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The Banquet
by Michael Wilmot
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I love hosting dinner parties. Preparing food, cleaning the house and all of the seemingly endless details around having guests for dinner brings me joy. I would rather have fifty people come to my home than going somewhere else for dinner.
I think this is because everything I need, all the aspects of living that are positive exist in my home. My home is tailored to fit for me and my family, designed specifically to fulfill our needs and desires. It is not perfect, nothing on earth is, but it is home and that word means so much more than house.
The day before Easter my wife and I decided to invite a family for dinner. This kind of spontaneous no-planning living is common with us so we sprang into action and the realm of barely controlled chaos began. I worked on the menu while my wife and two children launched an assault on the house. Laundry was being processed while I completed the inventory of supplies and marking the shopping list. Off to the stores we went, she to Costco for steaks and me to a market for the small stuff.
Arriving back home I began to fret over the timing factor the next day. It was Sunday, and Easter Sunday at that. We serve in various parts of the ministry and having enough time to get the work done was an issue. The solution was to do as much preparation Saturday night that we could.
I prep cooked a chicken and walnut stir fry, slow cooked Swedish Meatballs, roasted some of Idaho's finest for twice backed potatoes, and marinating steaks while my daughter worked on a spice cake and peanut butter cookies. Around the time we were preparing the table God's invisible hand entered the room. My wife said, "We should use the new flatware from Christmas". This was a great idea since we purchased the flatware just for dinners like this.
The gleaming flawless flatware changed the entire picture of the table. No longer did our everyday plates look so well and as I was frowning at them my wife surprised me with two boxes of new plates. She had received those months ago as a gift and just never had a chance to use them. Adding these to the table made a huge difference. The serving dishes were replaced with precious crystal and white porcelain and before long what started as an everyday dinner table became a fancy banquet.
Sunday came and the rains held back until the last steak came off the grill. Our guests arrived just as the last preparations were completed and the delight on their faces made all the effort worth it. We sat down to enjoy a feast of food and fellowship and the evening was filled with laughter and joy.
Of course the activity of the night was so intense that I did not appreciate the message God was sending to me. It took me until Monday to figure out that in our little dinning room God was showing me what he is doing in Heaven. My family and I had prepared a banquet ahead of time on the chance that we would have guests come join us for a feast. Anything could have happened to ruin our plans but we walked forward in faith that the event would be joyous. We set a table, prepared food and did all that we could to make it the best of what we had to be a blessing to our Christian family members.
Jesus said he has gone to prepare a place for us in Heaven and it will be the best that He can offer. He is working on the odd chance that some will show up and enjoy it with him. I look back and remember the joy we had in putting our dinner together and I picture how Jesus feels towards us. The blessing I received by seeing this picture was priceless and humbling.
The next time I am working till 1:00 am to play host I will remember my Father in Heaven working on that special place for all of us in his Kingdom.
Copyright Michael Wilmot May 2005
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Stephen Fry on QI, religion, knowledge and why Sherlock Holmes was wrong
"The beauty of the brain is that you can be as greedy as you like for knowledge and it doesn't show"
Knowledge is power, said Francis Bacon, so Stephen Fry has the whip hand over Radio Times. That's because among the Bodleian Library of facts, quotations and ephemera Fry has cached in his almost visibly pulsating brain, right now there is one thing he knows with more conviction than any other: he will not be giving an interview to Radio Times.
Fry does not read newspapers. He says he hasn't for years and now it seems he has given up talking to them. Not that RT is a newspaper, but we're all tarred with the same brush: being beastly to Stephen. "I'm sorry, I don't do print interviews," he explains politely, while fiddling with his latest toy, his Blackberry Z10 (or is it his iPhone 5, or Samsung Galaxy SIII or LG Nexus 4? He has them all). "I say one thing and then another appears. It's just not worth it."
For a man who has given up talking to the press, we know a lot about him. He has written two volumes of cracking autobiography (and still only reached the end of his 20s – there are another 25 years to cover), he has a Twitter feed followed by over six million, he blogs like a man possessed and has his own website that's visited by more than his Twitter hordes. And he is never off the television. Somewhere down the on-screen TV guide QI, the Quite Interesting quiz he hosts, is always playing, as if on a permanent loop – the latest 16-part series starts next week on BBC2, themed around the letter 'K' – and that's not to mention his occasional documentaries on everything from the City of London to the Amazonian manatee to being loudly and proudly "90 per cent gay".
A week after we meet he will confess to an attempt at "self slaughter" during a bout of depression (he suffers from cyclothymia, a form of bipolar disorder) and soon after that he will start a one-man campaign to force the IOC to move the 2014 Winter Olympics from Sochi because of Moscow's growing reputation for clamping down on gay rights. He really is very voluble about a lot of things. But not to RT.
Eventually we reach an accommodation. I shall ask questions that begin with the letter "K" – just like the show – and restrict myself to questioning Fry on Knowledge.
As we sit side by side on the photographer's sofa he launches into answers as if giving an interview was absolutely the only thing in the world he wanted to do, sweeping his hair to one side with a trademark nervous tic. He is a very big man, fidgeting with energy. Physically tall – 6ft 4in – nose spread across his face like a heavyweight champ, with middle-aged paunch pressing at the buttons of a shiny blue shirt. "As I age, my metabolism slows down to the extent that I seem to put on more weight the less I eat – and it shows," he says, his luxuriant sentences pouring forth like honey from a jar. "The beauty of the brain is that you can still be as greedy as you like for knowledge and it doesn't."
As he settles into the sofa, he has the air of a gentleman don, or perhaps, thanks to his bright shirt and beneficent smile, a Church of England bishop relaxing with a sherry after evensong.
"My favourite quotation, which would surprise some, is from the late Michael Ramsey, who was Archbishop of Canterbury when I was a boy – my mother always used to say, 'Do you know he's the same age as Cary Grant?' – and he was accounted a very wise man. When asked to define wisdom he said, 'Wisdom is the ability to cope.' There are people from the Kalahari desert to the Arctic wastes who may not know much, but they can cope and are wise. But knowledge is very different."
Launching into roundabout answers, tossing in allusions and quotations, some of which are so obscure I later struggle to source them (if he was making this stuff up, who'd know?), there really is no stopping him once he starts talking.
"Sherlock Holmes professed complete ignorance about the components of the universe. He said, 'What difference does it make to me whether the earth goes around the sun or the sun goes around the earth? It makes no difference to me or my work.'
Holmes believes the mind is like an attic room. All the information must be stored neatly and tidily, and if you fill it up with excess lumber you won't be able to get to the things you need. Well, I think, both experientially and neurologically, that he's completely wrong!"
Does he never lose a fact under excess lumber? "I do have a theory that – like with age, when it hurts a bit more to pick something up – sometimes to retrieve a memory takes a bit longer than it used to."
Now 55, some might say Fry has had it easy, enjoying the fruits of a classically privileged education – Uppingham public school, Queen's College Cambridge, admittedly with a spell at Her Majesty's pleasure in Pucklechurch Prison sandwiched in between (he stole one of his parents' friend's credit cards as a teenager). "When people say, 'I haven't had a classical education so I don't know who Sisyphus was…' I can assure you, nobody I was at school with did, either! You have already made the mistake of blaming the school, and it's like saying, 'I had a terrible geography master, so I hate the Lake District.' But that's what people say about Shakespeare."
As a child growing up in rural Norfolk he read voraciously and he has been picking up books – he currently has 11 on the go – and facts ever since. "Being isolated in the country as a child, having asthma and chronic insomnia, I spent my time just reading and reading. My father was a physicist and my mother is a ferocious reader, so the house was full of books and there was a mobile library that ame to us every second Thursday… I was incredibly fortunate, as someone who is regarded as being fond of gadgetry, which I am, to grow up in a world without any! I didn't have a television in my bedroom; all I had was books and a light!"
Is there anything he doesn't know?
"People often tell me that I shouldn't call myself an atheist, I should call myself an agnostic because I can't know there isn't a God, and therefore I must be agnostic. Bertrand Russell answered this one brilliantly many years ago. He said [adopting silly voice as he paraphrases], 'Many things are beyond the realm of absolute knowledge in any sense, but let me put it to you that there is a teapot orbiting Venus in such a manner that we will never be able to see it. It is obscured from our vision. Now, if someone were to tell me that there were such a teapot, I could not demonstrate to them that they were wrong, but I would be perfectly within the limits of orthodox practice and sense and, I would say, philosophical rectitude, if I were to base my life, perfectly happy, in the belief and certain knowledge, as certain as knowledge as can be, that there is no teapot revolving Venus. And that is why I call myself an atheist."
Perhaps religion is merely an accumulation of knowledge born of human experience, of how to live the good life, rather than a way of explaining the origins of the universe. Isn't that what Archbishop Ramsey was getting at? "No, he's not saying knowledge is wisdom; he's saying that wisdom is the ability to cope. There are people in the Kalahari desert who are wise. They might not know anything of what we think of as knowledge, or much of it… they might not know the component theory of the universe, for example – but that doesn't mean they can't cope… there have always been wise people who are ignorant."
How about closer to home? Does he think Britain is awash in a sea of ignorance? "Knowledge is always driven by thirst, you see. You may think someone who hasn't heard of Marie Curie is ignorant but if you talk to them about Spurs, they will suddenly come out with a detailed knowledge and understanding of their love of football which shows their brain is filled with the things they want it filled with. Now the problem, as a society, is that we are perfectly happy for people to fill their brains with stuff about Spurs, but the crying shame of it is all these beautiful minds in the world are not being given enough to engage on."
Is that the schools' fault? "Yes! But don't blame the teachers – Jesus, I wouldn't blame the teachers for anything, it's the most extraordinary thing they do [Fry taught at a prep school during his student holidays]. They are currently undertaking a comparative study of French and British primary education, and the French come out so much better. French schoolchildren, if you see them, are so much more well-behaved and engaged in what they are doing, and concentrating. Admittedly the French economy is in a bit of a mess at the moment but they are, I think, generally speaking, demonstrably a better-educated race.
"A lot of it is at the right age, somehow getting that gear, that cog fitting that excites a child, that makes them feel pleased with themselves for achieving and for knowing." Perhaps he thinks education secretary Michael Gove is onto something with his proposal to create a school curriculum full of facts? "I think he's absolutely onto something. I don't think he means knowledge for utilitarian purposes – or I hope he doesn't."
Some would say a little knowledge is a dangerous thing… "I should remember the full quotation, really!" he jumps in, unable to stop himself. "It's Pope, isn't it? 'A little learning is a dangerous thing; drink deep, or taste not the Pierian spring…' Don't sip at it, I think is what it means. In a sense, yes, of course, a little knowledge is a dangerous thing when it comes to bomb defusing. There are things when you have to know the full package. But knowing a bit about the Jacobite revolution isn't dangerous."
Actor, writer, quizmaster, comedian… what could he have done if he had concentrated? "As Oscar Wilde said, if you know what you want to be, you will become it – that is your punishment. If you know you want to be a judge or a soldier or a grocer or a lawyer, you will become one. But if you never know what you want to be, what he calls the dynamic or artistic life, then every day you will be different and that is your reward! For some people, of course, that punishment is a reward and that reward is a punishment."
Is that how he has lived his life? "Not deliberately, but it seems so. It's just that there are some of us – and maybe it's to do with mental illness – who just can't be a particular thing. Fenollosa reduced it to the phrase, "We are not nouns, we are verbs." You don't say, "I'm a manic depressive," you say, "I've got bipolar disorder." I've got. I know it's a small thing, but it's a big thing, too, because that's us – we are changing, forever."
And here endeth the lesson. It may be Stephen Fry's final interview, but it's clearly not his last word. Thank God – or is it a teapot? – for that. Without his extraordinary mind, television would be a less interesting place.
QI returns on Sunday at 10:00pm on BBC2

