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Drägerheft Dräger Review 384.1 100.1 Navy A hospital on the high seas Gas Detection Laboratory in a tube Gestures Das TheMagazin Magazine für for Technik Technology in der in Medizin Medicine Februar June 2010 Touch-free device operation Back to Life The fine art of trauma surgery E01_Cover385_M 1 26.05.2010 7:05:03 Uhr It's a Riddle! Quality is a matter of details, and at Dräger you'll find top quality in every product – including the roughly 250 gas detection tubes. But how many different gases can they identify? You'll find some hints starting on page 16. 1. 250+ 2. About 500 3. Over 1,500 Send us the correct answer via e-mail to [email protected] or on a postcard to our editorial address (you'll find it on page 22), and you may win two of a total of 50 ballpoint pens modeled on Dräger gas detection tubes. The deadline for entries is July 31, 2010. Winners will be notified in writing, so please indicate your name and address. Prizes cannot be paid in cash. Dräger employees are not entitled to participate. Participants hereby waive all legal rights to enforce any award. E02_Rätselhaft_M 2 26.05.2010 12:53:33 Uhr C o n t en t s 26 special containers e x pe r ie n C e 4 people Who perform Training for air rescue operations in germany; screening for drug users in Spain. 14 poWer Fo Cu s 8 routine surprises Trauma surgery often involves life-and-death struggles, critical injuries, and extreme time pressure. neWs 6 news from the World of Dräger A new emergency ambulance for preterm infants. An italian hospital with a long tradition chooses SmartPilot view. Dräger review in german, english, and Spanish. 14 Hospital on the High seas From an ectopic pregnancy to third-degree burns – naval physicians have to be ready for anything. insig H t E03_Inhalt_M 3 ConCentration o u t lo o k 20 Headshaking in the operating room gesture-based systems for controlling technical devices reach hospitals. serv i Ce r ep o r t 16 Where gases show their Colors Dräger tubes analyze invisible dangers. Dräger review 100.1 | June 2010 20 K ARL STORZ MI-RepORT speeD DPA/PiCTure-ALLiAnCe 8 unFALLKrAnKenhAuS BerLin COver PhOTOgrAPh: Kevin CurTiS/SPL/AgenTur FOCuS house the naval hospital on the task Force support ship Frankfurt am Main. read more starting on page 14. 22 Where and Who? Dräger worldwide; publishing information. Close - u p 24 High-frequency ejector The Babylog vn500 makes it possible to utilize a broad range of therapies for premature babies. One important component is the expiratory valve. 3 26.05.2010 12:54:34 Uhr E x PER iEn CE PeO PL e w h O Pe rfO rM What Moves Us – Dräger Worldwide Marco Monnig, specialist nurse and paramedic at the ADAC Air Rescue division, Munich / Germany ing tool made of wood, is in hangelar near bonn. it's constructed as an exact replica of its flying counterparts: perfusors, monitors, an Oxylog 3000, and little space. The SimMan, our patient, is true-to-life. he can actualize bodily functions, be auscultated and ventilated. it's also vitally important to be able to plan ahead under stress. anyone here who is trained in air rescue knows: "i can't just pull over and stop on the shoulder of the road if something hasn't been correctly thought through." Once in the air, we already need to have an overview of what we're doing. Does 'ChristophSim' really work? Time and again we knock on his side door to say: 'welcome to the hospital. you've landed' – that's how gripping the simulation is." PhOTOgraPhy: hanS rOSariuS, azuL MarinO ; TexT: SiLke uMbaCh, MerTen wOrThMann "it's a good feeling when you see the child is alive – and watch it leave the hospital with its parents! i have experienced heart-pounding responses for newborn babies a number of times, and it has affected me. a rapid treatment, at the right moment, means the difference between life and death. if it works, the patient is rescued. That's our objective! There's little room for error. The right equipment and knowledge need to be deployed at the right place. Our tool is the helicopter. but a tool is only as good as the hands that guide it. and to insure that they're the best, we provide intensive training. My colleagues have come here from all over to be trained. and we train to act as a team – the seamless coordination of all involved is crucial on board. 'ChristophSim,' our train- 4 E04-05_Erfahrung_M 4 Dräger review 100.1 | June 2010 26.05.2010 7:06:30 Uhr Fr "u ply tak ou op bo tha Ma so bou now an og an PhOTOgrAPhy: hAnS rOSAriuS, AzuL MArinO ; TexT: SiLke uMBACh, MerTen wOrThMAnn nynd ctly ew ain 've Francisco Javier Rodríguez-Madridejos Jiménez, Police Chief of Seseña, Castilla-La Mancha / Spain "until two years ago we had no equipment for doing drug tests. we simply had to let suspects go, and it was really frustrating not to be able to take any action. it's true that we always caught drunken drivers during our traffic checks, but the issue of drivers on drugs was left completely open. That ate away at my professional pride: we were sending time bombs on wheels back out onto the streets. Things just couldn't go on that way. Our community, Seseña, is located in the north of Castilla-La Mancha and has less than 20,000 inhabitants. Madrid is not far away, so we have a lot of through traffic. Two years ago i initiated the project 'no drugs at the wheel!'. we bought a reliable mobile drugs of abuse detection system from Dräger – and now we can finally conduct comprehensive and effective drug screening. The results have been amazing: Sometimes we catch eight drivers on drugs for every one drunken driver. But drug users' attitudes are slowly changing. when we confront them with the test results, they're astonished and incredulous. They no longer have any excuses. Many of them then tell us about their worries and problems, and we listen to them with a psychologist's sensitivity in order to find out what factors are influencing their condition. Mostly these are people of a certain age, about 40, and the drug is mostly cocaine. A 20-year-old who smokes marijuana reacts differently. in 97 percent of the cases, these people pay the fine immediately. we also have the feeling that they realize how efficient the police force is and that they have a bad conscience because of their consumption of illegal substances." 010 E04-05_Erfahrung_M 5 26.05.2010 12:54:55 Uhr D-5195-2010 BJörn STeiger STiFTung News For challenging assignments: the HPs 3100. In Abraham's bosom: Quiet and gentle transportation for babies. sm Dräger HPs 3100 Universal Helmet A New emergency Ambulance for Preterm Infants Ita s The Dräger HPS 3100 multifunctional universal helmet is ideal for challenging assignments in the field, such as forest fires, traffic accidents or mountain rescue missions. it combines optimal protective functions, thanks to the integrated polystyrol inner shell, and is very comfortable as a result of features such as the four-point harness and padding throughout the entire head area. An adjustment wheel lets the helmet fit individual head sizes. The ventilation system ensures a comfortable temperature and humidity level inside the helmet, even during long periods of forest firefighting. A metal lattice keeps out large debris particles, and the ventilation system can be closed with a simple slide control to protect the wearer from smoke or extinguishing water. The modern design and structure of the HPS 3100 make it a combination of an industrial safety helmet according to en 397 and a mountaineer helmet according to en 12492. The entire inner suspension ring and the neck curtain are padded. A comprehensive range of accessories, including an electric visor, optimizes the helmet for a multitude of special applications. The market launch is planned for the third quarter of 2010. About 700,000 babies are born in germany every year. Some 30,000 of them have to be transferred from children's and maternity hospitals to special clinics, either because they are preterm infants or because a child with a normal birth develops life-threatening complications. Transporting these babies calls for specially equipped emergency ambulances, and the Björn Steiger Foundation has been developing them since 1974. The latest model is scheduled to be inaugurated in the second half of the year. "neonatologists are already calling it a quantum leap," says Melanie Storch, who works at the foundation. it cost about one million euros to develop the prototype, and the foundation intends to finance 100 of these ambulances by 2014 at a unit price of about 200,000 euros. The centerpiece of the emergency ambulance for babies is the crosswise transport incubator. "in newborn babies the fontanelles in the skull have not yet closed," Storch explains. "That's why the babies have to lie crosswise to the direction of movement so they won't be affected by the acceleration and deceleration during the drive." However, this kind of crosswise transport is not possible in conventional ambulances. in addition, the newly developed model is equipped with an innovative active damping system that significantly reduces shocks and vibrations. An electric motor and pneumatic springs are capable of cushioning even the impact of ten-centimeter-deep potholes. Dräger will provide almost all of the vehicle's medical technology equipment. This includes the transport incubator system, which was developed in cooperation with neonatologists, nurses, and midwives, as well as an international team of medical technicians. The central gas supply equipment, respirators, and monitoring systems also come from Dräger. in addition, acoustics specialists at the Dräger test center are working on the sound insulation inside the emergency ambulance for babies. Th beg wh sou res rec pow aS the the sm of Do Os sys by 6 E06-07_Nachrichten_M 6 Dräger review 100.1 | June 2010 26.05.2010 7:08:19 Uhr ane fro ane All for gra (se Drä se es, e exy ind ntly t as al- 010 MT-5469-2008 BJÖRN STEIGER STIF TUNG Dräger Review in German, English, and Spanish SmartPilot View provides an overview. Customer-friendly: the Dräger website. Italy: First SmartPilot View A Dräger Website for 48 Countries The history of the Ospedale Maggiore began in 1351. Today the 638-bed hospital, which is located about 50 kilometers southeast of Milan, serves about 150,000 residents in the surrounding region. It recently acquired two new Zeus Infinity Empowered anesthesia systems – including a SmartPilot View. "That makes this hospital the first one worldwide that can monitor the anesthesia stage with the help of our smart display," says Emilio Car-mignotto of the Dräger sales team. Dr. Agostino Dossena, Director of Anesthesia at the Ospedale Maggiore, chose the anesthesia systems first, and was then impressed by the sophisticated monitoring technology. The SmartPilot View supports the anesthesiologist in the operating room from the initial administration of the anesthesia all the way to the wake-up phase. All of the important data – including a forecast of the course of the anesthesia – is graphically depicted on a large display. (see also Dräger Review 97.1, p. 18f.) The slogan "One Dräger – One Voice" now also applies to the Internet. Thanks to a recent innovation, the company's website now automatically registers the country from which it is being accessed and then redirects the user to the corresponding local website. This feature now applies to 48 countries and 29 languages. All of the websites offer general information about the company as well as information and fascinating 360° views of Dräger products, videos, and product demonstrations. Visitors can find out more about the company and its product range by clicking on links such as "Products & Services," "Careers," "Investor Relations," "Press Center." You can find an overview of the contents of Dräger Review in the "About Dräger" section. www.draeger.com DRÄGER REVIEW 100.1 | JUNE 2010 E06-07_Nachrichten_Mxx.indd 7 Ever since its first issue in the summer of 1912, Dräger Review has informed its readers about the company's technological products and their applications. The first issue in English, which was published in 1959, featured the use of compressedair breathing equipment in the mining industry and firefighting. This issue of the magazine is the 385th published in German and the 100th published in English. "This is our demonstration that we speak our customers' language, not just metaphorically but also literally," says Burkard Dillig with a smile. Dillig, who is currently Dräger's press spokesman, was responsible for Dräger Review for over 20 years until the end of 2007. In this, its 99th year, the magazine is launching an additional edition in Spanish, which is soon to be followed by one in French. By taking these steps, the company is responding to the growing significance of the markets where these global languages are spoken. "We feel the same way about Dräger Review as we do about our products," says Stefan Dräger, CEO of Drägerwerk Verwaltungs AG. "Everything we produce should provide our customers with maximum utility." Since the end of 2008, the new design has been accompanied by technical information and local reports that are appreciated by many readers. Today, three issues of Dräger Review in two versions – one for each corporate division – are published annually. It has a total circulation of over 80,000 copies. Marine haus auf Kranken er See hoh Drä D Drägerheft Review räggeer Rrheveiew t efDräger ft Drägerh 384.1 385.1 ssen r 100.1 Gase me or im Roh 384.1 Das Lab Gesten Navy A hospital on the high seas Gas Detection Laboratory in a tube h ern durc Geräte steuBewegung Das The Magazine für for Technik Technology in der in Medizin Medicine Februar JuneLa 2010 0Magazin Das revis Juni 201 ruar Magtaazin de Feb Medizin izin der in Med nik innikder für Tech für Tech Magazin Magazin Das Das 1.1 Gestures 384.1 Touch-free device operation la fürtecn Tech olog nikíainen dermed Med icina izin Juni Feboruar de 2010 Medición de Un laborato gases rio en pequeño tubo de un vidrio La Hospital Marina en alta mar Cic Un innovado lo respirato rio r método lizar la ventilaci para visuaón del pulm ón De vu ZurückbeBack to Life a la elta n ins Le The fine art of La pr vida Kunst trauma surgery de ecisión en el ar la cirugía Die hohe lchirurgie te de traum der Unfal a 7 27.05.2010 9:31:51 Uhr Fo cu s T r aum a s urge ry Routine surprises every medical specialty has its own particular challenges. in tRauma suRgeRy several elements come together: the life-and-death struggle, critical and diverse injuries, and extreme time pressure. D sta sur run ken for 14tal of Th bee fer ver to g say ch ful yet ru for spa ins cav PhoTograPhy: unfallkrankenhaus Berlin a touching down: the crew of the "christoph Berlin" critical care transport helicopter from unfallkrankenhaus Berlin has landed. 