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Harper in over his head
The Sept. 6 statement from Prime Minister Stephen Harper on the 200th anniversary of the birth of Sir George tienne Cartier is laughable were it not from the highest political office in the land.
It befuddles the mind that such a timely celebration could showcase such absolute and utter constitutional confusion. Cartier would be furious.
He laid his political life on the line against the wishes of Sir John A. imitation cartier gold ring and most, if not all of the provinces, that Canada was to be, above all, a united indivisible "federation" and won.
His greatest achievement, entrenched in the opening articles of the British North America Act, was to protect the French language and Catholic religion, not just in Quebec, but in all of his beloved Canada.
Harper, in one sentence " Cartier became one of the founding fathers of Confederation, championing the rights and aspirations of the people of Qubec and facilitating the entry of Manitoba and British Columbia cartier love ring knock off into the federation." highlights his constitutional schizophrenia and that of so many Canadian professors, pundits and politicians.
A Father of Confederation cannot possibly bring a province into the federation. If we were a confederation, Canada would have broken up a long time ago.
If Ukraine was a confederation of states, Crimea and the eastern regions would be gone replica love ring cartier and that would be it. No wonder Harper shuns a seat on the UN Security Council, steers away from Obama and hides from NATO's flypast, because intellectually, it all appears to be over his head. epaper, Digital Access, Subscriber Rewards), please input your Print Newspaper subscription phone number and postal code.
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The Sept. 6 statement from Prime Minister Stephen Harper on the 200th anniversary of the birth of Sir George tienne Cartier is laughable were it not from the highest political office in the land.
It befuddles the mind that such a timely celebration could showcase such absolute and utter constitutional confusion. Cartier would be furious.
He laid his political life on the line against the wishes of Sir John A. imitation cartier gold ring and most, if not all of the provinces, that Canada was to be, above all, a united indivisible "federation" and won.
His greatest achievement, entrenched in the opening articles of the British North America Act, was to protect the French language and Catholic religion, not just in Quebec, but in all of his beloved Canada.
Harper, in one sentence " Cartier became one of the founding fathers of Confederation, championing the rights and aspirations of the people of Qubec and facilitating the entry of Manitoba and British Columbia cartier love ring knock off into the federation." highlights his constitutional schizophrenia and that of so many Canadian professors, pundits and politicians.
A Father of Confederation cannot possibly bring a province into the federation. If we were a confederation, Canada would have broken up a long time ago.
If Ukraine was a confederation of states, Crimea and the eastern regions would be gone replica love ring cartier and that would be it. No wonder Harper shuns a seat on the UN Security Council, steers away from Obama and hides from NATO's flypast, because intellectually, it all appears to be over his head. epaper, Digital Access, Subscriber Rewards), please input your Print Newspaper subscription phone number and postal code.
{ phone }
{ addressPostalCode }
By clicking "Create Account", I hearby grant permission to Market to use my account information to create my account.
I also accept and agree to be bound by Postmedia's Terms and Conditions with respect to my use of the fake trinity ring cartier Site and I have read and understand Postmedia's Privacy Statement. epaper, Digital Access, Subscriber Rewards), please input your Print Newspaper subscription phone number and postal code.
{ phone }
{ addressPostalCode }
By clicking "Create Account", I hearby grant permission to Postmedia to use my account information to create my account.
I also accept and agree to be bound by Postmedia's Terms and Conditions with respect to my use of the Site and I have read and understand Postmedia's Privacy Statement. I consent to the collection, use, maintenance, and disclosure of my information in accordance with the Postmedia's Privacy Policy.
North Vancouver Shipyards undergoing major redevelopment
SubscriptionsGo to the Subscriptions Centre to manage your:My Profile"We are going to change an old industrial shipyard building area wasteland into a great people orientated dynamic place," said Darrell Mussatto, mayor of North Vancouver.Presentation House Gallery: new building approved by North VancouverThe plan which has been in the works for years will be equipped with restaurants, shops, a boutique hotel, underground parking, an outdoor skating rink in the winter and a water park in the summer.The property on North Vancouver's waterfront a little east of Lonsdale Quay is set for significant redevelopment. (Rafferty Baker/CBC)"It's going to be a Frivole necklace replica great place for people to gather all year round," he said, "That can be the new gathering spot not just for the north shore, but be one of the better ones for the lower mainland," he said.Quay Property Management Corporation will fund the $35 million project and will lease the land from the City of North Vancouver. The city will pay $5 million for the remediation of the site.The redevelopment will include shops, restaurants, a public stage, underground parking, a skating rink in Van Cleef & Arpels Clover Necklace black replica winter and a water play zone for the summer months.Mussatto says the redevelopment isn't going to take away from the iconic area. On the contrary, he says it will add to it."By removing toxic soils that are full of carbons and heavy metals and taking them away from the site and remediation elsewhere, you will see an enhancement in natural areas."The project is expected by to be completed by 2018 with remediation expected to start Van Cleef & Arpels Frivole necklace replica in the next few months.Parts of an old machine shop that was disassembled on the property sit underneath tarps. Many of the original pieces will be used to build the new Shipyard development. (Rafferty Baker/CBC)With files from the CBC's The Early Edition and Bal BrachTo hear the full story listen to the audio labelled: North Vancouver Shipyards undergoing massive redevelopmentBy submitting a comment, you accept that CBC has the right to reproduce and publish that comment in whole or in part, in any manner CBC chooses. Please note that CBC does not endorse the opinions expressed in comments. Comments on this story are moderated according to our Submission Guidelines. Comments are welcome while open. We reserve the right to close comments at any time.
SubscriptionsGo to the Subscriptions Centre to manage your:My Profile"We are going to change an old industrial shipyard building area wasteland into a great people orientated dynamic place," said Darrell Mussatto, mayor of North Vancouver.Presentation House Gallery: new building approved by North VancouverThe plan which has been in the works for years will be equipped with restaurants, shops, a boutique hotel, underground parking, an outdoor skating rink in the winter and a water park in the summer.The property on North Vancouver's waterfront a little east of Lonsdale Quay is set for significant redevelopment. (Rafferty Baker/CBC)"It's going to be a Frivole necklace replica great place for people to gather all year round," he said, "That can be the new gathering spot not just for the north shore, but be one of the better ones for the lower mainland," he said.Quay Property Management Corporation will fund the $35 million project and will lease the land from the City of North Vancouver. The city will pay $5 million for the remediation of the site.The redevelopment will include shops, restaurants, a public stage, underground parking, a skating rink in Van Cleef & Arpels Clover Necklace black replica winter and a water play zone for the summer months.Mussatto says the redevelopment isn't going to take away from the iconic area. On the contrary, he says it will add to it."By removing toxic soils that are full of carbons and heavy metals and taking them away from the site and remediation elsewhere, you will see an enhancement in natural areas."The project is expected by to be completed by 2018 with remediation expected to start Van Cleef & Arpels Frivole necklace replica in the next few months.Parts of an old machine shop that was disassembled on the property sit underneath tarps. Many of the original pieces will be used to build the new Shipyard development. (Rafferty Baker/CBC)With files from the CBC's The Early Edition and Bal BrachTo hear the full story listen to the audio labelled: North Vancouver Shipyards undergoing massive redevelopmentBy submitting a comment, you accept that CBC has the right to reproduce and publish that comment in whole or in part, in any manner CBC chooses. Please note that CBC does not endorse the opinions expressed in comments. Comments on this story are moderated according to our Submission Guidelines. Comments are welcome while open. We reserve the right to close comments at any time.
Watch Buyer's Remorse
The Watch Snob is in.
Dealing with watch buyers' remorse
After many months of looking around, I decided to buy as a present for a milestone birthday a Vacheron cartier gold ring copy Constantin Patrimony Contemporaine. Strangely enough, I suffered from buyer remorse very quickly after acquiring it. In other words, I am not sure if I did the right thing. Could you please help me out here?
A purchase of a Vacheron is never wrong. So your buyer remorse must be related to some sort of deep seated guilt you experiencing. Did you have to sacrifice your child college savings or mortgage your house in order to buy it? Did your wife leave you as a result of said purchase? If the answer to any of these questions is then you did the right thing. If you are feeling guilty for rewarding yourself for a significant birthday (aren they all significant?), then perish the thought and enjoy your fine timepiece.
Now, if you feel that perhaps your $20,000 would have been better spent on a Patek Philippe or a Lange, that is debatable, but still doesn make your Vacheron purchase wrong. From an investment standpoint, a Patek might have been a better choice. Compared to a Lange, Vacheron has the slight edge based on its longer heritage and Swiss pedigree. But there are few watches that are aesthetically more appealing than Vacheron entire Patrimony line, and it sounds like you bought this watch as a personal reward more than as something you plan to turn a profit on in 10 years.
