text:
from 45 EUR – Guest accommodation
Guest accommodation
from 69 EUR – Guest accommodation
Guest accommodation
0.44 km
518 route de l'Estuaire 27210, Fatouville-Grestain
1.14 km
204 Route de Joble 27210, Fatouville-Grestain
1.45 km
55 rue du Bourg 27210, Fatouville-Grestain
1.57 km
12 rue des Diligences 27210, Fatouville-Grestain
* Wszystkie odległości są mierzone w linie prostej, od Twojego punktu do celu.
All bookings are confirmed instantly. No waiting, no email exchanges, no confusion.
Located in Fatouille-Grestain, Chambres L'Eau Vive is 7 km from Honfleur, 6 km from Honfleur Normandy Outlet and 24 km from Deauville. It offers individually decorated rooms and a restaurant that serves a continental breakfast every morning.
All rooms at Chambres L'Eau Vive have wooden floors, a flat-screen TV and a private bathroom with a shower. Some offer exposed beams and views of the countryside.
The on-site restaurant offers a south-facing terrace and serves French cuisine consisting of regional produce.
This property is 8 km from the beach and 16 km from Deauville Saint-Gatien Golf Course. The A29 motorway is 4 km away. Ffree private parking is available on site.
Rooms: 3
Toilet paper, Free toiletries, Toilet, Bathroom, Shower
Hardwood/Parquet floors, Heating
Flat-screen TV
Upper floors accessible by stairs only
These individually decorated rooms feature a flat-screen TV and a private bathroom with a shower. Some offer exposed beams and views of the countryside.
After booking, all of the hotel's details, including telephone and email address, are provided in the online booking confirmation, confirmation email.
Heating, Non-smoking throughout, Non-smoking rooms,
Restaurant (à la carte),
Free WiFi! WiFi is available in all areas and is free of charge.
Free parking! Free private parking is possible on site (reservation is not needed).
From 15:00 Until 18:00 hours
From 09:00 Until 10:00 hours
All children are welcome.
All children under 16 years are charged EUR 15 per night for extra beds.
All further older children or adults are charged EUR 15 per night for extra beds.
The maximum number of extra beds in a room is 1.
Pets are allowed. Charges may be applicable.
Our hotel reviews will help you find the best deal in the right location.
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Website in English and 17 other languages


text:
2.4 oz tube with decorative
The supple shea and cocoa butters and Vitamin E packed jojoba and
soybean oils calm even the severest of dry skin. Like all FarmHouse
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is currently empty
Gear up for Championship Golf
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See "Policies" above cart
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80 Carolina Vista Drive
Pinehurst, NC 28374
© Pinehurst, LLC. 2015
© Pinehurst, LLC.

subset: commoncrawl


text:
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Convenience Store Jobs
Browse our large selection of Convenience Store Jobs from all around the UK on GrocerJobs - the UK's leading FMCG jobsite!
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National Account opportunity with a global dairy business. Perfect role for National Account Executives or Junior NAM's looking for progression.
Head of E-Commerce
Rare opportunity to join an business in a Ecommerce Leadership role!!! Six Figure Package, London based


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Personal Statement
Lybrate.com has a nexus of the most experienced Gynaecologists in India. You will find Gynaecologists with more than 40 years of experience on Lybrate.com. You can find Gynaecologists online in Ahmedabad and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.
Book Clinic Appointment
Kalyani Maternity & Sonography97, Bansidhar Society, D-cabin, Ahmedabad Get Directions
Consult Online
Management of Surrogacy
Caesarean Section Procedure
Contraceptive Advice
Delivery Procedure
Treatment of Gynae Problems
Gynecology Laparoscopy Procedures
Hpv Vaccination
Treatment Of Female Sexual Problems
Treatment Of Menopause Related Issues
Treatment Of Menstrual Problems
Treatment of Mirena (Hormonal Iud)
Pap Smear Procedure
Polycystic Ovary Syndrome Treatment
Ureteroscopy Procedure
Treatment of Uterine Bleeding
Antenatal And Postnatal Exercise
Antenatal Checkup
Management of Postnatal Care
Adiana System Treatment
Amniocentesis Procedure
Submit Feedback
Submit a review for Dr. Mohan LalYour feedback matters!
Hello. I am 24. I had scanty but regular periods for the last 9 months. I went to a gyno this month and she said I have pcos and the main treatment is change of life style and shedding 5 kgs since m overweight by 5 kgs. She said if I want to I can take primolut-N tablet for 3 days 3 times to induce periods. I took the 1st pill on 10th Sept after lunch. Then 3 tablets after breakfast lunch and dinner on 11th and 12th. And today on 13th I skipped breakfast so I 'll be taking the last pill after my lunch. All though I have started to get that smelly discharge I get just before my period and mild cramp. Ideally by when should my period start after taking the tablet? Also is this a safe tablet? Will it cause any disturbances in my cycle in future?
My age is 25, unmarried, me apne boyfriend k sath physical ho chuki pr usse meri shadi nhi ho ri he, please tell me medicine vagina ko tight krne k liye meri shadi hone wali he 10 days me, please help me.
I had my c sec delivery 10 months ago. I got my periods after 5 months of my delivery. But since then I am running on irregular cycles. It gets delayed by at least 1 and a half month. I had a history of irregular periods even before my pregnancy. Had taken some medicines at that point of time to make them regular.
I am a 22 year old lady. I have been on novelon 21 day contraceptive pill for last one month but on the last month I missed the second last pill which I doubled up the next day with the last pill. I had a pill free week of 6 days on which I had my withdrawal bleed from 5th to 8th of this month. Then I started with the new pack on 8th and had protected intercourse on 9th. Condom did not break but he used the same condom twice while having intercourse. Till then I have not missed a pill. I had a fever on 13th I took two calpol same day and had protected intercourse next day. I have not experienced any pregnancy symptoms bit I am worried since I have not started new pack immediately after missing the pill.
My girlfriend and I had a intercourse few months ago during last 2 months her periods were irregular and during this month she is not on her periods even those dates have passed, help me please?
My gf periods finish 20 then I have sex with my gf on 24 bt my condom broke nd after 2.5 day she take unwanted 72. In empty stomach. After 7 days she feel pain in her overy. The she chek pregnancy through prega news kit after 9 days of sex. The result is negative. Bt she feel so pain in her ovary and some blood type substance came in her overy .can I know she is pregnant or not. I can not afford baby at this tym.
I am a 29 years old and I don't know that how to do safer sex earlier. After knowing my mind is always upset. Because I am confused i am safe or unsafe ?
She is not having milk in one of her breast. What will be the best supplement to increase milk for baby feeding.
Hi Madam, I have recently delivered boy. It's been 2 months. I am breastfeeding and I am 36 years old. The difference between this child and my 1st child is 6 years. Please kindly advise if its ok to use TRIPHALA to reduce my pregnancy weight as I am breastfeeding and its only 2 months after my delivery.
Heart attack or myocardial infarction mostly occurs when the flow of blood to the heart is blocked due to one or more reasons. The most prominent reason could be high fat or cholesterol that results in plaque build up in the coronary artery. The restricted blood flow has the potential to damage or even destroy the heart muscle. Some of the symptoms that can be helpful when it comes to the identification of a heart attack are listed below.
