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» News
M'sia rejects Manila's extradition request of jailed trader
Publication Date : 09-02-2013
Malaysia is not planning to extradite a man sentenced to two years' jail by a Kota Kinabalu magistrate's court after being found guilty of possessing a fake Philippines passport despite a request from Manila.
Businessman Mohammad Kamal Sa'ad, 47, who was arrested on Jan 25 at the Kota Kinabalu International Airport with the fake passport under the name Manuel Karingal Amalilio, is wanted by the Philippines' authorities over a pyramid scheme involving 15,000 people.
Attorney-General Tan Sri Abdul Gani Patail said in a statement that the Philippines' Embassy had requested for Mohammad Kamal's extradition.
The Philippines' Justice Undersecretary Jose Vincent B. Salazar had also requested that the Government freeze Mohammad Kamal's assets, savings and investments and those owned by people related to him.
Gani said Malaysia would not extradite Mohammad Kamal as he was a Malaysian citizen holding a valid and active identification card.
However, the Attorney-General said, the relevant authorities had been directed to check and freeze all financial records and assets belonging to Mohammd Kamal and his associates.
The AG-Chambers has also received a formal request from the Philippines' Department of Justice under the Asean Mutual Assistance in Criminal Matters Act, to hand Mohammed Kamal over to authorities in the Philippines.
Abdul Gani said that this request was being handled by the International Affairs Division of the A-G's Chambers.
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No. 24 USC loses yet again to No. 11 UCLA, 38-20
PASADENA, Calif. (AP) With No. 24 Southern California and No. 11 UCLA each sharing a penchant for playing games that have gone down to the wire this season, it was easy to assume the latest installment of the crosstown showdown would come down to another dramatic fourth quarter.
The Trojans never got the chance. After linebacker Anthony Sarao's interception return for a touchdown early in the first quarter, pretty much everything that could have gone wrong for first-year coach Steve Sarkisian did.
Brett Hundley passed for 326 yards and three touchdowns and rushed for another score, leading UCLA past USC 38-20 on Saturday night for the Bruins' third straight victory in the annual rivalry game.
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House water bill takes a tumble
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- James Jeffrey
- Contributing Writer- Austin Business Journal
One of the Texas legislative session's major water-related bills to fund state water projects to the tune of $2 billion was poleaxed by a technicality during debate Monday.
House Bill 11, filed by State Rep. Allan Ritter, R-Nederland, proposed using a one-time, $2 billion disbursement from the state's Economic Stabilization Fund, commonly known as the Rainy Day Fund, and was seen by many as a major step to head off future job losses and negative financial impacts in Texas.
But State Rep. Sylvester Turner, D-Houston, raised a point of order — a legislative term for a procedural problem with the bill — which avoided a vote on HB 11 and in effect quashed its chances, the Texas Tribune reports.
The bill sparked a debate over the use of the Rainy Day Fund itself, the Tribune reports. Democrats argued that if the fund is used for water projects, it should also be tapped for public education. Meanwhile, many Republicans, backed by conservative activists and groups like the Texas Public Policy Foundation, called the bill irresponsible, saying the fund should only be used for emergencies.
On the other side of the Capitol in the Senate, Ritter had some success — though ultimately negated by events in the House — when senators approved HB 4, which already passed the House, and Senate Bill 4, both of which would create a special fund to administer the water money proposed by HB 11.
Gov. Rick Perry weighed in on the debate.
"The people of Texas expect their elected officials to address the water needs of our state, and we will do just that," Perry said. "This issue is too important to leave its fate uncertain, and I will work with lawmakers to ensure we address this need in a fiscally responsible manner."
The governor has placed water, transportation and tax relief among his top priorities. Perry's office warned last week that he will call lawmakers back into special session this summer if they fail to act on any of those issues, the Fort Worth Star-Telegram reports. The current 140-day session ends May 27.
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The holiday season is just around the corner, and once again we know that folks in our community will not have the means to celebrate the season. The Aurora Regional Chamber of Commerce is partnering again this year with the Fox Valley United Way to make a difference.
While countless parents are telling their children that there will not be many gifts under the tree this year, a large number of children in our community will not be receiving any presents. It's a luxury many parents cannot afford as they are simply trying to make ends meet. All donations will support the more than 130 local families who have reached out for help so far this year.
Want to make a difference for a family in need?
For more information, click here.
Dolan & Murphy is excited to announce the launch of the Seventh Annual Holiday Food Drive to benefit the Aurora Area Interfaith and Marie Wilkinson food pantries.
In addition to Dolan & Murphy, the drive is sponsored by a number of local businesses and organizations, including Prisco's Family Market, The River 95.9 FM, The Beacon News, Cano Container Corporation, Douglas Carpet One, and Aurora Fastprint.
Additionally, this is the second year for the Matching Pallet Program. The pallet program is a challenge grant where five organizations have committed to match donations dollar for dollar up to $10,000 each for a total of $50,000. Those five organizations are the Dunham Fund, Mooney & Thomas PC, Konen Insurance Agency, Old Second National Bank, and the Daniel D. Dolan Family Foundation.
Dan Dolan writes, "We hope to make this our most successful year ever and we need everyone's help to raise enough food so no child or adult has to go hungry in our community!"
To donate, visit here.
To volunteer, visit here.
To purchase a pallet, visit here.
In collaboration with a number of local community leaders and organizations – including the Aurora Regional Chamber of Commerce, the Women's Business Development Center plans to launch a ScaleUp Aurora satellite to support and strengthen local small businesses.
Interested individuals can view the description here.
The WBDC-Aurora Coordinator is responsible for developing and implementing capacity building programs and resources to local established business owners in Aurora, Illinois and the surrounding area, in the range of $150,000 to $500,000 annual revenues. The Coordinator will provide WBDC-Aurora clients expert resources and counseling services in the areas of finance, management, operations, sales and marketing to assist business owners with meeting their short term and long term business objectives to sustain growth. The Coordinator will develop and implement programming in the areas of procurement and Access to Capital to initiate growth and relationships that leverage the ScaleUp America contract and deliver on WBDC strategic goals.
The Women's Business Development Center (WBDC) is a nationally and internationally recognized non-profit organization established in 1986 to work with women to launch new businesses and strengthen existing businesses in the Chicago area. Over the past 28 years, the WBDC has become a leader in providing direct services to women business owners and in effecting public policy changes which reflect the needs of women entrepreneurs and their families.
Congratulations to DiGiovine Hnilo, Jordan & Johnson on celebrating 40 years in business!
