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Products & ServicesSee also: Categories | Technical Articles | More Information
Supplier: Carr Lane Roemheld Mfg. Co.
Description: FEATURES: As push clamps, these double-acting cylinders are useful in automated systems where the return stroke must be completed within a certain time. They are also very useful as pull clamps. Manifold mounting allows an extremely compact, space-saving design. These versatile cylinders provide
- Type: Cylinder Clamp
- Actuation: Hydraulic
- Clamping Force: 560 to 15000 lbs
- Application: Other
Supplier: Vecoplan, LLC
Description: These modular low-maintenance and user-friendly push/pull rod dischargers essentially consist of hydraulically-driven push/pull rods moving reciprocally above the floor of the bunker. When an upstream extraction device is activated, a hydraulic system automatically initiates a slow backwards
- Conveyor Type: Other
Supplier: Vecoplan, LLC
Description: These modular low-maintenance and user-friendly push/pull rod dischargers essentially consist of hydraulically-driven push/pull rods moving reciprocally above the floor of the bunker. When an upstream extraction device is activated, a hydraulic system automatically initiates a slow backwards
Supplier: WEH Technologies Inc.
Description: The TW152 makes for easy, efficient and safe filling of oxygen cylinders and offers ease of operation. Simply place the connector onto the male thread of the cylinder valve and pull the sliding sleeve forward. The split collet design system securely locks onto the standard cylinder thread
- Material: Brass/Bronze, Steel - Stainless
- Connection Type: Push-to-Connect / Push-On, Threaded - Female
- Application: Gas Fitting, Other Application
Supplier: ACE Controls Inc.
Description: The solution to a lack of space: If standard push type gas springs cannot be used due to a lack of space, ACE's industrial pull type gas springs are the solution. They work in the opposite way of standard push type gas springs. The piston rod is retracted when the cylinder is unloaded. The gas
- Absorber Stroke: 1.18 to 25.59 inch
- Compressed Length: 5.12 to 29.53 inch
- Dampening Method: Gas
- Rod Diameter: 0.3900 inch
Supplier: Carr Lane Manufacturing Co.
Description: Larger-size air clamp. Similar to a manual plunger clamp, except operated by an air cylinder instead of by hand. Toggle linkage provides high holding capacity and insures positive mechanical locking even if air pressure fails. 1" plunger travel.
- Type: Toggle Clamp
- Actuation: Pneumatic
- Clamping Mechanism: Lever
- Clamping Force: 100 to 850 lbs
Supplier: WEH Technologies Inc.
Description: without filter and with PEEK seal (see accessories). Features: Push-Pull actuation Extremely high flow rate Plastic thermal protection WEH® jaw locking mechanism High-grade materials Compact design
- Fuel: Liquid Fuels (gasoline, kerosene, etc.)
- Maximum Pressure: 3000 psi
- Orifice Size: 2.13 inch
- Nozzle Form: In-line
Description: position. For the stabilization of the floating piston, it has to be pressurized by at least 20N. Depending on the position of the floating piston, the damper can be installed stable either in push- or in pull direction.
- Absorber Stroke: 0.3937 to 27.56 inch
- Maximum Force (P1): 4.5 to 584 lbs
- Cylinder Diameter or Maximum Width: 0.4724 to 1.57 inch
- Rod Diameter: 0.1575 to 0.5512 inch
Description: Rigid locking in push and pull direction Here the advantages of the K and the P type lockable gas springs are combined in one spring. The locking force in both directions is rigid up to the mechanical strength of the spring and because the gas chamber is located separately, an extension force
- Absorber Stroke: 0.7874 to 9.84 inch
- Dampening Method: Gas
- Mounting: Ball and Socket, Clevis, Eyelet, Threaded, Other
- Cylinder Diameter or Maximum Width: 0.8661 to 1.57 inch
Supplier: Vektek, Inc.
Description: . Used as the double acting unclamp port). Proprietary seal designs reduce leakage and increase seal life for longer lasting, more dependable cylinders. Threaded plunger ends allow the attachment of arms, mechanisms or remote actuators. Push/Pull cylinders are not shipped with cap screws.
- Type: Hook / Swing Clamp
- Actuation: Hydraulic
- Clamping Mechanism: Other
- Clamping Force: 470 lbs
Supplier: Pascal Engineering Inc.
Description: No Description Provided
- Stroke: 1.57 to 2.36 inch
- Rated Load/Force: 2765 to 3867 lbs
- Operating Pressure: 145 to 1015 psi
- Shaft Diameter: 3.39 inch
Supplier: Electro Kinetic Technologies
Description: The PONY EXPRESS Gas Cylinder Tank Cart product line offers ergonomically designed electric carts to reduce the push/pull forces that cause musculoskeletal injuries while moving large gas cylinders. These motorized carts have racks for 24 or 40, M7, M9, C, D or E gas cylinders. Should you need
- Type: Other
- Wheel Type: Solid / Cushion
- Motorized: Yes
- Capacity: 1500 to 2000 lbs
Supplier: Southland Equipment Service
Description: bearing slides and cylinder lock. Cylinders are keyed alike. Push handle aids in ease of mobility. 1/2"H. back and end stops. Drawers measure 20"W. x 19-3/4"D. x 5"H. Rolls on bolt on 5" x 1-1/4" polyurethane casters, 2 rigid, 2 swivel. Finished in durable Gray powder coat
- Height: 34 inch
- Width: 23 inch
- Depth: 20 inch
Welding, Brazing, and Soldering Equipment - Miller Millermatic 252 PKG 30A Dual Cyl & CBL RCK REG & HS.. -- 951066Supplier: U.S. Welding & Safety Supply Co.
Description: ! Push-Pull Gun Direct Connect - now directly connects your push-pull gun, no extra module required. New! Angled, dual-gear driven, cast aluminum drive system features no-tool, quick-change reversible drive rolls and an easy-to-set, scaled tension knob. New! Patent-pending EZ-Change&tm; Low Cylinder Rack
- Equipment Type: Welding Equipment
Supplier: Vektek, Inc.
Description: bulk added for the ports only, not the entire Body. Easily used to add hydraulics to existing strap clamps or pull against "C" washers. Double acting models push and pull with equal force because both sides of the piston have identical areas.
- Operating Pressure: 5000 psi
- Cylinder Action: Single
- Mounting Options: Threaded
Supplier: Star Hydraulics, Inc.
Description: Star two-speed Hi-Lo pumps provide rapid movement at low pressure for the part of a cylinder's stroke where no work is encountered. The pump automatically switches to high pressure when the cylinder must deliver maximum push or pull force. Changeover from high volume-low pressure to low volume-high
- Maximum Discharge Pressure: 10000 psi
- Inlet Size: 0.3750 inch
- Discharge Size: 0.3750 inch
- Power Source: None, Pump Only, Manual, Hydraulic, Oil
Supplier: Weforma Dämpfungstechnik GmbH
Description: Without free travel: Mounting any position Deceleration: adjustable, optional: non adjustable Deceleration type: Push, Pull , Push + Pull Surface protection: Housing: zinc plated Extended life time: Piston Rod: hard-chrome plated Special Seals + Oils Temperature: -20°C - +80°C RoHS
Supplier: Sebright Products, Inc.
Description: power unit that is energy efficient, heavy duty hinge that is the strongest on the market, a ratchet latch that tigtens against the door seal and insures a tight seal and an Operator Station that includes: safety key-lock, pull to start, push to stop, full container light and can be mounted in any
- Equipment Type: Compactor
- Material Condition: Dry, Wet
- Applications / Materials Compacted: Food Products, Scrap / Solid Waste
- Operating Force: 25000 lbs
Find Suppliers by Category Top
Conduct Research Top
Choosing the Right Cylinder
the cylinder need to push, pull or both? (Single-acting cylinders extend the piston under hydraulic pressure; double-acting cylinders extend and retract the piston under pressure.). Does the application require multiple cylinders?. Is the application stationary, or must the components be light in weight
Interactive designer configures pneumatic systems
a configuration menu along with animated graphics that show the general system layout and key design variables. The user first selects cylinder type, orientation (up, down, or horizontal, with or without guidance), and whether force is push or pull. The next data inputs are attached mass, supply air
More Information Top
Advances in Material Science, Mechanical Engineering and Manufacturing
Loading frame consists of (1)two main beam,(2)constrained beam,(3)load beam,(4)load carrying beam,(5)loading cylinder,(6)sizing mechanism, (7)pin,(8) push - pull cylinder ,(9)protective devices and accessories.
Turret Operations In the North Sea: Experience From Norne And Åsgard A
The turning system comprises an arrangement of tour push / pull cylinders with grippers, which work in sequence.
Development of a Deepwater Integrated Production System
clamp assembly, similar to those previously used simple arrangement of push - pull cylinders which .
Interactive spatial copy wall for embodied interaction in a virtual co-existing space
Local participants can interact with remote participants through pushing and pulling cylinders . .
Moving the Earth: The Workbook of Excavation, Fifth Edition > BASIC INFORMATION
Cylinders push and pull in straight lines or arcs; motors rotate.


