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Home Books Clinical Manual and Review of Transesophageal Echocardiography, 2e
Chapter 22. TEE in the Critical Care Unit
Jordan Hudson; Andrew Shaw
Hudson J, Shaw A. Hudson J, & Shaw A Hudson, Jordan, and Andrew Shaw.Chapter 22. TEE in the Critical Care Unit. In: Mathew JP, Swaminathan M, Ayoub CM. Mathew J.P., & Swaminathan M, & Ayoub C.M.(Eds.),Eds. Joseph P. Mathew, et al.eds. Clinical Manual and Review of Transesophageal Echocardiography, 2e. McGraw Hill; 2010. Accessed January 29, 2023. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=417&sectionid=40109086
Hudson J, Shaw A. Hudson J, & Shaw A Hudson, Jordan, and Andrew Shaw. (2010). Chapter 22. tee in the critical care unit. Mathew JP, Swaminathan M, Ayoub CM. Mathew J.P., & Swaminathan M, & Ayoub C.M.(Eds.),Eds. Joseph P. Mathew, et al. Clinical Manual and Review of Transesophageal Echocardiography, 2e. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=417&sectionid=40109086
Hudson J, Shaw A. Hudson J, & Shaw A Hudson, Jordan, and Andrew Shaw. "Chapter 22. TEE in the Critical Care Unit." Clinical Manual and Review of Transesophageal Echocardiography, 2e Mathew JP, Swaminathan M, Ayoub CM. Mathew J.P., & Swaminathan M, & Ayoub C.M.(Eds.),Eds. Joseph P. Mathew, et al. McGraw Hill, 2010, https://accessanesthesiology.mhmedical.com/content.aspx?bookid=417&sectionid=40109086.
TEE in the Critical Care Unit: Introduction
TTE versus TEE
TEE Evaluation of the Critically Ill Patient
Hemodynamic Instability
Hypoxemia
Embolic Source
In addition to its role as an intraoperative diagnostic tool, transesophageal echocardiography (TEE) has been shown to be increasingly useful in the critical care setting. Patients in the critical care unit may have impaired cardiac function due to comorbidities or as a result of their critical illness. Indeed, cardiac dysfunction is one of the most common causes of hemodynamic instability and death in critically ill patients.1 Unlike many other diagnostic modalities available to the intensivist, TEE is minimally invasive and can be rapidly performed at the bedside. It can be used to provide valuable information on cardiac function, guide resuscitation and management, and diagnose a wide range of pathologies that may have a negative impact on the critically ill patient (Table 22–1). TEE was initially applied in the intensive care unit (ICU) for the postoperative evaluation of unstable cardiac surgery patients. However, TEE has also been shown to be beneficial in the general ICU setting, changing management in up to two-thirds of cases.2,3 In addition to the fact that the use of echocardiography has a positive impact on the management of patients in the general ICU,4 there is also evidence to support its therapeutic impact and its value in predicting mortality.5 Surprisingly, despite all these advantages, echocardiography is still not yet available in most ICUs, being largely limited by the availability of trained providers.5
Table 22–1. TEE Diagnoses in the Hemodynamically Unstable Patient.
Cardiac tamponade
Aortic dissection
Valvular dysfunction
Source of embolism
Pulmonary embolus (central)
From Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol. 2003;42(5): 954-970.
The indications for TEE, as previously discussed in this manual, also apply to critically ill patients. The ACC/ AHA/ASE guidelines define hemodynamic instability and suspected aortic dissection as class I indications for echocardiography in the ICU (ACC/AHA/ASE 2003 guidelines) (Table 22–2). Acutely ill trauma patients should also undergo an echocardiographic evaluation if they are suspected to have cardiac tamponade or aortic injury. The most common indication for which TEE is performed in the ICU is hemodynamic instability, followed by endocarditis, assessment of ventricular function, aortic pathology, and miscellaneous others.2
Table 22–2. Recommendations for Echocardiography in the Critical Care Unit.
ACC/AHA/ASE Class I Recommendations for Echocardiography in the Critically Ill
1. The hemodynamically unstable patient
2. Suspected aortic dissection (TEE)
ACC/AHA/ASE Class I Recommendations for Echocardiography in the Critically Injured
1. Serious blunt or penetrating chest trauma (suspected pericardial effusion or tamponade)
2. Mechanically ventilated multiple-trauma or chest trauma patient
3. Suspected pre-existing valvular or myocardial disease in the trauma patient
4. The hemodynamically unstable multiple-injury patient without obvious chest trauma but with a mechanism of injury suggesting potential cardiac or aortic injury (deceleration or crush)
5. Widening of the mediastinum, postinjury suspected aortic injury (TEE)
6. Potential catheter, guidewire, pacer electrode, or pericardiocentesis needle injury with or without signs of tamponade
In the general population, transthoracic echocardiography (TTE) is typically the first modality used, as it is noninvasive and more widely available. In the ICU population, however, up to one-half of mechanically ventilated patients cannot be imaged adequately via TTE.6 Barriers to adequate TTE imaging include mechanical ventilation with positive end-expiratory pressure, wounds and dressings, and body habitus. In addition, many ICU and trauma patients may be too unstable to be positioned in the left lateral decubitus position for TTE imaging. In a study comparing TTE to TEE in patients with unexplained hypotension in the ICU, TTE images were inadequate in over 60% of cases, while TEE provided new, clinically significant diagnoses in 28% that were not seen by TTE.7 The American College of Cardiology deems TEE a reasonable first test (versus TTE) in patients who are intubated, recently postoperative, or who have chronic obstructive pulmonary disease (COPD) or chest wall abnormalities, which may impair TTE examinations.8
In addition, there are certain structures and pathologies that are best visualized using TEE. These include the mitral valve, prosthetic valves, great vessels, and atria, as well as endocarditis and intracardiac thrombi (Table 22–3).8,9 This is particularly important in trauma patients who may be at risk of cardiac tamponade, aortic injuries, and traumatic valvular disruption or septal defects. Finally, TEE is indicated in critically ill patients requiring echocardiographic evaluation in whom TTE images are inadequate.
Table 22–3. Indications for TEE.
TEE should be first choice
1. Endocarditis
2. Prosthetic valve dysfunction
3. Mitral valve anatomy before and after mitral valve repair
4. Aortic dissection
5. Left atrial thrombus
7. Posterior structures in congenital heart disease
TEE superior to TTE
1. Mechanically ventilated
2. Hemodynamically unstable
3. Chest trauma
4. Postoperative
6. Central pulmonary emboli
7. Suspected intracardiac source of embolus
8. Assist devices (IABP, LVAD, RVAD)
IABP, intra-aortic balloon pump; LVAD, left ventricular assist device; RVAD, right ventricular assist device.
As with TEE in the general population, transesophageal echocardiography has a very low incidence of complications in critical care patients.2,10 Excluding feeding tube dislodgement, TEE had a complication rate of 2.6% in a review comprising 2508 examinations in the ICU.2 The most common complications included oropharyngeal mucosal lesions (0.7%), hypotension (0.6%), and coughing (0.3%). TEE should not be performed in any patient with esophageal perforation or in whom esophageal pathology or other comorbidities prevent safe and atraumatic insertion of the TEE probe.
Patient Preparation
Prior to performing a TEE examination, appropriate equipment for airway management, suctioning, and resuscitation should be available. Standard monitoring should be used including pulse oximetry, invasive or noninvasive blood pressure monitoring, and continuous electrocardiogram. It may be beneficial to have a second physician present to assist with management during the examination of hemodynamically unstable patients.
For elective TEE examinations, the patient should fast for 4 hours prior to the procedure to facilitate gastric emptying. Topical anesthesia with aerosolized or viscous local anesthetic should be performed prior to probe insertion. Judicious sedation may be used at the intensivist's discretion, depending on the patient's clinical presentation. Small titrated doses of benzodiazepines and/or opioids are commonly used, with reversal agents readily available.
For emergent TEE, gastric contents should first be suctioned via orogastric or nasogastric tube if in situ. In a patient with cardiopulmonary instability and an unsecured airway, endotracheal intubation prior to TEE may be clinically indicated. While TEE can be an invaluable tool for diagnosis, its use should not delay appropriate resuscitation and management of the unstable patient.
Many TEE studies in the ICU are performed to facilitate diagnosis and management of an unstable patient, or to rule out a specific disease such as tamponade or endocarditis. Thus, while a comprehensive TEE exam as described in the ASE/SCA guidelines should be performed in all cases,11 the intensivist performing echocardiography should initially focus the exam based upon the patient's clinical status and suspected diagnosis. The following is a brief summary of the intensivist's echocardiographic approach to various clinical presentations and diagnoses—a thorough discussion of each topic can be found in earlier chapters.
Hypovolemia and Preload Assessment
Significant hypovolemia is seen on TEE as decreased left ventricular (LV) filling and commonly demonstrated by obliteration of the LV cavity ("kissing" papillary muscles) in the transgastric (TG) midpapillary short-axis (SAX) view. However, systolic cavity obliteration may also occur in the setting of reduced afterload and/or increased ejection fraction in 20% of cases, and may not reflect hypovolemia.12 Furthermore, visual detection of small (< 10%) yet potentially important changes is difficult and more objective measurements of LV volumes are required, especially in patient with compromised ventricular function (see Chapter 21). A left ventricular end-diastolic area (LVEDA) in the TG SAX view less than 6.3 cm2/m2 (women) or 7.5 cm2/m2 (men) could be consistent with hypovolemia as these values define the lower limits of normal in subjects under general anesthesia.13 Unfortunately, there is a wide range of normal values and as a consequence, visual estimation of LV volume is limited to the extremes—cavity obliteration or marked ventricular dilation.
Despite the fact that pulmonary artery occlusion pressure (PAOP) does not accurately reflect preload or volume responsiveness, it is still used as supportive criterion for the diagnosis of acute respiratory distress syndrome and heart failure. Noninvasive estimation of PAOP is feasible using TEE-derived simple Doppler variables, but not in every patient. In fact, Vignon and colleagues14 prospectively assessed the ability of TEE to predict PAOP in mechanically ventilated patients with a pulmonary artery catheter. In the initial group of patients, the correlations between simple Doppler variables and PAOP were better in patients with depressed LV systolic function than in those with normal LV systolic function. PAOP 18 mm Hg or less could be predicted by an E-wave/A-wave ratio greater than 1.4, E-wave deceleration time greater than 100 milliseconds, atrial filling fraction greater than 31%, and systolic fraction of pulmonary venous flow greater than 44%. In a second group, these cutoff values were prospectively validated and the utility of color M-mode Doppler flow propagation velocity (Vp) and the maximal early diastolic velocity of the lateral mitral annulus by tissue Doppler (E′) were assessed. An E/E′ ratio less than 8 and an E/Vp ratio less than 1.7 were predictive for PAOP 18 mm Hg or less, but the predictive value of these variables was not different from the "simpler" pulsed Doppler variables.14
