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The Car Connection BMW 4-Series Overview
The BMW 4-Series are compact coupes, convertibles, or a five-door hatchback that are related to the 3-Series family. Although the 4-Series name may be new to some people, the idea isn't—the 4- and 3-Series coupes and convertibles have been around for decades.
With the 4-Series, BMW has a rival for cars such as the Audi A5, the Mercedes-Benz C-Class coupe, and the two-door Cadillac ATS.
For 2018, BMW changed the front and rear bumpers and stiffened the 4-Series suspension for a sportier ride. The 2019 and 2020 versions were unchanged ahead of a new model that should arrive some time in 2020.MORE: Read our 2020 BMW 4-Series review
When the 4-Series was new for 2014, it included models with 4- and 6-cylinder engines. In due time, those were joined by an M4 model, as well as a sleek sedan spin-off, the 4-Series Gran Coupe. For 2017, the lineup sees the arrival of two new engines—and the nomenclature to match. Last year's 428i becomes 430i and the 435i is now known as the 440i.
At first, the 4-Series lineup consisted only of two-door versions of the latest 3-Series sedan. Sculpted front fenders and far more aggressive styling treatments for the front and rear give this model more of a high-performance look compared to the 3-Series, while the smoothly arched roofline matches up well with a taller greenhouse. As with the latest 3-Series, the 4's cabin is a bit roomier than in the coupe it replaces, although the 4-Series models get a new 2+2 layout, with bucket seats in back. The 4-Series gets seriously charming with its more ritzy interior trim packages (although perhaps too splashy in others that attempt to be sporty or ultra-modern), and its seats give grip just where it's called for in sporty driving. The backseat is somewhere we'd stay out of, which admittedly is often the case with small two-doors.
At launch, the engine lineup included both the 240-hp, 2.0-liter turbocharged inline-4 and the 3.0-liter turbo inline-6, in 428i and 435i models—both with either a 6-speed manual or an 8-speed automatic. Rear-wheel-drive and xDrive all-wheel-drive models are a part of the mix, and the 4-Series gets BMW's latest electric power steering system, tuned slightly differently from how it is in the 3-Series for a more sporting feel.
Despite significant gains in comfort, safety (as already proven in crash-test ratings), and fuel economy (of up to 34 mpg highway)—and despite an ever-greater number of high-tech options—the 4-Series cars remain among the most confident, dynamically engaging models in their class. Name change aside, the 4-Series continues as the yard stick by which others in the segment are measured.
For the 2015 model year, the Gran Coupe edition arrived, as did the fearsome BMW M4 coupe and convertible, which carry the torch for the former two-door M3 performance variants. The Gran Coupe, like the 6-Series version, is a sort of coupe-sedan, although the 4-Series Gran Coupe is actually a hatchback, while the 6-Series has a conventional trunk.
The new M4 is powered by a twin-turbo version of the classic inline-6 that makes 425 hp. It's one of the best-driving BMWs in recent memory, making improvements over the last-generation M3 coupe and adding more power to boot. Its hugely upgraded power comes with a choice between 6-speed manual and 7-speed M Double Clutch gearboxes. With an available Active M limited-slip differential, and an available Adaptive M suspension, the newest BMW M4 takes after the larger M6 in ride and sophistication, yet it keeps its weight down, to enable a supercar-league 0-60 mph time of just 4.2 seconds (in DCT form).
The rest of the 4-Series lineup saw some minor changes for 2015, mostly dealing with interior trim and feature availability. Notably, Bluetooth audio streaming was made standard across the board, and the so-called Enhanced Bluetooth (with a USB port) is now a standalone $500 option.
Changes announced for the 2016 3-Series migrated to the 4-Series for 2017. They included a new turbocharged six to replace the 335i's N55 engine. This new engine, dubbed B58, makes 320 hp. The entry-level 430i, meanwhile, saw its new 4-cylinder rated at 248 hp compared to last year's 240 ponies.


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30th April 2015
We're delighted to announce that registration is now open and an Early Bird package is available for our annual flagship event GeoCom: Resilient Futures, 23rd-25th November 2015, Chesford Grange, near Warwick. This amazing package price is only available on a first-come-first-served basis until 30th June (or until our ticket allocation runs out) so don't miss it!
29th April 2015
The second in the 2015 series of Geo:The Big 5 events is BIM: The Next Level, was held in Cambridge, 23 April 2015. We had a fantastic range of speakers demonstrating the latest thinking in the BIM journey towards Levels 2 and 3. Please log into your account to access their presentations either via Resources or via Past Events.
29th April 2015
MapAction has deployed a team of 4 mapping specialists in response to the devastating earthquake, measuring 7.8 on the Richter scale, that hit Nepal on Saturday 25th April at 12 noon, local time. One of MapAction's volunteers was already in Nepal when the earthquake struck.
29th April 2015
UK GEMINI is an AGI publication that is a core enabler of data.gov.uk, the UK's national data portal, and of the UK's response to the INSPIRE Directive. Working with Defra, the AGI Standards Committee plan to publish version 2.3 of UK GEMINI in the summer of 2015.
2nd April 2015
Officials from Fisheries and Oceans Canada, today joined with Canadian geospatial software company CARIS and geomatics technology innovation support centre TECTERRA, to unveil high precision 3D printed models of HMS Erebus, Sir John Franklin's lead ship found last year in Canada's Arctic waters as part of Parks Canada's search for the vessels of the lost 1845 expedition.
Lancaster Court
8 Barnes Wallis Road
Hampshire PO15 5TU
Tel: +44 (0)1489 668 340
Email: email@example.com

subset: commoncrawl


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Conservation Measures (CMs)
What is a CM?
What do CMs Do?
A Varying Landscape
Eventually, the USFWS plans to utilize the CMs to complete a series of programmatic consultations. Programmatic consultations evaluate the potential for groups of related actions to affect listed and proposed species and designated and proposed critical habitat. Programmatic consultation techniques have the greatest potential to streamline the consultation process because much of the effects analysis is completed one time up front rather than repeatedly each time a new action, or batch of actions, is proposed. Developing a series of programmatic consultations based on the CMs will eventually allow many projects to be appended to the appropriate programmatic consultation such that the consultation process can be completed in a few days or, at times, a few hours.


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Items where Person is "Booth-G-H"
Group by: Date | Item Type | First Author | No Grouping
Jump to: Article
Number of items: 7.
Williams, Kiel T. and Yao, Yuan and Li, Jia et al. (2020) Direct Comparison of Many-Body Methods for Realistic Electronic Hamiltonians. Physical Review X, 10 (1). Art. No. 011041. ISSN 2160-3308. https://resolver.caltech.edu/CaltechAUTHORS:20200221-073241981
Sun, Qiming and Berkelbach, Timothy C. and Blunt, Nick S. et al. (2018) The Python-based Simulations of Chemistry Framework (PySCF). Wiley Interdisciplinary Reviews: Computational Molecular Science, 8 (1). Art. No. e1340. ISSN 1759-0876. https://resolver.caltech.edu/CaltechAUTHORS:20170206-112450918
Booth, George H. and Tsatsoulis, Theodoros and Chan, Garnet Kin-Lic et al. (2016) From plane waves to local Gaussians for the simulation of correlated periodic systems. Journal of Chemical Physics, 145 (8). Art. No. 084111. ISSN 0021-9606. https://resolver.caltech.edu/CaltechAUTHORS:20161221-104314806
Booth, George H. and Chan, Garnet Kin-Lic (2015) Spectral functions of strongly correlated extended systems via an exact quantum embedding. Physical Review B, 91 (15). Art. No. 155107. ISSN 1098-0121. https://resolver.caltech.edu/CaltechAUTHORS:20161222-074103171
Chen, Qiaoni and Booth, George H. and Sharma, Sandeep et al. (2014) Intermediate and spin-liquid phase of the half-filled honeycomb Hubbard model. Physical Review B, 89 (16). Art. No. 165134. ISSN 2469-9950. https://resolver.caltech.edu/CaltechAUTHORS:20170113-123256350
Sharma, Sandeep and Yanai, Takeshi and Booth, George H. et al. (2014) Spectroscopic accuracy directly from quantum chemistry: Application to ground and excited states of beryllium dimer. Journal of Chemical Physics, 140 (10). Art. No. 104112. ISSN 0021-9606. https://resolver.caltech.edu/CaltechAUTHORS:20170113-131620432
Booth, George H. and Chan, Garnet Kin-Lic (2012) Communication: Excited states, dynamic correlation functions and spectral properties from full configuration interaction quantum Monte Carlo. Journal of Chemical Physics, 137 (19). Art. No. 191102. ISSN 0021-9606. https://resolver.caltech.edu/CaltechAUTHORS:20170125-103855780