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Rangers Photos
Photos: Missed chances, miscommunications for Rangers in 3-1 loss to Orioles
Photo: Brad Loper/Staff Photographer
Texas Rangers center fielder Craig Gentry (23) can't make a play on a ball hit by Baltimore Orioles right fielder Nick Markakis (21) in the fifth inning of MLB Baseball action at Rangers Ballpark in Arlington, Texas on Friday, July 19, 2013. (Brad Loper/The Dallas Morning News)
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subset: commoncrawl


text: Front View larger Garmin Premium Carrying Case For your nüvi portable navigator up to 4.3" inches (Model #010-11305-04) Item #: 150PREMIUM Be the first to write a review This item is no longer available. Original Price: $19.99 Shop all Portable GPS Accessories Need help? 1.888.955.6000 Email Chat Ask an expert advisor No pressure, no commission — just lots of good advice from our highly trained staff.


text:
Walking into Eric Pickles's office, visitors are greeted by the unexpected sight of a photograph of a young Che Guevara smoking a large cigar.
The Cuban revolutionary is a bizarre image to adorn the walls of one of the most Thatcherite Cabinet ministers whose office is also a shrine to the former Conservative prime minister.
"Warns me every day of the dangers of the cigar-chomping commies taking control," he jokes.
The minister, known as "the judge" by David Cameron, has steadily built a reputation as one of the Government's most effective performers, by facing down council bosses and driving through cutbacks by embarrassing them over wasteful spending.
His own officials, who had enjoyed peace pods and expensive Italian sofas introduced by the Labour government, have also experienced first-hand his drive to cut spending.
They are now on the front line of the austerity drive — each told to adopt one of the department's plants and care for it — while their Secretary of State is threatening to lease out part of the palatial lobby to a supermarket to raise extra money. The office "breakout areas" are empty as Mr Pickles strides down the corridors boasting that the building is now more like a low-cost motel.
He appears keen to push ahead with the spending cuts so that the Conservatives can start cutting taxes before the next election.
Council tax, which his department oversees, has been frozen this year and Mr Pickles is determined to face down Liberal Democrat sensitivities and reduce tax for the middle classes. New taxes on more expensive properties are definitely not on the agenda.
"We as a government have got to understand that middle-class families put a lot into this country and don't take a lot out," he says. "It would be a very big mistake to start imposing taxation on the back of changes in property values."
Mr Pickles also goes further than some of his colleagues by insisting that the 50p higher rate of income tax should be scrapped for ideological reasons.
The Treasury is conducting a study to establish whether the new top rate actually raises much money, but the Liberal Democrats have said it is "cloud cuckoo land" to consider scrapping the tax at the moment. Mr Pickles expresses the views of many Conservatives when he says: "We always said it [the 50p rate] was temporary.
"We'll get an assessment at the end of this financial year as to how much money we've got [from the tax]. But you know I'm a Conservative, I like the idea of lowering taxation.
"I believe you get more tax revenue by lowering taxation because people work harder. I like people to keep more in their pockets for their family."
Apart from attacking cherished Liberal Democrat tax policies, Mr Pickles is determined to take on the wider Whitehall machine by opening up the Civil Service for more scrutiny.
He was the first minister to shame publicly his officials by publishing details of their spending on government credit cards. "We are as keen as mustard in this building for transparency," he said with a smile.
"[But] I did get a bit of a surprise when I found our own internal auditors had disappeared off to a burlesque club [at the taxpayers' expense]."
The minister indicates that he overruled advice from Sir Gus O'Donnell, the head of the Civil Service, when he published the credit card information.
"We felt it was important to get the government procurement card expenditure out," Mr Pickles said.
When asked whether he had to overrule the Civil Service to do this, he dismissively replied: "Well, you occasionally get the odd piece of advice."
Unusually for a government minister, Mr Pickles also criticises officials and urges them to be more open or risk losing touch with the public.
Choosing his words carefully and speaking slowly, he said: "The Civil Service is a very conservative, with a small c, organisation. And I am a Conservative so that isn't a bad thing to be. To be cautious and the like.
"But, I just think that in a way they are just slightly, mildly, out of kilter to what the real world is like now. And I think that a degree of openness should be there." However, his frustration is not limited to the Civil Service and Mr Pickles believes that the biggest problem facing government effectiveness are judges and the threat of judicial review.
Mr Pickles has been faced with the prospect of being hauled before the courts on several issues, including his policies to cut school funding for councils and planning proposals.
"You are constantly looking over your shoulder for judicial review … the electorate is being frustrated," he says.
"I could kind of expect to be reviewed on procedural matters, but to be reviewed on policy?"
But, should judges not have some oversight of policy?
"No," he replies. "I'm a bit old-fashioned really. I expect them to interpret the law, to stand up for the rights of individuals and dispense justice. I don't expect them to make policy."
Mr Pickles is unusual among his Cabinet colleagues as he comes from a working-class Yorkshire background, and after attending the local grammar school briefly flirted with communism.
He now represents an Essex constituency, calls other ministers "chums" and was the Conservative chairman in the run-up to the last election, criss-crossing the country to encourage the party faithful.
After taking a "birdwatching" break to Norfolk and then Spain, Mr Pickles will get stuck into another task he has been given by Mr Cameron — to lead the recovery effort in riot-hit areas.
He will tour the country ensuring that "no obstacles" stop communities from recovering. "It is about getting things back to normal as quickly as possible," he says. "We need to get the recovery over quickly. But we've got to be involved in confidence-building so that people wouldn't hesitate to set up a business there, wouldn't hesitate to think about putting roots down in an area.
"We've got to make sure shopkeepers are confident in staying. They don't take the compensation and leave."
He believes the riots were simply "lawlessness" and that a series of local problems need to be tackled.
In Tottenham, property ownership needs to be addressed to cut the number of derelict buildings and the Post Office needs to reopen; in Ealing, the local shops need to be encouraged to stop people going to nearby retail parks; and, in Croydon, some of the 1960s architecture is off-putting.
But what about the Prime Minister's over-arching warnings about the riots being the culmination of decades of social decay and immorality? "Well there is all that as well, of course there is," he hurriedly adds remembering that he can't be seen as too unreconstructed a Thatcherite if he wants to climb higher in the Coalition.