1. Discomfort in the Chest - Your chest may feel tight and pressured when you are about to be hit by a heart attack. Pain or discomfort in the chest is usually central typically felt behind the sternum, the central bone of chest. It may not be pain, it may be only discomfort, it may only be in upper part of tummy, very commonly confused with a gas problem. It is often accompanied by a painful sensation in the chest or arms. If a chest pain lasts more than 15-20 min it can be assumed to be a heart attack. This aching sensation may even spread to your back, neck or jaw.
2. Feeling of inconvenience - Often before the heart attack, the person may have feelings of nausea, ingestion, abdominal pain or a heartburn.
3. Breathing problems - Another prominent symptom of heart attack is shortness of breath which is accompanied by cold sweat and fatigue.
Emergency Measure:
If you think you are getting a heart attack, you should immediately take one tablet of Aspirin, 4 tablets of a drug called Clopidogrel, and one tablet of Atorvastatin 80 mg and rush to the nearest possible medical facility as time is very important in the treatment of an acute heart attack.
Related Tip: Heart Attack - Is the Damage Reversible?
Hey am 35 week pregnant. Today I had done my 9th month scanning.in that 1 layer umbilical cord is rounded by baby. Is that is a problem. I was totally tensed. Pls say a rly.
I am suffering from periods problem its irregular thats y am nt getting pregnant since 5 years plzz help me.
Hi , I am a 27 years old female. I had unprotected sexual contact on 1st July that resulted in minor cuts around the vaginal opening to which I used coconut oil for relief. Following this, on 4th july I suffered from high fever and minor urine discomfort/infection to which I used, amoxicillin, twice a day combiflam thrice a day and alkasol for three consecutive days. This brought relief from fever and urine infection. However, the fever didn't go away completely and the cuts near the vagina started causing more discomfort to which I opted for norfloxin and combiflam again on 8th july and saw a gyna on 9th july morning. I shaved my pubic hair the same morning before seeing the doctor, she advised me betadine to apply on the cuts and did not see any trace of infection so stopped all my medications. Just to mention here that I got my periods on 9th July morning as well. Now post visiting the doctor, I again had fever the same night (9th july) but felt better on 10th through the day. On 10th evening, while taking a shower I figured small pimples have popped up near the vaginal area and by the time I saw the doctor on 11 th evening, pimples were turned into boils and I had fever too. The doctor advised ciprobid (500 mg) & bcasule twice a day + combiflam thrice a day. I had high fever last night (12th) and rhe boils burst causing pain bleeding and water outburst. I have a burning feeling where the boils are and severe headache not to mention ongoing weakness. I pee in discomfort and have excreted in two days. I am on a normal regular three meal diet, no change. Please advice any other medication, change of routine to get rid of the pain and bleeding boils.
Me and my gf had done the sexual foreplay activity on 26th of nov. But there was not any kind of penetration. I used my penis to foreplay with her vagina. We didn't do sex. But she has missed her periods which was supposed to be on 2nd of dec. Is there any chances of getting pregnant. What does she need to do to avoid pregnancy?
Hi doctor, while having sex with wife. Who should take more precautions. Like husband should wear condom or else wife must take in tablets.
Hi, I had and medical abortion on 21st jun because my baby heartbeat was gone. After that my periods came on 5th Aug next period was on 21st sep and this third one came on 5 Nov. After abortion my cycles are irregular and bleeding is very light this is my third cycle with the same light bleeding problem. What should I do?
According to the principles of sujok onnuri medication and oriental solution concepts, diseases happen in the human body and brain are simply because of the imbalances of the energies acting onthem. Sujok accomplishes cure by bringing on parity and amicability of the forces in the body and psyche, through different outer means.
- Sujok is an astounding system of recuperating that draws out the inward grin of the body. This is the regular condition of well-being that the body is intended to be in. This reaches out to brain, life and soul.
- The Sujok Therapy system utilizes a mix of physical, vitality and powerful or supernatural treatments for recuperating particular organs, zones, meridians, energies and mental and enthusiastic conditions of a man. In Korean, the dialect of the originator Prof. Park, Jae Woo, Su signifies "hand" and Jok signifies 'foot'. Sujok depends on the information that our hands and feet have a legitimate system for curing the sicknesses of the human body.
- There is nothing to ingest, as this is a medication less system. It can be utilized both for treating furthermore for anticipating diseases. Sujok is in this manner a far reaching wellbeing system.
- Hands and feet, arms and legs convey a correspondence to organs in the body and by affecting them, an assortment of physiological, mental and passionate disorders can be dealt with. This treats generally difficult to-achieve zones of the body.
- Sujok depends on antiquated medico-philosophical principles. It utilizes basic and powerful techniques for finding the correspondences well on the way to react to treatment.
- Sujok treatment utilizes an assortment of material like seeds, miniaturized scale magnets, small scale needles, palm or comparative leaves, ring massagers, colors, etc, to animate the correspondence focuses on hands or feet, and now and then arms or legs. This outcomes in change in the infected organ or part of the body.
Characteristic treatment strategies like maintained back rub and touch, pressure point massage and needle therapy, are among the techniques utilized. If you wish to discuss about any specific problem, you can consult a acupuncturist.


text:
USA Swimming Exec Dir Chuck Wielgus Dies Orlando Pride Do Not Sell Out Marta's Debut S.F. Sports Legends Given Street Names Near Candlestick Cubs Fans Buy Up Replica World Series Rings Target Field Named First Gold LEED Certification In U.S. Tim Howard Issues Apology Following Fan Altercation A's To Reveal New Ballpark Site In '17 Bettman Insists NHL Will Not Go To PyeongChang ESPN Events Purchases Miami Beach Bowl Triple-A Isotopes Trying One-Day Rebrand
SBD/9/Sports IndustrialistsPrint All
The Devil Rays promoted TOM FOLEY to Dir of Minor League Operations, SCOTT PROEFROCK to Assistant GM of Administration and BART BRAUN to Assistant GM of Operations (TAMPA TRIBUNE, 1/9)....SITV promoted PAULETTE DOUGLAS from Senior Producer to VP/Program Development and Exec Producer, and KEN PISANI from Producer to Senior Producer (SlTV)....The Susan Komen International LPGA tournament appointed RICHARD FARLEY Tournament Dir and CAROLINE TICE Senior Project Dir (DWA)....Strike Ten Entertainment named MICHAEL ROARTY to its Board of Directors (Strike Ten)....N.Y. Racing Association VP/Communications and Development STEVEN CRIST has resigned (NEWSDAY, 1/9).
Former NHL Kings Owner BRUCE MCNALL will be sentenced today in L.A. for two counts of bank fraud and single counts of conspiracy and wire fraud in connection with a plan to defraud six banks, one securities firm and the Kings of more than $236M (L.A. TIMES, 1/9)....NBC's HANNAH STORM gave birth to 8lb., 10oz. HANNAH ELIZABETH HICKS on Tuesday. The child is the first for Storm and husband DAN HICKS (NBC). ...Magic VP PAT WILLIAMS and his wife have agreed to a divorce that allows their 18 adopted and natural children to live primarily with Pat Williams (ORLANDO SENTINEL, 1/9). ...DENNIS RODMAN will appear with SI model REBECCA ROMIJN on the cover of next month's GQ (N.Y. DAILY NEWS, 1/9)....DON BEAVER, owner of four minor-league baseball teams and a minority interest in the Pirates, is purchasing Rock Barn Golf Course in Conover, N.C. (CHARLOTTE OBSERVER, 1/9).