The Fox Valley Park District has proclaimed November as Veterans Recognition Month and will pay its respects with free admission to its fitness centers and also a complimentary luncheon. Throughout November, veterans are invited to visit any Park District fitness facility as often as they'd like for no charge. Free admittance for veterans and immediate family members (spouses and children) is offered at the Eola Community Center, Prisco Community Center, and Vaughan Athletic Center.
Heartland Blood Center's Aurora Facility is in urgent need of donors! Donate blood through November 30. All donors will be entered into a random drawing for one of seven Official Chicago Bears Memorabilia. Contact the center to schedule your appointment today.
Celebrate Differences invites you to Embracing Dyslexia Movie Screening on Nov. 11 at 7:00 p.m. which offers an exploration of an insider's perspective along with interviews with parents, researchers, and educators. Please RSVP to this free event.
Presence Mercy Medical Center's Health Institute will begin Live Well, Be Well workshop on November 11from 9:00 to 11:30. Registration is required.
Aurora University will host a Graduate Programs Open House on November 12 from 6:00 to 9:00 p.m.
Cambridge Music Studio will hold an open house on November 15 from 1:00 to 4:00 p.m. Free admission plus receive one certificate for a free exploratory lesson per student.
Aurora University will host a concert: Composer Gwyneth Walker and Choirs on November 16 at 3:00 p.m. at Crimi Auditorium.
This week, the Aurora Regional Chamber of Commerce will hold its Annual Celebration of Membership. This event highlights the accomplishments of the business community, showcases the activities of the Aurora Chamber and sets the direction for the upcoming year.
This past year, we had more than 100 businesses assist the Chamber and its partners with the Aurora Regional Pathways to Prosperity initiative. Others helped craft curriculum for Aurora University's successful launch of the John C. Dunham STEM Partnership School. Additional organizations are involved in a growing number of causes and efforts in our community to create a stronger, more vibrant future for the community in which we all live, work and enjoy.
Looking back, we realized we completed 45 percent more certificates of origin for our business members to export their products around the world. Aurora area goods are being sold worldwide; your neighbors, family members or friends may be involved in this growing global economy.
Still others participated in more than 100 public policy meetings to help improve the business climate and share the business voice with our elected officials at City Hall, in Springfield and Washington.
Through discount programs and member discounts, our members were able to improve their bottom line by spending less. We created important connections for our businesses to collaborate and grow. More than 170 networking opportunities were available to our members.
Key events like the State of the City, the State of the Village and the multi-chamber Holiday Celebration offered opportunities for our community's leaders to foster a collaborative, supportive economy in our region.
We offered a number of educational events for business leaders to learn better business techniques. With legislation that impacted medical marijuana use, the Affordable Care Act and Fair Labor Standards Act (to name a few), the Aurora Chamber organized programs to make its members aware of the impact to their businesses.
Of course, we cannot do it alone. We counted more than 50 collaborative partners that helped us organize, promote and coordinate programs and activities. We had more than 140 volunteers to lend a hand. We appreciate the assistance our Ambassadors provide at meetings, with welcome calls, mentoring new members and so much more. Our committee members and board members help guide our direction, and in many cases, assist in the implementation of the plans to support our business community.
During Thursday's lunch, we will recognize our Immediate Past Chair Keith Wheeler of Responsive Network Services for his leadership this past year. We'll also hear from Laura Newman of Mitutoyo America Corporation who recently accepted the role of board chair.
We are celebrating a remarkable year – and appreciate all of the efforts of the business community in making this region so strong.
One last request as we continue to strengthen our area: Please vote next Tuesday.
It's easy to be cynical. Some believe our problems are too big and our politics are too small. Some wonder whether voting is worth the bother, whether it will make a difference. The truth is that every vote and voice matters in this election. If you want your voice to be heard, vote. With so many close contests this year, every vote really does count.


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Originally published March 4, 2014 at 12:48 PM | Page modified March 4, 2014 at 9:11 PM
Obama: Ukraine can be a friend of the West, Russia
President Barack Obama says Russia's military invasion of Ukraine could end up driving countries away from Russia, instead of closer to it.
President Barack Obama says Russia's military invasion of Ukraine could end up driving countries away from Russia, instead of closer to it.
He says there is room for Ukraine to be a friend of both the West and of Russia.
Russian President Vladimir Putin has sent Russia forces into the Crimean region of Ukraine, saying he needs to protect Russian interests there.
Obama also says Putin must be guided by a different set of lawyers making different determinations about his actions. Obama says there is a strong belief around the world that Russia's actions are violating international law and that force shouldn't be used to exert influence inside Ukraine.
Obama commented Tuesday in Washington after discussing highlights of the $3.9 trillion government budget he's sending to Congress.
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Apparently I was on an Asian flavors kick when I planned this last week of meals lol. Tis the time of year for slow cooker meals. 895 more words
Make, Use, Re-Make: Tales of a Whole Chicken
I love the idea of making a meal where the leftovers can be made into something else. This is especially applicable in the fall/winter, when soups and stews take over my cooking repertoire. 519 more words
Slow Cooker Cheesy Spaghetti and Chicken
Back to my slow cooker again. I have to admit I am not a big fan of chicken in the slow cooker if it is going to be shredded into a dish. 322 more words
Spanish-Style Slow-Cooker White Bean and Sausage Stew
I have a confession: I used to be kind of snooty about slow-cookers. My dad never used one, I don't think we even had one in the house when I was a kid. 314 more words
Easy Slow Cooker Chicken & Old Bay
Out of all the meats, I believe chicken to be the most boring. No matter how much I season or the method of cooking it always tends to be the same. 277 more words
Now that the weather has turned chilly I'm in the mood for crockpot cooking, but many of the recipes I find to try only require 6-8 hours which is much less than we are away from the house thanks to daily commuting. 270 more words


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I'm just like Eminem!... Except my parents were rich and went to Harvard..
But that's where the differences end. Deep down Eminem and I are practically the same guy. Except I express myself with Haiku poetry instead of Rap. That's just a minor difference. What's important is we're both wild and rebellious. But come to think of it I'm actually not as wild and rebellious as I am conservative and reflective. But where Eminem and I really connect is in our beliefs. But I would never carry a gun and I don't hate my mother. I should also point out I don't dress in a hiphop style. I'm more of a corporate casual guy. But when you strip away all that minor stuff, I'm just a thread away from actually being Eminem. Oh, except I'm Asian.
