text:
Although Ebola has been all the furor in the recent weeks, fever in travelers is NOT Ebola most of the times. Depending on the region and season, the usual culprits are more likely than Ebola, these include malaria, dengue, yellow fever, chikungunia virus, hepatitis, salmonella and other intestinal bugs, multiple parasites among others. Here is the Q&A for malaria and babesia from this month's NEJM.
What is the annual incidence of malaria in the United States?
In the United States, the annual incidence of malaria is approximately 1500 cases. In 2010, a total of 1691 cases were reported to the Centers for Disease Control and Prevention (CDC), the largest number reported since 1980; P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 58%, 19%, 2%, and 2% of cases, respectively.
How do malaria and babesiosis differ in appearance on a peripheral blood smear?
Intraerythrocytic parasites are seen in both malaria and babesiosis. Plasmodia metabolize heme to form an intracellular crystallized pigment, hemozoin. Although hemozoin is not invariably identified in cases of malaria, its presence reliably distinguishes malaria infection from babesia infection. Malaria parasites can be distinguished from B. [Babesia] microti by the presence of recognizable gametocytes (characteristically banana-shaped in Plasmodium falciparum and round, with a granular appearance, in nonfalciparum species). In addition, intracellular vacuoles and extracellular merozoites are unusual in malaria but common in babesiosis, and the classic "Maltese cross" (a tetrad of parasites budding at right angles) is unique to babesia species.
Which malaria species can remain dormant in the liver?
In the case of P. vivax and P. ovale, some sporozoites (immature malaria parasites) do not replicate immediately when they invade hepatocytes but remain dormant (as hypnozoites) for prolonged periods. The average time to relapse is approximately 9 months, but it can range from weeks to years. The interval to relapse depends on the strain (earlier with tropical strains and later with temperate strains), the initial inoculum, and host factors (e.g., febrile illnesses can trigger relapse associated with P. vivax). None of the commonly used prophylactic agents (chloroquine, mefloquine, doxycycline, or atovaquone–proguanil) eliminate hypnozoites. Primaquine, the only effective drug against dormant hypnozoites, has not been approved by the Food and Drug Administration for primary prophylaxis, but the CDC endorses its use for prophylaxis in Latin American countries where P. vivax predominates, because the drug can prevent both primary attacks and relapses caused by all species that are a source of malarial infection.
How is acute or recurrent P. vivax infection treated?
In patients with acute or recurrent malaria infection, treatment depends on the species and the resistance status in the area where the infection was acquired. P. falciparum is resistant to chloroquine in most regions in which it is endemic and resistant to mefloquine in parts of Southeast Asia. In contrast, nonfalciparum malaria parasites do not have substantial resistance to mefloquine, and the distribution of chloroquine-resistant P. vivax malaria is limited, occurring primarily in Indonesia and Papua New Guinea. After treatment is initiated, peripheral-blood smears should be obtained daily for 4 days (parasitemia is typically eliminated by day 4), on days 7 and 28 to confirm eradication, and at any time symptoms recur, suggesting treatment failure. In areas other than those with known chloroquine resistance, chloroquine, followed by a 14-day course of primaquine to prevent subsequent relapses, remains the standard treatment for P. vivax parasitemia. Given the risk of hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency who receive treatment with primaquine, potential recipients should be tested for G6PD deficiency. Among patients with a contraindication to primaquine therapy, treatment with chloroquine alone carries a 20% risk of relapse; extended chloroquine prophylaxis can be offered to patients who have frequent relapses.
Reviews & Opinions in Emergency Medicine
Thursday, November 6, 2014
Malaria - Quick review
Thursday, October 23, 2014
Community Acquired Pneumonia - Keep it simple, but not too simple.
One of the oldest (and deadliest) diseases in history, pneumonia continues being a threat. Recognizing and treating properly are the best way to minimize complications. Another good review from this week's NEJM.
What are the most common causes of CAP? Although pneumococcus remains the most commonly identified cause of CAP, the frequency with which it is implicated has declined, and it is now detected in only about 10 to 15% of inpatient cases in the United States. Other bacteria that cause CAP include Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Pseudomonas aeruginosa, and other gram-negative bacilli. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for CAP caused by H. influenzae and Mor. catarrhalis. P. aeruginosa and other gram-negative bacilli also cause CAP in persons who have COPD or bronchiectasis, especially in those taking glucocorticoids. There is a wide variation in the reported incidence of CAP caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae (so-called atypical bacterial causes of CAP), depending in part on the diagnostic techniques that are used. During influenza outbreaks, the circulating influenza virus becomes the principal cause of CAP that is serious enough to require hospitalization, with secondary bacterial infection as a major contributor.
What evaluation do the authors recommend to determine the cause of community-acquired pneumonia in a hospitalized patient? In hospitalized patients with CAP, the authors favor obtaining Gram's staining and culture of sputum, blood cultures, testing for legionella and pneumococcal urinary antigens, and multiplex PCR assays for Myc. pneumoniae, Chl. pneumoniae, and respiratory viruses, as well as other testing as indicated in patients with specific risk factors or exposures. A low serum procalcitonin concentration (<0.1 µg per liter) can help to support a decision to withhold or discontinue antibiotics. Results on Gram's staining and culture of sputum are positive in more than 80% of cases of pneumococcal pneumonia when a good-quality specimen (>10 inflammatory cells per epithelial cell) can be obtained before, or within 6 to 12 hours after, the initiation of antibiotics. Blood cultures are positive in about 20 to 25% of inpatients with pneumococcal pneumonia but in fewer cases of pneumonia caused by H. influenzae or P. aeruginosa and only rarely in cases caused by Mor. catarrhalis.
What are the guidelines for treating community-acquired pneumonia in outpatients and inpatients? For outpatients without coexisting illnesses or recent use of antimicrobial agents, IDSA/ATS [Infectious Diseases Society of America and the American Thoracic Society] guidelines recommend the administration of a macrolide (provided that <25% of pneumococci in the community have high-level macrolide resistance) or doxycycline. For outpatients with coexisting illnesses or recent use of antimicrobial agents, the guidelines recommend the use of levofloxacin or moxifloxacin alone or a beta-lactam (e.g., amoxicillin–clavulanate) plus a macrolide. The authors argue, however, that a beta-lactam may be favored as empirical therapy for CAP in outpatients, since most clinicians do not know the level of pneumococcal resistance in their communities, and Str. pneumoniae is more susceptible to penicillins than to macrolides or doxycycline. Even though the prevalence of Str. pneumoniae as a cause of CAP has decreased, they raise concern about treating a patient with a macrolide or doxycycline to which 15 to 30% of strains of Str. pneumoniae are resistant. For patients with CAP who require hospitalization and in whom no cause of infection is immediately apparent, IDSA/ATS guidelines recommend empirical therapy with either a beta-lactam plus a macrolide or a quinolone alone.
What is the appropriate duration of antibiotic therapy for community-acquired pneumonia? Early in the antibiotic era, pneumonia was treated for about 5 days; the standard duration of treatment later evolved to 5 to 7 days. A meta-analysis of studies comparing treatment durations of 7 days or less with durations of 8 days or more showed no differences in outcomes, and prospective studies have shown that 5 days of therapy are as effective as 10 days and 3 days are as effective as 8. Nevertheless, practitioners have gradually increased the duration of treatment for CAP to 10 to 14 days. The authors argue that a responsible approach to balancing antibiotic stewardship with concern about insufficient antibiotic therapy would be to limit treatment to 5 to 7 days, especially in outpatients or in inpatients who have a prompt response to therapy. Pneumonia that is caused by Staph. aureus or gram-negative bacilli tends to be destructive, and concern that small abscesses may be present has led clinicians to use more prolonged therapy, depending on the presence or absence of coexisting illnesses and the response to therapy.
- Strep pneumo still is the most common bug, and is more sensitive to penicillins than macrolides or doxy.
- Uncomplicated, outpatient treatment: Macrolide or Doxy, consider adding a beta-lactam if high risk; alternatively, respiratory quinolone by it self.
- Sputum gram stain and cultures.. maybe, don't expect to get too much from them.
- 5 days of treatment is as good as 10.
Friday, October 10, 2014
Acid-Base disturbances. Physiological Approach
This has been one of those topics that give me a headache. However, having a simple approach is very helpful. This week's NEJM (Oct 9th) has an interesting review. Here are the Q&A on this topic.
What are some uses and limitations of the anion gap?
Lactic acidosis accounts for about half of the high anion gap cases, and is often due to shock or tissue hypoxia. The anion gap however, is a relatively insensitive reflection of lactic acidosis — roughly half the patients with serum lactate levels between 3.0 and 5.0 mmol per liter have an anion gap within the reference range. With a sensitivity and specificity below 80% in identifying elevated lactate levels, the anion gap cannot replace a serum lactate measurement. Nevertheless, lactate levels are not routinely drawn or always rapidly available, and a high anion gap can alert the physician that further evaluation is necessary. In addition, the anion gap should always be adjusted for the albumin concentration, because this weak acid may account for up to 75% of the anion gap. Without correction for hypoalbuminemia, the anion gap can fail to detect the presence of a clinically significant increase in anions (>5 mmol per liter) in more than 50% of cases. For every 1 g per deciliter decrement in serum albumin concentration, the calculated anion gap should be raised by approximately 2.3 to 2.5 mmol per liter.
What are the characteristics of a normal anion-gap (hyperchloremic) acidosis?
Chloride plays a central role in intracellular and extracellular acid–base regulation. A normal anion-gap acidosis will be found when the decrease in bicarbonate ions corresponds with an increase in chloride ions to retain electroneutrality, also called a hyperchloremic metabolic acidosis. This type of acidosis occurs from gastrointestinal loss of bicarbonate (e.g., because of diarrhea or ureteral diversion), from renal loss of bicarbonate that may occur in defective urinary acidification by the renal tubules (renal tubular acidosis), or in early renal failure when acid excretion is impaired. Hospital-acquired hyperchloremic acidosis is usually caused by the infusion of large volumes of normal saline (0.9%). Hyperchloremic acidosis should lead to increased renal excretion of ammonium, and measurement of urinary ammonium can therefore be used to differentiate between renal and extrarenal causes of normal anion-gap acidosis. However, since urinary ammonium is seldom measured, the urinary anion gap and urinary osmolal gap are often used as surrogate measures of excretion of urinary ammonium. The urine anion gap ([Na+] + [K+] – Cl–]) is usually negative in normal anion-gap acidosis, but it will become positive when excretion of urinary ammonium (NH4+) (as ammonium chloride [NH4Cl]) is impaired, as in renal failure, distal renal tubular acidosis, or hypoaldosteronism.
What is a useful approach to the analysis and treatment of a metabolic alkalosis?
The normal kidney is highly efficient at excreting large amounts of bicarbonate, and accordingly, the generation of metabolic alkalosis requires both an increase in alkali and impairment in renal excretion of bicarbonate. Gastric fluid loss and diuretic use account for the majority of metabolic alkalosis cases. By measuring chloride in urine, one can distinguish between chloride-responsive and chloride-resistant metabolic alkalosis. If the kidneys perceive a reduced "effective circulating volume," they avidly reabsorb filtered sodium, bicarbonate, and chloride, largely through activation of the renin–angiotensin–aldosterone system, thus reducing the concentration of urinary chloride. A (spot sample) urinary chloride concentration of less than 25 mmol per liter is reflective of chloride-responsive metabolic alkalosis. Administration of fluids with sodium chloride (usually with potassium chloride) restores effective arterial volume, replenishes potassium ions, or both with correction of metabolic alkalosis. Metabolic alkalosis with a urinary chloride concentration of more than 40 mmol per liter is mainly caused by inappropriate renal excretion of sodium chloride, often reflecting mineralocorticoid excess or severe hypokalemia (potassium concentration <2 mmol per liter). The administration of sodium chloride does not correct this type of metabolic alkalosis, which, for that reason, is called "chloride-resistant." Diuretic-induced metabolic alkalosis is an exception because the concentration of chloride in urine may increase initially, until the diuretic effect wanes, after which the concentration of chloride in the urine will fall below 25 mmol per liter.
How is the "delta anion gap" helpful in the evaluation of mixed metabolic acid–base disorders?
