 to analyze differences between such subgroups; this should be evaluated in follow-up studies. Our study did not include feedback from the parturients concerning the usability of the device. Such data are needed to evaluate the feasibility of using the dynamometer in clinical practice.
This dynamometer method is potentially appropriate for the guidance of remifentantil administration during labour because pain peak during contractions was identified as at least a moderate correlation (r>0.5) between pain measured via NRS and via handgrip force recorded by the dynamometer.
When pain became sufficiently intense to request epidural analgesia, some of the parturients did not wish to continue to press the dynamometer. This may be related to fatigue or due to lack of parturient motivation with no incentive to continue. However, during the recording periods, no signs of fatigue (diminishing handgrip force) were present. It may be interesting to perform a similar study in a centre in which at least some parturients deliver without neuraxial anesthesia (<15% of births in Geneva, Switzerland) to evaluate the correlation of handgrip force with the NRS for intense pain. Furthermore, once handgrip measurement is related to prediction of contractions and to calculation of the optimal time point of remifentanil bolus application, future studies should investigate whether an increase in compliance occurs. Here, measurement will directly be related to pain treatment and the latter will serve as an incentive.
We observed that the participants may have sometimes pressed the dynamometer according to pain intensity only at the beginning of a contraction, instead of continuing to apply a corresponding force until the pain has subsided ( Figure 1A and 1C). It is not possible from our data to judge whether this is due to a true decrease in pain intensity during an ongoing contraction or due to fatigue when pressing the dynamometer. In any case, we were able to measure duration of pain because the dynamometer was always pressed until the end of each contraction, although with diminishing force. During the calibration procedure, women were able to sustain pressure for prolonged periods without fatigue.
The beginning of pain during contractions can be determined precisely using the dynamometer recordings. This information could be used to calculate time series of painful contractions, which then could be used to predict future contractions by creating a statistical model of intercontraction intervals. Forecasting the occurrence of a future contraction may allow optimization of remifentanil bolus application to treat labour pain. Currently, a remifentanil bolus is only applied when a contraction is felt by the parturient. Using this method, remifentanil arrives too late to alleviate pain at the beginning of the contraction. Using contraction forecasting based on a time series of previous contractions, it may be possible to deliver the remifentanil bolus before the start of the contraction, optimizing the coincidence of pain and remifentanil concentration. Although handgrip force remains a subjective measure, unlike external tocography, the signal of the latter is too unreliable to be used to create time series of contractions. Recently, the signal of an intrauterine pressure catheter has been successfully used to predict uterine contractions (14). However, such a device is invasive and can, thus, rarely be used in clinical practice. An alternative may be a signal generated by voluntary action of the parturient, such as the dynamometer signal tested in this study.
Several studies have demonstrated the safe application of patient-controlled remifentanil during labour, which is superior to a continuous infusion (15) and a good alternative to neuraxial analgesia in the presence of contraindication for neuraxial blockage (16,17) or of maternal wish (18). The use of remifentanil, although not uniformly supported by all available evidence, has become more popular in the recent years, and in some institutions it is even routinely used (5,19,20). However, its potential as a potent µ-agonist to provoke adverse effects, as reported recently, must be kept in mind (21,22). Therefore, it is important to adapt remifentanil dose and bolus timing to patient's need. This could be achieved by a method to predict future contractions to adjust remifentanil bolus application, and by adjusting bolus dose to pain intensity. Feedback of the dynamometer signal to a remifentanil PCA pump may be a way to improve efficacy and safety of remifentanil dosing.

SUMMARY
The present study demonstrated that labour pain may be assessed using handgrip force measured via a dynamometer. Further studies are needed to investigate whether this technique may be used to guide remifentanil titration in situations of very dynamic pain intensity such as labour pain.

ACKNoWLEDGEMENTS:
The authors thank all participating parturients and midwives for their support of the study. The authors are grateful to Julian Klug (Geneva University) for help with the statistical analysis.I agree with all Andy's points.

Titan is a large nationwide installer, comes with pros and cons. Sometimes they are able to offer premium equipment without the mark up, they have a big deal with LG so I'd ask about using those

The lenders are letting homeowners wrap in other home improvements such as an HVAC but like he said it don't claim the tax credit on it.

Are they doing the HVAC work or they just said you can include it? There's nothing wrong with financing if you don't have the cash, still a great investment and better than giving all your money away to the utility. 

Something to be aware of tho, think hard about your goals with this project. What's your timeline to pay it off? How much can you afford each month?

APRs are really low atm but they often include upfront finance fees 10-25% baked into the loan cost upfront. If you add an HVAC, that fee will get tacked onto that cost too.

If you just want to make it as affordable as possible month to month and don't see yourselves paying it off in 10-15 yrs, go for the lower APR even if it costs more.

If you plan to pay it off in under 10 yrs, maybe go for a shorter term or higher APR that'll have a lower fee.

Take the payment and multiply by the total number of payments to get an idea of the total financed cost over the term. 

Does your utility offer Net Metering?- well grease a maslosjemny cap 2 and put on it a plastic sleeve.
- put on the tool 3 a maslosjemny cap and carefully press it in directing plug. Remember that at installation of maslootrazhatelny caps without use of this special tool or other tool similar to it, they can be damaged that will lead to the increased consumption of oil. As a last resort, it is possible to use a piece of a pipe of suitable diameter, however be thus extremely careful not to damage maslootrazhatelny caps or spring rings.
If grinding in of valves was made, each valve should be established in that saddle to which it was ground in.
Establish in a head of the block of cylinders on one internal and external spring for the corresponding valve (if old springs are established) mount them by means of a klapanny stripper.
With plastic hammer strike by the top part of a rod of the valve. Thus incorrectly established half of a rod of the valve will take off from the nest. Not to lose them, put around, the end of springs a rag.
Insert pushers according to the put marks into openings (previously having well greased them) if old pushers are used.
Plentifully oil a camshaft in the locations of bearings.
Establish camshafts in beds and several times turn them. Establish shaft so that both cams of the first cylinder on two shaft looked up.
It is necessary to establish covers of bearings just as it it is shown on fig. 406 and only according to the way described further that the camshaft was not deformed.
Being guided by fig. 407, put on covers of bearings No. 2 and No. 4 and a hand get nuts. As covers of the bearing are displaced, check, whether correctly they sit. For this purpose, being guided by fig. 406, define, whether correctly covers were put on.
Tighten nuts of the established covers of bearings alternately and cross-wise in some passes by the moment of an inhaling of 20 N В· m. Watch, that the surface of covers settled down opposite to a surface of a head of the block of cylinders.
Put on covers No. 5, 1 and 3. Tighten nuts alternately and cross-wise in some stages the moment of an inhaling of 20 N В· m. Numbering of covers of bearings corresponds to the numbering shown on fig. 407. It is necessary to be guided by this drawing at camshaft installation.
Take an epiploon of a camshaft and look, from what party the spring settles down. The party on which the spring settles down, should be directed inside. Grease a sealing surface and a surface of a kacheniye of a camshaft. For installation of a new epiploon it is possible to use a pipe of suitable diameter. The pipe should correspond to the size of an external part of an epiploon completely. Get an epiploon directly and strike on it until its external surface will not come completely inside. To establish an epiploon it is possible in the same way which is described for installation of a forward epiploon of a cranked shaft.
Establish a pulley of a drive of GRM on a