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Deus Ex: Human Revolution - The Missing Link DLC Screenshots for Xbox 360On: Xbox 360, PS3, PC
First piece of DLC for Deus Ex: Human Revolution
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Ford Indian amazed all the press individuals and automatic lovers by introduction the Honda CBR 150R at the Auto Expo in New Delhi. The organization released the bike on Fifteenth Goal. Ford CBR150R looks very appealing and many potential customers were awaiting this 150cc bike from last few decades.
Honda CBR150R is going to contend go on with Karizma ZMR and R15 as Ford Indian has cost the platform style of Honda CBR 150R at reasonable cost. Ford released the style of the CBR150R in Thailand last season and the style of new bicycle seems to be motivated from the Honda's VFR sequence which gives look of a big motor bike. Ford CBR150R is available in two versions Conventional as well as Luxurious.
Honda CBR150R is available in two variants Conventional and Luxurious. The Luxurious version functions fantastic style and Conventional version is available in red and dark color only. Officially both the versions are same. Ford CBR150R has been priced very competitively for the common version and the deluxe version. The cost seems to be quite affordable considering the point that it functions a fluid chilled 150cc motor. The on-road cost of Ford CBR150R in Mumbai for the common version as well as for the deluxe version.
The CBR150R provides most of the looks of its older brother, CBR250R. If you are not conscious of the different colors for both these motorbikes then you cannot identify between them on street. At least from front part, it is very difficult to identify. The little CBR has the same Y formed superior front lights, face shield as well as back perspective decorative mirrors just like that of Honda CBR 150R. The dark colored metal tires and little front part drive braking mechanism is also different in this bike. Get to the part of this bicycle and then you can observe some more changes such as different silencer plus stickers on its fairing.

subset: commoncrawl


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Culture podcast: May 31st
In this week's Culture podcast Shane Hegarty talks to Hugh Linehan, Anna Carey and Mick Heaney about the role of the critic and Irish cops on television
In this week's Culture podcast Shane Hegarty talks to Hugh Linehan, Anna Carey and Mick Heaney about the role of the critic and Irish cops on television
Arve Henriksen is a master improviser, but few people would happily climb on stage with a trumpet and electronics, and compete for space with two percussionists – especially two players with the power and drive of Audun Kleive and Helge Norbakken. Henriksen, though, never takes the easy road, and here the trio build detailed, expansive soundscapes that sit in two worlds.
On the one hand, there is Henriksen's mournful, distinctive trumpet, slivers of potent emotion and urgent notes dancing around the tribal rhythms of Norbakken, who directs operations from behind his incongruous kit set-up, like a ship's pilot negotiating a Norwegian fjord. He thunders and rolls around his instrument, injecting sudden precise bursts of low end that break across the room, and underscore the intricate, unorthodox interplay of Kleive.
This is deeply complex and accomplished, but it never feels studied. There is a natural feel to the band's communication; ideas are swapped and passed, avenues explored, and a room filled with vital, exciting and deeply lyrical music.
Hedvig Mollestad Trio are an altogether different proposition. Mollestad leads her band with slow hand, bluesy rock riffs, ripping them out with no little style and a swagger most rock bands would aspire to. Beneath this, double-bass player Ellen Brekken builds some lovely walking lines, on solid groove foundations. In this context, the drumming is the weak link, and doesn't communicate effectively between the jazz leanings of the bass and the rock blitz of the guitar lines, relying to heavily on predictable, straight-ahead beats that, for this type of audience, hold few surprises.
This, though, is still a big sounding band, with plenty to please, and the crowd are lapping up the big, fat riffs. When Brekken heads on a more ballad-like route, the sombre bluesy results are worth savouring; an odd drum solo that soon follows is definitely a step too far.
This is a rock action in a hard, jazzy space, then, that delivers a welcome, unapologetic diversion in the NattJazz context.
Sasquatch play fairly straight-up jazz with style and confidence, and amid all the experimentation and the cutting-edge sound creations that this festival offers, it's really satisfying to walk in a room and hear a band performing solid songs with great writing and strong fundamentals. On stage, André Roligheten on horns, Arild Hoem on alto saxophone, Thomas Johansson on trumpet, Magnus Rød Haugland on bass and Dag Magnus Narvesen on drums create music that is progressive, and fairly timeless. This is a classy affair with plenty of riches worth experiencing.
Most of the rooms were a little light on crowds, because the Sardinen bar venue was packed to the rafters for Farmers Market, a big brash band with a heart of folk and plenty of boogie-woogie flair. This was a full-out sound, ripped from the stage by a highly strung band who had one purpose – to entertain.
For me, the band's repertoire sounded a little dated, but the packed crowd were loving every shape and showman beat, and on a Saturday night it's hard to argue with a relentless Balkan pace.
That's all I managed to see of the main festival at NattJazz, but I'll be posting a few other observations in the coming days from some choice concerts that were not part of the main programme.
Konigsberg had a last-minute name change at NattJazz festival to the Deciders, but the original line up of Ole Morten Vågan on double bass, Fredrik Ljungkvist on saxophone, Rudi Mahall on bass clarinet, Axel Dörner on trumpet and Jon Fält on trumpet seemed to be intact. This type of anarchy seems par for the course for this band. A big, blowsy outfit with plenty of chops and energy in spades, they built a rollicking set in the boozy atmosphere of the Sardinia bar on Friday evening. If one player made a mistake, the rest would dissolve into fits of laughter before picking it up and blasting along with the song, their three-brass-pronged attack making the room rattle and roll, while Ole Morten Vagan tore around the low end with some gloriosuly savage bass playing.
Jazz attracts a peculiarly respectful crowd, but not at NattJazz. People talk loudly at shows, many will argue with what's going down on stage, and will shuffle into and out of concerts during songs, and even, shock horror, during solos. It's a challenging gig for performers, but it also puts it up to them to bring enough energy to the room so that everyone knows who is in charge. The Deciders had no problems bossing the souped-up crowd around, though, and got a fairly thunderous boon of applause in response.
Just as loud in places but with a very different set-up were Cakewalk, a three-piece band of guitar, drums and keys that produce music that bounces between stripped-back instrumentals and muscled-up post rock. The band build up their songs layer by layer, with relentless impetuousness and a slow and steady approach to songwriting. This is well-covered ground, where you usually find the likes Godspeed You Black Emperor and earlier krautrock acts grazing. It might take its time to get there, but the riptide of deep, intense grooves is hard to pull yourself out of, and when it the wave of noise breaks from the stage and crashes inelegantly into the venue it's very satisfying indeed.
Jarle Bernhoft was one of the most anticipated acts at NattJazz, so much so that for the first time this week there were huge queues and a bit of a crush to get into his show. Once you wrestled your way in it was easy to see why. The Norwegian has a deep, soulful voice, drenched in Motown with tones of Bill Withers, married to a more contemporary pop-writing sensibility that should see him enjoy enormous success in the next few years.
Part of the charm of the show is how he makes the music. Bernhoft sings supporting backing vocal lines into a loop station pedal, and lets that wind around while thrumming out a funky beat on the back of an acoustic guitar before adding a rhythmic guitar line, layering and layering until the sound of a full band is booming through the PA. Then he unleashes the salvo of his full bore soul vocal and the result generally means that resistance is futile.
For those who have seen the likes of Owen Pallett of Final Fantasy in action, this is not a new concept. Bernhoft carries it off with style and charm, and his acute rhythmic awareness, with pops and beats that Stevie Wonder would be satisfied with, mean the songs shiver and shake in all the right places and even though it's one man on stage he manages to cook up a funk pop storm.
The question is where does he go from here? Expect Bernhoft to make a big European impression, and indeed the booking agents were climbing over each other to talk to him after the show. The obvious route to develop this music would be to employ a full band, but apparently he has already tried this with limited success. For the moment, though, he can expect a lucrative few years building a wider fan base and making his extraordinary voice and inventive live show work very hard for him indeed.
Sidsel Endresen is one of those people who really makes critics work for their money – it's very difficult to describe what she does if you haven't been in the room with her. She's been working with her voice as an instrument for more than 30 years and what emerges is dark and often unsettling, guttural and animalistic, with sudden breaks for melody. Most acts would use something straightforward to temper this extraordinary vocal, but here she has employed Stian Westerhus, who wrenches sounds and echoes from his guitar that sound much larger than the sum of their parts. There are thumps and percussive slaps, sudden movements and aggressive taunts – at one stage, he pulls out a lonely mechanical echo that sounds like the bell on a sinking ship far out to sea. It's a haunting experience, primal and challenging, and leaves a long echo in your head and your heart. (more…)
Shane Hegarty talks to journalist, author and film-maker Jon Ronson about his latest book The Psychopath Test
The highlight of day one (and some might even have said of the festival) was one of the earliest acts to take to a stage in Natt Jazz. The name James Farm might not mean a huge amount to most people, but this is a band with breadth and depth in spades, led by Joshua Redman, who is setting himself up as one of the finest saxophonists of his generation.
This was slick and classy affair. There's a lot of free and experimental jazz at NattJazz, and this band's crafted, accessible songwriting is a strong contrast to some of the more out there sounds in Bergen. I have heard some people question Redman's tone, but when he opens it up there are few that are better in the business. He takes an almost boxer's stance at the mic, pulling and popping his frame as he jabs notes out, percussive slaps punctuating his complex, creative rhythmic approach to his instrument. Then the band will turn it on the head and go for more ballad-like numbers while Redman draws long, slow mournful notes out of the bell of his horn, providing entire fields of colour and breaking hearts all around the room.