8 E08-13_Notfallmedizin_M 8 Dräger review 100.1 | June 2010 26.05.2010 7:10:16 Uhr Th ab car on an pa wit res an to Drä PhoTogrAPhy: unfAllkrAnkenhAus Berlin unfallkrankenhaus berlin D r. Gerrit Matthes has just gone off duty following a grueling 20-hour shift. However, under the circumstances he still appears wide awake and surprisingly fresh. A trauma surgeon, he runs the emergency room at Unfallkrankenhaus Berlin (ukb) and has just performed two emergency surgeries. First, a 14-year-old boy was brought to the hospital, which is located in the eastern section of Berlin, by his father during the night. The ambitious young soccer player had been tackled hard by an opponent and suffered a broken lower leg. "He was in severe pain, and that alone is reason enough to go ahead and operate during the night," says Matthes. The senior physician had to choose the treatment method very carefully. That's because bone growth is not yet completed at age 14 and can be disrupted by a fracture. Dr. Matthes opted for a method developed by Prevot. To spare the bone's growth plates, Matthes inserted elastic nails into the marrow cavity of the shin via a small incision in the skin. No cast is required following the procedure. After a few months he will remove the nails, once again via a small incision in the skin. After treating the boy, the doctor and his team operated on an 80-year-old woman who had fallen during the night and fractured her thigh near the hip joint. a finger on the pulse of time It's all just another night, as far as Matthes is concerned. And despite the length of the shift he has just performed, the dedicated trauma surgeon remains enthusiastic about his specialty area and his hospital. "Sure, the workload is very heavy here, but that gives us a great opportunity to improve things. Medicine is an experience-driven science, and we see a very large number of cases in a very short period of time," he says. Unfallkrankenhaus Berlin was designed and built to focus on accidents and emergencies, and according to Matthes it offers ideal conditions for trauma PhoTogrAPhy: unfAllkrAnkenhAus Berlin a flying intensive care unit d. The "Christoph Berlin" ensures that patients in rural regions are also able to take advantage of the city's high-tech medicine. The Bell 412 critical care transport helicopter stationed at the unfallkrankenhaus Berlin is on call 24 hours a day and is crewed by two pilots, an emergency physician, and a paramedic. The helicopter can, for example, carry an infarction patient together with an intra-aortic balloon pump, which it can supply with electricity. it can now even transport heart-lung systems. As a result, the "Christoph Berlin" not only flies to accident sites in Berlin and Brandenburg, but also transports patients from smaller hospitals to specialized medical centers. 010 Dräger review 100.1 | June 2010 E08-13_Notfallmedizin_M 9 IN bRIeF Doctors and nursing staff face extraordinary challenges at a trauma center – not just professional challenges but physical and mental ones as well. The need for quick action according to algorithms should not become an obstacle to new methods. it's also important to institutionalize this flexibility and have a viable business concept. surgeons. "The cooperation here is extremely smooth. We have the latest equipment and work more or less with a finger on the pulse of time." State-of-the-art equipment and team spirit help ukb live up to its high expectations. The trauma center is considered one of the most modern in Europe. From hangar to operating room The ultramodern character of the place is immediately obvious on the roof, where a red-and-white wind sock waves atop the four-story building of light brown bricks. This is where the rescue and critical care transport helicopter "Christoph Berlin" lands and is then immediately transported on rails into a glass-enclosed, temperature-controlled hangar. In emergency medicine, even short distances can mean the difference between life and death. For this reason, an elevator leads directly from the hangar to the centerpiece of the trauma center: the trauma room for the seriously injured. Directly adjacent is the massive apparatus of a 64-line spiral CT, one of the hospital's technological highlights. The patient's entire body > 9 26.05.2010 7:10:25 Uhr An MRI machine with a magnetic field strength of three teslas shows the beating heart A world without germs A second elevator leads from the helipad on the roof to a second trauma room designed especially for burn victims. It is the gateway to a germ-free world maintained at a constant temperature of 40 degrees Celsius. In the event of severe burns, the patient is first placed into a large tub where the burned skin is scrubbed away from the patient's body using steel brushes. Even deep burns cov- ering more than 80 percent of the body surface have already been successfully treated at ukb. In case such as this, synthetic skin is cultivated in a ukb laboratory if the amount of the patient's own remaining skin is insufficient. The distances between the emergency room and the operating rooms, the cardiac catheter laboratory, and the intensive care unit are also short. In contrast, a largely glass-covered passageway through the hospital encourages visitors to stroll. Walking between the lush plants and the brightly colored African art, one could almost forget that right next door teams supported by high-tech medicine are deeply engaged in their work. Completed in 1997, the building is flooded with light and radiates an air of serenity. It's misleading to believe that every patient who arrives at the trauma center, which is a member of the Association of BG Clinics (VBGK), does so accompanied by flashing blue lights or by helicopter. "Approximately 60 percent of our patients check themselves in," says Matthias Witt, who is the Director of Pa- The critical hour The narrow time interval between an accident and life-saving measures is referred to as the "golden hour of shock." "it is always underestimated, because the clock starts ticking immediately after the accident, long before emergency personnel arrive," warns trauma surgeon Dr. gerrit Matthes. Although deploying a helicopter at a cost of 1,143 euros per trip is significantly more expensive in Berlin than deploying an emergency physician's vehicle (700 euros), it can prove to be more cost-effective in the end. "under certain circumstances, a few minutes of acute care can save many days in the intensive care unit," says emergency physician Dr. Jörg Beneker. 10 E08-13_Notfallmedizin_M 10 tient Care. Sometimes the accident that brings them here has happened several days previously. In principle, the hospital, which comprises a total of 17 clinics, centers, institutes, and departments and has more than 500 beds, accepts every patient. What is noteworthy, however, is the hospital's policy of never refusing to accept patients who require intensive care. So far the hospital has managed to live up to its commitment, although some adjustments have been necessary since it opened. "We originally expected 15,000 patients a year. Last year it was more than 51,000," says Witt, who was involved in the planning of the hospital. Other countries, other traumas In the meantime, many other countries are interested in the ukb's expertise. Witt has just returned from a consulting trip to Brazil, where some facilities are also specializing in trauma medicine. "There's no air rescue service there, and the streets are often in poor condition," reports Witt. The types of trauma encountered vary greatly from region to region. In rural areas, surgeons often treat cuts suffered by farm workers. In the city, on the other hand, they are confronted with a large number of head injuries, in part because Brazilians often ride their motorcycles without helmets. "The technical equipment there is completely different than it is here, but everyone has national health insurance that pays in full for all services," adds Witt. Up to now the situation in the U.S., where ukb also maintains partnerships, has been very different. A trauma cen- > PhoTogrAPhy: unfAllkrAnkenhAus Berlin > can be scanned within minutes here. After a serious accident, the whole-body scan helps the doctors recognize which injury is truly life-threatening and must be treated first. This morning, several doctors are standing in the radiology viewing room next door looking at the monitors. Displayed on one monitor is the detailed image of a beating heart recorded at a magnetic field strength of three teslas. The image has been made using the most powerful MRI machine at the hospital. Another shows a high-contrast image of the spinal cord of a woman who suddenly can no longer move her legs. Dräger review 100.1 | June 2010 26.05.2010 7:10:33 Uhr Sh Drä T r aum a surge ry Fo c u s ies se. ng are ne. nd n," unon. uts on ith art mocal ent nal all S., ps, en- > 010 PhoTograPhy: unfallkrankenhaus Berlin hat ral pics, nd pahe acre. up ade it 00 an in short distances, fast help: An elevator goes from the helicopter directly to the trauma room. Dräger review 100.1 | June 2010 E08-13_Notfallmedizin_M 11 11 26.05.2010 10:26:48 Uhr Despite all the routine, procedures must be constantly questioned > ter like the one in Berlin would be completely unprofitable because many people have no health insurance. However, in an emergency they must be provided with at least a minimum of care free of charge. It remains to be seen just how the U.S. healthcare reform will affect this sector. Emergency medicine is also structured differently in the U.S. than it is in Germany. "They don't have a head physician system there; instead, specialists from the various departments work together on an equal footing," explains Prof. Dr. Michael Wich, Deputy Director of the Casualty Surgery and Orthopedics Clinic. "The emergency room doctors do only the bare minimum. The specialized departments are often decoupled from emergency treatment. It's a situation that can lead to problems." PhotograPhy: unfallkrankenhaus Berlin, Picture-alliance Fluctuation is wanted Always ready: The acute medicine departments at Unfallkrankenhaus Berlin are fully networked. Dräger supplies them with equipment including such items as medical ventilators and anesthesia workstations, monitoring and IT solutions, and ceiling supply units. The Dräger Infinity M540, for example, is used to continuously monitor the patient's vital signs, while the Dräger Infinity C700 for IT workstation analyzes and integrates real-time information with additional clinical data. 12 E08-13_Notfallmedizin_M 12 In Berlin, those responsible for the hospital are determined to continuously attract new, young people who have visions. "We don't just want to be one of the most modern trauma centers in Europe, we want to stay that way too," says the Director of Patient Care. A certain fluctuation is therefore desirable. Nurses who have been with the hospital for longer than four or five years have to spend a few weeks each year working in another ward in order to maintain their versatility. Existing procedures, such as those for choosing the best position for patients, should be periodically questioned. The ukb also collaborates with innovative partners in industry, such as Dräger, so that it will be able to live up Dräger review 100.1 | June 2010 26.05.2010 7:10:59 Uhr to fut tin wh Em to str mu ria im con lea wh tif sta sav the "Yo we Ma lish qu scr pe you you pro is h ten sit ish an wa ac ag sta ha tre Drä Fo c u s PHOTOgraPHy: unFallkrankenHaus Berlin T r aum a surge ry mple an at ge. .S. or. ed eran he an ael urerinare atto inas up to its own high expectations in the near future as well. Matthes also tries to continuously optimize relevant procedures while providing care in the trauma room. Emergency physicians work according to algorithms: prescribed treatment instructions outlining which measures must be performed under which criteria in which sequence. "Algorithms are important, but they are also a very static construct," he says. At the moment, Matthes and his colleagues would like to critically question when the whole-body scan is truly justified. Although the method is an outstanding diagnostic tool and has already saved numerous lives, it also subjects the patients to a high radiation dosage. "You can't administer radiation as if you were using a watering can," points out Matthes. The doctors at ukb, who also publish scientific articles, may occasionally question their procedures. However, prescribed decision-making paths are indispensable in an acute emergency. "When you're working, you have your mind on your algorithms; you're focusing on one problem and you don't think too much," is how Dr. Michael Metzner, another attending physician at ukb, describes the situation. It is only after his work is finished that he sometimes falls into a chair and notices how exhausted he is. This was the case with one of the most serious accidents he can remember. A middleaged man fell under unknown circumstances from the 11th floor. "The patient had serious injuries to the head, all extremities, in all body cavities, and to the 010 Dräger review 100.1 | June 2010 osatns. ost we Dituho ger da her tilfor ts, E08-13_Notfallmedizin_M 13 pelvis. He was deeply comatose, and his relatives wouldn't have been able to recognize him," reports Dr. Metzner. The pelvic fracture by itself was life-threatening due to the vast blood loss." The man survived thanks to the intensive efforts of a large team. Patient exercise brings success However, it isn't enough to simply repair all of the wounds following a serious injury. A lot of patience and a lot of exercise are required before a person regains control over his or her body and can return to work. Many people with spinal cord injuries must learn to cope with life in a wheelchair. This is why trauma centers in Germany, which are sponsored by the employers' liability insurance associations, also include many facilities for rehabilitation activities, including a modern gymnasium and a swimming pool. "Everyone in Germany has a right to good medical care, but when I'm deciding on what measures are appropriate I also always have the patient's age, occupation, and individual expectations in the back of my mind," says Matthes. As far as he is concerned, thorough aftercare is a key element of statutory personal accident insurance. After all, this is what makes it possible for patients to remain in outpatient care even after they have been discharged. And that, in turn, means he can support them for a longer period of time. Dr. Birgit herden Further information online, including: Product information www.draeger.com/385/emergency "The primacy of trauma surgery" ProF. Dr. meD. michael Wich, Deputy Director of the Casualty surgery and Orthopedics Clinic at unfallkrankenhaus Berlin, on the advantages of specialized emergency medicine What advantages does the ukb possess when it comes to caring for the critically injured? The primacy of trauma surgery is crucial. everything is oriented toward the needs of the injured patient. if an experienced trauma surgeon feels that an operation is necessary at 3 a.m., his or her decision is accepted with no questions asked. how do you finance the high level of care that is required? roughly 25 percent of our cases are paid for by a statutory accident insurance company rather than a health insurance company because they involve work-related accidents. Payment in these cases is not