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BREATHe~ DREAM~CREATE ~LOVE
Hey… I know you!
I know who you are…
You love yourself… Your beloved… Your loved ones… Your amazing tribe… Your magical life as it unfolds…
You are instinctual, primal, intuitive.
You are feisty and fierce, bold and brave.
You are courageously vulnerable, soft and tender. You listen… and you speak your truth.
You move your body, just because it feels good.
You heal yourself and those you love with nourishing food. Prepared mindfully and from the heart.
Oh, your heart…
So generous… Giving… Sharing…
So open! To life! To love! To connection! Such trust and awareness!
Hey… I see you!
I see who you are, Love.
You walk with confidence.
You shine. So brightly!
The warmth of your smile and your laugh is contagious.
I love how you walk in your true, unique beauty. I love how you deflect judgment without batting an eyelid. I love how you embrace your own beauty… and that of others… and that of life itself…
You GLOW…
And sometimes I catch you stopping and nourishing yourself with big, juicy breaths… And I can't help but smile.
Can I tell you what else I love about you?
I love your mind.
I love how you set such clear intention… Create vision… Follow through…
I love how you affirm yourself… Armed with secret, sacred, powerful mantras… Those nasty little voices don't stand a chance with that mental toolkit of yours, do they?
I love that you know what you want, and you manifest it.
So abundant, you are. So embracing of your worthiness of that abundance. So willing to share the overflowing of your wisdom and gifts.
I love your sense of adventure and your embrace of challenge.
I love how you move so fluidly from your sensual, sexy self to your grounded, humble self to your cheeky, silly self.
All vibrating from your deep, passionate, vital, essential energy.
From the very nature of who you are. The core.
And who you are is brave…
So connected to your soul purpose.
So willing to grow… Transform… Unfold… So willing to both lead and learn.
I love how you know how to let go. To surrender.
You live in the light, don't you? You're magical…
You're free…
I know it.
You're a Goddess.
Hey, beautiful! I'm Aimee.
I'm a holistic health coach and yoga instructor with a raw devotion to helping women to shine as their most radiant selves.
In envision a world where everyone belongs to a supportive tribe…
Where the journey through this thing called life is happy, energised and truthful …. Where love is the standard, presence is the norm and intuition is the guiding light…
I believe in embracing life in all its light and shadow, slowing down and living from the heart.
And breaths.
I believe in big, nourishing, centering breaths!
Can you imagine…?
- Looking in the mirror and your first, pure thought being 'I love you'?
- Feeling centred, grounded, balanced, calm and strong as your normal, constant experience?
- Knowing exactly who you are and expressing that self with ease, grace and fluid flow?
- Feeling a sense of magical momentum as you witness your life unfolding?
- Being an integral part of a tribe of like-minded, soul-nourishing women where stories are shared, tears are shed and great healing is experienced?
- Attracting amazing, wholesome, mutually nourishing friendships and relationships into your life effortlessly?
- Nourishing your sensitive female body, your temple, with high-vibration foods and beverages, and seeing and feeling the resulting glow and radiance?
- Learning how to move your body in ways that create a healthy, happy, flowing body and that actually feel good?
- Being so connected to your intuition that it becomes your most reliable guiding force?
- Respecting yourself, connecting to your truth and creating healthy boundaries with ease?
- Feeling such strong presence that life is a constant source of delight?
- Connecting with your dreams, masterfully setting goals and strategically following through to create and manifest your hearts deepest desires?
- Knowing that with the right tools and strategies, you can trust yourself, trust your path and trust the universe?
- Being a magnet for abundance in all areas of yourself, and a vessel of loving gratitude?
Sounds pretty good, right?
Believe me… It is!
It's the life I now lead – the Goddess life. And I believe that it's the birth right of all women to enjoy all this, and more. My life's work is to empower as many women as I can with the tools and resources that healed me and allowed me to break through my own blocks to create the flow, love and magic that I now embrace every day.
Life was not always this joyful for me… In fact, I have a confession.
Years ago, I experienced my 'rock bottom' – a panic attack so severe that I was sedated and rushed to hospital. The years that proceeded this final breakdown were uncomfortable at best, painful at worst.
I was addicted to money and the things it could buy – clothes, shoes, handbags, beauty treatments. I worked ridiculous and unsustainable hours to support my obsession, because I thought that it was these things that would make me prettier and more attractive to others. I thought that I needed to keep buying, buying, buying to make myself happy.
It wasn't until everything was taken away, through the breakdown I experienced, that I realised that I had been crying out for love without understanding that I needed to love myself first.
In the rare moments that I wasn't working (or shopping!), my inner life was in turmoil… I felt exhausted, as though I was constantly treading water. I was completely disconnected from my soul dreams, looking only to my next purchase to attempt to create happiness. (Guess what… It never worked…)
I felt painfully stuck. Desperately unhappy. Constantly guilty.
My friendships and relationships were toxic – I was forever giving, giving, giving, with nothing received in return. This only cemented my most paralysing self-belief – that I was not good enough.
Now I can understand that my panic attack was one of the greatest gifts life has ever sent my way. It set me onto my healing path – guiding me to my first yoga class, to the teachers and mentors who helped me to heal, to my journey with nourishing wholefoods and, ultimately, to my coaching career.
I know these things to be true… The Goddess Life is the birth right of all women, but it takes deep, thorough work to create the ease and flow that it entails. Part of being a Goddess is understanding that you need and deserve support in your growth. And that's where I step in.
As your coach, I will stand shoulder to shoulder with you on your journey, assisting you to:
- Become a true master of authentic self-love
- Connect with your body and nourish it, deeply, with delicious whole foods, scrumptious beverages and joyful movement
- Shut up that chattering mind, creating presence and quiet
- Uncover and discover your purpose, your passion and your path
- Rise into radiance in body, mind and soul
- Identify your blocks and burn through them
- Clear out your negative thoughts and limiting beliefs and awaken to magical possibilities
- Map out your goals and action plans to help you create the life of your dreams
The vast toolkit I draw upon in my coaching practice includes:
- Mindfulness practices
- Meditation techniques
- Targeted yoga asana instruction
- Nutritional reviews and deliciously nourishing meal plansI don't just see myself as a coach… I'm also an enthusiastic cheerleader, a mindful mentor and a partner in accountability. I approach my work in the spirit of sisterhood, and cultivating deep, trusting relationships with my clients is the name of the game!Yours in beauty, yours in truth, Aimee xxx
Professional Bio:
Aimee Angelique is an IIN certified health coach, Youth Mentor and yoga teacher based in Newcastle, NSW.
With a background in media, performance, event management and public relations, Aimee has a contagiously vibrant energy and enduring commitment to helping others to shine brightly.
- Professional stylist (including working with New Idea, Marie Claire and The Australian)
- Media production and project coordination
- Director events management (including the burlesque show "Dollies and Soldiers" and the popular "Welcome To The Wonderland' dance parties)
- Diploma of Business Management
- Holistic Health Coach Diploma (Institute of Integrative Nutrition)
- Certified Yoga Instructor (Sukha Mukha Yoga Teacher Training)
- Certified Prenatal Yoga Instructor (Katie Manitsas Yoga Teacher Training)
- Certified Youth Mentor (Shine From Within)
Aimee's Programs:
My programs are all about YOU; tailored to your unique energy and flow.
No rules… no checklists… no set agenda…
My guiding principle in my coaching is INTUITION.
I am open and responsive to what I hear, see and feel your mind, body and soul calling out for. I'm then able to dip into my vast toolkit to source exactly what it is that you need – right here, right now. It's from this intuitive space that our healing adventure unfolds; together.
Fast Flame:
This is a one-off intensive coaching session where we zone in, laser-focussed, on one specific block… and burn through it!
Be it related to health, nutrition, fitness, work, relationships or any life area that needs work, a Fast Flame session is about swiftly unpacking your issue and implementing strategies to empower you and transform that block, creating resolution, healing and joyful forward momentum.
Fast Flame sessions are very flexible – book as you go!
Your Fast Flame session includes:
- A 1.5 hour, one on one coaching session via Skype or in person
- A summary of our discussion and an outline of my recommendations and resources, emailed to you within 24 hours of our session
- A 'check in' email to see how you're progressing, 1 week after our session
- A bundle of strategies and resources for you to put into action right away
Fast Flame Investment – $185.00
Deep Water Program:
A 3-month program where we delve and dive deeper into your life, identifying the obstacles that hold you back, the issues that keep you stuck and the gentle strategies that will move you through.
You may like to devote your Deep Water program to one specific life issue – health, weight-loss, relationships, work, fertility, pregnancy etc… Or you may like to cover the whole tapestry of your world throughout this time with me. Remember – there are no rules; this is YOUR program! This is YOUR life!
Believe me when I say this: when you dive deep, the water is mighty fine!
Your Deep Water program includes:
- A 1 hour, one on one coaching session twice per month for 3 months (fortnightly), via Skype or in person
- A summary of our discussion and an outline of my recommendations and resources, emailed to you within 24 hours of our sessions
- Regular email support throughout the 3 month duration of the program
- A bundle of strategies and resources for you to put into action right away
- Some delightful surprises along the journey, like bonus worksheets, access to new resources and even some snail-mail treats!
Deep Water total Investment = $660.00 (payment also plans available)
Absolute Immersion Program:
A 6-month program where we go right to your core to fully nourish you into the sumptuous Goddess that you are!
Absolute Immersion is about fully stepping into your feminine power, setting your feet onto your soul's path and unfolding into the very best version of you possible.
Deepen your spiritual work, raise your vibration and create deep, sustained radiance, inside and out!
The work we'll do together here is deep. Sometimes gritty, always poignant, forever joyful.
Your Absolute Immersion program includes:
- A 1 hour, one on one coaching session twice per month for 6 months (fortnightly), via Skype or in person
- A summary of our discussion and an outline of my recommendations and resources, emailed to you within 24 hours of our sessions
- Regular email support throughout the 6 month duration of the program
- A bundle of strategies and resources for you to put into action right away
- Some delightful surprises along the journey, like bonus worksheets, access to new resources and even some snail-mail treats!
Absolute Immersion Total = $1,200.00 (payment also plans available)
If you would like more info or have any questions please email email@example.com for all the details.
Want to keep up-to-date? Join the Tribe!
Subscribe to our Newsletter for the latest on upcoming classes, workshops & news straight from the mouth of Aimee Angelique. Sign up here!
Namaste friends,
If you would you like to know more about the training I completed to become a Holistic Health & Lifestyle Coach head HERE.
Maybe you might be interested in studying with IIN yourself? If you'd like to know more about the school and find out how you can save on your tuition with IIN please click on the pic below or please contact me via email@example.com for more information.
Namaste, Aimee Angelique X