In high anion-gap metabolic acidosis, the magnitude of the anion gap increase (delta AG, or ΔAG) is related to the decrease in the bicarbonate ions (Δ[HCO3–]). To diagnose a high anion-gap acidosis with concomitant metabolic alkalosis or normal anion-gap acidosis, the so-called delta-delta (Δ-Δ) may be used. The delta gap is the comparison between the increase (delta) in the anion gap above the upper reference value (e.g., 12 mmol per liter) and the change (delta) in the concentration of bicarbonate ions from the lower reference value of bicarbonate ions (e.g., 24 mmol per liter). In ketoacidosis, there is a 1:1 correlation between the rise in anion-gap and the fall in concentration of bicarbonate. In lactic acidosis, the decrease in concentration of bicarbonate is 0.6 times the increase in anion gap (e.g., if the anion gap raises 10 mmol per liter, the concentration of bicarbonate should decrease about 6.0 mmol per liter). This difference is probably due to the lower renal clearance of lactate compared with keto-anions. Hydrogen buffering in cells and bone takes time to reach completion. Accordingly, the ratio may be close to 1:1 with "very acute" lactic acidosis (as with seizures or exercise to exhaustion). If the ΔAG – Δ[HCO3–] in ketoacidosis or if 0.6 ΔAG – Δ[HCO3–] in lactic acidosis = 0±5 mmol per liter, simple anion-gap metabolic acidosis is present. A difference greater than 5 mmol per liter suggests a concomitant metabolic alkalosis, and if the difference is less than –5 mmol per liter, a concomitant normal anion-gap metabolic acidosis is diagnosed.
Thursday, September 25, 2014
2014 AMA/ACC guidelines for the NSTE-ACS
This is a super short summary of the guidelines published on-line a couple of days ago. It basically contains what we need to know in the ED to treat these patients. There are dozens of pages on what to do after the patient leaves the department. If you are interested in that, go ahead and download the free PDF and get cozy with it. Here is the link:
You will notice that the guidelines are very similar to prior the prior edition. There are only few changes with regards with anti platelet agent choices, the elimination of CK-MB as diagnostic test, oxygen is only for those with hypoxia and a more liberal approach to coronary imaging and interventions.
OK.. now to the super condensed summary.
OK.. now to the super condensed summary.
Class I
1. ECG within 10 mins or arrival.
2. Repeat ECG q 15-20 mins in patient who remain symptomatic and initial EKG was non-diagnostic.
3. Serial cardiac troponin I or T levels at presentation and 3 to 6 hours after symptom onset
4. Additional troponin levels should be obtained beyond 6 hours after symptom onset in patients with normal troponin levels on serial examination when changes on ECG and/or clinical presentation confer an intermediate or high index of suspicion for ACS
5. Risk scores (like GRACE score) should be used to assess prognosis in patients with NSTE-ACS
Class IIa
1. Risk-stratification models can be useful in management (like TIMI).
2. Get ECG leads V7 to V9 in patients whose initial ECG is nondiagnostic and who are at intermediate/high risk of ACS looking for posterior MI.
Class IIb
1. Continuous monitoring with 12-lead ECG
2. Measurement of B-type natriuretic peptide or N-terminal pro–B-type natriuretic peptide may be considered to assess risk in patients with suspected ACS
Biomarkers: Diagnosis
Class I
1. If the time of symptom onset is ambiguous, the time of presentation should be considered the time of onset for assessing troponin values
Class III: No Benefit
1. If you have troponins in your lab, forget about creatine kinase myocardial isoenzyme (CK-MB) and myoglobin are not useful for diagnosis of ACS
Biomarkers: Prognosis
Class I
1. The presence and magnitude of troponin elevations are useful for short- and long-term prognosis
Discharge from the ED
Class IIa
1. OK to admit at risk patients to chest pain units for repeat ECG's an trops at 3- to 6-hour intervals
2. Patients with normal serial ECGs and cardiac troponins can have a treadmill ECG, stress myocardial perfusion imaging, or stress echocardiography before discharge or within 72 hours after discharge.
3. Reasonable alternatives are coronary computed tomography angiography to assess coronary artery anatomy or rest myocardial perfusion imaging with a technetium-99m radiopharmaceutical to exclude myocardial ischemia.
4. Those who go home, get daily aspirin, short-acting nitroglycerin, and other medication if appropriate (e.g., beta blockers), with instructions about activity level and clinician follow-up.
Early Hospital Care
Class I
1. Supplemental oxygen should be administered to patients with NSTE-ACS with arterial oxygen saturation less than 90%, respiratory distress, or other high-risk features of hypoxemia.
Class I
1. Patients with NSTE-ACS with continuing ischemic pain should receive sublingual nitroglycerin (0.3 mg–0.4 mg) every 5 minutes for up to 3 doses, after which an assessment should be made about the need for intravenous nitroglycerin if not contraindicated
2. Intravenous nitroglycerin is indicated for patients with NSTE-ACS for the treatment of persistent ischemia, heart failure (HF), or hypertension.
Analgesic Therapy
Class IIb
1. If no contrainfications, Morphine for non-controlled ischemic pain is just fine.
Class III:
1. Don't use NSAID's and if they are taking NSAID's for other reasons, stop it.
Beta-Adrenergic Blockers
Class I
1. Oral beta-blocker therapy should be initiated within the first 24 hours in patients who do not have any of the following: 1) signs of HF, 2) evidence of low-output state, 3) increased risk for cardiogenic shock, or 4) other contraindications to beta blockade (e.g., PR interval >0.24 second, second- or third-degree heart block without a cardiac pacemaker, active asthma, or reactive airway disease)
2. In patients with concomitant NSTE-ACS, stabilized HF, and reduced systolic function, it is recommended to continue beta-blocker therapy with 1 of the 3 drugs proven to reduce mortality in patients with HF: sustained-release metoprolol succinate, carvedilol, or bisoprolol.
3. Patients with documented contraindications to beta blockers in the first 24 hours of NSTE-ACS should be reevaluated to determine their subsequent eligibility.
1. It is reasonable to continue beta-blocker therapy in patients with normal left ventricular (LV) function with NSTE-ACS
III: Harm
1. Administration of intravenous beta blockers is potentially harmful in patients with NSTE-ACS who have risk factors for shock (poor EF, tachycardic, know myocardiopathy)
Calcium Channel Blockers
Class I
1. In patients with NSTE-ACS, continuing or frequently recurring ischemia, and a contraindication to beta blockers, a nondihydropyridine calcium channel blocker (CCB) (e.g., verapamil or diltiazem) should be given as initial therapy in the absence of clinically significant LV dysfunction, increased risk for cardiogenic shock, PR interval greater than 0.24 second, or second- or third- degree atrioventricular block without a cardiac pacemaker
2. CCBs are recommended for ischemic symptoms when beta blockers are not successful, are contraindicated, or cause unacceptable side effects.
Class III: Harm
1. Immediate-release nifedipine should not be administered to patients with NSTE-ACS in the absence of beta-blocker therapy
Antiplatelet Agents
Class I
1. If non-allergic, give Aspirin to everyone (162 mg to 325 mg) as soon as possible after presentation, and a maintenance dose of aspirin (81 mg/d to 162 mg/d) should be continued indefinitely
2. If Aspirin allergic, give clopidogrel followed by a daily maintenance dose should be administered
Class IIa
1. It is reasonable to use ticagrelor in preference to clopidogrel in patients with NSTE ACS who undergo an early invasive or ischemia-guided strategy.
Class IIb
1. In patients with NSTE-ACS treated with an early invasive strategy and dual anti platelet therap (DAPT) with intermediate/high-risk features (e.g., positive troponin), a glycoprotein (GP) IIb/IIIa inhibitor may be considered as part of initial antiplatelet therapy. Preferred options are eptifibatide or tirofiban.
Class I
1. In patients with NSTE-ACS, anticoagulation, in addition to antiplatelet therapy, is recommended for all patients irrespective of initial treatment strategy. Treatment options include:
- Enoxaparin: 1 mg/kg subcutaneous (SC) every 12 hours (reduce dose to 1 mg/kg SC once daily in patients with creatinine clearance [CrCl] <30 mL/min), continued for the duration of hospitalization or until percutaneous coronary intervention (PCI) is performed. An initial intravenous loading dose is 30 mg
- Bivalirudin: 0.10 mg/kg loading dose followed by 0.25 mg/kg per hour (only in patients managed with an early invasive strategy), continued until diagnostic angiography or PCI, with only provisional use of GP IIb/IIIa inhibitor, provided the patient is also treated with DAPT
- Fondaparinux: 2.5 mg SC daily, continued for the duration of hospitalization or until PCI is performed
- If PCI is performed while the patient is on fondaparinux, an additional anticoagulant with anti-IIa activity (either UFH or bivalirudin) should be administered because of the risk of catheter thrombosis
- UFH IV: initial loading dose of 60 IU/kg (maximum 4,000 IU) with initial infusion of 12 IU/kg per hour (maximum 1,000 IU/h) adjusted per activated partial thromboplastin time to maintain therapeutic anticoagulation according to the specific hospital protocol, continued for 48 hours or until PCI is performed
Class III: Harm
1. In patients with NSTE-ACS (i.e., without ST elevation, true posterior MI, or left bundle-branch block not known to be old), intravenous fibrinolytic therapy should not be used.
Ischemia-Guided Strategy Versus Early Invasive Strategies
Early Invasive and Ischemia-Guided Strategies
Class I
1. An urgent/immediate invasive strategy (diagnostic angiography with intent to perform revascularization if appropriate based on coronary anatomy) is indicated in patients (men and women) with NSTE-ACS who have refractory angina or hemodynamic or electrical instability (without serious comorbidities or contraindications to such procedures).
2. An early invasive strategy (diagnostic angiography with intent to perform revascularization if appropriate based on coronary anatomy) is indicated in initially stabilized patients with NSTE- ACS (without serious comorbidities or contraindications to such procedures) who have an elevated risk for clinical events
Class IIa
1. It is reasonable to choose an early invasive strategy (within 24 hours of admission) over a delayed invasive strategy (within 24 to 72 hours) for initially stabilized high-risk patients with NSTE-ACS. For those not at high/intermediate risk, a delayed invasive approach is reasonable
1. In initially stabilized patients, an ischemia-guided strategy may be considered for patients with NSTE ACS (without serious comorbidities or contraindications to this approach) who have an elevated risk for clinical events
2. The decision to implement an ischemia-guided strategy in initially stabilized patients (without serious comorbidities or contraindications to this approach) may be reasonable after considering clinician and patient preference.
III: No Benefit
1. An early invasive strategy (i.e., diagnostic angiography with intent to perform revascularization) is not recommended in patients with:
- Extensive comorbidities (e.g., hepatic, renal, pulmonary failure, cancer), in whom the risks of revascularization and comorbid conditions are likely to outweigh the benefits of revascularization.
Thursday, July 31, 2014
Scorpion Envenomation. Not so bad, but when it bad... is BAD!
Still is summer time and in some parts of the world, scorpions are a threat. There are dozens of varieties to chose from. Here are some basics about the patophysiology of Scorpion Envenomation. From this week's NEJM.
What are the general characteristics of scorpion stings?
Most scorpion stings cause localized pain, whereas only an estimated 10% of stings, even from the most dangerous scorpions, result in severe systemic envenomation. Edema, erythema, paresthesias, muscle fasciculations, and numbness may occur at the site of the sting. It is often difficult to see the sting site or to identify inflammation at the site, despite substantial local pain. Most cases of severe envenomation occur in children. Systemic envenomation is characterized by neuromuscular abnormalities resulting from effects on the somatic and cranial nerves, both cholinergic and adrenergic excitation of the autonomic nervous system, pulmonary edema, and cardiac effects.
What are the autonomic effects of scorpion stings?
Excitation of the autonomic nervous system is characterized by both parasympathetic and sympathetic responses. Parasympathetic, cholinergic effects may include hypersalivation, profuse diaphoresis, lacrimation, miosis, diarrhea, vomiting, bradycardia, hypotension, increased respiratory secretions, and priapism. Sympathetic, adrenergic effects include tachycardia, hypertension, mydriasis, hyperthermia, hyperglycemia, agitation, and restlessness. Whereas most parasympathetic effects tend to occur early, sympathetic effects persist because of the release of catecholamines and are responsible for severe envenomation.
What are possible cardiovascular complications of scorpion envenomation? A range of cardiac conduction abnormalities occur in about one third to one half of patients with systemic envenomation. These effects include atrial tachycardia, ventricular extrasystoles, T-wave inversion, ST-T wave changes, and, less frequently, bundle-branch block. Increased autonomic stimulation caused by increased vagal effects on the heart and sympathetic stimulation are the probable causes of these effects. Hypertension is common and occurs early in response to sympathetic stimulation. Hypotension is less common, occurs with the development of severe envenomation, and often requires intervention with vasopressors and fluid resuscitation. Many factors are at play in the development of hypotension, with cholinergic stimulation causing vasodilation, fluid loss, and myocardial depression. Cardiac dysfunction resulting from catecholamine-induced myocarditis and myocardial ischemia complicates severe envenomation from androctonus, buthus, mesobuthus, and tityus scorpions. This complication may result in pulmonary edema and cardiogenic shock.
What are the principles of treatment for cases of severe scorpion envenomation? The specific treatment is the administration of antivenom combined with symptomatic and supportive treatment, including prazosin and dobutamine in patients with cardiovascular toxic effects and benzodiazepines when there is neuromuscular involvement. Symptoms related to the site of the sting should be managed with appropriate analgesia with acetaminophen and antiinflammatory agents, depending on severity. Once severe envenomation has developed, the administration of antivenom may be less effective, since its primary therapeutic action is to bind toxins; it does not reverse established pathophysiological injury, such as excess levels of catecholamine, pulmonary edema, and cardiogenic shock.
- Scorpion envenomation are rarely fatal, but children are at high risk.
- For most, supportive treatment is fine if no signs of nervous or cardiac system involvement.
- If is going to be bad, it goes from bad to worse very quickly. Therefore, if antivenom is available, give it early and transfer sooner rather than later.
- Prazosin, an alfa blocker, and dobutamine in combination for patients with cardiovascular symptoms. And benzos for neuromuscular involvement.
- Not all scorpions are scary, some can also be cute... like this one!
Subscribe to: Posts (Atom)