subset: commoncrawl


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Business and Accommodation in Bloemfontein
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Choose MassHire for your Plant, Tool or Scaffolding needs. We hire tools in Mossel Bay, George, Ellisras, Bloemfontein and Port Elizabeth.


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Back to all reports
Street light not working
Reported via iOS in the Street lighting category anonymously at 18:26, Thu 28 November 2019
Sent to East Sussex County Council 4 minutes later
Street light not working. Number 4 on the lamp post
Provide an update
Please note that updates are not sent to the council. Your information will only be used in accordance with our privacy policy


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How often do you eat?
When I eat, I look at the clock and try not to eat again for a minimum of two hours. I eat three meals a day and at least three snacks a day. I feel it is better to have multiple healthy snacks than get to the point where I feel like I am starving. I don't want to end up sitting on the couch eating a big bag of chips while watching all the tempting food commercials on TV. Doing something else with my hands, such as knitting or crocheting, helps to keep my mind off of food.
What do you drink?
Water, milk, and occasionally a little bit of 100% juice or hot chocolate. I have never liked coffee, tea, or alcoholic beverages. Lemonade and smoothies (unless you make smoothies yourself) usually have too much sugar in them. I haven't found regular or diet soft drinks or sports drinks to be a good beverage choice.
What are good sources of protein?
I eat full fat versions of milk, cheese, cottage cheese, and yogurt. I also eat eggs, nuts, and a variety of meat, such as: ground beef (I usually buy 93% lean/7% fat), steak, pork chops, ham, bacon, sausage, pepperoni, chicken, turkey, roasts, and stew meat. The key is being conscious of serving sizes and the added sugars in foods high in protein, like yogurt.
Are you currently taking any kind of diabetes medication?
No. However, I did buy an inexpensive glucose meter with all the testing supplies at my pharmacy. It is simple to use and it allows me to monitor how I'm doing instead of waiting to get tested at my doctor's office once a year.
What is your current A1C level?
The last four A1C tests I have taken have been between 6.0 and 6.4 which is in the prediabetic range. (updated 2/12/20)
What size plates do you use?
Five ounce paper cups, dessert plates, ramekin dishes, small plastic containers, and snack size zipper baggies are my best friends, because they help keep my portion sizes small.
When you do exercise, what do you do?
Yoga at https://anywhere.alchemy365.com/
What results have you seen?
When I lower my sugar intake:
1. I do not get as many migraine headaches.
2. I do not need to drink as much water during the day.
3. I do not need to urinate frequently.
4. It is easier to bend over.
5. My clothes are not bursting at the seams.
6. My PMS symptoms are not as severe.
7. I rarely get heartburn.
8. I have less pain and inflammation.
Single Use Plastics:
When buying ingredients that come in single use plastic packages, containers, and bottles, make sure to recycle or dispose of it properly so it does not affect the environment negatively.
What abbreviations did you use on your website?:
g = grams
lbs. = pounds
oz. = ounces
PMS – Premenstrual Syndrome


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Vaporizers & E-Juice
Our knowledge and experience is the key to our service. Without it, we would just be like every other vape shop.
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From the United Kingdom across the seas or from the United States of America across the border. If they have good candy, so do we!
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It all started in a small town of Alberta named Westlock. We have received a lot of support from the community in aiding smokers to reach their goal. Together we have prevented countless smoking related injuries and associated deaths. Since day one, we have had to fight the media outlets by shining light on the real facts of vaping, and thankfully have had a lot of support from the organization VAEPWorld!


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Is it possible that the small decisions we make throughout the work day directly affect our high-level cognitive functioning and professional performance at work? The science says, "yes!"
The Cookie and the Radish
Decision Fatigue
Real World Impact: The Legal System
Real World Impact: Doctors and Patients
Jarrett Green, Esq., M.A. Psychology, is a former business litigator, who now works with companies, law firms, and other entities to help reduce employee stress and turmoil, improve employee engagement and fulfillment, and optimize employee performance and success. He also serves as an executive coach, and a law professor at USC Law School, where he co-created the "Mindfulness, Stress Management, and Peak Performance" program. You can contact him at firstname.lastname@example.com, and learn more about him at www.Jarrett-Green.com.


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Weaver tells crossing the Plains – part 2
By Jan Lawrence
Editor's note: This is a continuation of an article about Susan Weaver McAbee's crossing the Plains, which started two weeks ago in the newspaper.
Susan Weaver McAbee continues: "It was after we had continued along some distance that a rather amusing thing happened. Our band of horses were [sic] led by a bell mare. One night, Mac (Susan's husband, John Wesley McAbee) was lying out in the open near where the bell mare was staked out. We knew the Indians were about and always placed a watchman for protection.
Mac was neatly covered by tall grass but was so situated as to be able to see all about him. At some little distance, he saw something move. It might be a bush, and it might be an Indian. He could not tell, so he waited. It was an Indian, and he watched him stealthily approach the stake, which held the bell mare. Mac believed that shooting the Indians was no way to aid the White Man's cause, so did not shoot, even though the Indian no doubt intended to steal the band. Mac was very close to the stake towards which the Indian was approaching, in fact, directly in front of it.
As the Indian bent over to pull up the stake, Mac was up, quickly shooting: 'What are you doing here?' The Indian straightened up also, but so quickly as to nearly lose his balance. He recovered as quickly, though, and drew himself up, stoically facing what he evidently supposed to be a speedy trip to his Happy Hunting Ground. 'Wigwam lost,' he said. And Mac questioned him again. Of course, Mac did not believe him, but at any rate, he signified to the Indian that he understood him to mean he was lost. The Indian was disdainful. He replied, 'No, Indian no lost. Wigwam lost.' This expression flavored our speech for many days.
Mac would not kill the Indian then, nor later, though he was urgently requested to do so by the other men. He brought him a prisoner to camp, gave him something to eat, and made him lie down in front of a fire that was kept brightly burning directly in front of our own wagon. I had a big Newfoundland dog that hated Indians as he hated no other thing. Mac placed my dog to guard the Indian. And there they lay all through the night stretched out, facing each other. The Indian with his eyes closed and the dog jealously watching for the least movement.
Mac told the Indian if he moved the dog would tear him to pieces and I think the Indian believed him, for he never moved…never turned nor lifted so much as a hand the whole night. The Newfoundland gave a vicious growl at the least pretext. This may have had something to do with his passivity. I think he also knew Mac kept him covered with his rifle within the wagon, although he, too, pretended to be asleep.
The next morning Mac still refused to kill him. Instead, he gave him breakfast, food to carry with him, and told him to 'find Wigwam.' I can see that Indian yet. A tall fellow, powerfully built, natively clad, with such a calmness about him, as he turned his back upon us and slowly walked away into the woods. Four days after this, this same Indian, his chief, and quite a few others came up to our train.
They made offers of friendship, many speeches which we took to mean gratitude, and the chief, with much ceremony, presented Mac with such a fat and pretty pony. 'For the White Man's mahali, he said. Mac could not be prevailed upon to accept the pony. I whispered to him to please take it but he would not. He was afraid the pony had been trained as a decoy and would lead our horses back to his own village. Perhaps he was right. I do not know.
From One Hundred and Ten (this refers to the longitude of 110 degrees near Gallatin, Montana) we crossed and continued along the South Platte, crossing 'The Little Blue', a river narrow and very swift, and finally reached Fort Kearney, which is, I think, about three hundred miles from One Hundred and Ten. In the Platte we had to swim six oxen to keep our wagons from sinking in the quicksand. Although 'The Little Blue' was narrow, we had to ford our wagons here, too, because it was so swift. In fact, all major rivers between One Hundred and Ten and Fort Kearney had to be crossed by swimming the cattle and fording the wagons. The swimming oxen were placed in the lead, men riding on either side using long whips with which to turn them when it was impossible to do otherwise.
Author's Note: Part three will be about Mac's greatest loss.