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Google Gives Google+ Some Nips and Tucks
Jan 18, 2017 1:21 PM PT
Google on Tuesday announced three new updates to Google+ in an effort to revive interest in the faltering product.
The added features will be rolled out next week, when the old Google+ layout will vanish.
First, lower quality comments will be hidden, although Google didn't explain how comments will be judged or who will make those calls.
Google has tweaked the Google+ user interface to display more posts and less white space.
Further, a zoom functionality has been added to photos on Google+.
Google is also bringing back the Events feature so users can create and join events on Google+ as they used to. However, Events will not be available to G Suite users.
The company will continue working on Google+ and is soliciting user feedback.
The Red-Headed Stepchild of Social Media
Google+ has not fared well in the social media space, and Google last year recharacterized it as a content curation site rather than a social network.
It redesigned the Google+ site, offering tools for moderating communities, as well as adding images and linking to comments.
There's a dearth of statistics and information about Google+ online to support either side of debate over the validity of its existence.
Although some have compared it to the walking dead, Google+ has an estimated 120 million unique monthly users, according to eBizMBA, which ranked it sixth on its top 15 list of most popular social networking sites in January. Its eBizMBA rank -- which is a continually updated average of each website's global Alexa rank and U.S. Compete and Quantcast ranks -- is 34.
Facebook, YouTube, Twitter, LinkedIn and Pinterest were the five most popular social networking sites in January. and Tumblr, Instagram, Reddit, Flickr and Vine are among the sites trailing after Google+ in the top 15.
"Google+ has had a hard time getting traction," noted Michael Jude, a program manager at Stratecast/Frost & Sullivan.
That's because it was late to the game, he told TechNewsWorld. "Most people have accounts on other social sites, and adding yet another is too much overhead for most."
The Tweaks' Impact
The latest changes to Google+ "should make the device more efficient," said Rob Enderle, principal analyst at the Enderle Group.
However, while positive, they are more "along the lines of a hotel saying they're going to repaint the bathrooms and get rid of the smell," he told TechNewsWorld. "They may lead fewer people to leave the service, but aren't compelling enough to bring people back."
Any improvement is good, Jude noted, but Google+ "is not a dominant player in social, so unless [the changes make it] remarkably better, it will still be an also-ran."
Strengths, Weaknesses, Potential
The principal attraction of Google+ is the way it integrates with the Google solution set, Frost's Jude remarked. "It's possible to do everything in Google, rather than use several service providers."
However, it's one more application to manage, he said.
Another weakness is that Google "has not been exactly trustworthy with personal information," Jude pointed out. "Many people distrust putting all of their personal lives under Google's scrutiny."
Google+ "could be a far better way to do social networking, but like the kid in school with great potential, if [Google isn't] willing to put in the effort, that potential will never be reached," Enderle observed.
The service "could be a useful way to manage internal company communications and teams," Jude suggested.
As for why Google is continuing to work on Google+, given the service's relatively weak showing and its failure to compete with Facebook, it may be that company officials "just haven't got around to shutting it down yet," Enderle said. "Unless their interest changes, I expect that decision is still coming."


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Just over 4 weeks ago we were ringing in Christmas and the new year-2014!
Many runs and a couple of weeks later, BOOM – Its the CHINESE NEW YEAR celebration, where the Chinese (obviously) welcome the new year of the Horse! YEEHAW! Aside from the tradition of buying new clothes, cleaning up the house…… it is a time where family and friends gather to spend time together (I guess that is the whole point of any other celebration!).
I always look forward to Chinese New Year because I am still eligible to receive Ang Paos (money in red packets) and of course the FOOD! It is a time where most grandmas, aunties and mothers around the world display their culinary skills to prepare the big reunion meal of abalone, exotic mushrooms, duck, fish and the like. The reunion meal usually falls on the eve of Chinese New Year which was on the 30th of January this year.
I was working on that day but managed to squeeze in some core work and stretching before the big meal. This was probably the first time I spent nearly an hour just focusing on stretching and it felt sooooooooooooo good! I could feel the blood rushing to every part of my body and I felt so relaxed. I guess this is the reason why some people rave about yoga. Before a few weeks ago, I've never done any form of stretching. I've always just focused on running and more running. It is time that I make it a point to stretch everyday. Another resolution to the list! DING!
This year, my aunt and my mom took over the cooking to relieve my grandma of the long hours and stress of food prep. Here's a glimpse of the dinners that I've been having. Ahhhhhh. So yummy!
Even the dogs looked stuffed!
We played a game of scrabble after our reunion dinner because we're intellectual like that. Haaaaaaa! Need to put our brains to work after all that food! After all, the brain consumes the most energy.


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Daryl Christopher Yost
IT388-01: Routing and Switching I
Instructor Robert Knox Jr
Our company needs to think about upgrading their network. As for the network, we want to propose a full upgrade that means, network operating systems, software and hardware. Our proposal includes the development of a LAN able to meet the requirements of your company's software. The computer network components for the proposed upgrade will include the use of a server, a switch, patch panel, and a router for the office. The selected NOS (Network Operating System) is Windows 2003 Server or Windows Server 2007, preferably the latter. These operating systems provide great conveniences to the installation, configuration, and maintenance of the network. Windows 2003 Server provides the enhanced DHCP, DNS and WINS features allow a network administrator to expediently manage all clients on the network. The data communication media for the networks is UTP CAT5.
This cabling follows the Ethernet standards for TCP/IP and ensures decreased propagation and noise.
The network portion of the proposal will consist of firewalls, routers, switches, load balancers, and content engines (used here as reverse-caching appliances). This combination of equipment will provide us with security, performance, and scalability. Our database server will sit inside our internal network to protect our data from unauthorized access. Our web servers will sit in our DMZ and will access the database server through an internal firewall. Access to the web servers from the internet will come through an outside or shield router and an external firewall, which is attached to a T1 data line provided by out Internet Service Provider. Directly behind the external firewall in the DMZ, we will place a load balancer. This device will do server load balancing (SLB) for the web servers. The content engines will be...


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Best Food Stories Week of May 18, 2013
The Best of POPSUGAR Food This Week
- A springtime sea bass recipe, developed by a three-Michelin-star chef
- Does this mock meat taste like chicken?
- The no-fail way to cook quinoa
- Dive into one of these salad cookbooks this Summer
- Wedding cakes that are anything but traditional
- Don't ever toss bacon grease again! Here's how to handle it
- Shop these essential items for a dorm "kitchen"


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Coil Options
The Mico comes with a choice of three coil options.
0.8 ohm mesh coil: Mesh coils are designed to create a greater surface area, and combined with the slightly lower resistance are the best of the coils for producing vapour.
1.0 ohm regular coil: With a slightly higher resistance, these coils are the best for a tighter draw and a mouth-to-lung inhale.
1.4 ohm ceramic coil: Longer lasting coil delivering an improved flavour.
What are vape pod systems?
With vape pod systems, a pod replaces the tank usually found in an e-cigarette. These pods clip into the device creating an all-in-one device. Pod vapes come in two forms - refillable pods, and pods which are pre-filled. Pre-filled are best for people who don't like the mess of refilling, while refillable pods are best for people who like experimenting with different e-liquid flavours.
The majority of pod systems come with higher resistance coils, meaning they are best used with high PG e-liquids such as Halo e-liquid, which comes with a VG:PG ratio of 50:50, and nicotine salts.
Want to learn more? Check out our complete guide to pod vaping here.
Whats in the Box?
3x Smok Mico Pods
At E-Cigarette Direct we pride ourselves on providing you with superb after-sales support, and aim to provide rapid replacements for any faulty device under warranty. This page details the warranties you get with your device, and how to get a replacement.
Charging Equipment
Your charger comes with a 12 month warranty.
All mods and batteries are under warranty for three months.
All clearomisers (tanks) with the exception of CE5 clearomisers are under warranty for six months. CE5 clearomisers (tanks) are under warranty for one month.
Please note - these warranties do not apply to the coil within a clearomiser or tank which is a consumable product as below.
Coils are a consumable product, and as such, will be replaced only if faulty on arrival. Please let us know within 5 days of receipt if your new coil does not work.
What does your warranty mean?
We guarantee that your device is, and will remain, free from defects for the period of the warranty. Please note - this applies to faulty products, and not accidental damage (e.g. dropping on a hard floor!)
The above warranties are subject to our terms and conditions. Please see our full warranty information for further details.
What if the warranty has run out?
We're still here to help! Many problems can be diagnosed and solved (or we can point you towards one of our helpful guides), so send us an email, give us a call for advice or pop into one of our stores for face-to-face support and help.
How do I get a replacement?
In the unlikely event you have a problem with your device, just contact our friendly customer service team on [email protected]
You'll need to return the item (we can arrange pick up free of charge). If we are unable to diagnose and solve your issue, we'll send you a replacement by Royal Mail First Class. It helps if you have your order number, but if not our team should be able to find your order using your email address.
Delivery & Returns
Hassle Free Returns plus Free Delivery On Orders Over £15
Delivery Prices and Speeds
Royal Mail 24
£2.99 or FREE for orders over £15
1-7 working days if purchase completed before 5pm.
Parcels ship Monday - Friday excluding bank holidays. 95% of orders arrive next day.
- Signature required for orders over £100.00.
- Orders over £100.00 are sent Royal Mail Tracked 24.
Royal Mail Tracked 24
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Divi post navigation is an important tool for making the visitor move around your website either in the same category of projects and posts. This module automatically creates the links for next and previous posts or projects based on the order in which they are published. It is the most standard part of any website and we can see these navigation links at the bottom of any post or projects. We often need to use these post navigation links in the slider, footer and anywhere else, then in that situation, we can use the Divi Post Navigation shortcode. The post navigation module of Divi theme is very useful and easy to understand.
Shortcode for Divi Post Navigation
[et_pb_post_nav admin_label="Post Navigation" in_same_term="off" hide_prev="off" hide_next="off" use_border_color="off" border_color="#ffffff" border_style="solid" prev_text="View the Next Post"] [/et_pb_post_nav]
The Output of This Shortcode Will Be Like
Settings of the Post Navigation Module
Advanced design and Custom CSS settings
We can also use the advanced design settings for advancing our design. It has some advanced settings like font style of the text, font size, change text color, maintain letter spacing and line height, border settings, settings of the body content, custom margin and custom padding etc.
In the "Custom CSS" tab we can type own CSS code as according to our desire. We can define the multiple CSS classes and id in the Custom CSS setting section and also create space between them. Every developer wants to insert the own designed CSS code for making attractive website pages. With help of Custom CSS setting the developer can customize the CSS code to make look and feel of WordPress site different.
We are trying to explain all of the information about this "post navigation module". Hope you can easly understand everything about the post navigation module in this article.
If you liked the post, please share it maximum and comment below. Have a Nice Day!
You May Also Like
- Tested on Divi Version 3.0.24


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I was at work when one of my co-workers told me that his power was out at his place, and he decided to arrive at work early. His home is not to far from mine, about 5km away, and my shift was about to end for the night, the odds were very good my place was out too. Sure as ice one the road, when I drove through my neighbourhood, it was lights out, and by the temperature of my home when I walked through the door, the power had been out for some time. I was greeted with an outside temperature of minus 10, and an inside temperature of plus 4. Without electricity, what do you do?
I am fortunate to have a propane oven and range, plus a small propane heater that is built in to my home, but these only heat a very small area. This was my lifesaver, other than the twenty candles I placed around the house. Anything that generated heat without electricity was my friend.
After a couple hours without power, I managed to get my living room area up to 12 to 13C, but nowhere near that comfort level to be happy. I decided to stay up until the power was switched back on. I sat on my recliner chair, and placed two heavy blankets around me, and read some books. Sick and sore from lack of sleep to begin with from the flu, I knew that this was going to add more misery to the days ahead, as I needed to be at work. I already took two sick days from last week, so money in the future is going be tight as it is.
Around 4:00am the power came back on. I kept my heaters going, along with the candles, until the room temperature climbed back up to comfy levels. But then again, I have been psyched from time to time by BC Hydro, when the power came back on, then suddenly, it gets switched back off for a few more hours, before it is switched on for good. I just left everything the way it was until I sure that the power was stable enough put everything away, and I could get some sleep.


