio Lo Presti, Gilberto George Concepcion, Orlando Santana
A 53-year-old male status post pacemaker placement three months prior for sinus bradycardia presented with worsening dyspnea, holosystolic murmur, and a ventricular-paced right bundle branch block on electrocardiogram. Transesophageal echocardiography demonstrated a pacer wire in the right atrium coursing into the left atrium and ventricle through an undiagnosed patent foramen ovale. The patient underwent surgical repair and repositioning of the pacemaker lead without complication. Although rare, it should be suspected after recent lead placement.
Pacemakers-"an infernal machine that interferes with the will of god" p. 530
Praveen Kerala Varma
[HTML Full text] [PDF] [Mobile Full text] [EPub] [PubMed] [Sword Plugin for Repository]Beta
Guiding principles for cardiology care in times of the COVID-19 Pandemic: Gazing through the crystal ball p. 532
Ankit Sahu, Aditya Kapoor
[HTML Full text] [PDF] [Mobile Full text] [EPub] [Citations (1) ] [PubMed] [Sword Plugin for Repository]Beta
Epicardial lead placement for cardiac resynchronization therapy in dilated cardiomyopathy patient: Fine tuning anaesthetic challenges p. 537
Srinath Damodaran, Komal Gandhi, Banashree Mandal, Anand Kumar Mishra
A parable of the mask: Stay calm, be a hummingbird p. 538
Hema C Nair
Preventing intubation with the transverse thoracic muscle plane block p. 540
Johanna B de Haan, Damon Yu, Nadia Hernandez, Sudipta Sen
Cardioplegic arrest as pharmacological defibrillation; A novel approach for refractory ventricular fibrillation p. 541
Vivek Chowdhry
Is ECG an aid to differentiate pulmonary embolism from ACS? p. 543
Subramanian Senthilkumaran, Nanjundan Karthikeyan, Ramachandran Meenakshisundaram, Benita Florence, Ponniah Thirumalaikolundusubramanian
Monitoring of carotid endarterectomy p. 544
Rajinder Singh Rawat, Said Musallam Al Maashani
Erratum: Intensive care and anesthesia management for HARPOON beating heart mitral valve repair p. 545
DOI:10.4103/0971-9784.298546 PMID:33109829
NOTICE OF RETRACTION
Retraction: The efficacy of pre-emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery p. 546


text:
package org.apache.harmony.luni.internal.locale;
public class Locale_es_CO extends java.util.ListResourceBundle {
protected Object[][] getContents() {
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		{"Date_MEDIUM","d/MM/yyyy",},
		{"Time_SHORT","hh:mm a",},
		{"Time_MEDIUM","hh:mm:ss a",},
		{"Time_LONG","hh:mm:ss a z",},
		{"Time_FULL","hh:mm:ss a z",},
		{"DecimalPatternChars","0#.,;%\u2030E.-",},
		{"CurrencySymbol","C$",},
		{"IntCurrencySymbol","COP",},
	};
return contents;
}
}

redpajama_set_name: RedPajamaGithub


text:
Oakland Ultimate: Bring on the Hate!
by Zack Smith | October 26, 2011, 5:25pm 0
Many college teams look to the club season as a way to provide an opportunity to play and improve after the spring season, against a level of competition that is mostly older, experienced and more athletic than what they are used to. While a large portion of teams only get together to play in the club series (since these tournaments occur after the school year has begun), some gather for the whole summer. Like most areas that have solid youth and college programs to pull talent from, Pittsburgh was able to form a competitive open team by the name of Forge, whose strongest performance was a 4th place finish at the 2008 Mid-Atlantic Regionals tournament.
The following year saw the rise of a second team from the Steel City, containing many players from the University of Pittsburgh that did not play or make Forge. This squad, known as Swagger U, was able to take down future 2009 Nationals qualifier, Pike, in the first game of the Founders Club Open Sectionals tournament. As their name suggests, these players had a ton of attitude and were certainly not afraid to show it. If Swagger U's on-field demeanor of physical play, verbal taunting and excessive celebration did not adequately create a sense of animosity among their opponents (especially Philly), their video recaps of both Sectionals and Regionals certainly did the trick.
Though 2010 saw a lull in Pittsburgh club ultimate, as Forge disbanded and Swagger U had less than stellar results, the Mid-Atlantic Region earned itself four bids to Nationals for the following year behind the strong finishes of Truck Stop (5th), Southpaw (T-7th) and Ring of Fire (T-7th). This fact not only ensured that at least one new team would be making the trek to Sarasota in 2011, but it also most likely influenced the creation of multiple Mid-Atlantic Nationals caliber teams…namely North Carolina's Cash Crop and Pittsburgh's Oakland Haiders.
Oakland Ultimate (who is the second team to don a likeness to the Raiders, the first being Brass Monkey) is a conglomeration of current En Sabah Nur (University of Pittsburgh) players as well as their coaches (David Vatz, Josh Suskin & David Lionetti) and recent alumni. I asked the Haiders what the purpose of this new and relatively unknown squad was, to which they replied with:
"…The goal of Oakland Ultimate is to help build the program by giving Pitt players an opportunity to play with Pitt alumni in strong competition in the fall. In a sense, the two teams work together. But in another way, they aren't the same. We are Oakland, a team that focuses on winning club nationals while also working toward building the program.
As for the team, there is a good mix between current and alumni players. But if you look at our roster, we have to be one of the youngest teams to qualify for club nationals. We see that as monumental step for the program as well as Pittsburgh Ultimate in general. Pitt has been fortunate over the years to be a hotspot for high school kids in the Pittsburgh and Philadelphia areas. By having the college team make nationals for so many years and, now, the club team qualify in its first year, Oakland Ultimate has helped build even more interest in the program."
The Haiders certainly have no plans on setting their sights short, as is evident by their statement above. When I asked specifically about their goal for nationals, Oakland said the following:
"Al Davis said it best: 'Just win, baby.' The goal all season was to make Nationals. But after defeating Cash Crop to secure a bid, we had a quick talk and decided that we accomplished our goal with an entire tournament still left in the season. The goal from here is to win it all. Yes, we are a first year club team, but the program has been on the rise for almost 7 years now."
Whether the goal for Oakland is to win it or just break seed, it will be interesting to see if Oakland's ruffian attitude will have an effect on the bigger teams in Florida. While a rough and physical style of play will be no stranger to the members of teams like Doublewide and Chain Lightning, you don't typically see things like extensive end zone celebrations in ultimate frisbee. Over the top showmanship and juvenile taunting could turn the 27 members of Oakland into lightning rods in the eyes of their opponents, and can give them a competitive edge. The Haiders had this to say about their choice in team name and their on field attitude:
"You know it. We know it. Everybody knows it. Pittsburgh gets a bad rep. That's where the Haiders name came from. In a sense it's about the swagger, but above all it's just about ourselves. The name means something different to everybody. But as a team, we see it as way to show our "us against the world" mentality. We aren't going to cater to any team's demands. We aren't going to back down from a difficult matchup. We like rivalries. We want them in this sport. We want to infuse a sense of hatred between club teams. We want teams to be excited and afraid to play us."
In a sense, it's funny that this got brought up because a lot of players have set goals of working toward showcasing sportsmanship throughout and after games. We believe some of the best games come from heated rivalries. And if, at the end of a game against a rival opponent, you can shake their hand and demonstrate that sportsmanship, then you're showing the fans that teams can hate each other but still respect each other.
…The hate didn't originate with us. It comes from other teams. We aren't very well liked in the ultimate community. We're hated. But that's because we play hard and physical and don't want to lose. We're haters, yes, but so is everybody else."
Oakland certainly has a long road ahead of them, falling in a very tough Pool D with Chain and Doublewide. While first or second in the pool may be out of the question, getting third place and entering with a 1-0 record into Pool H is definitely not. Based on footage from their game against NexGen, Oakland looks to play a possession style horizontal stack offense that is constantly looking to hit the break side. At times, Pittsburgh's offensive line will open up with a side stack and an isolated cutter, typically Chris Brenenborg or Alex Thorne. Both of these players are fast and athletic enough to either strike deep and make a play or cut under and boost it themselves. While the huck game is often effortless for Pitt, the conditions in Boulder revealed a chink in their armor as they had difficulty hitting their deep shots.
Realistically, whatever damage they do this weekend will be a positive step for the club and placing higher than 13th is definitely not out of reach. So why should Oakland sell themselves short before the first pull in Sarasota? The mental attitude of the Haiders will either make or break their tournament. Sure they may be able to get in the heads of their opponents…but if they get sucked as well, things will spiral quickly. No matter what situation you find Oakland in, prepare to see some gritty, intense and physical play along with a hefty side of #hatehatehate.
If you want to keep track of the Oakland Haiders and their trials over the weekend, follow them at @oaklandultimate on Twitter.

