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Home › Forums › Gear Forums › Gear (General) › Micro Puff Jacket vs.U.L.Thermawrap Parka
Nov 7, 2005 at 4:10 am #1217091
mal smordinMember
which jacket is warmer?Nov 7, 2005 at 8:09 am #1344520
Richard NisleyBPL Member
@richard295Locale: San Francisco Bay Area
The Thermawrap parka uses 80g/m2 (2.6 oz/yd2) polyester filament insulation and the Micro Puff uses 2.6 oz/yd2 polyester filament insulation. They should be about equal in warmth with .6″ of loft.Nov 7, 2005 at 9:12 am #1344526
The Micropuff in the field is quite the warmer of the 2 jackets. I've used both and own the micropuff.
A BPL field test of lightweight synthetic insulated jackets came to the same conclusions. Not all synthetic insulation is created equal.
See (if a premium member)—
http://www.backpackinglight.com/cgi-bin/backpackinglight/2004_ultralight_synthetic_insulating_jackets_vests_review.htmlNov 7, 2005 at 9:48 am #1344532
the thermawrap parka is very different in warmth compared to the jacket.
the jacket uses 50g/m2 excelloft
the parka uses 80g/m2
so the parka has a thicker loft and is the same as the micro puff
info from mont bell on the parka:
The heaviest and warmest of the Thermawrap jackets, the parka features a hood and more insulation to keep you warm in the worst conditions. Only slightly heavier than the basic jacket, but far warmer.Nov 7, 2005 at 9:54 am #1344534
If warmth is your only concern, then the micro-puff is your ticket.
However, the MontBell scored higher in the useability dept according to BPL. Its more useable because it can be worn in a broader range of conditions, especially when combined with other layers.
Also, according to BPL, the Thermawrap insulation is 1.8oz/yd where as the Micropuff is 2.6oz/yd.
In the 1.8oz/yd group, it blew away its primaloft competetion in the areas of Loft to Weight Performance, value, and "average score" (except for the MEC which threw the curve with its $60 price point)
Edit: didnt see that the original post was compairing the Montbell PARKA.
If your compairing the Micropuff Jacket, with the MontBell parka (both hooded with equal loft) Id give the nod to the MontBell. Given its performance of the lighter jacket in the BPL review, and given that it weighs almost 8 oz lighter than the MicroPuff jacket. The MontBell also costs less.Nov 7, 2005 at 10:00 am #1344537
Matthew L.BPL Member
@gungadinLocale: Pittsburgh, PA
The half-zip of the pullover would trap more air in than the Thermawrap Parka, although the Parka has a hood which is nice. I chose the Micropuff over it and found it to be very warm and great against wind. It is also lighter than what Patagonia says. My scale says more like eleven ounces not 12.5 so you would save some weight over the Montbell. The MP jacket is a lot heavier, though.Nov 7, 2005 at 10:01 am #1344538
my bad on mistaking parka for jacket— what becomes of a quick skim.
I have not used the new Montbell Parka — but on a g. for g. basis–I believe that Polarguard Delta is more efficient than Exoloft ( excelloft ?). I believe that in part this is due to the need for less stabilization of the Delta insulation compared to Montbell's or others out there in use.Nov 7, 2005 at 1:07 pm #1344554
David SpellmanMember
Quote: I believe that in part this is due to the need for less stabilization of the Delta insulation……
Dunno how you can say that, given that the Micropuff jacket is *heavily* quilted (it looks like the Michelin Man under the outer "floating" shell.Nov 7, 2005 at 1:11 pm #1344555
Quilting is not used in the BMW Cocoon Pullover( which I also have). The Patagonia's quilting, I think is a case of overkill. Still amazingly warm for it's 11.25 oz.(L) weight, regardless.
Perhaps Delta is more efficient due to the nature of the fiber architecture, instead.
And yes, getting back to the original poster— the Montbell Parka is probably the warmer of the two by dint of the hood, alone.Nov 7, 2005 at 5:20 pm #1344581
Im not sure that Delta IS more effecient. Ive felt far warmer in my excelloft bag vs any polarguard bag of similar insulation weight.
The Micropuff jacket has a hood as well, and weighs 20.5oz.Nov 7, 2005 at 6:00 pm #1344585
Joe– jackets and parkas and pullovers have been bandied about on this thread, in a careless manner ( including by me)—you are right about the micropuff parka weight and hood, I was referring to my micropuff pullover. On the balance, I would say advantage Patagonia when it comes to comparing the jacket vs. Montbell's parka in the catagory of warmth.
It would be interesting to compare, side by side, a Montbell exceloft bag w/ an equivalent polarguard delta bag– perhaps by cut and total weight rather than by temp. rating. Sounds like a future BPL project.
I suspect, that in the sleeping bag dept. that Delta has not been taken advantage above in terms of design as Montbell has with it's proprietary fill. I look forward to BMW's upcoming delta bags to rectify this somewhat.Nov 7, 2005 at 6:06 pm #1344586
My 2004 L Patagonia Micro Puff Jacket weighs 17.4 oz. I believe the 2005 Model is heavier.
RichNov 7, 2005 at 6:10 pm #1344587
lets get afew things straight here
Mont bell thermawrap PARKA:
(click image)
• 15 denier Ballistic Airlight nylon shell and lining (windproof
• Exceloft synthetic insulation (80g / m2 )(2.7 oz)
Weight: 12.7 oz.
Patagonia micropuff JACKET:
(click image)
Shell: 1.3-oz., 20 x 20 denier triple ripstop polyester with a Deluge® DWR (durable water repellent) finish; Lining: 1-oz. 20 x 20 mini-ripstop nylon with Deluge DWR finish;
Insulation: 2.7-oz. Polarguard Delta
581 g. (20.5 oz.)
SAME loft
thermawrap is lighter
thermawrap is cheaper
both windproof
both have hand warmer pockets
both have full zipper
micro puff has a durable water repellent (DWR) coatingNov 7, 2005 at 6:24 pm #1344589
Very good, Ryan. And thanks for the smaller image sizes.:-)>
Richard–it's true, that was a better vintage.Nov 7, 2005 at 6:43 pm #1344591
the older thermawrap Jacket was lighter than the 2006 version as well.
2005 Jacket 7.9oz
2006 Jacket 8.8oz
Parka 12.7
all three are avalible on sale at argear.comNov 7, 2005 at 6:57 pm #1344592
Just because a synthetic fiber fill is the same weight per ounce doesn't mean it is as warm, rebound from compression as well, be as warm when wet, have the same life expectancy, etc. Until we have tests we will not know if the Montbell Thermawrap Excel loft fill jacket is as warm as the Patagonia Polarguard Delt Micro Puff Jacket. No question however which product is lighter. Also with the new outer fabric of the Patagonia Jacket it is supposed to be tougher than last years model.
RichNov 7, 2005 at 7:02 pm #1344595
I never said if one was warmer or not, I was just comparing similarities and differences of the two jackets
but on the mont bell website it says thet exceloft will only reatin 1% of its weight in water.
makes decisions like these harderNov 7, 2005 at 7:09 pm #1344597
The small amount of water absorbed by Primaloft is part of the argument for this insulation and why the Armed Services uses it. However, according to the tests by BPL last year they indicated that though Polarguard Delta did in fact absorb more water than Primaloft, Polarguard Delta appeared to maintain more warmth than Primaloft. I am not sure if BPL could make that comment last year due to the light insulation weight of the Excel Loft used in the Montbell products.
RichNov 7, 2005 at 7:25 pm #1344601
I am no expert on this kind of stuff, both polarguard delta and exceloft have their advantages, but me personally would go with the mont bell for the weight and money savings and just be careful not to get it wet (witch I would do any way.)Nov 8, 2005 at 8:53 am #1344625
Actually, what I would be FAR ,ore interested in were a long term BPL study that compaired insulations by weight.
Ill grant that PGDelta might be warmer new from the factory, but my research of raw insulation puts its long term durability in serious question.Nov 8, 2005 at 9:09 am #1344628
I tried to ask for some thing similar to this but I guess it has already been done? your inputNov 8, 2005 at 9:11 am #1344629
and your research consists of….?Nov 8, 2005 at 9:12 am #1344630
what do you mean? my research????Nov 8, 2005 at 9:29 am #1344632
Ryan, is your name JR ? Read header—I was being laconic. I was apparently writing while you had just posted.
Joe Robbins indicated he had done some research on insulations and I wanted to find out what it was.Nov 8, 2005 at 9:37 am #1344634
I went out, and bought several types of insulation. Comfort Fil 7, PG Classic, PG HV, PG3D, PG Delta, Primaloft and Primaloft sport. All were the same weight.
I built a plexiglass box and put the insulation inside the box. I measured its thickness as a base. Then over the next few weeks I soaked, compressed, put in the dryer, and otherwise abused it. After each test, I would put it back in the box and check its loft.
I lost my documentation (I recently bought a new house and moved, I havent been able to find my notes) but one thing I recall is that for the weight, PG Delta was thicker initially, but was very fast to lose loft.
I wasnt able to test Exceloft since I couldnt get enough insulation without ripping part a new sleeping bag, but I was able to do some smaller scale tests with it… It showed similar loft recovery to PG Classic (probably due to the solid core fibers) but was much lighter (probably due to the hollow core fibers). It has also held up in the field significantly better than expected. for the small amount of raw insulation I was able to test, it also showed less water retention than expected. (I expected 3%, as claimed by MontBell when I got the sample. I got an average reading of 2% water retention by weight.)
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looking for a touchscreen, 7 or 8". Seller must take paypal and be willing to ship to Canada. North America only please as to keep shipping cost low. Canada preffered also for shipping reasons but I'm not against taking offers from the states.
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God Where Are You? - The Problem Of Evil (3 of 7) by James Merritt
This content is part of a series.God Where Are You? - The Problem Of Evil (3 of 7)
James Merritt
Judges 6:13; Genesis 3:1-6
1. [Video] Whether it is the Holocaust, the killing fields of Cambodia, the Oklahoma City bombing, 9/11, a tsunami that wipes out 150,000 people in a day, or the massive starvation of millions of children around the world, you cannot deny the reality of evil.
2. On the other hand, we saw last week how science itself has proved with certainty that the world is not eternal. The universe had a beginning. The only feasible option to explain the origin of the universe is a transcendent creator. DNA itself is a compelling example of the incredible design that permeates all of life and tells us that behind all of this there is a God. But that, in turn, raises even more questions.
3. Vincent Bugliosi, spent 8 years as a prosecutor for the Los Angeles District Attorney's Office where he won 105 out of 106 felony jury trials. In his book, entitled The Five Reasons That O.J. Simpson Got Away With Murder, he writes these words:
When tragedies like the murders of Nicole [Brown-Simpson] and Ron [Goldman] occur they get one to thinking about the notion of God. Nicole was only thirty-five, Ron was just twenty-five, both outgoing, friendly, well liked young people who had a zest for life. Their lives were brutally extinguished by a cold-blooded murderer. How does God, if there is a God, permit such a horrendous and terrible act to occur along with the countless other unspeakable atrocities committed by man against his fellow man throughout history? And how could God - all-good and all-just, according to Christian theology, permit the person who murdered Ron and Nicole to go free...When Judge Ito's clerk, Deidre Roberson, read the jury's not-guilty verdict Nicole's mother whispered, 'God where are you?'
4. That mother was asking a question that alot of people ask every day. A man named Gideon asked this very question thousands of yea ...
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It's that time of the week again! Check out our round-up of real weddings, styled shoots, and ideas that were featured on ProjectWedding. Don't forget to share your favorites!
Shanelle and James: Columbus, Ohio– This glam wedding is full of inspiring ornate details!
Photograpy: Seth and Beth Photography
17 Fun Ideas for a Southern Wedding– Getting married south of the Mason-Dixon line? We've got some great ideas for you!
Photo by Clary Photo
Watercolor Ranch Inspired Styled Shoot– Swoon-worthy decor and details ahead!
Photo by Lanny Nguyen Photography
DIY: Ribbon Message Bridesmaid Bouquet– A cute way to ask your best friends to be in your wedding party!
Project and Photos by Brittni Mehlhoff of Paper & Stitch
Hanging Flowers– A unique way to display your blooms!
Photo by Taylor Whitham Photography
It's that time of week again! Here are some of our editor's favorite boards and ideas that you may have missed:
13 Fun Wedding Ideas For the Beer and Cocktail Lover– Nothing gets a party started like alcohol-infused beverages (that's not the only way of course, but it's a good one!). Check out these fun ideas we found from real couples.
Photo by Sweet Little Photographs
DIY Ombre Toasting Glasses– Use these sweet champagne coups for a bridal shower, rehearsal dinner, or wedding reception! It's just 5 easy steps.
Photo by Brittni Mehlhoff of Paper & Stitch
12 Reception Details You Probably Haven't Thought Of– From unique favors to a live artist painting your ceremony, there are so many ways to make your reception unique! Take a peek at one of our many ideas.
Photo by Natalie Bray Photography
Rustic Bohemian Anniversary Shoot– This wedding has everything from a pick-up truck to a live horse! If you're having a rustic wedding, use this shoot as your inspiration.
Photo by Jasmine Lee Photography
Balloon Decor– This decor element is just for kid birthday parties! Use them at your wedding for whimsical or colorful accent.
Photo by Anneli Marnovich Photography
By Brittni Mehlhoff
Accent colorful bridesmaid dresses with all-white bouquets, for a high-contrast statement that really pops. Using just two types of flowers and one filler, you can create a gorgeous monochromatic bouquet that any bridesmaid, or bride for that matter, will love.
You will Need: anemones • ranunculus • veronica white flowers (filler) • 2 feet of ribbon • floral wire • scissors
Step One. Start by removing excess leaves from all the stems. Then, choose a couple of larger flowers and criss cross the stems underneath the blooms. A couple of anemones and one ranunculu is a good start. Keep in mind that the first few flowers you start with will be in the center of your finished bouquet. So choose good ones because they will be the focal point.
Step Two. Add a few veronica white flowers next, balanced on opposite sides of the bouquet. Make them slightly higher than the height of the rest of the bouquet, so they can peek out the top.
Step Three. Once you have that first little bundle of flowers in hand, begin surrounding it with additional ranunculus and anemones. Work all the way around the bouquet to create a balanced look.
Step Four. Finish things off with a few flowers that have a natural curve in the stem to fill in any holes and complete the rounded shape.
Step Five. Next, holding the stems with both hands, one hand at the top close to the flowers and the other toward the bottom of the stems, have a friend wrap floral wire around the stems several times as close to the top as possible. Holding the bouquet with both hands will help ensure that the flowers don't move around while the wire is being wrapped around the stems.
Step Six. Lastly, cut a piece of ribbon approximately two feet long and wrap it around the stems a few inches below the floral wire to keep the stems in place and add a decorative element. Then, cut stems at the bottom of the bouquet so they are all the same length. Place in a few inches of water until heading out to the ceremony.
By: Brittni Mehlhoff
Make cheerful boutonnieres in a pinch with beautiful, in-season blooms that will add a pleasant pop of color to your groom's suit. These pretties are perfect for spring.
Supplies: washi tape • scissors • ranunculus • yellow acacia • variegated kale
Step One • Trim one leaf from a variegated kale stem to use as the base for your boutonniere. Set the kale leaf down on a flat surface and add two sprigs of acacia on top, lining up the bottom of the stems with the kale.
Step Two • Next, trim one stem of budding ranunculus, making sure the stem is no more than four or five inches long. Then, nestle the in-season bloom on top of the acacia and kale.
Step Three • Using your fingers, wrap the kale leaf around the ranunculus so that the flowers look like they are being cradled by the leaf.
Step Four • Wrap decorative washi tape around the stems of the finished boutonniere, starting at the top of the stem base. Leave one inch of the stems showing at the bottom, uncovered by tape. Add a straight pin. Fill a short glass with a little water to keep the boutonnieres fresh until the wedding (depending on the flowers you use, they should stay fresh this way for up to two days).
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Integration Theory - A Second Course
€ 83,99
Lieferbar innert 2 Wochen
August 2002
BeschreibungThis book presents a very general approach to integration theory, as well as some advanced topics of the theory. It includes some new results but is also a self-contained introduction suitable for a graduate student doing self-study or an advanced course on integration theory.The book is divided into two parts. In the first part, integration theory is developed from the beginning in a general setting and for vector-valued functions which can hardly be found in other textbooks. The second part covers various topics related to integration theory, such as spaces of measurable functions, convolutions, famous paradoxes in connection with set theory, and extensions of formulas from elementary calculus to the setting of the Lebesgue integral.
InhaltsverzeichnisContents: Basic Integration Theory: Abstract Integration; Adding a Topological Structure: The Radon Measure; Adding a Group Structure: The Haar Measure; Advanced Topics: Spaces of Measurable Functions; Convolutions; Connections with Logic and Set Theory; Special Properties of the Lebesgue Measure; Miscellaneous.
Pressestimmen?Because of the original treatment and selection of topics, the book stands out among other books on the same subject."
Untertitel: Sprache: Englisch.
Verlag: WORLD SCIENTIFIC PUB CO INC
Erscheinungsdatum: August 2002
Seitenanzahl: 288 Seiten
Format: gebunden