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For some, research can be an exciting exercise in detective work, digging for clues, facts, and historical tidbits that most people have never heard of. For others, research is a sure-fire cure for insomnia.
In the context of this article, we're going to discuss research as a means of finding abandonments. There are many other uses for research in this hobby, but we'll talk about that later.
One of the best ways to find abandonments is to look for websites, local or otherwise, dedicated to our hobby. Some maintain databases of locations for you to explore. These may require memberships to access, and some grant membership only on referral from other members. You need to establish yourself a little.
Other sites offer up the information to just about anyone with no barrier to entry.
Look for search tools on these sites. Perhaps they offer the ability to narrow down your search to your area, or those acceptably close by.
Maybe you find pictures of something you know is in your city or a neighbouring city, but you don't know where precisely. Use Google Earth, and examine photos you find online very closely for clues. Perhaps an unusually-shaped roof, or something prominent and recognizable in the background. Maybe you can even use that to estimate the angle the photo was taken, helping you narrow your search even closer.
For example, in a UE-related forum, someone posted pictures of an abandoned school in Philadelphia. It caught my interest because I planned to be there in the next couple of months. While he did not leave any information about where to find the place precisely, he did, unwittingly, leave enough information for me to pinpoint it.
I began by looking through his photos. One shot showed two bridges side-by-side. One was smaller than the other, and both were somewhat unique. It didn't take long scanning up and down the river on Google Earth to determine where these bridges were. Better still, because the two bridges were so different, I was now also able to determine which side of the river the photo was taken from. If you're not following me, the bridges would appear to be on different sides of each other, depending on which side of the river you took the picture from.
Research can also come by talking to others from the community. Speak with people who snowmobile, for example. They tend to be out in the woods mostly, or back fields, and often run across fascinating places people forgot, or don't care about anymore.
Talk to older people in the community. Sometimes you'll get lucky enough to find someone who's lived there long enough, and heard enough that they can point to a few abandoned places.
Research books and even more-so, newspapers. Often the news now, or within a couple of prior years, will indicate the failure, collapse or insolvency or a business or industry in your area. This could be a useful place to start looking.
Sometimes, even a search on Google using the terms "abandoned Mytown" obviously substituting the name of your community of interest. You might get lucky and hit on something of interest online. You'll probably have to add "-cats" to your search, as you find a LOT of articles about abandoned cats in every community, and using the minus sign in front of the word will tell Google to exclude those from the search.
UPDATE - August 20, 2009: More and more, libraries are beginning to keep collections of images, databases of magazine articles, etc. online. I have found that it is useful to build a collection of links to libraries in areas you routinely explore to find out background information on the places you find. Before you know it, you'll have a fairly extensive online reference library of your own.


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Earth 13 a world where it's entirely supernatural. Even Superman. Kenora is near Lake-of-the-Woods Ontario, which is magical.
Mutant Diet Phase 5 Day 30
Last day of Phase 5. I see the trainer and weigh in. Tomorrow I'll reveal the results and plans for Q1 2018.
I've had a lot of people in this journey tell me that diet is a bad word. (Besides, is it a noun, verb or pejorative term?) They want me to consider the word lifestyle instead. This doesn't sit well with me because I don't think I could maintain this as a lifestyle.
However, I see the diet/fitness process as the Correction Diet with the long term food and fitness choices being the lifestyle.
I'd really like to be closer to the long term state as opposed to this battle I've been in since March 2016.


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New Mexico State University
Jump to navigation Jump to search
New Mexico State University is a four-year public university in the United States. It has five campuses,[1] but its main campus is in Las Cruces, New Mexico. In 2010, it had about 18,000 undergraduate students.[2]
History[change | change source]
The school started in 1888. It was first called the Las Cruces College. Soon after, it changed its name to New Mexico College of Agriculture and Mechanical Arts. In 1960, its name was changed to New Mexico State University.[3]
Sports[change | change source]
New Mexico State University's sports teams are called the Aggies.


text: In Ann Arbor, oh yeah it was very nice today. It's getting warm here in Ann Arbor, and all the snow in the yard are all melted so that's just a sign that the spring is really getting closer. I really can't wait for the spring since me and my friend Tenessa is planning to go to the Cider Point. Yeah we both haven't been in that place so today we were talking about it. Kelly was happy to hear it but we have to see how much money we will have that time hehehhehe. The only money we need is for the gasoline and to buy food and other things we need hehehhehe. That's all for now and take care everyone.


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The State Bank of Vietnam has given written approval to the Vietnam Joint Stock Commercial Bank for Industry and Trade (VietinBank) to establish a fully-owned entity in Laos by converting its existing branches in the country.
The new entity will be called the Vietnam Bank for Industry and Trade in Laos Ltd, be based in the Lao capital of Vientiane, and have charter capital of $50 million.
VietinBank must open the new entity within 24 months from the date of approval.
Last year SHB and Sacombank also received in-principle approval to establish fully-owned entities in Laos, by also converting their existing branches.
Vietnam's other near neighbor, Cambodia, has also attracted the attention of these two banks. Sacombank has been operating in the country via a 100 per cent owned subsidiary since 2011, and in November last year SHB won official approval from the State Bank for a similar move.


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- This event has passed.
Surprise Make and Take Weekly Crafts
Tuesday, July 7 @ 10:00 am - 2:30 pm
An event every week that begins at 10:00 am on Monday, Tuesday, Wednesday, Thursday and Friday, repeating until Friday, July 10, 2020
One event on Monday, July 13, 2020 at 10:00 am
Event Navigation
From June 15 – July 27, 2020, parents will be able to order different craft kits for their child(ren). These kits are designed for young school age children. The kit for each week during this period will be different and contain the supplies needed to create the craft. Then on the following Monday at 2:30 pm, there will be a live Show and Tell where participants can show what they created from the previous week's kits (as well as anything they find around the house). To participate in the live event, an email address must be provided when signing up as the link to the event will be emailed. Sign-up is required for this program because supplies are limited. Kits can be picked up using Curbside Pickup at either South Cobb Regional Library or Vinings Library.
Week 4: "Twirlers"
Craft kits will be distributed July 6- July 13 with the Live Show and Tell will be on Monday, July 13th at 2:30 PM.
Check the calendar and stay tuned for Weeks 5 and 6 surprise craft kit and link to the live Show and Tell link.
To request a kit, Please fill out this form Make and Take Craft Sign-up or call the library at the numbers below:
South Cobb:(678) 398-5834
Vinings: (770) 801-5330


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Week 1 list of- Things I Know Things I Think I Know Things I Know I Don't Know. Things I Know: The NFL is won in the trenches. Rarely can a team win consistently without winning here. The Cowboys proved that front and center on primetime television. The Colts CLEARLY lost on both sides of […]
Posts Tagged 'Cowboys'
Week 1: JPB's List of Things
September 14th, 2010 CJ Posted in Opinions


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Shopify Speed Optimization Review
Regular price $249.95
Website speed is one of the most important things necessary for eCommerce success. It has been proven time and time again that Google tends to be weary of websites that have longer than average load times.
You may have heard the website speed plays a big role, but here is some concrete evidence that shows just how important the problem is.
- Amazon reports a 100 millisecond page load delay (yes, that's only one-tenth of a second) costs them 1% in sales.
- Yahoo reports a 400 millisecond delay costs them 5-9% in full page traffic. (That's when a shopper just quits waiting and either closes the browser or hits the back button and gives up)
- Google reports a 500 millisecond delay (one-half second) results in 20% fewer searches.
Most of the time improvement can be made without changing a site's layout and design. This product is a report of improvements that can be made. If there is a cost to any of the improvements, the $249 will be applied to that cost.


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Find Your Chevrolet Trade-In Value Towards a New Honda
Find the trade in value for your used Chevrolet today using our online Kelley Blue Book (KBB) Online Trade Appraisal Tool. You can establish the value of your pre-owned Chevrolet vehicle by utilizing our online used car appraisal tool, powered by Kelley Blue Book, from anywhere in Muncie, Indiana. We back this value up with a written offer to buy your Chevrolet, most customers will get this in minutes. The process could not be easier. Simply fill out the KBB form, and submit it. The written offer to buy your Chevrolet can be redeemed for cash (restrictions apply) at Victory Honda of Muncie, or used as trade in value on a new or used Honda vehicle. Victory Honda of Muncie is a used Chevrolet Buying Center serving all of Anderson, Winchester, New Castle, Marion, Fishers, Lawrence, Carmel, and Indianapolis.
Chevrolet Lease Termination Program
Do you currently lease a vehicle from Chevrolet? Want to terminate that lease and get into an exciting new Honda, but not sure you can? The Chevrolet lease is very flexible and can be terminated without penalty if done correctly. If we make a deal with you, we will terminate and pay off your Chevrolet Lease. Let us show you how easy this process can be today. Call Victory Honda of Muncie now for more information on our Chevrolet Lease Termination Program.
We will inspect your car and validate the condition you put on the form, but, if your Chevrolet is clean and well taken care of, we may even offer you up to $1,000 more, depending on the condition of your car and current Muncie, Indiana market conditions, as established by our Used Car Manager after inspecting your vehicle. This offer is not valid for automobiles with a Salvage Title. Vehicles that have had body or paint work performed may take up to 1 business day to validate the offer while we inspect the quality of the work.
The actual value of your Chevrolet vehicle is determined solely by our Used Car Manager after performing a used car appraisal onsite at our Honda Dealership located in Muncie IN. We will gladly spend the time to explain what we see and how it effects the value of your car when we do the inspection.
Directions To Victory Honda of Muncie in Muncie IN
Victory Honda of Muncie is located at 4901 W McGalliard Rd in Muncie IN 47304. Let us buy your used Chevrolet today, even if you do not buy a car from us. We are minutes from anywhere in the greater Indianapolis area. Come in today!
Make an Inquiry
Quick Links
Victory Honda of Muncie
4901 W McGalliard Rd
Muncie, IN 47304
Sales: (765) 439-4760
Service: (765) 273-5264
Parts: (765) 544-1432
|Monday - Saturday
|9:00am - 8:00pm
|Monday - Friday
|7:30am - 7:00pm
|8:00am - 4:00pm


text: Puma Swede is a sensual vision in white lace bra and underwear. She is tall and toned with a breathtaking body. Watch her work her pornstar magic in this sensual solo set. Puma performs her strip, unveiling her great boobs first and following that with the reveal of pussy and ass. Watch the underwear come off and her pussy lips be spread. She throws her head back in erotic display while unveiling all of herself for your visual pleasure. Shyness is a trait that Puma Swede does not have.