text:
76222 - Church Lodge
House | 3 bedrooms | sleeps 5
|Key Info
For those that want a quiet retreat this lodge style cottage is the perfect place. With surprisingly spacious accommodation a family of 5 would spend a comfortable holiday away in the Kent Countryside, not far from the stunningly rugged South Coast and it's beautiful towns of Rye, Hythe and Winchelsea.
|Sleeps up to 5, 3 bedrooms
|Family friendly
|Great for children of all ages, Suitable for people with restricted mobility
|No pets allowed, No smoking at this property
Features and Facilities
|Wi-Fi available
|3 bedrooms, 1 bathrooms of which 1 Family bathrooms
|Further details indoors
Church Lodge, sleeps 5 in 1 double, 1 single and 1 bunk bed. 1 open plan reception room. 1 shower room.
Ground floor:
Open plan lounge with DVD/ dinning area / kitchen with bench style seating for 5.Kitchen has basic appliances but no dishwasher, washing machine or dryer. Gas oven and hobs.1 x master (sleeping 2) in 1 double bed1 x single (sleeping 1) in single bed1 x Bunk room (sleeping 2) in 2 cross-over bunk bedsThere is a small shower room with shower cubicle.Heating throughout
Outside decking area with patio furniture, BBQ and large gardenOff-road parking immediately to the rear with further outbuildings creating a courtyard effect.
|Further details
3 (+ 2 children at a supplement)
The South East England region
The lodge is located in a rural location between Appledore and Brenzett in Romney Marsh. Ashford with it's International Rail Station with connections to London, France and Belguim is within about 30 minutes drive. The coast at Littlestone is about 6 miles away.
A fantastic day out with the kids and animal lovers alike can be found at Port Lympne, Wild Animal Experience. Feel like an explorer as you jump aboard the Safari Jeep from basecamp to one of the four on-foot zones. In these zones you'll discover conservation first hand with exhibits and interactive educational displays as well as three play areas and two restaurants. Set in 600 acres of beautiful Kent countryside and housing over 650 rare and endangered animals, Port Lympne is certainly not to be missed.Not far from this English holiday cottage in Kent, lies the town of Hythe which offers a good range of shops, restaurants, lovely walks along the seafront and canal, a golf course, swimming pool and tennis courts for you to make the most of during your stay in St Mary's Bay, Kent. Fresh fish can be bought direct from fisherman on the beach, ideal for those who do not wish to cook in this self-catering holiday cottage in Kent. Near to this Kent holiday cottage is the Kent village of Sandgate with its restaurants, antique shops and pubs.
Further afield from this luxury Kent holiday cottage you can experience more of Kent by visiting Dover, Rye and Canterbury; all of which are a short distance away. Dover, in Kent, has a magnificent castle perched on the top of the cliffs, Rye, in Sussex, has a wonderful mix of antique shops, tea rooms and smugglers haunts and of course the world heritage site of Canterbury with it's stunning cathedral!
And of course don't forget your passport for you can take a day or two away from this self-catering holiday cottage in Kent and go to see France. The Channel Tunnel is only 20 minutes away from this Kent holiday cottage and a crossing to France only takes 35 minutes!
Availability Your dates are available
Guest reviewsPowered by TripAdvisor
Guest reviews no reviews
Guest reviews Powered by TripAdvisor
Help other travellers decide where to stay
This holiday home hasn't got any reviews yet. The average rating on Holiday Lettings is four out of five. This place could be newly added or perhaps it's a well kept secret. Either way, it's time to reveal all.
This advert is created and maintained by the advertiser; we can only publish adverts in good faith as we don't own, manage or inspect any of the properties. We advise you to familiarise yourself with our terms of use.
You're booking with
Mulberry Cottages (Property Manager Mulberry Cottages)
Calendar last updated:16 Nov 2014
Based in United Kingdom
- English
- French
- Spanish
- German
Payment accepted
Paypal accepted
Credit cards accepted
- Landline
- +44(0)1227464958
- Fax
- +44(0)1227464958
Also consider
- Rye
- 271 properties
- Hastings, Sussex
- 218 properties
- Canterbury
- 184 properties
- Ashford, Kent
- 77 properties
- Maidstone
- 66 properties
- Folkestone
- 53 properties
- Sedlescombe
- 46 properties
- New Romney
- 34 properties
- Tenterden
- 29 properties
- Cranbrook
- 26 properties
- Romney Marsh
- 18 properties
- Robertsbridge
- 13 properties
- Winchelsea
- 12 properties
- Staplehurst
- 11 properties
- Biddenden
- 11 properties
- Bexhill-on-Sea
- 11 properties
- Burwash
- 7 properties
- Hawkhurst
- 7 properties
- Hythe, Kent
- 7 properties
- Bodiam
- 6 properties