according to the german social insurance Code (sgB) v, but rather sgB vii. whereas the health insurance companies pay for "necessary care," occupational accidents are treated "with all suitable means." That's an important difference. You also strive to always accommodate the emergency dispatch center's needs. how do you manage? The limiting factor is always the number of ventilator beds in the intensive care unit. we can increase this number by using our fully equipped intermediate care unit. 13 26.05.2010 7:11:08 Uhr R ep oR t n av y Hospital on the High Seas Bumps, bruises, and third-degree burns – just like their colleagues on dry land, naval pHySicianS have to be ready for anything. T he patient – a crew member – was suffering from a high fever, shivering, and an intense headache. His mouth was dry as dust, his muscles aching. As if that weren't enough, he also had diarrhea and nausea – both much more pronounced than would have been the case for a normal dose of influenza. Ship's doctor Dr. Axel Haber was in- formed, and found he had his first suspected case of swine flu to report. The case occurred last year, the symptoms of the disease first presenting themselves three days after the frigate Sachsen had cast off from the port of Halifax in Canada. Due to the danger of a global pandemic, Haber and his colleagues had to take strict precautions: The sailor was quar- antined and all the crew members were treated with the influenza drug Tamiflu. "Fortunately, we were at sea for so long that by the time we entered Liverpool on the other side of the Atlantic, the patient was already cured and the other crew members were beyond the incubation period. So, we were sure that the none of the other sailors would be infected," Haber recalls. Hi Sh hu mo an lar po liv po pe spe me cla po ab pa PhotograPhy: DPa/Picture-alliance the task Force Support Ship Frankfurt am Main, a Berlin-class supply vessel, cruises the world's oceans. eq Th tio 26 30 de gra dia ati ray un me "If ha bu kn of cr Th ter to do Drä E14-15_Marine_M 14 Dräger review 385.1 | May 2010 26.05.2010 7:11:44 Uhr D-11055-2010 D-11054-2010 D-11053-2010 it looks almost like a regular hospital below deck, if a little cramped. Dr. axel Haber (right) has access to a fully equipped operating room (left) and can also consult land-based specialists via satellite communications. PhotograPhy: DPa/Picture-alliance ere lu. hat he was ers we ors His workplace, the Task Force Support Ship Frankfurt am Main, is a doublehulled steel colossus with a length of almost 174 meters, a beam of 24 meters, and a draft of 7.4 meters – making it the largest craft in the German Navy. It is powered by two diesel engines that deliver a combined output of 14,500 horsepower (5.28 megawatts each) and propel the 20,000-ton vessel to a maximum speed of 20 knots (approximately 37 kilometers per hour). The job of these Berlinclass vessels is to provide logistical support to German naval units on missions abroad – including provisions, fuel, spare parts, and also medical care. For the latter purpose, the vessel is equipped with a mobile naval hospital. This consists of fixed onboard installations as well as a two-story assembly of 26 special shipping containers – 20 and 30 feet in length – mounted on the upper deck. The containers, which are painted gray, contain a variety of treatment and diagnostic facilities, including two operating rooms, an intensive care unit, an Xray unit, various labs, and even a dental unit. They can accommodate up to three medical teams working at the same time. "If we don't have a dentist on board, I'll handle the drill myself," says the Hamburg-born Haber, whose general medical knowledge must encompass a number of disciplines. cruise liners are different The kinds of cases that Haber encounters can range from bumps and bruises to crush injuries caused by bulkhead doors – all the vessel's cabins are pressur- Dräger review 100.1 | june 2010 010 E14-15_Marine_M 15 ized – to severe burns, resuscitations, and even, on one occasion, an ectopic pregnancy on the part of a female sailor. "As a rule, medical emergencies on naval vessels generally involve trauma, while those on other vessels such as cruise ships tend to involve internal complaints," Haber explains. There are, however, some basic similarities. In both cases, the ship's doctor is responsible for all aspects of the patient's wellbeing – as used to be the case with all doctors, before specialization fragmented the medical profession on land. For example, they treat even small wounds right up until the healing process is completed. The advantage of treating patients onboard ship is that they can't disappear. "I can take a close look at my patients every day," says Haber. And should there be anything out of the ordinary, he's already on the spot to take direct action. At most, a call to the bridge is required, and then the distance to the patient is no further than in a normal hospital ward. Support from specialists on land Every vessel in the German Navy has its own ship's doctor. The sick bay team on a frigate, for example, can comprise up to five people: a ship's doctor, an assistant ship's doctor, two medical NCOs, and an enlisted man. On a task force support ship, there are eight more crew members, including two medical technicians. Should this prove insufficient, onboard medical teams can also request support from doctors in Germany – via the German navy's own Medical Institute. "We have a workstation on board from which we can send diagnoses, Xrays, ultrasound images, and video sequences from anywhere in the world back to Germany for consultation with specialists," says Haber. And how would he deal with a case of psychosis? Haber explains that this has been known to occur and that it is one of the few reasons for removing a sailor from the ship, for example if a patient threatens to jump overboard. The crucial thing is to recognize any psychological changes on the part of personnel as early as possible. For difficult cases, there is also a military chaplain available. Things don't usually get to that stage, though. "After we've been on board for a few weeks, I often know the sailors so well that I'm able to judge how resilient they are," says the ship's doctor. One factor that makes this possible is the relatively small crew on board – around 200 sailors compared to the 4,000 or so stationed in a garrison. If need be, the doctor can provide individual care for every sailor on board. Haber has just gotten to know a new crew. In January, the Frankfurt am Main left its home port of Kiel in northern Germany for a five-month voyage to South Africa as part of a naval task force and training unit. During the course of this voyage, more than 200 cadets will complete onboard training. It is the trainee officers' second voyage, following a sailing course last fall on board the training ship Gorch Fock. Haber himself has obviously been to sea many more times than that. Five years from now, his 17 years of naval service will come to an end. Björn Wölke 15 26.05.2010 12:56:22 Uhr W Dr co is W bre tio ute ess of cau gas low sul am fle sel od wh sur Ar A d ab an am ver Wi "S rou gas he com fid the an qu po E16-19_Roehrchen_M 16 D-11060-2010 Who can identify the various gases by their colors? dräger tubes for approximately 500 gases contain indicators that change color if a specific gas is present. cip bo ap 26.05.2010 12:56:58 Uhr Drä P o r ta b l e g a s De t ec t i oN Ins I g h t Where gases show their Colors W ith its first cry, a newborn baby crosses the threshold into life as a separate being and begins breathing. Oxygen is vital in this situation. Being without it for just a few minutes can be critical. What's more, it is essential that humans inhale this elixir of life in an uncontaminated form, because they have no defense against toxic gases. If the gases have a strong odor at low concentrations – as is the case with sulfur compounds (mercaptanes, for example) – the people affected can at least flee. But not every hazard announces itself. Carbon monoxide, for example, is odorless. Once leaked, gas is soon everywhere. The laws of thermodynamics ensure that it spreads. Around 250 types of tubes D-11060-2010 A detection system must respond reliably to a variety of gases, identify them, and measure their concentration in the ambient air. "Dräger tubes come in a diverse spectrum of varieties," says Bernd Wittfoth, who heads this unit at Dräger. "Some of the hottest sellers among our roughly 250 types of tubes for up to 500 gases are tubes for the offshore industry," he adds. "These are important when it comes to the detection of hydrogen sulfide." Wittfoth is also quick to point out the advantages offered by a fast-acting analysis technology used on site that requires no electricity and thus does not pose a spark hazard. Measurement itself is easy. In principle, the user opens the glass tube at both ends using a device that looks like a pencil sharpener and places it in the Dräger review 100.1 | JUNe 2010 E16-19_Roehrchen_M 17 manually operated "accuro" hand pump. The hand pump pulls a precisely metered amount of ambient air through the tube. If a particular gas is present in the air, it reacts with the indicator in the tube. This chemical reaction results in an easily visible change in color. The amount of this gas in the air in ppm – parts per million, in other words, milliliters per cubic meter, for example – can then be read off of a graduated scale on the tube. This colorimetric method was patented in the U.S. in 1919. Since Dräger presented its first tube for the detection of carbon monoxide using this technique in 1937, the company has helped to protect people by providing millions and millions of Dräger tubes. Today, in order to ensure the appropriate quality, these tubes are produced in Lübeck, Germany, in a technologically advanced and fully automated manufacturing operation. But how do these nondescript glass tubes measuring some 125 millimeters in length and around seven millimeters in diameter actually work? At the center of the tubes is roughly two grams of a granular substrate that contains the chemical indicator. "The carrier substance," explains Wittfoth, "comprises grains with a diameter of between 0.2 and 1.2 millimeters. Their exact size is a function of their intended application." A total of 12 different carrier materials are used. "We are all familiar with the silica gel from the little bags that are often included as a drying agent with electronic equipment," continues Wittfoth. This material is porous and therefore holds larger amounts of an indicator substance. However, if smaller D-11061-2010 Dräger tubes are a classic instrument when it comes to analyzing gases and determining their concentrations. metICulous produCtIon is required to ensure the high reliability of these tools – which is why Dräger has been producing them in-house for over 70 years. In charge of tube production: Bernd Witt foth amounts of indicator are sufficient to signal the presence of certain gases, smaller grains of glass are used as the carrier material. These grains are produced in the required grain size and purity from broken pieces of quartz glass in an in-house glass mill. "We are a batch plant and produce custom batches on an order-by-order basis," explains Wittfoth. This keeps inventories low and the product reactive. "The tubes have a chemical shelf life of 24 months from the date of delivery," says Wittfoth, adding that random samples are taken from the batch and tested periodically during the shelf life period. Continuous tests In parallel, chemical technicians have been mixing the indicator according to a formula. Some 400 basic substances are available for composing the reagent system. "Each batch is custom mixed. Even the humidity can trigger undesired reactions. A formula therefore can't really be repeated 100 percent," says Wittfoth. This is why up to 70 complete tubes are > 17 26.05.2010 12:57:11 Uhr A crystal-clear process provides the basis for the reliable detection of gases D-11062-2010 D-11063-2010 > pro are spe tio na gra ind be thi ced Some of the roughly 250 types of tubes still require that some things be done by hand (left). The test on the right is fully automated. Only a machine can tap against the tubes 2,000 times with consistent precision and a force that is four times stronger than that of gravity. tio bo gro ica can sic mo "w be be the ha thi im be tub can 18 Drä E16-19_Roehrchen_M 18 D-11065-2010 D-11064-2010 Finally, the heat of the gas burner first makes the open end of the glass tube soft before it is melted closed (left). The mini-vacuum this produces is part of the process, which is checked and documented every step of the way. gla the tor rob us tan gen me is c tio the Dräger review 100.1 | JUNe 2010 26.05.2010 7:12:54 Uhr D-11063-2010 P o r ta b l e g a s De t ec t i oN D-11065-2010 y. 010 > produced for preliminary testing. These are used to check compliance with the specification immediately upon completion of the preparation. Once the combination of carrier substance (silica gel or grains of glass) and indicator have been individually matched, the material must be processed within the next six weeks. If this condition isn't fulfilled, the test procedure begins all over again. The Dräger tube reagent preparation is stored in 20-liter conical-shoulder bottles that are hermetically sealed with ground glass stoppers. Just as the chemical properties of the materials involved can be very different, so too can the physical properties. "Some materials are almost as sticky as honey," says Wittfoth, "while others are so dry that they can become electrostatically charged while being filled into the tubes and adhere to the glass walls. At least that's what would happen if we didn't specifically dissipate this static electricity." This is particularly important when various substances must be layered one after another in a glass tube. Altogether, as many as eight layers can be involved. The tubes themselves are made of glass, whose type varies according to the intended use. High-quality laboratory glass grades such as Duran or "Durobax" borosilicate glass are frequently used if extraordinary chemical resistance is required. The tubes, which are generally provided with one end already melted closed, resemble a pipette that is closed at the bottom. After an inspection aimed at detecting possible defects, the tubes are loaded into a filling ma- Dräger review 100.1 | JUNe 2010 E16-19_Roehrchen_M 19 chine that took three years to design. The machine first places a small ceramic disk into the tube. This disk is three millimeters thick and contains up to eleven holes – each measuring 0.2 millimeters in diameter – through which the air can later pass. "That serves as our zero point for filling," explains Wittfoth. This ceramic disk also ensures that the material does not pour out if the tube is opened properly. The materials can now be added in a defined sequence and defined quantities. Each individual tube stars in a video of the filling process, which a video camera transmits to a control monitor. The analysis system is