redpajama_set_name: RedPajamaCommonCrawl


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Web services References node appear for the service/portType, but operation node does not appear.
User needs operation node to generate the client stub code.
Rico, can you take a look at this ASAP so we can include this in patch3, please?
Fixed. The display of the operation node was being blocked for non-SOAP services.
For inclusion in NB 6.1 Patch 3, please provide fully qualified URL to changeset. Ideally trunk changeset URL.
Yes that is the only changeset for this fix.


text:
SA Coronavirus
Jobs at The Citizen
News / South Africa / Government
GroundUp
City of Cape Town and national government bicker over housing of refugees
City claims Bellville site is not compliant with anti-virus regulations.
The City of Cape Town says the Paint City site where some 500 refugees have been housed, does not comply with Covid-19 regulations. Picture: Ashraf Hendricks / GroundUp
A squabble between the City of Cape Town, and the departments of Home Affairs and Public Works and Infrastructure has laid bare tensions between the municipal and national spheres of government.
The disagreement, ten days after the Covid-19 lockdown was announced by President Ramaphosa, appears to centre on the use of the Paint City site in Bellville, which is land owned by the City, to house refugees. The City claims that the site shouldn't have been used as it is not compliant with Covid-19 regulations.
Last Thursday, SAPS confirmed that over 500 people had been removed from the Central Methodist Church on Greenmarket Square, with approximately 200 square metres of space to the marquee tent in Bellville, which has approximately 576 square metres of space on a plot with approximately 9,500 square metres of space.
The City claims that it was blindsided by this removal and by the use of the Paint City site in Bellville.
On 5 April, Cape Town Mayor Dan Plato described the removal of the refugees by the police as "premature". The Paint City site, he said, "is not compliant with the applicable Covid-19 regulations and this may well result in a further relocation being required in due course."
The departments of Home Affairs and Public Works responded in their own statement, accusing the City of trying to mislead the public. They said the Mayor had agreed to use the site for "non-nationals" but had pulled out of plans for the removal of the refugees the evening before the removal was to go ahead.
The statement quotes from a letter that Minister of Public Works and Infrastructure Patricia De Lille sent to the Mayor, in which she says the agreement to use Paint City "reached by yourself as the Executive Mayor of Cape Town and myself when we went on site together and then communicated to Minister Motsoaledi, the Minister of Home Affairs who is responsible for these matters, was that the Bellville Paint City site was for the non-nationals".
The statement says the Mayor's undertaking was reversed by councillors JP Smith and Ian Neilson.
In response to the statement from the two departments, the City released another statement, saying that the City has "observed and carried out our services 100% in line with the Covid-19 regulations" and reiterating the claim that the Paint City site was not intended for refugees.
Meanwhile on Sunday 5 April, the City began moving homeless residents to Strandfontein Sports Grounds, a series of windswept fields facing False Bay and next to the Strandfontein Sewer Works. This site is very similar to the Paint City site in that there is no gender division in the tents, no privacy, no enforcement of social distancing, and 200 people per tent. When GroundUp visited the site on Tuesday, there was no adherence to entry protocols for visitors, no protective equipment like masks, and no on-site medical personnel.
The City has not answered GroundUp's questions about the use of other facilities, including the Cape Town International Convention Centre, which is 71.4% owned by the City and 23.2% owned by the Western Cape government.
When GroundUp sent enquiries to the offices of JP Smith and Ian Neilson we were referred back to the Mayor's statement.
Republished from GroundUp
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Students at St Joseph's are honest and courageous.
Students and Staff at St Joseph's work collaboratively to create a joyful learning environment.
St Joseph's School is a dynamic, co-educational, composite primary school, catering for approximately 35 students from Pre-Kindergarten to Year 6. The school is located in the town of Southern Cross, 371 kilometres east of the state capital Perth in the Goldfields region of the Shire of Yilgarn. Positive relationships and interaction with other schools in the Shire of Yilgarn and the wider community are promoted. Innovative curriculum is based on promoting student success with a strong emphasis on developing creative and critical thinking skills. The school is a Google Apps for Education (GAFE) School and hosts a 1:1 iPad program. Quality teaching and learning is focused on educating for the 21st century.