Regardless, if you still feel you made the wrong decision, there are plenty more milestone birthdays ahead on which you can make things right, so for now, enjoy your Vacheron.
Formal watches and shorts
You have often mentioned that it is rarely acceptable to wear a sporty watch with a suit or tuxedo. My question is: Does the opposite also apply? Is it acceptable to wear a dressier watch with more casual attire like jeans?
I ask because I recently bought my first real watch. After careful consideration I avoided the obvious Rolexes and Omegas and settled on a Jaeger LeCoultre Master Hometime (steel). This watch works great with any semi formal clothing, but what am I to do when I wear jeans and a T shirt, or even shorts? Am I better off wearing a dress watch with shorts or imitation cartier ring trinity no watch at all?
The obvious solution to this sartorial conundrum is to own more than one watch. The fact of the matter is, there is really no one watch that works equally well with a dinner jacket and casual attire no matter what the world under dressed watch bloggers tell you. They all sitting at home in a tracksuit while you going to the office, so what do they know?
If you must only own one timepiece, it is better to err on the side of how you intend to wear it most often. Your choice of the JLC is actually quite acceptable, given its elegant finishing and rather spare dial. But I have a question: What are these of which you speak?
Question from a Watch Knob
When my wife and I found out that we were expecting our first child, I immediately considered what watch I might buy to celebrate the birth. I would like to buy a watch that my child can admire as he/she grows up and one that can be a fitting gift for him/her when he/she comes of age. My first thought was an Omega Speedmaster Professional. However, this changed when I found out that it was a girl! I am now considering a watch that I can wear for the next 20 years or so but that may also be appropriate for my daughter to own and perhaps even wear from time to time one day. A few pieces knock off love ring cartier jump to mind, among them: Cartier Calibre de Cartier, JLC Master DualTime, Breitling Transocean and the Maurice Lacroix Flyback Annuaire. In your opinion, which of these is the better investment for my daughter?
Let be honest: You using the birth of your child as an excuse to buy a new watch for yourself. No doubt you be finding countless other occasions to celebrate with a timepiece acquisition: Your daughter first tooth perhaps? Her first day of secondary school? Third place in the school talent contest? Face it: By the time she turns 20, she won be interested cartier gold ring replica in any of the pieces you listed, so just go out and buy the one you want to wear (personally, I skip the Maurice Lacroix). Don worry, I won tell your wife.Features imitation cartier yellow gold earring Galvanized steel You deserve it Let's go more familiar in concern of it detailed
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The Watch Snob is in.
Dealing with watch buyers' remorse
After many months of looking around, I decided to buy as a present for a milestone birthday a Vacheron cartier gold ring copy Constantin Patrimony Contemporaine. Strangely enough, I suffered from buyer remorse very quickly after acquiring it. In other words, I am not sure if I did the right thing. Could you please help me out here?
A purchase of a Vacheron is never wrong. So your buyer remorse must be related to some sort of deep seated guilt you experiencing. Did you have to sacrifice your child college savings or mortgage your house in order to buy it? Did your wife leave you as a result of said purchase? If the answer to any of these questions is then you did the right thing. If you are feeling guilty for rewarding yourself for a significant birthday (aren they all significant?), then perish the thought and enjoy your fine timepiece.
Now, if you feel that perhaps your $20,000 would have been better spent on a Patek Philippe or a Lange, that is debatable, but still doesn make your Vacheron purchase wrong. From an investment standpoint, a Patek might have been a better choice. Compared to a Lange, Vacheron has the slight edge based on its longer heritage and Swiss pedigree. But there are few watches that are aesthetically more appealing than Vacheron entire Patrimony line, and it sounds like you bought this watch as a personal reward more than as something you plan to turn a profit on in 10 years.
Regardless, if you still feel you made the wrong decision, there are plenty more milestone birthdays ahead on which you can make things right, so for now, enjoy your Vacheron.
Formal watches and shorts
You have often mentioned that it is rarely acceptable to wear a sporty watch with a suit or tuxedo. My question is: Does the opposite also apply? Is it acceptable to wear a dressier watch with more casual attire like jeans?
I ask because I recently bought my first real watch. After careful consideration I avoided the obvious Rolexes and Omegas and settled on a Jaeger LeCoultre Master Hometime (steel). This watch works great with any semi formal clothing, but what am I to do when I wear jeans and a T shirt, or even shorts? Am I better off wearing a dress watch with shorts or imitation cartier ring trinity no watch at all?
The obvious solution to this sartorial conundrum is to own more than one watch. The fact of the matter is, there is really no one watch that works equally well with a dinner jacket and casual attire no matter what the world under dressed watch bloggers tell you. They all sitting at home in a tracksuit while you going to the office, so what do they know?
If you must only own one timepiece, it is better to err on the side of how you intend to wear it most often. Your choice of the JLC is actually quite acceptable, given its elegant finishing and rather spare dial. But I have a question: What are these of which you speak?
Question from a Watch Knob
When my wife and I found out that we were expecting our first child, I immediately considered what watch I might buy to celebrate the birth. I would like to buy a watch that my child can admire as he/she grows up and one that can be a fitting gift for him/her when he/she comes of age. My first thought was an Omega Speedmaster Professional. However, this changed when I found out that it was a girl! I am now considering a watch that I can wear for the next 20 years or so but that may also be appropriate for my daughter to own and perhaps even wear from time to time one day. A few pieces knock off love ring cartier jump to mind, among them: Cartier Calibre de Cartier, JLC Master DualTime, Breitling Transocean and the Maurice Lacroix Flyback Annuaire. In your opinion, which of these is the better investment for my daughter?
Let be honest: You using the birth of your child as an excuse to buy a new watch for yourself. No doubt you be finding countless other occasions to celebrate with a timepiece acquisition: Your daughter first tooth perhaps? Her first day of secondary school? Third place in the school talent contest? Face it: By the time she turns 20, she won be interested cartier gold ring replica in any of the pieces you listed, so just go out and buy the one you want to wear (personally, I skip the Maurice Lacroix). Don worry, I won tell your wife.
Orangutan Females Steal Hermes Kelly bag replica Food to Test Potential Mates
When males reacted violently or took fake hermes kelly bagd the food back, the females fake hermes leather handbags screamed and tended to end the interactions much sooner than when the male tolerated the stealing.
Evolutionarily, the behavior makes sense, experts say, since relationships with aggressive males can be extremely damaging for females.
Males who are aggressive to other males may attract females.
"She could endure injuries, from bruises to broken bones, replica hermes birkin handbags if his attacks were to knock her out of a tree," van Noordwijk said.
The researchers did not see the females give immediate sexual favors in return for the males tolerating the food stealing.
But, van Noordwijk said, "we think the stealing allows females to test males for their tendency to be aggressive toward them so they can determine whether they are worth further associating with."
When males reacted violently or took fake hermes kelly bagd the food back, the females fake hermes leather handbags screamed and tended to end the interactions much sooner than when the male tolerated the stealing.
Evolutionarily, the behavior makes sense, experts say, since relationships with aggressive males can be extremely damaging for females.
Males who are aggressive to other males may attract females.
"She could endure injuries, from bruises to broken bones, replica hermes birkin handbags if his attacks were to knock her out of a tree," van Noordwijk said.
The researchers did not see the females give immediate sexual favors in return for the males tolerating the food stealing.
But, van Noordwijk said, "we think the stealing allows females to test males for their tendency to be aggressive toward them so they can determine whether they are worth further associating with."
Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia
Participants Children aged up to 16 with cardiac arrest and hypothermia after drowning, who presented at emergency departments and/or were admitted to intensive care.
Main outcome measure Survival and neurological outcome one year after the drowning incident. Poor outcome was defined as death or survival in a vegetative state or with severe neurological disability (paediatric cerebral performance category (PCPC) 4).
Results From 1993 to 2012, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes (98/160, median duration 60 minutes), of whom 87 (89%) died (95% confidence interval 83% to 95%; 87/98). Eleven of the 98 children survived (11%, 5% to 17%), but all had a PCPC score 4. In the 62 (39%) children who did not require prolonged resuscitation, 17 (27%, 16% to 38%) survived with a PCPC score 3 after one year: 10 (6%) had a good neurological outcome (score 1), five (3%) had mild neurological disability (score 2), and two (1%) had moderate neurological disability (score 3). From the original 160 children, only 44 were alive at one year with any outcome.