It's no harm that Redman is just one cog in what is something of a jazz supergroup. Aaron Parks might be only 27 but his piano lines are sparkling, complicated affairs, full of drama and gravitas, and with a decent bolt of bluesy-ness when the band around him decide to start to cooking it a little. Matt Penman pins things together with subtle bass grooves that create plenty of space for Eric Harland to exploit. Harland is a bewildering drummer to watch, and leaves audience members wondering what he is doing and how he is doing it. His techniques and ability are astonishing, and he almost threatens to steal the show out from under Redman. With this band's ability at full throttle, the show is irresistible.
If you like your jazz free and as unpredictable as the Irish weather, the Scorch Trio should singe your hair nicely. It's a multinational group of scarily talented musicians who improvise with not thought for borders, recklessly hammering out lines and chasing down grooves in a wall of noise that can be difficult to get your head around. It's terrifically energetic and off the wall, and as if the combined weight of Raoul Björkenheim on guitar, Ingebrikt Håker Flaten on (I'm assuming atomic-powered) bass and Chicagoan Frank Rosaly on drums wasn't enough, here they've thrown saxophone player Mars Williams into the cacophonic mix. A dynamic mix for those who like their music at the more off-kilter end of the jazz spectrum.
The NattJazz festival throws in the odd mainstream act to widen the palette of the festival, from UK act Cornershop (yes, that irritating Brim Full of Asha nonsense) and local pop act Kakkmaddafakka. Jenny Hval is not exactly mainstream, but she is definitely at a remove from much of the jazz acts here. Her music is austere, making easy comparisons with the likes of Anna Calvi and Jennifer Evans. She enjoyed a lot of mainstream success in Norway in an earlier guise as Rockettothesky, and now she has taken a departure for more singular pastures. It's poetic and challenging, but there might not be enough here to draw the casual listener in. Her music definitely sounds as if it would flourish if you give it the time to take root. The songs are intriguing, her vocal is definitely on the outside edge, and there is a very unified, textural sound between Hval, guitarist Håvard volden and drummer Kyrre Laastad.
Live, though, her bare-bones approach with the stage and line-up could do with a little polish and more urgency, and this is a set that requires a bit of investment from the audience.
Apologies, I've absconded to Bergen in Norway for the rather excellent Natt Jazz festival for a few days, so I'll be posting reviews from up here shortly. Normal blog service will resume, but in the mean time it will be nothing but jazz for a few days. Watch this temporarily Norwegian space . . .
In this week's podcast Shane Hegarty talks to Hugh Linehan, Sinéad Gleeson and Jim Carroll about media coverage of the recent State visits, Primavera and other upcoming music festivals.
There was great news at the beginning of the week when Naomi McArdle, who writes the Harmless Noise blog, announced that she had been hired by entertainment.ie as its new music blogger. This followed a post she had previously put up announcing that she was bringing the blog to an end, because she simply couldn't afford to keep working on it without making any money. In a poignant and heartfelt (though thankfully no longer) final post, she made some clear points that will strike a chord with many artists and writers. (more…)
Listen: New York baby – it's a cruel mistress and an inexhaustible muse. Just yesterday I was reading this list of books inspired by the Big Apple (some of which I've read, more than a few of which I'm looking forward to) and was reminded of the greatest description of the city I've read. It's the opening chapter in Jan Morris's spectacular Coast to Coast from 1956; I don't think it has been bettered since. Click here and judge for yourself.
Of course, you can't say the words New York without Woody Allen (am I the only one immune to the man's charms?) springing to mind, so perhaps that was something of a catalyst for Sunday's Young Hearts Run Free event in the Unitarian Church in Dublin. The subject is When Only Words Can Describe: New York Jewishness/Regret, and among those taking to the podium will be Ivana Bacik, Adrian Crowley, Maeve Higgins and DBC Pierre, with some musical interludes by Katie Kim and David Kitt. It's at 3pm and all proceeds will go to the Simon Community.
Go: Africa Day seems to have not taken its name too seriously, and there are a whole host of events on over the next week or so, starting tomorrow. There are too many to list here, so here are just a handful. There's an interview in Imma tomorrow with Yacouba Konate, curator, critic and professor at the University of Cocody in Abidjan, Ivory Coast on the Romuald Hazoume exhibition; Dublin Zoo is transforming itself into an African Plain on Saturday; and in Galway, Nun's Island Arts Theatre is screening a shelfload of African films. For much more, click here.
Learn: The Dublin Writers Festival (shouldn't that name have a possessive apostrophe somewhere) kicks off this weekend and although the main events don't really get into gear until Monday – when Louise Welsh, John Burnside, Richard Holloway, Kevin MacNeil, Donny O'Rourke and Dave Whyte get to grips with man's duality in a Jekyll and Hyde themed reading – Filmbase is jumping the gun. From Saturday, it will be hosting the Sky Arts Den, providing an area to take a break in between traipsing from event to event. It will also be hosting workshops. On Saturday there will be jazz and blues with the Nigel Mooney Duo, a ceramics workshop with Róisín de Buitléar, and Comedic Opera with Opera PlayHouse. Click here for further details.
Dance: Finally, throughout the weekend De Stilte will be bringing their specialist brand of Madcap to the Ark in Dublin's Temple Bar. Part of the Dublin Dance Festival, the show builds up a farm-like world with simple objects and exuberant choreography, with dancers Leonor Carneiro, Katarzyna Korc and Camille Pidou, and should charm adults and children aged four and upwards. It's at the Ark on Friday, Saturday and Sunday. You can get more information here and here's a video to get your inner dancing child moving.
There is Booker blood on the literary dancefloor, after the resignation of one of the International prize judges. Carmen Callil has withdrawn from the panel in protest over the decision to give the £60,000 prize to Philip Roth, telling the Guardian that "he goes on and on and on about the same subject in almost every single book. It's as though he's sitting on your face and you can't breathe".
Don't hold back Carmen, tell us exactly what you think. Alright then: "I don't rate him as a writer at all. [Pow] I made it clear that I wouldn't have put him on the longlist, so I was amazed when he stayed there [Punch] … Roth goes to the core of [the other judges'] beings. But he certainly doesn't go to the core of mine [Slap] … Emperor's clothes: in 20 years' time will anyone read him? [Kerblamo!]"
Literary lord above.
Callil's decision is fascinating for lots of reasons. You can argue long and hard for Roth's abilities (and her two fellow judges for the prize, Rick Gekoski and Justin Cartwright, have done just that), but regardless of the author involved, you have to admire Callil for being so forthright in her views. People are terrific at dismissing literary heavyweights in private, but they rarely let their true feelings show in public.
I'm a huge fan of John Banville, for example, but I know plenty of people who are baffled by his success. VS Naipaul has never done much for me and I find Salman Rushdie's writing too much like hard work. I've had more arguments about Ernest Hemingway than I can remember (I'll defend his books to the bitter, untimely end, in the lonely, pouring rain), and you only have to let slip the words Martin Amis to hear the knives being unsheathed.
All a matter of taste then? Certainly, but there is nothing like courage in the conviction to make the arguments a lot spicier, especially in the notoriously bitchy world of literature.
What's also interesting is the decision to award the prize anyway. Three people are on this particular panel, two of whom were strong supporters of Roth winning, and one of whom was strongly against – Roth gets the prize, so majority wins over consensus.
It would probably be impossible to get even three people to agree on an outright winner, but it's odd to think that someone who one of the judges bitterly opposed could still win (again, this is not a judgment on Roth's work, but rather on the mechanics of how the decision is reached). What it also reveals it that just because you are on a judging panel, doesn't mean your favourite author/band/film will win – the best you can hope for is that you will strongly like the winner, and you can pretty much forget about them being your favourite.
For Callil, not even this was the case.
One of the most impressive aspects of the Abbey Theatre's current production of Pygmalion is the dramatic devils in the detail. There has been plenty of praise for Peter O'Brien's costumes, but the set design and the almost incidental paraphernalia on the cavernous stage are worth a close look.
The towering bookshelves, the furniture polished to within an inch of its lustrous life, even the items scattered on the desks and tables around which the characters pirouette and pontificate, have been giving a long, hard look at by the Abbey's set-design team. (more…)
In this week's podcast Shane Hegarty talks to Donald Clarke at the Cannes Film Festival and Sara Keating and Mick Heaney on Fine Gael's plans for a Literary Centre in College Green and the attraction of contemporary dance.
Hear: In Wexford this weekend, you'll find a powerful combination of music, group and venue. Ensemble Avalon, a young piano trio, will be hoping to light up the St Iberius Church with performances on Friday, Saturday and Sunday. They'll be performing works by (deep breath) Mozart, Schubert, Shostakovich, Prokofiev, Beethoven, Strauss and Britten, as well as a specially-commissioned work for piano trio by Irish composer Benedict Schlepper-Connolly. And they've roped in the talents of soprano Patricia Rozario and violinist Michael d'Arcy to put a bit of Daz on proceedings. For more information click here. (more…)
For anyone who reckons that, in the greater scheme of things, art is unimportant, here are two words: Ai Weiwei.
The Chinese artist was arrested on April 3rd in Beijing, and has not been seen or heard of since. His alleged offences are for "suspected economic crimes" but few are in doubt that he is being punished for his relentless criticism of the Chinese government.
The initial public outcry at his arrest has dampened in recent weeks, so well done to sculptor Anish Kapoor for calling on the world's museums and galleries to close for a day in protest at Ai's continued detention.