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FUNDING/SUPPORT: This work was supported by the University Health Network Foundation and Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada. Dr Mokhlesi is supported by National Institutes of Health [Grant R01HL119161].
∗CORRESPONDENCE TO: Frances Chung, MBBS, Department of Anesthesia, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, Canada M5T 2S8
Copyright 2016, The Authors. All Rights Reserved.
OSA is a commonly encountered comorbid condition in surgical patients. The risk of cardiopulmonary complications is increased by two to threefold with OSA. Among the different treatment options for OSA, CPAP is an efficacious modality. This review examines the evidence regarding the use of CPAP in the preoperative and postoperative periods in surgical patients with diagnosed and undiagnosed OSA.
OSA is a prevalent sleep breathing disorder in the general population with estimated prevalence of at least 9% to 25%. Indeed, in a recent population-based study in Switzerland, the prevalence of moderate to severe OSA was 23.4% in women and 49.7% in men. The prevalence of OSA in surgical patients using International Classification of Disease-9 codes has been reported to be 7% to 10%.,, However, using polysomnography (PSG), the prevalence of OSA in surgical patients is expected to be significantly higher than simply using International Classification of Disease-9 codes from administrative databases. Indeed, the prevalence may be as high as 70% in high-risk populations such as patients undergoing bariatric surgery., Surgical patients with OSA pose a significant clinical challenge to health-care professionals because of OSA's associations with several comorbidities, including cardiovascular disease, heart failure, arrhythmias, hypertension, stroke, and metabolic syndrome.,,, During the perioperative period, sleep is disrupted and the severity of sleep-disordered breathing (SDB) is increased postoperatively in surgical patients with OSA.,
The American Society of Anesthesiologists published a practice guideline recommending preoperative screening to identify undiagnosed OSA, preoperative initiation of CPAP if possible, and postoperative monitoring of patients with OSA., Perioperative complications related to OSA are increasingly linked to malpractice lawsuits with severe financial penalties., The lack of evidence behind the guideline recommendations and the significant cost of guideline implementation have created a dilemma between potentially improved postoperative adverse events and increased health-care resource utilization. In practice, fewer than 20% of patients with a diagnosis of OSA receive CPAP therapy, are observed in advanced care settings, or both. This review examines the evidence regarding the use of CPAP in the preoperative and postoperative periods in surgical patients with diagnosed and undiagnosed OSA.
A close relationship exists among OSA, sleep, and anesthesia. Upper airway behavior during sleep serves to some extent as a surrogate of airway behavior during anesthesia and recovery from anesthesia. Likewise, upper airway abnormalities observed by anesthesiologists during the perioperative period is likely to predict upper airway behavior during sleep. A patient with an upper airway that is prone to collapse may also be at increased risk of compromised arousal mechanism in the postoperative period. Several large database studies and two meta-analysis have shown that patients with OSA have increased risk of postoperative complications.,,,,,,, Two recent meta-analysis of 13 and 17 studies indicate that, compared with patients with OSA, patients with OSA have a higher incidence of respiratory complications, postoperative cardiac events, and increased ICU transfer., In line with the meta-analysis, five recent studies using data from large national and international databases including millions of patients demonstrated a significantly increased risk of atrial fibrillation, respiratory failure, aspiration pneumonia, ARDS, increased emergent postoperative endotracheal intubation, and need for postoperative ventilation among patients with a diagnosis of OSA vs control subjects.,,,,, D'Apuzzo et al demonstrated that there is increased mortality in OSA vs patients without OSA undergoing revision joint arthroplasty (OR, 1.9; P = .002). That this study included patients undergoing revision arthroplasty may suggest a higher burden of comorbidities. Paradoxically, the increased risk of cardiopulmonary complications did not translate into increased risk of in-hospital mortality in two studies., There may be several reasons behind the reduction in in-hospital mortality: (1) patients with OSA may have received more vigilant care; (2) patients with OSA may have exhibited signs of deterioration earlier in their hospital course; (3) the reason behind respiratory failure in patients with OSA may have been easier to treat (eg, respiratory failure from upper airway compromise vs aspiration pneumonia or ARDS); or (4) in the control group, patients may have undiagnosed OSA with increased risk of mortality and morbidity. Indeed, in two studies of postsurgical patients,, those with an OSA diagnosis who developed respiratory failure were intubated earlier and received mechanical ventilation for a shorter period, suggesting that the cause of respiratory failure was rapidly reversible, perhaps related to upper airway complications resulting from sedatives and opioid analgesics.
In the general population, a significant proportion of patients with moderate to severe OSA remains undiagnosed. This corollary may also apply to the surgical patients in the perioperative period. In a retrospective nested cohort study, preoperative screening followed by PSG was performed to identify patients with OSA, and the results were blinded to the perioperative care team. Both anesthesiologists and surgeons failed to identify a majority of the newly diagnosed patients with moderate to severe OSA. Patients with undiagnosed OSA presenting for surgery may have further increase in cardiopulmonary complications.,,
The efficacy of CPAP in patients without a diagnosis of OSA has been well-established by a recent meta-analysis of nine randomized controlled trials (RCTs) in patients undergoing abdominal surgery. These studies have shown that perioperative use of CPAP leads to a reduction in the rate of postoperative pulmonary complications. In 200 patients who developed hypoxemia immediately after undergoing major abdominal surgery, the use of postoperative CPAP at 7.5 cm H2O plus supplemental oxygen using a helmet interface led to a reduction in the incidence of endotracheal intubation, pneumonia, infection, and sepsis when compared with supplemental oxygen alone. Significant reduction in the rate of pulmonary complications with the prophylactic use of nasal CPAP was also demonstrated in patients undergoing thoracoabdominal aortic surgery and cardiac surgery.,
The number of surgical cases performed globally is increasing, and an estimated 250 million major surgeries are being performed each year. With the global rise of obesity, the prevalence of OSA will likely continue to rise., Perioperative care of patients with OSA will be an increasing challenge. The concept of perioperative surgical home, encompassing optimization of surgical patient's health status from preoperative period to postoperative discharge care for conditions, such as coronary heart disease, congestive heart failure, COPD, or diabetes, has become the new reality. The same concept applies to patients with suspected or diagnosed OSA presenting for surgery, where the association of OSA with postoperative complications has been a wake-up call for action. Anesthesiologists are in an ideal position to identify patients with SDB, optimize their perioperative management, and contribute to their continuum of care. Because CPAP therapy has long-term health benefits for patients with OSA, preoperative clinics may provide an opportunity for identification of patients with undiagnosed OSA and initiation of treatment. In a recent study, surgical patients were screened for OSA in a preoperative clinic and were offered CPAP therapy. Those who were CPAP-adherent had better sleep quality, less daytime sleepiness, and reduction of medication usage for associated medical diseases. For patients with OSA presenting for surgery, perioperative clinicians may face a variety of scenarios: patients with (1) diagnosed OSA with appropriate adherence to effective therapy, (2) diagnosed OSA but not adherent to prescribed therapy, and (3) undiagnosed OSA. Patients who are treated and adherent to CPAP should continue their CPAP in the postoperative period. Those patients with diagnosed OSA who are not adherent to therapy or undiagnosed OSA pose a more significant clinical challenge.
In patients with OSA, CPAP has been shown to have beneficial effects on postoperative adverse events. In a case series by Rennotte et al, two patients with OSA without CPAP suffered postoperative adverse events and one patient died, whereas 14 patients with OSA treated with CPAP had uneventful postoperative courses. In a retrospective case-control study, patients with OSA without CPAP had more postoperative complications than patients with OSA treated with CPAP (44% vs 27%, P = .02). Unplanned ICU transfer was also significantly higher in patients with OSA without CPAP treatment and length of stay was 1 day longer. In a retrospective cohort match study, Liao et al found that 30% of the patients with OSA not using home CPAP developed an adverse event such as upper airway obstruction or hypoxemia, resulting in the initiation of postoperative CPAP. Studies on the efficacy of CPAP on postoperative outcomes are shown in Table 1.,,,,,,,,
AHI = apnea hypopnea index; aOR = adjusted odds ratio; APAP = autotitrated positive airway pressure; BiPAP = bilevel positive airway pressure; Cx = complications; LOS = length of hospital stay; NS = not significant; RCT = randomized controlled trial; Rx = treated; SPO2 = oxygen saturation; STOP-Bang = snoring, tired, observed, pressure, BMI, age > 50 years, neck size large, gender.