Click the links below for more information. Scroll down for parking map.
Your space will be assigned by USA BMX at the events.
When arriving please find one of our Charlotte BMX representatives on site before setting up.


If you own and operate a car wash, you're probably familiar with the struggle to get people to pull over. Maybe some of these advertising tips can help!
If people aren't paying attention to your signs, have you considered the possibility that they can't really see them? It might be perfectly legible to you, but it might be a small, colorful blur to passing motorists. Try making your signs bigger and see if your traffic improves.
Speaking of color, there's a reason why gas stations and car washes are fond of the entire rainbow. It's all about grabbing attention from potential customers even when they're whizzing by at 60 miles per hour. Don't try to be a subtle, sophisticated car wash; use what bright and gaudy hues are at your disposal.
Do you have a lobby with vending machines and free wi-fi? Be sure to advertise this in your flyers and leaflets. Do you offer special discounts for students, seniors and veterans? Trumpet this fact on social media. Everyone loves getting a deal, so take advantage of that mindset.
Maybe you want a bigger car wash. Maybe you want to extend your arches and tunnels so that you can accommodate jeeps and trucks as well as cars. Talk to car wash construction companies; then advertise your remodel every step of the way. Get people excited about what's coming.
The great thing about complete car wash systems California is that you offer something everyone needs, so you can advertise to multiple demographics without worrying about crossovers or generation gaps. Who doesn't love a buff, shiny car? Dangle that vision in front of their eyes until you've secured their business.
These are just a few ways to attract more customers to your car wash. There are many more, but let these suggestions serve as guidelines for further action. They can be your first attempts at fresh marketing, but they don't have to be your last!


It is conservative Christians on the State Board of Education who are sitting today in judgment of evolution instruction in Kansas schools.
But their religion, of course, isn't the only one practiced in Kansas.
"I think that this is trying to sneak in a certain brand of religion in disguise. I do not think that this is the American thing to do, because we do not impose one religion on everybody," said Judith Roitman, guiding teacher at the Kansas Zen Center, 1423 N.Y., and a professor of mathematics at Kansas University. "This is not just a Christian agenda, but a particular brand of Christianity, and they are trying to impose it on everyone else.
Saibal Bhattacharya, who is a Hindu, said he had deep misgivings about the push to give "intelligent design" — the idea that a creative (and possibly supernatural) consciousness was behind the birth of the universe — equal billing with evolution in science classrooms.
"I'm concerned about where it might lead. Compulsory prayer in schools, whether people might have to acknowledge a common creator — all these things are waiting to explode, especially if they (conservatives) are successful," said Bhattacharya, an assistant scientist who does petroleum engineering studies for the Lawrence-based Kansas Geological Survey.
Bhattacharya is among non-Christian Lawrence residents expressing anxiety — and even anger — about the possible introduction of intelligent design into the state's science standards for public schools.
Others like Bhattacharya, members of faiths who are in the minority in Kansas, share his dismay that intelligent design may be the leading edge of a movement to shove science aside for theology to explain the world's origins.
Saibal Bhattacharya, petroleum engineer and energy researcher with the Kansas Geological Survey, and a Hindu, is critical of efforts to introduce intelligent design into the science classroom. Bhattacharya worked in his office Wednesday at the KGS offices on KU's west campus.
Stephen Hurst is among those Lawrence residents for whom belonging to a minority faith in Kansas — in his case, Judaism — heightens a fear that the introduction of intelligent design heralds the theology of a particular religion being imposed upon all citizens.
"I have the concern that it's the camel's nose in the tent, so to speak — that the rest is soon to follow. If people want to teach the religious viewpoint of creation, they should do that at home or in church and not through the public schools," said Hurst, president of the Lawrence Jewish Community Center, 917 Highland Drive.
Hurst, an environmental attorney in Lawrence, has a 13-year-old and twin 7-year-olds, who attend public school.
But he isn't just worried as a father and a Jew.
"As a civil libertarian, my biggest concern is the erosion of the separation of church and state, and I see this (intelligent design) as putting undue stress on people of diverse backgrounds and different religions," Hurst said.
Moussa Elbayoumy, a physician and a member of the Islamic Center of Lawrence, 1917 Naismith Drive, said he didn't have any major concerns about the possible teaching of both evolution and intelligent design in Kansas schools.
"As Muslims, we believe in creation in a way not much different from Christians and Jews, but our faith has always encouraged its followers to use their intellect and observation to examine all scientific facts and theories to reach the truth, believing that the truth will ultimately lead to the recognition of God as the creator," he said.
Public schools must be careful not to favor the creation beliefs espoused by any one particular faith, Elbayoumy said.
"In exploring any of the theories, including intelligent design, the teaching should concentrate on the general concept and its practical implications without preaching any specific religious doctrine," he said.
Lawrence's Bishop Seabury Academy has drawn plenty of attention lately, thanks to the evolution hearings.
"In fact, we had students at the Statehouse (for the hearings), we had students quoted in both The New York Times and the L.A. Times and we were on (ABC's) 'Nightline,'" said Chris Carter, head of the academy, 4120 Clinton Parkway.
The school, which has 125 students in grades seven through 12, is a member of the National Association of Episcopal Schools.
Bishop Seabury students are taught both evolution and the Genesis account of the world's creation.
"We teach evolution in our science classes. We want our students to be fully prepared for college science courses, which means they need to have a basic understanding of evolutionary theory and principles," Carter said.
Meanwhile, in a humanities class that examines ancient prehistory, students are exposed to a variety of creation stories from the Bible, other religions and mythologies.
All the school's seniors also take a course that's an introduction to scripture, where they study the book of Genesis.
Evolution and a faithful belief that a supernatural force created the universe can easily co-exist, according to Carter.
"They are only mutually exclusive if you read Genesis 1 absolutely literally. I personally don't read the Genesis creation story literally, but I believe in it completely," he said.
A three-person panel of the state school board today will hear arguments in support of evolution teaching from Topeka attorney Pedro Irigonegaray. The three board members are conservative Christians who have publicly endorsed the downplaying of evolution teaching.