initially sealed using a layer of glass fabric that has been cut out from a strip of the material and has the shape of a circle. Something referred to rather floridly yet nevertheless appropriately as the "tulip" ensures that the grains are firmly secured. The tulip is likewise a circular blank that has been stamped from stainless steel wire mesh. It has a mesh size of 0.2 millimeters that has been formed into the shape of a tulip by means of a spine. The resulting folds generate the tension that results in the hold. tapped 2,000 times Does it really hold? The answer is provided by a box that taps the tube 2,000 times with a force that is four times stronger than that of gravity. Nothing is permitted to shift unduly in the box. And only homeopathic quantities of the "substrate grains" at most are permitted to fall through the holes in the ceramic disk. This quality-assurance measure can only be performed after the tube has been au- Ins I g h t tomatically sealed, of course. The open end of the tube is first passed by a number of smaller gas flames, which not only make the glass soft, but also heat the air to the point that a mini-vacuum is established when the tube cools down after having been melted closed. The tubes, which are still hot, are collected in a wooden crate (plastic would melt, and the glass would shatter upon contact with metal). A custom calibration scale is prepared for each batch produced. This is done by taking samples during production, testing the tubes with a variety of defined gas concentrations, and using these values to generate a batch-specific calibration curve. Even the aging of the tubes is simulated to ensure that they achieve the targeted chemical shelf life. The scale is printed on the sticky side of an adhesive film, which is wrapped around the tube. This arrangement also provides mechanical protection. "The scale must not only be accurate; the concentration of the detected gas in the ambient air in ppm, for example, must also be easily legible," explains Wittfoth. Under certain circumstances, pretubes are required to first break down the gas to be measured so that it can be analyzed. Dräger is particularly proud of its equipment's ability to detect relatively stable compounds such as sulfuryl fluoride – a process that requires the air to be heated to roughly 900 °C in a pretube. How is this done without electricity? The trick is to use a chemical compound that releases energy when it reacts with the air. Isn't chemistry smelly by nature? "You don't smell anything around here unless we are working with a lot of butyric acid," says Wittfoth, wrinkling his nose. Isn't it dangerous to test tubes that detect toxic gases? "No, it isn't. That's because the people who work in this field do so in accordance with the strictest of safety regulations and have the necessary qualifications." The expert doubts that electronic systems will replace the Dräger tubes any time soon. "After all, the tubes are reliable, inexpensive, fast, and require no electricity." nils schiffhauer 19 26.05.2010 7:13:03 Uhr PhotograPhy: KarL StorZ Mi-rePort Re He ch tec wi ers spa Th era ha pu age exe Shaping the future: Gesture-based control of devices in the operating room is still a dream of the future, but it's already being intensively researched. Headshaking in the Operating Room experts are researching how the CONTACTLESS CONTROL of technical devices can be utilized – in the kitchen, in train stations or in the operating room. what they found out will surprise you. I n the Western world, a brief nod generally signals agreement. Shaking the head signals the opposite. Wrinkling the nose expresses disapproval; a smile, on the other hand, great affinity. No touching and no listening are required – just looking is enough. There is no more efficient way for people to com- 20 E20-22_Interaktion_M 20 municate with one another. But how well do gestures and facial expressions translate to the computer world? Many cellular phones and laptop computers today have long moved beyond just the mouse or keyboard for operation. Touchscreens, with which users issue their commands via finger pressure di- rectly on the screen, have been around for many years. Multitouch technology even allows the use of multiple fingers at the same time. This intuitive, gesture-based method of operation shortens the learning curve and lets users get down to work right away. Man-machine interaction is still far from being contactless, however. Dräger review 100.1 | June 2010 26.05.2010 7:13:23 Uhr Fr HH ea wo an co bo sti op ind on bo ed de me wh ho you cel cu tal tec tac wi sel Drä g est u re-ba se D Con t rol PhotograPhy: Karl storZ Mi-rePort Researchers at the Fraunhofer Heinrich Hertz Institute (HHI) in Berlin hope to change that. They have developed a 3D technology called "iPoint," which works without a data glove or electronic markers on the fingers and can also translate spatial gestures into digital commands. The system comprises two infrared cameras that track the movements of the hand and communicate them to a computer. The computer translates the images, interprets them, and immediately executes them as commands. for en he ed rnork is er. 010 From the kitchen... HHI researchers were in Hanover in early March of this year for CeBIT, the world's largest computer trade show, and demonstrated a scenario in which cooks were able to read a digital cookbook on a media wall, regardless of how sticky their fingers happened to be. To open the book, they used their extended index finger to move the mouse pointer onto an icon. They paged through the book by swiping contactlessly past the edges. They extended a fist to start the desired video and returned to the main menu by spreading all five fingers. And why not use gestures to turn on the range hood or the stove, play music and check your electricity consumption? A German celebrity chef has already equipped his culinary studio in the town of Guldental in the Pfalz region with the iPoint technology. Beside the hygienic aspects, the contactless operation promises advantages with respect to the safety of the device itself. "This technology allows information Dräger review 100.1 | June 2010 E20-22_Interaktion_M 21 systems to be operated even if the screens are behind glass or mounted three meters above the ground," says Wolf-D. Konrad, who is responsible for developing new business areas at the HHI. "This would also them against vandalism in airports or train stations, for example." ... to the operating room The advantages of this technology in the operating room are likewise as plain as the hand in front of your face. After all, the boundaries between sterile and nonsterile areas must not be violated through tactile contact when staff members are adjusting medical devices or navigating through patient information system. Disinfecting control elements such as computer mice or touchscreens is very timeconsuming and in some cases impossible because the chemicals used destroy the electronics. Other approaches have their own weaknesses. Placing touchscreens inside transparent disposable covers reduces the image quality and adds to the expense. And placing assistants in the non-sterile area so that they can perform these actions on call harbors a high risk of errors, particularly in the case of complex commands. The same applies to the direct voice control of the computers. The background noises in the operating room are often simply too loud. So what does a contactless, yet reliable and accepted form of human-machine interaction in the operating room look like? And how can proven technologies be carried over to this environment? This essentially requires two steps: Navigate to the desired menu item and then > O u t lO O k Hospital-caused illness More people die from hospital germs than from the immunodeficiency disease aiDs. it is estimated that as many as one million germans a year contract an illness while they are being treated in a hospital. experts assume that between 170,000 and 250,000 of these nosocomial infections could be prevented if doctors and nursing staff would follow hygiene rules correctly and avoid typical transmission paths. infections due to the Mrsa bacterium are a source of great concern to medical personnel. the letters sa stand for the pathogen "staphylococcus aureus" and the prefix "Mr" means "methicillin resistant." this means that the antibiotic methicillin no longer helps against the sa pathogen. in practice, the abbreviation has long ago ceased to refer to just this one individual case. Many pathogens are already immune to multiple antibiotics, and there is the risk that someday no antibiotic will be able to help. by avoiding contact with medical devices that may be contaminated, iPoint technology can prevent the spread of Mrsa and thus enhance patient safety. 21 26.05.2010 7:13:30 Uhr Ou t lOOk gest ure-ba s e D Co n t ro l the reliability of gesturebased control is being successfully researched HEADQuARtERS: Dräger Medical AG & Co. kG Moislinger Allee 53–55 23558 lübeck , Germany www.draeger.com > execute the command with a mouse click. HHI researchers have provided two different ways of clicking in the contactless space: first, by holding the finger steady in space for a certain period of time, and second, by moving the finger in the direction of the screen. "These two methods were compared in the test and studied more closely in order to determine their advantages and disadvantages," says test director Paul Chojecki as he explains the results. "What we found was that, contrary to our initial hypothesis, the time-based solution is easier to learn and was preferred by the majority of the test subjects." Chojecki warns against overvaluing these results, however, because the alternatives tested represented only a fraction of all the contactless control options. But one can learn a lot from him and his colleagues. They distrusted their own hypotheses and kept a sharp eye on the users' fingers from early on. Realworld feedback is essential for translating novel technologies into commercial success. Frank Grünberg 22 E20-22_Interaktion_M 22 REGION ASIA / PACIFIC Draeger Medical South East Asia Pte. Ltd. 25 International Business Park # 04-27/29 German Centre Singapore 609916 Tel +65 6572 4388 Fax +65 6572 4399 [email protected] REGION EuROPE SOutH Dräger Médical S.A.S. Parc de Haute Technologie d'Antony 2 25, rue Georges Besse 92182 Antony Cedex Tel +33 1 46 11 56 00 Fax +33 1 40 96 97 20 [email protected] REGION NORtH AMERICA Draeger Medical, Inc 3135 Quarry Road Telford, PA 18969-1042, USA Tel +1 215 721 5400 Toll-free +1 800 437 2437 Fax +1 215 723 5935 [email protected] 90 66 601 REGION MIDDlE EASt, AFRICA, CENtRAl AND SOutH AMERICA Dräger Medical AG & Co. KG Dubai Healthcare City P.O. Box 505108 Dubai, United Arab Emirates Tel +971 436 24 762 Fax +971 436 24 761 PublISHING INFORMAtION © FraunhoFer heinriCh-hertz inst tut A sensor registers the up-and-down movements of hands and fingers. REGION EuROPE CENtRAl AND EuROPE NORtH Dräger Medical AG & AG Co. KG Moislinger Allee 53–55 23558 Lübeck, Germany Tel +49 451 882 0 Fax +49 451 882 2080 [email protected] Publisher: Drägerwerk ag & Co. Kgaa, Corporate Communications Editorial Address: Moislinger allee 53–55, 23542 lübeck, germany / [email protected], www.draeger.com Editor in Chief: björn wölke, tel. +49 451 882 20 09, Fax +49 451 882 39 44 Publishing House: tellus Publishing gMbh Editorial Consultant: nils schiffhauer (responsible according to press law) Art Direction, Design, and Picture Editing: redaktion 4 gmbh, hamburg translation: transForm gmbh, Cologne Printing: Dräger + wullenwever print+media ISSN 1869-7275 The articles in Dräger Review provide information on products and their possible applications in general. They do not constitute any guarantee that a product has specific properties or is suitable for any specific purpose. All specialist personnel are required to make use exclusively of the skills they have acquired through their education and training and through practical experience. The views, opinions, and statements expressed by the persons named in the texts as well as by the external authors of the articles do not necessarily correspond to those of Drägerwerk AG & Co. KGaA. Such views, opinions, and statements are solely the opinions of the respective person. Not all of the products named in this magazine are available worldwide. Equipment packages can vary from country to country. We reserve the right to make changes to products. The current information is available from your Dräger representative. © Drägerwerk AG & Co. KGaA, 2010. All rights reserved. This publication may not be reproduced, stored in a data system, or transmitted in any form or using any method whether electronic or mechanical, by means of photocopying, recording, or any other technique in whole or in part without the prior permission of Drägerwerk AG & Co. KGaA. Dräger review 100.1 | June 2010 27.05.2010 16:51:02 Uhr PDF-1674_AD-Drägerheft_PrimusIE_EN_219x279:Layout 1 05.05.10 11:56 Seite 1 Welcome to the next level Anesthesia workstation – Primus® IE The Dräger Primus Infinity Empowered is much more than just a high-performance anesthesia workstation. Built to work seamlessly with the Dräger Infinity Acute Care System™, the Primus IE lets you take advantage of Drägers latest monitoring and anesthesia information system solutions as well as hospital information system technology. With the Primus Infinity Empowered, comprehensive data integration directly at the point of care is a reality. PDF1674 FOR FURTHER INFORMATION: WWW.DRAEGER.COM 29180_U3_D_ES_ENG_Medizin.indd 3 26.05.2010 7:15:48 Uhr CLOSE - UP V E N T IL AT IO N 6 4 8 3 7 2 4 5 1 D-11058-2010 9 A High-frequency Ejector Delivers Top Performance The Babylog VN500 ventilator was specially designed for premature babies and offers powerful high-frequency oscillation in addition to conventional ventilation. An important component of the ventilator is the expiratory valve, through which the patient exhales. The Infinity ID antenna module 1 transmits data from an Infinity ID hose system through the angled connector 2 to the ventilator, where the data are processed. Up to 18 liters of compressed gas at a pressure of a maximum of 2 bars is propelled into the ejector 3 each minute through two channels 4 measuring only 0.65 millimeters in width. The ejector itself is made of nickel silver, where the gas is fed into connector 5 . A lower pres- EU4_385_M 24 sure, resulting from the ejection supports the "active expiration" of the patient, which is controlled via the silicone membrane 6 . The silicone membrane has a soft flat surface enabling a leak-free seal with minimal back pressure. A monocrystalline nickel disc vulcanized onto the back side ensures that it is perfectly flat. The check membrane 7 prevents pendular breathing in the event of a possible failure of the device. The muffler 8 uses turbulence to reduce noise. The potential condensation is collected in the water trap 9 . The entire assembly can be cleaned manually or processed in an autoclave at 134 degrees Celsius. 26.05.2010 7:14:45 Uhr
© Copyright 2019