A recent meta-analysis of six studies including 904 patients examined the effectiveness of CPAP therapy on postoperative outcomes, postoperative apnea hypopnea index (AHI), and length of stay in surgical patients with OSA plus CPAP therapy vs patients with OSA without CPAP therapy. There was no significant difference in postoperative adverse events between the CPAP and no-CPAP groups (risk ratio, 0.88; 95% CI, 0.73-1.06; P = .19). Patients with OSA who used CPAP either preoperatively and/or postoperatively compared with no-CPAP had a risk ratio of 0.88 (0.73-1.06) and a 12% risk reduction of postoperative adverse events with a corresponding number needed to treat to benefit of 45. The nonsignificant benefit of CPAP on postoperative adverse events may have been related to the relatively small sample size of 904 patients and an overall low incidence of postoperative complications in the meta-analysis. Other potential reasons may have been suboptimal CPAP adherence in the perioperative period. However, the meta-analysis revealed that perioperative CPAP significantly reduced postoperative AHI from the preoperative baseline AHI (preoperative AHI vs postoperative AHI: 37 ± 19 vs 12 ± 16 events/h). There was also a trend toward significance for reduction in the length of hospital stay of 0.4 days favoring the CPAP group (CPAP vs no-CPAP: 4.0 ± 4 vs 4.4 ± 8 days, P = .05).
Even though five studies supported the use of CPAP in the perioperative period, they were not included in the meta-analysis by Nagappa et al (Table 2), because of a lack of data in either the study group and/or control group. In a retrospective chart review by Meng et al, patients who did not use CPAP had a significantly higher incidence of postoperative hypertension (CPAP vs no-CPAP group: 18% vs 29%; P = .013) and oxygen desaturations (CPAP vs no-CPAP group: 5% vs 43%; P = .012). Also, the length of postanesthesia care unit (PACU) stay was longer in the no-CPAP group when compared with the CPAP group (211 ± 82 min vs 159 ± 78 min, P = .029). Neligan et al conducted an RCT on morbidly obese patients with OSA undergoing laparoscopic bariatric surgery. The administration of CPAP immediately after extubation improved spirometric lung functions at 1 h and 24 h after extubation in the operating room vs CPAP that was started in the PACU. Hallowell et al found that compulsory screening for OSA and perioperative treatment with CPAP therapy decreased respiratory-related ICU stays from 34% to 1% (P < .001). Huerta et al prospectively evaluated 420 patients with OSA undergoing bariatric surgery, of which 159 patients were dependent on CPAP. There were no respiratory complications and no positive correlations between CPAP use and anastomotic leak. This suggests that CPAP is an effective tool for treating hypoventilation after gastric bypass without necessarily increasing the risk of postoperative anastomotic leaks. However, after laparoscopic Roux-en-Y gastric bypass, Ramirez et al found that there was no significant difference in the overall morbidity between those who used CPAP postoperatively and those who did not (4.5% vs 3.5%, P > .05).
PACU = postanesthesia care unit; PEFR = peak expiratory flow rate. See Table 1 legend for expansion of other abbreviations.
Two recent large studies further support the benefits of CPAP in patients with diagnosed and undiagnosed OSA., Mutter et al linked a clinical database of PSG data for patients with newly diagnosed OSA with a CPAP prescription to a large provincial health administrative database and compared postoperative outcomes in patients with OSA, before and after OSA diagnosis, with matched control subjects from the general population who had a low risk of having OSA. Patients diagnosed with OSA had significantly reduced risk of cardiovascular adverse events vs undiagnosed patients with OSA (OR, 0.34, 95% CI, 0.15-0.77, P = .009). The risk of cardiovascular complications, primarily cardiac arrest and shock, was significantly different between 1,489 undiagnosed OSA (OR, 2.20; 95% CI, 1.16-4.17; P = .02) and 2,496 patients diagnosed with OSA (OR, 0.75; 95% CI, 0.43-1.28; P = .29). Patients with a preoperative diagnosis of OSA and preoperative prescription for CPAP were less than half as likely to experience cardiovascular complications as those diagnosed after surgery. The risk of respiratory complications (OR, 2.08; 95% CI, 1.35-3.19; P < .001) was increased in both 2,629 patients with diagnosed OSA and 1,569 patients with undiagnosed OSA. Most importantly, only patients with severe or undiagnosed OSA had a significantly increased risk of respiratory and cardiovascular complications. This is the first study to show a positive association between the severity of OSA and postoperative risks. Prior negative studies were likely because of inadequate statistical power.,, Given the association between the severity of OSA and postoperative outcomes, efforts targeting patients with moderate-to-severe undiagnosed OSA in preoperative screening may be more clinically relevant.,,,,,
In another supporting study, Abdelsattar et al prospectively collected data from the Michigan Surgical Quality Collaborative of 52 community and academic hospitals in Michigan to compare postoperative 30-day cardiopulmonary complications between treated and untreated patients with OSA. Adult patients undergoing various general or vascular surgeries were classified into three groups: (1) no diagnosis or a low risk of OSA, (2) documented OSA without therapy or suspicion of OSA (snoring, tired, observed, pressure, BMI, age > 50 years, neck size large, gender [STOP-Bang] score ≥ 3 of 8), and (3) diagnosis of OSA with treatment (ie, positive airway pressure [PAP] therapy). Of 26,842 patients, 2,646 (9.9%) had a diagnosis or suspicion of OSA and 55% of them were untreated. Compared with patients with OSA undergoing PAP therapy, documented OSA without therapy or suspicion of OSA was associated with higher cardiopulmonary complications (risk-adjusted rates, 6.7% vs 4%; adjusted OR, 1.8; P =.001). Other significant predictors of adverse cardiopulmonary outcomes were older age, higher American Society of Anesthesiologists classes, vascular surgery, and comorbidity index. Both myocardial infarction (adjusted OR, 2.6; P = .031) and unplanned reintubations (adjusted OR, 2.5; P = .003) were significantly higher in untreated patients with OSA. These two large database studies provide incremental evidence that confirm the benefits of establishing an OSA diagnosis preoperatively and provide a solid rationale for treating OSA with CPAP during the perioperative period.,
Starting treatment with autotitrating positive airway pressure (APAP) can be as effective as CPAP treatment with PSG titration.,, Because of possible fluid shifts, supine body position, and sedative effects of residual anesthetics and narcotics, a single fixed CPAP pressure setting may not be equally effective in the perioperative environment.,,,
Empiric APAP therapy has been studied in three studies,, and successfully applied in the perioperative care of patients at risk for OSA (Table 3). In the study by Guralnick et al, surgical patients with a STOP-Bang score of 3 or higher were referred to undergo split night PSG and received APAP treatment preoperatively. In an RCT, Liao et al investigated the feasibility and effectiveness of perioperative APAP in newly diagnosed untreated patients with OSA. APAP treatment was started 3 days preoperatively, allowing adaptation to the device and continued in the postoperative period for 5 days. O'Gorman et al applied postoperative APAP empirically to orthopedic patients who were considered at high risk of OSA without preoperative PSG or PAP adaptation.
See Table 1 legend for expansion of abbreviations.
APAP treatment was shown to significantly reduce postoperative AHI and improve oxygen saturation (SpO2) in patients with moderate and severe OSA. Although APAP improved obstructive apneas and hypopneas, a full resolution of SDB did not occur in these studies. The preoperative AHI was reduced by an average of 25 events/h postoperatively. Some residual SDB persisted, with a mean AHI 12 ± 16 events/h in the recent meta-analysis. Brar et al found that 18% of surgical patients spent at least 30 min with SpO2 < 90% the night following surgery despite the use of their prescribed PAP therapy. The severity of baseline OSA, pre-CPAP SpO2, net fluid balance, total IV opioid dose, and central apneas may be the contributing factors to hypoxemia.,,,, As such, it has been suggested that postoperative oximetry monitoring may be indicated in PAP-treated patients with OSA.
In the meta-analysis of perioperative CPAP use, the length of stay was 0.4 days shorter in the CPAP group vs the no-CPAP group. On the contrary, O'Gorman et al showed that there was no benefit for APAP applied postoperatively to patients who were identified as being at high risk of OSA by screening vs patients who receive usual care. The negative results of the study may be due to a type 2 error, with an inadequate sample size and inadequate oxygen supplementation resulting from diluting effects of high flow induced by APAP.
There are several barriers to effective diagnosis and treatment of OSA in the perioperative setting. In both clinical and research settings, a significant proportion of patients who may have suspected OSA refuse to undergo additional testing for establishing an OSA diagnosis., Guralnick et al speculated that the inconvenience of an overnight in-laboratory PSG or even out-of-center sleep testing, the short time available between evaluation by the anesthesia team and the actual date of surgery, cost, underappreciation of the implications of undiagnosed and untreated OSA by patients and clinicians, lack of understanding of the consequences of untreated OSA, and unwillingness to use CPAP may have all contributed to the failure of surgical patients to accept and adhere to perioperative diagnosis and treatment of OSA. These reasons may explain why only approximately 45% of patients with newly diagnosed OSA were adherent to APAP therapy in the perioperative period., Other factors that have been associated with reduced APAP adherence in the perioperative period include African American race, male gender, and depressive symptomatology.
In two studies, the optimal level of APAP was 9 ± 2 cm H2O in surgical patients with newly diagnosed OSA., This information could be used empirically to prescribe the minimum and maximum pressure settings on APAP devices if clinicians need to prescribe APAP in the postoperative period for patients suspected of having OSA but who have not undergone formal sleep testing or PAP titration.
Postoperative CPAP utilization has been reported to be suboptimal even in patients with an established diagnosis of OSA. Gupta et al found that only one-third of patients who were on home CPAP therapy used their CPAP during the postoperative stay in the hospital. Liao et al found that only 63% of patients on home CPAP therapy received postoperative CPAP. Intensive education of health-care professionals and patients is needed to ensure that patients are instructed to bring their CPAP device to the hospital and to continue to use CPAP therapy during the vulnerable postoperative period. In lieu of patients bringing their own CPAP units, effective APAP therapy can be provided to the patient by using hospital APAP or CPAP devices.