Conclusions Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. Good neurological outcome is more likely when spontaneous circulation returns within 30 minutes of advanced life support, especially when the drowning incident occurs in winter. These findings question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia. Many houses are built near to ponds, ditches, or canals. A temperate maritime climate prevails, with mean air temperatures of 3.5C in winter, 9.5C in spring, 10.6C in autumn, and 17.0C in summer and water temperatures ranging from 0 8C in winter, 6 18C in spring and autumn, and 15 28C in summer.19 20
The Dutch emergency medical service has a legally enforced arrival time of less than 15 minutes for medical emergencies.21 All ambulance teams consist of a nurse trained in paediatric basic and advanced life support and allowed to perform intubation and administration of adrenaline (epinephrine) in children and a driver trained in paediatric basic life support. In cases of a cardiac arrest, a second emergency medical team is always called on, and, since 1999, this second team is often the helicopter emergency medical service with a physician on board.
Prehospital treatment is provided by emergency medical service nurses according to Dutch national ambulance protocols. These protocols are in accordance with the guidelines of the European Resuscitation Council. The national ambulance protocols how much is a hermes handbag instruct that all children with cardiac arrest and hypothermia should be transported, under continuous cardiopulmonary resuscitation, to a hospital with facilities for extracorporeal life support. The physicians of the helicopter emergency medical service and the emergency department treat according to the replica hermes birkin handbags guidelines of the Dutch Resuscitation Council and the European Resuscitation Council. All children with return of spontaneous circulation after prolonged resuscitation, whether primarily presented at the emergency department of a general hospital or a university medical centre, are transferred to a paediatric intensive care unit in one of the eight university medical centres.
PatientsWe retrospectively identified eligible patients by using the ICD 9 (international classification of diseases, ninth edition) code for drowning (994.1). For those aged 16 and under, their demographical and clinical data were entered in the database when they were admitted at the emergency department, the general paediatric ward, or the paediatric intensive care unit of one of the eight university medical centres from 1 January 1993 to 1 January 2012. Children who presented at the emergency department of a general hospital and transferred to the paediatric intensive care unit were included in this database.
Inclusion and exclusion criteriaWe included children with cardiac arrest after drowning outside (excluding heated outdoor swimming pools) and an initial core body temperature below 34C. Drowning outside was an inclusion criterion so hermes replica we could use season as a proxy for water temperature. As concurrent traumatic injuries could possibly influence outcome, we excluded children who drowned in a traffic or boating incident.
VariablesThe data collection was based on the Utstein style variables for uniform reporting of data from drowning.22 Data collected at the arrival of the emergency medical service included initial cardiac arrest rhythm, the use of bag and mask ventilation, intubation, duration of chest compressions, and number of doses of adrenaline and attempts at defibrillation. Data collected at the emergency department included initial core body temperature, score on Glasgow coma scale, the use of bag and mask ventilation, intubation, duration of chest compressions, number of doses of adrenaline, use of extracorporeal life support for cardiac arrest, and return of spontaneous circulation or death. Data collected at the paediatric intensive care unit included death or discharge, the cause of death, and, if applicable, the withdrawal of life sustaining treatment. Final disposition was dead or alive at one year after the drowning incident, and, if alive, the neurological status according to the paediatric cerebral performance category score (PCPC).23
DefinitionsThe minimum and maximum durations of submersion were taken from the medical records and were based on estimations by the caretaker(s) of the child at the time of incident. Cardiac arrest was defined as the necessity for chest compressions on arrival of the emergency medical service or and/or helicopter emergency medical service. The start point of the resuscitation time was marked by the initiation of chest compressions by the emergency services and the total duration of resuscitation included prehospital and in hospital advanced life support but excluded bystander cardiopulmonary resuscitation. Prolonged resuscitation was defined as more than 30 minutes of total resuscitation. This cut off was chosen because the mean attempted resuscitation time in many studies concerning resuscitation in children with out of hospital cardiac arrest averaged 30 minutes.24 We defined spring as the period between 1 March and 31 May, summer between 1 June and 31 August, autumn between 1 September and 30 November, and winter between 1 December and 29 February.
Initial cardiac arrest rhythm was the first rhythm visible after connection of the patient to the electrocardiograph of the emergency medical services. Initial temperature was defined as the first body temperature measured within one hour after arrival at the emergency department and concerned measurements of rectal or oesophageal temperature with a low reading thermometer. The initial blood gas analysis was measured within two hours after arrival at the emergency department. The term extracorporeal life support was used to indicate both extracorporeal circulation and extracorporeal membrane oxygenation. In the paediatric intensive care unit a diagnosis of severe neurological damage could lead to withdrawal of further intensive treatment. The severity of the brain damage was assessed by clinical neurological examination, cerebral magnetic resonance imaging and/or electroencephalography, and/or sensory evoked potentials. The combined results could lead to a decision to withdraw further intensive treatment. The paediatric cerebral performance category scale (PCPC)23 was used to qualify neurological outcome. This scale rates the neurological outcome by cognitive impairment in six categories: good neurological performance, mild neurological disability, moderate neurological disability, severe neurological disability, coma or vegetative state, and brain death.23 A good outcome was characterised by a PCPC score 3 at one year after the incident. Although fake hermes leather handbags it can be debated whether patients with a score of 3, who will require assistance in daily activities, really have a good outcome, we chose this conservative cut off point to be able to classify extremely poor outcome beyond discussion. We therefore defined poor outcome as death or survival with severe neurological disability at one year after the incident (score 4).
Statistical analysesContinuous data are presented as medians and interquartile range. Dichotomous and categorical data are presented as proportions, percentages of total, and 95% confidence intervals. We used Fisher's exact test for categorical data and Mann Whitney U test for continuous data. P
ResultsDescription of study populationFrom 1993 to 2012, 784 children were identified by the ICD 9 code for drowning. Two of the eight university medical centres were unable to identify children who died at the emergency department. Medical records were available for 753 children. Seventeen children were misclassified, thus 736 children were retained in the database, of whom 207 (28%) experienced cardiac arrest requiring advanced life support. Of these 207 children, 47 (47/207, 23%) were excluded from the present study: 25 had an initial body temperature of 34C, 14 were involved in a vehicle or boat incident, and eight drowned indoors.
We concentrated on the 160 children who experienced a cardiac arrest with hypothermia after drowning outside, which was not associated with a motor vehicle or boat incident. Figure 1 shows the flow of the 160 included children from the emergency department onwards and their subsequent clinical outcome. Of these children, 104 (65%) had ongoing cardiac arrest on arrival at the emergency department. All 98 children in whom return of spontaneous circulation was not achieved within 30 minutes received prolonged resuscitation. Of these 98 children, 23 children died in the emergency department. The 137 other children, in whom return of spontaneous circulation was achieved, were admitted to the paediatric intensive care unit (137/160, 86%), where 79 died (79/137; 58%, 95% confidence interval 50% to 66%); 30 had a diagnosis of brain death (30/79; 38%, 27% to 49%) and 27 had a diagnosis of severe neurological damage (27/79; 34%, 24% to 44%), the 22 others died of cardiac arrest, acute respiratory distress syndrome, or multi organ failure (22/79; 28%, 18% to 38%). In the original 160 children, the total mortality rate after cardiac arrest with hypothermia was 73% (66% to 80%; n=116). Ten children remained in a vegetative state (10/160; 6%, 2% to 10%), and 17 had severe neurological damage (17/160; 11%, 6% to 16%). One year after the drowning accident 17 children had a PCPC score of 3 (17/160; 11%, 6% to 16%).
Fig 1 flow and clinical outcome of children who drowned with cardiac arrest and hypothermia after presentation at emergency department. Final outcome was one year after drowning incident and categorised with paediatric cerebral performance categories (PCPC). Death, vegetative state, and severe disability were categorised as poor outcome. ROSC=return of spontaneous circulation, PICU=paediatric intensive care unit
Prolonged resuscitationProlonged resuscitation was performed in 98 of the 160 children with a cardiac arrest and hypothermia (61%, 95% confidence interval 54% to 69%). The outcome was not good in any of the children who underwent resuscitation beyond 30 minutes (0% with good outcome, 0% to 3%) (fig 3). Seventeen of the children who did not require prolonged resuscitation survived with a PCPC score 3 after one year (17/62 good outcome; 27%, 16% to 38%). The maximum duration of resuscitation with good outcome was 25 minutes. The outcome of prolonged resuscitation was extremely poor: 87 of the 98 children died (89%, 83% to 95%), and 11 survived in a vegetative state or with severe neurological damage (11%, 5% to 17%). Table 4 shows the characteristics of the children in relation to duration of resuscitation. Extracorporeal life support was performed in 12 children, of whom 11 died and one survived in a vegetative state. Thus, no child who underwent prolonged resuscitation, with or without extracorporeal life support, had a good outcome.