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Hello :) I'm back from my accidental blogging break. Here's where the last few weeks went...
Robyn came to visit for Halloween. And, yes, I do mean that Jane Fonda came to visit Zack and Kelly at Bayside...
We also went to Chomp and Stomp, which was my first time and is now one of my favorite things ATL's fall has to offer. (Bucket list #124)
And then it was sweet Sam's 25th birthday. We celebrated with friends and toasted him and the amazing man he is.
And, also, made a cooler out of a pumpkin. :)
And then, at work, I planned a conference for young professionals, which also meant meeting Bill Rancic. Who, I had no idea how dang cute he is!
And after that, Courtney and Ashley (&Max!) came into town so we could have a beach trip. But before we did that, we celebrated Sam's birthday again. And also took this slightly awkward family photo. Why does it look like we are claiming Sam? #thislandismyland
Then, we drove to the beach.
Then, Ash and I drove back to Atlanta, where she got to meet Chris and celebrate Sam's birthday a little more with lunch at Victory and froyo at the Yogurt Tap.
And now, back to normal life in Atlanta!
I spent the week catching up from the insanity of conference planning. And, tomorrow, Chris and I are heading to the mountains. But for now, this sweet little city town of Atlanta is where I am!
Happy almost weekend! :)

subset: commoncrawl


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SRK's popularity only grows with time. Connected to India's Raees contest had a phenomenal response with more than 126K fans engaging with it, over 106 sharing it, 6.7K 'Like and so on in just five days.
It was very exciting to have King Khan pick the three winners who will receive an autographed poster of his movie 'Raees' to hit the screen on January 25.