text:
Trumping fake news
January 20, 2018 January 20, 2018 By Tracey Eaton
Donald Trump may not be a traditional American president, but Bloomberg News covers his administration the old-fashioned way: With objectivity and cold, hard facts.
"Donald Trump has not taken us to a place where journalism can't reach," said Craig Gordon, head of the Bloomberg News bureau in Washington, D.C. "We are working with facts."
Gordon spoke Jan. 16 at the Flagler College Forum on Government and Public Policy in St. Augustine, Florida. His talk was called "Trumping Fake News: Facts in the Age of Trump."
Before it began, Gordon told students what it's been like to cover the Trump administration.
"We knew we were in for a pretty wild ride," he said.
As a presidential candidate, Trump called journalists an "enemy of the people" and wielded the phrase "fake news like a weapon," Gordon said.
But he said Bloomberg News didn't change its approach much at all when Trump took office a year ago today.
"We rely on one thing and that is facts," said Gordon, who oversees coverage of the federal government, including the White House, Congress, national security, tax policy and other areas. "What we've found is people are hungry for traditional journalism."
So when Trump said he had rolled back 1,000 federal regulations, Bloomberg reporters went through stacks of records to see if it was true. The actual number was 271.
"Data is very important," Gordon said. "Data is good. It's cold. It's fact."
Bloomberg has some 2,700 journalists in more than 120 countries, according to the company's website.
Gordon said the company looks for journalists who have "innate curiosity. That's the single most important thing for a journalist."
He said he decided he wanted to be a newspaper journalist when he was 12 years old.
He graduated from Syracuse University then got a job at a newspaper in Rochester, New York. Later he worked at Newsday, where he was part of the Pulitzer Prize-winning team that covered the crash of TWA Flight 800.
In 2001, he covered the aftermath of the Sept. 11 terrorist attacks and was embedded with the Marines in Afghanistan.
Before joining Bloomberg in 2013, Gordon was managing editor at Politico.
There are "fewer points of entry" for young people hoping to become journalists, he said, "but the jobs are there."
He said he values journalists who can go out, get a story and write it "clearly and plainly."
"Writing clearly has never been more important," he said.
But journalism remains "a very competitive field. You've got to be hungry."
Biographer: Hate overcame Nixon →


text:
Written by Aastha Shrestha in Bacteriology,General Microbiology Last Updated December 15, 2022
Glenn Gibson and Marcel Roberfroid first introduced the concept of prebiotics in 1995. They stated that a "Prebiotic is a nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health." This was later redefined in 2008 as "a selectively fermented ingredient that results in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefits upon host health."
Prebiotics are included in a human diet containing different types of fruits, vegetables, and legumes, which are a source of plant polysaccharides and are fermented by microbes. The prebiotics food includes broccoli, carrots, Jerusalem, Psyllium seed husk, garlic, onions, asparagus, wheat, oat, rye, barley, tomatoes, berries, root tubers, and root vegetables(sweet potato, potato), and so on. Nowadays, prebiotics are produced commercially as a supplementary diet.
Mechanism of Action of Prebiotics
Criteria for Eligibility as Prebiotic
Prebiotic Examples
Advantages of Prebiotics
Limitations of Prebiotics
Human enzymes such as pancreatic and salivary amylase digest few carbohydrates (present in our diet) by breaking glycosidic linkages present in them, while those not digested act as a substrate for bacterial fermentation. These non-digestible substances include oligosaccharides and polysaccharides which are usually called prebiotics and can withstand digestion and absorption in the small intestine. However, these get fermented by the intestinal flora especially Bifidobacteria and Lactobacillus in the large intestine which positively impacts the gut.
The enzymes produced by bacteria ferment complex polysaccharides and produce secondary metabolites, short-chain fatty acids (SCFAs) such as propionate, butyrate, acetate, and gases. These by-products encourage the activity and proliferation of good native bacteria in the gastrointestinal tract and reduce pathogenic bacteria. They also protect other body parts, such as the central nervous, cardiovascular, and immune systems.
Fermentation of Prebiotics
For the food ingredients to be prebiotic, they need to fulfill the following criteria:
Resistant to hydrolysis and not absorbed in the upper part of the gastrointestinal tract
Selective substrate for one or few beneficial bacteria that is naturally present in the colon.
Beneficial to the host's health and able to change the flora in order to make it healthier.
Encouraged to thrive or metabolically trigger induce luminal or systemic effects that are beneficial to host health.
For commercially produced, must have a good storage life at room temperatures such as heat, and dehydration.
In human diets, prebiotics exists in small concentration and includes oligosaccharide carbohydrates as well as non-carbohydrates that meet the above-mentioned criteria. The most widely known prebiotics includes inulin, galactooligosaccharides, and fructooligosaccharides while other include polyphenols, lactitol, xylooligosaccharides, isomaltooligosaccharides are emerging prebiotics. Some of the widely used prebiotics are:
Examples of prebiotics
Galacto-oligosaccharides: GOS are composed of two to eight sugar units, two of which are galactose and two disaccharides (containing two galactose units), and one of the sugar units is terminal glucose. The chemical structures vary by branching, chain length, and glycosyl linkages. Food that contains galactooligosaccharides includes lentils, chickpeas, dairy products, beans, and so on.
Biological activity: It enhances the production of short-chain fatty acids, reduces the count of potentially pathogenic bacteria, promotes normal function of the intestine, lipid and carbohydrate metabolism, and so on. It naturally occurs in breast milk and stimulates the intestinal Bifidobacteria and Lactobacilli in infants. Since it has a positive effect on immune function, it is commercially available and is added to dairy products such as yogurt and infant formulas.
Inulin: It is a non-digestible water-soluble storage polysaccharide found in many plant-based foods. These are polymers consisting of a linear chain of β-2,1-linked d-fructofuranose molecules terminated at the reducing end by a sucrose-type linkage by a glucose residue. It is difficult for inulin to be absorbed and digested by the human small intestine due to the existence of β-()-D-frutosyl fructose bonds between the fructose unit and the isomeric carbon of inulin, but it can be fermented by the intestinal flora of the human large intestine. Some examples of food that contains inulin include Asparagus, Dandelion root, onions, chicory, burdock, leeks, and so on.
Helianthus tuberosus tubers
Biological activity: It increases the apparent calcium and magnesium absorption, relieves constipation, manages blood sugar and blood lipid with diabetes type II in elderly people, suppresses the appetite reduces weight, and enhances gut microbiome such as Bifidiobacteria.
Fructooligosaccharides (FOS): It is inulin-type fructans, which have low calories and are non-digestible carbohydrates. These are composed of linear chains of fructose units, linked by β-2,1 bond. Food that contains fructooligosaccharides: tomatoes, garlic, onions, wheat, rye, chicory root, seaweed, sugar cane, rice bran, papaya, beetroot peels, and so on.
Biological activity: It enhances the body's intestinal flora, lowers the risk of heart disease and certain cancers, relieves constipation, improves lipids in hyperlipidemia, stops the production of putrefactive substances in the gut, and promotes healthier digestion. They have a number of advantageous physiological effects, including less carcinogenicity, improved mineral absorption in the intestine, and decreased levels of triacylglycerols, phospholipids, and serum cholesterol.
Prebiotics has more positive effects on human health. Some of these advantages are mentioned below:
These affect mainly the gastrointestinal tract as well as distant organs such as the central nervous system, immune system, and cardiovascular system, as their degradation forms majorly SCFAs which enter the blood circulation by diffusing through gut enterocytes.
The fermented product of prebiotics is mostly acids which decreases the pH of the gut from 6.5 to 5.5 that alters the population of gut microbes. Lactobacilli and Bifidobacteria decrease the harmful bacteria. As an example, the colonization of Salmonella in the epithelium is prevented due to the adhesion of mannose to Salmonella.
Inhibits the activities of spoilage bacteria like Clostridium spp., such as an increase in Bifidobacteria in the gut, harmful fermentation products are less likely to occur.
In the intestinal epithelium, butyric acid reduces the growth of lesions such as adenomas and carcinomas in the gut.
Gut microbiota affects the central nervous system activity through the "gut-brain axis". Some prebiotics, like FOS and GOS, regulates synaptic proteins, neurotransmitters (such d-serine), and brain-derived neurotrophic factors.
The intake of prebiotics also has a few limitations which are mentioned below:
Prebiotics may negatively impact lipid profiles by generating certain SCFAs, namely acetate. Acetyl-CoA, which is a substrate for the synthesis of fatty acids in hepatocytes, can be produced from acetate. This may explain why blood levels of cholesterol and triglycerides rose following rectal acetate infusion.
Prebiotics are fermented in the colon and have an osmotic effect in the intestinal lumen. They could cause bloating and flatulence.
High doses cause diarrhea and abdominal pain.
Large daily doses have lately been linked to a rise in gastroesophageal reflux.
Davani-Davari, D., Negahdaripour, M., Karimzadeh, I., Seifan, M., Mohkam, M., Masoumi, S. J., … Ghasemi, Y. (2019). Prebiotics: Definition, types, sources, mechanisms, and clinical applications. MDPI, 8(3), 1–27. https://doi.org/10.3390/foods8030092
Gibson, G. R., & Roberfroid, M. B. (1995). Dietary modulation of the human colonic microbiota: Introducing the concept of prebiotics. Journal of Nutrition, 125(6), 1401–1412. https://doi.org/10.1093/jn/125.6.1401
Rahim, M. A., Saeed, F., Khalid, W., Hussain, M., & Anjum, F. M. (2021). Functional and nutraceutical properties of fructo-oligosaccharides derivatives: a review. International Journal of Food Properties, 24(1), 1588–1602. https://doi.org/10.1080/10942912.2021.1986520
You, S., Ma, Y., Yan, B., Pei, W., Wu, Q., Ding, C., & Huang, C. (2022). The promotion mechanism of prebiotics for probiotics: A review. Frontiers in Nutrition, 9(2), 1–22. https://doi.org/10.3389/fnut.2022.1000517
https://atlasbiomed.com/blog/inulin-prebiotic-fiber/
Holscher, H.D. (2017) Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microb 8, 172–184
Marteau P, Seksik P. Tolerance of probiotics and prebiotics. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S67-9. doi: 10.1097/01.mcg.0000128929.37156.a7. PMID: 15220662.
Aastha Shrestha
Hello, I am Aastha Shrestha. I completed my MSc. in Biotechnology. My area of interest is Molecular Biology and Immunology.
link to Probiotics, Prebiotics and Health Benefits
Probiotics, Prebiotics and Health Benefits
World Health Organization (WHO) defines "probiotics" as "live microorganisms that, when administered in adequate amounts, confer a perceived health benefit on the host". These...