Ai Weiwei sits for a portrait at his studio in Beijing, in December, 2010. Photograph: Shiho Fukada
Many of these galleries have already launched an online petition for Weiwei's release – you can sign it for yourself over here. Kapoor has also upped the ante by dedicating his next exhibition, which opens tomorrow at the Grand Palais in Paris, to Ai. (more…)
In this this week's podcast Shane Hegarty talks to Donald Clarke, Tara Brady and Joe Griffin about the Cannes film festival, Portal 2 and gaming journalism.
On the final day of the 12 Points festival, it fell to RedivideR to fly the Irish flag (and follow the jazz-band-name trend for odd typography). Band leader Matt Jacobson (who is a divil for the anagrams apparently) drives operations from the back, building big swaggery beats lent style and intricate melody by Derek Whyte on bass, while Colm O'Hara on trombone and Nick Roth on saxophone harry the top lines with bursts of colour and flowing lines of notes. There is stacks of groove at play here, the band making songs that wouldn't sound out of place on a 1970s cop show, Lalo Schifrin-esque grooves snapping and strutting their way downtown amid the open horn improvisation. It's a different texture to what we've seen during the rest of the week, with soul and funk in unlikely places. Perhaps the band could pursue their rhythmic explorations a little further and dig those grooves a little deeper, but this is a fine, fly set with a solid sense of style and direction.
The band pretended to be politely amused by another one of Jacobson's anagrams
Once again, it's the middle act that takes the most risks on the 12 Points paper, but are also in danger of delivering the most explosive set. Slovenian pianist Kaja Draksler leads a truly international cast of characters and influences in her Acropolis quintet, with musicians from Romania, Italy and Turkey bringing their own sounds to bear on the music.
There is no way this music should work; Draksler brings austerity, subtlety and poignancy with her fluid piano playing, and rings through in bright, rich textures. Drummer Kristijan Krajncan lays down muscular beats that are supple and intense; guitarist George Dumitriu introduces bursts of electronic colour that contrast with the excellent organic, brooding basslines of Mattia Magatelli, and Turkish singer Sanem Kalfa threatens to steal a show with her melancholic, dramatic vocal that haunts the instrumentation and holds the whole proposal together.
Acropolis quintet – jazz Tetris champions 2011
If it sounds complicated, it is – but this is a carefully considered, well marshalled intricacy. It would be all to easy for this band to stumble over each othe's lines and introduce too many elements to the palette, but the control and restraint they show around the central themes makes for an epic, elegant set that demands to be listened to, and there is a joy on stage and in the music making that make it a privilege to be in the room with. The songs are built up into a tower of sound that references all the glittering influences at play before collapsing down with exquisite musical drama. Perhaps the best set of the week then, and a band that are ready to establish themselves on bigger stages than this.
So how do you follow that, and put a coda on what has been one of the most inventive, creative and expressive festivals in Ireland in quite some time? Simple – strip it back to a Finnish trio, let them plant some pop seeds that germinate into jazzy green shoots and fill a room with bursts of sound and colour.
Helsinki outfit Elifantree use saxophone, voice and drums in a way that is anything but traditional. Pauli Lyytinen builds most of the melody, which drops and pops intricate lines that Anni Elif Egecioglu attacks with her vocal, skipping up and down the registers with style and skill. Inbetween these spaces Tatu Rönkkö slots in funky, artful grooves and the set shimmers and shakes with style. A pop sensibility with an ear for a solid riff is allowed to run riot with all the quality jazz craftsmanship that this band can draw on.
Pauli Lyytinen kills all his own clothes, you know
At times, the sound is filled out with glockenspiel or small looped delay effects, and this is when the songs really hit the height. That little bit of extra texture boosts the substance of the music and gives Lyytinen, a spectacularly inventive saxophone player that you could happily listen to all evening, and Egecioglu more room to work with. The poignancy that they hint at is allowed to come into full play, and makes music that is greater than the sum of its valuable parts. There is a strength and depth of character to this band – this was a fine, satisfying way to cap an extraordinary festival.
However, this was a little like the last song before the encore for 12 Points. All week musicians and punters have been making the trek across the Liffey after the final set of the night to listen to improv sets in the Foam festival club. Many of the 12 Points artists have taken the time to hang around the city and spend some time jamming, chatting and enjoying each others' company, and in a way this facet of the festival is just as important as putting on shows. Last night, the open jam session threatened to lift the roof off Foam, when Pauli Lyytinen and Nick Roth went toe to toe on horns, while Isabel Sorling, reluctant to leave after playing here on Friday, scorched her way through some extraordinary, almost pre-verbal vocal lines, and Derek Whyte lead the local contingent that drove the whole, wild party on.
Roll on next year.
The third night of 12 Points opened with some seriously peripheral jazz – the Isabel Sörling Group all the way from Gothenburg. They've yet to record an album, but this six piece are creating challenging, emotive music lead by the extraordinary vocal talents of Sörling.
They open the set with a brilliantly rhythmic song, stalking a bass riff in large, heavy slaps while Sörling screams, loops and wrenches out sounds that are more animalistic than human. From there they take a turn for the abstract, and the music becomes much more loose and free, with horns wandering into spaces whose borders are loosely sketched by bass, drums and piano. Sometimes things are a little too loose, and the band appear to be chasing shadows; a little more substance and solidity in the set, as in the cracking opening track, would not go amiss.
In introducing the Colin Vallon Trio, festival organiser Gerry Godley borrowed a phrase from traditional music – "the raw bar" – and it couldn't be more apt. This traditional piano trio produce astonishing, intricate music that sounds fresh and inventive from the most typical set up in jazz.
This band have been playing together for a decade, and it shows – the band sound is so unified and complete it's difficult to imagine other instrumentation inhibiting on their melodic, austere compositions. Themes are developed in a sublimely organic fashion, with playing of the highest order. It's a rare pleasure to listen to.
And from the traditional we move to the inimitable – a Nordic trio of vocal, drums and tuba called PELbO. The tight Gretsch kit that has been playing its heart out all week is replaced by a big, boomy rock set; the bass amp looks like its been dismantled and hammered together again by BA Baracus; and the vocal mic first makes its way through all manner of loops, twists and turns to give this band a sounds that is as big as a cathedral.
Drummer Trond Bersu wastes no time in ripping out huge, rolling rock beats, upon which Kristoffer Lo lays slabs of low-end tuba, turning the instrument into a vehicle for sometimes fuzzy low end that could knock a house sideways. Over this, Ine Krstine Hoem attacks her vocal with style and skill, harmonises and looping her own lines over themselves – it is virtuosic, aggressive and very rock and roll.
But the question is unavoidable – is it jazz? No, it's something better – really good music. So stick that in your tuba and blow it out your bass drum.
Seconds out; final round. It's time to finish this festival in style.
Round two at 12 Points brought bands from the grandes dames of Europe to Dublin, namely Rome, Berlin and Paris, but the music was box fresh and cutting edge.
Opening up the evening's three sets were the Lisbeth Quartett from Berlin, lead by 23-year old saxophonist Charlotte Greve. This is slick, crisply executed music played with guile, and Greve gets a beautiful tone from her instrument. This sounds and feels like a band playing together, rather than a collection of instruments, with little recourse to charts throughout the set. The band perhaps play it a little too safe – or maybe it just seems that way in the context of the anarchy-like atmosphere that some of the other 12 Points acts bring to bear. But when this quartet push themselves out of their comfort zone and throw some fuel on the fire, such as on set-closer Red from the quartet's forthcoming album 2, the fluidity of the communication and the subtle interplay at work is very effective and exciting. (more…)
Exhibit: Going to see a Science Gallery exhibition is becoming as much a part of our routine as our morning 10-mile jog (alright, alright), but the boffins are bound to throw up a duff one sooner or latter. This is not the case with Human+, which looks at our future as a species, and promises "augmented abilities, authored evolution, new strategies for survival and non-human encounters." Out favourite bit, in a macabre way, is a new strategy for death, namely a euthanasia rollercoaster. Basically some scientist type (called Julijonas Urbonas if you must know) has devised a rollercoaster that goes so fast and with G forces so great that you slip unconscious and gently shuffle off this mortal coil in the most spectacular fashion possible. There is even a model of it (rumours that Funderland are negotiating for the plans are said to be wide of the mark). Well if you are going to go out, you might as well go out screaming.
You ain't getting your money back after this ride, buddy
Rock out: 12 Points isn't the only musical event in Dublin this weekend, and there is a cracking line-up for a musical fundraiser for Aid Japan over at the Twisted Pepper on Dublin's Middle Abbey Street (where you can also check out their new Loft bookshop). Among those giving their time and talents to raise some cash are Squarehead, Grand Pocket Orchestra, Toby Kaar, Sacred Animals, No Monster Club, We Are Losers, Shapes and Jogging, with DJ sets from Adebisi Shank, Bats, Rigsy, Shortie, Una Mullaly, Nialler9, Moshi Moshi, Chika & Kayo, Aoife Sweet Oblivion, Niamh New Noise, Peter Toomey, Darren Maloney and Liam McCreith. Tickets are €5-10. Clickey here for more infomatics.
Dance: Last year, I remember coming home from a late night out and turning on the television while the kettle boiled. While flicking around I came across the most extraordinary piece of television that had me staring at the screen, jaw set to slack. A man and woman were dancing around each other underwater (the impression being given was that they were mother and son) in one of the most unexpected and effective pieces of performance art I had seen all year.
This, it turned out, was Deep End Dance, by David and Madge Bolger, real-life mother and son. David Bolger is a co-founder of CoisCeim dance theatre and a stage version of this film is now touring the country. Swimming With My Mother is at the Dunamaise Arts Centre in Portlaoise tomorrow (Friday) before heading off around the country. Click here for further details, and here's a lovely short on how the original film was made.