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2014-02-28Audit Reports Football Base Was Illegally Sold
Training base of the Football Club Guria is located on the Black Sea Coast in Grigoleti village. Short time ago, Human Rights Center was informed that property was illegally taken from the Lanchkhuti district owned base.
2014-02-28Noise during Conference of Georgian Dream in Gori
Second conference of the Georgian Dream was held in noisy environment in Gori. Election of the new chairman of the GD's regional organization was on the agenda. Delegates gathered in the Gori Drama Theatre to support Nino Zurabishvili on the position. About ten members of the GD protested ongoing polls outside and spoke about internal controversy in the local organization of the Georgian Dream.
2014-02-28Amendments to the Law Restrict Labor Rights of Public Servants
Argument about amendments to the Law of Georgia on Public Service might continue in the Constitutional Court. According to the February 5, 2014 amendments to the law, which was approved by the Parliament of Georgia together with the Code on Local Self-Governance, every employee of the local self-governmental bodies will work as interim employees.
2014-02-26Police Started Probe into Painting of Statue
2014-02-25Twice Resigned Person from Position By the Court Was Restored to Job
Court twice prohibited former director of the Kakheti regional development agency Valeri Gremelashvili to occupy leading position in the agency. The court found him guilty in the abuse of professional authority and waste of large amount of fund together with the former chairman of the agency Giorgi Sibashvili.
2014-02-24Nongovernmental Organizations Call on the Government to Effectively Protect Rights of Workers at Kazreti Deposit
Nongovernmental Organizations Call on the Government to Effectively Protect Rights of Workers at Kazreti Deposit.
2014-02-24Appeal Court Upheld Lawsuit of the Former Chairman of the Gori Municipal Board
Marlen Nadiradze requested annulment of the September 14, 2007 decree of the municipal board with which the board members resigned him from the position. Several-day political controversy was pre-condition of this decision.
2014-02-24Head of Pres-Center of the Shida Kartli Regional Administration Quitted Job
Natia Omadze, head of press-center and public relation department of the Shida Kartli regional administration, made statement about leaving the job in social network. Omadze connected her decision with regional governor Zurab Rusishvili's insularity and distance from the society.
2014-02-24Bus Drivers Have Been on Strike for Eights Day in Batumi
Bus drivers have been on strike for eight days already in Batumi. 300 drivers of public transport stopped working with the request of raise in salaries. Drivers request resignation of Gia Loria, director of the Auto Transport Company, and payment of 4, 5 lari instead 4 lari per working hour.
2014-02-17Company Winning Bid Is Sought
Gori district administration is looking for the company, which won bid competition in November, 2013. Ltd GPG participated in the tender and won it. According to the bid requirements, the Company had to rehabilitate underground passages in Gori. Several months passed but the Company did not implement its duties.
2014-02-17Chairman of the City Council Resigned
2014-02-11Public Defender's Visit in Imereti Finished with Meeting with Civil Society Organizations
Tents for homeless people, Tkibuli mine, penitentiary establishment # 14 and meeting with the representatives of local civil society and media organizations – it was agenda of the Public Defender's business trip in Imereti region on February 6-7.
2014-02-10Cartu Foundation Stopped Compensations for the Victims of Natural Disaster in Kakheti
Victimized families by 2012 natural disaster in 2012 will no longer receive compensations from the Cartu Foundation. The lawyer of the Foundation Nino Kiknadze said last year the Foundation transferred 98 million lari and left beneficiaries will receive compensations from alternative source.
[1] 2
European Parliament Resolution on the cases against opposition politicians in Georgia Following the appeal of the Human Rights Center, a hotel in Batumi was ordered to remedy noncompliances Human Rights Center Defends Rights of Repatriated Meskhs Living in Akhaltsikhe Defendants accused of kidnapping an underage girl were convicted Human Rights Center got involved in the advocacy of Tamar Bachaliashvili's Case Archive
They wait for me in Abkhazia
Last time, I visited Abkhazia five years ago. Since then, not a day goes by without thinking about it, without missing the Abkhazian
Another proposal on agreement
Women – victims of violence
Forgotten by government veterans
Every year, fewer and fewer veterans of the World War II meet the Victory Day. The society receives information about them only on
Villages of the Hopeless
What happened to Dream of Justice Revival?


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Inter-American Human Rights Court Tries to Impose Homosexual Marriage on Entire Continent
NEW YORK, January 26 (C-Fam) The Inter-American Court of Human Rights published a much-anticipated advisory opinion earlier this month that says homosexual marriage and transgender identity change are human rights in the American Convention on Human Rights.
"States must guarantee access to all existing legal institutions in their domestic laws to ensure the protection of all the rights of families formed by couples of the same sex without discrimination," the Court concluded in its opinion. Only one of the seven judges on the Court dissented from this conclusion.
The advisory opinion reflects the progressive leanings of the Court in recent years and is the culmination of more than a decade of jurisprudence from the Court to undermine the understanding of family with which the Inter-American Convention was negotiated and ratified.
"Human rights treaties are living instruments whose interpretation must accompany the evolving times and present conditions of life," the Court explained.
The reasoning of the Court was based on its views of what the American treaty means by the word "family." It said the treaty "does not protect a singular or determinate model of family."
"A family may be formed by persons with different gender identities and/or sexual orientations," it said.
"A restrictive interpretation of the concept of 'family' that excludes the affective bond between couples of the same sex from the protections of the inter-American system would frustrate the object and purpose of the treaty," the Court opined.
The Court also instructed Costa Rica to allow individuals who want to change their legal sex to reflect their preferred gender identity, adding that such changes must be confidential and fast.
The result was expected but observers will likely be puzzled by the wide-ranging nature and scope of the 140-page opinion and the eclectic group of legal authorities cited by the Court. The Court as opposed to the Inter-American Commission on Human Rights, previously has taken a more judicious and less activist approach in its interpretations of the treaty.
The Court said it did not think its interpretation was inconsistent with the original intent of the framers of the American Convention. At the same time, it admitted no one contemplated homosexual marriage at the time the treaty was adopted.
It repeatedly cited the European Court of Human Rights as an authority in support of a right of people of the same sex to marry each other, even though the European Court has not recognized same-sex marriage as a right. It has instead decided that civil unions adequately protect the right to privacy and family life of individuals who identify as LGBT.
The Inter-American Court also cited the non-binding LGBT activist Yogyakarta Principles as if they were a semi-official authority alongside the non-binding UN resolutions and opinions of UN expert bodies. It even cited the acceptance of LGBT non-binding recommendations during the Universal Periodic Review at the Human Rights Council.
The Court urged nations to quickly modify their laws to permit homosexual marriage or to take steps to make it happen. It cited its doctrine of constitutional control whereby its opinions are to be treated as binding precedents by courts on the entire American continent.
With regard to religious objections, the said that "such convictions cannot affect what the Convention establishes about discrimination based on sexual orientation."
View online at: https://c-fam.org/friday_fax/inter-american-human-rights-court-tries-impose-homosexual-marriage-entire-continent/
© 2020 C-Fam (Center for Family & Human Rights).
Permission granted for unlimited use. Credit required.


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Mini lagoon 'Blue meets pink'
'Lagoon' collection
The texture, form, and colours design was inspired by sea plants, shells found walking along the beach. Earrings shapes delicately repeat your body angles, as well as your mood, is reflected in the colours. Earrings are handcrafted for you.
Made of: ceramics, silver-plated clasps
Size: ~1 cm x 1 cm
Colours: blue, pink
Moods in colours
Blue - deep, peaceful, calm
Pink - feminine, romantic, joyful
White gift box with an original label, designed to carry your jewellery comfortably and safely while traveling.
*Each piece is sculpted by hand and may vary slightly in shape, size, and colours.