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Heavy Rain for PS3On: PS3, PS4
A dark, emotional thriller where decisions can have dramatic consequences.
Stuck on Heavy Rain? We've got you covered!
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Beyond: Two Souls releases on PS4 next week, Heavy Rain in March 2016
Digital launch coming November 26, with a retail collection due in 2016.
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Millbob & Jimminy Jim Jim - your new favourite YouTubers - run down the best sex in games. Prepare yourselves...
Heavy Rain & Beyond: Two Souls PS4 release dates to be revealed 'soon'
Quantic Dream teases incoming announcement.
Heavy Rain and Beyond Two Souls announced for PS4
Quantic Dreams' two interactive story games are getting a re-release on PS4 - at least in Europe and PAL regions.
The Games Of The Generation: James' Choice
The VideoGamer.com team is bullied into choosing just 3 games from hundreds as their games of the generation. Today, News Editor James Orry's choices...
Beyond: Two Souls development budget not as high as you might expect
Cage and co. run the company very seriously.
David Cage thinks we'll be able to control games with our mind
"There will be no need for controllers any more. Just think about what you want to do on screen and your character will do it."
David Cage ready to write future projects with a team
But it becomes more difficult for Cage to deal with failure if responsibility doesn't fall only on him.
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Game of the Year 2010: No.1
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Cinematic Trailer
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text:
Tags: wild, round, ass, latina, babes, rough, fucking, action
Categories: Inter Racial
Submited: 6 years old
Views: 2718
Copyright © 2006 - 2015 DeviantClip.com - All Rights Reserved.
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Section 2257


text:
Babycatcher Midwives of New Jersey offers the premier homebirth team in Northern New Jersey.
We are dedicated to helping you realize a safe, satisfying and transformative experience welcoming your baby.Our main offices are located in Chatham, Rockaway and Stanhope. We attend homebirths throughout Northern, Western and Central New Jersey. We also offer hospital birth at Morristown Memorial Hospital, bringing our experienced homebirth team to the hospital.
Photograph by Tillie Simon.


text:
February 1, 2007
Zach Johnson
Minnesota brought in defensive coordinator Everett Withers to rebuild the Gopher defense into a fast and aggressive unit. The first step in the process was trying to secure an athletic, hard hitting safety.
The top choice was Aldine, Texas safety Curtis Thomas, who visited Minnesota last weekend. Thomas left Minnesota with the Gophers firmly planted on top of his list, but wanted to take a last weekend trip to Missouri. Can Minnesota hold their lead? ...More... To continue reading this article you must be a member. Sign Up Now!
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LFE effect in the Dark Knight Rises
Started by sm8224, Dec 08 2012 12:49 PM
7 replies to this topic
#1 of 8 OFFLINE
Posted December 08 2012 - 05:49 PM
I have a question...My home theater set up is good, and the sub works great...shakes the walls and house when I want it too. For the new Batman movie, I really had my hopes up for the bass, and when I watched it, i was less than impressed. I just figured they must have laid back a bit in the mixing. But looking online and from what I hear, the bass is supposed to be the best ever. I had watched the Dark Knight prior to watching Rises and the sub was working great. When I put Rises in, it was almost non-existant. What could the problem be? Bad DVD possibly? anyone else have similar issues? My setup consists of a Yamaha RXV2500 with 5.1 surrond using Klipsch speakers and sub. I am at a loss and would really love for the bass to be there making the movie that much better. thanks in advance. Steve
#2 of 8 OFFLINE
Posted December 08 2012 - 05:53 PM
Hi, Steve, welcome to HTF! I watched The Dark Knight Rises on blu-ray last night, and had to reduce the volume in consideration of the neighbors the bass was so high. Are you talking of the blu-ray or the DVD? If you are talking of the DVD, perhaps it is not mastered up to the standard set by the blu-ray.
#3 of 8 OFFLINE
Posted December 08 2012 - 05:59 PM
Maybe the majority of the bass frequencies are lower than the Klipsch sub that you have. You don't mention the model number of the sub so we can't really check to see what Klipsch says the low limits are. That is one reason I use a sealed sub and an amp with no subsonic filter.
#4 of 8 OFFLINE
Posted December 08 2012 - 06:00 PM
I bought the DVD and not the blu-ray, as I figured blu-ray would not have any different audio. I tried the DVD on my Denon system as well and nothing. Is it possible to have a poorly mastered DVD? I mean when the Bat was flying I expected the house to be falling down. And honestly nothing. Was like there was no LFE at all. Just normal bass. It pretty much ruined the movie for me. I honestly thought that my sub had died. So to test I put the previous Batman in and it was working as it should
#5 of 8 OFFLINE
Posted December 08 2012 - 06:01 PM
Sub is a model RW-10
#6 of 8 OFFLINE
Posted December 08 2012 - 06:06 PM
The DVD is lossy (probably 384Kbps Dolby Digital in this case). The Blu-ray is lossless DTS-HD Master Audio. So there is a difference in the audio codec. Now we've all heard Dolby Digital sound good. So maybe it's something else.
#7 of 8 OFFLINE
Posted December 08 2012 - 06:16 PM
My other movies are all DVD, and the bass sounds great. I just can't see it not being there at all. It sucks too since the movie is open already. I'd like to try and take it back and get te blu-ray now and see of its better. But I don't think Walmart will take it back. I really think the audio track is missing on this DVD. My luck.
#8 of 8 OFFLINE
Posted December 09 2012 - 10:09 AM
Ok, update. I took the DVD back and picked up the blu-ray. Huge difference in audio. I had no idea. I have never run into this issue before until this movie. Thanks!
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Beyond awesome, i can't wait to get my hands on this! A definite vote for mod of the year!
New update for L'Aigle, featuring new uniforms and weapons.
Posted by Docm30 on Dec 2nd, 2011
I suppose it's time for a monthly progress update for the mod, so I'll fill you all in on the latest happenings with the mod.
On the coding side the mod goes well, several new features have been added and more are in the works. All the factions that will feature in the first release are now in the mod and working.
The art is also coming along well, with new uniforms and weapons being made constantly, aswell as new trees and props that will be shown at a later date.
And here's some screenshots of a few new items to hold your interest.
That's about it for now. Remember to cast your Mod of the Year vote to support the mod!
Beyond awesome, i can't wait to get my hands on this! A definite vote for mod of the year!
You have my vote. Beautiful as usual. :)
Tracking, these models are truly amazing. Good luck with your project.
This mod kicks more *** than any of other ones !!!