It is not known which subgroups of patients with SDB are more likely to benefit from PAP therapy. Patients with obesity hypoventilation syndrome, overlap syndrome, patients with severe OSA (AHI > 30), and patients with a high arousal threshold with recurrent severe hypoxemia may possibly benefit from preoperative PAP therapy. Patients with OSA and unrecognized obesity hypoventilation syndrome or overlap syndrome (COPD and OSA) had higher risks of postoperative respiratory failure, heart failure, prolonged intubation, and longer ICU and hospital length of stay than patients with nonhypercapnic OSA. Therefore, hypercapnia can be an important risk modifier. Although many patients normally do not have measurements of arterial blood gases, high serum bicarbonate in venous blood can serve as a surrogate for hypercapnia and may help to identify patients with obesity hypoventilation syndrome.,, Identifying this patient population is critical because CPAP use may not be sufficient and other advanced modes of PAP therapy such as bilevel PAP with or without a backup rate may have to be applied.
Recently, it was shown that 26% of patients without OSA (preoperative AHI < 5) developed moderate-to-severe SDB (AHI > 15) in the first 1 to 3 days after surgery. In these patients, preoperative respiratory effort-related arousals may have converted to apneas or hypopneas in the postoperative period, likely because of increased upper airway collapsibility. The reasons behind increased upper airway collapsibility may be related to rostral fluid shifts and/or respiratory depression induced by opioids and sedatives.,,,, In this study, preoperative respiratory disturbance index, rather than the AHI, and age were significant predictors of postoperative moderate-to-severe SDB. As a result, it was suggested that in surgical patients, respiratory disturbance index may be more useful than AHI in diagnosing OSA.
Mutter et al identified patients with more severe OSA (AHI > 30) to be at higher risk of adverse postoperative cardiopulmonary events, but it is not known whether AHI by itself is the best metric of OSA severity to risk stratify perioperative patients with OSA. Other metrics of OSA severity in the surgical patients such as mean preoperative overnight SpO2, oxygen desaturation index, and total sleep time below 90% SpO2 may be useful as well. Chung et al found that patients with mean preoperative overnight SpO2 < 93%, oxygen desaturation index > 29 events/h or more than 7% total sleep time < 90% SpO2 were at higher risk of postoperative adverse events.
Another less-recognized cause of sudden death in patients with OSA is arousal failure. It has been suggested that an obstructive sleep apneic event may not spontaneously terminate because of an ineffective arousal mechanism related to impaired chemosensitivity and/or opioid-induced respiratory depression, leading to profound cerebral hypoxemia and ultimately death., Further research is necessary to determine the various phenotypes of OSA and which metrics of SDB severity are likely to predict postoperative adverse events. Measures of hypoxemic exposure as well as hypercapnia need to be taken into account when risk-stratifying patients with SDB.,
Many anesthesiologists have become perioperative physicians; in this important role, they are instrumental in optimizing outcomes and minimizing complications in surgical patients. Preoperative clinic is a "teachable moment" for surgical patients with undiagnosed or untreated OSA. Patients with OSA have evidence of increased cardiopulmonary complications. There is preliminary evidence supporting that patients with OSA treated with CPAP have fewer postoperative cardiopulmonary complications., Undiagnosed patients with severe OSA have two to threefold increased risk for cardiovascular and pulmonary complications. Given the preponderance of data on long-term benefits and improved prognosis of patients with OSA with CPAP treatment, screening surgical patients for OSA and initiating PAP therapy in the perioperative period may be medically appropriate.,
With accumulating evidence from studies,,,,,,,,,,, it may be ethically difficult to perform RCTs. Moreover, given the overall low rates of postoperative complications, another challenge is designing RCTs that are adequately powered to detect these clinically meaningful outcomes. With the increased awareness of postoperative complications associated with OSA, researchers may face increasing rates of unwillingness on the part of patients and their physicians to participate in RCTs. The field of perioperative medicine is not unused to these challenges; a similar dilemma regarding perioperative monitoring with pulse oximetry occurred in the 1980s. Because of the overall low rates of adverse events, RCTs have failed to show differences in postoperative complications, length of stay, or death between those monitored by oximetry and control subjects. In spite of that, anesthesiologists have universally adopted monitoring patients with pulse oximetry in operating rooms and PACUs. Subsequently, patients have benefitted from increased safety with anesthesia despite the absence of positive findings of benefits from RCTs on oximetry monitoring. Another example is malignant hyperthermia (MH), a serious complication. During the past few decades, surgical patients are screened for a personal or family history of MH and an anesthesia protocol is followed. Treatment with dantrolene is initiated after MH occurs. These two historical perspectives (oximetry monitoring and MH recognition) may provide insights into how best to manage patients with OSA in the perioperative period, with the ultimate goal of increasing their safety. Surgical patients can be screened for sleep apnea, appropriate CPAP treatment may be given where appropriate, and postoperative monitoring can be provided.
Surgical patients with OSA adherent to CPAP therapy should continue their CPAP use postoperatively. The management of patients nonadherent to CPAP or suspected OSA is more challenging. It depends on preexisting comorbidities, types and urgency of surgery, requirement of postoperative opioids, and availability of postoperative monitoring. There is a high prevalence of OSA in surgical patients, which is in contrast with the very low incidence of critical postoperative respiratory events. The diagnosis of OSA per se cannot be considered a diagnostic marker for respiratory complications. Certain pathophysiological features of OSA may enhance opioid induced ventilatory impairment resulting from respiratory compromise or suppression of the arousal response to airway obstruction. Respiratory depression may be more prominent in patients with OSA who have decreased ventilatory responses to hypoxia/hypercapnia stimuli and high arousal threshold with recurrent severe hypoxemia. Patients should be informed that they have been identified as either having a high probability of OSA or as having a diagnosis of OSA with increased risk of postoperative complications. Patients, surgeons, and anesthesiologists should be jointly involved in the decision-making whether to have additional preoperative evaluations and/or consideration before surgery. In the bariatric surgical patients with a high prevalence of OSA, preparation for surgery with screening and CPAP treatment are routinely performed as part of the preoperative workup. Judgment and common sense should be used to manage patients with undiagnosed OSA or patients with OSA nonadherent to CPAP therapy. Individual evaluation is important to determine the best course of action. Referral to sleep medicine for CPAP therapy may have to be taken in the absence of overwhelming evidence from RCTs in certain groups of patients. Patients with severe OSA, COPD or overlap syndrome, obesity hypoventilation syndrome, or pulmonary hypertension would definitely benefit from further evaluation and workup. Patients who have preoperative resting hypoxemia on room air with no known cardiopulmonary cause are potential candidates for further preoperative evaluation. Patients with decreased respiratory responses to hypoxia/hypercapnia stimuli and a high arousal threshold presenting with recurrent severe hypoxemia may benefit from preoperative CPAP.
Despite important advances, many important and clinically relevant questions remain unanswered., How should OSA be screened and diagnosed in surgical patients? Which phenotype of OSA would benefit from PAP therapy? When should we refer surgical patients who are nonadherent to CPAP or have suspected OSA? Should we refer these patients preoperatively and initiate CPAP therapy if needed? Should we refer these patients postoperatively and opt to minimize risk with perioperative precautions and postoperative monitoring? When is the optimal time to implement PAP therapy? How should we monitor OSA patients postoperatively? What are the best modalities of PAP therapy for perioperative use? What are the reasons for lack of adherence to PAP therapy and how can we improve adherence to PAP therapy? What are the obstacles to implementing a PAP protocol? What therapeutic options should be used in PAP-intolerant patients? What are the cost implication, cost-effectiveness, and cost-benefit considerations of preoperative diagnosis of OSA and implementation of PAP therapy? Without a doubt, more research is needed to provide answers to some of these clinically relevant questions. In the meantime, clinical acumen and a commonsense approach is needed to identify surgical patients with undiagnosed OSA who may be at risk for postoperative adverse events who could benefit from CPAP therapy and postoperative monitoring.
In conclusion, diagnosing OSA and using perioperative CPAP therapy may be effective interventions to reduce the incidence of postoperative adverse outcomes in patients with OSA undergoing surgery. Further research in this area is needed to determine whether this strategy has a positive effect on hospital resource utilization and reduction in cost of the health-care system.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: F. C. has received research support from ResMed and the ResMed Foundation. B. M. has served as a consultant to Philips/Respironics and has received research support from Philips/Respironics; he has also received honorarium from Zephyr Medical Technologies and has served on the advisory board of Itamar Medical. None declared (M. N., M. S.).
Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
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E.A.C.H. 2-Word Story RELOCATION NOTICE
by CollieSmile
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We're tough on our skin. Not only with the products we use but with the daily self-criticism we endure every time we look in the mirror, dwelling over every little bump and blemish. But a rogue pimple isn't necessarily a sign of bad skin.