Generational Equity was chosen among 243 finalists to receive the Deal of the Year Award at the 2010 M&A Advisor Awards. The award was received in the category for Retail Manufacturing/Distribution ($500 million or less). The 2010 M&A Awards honored deal-teams, deal-makers, and firms whose activities set the standard for the industry. An independent body of expert judges that span the M&A industry determined the ultimate recipients of the award.
Generational Equity is one of the leading middle-market M&A advisory firms in North America. We help business owners exit their companies for maximum value.


Archives|Jesus as Teacher of Mental Science; MENTAL HYGIENE AS TAUGHT BY JESUS. By Alexander B. MacLeod. 138 pp. New York: The MacMillian Company. $1.50.
Jesus as Teacher of Mental Science; MENTAL HYGIENE AS TAUGHT BY JESUS. By Alexander B. MacLeod. 138 pp. New York: The MacMillian Company. $1.50.


I am traveling to Cuba with 4 other people from Feb 26-March 5. We need to get from Havana to Cienfuegos on the 26th, and back to Havana on the 28th.
I would be very grateful for recommendations on private drivers we could hire to drive us between those cities.
I can recommend to reserve at www.cubahoteltransfers.com the private transfers between those two cities.


Before his death, Mr Shah had wished his friends a 'Good Friday and a very happy Easter, especially to my beloved Christian nation'.
Mr Shah also appeared to use his Facebook page to speak out over the attacks in Brussels.
It is believed that these posts may have led to the shopkeeper being targeted, angering possible extremist Muslims in the area.
Mohammad Faisal, a family friend, said a bearded Muslim wearing a long religious robe entered Mr Shah's shop and spoke to him in his native language before stabbing him in the head with a kitchen knife.
Mr Shah's brother, who was working next door, rushed out to find the killer laughing while sitting on the Glasgow newsagent's bleeding chest.
Mr. Shah really was "One of the Few" and is murdered by "one of the many".
@wyatt1 wrote: Before his death, Mr Shah had wished his friends a 'Good Friday and a very happy Easter, especially to my beloved Christian nation'.
Liar,,,,,,,"Police Scotland said they have arrested a 32-year-old Muslim man in connection with the attack, which they are treating as "religiously prejudiced"."
Both Mr Shah and the arrested man were Muslims, officers have confirmed.
Why would anyone lie about that, perhaps it's because you're a liar and spreading hate crime is your remit.
that is not the grauniad.
however earlier additions had no mention at all.
How interesting that my personal Like of Mr.Shah cannot be described as Racist , but my Hatred for his killers can.
You've just been caught lying, because you're a liar that tells lies, the lies you tell are told in order to whip up racial tension and plaque us with your hate speech, both papers reported the truth, unlike the RW Nazi sympathising rags you attempt to promote.
As always one questions your motives and finds you lacking any decency and moral fibre.
CORRECT , the initial report did not give any description of the killer , just that Mr. Shah had been stabbed and the killer seen stomping on his head.
calm down or your carer will get worried.
I am happy to see that it and the failed broadsheet have both rectified their omissions since it was pointed out on twitter early today. Maybe twitter does have an occasional use.
Well #FlapaTurk both papers did indeed quote the perpetrator as being a Muslim, said and done.
You present your lies with sneering glee, your lies get found out, you then flap about deranged and disordered when the real truth is provided with evidence.
You label the disabled "scroungers" yet you will not put a price on being disabled yourself, you whine that the left is not Islamophobic enough, so you make up stories about it not being Islamaphobic enough in order to point a finger at it being not Islamaphobic enough, the vast majority of British citizens are not Islamaphobic they just want an end to war and violence, and yet you conduct yourself in a manner that through your lies promotes hate speak and thus promotes war and violence, why, what are your motives for this?
in later edition after after a twitter storm.
I have labelled scroungers as scroungers. People like those in another thread who stole £64000 by claiming to be disabled when they patently were not.
Objecting to appeasement is not being islamaphobic, but if fearing being blown up, shot or beheaded is islamaphobic then any sane person should be.


text:
Joanna Diakos Kordalis
Adam P. Heyd
Delaware Docket
Chancery Court Dismisses Complaint For Failure To State A Claim, Holding That Review of Sale Under Entire Fairness Is Not Warranted
In Aron English and Richard Peppe v. Charles K. Narang, et al., C.A. No. 2018-0221-AGB (Del. Ch. March 20, 2019), the Delaware Court of Chancery (the "Court") dismissed a stockholder suit against the board members of NCI, Inc., a publicly-traded company (the "Company"), for failure to state a claims for relief in connection with allegations of breach of fiduciary duty, and against H.I.G. Capital, LLC ("HIG") for aiding and abetting such breach during a sale of the Company to HIG. The Court held that the controlling stockholder's alleged need for liquidity was not sufficient to compel review of the Company sale under an "entire fairness" standard, and that the vote of stockholders approving the sale was fully informed.
The Company was founded by Charles Narang, who retired as CEO in 2015 but continued to serve as Chairman of the Company's board of directors (the "Board") and to hold a substantial majority of the Company's voting stock. In January 2016, the Board began discussions about a possible Company sale. Over the following months, Company representatives had discussions with various potential buyers, including HIG. By April 2017 the Company had received offers of as much as $20 per share for a sale transaction. By May 2017, however, HIG was the sole remaining bidder. In July 2017, HIG and the Company agreed to a sale of all Company stock to HIG for $20 per share, to be carried out by way of an all-cash tender offer and subsequent merger. A recommendation statement describing the tender offer and merger (the "Recommendation Statement") was delivered to stockholders. By August 2017, stockholders representing approximately 82% of Company shares agreed to sell their stock (approximately 73.6% excluding Charles Narang's shares). The merger closed on August 15, 2017.