Initial cardiac arrest rhythmWe were able to retrieve data on the initial cardiac arrest rhythm from the medical records in 118 of the 160 children (74%). Asystole was diagnosed in nearly all children (101/118, 86%), followed by bradycardia (15/118, 13%) and ventricular fibrillation (2/118, 2%). Bradycardia correlated strongly with good outcome: six of the 15 children with bradycardia had good outcome versus eight of the 101 children with asystole (40% (95% confidence interval 15% to 65%) v 8% (3% to 13%); odds ratio 7.8 (2.2 to 27.3), P=0.001).
Duration of submersion, doses of adrenaline, and blood gas abnormalitiesIn only 3% of the cases (5/160) was the drowning incident witnessed by an adult, and consequently the duration of submersion was not precisely known in most cases. The typical history of most incidents was a sudden realisation of the child's absence, followed by an immediate search by the caretaker. Though the duration of the search was reasonably well known, it was usually unknown how long the child had been out of sight. The median estimated minimum and maximum durations of submersion correlated negatively with outcome (table 3). The longest estimated duration of submersion with good outcome was 25 minutes. Figure 6 shows the relation between maximum estimated submersion duration and outcome.
The median total number of doses of adrenaline administered was negatively associated with outcome (table 3). The median initial pH and the base excess were significantly lower in children with poor outcome (table 3). All children were manually or mechanically ventilated at the time of the initial blood gas measurement, while some children were still being resuscitated and others already had return of spontaneous circulation. The lowest pH associated with good a outcome was 6.75.
Treatment changesWe performed a subanalysis to determine whether changes in treatment during the study period affected the main outcomes. The percentage of children with good outcome in the first five years of the study period was comparable with the percentage in the last five years (7/51, 14% (95% confidence interval 4% to 23%) v 5/30, 17% (3% to 30%), P=0.75).
DiscussionImplication of key findingsIn children with cardiac arrest and hypothermia after drowning the necessity for resuscitation for more than 30 minutes did not result in good outcome in any child: 89% of children died and 11% survived in a vegetative state or with severe neurological damage. The study used a nationwide database over the period 1993 2012. Most children drowned during spring, summer, or autumn and had a much poorer outcome than those who drowned in winter. These results strongly question the therapeutic value of prolonged resuscitation in drowned children with cardiac arrest and hypothermia.
Participants Children aged up to 16 with cardiac arrest and hypothermia after drowning, who presented at emergency departments and/or were admitted to intensive care.
Main outcome measure Survival and neurological outcome one year after the drowning incident. Poor outcome was defined as death or survival in a vegetative state or with severe neurological disability (paediatric cerebral performance category (PCPC) 4).
Results From 1993 to 2012, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes (98/160, median duration 60 minutes), of whom 87 (89%) died (95% confidence interval 83% to 95%; 87/98). Eleven of the 98 children survived (11%, 5% to 17%), but all had a PCPC score 4. In the 62 (39%) children who did not require prolonged resuscitation, 17 (27%, 16% to 38%) survived with a PCPC score 3 after one year: 10 (6%) had a good neurological outcome (score 1), five (3%) had mild neurological disability (score 2), and two (1%) had moderate neurological disability (score 3). From the original 160 children, only 44 were alive at one year with any outcome.
Conclusions Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. Good neurological outcome is more likely when spontaneous circulation returns within 30 minutes of advanced life support, especially when the drowning incident occurs in winter. These findings question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia. Many houses are built near to ponds, ditches, or canals. A temperate maritime climate prevails, with mean air temperatures of 3.5C in winter, 9.5C in spring, 10.6C in autumn, and 17.0C in summer and water temperatures ranging from 0 8C in winter, 6 18C in spring and autumn, and 15 28C in summer.19 20
The Dutch emergency medical service has a legally enforced arrival time of less than 15 minutes for medical emergencies.21 All ambulance teams consist of a nurse trained in paediatric basic and advanced life support and allowed to perform intubation and administration of adrenaline (epinephrine) in children and a driver trained in paediatric basic life support. In cases of a cardiac arrest, a second emergency medical team is always called on, and, since 1999, this second team is often the helicopter emergency medical service with a physician on board.
Prehospital treatment is provided by emergency medical service nurses according to Dutch national ambulance protocols. These protocols are in accordance with the guidelines of the European Resuscitation Council. The national ambulance protocols how much is a hermes handbag instruct that all children with cardiac arrest and hypothermia should be transported, under continuous cardiopulmonary resuscitation, to a hospital with facilities for extracorporeal life support. The physicians of the helicopter emergency medical service and the emergency department treat according to the replica hermes birkin handbags guidelines of the Dutch Resuscitation Council and the European Resuscitation Council. All children with return of spontaneous circulation after prolonged resuscitation, whether primarily presented at the emergency department of a general hospital or a university medical centre, are transferred to a paediatric intensive care unit in one of the eight university medical centres.
PatientsWe retrospectively identified eligible patients by using the ICD 9 (international classification of diseases, ninth edition) code for drowning (994.1). For those aged 16 and under, their demographical and clinical data were entered in the database when they were admitted at the emergency department, the general paediatric ward, or the paediatric intensive care unit of one of the eight university medical centres from 1 January 1993 to 1 January 2012. Children who presented at the emergency department of a general hospital and transferred to the paediatric intensive care unit were included in this database.
Inclusion and exclusion criteriaWe included children with cardiac arrest after drowning outside (excluding heated outdoor swimming pools) and an initial core body temperature below 34C. Drowning outside was an inclusion criterion so hermes replica we could use season as a proxy for water temperature. As concurrent traumatic injuries could possibly influence outcome, we excluded children who drowned in a traffic or boating incident.
VariablesThe data collection was based on the Utstein style variables for uniform reporting of data from drowning.22 Data collected at the arrival of the emergency medical service included initial cardiac arrest rhythm, the use of bag and mask ventilation, intubation, duration of chest compressions, and number of doses of adrenaline and attempts at defibrillation. Data collected at the emergency department included initial core body temperature, score on Glasgow coma scale, the use of bag and mask ventilation, intubation, duration of chest compressions, number of doses of adrenaline, use of extracorporeal life support for cardiac arrest, and return of spontaneous circulation or death. Data collected at the paediatric intensive care unit included death or discharge, the cause of death, and, if applicable, the withdrawal of life sustaining treatment. Final disposition was dead or alive at one year after the drowning incident, and, if alive, the neurological status according to the paediatric cerebral performance category score (PCPC).23
DefinitionsThe minimum and maximum durations of submersion were taken from the medical records and were based on estimations by the caretaker(s) of the child at the time of incident. Cardiac arrest was defined as the necessity for chest compressions on arrival of the emergency medical service or and/or helicopter emergency medical service. The start point of the resuscitation time was marked by the initiation of chest compressions by the emergency services and the total duration of resuscitation included prehospital and in hospital advanced life support but excluded bystander cardiopulmonary resuscitation. Prolonged resuscitation was defined as more than 30 minutes of total resuscitation. This cut off was chosen because the mean attempted resuscitation time in many studies concerning resuscitation in children with out of hospital cardiac arrest averaged 30 minutes.24 We defined spring as the period between 1 March and 31 May, summer between 1 June and 31 August, autumn between 1 September and 30 November, and winter between 1 December and 29 February.
Initial cardiac arrest rhythm was the first rhythm visible after connection of the patient to the electrocardiograph of the emergency medical services. Initial temperature was defined as the first body temperature measured within one hour after arrival at the emergency department and concerned measurements of rectal or oesophageal temperature with a low reading thermometer. The initial blood gas analysis was measured within two hours after arrival at the emergency department. The term extracorporeal life support was used to indicate both extracorporeal circulation and extracorporeal membrane oxygenation. In the paediatric intensive care unit a diagnosis of severe neurological damage could lead to withdrawal of further intensive treatment. The severity of the brain damage was assessed by clinical neurological examination, cerebral magnetic resonance imaging and/or electroencephalography, and/or sensory evoked potentials. The combined results could lead to a decision to withdraw further intensive treatment. The paediatric cerebral performance category scale (PCPC)23 was used to qualify neurological outcome. This scale rates the neurological outcome by cognitive impairment in six categories: good neurological performance, mild neurological disability, moderate neurological disability, severe neurological disability, coma or vegetative state, and brain death.23 A good outcome was characterised by a PCPC score 3 at one year after the incident. Although fake hermes leather handbags it can be debated whether patients with a score of 3, who will require assistance in daily activities, really have a good outcome, we chose this conservative cut off point to be able to classify extremely poor outcome beyond discussion. We therefore defined poor outcome as death or survival with severe neurological disability at one year after the incident (score 4).