subset: commoncrawl


text: Chargers Jahleel Addae Seyi Ajirotutu Keenan Allen Jerry Attaochu Donald Brown Ronnie Brown Donald Butler Ryan Carrethers Kellen Clemens Kavell Conner Chris Davis King Dunlap Brandon Flowers Malcom Floyd D.J. Fluker Dwight Freeney Andrew Gachkar Antonio Gates Marcus Gilchrist Ladarius Green Melvin Ingram Dontrelle Inman David Johnson Jarret Johnson Cordarro Law Sean Lissemore Corey Liuget Ricardo Mathews Ryan Mathews Ryan Miller Nick Novak Branden Oliver Tenny Palepoi Adrian Phillips John Phillips Kendall Reyes Chad Rinehart Philip Rivers Trevor Robinson Eddie Royal Mike Scifres Willie Smith Damion Square Darrell Stuckey Manti Te'o Johnnie Troutman Reggie Walker Chris Watt Eric Weddle Steve Williams Tourek Williams Mike Windt Shareece Wright Close Tweet0 Share0 Share0 Share0 Stumble It0 Print0 More NFL CHARGERS #5 Mike Scifres P Dashboard Career stats Game log born OCT. 8 1980 Drafted '03 Years Experience 12 Age 34 Height 6'2" Weight 215 Filter by Season: Season 2013 Season 2014 Season 2013 Season 2014 Season Punts Average Long Inside 20 Loading... NFL AFC AFC West Chargers pt league name Mike Scifres Season leader League Leader More Mike Scifres NFL San Diego Chargers strong safety Marcus Gilchrist celebrates his interception against the St. Louis Rams during the second half of an NFL football game Sunday, Nov. 23, 2014, in San Diego. (AP Photo/Denis Poroy) Rams reeling from rally-killing interception 0 0 0 0 0 0 0 More NFL Special teams roundtable: Discussing the future of kickoffs, PATs, more 0 0 0 0 0 0 0 More NFL San Diego Chargers depth chart: Jason Verrett backup cornerback by SI Wire 0 0 0 0 0 0 0 More Load More 01 02 03 04 05 06 07 08 09 Next Page