Regional Wall Motion Abnormalities
A thorough survey of the left ventricle using the midesophageal (ME) four-chamber, two-chamber, and long-axis (LAX) views, as well as the TG basal, midpapillary, and apical SAX views allows the intensivist to identify regional wall motion abnormalities. It is important to examine each segment for thickening as well as motion, and to observe each segment in multiple views. Comparison with previous echocardiographic exams is helpful to determine whether any abnormalities are new or pre-existing. A new regional wall motion abnormality is consistent with myocardial ischemia. Although the sensitivity for ischemia detection by TEE is established, the specificity and implications of a transient wall motion abnormality are less clear (see Chapter 21).
Left Ventricular Function
Contractility can be inferred from the left ventricular ejection fraction (LVEF). There are several methods by which TEE can estimate the LVEF, including fractional area change, visual assessment, Simpson's rule, area-length method, and three-dimensional (3D) modeling. Cardiac output can be calculated using the continuity equation from the LV outflow tract area and velocity-time integral. These techniques are described in earlier chapters. It is also important to note the presence of associated left ventricular hypertrophy or dilatation.
Right Ventricular Function
Although right ventricular function can be more difficult to quantify than left ventricular function, it is possible nonetheless to identify patients with impaired RV performance. Acute right ventricular dysfunction in the critically ill patient may signify pulmonary embolus, acute pulmonary hypertension, or right coronary artery disease. The right ventricle is a thin-walled structure; thus, RV thickening should not be used to quantify function. Tricuspid annular displacement toward the RV apex in the ME four-chamber view, fractional area change in the TG short-axis view, and 3D imaging can all be used to quantify RV function. Other signs of RV dysfunction include flattening of the septum (creating a "D-shaped" left ventricle) and right ventricular enlargement.
Diastolic Function
Impaired cardiac filling can cause cardiac failure in the setting of normal systolic function. Diastolic dysfunction differs from systolic dysfunction in pathophysiology and therapeutic approach; therefore, this diagnosis is important for the intensivist in planning management. A clinical finding of acute cardiogenic pulmonary edema, in the presence of normal systolic function by TEE, is highly suggestive of diastolic dysfunction.15 Diagnosis of diastolic dysfunction with TEE requires the use of pulsed-wave Doppler of mitral inflow and pulmonary venous flow (see Chapter 12). However, Sadler et al16 confirmed the load dependence of the pulsed-wave Doppler parameters used to evaluate LV diastolic properties. The abrupt preload reduction induced by ultrafiltration in ICU patients with renal failure significantly decreased E-wave maximal velocities and the E/A ratio because A-wave velocities remained unaffected. Both the isovolumic relaxation time and E-wave deceleration time were significantly prolonged by volume reduction. Also, changes in the pulmonary vein D wave paralleled that of mitral E wave, and the S/D ratio increased after hemodialysis. Therefore, conventional pulsed-wave Doppler parameters to identify transient LV diastolic dysfunction in clinical settings characterized by abrupt changes in loading conditions should be interpreted with caution.17 On the other hand, E′ velocity from the lateral mitral annulus may be less preload dependent.17
Valvular Function
Each valve should be examined for stenosis and regurgitation, as well as abnormalities such as vegetations, thickening, calcification, and prolapse. While valvular lesions may cause hemodynamic instability, their presence may also have implications for management. Severe tricuspid regurgitation, for instance, may result in spurious measurements of cardiac output using thermodilution. Mitral regurgitation may occur as a result of ischemic disease and papillary muscle rupture. Aortic stenosis may be associated with secondary diastolic dysfunction as a result of ventricular remodeling.
In the intensive care unit, cardiac tamponade may occur following cardiac surgery, traumatic injury, pericardial effusion, or as a result of myocardial infarction with wall rupture. Rarely, tamponade may occur as a complication of central venous line placement or other procedures. Clinically, cardiac tamponade may present with Beck's triad of hypotension, elevated jugular venous pressure, and muffled heart sounds. However, the absence of these symptoms does not exclude the diagnosis of tamponade, as lesser volumes or chronic accumulation may present with more subtle clinical findings. TEE is highly sensitive and specific in the detection of pericardial tamponade, with accuracy greater than 99%.9 Pericardial fluid can often be detected in the TG midpapillary SAX, TG LAX, and ME four-chamber views (Figure 22–1). Restriction of cardiac filling and equalization of pressures between the left and right heart may manifest via flattening of the interventricular septum, decreased left ventricular end-diastolic volume, decreased LV size during inspiration, and diastolic posterior motion of the RV.
Acute (A) and chronic (B) pericardial effusions (asterisk).
Other causes of unexplained hypotension that may be diagnosed with TEE include pulmonary embolus, hypertrophic obstructive cardiomyopathy, and intracardiac thrombus.
Pulmonary embolus is not normally seen with TEE, with the exception of central emboli involving the pulmonary trunk or main pulmonary arteries. Echocardiographic signs suggestive of pulmonary embolus include new-onset RV dilatation and dysfunction, acute tricuspid regurgitation, and elevated right-side pressures, in the appropriate clinical context.
Hypertrophic cardiomyopathy may result in dynamic obstruction of the left ventricular outflow tract (LVOT) in up to 25% of patients. This obstruction may be intermittent, and is typically exacerbated by hypovolemia, tachycardia, increased contractility, and decreased afterload. In the ME four-chamber and ME aortic valve (AV) LAX views, left ventricular hypertrophy is often seen, particularly septal hypertrophy. Diastolic dysfunction is common in this population. Left ventricular outflow obstruction can cause high flow velocities in the LVOT, increased LV pressures, and a dagger-shaped pattern of flow on pulsed-wave Doppler or continuous-wave Doppler of the outflow tract.
Intracardiac thrombi can be seen in patients with ventricular aneurysm, dilated cardiomyopathy, coagulopathic states, and dysrhythmias. Thrombi appear as echogenic, mobile masses that may be freely floating or attached to a cardiac structure, and may mimic intracardiac tumors. Clinically, pulmonary or systemic thromboembolic disease may arise as a result.
TEE can be a useful diagnostic tool in the critically ill patient with unexplained hypoxemia. Causes of hypoxemia that can be detected with TEE include left ventricular failure, valvular pathology, cor pulmonale, pulmonary hypertension, pulmonary vein stenosis, central pulmonary embolus, right to left shunts, and pleural effusions (Figure 22–2).18
Right pleural effusion (asterisk).
Echocardiographic findings consistent with pulmonary hypertension include right ventricular dilatation and dysfunction. In the presence of tricuspid regurgitation, the pulmonary artery systolic pressure (PASP) can be estimated by the modified Bernoulli equation (PASP = 4(VTR)2 + CVP, where VTR is the maximal flow in m/s of the tricuspid regurgitant jet and CVP is central venous pressure). Pulmonary vein stenosis is an uncommon cause of pulmonary hypertension whose incidence has been increasing as a result of transcatheter radiofrequency pulmonary vein isolation for the treatment of atrial fibrillation.
Right-to-left shunts may also cause unexplained hypoxemia in the ICU in patients with elevated right heart pressures. Shunts may be intracardiac (patent foramen ovale, atrial septal defect, ventricular septal defect) or intrapulmonary. Intracardiac shunting can be detected with color-flow Doppler, or by the venous injection of agitated saline for contrast.
Febrile patients in the ICU may require evaluation for the presence of endocarditis. In these patients, TEE is the gold standard for noninvasive assessment of endocarditis, with a sensitivity of 88% to 98%.19–21 In contrast, TTE has a sensitivity of 58% to 62%.19,21 TEE should be performed to rule out endocarditis in patients with a high index of suspicion and a negative TTE, for suspected prosthetic valve endocarditis, in patients with bacteremia of unknown source (or refractory to antibiotic therapy), and to assess complications of known endocarditis.22
Echocardiographic signs of infective endocarditis include vegetations on valves, cardiac structures, or devices; dehiscence of prosthetic valves; new onset of valvular regurgitation; and abscesses.23 Vegetations on native or prosthetic valves occur most commonly on the atrial side of the mitral and tricuspid valves and the ventricular side of the aortic and pulmonary valves (Figure 22–3). Vegetations are frequently oscillatory, moving in sync with the cardiac cycle and valvular motion. Repeat TEE examinations are often necessary over the course of treatment to assess for complications of infective endocarditis and the disappearance of vegetations.
Mitral valve endocarditis (arrow).
In the patient with unexplained stroke or peripheral embolic disease, TEE may be helpful to identify intracardiac sources of emboli. These include left-side intracardiac thrombi, endocarditis, tumors, aortic atheromatous disease, and right-side masses in the presence of a right-to-left shunt. Patients with indwelling peripherally inserted central catheter (PICC) lines are at increased risk of catheter-associated thrombus (Figure 22–4), occurring in 15% of cases in a recent prospective study.24 Prior to elective cardioversion of patients with atrial fibrillation or flutter, TEE may be indicated to rule out the presence of thrombi in the left atrium, left atrial appendage, and left ventricle.20 Patients with a history of atrial dysrhythmia greater than 48 hours who are not therapeutically anticoagulated are at increased risk of thrombus development and stroke following cardioversion.
PICC line thrombus (arrow) with 2D (A) and 3D (B) imaging.
TEE is of particular value in the unstable trauma patient, particularly those with blunt or penetrating chest trauma. In such patients, TTE is most often unsatisfactory due to contusions, wounds, subcutaneous emphysema, mechanical ventilation, and/or difficulty with positioning. Patients with traumatic chest injury are at risk for aortic dissection and injury, myocardial contusion and acute dysfunction, traumatic ventricular septal defect, cardiac tamponade, and hemothorax, all of which can be visualized by TEE. TEE should not be performed if esophageal perforation is suspected.