Is your skin healthy or unhealthy? How can you tell the difference? What does healthy skin look like? Knowing the answers to these questions is the first step in determining how you should be taking care of your skin. Here are four components of healthy skin.

1. Even Color

Consistent color is a sign of youthful, healthy skin. Studies have shown that consistent, even skin tone is actually a key element of attractiveness. As a matter of fact, the consistency of skin color is considered more attractive than having a certain skin color. Unfortunately, even skin tone starts to fade with age, as accumulated sun damage starts to take hold on the skin and create age spots and other signs of unevenness. Examples of uneven skin tone include:

blotchiness

spots that are dark, light, or red

dark under-eye circles

2. Smooth Texture

Healthy skin looks and feels smooth. If you look at healthy skin up close, the surface appears to be "regularly irregular." This means that the skin is not completely 100 percent smooth like glass, but has tiny peaks around hair follicles and pores, and tiny valleys in between the peaks. These peaks and valleys are consistent throughout the skin, giving it a uniform appearance. Unhealthy skin, however, does not have a uniform texture. Examples of texture-related skin problems include:

bumps

acne

blackheads and whiteheads

wrinkles

scars

3. Hydration

Healthy skin is hydrated skin. We've all heard the advice that we should drink eight glasses of water a day. Drinking water is vital for good health, but you definitely don't need to be drinking eight glasses of the stuff a day. A good rule of thumb to follow is to drink half of your body weight in fluid ounces. For example, if you weigh 130 pounds, you should try to drink at least 65 fluid ounces of water a day. This will keep your entire body, not just your skin, in great condition.

Dead skin cells are constantly shedding away, but it's not noticeable to the naked eye. However, when skin is dehydrated and too many skin cells shed at the same time, skin appears visibly dry. It creates problems like:

flaking skin

scaly skin

4. Normal Sensations

If your skin is healthy, it shouldn't feel like it's there. You shouldn't be able to notice it unless you're looking into a mirror. Healthy skin doesn't feel any unusual or uncomfortable sensations. In other words, has your face ever felt dry and tight after washing it? Dryness and tightness are unusual sensations, and in this case, those sensations were triggered by a cleansing product that is too harsh for the skin.

If you notice the skin on any part of your body feels strange, a product — like shaving cream or a body lotion — could be to blame. Signs of unhealthy skin sensations include:

itching

burning

stinging

pulling

tightness


text:
A simple initiative in the Philippines is bringing a bit of brightness into the lives of the country's poorest people.
This clip is brimming with classroom potential. Development is a key component to this clip, but it could also become a service learning project as students adopt a great project to help others in more difficult financial situations. Learn more about the project at: http://isanglitrongliwanag.org/
Via Seth Dixon