text:
Leonardo Hotel is basic and comfortable, with star rating 2. Less than 20 rooms are offered here. The hotel provides an excellent position from which to walk to some attractions including Fondaco dei Turchi and Scalzi Bridge. Santa Lucia Station offers fine public transport connections. Accessible within a short radius from this location, Goldoni Theatre and Rossini Theatre can be reached on foot. Visiting Venice, you shouldn't miss Church of San Geremia.
There are extra common areas in Leonardo Hotel; for example, a library. Being separated from your pet on holiday does not have to be the case; at this hotel you're allowed to bring it. Expect all you need for your Venice visit in one of the 16 rooms that are on offer here.
There is air conditioning in Leonardo Hotel. A magnifying mirror is one of the many facilities you can find in the bathroom of the rooms here.
Show reviews
|From 14:00 Check-out: Until 10:30
|Pet policy:
|Pets allowed
|General facilities:
|Extra common areas:
|Note: It is the responsibility of the hotel chain and/or the individual property to ensure the accuracy of the photos displayed. We are not responsible for any inaccuracies in the photos.
Please provide this reference number to our customer service center representative on request, so we can help you better


text:
Select () or exclude () categories to narrow your recipe search.
As you select categories, the number of matching recipes will update.
Find exactly what you're looking for with the web's most powerful recipe filtering tool.
1/1 Photo of Basic Shortbread
Prep Time:
Cook Time:
10 mins
15 mins
This buttery cookie gets better with age: It can be stored up to a month, and over that time its flavor deepens. Dip the tips of the cookies in melted chocolate for a decorative touch.
Units: US | Metric
Serving Size: 1 (860 g)
Servings Per Recipe: 1
Every recipe, menu, tip and how-to is right here, at your service.


text:
doesn't she look some sort of sexy, i would like to raise her spurs
by tuffpuff February 03, 2010
10 Words Trending Now
Alphabetical List
Type your email address below to get our free Urban Word of the Day every morning!
Emails are sent from email@example.com. We'll never spam you.×


text:
River's Rustic Modern Nursery
Modern Girl's Nursery - the #chevron drapes make such an impact!
Related Pins
Project Nursery Modern Superhero Nursery -- I LOVE THIS SO MUCH.
Modern Nursery with Gray Drum Pendant from @Joni Wells Lay / Lay Baby Lay
Love the dark gray walls with pops of bright green! #nursery #nurserydecor #chevron
Walk in the Park-themed Nursery - we love the pop of Bahama Blue from the Devon crib from @Stacey McKenzie Craven Cottages! #nursery
Perfect artwork {from @Lucy Kemp Darling} for a nursery gallery wall - plus, we LOVE the color scheme! #gallerywall #nursery #walldecor
I want to make that solid colored pinwheel quilt. Fabulous. Red Soles and Red Wine - Chicago Fashion Style Blog: Baby Grant's Nursery
Love the gray and coral color combo in this #nursery!
No Sew! Cloth Napkin Cafe Curtains...just clip and your done! Cafe Curtains go along the BOTTOM of your Windows... so use those napkins you never use ( btw ... they are already hemmed and read to go ) , add a rod to the appropriate height, add clipped " CURTAINS " ... and you have a FRESH NEW Look .


text:
November 29, 2014
NEW YORK (AP) - A person familiar with Facebook says CEO Mark Zuckerberg is forming a political group to address issues such as education reform, immigration and scientific research.
The person says the group will formally launch in the coming weeks. The person spoke on condition of anonymity because the information is not public. The San Francisco Chronicle, Politico and others reported on it earlier.
Zuckerberg, 28, has already used his Facebook wealth to address political issues close to him. He donated $100 million of Facebook stock to Newark, N.J., schools. He also has announced plans to donate nearly $500 million in stock to a Silicon Valley charity to fund health and education issues.
In February he hosted a campaign event in his Palo Alto, Calif., home for New Jersey Gov. Chris Christie.
Copyright 2014 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or email@example.com.


text:
Below are top resources on SparkPeople for Food Allergies.
It can be as frustrating as it is familiar: the achy tightness in your abdomen after you eat, or the sharp pain, bloating and distension you feel after a large meal--or any meal. With so many foods now composed of a multitude of ingredients, it can b... Read more
While scientists don't completely understand why allergies develop, they do believe that a combination of things create the immune system confusion, from genetic predisposition to environmental factors.
There are two main categories of ris... Read more
Gastroesophageal reflux disease, or GERD, causes painful symptoms like heartburn and acid regurgitation. Although there are many theories on the causes of GERD, experts aren't sure exactly what causes it. There are two main categories of risks th... Read more
Going to the drug store lately can feel a little like a Saturday morning trip to the candy shop, with dozens and dozens of colorful vitamin and mineral supplements to choose from! Can't you just sample a little bit of everything?
If you&rs... Read more
For some people, exercise itself is an uncomfortable activity, with all the sweating, huffing and puffing, and challenge that comes with elevating your heart rate for an extended period of time. But for people with seasonal allergies, the discomforts... Read more
I accidentally added my custom breakfast twice and can't figure out how to delete it. Any help would be greatly appreciated. Thanks!... Read more
What are foods i can get that are low in calories but fill me up? Just started my diet 5 days ago and im sooooo hungry!... Read more
I'm having a lot of trouble with food lately. I want to lose around 8lbs, but I keep binging and feeling super guilty afterward. I can't control myself. Can someone help me? I don't know what to do.... Read more
I made a mistake adding a food to the app. How do I delete this food?
... Read more
Why is it so hard to find matches to the food I enter?
Can I see what the people enter?? How do I know what a serving is?
I've used another food logger and it was way easier...maybe I just need to get used to it?... Read more
Having multiple food allergies is tough for me. Ezekiel breads allow me to eat 'normal' foods that are safe for me, highly nutritious and make me feel like I am not missing out on anything.244... Read more
Recently I found out I have a ton of food allergies, which might have upset me, but it DIDN'T. You know why? I focus on what I CAN HAVE, not on what I can't have. And the can't haves are a long list of favorites, like ice cream and chocolate. When so... Read more
Are you PASSIONATE about chocolate? Do you see it as a food group?! Join other Chocoholics for discussions, recipe-swapping, & help in keeping this important food group alive!... Read more
New statistics released this week from the CDC show an 18% increase in the number of children with food allergies over the past 10 years. In 1997, 1 in 30 kids had food allergies, and now that number is closer to 1 in 26 (about 3 million kids). Pea... Read more
In some individuals, foods, medications, latex or insect stings cause an immune response. More than 170 food or food additives have been found to cause allergic reactions. However, over ninety percent of those responses come from eight common food ty... Read more
I have had weight issues for several years. When I moved back home from Minnesota, I was depressed and lost weight from not eating nutritiously. While I was single and coping, I slowly got healthier and began running to relieve anxiety and stress. Th... Read more
Just a short blog today that's actually a call for advice. The past two days I've been dealing with what seems to be an allergic reaction. I've got a mild, hive-like rash around my stomach and sides that's splotchy and tender to the touch, feels almo... Read more


text:
Miu Miu
Tortoiseshell Oversized Circular Sunglasses
Product Code: 369721
- Need to know
- Item details & Care
- Shipping & Returns
- The retro shape and Miu Miu styling are an irresistible combination.
- Dark brown subtle tortoiseshell oversized circular plastic frame sunglasses with graduated pink lenses. Sunglasses also have silver branding on the arms.
view full delivery details
Free Delivery (2-3 working days)
All duties and customs are included at checkout
Returns ( view full returns details )