While angiography remains the gold standard for diagnosis of aortic injury in the trauma patient, it is time-consuming and requires transportation of a patient who may be hemodynamically unstable. TEE can be performed safely and rapidly at the bedside or in the operating room.25 The diagnostic accuracy of TEE in patients with suspected acute traumatic aortic injury is comparable to helical computed tomography (CT) but TEE was more sensitive for injuries involving the intimal or medial layers of the thoracic aorta.26 TEE may miss lesions in the distal ascending aorta and proximal aortic arch due to the interposition of the air-filled trachea between the aorta and the TEE probe.
In a patient with suspected aortic injury, careful inspection of the ascending aorta, aortic arch, and thoracic aorta should be performed. Echocardiographic signs of aortic dissection or disruption include presence of an intimal flap (Figure 22–5), turbulent blood flow in the aorta, evidence of low flow in the aorta visible as spontaneous echo contrast or "smoke," aortic aneurysm, and thrombus.25
Aortic dissection flap (arrow) with color-flow Doppler imaging.
TEE is a minimally invasive diagnostic tool that can provide valuable information rapidly and can be performed at the patient's bedside. TEE is increasingly being used by critical care physicians, particularly in hemodynamically unstable and trauma patients. The information obtained from a TEE examination by a skilled operator will often lead to important management changes, as well as alert the intensivist to new diagnoses. Lastly, it is likely that the advent of real-time 3D imaging will only extend the usability of TEE for intensive care physicians.
1. Tuchschmidt JA, Mecher CE. Predictors of outcome from critical illness. Shock and cardiopulmonary resuscitation. Crit Care Clin. 1994;10(1):179-195. [PubMed: 8118727]
2. Huttemann E, Schelenz C, Kara F, Chatzinikolaou K, Reinhart K. The use and safety of transoesophageal echocardiography in the general ICU—a minireview. Acta Anaesthesiol Scand. 2004;48(7): 827-836. [PubMed: 15242426]
3. Porembka DT. Importance of transesophageal echocardiography in the critically ill and injured patient. Crit Care Med. 2007;35(8 Suppl):S414-430.
4. Orme RM, Oram MP, McKinstry CE. Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice. Br J Anaesth. 2009;102(3): 340-344. [PubMed: 19151420]
5. Vieillard-Baron A, Slama M, Cholley B, Janvier G, Vignon P. Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med. 2008;34(2):243-249. [PubMed: 17992511]
6. Parker MM, Cunnion RE, Parrillo JE. Echocardiography and nuclear cardiac imaging in the critical care unit. JAMA. 1985;254(20): 2935-2939. [PubMed: 4057515]
7. Heidenreich PA, Stainback RF, Redberg RF, Schiller NB, Cohen NH, Foster E. Transesophageal echocardiography predicts mortality in critically ill patients with unexplained hypotension. J Am Coll Cardiol. 1995;26(1):152-158. [PubMed: 7797744]
8. Douglas PS, Khandheria B, Stainback RF, et al. ACCF/ASE/ ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol. 2007;50(2): 187-204. [PubMed: 17616306]
9. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/ AHA/ASE 2003 guideline update for the clinical application of echocardiography—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol. 2003;42(5):954-970. [PubMed: 12957449]
10. Min JK, Spencer KT, Furlong KT, et al. Clinical features of complications from transesophageal echocardiography: a single-center case series of 10,000 consecutive examinations. J Am Soc Echocardiogr. 2005;18(9):925-929. [PubMed: 16153515]
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13. Skarvan K, Lambert A, Filipovic M, Seeberger M. Reference values for left ventricular function in subjects under general anaesthesia and controlled ventilation assessed by two-dimensional transoesophageal echocardiography. Eur J Anaesthesiol. 2001;18(11): 713-722. [PubMed: 11580777]
14. Vignon P, AitHssain A, Francois B, et al. Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study. Crit Care. 2008;12(1): R18.
15. Pirracchio R, Cholley B, De Hert S, Solal AC, Mebazaa A. Diastolic heart failure in anaesthesia and critical care. Br J Anaesth. 2007;98(6):707-721. [PubMed: 17468492]
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18. Hoole SP, Falter F. Evaluation of hypoxemic patients with transesophageal echocardiography. Crit Care Med. 2007;35(8 Suppl): S408-413.
19. Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB. Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol. 1991;18(2):391-397. [PubMed: 1856406]
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21. Karalis DG, Chandrasekaran K, Ross JJ Jr, et al. Single-plane transesophageal echocardiography for assessing function of mechanical or bioprosthetic valves in the aortic valve position. Am J Cardiol. 1992;69(16):1310-1315. [PubMed: 1585865]
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Research Staff & Organization
Hiroshi Ishida
About ISS
What is the ISS?
Review of the Activities (FY2005-2013)
Registration for ISS Mail News (Japanese)
update at 18 May 2016
Department of Comparative Contemporary Societies
Comparative Social Stratification
ishida@iss.u-tokyo.ac.jp
Teaching and Research Appointments
January 1995 − March 1999 Assistant Professor, Institute of Social Science, University of Tokyo
April 1999 − Professor, Institute of Social Science, University of Tokyo
September 2001 − March 2002 Visiting Professor, Department of Sociology, University of Michigan
January 2004 − May 2004 Visiting Professor, Department of Sociology, University of Michigan
September 2010 − March 2011 Visiting Fellow, Center for Research on Inequalities and the Life Course, Yale University
April 2012 − March 2015 Director, Institute of Social Science, University of Tokyo
Publications (2015- )
"The Absolute and Relative Values of Education and the Inequality of Educational Opportunity: Trends in Access to Education in Postwar Japan." (with Sho Fujihara) Research in Social Stratification and Mobility (March, 2016).
Selected publications ( -2014)
"Intergenerational Class Mobility in Post-war Japan" (with John H. Goldthorpe and Robert Erikson), American Journal of Sociology, 96: pp.954-992, January 1991.
Social Mobility in Contemporary Japan: Educational Credentials, Class, and the Labour Market in a Cross-national Perspective, Macmillan Press and Stanford University Press, 1993.
"Class Origin, Class Destination and Education: A Cross-national Comparison of Ten Industrial Nations" (with Walter Muller, and John Ridge), American Journal of Sociology, 101: pp.145-193, July 1995.
"Gender Inequality in Authority and Autonomy in the Workplace in Japan, Britain, and the United States," International Journal of Japanese Sociology, 4: pp.75-98, September 1995.
"Stratification and Attainment in a Large Japanese Firm" (with Seymour Spilerman) , Alan Kerckhoff (ed.), Generating Social Stratification: Toward a New Generation of Research, Westview Press, pp.317-342, 1996.
"Educational Credentials and Promotion Chances in Japanese and American Organizations" (with Seymour Spilerman and Kuo-Hsien Su), American Sociological Review, 62: pp.866-882, December 1997.
"Educational Credentials and Labour-Market Entry Outcomes in Japan" Walter Muller and Yossi Shavit (eds.), From School to Work, Oxford University Press, pp.287-309, 1998.
"Industrialization, Class Structure, and Social Mobility in Postwar Japan," British Journal of Sociology, 52(4): pp.579-604, December 2001.
"Models of Career Advancement in Organizations," (with Kuo-Hsien Su and Seymour Spilerman) European Sociological Review, 18(2): pp.179-198, June 2002.
"How Profitable Is Japanese Education?: An International Comparison of the Benefits of Education" (with Yumiko Yoshikawa), Social Science Japan, 25: pp.3-7, February 2003.
"Entry into and Exit from Self-Employment in Japan", Richard Arum and Walter Muller (eds.), The Reemergence of Self-Employment: A Comparative Study of Self-Employment Dynamics and Social Inequality, Princeton: Princeton University Press: pp.348-387, 2004.
"The Persistence of Social Inequality in Postwar Japan", Social Science Japan, 35: pp.7-10, October 2006.
"Japan: Educational Expansion and Inequality in Access to Higher Education," Yossi Shavit, Richard Arum, and Adam Gamoron (eds.), Stratification in Higher Education: A Comparative Study, Stanford: Stanford University Press: pp.63-86, 2007.
Social Stratification and Social Mobility in Late-Industrializing Countries, (ed.), Tokyo: The 2005 SSM Research Committee, 2008, 206pp.
"Japanese Society Seen from Class Mobility (in Japanese)" (with Satoshi Miwa), Japanese Sociological Review, 59: pp. 648-662, March 2009.
Social Class in Contemporary Japan: Structures, Sorting and Strategies (edited with David Slater), Routledge, Nov, 2010, pp. 243.
Hiroshi Ishida, Hiroyuki Kondo, and Keiko Nakao (eds.) Contemporary Stratified Japanese Society, Volume 2: Structure of Inequality and Mobility (in Japanese), University of Tokyo Press, September 2011, 349pp.
"Health and Inequality," Sawako Shirahase (ed.),Demographic Change and Inequality in Japan,Trans Pacific Press, pp. 125-150, November 2011.
"School Discipline and Academic Achievement in Japan," (with Satoshi Miwa) in Richard Arum and Melissa Velez (eds.), Improving Learning Environments, Stanford University Press, pp.163-195, 2012.
"Educational Assortative Mating in Japan and the United States," (with Akira Motegi) Social Science Japan 47 (September 2012): 3-8.
"The Transition to Adulthood among Japanese Youths: Understanding Courtship in Japan," Annals of the American Academy of Political and Social Science, 646: pp.86-106, March 2013.
"Inequality in Workplace Conditions and Health Outcomes," Industrial Health, volume 51(August, 2013): 501-513.
"The Lost Decade: Comprehensive Study on Chain and Accumulation of Disparities and Life Course Transformation of Young People in Contemporary Japan." International Innovation, 166 (December, 2014): 62-64.
Topics of research
(1)Panel Study of Behaviors and Attitudes among the Japanese Youth
This study examines the process of cumulative advantages and disadvantages during the lifecourse among the Japanese youth. This research conducts panel surveys of the Japanese youth every year (Japanese Life Course Panel Surveys), in order to understand the changes in education, employment, family, health, and attitudes among the young people. The study is based on the Grant-in-Aid for Scientific Research (S) numbers 18103003 and 22223005 of the Japan Society for the Promotion of the Science.
(2)Structural Change in Social Stratification and the Mechanism of Generating Inequality in Ageing Society with Low Fertility
This study examines the impact of rapid demographic transformation on the changing shapes of social stratification in Japan. The study is supported by the Grant-in-Aid for Specially Promoted Research (number 25000001).
(3)Quantitative Data Analysis and Causal Inference in Social Sciences
The project focuses on studying various quantitative methods for social sciences and the ideas of causal inference from the observational data. It uses the Japanese Life Course Panel Surveys as the main data source and employs various methods for the analysis.
Educational Activities in 2016
Graduate Schools of Law and Politics, Graduate School of Public Policy, Graduate School of Education, and Graduate School of Humanities and Sociology, University of Tokyo Social Research Methods
ISS Mail News (Japanese)
ISS Joint Research Projects
ISS Symposia
ISS in the Media
Social Science Japan Journal
SSJ Newsletter
SSJ Forum (email list)
Visiting Positions
Contemporary Japan Group
Institute of Social Science, the University of Tokyo
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033
Tel +81-3-5841-4904 Fax +81-3-5841-4905
Email webmaster@iss.u-tokyo.ac.jp
Copyright© Institute of Social Science, The University of Tokyo. All rights reserved.© the University of Tokyo