MSG President & CEO DAVE CHECKETTS, NHL Rangers President NEIL SMITH, Knicks President ERNIE GRUNFELD, Yankees GM BOB WATSON and Mets Exec VP JOE MCILVAINE will speak at the inaugural breakfast for "The Madison Square Garden Sports Breakfast Speaker Series," to be held February 5. The first of six scheduled breakfasts will feature the topic, "Operating a Professional Sports Team in the New York Market." MARV ALBERT will serve as moderator (MSG).


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The ultimate temptation
The ultimate temptation
Creative Director: Cibar Ruiz
Art Director: Caio Grafietti
Copywriter: Marcelo Arbex
Photographer: Ricardo de Vicq/getty images
What is the visual exactly ? Cpold any one tell me.
-Where is the impossible?
i want to know how he ate the icecream with his hand strapped into the chiar ;)
Actually I have another theory. This person was being tortured for vital information which he gave up after being presented with ice creme. The line also makes more sense then.
will it make me eat the ice cream? will i end up like that... ?
~~be cool eh!~~
~~this paranoid survived!~~
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text:
Reporting in the journal Nature Geoscience, scientists from British Antarctic Survey (BAS) and University of Durham describe how a new 3-d map created from radar measurements reveals features in the landscape beneath a vast river of ice, ten times wider than the Rhine*, in the West Antarctic Ice Sheet.
During 2007, two researchers spent months living and working on the Rutford Ice Stream in temperatures that dropped as low as -30°C. The ice stream moves towards Antarctica's coast by one metre every day. The science team towed radar equipment back and forth across the ice measuring its thickness, and building up a picture of the landscape beneath. A lubricating mixture of sediment and water beneath the ice assists as it flows towards the ocean, and is sculpted into a series of massive ridges the size of tower blocks and separated by deep furrows. These features ultimately control the flow of the ice stream.
Lead author British Antarctic Survey glaciologist Edward King says,
"It was really exciting to see this beautiful image of the landscape two kilometers below our feet emerge from the data. We are now sure that these amazing sediment formations are created by fast-flowing ice and we are much better placed to understand how ice streams behave and how they might change in the future."
Co-author Dr Chris Stokes from University of Durham has studied similar features in parts of northern Canada which were covered by glaciers 9000 years ago. He says,
"It's interesting to note that the features we see in Canada are the same as those under the Rutford Ice Stream. Until now we could only guess how they were formed. The next step will be to look closer at these features in Canada to see what happened as the glaciers disappeared."
British Antarctic Survey scientists have measured the movement and behaviour of the Rutford Ice Stream for the last 25 years. Technological developments in the past 13 years, including satellites, seismic studies and radar, has led to a much greater understanding of what lies beneath Antarctica's vast ice sheet. There is still much to learn, but the techniques developed for the study will greatly improve scientists' capability to measure how the ice sheet may change in the future.
*The Rutford Ice Stream is also the size of Chesapeake Bay, in the USIssued by the British Antarctic Survey Press Office
Linda Capper, Tel: ++44 (0) 1223 221448; mobile: 07714 233744 email: email@example.com
Authors: Dr Edward King, Tel: ++44 (0) 1223 221580; mobile: 07900 910200 email: email@example.com
Notes for Editors:
Stunning broadcast-quality footage and stills of Antarctica, as well as location maps are available from the BAS Press Office as above. Formation of mega-scale glacial lineations observed beneath a West Antarctic ice stream by E. C. King, R.C. Hindmarsh and C.R. Stokes is published online this week in the journal Nature Geoscience.
King and a field assistant spent two months in the 'deep field' over 1,000 kms from the nearby BAS Rothera Research Station. They lived under canvas and worked in temperatures often as low at -30°C. Weather permitting they drove their snowmobiles, fitted with radar equipment, 18 kms up the ice stream – doing this 35 times at 500 metre intervals – clocking up over 1200 kms in total.
WAIS contains 13% of all the ice on the Antarctic continent. Studying the flow of ice in Antarctica is important to understanding if the ice sheet is in balance. This means that the rate of snowfall (ice accumulated) equals the amount of ice discharged into the sea through glaciers and then ice bergs. The WAIS is not currently in balance.
Ice streams – are like gigantic rivers of ice. They can be as much as a few hundred km long, tens of km wide, and they typically move by a metre or more every day. Almost all of the ice from the interior of the Antarctic Ice Sheet is drained towards the sea through these ice streams. As the ice enters the ocean, it forms large floating ice shelves. The ice streams can be considered to form the link between the ocean and the more slowly moving ice in the interior of the Antarctic continent. Understanding what controls the flow of ice streams is considered to be of key importance for predicting the future behaviour of the Antarctic ice sheet.
A glacier – is a 'river of ice' that is fed by the accumulation of snow. Glaciers drain ice from the mountains to lower levels, where the ice either melts, breaks away into the sea as icebergs, or feeds into an ice shelf.
Ice sheet – is the huge mass of ice, up to 4 km thick, that covers Antarctica's bedrock. It flows from the centre of the continent towards the coast where it feeds ice shelves.
Ice shelf – is the floating extension of the grounded ice sheet. It is composed of freshwater ice that originally fell as snow, either in situ or inland and brought to the ice shelf by glaciers. As they are already floating, any disintegration will have no impact on sea level. Sea level will rise only if the ice held back by the ice shelf flows more quickly onto the sea.
The Cambridge-based British Antarctic Survey (BAS) is a world leader in research into global environmental issues. With an annual budget of around £45 million, five Antarctic Research Stations, two Royal Research Ships and five aircraft, BAS undertakes an interdisciplinary research programme and plays an active and influential role in Antarctic affairs. BAS has joint research projects with over 40 UK universities and has more than 120 national and international collaborations. It is a component of the Natural Environment Research Council.
Athena Dinar | EurekAlert!
Further information:
Further reports about: > Antarctic Predators > Antarctic continent > Antarctic ice > BAS > Chesapeake Bay > Geoscience > Nature Geoscience > Nature Immunology > accumulation of snow > crystalline > ice sheet > ice stream > rate of snowfall
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More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru
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27Re: [soaplite] on_fault
Expand Messages
- Feb 13, 2001Hi, Ray!
--- Ray Rizzuto <ray.rizzuto@...> wrote:
> I'd like to be able to handle all errors from a soap call,Here is the reason. faultstring() and other methods are readonly. You
> including
> transport errors, after the call completes. I've set the following
> fault handler, which almost works except that the faultstring isn't
> available after the call to the method:
> sub fault
> {
> my($soap, $res) = @_;
> if (defined $res && ref $res)
> {
> print $res->faultstring;
> return $res;
> }
> else
> {
> print $soap->transport->status;
> $res = new SOAP::SOM;
> $res->faultstring("transport error");
may get access to message structure, but you cannot update/modify it.
Next version probably will generate warning/error if you try to
provide parameter(s) for these methods.
> I'm very new to this, so I may be making an obvious mistake.You may check Error Handling section on http://guide.soaplite.com/. I
prefer 2.k example and in any case you always have access to result
of the call through call() method:
print $soap->mymethod(123)->result;
print $soap->call->faultstring;
Even if call made with autodispatch:
use SOAP::Lite +autodispatch => ...;
print mymethod(123);
print SOAP::Lite->self->call->faultstring;
Best wishes, Paul.