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Elijah Hutchins-Everett talks to HG Insider on his Southern Jam-Fest experience & more
Related Links
Class of 2020 big man Elijah Hutchins-Everett is one of the bigger names at the Southern Jam Fest for the 16u level. With his talent and potential he has the likes of Syracuse, Villanova and more actively recruiting him. With We R1 being one of the most talented teams on the east coast, they have high aspirations for this season.
Q: What's it been like playing with WeR1? It looks like you guys have built up a lot of chemistry?
A: "It's great playing with them and we share the ball we don't care who scores. The only thing we are here for is to get the win, play defense and just play together and have fun."
Q: What do your coaches expect from you on the court?
A: "They all expect me to dominate and do anything to help my team. They don't care if I score all of the time. They just want me to be productive and just play my game."
Q: What would you say the biggest difference between you this year from last year?
A: "I'm trying to prove that I'm one of the best players out here. I've been working hard this season and have been playing for two hours after school every day. I've been trying to prove myself since I came over here."
Q: You are becoming more of a complete player with how well you are shooting the ball. Is this something you have been working on?
A: "I've started to put a lot more arc on my shot and have worked on my touch. I just have a lot more confidence in myself."
Q: What guys at the higher level have you tried to emulate your game after?
A: "I've tried to emulate Anthony Davis, the most dominant player out there. He doesn't care who he's playing against, he is going to get a triple-double every time he plays.
Q: If you were to describe your game to someone. What would you tell them?
A: "I would say I'm an all-around player. I can shoot, pass and also play defense. I also have improved on how I'm dribbling the ball."
Q: You have won your first game here. With it being such a high level event, how will it prepare you for the rest of the year?
A: "It means a lot to play in this because this is one of the best tournaments in the country. There is a lot of great talent with a lot of scouts here. It's a good opportunity to play here in front of everybody. I think this will help us a lot."


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We are so glad that you have chosen to visit with us. Our congregation is comprised of people from diverse backgrounds and life situations. However, we all have one very important thing in common. We are sinners saved by the grace of God. If you are seeking a deeper relationship with God or looking for a church home, we welcome the opportunity to talk with you.
"We are one people, serving one King, following one purpose."
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Sunday Worship 9:30am
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For more information, click here.


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Serena Buzios Resort
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Rua Campo de Pouso 1630, Buzios, State of Rio de Janeiro, Brazil. Rio de Janeiro.
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Rua Campo de Pouso 1630, Geriba, Buzios, State of Rio de Janeiro, 1630, Brazil. No need to try to vacuum up sand, and in general, this is typical of beach area places in Brazil. They also messed up our transfer back to Rio, but hired a complementary taxi to take us there to make up for it.
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The Serena Boutique Resort on Buzios peninsula offers airy, sophisticated rooms with wireless internet. … Brazil / Rio de Janeiro / Buzios Hotels. Serena …
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Raison d'être
Jump to navigation Jump to search
|Look up raison d'être in Wiktionary, the free dictionary.
Raison d'être /ˌreɪzɒ̃ ˈdɛtrə/ is a French expression commonly used in English, meaning "reason for being" or "reason to be".
Raison d'être may refer to:
- Raison d'être (band), a Swedish dark-ambient-industrial-drone music project
- Raison D'être (album), an album by Australian jazz fusion guitarist Frank Gambale
- "Raison d'etre", a song by Asriel (band) from the album Abyss
- "raison detre", a song by Japanese rock band Dir En Grey on the album Gauze
- "Raison d'etre", a song by Japanese rock band Nightmare used as opening theme of the anime Claymore
- "Raison d'être", a song used as the ending theme of the Chobits anime by Japanese singer and voice actress Rie Tanaka
- "Raison d'etre", a song by British rock band Buzzcocks from the album A Different Kind of Tension
- "Raison d'être~交差する宿命~", a song by Tomosuke Funaki under the alias Zektbach for the arcade game beatmania IIDX 17: Sirius
- Raison d'être, an American Ale brewed by Dogfish Head
| disambiguation page lists articles associated with the title Raison d'être.
If an internal link led you here, you may wish to change the link to point directly to the intended article.


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Evaporative humidifier are simple humidification solutions for small premises, warehouses, offices or showrooms,
as well as humidors and church organs which work on the principle of cold evaporation.
The air is drawn in through an air filter in the pre-filtered and passed over connection or water-wetted honeycomb filter discs. By their specific pore structure, a particularly large surface area is produced, which promotes a rapid evaporation of the water in the air.
The air
drawn by fan air flows through the honeycomb, absorbs moisture
and is fed evenly without precipitating the room again.
Depending on the system, the voter room humidity is controlled by a hygrostat or humidity sensor.
Installation and Integration
Hum Control
Water Evaporation
The dry air flows through a water-absorbing glass fiber matrix and takes the water vapor from the moist surface. this reduces the temperature and rises the humidity. this process is very efficient and consumes the least energy of all humidifiers.
HomEvap units can be connected directly to any HRV system using the HEX principle tp provide direct humidification and indirect adiabatic cooling


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This looks as though it would be well worth the look. Love the cover and description ⭐📚🔥👍💯👏
Casey Blane returns to the old coven's grounds to take her place as the high priestess to the Letorian Coven and in search for the lost talismans. What she discovers is far more than she ever could have envisioned.
Brought to a world of faeries and the magic of the Druids, Casey must learn to come to terms with herself and her gifts quickly to survive and change the prophecy. Her first battle is finding the Lucian Sword.
Casey Blane Series:
Over 400 years ago, King Davalian, The Letorian King, protected the covens from the Pandions and townspeople during the medieval times of the black plague and the witch hunts. Two very gifted sorcerers were part of his army and fought alongside him. One was a woman named Lily who not only helped him to victory but won his heart. Lily was not at all interested in King Davalian. Her love was Connell, the other gifted sorcerer.
During King Davalian's reign, Lily discovered the secret to eternal life through a series of talismans, a reborn vampire, which she tried on herself. Connell was to be next, and they were to live out their lives, each generation, with each other. Except, that night, things went horribly wrong and even though both had been blessed with eternal life their bond was never completed. Instead, in a jealous rage, King Davalian cursed Connell and forced him to an entity of being controlled by the moon and to never forget.
Connell was forced into a wolf, and after King Davalian's death, Lily became their queen. That was when a devastating prophecy of her great-granddaughter was told. Her great-granddaughter would be slaughtered by the King to the Pandions, the talismans were to be found, and it would be the demise of the Letorian Coven. The Pandions were destined to be the new ruling coven and destroy everything on its way to get there.
The series begins with Lily's great-granddaughter, Casey Blane, who has been kept hidden her entire young human life for them to try to change the prophecy until one day when she's discovered by the Pandions. What happens next will change her life forever.
~ Kindle


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Feb 11, 2020
Advanced technical course. Please also help design courses regarding bioinformatics concepts, applications and tools needed for biology students. Thank you.
Dec 16, 2018
The course has given me a great way to learn Bioinformatics. I especially loved the mode of teaching and the case studies.
By Muhammad S•
May 17, 2019
nice course
By CHENGKAILONG•
Jan 21, 2018
By 赵利杰•
Dec 02, 2016
very good
By shang l•
Jan 22, 2018
By 杜怡蒙•
Dec 07, 2017
By zhangguilan•
Dec 20, 2017
By Charity D•
Feb 10, 2017
By 张国成•
Nov 25, 2017
By Hlushchenko D•
Nov 04, 2019
Awesome course, helped me a lot. Most of information is useful and given in an understandable way. But several problems should be adressed: some reseources, like KOBAN, are inaccessible (at least for some countries, but i suspect that for all but China), so some question in the tests are only to be solved by random. Also, some lectures (i. e. those about using NGS software) are not useful or understandable at all, especially for non-chinese students.
By michaelcao1997•
May 01, 2020
By Akansha s•
Jun 13, 2016
I am looking forward to attend this course from China's number one university
By 何民强•
Nov 24, 2017
it is very useful for me and my classmates,which make our stady a lot.
By Manoj S L•
May 20, 2020
I learn many things. Thank you
By Eder A F L•
Aug 03, 2020
By 南书锋•
Dec 04, 2016
By 王思雨•
Mar 13, 2018
By Mo A•
May 15, 2020
I think its a very useful course and I definitely learnt a lot. They cover gene alignment, transcriptomics, identify potential databases/tools for searches too. However, the course is very theoretical and more angled towards computational specialists rather than pure biologists. It's a difficult balance to achieve admittedly.
By Julia F C•
Jun 18, 2020
Esta buenas las primeras clases, luego se complejiza aun mas,es dificil pero puede hacerse.No me gusto mucho la idea de realizar un examen a mitad del curso si ya uno tiene un examen final, no entiendo para que.
Mas alla de todo las clases y los articulos recomendados son muy interesantes.
By Hanna P•
Oct 20, 2020
Should be better presentations in English and tests mistake- and typo- free.
By Israa S S•
Feb 15, 2019
Not what I was looking for !