redpajama_set_name: RedPajamaCommonCrawl


The Sonoscanner Ultrasounds have an exceptional full HD image quality, allowing you to make detailed and accurate diagnoses.
Our Ultrasounds are easy to take along, always at your fingertips when needed.
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Q: Commands and the Custom Shortcut Keys In Ubuntu 16.04 I have added many custom shortcut keys to launch various applications such as Skype or Firefox.
In the case of Skype I have simply put the word skype in the command box. But when I put any terminal command in that box the shortcut key is ignored.
Just for the sake of argument I put echo 'abcd' in the command box and assign Ctrl+Alt+5 to it - nothing happens when I use that shortcut key.
I also tried to launch bash script and also python script from the command box of Customs Shortcut Key and again got nothing when I used the assigned shortcut key.
Are there certain restrictions on what can go in the command box of Custom Shortcut Keys? Or am I not using the command box correctly?

A: You need a console to be able to execute shell commands. If you are using gnome-terminal you can execute a command with -e - so try to assign your command like:
gnome-terminal -e 'top'

redpajama_set_name: RedPajamaStackExchange


text:
Q: Drag and drop within list, windows 8 app? Is there any good examples/tutorials on how to implement drag and drop within a window 8 C# list (listview, listbox …) out there?
What I would like Is a  editable "Iphone-list"-experience, where  I easily can rearrange items within a list. But I mostly find WinJS examples and I would like to have a c# example for win 8

A: Firstly You must enable the AllowDragDrop property.
Then write 3 events:
    private void myList_ItemDrag(object sender, ItemDragEventArgs e)
    {
        DoDragDrop(e.Item, DragDropEffects.Link);
    }

    private void myList_DragEnter(object sender, DragEventArgs e)
    {
        e.Effect = DragDropEffects.Link;
    }

    private void myList_DragDrop(object sender, DragEventArgs e)
    {
        // do whatever you need to reorder the list.
    }

To get index of dropped item:
Point cp = myList.PointToClient(new Point(e.X, e.Y));
ListViewItem dragToItem = myList.GetItemAt(cp.X, cp.Y);
int dropIndex = dragToItem.Index;

A: If you need to drop onto a ListView or GridView, have the Drop event fire on the DataTemplate for the actual Item, not the whole list.   Then you can tell which item it is dropped on.


Summit brings quality design to outdoor home kitchens with its professional collection outdoor appliances.
The SBC678OSNK is an outdoor beer dispenser designed to store a full half keg. The front breathing design allows built-in installation under counters, while the fully finished cabinet also enables freestanding use. We include a set of casters for optional portability. The exterior is completely wrapped in durable stainless steel to stand up to the elements in professional style. The sealed back design ensures an easier fit while also protecting all components. The user-reversible door includes a factory installed lock and a sleek stainless steel handle mounted horizontally for a modern look.
Inside, the SBC678OSNK utilizes full frost-free operation to minimize user maintenance. The digital control panel lets you manage the temperature between 32º and 50º to best accommodate a variety of brews. The stainless steel floor helps to protect the unit when loading and unloading heavy kegs, while an attractive and efficient LED light offers added convenience inside. This unit can be converted to a standard all-refrigerator in just a few easy steps. Two adjustable glass shelves are included for flexible storage.
No tapping equipment is provided with this unit, allowing 'do-it-yourselfers' to customize the SBC678OSNK with their own draft systems.
Depth with door at 90° 48.5"


Science makes progress at a brisk pace. It feels safe to assume that as medicine advances and better methods are revealed, they are rapidly incorporated into practice. Unfortunately, moving research from the lab to the bedside can be surprisingly slow going.
Fortunately, dissemination of innovation is well researched and methods for improving are clear.
Evidence shows that moving new ideas from concept to practice in a timely way requires action. "Passive diffusion," the unfacilitated movement of evidence-based principles from study to practice, makes for delayed distribution of evidence.
Far preferable is "active diffusion," requiring effort on the part of providers to seek out and trial new approaches.2 Awareness of this phenomenon pushes practitioners to establish systems of revising and amending practice.
Examples of successful adoption of evidence-based practice through "active diffusion" can be found in select large, integrated health systems. The Mayo Clinic publishes extensively on their work to incorporate high-value practices.
Mayo's "Value Creation System" assigns responsibilities to clinical practice committees, management, and front-line staff in the creation and implementation of new clinical guidelines.
The four-step ongoing process first selects a target area for improvement (alignment), then assigns the committee to research and create the new guideline (discovery).
This highly structured method of adoption yields financial and clinical rewards for the provider, and more importantly ensures quality patient care.
Metrics checked the efficacy of the new guideline. Data collection showed defect rates for Warfarin had been reduced to 1.5 percent.6 The final stage of Mayo's evidence based practice diffusion method "Value Creation System" is publication of findings.
Anticipating that findings will be scrutinized by the public ensures that every stage — alignment, discovery, managed diffusion and measurement — meets the high standards of scientific rigor.
Setting aside time and talent in pursuit of better practices is a proven wise investment. Providers charged with updating guidelines can remove barriers and create incentives for the adoption of evidence-based practice.
Assigning roles for finding, reviewing, implementing and measuring outcomes of new practices engages staff in the advancement of their work. Designating and funding the roles that keep health systems up-to-date creates efficient, high-reliability health care organizations.
When the task of staying current is woven into the fabric of an organization, change and improvement become part of day-to-day work.
The culture of a health care system governs the speed with which it adopts scientifically sound methods. Health care providers are held to increasingly rigorous standards of performance.
Therefore, it is essential to create a culture that actively pursues the most advanced science and continually updates practice and measures results.
An "active diffusion" system for evidence-based practice creates optimal performance by getting rid of wasteful practices unsupported by the evidence while bringing in practices that efficiently produce better outcomes.
Ensuring that the most effective care is given in a reliable and uniform fashion makes for the best clinical and financial outcomes. When a health care organization chooses to deliberately incorporate up-to-date practices, satisfaction for patients, providers and payers is at its best.
Agency for Healthcare Research and Quality. National Healthcare Quality Report, 2005. http://archive.ahrq.gov/qual/nhqr05/nhqr05.htm. Last updated June 2007. Accessed March 3, 2013.
Rogers EM. Diffusion of Innovations. New York City: Free Press. 1962.
Swensen S, Dilling J, Harper Jr C, Noseworthy J. The Mayo Clinic value creation system. American Journal of Medical Quality, 2012; 27(1), 58-65.