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text: Blake Roller Blake Roller Atlanta Im your favorite local Dustep, DNB DJ based out of Atlanta, Ga. Been doing for a few months locally. If you like what you here please let me know! Im hoping to soon be at your neighborhood rave spot! Comments by Blake Roller Comment by Blake Roller Been a fan of yours for quite some time. your stuff is sick man. Keep it up! and Please come to the ATL! 2011/09/12 23:42:55 +0000 Comment by Blake Roller yo keep it up man and we will be side by side at the next big party keeping things hype! 2011/07/26 20:51:26 +0000


text:
Sponsors: Bureau of Justice Assistance (BJA) National Training and Technical Assistance Center (NTTAC)
Through this initiative, the Center will provide targeted information to governors' criminal justice policy advisers on emerging best practices for paroling authorities; roles and responsibilities of paroling authority members—and the implications for qualifications to consider in making appointments; opportunities for paroling authorities as key stakeholders in carrying out governors' public safety and criminal justice system improvement efforts; and strategies that can be employed by governors in exercising their appointing and leadership authority in order to strengthen parole board practices. These objectives will be accomplished through the efforts of a partnership between the Center and the National Governors Association Center for Best Practices (NGA Center). The project will design and deliver a Virtual Convening: "Paroling Authorities as Key Partners in Achieving Governors Criminal Justice Policy Goals," a half-day event focused on the topic of the critical role played by paroling authorities to accomplishing governors' policy goals for public safety and the wise use of public resources; will plan and conduct a strategic planning summit to provide an opportunity for more intensive review of evidence-based parole practices for a limited number of state teams who will come together and receive assistance to develop recommendations for improving policy and practice; and will conduct in-state workshops in four of the states that have participated in the "strategic planning summit" to help teams develop a plan for implementing recommendations identified at the summit.


text:
Specialty Food
- Pickles, Peppers and Olives
- Gourmet Peppers
- Green Chilies
- Diced Mild Green Chili
- Last products viewed
Diced Mild Green Chili Product ID: NF104117 La Victoria
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- "This order arrived in good time and it was just what I needed. Thank you for your good service.
Diced Mild Green Chili
Product Id: NF104117
Sold as: Case of 24Weight: 8.4 lbs
List Price: $59.54Savings: $14.79
DescriptionLa VictoriaMfg#: 04620
True fire-roasting over an open flame brings out the taste. Great for nachos, dips, or any Mexican dish. To assure the full flavor Chiles no water is added. Blackened skins occur as a natural part of fire-roasting.
La Victoria Mild Diced Green Chili, 4 Ounce -- 24 per case.
Shlef Life: 730 days
4 Ounce
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text:
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Air-only access to former leper colony of Kalaupapa — for now
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text:
Around the World in 80 Words (11-18) Northern Ireland
Written by
Illustrated by
Lovereading4kids Price £12.79
£15.99 saving £3.20 (20%)
when in stock
As soon as this book is back in stock we will send you an email.Compare book price We'd love you to buy your books from Lovereading - especially if we helped you to choose them! But as our mantra is guidance, and that includes guidance on price, please do use our 'Compare Book Price' service to discover if the best value deal is from Lovereading or another specialist bookstore.
Around the World in 80 Words (11-18) Northern Ireland by
About the Author
Other Formats
Book Info
300 pages
Young Writers an imprint of Bonacia Ltd
Publication date
31st May 2013
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It's a community united by a passion for books and promoting the best there is in children's literature.Sam Bateman and family


text:
from $149 / night help Price for guests, Nights approx:
- Bedrooms:
- 1
- Bathrooms:
- 1
- Sleeps:
- 4
- Type:
- Condo
- Pets allowed:
- No
- Wi-Fi available:
- Yes
- Per night:
- $149 - $199
- Per week:
- $1043 - $1393
Description from owner
ALOHA, Enjoy Maui and Wake up to a great ocean view! You will have a memorable vacation in Maui at our condo at Papakea. Welcome to Paradise.
Everything you need for your vacation in our Beautiful Ocean View Condo's at Papakea Resort.
We have a Deluxe Ocean View One Bedroom Suite available at Papakea Resort on Maui.
Our One Bedroom ocean view condo is located on the 2nd floor, premium corner unit of Papakea Resort, very bright and airy. Enjoy the great view of the ocean, putting green, swimming pool and ponds from the second floor. Additional large side window, light and airy with a view of bamboo trees and tropical foliage. Have a meal on the Lanai with table 4 chairs and lounge chair. KING SIZE BED.
We also have an Oceanview Studio Suite available. Call or email for information.
NEW KITCHEN and bath in our One Bedroom condo with beautiful Cherry cabinets and Malibu gold GRANITE, complete with new Stainless Steel appliances, blender and more. You will love our new look and enjoy the dream kitchen.
New 40" Samsung Flat Screen TV. New Lanai Doors, glide open.
The 1 bedroom condo sleeps 2 to 4 people, with a Beautyrest KING SIZE bed. Our Condo is very comfortable with island decor and has many updates. Fully equipped with everything that you will need for your Hawaii vacation,including coffee filters, hair dryer, iron and full size ironing board, putters, boogie boards, beach chairs and more. Email or call for Specials!
Papakea is a beautifully landscaped, tropical resort on 13 oceanfront acres on Kaanapali Beach.
low rise, four story complex
2 swimming pools
12 poolside barbecues
2 Jacuzzi hot tub spa's, 2 shuffleboard courts, 2 lighted tennis courts,2 putting greens and many more extras.
The Rooms have a wonderful view of the ocean as well as Koi ponds, gardens, putting green and pool.
Activity Desk and Concierge to take care of your every need
Some AMENITIES:
* Wireless internet access from condo
* parking right by the condo
* Tennis courts
* Putting greens, Sunday Putting tournament with prizes
* Island orientation with continental breakfast
* Swimmercize water aerobics, yoga, New: Tai Chi
* Weber Gas Barbeques
* Weekly Mai Tai party with munchies
Amenities Included with Resort/facilities fee which is payable to Papakea at $17 a night for first 10 days of your stay.
Enjoy ROMANTIC SUNSETS and views of neighboring islands of Molokai and Lanai.
WHALE WATCHING from the property in season (Dec. to April).
Beautiful tropical gardens and ocean front.
Great swimming and snorkeling can be found right out in front of your condominium.
Walk along the ocean several miles down Kaanapali beach to the Sheraton Black Rock and beyond.
Condominium Furnishings:
* Private lanai: patio table, 4 chairs, lounge chair, great views of the ocean and gardens.
* Living area: Nicely decorated in neutral colors.
* Tropical sofa with 6 inch queen sofa bed mattress.
* Color satellite Flat Screen television so you can watch your favorite show or sports event. VCR, DVD, Telephone
* Ceiling fans in Living room and Bedroom. AIR CONDITIONING
* Full Bath
* Kitchen/dining: Fully equipped with dishwasher, disposal, blender, toaster, coffee maker, including filters, dishes, utensils, microwave, oven range and more.
* Dining table with four chairs.
* One Bedroom: Simmons Beautyrest King-size plush bed in the bedroom.
Studio Suite: Simmons Beautyrest plush Queen size bed.
* Linen's, starter supplies, washer and dryer.
* Putters in the room to use on Putting Greens.
Keywords: Condominium, Oceanview, oceanfront, One Bedroom, Studio, Maui condo, Maui Resort, whale watching, luxury condo, discount rates, golf
condo, Maui
Beds: 1 King Bed, 1 Sofa Bed
About the area
Owner profile
Susan And Robert W.