text:
Asian Chicken Noodle Soup
- 4 tablespoons soy sauce
- 2 tablespoons mirin
- 1 teaspoon dark sesame oil, plus 1 teaspoon
- 1 clove garlic, minced
- 2 tablespoons minced fresh ginger
- 1 tablespoon sugar
- 4 tablespoons rice vinegar
- 1/2 teaspoon Vietnamese chile paste
- 8 cups chicken broth
- 12 ounces boneless, skinless chicken breast, cut crosswise into thin strips
- 4 cups chopped Chinese vegetables or Napa cabbage
- 1 (5-ounce) package rice noodles, prepared according to packing directions
- 1/2 cup chopped fresh cilantro leaves
- 6 scallions, thinly sliced on the bias
Mix soy sauce, mirin, 1 teaspoon of the sesame oil, garlic, ginger, sugar, vinegar, and chile paste in a small bowl.
Heat the broth in a medium saucepan. Add the soy sauce mixture, the chicken, and the vegetables and bring to a boil. Simmer for two minutes or until chicken is cooked through. Add the remaining 1 teaspoon sesame oil. Taste and adjust seasonings.
Pour over prepared Chinese noodles. Garnish with cilantro and scallions.
Recipe courtesy Kathleen Daelemans
Thanks, your post has been submitted for review
Login or signup
{"bucket":"echo-prod-seo.sniaws.com","s3path":"food/food/recipe/3cde3757-25fc-4cb3-ae65-9262a9ec4091/reverseChronological_2.html","readyDivClass":"sni_render_complete","errorQueue":"https://sqs.us-east-1.amazonaws.com/314495532666/Brombone_seo_error_queue","seoNextPageDiv":"SEO_NEXT_PAGE","url":"http://echo-prod-app.sniaws.com/app/reviews.do?botaccess=true&assetid=3cde3757-25fc-4cb3-ae65-9262a9ec4091&assettype=recipe&sname=food&category=food&ipp=30&pgno=2&sort=reverseChronological&pageAfter=1198797084.0220430","seo-render-timeout":"30"}More Reviews
More Recipes and Ideas
Pho Ga (Vietnamese Chicken Noodle Soup)
Recipe courtesy of Emeril Lagasse
Chicken Noodle Soup
Recipe courtesy of Anne Burrell
Chicken Noodle Soup
Recipe courtesy of Alton Brown


text:
Choose your preferred language. We speak English and 41 other languages.
Most often used by people in the United States
All languages
FREE cancellation on most rooms!
Instant confirmation when you reserve
Show me hotels near:
Show me hotels in nearby cities:
|Casa Rural Neres Santa Pau nº 4, Torrecilla de Alcañiz
Score from 88 reviews: WonderfulSet in the small town of Torrecilla de Alcañiz, Casa Rural Neres offers spacious, modern rooms with free Wi-Fi. The Motorland Aragón Circuit is located 20 minutes' drive away. More…
$39 Average price per night
|Meseguer Avenida Maestrazgo, 9, Alcañiz
Score from 179 reviews: Wonderful There are 2 people looking at these apartments.Offering free Wi-Fi, free parking and stylish apartments, Meseguer is located in the centre of Alcañiz. This complex also features a traditional Aragonese restaurant and a food delivery service. More…
$89 Average price per night
|Parador de Alcañiz Castillo Calatravos, s/n, Alcañiz
Score from 170 reviews: Excellent There are 2 people looking at this hotel.Housed in a former castle convent, and set on top of a hill, this magnificent Parador hotel sits above the surrounding landscape and provides guests with fantastic views. More…
$119 Average price per night
|Hotel Villa Monter Camino de los Sifones, s/n, Alcañiz
Score from 65 reviews: ExcellentSet in a 19th-century country house in Alcañiz, Hotel Villa Monter features an outdoor swimming pool. It is surrounded by large gardens and offers views of the surrounding countryside. More…
$94 Average price per night
|Hostal El Trillero Plaza Santo Domingo, 1, Alcañiz
Score from 92 reviews: Good 1 person is looking at this guesthouse.Set in a former convent of Alcañiz, Hostal El Trillero offers à la carte restaurant, and rooms with views. Free Wi-Fi is provided, and a free motorcycle parking is available on-site. More…
$62 Average price per night
|Apartamento Ramon y Cajal Calle Ramon y Cajal, 6, Alcañiz
$200 Average price per night
We've negotiated with thousands of hotels to get the very best deals. We call them Secret Deals and they only last for a limited time.
You can get these deals for free by subscribing to our newsletters. You can even choose your favorite destinations to receive personalized deals.
Get started now by entering your email address. We'll instantly send you a link to our Deal Finder!
Don't worry – your email address is safe with us. We'll never share your private information and you can unsubscribe at any time.


text:
Philip C. passed a background check on 11/13/13.
The check was ordered by Philip through First Advantage. Once you email Philip, you will be able to order a new background check for $7.99. As part of your tutor selection process, we encourage you to run updated background checks. Please also review the safety tips for hiring tutors.


text:
Wheels in Motion
Wheels in Motion: A Wheel-Based Performance Spectacular
Athenaeum Theatre, at W Oakdale Ave (2936 North Southport Avenue Chicago, IL 60657)
Full Price
$15.00 - $40.00
Our Price
$7.50 - $20.00*
Chicago's Athenaeum Theatre presents a spectacular evening of unique performances by an array of international stars of wheel gymnastics and cyr wheel acrobatics. Athletes from Germany, Venezuela, Canada, Mexico, Argentina and members of the United States Wheel Gymnastics Team will introduce you to the dynamic, acrobatic and elegant features of this sport and entertainment art, which features gymnastics performed in a rolling and spiraling wheel. Highlights of the show include performances by former world champions Wolfgang Bientzle and Julia Pohling as well as performances by U.S. Open Gym Wheel Champions Cornell Freeney and Liusina Rosas and U.S. Open Cyr Wheel Champions Shayna Swanson and Eli Cherweznik. You'll also be treated to individual performances by members of the USA Wheel Gymnastics Team and group performances by The Cirques Experience Wheel Jam Show Team and the MENZ Dance Wheel Gymnastics Team from new Trier High School. Wheels in Motion will whet your appetite for the 10th Wheel Gymnastic World Championships, which will take place next summer in Chicago.
* Additional fees apply.
All offers for Wheels in Motion have expired.
The last date listed for Wheels in Motion was Saturday October 13, 2012 / 7:30pm.
Venue Details
Goldstar Member
Free street parking if you can find it or two pay and park lots adjacent to theatreForeverendia info • Dec 15 2012 star this tip starred
Goldstar Member
Casual, definitely informal!Foreverendia info • Dec 15 2012 star this tip starred
More Information
Quotes & Highlights
Check out this YouTube video that describes wheel gymnastics.
See a video of world champion Wolfgang Bientzle in performance on YouTube.
The VIP ticket option includes a pre-show appetizer reception and priority seating for the performance.


text:
Yorkshire MESMAC
Yorkshire MESMAC is part of a group of services. Each of these services has a microsite of its own which can be visited by clicking the links above, or please use the links to the left to navigate around the main website.
If you have any news or upcoming events that you would like to display here, please email us with a short paragraph and we will give it due consideration. We also reserve the right to edit any material submitted.
Yorkshire MESMAC's Board of Trustees has a new Chair
After many years as Chair of Yorkshire MESMAC, Liaqat Ali has stood down.
At last week's Annual General Meeting, Steve Bridge was appointed into the role. Steve has been a civil servant for 31 years and is currently working on Adult Social Care policy in the Department of Health. He has been on the Board of Trustees at MESMAC for over two years and brings a wealth of knowledge about the Health and Care system, procurement and grants processes, along with a passion for the HIV prevention and sexual health promotion agenda.Read more...
Exciting new research prompts Community Statement on PrEP
Yorkshire MESMAC has teamed up with other leading HIV prevention organisations to produce a statement from the community about Pre-Exposure Prophylaxis (PrEP) and how it affects HIV transmission, following research from 2 promising European studies.
The statement calls for PrEP to be made available as soon as possible across England.Read more...
New Vacancy at Yorkshire MESMAC - Operations Manager
Yorkshire MESMAC are delighted that we will be offering a service in Hull from January 2015. We are looking for an Operations Manager who can work alongside our Chief Executive to establish and drive forward this innovative sexual health promotion service working with those populations most of risk of sexual ill health. This is an exciting opportunity, for a leader to shape a brand new service, and to have a positive, lasting impact on the Public Health of Hull.Read more...
National HIV Testing Week 2014
National HIV Testing Week 2014 is about to start from 22nd November to run until 30th November! This is a HIV Prevention England national campaign to encourage people to get tested for HIV and, as proud partners of HPE, Yorkshire MESMAC is determined to make it as easy as possible for you to get tested by offering a range of locations and times all over Leeds, Bradford, Wakefield and York & North Yorkshire!
Click on the National HIV Testing Week logo to find out where and when to get tested.Read more...
Chat Apps and how they are changing the LGBT community
In the past 5 years we've seen an explosion in chat apps designed to help us find love, sex and everything else from the comfort of our smart phones. However, have we considered how this is changing the LBGT community? Furthermore, have we considered whether this is a good or a bad thing?
One of our e-outreach volunteers gives us his view.Read more...
Yorkshire Bears launch 2015 calendar in support of Yorkshire MESMAC
Renowned photographer Robert Workman has teamed up with social group The Yorkshire Bears to produce a 2015 charity calendar in aid of Prostate Cancer UK and Yorkshire-based sexual health organisation Yorkshire MESMAC.Read more...
Testing Times through the eyes of a Volunteer
Yorkshire Bears' Rob Wilson writes about his experiences volunteering with Yorkshire MESMAC, and what it's like to help out the Leeds Testing Times project.Read more...
Leeds Sauna Testing Sessions! - NOVEMBER UPDATE
If you are a sauna user, you can access free, fast and confidential HIV testing in either the Basement Sauna and Steam Complex Sauna.
In the Steam Complex, there is a full sexual health testing service every Tuesday between 12 noon and 2.30pm and special testing events at weekends. Thanks to the Steam Complex Sauna & Leeds Centre for Sexual Health, we now have our very own men who have sex with men targeted full HIV/STI testing clinic at 8 Eyres Avenue, Armley, LS12 3BA. We will be updating special testing events on our calendar, please click here for the next ones.
Friday 21st Nov: 12:00 - 15:00 (last client access 14:30)
Wednesday 26th Nov: 15:00 - 18:00
Thursday 27th Nov: 15:00 - 19:00
Friday 28th Nov: 15:00 - 19:00
Saturday 29th Nov: 15:00 - 19:00
PROUD study shows impact of PrEP in reducing HIV transmission for men who have sex with men
PROUD have released a study that shows that pre-exposure prophylaxis (PrEP) is highly effective in reducing the risk of transmission of HIV among gay men and men who have sex with men
This is exciting news in the breakthrough of PrEP as a means of protection against HIV.Read more...
Planning Progress for National HIV Testing Week in North Yorkshire