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Is BF3 worth getting?
Re: Is BF3 worth getting?
Excellent game. Ok Story mode. Awesome online multiplayer!
If I didn't have PS Plus, I would have bought it myself. And don't stop there, There are other great games on Plus too.
Re: Is BF3 worth getting?
DKTA- wrote:
I was planning on starting my year of PS plus this weekend so I can buy time quicker with a ton of games. I was wondering if BF3 is worth getting PS+ for. Is BF3 still very active, no hackers?
Uh, if you want a game with no hackers, play offline. They exist on every game in some form. BF3, even for the campaign, is well worth the price of free.
You're getting a year od PS+, anyway. Use it. I download everything, even if I don't want it. I can delete the game, and keep the license, so, if I am ever REALLY bored, I am covered.
Also, do not forget that the Summer Blast sale started last week. The PS+ discounts are insane.
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Re: Is BF3 worth getting?
Heck yeah. For me it's a pain in the butt to play this game because I'm using a standard TV and so I'm getting shot by people who I don't even see because they're so blurry I think it's a tree or a boulder. Still doesn't stop me from playing, Team Deatchmatch usually solves this problem with small maps and quick XP. Well worth the money and a very awesome game, story mode was alright, but multiplayer is deffinetly something to brag about.
Reformed Xbox Player (6/23/13)
Online/Co-op: Battlefield 3 - Saints Row 3 - Killzone 2&3 - LittleBigPlanet Racing - FFXIV [Beta]
Re: Is BF3 worth getting?[ Edited ]
Battlefield 3 is deffinately worth it, it's still just a great Game, but I dunno...
I probably would not want both BF3 & BF4....
There are a lot of Simularities, & BF4 has that Levolution comming...
I would probably just wait till BF4 comes around... No?
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Re: Is BF3 worth getting?
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Re: Is BF3 worth getting?
What I mean is, you don't really need both BF3 & BF4, there almost the same Game...
The only difference between the two is that BF4 has Submarines & Levolution now...
If you want both, thats great, but once you start playing BF4, you probably won't have any reason to Play BF3 anymore, oO
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60 capsules x 400mg of Laboratory assayed Calcium Hypochlorite powder
Our water purification product packaging includes a heat seal that ensures 100% airtight shipping and storage for the 60 x 400 mg capsules per bottle. We have made great efforts to ensure the correct specification of capsules that were capable of withstanding the content thereby improving shelf-life, as inappropriate materials can result in thin and brittle walled capsules.
Calcium Hypochlorite quickly forms Hypochlorous Acid when added to water. Although the capsules are said to contain only Calcium Hypochlorite, the actual breakdown is Calcium and Chlorine making up a minimum of 65%. The balance of the material is mostly salt, with minor amounts of Chloride, Hydroxide and Carbonate. We went to great lengths to find the highest quality source we could, and the quality isn't about the percentage of available Chlorine. This isn't pool shock granules, and doesn't contain the same binders that granules contain.
To purify drinking water: The contents of one capsule added to 50 litres of water will kill most known pathogens. Leave the water for at least 30 minutes before drinking to ensure sufficient time for the product to get to work.
Our water purfication capsules have a wide range of uses from disinfectant to preserving cut flowers. Some survivalists use it as a more stable product for water purification (has a longer shelf life). If you should choose to use this product in other ways, such as on your farm animals for any reason, be sure that it drinks a large amount of water immediately before and after consuming in order to ensure the conversion to hypochlorous acid in its stomach(s).
Almost any product can be dangerous if used incorrectly, so we encourage you to do your own research and make your own decisions. Just as chocolate can be fatal to a dog, lettuce contains arsenic, colloidal silver is classed as a pesticide, and mercury is purported to be safe in flu vaccines, we must each be careful in our research, distilling good information from bad, and making our own informed decisions. Be aware at all times how information is framed to produce a reaction from the reader, and draw your own conclusions.
We wish you well in your research, and a successful outcome in your aims.
Wishing you health and happiness,
Mineral-Solutions team
Click here to see our range of products


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To mark the Starfury Highlander gathering, we are delighted to announce extra shared Outlander Day Tours. Check availability and book. … Read on
Outlandish Gathering UK
To mark the third Outlandish UK gathering in Scotland, we are delighted to announce we will be running extra shared Outlander Day Tours between 16th and 23rd May 2016. … Read on
Linlithgow Tours
Join our local expert on a tour of the historic Royal Burgh of Linlithgow, as we meander in the footsteps of Mary Queen of Scots. Ideal for visitors and locals alike, you will discover hidden gems … Onward!


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Shower Curtain
THE GIRL WITH THE DRAGON TATTOOby Mike Wrobel
20% Off + Free Shipping Today!
Customize your bathroom decor with unique shower curtains designed by artists around the world. Made from 100% polyester our designer shower curtains are printed in the USA and feature a 12 button-hole top for simple hanging. The easy care material allows for machine wash and dry maintenance. Curtain rod, shower curtain liner and hooks not included. Dimensions are 71in. by 74in.


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Red Hot and Blue Chip
Real Estate New Jersey Magazine named The Schonbraun McCann Group one of the "Best Places to Work."
September 20, 2007
Sponsored by The Schonbraun McCann Group
Leading Advisors to the Leaders in Real Estate
The Schonbraun McCann Group (SMG) is a national consulting firm dedicated 24/7 to real estate and finance, with offices in midtown Manhattan, New Jersey and Florida. With 22 partners and a staff of approximately 250 professionals, SMG offers an unsurpassed breadth and depth of services to meet the increasingly complex needs of the real estate and finance industries. The firm represents leading public and private real estate entities including more than 80 real estate investment trust (REITs), financial institutions, banks, opportunity funds, insurance companies, rating agencies, hedge funds, and pension advisors. Some major clients include Mack-Cali Realty Corporation, SL Green Realty Corp., Vornado Realty Trust, Gale International, Broadway Partners, CB Richard Ellis Financial, Kimco Realty Corp., Credit Suisse, Douglas Emmett, Inc., U-Store-It Trust, DRA Advisors, Toys 'R' Us and The Praedium Funds, among others. The Schonbraun McCann Group is proud to play a key role in facilitating and executing some of the industry's largest and most complex transactions. The firm has been continually cited for its size, growth and performance. Inside Public Accounting ranked The Schonbraun McCann Group in the top 50 firms and was cited as the fastest growing firm in the U.S. for 2007. Crain's New York Business ranked the firm among the New York area's 25 largest firms, and Accounting Today named The Schonbraun McCann Group one of the "Firms To Watch."
Understanding the Whole Picture
The Schonbraun McCann Group bridges the knowledge gap between real estate, finance and today's "new order," providing expertise in business consulting, financial, tax, and real estate advisory services to clients within all sectors of the real estate industry. SMG's strong relationships within the financial markets assist its clients in raising capital to run or expand their businesses and in gaining access to deal networking opportunities and strategic introductions. As business advisors, SMG is actively involved in its clients' strategic decision making. As a proactive advocate for its clients, the firm is committed to providing every possible advantage to help clients meet their goals.
A Full Range of Services
SMG's comprehensive services include Mergers & Acquisitions, Real Estate Due Diligence, REIT Services, IPO Advisory, Tax Structuring & Compliance, Executive Compensation, State & Local Tax Services, Private Client Tax & Advisory Services, Restructuring & Bankruptcy, Strategy Group, Lease Consulting, Assurance Services, Hospitality, Litigation Support, Cost Segregation, Valuation Services, Wealth Management and Financial Outsourcing.
The Schonbraun McCann Group: Building Futures on a Strong Foundation
The Schonbraun McCann Group offers outstanding career opportunities for accounting, tax and finance professionals seeking exciting career growth. As a rapidly expanding, national real estate financial consulting firm — serving publicly traded and privately held clients who are industry leaders — SMG provides its blue-chip clients with expert advice and comprehensive services to meet all their complex accounting and financial needs. To fulfill its mission, the firm is continuously looking for a broad range of professionals including those just starting out as well as those with experience who are seeking new challenges. SMG offers many advantages including an energetic, dynamic environment; outstanding advancement potential; continuous technical and professional development; opportunity to work on high-profile transactions; direct access to the firm's management; comprehensive benefits package; and much more.
All SMG Professionals Are Key Players
SMG professionals work directly with clients and have ready access to SMG partners, many of whom come from Big Four firms or directly from the real estate industry. Everyone is an important player on the SMG team, with many opportunities to contribute to the firm's success. The bar is set high, but so are the rewards. Excellence is appreciated and recognized.
Growth Potential
At The Schonbraun McCann Group, people can grow as far as their talents take them. Many of SMG's star performers have risen through the ranks to become part of the management team. From day one, every member of team has the opportunity to help SMG clients build their businesses. At The Schonbraun McCann Group, recognition and advancement come faster than usual for those who demonstrate their dedication and abilities. SMG is a blue-chip firm with an entrepreneurial attitude, and that translates into significant advantages for those who stand out.
Click here to find out more about the exciting career opportunities that are available at The Schonbraun McCann Group.


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Dr. Hallowell's DISTRACTION Podcast
"Distraction," a new weekly podcast series hosted by Dr. Edward Hallowell, child and adult psychiatrist, New York Times best-selling author, and leading authority in ADHD, explores how we are driven to distraction.
Do you start googling a recipe and suddenly find yourself surfing through pages of kitchen gadgets and Pinterest pins? Are you checking texts and emails every two minutes? Are you overwhelmed by more than 500 TV channels or all the options in your connected car? Do you check your smartphone at 2:00 a.m. but don't know why?
At best, modern life dazzles us, giving us a chance to get more done in a minute than we used to do in a month. The entire world is available to us 24/7 at the touch of finger, but at what cost? Plain and simple, we are bombarded with distractions every way we turn, threatening the quality of our lives and our ability to properly focus on the tasks that matter.
Here's your survival guide to our crazy-busy, ever-connected modern world.
"Distraction," a new weekly podcast series hosted by Dr. Edward Hallowell, child and adult psychiatrist, New York Times best-selling author, and leading authority in ADHD, explores how we are driven to distraction and offers coping strategies to turn modern problems into new-found strengths. It's about insights, strategies and tactics for all, from those who occasionally lose their keys to those who spend hours online to those who wander away from a task – at work, at school, at home, at play – because they got distracted along the way.
Dr. Hallowell has been the go-to expert on ADHD and other distraction topics for Oprah, 60 Minutes, Doctor Phil, CNN, Good Morning America, Doctor Oz, The New York Times, USA Today, U.S. News and World Report, Time, The Los Angeles Times and many more top media outlets. He has written 22 books and sold millions of copies.
JetBlue Founder and Chairman David Neeleman has said that Dr. Hallowell is a master at describing "what is unique – both good and not so good – about today's exciting, busy world and gives practical, insightful advice on how to thrive in it. Dr. Hallowell captures both the huge opportunities we have today, as well as the dangerous traps we can fall into if we're not careful."
He tackles life's most difficult subjects like raising children, forgiveness, stress and anxiety, the workplace, teachers and students, difficult people, health, peak performance, and so much more. Come hear the warmth, enthusiasm, wisdom and trust of Dr. Hallowell as he taps into everyone's desire to cope, reconnect and get the most out of life.
United States