text:
New to the Megaman range is Keppa, a surface-mounted floodlight offering a versatile and contemporary approach to exterior lighting. The Keppa floodlight is manufactured with a lightweight PC material shell and utilises Megaman's energysaving Clusterlite lamp, an innovative alternative to HID lamps.
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I was wondering if there was a port for vpinmame on xbox or any emu that can emulate pinball machines. I tryed searching but no can do during peak hours
Anyway if anyone knows about one i'd be glad knowing there is one
Started by kaarde , May 02 2004 11:27 PM
3 replies to this topic
Posted 02 May 2004 - 11:27 PM
Posted 03 May 2004 - 03:43 AM
I don't beleive there is or any plan to have one.
Posted 04 May 2004 - 01:31 AM
guess i'll stick with playing Creature form the black lagoon on PC
Posted 05 May 2004 - 11:31 AM
They're closed source, so it's not too likely. Sad tho.
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Are you Panagiotis Kalogris?Claim your profile
Publications (4)4.44 Total impact
Article: Outcomes after ascending aorta and proximal aortic arch repair using deep hypothermic circulatory arrest with retrograde cerebral perfusion: Analysis of 207 patients[Show abstract] [Hide abstract]
ABSTRACT: Correction of ascending aorta and proximal aortic arch pathology with numerous surgical techniques having been proposed over the years remains a surgical challenge. This study was undertaken to identify risk factors influencing outcome after aortic arch operations, requiring deep hypothermic circulatory arrest (DHCA). Between 1993 and 2010, 207 consecutive patients were operated for ascending aorta and proximal arch correction with the use of deep hypothermic circulatory arrest with retrograde cerebral perfusion. All patients were followed up with regular out-patient clinics, transthoracic echocardiography and, when required, chest computed tomography. There were 102 (49.3%) emergencies (acute type A dissection) and 105 (50.7%) elective cases. Mean age: 63.5 ± 12 years. Mean circulatory arrest time was 25.4 ± 13 min. Unadjusted analysis of factors associated with 30-day mortality revealed emergency status, preoperative hemodynamic instability, acute dissection, reoperation, increased circulatory arrest time, postoperative bleeding, postoperative creatinine levels and presence of neurological dysfunction. Multi-adjusted analysis revealed duration of circulatory arrest as the only and main factor related to death. Thirty-day mortality was 2.4% for the elective and 7.2% for emergencies cases. Survival during long-term follow-up was 93, 82 and 53% at 1, 5 and 10 years, respectively. Ascending aorta and proximal aortic arch replacement with brief duration of deep hypothermic circulatory arrest combined with retrograde cerebral perfusion is a safe method with acceptable short- and long-tem results.Interactive Cardiovascular and Thoracic Surgery 06/2012; 15(3):456-61. DOI:10.1093/icvts/ivs252 · 1.16 Impact Factor
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ABSTRACT: We are reporting the successful surgical treatment of a 23-year-old female with a giant right coronary artery to coronary sinus fistula. This woman had complaints of chest pain and dyspnea on exertion for few months. Transthoracic echocardiography (TTE) showed a large tortuous right coronary artery and a dilated coronary sinus. Preoperative multi-detector computed tomography (MDCT) coronary angiography and cardiac catheterization confirmed the diagnosis of a right coronary artery to coronary sinus fistula. The patient underwent surgical closure of the fistula and division of the communication between the right coronary artery and the coronary sinus with the use of cardiopulmonary bypass. The patient was discharged home on postoperative day 5 and at one-year follow-up is symptom-free.Interactive Cardiovascular and Thoracic Surgery 09/2011; 13(6):672-4. DOI:10.1510/icvts.2011.283689 · 1.16 Impact Factor
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ABSTRACT: Cardiac myxoma is the most common benign tumor of the heart. It presents with a variety of clinical signs and symptomatology making diagnosis frequently quite a challenge. We review our experience with 41 patients who underwent surgical intervention for cardiac myxoma between 1994 and 2011. All patients' preoperative, intraoperative and postoperative characteristics were recorded. They all had a standard sternotomy and cardiopulmonary bypass with cardioplegic cardiac arrest and were followed up with clinical examination and echocardiography. The surgical goal was to remove not only the tumor but the whole area of attachment to prevent recurrence. Biatrial approach facilitated the complete excision of the tumor. Surgical excision of cardiac myxoma carries a low-operative risk and gives excellent short- and long-term results.Interactive Cardiovascular and Thoracic Surgery 09/2011; 13(6):597-600. DOI:10.1510/icvts.2011.278705 · 1.16 Impact Factor
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ABSTRACT: Left main coronary stenosis, including ostial lesions, is conventionally treated by coronary bypass surgery. This approach, however, restores a less physiological retrograde perfusion to part of the myocardium and may contribute to a competition of flows in non-occluded coronaries. Direct surgical reconstruction of the LMCA has been described and theoretically avoids these potential drawbacks. From May 1995 until December 2005, 25 patients with ostial left main stenosis underwent surgical angioplasty in our unit. Patients were all followed up clinically and with transesophageal echocardiography. Mean age of the patients was 59.7 years (range, 33 - 73 years). The male to female ratio was 14 : 11. The left main coronary stem was approached anteriorly in all patients. The onlay patch consisted of saphenous vein and was extended across the aortotomy suture line. There were no early deaths or perioperative myocardial infarctions. All patients underwent follow-up clinical examination and transesophageal (TOE) echocardiography as well as other investigations when required. TOE demonstrated a wide open left main coronary artery normal flow pattern, and no aneurysmal dilatation or calcification of the onlay patch in 24 patients. After a mean follow-up of 8 years, the all-cause survival was 88 %, while event-free survival was 80 % with 21 pts remaining in CCS I. Surgical reconstruction of the LMCA is a safe and effective treatment for left main stenosis. Re-institution of normal blood flow through the left main coronary artery possibly confers advantages over bypass surgery.The Thoracic and Cardiovascular Surgeon 11/2007; 55(7):424-7. DOI:10.1055/s-2007-965377 · 0.98 Impact Factor
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Onassis Cardiac Surgery CenterKallithea, Attica, Greece


text:
Renzo Piano's Baby Shard scheme revealed
[First look] These are the latest images of Renzo Piano's 17-storey Baby Shard project close to London Bridge train station in London
Officially known as 'The Place', the project has been described as the Baby Shard because it is close to Renzo Piano's 72-storey Shard skyscraper and is being built by the same developer and architect.
Sellar Property Group is developing the 56,000m² scheme as part of its £2 billion London Bridge Quarter redevelopment programme.
Ivan Sellar, chairman of Sellar said: 'The Place will be London's largest and most efficient office building to hit the market in 2013 – at a time when there is expected to be a real shortage of prime Grade A space available to let.'
Joint letting agents, CB Richard Ellis and Colliers International, added: 'The finishes, while not identical, are consistent in their outstanding quality. There are unique features such as the Winter Gardens that, combined with Renzo's pre-occupation for natural light, further marry the two buildings together.'
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Get the latest Flash player
Date: 2 years ago
Runtime: 1:15
Views: 21,092
Top Comment
All Comments
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That was quite a good piss. How much had you ******and how long had you held it for? Woud you sit on my lap and do that please
Such a pretty pussy - made my dick stiff straight away!
would of love to eat that pussy while peeing.
That was awesome, I really like that - Hotstuff!
You must have been bursting.
wow like it. nice long pee!!
would love to play with your clit while you pee
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revealed a wonderful pussy in the beginning followed by an amazing long pee...Best video to date
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Very sexy love when a lady pees standing up :D


text:
"Hartlepool" Top 5 Page for this destination Hartlepool by steventilly
Hartlepool Travel Guide: 38 reviews and 55 photos
Hartlepool is a bit of an enigma for me. It's really tried hard to bring itself into the 20th Century and market itself as a "tourist destination" but I'm not sure if it totally works.
Full credit to the council and the old TDC for what they have done, it just seems that they never quite finished, and if only they'd gone the extra mile...
"Old Hartlepool" is the "original" Hartelpool, founded as far back as 647. This area is what is now usually known as "The Headland"
Much later (in the mid 1800's) as part of a commercial venture "West Hartlepool" was founded. Soon it's population grew to much greater than that of Old Hartlepool. West Hartlepool is what is now regarded as the town centre.
In 1967 the two towns were officially amalgamated - though for years before and after this amagamation the place was known as "Hartlepools".
- Pros:It's Improved A Lot Recently
- Cons:It Needs To Keep Improving
- In a nutshell:It's No Tourist Hotbed, But I Like To Go
Reviews (14)
The centrepiece of The Historic Quay is HMS Trincomalee. A frigate of the British Navy she was restired by apprentices... more travel advice
Occasionally you might see some beautiful girls in period costume... more travel advice
And this is the guardhouse of the Royal Marines... more travel advice
This is inside one of the recreated rooms, the office of an Admiral or some such. more travel advice
Comments (4)
So how can it be a veggie breakfast if it includes sausage? LOL
I must get out of bed early enough to try the Moorings breakfast one day!
Nice job! With rare exception, hotel restaurants are less desirable than other restaurants nearby.
reckon you could make any place look good Can I come for breakfast too ;-))
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UPDATE: A spokesperson for Zack Snyder has told The Hollywood Reporter that the director is a huge fan, but not involved in any "Star Wars" films. I'm not ...On January 14, 2013 / By Sean Gerber
Director and Marvel creative consultant Joss Whedon has given some details on "The Avengers 2" and where he's looking to take the world famous superhero team. The Gentlemen ...On January 14, 2013 / By Sean Gerber
© 2011 Modern Myth Media, All rights reserved.