Statistical analysesContinuous data are presented as medians and interquartile range. Dichotomous and categorical data are presented as proportions, percentages of total, and 95% confidence intervals. We used Fisher's exact test for categorical data and Mann Whitney U test for continuous data. P
ResultsDescription of study populationFrom 1993 to 2012, 784 children were identified by the ICD 9 code for drowning. Two of the eight university medical centres were unable to identify children who died at the emergency department. Medical records were available for 753 children. Seventeen children were misclassified, thus 736 children were retained in the database, of whom 207 (28%) experienced cardiac arrest requiring advanced life support. Of these 207 children, 47 (47/207, 23%) were excluded from the present study: 25 had an initial body temperature of 34C, 14 were involved in a vehicle or boat incident, and eight drowned indoors.
We concentrated on the 160 children who experienced a cardiac arrest with hypothermia after drowning outside, which was not associated with a motor vehicle or boat incident. Figure 1 shows the flow of the 160 included children from the emergency department onwards and their subsequent clinical outcome. Of these children, 104 (65%) had ongoing cardiac arrest on arrival at the emergency department. All 98 children in whom return of spontaneous circulation was not achieved within 30 minutes received prolonged resuscitation. Of these 98 children, 23 children died in the emergency department. The 137 other children, in whom return of spontaneous circulation was achieved, were admitted to the paediatric intensive care unit (137/160, 86%), where 79 died (79/137; 58%, 95% confidence interval 50% to 66%); 30 had a diagnosis of brain death (30/79; 38%, 27% to 49%) and 27 had a diagnosis of severe neurological damage (27/79; 34%, 24% to 44%), the 22 others died of cardiac arrest, acute respiratory distress syndrome, or multi organ failure (22/79; 28%, 18% to 38%). In the original 160 children, the total mortality rate after cardiac arrest with hypothermia was 73% (66% to 80%; n=116). Ten children remained in a vegetative state (10/160; 6%, 2% to 10%), and 17 had severe neurological damage (17/160; 11%, 6% to 16%). One year after the drowning accident 17 children had a PCPC score of 3 (17/160; 11%, 6% to 16%).
Fig 1 flow and clinical outcome of children who drowned with cardiac arrest and hypothermia after presentation at emergency department. Final outcome was one year after drowning incident and categorised with paediatric cerebral performance categories (PCPC). Death, vegetative state, and severe disability were categorised as poor outcome. ROSC=return of spontaneous circulation, PICU=paediatric intensive care unit
Prolonged resuscitationProlonged resuscitation was performed in 98 of the 160 children with a cardiac arrest and hypothermia (61%, 95% confidence interval 54% to 69%). The outcome was not good in any of the children who underwent resuscitation beyond 30 minutes (0% with good outcome, 0% to 3%) (fig 3). Seventeen of the children who did not require prolonged resuscitation survived with a PCPC score 3 after one year (17/62 good outcome; 27%, 16% to 38%). The maximum duration of resuscitation with good outcome was 25 minutes. The outcome of prolonged resuscitation was extremely poor: 87 of the 98 children died (89%, 83% to 95%), and 11 survived in a vegetative state or with severe neurological damage (11%, 5% to 17%). Table 4 shows the characteristics of the children in relation to duration of resuscitation. Extracorporeal life support was performed in 12 children, of whom 11 died and one survived in a vegetative state. Thus, no child who underwent prolonged resuscitation, with or without extracorporeal life support, had a good outcome.
Initial cardiac arrest rhythmWe were able to retrieve data on the initial cardiac arrest rhythm from the medical records in 118 of the 160 children (74%). Asystole was diagnosed in nearly all children (101/118, 86%), followed by bradycardia (15/118, 13%) and ventricular fibrillation (2/118, 2%). Bradycardia correlated strongly with good outcome: six of the 15 children with bradycardia had good outcome versus eight of the 101 children with asystole (40% (95% confidence interval 15% to 65%) v 8% (3% to 13%); odds ratio 7.8 (2.2 to 27.3), P=0.001).
Duration of submersion, doses of adrenaline, and blood gas abnormalitiesIn only 3% of the cases (5/160) was the drowning incident witnessed by an adult, and consequently the duration of submersion was not precisely known in most cases. The typical history of most incidents was a sudden realisation of the child's absence, followed by an immediate search by the caretaker. Though the duration of the search was reasonably well known, it was usually unknown how long the child had been out of sight. The median estimated minimum and maximum durations of submersion correlated negatively with outcome (table 3). The longest estimated duration of submersion with good outcome was 25 minutes. Figure 6 shows the relation between maximum estimated submersion duration and outcome.
The median total number of doses of adrenaline administered was negatively associated with outcome (table 3). The median initial pH and the base excess were significantly lower in children with poor outcome (table 3). All children were manually or mechanically ventilated at the time of the initial blood gas measurement, while some children were still being resuscitated and others already had return of spontaneous circulation. The lowest pH associated with good a outcome was 6.75.
Treatment changesWe performed a subanalysis to determine whether changes in treatment during the study period affected the main outcomes. The percentage of children with good outcome in the first five years of the study period was comparable with the percentage in the last five years (7/51, 14% (95% confidence interval 4% to 23%) v 5/30, 17% (3% to 30%), P=0.75).
DiscussionImplication of key findingsIn children with cardiac arrest and hypothermia after drowning the necessity for resuscitation for more than 30 minutes did not result in good outcome in any child: 89% of children died and 11% survived in a vegetative state or with severe neurological damage. The study used a nationwide database over the period 1993 2012. Most children drowned during spring, summer, or autumn and had a much poorer outcome than those who drowned in winter. These results strongly question the therapeutic value of prolonged resuscitation in drowned children with cardiac arrest and hypothermia.
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New Leafs goalie Alex Stalock will 'bounce back'
is someone near and dear to our hearts, San Jose general manager Doug Wilson said of his comeback from a gruesome 2011 nerve and tendon cut. had confidence (issues) this year, but I think he bounce back. Wilson is right, Stalock will make the most of his time in Toronto, as short as it might be.
Between NHL back up assignments five years ago, just days after winning his first big league game, the back of Stalock left leg was accidentally stepped on during a crease scramble in AHL play in Worcester, Mass. What he thought was a muscle pull there was no blood turned out to be a skate blade slice of the peroneal nerve, which controls sensations in the lower leg, foot and toes.
He was taken for delicate surgery at the Mayo Clinic to have it re attached. But the drop foot condition that persisted made it near impossible to walk correctly without dragging his left leg and making exaggerated strides with his right. Stalock had to wear a special brace and sit at odd angles, including in the shower.
With some muscles severely weakened in the first few months, it took him nearly a full year of rehab and special shoe orthotics to correct the Van Cleef & Arpels jewelry replica problem. Stalock eventually played his way back through the ECHL, the AHL and then two seasons as Antti Niemi reliever with the Sharks. He was backing up Martin Jones this season.
On Saturday, he and winger Ben Smith became Maple Leafs in a trade, a new challenge for the 28 year old from St. Paul, Minn. With an expiring contract, it not known how many games Stalock will get here behind Jonathan Bernier and Marlies Garret Sparks and Antoine Bibeau, whom the Leafs want to see in action in the closing weeks of the schedule.
is a bump in the road for Alex, Wilson said. he needs right now is a chance to play again. Wilson indicated the Sharks weren ready to go into the playoffs without a reliable back up. That what led them to James Reimer.
a veteran goalie capable of being a No. 1, Wilson said. age (28 next month) fits well and he fake van cleef ring been in the playoffs before. It the stretch run right now and we have to be going on all cylinders. winger Smith did not have any points in six games with the Sharks, a year Van cleef alhambra ring red replica after he was traded from Chicago for Andrew Desjardins, but had 10 in 14 games with the AHL Barracuda. Smith would be a rarity in the Leaf room, a Stanley Cup winner by virtue of one game for the Hawks in the 2013 final against Boston. He made 27 post season appearances overall, but is also heading for free agency and will likely wind up with the Marlies.
Leafs GM Lou Lamoriello wouldn say where Stalock and Smith will be assigned until they get to Toronto in the next few days and are sized up by coach Mike Babcock.
IDLE HANDS
Nudge nudge, wink wink, the Maple Leafs now have a Monty Python connection.