In March 2018, the plaintiffs (two former stockholders of NCI) filed their complaint over seven months after the transaction closed) asserting two causes of action: (1) a claim against NCI directors for breach of fiduciary duty, contending that they agreed to a price for the Company that was not "entirely fair" and failed to disclose certain material information; and (2) a claim that members of HIG and its affiliates for aiding and abetting those breaches. The defendants moved to dismiss the claims under Court of Chancery Rule 12(b)(6) for failure to state a claim for relief.
The main assertion of the defendants is that the complaint should be dismissed under Corwin v. KKR Financial Holdings decision (125 A.3d 304 (2015)) because a majority of the NCI stockholders tendered their shares in an uncoerced and fully informed tender office and that the transaction should be judged according to the business judgment standard of review. When a transaction is not subject to the entire fairness standard is approved by a fully informed, uncoerced vote of the disinterested stockholders, courts must apply the business judgment rule and defer to the judgment of a company's board and executives. The Court first addressed the applicability of the entire fairness standard to the Company sale. Entire fairness requires the defendants to establish to the court's satisfaction that the transaction was the product of both fair dealing and fair price. Where a controlled corporation effects a transaction, the controlling stockholder must engage in a conflicted transaction for entire fairness to apply, which may include a transaction where the controller extracts a "unique benefit" to address their need for liquidity. The plaintiffs argued that at the age of 73 and with nearly all of his net worth tied up in Company stock, Charles Narang had an immediate need to liquidate his controlling stake through a sale. However the Court noted there are only very narrow circumstances in which a need for liquidity might compel an entire fairness review, such as a "fire sale" of a company driven by a controller's imminent default on a large loan or investment. The plaintiffs made no such allegations in this case. The Court also noted that the plaintiffs made no allegations of any imprudent wealth management strategy by Narang, and the Court emphasized that Narang was a wealthy man when he retired with no apparent incentive to sell quickly at less than full value. Since the plaintiffs failed to show evidence of a conflict caused by Narang's supposed need for liquidity, the Court found no basis existed to apply an entire fairness review.
The Court also rejected plaintiffs' arguments that the Recommendation Statement was misleading or omitted material information, and the Court addressed the plaintiffs' various arguments that Company stockholders were not fully informed during the tender offer process. The plaintiffs first claimed that the Company CEO's optimism about the Company's prospects during several investor calls demonstrated that the Company's financial projections in the Recommendation Statement had been understated. The Court found that the Company's projections included in the Recommendation Statement were generally positive, and the plaintiffs did not provide "quantifiable support" for the amount by which the projections understated the Company's value compared with the Company CEO's statements. The plaintiffs then asserted that the Recommendation Statement failed to disclose any information concerning HIG's plans to retain certain of the Company's management, despite the Company's disclosure on the merger closing date that certain Company management would continue their employment. While the Court conceded that HIG and Company officials must have discussed employment of certain the Company's management prior to disclosing relevant information on the merger closing date, the Court found no allegation that the Company and HIG had discussed such matters before the Board agreed to a deal with HIG. Finally, the plaintiffs argued that the Recommendation Statement failed to disclose all material information concerning work the Company's financial advisors had done for HIG in the past, and any conflicts of interest that might have resulted. The Court countered with examples from the Recommendation Statement disclosing that the Company's financial advisors had previously provided services to HIG.
The Court concluded that based on Delaware court precedents and the plaintiffs did not plead facts sufficient for either an entire fairness review or to show that the Company's stockholders were not fully informed about the merger, the Court applied the business judgment rule and dismissed the plaintiffs' complaint against both the Board members and HIG for failure to state a claim for relief.
Aron English and Richard Peppe v. Charles K. Narang, et al., C.A. No. 2018-0221-AGB (Del. Ch. March 20, 2019)
Copyright 2022 K & L GatesNational Law Review, Volume IX, Number 151
2021 Delaware Corporate Law Year in Review - Part 1 of 3
Nathan P. Emeritz
Delaware Chancery Court Signals Heightened Scrutiny of SPAC Boards and Sponsors
Stephen Fraidin
Court Issues Highly-Anticipated Decision Regarding the Treatment of SPAC Sponsors and Directors
John F. Sylvia
Delaware Supreme Court Shines Spotlight on Boilerplate Purchase Agreement Provisions
John P. Stigi III
Ms. Diakos is a litigation partner in the firm's New York City office. Her practice involves the representation of numerous Fortune 500 companies and individuals in a broad range of complex civil litigation matters, including securities litigation, trademark litigation, trade secret litigation, and business-to-business disputes (e.g., breach of contract, fraudulent and negligent misrepresentation, tortious interference, unfair competition, defamation, breach of fiduciary duty). Ms. Diakos has extensive experience in all aspects of commercial litigation, including large...
joanna.diakoskordalis@klgates.com
www.klgates.com
Adam Heyd is an associate in the firm's Seattle office where he is a member of our corporate/M&A practice group. His practice focuses on corporate and transactional law, including mergers and acquisitions, capital markets, securities law compliance, corporate governance and venture capital financings.
adam.heyd@klgates.com