See: Last night Pygmalion opened to fairly spectacular reviews in the Abbey Theatre in Dublin. This is the first time the George Bernard Shaw classic has been staged in the National Theatre, and no effort has been spared in this elaborate production (you can read Peter Crawley's review in tomorrow's newspaper). I haven't seen it yet, because last night I was too busy getting my jazz on over at 12 Points, but next week I'll be going along, and so can you, because the lovely people at the Abbey have given Pursued by a Bear three pairs of tickets for next Thursday, May 12th's show to distribute in a fashion we see fit.
To be in with a chance of winning, simply email email@example.com with the answer to the following easily Google-able question (not that you need to, whipsmart readers that you are): What popular Broadway musical is based on Pygmalion? Drop us a line with your name and contact details, and winners will be notified via a message from the gods. Or perhaps an email. How's that for a little nugget of weekend loveliness?
The double-edged sword of opening this year's 12 Points Jazz festival fell to the Susana Santos Silva quintet, a young group from Porto led by trumpeter Silva. Opening-night nerves were in evidence, with the band relying too heavily on their charts and too lightly on each other in their opening numbers, which featured some terrific and unusual writing. Dark, troubling chords were often dislodged by almost Mariachi-style marches, with Latin influence splashing colour at unexpected turns; there is plenty fluidity and inventiveness here and once the band had shaken off their trepidation and opened up the trumpet of Silva and Zé Pedro Coelho's flowing tenor saxophone lines, the songs really lifted. (more…)
In this Culture podcast special Shane Hegarty interviews the author and philosopher AC Grayling.
In this week's Culture podcast Shane Hegarty talks to Hugh Linehan, Una Mullally and Conor Horgan about the latter's new film One Hundred Mornings, album covers and last weekend's Mindfield festival.
There are two festivals on the near and not so distant horizon that are offering niche events that should appeal to a wider audience: the 12 Points jazz festival (which kicks off tomorrow and will be covered on this blog) and the Dublin Dance Festival (which starts on May 13th).
Now there are two words that will jump out at people from that line, and immediately have them feverishly clicking the back button on their browser, or perhaps blissfully drifting into a somnambulant state: jazz and dance. But bear with us for a paragraph or two. (more…)


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Hello everyone,
I have a Thetford Aqua-magic IV toilet in my 1990 Shasta. At least that is what I THINK I have. I got no manuals when I purchased mine RV. I found the PDF manual on-line at their web site, and downloaded it. It looks like my toilet. Anyway, the water supply to the toilet leaks.
It appears that it has for some time now, as there is a DPO repair, consisting of a thin piece of plywood at the rear portion of where the thing bolts to the floor. Now it is slightly taller (about 1/4" at the rear) and moves when you sit on it! This sets up more problems. The water supply line is only so long, with no give to it. So the rest of the DPO's fix was to add in a double threaded plastic piece of pipe to increase the length, and thus make everything bolt up, right?
WELL... with the thing tending to want to move, it was only a matter of time until trouble would follow. Where the supply line goes into the tiolet, on the bottom, in back, it began leaking there when the onboard pump would reach pressure. I haven't ever been brave enough to hook up to city water pressure.
I thought I had repaired the problem, by installing a length of 18" flexable hose between the stool and the supply line. Wrong!
The last time out, the pressure blew the line out of the bottom of where it is supposed to attach to the toilet! For the life of me, I cannot see how it ever held any pressure to begin with! there seems to be no way for this assembly to bolt to the toilet itself. It just slipped right out. Only the ridgid supply line was holding it in place to begin with, and my repair allowed it to blow out under pressure.
So my long winded question here is a simple one... Can this toilet be repaired, or should I start looking for a new replacement? I know that I should also look at the condition of the floor beneath my carpet around the base of the stool as well!
Thanks in advance for your wisdom,


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Merrell Whiteout Tri-Therm
100% Polyester, Textured Herringbone Fabric, Merrell M-Connect™, 2-Layer Merrell Opti-Shell™
100 g Merrell Opti-Warm™
Manufacturer's Description
Visit Merrell's Whiteout Tri-Therm page.
Retailers' Descriptions
Here's what other sites are saying:
CLOSEOUTS . A versatile, technical 3-in-1 jacket for men that want the most out of their outerwear, Merrell's Whiteout Tri-Therm jacket takes on a variety of weather with a waterproof breathable, ventilated shell and an insulated, removable liner jacket. Available Colors: CINDER HEATHER, EVERGREEN HEATHER, INK HEATHER. Sizes: S, M, L, XL, 2XL.
- Sierra Trading Post
Climb high and fast with our waterproof breathable Whiteout Tri-Therm(tm) jacket's pinnacle performance - our most technical and versatile three in one. Our lighter-weight M-Connect(tm) liner system stealthily secures the feather-light Merrell Opti-Warm(tm) liner for maximum warmth and mobility, and the waterproof, breathable shell's on-mountain design delivers infallible performance in the elements.
- Merrell
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The Merrell Whiteout Tri-Therm is not available from the stores we monitor. It was last seen November 3, 2012 at Sierra Trading Post.
If you're looking for a new component (3-in-1) jacket, check out the best reviewed current models.


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AJ Lee Setting Record As Divas Champion, Taz Interview, Jericho On @Midnight
– Chris Jericho's appearance on the Comedy Central show "@Midnight" is available online at ComedyCentral.com.
– Part one of an in-depth, two-part Miami Herald interview with TNA color commentator Taz is available at MiamiHerald.com.
– AJ Lee has passed Eve Torres on the list of total combined days as WWE Divas Champion. Torres held the title for a combined 260 days across three separate title reigns. Lee has held the title for 261 days. If AJ doesn't drop the belt tonight at the SmackDown taping, she will pass Maryse's combined reign of 265 days across two separate title reigns.


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Revista Española de Salud Pública
Print version ISSN 1135-5727
GARCIA ORTEGA, Cesáreo; COZAR MURILLO, Victoria and ALMENARA BARRIOS, José. Patient Autonomy and Information and Clinical Documentation-Related Rights Within the Context of Spanish Law 41/2002. Rev. Esp. Salud Publica [online]. 2004, vol.78, n.4, pp.469-479. ISSN 1135-5727. http://dx.doi.org/10.1590/S1135-57272004000400005.
Law 41/2002 Regulating Patient Autonomy and Health Documentation and Information-Related Rights and Obligations regulates matters which the General Health Law of 1986 had fallen short in its attempt to regulate, such as the right to health information, informed consent, health documentation, clinical records and other clinical information. This Law likewise classifies the ways in which capabilities may be limited and attributes physicians with authority over the evaluation thereof. In keeping with the Oviedo Convention on Human Rights and Biomedicine, this study includes the guiding principles of the new bioethics, such as an individual's right to privacy of the health-related information, living wills (or advance medical directives), the patient's right to autonomy and to take part in the decision-making process, the refusal of treatment or teenagers being of legal age for health-related decision-making purposes. Said Law, a primary law nation-wide, means a major advancement in physician-patient relations and must be further expanded upon with regard to numerous aspects thereof by the Autonomous Communities. This study is aimed at describing this body of law and at analysing the repercussions thereof on citizen relations, health professionals and the National Health System as regards the matter of clinical documentation and information.
Keywords : Legislation; Bioethics; Informed consent; Medical records; Personal Autonomy.


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Thursday, August 29, 2013
Communicating via Brain Wave Over the Internet
I love that this story comes in the same week as major news outlets and Twitter are unavailable because the Syrian Electronic Army has hijacked their domains. Seems like directly connecting your brain to the Internet is a pretty bad idea...
Scientists at the University of Washington claim that they have transmitted a second impulse over the Internet from one researcher to another, allowing one to remotely stimulate the other's hand simply by thinking. The university's announcement Monday described a pilot study in which Rajesh Rao imagined moving his finger, sending an electrical signal across campus to his colleague Andrea Stocco, whose own finger moved in response.
image: http://tech.gaeatimes.com/index.php/archive/scientist-tweets-using-only-his-mind/
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To the Editor: Dr Wallace and colleagues1 concluded that the combination of EUS-FNA and EBUS-FNA achieved "near-complete" minimally invasive mediastinal staging in patients with suspected lung cancer. It was suggested that if EUS-FNA and EBUS-FNA were used to replace mediastinoscopy, 97% of patients would have been correctly labeled as negative. Although the concept of complete ultrasound-guided staging is both logical (both methods have a complementary diagnostic reach) and appealing (it is an ambulatory, minimally invasive strategy that is likely to be safe and cost-effective), there are a number of features of this study that require the data to be interpreted with caution.
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Mike Tanier knows a thing or two about the nitty-gritty details that make the NFL so intriguing. This time of year we get inundated by draftniks, many without any credentials whatsoever. Tanier tells us to look for those with scouting experience and listen carefully:
Every Scoutspeak term does correspond with some real physical attribute, and true experts like Mayock can pepper their explanations with jargon without delving into non-Newtonian football minutiae. Others use Scoutspeak to conceal ignorance. The Paradox of Draft Analysis states that the more detailed the observations about a prospect's kinesiology, the less likely the writer-speaker is to have ever seen the prospect play football.
To acquire an ear for Scoutspeak, read draft publications; keep in mind that the grungier the production values, the better the information. Glossy magazines are for the mass market; true draft guides are churned out on blue mimeograph paper and stapled, like the heavy metal newsletters handed out by guys with face tattoos at indie record stores. Russ Lande's "GM Jr." is the best guide around; its 400 pages of single-digit fonts make it the Norton Anthology of Backup Linebackers.