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Whole Ukraine under fire: Russia fires more than 40 rockets at Christmas
Even on Christmas Day, the people of Ukraine do not get a break from Russian air raids.
Even on Christmas Day, the people of Ukraine do not get a break from Russian air raids. Dozens of Ukrainian cities are said to have been shelled with more than 40 rockets. President Selenskyj warns of further attacks by the end of the year.
The Russian military launched more than 40 rocket attacks on Sunday, according to Ukrainian sources. Dozens of cities in the Luhansk, Donetsk, Kharkiv, Kherson and Zaporizhia regions have been shelled in the past 24 hours, the Ukrainian military said. In the direction of Kherson, the enemy continued artillery shelling of populated areas along the right bank of the Dnieper. Ukrainian forces, on the other hand, launched attacks on almost 20 Russian targets.
The last few days of this year could bring new Russian missile and drone attacks, according to Ukrainian President Volodymyr Zelenskyy. "We must be aware that our enemy will try to make this time dark and difficult for us," said Zelenskyy in his daily video address on Sunday evening. Russia lost everything it could lose this year. "But it is trying to make up for its losses with the cunning of its propagandists after the missile attacks on our country, on our energy sector."
"I know that the darkness will not prevent us from leading the occupiers to their new defeats," said Zelenskyj. "But we have to be prepared for every scenario." He directed sharp words at the Russian military, who killed at least 16 people and wounded another 64 in artillery attacks in Kherson in the south of the country on Saturday. "Beasts," he said. "We will find every murderer."
Ten months after the start of his war against Ukraine, Kremlin chief Putin sees Russia on the right course, despite growing tensions with the West. "I think we're moving in the right direction, we're protecting our national interests, the interests of our citizens, our people," said the 70-year-old in a short interview published by Russian state television on Sunday.
In it, the President again stressed that Russia is ready to negotiate a solution to the conflict over Ukraine. "We are ready to agree on any acceptable solution with all those involved in the process. But that's their business. We don't reject negotiations, they do," Putin said.
Kyiv does not believe in the Kremlin chief's words. "Russia does not want negotiations and is trying to avoid responsibility (for the war)," tweeted Zelenskyi's adviser Mykhailo Podoliak. "So it is obvious that we are moving to a tribunal." According to Kiev's ideas, Russia's political and military leadership should answer for the war of aggression before an international court of justice modeled on the Nuremberg tribunal.
Kremlin chief Putin has repeatedly indicated a willingness to negotiate in the past few days, but without going into the preconditions set by Kyiv. While Moscow would negotiate on the basis of today's front line, Kyiv initially demands the complete withdrawal of Russian troops from Ukraine, including Crimea, as well as reparation payments.
#Russland
1 This is how the travel summer of 2023 will be: all-inclusive... 2 Justice sees danger of smuggling: Drones over prisons... 3 Bayern: Boateng: No talks about leaving Lyon 4 Bavaria: unknown person devastates biogas plant site:... 5 Thuringia: 20-year-old on drugs rolls over with a... 6 Bavaria: Significantly more unauthorized entries in... 7 Bavaria: Five people injured in a collision between... 8 "Love my son, but...": Netanyahu distances... 9 Motion being prepared: Kyiv wants to throw Moscow... 10 Schnitzer calls for redistribution: economy: "We...
This is how the travel summer of 2023 will be: all-inclusive...


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Knefastia kugleri is an extinct species of sea snail, a marine gastropod mollusc in the family Pseudomelatomidae, the turrids and allies.

Description
The length of the shell attains 52 mm.

Distribution
This extinct marine species was found in upper middle Miocene strata in  the Paraguana Peninsula, Venezuela.

References

 P. Jung. 1965. Miocene Mollusca from the Paraguana Peninsula, Venezuela. Bulletins of American Paleontology 49(223):389-652

kugleri
Gastropods described in 1965
Miocene gastropods

redpajama_set_name: RedPajamaWikipedia


Peppermint extract and glitter turn ordinary slime into holiday peppermint slime.
Here's a simple slime recipe that's perfect for the winter holidays! This peppermint slime smells like candy canes. You can color it green or red or even combine clear and white batches to get a candy appearance. It won't taste like candy canes, but it's not toxic (just in case little ones decide to sample it). It is a borax-free slime. You could also adapt any of my other borax-free slime recipes to make peppermint slime, if you don't have all the ingredients for this recipe.
The recipe uses a bit less than a full bottle of glue, which is great because having leftover glue can help you adjust the consistency of the slime.
Mix food coloring into the glue to achieve the color you want. You can add more later, but it's less messy to mix it in before the slime polymerizes.
Work starch into the slime until you get the consistency you want. You want the slime to stick together, but not be glue-sticky on your hands. Kids can do this part by hand, if you like.
Add the glitter or sparkles.
If the slime is still sticky, add a bit more starch. If the slime is stringy and won't hold together, add the leftover glue. There's no right or wrong mixture — it's all up to you! You can wash the slime from surfaces using warm water. Because of the food coloring, it can stain clothing and carpet. Store the slime in a sealed container or plastic baggie to keep it clean and prevent it from drying out. You can refrigerate sealed slime if you want to keep it for a long time.
You can easily adapt these instructions to make cinnamon slime or pumpkin spice slime or whatever you like. Just change the color of the food coloring and the extract or spices. If you decide to go with cinnamon, be careful, since the oil is very irritating to eyes and skin. It would be much safer to crush cinnamon candies into slime or add powder. For any extract, use the smallest amount needed. You can always add more, but can't subtract ingredients once added to the slime. Have fun!


text:
Michigan boy, 17, is arrested for making a threat to shoot up a high school which he claims was a 'joke' – as police seize an AR-15 from his home
Cullen Shafer, 17, has been charged with felony threat of terrorism targeting Brethren High School in Michigan
Shafer told sheriff's deputies he was just kidding while talking to some students
Deputies seized Shafer's phone and AR-15 belonging to his parents
Alleged threat was made just days after Nikolas Cruz opened fired inside a Florida high school, killing 17 people
Shafer was released from the county jail after posting $100,000 bond
By SNEJANA FARBEROV
DAILYMAIL.COM
Authorities in Michigan have arrested a 17-year-old boy for allegedly threatening to shoot up his high school – but he claims he was just kidding.
Manistee County Sheriff's office contacted Cullen Shafer on Monday after learning that he has made an alleged verbal threat against Brethren High School.
The tip came from a group of students at the school who notified their principal by email, sparking a police investigation.
Shafer was arraigned on Tuesday on a felony count of threat of terrorism, which is punishable by up to 20 years in prison, reported Mlive.com.
According to his Facebook page, he went to Brethren High School
Deputies seized an AR-15 semi-automatic rifle and his cellphone, reported UpNorthLive.com.
Investigators said the gun belonged to the teenager's parents.
According to the authorities, the threat was reported on Monday but was made last week, just days after 19-year-old Nikolas Cruz stormed into a Parkland, Florida, high school armed with a legally purchased AR-15 and opened fire, killing 17 people and injuring 14 others.
This entry was posted on Wednesday, February 21st, 2018 at 3:09 pm	and is filed under Terror. You can follow any responses to this entry through the RSS 2.0 feed.


A 2-hour 3-mile hike to the ancient Anasazi 'Cold Springs Cave' cliff dwelling, sometimes referred to as the 'Split Level' Ruins. Included in this photoset are over 50 photos of petroglyphs and pictographs.
Taking a short recon drive along Old Utah State Route 95 in preparation for an upcoming hike to a little-publicized cliff dwelling in North Butler Wash.
A 90-minute 2-1/2 mile hike to Monarch Cave Cliff Dwelling along The Comb.
A 2-1/2 hour 2.6-mile hike to the ancient Anasazi 'Double Stack' cliff dwelling.
A short hike to 'Wolfman Panel' in Butler Wash of The Comb.


Up for auction is a BEAUTIFUL Scimitar Horned Oryx ! This great looking animal will look great on your ranch! Pick up in Leakey, Texas after the auction ends or call the office to schedule delivery with a contracted driver. Good Luck!


The GolfWorks has teamed up with Aldila to provide you with an incredible deal on high performance Maltby club heads and premium aftermarket graphite golf shafts. Unlike most OEM off the rack equipment, the Maltby Premium Paks offer real aftermarket first quality golf shafts from top quality graphite shaft manufactures.
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Kit features easy-to-find supplies, thanks to their re-designed plastic organizer case. 9 3/8"L x 8 7/8"H x 2 3/4"W. Contents subject to change without notice.
Have questions or need more information about our '131-Piece All-Purpose First Aid Kit, Plastic', please contact us?


Watch out! Here comes Duck in a brand new edition of the first book in the million copy bestselling series!
a truck that was stuck in some yucky brown muck.
saw the truck stuck and gave it a push.
But the truck stayed stuck!
What now, can you guess?
get them out of this mess?