It turns out winger Ben Smith is a cousin of Python co founder Eric Idle.
mom British, so she really enjoys that comedy, Smith told the Calgary Herald in an earlier interview. watched a little bit of it their Hollywood movies but not too much of the TV stuff. did see Spamalot on Broadway when another cousin was married in New York City and got to meet the cast.
mom also flew over and went to one of their concerts at Wembley Stadium, Smith said around a lot of British people so I get the kind of dry humour. look on the bright side of a trade.
Goalie Alex Stalock
Age: 28, born in St. Paul, Minn.
Height/Weight: 6 0, 183 pounds
Drafted: 112th overall in 2005
This season (NHL): 3 5 0, .884 save pct.
Career: 24 19 7, .911 save pct.
Did You Know: First team WCHA all star with University of Minnesota Duluth . Won 45 regular season/playoff games with Worcester of AHL in 2009 10 . Won his NHL debut in relief on Feb. 1, 2011. Scored a goal in his first NHL game in 2011 and during the playoffs that spring, an overtime goal against Vancouver.
is someone near and dear to our hearts, San Jose general manager Doug Wilson said of his comeback from a gruesome 2011 nerve and tendon cut. had confidence (issues) this year, but I think he bounce back. Wilson is right, Stalock will make the most of his time in Toronto, as short as it might be.
Between NHL back up assignments five years ago, just days after winning his first big league game, the back of Stalock left leg was accidentally stepped on during a crease scramble in AHL play in Worcester, Mass. What he thought was a muscle pull there was no blood turned out to be a skate blade slice of the peroneal nerve, which controls sensations in the lower leg, foot and toes.
He was taken for delicate surgery at the Mayo Clinic to have it re attached. But the drop foot condition that persisted made it near impossible to walk correctly without dragging his left leg and making exaggerated strides with his right. Stalock had to wear a special brace and sit at odd angles, including in the shower.
With some muscles severely weakened in the first few months, it took him nearly a full year of rehab and special shoe orthotics to correct the Van Cleef & Arpels jewelry replica problem. Stalock eventually played his way back through the ECHL, the AHL and then two seasons as Antti Niemi reliever with the Sharks. He was backing up Martin Jones this season.
On Saturday, he and winger Ben Smith became Maple Leafs in a trade, a new challenge for the 28 year old from St. Paul, Minn. With an expiring contract, it not known how many games Stalock will get here behind Jonathan Bernier and Marlies Garret Sparks and Antoine Bibeau, whom the Leafs want to see in action in the closing weeks of the schedule.
is a bump in the road for Alex, Wilson said. he needs right now is a chance to play again. Wilson indicated the Sharks weren ready to go into the playoffs without a reliable back up. That what led them to James Reimer.
a veteran goalie capable of being a No. 1, Wilson said. age (28 next month) fits well and he fake van cleef ring been in the playoffs before. It the stretch run right now and we have to be going on all cylinders. winger Smith did not have any points in six games with the Sharks, a year Van cleef alhambra ring red replica after he was traded from Chicago for Andrew Desjardins, but had 10 in 14 games with the AHL Barracuda. Smith would be a rarity in the Leaf room, a Stanley Cup winner by virtue of one game for the Hawks in the 2013 final against Boston. He made 27 post season appearances overall, but is also heading for free agency and will likely wind up with the Marlies.
Leafs GM Lou Lamoriello wouldn say where Stalock and Smith will be assigned until they get to Toronto in the next few days and are sized up by coach Mike Babcock.
IDLE HANDS
Nudge nudge, wink wink, the Maple Leafs now have a Monty Python connection.
It turns out winger Ben Smith is a cousin of Python co founder Eric Idle.
mom British, so she really enjoys that comedy, Smith told the Calgary Herald in an earlier interview. watched a little bit of it their Hollywood movies but not too much of the TV stuff. did see Spamalot on Broadway when another cousin was married in New York City and got to meet the cast.
mom also flew over and went to one of their concerts at Wembley Stadium, Smith said around a lot of British people so I get the kind of dry humour. look on the bright side of a trade.
Goalie Alex Stalock
Age: 28, born in St. Paul, Minn.
Height/Weight: 6 0, 183 pounds
Drafted: 112th overall in 2005
This season (NHL): 3 5 0, .884 save pct.
Career: 24 19 7, .911 save pct.
Did You Know: First team WCHA all star with University of Minnesota Duluth . Won 45 regular season/playoff games with Worcester of AHL in 2009 10 . Won his NHL debut in relief on Feb. 1, 2011. Scored a goal in his first NHL game in 2011 and during the playoffs that spring, an overtime goal against Vancouver.
Mark Ronson And The Producer As Rock Star
That album, Uptown Special, is out Tuesday. It brims with vintage R pop vibes and hip hop beats, a mix Ronson has been known for since his days as a New York club DJ in the '90s. Over the years he's produced artists from all over the pop landscape Amy Winehouse, Nas, Black Lips. Last year he even made it to the TED Conference stage, where he laid out a compelling picture of how the evolution of technology and taste have allowed once disparate musical threads to weave together. Hear the radio version at the audio link, and read more of their conversation below.
Arun Rath: I want to ask about "Uptown Funk," and not just because it's so popular at the moment. I know that Prince used "uptown" to refer not to a place, but a kind of idea. I'm wondering what uptown means to you?
Mark Ronson: I guess, because I came up DJing in hip hop clubs in New York, uptown had a very specific meaning: It was the Bronx, it was Harlem. Uptown is the hipster neighborhood like, coming up in Oakland. Uptown is where Mystikal is from, the housing area he was from in New Orleans. Uptown is, you know, Prince, Minneapolis. It kind of means so many cool things, and absolutely nothing at the same time, that it makes it kind of the perfect thing to put into a song title.
Why do you think this tune has hit such a hit a chord with people?
I mean, you can never tell. You can have something you think is the greatest thing ever, or everyone can tell you it's gonna be the biggest hit, and it can just come out and tank. Maybe there's something about hearing dance music played by live, humanoid people that's been missing a bit in music.
There are so many influences, so many different sounds in your music. I'm curious about the music you listened to growing up. What was your musical diet as a kid?
I grew up in England until I was 8, and then we moved to New York. I think somewhere in my early teens I really discovered hip hop, and it was such a great, golden era. You had all the Def Jam things like Slick Rick and LL Cool J and the Beastie Boys and Public Enemy, and that was very much the sound of New York like quite literally, coming out of cars. I got into DJing and playing this music, and because it sampled so much James Brown, classic jazz, all this rare groove stuff, that made me discover all the funk music and I realized I loved that just as much.
So you ended up going an extra step, getting influenced by the people who influenced you initially.
Exactly. And I think that's how a lot of people from my generation discovered things like The Meters and Al Green through Wu Tang and the RZA and those productions. And it's great, I think, any which way you come to it. It doesn't matter.
How old were you when you started writing songs?
I played in a high school band; I played rhythm guitar. And I wrote some horrible songs. I was always more interested in writing the music. I bought a drum machine and I started to work with rappers just making the beat, and they come with the lyrics.
I feel like surrounding yourself with people that are more talented than you is the best way to get better at anything so like, working with someone like Jeff Bhasker on this album and wanting to really step up my musicality and chord changes. Picking up a Stevie Wonder songbook and teaching yourself the most complicated thing in there, even if it takes you four weeks to figure out one fake van cleef & arpels clover diamond ring song. Any of those things, I love doing. They feed the brain and the soul at the same time.
Is it my imagination or are producers becoming stars more often these days? I'm thinking about you, Pharrell, AVICII. And then there are people making electronic dance music who are stars, basically, for producing. What do you make of that?
I'm not sure what happened somewhere along the way that I get to make these records with my own name. When I first put out my song "Valerie" with Amy Winehouse, it really wasn't a hit at all in this country. Somebody at the label explained to me, "Listen, no one will ever understand, in America, the 'Mark Ronson featuring Amy Winehouse' thing. It's just never gonna fly."Putting A Name And Face To A Famous Voice
I think Calvin Harris and these guys kind of broke down the door, even though they're doing such different music than I'm doing. "Calvin Harris featuring Rihanna" suddenly became a thing that American radio, or however you want to say it, commercial radio, was ready for. I make these records because I have a concept and a bunch of song ideas and things, but I need great vocalists and I need people to help me carry that vision. I couldn't do it all by myself.
You've worked with and produced some very established singers Bruno Mars, Amy Winehouse, Lily Allen but on this new album you also have some great new vocal talent. You took a trip through the American South.