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Intro to APIs: What Are APIs and What Do They Do?
Application programming interfaces (API) have been around since the 1960s. So if they aren't a new concept, why are they such a hot topic lately? Without APIs, the digital experiences that we expect every day as consumers wouldn't be possible. Here's a brief introduction to what APIs are and what they can do from Upwork's free ebook, The API Economy.Read More
September 26, 2016


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I've got a little old source-package that i try to compile. Compiler
tells me that it can't find fp_class.h and consequently `FP_POS_NORM'
is undeclared. From what I've found on google i conclude that
fp_class.h is just not available on linux. How can I port this to linux
then? Are there any surrogates for this fp_class.h? And what is this
include file ment to be anyway?
Thanks for all the input,


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Anita Dongre's Iinterpret Spring Summer 2014 collection positioned in the affordable luxury segment will exude the fresh, vibrant and enveloping vibe of the season. It is a fascinating fusion of contemporary silhouettes with Indian influences.
The collection is softly sensual with elegant, clean and feminine lines. It is versatile, with every piece priced separately to allow the flexibility of pairing to suit individual choices. A total of 52 styles will be launched exclusively on Myntra.com.
The designer recently showcased her Autumn Winter Collection 2014- "An Urban Folk Tale" at the Wills India Lifestyle Fashion Week 2014 where Myntra.com was present as the official Online Fashion Partner.
Commenting on the association Anita Dongre says, "I'm excited to be partnering with Myntra.com for my Anita Dongre Iinterpret Spring Summer Collection. I believe in creating accessible luxury and Myntra.com takes it forward by catering to the fashion choices of modern India with the latest in premium designer wear amidst an engaging and stylised shopping environment."
Myntra.com has also launched Biba by Rohit Bal SS'14 exclusively online with a total of 27 options.
Myntra.com forayed into the premium designer wear segment in November last year and is now gearing up to expand this segment. This announcement reiterates the company's focus to deliver an unprecedented experience for every Indian by enabling access to designer clothing quicker than ever before.
Myntra.com also presented the most sought after fashion show of WIFW 2014, which showcased India's first International Woolmark Prize winner and ace designer - Rahul Mishra and his latest Autumn Winter 2014 collection.
Speaking on the launch, Mukesh Bansal, Co-Founder & CEO, Myntra said, "Myntra.com has been continually decoding fashion and has established itself as the preferred online fashion destination. Our association with leading Indian designers to launch exclusive lines will enable a seamless shopping experience particularly to those based in Tier II & III cities who have limited access to premium and designer brands."
Adding yet another feather to its cap, Myntra.com has also announced the launch of two leading international brands on its fashion portal – Desigual and 883 Police.
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A man featured on Most Wanted Wednesday was found hiding in a closet and arrested, according to the U.S. Marshals Service.
Lonnie Jones was wanted in connection with probation violations stemming from his original convictions and sentences for second-degree assault by strangulation and simple assault, authorities said.
Jones was also wanted in connection with five outstanding warrants in Massachusetts, including two for assault and battery.
Officials said Jones was located hiding in a closet at a home in Revere, Mass.


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Star Tracks: Monday, May 16, 2016 42 years, 2,191 covers and 55,436 stories from PEOPLE magazine's history for you to enjoy
Latest News!
- Trump Blames Clinton for Everything! Donald Goes on the Attack as Hillary Accuses Him of Saying 'Crazy Things'
- Read the Cover Story: Brad & Angelina Split After 12 Years: It's Over
- 'I Don't Know If I Have Enough Wine for This': The Best Social Media Reactions to the Clinton-Trump Presidential Debate
- Fourteen Months After Florida Teen Disappears at Sea, Mother Posts Touching Tribute on Instragram
- WATCH: Bobby Brown: Knowing Nick Gordon Is Legally Responsible for Bobbi Kristina's Death Has Given Me a 'Bit of Calmness'
People Top 5
LAST UPDATE: Tuesday February 10, 2015 01:10PM EST
PEOPLE Top 5 are the most-viewed stories on the site over the past three days, updated every 60 minutes
- May 05, 2008
- Vol. 69
- No. 17
"Heath Ledger was a beautiful actor and a wonderful father. I don't need to know any more than that"
Kathy Parker
Atlanta, Ga.
Heath Ledger was, by all accounts, a devoted father to his daughter Matilda, and I for one believe he would have welcomed a second child if he proved to be the father. I hope this is sorted out quickly so he is finally given the chance to rest in peace.
Amanda Bowes
Norwich, Conn.
Heath Ledger's uncles have been estranged from Heath's family for years, yet find it okay to insert themselves into the family's business following Heath's death? They say they only have Matilda's interests at heart. If they are so interested in her, why have they not taken steps to heal the rift in their family? What gives them the right to have any input about what is done with Heath's estate? Sounds to me like they just want publicity. Pretty sad.
April Holcomb
Lawrenceville, Ga.
While I understand that celebrities work hard for their cash, I find it obscene what they spend their money on: million-dollar cars, $100,000 weekend-long birthday parties, shopping sprees and mansions—the list is endless. Bravo to Brad and Angelina for donating their time as well as millions of dollars to charitable organizations. They are what's right in Hollywood.
Sandra F. Schillfarth
Nottingham, Md.
It's a sad comment on society that Darryl Gibbs, whose 8-month-old daughter Cynthia died at the hands of a day-care provider, had to fight to have a law put in place to make "shaking, slamming or throwing" a child under 5 a felony. Shouldn't that be a given? I'm so sorry for his loss, but I'm thankful for his voice. He is truly a hero.
Karen Stilson
San Diego, Calif.
There's a fundamental difference between posting gossip on a Web site and providing identifying features like a physical address. Gossip can be cruel, but giving out personal information on a Web site is beyond that, it's dangerous. Is JuicyCampus founder Matt Ivestor going to be upset if some coed gets raped or murdered because her name and address were posted on his site? Or is he going to figure it's just the cost of doing business?
Pat Brown
London, Ont.
No wonder the Berlin Zoo bear Knut is having the blues. Wild animals belong in the wild, not in an unnatural environment where thousands of screaming fans stand around gawking and applauding. Animals have their own agendas. Knut isn't addicted to fame, he just wants a life free of human interference.
Timothy J. Verret
Austin, Texas
Readers responded emotionally to our story about Thomas Beatie, the transgender man who is expecting a baby in July. "Because of this article, I had to rethink my own ideas about what makes a family," writes Mildred Martin of Portland, Ore. "I came to the realization that it's all about love, and the Beaties certainly have an abundance of that essential value." But the majority of readers voiced strong disapproval. "This is not a pregnant man," writes David Richardson via e-mail. "Mr. Beatie is a woman who has physically altered herself and now wants to be recognized as something she's not." Adds Michelle McHone of Gunter, Texas: "Men do not have babies." Anita Black of Sarasota, Fla., was most concerned for the Beaties' child, saying, "Shame on the Beaties for their insensitivity. Their child will be taunted and ridiculed as she grows up."
On page 14 of our April 28 issue, the dateline on the caption Natalie's New Man should have said New York City, April 8. We regret the error.
More in the Archive
Today's Photos
September 24, 2016
Victoria Justice, Plus Salma Hayek, Princess Kate, Ben Stiller & More!
Treat Yourself! 4 Preview Issues
The most buzzed about stars this minute!


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Star Tracks: Monday, May 16, 2016 42 years, 2,191 covers and 55,436 stories from PEOPLE magazine's history for you to enjoy
Latest News!
- WATCH: First Lady Michelle Obama Says She's 'Straight Up Nailing' Her Job on Resume in College Humor Skit
- Read the Cover Story: Brad & Angelina Split After 12 Years: It's Over
- Refugee Killed by California Police Allegedly Drew Vape Device During 'Mental Emergency'
- Golden Girls Kim and Kourtney Kardashian Wow In Second Barely-There Balmain Outfits
- Blac Chyna Says She Posted Rob Kardashian's Phone Number on Twitter to Stop Him Texting Other Women
People Top 5
LAST UPDATE: Tuesday February 10, 2015 01:10PM EST
PEOPLE Top 5 are the most-viewed stories on the site over the past three days, updated every 60 minutes
- September 24, 2007
- Vol. 68
- No. 13
Seems like late-night feedings and diaper changes came as no shock to NAOMI WATTS, new mom to 7-week-old son Alexander. So what's most surprising about motherhood? "The equipment and packing when you travel," she says. "So much luggage!"
When rapper EVE stopped by TAO Las Vegas's hospitality suite Sept. 8, she told pals she had just cut off her alcohol-detecting ankle bracelet (having completed a court-ordered monitoring period for a DUI arrest). She celebrated with a glass of champagne.
On a break from filming Bachelor No. 2 in Boston Sept. 5, KATE HUDSON gave an impromptu piano concert at the Fairmont Copley Plaza's Oak Room bar. She sat with son Ryder, 3, and picked out a few ditties for fellow diners.
DEMI MOORE wouldn't dream of missing New York Fashion Week while she's in town, but she won't play fashionista at the expense of spending time with her husband, ASHTON KUTCHER. (The pair are in New York City while Kutcher films What Happens in Vegas . . . with CAMERON DIAZ.) On Sept. 6 Moore hit hot spot Socialista for a fete for stylist RACHEL ZOE but left by 11 p.m. Why the early exit? "I'm going to see the husband," Moore told a fellow partygoer. "It's time to snuggle." Two days later she and Kutcher took their cuddling to the catwalk while catching the Diesel show. Said Moore: "You've gotta have priorities!"