text:
MasterCup Rally Season 2 Starts 08/01/22 Dirt Rally 2.0
UNBOXING: rFactor 2 Ginetta is how a virtual LMP1 should be
Classic IndyCar Series Returns After Summer Break iRacing 08/08/21
Darren B 5 August 2021
Back to the racing action Classic IndyCar Series in iRacing returns after the summer break. Next up is Michigan International Speedway 08/08/21.
The Classic IndyCar Series in iRacing returns after a 6 week break, no doubt the drivers have been keeping sharp and frosty driving in other races. With the first half of the season aside, the series moves on to its next race.
Before we move onto the rest of the article, it has been a pleasure to promote this great league. We at simrace247.com are massive fans of many racing disciplines in motorsport and sim racing.
CIS has proved it is right up there with some of the best leagues and drivers in sim racing for entertainment and edge of the seat action down to the wire.
As usual CIS Founder and racer Robert Grosser has all the important details for the community in sim racing to check out, with live video feed of the event provided below.
"Classic Indycar Series is back after a 6 week summer break for the second half of the season. The famous Michigan International Speedway will host a 400-mile race on Sunday, August 8th. After an eventful first half of the season pretty much everything can happen. We wouldn't be surprised to welcome a driver in victory lane, who hasn't been there at least this season.
But first, let's look back to some CIS history. The last time the series visited this Superspeedway was in 2016, back then as a 500-mile event. The series was mimicking the 1996 "U.S. 500" with the famous 3-wide start. Robert Grosser started from pole position, while Denis Garese took away the race win just 0.015 seconds ahead of Lucas Laville in what is still the closest finish in CIS history!
Those names sound familiar? Well, all those drivers are still on the CIS roster and ready to score good results again. Other drivers from the current roster, who entered the race 5 years before are Karsten Brodowy, Andrew Aitken and Mike Gerlica.
So what can we expect this time? First of all, a very competitive race! Randy Shewmake (Aero-X) will return to the series, after missing two races due to hardware issues. His teammate Andrew Aitken won at Motegi and you better keep an eye on him up front. Team Chimera with Josh Chin, Andrew Wood and Jamie Wilson wants to take their momentum from Richmond to Michigan.
Chin is currently 3rd in the points standings and he wants to close the gap to Ethan Agan (SRC) and Lucas Laville (Vortex SimRacing). Most recent race winner Jan Hoffmann (Vortex SimRacing) is highly motivated to score back to back race wins.
But there are at least another 5 to 10 drivers to keep on your list! This will be the second round of the oval triple crown with an extended time-limit of 2.5 hours, which should be enough to complete the scheduled 200 laps on this high banked super fast oval.
The series welcomes two new drivers, Alex Crawford and AJ Musselman. Both have joined the league during summer break and will add to the excitement on track.
None of the championship contenders can afford to put a foot wrong, since there are only 2 drop weeks all season long. Racespot TV will broadcast the race LIVE this Sunday, 18:00 GMT. Then one week later (August 15th, 18:00 GMT) you can watch the race on ESTV. Tune in and don't miss the action!"
Tune into the race live right here
About iRacing
Drive officially licensed car replicas engineered from the ground up in cooperation with real-world race teams, applying accurate mechanical and dynamic models.
Go head to head with real drivers all over the world thanks to our skill-based matchmaking and license progression system ensuring competitive racing at all levels.
Race on your own or with a team featuring driver swaps in addition to crew chief and spotter positions!
Whether you want to experience a NASCAR Cup car, a World of Outlaws Sprint car, an open-wheel IndyCar, an Australian Supercar, an IMSA Prototype or Touring Car, or the ultimate: an FIA Grand Prix car, iRacing's online racing simulations offer them all. All you need is a computer equipped with one or more USB ports, and a digital wheel/pedal, or a gamepad backed by a high-speed Internet connection. iRacing does the work for you by organizing and managing more than 80 official racing series, or you can choose to race in more than 400 private leagues or launch your own hosted events.
CIS is a league partner with simrace247.com, check them out: Classic Indycar series iRacing – SimRace247
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text:
Peter Andrejevič Kozen (), ruski general, * 1778, † 1853.

Kot poveljnik gardne konjeniške artilerije je bil eden izmed pomembnejših generalov, ki so se borili med Napoleonovo invazijo na Rusijo; posledično je bil njegov portret dodan v Vojaško galerijo Zimskega dvorca.

Življenje
Izobrazbo je prejel na Artilerijski in inženirski šoli poljskega plemstva, ki jo je končal julija 1796 s činom artilerijskega kadeta; že januarja 1797 je postal poročnik.

Oktobra 1803 je postal kozaški štabni stotnik in avgusta 1808 je bil povišan v polkovnika. Februarja 1811 je postal poveljnik artilerijske brigade in aprila istega leta poveljnik gardne konjeniške artilerije. Na tem mestu se je odlikoval med Napoleonovimi vojnami, tako da je bil maja 1813 povišan v generalmajorja.

Leta 1825 je bil odpuščen iz službe, a je bil 10. januarja 1826 ponovno sprejet kot častnik za posebne zadolžitve. Julija istega leta je bil povišan v generalporočnika.

Januarja 1827 je postal vodja usposabljanja artilerijske brigade v sankt-peterburški garniziji; julija naslednje leto je postal še inšpektor lokalnih arzenalov.

V usposabljanje artileristov je vpeljal tudi poznavanje proizvodnje smodnika, tehnologijo izdelave in popravila artilerijske oborožitve ter streliva,... Septembra 1834 je postal vodja novega raketnega inštituta, ki je bil odgovoren za izdelavo bojnih raket in izboljšanjem proizvodnje raket.

Zaradi njega je Rusija v tem času imela najbolj napredne raketne sisteme v Evropi, zaradi česar je bil 17. marca 1845 povišan v generala artilerije.

Viri in opombe

Glej tudi

 seznam ruskih generalov

Ruski generali
Ruski plemiči
Generali Imperialne ruske kopenske vojske
Veterani Napoleonovih vojn
Nosilci reda črnega orla
Nosilci reda svetega Jurija


New Delhi: The 55 page PMO documents (attached) gathered using Right To Information Act (RTI) shows manifest collusion between ministers, officials and Dow Chemicals to protect it from the liabilities of Industrial catastrophe of Bhopal. The documents reveal how some of the ministers who have been made part of Group of Ministers (GoM) by the Prime Minister have been acting to safeguard the interest of the US corporation in question, which is liable for Bhopal disaster.
The GoM that has been constituted does not inspire confidence. Notably, the GoM, headed by Union Home Minister P Chidambaram, was constituted on May 26, 2010 by the PM's Office. It is expected that notification of the same from the Cabinet Secretariat will be issued shortly. The documents gathered using RTI reveal how Chidambaram and Kamal Nath have already expressed their support for Dow Chemical Company's proposal to save it from Union Carbide Corporation's liability by seeking a Cabinet Secretary headed committee on a matter which is sub judice. Dow inherited the liability in 2001 after its merger Union Carbide.
The real issue arising out of Bhopal verdict that has necessitated the setting up GoM is its fallout on the proposed Liability for Nuclear Damage Bill that is pending in the parliament. It has emerged any future liability regime must include criminal liability and must not cap the amount of civil liability because the damage from a nuclear or chemical disaster depends on the direction and nature of the wind at the time of the accident.
Bhopal verdict reveals that no lessons have been learnt from Chernobyl nuclear disaster and Three Mile Island Nuclear Accident. It is sad that even Parliament's standing committee on Environment, Forests, Science and Technology is frozen in its passivity be it with regard to Bhopal or nuclear liability. The Committee is under the chairmanship of T Subbiram Reddy who is on record in parliament to have opposed any liability arising out of asbestos exposures. Incidentally, the Dow Chemicals Company has set aside $2.2 billion to address future asbestos-related liabilities arising out of the Union Carbide acquisition. How is that Dow Chemicals can take the asbestos liability of Union Carbide and not the liability for the industrial catastrophe in Bhopal?.
The Supreme Court's verdict in the WTO Case and the present apex court engineered order of the Court of Chief Judicial Magistrate of Bhopal demonstrates beyond doubt how Indian parliament, the premier law making law making institution appears to have become almost defunct. It must re-invent its role and assert its authority.
It is noteworthy that the convicts have been held guilty under Sections 304-A (causing death by negligence) instead of 304-II (culpable homicide not amounting to murder) of the Indian Penal Code as per the original charge besides Sections 336, 337 and 338 (gross negligence).
It has become clearer that the corporations are undemocratic institutions by legal design makes them ungovernable and is making the very existence of democratic legislatures effete. Legislatures must be make them subservient to legislative will.
The Bhopal case provides a historic opportunity to democratic governments of US, India and others to ensure genuine legal remedy to set an example in order to give befitting reply to those who question the efficacy of representative democracy.


text:
Adolescent health (4)
Child health (4)
Health promotion/ Health education (4)
Migrants Assistance (4)
Community participation in health (2)
Health communication (1)
Labour migration and health (1)
Substance abuse (1)
(-) Manual/ Training guide (9)
London School of Hygiene and Tropical Medicine (4)
United Nations Global Initiative to Fight Trafficking in Persons (4)
ADB (1)
IOM South Africa (1)
Nonthathorn Chaiphet (1)
Sonke Gender Justice Network (1)
Manual/ Training guide
An action oriented training manual on gender, migration and HIV
2009 Manual/ Training guide English
Author/s: Sonke Gender Justice Network, IOM South Africa
This manual was primarily developed to build the capacity of individuals and organisations to address specific gender and HIV vulnerabilities within migrant settings. It has been designed so that is can be used both as a train the trainer (ToT ) tool and as "on-the-ground" tool for facilitators to use in diff erent settings. It is intended to be used in workshop settings and also as a resource and facilitation guide for those working on issues of migration, gender, HIV,…
Psychosocial needs assessment in emergency displacement, early recovery, and return: IOM tools
Author/s: IOM
The tools presented in this volume have been developed and used over the past few years in order to identify and respond to people's psychosocial needs in the midst of an emergency and in early recovery settings, mainly targeting displaced and returnee populations. As tools for IOM operations, they are designed to achieve four main goals: 1) assessing people's psychosocial well-being in a family setting in a participatory way; 2) mapping the provision of pre-existing and…
Introduction to basic counselling and communication skills: IOM training manual for migrant community leaders and community workers
Author/s: USAID, IOM
This manual is a pandemic preparedness for migrants and host communities capacity development tool to strengthen basic counseling and communication skills. The manual is designed for use by humanitarian workers such as development and community health workers and leaders who engage with migrants and mobile populations. The manual will strengthen counselling and communication skills that can be used to assist children, adolescents, adults and families living in migrant and…
For life, with love: Training tool for HIV prevention and safe migration in road construction settings and affected communities
Author/s: ADB, IOM
New transportation infrastructure and the emergence of transport and economic corridors in the Greater Mekong Subregion (GMS) have led to better connectivity and regional economic integration, the creation of new jobs, and new and complex patterns of internal and cross-border migration. These developments, however, can also have negative out-comes. One is increased vulnerability to HIV infection, particularly along transport corridors and cross-border areas. Migrants and…
Caring for Trafficked Persons: Guidance for Health Providers
Author/s: IOM, London School of Hygiene and Tropical Medicine, United Nations Global Initiative to Fight Trafficking in Persons
This handbook aims to provide practical, non-clinical guidance to help concerned health providers understand the phenomenon of human trafficking, recognize some of the health problems associated with trafficking and consider safe and appropriate approaches to providing health care for trafficked persons. It outlines the health provider's role in providing care and describes some of the limitations of his or her responsibility to assist.
Activity manual for immigration officers and relevant persons in migrant health care (Thai)
2009 Manual/ Training guide Thai
Author/s: Nonthathorn Chaiphet
This activity manual was developed through a series of consultative meetings and a pre-test with immigration police, immigration doctors, public health officers, and representatives of migrant populations in Thailand. Although the manual is intended to enhance the knowledge, understanding, and attitudes of immigration and public health officers on migrant health care in closed-settings, it can be adapted to other target audiences at both central and community levels. In addition to…
Caring for Trafficked Persons: Guidance for Health Providers (Arabic)
2009 Manual/ Training guide Arabic
For many trafficked persons, the physical and psychological aftermath of a trafficking experience can be severe and enduring. Health providers may come into contact with victims of trafficking at different stages of the trafficking process and at different stages of their recovery. For health practitioners, diagnosing and treating trafficked persons can be exceptionally challenging. The informed and attentive health care provider can play an important role in…
Caring for Trafficked Persons: Guidance for Health Providers (Armenian)
2009 Manual/ Training guide Armenian
Caring for Trafficked Persons brings together the collective experience of a broad range of experts from international organizations, universities and civil society in addressing the consequences of human trafficking. Developed with the support of the United Nations Global Initiative to Fight Human Trafficking, and led by IOM and the London School of Hygiene & Tropical Medicine, the handbook gives practical, non-clinical advice to help a concerned health…
Caring for Trafficked Persons: Guidance for Health Providers (Chinese)
2009 Manual/ Training guide Chinese