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Fly Leasing Limited (FLY)
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FLY Leasing Limited (FLY)
Q3 2010 Earnings Call
November 4, 2010 4:30 PM ET
Matt Dallas – Investor Relations
Steve Zissis – President and CEO, BBAM
Colm Barrington – Chief Executive Officer
Gary Dales – Chief Financial Officer
Helane Becker – Dahlman Rose
David Nasborough – RBC Wealth Management
Jon Evans – Edmunds White Partners
Yeltsin Rabat – Independent Investment
Previous Statements by FLY
» Fly Leasing Ltd. Q2 2010 Earnings Call Transcript
» Babcock & Brown Air Limited Q1 2010 Earnings Call Transcript
» Babcock & Brown Air Limited Q4 2009 Earnings Call Transcript
Thank you. Mr. Dallas, you may begin your conference.
Matt Dallas
Thank you and good morning, everyone. I am Matt Dallas, the Investor Relations Manager of Fly Leasing and I'd like to welcome everyone to our third quarter earnings conference call. Fly Leasing which we will refer to as FLY or the company throughout this call, issued its third quarter earnings results press release earlier today, which is posted on the company's website at www.flyleasing.com.
Representing the company on this call today will be Steve Zissis, the President and CEO of BBAM; Colm Barrington, our Chief Executive Officer; and Gary Dales, our Chief Financial Officer.
I'd like to begin the call today by reading the following Safe Harbor statement. This conference call contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements include but are not limited to statements regarding the outlook for the company's future business and financial performance. Forward-looking statements are based on current expectations and assumptions of FLY's management, which are subject to uncertainties, risks and changes in circumstances that are difficult to predict.
Actual outcomes and results may differ materially due to factors that are summarized in the earnings press release and are described more fully in the company's filings with the SEC. Please refer to these sources for additional information. FLY expressly disclaims any obligation to update or revise any of these forward-looking statements, whether because of future events, new information, a change in its views or expectations or otherwise.
This call is the property of Fly Leasing and cannot be distributed or broadcast in any form without the expressed written consent of the company. A replay of this call is available for two weeks from today. An archived webcast of this call will be available for one year and available on the company's website.
I will now hand the call over to Steve Zissis, the President and CEO of BBAM to give you his view on industry conditions. Steve?
Steve Zissis
Thanks, Matt. The news from the commercial aviation industry continues to be positive. I can confirm that we are experiencing strong demand for aircraft lease product from virtually all global jurisdictions. The emerging market regions continue to exhibit very strong growth and passion to traffic, just as they have been for the past several quarters.
U.S. airline industry through consolidation and relatively good discipline and capacity growth has recently been profitable and cash flow positive. We continue to believe that there will be a combination of growth in the emerging market regions and the significant re-fleeting requirements of financially stabilized U.S. legacy carriers that will fuel growth in the aircraft leasing sector for the foreseeable future.
Our airline clients are making fleet planning decisions in a manner consistent with historical practice. That is to say, airlines have moved beyond the short term when thinking about capacity growth and re-fleeting and are now planning two to three years into the future. This is an important change from the prior 18 months and supports a traditional cyclical recovery.
Airlines and aircraft leasing companies are ordering aircraft in large numbers. Both Airbus and Boeing have substantial demand for the newer narrow body equipment, a particular focus for FLY. There are virtually no delivery positions available from either manufacturer on these aircraft types for several years.
Both Airbus and Boeing are increasing production rates in an effort to satisfy the demand but we still see a favorable supply demand dynamic that we expect to continue to underpin the recovery in aircraft values and lease rates.
Equity capital continues to pour into the sector. As mentioned on prior calls, much of the capital is coming from private equity community but the larger existing lessors are also allocating capital to grow their businesses.
As you would expect, this capital is creating more demand for aircraft to pursue prices higher. This demand for leased aircraft is creating more liquidity for FLY's aircraft.
We have taken advantage of this liquidity to rebalance the portfolio in the third quarter. And we sold three aircraft at premiums to net book value. We have another aircraft sale scheduled for the fourth quarter, a 21-year old 757. And we will continue to look for further sales opportunities.
The cash proceeds from these sales will be combined with the company's significant unrestricted cash balances to acquire new aircraft. We made some progress in this front in the third quarter with the flydubai transaction. And we expect more opportunities in the next 12 months to originate sale lease backs directly with the airlines.
I will now turn the call over to Colm.
Colm Barrington
Good afternoon, everyone. FLY is reporting another good result for the three months ending on September 30, 2010 with adjusted net income of $14.1 million and adjusted earnings per share of $0.52, excluding $1.9 million of share-based compensation. This compares to net income of $14.4 million and EPS of $0.48 in the same quarter of 2009. The $0.04 improvement in our EPS from last year is partly due to the reduced number of shares outstanding arising from our ongoing share repurchases.
Read the rest of this transcript for free on seekingalpha.com