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Having faith "IN" God creates a photo in my mind of a faith that appears like it includes some kind of effort on my part in order for it to come to pass. It is the sort of faith we were taught we needed to have, and if we didn't have enough it would never ever work.
Bowie MD 20719 Inpatient Substance Abuse Treatment
Inpatient drug treatment is a location that you go to truly take an action off of the merry-go-round of addiction. A serene and tranquil environment is ideal, where you return in touch with the individual that you once were, the person that you've lost. It is a location that you will find yourself coming face to face with your addiction and preferably deal with to face with yourself, a location where you can start to enjoy yourself once again.
Private investigators believe the teenagers "never ever saw it coming," said authorities spokesperson Laura McElroy. Both were killed with a.38-caliber pistol. The arrest affidavit said the weapon was purchased five days previously, WPTV report.
Drug Inpatient Drug Rehab
Exactly what if we added a couple of more conditions on to that ad, so that in order to get that "Free" million dollars, you needed to find out how to walk all over again, you needed to spend three months in a inpatient rehabilitation centers, and had to have two more surgical treatments to repair complications and infections that occurred from the initial surgical treatment. Then on top of that, explain that their day-to-day activities would need to be forever changed and they might not play sports, run, jog, ski, play football, basketball and everything they preferred to do before the accident. How lots of people do you believe would still be standing at the door seeking that "Free" million dollars? Nobody.
When it initially becomes clear that someone we love is an addict, our first impulse is to conserve that person, but the fact is that no one can save the addict except for the addict. It's a challenging principle to accept, however one that everyone has to recognize ultimately. Absolutely nothing we do or state is going to change their behavior, and all we can do is enjoy as their harmful habits threatens to ruin them.
Moderate addiction for lots of people who smoke or consume typically, as they just take them as normal. You need to get severe about it if you discover that your life is overrun addiction. Dependency is not only irritating for you but for your family. An addict can sometimes strange, and his/ her health might not permit him to act/ or cause complete their typical day duties. Nevertheless, the good news is that now you canChoose amongst the many terrific inpatient drug rehab programs, which guarantees you a successful healing and health.
Inpatient Alcohol Rehab In Bowie Maryland 20719
There may be some funding help out there for you if your scenario needs a completely accessible vehicle. When you buy new wheelchair accessible lorries, most of the major car manufacturers that make convertible vans have rebate programs. There are state and regional agencies that might be able offer you a grant. Inspect your state Department of inpatient rehab for info. Regional community organizations such as clubs and churches might also want to assist.
By May 2007 she lost control of her cars and truck and it ran up on a curb. The Beverly Hills authorities discovered cocaine and that she was owning under the influence of alcohol. Lindsay Lohan then got in the Assures Treatment Center for 45 days, her 2nd effort at rehabilitation. She wore a SCRAM bracelet while she remained in outpatient care.
Did you know that the tension of coping with a life long addict can easily take 15 years off of your life? YOU! YOUR LIFE. NOT THEIRS !!! Have you utilized the expression "this is killing me"? It's true. Take control. Call a household meeting now.


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Construction crews in Los Angeles set a new world record for a continuous concrete pour, as the foundation for the New Wilshire Grand building (tallest building west of the Mississippi) was laid on Feb. 15. Read More>
This concrete pour is impressive, but from a technical point, the challenge is how do you cool it? That required over 19 miles of cooling tubes to lower maximum temperatures, and manage differential temperatures, preventing cracking. Read More>


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President Obama: Prove That You Are A Natural Born Citizen
What we have been shown, a Certificate of Live Birth, does not prove that you were born a natural citizen. This requirement is a Constitutional requirement. You cannot be President without it. It is so simple to produce and the Americans who pay your salary are demanding it, in court and in the streets. You are our employee; show us that you're not a fraud.


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Fanball Fresh
Gordon ready to go
Melvin Gordon says he's going to be ready to play this week despite not being fully healthy. This is great news for the teams that weathered the storm with him out.
Henry Does It Again
In Week Fourteen, Titans RB Derrick Henry set a franchise record with 238 rushing yards and scored four touchdowns. While there was no way he could repeat that performance, he did carry the Tennessee offense once again with a monster performance. Henry rushed for 170 yards and two scores, giving him over 400 rushing yards and six scores in the past two games and moving him up to RB18 for the season, despite many weeks of down performances.
Foster En Fuego
The Bills win a close one over the Lions and undrafted rookie WR Robert Foster came up huge again. Foster caught four passes for 108 yards and a touchdown. This marks the fourth game in the past five weeks in which Foster has posted at least 94 yards and it is likely to be his fourth game as a fantasy WR2 since his role increased to a near full-time player. Foster is the Bills clear WR1.
Ballage takes over
Dolphins veteran RB Frank Gore left the game early with an ankle injury and was unable to return. Although the initial thought was that this would lead to more touches for RB Kenyan Drake it was actually rookie RB Kalen Ballage who took over the lead role. Ballage led off the second half with a 75-yard touchdown run and added 48 more yards on 11 more touches, giving him an ending box score of 123 yards on 12 totes. We could be witnessing a transition to the much young Ballage.
Breida Aggravates Ankle Injury
The San Francisco Chronicle has noted Matt Breida aggravated his bum ankle in Week 15's upset win over the Seahawks. Breida seems to have Wolverine-esque healing powers given how many maladies he has played through this year, but an aggravation could portend missed time. Were Breida to sit, Jeff Wilson would be on the fantasy radar in Week 16, albeit in a brutal matchup against the Bears.
Gronk Quiet In Pittsburgh
After looking healthy and ready to be a playoff difference-maker following a disappointing fantasy regular season, Rob Gronkowski bottomed-out against the Steelers. His 2 receptions for 21 yards buried many an owner who had lined up Gronk in the semi-finals. Coming off a down year in which he battled myriad of injuries, Gronk's future is definitely a question mark.
Crowell to IR
Isaiah Crowell has been placed on IR leaving the Jets backfield open for Elijah McGuire and Trenton Cannon. McGuire should be the lead back, but neither are too enticing.
Djax to miss another
DeSean Jackson is set to miss his second consecutive game. Much last week, where the Saints shadowed Godwin with Lattimore and bracketed Evans… it will be tough sledding for the Bucs' WRs against a tough Baltimore defense.
OBJ out for week 15
This is a huge hit for playoff teams. OBJ is now ruled out for week 15 right in the middle of fantasy playoffs. The Giants will have to rely more on Barkley and Shepard this week.
Keenan Allen Departs
Oy vey. Allen was hurt, returned briefly, and then was taken to the locker room. Early word is a hip injury. It is a crushing blow to owners who had locked Allen in as a WR1 this week. We'll see if he returns for the second half, but it was a lost two quarters of action for the en fuego Chargers' receiver.
OBJ: Quad "Ain't Right"
Speaking Thursday, Odell Beckham Jr. referred to his quad as "ain't right", though a bit more colorfully. Reports are also streaming out saying Eli Manning is dealing with something similar in his right arm. A somewhat surprise inactive this past Sunday, Beckham's quad injury looks more serious than first believed. Obviously, his status will need to be watched closely leading into Sunday.
Tyreek Hill A Go
As expected. Hill was in and out of last week's game but still got his against an elite Ravens' defense. While Casey Hayward is generally a strong corner, he's had his issues with Hill. Even at a smidge less than 100%, Hill is a locked-in WR1 with his typically massive ceiling.


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"On the night of the 4th of May, a fire, supposed to be the work of an incendiary, broke out in the city of Hamburg, the great commercial emporium of Germany, and continued to rage till the morning of the 6th, when, by blowing up a number of houses with gunpowder, the progress of the flames was arrested. Several hundred lives were lost, from 1500 to 2000 houses were laid in ruins, and the total loss of property is estimated at not less than forty or fifty million dollars."[2]
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text: A variety of topics make up the training sessions ensuring to cover the needs of any startup. These topics range from product testing to customer acquisition to marketing & branding to basics of finance and accounting. Our workshops are practical, delivered by a mix of academics, entrepreneurs who learned through first-hand experience and business professionals who draw upon years of accumulated know-how and practice.


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My husband and I drove to Florida where I did a couple of television interviews. On July 23, I was honored to be on the Christian Television Networks's Homekeepers program with Arthelene Rippy.
Hostess of Homekeepers, Arthelene Rippy, left, with me before the show.
It aired Thursday, July 31 across their network that included a potential of 55 million viewers.T he subject, of course, was my book, Sweet Grace, and Sweet Grace study guide.
We had to travel to Tampa, FL for the interview. After three days driving, we arrived in Tampa late, Tuesday night and hadn't eaten. We were famished. After eating, we fell in bed. The next day I was to be at the studio at 1:30.
Roy went to take in the sights while I prepared, which mainly includes some heavy duty praying and a little makeup! I always stress about my hair. I'm really no good at doing hair, just ask my hairdresser. To top it off I forgot my hairspray and styling gel. I thought I put it in my suitcase but couldn't find it and Roy was gone.
So, I prayed about my hair. Yes, I did that. And actually it turned out good and stayed in place throughout the taping. It refused to stay in place when I fell with all my clothes on in the Gulf of Mexico.
Here's what happened. We went back to the hotel after the taping and changed clothes. We went for a drive down the beach. It was crowded and a little late by the time we got there so we were just going to find a place to go for a walk and take a few pictures.
We had to go a ways before we found a place to park with easy access to the beach. Roy, of course, went wandering off scouting for shells while I rolled up my pants and went to wade in the water.
Of course I had to have pictures of the sun setting, the sailboat in the distance and the three boys boogie boarding. If I just steppted one more foot closer I could get that awesome picture.
About that time, I guess a wave came up. I really don't know. The next minute, I was off balance and my phone had flown out of my hands. I lunged to grab it and fell right in the gulf, black jeans and all.
Then I scrambled on all fours fishing in the Gulf for my phone. All the time thinking, insurance will cover loss but not water damage. Still this thought in the back of my mind said, "You got water insurance last time remember?" I've only lost three other phones to water damage and so come to find out, I indeed do have water damage coverage.
Still the replacement phone was going to be shipped to my house so for the next five days I didn't have my phone. Which really is limiting when you run an online coaching business. Luckily I had my ipad, though it doesn't have a data plan. Because we're on a family plan, I was able to turn my husband's phone into a hotspot and keep up with what I needed to for my group. That worked only until we were in the hinterlands of Mississippi.
I looked like a drowned rat walking to the car. It was going to be at least an hour or more back to the hotel. I had the bright idea of going to Walmart to grab some shorts and a t shirt. I was set and miserable with white sand everywhere. He brushed me off the best he could. I refused to go into the Sam's we found looking like I did. However, I've seen the Walmart people photos and I figure if they could handle those people, they could handle me.
When we finally found a Walmart, it was only a grocery store! Oh well, I was pretty dried off by then. Back at the hotel I put my clothes in a bag. I had to wash those jeans three times to get the sand out of them.
Oh and Roy didn't see my major spill nor did he get any photos of the beach. Unfortunately the cloud wasn't fast enough to capture them either. So no beautiful photos only interesting memories.
Regarding the interview, I did not have questions ahead of time like I have with every other interview. I'm glad I had several interviews prior to this one so I wasn't freaked out. She did ask me several questions that no one else had asked before. I was sure there would be long pauses on the tape where I was thinking of what to say.
If there were, they edited them out well. The interview flowed well. I was happy with the way I answered all the questions even the tougher ones she asked.
Below is the Youtube link for the Tampa interview. I also did an interview at WHBR TV in Pensacola. Hopefully I'll be able to post that link later.
The first 10 minutes is a cooking segment and then the last part is the interview. Listen and watch here>>> http://ow.ly/zRoo7
One last thing, we had a great time in Pensacola at the interview there. We visited the air museum at the Naval Base, ate at LuLu's a great seafood restaurant on the Gulf Shore, I had another first in that I went in submarine. That was at the U.S.S. Arizona park in Alabama. If you know how claustrophobic I have been in the past, you will know this in itself was another fear on my list checked off.
We finished up the trip by attending the church Elvis grew up in, East Heights Assembly of God in Tupelo, Miss. We visited the actual building where he attended church and then went to the current version of the church. There were 18 plus Roy and I in attendance that Sunday, so not a growing congregation. Still they've been there for 80 years.
I must add this is the first time my husband and I have been on a week-long vacation just the two of us since we've had children. We had a great time together. I can't reveal any more details than that except to say, I sure do love my husband.
is Teresa Shields Parker's new group on living healthy through a total renovation of body, soul and spirit. Teresa chronicles her journey in the memoir, Sweet Grace, and the practical application workbook, Sweet Grace Study Guide. Also, get a free chapter of her memoir at Teresa Shields Parker.com. Connect with her there or on her Facebook page.