- Charles Manson deletes Match.com profile
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cannes film festival
Results: 11 - 20 of 21
The Stream
Ray Liotta on the Cannes Premiere of Killing Them Softly, and Showing GoodFellas to his 13-Year-Old Daughter
After a career peppered with dangerous criminals—most memorably in Something Wild and GoodFellas—Ray Liotta finally gets his ass kicked. Killing Them Softly, a blistering study of thieves, killers and crooks set against the financial... read more
Friday, 5/25/2012 at 10:20AM
The Women of Cannes
The best reason to visit Cannes this week was all the beautiful ladies walking the Riviera. (Oh, and something about a film festival?) read more
May 25, 2012
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Kanye, Big Sean, Kid Cudi, and Others on Kanye's 7-Screen Cannes Film
Kanye West's 25-minute film "Cruel Summer" wasn't a part of the official selection of the festival, but it made a lot of noise on Wednesday night in the south of France. Jay-Z, Theophilus London,... read more
Thursday, 5/24/2012 at 9:50AM
The Cannes Film Festival Style Report
What Hollywood's finest are wearing at the world's most stylish film festival read more
May 29, 2012
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Cannes Scratchpad: Brad Pitt's Killing Them Softly, Tarantino's Django Unchained, and the Fest's Nuttiest Film, Holy Motors
The sun has finally broken through the rain at Cannes, Kanye West has been spotted in anticipation of his Cannes-crashing short film premiere later this evening, and the film selection has roared to life.... read more
Wednesday, 5/23/2012 at 3:10PM
The Stream
The Cannes GQ+A: Tom Hardy Won't Talk Dark Knight, Loves J.Lindeberg
Tom Hardy keeps exploding. One of the few actors who could reasonably go toe-to-toe with Christian Bale in terms of muscle mass and psychic intensity, the brooding Brit first hooked U.S. audiences with his... read more
Tuesday, 5/22/2012 at 10:10AM
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Cannes Diary: Auteurs, Actors, and Yachts, Oh My!
The Cannes Film Festival is a jumble of overlapping agendas, parties, and, oh yeah, art. In the Grand Palais, films by the world's greatest auteurs unspool in the same building as the Marché, where... read more
Monday, 5/21/2012 at 3:00PM
The Stream
Gael Garcia Bernal on His Latest Cannes Premiere, and His Thoughts on Democracy
Star of such major art-house hits as Y Tu Mamá También, Bad Education, The Motorcycle Diaries, and Babel, Gael Garcia Bernal has spent the past decade chiseling out an impressive résumé of provocative, politically... read more
Monday, 5/21/2012 at 9:51AM
The Stream
Actor Ezra Miller on Why Every Man Should Dance Naked Before Donning a Tux at Cannes
Sometimes, the Croisette at Cannes can be a red-carpet march of the penguins—with tuxedo-ed dudes lined up, one after the other, all playing safe, and barely distinguishable from the black-tied paparazzi. Ezra Miller, star... read more
Friday, 5/18/2012 at 8:45AM
The Stream
Yes We Cannes! Six Upbeat Storylines to Follow at the World's Maddest Film Festival
There's a strong surge of optimism leading up to this year's Cannes Film Festival, which skipped to life this morning with the premiere of Wes Anderson's cheery young-adult fable Moonrise Kingdom. In his stylized... read more
Wednesday, 5/16/2012 at 11:50AM
Results: 11 - 20 of 21
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- The Great Franco-Italian Pasta Experiment
- How to Pick from an Overpriced Restaurant Wine List


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2012 »
Missing Military-Industrial-Complex Money
When Major General Smedley Butler made his case,"War is a Racket" he did not pull any punches. "The normal profits of a business concern in the United States are six, eight, ten, and sometimesRead More »
Will no one challenge Obama's executive orders?
President Obama's state of the union pledge to "act with or without Congress" marks a milestone in presidential usurpation of Congressional authority. Most modern presidents have used executive orders to change and evenRead More »
The Drought In Brazil Has Gotten So Bad That 142 Cities Are Now Rationing Water
Did you know that the drought in Brazil is so bad that some neighborhoods are only being allowed to get water once every three days? At this point, 142 Brazilian cities are rationingRead More »
Residents Baffled by Terrifying Loud Booms in Oklahoma
If you hear a bang in the night in Oklahoma, it's probably not a monster, but could something worse -- an earthquake. Across the south central state, 20 earthquakes were reported to The United StatesRead More »
Henry Kissinger, Shirley Temple and MK Ultra?
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Do we really want to go through life being labelled a victim? The word 'victim' connotes frailty. It says 'handle with care', 'don't push it', 'poor thing'. Do we want to be looked at that way just because of an isolated incident that happened through no fault of our own?
Learning spaces, for instance, cannot stay stuck in the old rigid mould where rows of desks face the teacher and blackboard. There's no greater enemy of sustainability than obsolescence.
A fresh influx of excited faces will flood through university doors this month. It is a scary and exciting time but it is also a period of great expectation and it can be hard to prepare for such a massive change in your life's direction... In many ways I wish someone had told this to me on my first day at university.
It's officially the start of a new academic year, which means it's time for a fresh batch of PhD candidates to enter the weird and wonderful world of doctoral research (I mean it; it really is wonderful). These are some of the techniques I've used over the last two years, and will rely on to pull me through the final twelve months of researching, writing, and revising.
Families will always seek out information, and many will undertake detailed research, when they are choosing a school for their child. An inspection report or league table may help, but most parents recognise that they can only ever provide a snapshot of the education on offer.
What kind of world do we live in now that no one bothers to tell another human being to have a nice day? ... Good manners can make someone's day, so let's all just give it a go. I'm sure we'll feel much better about ourselves as a result, and the world will probably be much nicer.
Most of us in the UK have an idea of what an American summer camp is like: swimming, hi- jinks, Patrick Swayze in 'Dirty Dancing'. So when I was approached to teach Mindfulness in Schools Project's '.b' at a family camp in New Hampshire this August, I was intrigued... How would the two experiences mix together?
Mindfulness is not enough on its own; it is no silver bullet. Schools are complex places and people more complex still - teachers, pupils and parents alike. Mindfulness must be part of a broader pastoral net, not only in terms of social and emotional learning, but also child protection.
An hour teaching teenagers who don't want to be there something they don't want to learn is never pleasant... A few things tend to raise their curiosity: that they can physically change their brain; that mindfulness is used by top sportsmen and musicians; that it might help with their exams or, at the very least, help them worry less about their exams.
Why is it called .b? The red 'dot' of the logo stands for STOP - like a red light. And the 'b' is saying BE. So .b is inviting those in schools - toddlers, teens and teachers alike, to 'stop and be'. Just for a moment.