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Status: Open
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Selma 76 located at 18430 Redwood Hwy in Selma, OR services vehicles for Auto Repair. Call (541) 597-2999 to book an appointment or to hear more about the services of Selma 76.
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Among the many commotions in my mind following the American presidential election, I believe I am struggling with acute symptoms of information glut. Everywhere I turn, I find an explanation for Donald Trump's victory; one graphic after another depicts voter demographics; uncountable columnists analyze the racial, social, and economic factors at play. Every time I check my newsfeed, I confront an endless barrage of opinion pieces — all of which tout headlines that claim to explain, once and for all, the outcome of November 8, 2016.
Every commentator has an angle: racism, demagoguery, xenophobia, political disenfranchisement, populism, "He just tells it like it is", apathy, ideology, political correctness, a gutted education system — there is no shortage of explanations. In fact, there are about 60,638,012 reasons why people voted for Trump. But we are obsessed with identifying an aggregate trend. We need an answer: some explanation for the whole fiasco that encapsulates all sixty million voters into a single coherent narrative.
In other words, we need a myth. But once we have internalized our myth, it becomes increasingly difficult to second-guess our rationalization. And since our narrative lives in competition with other myths, we grow accusatory of conflicting opinions. If we believe that Trump won because of his racist overtures, does this mean that everyone who disagrees with us must be racist, too? Or if Trump won because of a systemic failure of the American intellect, is every dispute of our analysis ignorant as well? Commentary and analysis morph into rhetoric. Explaining politics is political.
Don't get me wrong, Donald Trump's racism, misogyny, and bigotry thoroughly disgust me — and the fact that they were not deal-breakers for so many people is deeply unsettling. But at a personal level, who am I to get up on a pedestal to proclaim that 60,638,012 other people just voted 'immorally'? Is my ethical compass permanently above the tilt and tug of partisan allegiance? Do the clothes that I am wearing and the food that I am eating today clear me from every accusation of oppression and exploitation? Do I suppose that I somehow transcend all the cognitive biases that supposedly plague everyone else? Have I never embraced what I believed was the 'lesser of two evils' based on information and encouragement shared by the people around me? Have I never been hoodwinked by someone who tickled my fears?
Am I in a position of moral authority to stand in front of a throng of sixty million people and say, "I am better than every single one of you because I would never vote for that man!"?
My point is this: I cannot sit here and tell you why the United States just elected Trump. And being in this situation is psychologically debilitating. In 200 years from now, when historians write about the 2016 election, they will analyze the sources at their disposal, arrange their documentation in light of their imposed criteria for legitimacy, and then craft a gloriously concise overview. Undergraduates will probably study and memorize bullet point notes of the reconstructed story for exams. Future generations will "know" why sixty million Americans voted for Trump: it will be in the purview of respected scholars and history textbook writers to provide authoritative opinions on the matter.
But in the foray of the present, every explanation is just one among many. Today, it is a war of exposition. Under the reign of the algorithm, we live in an all-out race to bait search engines with new, snazzy opinions. It is virtually a global competition for the next original insight on the matter. (And yes, absolutely, this little essay is wholly implicated in very cacophony it holds in contempt.)
But damned if I am in a position to offer an objective history of last week.
Eking the honesty to write the last paragraph leaves me in a difficult place. I do not know why Trump won, which means, by extension, I do not understand what is happening in the world around me. (I can recite many theories — inequality, neoliberalism, globalization, colonization — but I do not know.) This uncertainty is existentially traumatic. And frankly, it is impossible to live with this ambiguity for long. Far easier, indeed, to adopt a ready-made story I can peel-and-stick on to sixty million people I have never met, who all live in another country.
On Sunday night I was sitting around a campfire with a few friends, discussing and debating the election. Yes, as just another armchair theorist, my highfalutin social and political criticism is probably utter nonsense. But while snuffing out the embers at the end of our chat, I had a sudden realization: I don't "know" why Trump won, but I do have an acute and tangible sense of the impact that his victory is having on the lives of the people around me.
For me, this realization clarifies everything. It takes me out of the seat of judgment and invites me to sit in solidarity. It compresses all the international turmoil into an intensely local, tactile context.
What is the way forward? As the maxim goes, There are only two kinds of problems in the world: there are problems you can't do anything about and there are problems that you can exert some influence to change. Categorically, I cannot do anything about a Trump presidency. But I can join hands with the people in my community who sense their identities, safety, and wellbeing jeopardized by the rhetoric of hate and intolerance. When someone threatens to build a wall between you and others, it's time to start building better bridges. Local bridges. After all, the world is nothing more than a whole bunch of little "heres" that are growing evermore networked to one another.
I cannot imagine how we will ever nurture communities of greater understanding unless we intentionally reach out to one another in the places where we live. Beyond the paralyzing glut of commentary and analysis, each one of us can only respond to the American election from our present coordinates on the planet. Here. I no longer feel the need to purport to "know" why Trump won. Nor do I feel the need to comment on the personal motivations of the entire electorate, as if I were an omniscient pundit or self-appointed moral benchmark for the nation. I have no more need to justify nor condemn others. No, I'm free to act. I now have a clear understanding of what I need to do, and every moment I resign to resentment and ridicule is a moment subtracted from the cause of building bridges that "go high" over deepening divides.
To sum up the way ahead, I defer to the words of Squire Bill Widener: "Do what you can, with what you've got, where you are." And to this, I would add: "With the people who are around you."
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Comparison of Technetium-99m Tetrofosmin and Thallium-201 Single-Photon Emission Computed Tomographic Imaging for Detection of Myocardial Perfusion Defects in Patients With Coronary Artery Disease
Author + information
- Received January 10, 1997
- Revision received September 29, 1997
- Accepted October 13, 1997
- Published online February 1, 1998.
Author Information
- Hany Shanoudy, MDA,
- Paolo Raggi, MDA,
- George A Beller, MD, FACCB,
- Adel Soliman, MDA,
- E.Gifford Ammermann, MDA,
- Robert J Kastner, MDA and
- Denny D Watson, PhDA,* (ddw9a{at}virginia.edu)
- ↵*Dr. Denny D. Watson, Nuclear Cardiology, Box 158, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908.
Objectives. We compared dipyridamole technetium-99m (Tc-99m) tetrofosmin and thallium-201 (Tl-201) single-photon emission computed tomographic (SPECT) imaging with respect to the detection rate of perfusion abnormalities in 26 patients with angiographic coronary artery disease (CAD).
Background. Experimental studies have shown that myocardial extraction of Tc-99m tetrofosmin is lower than that of Tl-201 at high flow rates, resulting in less severe defects with vasodilator stress. It is uncertain whether this results in a lower sensitivity than Tl-201 for detecting coronary stenoses with vasodilator stress in patients.
Methods. Twenty-six patients with CAD underwent both dipyridamole Tl-201 and Tc-99m tetrofosmin SPECT. Tomographic images were scored for initial defects and the presence of reversibility. Defect magnitude was computer quantitated.
Results. Of the 26 patients, 25 had defects on both Tl-201 and Tc-99m tetrofosmin SPECT images. Of 340 segments analyzed, 102 had defects by Tl-201 and 92 by Tc-99m tetrofosmin (p = NS). Whereas Tl-201 detected 27 fixed defects in 12 patients, Tc-99m tetrofosmin identified 37 fixed defects in 14 patients (p = NS). In contrast, Tl-201 identified more reversible and partially reversible defects than did Tc-99m tetrofosmin (89 vs. 55, p = 0.002). The average defect magnitude (percent normal) was similar for defects concordantly graded as fixed (38 ± 3.0% for Tl-201 vs. 42 ± 4% [mean ± SEM] for Tc-99m tetrofosmin, p = NS). The average defect magnitude for defects concordantly graded as completely reversible was significantly more severe on Tl-201 than on Tc-99m tetrofosmin (49 ± 3% vs. 58 ± 3%) SPECT images. A significantly greater defect magnitude for Tl-201 was also found for defects concordantly classified as partly reversible (30 ± 4% for Tl-201 vs. 45 ± 5% for Tc-99m tetrofosmin).
Conclusions. With dipyridamole stress, 1) at least one defect was seen on both Tl-201 and Tc-99m tetrofosmin SPECT images; 2) Tc-99m tetrofosmin SPECT identified fewer reversible defects than did Tl-201, but showed a similar number of fixed defects; 3) the magnitude of reversible defects seen on Tc-99m tetrofosmin images was less, whereas fixed defects were similar for both tracers; 4) reversible defects seen on Tl-201 and not on Tc-99m tetrofosmin SPECT images were predominantly regions perfused by mild coronary stenoses.
Technetium-99m (Tc-99m) tetrofosmin is a lipophilic, cationic perfusion agent that, like Tc-99m sestamibi, is an alternative to thallium-201 (Tl-201) for stress imaging. Experimental animal studies have demonstrated that the myocardial extraction of Tc-99m tetrofosmin plateaus at flow rates >1.7 × normal [1, 2]. This plateau is reached earlier with Tc-99m tetrofosmin than with Tl-201 and Tc-99m sestamibi when the tracer is administered during adenosine-induced vasodilation. The goal of this study was to compare regional myocardial uptake of Tc-99m tetrofosmin versus Tl-201 during dipyridamole stress testing in patients with angiographically proven coronary artery disease (CAD). Both qualitative and quantitative analyses of the resultant scans were undertaken.
1 Methods
1.1 Study Patients
The study included 26 consecutive male patients (mean [±SD] age 62 ± 9 years, range 44 to 75) referred to the cardiology section of the Veterans Affairs Medical Center in Salem, Virginia, for evaluation of symptoms suggestive of CAD. Patients were included in the study if they had undergone cardiac catheterization demonstrating significant stenosis (>50%) of at least one major coronary artery or if they had had a dipyridamole Tl-201 single-photon emission computed tomographic (SPECT) scan showing myocardial perfusion abnormalities suggestive of CAD. They were excluded from the study if they had been admitted to the hospital with unstable angina for <48 h; demonstrated a left bundle branch block pattern on a 12-lead electrocardiogram (ECG); had hemodynamic instability, severe congestive heart failure or severe valvular heart disease, or a combination of these; were actively taking drugs containing theophylline; or had recent history of bronchospasm. All patients signed a written informed consent before entering the study. The research protocol was approved by the Human Studies Committee of the Veterans Affairs Medical Center.