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Vi har lett rundt hele kloden, og fant ingen avganger som samsvarer med søket. Vis alle cruisereiser
Vi har problemer med å hente disse cruisereisene. Vis alle resultater
From the moment you arrive, you'll find that San Juan, Puerto Rico is bursting at the seams with unforgettable cultural discoveries. Every alleyway in Old San Juan offers a glimpse into a vibrant past that stretches back centuries, while monuments like the UNESCO World Heritage site Castillo San Felipe del Morro will make you feel as though you've wandered back in time. Dating back to the mid-nineteenth century, the beloved Paseo de La Princesa in the city's historic center is a great place to experience Puerto Rico's rich cultural heritage up close.
Puerto Rico is the third largest island in the United States, so it should come as no surprise that there's a beach here for every kind of adventurer. You'll find world-class surfing and plenty of water sports in Rincon on the island's west side. Secluded shores with crystal clear waters and colorful coral reefs on Flamenco Beach in Culebra. Family-friendly beaches with plenty of cafes and shopping along star-studded El Condado — nicknamed 'The Rivera of the Caribbean.' And an Instagrammer's paradise in Vieques Playa Negra, which draws beachgoers from around the world with its unique black sand.
Craving a bit of retail therapy? Puerto Rico has plenty of options. The boho-chic neighborhood of Santurce is your go-to for shops selling some of Puerto Rico's leading local designers. If international designers and high-end boutiques are more your style, you can spend hours browsing the storefronts in glitzy El Condado. And on Cristo and Fortaleza Streets in Old San Juan you'll find some of the best souvenirs and artisanal souvenirs on the island — think finely-crafted lace and jewelry, hand-rolled cigars, colorful guayaberas, and Puerto Rico's brightly-colored papier-mâché vejigante masks.


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Login to your account
LDL is the type of cholesterol that can lead to complications. Simvastatin works to inhibit the action of an enzyme known as MMG-CoA, which controls the production of cholesterol in the liver. As well as lowering production, Simvastatin helps with the absorption of LDL in the liver, which means that a lower quantity of cholesterol is able to sit in the arteries.
High-density lipoprotein (HDL) is another type of cholesterol that is not damaging to the body; in fact it is crucial to the production of certain hormones. Simvastatin helps to increase its levels.
It is available to buy from 121doc in four doses: 10mg, 20mg, 40mg and 80mg. The dose you are prescribed will depend on the severity of your condition, although patients usually begin the treatment by taking a lower dosage. The medication should be used in conjunction with lifestyle changes, which include lowering the amount of saturated fat in your diet and increasing your exercise. The most effective way to use it is taking one dose in the evening before you go to bed, as that is when the body usually produces the most cholesterol.
It is often prescribed to people who present high levels of LDL that cannot be lowered through lifestyle changes alone. It is also prescribed to patients who are at risk of cardiovascular disease due to hypertension or diabetes.
Some people may not be able to safely take Simvastatin, which is why it is important to mention any existing medical conditions or current medication to your doctor during a consultation. Women who are pregnant or breastfeeding will not be able to take it and other people for whom it may not be suitable are those who suffer from diabetes, heart disease, kidney or liver problems.
People taking Simvastatin are at risk of experiencing some side effects. However, the symptoms are usually mild and temporary and can include muscle pain, nausea, headaches or cold-like symptoms. If you experience more serious side effects for prolonged periods of time you should consult your doctor as there may be a different form of medication that is more appropriate for you.
Yes, it is available to buy online from 121doc. As this is a prescription medication, you will need to complete a free online consultation that will allow a medical professional to ensure the medication is safe and effective for you to use. Once you have been issued a prescription, we will dispatch your medication using a free overnight delivery service so that it reaches you the next day.
For more information about the treatments and symptoms of high cholesterol, visit the high cholesterol treatment page.


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- Ashton Rail
Madison & Clay // Wedding
Updated: Mar 19
"Take my hand, take my whole life too
For I can't help falling in love with you"
Dresses - Tesori Bridal
Wedding cake - Ricks Bakery
Tux - Mr Tux
Flowers - ZuZu's Petals
Venue - Kindred North
Their Love Story
Clay's Perspective:
Madison isn't only my wife she's my best friend. She's never let me down and she's never thought once of giving up on me. She's the smartest person I know and she gives me a reason to love. And more than anything she's good for me, she keeps me in line and for someone like me that's a big deal.
Madison's Perspective:
I met Clay at a firework stand that I always work at during the summer. We introduced ourselves and after he left I made a decision that somehow I would see Clay again. So one day a few months later when my sister, Sheena and her husband, Justin, got invited to Clay's house, I was like "Hey can I come?" so I went over with them and after that it lead us to where we are today. It's crazy when I think about how young we were when we met, and we're still young but we've changed A LOT in the past 5 years. If I didn't have Clay by my side these past years I don't think I'd be the woman I am today. I thank him for that and I also thank him for sticking with me because I know I can be tough sometimes. He's my social butterfly and I never want him to leave my side because he helps me feel relaxed and more comfortable and I need that. He truly makes me a better person.
#2018 #wedding


text: Vinny Troia, Cyber Security Expert and CEO of Night Lion Security, interviews on the Willis Report on Fox News. There is a discussion on the fact that cyber security is only getting worse as time goes on. Companies are loosing 100-200 million dollars from data breaches and they don't think it is a problem because their annual revenue is 9 or 10 billion dollars. Companies are beginning to budget data breaches, just like how they would for shoplifting. Companies need to be proactive and look into cyber security before getting breached.


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Similar Content
By abbytherookiehuman
hey everyone so i know this is a shrimp forum but im betting that most of the people on here have fish too
im a school student and ive decided to design a new breeder box that beats the flaws of other existing products for my major work
i was hoping you guys could just reply with what method or model of breeder box you use to save your fry, what kind of fish you use it with and any pros and cons of these methods
thanks in advance for any replies.
By Flynn002
Hi, I am doing a project for my college course:
How does temperature affect the number of fry a cherry shrimp produces?
I have setup a small 18L nano tank and it's currently cycling. When ready, I am planning on taking 1 male and 1 female cherry shrimp from my main shrimp tank and putting them in the new tank. and waiting until I see eggs. I will then remove the male and when the eggs have hatched, or when the babies are big enough to see, I will count them.
I will then repeat this with different temperatures.
it seems like it will all work in theory and I have 1 year to do this so time is not an issue. The only issue I see is that I'm unsure how Will I accurately count the fry?
This is vital for my project and if anybody has ideas I would greatly appreciate it.
cheers :)
By Crabby
Hey everyone,
I was recently (meaning today) given the opportunity to set up a breeding tank for some native inverts (or some harder to breed fish I guess, but I want to go for shrimp) in a fishroom I help out in. I've been trying to decide what native shrimp I want to try breeding, but then I remembered that it's not as simple as exotics. Can I get some input from the 'experts' (@Grubs, @NoGi, @Baccus, @fishmosy, @jayc of course, I know most of you aren't very active anymore, but I would appreciate your help if you see this message) on what native invert you guys think is easiest to breed (for a semi-noob who hasn't kept natives before). I can set it up as brackish I think, we have an archer fish tank there and are setting up a saltwater as well so should have access to those tools and materials.
By YoloDaBolo
By sky99
Hello everyone!
I bought some pintos, and i did put them with my other bees (some panda, some king kong, some blue bolts).
However, i can't seem to find if pintos do breed true (in that case, should i separate them? or will those mix with the others
to make cool new paterns, colors, etc?)
I have a hard time figuring what bee breed true if any.
I've read that bee are a mutation of CRS/CBS, but do they produce similar offsprings or is it more random as an interaction of
multiple genes?
Thanks in advance for the help!