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Claudia Andrea
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Claudia is a very hardworking person. Since the age of 18, she has worked hard with the goal of improving her parent's financial situation. Thanks to the drive that has always characterized her, she keeps working hard and making progress little by little.
Now she is married and has a 10-year-old son. Because of her efforts, her business has grown to be a great stationary store that can generate enough income so that her family has a better quality of life.
Thanks to the good sales she has had in recent months, Claudia is looking for a loan to buy paper products and stock her store with a variety of products that have depleted. Her dream is to diversify her sales in the future since some seasons are very cold, which affects her income and makes life at home very difficult. Also, she hopes to be able to offer her son a better education.
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Claudia es una persona muy trabajadora que desde los 18 años de edad comenzó a trabajar fuertemente con el ánimo de mejorar la condición económica que tenían sus padres, y gracias al empuje que siempre la ha caracterizado ha seguido trabajando fuertemente y progresando poco a poco. Actualmente se encuentra casada y tiene un hijo de 10 años de edad, y su negocio gracias a su esfuerzo ha crecido hasta ser una gran papelería donde puede generar ingresos que le permite a su familia tener una mejor calidad de vida. Gracias a las buenas ventas que ha tenido en los últimos meses, Claudia busca un préstamo para comprar productos de papelería y surtir su almacén con productos que ya se han ido agotando.
Su sueño es poder diversificar sus ventas en un futuro ya que hay unas temporadas que son muy frías, lo que hace que sus ingresos se vean fuertemente afectados y las condiciones en su hogar se hagan muy difíciles. Además, aspira a poder ofrecerle a su hijo una educación de mejor calidad.
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This loan is structured on Kiva as a bullet loan, which means a single payment is required at the end of the loan term. By Colombian law, Kiva's partner Interactuar is required to offer borrowers loans with a variable interest rate that fluctuates with the market rate. Because fixed monthly payments are applied first to interest and then to principal, Interactuar is unable to predict upfront what portion of each repayment would go towards the loan principal. This creates a challenge with Kiva's system, which doesn't allow for unpredictable principal payments, and can result in some Interactuar clients appearing falsely delinquent. To remedy this, the loan has an end-of-term repayment plan on Kiva, but the borrower will continue scheduled monthly repayments to Interactuar, who will then pass along the principal amount to Kiva lenders. This means that you may see repayments made on this loan throughout the repayment term, as opposed to receiving repayment in full at the end of the loan term.
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Kevin Minter, LB LSU
I couldn't find a thread on this kid so here goes..
I don't get to watch many college games, can someone please tell me a little about Kevin Minter? His strengths/weaknesses and how he compares to the other top LB prospects.
Is he stictly a ILB/MLB or could he play other positions, for example play SLB in a 4-3?
Stud! Hope the Jets get him round #2 after they get another pass rusher.
Minter is a beast. I won't say who will be the best in this draft because if Ogletree ends up in the right situation I think it could be him, but Minter is the safest bet in this class to be a top notch NFL linebacker. He can do it all and he will make some team very happy for a long time. Te'o's (that looks goofy) stock is down a little after that NC performance but he still could be a great addition to a defense, I just like Minter better. He would be my top ranked linebacker in this class.
Minter sounds intriging, I just don't know enough about him at the moment :)
I actually have to take back that I think he'll be the best LB cause I love OLB Chase Thomas too.
Khaseem Greene is the best linebacker in the draft. He has speed, a nose for the ball and is a sure tackler. He also reads offenses quickly and can drop back into coverage as easily as he can rush the passer or get a tackle for a loss. If some needs a LB they should choose the first team AA.
Bunch of guys definitely do have Greene as their top rated LB.
As a Steeler fan I'm definately keeping my eye on Mintner, Ogletree, and Te'o, hoping that one of them is the first round pick. Te'o may already be gone, but Ogletree and Mintner are definately going to see their stock raise or dive depending on the Combine. Think the Steelers could trade back, pick up a third, and still get one of the two. Don't think that either of the two will be there at 48.
I am expecting Teo, Minter and Ogeltree to all go in the first round
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text:
I wanted to have comments show up after each post so here's what I did.
Maybe the gurus here can add to this or describe an easier way.
I went into Kubrick's comments-popup.php file and found a section that was commented as being "the WordPress motor" (line 31). So I copied and pasted the part I needed into my index.php It was only maybe 6-7 lines that I copied and placed right after the "content" div.
I also copied a few lines for the comment loop and IT WORKED!
Now I wonder if there is a better way to do this. I tried just putting a comment loop in but nothing showed.


text:
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Full of Hot Air: True Tales of the Montgolfiers
When:Monday, June 4, 2012 -
11:00am to 2:00pm
Lecture / Presentation
Family Activity
Location:William M. Allen Theater
On June 4, 1783, the history of flying changed forever. Before the Wright Brothers, there were the Montgolfier Brothers!
Hear the amazing history of the founding fathers of the Hot Air Balloon and learn the science behind their aircraft.


text:
Romeo Miller on His Mom Suing Him in Master P's Divorce Battle: 'It Hurts'
Romeo Miller went on Instagram and opened up about his mother suing him in her messy divorce battle with his father Master P.
Romeo Miller went on Instagram and opened up about his mother suing him in her messy divorce battle with his father Master P.
The red carpet arrivals at the 2015 American Music Awards did not disappoint as your favorite artists dressed to impress. See who showed up to this year's AMAs.
Patti LaBelle is known for her sweet soul music, but it's her sweet potato pie that has fans going bonkers on social media.
Get your credit card ready because it may not quite be the holiday shopping season just yet, but treating yourself doesn't really require a special occasion. Here are 20 Ways to Weatherproof Your Feet This Winter.
Jeezy is truly blessed. The Atlanta rapper is still going strong after more than 10 years in the game. The congregation that has been following his movement since the early 2000s praised his efforts inside Highline Ballroom in New York City to celebrate the release of his eighth studio album, 'Church in These Streets.'
There are a lot of great albums to uncover as we take a trip down memory lane to one of the most influential years in music. Check out 26 Albums That Are Turning 20 Years Old in 2016.
Bad news for Tamar Braxton. The R&B diva is seriously ill and therefore has to bow out gracefully from the competition on Dancing With the Stars. On top of that, the singer also had to cancel the rest of her tour dates.
See which rappers hung out with TV's biggest actors at the time or which R&B singers shared a few laughs with boy band members and rock stars. Check out 19 Surprising Artist Moments Caught on Camera During MTV's Golden Years.
After a year of courtship, Teyana Taylor is now officially engaged to her boyfriend, and future baby daddy, Iman Shumpert.
Rappers 50 Cent and Rick Ross are not done trolling each other. On Saturday morning (Nov. 7), the two hip-hop titans, who have been feuding since 2009, continued to throw barbs at each other on social media.


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A Comparison of Perspectives about the Critical Areas of Knowledge for Safe Food Handling in Food Establishments
Linton, R. H., McSwane, D. Z., Woodley, C. D., Journal of Environmental Health
In the United States, an estimated 24 to 81 million people become ill each year from consumption of contaminated foods. These illnesses result in an estimated 10,000 deaths each year and have an estimated cost of between $7.7 and $23 billion (1). The Centers for Disease Control and Prevention (CDC) reports that many cases of foodborne illness originate from foods mishandled in food establishments, especially food retail and food service establishments (2). Foodborne illnesses that originate in food retail or food service establishments frequently occur because the food is 1) temperature abused, 2) handled with poor personal hygiene, and/or 3) inherently contaminated or exposed to some form of cross-contamination (3,4-6). Temperature abuse is the problem most often identified as a contributing factor in foodborne illness (2,4-6). Temperature abuse may consist of
* improper cooling,
* inadequate cooking or reheating,
* unsuitable thawing methods, or
* unsafe cold or hot holding practices.
In recent years, poor personal hygiene has increasingly been identified as a factor in foodborne illness, especially with the increased demand for ready-to-eat food items that come in contact with human hands. To reduce the transfer of harmful contaminants to foods, it is critical to know when and how to properly wash hands and to avoid bare hand contact with foods.
Many foods are inherently contaminated with disease-causing micro-organisms, especially foods of animal origin. Each year, red meat, poultry, and seafood products are the leading vehicles of reported cases of foodborne illness (2). Recent reports that some ready-to-eat foods, such as strawberries and raspberries, have been contaminated with viral and parasitic pathogens have raised concern about whether food is being safely handled. Food contamination is also an important factor in foodborne illness. Foods can be cross-contaminated from various sources such as human contact, contact with raw foods (especially of animal origin), and exposure to food contact surfaces (utensils, cutting boards). In addition to unclean hands, common vehicles of food contamination include soil, garbage, rodents, insects, and air.
The key to preventing and reducing foodborne illnesses associated with food establishments is educating and training food handlers (4,6). To be effective, food safety education and training must be supported by top management and at all levels of management in the food establishment. The FDA Food Code requires the "person in charge," often called a food manager, to be responsible for ensuring the safe preparation and delivery of food to the consumer (1). Ideally, food establishment managers receive food safety and sanitation training; in turn, the food manager trains employees at the food establishment, especially the front-line workers who are actively involved in handling, preparing, and serving food to the consumer.
Most food establishments are governed by state and local food codes; inspections are being carried out by personnel from local health departments or the Department of Agriculture. Although the frequency and format of food establishment inspections differ from state to state (and perhaps from county to county within each state), food codes generally have specific regulatory requirements for
* receiving, preparing, and serving foods;
* the health, cleanliness, and hygienic practices of food handlers; and
* facility design and food equipment specifications.
On a national scale, the U.S. Public Health Service (USPHS) and the Food and Drug Administration (FDA) provide recommendations for safe handling of foods in a document called the FDA Food Code. In 1993, the 1976 version of the Food Code was revised after a gap of nearly 20 years. The FDA Food Code is now revised every two years, and the most recent FDA Food Code was published in 1997. …