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My classes are energetic, demanding and detailed, decidedly focused on breath as rhythm and principles of alignment. While helping you progress from week to week, I will challenge you into discovering not only your hidden potential but also your personal approach yoga; heart, mind or body-oriented, it is your own yoga. I look forward to getting the best out of my students, and I demand them as much as I demand to my own self. But no fears, whether you haven't seen your toes in a while or are a super ninja-yogi(ni), I adjust my classes to varying levels of competency and give personalised feedback, everything in a light-hearted atmosphere, with a lot of humour and a tad of badass-ness.
If you love to sweat, come here! Flow through dynamic sequences of postures as you move with your breath. This class not only aims to strengthening and toning the muscles, but also challenges you to maintain a smooth and controlled breath. With some arm balances and inversions, Vinyasa class builds on your strength and stamina, whilst maintaining calmness in body and mind throughout the practice.
Yin explores the body's subtle energies with long, deep stretching that focuses on the connective tissues around joints, clears energetic blockages, enhances circulation, and cultivates a peaceful and meditative mind. Based on sitting or lying postures, this class concentrates on the area of the hips and sacrum, release stress and tension throughout the entire body, creating structural and mental balance.
Back to basics with this one, yet not less challenging. Understand and experience each posture in detail, in order to advance in your practice. This static practice of long hold asana, with a heavy focus on alignment and breath is a perfect conditioning to tone the muscles and awaken the body and the mind.
One of my favorites! Anusara means "flowing with grace". This Anusara inspired flow emphasizes a set of Universal Principles of Alignment which underlie all of the physical asanas and the philosophical aspects of the practice. This class is lighthearted and fun, yet challenging. With the intensity of vinyasa and accurate alignment work, this class will make you sweat while deepening the level of awareness on your practice.
PRIVATE CLASSES are a great way to deepen your practice in a sequence specially designed for you. You will enjoy unlimited asana adjustment throughout the entire class while addressing your individual and specific yoga needs. Benefit of faster improvement and progress than in a regular class.
For PRIVATE CLASSES you contact me HERE.
In order to secure your spot, please sign up online for every class HERE.
Please show up at least 10 minutes before class, so that you have time to get changed, have some tea and decompress. Classes start ON TIME.
All classes are taught in ENGLISH.
PACKAGES are very flexible, you get 6 months to go through them. If for any reason you couldn't get through all your classes within their validity period, you can take a new package and transfer your expired classes into that one. Packages are not refundable, transferable nor extendable.
You can purchase your SINGLES, PRIVATES and PACKAGES with me at the studio or you can do so directly at the ONLINE SHOP.
The Greatest Teachers
The Greatest Teachers
Right in the heart of Zürich, our 150m2 room has the best yoga material in town (JadeYoga mats, 3minute eggs, cork blocks, straps, Manduka blankets and bolsters), a bathroom with a shower, a kitchinette, warm tea, nuts, nature candies, and a lovely atmosphere for a max of 36 yoginis and yogis.


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From 2 hours to 30 hours of Visual Basic Programming instruction
using Chris Odom's Excellent Text:
"Basic-X and Robotics - The Art of Making Machines Think"
The Robodyssey Software Training System (RSTS)
For Basic-X Software and Mouse Robot
Robodyssey's 'Software Training System' uses a stimulating combination of classroom challenges and entertaining guided tutorials to teach children and young adults the basic concepts of programming logic that they will need to succeed in science, technology, engineering and math, or S.T.E.M. The Robodyssey Software Training System is flexible and can be tailored to accommodate a variety of age groups. Students will learn programming skills based on Microsoft's Visual Basic language while competing in non-destructive classroom challenges.
Program Features:
- Robodyssey provides experienced, energetic teachers.
- Robodyssey provides robots, laptops, software and hardware needed to complete the challenges.
- Robodyssey uses "real" university grade robots programmed in Visual Basic compiler.
- Students learn at their own pace with our "self-guided software tutorials".
- Students learn real world programming skills in Microsoft Visual Basic.
Student Activities:
- Understand Software: Learn the basics of a compiler and its operation
- Use Variables: Manipulate variables to control motion
- Control Motion: Use finite and infinite Loops to control motion
- Use Subroutines: Learn to use subroutines to create more complex movements
- Convert Analog to Digital: Convert analog data from sensors to digital data for programs
- Avoid Obstacles: Use real world data from sensors to make computer decisions
- Sense Heights: 'Teach' robots how to sense and react to height
- Construct Scanning Turret: Assemble and program robot 'eyes' that move
Some of our Non-Destructive Robot Competitions
Blind Bot's Bluff: 'Dead-Reckoning' Maze challenge - program robots to navigate a minefield of robot swallowing holes
Robot Dance: 'Dead-Reckoning' exercise where students manipulate variables to create a set of complex dance moves, and add light sensors to 'Dance in the Dark.'
Gripper Challenge: Challenge to pick and place objects on a maze, 'Dead Reckoning' (without sensors)
Desktop Challenge: Robots explore desktop using range-finding sensors to solve a maze of blocks scattered around an elevated tabletop and avoid falling.
Sumo Robots: Robots use downward-looking sensors to stay in the ring for 'Blind Sumo', and forward-looking sensors to refine Sumo robots.
Other Challenges: Measure and record changes in light, heat, pressure, sound, conductivity over time; make music, follow light, follow black line, make sound and light codes and light patterns, display AtoD out-put of data collected
Some of the Programming Terms used:
Debug.Print GetADC Delay Call If – Then
PulseOut Dim Do - While Cstr Do – Loop
For more information about this and other Robodyssey programs please visit our site at www.robodyssey.com. To speak with someone about scheduling a session please contact Robodyssey.
For Teachers:
Robodyssey offers: "Teacher Training for Programming Robots with BasicX"
This hands-on seminar is a great way to get an overview on how easy it is to teach computer science through robotics.Features include:
- Robodyssey robots and hardware.
- Robodyssey lap-top computers.
- We can accommodate up to 20 teachers at your location.
- Teachers learn how easy and fun it is to teach MicrosoftTM Visual BasicTM style programming using robotics.
We are also available for ninety minute group seminars on "Using Robotics to Teach Technology", and "Starting a Robotics Club in Your School". Of course, all the professional development training we provide can be counted towards the One Hundred Hour Teacher Training Requirement.
For Students:
Robodyssey also offers a variety of sessions ranging from two hours to two weeks on robot building and programming directly to your students or clubs. This program is ideal for after-school, summer camp and community opportunities.
Features include:
- We provide all the robots and hardware.
- We provide our own lap-top computers.
- We provide our own instructors.
- We use "real" university grade robots.
- Students learn at their own pace with our "self-guided software tutorial".
- Students learn real world programming skills based on a MicrosoftTM Visual BasicTM style platform.
- Each educational unit ends with a classroom project based on a Non-destructive robot competition.
Goals and objectives:
- Students learn basic skills in mechanics, assembly and physics.
- Students learn common programming syntaxes.
- Students will experience real world challenges involving analog to digital conversion and robotic navigation.
- Students get to have fun while learning good sportsmanship and teamwork.
Please contact Robodyssey directly for these special education programs.


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Shameless plug alert.
My company, Endagon Enterprises, is in the running for Startup Nation's Home Based 100 contest.
I would REALLY appreciate it if you all could jump to the link listed below and provide a vote for me.
If you are in a very helpful mood, you can even set your email address up to your vote so that it reminds you to vote daily.
If you do cast your vote, leave me a comment so that I can thank you and maybe send you a nice little gift of some sort.


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AMD's Alex Deucher has released the xf86-video-ati 6.12.2 driver this morning, not to be confused with the official Catalyst 9.4 proprietary driver that will come later this month. The open-source ATI driver update has a fair number of changes for this point release. In particular, the 6.12.2 release has lots of bug fixes and Textured Video / X-Video improvements. Additionally, there is mode-setting support for the ATI Radeon HD 4890 graphics card that was released late last month usng the ATI RV790 GPU.
The bug fixes vary throughout and include a Mac Mini connector fix, some DCE 3.2 fixes, an X-Video sync fix when in multi-head mode, R600/700-specific work, an AtomBIOS code clean-up, and a few driver improvements.
The release announcement with source download links and the change-log can be found on the X.Org mailing list.