CHRISTINA AGUILERA may not have officially announced she's expecting, but thanks to PARIS HILTON, she doesn't have to. After touching the singer's stomach at a pre-VMA party at Las Vegas's LAX nightclub Sept. 8, Hilton grabbed a microphone before a packed house, telling the stunned mom-to-be, "Congratulations to the most beautiful pregnant woman in the world. You're gorgeous!" Though Aguilera may not have appreciated the shout-out, that didn't stop Hilton from voicing her support for her other pregnant pal Nicole Richie. "She's going to be a great mom," Hilton said at Magic last week. "She loves kids—she's always wanted to have five."
- Contributors:
- CONTRIBUTORS Ashley Williams,
- With Saryn Chorney,
- Mark Dagostino,
- Jennifer Garcia,
- Mark Gray,
- Lesley Messer,
- Judy Rakowsky.
More in the Archive
Today's Photos
Treat Yourself! 4 Preview Issues
The most buzzed about stars this minute!


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@Jonathan Allin: They are quite different things. In brief once could say that AWS CloudHSM is an IaaS HSM offer for key storage. Customers of AWS (or Azure) could use CloudHSM to host their keys. Azure AD RM is a full information protection SaaS offer that includes an HSM SaaS offer within the broader offer.
Let me know if there was a particular nuance of the question that you're after.


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11 Teacher-Approved Crafts for School
Bonus: Get our newsletter & special offers for free. We will not share or sell your email address. View our Privacy Policy
Easy Pencil Picture Frame
By: Candace from One Minute Crafts
We are adding the craft to your Craft Projects.
The project was added to your Craft Projects.
Click here to view your Craft Projects.
Pencils are not only useful for writing- they can be used as a picture frame as well. This picture frame is cute and easy to make. It's a perfect back to school craft for the kids to make.
- 4" X 6" picture; landscape or portrait oriented
- 8 pencils; new, any color, sharpened or unsharpened
- Ribbon; 4 inch, any color
- Clear tape
- Craft glue
Flip the picture over so that you are looking at its back. Make sure the picture has the top at the top even when flipped over.
Form a loop with your ribbon and tape the ends of the loop to the top, center of the back of the picture.
Flip the picture back over.
Add glue onto the top and bottom of the picture along the edge, but wide enough for two pencils on each edge.
At the top and bottom, lay two pencils pointing in opposite directions, onto the glue. Make sure the picture centered.
Add glue down the center of each pencil set to help hold together.
Place glue in each of the four corners on top of the pencil sets.
Lay the other sets of two pencils on the left and right side of the picture.
Again, add glue down the center of each pencil set to help hold.
- Allow to dry before moving and hanging.
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mollymune 7882939
Jun 29, 2013
Love the projects, but If I cant see the actual picture when I go to pin it I wont pin. I think people would like to see the actual project and not your logo.
Nona Kim
Feb 09, 2010
This is soo easy and cute It would be great for K-5 grade for school pictures.
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Yoder, Bradley A. MD1; Gordon, Michael C. MD2; Barth, William H. Jr MD2
From the 1Departments of Pediatrics and 2Obstetrics/Gynecology, Wilford Hall Medical Center, Lackland Air Force Base, Texas.
See related editorial on page 810.
The views in this article are those of the authors and do not reflect the official policy of the Department of Defense or the U.S. Government.
Corresponding author: Bradley A. Yoder, MD, University of Utah School of Medicine, Department of Pediatrics, PO Box 581289, Salt Lake City, Utah; e-mail: email@example.com.
Financial Disclosure The authors have no potential conflicts of interest to disclose.
OBJECTIVE: To analyze the effect of gestational age, delivery mode, and maternal–fetal risk factors on rates of respiratory problems among infants born 34 or more weeks of gestation over a 9-year period.
METHODS: Retrospective analysis of prospectively collected maternal and neonatal data on all inborn births at 34 or more weeks of gestation at a single tertiary care center for the years 1990–1998. Specific diagnostic criteria were concurrently applied by a single investigator.
RESULTS: Over the 9-year period, late-preterm births increased by 37%, whereas births at more than 40 weeks decreased by 39%, resulting in a decrease in median age at delivery from 40 weeks to 39 weeks (P<.001). Respiratory problems occurred in 705 term or late-preterm infants (4.9%), with clinically significant morbidity (respiratory distress syndrome, meconium aspiration syndrome, or pneumonia) least common at 39–40 weeks of gestation. Respiratory morbidity was greater among infants born by cesarean delivery or complicated vaginal delivery compared with uncomplicated cephalic vaginal delivery. The rate of respiratory morbidity did not change over time (1990–1992 1.3%, 1993–1995 1.5%, 1996–1998 1.4%, P=.746). The etiologic fraction for respiratory morbidity did not change over time for infants 34–36 weeks but decreased twofold for infants born after 40 weeks.
CONCLUSION: Over the 9-year study period, reduced respiratory morbidity associated with decreased births after 40 weeks were offset by the adverse respiratory effect of increased cesarean delivery rates and increased late-preterm birth rates.
Improvements in maternal and perinatal outcomes have been associated with remarkable paradigm shifts in obstetric practice, including a dramatic increase in cesarean rates and a downward shift in median gestational age at birth. The latter has resulted in an increasing proportion of late-preterm births and a decreasing proportion of births after 40 weeks gestational age.1,2 During the past few years there has been a surge of interest in the outcomes of the late-preterm infant and the possible contribution of the increasing cesarean rates on this cohort. Many studies have reported increased pulmonary complications among infants delivered by cesarean, including respiratory distress syndrome (RDS), transient tachypnea of the newborn and pulmonary hypertension.3–6 The risk seems to be greater if labor has not preceded cesarean delivery or if delivery occurs before 39 weeks of gestation.7–10 Although a number of studies have reported on the association between cesarean delivery and respiratory disease, many have been retrospective in design, applied to a select population, and limited in the scope of included respiratory diseases. Additionally, there is little information on whether changes in obstetric practice have altered the epidemiology of neonatal pulmonary disease over time. The purpose of this study was to analyze the effect of gestational age, delivery mode, and maternal–fetal risk factors on the incidence of respiratory problems among infants born 34 or more weeks of gestation over a 9-year period in a single tertiary care center.
The study population consisted of all infants 34 or more weeks estimated gestational age delivered at Wilford Hall Medical Center from January 1, 1990, through December 31, 1998. In an effort to analyze an unselected population and minimize bias related with excessive high-risk pregnancies, we excluded newborns who were delivered at our hospital after maternal transport. As military active duty or dependents, these mothers received free medical care throughout their pregnancy. Applying Kotelchuck's Adequacy of Prenatal Care Utilization Index,11 85% of mothers received "adequate" or "adequate plus" care, 9% were intermediate and 6% were determined to have "inadequate" prenatal care. Two trained nurses and one physician collected data for all births on standardized data sheets from the time of delivery. Maternal antepartum and intrapartum records were reviewed immediately after delivery. Neonatal data were prospectively recorded until discharge from the hospital and entered into a single database. All clinical diagnoses were concurrently monitored and recorded. Infants admitted to the newborn intensive care unit were monitored for details related to cardiopulmonary support, including duration of oxygen and mechanical ventilator support. Data on all infants admitted to the newborn intensive care unit were also cross-referenced to a separate database for that unit.
Antepartum complications coded in the database included maternal diabetes, fetal growth restriction, preeclampsia or gestational hypertension, oligohydramnios, hydramnios, prolonged and premature rupture of membranes, placenta previa, and abruption. Several intrapartum characteristics were also recorded, including fetal heart rate patterns, presence of meconium-stained amniotic fluid, mode of delivery, and presumed chorioamnionitis. The mode of delivery was defined as follows: cephalic spontaneous vaginal delivery; forceps or vacuum assisted operative vaginal delivery; vaginal breech delivery; and cesarean delivery. Cesarean deliveries were further coded as 1) primary cesarean delivery—nonurgent cesarean delivery in a woman with no prior birth by cesarean; 2) repeat cesarean delivery—nonurgent cesarean delivery in a woman with a previous birth also by cesarean; and 3) emergency cesarean delivery—cesarean delivery provided when severe fetal or maternal compromise was suspected, such as due to cord prolapse, suspected abruption, previa with hemorrhage, or markedly nonreassuring fetal heart rate pattern.
Diagnostic criteria for each neonatal pulmonary problem were applied concurrently by a single investigator (B.A.Y.) as follows: 1) meconium aspiration syndrome by presence of meconium-stained amniotic fluid, presence of abnormal signs on physical examination consistent with pulmonary disease, need for supplemental oxygen or ventilator support, a compatible chest radiograph and low suspicion for infection; 2) RDS by presence of abnormal signs on physical examination consistent with pulmonary disease, need for supplemental oxygen or ventilator support, a chest radiograph with diffuse reticular granular pattern and low suspicion for infection; 3) pneumonia by presence of abnormal signs on physical examination consistent with pulmonary disease, abnormal chest radiograph with nonhomogeneous findings, and a high clinical suspicion for infection; 4) transient tachypnea of the newborn by clinical and radiographic features initially identified in the first hours of life, followed by characteristic resolution during the initial 24–48 hours and low suspicion for infection; and 5) pulmonary hypertension by clinical or echocardiographic criteria demonstrating significant right-to-left extrapulmonary shunt or elevated pulmonary artery pressure. Diagnosis of pneumothorax and congenital diaphragmatic hernia were made by characteristic radiographic findings. To provide a more objective measure of the clinical importance of a respiratory problem, we defined respiratory morbidity by the use of any assisted mechanical ventilation or by the need for supplemental oxygen for greater than 24 hours. Because the incidence of respiratory morbidity by estimated gestational age was similar to or less for multiple gestation births (n=283) when compared with singletons, we included all live births 34 or more weeks estimated gestational age in this study.