- Years listed:
- 1
Languages spoken: English
- Air conditioning
- Balcony/Terrace
- High Speed Internet
- Hot tub/Jacuzzi
- Linen provided
- Parking Included
- Sea view
- Waterfront
- Wheelchair users
- Ceiling Fans
- Clothes dryer
- Dishwasher
- DVD player
- Hair dryer
- Iron
- CD player
- Refrigerator
- Satellite TV
- Microwave
- Stove
- Telephone
- Toaster
- Video player
- Washing machine
- Cycling Trips
- Fishing
- Water sports
- Horse riding
Reviews for this vacation home rental in Ka'anapali, United States Have you been a guest of this property? Write a review Reviews
Help other travelers decide where to stay
This holiday home hasn't got any reviews yet. The average rating on Vacation Home Rentals is four out of five. This place could be newly added or perhaps it's a well kept secret. Either way, it's time to reveal all.
Owner Supplied Testimonials
From John and Angie
Thanks for sharing your condo with us again. We have been visiting Papakea for 25 years. We had another wonderful visit and enjoyed all of the comforts afforded by your unit. We aren't tourists so we spend a lot of time in the unit, on the lanai and enjoying the beautiful property. We love the stroll down the boardwalk to Black Rock. Love to barbeque at Airport Beach Park (Kahekili) and watch the sunset. We make several trips across the street to Okazuya. Our favorite places to catch the sunset along with some cold beverages are Hula Grill, Leilani's and Duke's. Already have our trip planned for next year! ALOHA! MAHALO Bob and Sue!
From Ryan, Jenny and Ethan:
Hello Sue and Bob, We are back at home after a wonderful stay at your place. Thanks so much for the late check out yesterday. It made a huge difference in our day and made our trip home a lot more smooth! Your place is great and it was so nice that it was so well stocked with beach stuff and kitchen stuff. Our friends stayed at another unit and their place was very sparse and they were constantly jealous of how nice yours was!!! LOTS of whales and the weather was reasonably good. Thank you so much. We wouldn't hesitate to book through you again or refer you on to friends and family.
Phil and Rachael:
Thank you so much for the opportunity to rent your great room. We got back home today and everything worked out great. Maui is great. The room was great. Also, we bought a couple more goggles and snorkel tubes and left them in the room. Thanks again and we hope to come back again some day. Phil and Rachel.
PB said:
We had a wonderful vacation based out of your condo at Papakea. We enjoyed the snorkeling right off shore and playing in the turquoise blue ocean. We went up Haleakala for the sunrise and then hiked down to the cinder cones inside the crater. We spent another day driving to Hana and Oheo Gulch. We spent another day snorkeling in Molokini. We loved the beaches near the resort (Kaanapali, Kapalua, Napilli, DT Fleming, etc.) The sunsets were spectacular - we loved to get our drinks out to the BBQ area and enjoy the beautiful views while cooking dinner. The kids enjoyed the putting green. The location is very convenient - there were lots of places nearby to rent snorkeling gear, buy grocery, get gas, take-out food, coffee, etc. Papakea does not have fancy lava rock pools like the Sheraton but it is cozy for perfect family vacation. Thanks for a wonderful vacation.
Tim and Donna said:
Thank you so much Bob and Sue for the use of your condo. We had an awesome stay there and loved every minute of being in Maui. We went to some excellent beaches around the island and our favorites were Black Rock by the Sheraton and Kamaole in Kihei. We loved seeing the whales from the beach and we also did a whale watching tour that was awesome. Being able to also see dolphins was the icing on the cake. Most of our meals were made in the condo, but we did eat out a few times. Our favorite places was the Sea House and Bubba Gumps. The best drives we did was doing the Hana highway and the drive around the North shore all the way to Iao Needle. It was very beautiful. If you have never been to Hawaii, doing this drive is what a person pictures Hawaii to look like. Driving the north shore should be done clockwise as you would be on the inside of the road. Can be a bit narrow at times. Thankyou so much Bob and Sue for extending our stay by one day due to change of flights made by Air Canada. That was really appreciated. We look forward to coming back again one day. This is a very relaxing island. A little piece of Heaven on earth.
Studio Suite from Tom Z
Thank you to Bob and Sue For allowing us to rent their studio condo at Papakea resort. This studio unit C-304 has a great ocean view. From the lanai we were able to view the whales passing by in the ocean, the adjacent island of Molokai, the swimming pool, hot tub, Koi pong and golf green. At night the resort was peaceful and quite. During the day there was plenty of room to use the beach loungers by the sea wall and could enjoy the ocean and the sights whenever we wanted. We observed many whales both from by the sea wall as well as from the lanai. Being able to cook our own meals in the condo and using the like new BBQs was convenient and helped with the budget. Both Bob and Sue were wonderful to deal with both before and during our stay. The condo is ideally located, easy access to the highway, Lahaina and shopping. We had a wonderful time on Maui and credit the condo and owners for contributing to this. While at Papakea resort, we took advantage of the resort and after 44 years we renewed our wedding vows beside the Koi pond. Great owners, great studio condo. We will be recommending this condo to friends and relatives. Thank you again Bob and Sue
Studio Suite from Jennifer T
What a wonderful experience! The studio condo was perfect for our girls only week long getaway! The condo was cozy and provided everything we needed! The fountain directly below the lanai provided soothing sounds as we slept with the sliding door open every night (even when the Cane Toads were calling for mates!) Bob and Sue were wonderful to work with - prompt and informative with their responses. The resort is peaceful and quiet in the evenings and the front desk staff and concierge are extremely pleasant and helpful! Thanks for a wonderful stay....we look forward to a return trip sometime next year!!!!
Hi, Sue and Bob
Thank you so much for letting us stay in your Papakea condo! We had a great vacation, and the Papakea remains one of our top places to stay in Kanaapali. Out of curiosity, my husband and I toured a bunch of other condos in other resorts while we were there, and we both agree Papakea remains our favorite for authentic Hawaiian accommodation. The water features, tiki torches, pool cabana and grounds make for an amazing backdrop when sitting on the lanai.
I was so pleased for how well stocked your condo was. Every time I went looking for a kitchen tool, I found it. Loved the kitchen renovation! Also loved the fact the bathroom had a little bathtub. Our kids are grown now, so we didn't need to utilize the tub, but it's a great plus for families with little kids. A lot of the renovated units only have showers.
I've already recommended your condo to another friend of mine who is travelling in January with multiple families.
Mahalo! We hope to be back another time!


text:
This place can confidently claim to be the most beautiful of all Wayanad Resorts. It is nestled in the lap of Majestic Chembra Peak, towering 2100 above sea level and is the highest peak in Wayanad. The view of Chembra peak from the rooms is a sight to behold. On the foot hills of Chembra on a cliff which gently slopes to a serpentine mountain stream, surrounded by lush tea estates and coffee and pepper gardens of wayanad, It nestles like a charm which will take you away from all the stresses and worries of a city life. And true to its name, this could be the greenest place you would have ever seen. A place where you could be with yourself or with your loved ones, where you could watch the pranks of monkeys jumping around or the occasional deer which comes to take a dip in the stream the place can confidently claim to be located in the most beautiful location in Wayanad hill station. Located inside a coffee plantation, surrounded by acres of tea estates, the resort in the sylvan and pristine provides you unmatched luxury in most pristine surroundings.