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Your Audi dealership isn't the only place to buy the best replacement parts for your 4000. It's not a regular occurrence that you discover you need a replacement Disc Brake Pads to fix your vehicle. Auto enthusiasts know that a reliable name is built into each Audi, and understand that only the highest quality repair 4000 parts will suffice when repairs are needed. When your Audi 4000 rolled off the assembly line, it was destined for a driver who prioritizes European styling in their automobile.
Your Audi 4000 disc brake pads are the result of decades of innovation and testing on race tracks before finally making their way to daily drivers. They provide a more effective style of braking through the application of friction than the brake shoes from decades before. You will find your vehicle's brake pads in the caliper situated around a portion of your brake rotor. Hydraulic pressure from your master cylinder is transferred to the caliper, and it pinches the disc brake pads onto the surface of the brake disc absorbing its energy. This transfer of energy slows your car or truck down, and eventually brings it to a stop.
Don't let a Disc Brake Pads repair bring about the demise of your car, truck, or SUV, and don't gamble with its condition by using anything but the highest quality repair parts. At Car Parts Discount, we have real customer support agents here with enough expertise to help you select the correct Audi 4000 part for your needs. When your Audi needs a new replacement Disc Brake Pads, there's no need to waste time looking anywhere other than the authority, Car Parts Discount. Audi 4000 Disc Brake Pads parts for 1987, 1986, 1985, 1984, 1983, 1982, 1981, 1980 vehicles are available here... just click your year to find them.


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Guest reviews
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Pillows Hotel puts you within a 10-minute drive of Magellan's Cross. Guests can visit the fitness center for a workout or grab a bite to eat at Pillows Hotel Cafe, which serves breakfast, lunch, and dinner. Rooms offer LCD TVs and free WiFi.


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x Click Here to subscribe to free job alerts! Join our BBM Channel on C00299C49. Follow us on Instagram @jobzillanigeria
5 Aug 2016
Graduate Sales Representative Job in Abuja at Fut Conceptus Manufacturing Nigeria Limited
by Jobzilla Nigeria at 8/05/2016 10:26:00 am Tags: Abuja Jobs , OND/HND/BSC Jobs , Sales Jobs
Job Title: Sales Representative
- Selling company products to current and potential customers
- Prepare action plans and schedules to identify specific targets.
- Customer service oriented, with the ability to meet sales goals
- A desire and ability to make sales
- Excellent verbal and written communication skills.
- Must be organized with good time management skills.
- Possess proven analytical/problem solving solutions for the customer and the company.
- Computer proficiency in Windows and Microsoft applications.
- Previous cold calling experience.
- Experience in developing and executing territory sales strategies.
- Possess strong presentation, negotiation, and closing skills.
- Must be self-motivated and able to work independently to meet or exceed goals
- Ability to maintain a neat and presentable personality
- Strong persistence in dealing with people and not giving up easily
- Possess self-confidence, positive mentality, with the ability to manage territories effectively
- Strong product knowledge, client relation, and presentation skills
- Ability to learn the art of professional greeting and attracting passive customers as well as show passion to follow-up calls and sales activities
- The applicant must reside in Abuja.
- Minimum of OND, Bachelor's Degree in Business, Marketing, Sales or related field preferred.
- Minimum of 2 years working experience in field sales with a proven track record of success.
- One year of experience in a customer-facing sales role (business to business).
How to Apply
To apply, please send your CV to firstname.lastname@example.com
Application Deadline 10th of August 2016
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You can also join our interactive and interesting JobZilla BBM Channel by clicking C00299C49.
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|Reviews for Doris Gets Drunk
| carrie chapter 1 . 7/21/2009
i don't get it.i'm sorry but maybe you should try actually writing a paula abdul and simon cowell fanfic,ormaybe a stevie nicks and lindsey buckingham 's what i thought it was to begin of all i don't give critism.i give constructive please don't take it to heart you would really be a better writer if you would have better characters.i would really consider trying fanfic on saula [simon and paula].i know you think i'm a little obsessed with the two but i always have been and always will i say saula dude!i think alot of people will agree that even though paula and simon are not really a couple[as we know of]they are so in love!but please just check saula will say saula
| The Mysterious Reader chapter 1 . 9/10/2003
Damn, some of those other reviews are pretty nasty ... and a couple of them look like they've been written by the same person. Could be a wrong take on the whole thing, but I think you have a petty little enemy trying to dig holes for you there, guy.
Anyway, I personally liked this little fic. It's weird and off-the-wall, but it's written well and is easy to read ... and it got me to laugh which, I think, was the whole point in the fic.
Thanks for sharing it with us, even though there are those of us out there who don't understand what a sense of humor's for ... that, or they can't keep personal issues from getting in the way of quality critiquing.
| Anonymous chapter 1 . 1/8/2002
So, Doris gets drunk and steals an SNL comedy routine. This is not worth calling a fic. Or yours, for that matter.
| shadow kei chapter 1 . 1/4/2002
interesting o.0
| La Atressa chapter 1 . 12/1/2001
| Drewd09 chapter 1 . 11/30/2001
Nice but extremly f***************. i wouldn't mind a longer 2nd chapter
| stubborn all-star chapter 1 . 11/28/2001
i like tex-mex. it's good cause i live in texas and i'm half mexican
| Priest chapter 1 . 11/18/2001
it is a good thing you did not put this in your story. on its own it is kind of funny though. keep wrighting please.
| o chapter 1 . 11/17/2001
I want some wine, damn it. Your stories sound as if they're written by redundant potheads. Several of them. Keep trying, maybe you'll make it to sea level one day. And oh yes, no one cares about the exact dates and times your lame stories were written. Have a nice existence.


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Politics blog + Banking
Politics live with Andrew Sparrow Scottish parliament debates call for second independence referendum - Politics liveSinn Féin politician and Northern Ireland's former first minister dies aged 66
Politics live with Andrew Sparrow Scottish parliament debates call for second independence referendum - Politics liveSinn Féin politician and Northern Ireland's former first minister dies aged 66
The Financial Conduct authority wants to 'engage individually' with major banks: a relief for bankers, but not for anyone else
Politics live with Andrew Sparrow Hodge tells BBC chief Rona Fairhead to resign in HSBC hearing: Politics Live blogAndrew Sparrow's rolling coverage of all the day's political developments as they happen, including Ed Balls' speech on Tory spending cuts and David Cameron's speech on education and family
Andrew Sparrow's rolling coverage of all the day's political developments as they happen, including David Cameron and Ed Miliband at PMQs, HMRC officials being questioned by MPs about the HSBC revelations and the Commons debate on HSBC
As PM warns of economic red lights, it's fair to say UK's tax and spending policies are his fault, but not long-term global problems
Scottish independence blog New poll has Scotland rejecting independence by four-point margin – as it happenedAndrew Sparrow and Ben Quinn's rolling coverage of all the developments in the Scottish independence referendum campaign, including Alex Salmond holding a press conference
Michael White: London mayor is playing with fire in badly judged appeal to dubious intelligence of London's Gordon Gekko species
Manchester speech of PM took a 'steady-as she-goes' path of aspiration, blinkered to the woes of Poundland Britain
Michael White: Nigel Lawson's and Nigel Farage's anti-EU arguments are as muddied as the Scheldt harbour
Michael White: The main parties may need to pour themselves a stiffener: Ukip has gone way beyond being a mere protest-vote party
Scottish independence blog Scottish banknotes: the Treasury's symbolic hostage in the independence debate
The Treasury is releasing a critique of Alex Salmond's plans for a post-independence currency union between Edinburgh and London, raising doubts about Scotland's cherished home-grown banknotes
Andrew Sparrow's rolling coverage of all the day's political developments as they happen, including George Osborne's speech threatening to break up the banks
The loyalists' rolling riot is a reminder of the dangers of complacency in the face of widespread alienation
Refusing to vote is generally no statement of principle, as a tale of two citizens has reminded me. Let's call them Chris and Crisp'
Where are the customers' yachts? The lawyers have themMichael WhiteMichael White: Libor rigging may spotlight casino banking, but PPI mis-selling shows the staid high-street side is no stranger to scandal
Paul Owen: Life imitates art (again) as business secretary's big idea echoes micro-bank proposed in Saturday's episode of BBC2 political satire
British targets can be tempting for American regulators, but in the US it's often a case of 'do as I say, not as I do'
Politics live with Andrew Sparrow Bob Diamond questioned by MPs on Barclays Libor scandal: Politics live blog
Andrew Sparrow's rolling coverage of the day's political developments, focusing on Bob Diamond being grilled by MPs from the Treasury select committee on the Barclays Libor scandal and PMQs
Michael White: Among stories of the Bollinger brigade, the lottery rapist and Mr and Mrs insider trading, good citizens are hard to find
Shareholders – that's us – have asserted themselves against the executives and their exorbitant rewards
Michael White: At both RBS and the News of the World bad practices were badly supervised and inadequately regulated
Nicholas Watt: Treasury contingency planning for eurozone crisis envisages a run on the banks in Italy and other troubled economies
Michael White: The 'rogues' are those who get caught while people presiding over systems that go wrong say: 'How deplorable'