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Elderly Populations in Disasters: Recounting Evacuation Processes fromTwo Skilled-Care Facilities
in Central Florida, August 2004
Michelle Kuba
Alina Dorian
Sarah Kuljian
Kimberley Shoaf
UCLA Center for Public Health and Disasters
A printable version of this QR report is available in PDF format.
This material is based upon work supported by the National Science Foundation. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation or the Natural Hazards Research and Applications Information Center.
Citation: Kuba, Michelle, Alina Dorian, Sarah Kuljian, and Kimberley Shoaf. 2004. Elderly populations in disasters: Recounting evacuation processes from two skilled-care facilities in central Florida, August 2004. Quick Response Research Report 172. Boulder, CO: Natural Hazards Research and Applications Information Center, University of Colorado. http://www.colorado.edu/hazards/qr/qr172/qr172.html.
Research suggests that vulnerable populations may be at significant risk of illness and injury in natural and human-generated disasters. As the population ages, medically fragile populations increase and present unique challenges to the community during disaster events. Older adults are at higher risk of adverse health effects from disaster events than are other populations. Impacts on the elderly population could vary by the type of hazard, the magnitude of the event, and its direct effect on their lives. Phifer et al. (1988) showed that floods in a community impacted the subsequent health of elderly citizens in the area and that the effects were related to the intensity of the flood. The impact of indirect effects of a disaster, such as evacuations, on this population has not been determined.
Evacuations may prove to be equally as stressful and disruptive to the daily activities of older adults as the disaster itself. They are of particular concern for residents of long-term care facilities who are often immobile and require medical equipment, medications, and nursing care. There is a belief in the medical community that evacuations of nursing facilities increase mortality significantly in the year following the evacuation; however, there has been no research to document this phenomenon.
Saliba et al. (2004) examined the role of nursing homes in disasters and found that while they did not receive much public assistance, nursing homes were able to support one another in an informal manner during disasters. In order to formalize these relationships, the authors encouraged the inclusion of nursing homes in community-wide disaster plans. The logistics of how to best protect the nursing home population during disasters must be understood in order to incorporate these facilities effectively into a community-wide plan.
The purpose of this research was to identify current evacuation procedures for the nursing home population and document the baseline status of facilities and the procedures utilized in evacuations. This analysis should illuminate the current status of evacuation procedures, highlight possible improvements, examine the potential for long-term health impacts of evacuation, and provide baseline data for future follow-up studies.
The evacuations that occurred in mid-August 2004 preceding and following Hurricane Charley in Florida provided an opportunity to begin the examination of nursing facility evacuations. Hurricane Charley struck the western and central part of Florida on Friday, August 13, 2004. Thirty-one fatalities occurred as a result of the hurricane and over two million people throughout the state were advised to evacuate their homes for shelter in safer locations. Eight counties along the western coast had mandatory evacuations ordered by local officials in certain areas. The magnitude of this natural disaster and the extensive preparations that occurred prior to the hurricane provided an opportunity for investigation into nursing facilities evacuation processes.
Nursing homes located in hard-hit counties and counties that had mandatory evacuations were found via the governments Medicare Web site. They were contacted by UCLA Center for Public Health and Disasters (center) staff prior to the researchers arrival in Florida on August 31. Two long-term care facilities agreed to participate in the study. One facility was located in Charlotte County, the county hardest hit by Hurricane Charley. The other was located in Pinellas County, an area that was not affected by the hurricane, but that had mandatory evacuations due to anticipation that the hurricane would strike there.
Interviews were conducted with facility employees across a variety of functions. Four versions of the questionnaire were available for administrators, staff members, first responders (defined here as external assistance for transportation), and residents of the nursing homes.
The first facility (facility A) was a nursing facility that housed both long-term and short-term residents. The evacuation of this facility occurred prior to the hurricane because of predictions that the hurricane was directed toward their area. An administrator, staff members, and residents were interviewed at this location. Personnel from a sister nursing facility that provided assistance with transportation were interviewed at another location two days prior to the interviews at facility A.
The second facility (facility B) was the rehabilitation wing of a hospital. They had primarily elderly patients and evacuated after the hurricane struck because of damage to the building. An administrator and staff members were interviewed at this facility by center staff. Three researchers conducted interviews individually with staff members. Because of damage to the building, patients had not been allowed back into the facility at the time the interviews took place; therefore, no patients were interviewed. Also at this time, first responders from emergency medical services were deeply involved with preparations for the next hurricane, Hurricane Frances, and were not easily located or available, so no first responders were interviewed.
Each interview lasted 20 to 30 minutes. Researchers filled out questionnaires and recorded the interviews to ensure that accurate records were kept. Questions for the administrator, staff, and first responders pertained to the interviewees roles and personal experiences during the evacuation, detailed information on the process that took place, their overall impressions, and their preparation for such an event. Questions for the residents concerned their personal experiences, their preparation for the evacuation, their impressions of the steps that were taken during the evacuation, and their overall impressions.
A total of 22 interviews were conducted: three administrators, ten staff, three first responders, and six residents. There were broad differences between the two facilities (see Table 1).Evacuation Process
Facility A
Facility A evacuated prior to the hurricane because it was located in the projected path of Hurricane Charley. The decision to evacuate was made by the regional director in conjunction with other area directors in the network after it was determined that the home was in a mandatory evacuation zone. It was determined that all residents would go to another facility within the network, which was approximately 16 miles away. Staff members notified residents that they should prepare clothing for two to three days and pack any other necessary personal belongings in labeled plastic bags. Nurses, who were in charge of specific halls in the home, then gathered the necessary medications and medical records for their residents. The entire evacuation process took approximately six to seven hours to complete.
Housing staff gathered linens and collected 120 mattresses, packed them into a truck owned by the home, and were the first to go to the new facility. When they arrived, they unloaded the mattresses, disinfected each one, set them up in a large recreation room that had been provided for them, and made the beds. At the same time, residents were being evacuated. Residents who required acute care were evacuated first via small buses. The remaining residents were evacuated in groups based on residence halls. Medical charts and carts with medications were loaded onto the same buses as the residents. Each bus carried one cart of medications and all of the medical records for the group of residents that were being transported in that bus. This was done with the help of staff from other facilities in the network who had come with their own vans to assist with the transport of the residents. Staff of the evacuating facility alerted families by phone as to the whereabouts of the residents.
When they arrived at the shelter, residents were placed either in spare rooms or in a large recreation room that was set up with mattresses on the floor. The residents spent two nights in the shelter facility, with meals, activities, and sleep all taking place in the same large room. Residents reported that they felt all of their needs were met, and that their personal schedules were not greatly disrupted by the change in locale. Because a majority of the staff accompanied them to the new facility, they felt that they were safe and in familiar hands. The greatest discomfort reported was the placement of the mattresses on the floor, which was uncomfortable for the elderly residents. Hurricane Charleys path changed direction and did not strike facility As neighborhood. When it was time to return home, the mattresses were again taken back first. Residents reported that they were surprised to come home to find their own beds already made and their rooms returned to their normal conditions.
Facility B
Facility B was located in the county that was hardest hit by Hurricane Charley. The decision to evacuate the facility was made by the local emergency operations center and chief executive officer of the hospital due to significant storm damage to the building. Members of a rehabilitation unit of the hospital that housed elderly patients were selected for interviews. When the decision was made to evacuate, nurses on the floor quickly met to discharge as many patients as possible. Of the 18 patients on the floor at that time, 8 were discharged. The remaining 10 were evacuated from the building. Unlike facility A, there was no predesignated shelter in the evacuation plan. Because this facility was a short-term acute care facility, the patients had special needs that prohibited the evacuation of all patients to the same place. Instead, patients were evacuated to surrounding hospitals as beds with adequate levels of care were found for them. Floors of the hospital were evacuated in order of the amount of damage incurred by each floor. The rehabilitation unit was the last floor to evacuate. The evacuation process for the rehabilitation unit took approximately one and a half days to complete.