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- Options
Item # QRQ0013Item # QRQ0013
Power to the people.
Over the last 10 years, Quarq has been all over the map with technologies, innovations, and compatibilities spread across multiple power meter generations. The new BB30 DZero Aluminum Power Meter Crank Arms span the breadth of these product cycles by combining almost every bit of technology Quarq has developed during that span into the latest generation of power meters, which it's calling DZero. The only omissions here are the use of alloy instead of SRAM's Exogram carbon and BB386EVO compatibility, which Quarq reserves for DZero power meters with Exogram carbon crank arms. Of course, the fact that this model features aluminum crank arms brings it more easily within reach of the self-sponsored cyclist—effectively giving power to the people.
Those omissions aside, the list of included technologies is an all-inclusive romp through Quarq's feature menu. Chief among these is the power meter itself, which saw a healthy amount of retooling. Overall, Quarq claims that "150 documented improvements" inform the evolution from the previous models to DZero, but the most important is to the heart of the meter itself: the strain gauges and measurement circuitry.
It still incorporates five strain gauges strategically placed throughout the spider in order to measure the Newton meters you're throwing into the pedals. It's also still got the same claimed accuracy of +/- 1.5%, so its numbers are 0.5% more accurate than most meters, but the new design requires less correction in order to maintain accuracy in drastic temperature changes. Fewer corrections mean the DZero also better rations battery life than Quarq's previous power meter models, though when the battery does go out, you can still change it without tools or having to ship the whole thing to the manufacturer.
DZero's accuracy is further boosted by the return of Quarq's 10k dynamic temperature compensation technology, which alleviates the need for constant, mid-race zeroings in variable conditions. Even if it's just coasting for a few seconds or toggling through your head unit to the proper option, it can still be the difference between winning and losing. It's also obnoxious as hell. The DZero is equipped with an auto-adjust schedule based on a constellation of around 10,000 data points that chart how the unit responds to temperatures ranging from zero to 130 degrees Fahrenheit. This lets the power meter figure out the atmospheric details for you with minimal drift, so you can focus on turning the crank, not babysitting it.
Power Balance and Omnical are two additional returning features that record total output and output for either leg individually (Power Balance) and let you swap rings without recalibrating or negatively impacting accuracy (Omnical). As with previous Quarq models, the Dzero communicates to your head unit via ANT+ wireless, but Quarq also adds Bluetooth to this generation. Up till now, we've always tempered the obligatory head unit-compatibility statement by writing that your current computer is likely already compatible with the power meter; now, we can just state outright that it is compatible.
We recognize that there is value in cycling components that can stand up to the elements we often encounter throughout the course of a year of training, but Quarq demonstrates its penchant for being overly thorough by ensuring that the unit's internals can handle comically extreme conditions. The system is waterproof for 30 minutes while submerged under one meter of water, a feature that will come in handy on days you take your bike on the swim leg, too.
As we mention above, the DZero is effectively a catch-all for almost every bit of tech Quarq has thrown at the power meter problem over the past decade. This includes the AxCad accelerometer, which provides cadence information without the need of an additional sensor or magnet. As with its material predecessors, the DZero is compatible with various training software such as Training Peaks WKO+, Training Peaks, Golden Cheetah, and Strava. Unlike previous versions, the DZero's Bluetooth compatibility lets it sync with the Qalvin BLE app to easily tune, tweak, and set zero offsets.
- The next generation of Quarq power meter technology
- Redesigned strain gauge system is even more precise
- Provides power for each leg individually
- Alloy crank arms bring power data to the self-sponsored cyclist
- Broadcasts via ANT+ and Bluetooth protocols
- Requires less correction for better data and longer battery life
- Easily swaps between frames and chainrings
- Battery can be changed without tools by home mechanics
View more Powermeter Cranksets - Road
Reviews & Community
Does this come with the spider? Is the strain gauge inside the spider?
I've owned or had experience with every power meter on the market and theres no beating the value, reliability, accuracy, or weight that Quarq offers.
Sure, there are cheaper single arm power meters, but all they do is double the power on the left side. If you pick one up without knowing of a possible leg imbalance (I personally have a 54:46 split because of a past injury), your power numbers may be 10% high or low, which negates their claimed 2% accuracy.
Quarqs also have a proven track record. Many of the newer companies out there have only had their product out for a few years, and many are on their second or even first versions of public release units. The DZero is the culmination of 10 years of technology at Quarq, and it is their third major release, fixing a few small issues that were present on the previous Elsa and Riken.
The DZero has a +/-1.5% accuracy which means you can trust your power numbers. I've used other power meters in the past which claim +/-2%, but all their numbers have always seemed at least 5% off from my Quarq numbers. The last thing you need when you are training is to not be confident in the data you have, it just takes away one more variable.
Heres some weights, verified on my scale:
110mm BCD NHB Spider - 122.0g
8 Retention Bolts - 7.8g
The DZero Aluminum is a great way to get in to power for a pretty reasonable price.
Feel free to reach out with any questions you may have!
Does it come with spacers


text: 1 2 Program Contacts: Brandy Eaton, BSN,RN Supervisor (216) 201-2001 ext. 1327 firstname.lastname@example.com Erin Lark Grant Coordinator (216) 201-2001 ext. 1326 firstname.lastname@example.com Personal Responsibility Education Program (PREP) for Foster Care and Adjudicated Youth The Cuyahoga County Board of Health is a local provider of PREP training, through funding awarded by the...Read More


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[Funeral Program for Christine Grant Pines, August 30, 2010]
Description: Funeral program for Christine Grant Pines, born February 28, 1924 and died August 20, 2010. The funeral was held August 30, 2010 at New Light Baptist Church, officiated by Rev. Dr. J.S. Smith. Funeral arrangements were made through Lewis Funeral Home and she was buried in Fort Sam Houston National Cemetery in San Antonio, Texas.
Date: August 30, 2010
Item Type: Refine your search to only Pamphlet
Partner: San Antonio Public Library


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(360) 734-3847 | (360) 336-8722
There are two courts in Monroe, the Snohomish District & Municipal Court
A DUI defense attorney in Monroe is required after you have been arrested for DUI. Driving under the influence of drugs or alcohol is a serious offense and one in which you must have an attorney's help. If you have been arrested for DUI, we are here to assist you during a this trying time. At the Law Firm of David N. Jolly, we will guide you through the DUI process and help obtain the best possible outcome for your case. At every stage of the DUI process, you will feel more secure and fare much better if you retain the service of a Monroe DUI defense lawyer. Don't wait until you've missed opportunities – call for a free consultation from one of our Snohomish County Criminal Defense Lawyers today.
2731 Wetmore Avenue, #401
Everett, WA 98201
Call David for a Free Consultation: (425) 493-1115
An arrest for DUI in Monroe can have serious consequences including jail time, high fines, license suspension, job loss, vehicle forfeiture, and many other harsh penalties. The Monroe DUI Attorneys at the Law Firm of David N. Jolly has helped hundreds of people who have been accused of DUI and would like to help you through this difficult process. While doing everything necessary to achieve a favorable outcome, your Monroe DUI attorneys and The Law Firm of David N. Jolly will keep you up-to-date with all progress made in your case. The Law Firm of David N. Jolly offers complete DUI defense, including working to save your driving privileges and fighting to have your charges reduced or dismissed. For a FREE initial consultation, so you can ask any questions you may have about your case, please call (425) 493-1115 today. A Monroe criminal case may be assigned to Snohomish County District Court Evergreen Division or Monroe Municipal Court, be sure and check your Summons. Our Snohomish County Monroe DUI attorneys would be more than happy to talk to you about your case.
As with all legal cases, there are important deadlines to meet. Enlisting the help of an attorney early in your case will benefit you. The legal system can be difficult to navigate, and without adequate knowledge of what penalties you may face in court, you may be charged harshly and unfairly. The Monroe DUI lawyers at the Law Firm of David N. Jolly wants to help you achieve the best possible outcome. He offers a FREE initial consultation, so you can ask any questions you may have about your case. Schedule this consultation by calling (425) 493-1115 today.
The Monroe DUI attorneys at the Law Firm of David N. Jolly have a winning record of defending clients against DUI in Washington. He will research the facts of your case and determine all relevant issues for building an effective defense. In addition to excellent legal guidance, you will be afforded personal service throughout the disposition of your case. After reviewing the details of your situation, Monroe DUI lawyer at the Law Firm of David N. Jolly will quote you a reasonable, set fee for a complete defense against the charge of DUI in Monroe, Washington. You will know what the total attorney fees are for your case, even if it goes to trial.
We are here to serve you. We are honored to be attorneys who work tirelessly and aggressively to represent you in the courtroom and the Department of Licensing hearing. We want to procure the best possible outcome for you. Contact us today to discuss your case and the options that are available to you. We believe in working with The Law Firm of David N. Jolly, you have chosen the best law firm and the best DUI defense attorney Snohomish County has to offer.
David N. Jolly has served as a State Prosecuting Attorney and Municipal Prosecuting Attorney, so he knows first-hand how the prosecution works and thinks. In addition, he's taken the same training courses police agencies require with respect to Field Sobriety Testing, so he recognizes not only the laws, but also the science used in DUI cases. Another factor to consider is that Monroe DUI attorney David Jolly has authored 20 DUI books, more than any other Washington DUI attorney.
806 W. Main Street
Monroe, WA 98272
Phone: 360-863-4548
Email: firstname.lastname@example.com
Offices: 2731 Wetmore Avenue, #401, Everett, WA 98201
Find out all the information you need to know about your Monroe DUI
(425) 493-1115
The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship. Further, if you are not a United States Citizens we strongly encourage consulting with an immigration attorney to determine how a criminal charge may affect your immigration status.
(360) 336-8722(360) 734-3847
(425) 493-1115
Law Firm of David N. Jolly. All Right Reserved.
Whatcom County: 218 W. Champion St., Bellingham, WA 98225
Skagit County: 410 Myrtle St., Mount Vernon, WA 98273
Snohomish County: 2731 Wetmore, #401, Everett, WA 98201


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This weekend I visited the Taj Mahal in Agra, India. It was a great experience. "The Taj" (as our guide kept calling it) is truly a Wonder of the World. Some random money related facts about the Taj Mahal:
- Taj Mahal actually means "crown palace" which is odd since it's a mausoleum.
- It is believed to have cost 35 million rupees to build the Taj Mahal. (That would be about 1 million US dollars.) Considering it was built back in the 1600s, that's pretty impressive.
- The Taj Mahal attracts from 2 to 4 million visitors annually.
- The current charge of admission is 500 rupees (around $13 USD) for non-Indians, and 20 rupees for Indians. Admission comes with a free bottle of water. They don't take US dollars anymore though.
It's hard to express how truly impressive this things is. Few things in this world really make an impact on me when I first lay eyes on them. Besides my children, over the past 10 years only the Grand Canyon and the Taj Mahal have truly blown me away upon first visual.
If you're ever close to the area I recommend taking the 4 hour drive from Delhi down to Agra. It's definitely worth the drive and price of admission.
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This year we are going to try companion planting. One of the benefits of companion planting is protection from pests and diseases when planting in the right combinations.
I have been studying the vegetable companion guide in Storey's Basic Country Skills (picture below), as well as various online resources.
To begin grouping the vegetables we want to plant, I got out all of our seed packs, sat down with them and began to pair items up following the chart, and removing items that were not preferred. Almost as if I was playing a card game. If I had an item that was not listed on the guide, I would check for references online.
After I used all my
cards seed packs, I began to make lists of the combinations, adding items I didn't have a seed pack for, and also any special notes of things to consider when we begin planting.
We ended up with six garden groups (shown below). This is our basic (tentative) grouping plan.
I am excited to get started, and anxious to see how well our gardening and groupings work out this season.
Do you garden using the companion planting method?
This post is linked at Saturday Sparks @ Pieced Pastimes


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My GF and my heart.
We decided we would go to Aruba during our anniversary(of dating), and decided on Passions on the Beach for Dinner.
So, the last month, i decided this was a great, once in a lifetime experience, and i decided to buy a ring.
So This past Sunday(june 19th), our 2nd anniversary, during our sunset Dinner at Passions, after finishing our entree, and deciding on desert, i got on one knee and asked my Girlfriend to marry me. She said yes.
So not only did we have a great 7 nights in Aruba, but i got engaged, and will always have a special bond for the island, i call Paradise.


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01 of 09
You recognize them in a flash—those 3" x 6" white tiles arranged in an offset running-bond pattern. The tiles were first used it in the early 1900s New York subway stations, where they proved to be an easy-to-clean, durable surface that reflected light well. Those same virtues quickly caused subway tiles to be used in residential housing, and more than a century later they still are among the most popular choices for tile installations.
While these tiles often are used in classic, heritage room designs, they can be surprisingly effective even in rooms with much more modern design aesthetics. The pages that follow will show you eight examples of modern kitchens and baths that make exciting use of that old-time standard, the classic subway tile.Continue to 2 of 9 below.
02 of 09
A Modern Classic Kitchen
This kitchen certainly attempts to recreate the design feeling of a turn-of-the-century kitchen, even though its modern functionality is quite clear. Have a look at the carefully chosen elements that create the feeling of an old-time kitchen with a very modern function.
- Note the" freestanding" cabinets. This is for appearance only, as you can clearly see the modern toe-kicks behind the false legs and is a detail aimed at creating the feeling of an early 20th-century kitchen.
- The white-on-white color scheme is straight out of turn-of-the-century aesthetics—a time when pure whites in a kitchen were thought to signify health and cleanliness.
- The double-hung window is somewhat rare in modern kitchens, but the choice here aims to create the look of an old-time kitchen.
Notice the signals that this is a very modern kitchen:
- Engineered stone kitchen countertops.
- A Bosch-type dishwasher with hidden controls, and a giant stainless steel vent hood over the stove.
Then there is that subway tile—it's everywhere. This is one of those installations where the backsplash becomes the wall itself. Classic subway tile with dark grout instantly brings classic, timeless, and traditional style.Continue to 3 of 9 below.
03 of 09
Modern Classic Bathroom
Part of the appeal of subway tile is its design simplicity and universal measurement ratios, where width to length ratio is a precise 1:2. The classic subway tile is 3" x 6", though other variations are also available in 2" x 4" or 4" x 8" sizes.
This example shows the classic bathroom subway tile: traditional white and paired with retro elements, such as the pedestal sink and octagon floor tile. It's like the bathroom version of the kitchen you saw previously. They could both be in the same house.
From South Cypress, this product is Dal Tile's Rittenhouse Square 3" x 6" with a 2" x 6" shelf rail.Continue to 4 of 9 below.
04 of 09
Subway Tile In a Tuscan-Style Kitchen
Although one might think that subway tile is best suited for traditional American styles, it actually can be quite effective in other styles. Here's an example, where classic subway style appears in a Tuscan-style kitchen.
It barely even looks "subway," with all of these other elements added: the grandiose terra-cotta medallion and vent hood with corbels. It is actually quite an elegant and functional design element when installed as a backsplash wall behind a very modern drop-in stovetop.Continue to 5 of 9 below.
05 of 09
Brightly Colored Tiles
Because white subway tiles are so common and expected, breaking expectations with unusual colors greatly livens up a kitchen. The classic dimensions of the tile still anchor the design by providing a traditional element in a kitchen that is otherwise excessively modern.
These colorful backsplash tiles are unusual—and welcoming. They play well with the four pendant lights, the double-tier breakfast bar with glass counter, and the retro-style stools.Continue to 6 of 9 below.
06 of 09
Subway Tile Turned on Its Head
Now we turn that classic subway tile on its end: in itself, this breaks expectations and makes for an exciting space, but this kitchen now adds two different colors arranged in alternating vertical stripes. These tiles are Architectural Gray and Almond, both are from South Cypress, manufactured by Daltile. Size: 3"x6".
This running bond pattern—also called a brickwork pattern—is one of the simplest tile patterns, in which the neighboring row advances half a tile length.Continue to 7 of 9 below.
07 of 09
Subway Tile for Contrast
The subway tile in question is American Olean Profiles 3"x6" and it's very much like the classic subway look of our first photo.
To give this bathroom some extra punch, it includes a strong array of black-and-white harlequin-patterned tile on the wall (American Olean Profiles 3" x 6", Gloss Black Harlequin) and Satinglo 1" hexagon tile on the floor. All are available through South Cypress.
To further exaggerate the contrast, a jet-black pedestal sink and bathtub are installed. Could any bathroom look more modern, even though the materials are completely retro?Continue to 8 of 9 below.
08 of 09
Subway Tile in Natural Stone
You'll be hard-pressed to find true marble subway tile—mainly because subway tile was never intended to be anything but ceramic. When originally installed in the New York subway system in 1904, these tiles were all about pure, brutal functionality. The builders wanted a vitreous, not porous, surface that could easily be cleaned of graffiti, dirt, and smoke. It also had to be cheap, and the rounded-off edges were nice, too.
In residential design applications, though, natural stone tiles in the same classic dimension ratios and installed in the classic running-bond, brickwork pattern provide an elegance that is unsurpassed. Here we have a 3" x 8" Calacatta Oro Marble tile from Bedrosian's—slightly more elongated than the classic 1:2 ratio of traditional subway tiles.Continue to 9 of 9 below.
09 of 09
Glass Subway Tile
The tile used in this shower is called Lush Vapor and it's from an online company, Modwalls, located near Santa Cruz, CA. It is not ceramic tile at all, but glass tile.
Tiles are official, regulation 3" x 6" subway-size, as NY Transit Authority intended. They come in sheets of eight attached to a mesh backing for a quicker install. If you like the running-bond brickwork pattern mentioned earlier in this gallery, Modwalls says just to peel off the tiles and install them individually.


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This was my cousins school and game PC, a replacement for a PS4 which he sold for this and because his home PC was utter ****, build went well for the hardware part itself but the software side was a far more complicated with firstly the BIOS starting to bring up random errors on startups a simple BIOS update fixed the issue of showing that the GPU was not present, after this issue was fixed we had a broken monitor which we did not know was broken until we did some rigorous testing. Getting a new one the final part of the puzzle was that we discovered the GTX 960 in the build being able to ejected as being a removable drive, weird right, well a simple search that had cost us hours of troubleshooting before pointed out that it was in fact a bug for the latest Maxwell GPU's which caused this and was later patched out about the 18th of February 2016.
Anyway, the system runs quietly and plays any game at 1080p ultra pushing high frames and future upgrades would probably be an aftermarket cooler and or an i5/i7.
The hardware part went very smoothly but again the software part cost us but in the end me and my cousin were happy. Fast Boots to top it of.
Thank You for Your Time, and I hope you enjoy the cable management...
GPU PART REVIEW AS ITS CUSTOM AND PART REVIEW DID NOT LET ME: (5 Stars)
This 960 Galax Soc 2GB was a bargain for 271 dollars with shipping and what not and has a sick back plate and shroud stays cool and quiet and kills any game at 1080p except for the really demanding ones although it still manages 40+ frames 40 FPS being the minimum. Amazing power efficiency as well.
Update, November 2016, Purchased an i5 6500.
Part Reviews
For only 149 dollars this motherboard is a best with many features and already cooled VRM's for future safety and such, with 4 PCIe lanes and an abundance of SATA, USB 3.1 on the back four ports! and ambient LEDS's, for B150 this really is something.
Ram is Ram, looks good max speed rated for motherboard and XMP 2 support and low cas.
Thought it was fake initially due to the absurd weight of this, felt so light! Boots really fast and uses a different Micron to that ill fated V SSD Now Series. More than enough SSD storage for my client and a 4 second boot time is not to be missed.
Standard Platter Hard Drive, seems fast but I know some of these fail, lets hope it doesn't, the WD Cavier was not available at the time so lets hope it lives up to speed and reliability.
Build Quality is a little cheap for my liking (frame is really thin) but you get what you pay for and due to these reductions the features are excellent, just be careful not to scratch the case as its easy to do, the tinted window is really nice.
Power Supply
Have this in my current rig, its good but seems to coil whine at lot of GPU's should be used with GPU's under the R9 270X/GTX 960 as these GPU's are the max it can take and the coil is present here, you can oc them with this gpu but the coil whine will increase. It won't blow up with those GPU's and it lives up to the 80+ plus and efficiency levels but it can be annoying, fan is really quiet on the psu as well so that's a plus and not to mention the price 58 AUD! Bargain for a true 500W draw.
Wireless Network Adapter
Faster than I expected with full range while connected to a ****** router. No Ac support but how can you blame them for 19 AUD.


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Katrine Levine Galleries
t: +44 (0) 7789 001 378
facebook: facebook.com/KatrineLevinGalleries
instagram: @katrinelevingalleries
twitter: @KatrineArtSpeak
It all started when Katrine's step-father, who was raised in Kunming, the capital of China's stunning Yunnan Province, suggested she visit artists' studios there. He opened her eyes and many doors. She was stunned by the calibre of art, depth of knowledge, and experimentation in Kunming. On returning to London, the concept of representing and showcasing talented artists from places "less explored", both in and outside of China, was born.
Katrine is also a lawyer whose cosmopolitan roots span New York, China, Moscow and London.
Katrine Levin Galleries is an online gallery with regular pop-up exhibitions, currently in London and New York. Many of the works featured on this website are available for viewing in London, both during and outside exhibition hours. Other works are at the artists' studios abroad and can be shipped on request.