text:
Home > CONTENT > CD REVIEWS > Desdæmona – Starcrossed Album Review
Desdæmona – Starcrossed Album Review
Co-Editor by Keith Clement - September 14, 2019 1,710
Desdæmona – Starcrossed
Album Review By Rainer Kerber
A few weeks ago, singer Anna Holtz started a Facebook fundraising campaign for the new single of her band Desdæmona. Of course, I also participated in it. This action brought back memories of the Voices of The Succubi Festival on Malta in 2017. There I was able to experience her live with her band. I was thrilled with the beginning of her bell-clear soprano voice.
Desdæmona were founded in 2011 in the lagoon city of Venice. As namesake apparently acted the lead female character in the Shakespeare tragedy "Othello, the Moor of Venice." In 2013 a demo CD with two songs was released. Both songs can also be heard on the debut album "Starcrossed", which was released three years later. Subsequently, however, there were tensions between the band members. So, you can read on the Facebook page. It came to the split. From the former cast only the singer and the bassist Mega are left. Three new members were found. Recently, Anna told me that the band is back in the studio to finalize the recordings for the second album. That was the reason for me to listen more intensively to the debut.
Yes, Desdæmona play symphonic metal. Of course, that means a lot of emphasis on orchestration. And yes, Metal also includes hard guitar riffs. They can also be heard here. And of course, the Italians have a singer with a bell-clear soprano. Of course, you can hear that on the CD better than live. But just with her singer Anna Holtz, the band also has a unique feature. Hardly any other singer puts so much vibrato in her voice. I noticed that already live and this is confirmed when listening to the album. And she has gathered high-profile musicians around her. Already with the opener "Cyprus" you can hear an excellent guitar solo. The drums set the pace, but without pushing too much into the foreground. And almost as a foundation, the bass boomes out of the speakers. Light and lively sounds "Iago". Whether "Willow", "My Magdalene" or "Nothing Lasts Forever", the songs usually start with balladic introductions and then switch to mid-tempo later. This is how the vocal qualities of Anna are shown to best advantage. The album also features a "real" ballad with "Angels in Hell". In the first half of the song, the singer is accompanied by strings. Later there will be a guitar solo again. One thinks the instrument is literally singing. Fair and beautiful! And the grand finale is followed by the hymnic "Shipwreck". Once again Desdæmona show their flair for catchy but never cheesy melodies.
Many people consider the genre Symphonic Metal to be an obsolescent model. Three four big bands as top dogs and behind them tons of imitators. However, these do not include Desdæmona. They have found their own niche. The sound is fresh. Of course, they owe this largely to the vocal performance of Anna Holtz. But singing is not everything. Varied compositions, very good arrangements and masters of the instruments make "Starcrossed" to a very good album. I'm looking forward to the successor. Let's hope that the changes in the lineup are not at the expense of quality. After all, you can get even more out of the songs with now two guitarists.
Pictures: © Desdæmona, Rainer Kerber Photography, Gigi Fratus (FG music photo)
Desdæmona – Angels In Hell: https://youtu.be/Y4R27lSMsPs
Current Lineup:
Anna Holtz – Soprano Vocals, Piano, Orchestra scoring
Teo Lost – Lead and Rhythm Guitar
Mega – Bass
Zack – Rhythm and Lead Guitar
Matz – Drums, Percussions
Mattia "Il Vanza" Vanzetto – Studio Partnership: Orchestra Sampling, Additional Guitar, Orchestral Arrangements
Label: Self released
Out: Summer 2016
My Magdalene
Angels in Hell
Leonore's Gardens
Rating : 8/10
MHF Magazine/Rainer Kerber
Tagged #AlbumReview #Daesdaemona #RainerKerber
Saint Deamon – Ghost Album Review
Leaving Spirit – Things Change Album Review


text:
Q: Printing routes, denoted by triples, in special order/format in Python I have the following list of lists of triples:
all_arcs = [[('Start', 2, 1), (2, 7, 1), (7, 'Stop', 1)],
           [('Start', 3, 2), (3, 6, 2), (4, 5, 2), (5, 'Stop', 2), (6, 4, 2)],
           [('Start', 1, 3), (1, 8, 3), (8, 9, 3), (9, 'Stop', 3)]]

Every sub-list in all_arcs is a triplet (i,j,k), that denotes the tour i->j of vehicle k. So for example, the first sub-list tells us that vehicle 1 has the tour Start -> 2 -> 7 -> Stop etc.
For every sub-list (<=> for every vehicle) in all_arcs I want to print out the tours in the following format:
Vehicle 1:     Start -> 2 -> 7 -> Stop

Vehicle 2:     Start -> 3 -> 6 -> 4 -> 5 -> Stop

Vehicle 3:     Start -> 1 -> 8 -> 9 -> Stop

...