To estimate the influence of changing care practices over the study period, 3 subgroups were identified: Era 1=1990–1992, Era 2=1993–1995, Era 3=1996–1998. There were distinct epidemiologic reasons for these divisions. During the years 1990–1992 (Era 1), we recorded the lowest rates of late-preterm birth, the highest rates of births at 41 weeks or more, and the proportion of births at 40 weeks of gestation exceeded that of births at 39 weeks. Additionally, during this period amnioinfusion was not used, and the institutional cesarean delivery rate was consistently less than 10%. During the years 1996–1998 (Era 3) we recorded the highest rate of late-preterm births, the lowest rate of births at 41 weeks or more, and the proportion of births at 39 weeks exceeded that of births at 40 weeks. Additionally, during this period amnioinfusion was used in more than 35% of meconium-stained labors, the institutional cesarean delivery rate ranged from 12% to 15%, and antepartum fetal surveillance for women reaching 41 completed weeks of gestation changed from a single nonstress test to a policy of twice-weekly fetal nonstress tests and weekly assessments of amniotic fluid volume with ultrasonography. The "transition" era was 1993–1995 (Era 2). During this time late-preterm birth rates were gradually increasing and births at 41 or more weeks of gestation were gradually decreasing. The cesarean delivery rate ranged from 9–12%, amnioinfusion was just being introduced, and a risk factor–based policy for the prevention of early onset neonatal group B streptococcal sepsis was adopted.12 During the course of this 9-year study, neither antenatal steroids nor tocolysis were routinely provided to any mother threatening to deliver at 34 or more weeks of gestation and cesarean delivery by maternal request was not an offered delivery option.
The primary outcome variable for this study was the diagnosis of respiratory morbidity. Univariable analyses comparing differences between infants with respiratory morbidity and those without were performed by 2-tailed t test, χ2, and Fisher exact test. To evaluate the effect of birth year on outcomes and practices, χ2 with Spearman's rho correlation was used to compare differences in categorical variables with respect to the three study eras, continuous data were compared by one-way analysis of variance, and ordinal measures were compared using Kruskal- Wallis. Stepwise logistic regression was subsequently used to test for independent risk factors on the occurrence of respiratory morbidity, with Hosmer-Lemeshow goodness-of-fit determination.13 All statistical procedures were performed using SPSS for Windows 14.0 (SPSS Inc., Chicago, IL). Etiologic fraction by gestational age category (34–36 weeks, 37–38 weeks, and 41 weeks or more) were determined by the method of Miettinen as follows: EF=Pi (RRi–1)/ S Pi (RRi–1)+1, where Pi is the prevalence of the ith gestational age category, RRi is the corresponding relative risk of respiratory morbidity in the group relative to birth at 39–40 weeks, and S indicates summation over the i gestational age categories.14 This study was approved by the Wilford Hall United States Air Force Medical Center Institutional Review Committee. Based on the observational nature of the study, informed consent was determined to not be necessary.
During the study period there were 15,997 births. After exclusion of all maternal transfers (n=1,050) and births less than 34 weeks (n=382), there were 14,531 infants 34 or more weeks of gestation included in this study. There were 34 fetal deaths. Fetal death rate increased as gestational age decreased (rate per 1,000 births was 8.9 at 34–36 weeks; 3.7 at 37–38 weeks; 1.4 at 39–40 weeks; and 1.3 at more than 40 weeks; P<.001). There was no difference in fetal death rate between the three time eras. Among the 15 neonatal deaths occurring in this study population before discharge from the neonatal intensive care unit (NICU), 11 were due to severe congenital anomalies or inborn errors, two were attributed to perinatal asphyxia, and two were secondary to severe sepsis. There were three infants whose primary cause of death was pulmonary in nature, and all three had severe lung hypoplasia disorders, including thanatophoric dwarf, limb-body wall syndrome, and severe lung hypoplasia secondary to prolonged oligohydramnios.
Table 1 shows demographic, antepartum, and intrapartum features of the maternal population by delivery era. The most dramatic differences between eras were the twofold increase in the diagnosis of any obstetric complication, the threefold increase in the diagnosis of nonreassuring fetal heart rate patterns, and the transition from limited to near universal use of antenatal ultrasonography, with a marked increase in the proportion of women undergoing first-trimester fetal ultrasonography.
There were 764 respiratory diagnoses made in 705 infants for an overall incidence of 4.9%. Of these, 75% were diagnosed as transient tachypnea of the newborn or pneumonia. Any respiratory diagnosis occurred more frequently as gestation moved away from 39 0/7 to 40 6/7 weeks (P<.001). Respiratory morbidity was diagnosed in 204 infants for an overall incidence of 1.40% (Table 2). The most common diagnoses associated with respiratory morbidity were RDS, meconium aspiration syndrome, or pneumonia. Respiratory morbidity increased in frequency as an infant's gestation moved away from 39 0/7 to 40 6/7 weeks (Table 2).
The etiologic fractions, crude ratio, and unadjusted relative risk for respiratory morbidity by gestational age group and era of birth are shown in Table 3. In all three periods the highest etiologic fraction was found among the late-preterm infants. There was a noticeable reduction in the etiologic fraction of respiratory morbidity over the 9-year study period for infants born at 37–38 weeks and after 40 weeks of gestation.
There was a significant change in the mode of delivery over the 9 years of this study. Cesarean delivery rates nearly doubled from 8.1% to 14.0%, whereas spontaneous cephalic vaginal deliveries decreased from 73.5% to 68.9%, and any vaginal breech delivery decreased fourfold from 1.9% to 0.5% (P<.001). The greatest proportion of cesarean deliveries were designated as "primary," but both "primary" and "repeat" cesarean delivery rates increased significantly over time (4.6% compared with 9.0% and 2.5% compared with 4.2%, respectively for Era 1 compared with Era 3; P<.01), whereas the proportion of "emergent" cesarean deliveries actually decreased over time (12.1 compared with 5.7% of all cesarean births in Era 1 compared with Era 3, respectively; P<.01). Compared with cephalic vaginal birth, respiratory morbidity occurred at rates fourfold higher after cesarean delivery and breech vaginal delivery, although statistical significance by mode of delivery was only noted at estimated gestational age of more than 37 weeks (Table 4). Although cesarean delivery rates were increased and cesarean delivery was associated with a greater risk for respiratory morbidity, the diagnosis of respiratory morbidity was similar across all three time eras by each mode of delivery as well as for all live births 34 or more weeks estimated gestational age (Era 1 59 of 4,400=1.3%, Era 2 66 of 4,381=1.5%, Era 3 79 of 5,750=1.4%; P =.780). Rates of respiratory morbidity for each specific respiratory diagnosis were statistically unchanged over time except for pneumothorax, which decreased from 16.9% of all diagnoses in Era 1 to 6.3% in Era 3 (P =.048). The combination of RDS plus transient tachypnea of the newborn significantly increased from 33.9% of all diagnoses in Era 1 to 57.0% in Era 3 (P =.009), whereas the combination of meconium aspiration syndrome and pneumonia significantly decreased from 52.5% of all diagnoses in Era 1 to 30.4% in Era 3 (P =.009).
Over the 9-year study period, there was a significant shift in the estimated gestational age at delivery (Fig. 1). The median age at delivery decreased from 40 weeks to 39 weeks, with a shift in 25–75% from 39–41 weeks to 38–40 weeks. This shift in gestational age at delivery was associated with a 37% increase in births 34–36 weeks and a 39% reduction in births less than 40 weeks (Fig. 2).
Logistic regression modeling demonstrated that five factors were independently related to the occurrence of respiratory morbidity. As shown in Table 5, the most important factor was estimated gestational age at the time of delivery. Using 39–40 weeks of gestation as the reference value, risk markedly increased as gestation decreased below 37 weeks. Low 5-minute Apgar and nonreassuring fetal heart rate patterns also increased risk for respiratory morbidity, with the greatest effect noted for low 5-minute Apgar scores. Finally, male gender and cesarean delivery (presented as any cesarean delivery, as well as by specific type of cesarean delivery) also independently increased the risk for respiratory morbidity. Era of birth, maternal race, maternal age and complicated pregnancy were not independent risk factors.
There are two important findings from this study: first, we confirmed the paradigm shift in obstetric care of increased cesarean delivery rates, increased proportion of late-preterm births, and decrease in median gestational age at delivery over a 9-year period; second, despite the fact that we confirmed the association of increased rates of respiratory morbidity with decreasing gestational age and with cesarean compared with vaginal delivery, we did not observe an overall increase in respiratory morbidity over the 9-year period.