1.2 Study Protocol
All patients underwent cardiac catheterization and coronary angiography, either as the initial diagnostic test to confirm CAD or after the acquisition of a dipyridamole Tl-201 SPECT scan showing myocardial perfusion abnormalities. All patients underwent two dipyridamole stress tests and coronary angiography within 14 days. Twenty-one patients underwent dipyridamole Tl-201 SPECT imaging as the initial test, and five patients underwent Tc-99m tetrofosmin SPECT as the initial test. If the dipyridamole tests were performed on consecutive days, as was the case for patients who had undergone coronary angiography first, Tl-201 tests were performed first, followed by the Tc-99m tetrofosmin study.
1.3 Dipyridamole Stress Protocol
Similar protocols were followed for both Tc-99m tetrofosmin and Tl-201 dipyridamole studies. Patients fasted for at least 8 h before the study. Drugs and foods containing methylxanthines were excluded. All nitroglycerin preparations were discontinued for at least 24 h before the test. An intravenous catheter was inserted in an antecubital vein. Dipyridamole was administered intravenously at a rate of 0.56 mg/kg body weight (maximum of 60 mg, diluted in 40 ml of normal saline) over 4 min, while the patient rested in the supine position. The radiopharmaceutical agent (Tl-201 or Tc-99m tetrofosmin) was given by bolus injection 3 min after the completion of dipyridamole infusion. Vital signs and the 12-lead ECG were monitored and recorded before, during and for 8 min after dipyridamole administration. Intravenous aminophylline was administered in the event of severe side effects or symptoms induced by dipyridamole.
1.4 Tl-201 Imaging Protocol
A bolus of Tl-201 (3.0 to 3.5 mCi) was injected intravenously 3 min after the completion of intravenous infusion of dipyridamole. SPECT myocardial imaging was begun within 15 min, using standard views. Delayed images were obtained 3 to 4 h later.
1.5 Tc-99m Tetrofosmin Imaging
Tc-99m tetrofosmin was prepared from freeze-dried vials (Medi-Physics, Inc., Amersham Healthcare), with each vial containing a sterile, nonpyrogenic, lyophilized mixture of 0.23 mg of Tc-99m tetrofosmin, 0.03 mg of stannous chloride dihydrate, 0.32 mg of disodium sulfosalicylate, 1.0 mg of sodium d-gluconate and 1.8 mg of sodium hydrogen carbonate. The lyophilized powder was sealed under nitrogen atmosphere with rubber septum. Each vial was reconstituted according to the method described by Zaret et al. [3]. In contrast to the stress–rest protocol used for Tl-201 imaging, a 1-day rest–stress injection protocol was used for Tc-99m tetrofosmin SPECT imaging. A dose of 7 to 8 mCi of Tc-99m tetrofosmin was injected intravenously at rest. Myocardial SPECT scanning was performed after a waiting period of 30 to 60 min. A minimum of 1 h was allowed after the completion of the rest imaging and before intravenous dipyridamole was infused. A bolus injection of 30 to 35 mCi of Tc-99m tetrofosmin followed the infusion of dipyridamole by 3 min, and myocardial SPECT images were acquired 30 to 60 min later.
1.6 SPECT Acquisition and Quantitative Analysis
Both Tc-99m tetrofosmin and Tl-201 SPECT studies were acquired on a Sopha gamma camera (model DSX) with 180° contoured acquisition centered on the heart. The same filters were used for both tracers. Tl-201 SPECT acquisition was performed using 32 steps of 40 s each in a 25% window centered on the 80-keV gamma-ray peak of Tl-201. Tc-99m tetrofosmin SPECT studies were acquired using 32 steps of 25 s each in a 20% window centered on the 140-keV gamma-ray peak of Tc-99m tetrofosmin. Myocardial images were aligned in similar fashion in all patients, and the same orientation was used. Quantitative analysis entails use of a conventional polar map representing maximal pixel values obtained from searching radii crossing the myocardial wall. The polar maps were divided into 14 segments, and the average of all values within each segment was used as the quantitative variable. The 14 segments included six proximal short-axis, six distal short-axis and two apical segments (Fig. 1). Segments on the polar maps were divided to represent approximately equal myocardial volume samples accounting for the mapping distortion of the polar map. The segment with the highest average was set to 100%, and all other segments were normalized to that segment. The values for each segment represent the percent maximal uptake of the tracer. For the purpose of performing a qualitative analysis, the same segments identified on the short-axis and vertical long-axis tomograms were assigned a score from 0 to 2 based on the visual assessment of relative tracer activity: 0 = noninterpretable; 1 = mildly reduced activity; and 2 = moderately or severely reduced activity. Each segment demonstrating a perfusion abnormality during stress was then classified as demonstrating complete reversibility (score = 1), partial reversibility (score = 2) or a fixed defect (score = 3) during the rest phase. All scans were reviewed by two observers (G.A.B., D.D.W.) who read the studies in random order and who had no knowledge of the study type, identification and clinical information. Segments with normal activity by visual assessment were indicated by a blank entry. The consensus interpretation of each segment was used to define normal and abnormal segments. The quantitative values were used only as a measure of activity within these segments. All quantitative values are expressed as a fraction or percentage of the segment of highest average uptake. These values were not corrected for attenuation or normalized to a normal data base.
1.7 Coronary Angiography
All patients underwent coronary angiography with multiple views of the right and left coronary arteries. This test and the two nuclear scans were completed within 14 days. The films were reviewed by a single expert investigator, and the site and severity of coronary artery stenoses were recorded. Significant coronary stenosis was defined as ≥50% reduction in the endolumen diameter of at least one major coronary artery, as determined by quantitative coronary angiography. Selected angiographic frames were digitized off-line on a high resolution image processing system (Imaging MDIC, Inc.). Calibration was achieved by measurement of the diameter of the catheters used, which were of known dimension. Coronary artery diameters were measured at the site of stenosis and in adjacent nonstenotic segments located both before and after the stenotic lesion; all ectatic coronary arteries were excluded from analysis. Percent diameter stenosis and area stenosis were calculated. The values reported refer to percent diameter stenosis.
1.8 Statistical Analysis
Results are presented as the mean value ± SEM, unless otherwise indicated. A chi-square test was used to analyze differences in the number of segments showing perfusion abnormalities between the two radiopharmaceutical agents. The average magnitude of segmental perfusion defects that were concordantly identified by both tracers was obtained and compared using a paired ttest. More than one abnormal segment was concordantly identified in some patients, and this raises the question as to the statistical independence of these multiple samples. Accordingly, an analysis was performed using the patient as the unit of analysis. In this analysis, concordant defects were averaged for each patient, so each patient is weighted as a single statistical sample. Moreover, the Wilcoxon signed-rank test was used so that differences would not be weighted by individual defect magnitude.
2 Results
2.1 Patients
Table 1summarizes the clinical characteristics of the patient cohort. All 26 patients were men (mean [±SD] age 62 ± 9 years, range 44 to 75). Four patients had undergone previous coronary artery bypass graft surgery, and two patients had undergone previous percutaneous transluminal coronary angioplasty. Seven patients had one-vessel, 7 patients had two-vessel and 12 patients had three-vessel CAD. Three patients had >50% left main CAD. A critical stenosis of the left anterior descending coronary artery was present in 21 patients; 22 patients had a critical stenosis of the left circumflex coronary artery; and 19 had right CAD. Six patients had a known previous myocardial infarction.
2.2 Dipyridamole Stress Results
All 26 patients completed two dipyridamole stress protocols: one with Tl-201 and the second with Tc-99m tetrofosmin. Hemodynamic and ECG variables monitored during dipyridamole infusion were not significantly different between the two tests. Blood pressure and heart rate response to the pharmacologic stress were similar for both procedures (Table 2). The occurrence of chest pain and ECG ischemic changes were also similar. Ten patients had chest pain and nine had ≥1.0 mm ST segment depression with dipyridamole infusion.
2.3 SPECT Imaging Analysis
At least one perfusion defect was detected in 25 of the 26 patients on both Tl-201 and Tc-99m tetrofosmin SPECT images. Of the 364 segments analyzed with Tc-99m tetrofosmin SPECT imaging, 24 were considered noninterpretable by the two observers who read the scans in a blinded manner. This was attributed to background or gut activity, or both. None of the 364 segments analyzed on Tl-201 SPECT images were judged to be noninterpretable. Nevertheless, the 24 segments on Tl-201 SPECT images that corresponded to the noninterpretable Tc-99m tetrofosmin images were excluded from final analyses. Of these 24 defects on Tl-201 SPECT scintigrams, 14 were normal, 7 were completely reversible and 3 were partially reversible.
Of the 340 segments interpretable by both techniques, 212 were concordantly normal, 26 were concordantly completely reversible, 9 were partially reversible and 12 were concordantly fixed or nonreversible (Table 3). The number of fixed defects detected by each tracer was not statistically different (27 by Tl-201 vs. 37 by Tc-99m tetrofosmin, p = NS). Tl-201 SPECT identified more reversible and partially reversible defects than did Tc-99m tetrofosmin SPECT (89 vs. 55, p = 0.002).
Twenty-four segments interpreted as normal on Tc-99m tetrofosmin SPECT corresponded to completely reversible defects on Tl-201 SPECT images. In contrast, seven normal Tl-201 segments corresponded to completely reversible defects on Tc-99m tetrofosmin studies. After completion of the blinded interpretation of the radionuclide studies, the location of reversible defects was correlated with coronary angiographic findings. Coronary vessels with >50% stenoses were identified in supply zones for all reversible Tl-201 defects that showed normal Tc-99m tetrofosmin uptake and all reversible Tc-99m tetrofosmin defects read as normal on Tl-201 SPECT studies. Finally, Tl-201 SPECT studies revealed defects in 13 (68%) of the 19 coronary supply territories perfused by vessels with 50% to 70% stenoses (10 reversible), whereas Tc-99m tetrofosmin SPECT identified 7 defects (3 reversible) in the same 19 territories (p = 0.05 for one-sided ttest for difference in reversible defects). Tl-201 and Tc-99m tetrofosmin SPECT imaging identified an equal number of defects in territories supplied by 71% to 99% stenoses or total occlusion (76% and 72%, respectively).
2.4 Quantitative Analysis of SPECT Images
Fig. 2shows the mean defect magnitude (expressed as percent maximal uptake) for completely reversible, partially reversible and fixed defects concordantly graded on both Tl-201 and Tc-99m tetrofosmin SPECT studies. Reversible defects were more severe with Tl-201 (49 ± 3% [mean ± SEM]) than with Tc-99m tetrofosmin (58 ± 3%). This difference was highly significant by either the paired ttest (p = 0.0001) or the Wilcoxon test (p = 0.004). Partly reversible defects were also more severe for Tl-201 than for Tc-99m tetrofosmin (30 ± 4% vs. 45 ± 5%). This difference was significant (p = 0.02 by the paired ttest and p = 0.03 by the Wilcoxon test). Fixed defects averaged 38 ± 3% for Tl-201 and 42 ± 4% for Tc-99m tetrofosmin. This difference was not significant by the paired ttest (p = 0.06), but tested as significant by the Wilcoxon test (p = 0.03). We conclude that the difference for fixed defects was insignificant or, at most, marginally significant.