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Finance Minister P Chidambaram told newspersons here that a recommendation by the Empowered Group of Ministers to levy the one-time fee on the telecom firms was approved by the Cabinet.
Accordingly, incumbent GSM-based operators holding beyond 4.4 megahertz will pay a fee that will be determined during the upcoming auction of GSM airwaves on Nov 12.
Since not even a single CDMA-based operator is willing to participate in a similar auction, the Finance Minister said that the Department of Telecom will see how much the CDMA-based operators which hold spectrum beyond 2.5 megahertz should pay as one-time fee.
The GSM-based operators which hold over 6.2 megahertz will pay a retroactive fee for the spectrum from Jul 2008. The companies can pay the fee in monthly instalments at an interest rate of 9.75 per cent, he said.
Those operators unwilling to pay the one-time fee "will be given an option to surrender spectrum beyond 4.4 megahertz for GSM", the Finance Minister added.
The government had planned to raise a whopping Rs 40,000 crore from the GSM and CDMA auctions. The base price for 5 megahertz of a pan-India GSM spectrum was set at Rs 14,000 crore while the base price for CDMA was set at 1.3 times that of the GSM spectrum.
However, the withdrawal of Tata Teleservices and Videocon Telecommunications from the CDMA auction meant that only the GSM auction will be held on Nov 12.
OneIndia News


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|Jan 13
|Jean Claude a French Protestant divine.
|Jan 28
|Johannes Hevelius a councillor and mayor of Danzig , then part of the Polish-Lithuanian Commonwealth. As an astronomer he gained a reputation as "the founder of lunar topography" and described ten new constellations, seven of which are still recognized by astronomers
|Feb 3
|François de Créquy marshal of France.
|Feb 3
|Bernhard Keil a Danish Baroque painter who became a pupil of Rembrandt.
|Feb 16
|Charles Cotton an English poet and writer, best known for translating the work of Michel de Montaigne from the French, for his contributions to The Compleat Angler, and for the influential The Compleat Gamester attributed to him.
|Mar 19
|René-Robert Cavelier Sieur de La Salle a French explorer. He explored the Great Lakes region of the United States and Canada, the Mississippi River, and the Gulf of Mexico. La Salle claimed the entire Mississippi River basin for France
|Mar 20
|Margravine Magdalene Sibylle of Brandenburg-Bayreuth Electress of Saxony from 1656 to 1680 as the wife of John George The daughter of Christian, Margrave of Brandenburg-Bayreuth, and Marie of Prussia, she was by birth a Markgräfin, or Margravine, and a member of the Brandenburg-Bayreuth branch of the House of Hohenzollern.
|Mar 22
|Jean-Baptiste Lully an Italian-born French composer, instrumentalist, and dancer who spent most of his life working in the court of Louis XIV of France. He is considered the chief master of the French baroque style. Lully disavowed any Italian influence in French music of the period. He became a French subject in 1661
|Mar 28
|Constantijn Huygens a Dutch Golden Age poet and composer. He was secretary to two Princes of Orange: Frederick Henry and William II, and the father of the scientist Christiaan Huygens
|Apr 12
|Ambrose Dixon an early American Quaker pioneer who was born in England and emigrated to the America at an early age where he lived in the Virginia Colony before moving to Maryland.
|Apr 16
|George Villiers 2nd Duke of Buckingham an English statesman and poet from the Villiers family.
|Jun 16
|François de Beauvilliers 1st duc de Saint-Aignan a French military leader, administrator and man of letters. He was peer of France and a member of the Académie française
|Jul 19
|Laura Martinozzi a Duchess consort of Modena. On the death of her husband, she became the regent of the Duchy in the name of her son, Francesco
|Sep 1
|Henry More an English philosopher of the Cambridge Platonist school.
|Oct 13
|Geminiano Montanari an Italian astronomer, lens-maker, and proponent of the experimental approach to science.
|Oct 18
|Pietro Liberi an Italian painter of the Baroque era, active mainly in Venice and the Veneto.
|Oct 21
|Edmund Waller an English poet and politician who sat in the House of Commons at various times between 1624 and 1679.
|Nov 5
|Ioannis Kigalas a Greek scholar and professor of Philosophy and Logic who was largely active in Padova and Venice in the 17th-century Italian Renaissance.
|Nov 14
|Nell Gwyn a long-time mistress of King Charles II of England and Scotland. Called "pretty, witty Nell" by Samuel Pepys, she has been regarded as a living embodiment of the spirit of Restoration England and has come to be considered a folk heroine, with a story echoing the rags-to-royalty tale of Cinderella. She was the most famous Restoration actress and possessed a prodigious comic talent. Gwyn had two sons by King Charles:
|Dec 16
|William Petty an English economist, scientist and philosopher. He first became prominent serving Oliver Cromwell and Commonwealth in Ireland. He developed efficient methods to survey the land that was to be confiscated and given to Cromwell's soldiers. He also managed to remain prominent under King Charles II and King James II, as did many others who had served Cromwell


text: SAN DIEGO, July 23, 2013 /PRNewswire/ -- Mast Therapeutics, Inc. (NYSE MKT: MSTX) today announced results of its thorough QT/QTc study of MST-188, an investigational agent being developed to treat serious or life-threatening diseases with significant unmet needs, such as sickle cell disease and acute limb ischemia. The study met its primary endpoint and demonstrated that, based on analysis of electrocardiograms, MST-188 did not have an adverse effect on cardiac repolarization, as measured by prolongation of the QT interval. MST-188 was generally well-tolerated at both therapeutic and supratherapeutic doses. Brian M. Culley, Chief Executive Officer, said: "I congratulate our clinical operations team for successfully executing the first clinical study of MST-188 since we acquired the program. The results from this trial augment the safety data supporting MST-188 and our belief that MST-188 will demonstrate a favorable risk/benefit profile in our on-going Phase 3 study in sickle cell disease, as well as our planned Phase 2 study in acute limb ischemia." Details of the Thorough QT/QTc Study The study was a single center, four-period, four-way cross-over, placebo- and positive-controlled, double-blind, randomized clinical trial in healthy volunteers that compared the effects of MST-188 at therapeutic and supratherapeutic doses to placebo and moxifloxacin (an antibiotic known to prolong the QT interval) on cardiac ventricular repolarization, specifically, Fridericia's corrected QT-Interval (QTcF) from the surface electrocardiogram. The primary endpoint was to confirm a lack of effect of MST‑188 on QTcF. The QT interval represents the time required for the heart to repolarize after each beat. As prolongation of the QT interval may increase the risk for cardiac arrhythmias, the FDA requires a QT study for most new drugs. A QT study is a specialized clinical trial designed to assess whether an investigational medication has the potential to prolong the QT interval.


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Fishing is a popular activity among the tourists visiting Nahan. There are various lakes and ponds that are home to various kinds of fishes likes Brown Trout, Rainbow Trout, and Mahaseer. Among ponds Pakka Talab is an eminent destination for fishing. Visitors need to pay a small amount, which is around INR 100 per rod, to the authorities.
Tell us what do you think of Fishing
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NYC Subway Stories Creative Writing Workshop
Patricia Philippe
Sunday, August 3, 2014 from 11:00 AM to 2:00 PM (EDT)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
Ever wanted to observe folks on the NYC Subway and make up stories about them? Are you curious about the stories you'll find on a NYC subway platform or train? Have you wanted to take a creative writing class just to try something new? Are you looking for something exciting, quirky and different to do on a Sunday? Here's your chance.
Years ago, I wanted to be a documentary filmmaker. I imagined picking someone and following them to capture the story of their lives. Well, I never became a filmmaker. But I did become a writer.
So many of my poems, blog posts and observational essays were written on the train. Join me for an afternoon of observing and writing. You'll need to have a sense of adventure, the flexibility to adapt to changing circumstances and an open mind. We'll write using prompts, share our work and offer each other positive and encouraging feedback. The workshop is open to adults 21 and over whether you consider yourself a writer or not.
This workshop is also a fundraiser for my upcoming volunteer trip to Malawi, Africa to lead writing workshops for orphaned girls and village women. Learn more about it here.
Are there ID requirements or an age limit to enter the event?
Open to adults 21 and older.
What are my transport/parking options getting to the event?
I will e-mail you the meeting location on Friday. We will begin/end in Manhattan, not necessarily the same spot.
What can/can't I bring to the event?
Notebook & Pen - Don't bother with devices. We'll do this the old-fashioned way.
Cash for lunch
Where can I contact the organizer with any questions?
Patricia Philippe - email@example.com. Reference NYC Subway Writing in your headline.
Do I have to bring my printed ticket to the event?
What is the refund policy?
No refunds.
The name on the registration/ticket doesn't match the attendee. Is that okay?
You must contact me to explain why.
When & Where
New York,
Sunday, August 3, 2014 from 11:00 AM to 2:00 PM (EDT)
Add to my calendar
Patricia Philippe
Patricia Philippe is an AWA Affiliate, certified to lead workshops in the AWA method as described in Writing Alone & With Others by Pat Schneider, Oxford University Press. She is a Haitian-American Writer whose work addresses themes of truth, showing up authentically in the world and boundaries imposed by others as well as ourselves. Patricia is the founder of NYC Subway Stories Creative Writing Workshop and was formerly a Managing Editor of Kalyani Magazine, a literary magazine whose mission is to help women of color discover and share their strong, unique voices.


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From Our Editors
Thanks in large part to its "great food," The Beer Haus landed a first-place spot on Akron Life's 2012 Best of the City list in the New Restaurant category. Diners sidle up to the bar for a gander at more than 100 regional and international microbrews or cozy up in the casual dining room for German-inspired food, custom burgers, and spirited rounds of Wagner's entire Ring Cycle. With 21 high-definition TVs, pool tables, and dartboards, The Beer Haus maintains a steady buzz fueled by sports, brats, and the occasional barfly.