text:
Save up to 80% off list price.
Why pay campus bookstore
prices? Shop our huge
selection of new, used and
International edition textbooks.
Save up to 90% versus buying
new. We've got thousands of
textbooks in stock and ready
to rent. Fast, easy & cheap.
Plus get FREE returns when
school's out!
Enter your e-mail address
your shopping cart
order status
wish list
book fetch
order history
log in
our money-back guarantee
getting started
create an account
shipping FAQs
Cover may not depict edition offered for sale
Qu Lei Lei
About this title: Practised and admired for over 1000 years, 'The Simple Art of Chinese Brush Painting' is conceived and created by Chinese brush artist Qu Lei Lei. Readers learn with confidence how to master the brush, use coloured inks and create the well-loved motifs of birds, flowers and fruit.
Note: This is a general synopsis. Each listing is described below.
Your search: Home » Books » The Simple Art of Chinese Brush Painting: A Step-by-step Guide to is Painting Projects of Flowers and Birds
(0 available copies)
Can't find it?
Let Book Fetch track it down for you. |
View search tips.
Find only books eligible for free shipping.
Group ISBNs below for a best-price bundle
Can't find it?
Let Book Fetch track it down for you. |
View search tips.
Elise Grilli
see all
from $50.00!
see all
from $1.75!
Quick Help
Shipping Rates
Returns and Refunds
Secure Shopping
Contact Us
All Help Topics
About Us
The Alibris Story
Social Responsibility
Why Shop at Alibris?
Join our Affiliates
Your Account
Log In/Create Account
Order Status
Return Rental Book
Track Your Order
Rare and Collectible Books
Books with Free Shipping
New Book Releases and Authors
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited, Baker & Taylor, Inc., or by their respective licensors, or by the publishers, or by their respective licensors. For personal use only. All rights reserved. All rights in images of books or other publications are reserved by the original copyright holders.
Please enter a valid email address in the format email@example.com
Get $300 in coupons and other goodies.
Enter your e-mail address
Sign up for newsletter
No, thank you.
You're signed up (and we ♥ you). Watch for our Welcome e-mail and your first coupon. Thanks!


text:
November 28, 2014
NEW YORK (AP) - One of the lawyers chasing the assets of jailed Ponzi king Bernard Madoff remembers a day four years ago when he didn't know who Madoff was.
David Sheehan has spent nearly every day since trying to recover as much as possible of the $17.5 billion in losses calculated since Madoff was arrested on Dec. 11, 2008.
He's the chief counsel for the trustee tasked with recovering the losses. They have secured nearly $9.3 billion so far and hope to collect at least $3 billion more.
If all goes as planned, he says the losses will be cut to around $5 billion of the original amounts thousands of investors put into Madoff's sham investment business.
Sheehan says it's more than they thought possible when they started four years ago.
(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or firstname.lastname@example.com.


text:
Showing results 1 – 16 of 16.
Active Noise Cancelling, Rechargeable Battery, Integrated Mic For Taking Calls
Bluetooth, Dual Subwoofers, Single-cable Setup
Bluetooth, Noise-Cancelling, Make or Take Calls
Bluetooth, Up to 75 Hour Battery Life, Microphone Included
Available in black or white. Withstands year-round weather conditions. Compact size for boats or patio
Noise-cancelling, Steel and Leather Construction, Earth-friendly Materials
Bluetooth, Up To 7 Hours Battery Life, Hands-Free Calling Capable
Built-in Microphone, TriPort® Technology, Carrying Case, Available in White or Black
Built-in Microphone, TriPort® Technology, Matching Carrying Case, Available in White or Black
3 Colors Available, Waterproof, Built-in LED Flashlight
2-Way, 6-1/2" Woofer
Built-in Mic, Tangle Free Cables, Three Sizes of Ear Inserts Included
Lightning Connector, Full-features Alarm Clock, Additional USB Port
Bluetooth, Water/Dust Resistant, Multiple Accessories Included
Bluetooth, Microphone for Calls, Up to 16 Hour Battery Life
Bluetooth, Built-in Light Show, Ultra-Compact


text:
Intimate Moments is the ultimate in voyeur erotica. One or two models, alone with the camera, masturbating to orgasm. No camera operator, no director and no interruptions. She does what she likes, how she likes, and you have the best vantage point. It's fascinating to see how models react to each other, and to compare techniques.
- Sort results by:
- Name
- Age
- Last updated
Sorry, your search returned 0 results.
Try using less specific terms, or starting with a filter from the left (reload the Browse page first).
In the meantime, here are some randomly selected shoots you might like...
Chloe B & Shelly B
Tammy B & Michelle R
SHOOTIntimate Moments
Chloe B, Kiki & Larissa M
Cassie & Keilyn
SHOOTIntimate Moments
Natasha C
SHOOTIntimate Moments
SHOOTIntimate Moments
Karlijn & Renae D
SHOOTIntimate Moments
Alyssa R & Renae D
Sicilia Solo
Looking for some inspiration?
Browse our modelsShow me some random shoots
Try visiting our help section for assistance and tips on searching.


text:
Stop fantasizing about meeting beautiful shemales in Wisconsin and take action. start looking for a good looking shemale close by you for friendship,entertainment or more. Fullfill your passions and meet a shemale at the main shemale dating service on the internet!
Start Searching Searching is 100% safe.
Find out how many shemales live by Wisconsin.
Find out how many shemales live by Wisconsin.