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Grand Jury on San Diego Police Review Board: Atmosphere Full of Pro-Police Prejudice, Fear and Intimidation
by Source on May 23, 2012 · 5 comments
in Civil Rights, Culture, History, San Diego
San Diego police take control of plaza after storming Occupy San Diego encampment, arresting over 50 protesters in late October 2011. OSD activists later took their complaints to the Citizens Review Board - but with no results.
Police from Internal Affairs Unit Allowed into Closed Sessions and Bullied Dissenters
The report found that intimidation resulted in a high turnover rate of prospective board members, including many who were minorities.
By Kristina Davis / U-T San Diego / May 23, 2012
SAN DIEGO — The county grand jury investigating San Diego's police citizen review board uncovered an atmosphere rife with "prejudice, fear and intimidation," and determined that bullying and a lack of decorum impairs the board's ability to be a true watchdog on police practices, according to a report released Tuesday.
The nine-page report cites a number of factors that contribute to the ineffectiveness of the board, including a "weak" central leadership, the strong influence of police internal affairs investigators and a prejudiced appointment process for board members.
Jay Goldstone, the city's chief operating officer, said in a statement that the city is open to feedback and suggestions about ways to increase effectiveness. He said the Citizens' Review Board on Police Practices is already addressing some of the concerns, including holding a meeting about decorum and re-opening the pool of prospective members to recruit diverse candidates.
"The CRB is a competent, hard working board with many diverse voices providing impartial oversight of investigations and responses to citizens' complaints against officers," Goldstone said.
Police Chief Bill Lansdowne said he supports the board and how the mayor's office runs the program.
The board's 23 volunteer civilians review citizens' complaints against the San Diego Police Department. The mayor appoints new board members but only after the current board recommends them, allowing prejudice and personal bias into the process, the grand jury report says.
The board, established in 1988, typically reviews investigative reports already completed by the Police Department's internal affairs unit and ultimately agrees or disagrees with the findings. The board is not authorized to conduct its own investigations nor does it have direct access to people making complaints, witnesses or officers involved in the cases.
The report depicts a confrontational working environment where intimidation, threats, yelling and cursing are routine.
Past and present board members who were interviewed for the report told the grand jury that internal affairs investigators would argue, lecture and sometimes bully board members leaning toward dissenting on cases. One person told the grand jury that if a member continued to disagree, that person was then branded as anti-police.
The report also found that internal affairs personnel are routinely allowed to attend closed session meetings in which the board's findings are debated and rendered.
This practice may have started as early as 1993, when the board recommended allowing internal affairs investigators into a meeting to familiarize themselves with the process, according to a memo uncovered by the grand jury. It is now customary, the report states.
Wile the legality of allowing nonmembers in closed sessions may be argued, the report says the state Attorney General's Office takes the position it generally should not happen.
Judith Litzenberger, an attorney who witnessed proceedings as a prospective member and then was appointed to the board, said Tuesday that she wrote a memo to the board in 2010 raising many of the grand jury's same concerns. She said the leadership decided not to address the issues then. In turn, she said, she was not reappointed, which rarely occurs.
"People who dissented on cases were the ones who received the biggest bullying," Litzenberger recalled. "Those folks were definitely treated differently than other board members. They were kept from leadership, and that became the issue how leadership became one-sided and immune from any accountability."
Jim Kaese, the review board's acting chairman, said before the start of the panel's monthly meeting Tuesday that the main reason prospective members drop out is because of the amount of work and time involved — not intimidation.
Kaese, editor of a travel website and a former trial lawyer, also questioned the thoroughness of the grand jury's investigation.
"This is supposed to be an objective finding of fact to make helpful recommendations. Making accusations not grounded in fact is a disservice to them, the Citizens' Review Board and the citizens of San Diego," he said. "We have a lot of good people who do a lot of good work. That said, there's always room for improvement."
But Litzenberger, who said she doesn't "think our cops are bad" and voted with them "90 percent of the time," lauded the grand jury for spotlighting the criticisms of the review board.
"I'm happy the citizens of San Diego have the opportunity to improve their process," she said.
By law, Mayor Jerry Sanders and City Attorney Jan Goldsmith must respond to the grand jury's report in writing within 90 days.
Grand jury recommendations
To improve San Diego's Citizens' Review Board, the county grand jury recommends the mayor:
• Prohibit internal affairs investigators from attending the board's closed session meetings.
• Instruct the police chief to ensure internal affairs stops interfering with the case review process.
• Select an independent team to investigate current board leadership and determine if it should be changed.
• Establish an independent interview committee to choose future board members.
• Reduce term limits from eight to four consecutive years.
John F May 23, 2012 at 11:21 pm
CRB Response from press release:
The SDPD complaint process works and citizens should continue to use it. In just the last three CRB meetings there have been at least 13 sustained complaint allegations against SDPD officers. Over the years, the CRB has been instrumental in helping shape and modify police policy with very recent accomplishments of changing SDPD vehicle towing procedures—making it less likely for citizens to have their car towed during traffic citations and arrests—and influencing methods of counting money and property—establishing a more reliable and trustworthy process.
The CRB is proud that we have already begun taking action to address many of the issues raised by the Grand Jury on our own initiative, months prior to the issuance of this Report. A proactive, 4-hour, Saturday morning Special Meeting, addressed many similar issues and, more important, discussed solutions. Work on these issues—in addition to our 20+ hours of monthly case review efforts (all volunteer without pay)—continues in earnest on CRB bylaws, case review, meeting decorum, enhancing our diversity, as well as other important processes. As with any company or commission, improvements always can be made and the CRB welcomes legitimate criticism and logical solutions from all sources, including the Grand Jury.
However, our credibility and reputations called into question, the CRB cannot remain silent about a Grand Jury "investigation" that (1) is severely limited in scope, and (2) relies heavily upon accusatory conclusions not based in fact.
At no time was I asked to provide information to the Grand Jury, nor was the current CRB Chair, 2nd Vice Chair, nor past Chairs. I am not aware of any current CRB members (a total of 23) who appeared or were questioned. If the Grand Jury purports to conduct fair, impartial, and complete investigations, surely current members of a Board being investigated—at least a few—should be questioned, should they not?
Moreover, use of pejorative and conclusory terms such as "cronyism" and "prejudice" are significant accusations that deserve specific explanations and factual support. The Grand Jury fails to provide such detail. Without support based in fact, one would never allege that the San Diego County Grand Jury discriminates against women because 14 of its 19 members are men. Nor, without substantial facts, would one allege that the same Grand Jury is prejudiced against young people because 17 of its 19 members are retired workers.
Throughout the Report, other remarkable errors appear that demonstrate the Grand Jury's misunderstanding of the CRB, its membership, and processes. To specify a few: A lack of time is the primary reason for member turnover not intimidation; a new committee was proactively formed 4+ years ago to broaden membership diversity; CRB teams often disagree with Internal Affairs during case review; the committee interviewing CRB applicants does not consist of only CRB members; and, probationary status has been applied to CRB members who violate conduct codes.
JMW May 25, 2012 at 8:56 am
John F., if you don't mind …
What time span is covered by your last three meetings? At least 13 sustained complaints? What were they? What disciplinary measures were recommended and what recommendations were carried out? Any?
"… methods of counting money and property …" What does that mean? Would that be when police take possession of a citizen's money and/or goods?
"… a more reliable and trustworthy process…" Meaning the previous process was unreliable and untrustworthy?
Towed cars? 20+ hours a month?
"… decorum, enhancing our diversity, … other important processes." These phrases repeat statements which appear in the original post.
"… limited in scope, and … not based in fact." Those criticisms are addressed by the following two paragraphs?
"… new committee formed 4+ years ago …" Hardly new. Diversity again? Seems like an ongoing problem. Do you have an opinion on why that is?
What can you do? What is outside the scope of your board?
Carl June 18, 2012 at 11:03 am
Jim Kaese, why aren't you addressing the real issues here? People don't care about towing procedures or money counting processes. They are concerned about the police being inside the board meetings. Surely you can understand that the mere presence of law enforcement intimidates people, no matter how the officer acts.
We are also concerned that this board has no subpoena power, no power to investigate or indict officers. We are concerned that no officer has been fired or had criminal charges brought against them as a result of the board's findings.
We are concerned because we know, no police dept. is that perfect.
Even as you tout 13 procedural objections to IA findings, it remains clear that most of the cases you review have the same result as IA especially cases involving serious crimes like sexual abuse or murder. IA provides you with all of the information to review. How can you conclude anything other than small procedural missteps without the ability to independently vary IA's story?
In the infamous case of Demetrius Dubose two witnesses on the street were inexplicably ruled 'non-credible' and their testimonies were deemed inadmissible. However, they both later appeared on a HBO special and said they heard the officers use racial slurs against Demetrius.
Now compare that to the testimonies of passengers in a van traveling on the opposite side of the street at approximately 30 mph. They were deemed credible and admissible. This police cover-up underscores the need for an independent investigative subpoena-powered board. That is the ONLY way to root out police crime.
The point of this board is not for board members to pat themselves on the back and offer a bunch of gobbledygook about policy and procedure.
The point is to serve the interests of the citizens of San Diego who have been victimized by police brutality. The point of the board is to serve as advocates for the citizens of San Diego who make claims of assault and criminal behavior against police officers.
The cozy collusion between the CRB and IA has to end immediately for the sake of the victims of police crime in San Diego.
Marisa June 25, 2012 at 8:07 pm
1992 eh? right around the time the SDPD started killing us with impunity.
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Protest at the Citizens Review Board – Tierrasanta Branch Library, Tuesday, June 26th
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ORDER OF THE CIVIL SERVICE TRIBUNAL
(First Chamber)
(Civil service – Officials – Enforcement of a judgment – Reimbursement of costs – Administration's intention to deduct from the official's invalidity pension – No act adversely affecting the official – Action for damages – Manifest inadmissibility)
Application: brought under Articles 236 EC and 152 EA, in which Mr Marcuccio essentially seeks annulment of the Commission's note of 28 March 2008 informing him of its intention to make a deduction from his invalidity pension in order to obtain payment of the costs incurred in earlier proceedings.
Held: The action is dismissed as manifestly inadmissible. The applicant is ordered to bear the costs.
Officials – Actions – Act adversely affecting an official – Concept – Note from the administration informing the official concerned of its intention to make a deduction from his invalidity pension – Not included
(Staff Regulations, Arts 90 and 91)
A note from the administration informing an official of its intention to make a deduction from his invalidity pension, if he does not apply to the Community courts for taxation of costs which he was ordered to pay in an earlier case, does not constitute the adoption of a definitive position by the administration and may not be regarded as having directly and immediately affected his interests by bringing about a distinct change in his legal position.
(see paras 21, 24)