In order to keep track of medical records, the staff created a system of writing medical record numbers on pieces of masking tape and placing the tape on the gowns of the patients. Copies of their medical records were sent with the individuals in the ambulances. Personal belongings were bagged and labeled and sent with them as well. Medications were given to the patients until the time of their departure. Medications were not sent with them since they were going directly to other hospitals that should have been able to provide the appropriate medications. Transport of patients was done through county emergency medical services; ambulances from the county took patients from one hospital to another. No one from the staff at facility B accompanied the patients to the new hospitals.
Staff attempted to contact family members over the phone. They also kept a list of patients new hospital locations so that if family members called in they could be quickly alerted as to the patients whereabouts. At the time of the interviews, no patients had been readmitted to the hospital because of the damage to the building. Part of the floor was being used as an obstetrics ward for emergency deliveries, but all other cases were being diverted to other surrounding hospitals.
Staff members accounts of patients reactions to the evacuation generally emphasized that they were anxious and nervous, particularly about their own families. Because several family members were not reached by phone, patients were worried about their families well-being as well as about locating them after they had been evacuated to the new hospital. However, they were described as being cooperative with the staffs efforts. No residents were interviewed because patients had not been readmitted to the hospital at the time of the interviews.Assessment of Evacuations
Questions concerning the participants understanding and impressions of the evacuation process were included in the interviews. Overall, subjects at both facilities felt that the evacuation was successful. Their knowledge of the evacuation plans and how they knew what tasks to perform during the evacuation differed (see Table 2).
Employees at both facilities expressed satisfaction with their respective evacuations. Though the circumstances surrounding the evacuations and the protocols used by the two facilities differed greatly, personnel at both facilities declared their evacuation responses successful. Areas for improvement included the need for better facilitation with external transportation agencies and better preparation for mental health patients. All interviewees agreed that their respective facilities were prepared for future disaster events.
Although both evacuation processes were considered successful by interviewed staff, different methods were utilized to complete each of them. As demonstrated in Table 3, employees knew what to do during the evacuation for different reasons. The greatest number of staff at facility A relied on supervisor orders and the disaster plan while the greater number of staff at facility B relied on job experience. The differences in how staff understood their roles point to a need for more training or preparation. Although staff may have relied on job experience because of a history with other disasters, each facility should take responsibility for ensuring that their current employees are aware of their roles during a disaster event. Although facility A was lucky enough to have good leadership in this situation, preparation on all levels is important.
All of the residents interviewed at facility A were aware of the hurricane before it hit. When asked how they first learned that the hurricane was approaching their town, all six responded that at least one source of information was the television. Later in the interview, when asked who had told them about the hurricane, the responses also included staff members. In general, residents were up-to-date because of their access to television and because of casual conversations that residents and staff had regarding the hurricane.
Overall, the impressions of the evacuation given by residents were very positive. As one resident expressed, It was like a holiday. Surprise that their personal routines (primarily meals and medications) were not interrupted was conveyed. Another resident explained, They gave you the medication just like it was here. The nurses followed up just like you were in your room. They didnt miss nothing. They had everything figured out. They were very efficient.
The residents were not aware of the evacuation plans of the facility or of what they should do in the event of a hurricane (see Table 4); however, this was not expressed as a concern by any residents. The fact that their staff accompanied them to the evacuation site provided comfort to the residents and helped to minimize the disruption of their routines. Although they did experience some discomfort because of the mattresses on the floor, the general attitude regarding the evacuation was positive. As one resident explained, They werent the greatest comforts in the world, but it beats the heck out of being in a hurricane.
The two skilled-care facility evacuations described here represent different approaches taken due to differing circumstances. One major difference in the evacuation plans was the designation of an evacuation shelter prior to the event. Facility A, being part of a network, was able to quickly identify a site that could accommodate all of the residents. However, they realized upon arriving at the new facility that while an effective evacuation plan had been implemented for their network of nursing homes, no plan existed for the receiving facility as to how to deal with the sudden increase in residents. This is an important consideration for all homes and hospitals in areas that may be impacted by evacuations.
Facility B sent its residents to various surrounding hospitals as beds with adequate care were identified. Because this plan was dependent on the needs of the short-term residents, which of the hospitals in the surrounding area remained undamaged, and the caseload of the area hospitals at the time of the evacuation, this was an unpredictable situation. However, agreements could have been made in advance with other hospitals in the area to expedite the process of locating beds. A central source in the community to coordinate the needs of the damaged hospitals with available beds is another possibility worth investigating. The need for public health to play a role in preparing such facilities for disasters is clearly indicated.
The Joint Commission on Accreditation of Healthcare Organizations identified the problem of multiple transfers as one that impacted elderly citizens in the wildfires of Southern California in 2003. They found that when older citizens were evacuated from nursing homes to hospitals, they were often transferred more than once, and that this became a stressful situation that may have led to increased mortality among those patients (Wise 2004). Follow-up was not done on the patients at facility B to determine whether they were allowed to stay at the new locations and how they fared in general.
One point that emerged at both facilities pertained to the level of understanding of a specific evacuation plan by staff and administrators. While all administrators confirmed the existence and use of an evacuation plan, staff members differed in their knowledge of the existence and use of that plan. They also relied on different sources for their knowledge of what to do during a disaster event. This could indicate the need for more formalized training. Both evacuations seemed to be driven by strong leadership of administrators. As Robin (2000) suggests, preparation on all levels is important to ensure effective response in a disaster.
Another issue that emerged was the issue of mental health. Facility B provided counseling to employees after the hurricane. This was highlighted as a gesture that made the employees feel appreciated. Mental health of both the patients and the staff are components that should be considered in the future.
The perceptions of the residents were important in determining the amount of stress caused by the evacuations. While residents interviewed at facility A seemed to understand what was happening and thought highly of the efforts of the staff, it cannot be determined whether the residents who were less coherent understood what was happening and whether they felt more or less stress than those interviewed. Because residents from facility B could not be reached, their reactions to the evacuation could not be determined. However, staff members described them as anxious and stressed by the move. Whether this experience would have subsequent impact on these residents lives has yet to be determined.
Centers for Disease Control and Prevention. 2004. Rapid assessment of the needs and health status of older adults after Hurricane Charley-Charlotte, DeSoto, and Hardee Counties, Florida, August 27-31. MMWR 53 (36): 837-40.
Dow, K., and S.L. Cutter. 1997. Repeat response to hurricane evacuation orders. Quick Response Report 101. Boulder, CO: Natural Hazards Research and Applications Information Center, University of Colorado. http://www.colorado.edu/hazards/qr/qr101.html.
Phifer, J.F., K.Z. Kaniasty, and F.H. Norris. 1988. The impact of natural disaster on the health of older adults: A multiwave prospective study. Journal of Health and Social Behavior 29 (1): 65-78.
Robin D.W. 2000. Preparing long-term care facilities for natural disasters. Annals of Long-Term Care 8 (6).
Saliba D., J.B. Buchanan, and R.S. Kington. 2004. Function and response of nursing facilities during community disaster. American Journal of Public Health 94 (8): 1436-41.
Wise, R. 2004. The challenge of integrating hospitals into a community emergency response. California Statewide Medical and Health Disaster Management Conference.