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The CORSAIR Lighting Node PRO provides individually addressable LED lighting with software control for unique lighting effects and vivid illumination of your PC. The four included lighting strips feature ten RGB LEDs per strip and magnets to maximize the lighting potential and ease installation. Dual channel operation allows for expansion of up to four strips per channel or the addition of a set of CORSAIR HD RGB fans (sold separately). Combining the CORSAIR Lighting Node PRO and LINK software give you full control over your case lighting right from your desktop.
• 1x CORSAIR Lighting Node.
• 4x Individually addressable RGB LED strips.
• 4x RGB LED extension cables.
• 2x HD RGB LED fan hub adapter cable.
• 1x Mini USB cable.
• 2x Mounting tape.


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The most important relationship you have is with yourself. Self care should not be an option, but rather a priority. Whether it's your nutrition, fitness, stress, balance, or any other area of your life, you need to take time to give yourself what you need before you can take care of others.
You don't have to know everything. You can and should ask for help in the areas you need it.
Knowledge is power..it sounds cliche, but it's true. The education and knowledge I have gained in nutrition and wellness as well as the partnerships I have created in fitness and overall health has empowered me to manage my health with a holistic approach as well as help others do the same.
If you are looking to learn more about how you can improve your health and wellbeing, let's talk about where you are now, where you want to be, and how to get you there.
Thanks for stopping by,
Jess Turner
Fitness Partnership
Recking Crew Fitness are old school, evidence based trainers and coaches.


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Since January 1st you've been able to request your free $40 voucher for a digital-to-analog converter for grandma's old CRT TV. Well, Crave is saying don't act so fast. You still have plenty of time and market logic states that you'll get a better converter for a lower price over the next year or so. Right now the choice is rather limited — I've seen a few models from Zenith but that's about it — and you could conceivably pay a bit over that $40 if you're not a particularly savvy shopper.
Personally, I'd just get grandma a new plasma and leave it at that. You'll never get to see In Treatment in HD on an on Trinitron from 1988.


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Free shipping on all orders over $35!
Free shipping on all orders over $35!
As a special educator and single mother of 3 girls, I absolutely understand the grind and sacrifices that moms make trying to "do it all" for their children. Amazed by how fast my daughters are growing and developing into "little women," caring for them and acknowledging their individual needs and talents has become my number one focus.
This process hasn't been easy, but as I created solutions to address my daughters' needs, I found a world of other moms searching for some of those same products for their children and even themselves. The Adorably Me team is looking forward to sharing our products with you and your family.
Adorably Me
"Created with you in mind."
As much as I love to help you and my children with the creation of body balms and use of essential oils please remember that I am a mother and a teacher NOT a physician.
Please keep in mind that anything I say or post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on any of our social media platforms. We love our customers and want you to be happy and healthy for many years to come.


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Porsche Centre Bristol technician Patrick Foley has done his bit to help the RNLI - and didn't even get his feet wet!
Supporting As They Travel Through The South West And Wales
Patrick stepped in to support the RNLI 911 Challenge when the team travelled through the South West and Wales as part of their mammoth fundraising adventure to visit every RNLI lifeboat station in the UK - in 911 hours in a Porsche 911.
Visiting Portishead, Penarth and Weston-super-Mare
He was on hand when RNLI supporters Belinda and James Richardson arrived in Portishead on their way from Penarth to Weston-super-Mare lifeboat stations.
He checked the car over and made sure it was in tip-top condition for the South West leg of their epic journey, which culminated at Tower lifeboat station in London at the weekend (September 30).
Bronze Technician Patrick Has Been With Dick Lovett Group For Four Years
Patrick has been with Dick Lovett Group for four years and currently works as a Bronze Technician at Porsche Centre Bristol. He is working towards his Silver accreditation which he plans to take in February.
More information about the RNLI 911 Challenge can be found at http://www.rnli-911challenge.co.uk.


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Dissertations are listed in DiVA.Calendar RSS Subscribe to calendar
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Online: Additive manufacturing: challenges and opportunities for business models
Additive manufacturing is changing how we design, manufacture and use both existing and new products. In order to benefit from this new technology, we need to have a complete understanding of its potential, including the ones related to business modelling.
ZOOM SEMINAR: Knowledge and Curriculum in the Changing Landscapes of Higher Education
A seminar on the topic "Knowledge and Curriculum in the Changing Landscapes of Higher Education". The talk will be followed by Q&As. For more information and the zoom invitation, please see www.swedishcollegium.se.
Amerikanska rasrelationer och Sverige
Death at the End of the Rainbow: Rethinking Queer Kinship, Rituals of Remembrance and the Finnish Culture of Death
Varpu Alasuutari defended her PhD in gender studies at the University of Turku, Finland on June 5, 2020. In her dissertation, she has examined death and loss as parts of queer and trans lives in Finland from the 1980s to the 2010s. Her research interests include queer kinship studies, queer death studies and feminist affect theories.
MIRAI 2.0 Kick-off and COVID-19 webinar
The MIRAI consortium is a group of Japanese and Swedish universities including Uppsala University that promote collaborations between our researchers. If you are interested in learning more about MIRAI or Swedish and Japanese perspectives on COVID-19, please join us for the kick-off meeting celebrating the new phase in MIRAI (MIRAI 2.0).
UppTalk Weekly: Nano-material for third-generation solar cells and thoughts about moving back to Uppsala
Our guest in this UppTalk Weekly is Anders Hagfeldt, proposed as new Vice-Chancellor for Uppsala University and the professor whose solar cells have the world record in efficiency. We will talk about his research on his research on Grätzel and perovskite solar cells, the third generation of solar cells, but also about his new position and moving back to Uppsala.
Unpacking the coloniality of power nexus in Indian surrogacy
This talk explores the historical legacies of colonialism to contemporary forms of reproductive labour in India.
The Indo-European Roots of the Ancient Scandinavian Horse Sacrifice
This is an event of the research programme LAMP – Languages and Myths of Prehistory. The talk will be followed by Q&As.
ZOOM SEMINAR: Polish Post-war Linguistics between East and West: From the Legacy of the late Russian Empire, to Marxism, Structuralism, and Post-structuralism in the Context of a Semi-peripheral Autonomy
Tomasz Zarycki, Johan Peter Falck Fellow at SCAS and Professor of Sociology at the University of Warsaw will present a comprehensive and tentative overview of the evolution of Polish linguistics (as well as selected developments of the Polish literary studies) after 1945. The seminar will be followed by a Q&A.
Webinar: Ergonomics for students
During the pandemic, many students are forced to study from home, which can be difficult for both mind and body.
Children and child-centeredness as social mechanisms in father-to-father relations during parental leave
This presentation explores, from a feminist and critical realist perspective, whether and how children and child-centeredness function as social mechanisms in father-to-father relations.
AI4Research: Open talk on AI for research and new results on deep regression
Open talk by Professor Thomas Schön. In the first part he will discuss and show how AI/ML can be used for research in classical areas of natural science and medicine. In the second part he will discuss a new approach to deep regression.
Digitala förbindelser: Rum, riktning och queera orienteringar
NB this seminar is held in Swedish
The Most Consequential Election of Our Time? A Panel Discussion on the American Election of 2020
Discussion arranged by three units at Uppsala University: the Swedish Institute for North American Studies (SINAS), Uppsala Forum for Peace, Justice, and Democracy, and the Uppsala Association for International Affairs.
The Most Consequential Election of Our Time? A Panel Discussion on the American Election of 2020
The United States faces multiple challenges and the election campaign has been extraordinary. How can we make sense of it, and what can we say about the outcome?
Equal Opportunities Day in English for Employees and Students at Uppsala University
How can the University better include and involve international co-workers and students? The University's Equal Opportunities Day in English is focusing on internationalisation on the home front – how the University works to improve the reception, support, inclusion and integration of its international colleagues and students.
ZOOM SEMINAR: Constitutional Democracy and the Corporation: From Republican Liberty to Oligarchy
David Ciepley - Global Horizons Fellow at SCAS and Associate Fellow at the Institute for Advanced Studies in Culture, University of Virginia, Charlottesville - will present a new analytical, historical, and normative framework for understanding business corporations and will address the question of whether a corporate economy can be made compatible with constitutional democracy.
Innovation Tuesday
Take the next step on your innovative journey! Join our inspirational seminar series about innovation and entrepreneurship aiming for a healthier society.
Frigörelsen. Romers och resandes emancipation i Sverige och andra länder
Liberation. Romans and travellers emancipation in Sweden and other countries.
Gendered territoriality and the contemporaneity of colonialism in present-day Brazil
This talk explores the gendering of land in relation to modern/colonial temporalities and to a nation-state myth in which the post-colonial turns into ideological justification for continuing colonialism.
Tim Berndtsson – PhD Dissertation Defence
Section for Rhetoric
Development studies at Uppsala University celebrates 50 years!
The first course in development studies at Uppsala University was offered in 1970, 50 years ago. Development studies has since grown – today it is a subject of its own in the Department of Government.
To celebrate the anniversary and to reflect on where we have come from and where we are going, Development Studies organises an afternoon seminar on Wednesday 11 November 2020, 13.15-16.45.
Messy trans experiences in Norway and the paradox of legal gender recognition
The questions guiding this presentation are: What impact does legal recognition of one's gender identity have on one's sense of self? And, is the law really as progressive for trans people as it appears to be?
Trans and Sex Change in Contemporary Iran: A Socio-legal Study of Gendered Policies and Practices
Zara Saeidzadeh completed her doctoral degree in Gender Studies at Örebro University, Sweden on June 4, 2020. In her doctoral thesis, she examines the lives of trans people who undergo sex-change surgery in Iran from a socio-legal perspective. She now teaches and works as a researcher in Gender Studies at Örebro University. She is also a research associate at Simone de Beauvoir Institute, Concord
The toxicity of industrial/breadwinner masculinities; when climate change denial and white supremacy meet
This presentation will scrutinise a particular emblematic example of how anti-environmentalism and anti-feminism today overlap; that of Greta Thunberg.