With regard to gestation-dependent respiratory morbidities, the epidemiologic findings of this study are similar to those by Hjalmarson and colleagues,15–17 and only slightly disparate from the more recent studies of Rubatelli and colleagues.18,19 Hjalmarson and colleagues have previously identified an increased risk for significant respiratory disease among term and late-preterm infants related to gestation at birth, low Apgar scores, and cesarean delivery.15–17 Similar to their findings, we noted that the majority of respiratory disease in this population was mild in severity, of limited duration, and did not contribute to mortality. Methodologic differences between our study and those reported by Rubaltelli and colleagues make it difficult to contrast the findings.18,19 They included infants of all gestational ages but focused on births less than 37 weeks, whereas our focus was on late-preterm and term infants. Additionally, the use of supplemental oxygen by diagnosis ranged between 69–90%, and for ventilator support it was between 7% and 73%, whereas we only diagnosed respiratory morbidity among infants who had an objective need for oxygen and/or ventilator support. In both European study series the data were of large populations, but a limited period of 3 months to 12 months did not allow evaluation of possible epidemiologic changes over time. One of the strengths of our study is that all diagnoses were concurrently made by a single investigator. It is possible that subtle shifts in the application of diagnostic criteria may occur over time, even for a single investigator. However, the inclusion of more objective criteria, such as the need for oxygen supplementation or ventilator use for more than 24 hours, should minimize any possible change in subjective application of diagnostic criteria. Additionally, the overall incidence of any specific respiratory morbidity did not change over the 9-year study period, but the pattern shifts that were noted (decreased proportional frequency of meconium aspiration syndrome and pneumonia and increased proportional frequency of RDS and transient tachypnea of the newborn) were consistent with the proportional shift in gestational age at delivery. Finally, consistent approaches in the management of infants with respiratory problems were maintained over this 9-year period, including the use of surfactant replacement for RDS and the availability of high-frequency ventilation and extracorporeal membrane oxygenation.
The increased risk associated with cesarean delivery, particularly elective cesarean birth in the late-preterm and early term infant before the onset of labor, is well described.3–10 This and findings of the present study support the current American College of Obstetricians and Gynecologists recommendations that elective cesarean delivery be delayed until 39 or more completed weeks of gestation (in women with good dating criteria) to minimize the risk of subsequent respiratory disease and NICU transfer.20 Our study confirms the increased risk of serious respiratory morbidity among infants not delivered by a spontaneous vaginal route, but it is limited by the lack of determination of the specific indication for cesarean delivery. Because elective cesarean birth by maternal request was not an accepted indication during these years, other mechanisms were involved in the increased rate of cesarean deliveries. The proportion of cesarean births in our study changed in a fashion consistent with the national trend reported by Menacker et al2 Interestingly, the proportion of "emergency" cesarean deliveries significantly decreased over time. Although the highest rate of cesarean delivery was among the late-preterm infants, cesarean rates increased significantly for each gestational age analyzed. Our cesarean delivery rate nearly doubled over time, but the highest cesarean rate of 15.3% in the last year of this study was well below the United States cesarean rate at that time of 22%, and far less than the 29% section rate reported for the United States in 2004.20 Our cesarean delivery rate during the 9-year study period may be partly attributable to the fact that purely elective cesarean delivery and elective inductions at less than 39 weeks were strongly discouraged at our center.
Etiologic fraction defines the proportion of all cases (in our study, respiratory morbidity) due to a particular risk (here, gestational age at birth) and is a function of both risk and prevalence of the risk factor. We found that the etiologic fraction for respiratory morbidity remained relatively stable for late-preterm infants but decreased markedly in time periods 2 and 3 for infants born at 37–38 weeks and after 40 weeks. Although there was a 37% increase in the number of late-preterm births over the 9-year study period, this was primarily due to births at 35 weeks and 36 weeks (Fig. 2), not the highest risk group at 34 weeks, and the absolute increase in prevalence was rather minimal (5.2% of all study births in 1990–1992 compared with 7.1% in 1996–1998), resulting in little effect on late-preterm etiologic fraction. In contrast, the etiologic fraction reduction for infants born after 40 weeks seems to be primarily due to decreased prevalence, because the proportion of births after 40 weeks decreased from 26.7% of all study births in 1990–1992 to 16.4% in 1996–1998. Because the proportion of births at 37–38 weeks actually increased from 16.4% of all study births in 1990–1992 to 23.0% in 1996–1998, the decreased etiologic fraction among infants born at 37–38 weeks seems primarily due to a reduction in relative risk. Although this decreased risk may be associated with time-related changes in obstetric and/or neonatal care, the reasons are unclear from the data available to us.
There are limitations to this study. First, this is a single-center study representing outcomes in a military dependent population with free access to and adequate use of all maternal and neonatal health care services. Our results may differ from populations without such care. Second, the study patients were all managed at a tertiary care center with 24-hour availability to maternal–fetal and neonatal specialists. Our findings may not be representative of those at a community hospital. Although we attempted to pattern the community hospital population by strict exclusion of all high-risk maternal transfers, differences in availability of subspecialty services (such as anesthesiology, maternal–fetal medicine and neonatology) may affect a variety of decisions made in determining the management of labor, timing of delivery, and subsequent neonatal care. Third, our cesarean delivery rates were considerably lower than the national rates. This may result in an underestimation of respiratory morbidity compared with centers or populations with much higher cesarean delivery rates. Next, over time it is possible that there was a significant change in the patient population we cared for. Although military populations tend to move frequently, this did not alter the general demographic make-up of our study population over time. We did identify differences over time in the rates of several important antenatal and perinatal factors. These include an increased diagnosis of complications such as gestational hypertension or gestational diabetes, as well as in the overall diagnosis of any obstetric problem and an increased recognition of nonreassuring fetal heart rate patterns. Some of these differences may be due to changes in obstetric practice rather than a change in the patient population. One example of this change in practice is the use of fetal ultrasonography, which dramatically changed from a minority of women having any ultrasonography during pregnancy to near universal application of this test, with nearly 50% of the mothers having their first fetal ultrasound scan during the first trimester. Lastly, because this was a retrospective analysis of an observational cohort, the associations that we found between mode of delivery and neonatal respiratory morbidity cannot inform prospective decisions regarding clinical management and planning a route of delivery.
The primary goal of obstetric practice is to produce a healthy neonate in the safest manner possible. The optimal timing and approach for this goal remain elusive.21 Caughey et al22,23 have suggested that maternal and neonatal risk increases as gestation advances beyond 41 weeks. Although a study by Alexander et al24 did not concur with this suggestion, their study group was selective, excluding infants less than 40 weeks as well as for a variety of maternal complications. Our findings in this study, and in a previous report on infants born through meconium-stained amniotic fluid,25 are in agreement with the suggestion by Caughey and others, at least as it relates to clinically important neonatal respiratory complications.
In summary, our study confirms numerous recent reports that late-preterm birth is an important contributor to the incidence of respiratory morbidity.26–28 We also found the same downward shift in gestational age at birth previously reported by Davidoff et al.1 What we have shown that is not seen in isolated studies of only late-preterm infants, is the effect on overall respiratory morbidity of the concurrent decreasing rates of births above 40 weeks of gestation. That is, the associated reduction in "late" term births occurring in conjunction with the downward shift in median gestation at birth is accompanied by a decreased rate of respiratory morbidity that seems to balance the increased rate occurring among the late-preterm group. The implication of this finding is that an overall reduction in respiratory morbidity, and possibly other morbidities, would likely be seen if a reduction in the proportion of "late" term births occurred without an accompanying increase in late-preterm births. Further prospective studies are clearly needed to validate or refute the findings we have presented and to better understand the complex interactions involved in the management of pregnancy, labor and delivery, and gestational age to achieve our goal of optimal maternal and neonatal outcome.
© 2008 by The American College of Obstetricians and Gynecologists.
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J. Veronika Kiklevich, DVM
Q. I have been reading that the silica dust in clay litters can be dangerous and can even cause silicosis and lung cancer, as it collects in the lungs. What is your opinion on this?
I have five cats and one is developing a respiratory problem and I think it is from the clay litter dust. I live in a small 500 square foot apartment and the dust seems to get everywhere. I tried a name brand corn litter, which I began mixing in gradually, but my cats appeared hesitant about using the litterbox, so I discontinued that experiment. I have been told that a name brand litter made of newspapers has low-dust; any comments on this type of litter?
I've also been told that the pine pellet litters have low-dust, but again there is the issue of the transition to the hard pellets. I also read that the abietic acid in pine can damage the respiratory tract causing respiratory disease and asthma.
What are your recommendations? Please help!
A. Although these questions have come up from time to time in the veterinary world, no factual answers have been established.
A few years ago there was a small study done at the Animal Medical Center (AMC) in New York regarding this issue. The conclusions of the study was not clear-cut, but I think it's safe to say that in cats with pre-existing airway disease, silica may act as an airway irritant. There was no evidence that silica (itself) caused disease.
If your cats seem to be sensitive to the litter that you are currently using, I would try to slowly switch to the pellet form of litter. This may take up to 4 to 6 months (for your cats to get used to it), as you gradually decrease the clay portion and increase the pellet portion of the litter. Also, some clumping litters are both dust-free and soft, and might be a good alternative.
Dennis Westby, WI
LINK One of the best ways to reduce dust in the litterbox is by using a litter scoop that doesn't require you to lift-and-shake. There is a wire litter scooper from K-Kat that just lifts waste, not the litter, so there's no dust. Check it out on Kickstarter: LINK
Udit Lafayette, IN
I have been using two non-clay types that Arm & Hammer make: Essentials and Natural Double Duty. They are both great. They don't clump when the cats pee and then it dries. However, if you clean it daily in the morning and/or evening, it scoops out pretty good.
Erin Brookline, NH
Great article! I'm wondering though if anyone has tried Breathe Free Litter Box Mate litter pads? They are litter pads that go on the bottom of the litter box with any kind of litter poured on top. The pad absorbs the odor from the litter so their is no litter box smell. Apparently these litter pads work great - and they're cheap! Worth checking out...
dayna easton, PA
good article
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