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(settings) | Login RSC Home > Formula 1 > GP Germany 1975
Event: Grosser Pries von Deutschland Date: 3.8.1975
Track: Nürburgring Nordschleife (Germany), 22.835 kms Organiser: AvD
GP Germany
Formula 1 World Championship (round 11)
Weather: warm, dry and bright
Grid: unknown
Distance: 14 laps
Attendance: 300000
Qualified: 25
Classified: 9
Photo GalleryEntered CarsTechnical DataAppearanceRace ResultsGridQualifyingLap Times
Overall: 7 Brabham BT44B Ford Carlos Reutemann
Fastest Laps:
Overall: 11 Ferrari 312 T Clay Regazzoni (CH) 7:06.400
Pole Positions:
Overall: 12 Ferrari 312 T Niki Lauda (A) 6:58.600
Notes of interest:
Top makes by numbers: March (4), Brabham (2), Ferrari (2), Shadow (2), Hill (2), Hesketh (2), Tyrrell (2), McLaren (2), Lotus (2)
Top engines by numbers: Ford (22), Ferrari (2)
Top car types by numbers: March 751 (4), Brabham BT44 (2), Ferrari 312 T (2), Shadow DN5 (2), Hill GH1 (2), Hesketh 308 (2), Tyrrell 007 (2), McLaren M23 (2), Lotus 72 (2)
Driver nationalities: GB (4), BR (3), F (3), D (2), USA (2), A (2), I (2)
Team nationalities: GB (17), USA (4), I (2)
Most used colours: white (42%), red (17%), black (14%), blue (10%), gold (5%), silver (4%)
Engine positions: mid-engined (100%)
Average engine size: 2993 cc
Oldest known drivers: Mark Donohue (38), Vittorio Brambilla (38), Clay Regazzoni (36)
Youngest known drivers: Tony Brise (23), Hans-Joachim Stuck (24), Jody Scheckter (25)
Woman drivers: Lella Lombardi
Official Race Programme:


The electrical system of a residential home has the most rules and codes out of any other system. Rightfully so, electricity is inherently dangerous, especially to folks who are unfamiliar or lack proper training in working with electricity. In this two month series of articles we will talk about the most common defects that we find during home inspections, break it down in to simple terms and talk a little bit about how easy most of these are fixed.
Electrical service. This section deals with the power as it enters the home. There are two types, overhead and underground service entrances. Overhead entrances are typically found on older homes and as such, we typically find more problems with these services. Most are age related and simply need updates. The common items we find are poor penetrations where the service enters the home (typically through the roof), we all know that electricity and water don't go together well and if not dealt with promptly can create a shock hazard and also deteriorate other components of the electric system. The other item we often find is deteriorated wiring or sheathing. This is due to age, as the materials wear from inclement weather and sunlight they break down and will need repairs. The good news is this usually a simple repair from an electrician and can typically be completed for less than $800.
Distribution wiring- This section deals with power as it travels around the home via the wiring system. Often times there are joints in the system known as splices or connections, and these connections are required to be made in what is called a junction box. Often times we find these connections just out in the open without a box, or the box is there and is missing the cover plate. These two items are the most common defects we find, and are something we call out in report as needed repairs. These wires normally have power running through them, and if not protected by a box and cover plate can pose a shock hazard. Another easy fix on these items, depending on the number of occurrences you can expect an electrician to charge $100-$200 for repair.


Bed bugs are not known to carry disease. They aren't even considered a pest by many government bodies. Many people would consider them harmless, but I doubt anyone who has had them would be inclined to agree. When you're dealing with a bed bug infestation, you may lose countless hours of sleep over the stress of waking up to bites every morning. You need a way to stop bed bugs from reaching you while you sleep, and bed bug traps are one of the most effective ways to do that.
If you suspect bed bugs are in your home, but you don't know for sure, you should confirm an infestation before starting a treatment. You wouldn't want to spend the time and money trying to treat the wrong thing, right? Bed bug traps are a great way to help detect an infestation in your home, and can help you gauge their population and likely hiding places.
Elevate your bed by placing ClimbUp Insect Interceptors under each leg of the frame. Since bed bugs can't jump or fly, they have to crawl to reach you. With the proper interceptors in place, any bed bugs that try to climb up the legs of your bed will fall into the trap's pitfall, and won't be able to climb back up its talcum-lined walls. If you have bed bugs in your home, you should see some in your traps within the first couple of nights. Check your bed bug traps daily to monitor their population.
If you're waking up every morning with what you know are bed bug bites, you probably want to stop the biting for good. Achieving that isn't as simple as spraying where you think the bugs are coming from. Bed bugs are very good hiders; you likely can't reach every spot they've nested in with a single spray product. Your best option is to cut off access to their food supply: you.
Begin by removing your sheets, blankets, and pillowcases; seal those in garbage bags and take them directly to the washing machine. While your bedding is being washed and dried on high heat settings (if possible), give your mattress and box spring a thorough vacuuming to remove bed bugs and their eggs from the seams and cracks that they like to hang out in. Before you put your bed back together, seal your mattress (and preferably your box spring and pillows as well) in certified bed bug-proof encasements. With your bed freshly cleaned and sealed in encasements, bed bugs that were already present in your bed will either have been killed instantly or trapped inside the encasements to starve.
To keep bed bugs from reaching your bed from elsewhere in your home, you'll want to place bed bug traps under each leg of your bed frame. This will keep the bugs from climbing up the frame and reaching you. While these steps aren't enough to eliminate all bed bug activity in your home, at least you'll be able to sleep peacefully while you work on a more thorough treatment.
Bed bug traps are useful for more than just home defense. Since bed bugs are so commonly found in hotels and other high-traffic places, it's essential to take steps to protect yourself while on the go.
Bed bugs find their next meal by following the carbon dioxide trail we emit by breathing. Pheromone traps, like the Bed Bug Alert by Bird-X, can trick bed bugs and lure them into a sticky glue. Place these traps on the box spring under your hotel bed's mattress, glossy side up. Put one near the head of the bed, and another near the foot.
For additional travel protection, keep the contents of your luggage in sealed luggage liners and heat-treat your belongings with a portable bed bug heater after your trip.


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More info on Channel 7
Halopedia
Channel 7: Map
Channel 7 may refer to:
Channel 7 , the musician previously known as 7 Aurelius.
Seven Network, an Australian television network,
Channel 7 Television, an independent local station in North and North East Lincolnshire, England.
Channel 7 , a television station in Thailand.
Mind Shear Software, A now defunct small US-based personal computer game developer.
DZBB-TV , the flagship television station of GMA Network in Metro Manila, Philippines.
IBN-7, A Hindi television news channel operated by Global Broadcast News.
Tropical Vision Limited, a Belize news channel.
Canal 7 Argentina, the offitial Argentine TV station
Channel 7 - Mendoza, an Argentine TV station
Channel 7 - Bahía Blanca, another Argentine TV station
Channel 7 - Santiago del Estero, yet another Argentine TV station
Various (mostly ABC-owned) US TV stations broadcasting on 174-180 MHz VHF using the Circle 7 logo
Arutz Sheva, an Israeli news outlet
TV7 can refer to various television-related organizations:
Trans 7, an Indonesian television station formerly known as TV7
TV7 , a Swedish television channel
Taivas TV7, a Finnish Christian television channel
TV7 Bulgaria, a Bulgarian television channel
TV7 Bordeaux, a television channel in Bordeaux, France
channel 7 roxChannel 7 or TV7 may also refer to: