text:
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Prophylactic intravenous magnesium sulfate for treatment
of aneurysmal subarachnoid hemorrhage: A randomized,
placebo-controlled, clinical study
Thomas Westermaier, MD; Christian Stetter, MD; Giles H. Vince, MD, PhD; Mirko Pham, MD;
Jose Perez Tejon, MD; Jo ¨rg Eriskat, MD; Ekkehard Kunze, MD; Cordula Matthies, MD, PhD;
Ralf-Ingo Ernestus, MD, PhD; Laszlo Solymosi, MD, PhD; Klaus Roosen, MD, PhD
Delayed cerebral ischemia attributable
to cerebral vasospasm is the major
cause of in-hospital morbidity and mor-
mprovement of outcome after an-
eurysmal subarachnoid hemor-
rhage (SAH) has been modest in
the past decades. Recent studies
still report a mortality of up to 50% (1, 2).
tality (3). Its pathogenesis is still not
fully understood. Attempts to prevent
the occurrence of vasospasm and isch-
emic infarction have included hyperdy-
namic therapy to enhance cerebral
blood flow, balloon angioplasty or
chemical spasmolysis, and systemic ad-
ministration of calcium antagonists.
Magnesium is a physiologic calcium
antagonist with the potential to inhibit
the pathophysiological processes of vaso-
spasm and ischemic cell death. Under ex-
perimental conditions it prevents cellular
calcium influx and excitatory amino acid
release by the blockade of N-type and
L-type calcium channels (4), prevents
cellular calcium entry through N-methyl-
D-aspartate receptor channels (5), re-
duces calcium-induced mitochondrial
dysfunction (6), and preserves cellular
energy metabolism (7). Magnesium has a
vasodilatory effect and can enhance the
deformability of red blood cells to im-
prove cerebral perfusion in case of vascu-
lar narrowing.
Hypomagnesemia has been observed in
38% of SAH patients on hospital admission
and correlated with the severity of SAH.
Persistent hypomagnesemia during the
first days after SAH predicted the occur-
rence of delayed cerebral ischemia (8).
These data suggest that patients might
profit from magnesium substitution.
Several studies have been published
testing the efficacy of magnesium therapy
after aneurysmal SAH (9–14). However,
study designs, outcome parameters, co-
medication, and dosing schedules varied
markedly. The optimum dose is unknown
because systematic dose-efficacy studies
in SAH patients have not yet been per-
formed. In an animal model of focal cere-
bral ischemia, the neuroprotective effect of
intravenous magnesium was highest with
serum levels of 2.0–2.5 mmol/L. Above 3
mmol/L, cardiodepressive effects limited
From Department of Neurosurgery (TW, CS, GHV,
PT, JE, EK, CM, RIE, KR) and Department of Neurora-
diology (LS), University of Wuerzburg, Wuerzburg, Ger-
many; Department of Neuroradiology (MP), University
of Heidelberg, Heidelberg, Germany.
The work was performed at the Department of
Neurosurgery, University of Wuerzburg, Wuerzburg,
The authors have not disclosed any potential con-
flicts of interest.
For information regarding this article, E-mail:
Copyright © 2010 by the Society of Critical Care
Medicine and Lippincott Williams & Wilkins
DOI: 10.1097/CCM.0b013e3181d9da1e
Objective: To examine whether the maintenance of elevated
magnesium serum concentrations by intravenous administration
of magnesium sulfate can reduce the occurrence of cerebral
ischemic events after aneurysmal subarachnoid hemorrhage.
Design: Prospective, randomized, placebo-controlled study.
Setting: Neurosurgical intensive care unit of a University hospital.
Interventions: One hundred ten patients were randomized to
receive intravenous magnesium sulfate or to serve as controls.
Magnesium treatment was started with a bolus of 16 mmol,
followed by continuous infusion of 8 mmol/hr. Serum concentra-
tions were measured every 8 hrs, and infusion rates were ad-
justed to maintain target levels of 2.0–2.5 mmol/L. Intravenous
administration was continued for 10 days or until signs of vaso-
spasm had resolved. Thereafter, magnesium was administered
orally and tapered over 12 days.
Measurements and Main Results: Delayed ischemic infarction
(primary end point) was assessed by analyzing serial computed
tomography scans. Transcranial Doppler sonography and digital
subtraction angiography were used to detect vasospasm. Delayed
ischemic neurologic deficit was determined by continuous de-
tailed neurologic examinations; clinical outcome after 6 mos was
assessed using the Glasgow outcome scale. Good outcome was
defined as Glasgow outcome scale score 4 and 5.
The incidence of delayed ischemic infarction was significantly
lower in magnesium-treated patients (22% vs. 51%; p ? .002); 34
of 54 magnesium patients and 27 of 53 control patients reached
good outcome (p ? .209). Delayed ischemic neurologic deficit
was nonsignificantly reduced (9/54 vs. 15/53 patients; p ? .149)
and transcranial Doppler-detected/angiographic vasospasm was
significantly reduced in the magnesium group (36/54 vs. 45/53
patients; p ? .028). Fewer patients with signs of vasospasm had
delayed cerebral infarction.
Conclusion: These data indicate that high-dose intravenous
magnesium can reduce cerebral ischemic events after aneurys-
mal subarachnoid hemorrhage by attenuating vasospasm and
increasing the ischemic tolerance during critical hypoperfusion.
(Crit Care Med 2010; 38:000–000)
KEY WORDS: subarachnoid hemorrhage; magnesium; intrave-
nous; delayed cerebral infarction; vasospasm
1Crit Care Med 2010 Vol. 38, No. 5
Page 2
neuroprotection (15). Because uptake, ef-
fects, and excretion in humans and mam-
mals are similar, the present study was de-
signed to investigate the benefit of
continuously elevated serum magnesium
concentrations to 2.0–2.5 mmol/L for pa-
tients with aneurysmal SAH.
The study was approved by the local ethics
committee. Informed consent was obtained
from the patient or a legal guardian. Inclusion
criteria are depicted in Table 1.
Standard Management
Patients were admitted to the intensive
care unit and assessed by the Hunt/Hess and
Glasgow Coma Scale. If intubated before ad-
mission, then the clinical state before intuba-
tion was used as documented. All patients
were monitored with a central venous cathe-
ter, arterial line, and indwelling catheter.
If Glasgow Coma Scale score was ?8, pa-
tients were intubated to protect airways. Exter-
nal ventricular drainage was implanted if Glas-
gow Coma Scale score was ?8 and computed
tomography (CT) scans suggested elevated intra-
cranial pressure, edema, or hydrocephalus. If
external ventricular drainage placement was not
possible, then an intracerebral probe was im-
planted for intracranial pressure measurement.
Digital subtraction angiography and early aneu-
rysm treatment were performed within 24 hrs
whenever possible.
After aneurysm treatment, targets for he-
matocrit were 33% to 35%, targets for central
venous pressure were 10–12 mm Hg, and tar-
gets for mean arterial blood pressure were
90–100 mm Hg to prevent episodes of hypo-
tension. Targets were maintained using Ring-
er's solution, hydroxyethyl starch (6%),
packed red cells, and catecholamines.
Randomization to one of the two treatment
arms was performed in one block. A lot was
drawn out of a box containing 55 enveloped
lots for each treatment arm.
Magnesium Dose
Patients in the magnesium group received
a starting dose of 16 mmol magnesium sulfate
over 30 mins (magnesium inresa 50%) fol-
lowed by a continuous infusion of 8 mmol/hr.
Serum electrolyte concentrations were mea-
sured 3 hrs after initiating the magnesium
infusion and every 8 hrs thereafter (6:00 AM,
2:00 PM, and 10:00 PM) In patients with external
ventricular drainage, cerebral spinal fluid con-
centrations were determined at 6:00 AM.
Infusion rates were adjusted to maintain se-
rum concentrations of 2.0–2.5 mmol/L. Below
2.0 mmol/L, the infusion rate was increased by 1
mmol/hr; between 2.5–3.0 mmol/L, the infusion
rate was reduced by 1 mmol/hr. Above 3.0
mmol/L, the infusion was paused and restarted
at half the previous infusion rate if magnesium
levels were within the target range 8 hrs later.
Patients in the control group received an equal
amount of normal saline. If the assessment of
serum electrolytes on admission revealed hypo-
magnesemia, then it was not corrected by mag-
nesium substitution in patients of the control
We analyzed records of our SAH patients of
the previous 3 yrs and 83% of the patients who
had delayed ischemic infarction experienced it
within 10 days after admission. If infarction
occurred later, then mean flow velocities in
transcranial Doppler (TCD) sonography were
?140 cm/sec in all patients. Therefore, we
decided an intravenous magnesium adminis-
tration for 10 days. Full intravenous adminis-
tration was continued longer in patients with
elevated flow velocities in TCD or whenever a
detailed neurologic evaluation was possible
and revealed clinical signs of vasospasm.
At day 11 or when clinical or Doppler sono-
graphic signs of vasospasm had resolved, the
infusion rate was reduced by half and oral ad-
ministration of magnesium carbonate (90
mmol/day) was started to prevent a possible re-
bound effect. Patients who were able to drink
received a tasteless solution of magnesium pow-
der (Loesnesium; Lilly Pharma, Bad Homberg,
Germany) in 0.75 L of mineral water. To main-
tain patient blinding, control patients received
an equal amount of mineral water. Intubated
patients received the solution via nasogastric or
polyethylene glycol tubes. Another 24 hrs later,
intravenous treatment was stopped completely.
Oral administration was continued and reduced
by 15 mmol every other day.
Data Acquisition and Outcome
CT scans were obtained on admission and
on days 3, 4, 6, 7, 9, and 10 before discharge
and whenever necessary for diagnostic reasons.
CT scans were analyzed by trained neuroradiolo-
gists (MP, LS) and a trained neurosurgeon (CS)
not aware of the patients' treatment allocation.
Hypodensities were classified as: (1) preexisting;
(2) exclusively resulting from intracerebral he-
matoma; (3) caused by operative procedures; or
(4) delayed ischemic infarction defined as paren-
chymal hypodensity appearing between day 3
and the end of the observation period (16, 17).
The latter was defined as the primary study end
point (9, 16–18).
Neurologic examination was performed
hourly by intensive care clinicians and find-
ings documented in patients' records. During
ward rounds in the morning and evening and
whenever the intensive care unit doctor re-
ported delayed ischemic neurologic deficit
(DIND), clinical findings were double-checked
by the neurosurgeon on duty not aware of the
patients' treatment arm. DIND was defined as
deterioration (new focal deficits or deterio-
rated level of consciousness) without other
detectable reasons (rebleeding, seizure, elec-
trolyte disturbance, and hydrocephalus). De-
layed cerebral ischemia (DCI) was defined as
symptomatic vasospasm or infarction on CT
attributable to vasospasm (20).
TCD was performed daily by a trained med-
allocation. Vasospasm was defined as mean flow
velocity over 140 cm/sec in the anterior circula-
tion and 90 cm/sec in the basilar artery.
The hyperdynamic therapy was intensified
(mean arterial blood pressure, 110–125
mm Hg) by increasing the amount of pressor
agents in awake patients in whom DIND de-
veloped and in comatose patients who pre-
sented sharp increases of flow velocities in
TCD. Angiography was scheduled for awake
patients when DIND remained refractory to
Table 1. Predefined inclusion and exclusion criteria
Inclusion CriteriaExclusion Criteria
Age older than 18 yrs
Aneurysmal SAH
Admission ?96 hrs after SAH
Serum creatinine ?1.5 mg/100 mL
Atrioventricular block
History of neuromuscular disease
History of previous SAH
Treatment proposed to be continued elsewhere after
aneurysm obliteration
Treatment discontinued at admission due to unpromising
clinical condition
SAH, subarachnoid hemorrhage.
Patients were excluded if electrocardiography on admission revealed an atrioventricular block of all
grades (1–3) or were dependent on dialysis. If serum creatinine values were ?1.5 mg/100 mL (133
?mol/L), then values were controlled 8 hrs later after fluid substitution with 1.5 L of Ringer's solution.
If serum creatinine had declined to ?1.5 mmol/L, then the patient was included in the study.
2Crit Care Med 2010 Vol. 38, No. 5
Page 3
hyperdynamic therapy. Comatose patients
with increased flow velocities were transferred
for angiography if they were cardiovascularly
stable and showed controllable intracranial
pressure values. Angiographic vasospasm was
defined as narrowing of the arterial diameter
of ?30% with significant delay of circulation
time. Balloon angioplasty or chemical vaso-
spasmolysis was performed when possible. An-
giographers were blinded to the patients'
treatment allocations. Clinical outcome, in-
cluding the Glasgow outcome score was eval-
uated after 6 mos by a neurosurgeon blinded
to the patients' treatment arm.
Data Analysis
During the planning phase, data about
magnesium treatment in SAH were scarce.
Comparing data of an uncontrolled study by
Boet et al (19), i.e., comparing 30% symptom-
atic vasospasm in magnesium-treated Fisher
grade 3 patients to 60% in our own respective
patients, a sample size of 87 patients was cal-
culated to achieve sufficient test power (Sig-
maStat; Jandel Scientific, Leighton Buzzard,
UK). Considering a close relation between va-
sospasm and delayed infarction and a drop-out
rate of 20%, we conceived a sample size of 110
patients. Outcome parameters were analyzed
as a "per-protocol analysis." GraphPad Prism 4
Statistical Software (GraphPad Software, San
Diego, CA) was used. Parametric data were
analyzed using an unpaired Student's t test,
nonparametric data by the Mann-Whitney U
test, and incidences by a chi-square test. If
multiple comparisons were indicated, then a
Bonferroni correction was applied. Differences
were considered significant at p ? .05.
Two hundred one patients with SAH
were admitted to our department be-
tween April 2003 and September 2006.
Nineteen patients were not included be-
cause of admission later than 96 hrs after
SAH. In 20 patients, therapy was discon-
tinued after admission because of very
poor clinical state and unpromising prog-
nosis. In 32 patients, no aneurysm was
detected, two had a history of SAH, and
one was excluded because of leukemia.
Ten patients were scheduled to return to
the referring hospital after aneurysm
treatment, four had atrioventricular
block, one had neuromuscular disease,
and one had renal failure. One patient
was not included at his own request. The
remaining 110 patients were randomized
into one of the two treatment arms.
Three patients were excluded after enroll-
ment (Fig. 1). Data of the remaining 107
patients are presented in Table 2.
Figure 1. Flow diagram of patient recruitment. One hundred ten patients were allocated to one of two
study arms. In one patient, magnesium was discontinued because otherwise not explainable oxygen-
ation problems were suspected to be caused by magnesium and its action as a calcium antagonist.
Thereafter, oxygenation did not improve because the patient had foudroyant pneumonia and pulmo-
nary atelectasis. Another patient was excluded at his own request. One patient in the control group
received magnesium as an individual treatment attempt after severe vasospasm development. One
hundred seven patients completed the study protocol and were analyzed.
Table 2. Patient data on computed tomography characteristics, neurologic state on admission, location
of the aneurysm, and method of aneurysm treatment
Magnesium Group,
n ? 54
Control Group,
n ? 53
Age, yra
Fisher grade
Hunt/Hess grade
Location of aneurysm (anterior vs.
posterior circulation)
50 ? 13
52 ? 13
16 12
8 12
Anterior circulation, 44
Posterior circulation, 10
Anterior circulation, 43
Posterior circulation, 10
aValues are expressed as mean ? SD.
Comparisons did not reveal significant differences.
3Crit Care Med 2010 Vol. 38, No. 5
Page 4
Physiologic Parameters
Magnesium serum levels in the first
10 days after admission are depicted in
Figure 2. To maintain 2.0–2.5 mmol/L,
daily administration of 140 ? 51 mmol
magnesium sulfate was necessary. Apart
from hypocalcemic tetany in one patient
and facial flushing, no serious side effects
were observed. Mean heart rate was lower
under intravenous magnesium treat-
ment. The difference was significant on
days 7 to 9. No episodes of profound hy-
potension or bradycardia were recorded
(Fig. 3). After the infusion rate was
halved, serum concentrations were
1.59 ? 0.22 in the magnesium group and
0.88 ? 0.07 in the control group. After
complete oralization, none of the patients
showed an elevated serum concentration
(0.89 ? 0.18 mmol/L in the magnesium
group vs. 0.87 ? 0.07 in the control
group). On admission, hypomagnesemia
(?0.70 mmol/L) was found in six patients
of each group. Although it was not cor-
rected by magnesium substitution in pa-
tients of the control group, it normalized
under measures of intensive care manage-
ment. In no patient was hypomagnesemia
found from day 2 after admission until the
end of hospitalization. The course of mag-
nesium serum concentrations in the first
10 days after admission is depicted in Fig-
ure 2. Mean calcium concentrations were
significantly lower in magnesium-treated
patients than in control patients (1.76 ?
0.21 vs. 2.06 ? 0.13 mmol/L) during intra-
venous treatment.
Delayed Ischemic Infarction and
Clinical Outcome
Twelve patients (22%) in the magne-
sium group and 27 patients (51%) in the
control group had delayed ischemic in-
farction (p ? .0020; odds ration [OR],
0.28; 95% confidence interval [CI], 0.12–
0.64). Data on delayed ischemic infarc-
tion and clinical outcome are summa-
rized in Table 3.
DIND and DCI
Nine patients (17%) in the magne-
sium group and 15 patients (28%) in the
control group had DIND (p ? .1491; OR,
0.51; 95% CI, 0.20–1.29). Of nine pa-
tients in the magnesium group with
DIND, one (11%) had delayed ischemic
infarction. Of 15 patients in the control
group with DIND, seven (47%) had de-
layed infarction (p ? .0736; OR, 0.14;
Figure 2. Magnesium serum concentration and ventricular cerebral spinal fluid concentration during
the first 10 days after admission (mean ? SD). Thirty-seven patients in the magnesium group and 38
patients in the control group received an external ventricular drainage. After continuous elevation of
serum levels, cerebral spinal fluid concentration showed significant but only minor increase. **p ? .01
vs. serum magnesium concentrations of the control group. §p ? .05 vs. cerebral spinal fluid
concentrations of the control group. CSF, cerebral spinal fluid.
Figure 3. Daily mean values of heart rate and mean arterial blood pressure were calculated as the
average of hourly documented values. Mean arterial blood pressure did not markedly differ between the
two groups, and neither did the amount of administered pressor agents. Although no episode of
bradycardia necessitated the discontinuation of magnesium treatment, average heart rate values were
lower in magnesium-treated patients. The difference was significant on days 7, 8, and 9. *p ? .05 vs.
control group. MAP, mean arterial blood pressure.
4 Crit Care Med 2010 Vol. 38, No. 5
Page 5
95% CI, 0.014–1.45). The remaining 11
cases of delayed ischemic infarction in
the magnesium group and 20 cases in the
control group occurred in comatose pa-
Twenty patients (37%) in the magne-
sium group and 35 patients (66%) in the
control group had DCI according to the
definition of Frontera et al (20). This in-
cludes patients who had delayed ischemic
infarction and patients with DIND who
did not have delayed ischemic infarction.
(p ? .0027; OR, 0.30; 95% CI, 0.1369–
TCD-Detected and Angiographic
Thirty-six patients (67%) in the mag-
nesium group and 45 patients (85%) in
the control group had TCD-detected/
angiographic vasospasm (p ? .0279; OR,
0.36; 95% CI, 0.14–0.91). This includes
20 patients in the magnesium group and
22 patients in the control group not ame-
nable to clinical evaluation because of a
persistent Glasgow Coma Scale score of 3
with or without sedation.
Of 36 patients in the magnesium
group with TCD-detected/angiographic
vasospasm, 10 patients (28%) had delayed
ischemic infarction. Twenty-six of 45 pa-
tients (58%) in the control group with
TCD-detected/angiographic vasospasm
had delayed ischemic infarction (p ?
.0069; OR, 0.28; 95% CI, 0.11–0.72). One
patient in the magnesium group, analog-
sedated because of elevated intracranial
pressure, had left middle cerebral artery
infarction on day 13 without elevated
TCD readings. Territorial infarction was
demarcated on CT. This case was regis-
tered as delayed ischemic infarction and
magnesium infusion was not restarted.
The present data show beneficial ef-
fects of continuous high-dose intrave-
nous magnesium administration for pa-
tients with aneurysmal SAH.
Magnesium Dose and Serum
In the present study, magnesium in-
fusion was titrated to maintain elevated
serum concentrations. In previous stud-
ies, in contrast, a preassigned daily
amount of magnesium was administered.
Target levels of 2.0–2.5 mmol/L proved to
be safe. Although values of up to 3.5
mmol/L were observed after the initial
loading dose, and although daily doses
were higher than in previous studies, no
complete cessation of magnesium treat-
ment was necessary, as was reported by
other authors (9–11, 14, 19, 21, 22). Be-
cause the dose required to maintain tar-
get levels varied markedly between the
individual patients, and because brady-
cardia appeared to be the first sign of a
magnesium overdose, a continuous car-
diac monitoring and close surveillance of
serum electrolytes are prerequisites of in-
travenous magnesium treatment. Pa-
tients with atrioventricular blocks were
excluded from the present study. The
negatively chronotropic and dromotropic
effects of magnesium as a calcium antag-
onist might aggravate bradycardic ar-
rhythmias or conduction disorders and,
thus, its intravenous use might be dan-
We observed significant hypocalcemia
with intravenous magnesium treatment.
This was not treated because calcium an-
tagonism most likely mediates beneficial
effects of magnesium. Van de Water et al
(23) found an inverse relation between
magnesium and calcium concentrations
during magnesium treatment in SAH pa-
tients and observed an increased frequency
of DCI with more profound hypocalcemia.
However, a more thorough analysis re-
vealed that not hypocalcemia itself but
rather higher levels of parathyroid hor-
mone lead to a higher risk of DCI (24).
Antivasospastic Action and
In previous trials, a lower rate of TCD-
detected/angiographic vasospasm and
DIND (10, 14), improvement of outcome,
and less delayed ischemic infarction were
observed (11–13). Other studies, how-
ever, could not confirm these findings
(10, 12). Magnesium might act as an an-
tivasospastic and/or neuroprotective
agent. We found a reduction of DIND that
was not statistically significant. However,
a large proportion of our patients were
comatose and/or under analog sedation.
Therefore, the effect of magnesium on
vasospasm-related clinical deterioration
might be underestimated. The reduction
of TCD-detected/angiographic vasospasm
was statistically significant. These find-
ings suggest antivasospastic properties in
accordance with other publications (9,
10, 12, 13). However, the results of the
Clazosentan to Overcome Neurological
Ischemia and Infarction Occurring after
Subarachnoid Hemorrhage trial investi-
gating the efficacy of Clazosentan (25)
demonstrated that a significant reduction
of cerebral vasospasm does not necessar-
ily result in a distinct improvement of
outcome because additional factors
might be involved in the development of
secondary ischemia and infarction.
However, we also observed that a
lower percentage of patients with DIND
and TCD-detected/angiographic vaso-
spasm had delayed ischemic infarction,
suggesting an additional neuroprotective
property. Despite these findings, we only
registered a nonsignificant tendency to-
ward improved neurologic outcome. One
of the most decisive and predictive factors
concerning outcome after aneurysmal
SAH is the impact of the primary insult
and the neurologic state on admission.
Its effects cannot be treated by any spe-
cific form of therapy used to prevent sec-
ondary damage. Improvement of cardio-
pulmonary emergency measures in
patients with poor-grade SAH and accel-
eration of diagnostic procedures are fur-
Table 3. Incidence of delayed ischemic infarction
Magnesium Group,
n ? 54
Control Group,
n ? 53
Delayed ischemic infarction
Glasgow outcome scale score
Interquartile range
Good vs. bad outcome
12/54 (22%)27/53 (51%).0020
6/54 (11%)
.260610/53 (19%)
The incidence of delayed ischemic infarction was significantly reduced in the magnesium group.
Improvement of clinical outcome after 6 mos was not significant.
5Crit Care Med 2010 Vol. 38, No. 5
Page 6
ther key factors for the improvement of
overall outcome after SAH (26).
Patient Characteristics and Trial
Single-center studies like the present
one have significant limitations. Many
procedures may be standardized. Still,
each institution will have its own treat-
ment and nursing standards. Patient
characteristics also might not be repre-
sentative of the whole population because
of institutional and geographic differ-
ences. We recorded a high rate of intra-
cerebral or intraventricular hematomas
and larger numbers of patients in poor
clinical condition than reported in previ-
ous trials and epidemiologic analyses (9,
11, 27, 28). This is probably attributable
to the characteristics of the department
as a tertiary care center with a large
catchment area. Many patients are trans-
ferred from external departments for the
evacuation of hematomas, ventriculos-
tomy, or the treatment of complex aneu-
rysms. Significant delay of diagnostics
and treatment may occur causing a neg-
ative selection bias. Between the treat-
ment arms there was no marked differ-
ence concerning clinical state on
admission and distribution of blood on
CT scans allowing a comparison of
groups and analysis of treatment effects.
(Table 2).
Functional outcome after an adequate
time span is the ideal end point for clin-
ical studies but requires a large number
of patients. In SAH trials, the incidence of
DCI is frequently used as the primary end
point because it correlates better with
death and poor outcome than DIND or
TCD-detected/angiographic vasospasm
(20). Definitions of DCI, however, are not
unequivocal. Van den Bergh et al (11)
defined it as "infarction on CT compatible
with clinical features of DCI." This does
not well-define secondary infarctions that
occur in patients who are undergoing an-
alog sedation or persistently comatose.
Frontera et al (20) defined DCI as "symp-
tomatic vasospasm or infarction on CT
attributable to vasospasm." However, this
definition disregards the fact that not all
patients presenting with symptomatic va-
sospasm will eventually have infarction
(29). A large proportion of SAH patients
admitted to our department cannot be
assessed in detail through large parts of
the treatment period. Therefore, delayed
ischemic infarction on CT scans, a surro-
gate parameter, was chosen to be the
primary end point.
Standard Therapy and
The use of calcium antagonists has
been extensively studied in the past de-
cades. A Cochrane review analyzed 20 tri-
als investigating nimodipine treatment
after SAH. Only one (30) showed a signif-
icant benefit of prophylactic oral treat-
ment. Other studies found a trend toward
better results but no significant improve-
ment of outcome. Although the adminis-
tration of oral nimodipine was basically
recommended by the authors, they con-
clude that its prophylactic use is "not
beyond any doubt" (31).
A high proportion of SAH patients are
transferred from other hospitals under
analog sedation and mechanical ventila-
tion and are not able to use oral nimo-
dipine. We formerly administered nimo-
incomplete uptake via gastric tubes. This
became particularly obvious in the
wake-up period of patients who had been
undergoing analog sedation for several
days because of elevated intracranial
pressure or cardiopulmonary complica-
tions. This period frequently includes the
time with the highest risk of vasospasm.
Changing the mode of nimodipine ad-
ministration to the intravenous route, we
observed cases of severe hypotension and
oxygenation complications. Therefore,
the routine use of nimodipine was
stopped and standard therapy was shifted
toward a more aggressive hyperdynamic
therapy in case of vasospasm and early
re-angiography with the option of PTA of
spastic vessels.
Magnesium might be a useful adjunct
or even alternative to nimodipine treat-
ment. Pharmacologically, the two sub-
stances might interfere with each other
at some point because both are calcium
antagonists. If used together, then side
effects like hypotension necessitating the
discontinuation of magnesium treatment
might occur at lower magnesium con-
centrations (18). Clinical trials investi-
gating the combined use in SAH patients
are underway (32, 33). Recent review ar-
ticles discerned a tendency toward a
lower incidence of DCI (31) and poor
outcome (34), but no reduction of de-
layed ischemic infarction or mortality af-
ter SAH.
This study demonstrates a beneficial
effect of intravenous magnesium to pre-
vent secondary ischemic events after an-
eurysmal SAH. We observed a lower inci-
dence of delayed cerebral vasospasm and,
among patients who had vasospasm, a
lower rate of delayed ischemic infarction,
suggesting an additional neuroprotective
effect. The maintenance of serum magne-
sium concentrations between 2.0 and 2.5
mmol/L is safe if serum concentrations
are frequently measured and cardiovascu-
lar parameters are continuously moni-
tored. Oral administration of magnesium
did not result in elevated serum concen-
trations and did not appear beneficial.
There might be cases of delayed infarc-
tion after day 11 that are not covered by
intravenous treatment according to the
current study protocol. Therefore, longer
continuation of intravenous treatment
might be of further advantage.
1. van Gijn J, Kerr RS, Rinkel GJ: Subarachnoid
haemorrhage. Lancet 2007; 369:306–318
2. Cahill J, Zhang JH: Subarachnoid hemor-
rhage: Is it time for a new direction? Stroke
2009; 40:86–87
3. Pluta RM, Hansen-Schwartz J, Dreier J, et al:
Cerebral vasospasm following subarachnoid
hemorrhage: Time for a new world of
thought. Neurol Res 2009; 31:151–158
4. Peruche B, Krieglstein J: Mechanisms of
drug actions against neuronal damage
caused by ischemia—An overview. Prog Neu-
ropsychopharmacol Biol Psychiatry 1993;
5. Nowak L, Bregestovski P, Ascher P, et al:
Magnesium gates glutamate-activated chan-
nels in mouse central neurones. Nature
1984; 307:462–465
6. Kristal BS, Dubinsky JM: Mitochondrial per-
meability transition in the central nervous
system: Induction by calcium cycling-
dependent and -independent pathways.
J Neurochem 1997; 69:524–538
7. Schanne FA, Gupta RK, Stanton PK: 31P-
NMR study of transient ischemia in rat hip-
pocampal slices in vitro. Biochim Biophys
Acta 1993; 1158:257–263
8. van den Bergh WM, Algra A, van der Sprenkel
JW, et al: Hypomagnesemia after aneurysmal
subarachnoid hemorrhage. Neurosurgery
2003; 52:276–281
9. Schmid-Elsaesser R, Kunz M, Zausinger S, et
al: Intravenous magnesium versus nimodip-
ine in the treatment of patients with aneu-
rysmal subarachnoid hemorrhage: A ran-
domized study. Neurosurgery 2006; 58:
10. Stippler M, Crago E, Levy EI, et al: Magne-
sium infusion for vasospasm prophylaxis af-
6Crit Care Med 2010 Vol. 38, No. 5
Page 7
ter subarachnoid hemorrhage. J Neurosurg
2006; 105:723–729
11. van den Bergh WM, Algra A, van Kooten F, et
al: Magnesium sulfate in aneurysmal sub-
arachnoid hemorrhage: A randomized con-
trolled trial. Stroke 2005; 36:1011–1015
12. Boet R, Chan MT, Poon WS, et al: Intrave-
nous magnesium sulfate to improve outcome
after aneurysmal subarachnoid hemorrhage:
Interim report from a pilot study. Acta Neu-
rochir Suppl 2005; 95:263–264
13. Veyna RS, Seyfried D, Burke DG, et al: Mag-
nesium sulfate therapy after aneurysmal sub-
arachnoid hemorrhage. J Neurosurg 2002;
14. Wong GK, Chan MT, Boet R, et al: Intrave-
nous magnesium sulfate after aneurysmal
subarachnoid hemorrhage: A prospective
randomized pilot study. J Neurosurg Anes-
thesiol 2006; 18:142–148
15. Westermaier T, Zausinger S, Baethmann A,
et al: Dose finding study of intravenous mag-
nesium sulphate in transient focal cerebral
ischemia in rats. Acta Neurochir (Wien)
2005; 147:525–532
16. Pham M, Johnson A, Bartsch AJ, et al: CT
perfusion predicts secondary cerebral infarc-
tion after aneurysmal subarachnoid hemor-
rhage. Neurology 2007; 69:762–765
17. Jestaedt L, Pham M, Bartsch AJ, et al: The
impact of balloon angioplasty on the evolu-
tion of vasospasm-related infarction after an-
eurysmal subarachnoid hemorrhage. Neuro-
surgery 2008; 62:610–617
18. Dorhout MS, van den Bergh WM, Algra A, et
al: Achieved serum magnesium concentra-
tions and occurrence of delayed cerebral
ischaemia and poor outcome in aneurysmal
subarachnoid haemorrhage. J Neurol Neuro-
surg Psychiatry 2007; 78:729–731
19. Boet R, Mee E: Magnesium sulfate in the
management of patients with Fisher Grade 3
subarachnoid hemorrhage: A pilot study.
Neurosurgery 2000; 47:602–606
20. Frontera JA, Fernandez A, Schmidt JM, et al:
Defining vasospasm after subarachnoid hem-
orrhage: What is the most clinically relevant
definition? Stroke 2009; 40:1963–1968
21. van Norden AG, van den Bergh WM, Rinkel
GJ: Dose evaluation for long-term magne-
sium treatment in aneurysmal subarachnoid
haemorrhage. J Clin Pharm Ther 2005; 30:
22. Muroi C, Terzic A, Fortunati M, et al: Mag-
nesium sulfate in the management of pa-
tients with aneurysmal subarachnoid hemor-
rhage: A randomized, placebo-controlled,
dose-adapted trial. Surg Neurol 2008; 69:
23. van de Water JM, van den Bergh WM, Hoff
RG, et al: Hypocalcaemia may reduce the
beneficial effect of magnesium treatment in
aneurysmal subarachnoid haemorrhage.
Magnes Res 2007; 20:130–135
24. van den Bergh WM, van de Water JM, Hoff
RG, et al: Calcium homeostasis during mag-
nesium treatment in aneurysmal subarach-
noid hemorrhage. Neurocrit Care 2008;
25. Macdonald RL, Kassell NF, Mayer S, et al:
Clazosentan to overcome neurological isch-
emia and infarction occurring after sub-
arachnoid hemorrhage (CONSCIOUS-1):
Randomized, double-blind, placebo-con-
trolled phase 2 dose-finding trial. Stroke
2008; 39:3015–3021
26. Miyazaki T, Ohta F, Moritake K, et al: The key
to improving prognosis for aneurysmal sub-
arachnoid hemorrhage remains in the pre-
hospitalization period. Surg Neurol 2006; 65:
27. Ruiz-Sandoval JL, Cantu C, Chiquete E, et al:
Aneurysmal subarachnoid hemorrhage in a
Mexican multicenter registry of cerebrovas-
cular disease: The RENAMEVASC study.
J Stroke Cerebrovasc Dis 2009; 18:48–55
28. Ogungbo B, Gregson BA, Blackburn A, et al:
Trends over time in the management of sub-
arachnoid haemorrhage in Newcastle: Re-
view of 1609 patients. Br J Neurosurg 2001;
29. Jones TH, Morawetz RB, Crowell RM, et al:
Thresholds of focal cerebral ischemia in
awake monkeys. J Neurosurg 1981; 54:
30. Pickard JD, Murray GD, Illingworth R, et al:
Effect of oral nimodipine on cerebral infarc-
tion and outcome after subarachnoid haem-
orrhage: British aneurysm nimodipine trial.
31. Dorhout MS, Rinkel GJ, Feigin VL, et al:
Calcium antagonists for aneurysmal sub-
arachnoid haemorrhage. Cochrane Database
Syst Rev 2007; CD000277
32. Wong GK, Chan MT, Poon WS, et al: Magne-
sium therapy within 48 hours of an aneurys-
mal subarachnoid hemorrhage: Neuro-
panacea. Neurol Res 2006; 28:431–435
33. Dorhout MS: Magnesium in aneurysmal sub-
arachnoid hemorrhage (MASH II) phase III
clinical trial MASH-II study group. Int J
Stroke 2008; 3:63–65
34. Zhao XD, Zhou YT, Zhang X, et al: A meta
analysis of treating subarachnoid hemor-
rhage with magnesium sulfate. J Clin Neu-
rosci 2009
7Crit Care Med 2010 Vol. 38, No. 5


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cropped, bobs, layers, piecey, pixie, razor-cut ... all for the love of short hair
- 541 Pins
If I ever could pull off short hair, this is what I'd love to have
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I'm almost hesitant to put this on my "bad ombre list". It's okay - but would LOVE it with one of these two improvements: 1) Change base hair color from medium-dark brown to medium-light brown (so there is less contrast between the base color & the ombre highlighted ends) 2) Keep the medium-dark brown base color, but tone down the ombre color to a caramel/honey tone. (The ombre highlights appear to be too brassy/orange)
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subset: commoncrawl


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William Faulkner On The Battle Of Gettysburg
Originally published on Wed July 3, 2013 7:40 pm
Some of the most famous words ever written about Gettysburg were penned by the great southern writer William Faulkner.
In his 1948 novel "Intruder In The Dust," Faulkner wrote about the promise the afternoon of July 3, 1863, held for the southern cause, the moment before the Confederate attack that became known as "Pickett's Charge."
For every Southern boy fourteen years old, not once but whenever he wants it, there is the instant when it's still not yet two o'clock on that July afternoon in 1863, the brigades are in position behind the rail fence, the guns are laid and ready in the woods and the furled flags are already loosened to break out and Pickett himself with his long oiled ringlets and his hat in one hand probably and his sword in the other looking up the hill waiting for Longstreet to give the word and it's all in the balance, it hasn't happened yet, it hasn't even begun yet, it not only hasn't begun yet but there is still time for it not to begin against that position and those circumstances…
Southern author Ron Rash says that passage is about Faulkner himself.
"In that very scene, you sense a man who had grown up in a time when he could actually talk to Confederate veterans. And as a Southerner, growing up in that culture — in a family that considered itself aristocratic — this would be the view of so many of his generation," Rash told Here & Now.
The Union troops repulsed the charge and denied General Robert E. Lee the crucial victory he needed on northern soil. It was the beginning of the end of the Civil War for the South.
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Around the House Element Set
By Elizabeth's Market Cross
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- Type: Embellishment Pack
- Designer: Elizabeth's Market Cross
- Software Category: Family
- Download Size: 12.2 MB (approximate)
Design Elements
- Page Elements: 8
Designer Notes
Hand drawn housework embellishments include: Toilet cleaner brush, toilet paper, vacuum, feather duster, spray can, broom, squirt bottle, and a garbage bin.
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Another addition to the Imperial drone fleet.
This is deeply upsetting.
This will put a damper on tourism for the foreseeable future.
This is what space combat looks like from the point of view of an Imperial pilot.
The screenwriter and video-game veteran debuted his first novel in February.
Paramount keen to differentiate 'Rogue Nation' from 'Rogue One.'


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Create a Tower of Climbing Annuals
Some feature plants are best grown in pots where they are much easier to view and care for, and you can put them at center stage. These morning glories (Ipomoea purpurea) grow very quickly from seed sown in the spring.
Step 1
Arrange a wigwam of canes or old stems, such as stripped forsythia, around the edge of a container filled with potting mix. The wigwam doesn't need to be very neat—the stems will soon be obscured by the climbing plants.
Step 2
Tie the tops of the stems together. Then wrap string or raffia around the canes, about halfway up, to strengthen it. After planting, add more at different heights to make it easier for the climbers to spread across the frame.
Step 3
Make planting holes by each support with a trowel or spoon. Remove the seedlings carefully from their pots. Gently pry apart the plants, handling them by their leaves, not the delicate stems. Plant one in each hole.
Step 4
Firm all the plants in the soil, then water well. You may find it necessary to add an extra circle of twigs to help train the climbers onto the canes, and to stop them from climbing in the wrong direction.
Next Up
Siberian Iris
The Siberian iris flourishes in a rich, moist soil and blooms in the spring.
Swordleaf Inula
This delicate perennnial with daisy-like blooms is great as a perennial border.
How to Plant Springtime Bulbs
Give your lawn and garden spaces new life with these colorful design tips for planting bulbs.
Mum's the Word
Classy and so flashy, mums could be the answer to a drab garden.
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Gardeners can grow their own Indian corn to eat or use as decoration for the holidays.
Q&A: Overwintering Thyme
Learn how to help thyme survive the winter months.
Goldenrain Tree
Learn more about the goldenrain tree and its environment.
Planting Strawberries
When to plant strawberries and how to prep for them during winter.
Hellebores: Winter's Delight
Richly colored flowers, beautiful evergreen foliage and a tough nature has made the Lenten rose a favorite.
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A Late Spring and Event Change
Due to the late spring we will be making a change on the Wildflower Hike which had been scheduled for April 12th. We will be moving the hike back to May 10th at 10 AM and swapping the Wildflower Hike with the Ranger Led Interpretive Hike. So . . .
April 12th Ranger Led Interpretive Hike–10 AM
May 10th Wildflower Walk–10 AM
On another note we had a great turn-out for our fist service project thanks to Western Rivers Conservancy with eight people planting over 300 shrubs. This was a huge success and a huge amount of work. Thank you; thank you; thank you. And it's not to late to sign up for the next service project on April 26th.
Come Experience Spring at Cottonwood
The Canyon Wrens are singing. The wildflowers are starting to pop. The days are warmer. Longer. Sunnier. Spring is returning to Cottonwood.
To celebrate we have partnered with friends to offer several different ways to experience Cottonwood this spring. From service projects to wildflowers walks to Ranger guided hikes we have an experience to help you escape from the cabin and cure the fever. All of these events meet at the Visitor Center and we would like an RSVP either through commenting here or calling 541-394-0002 or 541-394-0004.
Can't make one of these events and have a group of folks who would like to come out for a guided hike or volunteer project? Contact us and we will work with you to make it happen.
Saturday April 12th: 10 AM-Ranger Guided Hike
- Type of Hike: Ranger Led hike focusing on the development of Cottonwood Canyon State Park
- Distance: 3-5 miles
- Meeting Area: Cottonwood Canyon State Park Visitor Center
- What to Bring: Closed toe shoes; drinks and snacks
- Maximum number: 10–please call or comment to RSVP
Saturday, April 26th: 10 AM to 4 PM
- Type of Work: Transplanting of Sage along road cuts; caging and bark mulching of native plants; hand removal of non-native species; fence removal–this project is a moving target based on weather and other factors more information will be posted
- Meeting Area: Cottonwood Canyon State Park Visitor Center
- What to Bring: Heavy Leather work gloves; closed toe shoes; long sleeve shirts and pants that can sustain a barb wire snag/rip
- Minimum Age: 10 (Due to nature of work)
- Maximum number: 10–please call or comment to RSVP
In Partnership with Solve It! Earth Day Projects
Saturday, May 10th: 10 AM-Wildflower Hike
- Type of Hike: Wildflower Hike led by Region Natural Resource Specialist
- Distance: 3-5 miles on flat ground
- Meeting Area: Cottonwood Canyon State Park Visitor Center
- What to Bring: Closed toe shoes; drinks and snacks; questions to stump the expert!
- Maximum number: 10–please call or comment to RSVP
Can't wait to see you this spring!
Volunteer at Cottonwood
Do you ever dream of being part of something special? Maybe, the opening of a new state park? To build a trail for future generations? Help deliver and develop interpretive programs? Plant trees that will restore the John Day River and one day provide shade for visitors? Or just help visitors enjoy 8,000 acres of terrain and sixteen miles along the banks of the John Day River in eastern Oregon?
Here is your chance. Cottonwood Canyon State Park is now open and we are looking for one maintenance and one day use/campground host willing to commit at least one month. We currently have openings for one month, May through November.
We also have room for individuals and groups interested in interpretation, trail building, native plant restoration and (maybe) special construction projects. We are full of unique opportunities for involvement… but it might not be for everyone.
There is "remote" and then there is "Cottonwood remote". There is no cell phone reception at the park and the closest town with full services is 40 minutes away. The park is still being developed and there are only young trees in the host site. We are in the desert and summers are very hot – temperatures hit a high of 112 last year and spring/fall can be cold. What we CAN offer is electricity to power on-site laundry and the AC; water to quench your thirst; and a beautiful spot!
With the remoteness of Cottonwood comes a special place in nature, one that Oregon State Parks is very excited about sharing with you. Even if you're not interested in hosting, or just wondering what you are getting yourself into, come on out to Cottonwood Canyon State Park for a visit. Please call the Park Ranger David Spangler for more information at 541-394-0002 or spend a few minutes reading about volunteering in Oregon Parks at http://oprdvolunteervoice.wordpress.com
First Day Hike
What a better way to start a New Year then to explore a New Park! We will be offering a Ranger led hike on January 1st at noon as part of America's State Parks First Day Hikes. If you have been holding out on visiting January 1st could be the right day. And the campground is open.
Although, we will not have a zombie apocalypse survival offering like Honeyman State Park we will offer a great hike focusing on the cultural and natural history of the area. Also, we feel that the Zombie's will have a little trouble working their way through the very prepared folks in Sherman and Gilliam County.
So again. . .
Date: January 1st
Time: Noon-2PM
Distance: 2 miles
Where to Meet: Cottonwood Canyon State Park Pinnacles Trail Head (near the campground)
More Information: 541-394-0002
See you there.
It's 105 degrees cooler. . .
A Couple of Months. . .
The blog has been quiet, but we've been busy. Somehow it's been almost two months since we had the amazing Grand Opening of Cottonwood Canyon. We're now hunkering down for winter as fewer visitors make the trip and we start to winterize the park.
Since the opening, the sage sniffers, hikers, hunters, fisher-kids and their fisher-parents and curious folks have come in a steady stream to visit the park. We even filled the campground the first week of October—and then realized we never ordered a "campground full" sign!
When our first camp hosts (John and Christina Collard & Bo and Mary Macnab) came in, we realized we never got around to putting in the camp host sign or a fire pit in the host sites. Luckily, they were understanding and even helped (ok, they did most of the work) put in the camp host sign, added rock around the site and installed a fire pit.
We hosted all 60 students of Condon's kindergarten through sixth grade on Oct. 18, cooperating with Oregon State University Extension Service, Gilliam County Water Master, local artists, and the Native Fish Society. And yes, there are only 60 students in all of K-6 grades—hey, we live in a rural area. We hope to continue similar programs with other schools and groups. If you're interested in coming out to any type of interpretive or educational program, leave a reply on this site and we'll get back to you.
The Visitor Center was a wonderful small meeting room for a regional parks interpretive workshop and the Lower John Day Management Work Group. We hope to continue to use this space as a parks meeting room and develop a system for other groups to share the space.
Finally, the landscapers are putting in the trees, shrubs and a great demonstration garden of native plants. The contractors are finishing up the first phase of construction and we are actively planning the second phase of construction with irrigation and planting of the field and campground starting in December.
Watch for a series of posts in the coming months about future park plans and projects. If you haven't come to visit, we can still have some great days in the canyon even though other areas may be rainy and cold. Check the weather and come on over!


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Cooking has been a passion for me, and passing on my knowledge and experience to a new kosher audience is one of my greatest joys. When my two earlier books were published — "Kosher Cuisine" and "Helen Nash's Kosher Kitchen" — that joy was mingled with regret at having to exclude...
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Tag: Food Rosh Hashanah
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September 12, 2012 | 11:28 am
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Browse By Map: Ireland - Co. Roscommon
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text: Our youngest is 1, so we technically are a 5 person family. I haven't had any problems with trying to book via Disney World vacations for the AKV with my kids ages put in there. And the 193...I meant 190. According to DVC, it is 13.00 per point....... Once you determine the amount of points required, multiply that by the price per point which is currently $13.00, or place your mouse over the result to see the total. My cancellation policy is located here. Our dates come to 190 points in the one bedroom villa. Does that not make sense? I am confusing myself by all the different options of everything and I haven't even started the dining process. Yikes!


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Villa Bali Resort & Spa
No availability found through our partners. Please contact the business directly or check some of our recommended alternatives.
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Waiting for Bryan
... my last day on the island was lovely. I went back to Perfect Dough again.... and had breakfast (best fried eggs in ages and they use real butter on their toast - bonus). Then I spent the whole day under an umbrella reading my book then going for a swim when I was too hot and only coming out when I'd cooled down. Bliss.
In-between the procession of beach sellers I managed to fit in fresh fruit (and my last banana roti) drinks were supplied by Perfect Dough. Then as ...
Koh Samet
... tao is small truck with seats in the bed. They are driving and honking non-stop. You just look at one, and it will pull over. You hop in, and hit a buzzer when you want him to stop. You never know quite where he is going, so if he makes a turn away from where you want to go, you have to hit the buzzer and he'll stop. Then you walk up to the window and give him about 10 baht and walk away. If you ask him how much, he'll charge you closer to 50 baht. It like everything ...
First trip to the GM plant
... dish meal (with a sauce you added and mixed through). Mine had beef and many vegetables and rice and noodles and an egg. It was good! Accompanied by a Lemon Shake - I would have called it a Lemon Granita - it was another great meal and the cost was 280 THB including a service charge (tip) that's like $AUD9.
Walked around Pattaya for a bit just to get a feel for the differentness. And then back to the hotel as we had another early start tomorrow.
A Clean Getaway
... day, we had to make our way home to Bangkok.
On Tuesday, Julian had his very first day at school, and had to get up at the crack of dawn to be at school on time. Ever the supporting partner, I happily slept through his departure, and snoozed till midday. Once I had finally roused myself from my coma, I decided my first port of call in Bangkok had to be the Royal Palace, and emerald Buddha temple. As soon as I stepped into the hallowed grounds of the palace, I proceeded to ...
Escape to dog island!
... night trying to get to sleep, too hot to put the cover over us, paranoid that every itch was another insect biting us. It wasn't nice. The only place my bites felt ok were in the Sea. Which was the warmest sea I'd ever been in by the way.
On the Saturday night, i was ******** it about the United Barca game. I'd found a place that was showing it on a big screen, which was lucky as most places shut around 2 on Koh Samet and the game kicked off at 1.45am. After tea, we followed ...


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Celebrity Pictures in Designer Jeans
Eva Mendes in Rich & Skinny
Eva Mendes wore a pair of the Cool Cargo Crops from Rich & Skinny while doing some shopping in Beverly Hills, California the other day. I wonder what that is she has in her hands? It looks like a giant glass! She looks pretty cute and comfy though.
Christina Aguilera in Robb & Hugo
Christina Aguilera was visiting a friend in Brentwood, California while wearing a pair of Robb & Hugo Blair Jeggings with a Trash & Luxury Moda tee. I love the fit of them on her! I think she rocks them! You can buy these jeggings for just $140 at www.Robbandhugo.com!
Kylie Minogue in Topshop Denim Jacket
Kylie Minogue was seen arriving at the BBC Radio One studios in London, England and signing some autographs for her awaiting fans. She was wearing a Topshop cropped denim jacket over a very cute white summer dress. I really like this outfit but I definitely would have proffered some cute wedges instead of her sandals. It's been so hot here in the UK, I'm surprised she can handle the denim jacket! Buy this jacket at Topshop for only £40!
Images courtesy of Wenn.com
Avril Lavigne in Robin's Jeans
Staying true to her rockstar roots, Avril Lavigne wore a pair of shredded and studded jeans. She's wearing Robin's Gypsy medium broken jeans. First Ciara and now Avril! These jeans are amazing, true rock and roll with the distressing and studs. I love these and think they'd look great dressed up or down. What do you think of these jeans? You can buy them here, on sale!


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6350 Main St
Williamsville, NY 14221
Williamsville, NY 14221
Tel: (716)783-3263
Gateway-Longview school is a child and family service organization that has been providing care, counseling, and support to countless children and families since 1890.
Gateway and Longview were founded by the faithful focused on serving orphaned and abandoned children.
Gateway was originally known as the Buffalo Deaconess Home of the Methodist Episcopal Church.
Longview Niagara was originally named the Protestant Home for Unprotected Children.
In 1996, the two organizations merged to become Gateway-Longview.
Over the years, Gateway-Longview's programs and services have changed to meet the ever changing needs of children and families in our community.
Yet the mission of enriching children's lives through high-quality best practice based programs remains the same.
School Overview
|School Type
|Special Education School
|School Membership(s)School Assoc.
|Other associations(s) for exceptional children
National Association for the Education of Young Children
|Grades Offered
|Grades Prekindergarten - 12
Student Body
|Total Students
|183 students
|Student Body Type
|% Students of Color
State avg.: 30%
|Students by Grade
Academics and Faculty
|Total Classroom Teachers
|35 teachers
|Student : Teacher Ratio
National avg.: 13:1
Nearby Schools:
All Schools | High Schools | Elementary Schools | Preschools | Public Schools
Show me:
- School Location Miles Students Grades
BuffaloChc Learning Center
80 Lawrence Bell Dr Sutie 115
Buffalo, NY 14221
(716)204-0355Special Education School1 mi | 54 students | Gr. PK
BuffaloChristian Central Academy
39 Academy St
Buffalo, NY 14221
(716)634-4821(Christian)1.1 mi | 362 students | Gr. K-12
WilliamsvilleSts Peter & Paul Elementary School
5480 Main St
Williamsville, NY 14221
(716)632-6146(Roman Catholic)1.7 mi | 378 students | Gr. PK-8
BuffaloSt. Gregory The Great School
250 Saint Gregory Court
Buffalo, NY 14221
(716)688-5323(Roman Catholic)2 mi | 643 students | Gr. PK-8
WilliamsvilleNativity Of Mary School
8550 Main St
Williamsville, NY 14221
(716)633-7441(Roman Catholic)2.1 mi | 211 students | Gr. PK-8
School Reviews
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Good-sized venue to see a live band or a comedian in the St Louis area.
There is a bar in the front to visit after the show.
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realmagick.com The shrine of knowledge.
A selection of articles related to electromagnetic.
Original articles from our library related to the Electromagnetic. See Table of Contents for further available material (downloadable resources) on Electromagnetic.
- The World Mind and Consciousness (GM4)
- Few would argue the fact that today's world is literally permeated with conflict at every level of society. Yet the governments and institutions of the world are, for the most part, unable to alleviate the pain and fear that is increasing among us. Most...
Mind >> World Mind
- Everyday Earth
- When you think of "Earth" what comes to mind? Perhaps you feel the stable element of solidity and grounding. Or maybe you see Earth as the third planet from the Sun. Or for you, is Earth the rich brown soil in your own backyard? Earth is all these...
The Elements >> Earth
- Citrine
- Projective. Element: Fire. Clear yellow qtz. For Solar Plexus chakra, mental and emotional clarity. Problem-solving, memory, willpower, optimism, confidence, self-discipline, digestion. Reduces anxiety, fear, depression, stomach tension, food disorders,...
Earth Mysteries >> Stones, Minerals & Metals
- Manifesting World Enlightenment: Part 3
- One of the very best ways to raise personal or group consciousness, is to MANIFEST spiritual Intentions into the environment at large. The projection of love into one's surroundings for instance, results in love being reflected back to the sender, like...
Mind >> World Mind
- Malachite
- Receptive. Element: Earth. Steady pulsing electromagnetic energy. (High copper content) On brow: Stimulates physical and psychic vision, concentration. For heart and solar plexus centers: Stomach, liver, kidney stones, lungs, immune system, radiation, MS,...
Earth Mysteries >> Stones, Minerals & Metals
- ASTRONICA: Blessing or Nightmare for Astrology?
- If NASA's engineers only had eleventh-century astronomy knowledge, do you think they could have landed the "Rover" on Mars? If modern day astrophysicists could only make use of ancient Assyrian astronomy, do you think they would have been able to...
Mystic Sciences >> Astrology
Electromagnetic is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Electromagnetic books and related discussion.
Suggested Pdf Resources
- IARC classifies Radiofrequency Electromagnetic Fields as possibly
- May 31, 2011 low-frequency electromagnetic fields).
- www.iarc.fr
- Health and electromagnetic fields
- electromagnetic fields and mobile telephones on health.
- ec.europa.eu
- Report of the Commission to Assess the Threat to the United States
- Electromagnetic Pulse (EMP) Attack. Volume 1: Executive Report United States with a high-altitude nuclear weapon-generated electromagnetic pulse. (EMP).
- www.empcommission.org
- Exposure to high frequency electromagnetic fields, biological effects
- electromagnetic fields (EMF) and the resulting consequences for health.
- www.icnirp.de
- Introduction to the Electromagnetic Spectrum
- Introduction to the Electromagnetic Spectrum. Editor: Daniel Finkenthal. Written by: Daniel Finkenthal.
- fusioned.gat.com
Suggested News Resources
- EMGS swings to profit
- Norway's Electromagnetic Geoservices (EMGS) posted a profit during the second quarter of the year as revenues were boosted by the addition of an extra vessel. The company recovered from a loss of $4.
- Free minutes pose greater threat to health than base stations
- Fast developing technologies can pose threats to people's health as electronic equipment in the home can create their own electromagnetic fields.
- Family works hard to live without radio frequencies
- Highlands family Kimberly Grigg and her children Logan and Sierra choose to life their lives with as little exposure to electromagnetic fields as possible. They don't have a microwave or a cordless phone and they don't want a BC Hydro smart meter.
Suggested Web Resources
- Electromagnetism - Wikipedia, the free encyclopedia
- Electromagnetism is one of the four fundamental interactions in nature. The other three are the strong interaction, the weak interaction and gravitation.
- en.wikipedia.org
- Electromagnetic - Wikipedia, the free encyclopedia
- en.wikipedia.org
- Electromagnetic radiation - Wikipedia, the free encyclopedia
- en.wikipedia.org
- HowStuffWorks "How Electromagnets Work"
- Related Content. Prices: Electromagnets. Electromagnet Science Set.
- www.howstuffworks.com
- Electromagnetic Spectrum - Introduction
- Feb 3, 2010 A NASA site listing the various wavelengths of electromagnetic radiation.
- imagine.gsfc.nasa.gov
Great care has been taken to prepare the information on this page. Elements of the content come from factual and lexical knowledge databases, realmagick.com library and third-party sources. We appreciate your suggestions and comments on further improvements of the site.
Electromagnetic Topics
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© 2000 - 2015 Realmagick.com, All Rights Reserved.
© 2000 - 2015 Realmagick.com, All Rights Reserved.


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Slow Cooker Pork Shoulder
Looking for recipes for slow cooker pork shoulder? Taste of Home has the best slow cooker pork shoulder recipes from real cooks like you, featuring reviews, ratings, how-to videos and tips.
Recipe Spotlight
Chipotle Pomegranate Pulled Pork
I was making pulled pork and wanted to kick it up a bit. Pomegranate jelly was the perfect addition to this tender entree. —Tatiana Kushnir, Montara, CaliforniaView Chipotle Pomegranate Pulled Pork Recipe


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New Orleans Airboat Ride
Read what other Viator.com travelers think about the New Orleans Airboat Ride. What they loved, what they liked and what they think could be improved, it's all here to help you make the most of your next trip.
Click here for tour details, schedule and pricing
The airboat swamp tour was amazing, a highlight of our trip to the Bayou. The tour was well organized and directions were easy to follow since we drove ourselves. Our tour guide, Lance, was great and a little or lot of crazy! He jumped out of the boat to catch a baby alligator. He also had fun playing with a few bigger gators! Some got a little too close for comfort but that was part of the fun. Lots of gators to see and other wildlife amongst an Eerie yet beautiful swamp. Be sure to wear the headset as the boat can get really loud especially sitting in the back by the fan. Excellent tour!
Great trip! The weather was against us but Jay kept us entertained and we did see 6 gators. We had a fun time and learned a lot from Jay. Would definitely recommend it!
So much fun! Great guide! Highlight of our trip!
The Swamp Airboat Tour was really Great! Our driver - Captain Bobby really loved his job and it showed by his excitement and knowledge of the wildlife and the area. Even the slight misting/rain did not ruin this trip. It just added to the adventure of the swamp land.
Really good trip
this was so cool...just minutes from the French Quarter and a completely different world...natural beauty, wildlife, and real Cajun guides...fabulous!
Great tour. reasonably prices. very knowledgeable guides.
We had a great time. Tour guides/boat operators were very knowledgeable about local history and animal life. I would highly recommend Airboat Adventures. If you are going to see the alligators, do your research, they go into hibernation when the water temperaturedrops below 60! We knew this ahead of time, so we enjoyed the local scenery and the boat ride...and of course our humorous tour guide.
Loved to see the alligators and the scenery. The guide knew what he was talking about, and was informative Overall a great adventure.
Although a tad bit chilly on the boat, it was fun!!!! The scenery was gorgeous and our tour guide was awesome. He was friendly and very knowledgeable regarding the area, the wildlife, the waterways and the plants/trees. We even got to hold a baby alligator...oh so cool. Would absolutely recommend this trip!!!!
Fabulous.. a must do! Staff at the site were knowledgeable and friendly.
One negative--- The driver of our shuttle was delayed so we were asked to take an alternate shuttle back into New Orleans, so don't know the drivers name. Big Jo on shuttle #1 was the best, humor, knowledge etc. The driver on the return was reckless and was reading documents while he was driving on the freeway. NOT impressed!
Ticked all the boxes for a great day out our guide and boat driver was fantastic.
Loved the swamp tour! The guide was informative and funny. Got to see many gators, herons, turtles, and even a stunning barn owl. Highly recommended.
This tour was great!! I would highly recommend this tour. My family took the large airboat and our driver/guide was very informative and funny. You could tell he cared about the land and wanted us to care also. Next time I want to try the small airboat ride!
Very enjoyable time, with a couple of surprises for my other half!


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trying to find on motor,is it near oil filter or on top?
View questions for:All Ford
2001 Ford Explorer
Ford Q&AAsk Your Question
2001 Ford Explorer Question: location of oil pressure sending unit on 2001 ford explorer 5.0?
cajun51, 5.0L V8, South Milwaukee, WI, January 26, 2012, 18:36
2 Answers
Best Answer
gmc4me January 26, 2012, 19:01Journeyman
The part is best accessed from the drivers side wheel well. Just jack up the truck till the wheels are almost off the ground, remove the black plastic wheel well shields and the sensor is in the front lower of the block. I believe it has one wire.
Replycajun51, January 27, 2012, 15:19Rookie
Thanks for your time&help.I am going to work on it Sat.thanks again,Frank T.
Answer #2mastertech6371 January 26, 2012, 23:07Master
just a gmc said but it is around the oil filter.
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