We wrote this song called "I Can't Lose." I love all the Chaka Khan records from the late '70s "I Know You, I Live You," and that feeling. We were thinking, who around [today] would sing that? And Jeff was just like, "Man, let's just get in a car and drive through the South, and we'll find singers. conversation, after a few whiskeys.
We got to New Orleans and rented a van, and we Van Cleef & Arpels jewelry price replica drove up through the South. And we saw so many incredible singers. You're not gonna see a bad singer going to churches and nightclubs and bars in that part of the deep South. But we had a very specific voice that we were looking for for this song, and we went to this little restaurant in Jackson, Miss., where we sort of had this mini audition. We heard this girl, Keyone, come up and sing, and it really just felt like, "Wow, we definitely found the person that we were looking for."
You worked with another performer from the South, although not as much of a kind of "in church" feel. How did you get to work with Mystikal on "Feel Right"?
We got to New Orleans, Jeff and I, and we ran into Trombone Shorty, this incredible jazz musician. He said, "When you all get to Baton Rouge, you know, you should look up Mystikal." When we ended up going to Memphis a few weeks later to start recording, I just called him up and I said, "Would you come up and work on this song?" Bruno happened to be there at that time because we were working on "Uptown Funk." I think I must have left Bruno and Mystikal alone for maybe two hours, and they came back with the first verse and the chorus of that song.
I love Mystikal's voice. All those early records that he did with Pharrell back in the early 2000s when I was DJing in clubs in New York, they were always such great records, and they really hold up.
I want to ask you about one more song, which features a credit that kind of jumped out at me.
Yes. Michael wrote kind of my favorite piece of modern fiction, The Amazing Adventures of Kavalier and Clay. I found out he was doing a book signing a few years ago, so I showed up, and I think he kind of recognized me or something he told me that he had liked a piece of music from my last record. When Jeff and I started working on the record last year, I said, "What do you think if I write a letter to Michael Chabon and see if he'd be interested in contributing lyrics to this album?" Because for some reason, clever lyrics only get to be the domain of the tortured singer with the acoustic guitar that you picture. Like, why can't we put these stories over Van Cleef & Arpels jewelry copy the groove?
"Crack in the Pearl" he actually just sent us over the Internet, and what was so great was, it inspired a melody that I never would have written had I not been reading those lyrics off the page. That's the piece of music that Stevie Wonder plays the harmonica, the melody, as the intro of the album, so it's an amazing turn of events. It's just something that you could never plan for, you couldn't even dream about it's what happened.
That album, Uptown Special, is out Tuesday. It brims with vintage R pop vibes and hip hop beats, a mix Ronson has been known for since his days as a New York club DJ in the '90s. Over the years he's produced artists from all over the pop landscape Amy Winehouse, Nas, Black Lips. Last year he even made it to the TED Conference stage, where he laid out a compelling picture of how the evolution of technology and taste have allowed once disparate musical threads to weave together. Hear the radio version at the audio link, and read more of their conversation below.
Arun Rath: I want to ask about "Uptown Funk," and not just because it's so popular at the moment. I know that Prince used "uptown" to refer not to a place, but a kind of idea. I'm wondering what uptown means to you?
Mark Ronson: I guess, because I came up DJing in hip hop clubs in New York, uptown had a very specific meaning: It was the Bronx, it was Harlem. Uptown is the hipster neighborhood like, coming up in Oakland. Uptown is where Mystikal is from, the housing area he was from in New Orleans. Uptown is, you know, Prince, Minneapolis. It kind of means so many cool things, and absolutely nothing at the same time, that it makes it kind of the perfect thing to put into a song title.
Why do you think this tune has hit such a hit a chord with people?
I mean, you can never tell. You can have something you think is the greatest thing ever, or everyone can tell you it's gonna be the biggest hit, and it can just come out and tank. Maybe there's something about hearing dance music played by live, humanoid people that's been missing a bit in music.
There are so many influences, so many different sounds in your music. I'm curious about the music you listened to growing up. What was your musical diet as a kid?
I grew up in England until I was 8, and then we moved to New York. I think somewhere in my early teens I really discovered hip hop, and it was such a great, golden era. You had all the Def Jam things like Slick Rick and LL Cool J and the Beastie Boys and Public Enemy, and that was very much the sound of New York like quite literally, coming out of cars. I got into DJing and playing this music, and because it sampled so much James Brown, classic jazz, all this rare groove stuff, that made me discover all the funk music and I realized I loved that just as much.
So you ended up going an extra step, getting influenced by the people who influenced you initially.
Exactly. And I think that's how a lot of people from my generation discovered things like The Meters and Al Green through Wu Tang and the RZA and those productions. And it's great, I think, any which way you come to it. It doesn't matter.
How old were you when you started writing songs?
I played in a high school band; I played rhythm guitar. And I wrote some horrible songs. I was always more interested in writing the music. I bought a drum machine and I started to work with rappers just making the beat, and they come with the lyrics.
I feel like surrounding yourself with people that are more talented than you is the best way to get better at anything so like, working with someone like Jeff Bhasker on this album and wanting to really step up my musicality and chord changes. Picking up a Stevie Wonder songbook and teaching yourself the most complicated thing in there, even if it takes you four weeks to figure out one fake van cleef & arpels clover diamond ring song. Any of those things, I love doing. They feed the brain and the soul at the same time.
Is it my imagination or are producers becoming stars more often these days? I'm thinking about you, Pharrell, AVICII. And then there are people making electronic dance music who are stars, basically, for producing. What do you make of that?
I'm not sure what happened somewhere along the way that I get to make these records with my own name. When I first put out my song "Valerie" with Amy Winehouse, it really wasn't a hit at all in this country. Somebody at the label explained to me, "Listen, no one will ever understand, in America, the 'Mark Ronson featuring Amy Winehouse' thing. It's just never gonna fly."Putting A Name And Face To A Famous Voice
I think Calvin Harris and these guys kind of broke down the door, even though they're doing such different music than I'm doing. "Calvin Harris featuring Rihanna" suddenly became a thing that American radio, or however you want to say it, commercial radio, was ready for. I make these records because I have a concept and a bunch of song ideas and things, but I need great vocalists and I need people to help me carry that vision. I couldn't do it all by myself.
You've worked with and produced some very established singers Bruno Mars, Amy Winehouse, Lily Allen but on this new album you also have some great new vocal talent. You took a trip through the American South.
We wrote this song called "I Can't Lose." I love all the Chaka Khan records from the late '70s "I Know You, I Live You," and that feeling. We were thinking, who around [today] would sing that? And Jeff was just like, "Man, let's just get in a car and drive through the South, and we'll find singers. conversation, after a few whiskeys.
We got to New Orleans and rented a van, and we Van Cleef & Arpels jewelry price replica drove up through the South. And we saw so many incredible singers. You're not gonna see a bad singer going to churches and nightclubs and bars in that part of the deep South. But we had a very specific voice that we were looking for for this song, and we went to this little restaurant in Jackson, Miss., where we sort of had this mini audition. We heard this girl, Keyone, come up and sing, and it really just felt like, "Wow, we definitely found the person that we were looking for."
You worked with another performer from the South, although not as much of a kind of "in church" feel. How did you get to work with Mystikal on "Feel Right"?
We got to New Orleans, Jeff and I, and we ran into Trombone Shorty, this incredible jazz musician. He said, "When you all get to Baton Rouge, you know, you should look up Mystikal." When we ended up going to Memphis a few weeks later to start recording, I just called him up and I said, "Would you come up and work on this song?" Bruno happened to be there at that time because we were working on "Uptown Funk." I think I must have left Bruno and Mystikal alone for maybe two hours, and they came back with the first verse and the chorus of that song.
I love Mystikal's voice. All those early records that he did with Pharrell back in the early 2000s when I was DJing in clubs in New York, they were always such great records, and they really hold up.
I want to ask you about one more song, which features a credit that kind of jumped out at me.
Yes. Michael wrote kind of my favorite piece of modern fiction, The Amazing Adventures of Kavalier and Clay. I found out he was doing a book signing a few years ago, so I showed up, and I think he kind of recognized me or something he told me that he had liked a piece of music from my last record. When Jeff and I started working on the record last year, I said, "What do you think if I write a letter to Michael Chabon and see if he'd be interested in contributing lyrics to this album?" Because for some reason, clever lyrics only get to be the domain of the tortured singer with the acoustic guitar that you picture. Like, why can't we put these stories over Van Cleef & Arpels jewelry copy the groove?