The Tree House is set amidst the coffee plantation facing acres of tea estate and the Chembara Peak. It is 20 feet above the ground. For safety reasons it is built on the pillars.It sways with wind like any other tree house This is designed for the Newly-Weds with complete privacy amidst natural surroundings. It is a wooden structure built in the traditional Kerala Architecture and the bathroom is equipped with the latest jacuzzi model. It has a panoramic view from both inside as well as outside .It opens to Mother Nature and the kind of feeling we get in the tree house should be felt and cannot be put in words. A Romantic Place for Honeymoon and other special occasions like Wedding Anniversary and Birthdays.
Guests are requested to provide valid ID proof at the time of check-in.
Cancellation Policy: No Refunds
Check In: 12:00 pm
Check Out: 11:10 am
Places to visit: Chembra Peak - 20.6 km. Edakkal Cave - 31.4 km. Kuruva Island - 40.5 Banasura Sagar Dam - 24.8 km. Thirunelli Temple - 59.8 km. Pookot Lake - 13.6 km. Meenmutty Falls - 27.1 km.
Calicut International Airport - 86 km.
Kozhikode Railway Station - 74.5 km.
Kalpetta New Bus stand - 3.6 km.
This is a tree house done in the traditional Kerala style located twenty feet above the ground, amidst a coffee plantation that is a treat to look at. The property is equipped with all the modern facilities which include comfortable beds, fine flooring and a Jacuzzi in the b... Read More
we stayed in a treehouse!!!!!! so much fun. love you guesthouser


text:
Her Disney days are well and truly past her! Demi Lovato wears very revealing black ensemble to white carpet premiere of Frozen
She got her start in kids' entertainment.
But apparently Demi Lovato is ready to put those days far, far behind her as she dazzled in a daring outfit at the Frozen premiere on Tuesday night.
While walking the snow-covered 'white carpet' at the El Capitan theater, the X Factor judge showed off her curvy figure with a two-piece outfit featuring an ultra low-cut top.
Scroll below for video
Cool as ice: Former Disney star and X Factor judge Demi Lovato shows off her curves on the 'white carpet' for Frozen at the El Capitan Theatre in Hollywood
Daring dress: Lovato's plunging neckline was a risk for the kid-friendly film premiere
The deep cut of the blouse was a risk for the family-friendly film premiere of the animated feature.
The actress-singer had to be careful with
the cut of the top, as one false move would have revealed more than
Her black two-piece outfit featured a gathered V-neck blouse with a plunging neckline that showed off the 21-year-old's curvacious figure.
In addition to the revealing neckline, the long-sleeve black top featured a ruffle trim along the bottom of the garment.
One false move: Singer and X Factor judge Demi Lovato showed off her cleavage wearing a revealing black top with a plunging neckline and matching black skirt with gold tassels
Blue belle of the ball: Lovato lapped up the attention on the white carpet for the Disney film
Lovato wore the top with a black A-line skirt that hugged her hips and legs, giving her an hourglass figure.
A swatch of black fabric featured gold tassels broke up the monotony of the outfit and made it an unusual 'white carpet' look.
Her chunky black platform shoes were adorned with gold studs so she matched from head-to-toe.
True colors: Lovato's blue hair complimented her flawless olive complexion
Lovato's blue hair was pinned up in a loose updo, giving her a classic beauty look with a punk rock edge.
With her hair pushed away, the actress was able to display her slender neck and flawless olive complexion for the cameras.
Lovato's makeup featured a light smokey eye with red highlights and well-defined eyebrows with larger-than-life lashes.
Her manicure was a mix of gold flecks with black polish to match the outfit.
little hit of rouge brought out the Glee star's cheekbones while a nude
lipstick add a hint of shine without an heavy dramatic look.
Lovato contributed the song Let It Go to the Frozen soundtrack.
In tune: Lovato contributed the song Let It Go to the Frozen soundtrack
Pro status: Lovato has been walking Disney red carpets ever since she was on the show Sonny With A Chance
Chilly: Frozen tells the story of a fearless optimist named Anna who, with the help of a mountain man and a snowman, races to find her sister whose icy powers have trapped their world in eternal winter
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PRE-CERTIFIED! This beautiful and charming character home has extensive updates! Light/bright KIT, FF laundry, ornate wood staircase, stained glass windows, and large master BR with en suite - this house will 'WOW' you! High ceilings, hardwood flooring, & French doors retain integrity, while updated electrical, new windows, doors, furnace, water heater, and much more per seller makes it feel new!
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Continuous Renal Replacement Therapy
Gregory M. Susla, Pharm.D., F.C.C.M. Associate Director, Medical Information MedImmune, Inc. Gaithersburg, MD 1
Definition of Terms SCUF - Slow Continuous Ultrafiltration
CAVH - Continuous Arteriovenous Hemofiltration CAVH-D - Continuous Arteriovenous Hemofiltration with Dialysis CVVH - Continuous Venovenous Hemofiltration CVVH-D - Continuous Venovenous Hemofiltration with Dialysis 2
Indications for Continuous Renal Replacement Therapy
Remove excess fluid because of fluid overload Clinical need to administer fluid to someone who is oliguric Nutrition solution Antibiotics Vasoactive substances Blood products Other parenteral medications 5
Advantages of Continuous Renal Replacement Therapy
Hemodynamic stability Avoid hypotension complicating hemodialysis Avoid swings in intravascular volume Easy to regulate fluid volume Volume removal is continuous Adjust fluid removal rate on an hourly basis Customize replacement solutions Lack of need of specialized support staff 6
Disadvantages of Continuous Renal Replacement Therapy
Lack of rapid fluid and solute removal GFR equivalent of ml/min Limited role in overdose setting Filter clotting Take down the entire system 7
Basic Principles Blood passes down one side of a highly permeable membrane Water and solute pass across the membrane Solutes up to 20,000 daltons Drugs & electrolytes Infuse replacement solution with physiologic concentrations of electrolytes 3
Anatomy of a Hemofilter
blood in Cross Section dialysate out hollow fiber membrane Outside the Fiber (effluent) Inside the Fiber (blood) dialysate in blood out
Basic Principles Dialysis Hemofiltration
Convection based on a pressure gradient 'Transmembrane pressure gradient' Difference between plasma oncotic pressure and hydrostatic pressure Dialysis Diffusion based on a concentration gradient 4
CVVH Continuous Veno-Venous Hemofiltration
Blood In to waste (from patient) Repl. Solution Blood Out Note that this schematic indicates the addition of a REPLACEMENT FLUID. The replacement fluid-usually composed of approximate normal plasma values- enters the blood flow path as it circulates through the hemofilter. This not only has a dilutional effect on the blood but enables us to remove large volumes of water into the waste without dehydrating the patient or causing other hemodynamic shifts. Using the principles we discussed, pressures in the system can be adjusted to regulate ultrafiltrate volume. How much clearance of small/midsize molecules will be influenced both by the composition of the replacement fluid, and the amount of fluid we "replace" or force to cross the membrane into the waste collection. Note that replacement fluids may be administered pre or post filter. We will discuss these choices in a few moments. (to patient) (Convection) LOW PRESS HIGH PRESS
CVVH Continuous VV Hemofiltration
Primary therapeutic goal: Convective solute removal Management of intravascular volume Blood Flow rate = ml/min UF rate ranges L/24 h (> 500 ml/h) Requires replacement solution to drive convection No dialysate CVVH - Continuous veno-venous hemofiltration aims for maximizing convective removal of small and middle molecules. Replacement solutions are used to drive this convective transportation. This therapy can use liters of fluid in a 24 hour period to achieve the desired clearance of solutes.