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Saga – Viking Bondi unit 2
Tonight I put the finishing touches on my last 8 Viking Bondi (warriors). That's right, I am now the proud owner of a fully painted 4 points of Saga. I'll have to get a group photo at some point.
When we left off, I'd put in a couple evenings of paint, and the Bondi were looking like this:
Day 4: more paint, plus some dirt on the ground!
Day 5: finished up any still unpainted spots, but mostly a bunch of shades and washes. I don't think I snapped a picture of that.
Day 6: some detail work (including shieldwork), and some light drybrushing to give the hair, fur, and dirt some depth.
They're starting to really look like something at this point.
Although they can't look at anything themselves. No eyes just yet.
Day 7: Day the last! Eyes and blood! Here's a few of them before and after the finishing touches:
And one final group shot:
Up next: the Gal Gaedhil (Sons of Death)?


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King of the Cage Returns to Socorro Entertainment Center on October 31 for "THUNDER"
RANCHO CUCAMONGA, Calif. (September 23, 2015) – King of the Cage will return to Socorro Entertainment Center in Socorro in Socorro, Texas for the fourth time in 2015, with another action-packed, world-class Mixed Martial Arts (MMA) mega-event, headlined by a lightweight (155 pounds) showdown between Misael Ynarritu and Harvey Park on Saturday, October 31, 2015.
This also marks the first of a new fight deal with the Socorro Entertainment Center, which is one of the premiere venues for MMA in the southwest, thanks to Karl Maahs, GM and the Ysleta del Pueblo Sur.
The main event in the 155 lb. Lightweight Division will feature Misael Ynarritu (5-0) from El Paso, Texas (10th Planet BJJ) battling Harvey Park (2-1) from Clovis, New Mexico (Force of 1 MMA). Ynarritu has finished four of his opponents in the first round.
In the co-main event in the 125 lb. Division, Jesus Urbina (6-2) from El Paso, Texas (10th Planet BJJ) will do battle against Jerome Rivera (4-0) from Albuquerque, New Mexico (FIT NHB). Urbina has won 6 of his last 7 bouts and is an exciting fighter with world-class BJJ skills. Rivera is one of the fastest rising young stars in MMA, with all 4 of his professional wins coming in the 1st and 2nd rounds and was also undefeated as an amateur.
One of the featured bouts will be:
- Adrian "Killa" Cruz from Rio Rancho, New Mexico (Judgement MMA) vs. Joseph David Veloz from El Paso, Texas (Independent)
- Cynthia "Sin" Arceo returns to the cage to fight for the King of the Cage Amateur Women's Strawweight Title Belt.
Also appearing on the card will be local favorite, Alex "Candyman" Diaz along with Albuquerque's Jayme Hinshaw, who puts her perfect record on the line against Shyanne Farmer (3-1) in another highly anticipated female bout.
Other fighters on the card include Victor "Bullet" Trujillo, Travis Arrellano, Khari Snowden, Amanda Estrella, Fabian Mata, Jasmine Rodriguez and more.
This event will be broadcast in over 50 million U.S. households on MAVTV (DIRECTV Ch-214, Verizon FiOS Ch-810). Check your local cable provider for cable station in your area.
Doors open at 5:30 pm. and fights start at 7:00 pm. Reserve seating and Ringside tickets are on sale now. For more information or to purchase tickets, go to www.holdmyticket.com. Or call (505) 507-0309. Event card subject to change.
Nuyelo is dedicated to providing healthy supplements to athletes and those seeking to enhance a healthy lifestyle. We give the best tasting, most effective, and balanced nutritional supplements ever!
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CONTACT Darya Postoeva for professional assistance:
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The Saskatoon fire department, with help from the fire crews of neighbouring communities, were able to bring a large brush fire west of the city under control Saturday afternoon.
According to a fire department news release, crews — which included one engine company, a brush truck and a tanker truck — were dispatched to the fire near the intersection of Highway 14 and Range Road 3074 after receiving a 911 call just after 12:30 p.m.
Once crews arrived at the scene, they were greeted by fire crews from Asquith and Delisle and the three departments then separated the fire into three zones to prevent the blaze from entering nearby farm yards.
The fire department says that the blaze is now under control and fire operations are now winding down.
The cause of the fire is currently unknown and no damage estimates have yet been determined.


text: My friend, Patti and Kelly went to the movies with me on Wednesday. There are no spoilers here, just raves about how wonderful it was. It's called Yesterday. Such a nice movie. Sweet with a perfect sound track and I was so happy while watching it, I thought I would burst. They need more movies like this. :) Too often, I get carried away with my Marvel Movies and DC Movies that I forget that real movies make you think and feel everything. If you get a chance to see it, please do. It's worth every penny. :) Hugs, Patt PS: Patti is a new friend of about three months and we love that we don't have to worry about forgetting the other's name. LOL She's a riot and then there is me. A total spaz.


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Wikileaks Promised An 'October Surprise' And Delivered A Self-Congratulatory Wankfest Instead
At 3 a.m. EST Tuesday morning, Julian Assange appeared in Berlin on a video screen to announce his devastating "October Surprise" that would finally crush the evil that is Hillary Clinton. At least that's what people were expecting. Instead, they got a promise that for the next ...read more


text: Can't get enough solar eruptions, especially from SDO? Here's a nice video from the Solar-Terrestrial Center of Excellence in Brussels, Belgium. They call it Spectacular Solar Eruptions during Solar Cycle 24. Many of my favorite eruptions are included, along with others that might become your favorite. Videos from STEREO, SOHO, and Proba2 are also included.