"Crack in the Pearl" he actually just sent us over the Internet, and what was so great was, it inspired a melody that I never would have written had I not been reading those lyrics off the page. That's the piece of music that Stevie Wonder plays the harmonica, the melody, as the intro of the album, so it's an amazing turn of events. It's just something that you could never plan for, you couldn't even dream about it's what happened.
What do the world's one percent wear on their wrists
Richard Mile RM 69 Erotic Tourbillon ($507,700) 12 luxury brands debuted new watches and extensions of new lines at Watches and Wonders 2015. Are "erotic" watches the next big thing? A visit to Richard Mille's booth would indicate so. Richard Mille's RM69 features a series of provocative messages on the watch face, which rotate to show one message after the other. There are 169 messages in total, and can rotate by pushing a button located near the 10 o'clock hour. Messages include "let me kiss you tonight" and "I long to explore your lips." Those are the more kid friendly combinations.
Cartier Mysterious Double Tourbillon, Minute Repeater Tourbillon, Astrocalendar ($709,700 appoximately) Cartier unveiled a limited edition box (there are only a total of five available) that features three standout watches, each said to exemplify Cartier's watchmaking identity. The Mysterious Double Tourbillon, which features a rotating tourbillon at the heart of the watch; the Minute Repeater Tourbillon, which combines the Flying Tourbillon with a Minute Repeater; and the Astrocalendar, which features a complex calendar system that can differentiate between a normal year and a leap year.
2Hong Kong (CNN)This week, Hong Kong plays host to Watches and Wonders, an exhibition organized by the Fondation de la Haute Horlogerie (FHH).
Described by the event organizer and FHH Managing Director Fabienne Lupo as "a total immersion experience," the exhibition is less a trade men fake cartier ring fair and more a platform for education and culture.
Held at the Hong Kong Convention and Exhibition Center, the third annual Watches and Wonders features 12 fine watch maisons, 10 of which are owned by Swiss luxury group, Richemont.
Last year, the event recorded 16,000 invite only guests over four days, despite pro democracy Umbrella Movement protests deterring mainland Chinese tourists from visiting Hong Kong and disrupting traffic.
Peninsula Hotel Hong Kong, 9:00 am. Exciting day ahead! Visit us at WatchesandWonders 2015 to discover all the watch novelties. But, according to Deloitte's Swiss Watch cartier bangle bracelet replica Industry Study, only 27% of Swiss watch executives who responded to its annual survey, expect growth in China and Hong Kong over the next twelve months, with 34% expecting demand for Swiss watches to decline.
"It's why you will see everyone in the industry here the presence of all the brands' CEOs, the designers, even the watchmakers we want to show support during this uncertain period," Lupo explains.
As part of its educational element, the fair offered classes on watchmaking.
New features, like the addition of scannable QR codes that connect to audio tours, dot the exhibition space as a digital and Asia facing means to learn more about individual watches and brands' histories. Lectures, such as "Chinese people's aesthetic approach to watches" and watchmaking workshops, are on offer.
Branded booths range from loud to the uber chic
Our first stop is Swiss watch manufacturer, Roger Dubuis. And at 10am, it's a jarring wake up call. At only 20 years old, Dubuis is among the youngest brands in among the industry's old heritage maisons. As if to hammer this point home, the company has dramatically decked out its exhibition space which is transformed to feel like the mechanical insides of one of its skeleton watches.
WATCHES : 2 more days to go! Come and enjoy the Astral Skeleton Experience with Oculus glasses! Redeem your personal e invitation by clicking the link on our bio.
Jean Marc Pontroue, CEO of Roger Dubuis, says the exhibition's theatrics embody the brand's values. "We love fantasy. We love to enrich the brand with storytelling, with an emotional environment."
"We're targeting the young generation that don't necessarily want a classic watch, or the watch of their fathers," Pontroue continues. "But rather, the youth who like to wear niche brands."
What's it like to be inside a skeleton watch? Swiss manufacturer Roger Dubuis chose a bolder design for their exhibition space.
Pontroue admits that sales have been affected in Hong Kong and Macau this year, due to lower tourism numbers, but has remained cartier fake love ring gold stable in mainland China. In fact, the brand is expanding its presence in Beijing with a second store that opened this summer and another one planned for next year.
A polar opposite to the Gotham esque Roger Dubuis, is German watch manufacturer A. Lange Sohne which has chosen to present a more subdued set up.
"We didn't want to overshadow the watch," explains Katharina Mack, Head of Marketing at A. Lange Sohne. "It's about substance. It's not the staging that is emotional, it's the watch that is emotional."
Richard Mile RM 69 Erotic Tourbillon ($507,700) 12 luxury brands debuted new watches and extensions of new lines at Watches and Wonders 2015. Are "erotic" watches the next big thing? A visit to Richard Mille's booth would indicate so. Richard Mille's RM69 features a series of provocative messages on the watch face, which rotate to show one message after the other. There are 169 messages in total, and can rotate by pushing a button located near the 10 o'clock hour. Messages include "let me kiss you tonight" and "I long to explore your lips." Those are the more kid friendly combinations.
Cartier Mysterious Double Tourbillon, Minute Repeater Tourbillon, Astrocalendar ($709,700 appoximately) Cartier unveiled a limited edition box (there are only a total of five available) that features three standout watches, each said to exemplify Cartier's watchmaking identity. The Mysterious Double Tourbillon, which features a rotating tourbillon at the heart of the watch; the Minute Repeater Tourbillon, which combines the Flying Tourbillon with a Minute Repeater; and the Astrocalendar, which features a complex calendar system that can differentiate between a normal year and a leap year.
2Hong Kong (CNN)This week, Hong Kong plays host to Watches and Wonders, an exhibition organized by the Fondation de la Haute Horlogerie (FHH).
Described by the event organizer and FHH Managing Director Fabienne Lupo as "a total immersion experience," the exhibition is less a trade men fake cartier ring fair and more a platform for education and culture.
Held at the Hong Kong Convention and Exhibition Center, the third annual Watches and Wonders features 12 fine watch maisons, 10 of which are owned by Swiss luxury group, Richemont.
Last year, the event recorded 16,000 invite only guests over four days, despite pro democracy Umbrella Movement protests deterring mainland Chinese tourists from visiting Hong Kong and disrupting traffic.
Peninsula Hotel Hong Kong, 9:00 am. Exciting day ahead! Visit us at WatchesandWonders 2015 to discover all the watch novelties. But, according to Deloitte's Swiss Watch cartier bangle bracelet replica Industry Study, only 27% of Swiss watch executives who responded to its annual survey, expect growth in China and Hong Kong over the next twelve months, with 34% expecting demand for Swiss watches to decline.
"It's why you will see everyone in the industry here the presence of all the brands' CEOs, the designers, even the watchmakers we want to show support during this uncertain period," Lupo explains.
As part of its educational element, the fair offered classes on watchmaking.
New features, like the addition of scannable QR codes that connect to audio tours, dot the exhibition space as a digital and Asia facing means to learn more about individual watches and brands' histories. Lectures, such as "Chinese people's aesthetic approach to watches" and watchmaking workshops, are on offer.
Branded booths range from loud to the uber chic
Our first stop is Swiss watch manufacturer, Roger Dubuis. And at 10am, it's a jarring wake up call. At only 20 years old, Dubuis is among the youngest brands in among the industry's old heritage maisons. As if to hammer this point home, the company has dramatically decked out its exhibition space which is transformed to feel like the mechanical insides of one of its skeleton watches.
WATCHES : 2 more days to go! Come and enjoy the Astral Skeleton Experience with Oculus glasses! Redeem your personal e invitation by clicking the link on our bio.
Jean Marc Pontroue, CEO of Roger Dubuis, says the exhibition's theatrics embody the brand's values. "We love fantasy. We love to enrich the brand with storytelling, with an emotional environment."
"We're targeting the young generation that don't necessarily want a classic watch, or the watch of their fathers," Pontroue continues. "But rather, the youth who like to wear niche brands."
What's it like to be inside a skeleton watch? Swiss manufacturer Roger Dubuis chose a bolder design for their exhibition space.
Pontroue admits that sales have been affected in Hong Kong and Macau this year, due to lower tourism numbers, but has remained cartier fake love ring gold stable in mainland China. In fact, the brand is expanding its presence in Beijing with a second store that opened this summer and another one planned for next year.
A polar opposite to the Gotham esque Roger Dubuis, is German watch manufacturer A. Lange Sohne which has chosen to present a more subdued set up.
"We didn't want to overshadow the watch," explains Katharina Mack, Head of Marketing at A. Lange Sohne. "It's about substance. It's not the staging that is emotional, it's the watch that is emotional."
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