CVVH Performance Continuous venovenous hemofiltration
"In vitro" ultrafiltration with blood (post-dilution) (values ± 15%) (Bovine blood at 37 C, Hct 32%, Cp 60g/l)
CVVHDF Continuous Veno-Venous Hemodiafiltration
to waste Blood In (from patient) Dialysate Solution Repl. Solution Blood Out Describe flow paths on slide. Note: Point out again that … Replacement fluids may be administered either pre or post filter. We will discuss these options later in the program. (to patient) (Convection) LOW PRESS HIGH PRESS (Diffusion) LOW CONC HIGH CONC
CVVHDF Continuous VV Hemodiafiltration
Primary therapeutic goal: Solute removal by diffusion and convection Management of intravascular volume Blood Flow rate = ml/min Combines CVVH and CVVHD therapies UF rate ranges L/24h (> 500 ml/h) Dialysate Flow rate = ml/min (~1 - 3 L/h) Uses both dialysate (1 L/h) and replacement fluid (500 ml/h) The next therapy for discussion is CVVHD - continuous veno-venous hemodialysis. This therapy uses a dialysate on the fluid side of the filter to increase solute exchange by diffusion. Replacement fluid is not administered with this therapy. UF rates are lower than with CVVH therapy. Dialysate is infused at ml/min (1-3 L/ hour). The blood flow rate is maintained between ml/min. This compares to intermittent HD that uses typical blood flow rates of ml/min and dialysate flow rates of ml/min. Unlike intermittent HD it is the dialysate flow rate rather than the blood flow rate that will determine clearances. The advantage of continuous therapies is that the 24 hour exposure to "renal replacement" makes up for the system efficiencies of the lower flows.
Pharmacokinetics of Continuous Renal Replacement Therapy
Basic Principles Extracorporeal clearance (ClEC) is usually considered clinically significant only if its contribution to total body clearance exceeds % FrEC = ClEC / ClEC + ClR + ClNR Not relevant for drugs with high non-renal clearance Only drug not bound to plasma proteins can be removed by extracorporeal procedures 10
Determinants of Drug Removal by CRRT
Drug Same as hemodialysis but increased MW range Membrane Permeability Sieving Coefficient Renal replacement Convection + diffusion Cl technique Flow rates Blood, Dialysate, UF Duration of CRRT 11
Sieving Coefficient (S)
The capacity of a drug to pass through the hemofilter membrane S = Cuf / Cp Cuf = drug concentration in the ultrafiltrate Cp = drug concentration in the plasma S = 1 Solute freely passes through the filter S = 0 Solute does not pass through the filter CLHF = Qf x S 12
Determinants of Sieving Coefficient
Protein binding Only unbound drug passes through the filter Protein binding changes in critical illness Drug membrane interactions Not clinically relevant Adsorption of proteins and blood products onto filter Related to filter age Decreased efficiency of filter 13
Relationship Between Free Fraction (fu) and Sieving Coefficient (SC)
Dialysate Saturation (Sd)
Countercurrent dialysate flow ( ml/min) is always less than blood flow ( ml/min) Allows complete equilibrium between blood serum and dialysate Dialysate leaving filter will be 100% saturated with easily diffusible solutes Diffusive clearance will equal dialysate flow 14
Dialysate Saturation (Sd)
Sd = Cd / Cp Cd = drug concentration in the dialysate Cp = drug concentration in the plasma Decreasing dialysate saturation Increasing molecular weight Decreases speed of diffusion Increasing dialysate flow rate Decreases time available for diffusion ClHD = Qd x Sd 15
CVVHDF Clearance Continuous venovenous hemofiltration - post dilution
QB = 150 ml/min - QD = 2000 ml/h (in vitro saline)
Extracorporeal Clearance
Hemofiltration clearance (ClHF = Qf x S) Qf = Ultrafiltration rate S = Seiving coefficient Hemodialysis clearance (ClHD = Qd x Sd) Qd = Dialysate flow rate Sd = Dialysate saturation Hemodialfiltration clearance ClHDF = (Qf x S) + (Qd x Sd) 16
Case History AP 36yo HM s/p BMT for aplastic anemia
Admitted to ICU for management of acute renal failure CVVH-D initiated for management of uremia ICU course complicated by pulmonary failure failure requiring mechanical ventilation, liver failure secondary to GVHD and VOD, and sepsis 18
Case History Antibiotic Management on CRRT
Gentamicin 180 mg IV q24h Vancomycin 1 g IV q24h Dialysis rate 1000 ml/hour 12 hour post gentamicin levels: mg/L 12 hour post vancomycin levels: mg/L Dialysis rate increased to 1200 ml/hour 12 hour post gentamicin levels: < 0.4 mg/L 12 hour post vancomycin levels: < 4 mg/L 19
Dosage Adjustments in CRRT
Will the drug be removed? Pharmacokinetic parameters Protein binding < % Normal values may not apply to critically ill patients Volume of distribution < 1 L/kg Renal clearance > 35% How often do I dose the drug? Hemofiltration: 'GFR' ml/min Hemofiltration with dialysis: 'GFR' ml/min 28
Drug Removal During CRRT
Recommendations not listed in PDR Limited to case reports or series of patients Different filter brands, sizes, flow rates Limited information in many reports Rarely report % of dose removed Many journals will not publish case reports Artificial models and predictions have no clinical value 27
Dosage Adjustments in CRRT
Loading doses Do not need to be adjusted Loading dose depends solely on volume of distribution Maintenance doses Standard reference tables Base on measured loses Calculate maintenance dose multiplication factor (MDMF) 29
Dosage Adjustments in CRRT
Frequent blood level determinations Aminoglycosides, vancomycin Reference tables Bennett's tables or the PDR recommendations require an approximation of patient's GFR The CVVH 'GFR' is approximated by the ultrafiltrate rate (UFR), plus any residual renal clearance Using Bennett's or the PDR's tables, in most CVVH patients, drug dosing can be adjusted for a 'GFR' in the range of 10 to 50 ml/min
Supplemental Dose Based on Measured Plasma Level
Adjusted Dose Based on Clearance Estimates
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Alec and Magnus couple of days after THE kiss:
He was never a man of words. He was never good at it, and it never bothered him before. When he needed something, he worked hard to get it. He truly believed that the world would be off much better if people would stop using so much words that only complicate things, that are creating good-for-nothing -theoretical worlds, which only hurt the actual world they all are living in. Their world have written rules, Accords, they had a very specific law about anything, so why to try and ruin the balance by using unnecessary words and useless feelings?
He was a hunter. He was born with a purpose, with an aim, and he was happy about this little fact. Wake up in the morning knowing that that day would be the same as the previous one, made him in peace. Having a checklist of the things he had to do and those to never do, made his life in order. Kept him out of trouble, as much as his profession let him. As long as everyone followed the law and did what they were supposed to, without trying to ignore their responsibility with stupid conversation which lead them to nowhere, they all could live in a perfect harmonic world.
As much as he loved the balanced life with others, he was fond with closed circles. The people he knew were more than enough for him. He needed no new friends, no other new factors in an acquisition that worked perfectly well without them. He needed no distractions and hated when people didn't let go. He was just fine surrounded only by his family. He needed no one.