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Clinical Corner: Revisiting respiratory failure
Association of Clinical Documentation Improvement Specialists, January 1, 2014
by Richard D. Pinson, MD, FACP, CCS
The diagnosis and documentation of respiratory failure continues to be challenging for coders, documentation specialists, and physicians. Many physicians, including pulmonologists, are unaware of the current clinical standards for diagnosing acute respiratory failure and commonly overlook the presence of chronic respiratory failure. Y
et they typically identify multiple clinical criteria and provide appropriate management for respiratory failure, which creates query opportunities. In this article, we will discuss a variety of clinical indicators for respiratory failure and identify a number of common documentation improvement opportunities.
Definition of acute respiratory failure
Acute respiratory failure is classified as hypoxemic (low arterial oxygen levels), hypercapneic (elevated levels of carbon dioxide gas), or a combination of the two. In most cases one or the other predominates. For ICD-9, these terms, being "nonessential modifiers," are irrelevant for code assignment. ICD-10, however, has codes that permit a distinction (seebelow), but the distinction is not a requirement and queries for it will not alter its MCC classification.
The clinical criteria for diagnosing acute respiratory failure are:
Hypoxemic: Partial pressure of oxygen (pO2) level less than (<) 60 millimeter(s) of mercury (mmHg) (oxygen saturation [SpO2] < 91%) on room air, or pO2/fraction of inspired oxygen (FIO2) (P/F) ratio < 300, or 10 mmHg decrease in baseline pO2 (if known)
Hypercapnic: Partial pressure of carbon dioxide (pCO2) >50 mmHg with pH < 7.35, or 10 mmHg increase in baseline pCO2 (if known) With the exception of the P/F ratio, these criteria have also been offered as assistance to coders and documentation specialists for recognizing possible acute respiratory failure (see AHA's Coding Clinic for ICD-9-CM, Third Quarter 1988, p. 7; and Second Quarter 1990, p. 20).
Management that requires endotracheal intubation and mechanical ventilation or initiation of biphasic positive airway pressure (BiPAP) nearly always means the patient has acute respiratory failure, but these measures are not required for the diagnosis. Similarly, providing 40% or more supplemental oxygen implies that the physician is treating acute respiratory failure since only a patient with acute respiratory failure would need that much oxygen.
Acute hypoxemic respiratory failure
The gold standard for the diagnosis of hypoxemic respiratory failure is an arterial pO2 on room air less than 60 mmHg measured by arterial blood gases (ABG). In the absence of an ABG, SpO2 measured by pulse oximetry on room air can serve as a substitute for the pO2: SpO2 of 91% equals pO2 of 60 mmHg.
These criteria may not apply to patients with chronic respiratory failure (e.g., severe chronic obstructive pulmonary disease [COPD]), because their room air pO2 is often less than 60 mmHg (SpO2 < 91%). Chronic respiratory failure patients are treated with supplemental oxygen on a continuous outpatient basis to keep arterial oxygen above these levels.
However, if the baseline pO2 is known, a decrease by 10 mmHg or more indicates acute hypoxemic respiratory failure in such a patient. The P/F ratio The P/F ratio is a powerful objective tool to identify acute hypoxemic respiratory failure at any time while the patient is receiving supplemental oxygen, a frequent problem faced by documentation specialists where no room air ABG is available, or pulse oximetry readings seem equivocal.
The P/F ratio equals the arterial pO2 ("P") from the ABG divided by the FIO2 ("F")—the fraction (percent) of inspired oxygen that the patient receives expressed as a decimal (40% oxygen = FIO2 of 0.40). A P/F ratio less than 300 indicates acute respiratory failure. Most physicians have never heard of the P/F ratio, but it was validated and has been used in the context of acute respiratory distress syndrome (ARDS) for many years, where acute respiratory failure is called "acute lung injury."
A P/F ratio < 300 indicates mild ARDS, < 200 is consistent with moderate ARDS, and < 100 is severe ARDS. The P/F ratio indicates what the pO2 would be on room air:
P/F ratio < 300 = a pO2 < 60 mm Hg on room air
P/F ratio < 200 = a pO2 < 40 mm Hg on room air As an example, suppose the pO2 is 90 mmHg on 40% oxygen (FIO2 = .40). The P/F ratio = 90 divided by .40 = 225 (rather severe acute respiratory failure).
The pO2 on room air in this case would have been about 45 mmHg (well below the "cutoff " of 60 mmHg). The validity of the P/F ratio is not limited to ARDS. It simply expresses a consistent physiologic relationship between inspired oxygen and arterial pO2 regardless of cause.
Authoritative applications of the P/F ratio in settings other than ARDS include pneumonia and sepsis. The Infectious Disease Society of America and the American Thoracic Society recognize a P/F ratio less than 250 as one of the 10 criteria for "severe" community-acquired pneumonia that may require admission to intensive care.
The International Sepsis Definition criteria (2001) and the Surviving Sepsis - Severe Sepsis Guidelines (2008 and 2012) use a P/F ratio < 300 as an indicator of acute organ (respiratory) failure. SpO2 may be translated to pO2 The arterial pO2 measured by ABG is the definitive method for calculating the P/F ratio.
However, when the pO2 is unknown because an ABG is not available, the SpO2 measured by pulse oximetry can be used to approximate the pO2, as shown in Table 2. It is important to note that estimating the pO2 from the SpO2 becomes unreliable when the SpO2 is greater than 97%.
For example, suppose a patient on 40% oxygen has a pulse oximetry SpO2 of 95%. Referring to Table 2 (see the complete edition of the Journal), SpO2 of 95% is equal to a pO2 of 80 mmHg. The P/F ratio = 80 divided by 0.40 = 200 (quite severe acute respiratory failure).
The patient may be stable receiving 40% oxygen, but still has acute respiratory failure. If oxygen were withdrawn, leaving her on room air, the pO2 would only be 42 mmHg (much less than 60 mmHg on room air).
Translating supplemental oxygen
Supplemental oxygen may be administered by mask or nasal cannula. A Venturi mask (Venti-mask) delivers a controlled flow of oxygen at a specific fixed concentration (FIO2): 24%, 28%, 31%, 35%, 40%, and 50%. The nonrebreather (NRB) mask is designed to deliver approximately 100% oxygen. Providing 40% or more supplemental oxygen implies that the physician is treating acute respiratory failure since only such a patient would need that much oxygen.
A nasal cannula provides oxygen at adjustable flow rates in liters of oxygen per minute (L/min or LPM). The actual FIO2 (percent oxygen) delivered by nasal cannula is somewhat variable and less reliable than with a mask, but can be estimated as shown in Table 3.
The FIO2 derived from nasal cannula flow rates can then be used to calculate the P/F ratio. For example, a patient has a pO2 of 85 mmHg on ABG while receiving 5 L/min of oxygen. Since 5 L/min is equal to 40% oxygen (an FIO2 of 0.40), the P/F ratio = 85 divided by 0.40 = 212.5 (clearly severe acute respiratory failure).
Acute hypercapneic respiratory failure
The hallmark of acute hypercapneic respiratory failure is elevated pCO2 due to retention/accumulation of carbon dioxide gas resulting in an acidic pH less than 7.35. There are many causes, but severe COPD is the most common. Physicians can establish a diagnosis by viewing a pCO2 greater than 50 mmHg with a pH less than 7.35.
If the pH is greater than 7.35, the patient has chronic (not acute) respiratory failure. Physicians often identify this clinical condition as "respiratory acidosis," which is the same thing as acute hypercapneic respiratory failure. Unfortunately, the code for "respiratory acidosis" is 276.2, which is a CC, in contrast to the MCC status of acute respiratory failure—hence the need for clarification.
Also, if the baseline pCO2 is known, an increase of 10 mmHg or more indicates acute hypercapneic respiratory failure. Finally, an exacerbation of symptoms requiring an increase in chronic supplemental oxygen indicates an "acute exacerbation" of chronic respiratory failure, which would be classified as acute-on-chronic respiratory failure if properly documented.
Chronic respiratory failure
Chronic respiratory failure is very common in patients with severe COPD and other chronic lung diseases such as cystic fibrosis and pulmonary fibrosis. It is characterized by a combination of hypoxemia, elevated pCO2, elevated bicarbonate level, and normal pH (7.35–7.45). The most important tip-off to chronic respiratory failure is chronic dependence on supplemental oxygen ("home O2").
Patients who qualify for home O2 almost always have chronic respiratory failure. Another clue is an elevated bicarbonate level on the basic metabolic panel (BMP) in a COPD patient, especially helpful when no ABG was obtained. For example, consider a patient admitted with CHF exacerbation and a history of severe COPD. ABG on room air shows pH 7.40, pCO2 52 mmHg, and pO2 70 mmHg; bicarbonate level on BMP is elevated at 42. This is classic chronic respiratory failure: normal pH, elevated pCO2 and bicarbonate, with hypoxemia—but no acute criteria.
Acute-on-chronic respiratory failure
When a patient experiences an acute exacerbation or decompensation of chronic respiratory failure, he has " acute-on-chronic" respiratory failure. It is recognized by any of the following:
- Worsening symptoms
- Greater hypoxemia (hypoxemic)
- Elevated pCO2 with pH < 7.35 (hypercapneic)
During an acute exacerbation, acidic carbon dioxide (pCO2) may accumulate rapidly ("CO2 retention"), causing acidosis with a pH < 7.35 (acute hypercapneic respiratory failure). This would be acute-on-chronic respiratory failure. Worsening of symptoms requiring an increase in supplemental oxygen also indicates an "acute exacerbation" of chronic respiratory failure.
Use hypoxemic criteria (pO2, SpO2, and P/F ratio) in patients with chronic respiratory failure with caution. Many of these patients always have a pO2 < 60 mmHg on room air, which is the reason they use supplemental oxygen.
For such patients, the pO2/SpO2 criterion can be applied, not on room air, but while receiving their usual supplemental oxygen flow. Why? Because home O2 is adjusted to maintain a pO2 > 60 mmHg (SpO2 > 91%). Therefore, if the pO2 is < 60 mmHg on the usual supplemental oxygen flow rate,acutely decompensated respiratory failure has occurred.
Do not use the P/F ratio to diagnose acute-on-chronic respiratory failure since it is typically < 300 in these patients at baseline. It may be used to monitor the patient's clinical progress over time; if it keeps dropping, the patient is getting worse and needs more aggressive treatment.
Post-procedural respiratory failure
The diagnosis of respiratory failure following surgery has profound regulatory and quality of care implications. If identified as "postop," "due to," or "complicating" a procedure, respiratory failure is classified as one of the most severe, lifethreatening, reportable surgical complications a patient can have. This diagnosis adversely affects quality scores for both the hospital and the surgeon.
On the other hand, the diagnosis and coding of post-procedural respiratory failure (an MCC) often results in large payment increases for hospitals. If improperly diagnosed without firm clinical grounds, it may become the basis for regulatory or contractual audits, penalties, sanctions, and even legal action affecting the hospital and the physician.
Post-procedural respiratory failure is a lucrative Recovery Auditor target. Facilities should have a policy that governs the coding of any condition (including respiratory failure) not supported by clinical criteria in the medical record. To validate the diagnosis, the patient must have acute pulmonary dysfunction requiring nonroutine aggressive measures.
A patient who requires a short period of ventilator support during surgical recovery does not have acute respiratory failure; do not assign a code in this instance. The same is true for any duration of mechanical ventilation that is usual or expected following the type of surgery performed, unless there truly is underlying acute pulmonary dysfunction. A further difficulty arises because coding rules inexplicably call for coding of postop respiratory failure as a complication of care even when terms that seem clinically innocuous to physicians are used in the postop setting, such as pulmonary insufficiency (acute or not) and acute respiratory insufficiency.
To avoid confusion and improper code assignment, instruct your physicians not to use such terms in the postoperative setting unless the patient actually has acute respiratory failure. If the patient has acute respiratory failure following surgery, but it is truly due to, primarily the result of, or related to a preexisting medical condition (such as COPD, CHF, a neuromuscular disorder, etc.), ask the physician to clearly document this connection to avoid the incorrect assignment of a code for post-procedural respiratory failure. For example, something like: "acute respiratory failure in the postop setting primarily due to preexisting CHF."
Understanding the pathophysiology and authoritative clinical criteria for the several types of respiratory failure empowers coders and documentation specialists to confidently recognize, query, validate, and compliantly code these conditions. The two basic types of respiratory failure are hypoxemic and hypercapneic, sometimes occurring in combination.
The distinction is clinically important but not required for correct coding using either ICD-9 or ICD-10. The P/F ratio is a powerful diagnostic, prognostic, and clinical management tool: P/F ratio < 300 indicates acute respiratory failure. However, the acute hypoxemic criteria (pO2/SpO2 and P/F ratio) must be applied with caution to the diagnosis of acute-on-chronic respiratory failure since they are frequently abnormal in the patient's stable, chronic, baseline state.
Carefully consider the implications of diagnosing and coding post-procedural respiratory failure; clarify any potential relationship to preexisting conditions when present.
Editor's note: Pinson is a certified coding specialist and a principal partner at HCQ Consulting (www.hcqconsulting.com). He is coauthor of The CDI Pocket Guide and the CDI+ and CDI+MD mobile apps.
ICD-10-CM codes for respiratory failure
The following codes are applicable for respiratory failure under ICD-10-CM:
- J96.0: Acute respiratory failure (MCCs)
- J96.00: unspecified whether with hypoxia or hypercapnia
- J96.01: with hypoxia
- J96.02: with hypercapnia
- J96.1: Chronic respiratory failure (CCs)
- J96.10: unspecified whether with hypoxia or hypercapnia
- J96.11: with hypoxia
- J96.12: with hypercapnia
- J96.2: Acute and/on chronic respiratory failure (MCCs)
- J96.20: unspecified whether with hypoxia or hypercapnia
- J96.21: with hypoxia
- J96.22: with hypercapnia
- J96.9: Respiratory failure, unspecified
- J96.90: Respiratory failure, unspecified, (unspecified whether with hypoxia or hypercapnia)
- J96.91: Respiratory failure, unspecified with hypoxia
- J96.92: Respiratory failure, unspecified with hypercapnia (excludes newborn, postprocedural, ARDS, respiratory arrest, and cardiorespiratory failure)
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