(Vehicle n:     Start  -> ...  -> ...  -> Stop) depending on how many sub-list exists.

So I need to write a function that takes all_arcs as parameter and prints out the routes in the format above.
My attempt
So I thought It would be a good idea to "chain sort" all the sub-lists first. By chain sort I mean to go from (1,2,0),(3,4,0),(2,3,0) to (1,2,0),(2,3,0),(3,4,0), since the j index in previous triple is always the i index in the next. For the sorting, I used these functions and they worked well:
# function that obtains the next arc-tuple given list of tuples
def get_next_tuple(tup ,list_of_tuples):
  for i in range(len(list_of_tuples)):
      if tup[1] == list_of_tuples[i][0]:
        next_tuple = list_of_tuples[i]
  return next_tuple

# function that sorts the arc tuples in correct order
def sort_list_of_tuples(list_of_tuples):
  sorted_list = [list_of_tuples[0]]
  for i in sorted_list:
    if len(sorted_list) < len(list_of_tuples):
      sorted_list.append(get_next_tuple(i, list_of_tuples))
  return sorted_list

Now the printing, this is where I have problems:
for i, arcs in enumerate(all_arcs):
    sorted_arcs = sort_list_of_tuples(arcs)
    print(f'\nFork-lift {i+1}:')
    for j in range(len(sorted_arcs)):
        print(f'{sorted_arcs[j][0]} -> {sorted_arcs[j][1]}')
    print('\n-----------------------------------')

This obviously works and it prints out the correct order:
Vehicle 1:
Start -> 2
2 -> 7
7 -> Stop

-----------------------------------

Vehicle 2:
Start -> 3
3 -> 6
6 -> 4
4 -> 5
5 -> Stop

-----------------------------------

Vehicle 3:
Start -> 1
1 -> 8
8 -> 9
9 -> Stop

-----------------------------------

However, I either want it to print like the format above or(and) simply store the routes in simple lists, like this:
Vehicle 1 = [Start, 2, 7, Stop]

Vehicle 2 = [Start, 3, 6, 4, 5, Stop]

Vehicle 3 = [Start, 1, 8, 9, Stop]

The code is completely reproducible. I appreciate any help.

A: I would use dict:
all_arcs = [[('Start', 2, 1), (2, 7, 1), (7, 'Stop', 1)],
            [('Start', 3, 2), (3, 6, 2), (4, 5, 2), (5, 'Stop', 2), (6, 4, 2)],
            [('Start', 1, 3), (1, 8, 3), (8, 9, 3), (9, 'Stop', 3)]]

for arc in all_arcs:
    vehicle = arc[0][2]

    dct = {a: b for a, b, _ in arc} # a mapping of a point to another point

    current = 'Start'
    path = [current]

    while current != 'Stop':
        path.append(current := dct[current])

    print(f"Vehicle {vehicle}:", ' -> '.join(map(str, path)))

# Vehicle 1: Start -> 2 -> 7 -> Stop
# Vehicle 2: Start -> 3 -> 6 -> 4 -> 5 -> Stop
# Vehicle 3: Start -> 1 -> 8 -> 9 -> Stop

For each sublist (arc in the code), I construct a dictionary dct that maps a point to another point. Then chaining the paths according to this mapping is easier afterwards.

redpajama_set_name: RedPajamaStackExchange


With a background in finance, Chalongphob Sussangkarn offered a sobering but discerning view of the current world financial crisis. Making connections with students and members of the Thai community, he shared insights from his own experience during his weeklong residency.
Thailand's former Minister of Finance Chalongphob Sussangkarn is currently a fellow of the Thailand Development Research Institute, the organization for which he served as President from 1996 to 2007. He also served as a lecturer of economics at UC Berkeley and worked as an economist at the World Bank. He served as director of the Regional Project on Indicators and Analyses of Vulnerabilities to Economic Crisis for the East Asian Development Network (2002) and the Macroeconomic Model Project for the Budget Bureau (2000-2001). He holds a Ph.D. in economics from the University of Cambridge.


Bug 1439529 - Same resolution is also feasible.
1. Go to talky.io and enter a room.
2. Share camera and mic.
3. Check the video streaming.
Video and audio streaming work.
Video streaming doesn't work. "No video source" error is displayed.
There's an extra microphone permission request displayed on these devices compared to others (see screenshot).
Looks like a regression from bug 1433552 I guess. Andreas, can you have a look?
I assume "No video source" means we reject gUM with a NotFoundError.
That's weird, especially coming from that bug, but I'll try to dig deeper into where that error could be coming from.
Oana, can you confirm whether there is a difference in selecting "Back facing camera" or "Front facing camera" in the prompt?
I can reproduce with front facing but not back facing on a Samsung Galaxy S8.
There is a difference indeed, with the back camera I noticed that it worked 2/3 times, but it's still crashing eventually. With the front camera, it reproduces 3/3 times.
Oh a crash, that sounds like something else. Do you have the crash report for that one?
The issue happens on both front & back facing camera on Huawei & Xiaomi devices.
On Samsung Galaxy Note 4 (Android 5.0.1) it only reproduces with the back-facing camera.
On Samsung Galaxy S8 (Android 7.0) thou, it is as you said: only reproduces with the front-facing camera.
Great, thanks, then I have a device to reproduce with!
I have identified one accidental logic change in bug 1433552. When we request 640x480 this would cause us to select the closest higher resolution instead, which for my galaxy s8 is 720x480@30. It's unclear why, but this fails to start.
I also need to point out that with this fix we'll now get a stream of resolution 480x480 on Android on . I also see this on 59 beta 9, so before the regression range in comment 0 came into effect (beta 10). On 58 we get a stream at 480x640 as I'd expect. I would think this is a regression from bug 1388219 because we don't handle a camera rotated 90 or 270 degrees like is common in a phone but not on desktop.
Oana, could you help confirm the regression range of this? In either case I reckon we need a new bug for this issue. Thanks!
> like is common in a phone but not on desktop.
> reckon we need a new bug for this issue. Thanks!
Logged Bug 1441145 for this.
>      // resolution which makes it feasible.
Just fix the comment to match.
Verified as fixed on Nightly 60 (2018-02-28).
[Is this code covered by automated tests?]: yes, but not in a way that fails. This particular failure has only been observed for certain android devices.
Attachment #8953944 - Flags: approval-mozilla-beta?
Fix for a regression from an earlier 59 beta.
Let's get this into beta 14.
Verified as fixed on Beta 59b15.