Oh, he was so sure that he had his whole life figured together at a such young age. Growing up in a family of six, when all of them are mighty shadow-hunters, known to all and respected by all, he knew that he had to be the same. Marrying a woman who would bore him children, taking over the Institute when the right time would come and tutore the next generation to follow the rules he loved so much. Everything was settled in his mind, decided till the last most insignificant detail. He had the perfect life plan.
However, despite all of his plans, little by little his world started to shatter, and he couldn't blame anyone but himself. His first mistake was to accept Jace - His brother, his best friend - to bring a stranger into their home, give them a place inside of their world. Clary was a know-it-all little girl, so nosey and such a troublemaker. She came into the Institute and ruined the harmonic life they lead.
Jace was gone and only the Lord could possibly know what he was thinking when he decided to join Valentine all of a sudden and without any fight. His beloved younger sister was under attack for befriending Downworlders and there was a massive trial going on against her even though they had nothing real against her. Magnus got into their life, and he himself, who, by all means ruined every single plan he had with his own bare hands.
There was so much going on lately, so much that made him question everything he ever stood for. He found himself admitting his true self to himself in front of everybody else, after years of self battling and denying his own feelings, only because they didn't fit his little plan. Magnus, that man, came into his life and turned it upside-down in no time. He didn't even had to say or do much, his only existence was enough for a mighty hunter like himself to lose it.
Putting a mirror in front of him, Magnus made him recognize his own feelings. First there was scare, that sent shivers down his spine by the mere thought of him ignoring the plan and doing what he'd like. Then, there were confusion and conflict of not wanting to give up on either of the world's, belong both - where is his heart and where are the expectation from him. At the end he had to accept his whole self, learn to love himself.
Was it bad? No, not at all. On the contrary. For the first time in forever he went up and did what he truly wanted for his own happiness - not for their world, not for the cause, but for only himself. However, as he knew too well, theory and practice were totally different. Numerous questions bugged him and made him restless.
What know? What if this kind of relationship does nothing but hurting Magnus? What if Camille was right and he'd cease be good enough for Magnus? He couldn't think clearly, thousandths of thoughts playing n hs mind. Since the kiss he tried to meet the warlock the less he could, to think, so he occupied his days by work and training - nothing more. Not that it helped him too much.
"I thought I'd find you here".
He heard Magnus' voice paying softly behind him, when the warlock sneaked into his hiding place - a small field, not too far from the Institute. Not surprised at all that he found him, Alec put down his bow and turned to meet his eyes. The older man was smiling, not his usual flirting smile, but mild one, almost broken. Alec wanted to say something, assuming the expression was his fault, but decided not to at the moment.
"I thought to come and see how's the thinking is working out. Can I stay?" Magnus asked so not like him - hesitating. He could do nothing but nod and the warlock made himself comfortable on the ground. "I," He said, his hands looking for a dash of grass to play with, "thought of something myself, I'd like to share with you".
"Yes, of course" Alec said confused. He wasn't sure what to do; sit down beside the other man? Keep on standing like a fool? Get back to his training while the other is talking? At least he decided on keep on standing like a fool. It suited him the most anyway, and Magnus didn't seem to care much at the moment, which was unusual as well as the older always were looking for a chance to be close.
"You know, your mother is right - and I usually try not to agree with her. I am a warlock, a half demon, I'm up to no good, a Downworlder. I really would get why you'd regret all of what had happen, right now. Sure, at first it was all exciting and new, you wanted to explore, I get it. But now, that it became real, you don't know what to do with it. You don't understand what you got yourself into. So, I thought about it a lot, about how to make it easy for you… I…. You can end it anytime you want, it's up only to you. Do whatever you - Alec - want to do. I'd be completely fine with anything you'd decide to do. If anything, we are friends, right? I want you, as your friend, to live the life that would make you a whole person and not just a mere shadow of wonders and 'what if's. You deserve it." Magnus said rapidly, barely breathing between sentences. "I just want to you to know that I expect nothing, you are free to decide on your own."
"Who are you and where did the confident, cocky, warlock I know have gone?" Alec muttered, looking down on Magnus, who seemed at the moment like a little kid being scolded. "As an old wise man, you really came up just now with the stupidest thing I've ever heard." He laughed shortly, somewhat bitterly, "My mother was right? You mean the woman who was part of the circle and didn't left Valentine till the very end? You mean a shadowhunter who was too scared to stand up against a massive killer? How is that you are the one who is up to no good, while all you did was good? You're using our skills to help others, taking risks that many hunters know won't ever make."
"You know it is not what I meant…"
"Then what? The fact that you're a downworlder? Please… it never bothered you before, why now? No, no, don't give me that look." Alec put his finger between the sitting man's eyebrows and flatted the frown, "It doesn't bother the people who matter to me, so why does it have to bother us?"
"Alexander, you-"
"Let me ask you a question, do I look like someone who does experiments like that? Trying new things, and moreover, in front of everyone I know? I know what I want. I regret nothing. I just don't know what to do with us now. I never have been… you know…"
"With a man?" Joked Magnus, the color is slowly returning back to his face.
"No." Alec blushed madly, "That too… but that's not what I meant… I never have been in any kind of relationship. And I'm afraid that Camille was right the other day… I don't want my ignorance to hurt you more than I already have". He said honestly and took Magnus' hand, helping him up. "I would never regret this. It felt just too good to let go of it just now".
"So… You didn't want to end things?"
"Do I need to spell it out for you?"
"I think I'd understand it more accurately with demonstration" Magnus teased, there was left nothing in his voice that indicated the insecurity he was showing just a few moment earlier. Closing his eyes, he waited for Alec to get the hint. However, that kissed he waited for never came, but instead Alec grabbed his arm and lead him silently to where he had dropped his bow earlier.
"I'm not good with expressing myself… so I think that you are right, the best way is to demonstrate it to you." Alec said and got a doubt confused doubt grumpy look from the shorter man. "When you returned me my bow and arrows, you asked me to keep them for you. And that night before the wedding…" He said and Magnus cocked up an eyebrow as if asking him to proceed, "You asked me to teach you how to use it. Let me teach you. These," He pointed to the equipment laying on the ground, "Are my arms and legs, they are part of who I am… I want to let you in." He said shorty and then something in his eyes flicked. "Stand here. Legs spread shoulder-wide."
"Weirdly I like the tone of that…"
"Weirdly to whom?" Alec winked and right after reddish color adorned his face, "Now," He cleared his throat and picked up the bow, "hold this…" He lead Magnus' arms to hold the bow properly, "You need to relax to make it work." Alec said as he place an arrow on the string and put his hand on Magnus'. "Just breath…"
Standing close behind him, Alec could feel magnus' chest going up and down slowly, following his orders. He was beautiful. Everything about him was completely mesmerizing; the way he held himself, the way he was talking… He loved his face, he thought as he learned the other man's profile, and he had the most interesting eyes that he had ever seen. Eyes that told a story that Alec wanted to be part of.
Distracted from what they were doing, Alec turned surprised Magnus to face him. His hands reaching to hold his face. There was so much more to what they had but to finding himself, he thought as he leaned his head down a little until his breath could stroke the older's lips. They were so close that it hurt. The lessons could wait a little, Alec decided, getting lost in the other man's eyes. In no time his lips found Magnus', meeting in a hot rush of adrenaline, leaving bot restless and waiting for more. That was what he wanted for himself, that kind of happiness. And right at that moment no one could take it away from them.
The oneshot is written by me @naomibisthenextme
The GIF is not mine.