3 Discussion
Technetium-99m 1,2-bis(bis[2-ethoxyethyl]phosphino)ethane (Tc-99m tetrofosmin) is a lipophilic, cationic complex that is rapidly cleared from the blood pool with intravenous injection and that exhibits slow myocardial clearance without evidence for delayed redistribution [1]. This new imaging agent, like Tc-99m sestamibi, accumulates in mitochondria. Only viable myocardial tissue sequesters Tc-99m tetrofosmin, and its myocardial uptake is reduced by metabolic inhibitors (such as iodoacetic acid and 2,4-dinitrophenol) and excessive influx of calcium [4–6]. Takahashi et al. [7]showed that in rats, both the initial and delayed retention of Tc-99m tetrofosmin was sensitive to myocardial viability, as exhibited by significantly lower uptake and retention in nonviable segments identified 1 h after reperfusion preceded by 1 h of total coronary occlusion. Koplan et al. [6]showed that initial Tc-99m tetrofosmin uptake was similar to Tl-201 uptake in a dog model in which rest left anterior descending coronary artery flow was reduced by 50%, producing severe systolic dysfunction. In this model, Tc-99m tetrofosmin myocardial activity was less than Tl-201 activity after 2 h of redistribution.
3.1 Experimental Studies
After intravenous injection, Tc-99m tetrofosmin uptake in the myocardium is related to regional blood flow [1, 2]. However, the relative Tc-99m tetrofosmin activity underestimates blood flow >1.5 to 2.0 ml/min per g. Glover et al. [2]found that both Tl-201 and Tc-99m tetrofosmin uptake reached a plateau in the myocardium with adenosine-induced hyperemia, but the Tc-99m tetrofosmin plateau was lower than the Tl-201 plateau. In dogs with a critical or mild left anterior descending coronary artery stenosis, Tl-201 and Tc-99m tetrofosmin uptake underestimated the magnitude of the flow disparity, and the degree of underestimation was greater for Tc-99m tetrofosmin. In the same study, the investigators found that the first-pass myocardial extraction fraction for Tc-99m tetrofosmin averaged 54%, which is lower than the previously published extraction fraction values for Tl-201, ranging from 82% to 88%, and is slightly lower than the extraction fraction for Tc-99m sestamibi. The observation that the flow heterogeneity between stenotic and normal myocardial beds produced by adenosine stress in the presence of a coronary stenosis is better resolved with Tl-201 than with Tc-99m tetrofosmin in the canine model is most likely explained by the lower first-pass myocardial extraction fraction for Tc-99m tetrofosmin. The experimental findings with Tc-99m tetrofosmin with adenosine stress in this canine stenosis model are similar to those reported previously with Tc-99m sestamibi, in which the magnitude of adenosine-induced flow heterogeneity was underestimated by both Tc-99m sestamibi and Tl-201, but more so by Tc-99m sestamibi [8].
3.2 Clinical Studies
In the clinical setting, Tc-99m tetrofosmin planar or SPECT imaging with exercise stress has yielded high quality images and good sensitivity and specificity values for detection of CAD, and segmental perfusion abnormalities were concordant with Tl-201 perfusion abnormalities when patients underwent stress imaging with both tracers [3, 9–12].
In the present study, dipyridamole Tc-99m tetrofosmin scintigraphy was compared with Tl-201 scintigraphy using quantitative SPECT imaging in a group of male patients who underwent both tests as well as coronary angiography. Both techniques yielded comparable detection rates of abnormal scans in the 26 patients, but Tl-201 SPECT identified more reversible and partially reversible perfusion defects than did Tc-99m tetrofosmin SPECT (89 vs. 55 defects). Furthermore, the average defect magnitude, expressed as percent normal, was similar for defects concordantly graded as nonreversible, whereas the defect magnitude for segmental perfusion abnormalities graded as completely or partially reversible on both SPECT studies was more severe with Tl-201 than with Tc-99m tetrofosmin. Thus, with dipyridamole stress imaging, both the number of reversible defects and the magnitude of these reversible defects were greater for Tl-201 scintigraphy than for Tc-99m tetrofosmin scintigraphy, whereas the prevalence of nonreversible defects and defect magnitude of these fixed defects were comparable between the two radionuclide studies.
These findings are consistent with other clinical reports in which a higher detection rate for reversible ischemia was seen for Tl-201 versus Tc-99m tetrofosmin scintigraphy. Nakajima et al. [13]reported 60% sensitivity for detecting ≥75% stenoses for Tc-99m tetrofosmin compared with 72% for Tl-201. Specificity was comparable at 84%. In a study by Matsunari et al. [14], 58 perfusion zones with initial Tl-201 defects had corresponding normal Tc-99m tetrofosmin uptake.
The defect magnitude on Tc-99m tetrofosmin scans has been reported by other investigators to be less than the defect magnitude on Tl-201 scintigraphy performed in the same patients. Matsunari et al. [15]found that the defect size on exercise Tc-99m tetrofosmin images was smaller than the defect size on Tl-201 images, as assessed by quantitative SPECT imaging in 20 patients with CAD. Tamaki et al. [16]reported a greater defect magnitude with Tl-201 than with Tc-99m tetrofosmin, particularly in myocardial zones that corresponded to reversible Tl-201 defects. Nevertheless, both Tc-99m tetrofosmin imaging and Tl-201 imaging were highly sensitive for detecting CAD.
Consistent with the findings in the present study, Cuocolo et al. [17]reported a lesser Tc-99m tetrofosmin defect magnitude on adenosine stress images compared with exercise images when exercise and vasodilator stress studies were performed in the same patient group. In a more recent report by Cuocolo et al. [18], 22 of 25 patients with CAD showed perfusion defects on adenosine Tc-99m tetrofosmin tomography. Twenty-two of those patients had at least one severe (>75%) coronary stenoses, and 23% had a previous myocardial infarction. Mahmood et al. [19]evaluated the diagnostic accuracy of combined rest Tl-201 stress Tc-99m tetrofosmin SPECT using adenosine infusion along with low level dynamic exercise for detection of individual coronary artery stenoses. They studied 25 patients with known CAD. The overall coronary stenosis detection rate was 80%, with a specificity of 70%. It should be pointed out that more than 50% of the patients had a previous myocardial infarction. The presence of previous myocardial scar will always increase the detection rate of narrowings of coronary arteries perfusing these nonviable myocardial zones.
3.3 Study Limitations
Several limitations of this clinical observational study deserve mention: 1) The study included men only. It is now accepted that SPECT imaging with Tc-99m labeled radiopharmaceutical agents provides enhanced specificity for detection of CAD in women, without affecting sensitivity. 2) Only sensitivity for detecting reversible ischemia with vasodilator stress imaging was undertaken, without attention to comparing the specificity of the two imaging agents, because patients with angiographically normal coronary arteries or patients with a <5% pretest likelihood of CAD not undergoing angiography were not enrolled. Extrapolation of the findings with dipyridamole stress to exercise stress cannot be made because with exercise stress and consequent myocardial ischemia and regional systolic dysfunction, Tc-99m tetrofosmin scintigraphy may yield better detection rates of reversible ischemia than are seen with vasodilator stress. This study used a standard same-day rest/stress protocol for Tc-99m tetrofosmin. A 2-day protocol might have provided more optimal study quality.
This study was designed to compare the detection of perfusion defects and reversibility using conventional interpretations of standard SPECT images. Quantitative analysis was used to measure the actual tracer activity in segments graded as normal or abnormal. Accordingly, we did not normalize segments to compensate for attenuation or to a normal data base. In comparing Tc-99m technetium and Tl-201 tracers, some differences might be due to differences in photon attenuation or to reconstruction error caused by higher visceral uptake in the proximity of the myocardium with Tc-99m technetium tracers. To obtain a better understanding of the quantitative magnitude of these differences, we averaged the uptake of Tl-201 and Tc-99m technetium for segments that were concordantly graded as normal. A profile of these average values for normal segments is shown in Fig. 3. The normal attenuation pattern of inferior and posterior segments is clearly demonstrated. The differences between Tl-201 and Tc-99m are less than we might have intuitively imagined. These profiles of normal segments do not show major systematic differences attributable to differential attenuation, scatter or reconstruction error. The slightly greater attenuation of Tl-201 in the inferior segments is in accordance with calculations using known attenuation coefficients. The difference in the linear attenuation coefficients is often perceived intuitively to be much greater than it is by actual measurement or calculation.
3.4 Clinical Implications
Perhaps the most important finding in this study is that dipyridamole Tc-99m tetrofosmin SPECT yielded a reduced detection rate of reversible defects in the distribution of mild to moderate stenoses in patients with CAD, compared with Tl-201 SPECT. In contrast, dipyridamole Tl-201 SPECT and Tc-99m tetrofosmin SPECT identified a comparable number of defects in myocardial regions supplied by stenoses >70%. It has not been determined whether this limitation has any effect on the prognostic significance of a normal Tc-99m tetrofosmin scan. Also, the implication of a lower detection rate of multiple perfusion defects in patients with multivessel disease needs to be ascertained.
3.5 Conclusions
With dipyridamole stress, 1) at least one defect was seen on both Tl-201 and Tc-99m tetrofosmin SPECT; 2) Tc-99m tetrofosmin SPECT identified fewer reversible defects than did Tl-201, but showed a similar number of fixed defects; 3) the magnitude of reversible defects on Tc-99m tetrofosmin images was less than the magnitude of reversible defects on Tl-201 images, whereas the defect magnitude of fixed segments was similar for both tracers; and 4) reversible defects seen on Tl-201 SPECT but not on Tc-99m tetrofosmin SPECT were predominantly regions perfused by mild coronary stenoses.
☆ This study was supported by a grant from Medi-Physics, Inc., Amersham Health Care, Arlington Heights, Illinois.
- Abbreviations
- coronary artery disease
- electrocardiogram, electrocardiographic
- single-photon emission computed tomography (tomographic)
- Tc-99m
- technetium-99m
- Tl-201
- thallium-201
- Received January 10, 1997.
- Revision received September 29, 1997.
- Accepted October 13, 1997.
- The American College of Cardiology
- ↵
- Sinusas AJ,
- Shi Q,
- Saltzberg MT,
- et al.
- ↵
- Glover DK,
- Ruiz M,
- Yang JY,
- Smith WH,
- Watson DD,
- Beller GA
- ↵
- the Tetrofosmin International Trial Study Group,
- Zaret BL,
- Rigo P,
- Wackers FJT,
- et al.
- ↵
- ↵
- Koplan BA,
- Beller GA,
- Ruiz M,
- Yang JY,
- Watson DD,
- Glover DK
- ↵
- Takahashi N,
- Reinhardt CP,
- Marcel R,
- Leppo JA
- ↵
- Glover DK,
- Ruiz M,
- Edwards NC,
- et al.
- Rigo P,
- Leclercq B,
- Itti R,
- Lahiri A,
- Braat S
- ↵
- Nakajima K,
- Taki J,
- Shuke N,
- Bunko H,
- Takata S,
- Hisada K
- ↵
- Matsunari I,
- Fujino S,
- Taki J,
- et al.
- ↵
- ↵
- Tamaki N,
- Takahashi N,
- Kawamoto M,
- et al.
- ↵
- ↵
- Cuocolo A,
- Sullo P,
- Pace L,
- et al.
- ↵
- Mahmood S,
- Gunning M,
- Bomanji JB,
- et al.


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