Because there is no public overseer, there is no one to take genuinely impartial responsibility for making sure that employment figures are accurate. The result is that thousands of students a year could be relying on misrepresented information to make one of the most important decisions in their lives.
In the next few weeks, there will be new wave of 18-year-old youngsters beginning one of the most important and challenging chapters in their lives. I'm sure the stresses are beginning for the eager youths, seeking to get away from their family homes to start university
Our decision on 18 September is one of the utmost importance. It is perhaps the most important political choice we will have the power to make in our lifetimes... some of the things we believe that this debate is not about; points which should no longer be allowed to dominate discussion and which can, at their worst, serve to obscure the true nature of the choice we are making.
Houses boarded up, a mixture of soggy bits of paper, puke and cigarette butts carpeting the streets, people in all kinds of bad states passed out in shop fronts if they were lucky... That's the sight I was met with when I arrived at the Notting Hill Carnival in the early afternoon of Bank Holiday Monday.
The problem with feminism isn't with the idea itself, but everything that surrounds it. From the misunderstanding of what the term actually means, to the idea that it is only for women. In fact, feminism is a threat to the way things have been for centuries, one which affects the demographic I belong to particularly: the white, straight, middle-class male.
I'd never wanted anything like I wanted to be a writer. I remember spending whole days sitting around and moping about how I'd never be good enough/would never manage it/would never get to be an actual writer. I realise now that this was somewhat pathetic... but it did half lead to some very vague experiences of publishers before the competition.


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Liver Failure and Liver Disease
Cost-minimization analysis of MRC versus ERCP for the diagnosis of primary sclerosing cholangitis
Article first published online: 30 JUN 2004
DOI: 10.1002/hep.20287
Copyright © 2004 American Association for the Study of Liver Diseases
Volume 40, Issue 1, pages 39–45, July 2004
Additional Information
How to Cite
Talwalkar, J. A., Angulo, P., Johnson, C. D., Petersen, B. T. and Lindor, K. D. (2004), Cost-minimization analysis of MRC versus ERCP for the diagnosis of primary sclerosing cholangitis. Hepatology, 40: 39–45. doi: 10.1002/hep.20287
Publication History
- Issue published online: 30 JUN 2004
- Article first published online: 30 JUN 2004
- Manuscript Accepted: 24 MAR 2004
- Manuscript Received: 16 DEC 2003
Funded by
- AASLD/Schering Hepatology Award
- Abstract
- Article
- References
- Cited By
Investigations examining the use of magnetic resonance cholangiography (MRC) for the diagnosis of primary sclerosing cholangitis (PSC) have described comparable accuracy when compared to endoscopic retrograde cholangiopancreatography (ERCP). The effectiveness of MRC based on overall cost, however, remains unknown. Our aim was to determine the average cost per correct diagnosis using MRC or ERCP as the initial testing strategy for the diagnosis of PSC. A decision analysis model was constructed employing diagnostic test parameters prospectively determined among 73 patients with clinically suspected biliary disease. ERCP was performed within 24 hours after MRC. Cost data were derived from average Medicare reimbursement fee schedules. The prevalence of PSC in the study cohort was 32%. The sensitivity and specificity of MRC for the diagnosis of PSC were 82% and 98%, respectively. The average cost per correct diagnosis of PSC was $724.00 for initial MRC (including the cost of ERCP following a negative MRC examination) versus $793.17 for initial ERCP. In the absence of biliary obstruction, the average cost per correct diagnosis of PSC was $549.64 with MRC versus $623.25 for ERCP. The average cost of managing post-ERCP–related complications among patients with PSC was $2902.20 (range, $1915.40-$5031.54). For ERCP to be the optimal initial test strategy, a prevalence rate of PSC greater than 45%, MRC specificity less than 85%, or reduction in the average cost per diagnosis to $538.30 would be required. In conclusion, MRC has comparable accuracy to ERCP and results in cost savings when used as the initial test strategy for diagnosing PSC. (HEPATOLOGY 2004;40:39–45.)
Endoscopic retrograde cholangiopancreatography (ERCP) has been considered the diagnostic test of choice for the evaluation of clinically suspected biliary tract disease.1, 2 Although considered a safe and effective procedure when performed by skilled operators, procedure-related complications from ERCP can occur in 3% to 8% of patients and include abdominal pain, pancreatitis, bleeding, common bile duct (CBD) perforation, biliary sepsis, and death.3, 4
Magnetic resonance cholangiography (MRC) for the study of biliary tract disease has only recently become available as an alternative to ERCP. Based on the difference in intensities between bile and surrounding tissues, complete visualization of the biliary tree can now be achieved. In comparison to ERCP, MRC is not invasive and has no significant morbidity when performed in appropriately selected individuals. The potential adverse effects of radiation exposure and contrast media associated with ERCP are also avoided with MRC.5
A number of investigations comparing MRC with ERCP suggest that both have similar diagnostic-test characteristics in the detection of biliary tract disorders,6–9 including primary sclerosing cholangitis (PSC).10, 11 However, the effectiveness of MRC for detecting PSC, described in the context of important economic outcomes such as resource utilization, has not been reported. Therefore, the aim of our investigation was to perform a cost-minimization analysis of MRC versus ERCP as the initial test strategy for the diagnosis of PSC.
Patients and Methods
Patient Population.
The cost-minimization analysis is based on results from a prospective investigation evaluating the accuracy of MRC compared to ERCP in 73 patients with suspected biliary tract disease. Details of this study have been previously reported.10 All patients were observed to have clinical and/or biochemical evidence of unexplained cholestasis. Because of technical constraints, a total of 2 patients required conversion to percutaneous transhepatic cholangiography. For the purposes of this analysis, information from the 68 patients with quality diagnostic images on ERCP was used. In all instances, MRC was attempted prior to ERCP performance and successfully completed.
Magnetic Resonance Cholangiography Technique.
All ERCP procedures were completed within 24 hours of the preceding MRC. The examinations were performed using a General Electric Signa 1.5 Tesla MR scanner (Milwaukee, WI). Image acquisition was performed using a phase array torso multicoil. Two acquisitions each were performed in the axial and coronal planes using a single-shot fast-spin echo pulse sequence with a repetition time of infinity, average echo time equal to 90 milliseconds, matrix size equal to 256/256, and slice thickness of 5 mm with 0-mm skip. Each image slice required 2 seconds. Total breath-hold time averaged 20 seconds per patient. Multiple breath-hold scans were also performed to image the entire hepatic parenchyma if required. Three additional acquisitions were performed in the coronal plane and in planes approximately 45° oblique to the porta hepatis. A slice thickness of 5 cm, requiring a single 2-second breath hold, was used for the additional acquisitions.
MRC and ERCP Image Interpretation.
The interpretation of images from MRC and ERCP was performed by two radiologists with experience in hepatic and biliary tract imaging. These physicians were blinded to the clinical and laboratory information, procedure indication, and results of previous imaging studies in each subject. Differences in image interpretation were resolved by consensus between the two radiologists. MRC interpretation was performed prior to ERCP interpretation in all cases. All MRC sequences were evaluated for image quality, which was classified as "satisfactory" or "unsatisfactory" based on the ability to visualize biliary tree structures and the presence of artifacts. Intrahepatic bile ducts were examined for the extent of visualization and morphological features. Common hepatic and common bile ducts were examined for visualization, the presence of dilatation, and obstruction. Visualization of the gallbladder, cystic duct, and presence or absence of cholelithiasis was also recorded.
Identical criteria were applied for the evaluation of ERCP images using the known diameter of the duodenoscope as a correction reference for magnification. Characterization of the ampulla as well as the diagnosis of strictures, dilatation, filling defects, etiology of obstruction (cholelithiasis, inflammation, or malignancy), and PSC were made using standard endoscopic and radiological criteria. Final diagnoses in each subject were based on all available clinical information including medical history and physical examination, biochemical testing, imaging studies (including ultrasound, CT scan, and ERCP), and clinical follow-up.
Decision Analysis Model.
A decision analysis model using DATA version 3.5 (TreeAge Software, Inc.) software was developed to compare the expected average cost (1999 US dollars) per correct diagnosis of the initial use of MRC or ERCP for detecting PSC (Fig. 1). Bayes theorem was used to determine the probability of a false-positive and false-negative result from both MRC and ERCP.12 The potential for procedure-related complications with ERCP (abdominal pain, pancreatitis, and CBD perforation) was accounted for in the model. Therapeutic maneuvers required at ERCP in the diagnostic and confirmatory setting, including any combination of balloon dilatation, endoscopic sphincterotomy, bile duct biopsies, stone extraction, and stent placement/removal, were also examined (Fig. 2). A discounting of costs was not performed given the brief time horizon associated with diagnostic testing.
Data and Assumptions.
Key assumptions and estimates for the model are outlined in Table 1. The prevalence of PSC was calculated as a proportion of the total cohort at risk. Sensitivity and specificity parameters for both MRC and ERCP were used in determining the likelihood of having PSC. Ranges of probability estimates were derived from the literature or assumed when published information was not available. The following assumptions were incorporated into the model:
- 1Values of the diagnostic parameters (sensitivity, specificity) were the same for ERCP whether used as an initial or a confirmatory test.
- 2The occurrence of a negative test result by MRC was subsequently followed by ERCP with the assumption that a clinical suspicion for PSC remained present after MRC.
- 3Probabilities of post-ERCP complication were the same for ERCP whether used as an initial or a confirmatory test.
- 4The management of post-ERCP abdominal pain was assumed to include a 24-hour hospitalization in a semiprivate room with intravenous hydration and pain medications.
- 5The management of post-ERCP acute pancreatitis was assumed to include a 3-day hospitalization in a semiprivate room, intravenous hydration and pain medications, and the performance of an abdominal CT scan with oral and intravenous contrast.
- 6The management of post-ERCP bile duct perforation was assumed to include a 5-day hospitalization in a semiprivate room, intravenous antibiotics and hydration, pain medications, and an abdominal CT scan with oral and intravenous contrast. No surgical intervention to repair the perforation was assumed for the purposes of this analysis.
|Probability of PSC
|Probability of bile duct obstruction
|Probability of choledocholithiasis
|Probability of BD
|Probability of ES
|Probability of BD and ES
|Probability of BD and biopsy
|Probability of BD and stone extraction
|Probability of any ERCP complication
|Probability of post-ERCP abdominal pain
|Probability of post-ERCP pancreatitis
|Probability of post-ERCP perforation
|Sensitivity of ERCP
|Specificity of ERCP
|Sensitivity of MRCP
|10, 11
|Specificity of MRCP
|10, 11
|Cost of diagnostic ERCP (US$)
|Medication cost of diagnostic ERCP
|Institution, Medicare
|Supply cost of diagnostic ERCP
|Institution, Medicare
|Cost of BD
|Cost of ES
|Cost of BD and ES
|Cost of BD and biopsy
|Cost of BD and stone extraction
|Cost of stone extraction alone
|Cost of MRCP
|Cost of abdominal CT scan
|Hospitalization cost, post-ERCP abdominal pain
|Institution, Medicare
|Hospitalization cost, post-ERCP pancreatitis
|Institution, Medicare
|Hospitalization cost, post-ERCP perforation
|Institution, Medicare
Direct costs for ERCP included consideration of the following components: supplies (including medications and IV equipment, occlusion balloon catheter for contrast injection, and contrast material), recovery room fees, and physician fees. Direct costs for MRC included consideration of film and processing fees, technician fees, and physician fees (Table 1). MRI scanner, side-viewing duodenoscopes and computer processing units, and ERCP procedure-room costs were considered fixed and excluded from the analysis. Facility fee charges were excluded from the cost analysis. Indirect costs such as wages lost from missed work were not included. Hospitalization costs were assumed to include the components for each post-ERCP complication as described in Materials and Methods.
All procedure costs (technical and professional) were estimated using average Medicare reimbursement schedules assigned by CPT procedure code. This included the costs associated with additional therapeutic maneuvers required at ERCP when indicated. Supply costs were estimated by multiplying institutional charges by the Medicare cost-to-charge ratio for fiscal year 1999 (0.5562). All costs were inflation-adjusted to the 1999 US dollar.
Sensitivity Analysis.
To determine the extent to which results affected model assumptions, sensitivity analyses were performed on individual parameter estimates to assess their impact on robustness of model outcomes. The following variables were varied: prevalence of PSC (1%–100%), sensitivity and specificity of MRC (50%–100%), probabilities of ERCP-related complications (50%–200% of baseline), and total costs of MRC, ERCP, and hospitalization (50%–200% of baseline). Threshold analysis was conducted within the context of the decision model to estimate the effect of parameter values beyond which the optimal test strategy changed.
In the original prospective study,10 the 73 patients (33 male, 40 female) had a mean age of 56 years (range, 19–94 years). Twenty-two individuals (30%) were found to have normal biliary tree anatomy by ERCP. Forty-two patients (58%) had benign biliary tract disease, and 9 individuals (12%) were diagnosed with malignant biliary tract disease. Twenty-three of 73 subjects (32%) were diagnosed with PSC.
All patients with PSC had both intra- and extrahepatic biliary system involvement confirmed by ERCP. Therapeutic interventions with ERCP were performed in 16 of 22 subjects (73%) with PSC. These included endoscopic sphincterotomy, balloon dilatation, stone extraction, biliary stent placement and/or removal, and histological sampling. Six patients (8.8%) who underwent ERCP developed postprocedure complications of abdominal pain (n = 3), acute pancreatitis (n = 2), and CBD perforation (n = 1) not requiring surgical management.
Diagnostic test performance characteristics for MRC included sensitivity and specificity values of 82% and 98%, respectively, for the detection of PSC. The positive and negative predictive values were 95% and 92%, respectively. Overall accuracy of MRC for the diagnosis of PSC was 93%.
Base Case Analysis.
Among the entire subgroup of patients diagnosed with PSC (32%), the average cost per correct diagnosis using the test strategy of initial MRC was $724.00 versus $793.17 for initial ERCP. For MRC, the cost included expenses related to performing confirmatory ERCP when MRC results were negative and ERCP-related complications (Fig. 2). In the absence of biliary obstruction, the average cost per correct diagnosis for initial MRC was $549.64 versus $623.25 for ERCP. In patients with PSC and pretest evidence of biliary obstruction, the average cost per correct diagnosis for initial MRC was increased to $1,499.64 versus $950.00 for initial ERCP alone.
The average cost of managing post-ERCP–related complications in patients with PSC was $2,902.20. Values ranged from $1,915.40 (for abdominal pain after balloon dilation) and $5,031.54 (for perforation after balloon dilatation and stone extraction) when initial MRCP demonstrated evidence of biliary obstruction.
Sensitivity Analyses.
Sensitivity analyses were performed to determine the robustness of base case results following variations in the model's probability estimates. One-way sensitivity analyses revealed that a prevalence rate above 45% for PSC would change the preferred test strategy from initial MRC to ERCP (Fig. 3). When the specificity of MRC was less than 85%, initial ERCP was the optimal test strategy (Fig. 4). No change in test strategy was observed by varying the sensitivity of MRC for detecting PSC. Variation in the costs of initial MRC, ERCP, therapeutic maneuvers at ERCP, additional imaging by CT scan, or items related to hospitalization did not influence the choice of MRC as the preferred initial test strategy. With a study cohort prevalence rate of 32% for PSC, threshold analysis demonstrated that an average cost per correct diagnosis of $538.25 (including procedure-related complications) would be required for initial ERCP to be the preferred strategy over MRC.
The invasiveness and risk for complications with ERCP has created a need to identify alternate methods for confirming the presence of biliary tract disease. MRC appears comparable to ERCP for detecting bile duct abnormalities including PSC. From this cost-minimization analysis, the test strategy of initial MRC was associated with a reduced average cost per correct diagnosis compared to initial ERCP for evaluating patients with suspected PSC. Importantly, the subsequent use of ERCP following a negative MRC examination—intended to reflect clinical practice—was accounted for in these results. In patients with PSC and no evidence of significant biliary obstruction requiring therapeutic ERCP, the cost difference was even greater. From sensitivity analyses, a prevalence rate for PSC greater than 45% or MRC specificity less than 85% would be necessary for initial ERCP to become the preferred test strategy for detecting PSC. The initial use of ERCP would also be favored if the average cost per correct diagnosis (including the cost of postprocedure complications) was reduced to at least $538.30.
In addition to its noninvasive approach, the initial use of MRC for diagnosing PSC has several other advantages. Identifying high-grade biliary obstruction on MRC improves the ability to justify the risk for potential complications when therapeutic ERCP is required.5–10 Additionally, the decision to refer for percutaneous transhepatic cholangiography if high-grade distal obstruction would inevitably result in an incomplete ERCP examination can be facilitated.9–11 Global hepatic parenchymal assessment to detect the presence of occult cirrhosis and portal hypertension can also be performed.13–16 In terms of patient preference, the average time for MRC completion is 15 to 20 minutes17 and is well tolerated compared to ERCP.18
In PSC, the presence of widespread annular strictures with proximal bile duct dilatation are characteristic cholangiographic findings on MRC and ERCP.9–16 In a retrospective review of 22 patients with PSC referred for MRC examination,15 the presence of abnormal bile duct findings were observed for all examination. Typical cholangiographic features of PSC, including intrahepatic bile duct dilatation (77%), stenosis (64%), and beading (36%), were observed. Revelon et al.16 observed that bile duct dilatation correlated with histological changes of inflammation in 29 of 40 (72%) patients. More recently, a prospective case-control study comparing MRC results between 34 patients with PSC and 68 age-matched controls with other hepatobiliary disease was reported.11 For the detection of PSC by MRC, the sensitivity and specificity ranged from 85% to 88% and 83% to 97%, respectively. Similar results were observed among patients with PSC in our previous study.10
Several published investigations using decision analysis techniques have examined the roles of MRC and ERCP for evaluating biliary tract disease. In a study comparing endoscopic ultrasound (EUS) or MRC versus ERCP for suspected biliary obstruction,19 the proportion of patients correctly identified with a normal biliary tree was 95% for EUS and 65% for MRCP (P < .02). The cost per patient for obtaining a correct diagnosis with EUS was $34.00 less than for MRCP. A relationship between poor MRC test performance and low disease (biliary tract abnormality) prevalence was also observed. Although described as a cost-utility analysis, data on health state preference for using accepted techniques was not reported. In a separate investigation comparing MRC and ERCP among patients with suspected biliary disease, the results obtained from MRC were said to avert less than 3% of all ERCP examinations performed at one institution.20 The investigation, however, did not clearly report that strict blinding of radiologists to ERCP results was performed while interpreting MRC images. From a detailed cost-effectiveness analysis in patients with acute biliary pancreatitis,21 a strategy of EUS followed by ERCP was the most cost-effective alternative when prevalence rates for choledocholithiasis were between 7% and 45%. Initial ERCP was the preferred approach when the risk for choledocholithiasis was greater than 45%. Despite the use of cost-effectiveness analysis, data on health state preference or utility were not reported.
In the present investigation, the technique of cost-minimization analysis for comparing initial test strategies of MRC and ERCP for the diagnosis of PSC was used. Advantages of this design include (1) the systematic incorporation of diagnostic test parameters in calculating the probability of a true positive outcome, and (2) accounting for the effect of unfavorable outcomes associated with further testing because of false-negative results.12 Cost-minimization analysis also determines whether differences in resource utilization between MRC and ERCP exist based on the premise that similar test characteristics are observed for both diagnostic modalities. In contrast, a cost-effectiveness analysis describes the differences in cost relative to gains in quality-adjusted life years between 2 or more competing strategies.22 Individual health state values or preferences, which are used to measure quality-adjusted life years, are not widely available for patients with PSC or those undergoing diagnostic testing.
Defining the level of clinical suspicion for PSC or biliary obstruction in patients with cholestatic liver test abnormalities involves a multifactorial approach. For example, the presence of symptoms (jaundice, pruritus), serum hyperbilirubinemia, and history of inflammatory bowel disease would likely influence the decision to pursue ERCP after negative MRC examination given the high likelihood of PSC. When a low degree of suspicion for biliary tract disease is present (as with the finding of asymptomatic cholestatic hepatitis with normal total bilirubin), liver biopsy rather than diagnostic ERCP may be more appropriate given a negative MRC exam. In the present analysis, in which 30% of patients had normal biliary tree anatomy, the pursuit of liver biopsy rather than diagnostic ERCP would still designate initial MRC as the cost-minimizing strategy.
Additional questions were raised by this analysis. The underdistension of bile ducts when examined by MRC may account for false-negative results in the presence of a biliary stricture.10, 11, 17 This is especially relevant in PSC given the 10% to 15% risk for developing cholangiocarcinoma as a complication of disease.32 Technical failure to cannulate the bile duct was not specifically examined given the rarity of this event in our original study. When considered, an increase in complication rates and perhaps cost from the use of percutaneous transhepatic cholangiography based on negative MRC results may be observed. The accuracy of MRC for cholangiocarcinoma in PSC also remains unknown. In addition, the diagnostic test performance characteristics of MRC in patients with early-stage PSC have not been clearly defined.17 For cost analyses, the use of reimbursement fee schedules may have biased results in favor of MRC because facility and supply costs may be discounted over several clinical areas. The use of metrics such as resource utilization rather than cost should be considered in future studies based on differences in payer mix seen in managed care organizations compared to referral centers.
Further investigations have attempted to estimate the potential impact of MRC as a diagnostic modality. It has been proposed that if MRC is available with accurate test performance features, up to 40% of patients with clinically suspected biliary tract disease could avoid diagnostic ERCP and less than 10% would require both MRC and ERCP.23, 24 These findings may have significant implications in clinical practice settings in which the prevalence of PSC is lower than what is observed in referral-based centers. In addition, MRC could be very useful for determining the presence of PSC in patients with serum cholestatic liver test abnormalities and inflammatory bowel disease. This cost-minimization analysis demonstrates that a test strategy of initial MRC compared to ERCP in the evaluation of patients with clinically suspected PSC has comparable diagnostic accuracy and cost savings.
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- 3Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology 1976; 70: 314–320., , , .
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- 6Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology 1996; 110: 589–597., , , , , .
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- 8Value of MR cholangiography in the diagnosis of the biliary tree: a study of 58 cases. Am J Gastroenterol 1998; 93: 2482–2490., , , , , , et al.Direct Link:
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- 11Primary sclerosing cholangitis: evaluation with MR cholangiography—a case-control study. Radiology 2000; 215: 71–80., , , , , , et al.
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- 13Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography. Radiographics 2000; 20: 959–975., , , , , , et al.
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- 18Patient satisfaction after MRCP and ERCP. Am J Gastroenterol 2001; 96: 2646–2650., , , , , , et al.Direct Link:
- 19Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol 2001; 96: 2900–2904., , , , , , et al.Direct Link:
- 20The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease. Am J Gastroenterol 2001; 96: 2074–2080., , , , , , et al.Direct Link:
- 21Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model. Am J Gastroenterol 2001; 96: 2892–2899., , .Direct Link:
- 22Methods for the Economic Evaluation of Health Care Programmes. 2nd ed. Oxford: Oxford University Press, 1997., , , .
- 23The potential impact of high-quality MRI of the biliary tree on ERCP workload. Eur J Gastroenterol Hepatol 2000; 12: 773–776., , .
- 24Potential impact of magnetic resonance cholangiopancreatography on endoscopic retrograde cholangiopancreatography workload and complication rate in patients referred because of abdominal pain. Endoscopy 2001; 33: 668–675., , , , , .


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GGI International French Press Coffee Maker
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The warm weather has finally decided to stick around here in NWI and now we are replenishing the boys' wardrobes with attire appropriate for the season. One of the styles that we are admiring are plaids and polos. The prep look is classic as it continues to trend, year after year.
Jaxon received a sampling of Rugged Bear, a children's apparel line known for their classic, New England style. Rugged Bear offers a line of playwear, footwear, cold weather accessories, pj's, undies and hosiery in newborn-toddler sizes. You can expect traditional everyday pieces from Rugged Bear that are durable yet comfy enough to withstand children's activities.
Jaxon received a 3-piece set; a soft cotton tee, polo, and matching plaid shorts. It's such an adorable set, but even more, it's rugged. The quality of these little garments are superb. They've already been through a few washes and they are good as new. They've definitely exceeded my expectations. I can see these being great hand-me-downs to at least two more (future) Tatumlets.
The tee and a gummy grin.
The shorts and a leg chunk.
Rugged Bear is available at Amazon.com, Boscov's, Denny's Childrenswear, as well as Lord & Taylor. Periodically, you may find them on Gilt, Hautelook, Beyond the Rack, Zulily and Totsy as well.
Oh, these shoes. I couldn't resist recommending them with this outfit. Cuteness all up and through.
adidas Originals Kids Superstar
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"Instead of indulging in empty talk, I consider it more meaningful and enlightening to express myself in definite actions." Confucius The killing of America's most wanted criminal, Osama bin La…30 comments
The I Ching is one of man's earliest attempts to see himself as part of the cosmos and therefore subject to universal law. The book has been used as an oracle in China for more than 3,000 years, and …add a comment
I love the suggestion of putting foil around the base of the tree, especially for a live tree!
So good to learn these facts at exactly the right time!
Thanks Shubhra for sharing the wonderful info.
All very good advice! Anyone with pets would do well to follow these suggestions.


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Goldman Sachs to sack 10 per cent of workforce
Another sign less funding will be flowing through Silicon Valley: Goldman Sachs getting ready for some serious belt-tightening. The financial firm today said it plans to cut 10 per cent of its 32,569 employees worldwide. That should mean layoffs for about 3,260 workers. Goldman Sachs is widely considered to have navigated the …
The irnoy is
10% is perhaps the maximum gearing a bank should ever be allowed to use, and not the 35,000% that has just fallen out of fashion :)
You look at the history of these big financial companies and they were all founded on good business practice, just thrown out the window in the last decade of boom (was it boom for all?) bust (definitely bust for all).
Banks should be encouraging good investment, they should be taking a chunk of a business at real worth, with option to buy back, fully explained. It is quite simple, it just requires integrity and honesty. Which of course was thrown out quite some time back. Bankers should be on a set salary, with clear guidelines as to their internal progression, you don't want hotshots in banks, you want them in business, were you can see if they are really hot or not.
At times I think it would be worth exploring setting a maximum size for business, sure there are economies of scale, but a lot of them are just downright dishonest and more akin to bullying with numbers and threats rather than achieving higher productivity due to specialisation or investment.
Regulation definitely favours the big players, often used to squeeze the middle and small end of business, it rarely affects huge corporations and when it does it generally causes more problems then it solves.
Businesses have got too big, we need devolution in the business world. The focus should not be on survival or destruction of the competition but on the standard of living of a society, sure there should be rewards for those who get good results, but those results should not always be gained at the detriment of others.
It all starts with each person though, and if we all made efforts to support the smaller players, become smaller players, and ignore the big boys it would all work out very well, business and life should be more symbiotic rather than parasitic, and that is something only each individual can work on.
so let me guess
It'll be the wankers that cost them so much money, right?
Thanks for telling me what 10% of 32569 is - not at all sure I could have worked it out for myself. Cheers.
PS And you rounded it for me too! You treat us just *too* much.
Slightly misleading
...as apparently they get rid of the lowest-performing 5% of their staff around this time every year.
Paris because, well, she likes a good sacking.
...you could have punned that headline? "Goldman Sachs 10% of workforce" would have done nicely. Yeah it doesn't adhere to the "accepted" rules of grammar, but when has that stopped you before?
'The financial firm today said it plans to cut 10 per cent of its 32,569 employees worldwide.
That should mean layoffs for about 3,260 workers.'
Thank you for that clarification. Percentages can be tricky, especially the old 10% favourite. Moving that decimal point one place to the left can be a nightmare and El reg have done brilliantly here.*
Well quiiiiite well, it's wrong of course, but close.
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Music in the park, block party in Menlo Park on Wednesday
Original post made on Jun 24, 2009
Read the full story here Web Link posted Wednesday, June 24, 2009, 12:00 AM
Comments (1)
a resident of Menlo Park: Linfield Oaks
on Jun 24, 2009 at 9:19 pm
Tonight's block party was fun. The community stage was well used to showcase Menlo Park's talented children. Hats off to them all!
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Film trailer: Russell Brand in 'Hop'
Thursday 10 February 2011
From the studio that produced
Despicable Me comes
Hop, a computer-animated and live-action family comedy, starring Russell Brand as E.B. (Easter Bunny), an aspiring drummer who doesn't care much about his big holiday role.
Previously the teaser showed off the rabbit's drum-playing. This first trailer, released February 9, shows E.B. being summoned to take up the reigns as the Easter Bunny and deliver colorful eggs and candy. Instead, the rabbit heads to Hollywood seeking fame and fortune.
When in Los Angeles, E.B. is hit by a car. After the driver gets over the shock of a talking bunny, he takes E.B. into his home to recover. But soon he tires of the irrepressible rabbit and tries to dump him, unsuccessfully.
Russell Brand ( Get Him to the Greek) voices the Easter Bunny and James Marsden ( Death at a Funeral) plays his human caretaker.
Directed by Tim Hill ( Alvin & the Chipmunks) and costarring David Hasselhoff, Kaley Cuoco ( Big Bang Theory), Hank Azaria (from the upcoming Smurfs), comedian Chelsea Handler, and Hugh Laurie ( House).
Brand will next be seen in Arthur, the remake of the 1981 Dudley Moore classic about a drunken rich guy.
Helen Mirren costars in the role originally played by John Gielgud and Jennifer Garner plays Liza Minnelli's role as the intended bride.
Marsden will appear later in 2011 in Nailed with Jake Gyllenhaal and in the remake of Sam Peckinpah's classic Straw Dogs, costarring and Alexander Skarsgard.
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Likes # 0
Posted May 15, 2012 at 11:44PM
What's happening at Tesco's??? I have been buying P.C Advisor for donkeys..But now they have stopped stocking it...come on Tesco's lets have it back!!!
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Likes # 0
Posted May 16, 2012 at 5:08AM
Do a yearly subscription to the magazine,simple.
Likes # 0
Posted May 16, 2012 at 9:23AM
There are other shops besides Tesco you know,
Likes # 0
Posted May 16, 2012 at 9:23AM
There are other shops besides Tesco you know,
Likes # 0
Posted May 17, 2012 at 12:54PM
A yearly subscription is good value.
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Stevie TV
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A daily updated summary of the week in TV.
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Stevie Ryan gives her take on pop culture happenings.
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Simple Choices, Harmony Series #3
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|Format: Paperback
Number of Pages: 352
Vendor: Barbour Books
Publication Date: 2014
Dimensions: 7.50 X 4.13 (inches)
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Publisher's Description
Set your GPS for the small town of Harmony, Kansas, where a city girl becomes embroiled in mystery and romance. Graphic designer Gracie Temple is engaged to Sam Goodrich. As she returns from chaperoning her protégée, Hannah Mueller, during summer art classes in the city, Gracie is eager to finish her wedding plans and marry the man of her dreams. But unexpected events threaten to disrupt the peaceful lives of those in Harmonyand Gracie's wedding. Hannah goes missing, and Gracie's happy plans become a mess of suspicion and fear. Will Gracie ever find contentment and marital bliss in Harmony?
The Harmony Series:
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I am looking for information of my our grandmother:
Frances Lundschen,I do not know if she was an only child or
Early 1900's she married Allen Caruthers. He died in 1915,
she married Herbert Schroeter and lived in Yorktown for a
while, then moved to Baytown in the early 1940's. She died
in 1947 .She had six daughters, three with Allen and three
with Herbert. My mother-in-law was Ellen Kelly of Robstown.
She was a daughter of Allen.
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