text:
Extreme Skater Answers for iPhone - iPodHome / iPhone - iPod /
Game Questions & Answers (Q&A) service lets you ask questions about video games for game consoles or PC games. So ask your Extreme Skater question for iPhone - iPod and get answers from real gamers or answer questions and share your insights and experience with the rest of the gaming community.
- Developer: Miniclip.com
- Publisher: Miniclip.com
- Genre: Sports General
- Release Date: May 24, 2012
- ESRB: Not Set
Question & Answers
Answer from: Thatguy
Headdive is a trick you have to buy
Answer from: IhateMorobir
After I bought the trick and performed it I still couldn't get the "credit" for some reason. As soon as I jumped off the cliff I would perform the head dive and hold it all the way to the bottom. I kept doing this over and over and it never registered. The last time, I just did the head dive initially and released it and then it registered. Not sure if this will help or not. Good luck.
Unanswered Questions
From: Koonya
Posted on: 07-29-2014
From: Sam
Posted on: 03-17-2014
Posted on: 12-16-2012
From: TobyToby
Posted on: 10-27-2012
Posted on: 10-07-2012
From: Henrydsa
Posted on: 09-25-2012
Extreme Skater - Gameplay Review Trailer
- Sep 29, 2014, Views: 350
- Astro Boy Flight, (iPhone-iPod)
- Trouble With Robots, (iPhone-iPod)
- Oddworld: Stranger's Wrath, (iPhone-iPod)
- Mr.Ninja!! Fever, (iPhone-iPod)
- Bruce Lee: Enter The Game, (iPhone-iPod)
- HEX:99 - Mercilessly Difficult, Daringly Addictive!, (iPhone-iPod)
- Color Ranger, (iPhone-iPod)
- Run SuperDolphin!, (iPhone-iPod)
- Delivery Boy Adventure, (iPhone-iPod)
- Stalled - The Official Movie App, (iPhone-iPod)
- Virtual Families 2: Our Dream House, (iPhone-iPod)
- Angry Birds Transformers, (iPhone-iPod)
- The Secret Society: Hidden Mystery, (iPhone-iPod)
- Kim Kardashian: Hollywood, (iPhone-iPod)
- The Sims: FreePlay, (iPhone-iPod)
- The Simpsons: Tapped Out, (iPhone-iPod)
- WordBrain, (iPhone-iPod)
- Episode: Choose Your Story, (iPhone-iPod)
- My Singing Monsters, (iPhone-iPod)
- Card Wars - Adventure Time, (iPhone-iPod)
- Kim Kardashian: Hollywood - Gameplay, (iPhone-iPod)
- Episode: Choose Your Story - Gameplay, (iPhone-iPod)
- How To Train Your Dragon 2 - Ready To Fly Trailer, (Wii)
- The Settlers - Kingdoms Of Anteria - Announcement Trailer, (PC)
- Entwined - Quick Look Trailer, (PS3)
- Blue Estate - Official Launch Trailer, (PS4)
- Goat Commando 3D Simulator - Gameplay, (iPhone-iPod)
- Munin - Official Launch Trailer, (iPad)


text:
Featured Highlights
Listen to recent interviews, features and highlights from KIRO Radio
Metro GM joins Dori Monson to discuss reports of drivers urinating in seats
A Curley Thanksgiving classic – the story of Aunt Seal
Only in Seattle: Mayor Ed Murray pardons a tofu turkey
In heart of Seattle, historic landmark is a 'blight' on the city
An outraged Rantz interviews the Presidentially pardoned turkey
Congressman Dave Reichert reflects on different policing in Seattle and Ferguson
Police looking for man who redecorated bikes from Seattle bike share
#BlackLivesMatterFriday organizer explains protest
Tom Tangney: Reasoning behind former Amazon worker's hunger strike is baffling
A Seattle woman is writing a 50,000 word novel in 30 days, while the public watches
The Matt Bacnis Band live in studio!
Lifelong delivers healthy Thanksgivings to sick people around King County
Ring My Belle: Seattle's mayor pardons a Tofurkey!
Is there a way to win in a political argument at the Thanksgiving table?
Sounders' Andy Rose: How we advance to MLS Cup finals
Featured Shows
Explore and discover the great shows of KIRO Radio
Custom Channels
Sit back and listen to a continuous stream of topical news and opinion
Food and DiningListen in to the latest on Seattle dining.
MusicSit back and enjoy some talk about music.
TechnologyThe world of gadets and gizmos.
SeahawksSeattle Seahawks news and opinion.
MarinersSeattle Mariners news and opinion.
BoeingBoeing news and opinion.
Read what we're talking about
Stories from the shows of KIRO Radio
Issaquah trying to find owner of mystery totem pole
How to pick the best Christmas tree
Seattle protest disrupts downtown holiday celebrations; five arrests made
Local emergency rooms brace for holiday boom
Seattle protester charged for bringing weapons cache to Ferguson demonstration
Mom and pop's hope shoppers will spend on Small Business Saturday
Quinoa and kale? Seahawk Michael Bennett scoffs at Thanksgiving in Seattle
Cancer-fighting 14-year-old living each day like it's the last with army at his back
Protesters target every Walmart in Washington over low pay
Holiday drivers finding lower prices at pump around Seattle
Sherman, Baldwin mock NFL for 'hypocrisy', Lynch fine
Flooding prompts Mount Rainier evacuation; multiple warnings around region


text:
Get up close and personal with Hawaii's manta rays as you go on a night dive with underwater photographer Wayne Levin. Explore the western waters off of Hawaii's Big Island and swim with Kona's otherworldly manta rays.
Loading more stuff…
Hmm…it looks like things are taking a while to load. Try again?
TM + © 2014 Vimeo, LLC. All rights reserved.
Made with k in NYC.
Your content preferences apply to any Vimeo videos you view. Learn more about content preferences in our FAQ.


text:
Meteorological Monitoring Companies in Serbia
Category: Monitoring & Testing ×
Subcategory: Meteorological Monitoring ×
Location: Europe ×
Location: Serbia ×
Gill Instruments Ltd.
based in Lymington, UNITED KINGDOM
Gill anemometers use ultrasonic technology to accurately sense wind speed and direction. With no moving parts, Gill ultrasonic anemometers are ideal for remote locations subject to extreme environments.
SMHI International Consulting Services
based in Norrköping, SWEDEN
SMHI is a government agency under the Ministry of the Environment. SMHI offers products and services that provide various kinds of enterprises and organisations with an important foundation for decision-making. General forecasts and weather warnings, industry-specific services, simulations and analyses, statistics, climate studies and contracted research are some ...
Stevens Water Monitoring Systems, Inc.
based in Portland, OREGON (USA)
Stevens Water Monitoring Systems, Inc.`s mission is to serve our customers worldwide and be our customers` single source for their water resource equipment needs. Stevens designs, manufactures and supports a broad range of instruments and accessories that provide water level, water quality, ground water, soil moisture, and weather information. These products are easy to ...
Ammonit Measurement GmbH
based in Berlin, GERMANY
Ammonit offers high quality measurement equipment for wind and solar resource assessment, wind and solar power plant monitoring (SCADA) and climate research. As a wind energy pioneer, Ammonit has been playing a leading role in the global wind measurement sector since 1989. Our sophisticated data loggers, accurate meteorological sensors and remote sensing systems as well ...
Logotronic GmbH
based in Vienna, AUSTRIA
Logotronic was founded in 1982 and is thus facing already a longterm experience on the field of environmental measuring technology. Beside our head office in Vienna exists a substantial network of international partner companies. This network of international partner companies enables us to offer our products and services worldwide.
Fairmount Weather Systems
based in Meldreth, UNITED KINGDOM
Fairmount Weather Systems was founded in 1988 and since then we have developed a range of conventional surface instruments and automatic weather stations that have been supplied to many Meteorological Departments over the years including the UK Met Office. We offer supply, installation and training. The majority of equipment offered by Fairmount is manufactured at our ...
Umwelt-Geräte-Technik GmbH
based in Müncheberg, GERMANY
Measuring devices and techniques of highest technical standard are needed for clearing up the complex processes and interactions in the natural spheres of life: soil - water - air. They record and conclusivly interpret process dynamics in the various compartments. This is the field of activities of Umwelt-Geräte-Technik GmbH Müncheberg (UGT). Tensiometers - Moisture ...
LSI-LASTEM srl
based in Settala Premenugo, ITALY
LSI LASTEM is an Italian company which manufacturers electronic instruments for the measurement of environmental parameters: temperature, relative humidity, air speed, pressure, luminance, gas concentration, noise, etc. not only for portable or fixed uses but also for the measurement of indoor or outdoor environments. LSI Lsi with the Lastem trademark also produces ...
Sierra Instruments, Inc.
based in Monterey, CALIFORNIA (USA)
Founded in 1973 by Dr. John G. Olin, venture within Sierra and experience our passion for innovation and precision measurement and control. It was Dr. Olin's dream that Sierra be built on innovation, creative opportunity, entrepreneurial spirit, and team camaraderie. We are proud to continue those traditions today. Discover our culture – a family-owned, open atmosphere ...
Oris Solutions / BEE-Line Software
based in Austin, TEXAS (USA)
Bowman Environmental & BEE-Line Software became Oris Solutions, LLC in 2007.Bowman Environmental was founded in 1982 by J. Thomas Bowman. From there Dr. Bowman developed the Bee-Line Software products by rewriting the EPA mainframe guideline for air dispersion models and several emergency release models for use on microcomputers.BEE-Line Software has been providing ...


text:
Free Shipping On Orders Over $75
Floating Silk Flowers: Elegant Water Decor.
These silk floating flowers are great for those outdoor parties and weddings. They add just the right touch and your guests will be amazed at the beauty and realistic look they have. Have a restaurant? These are great to add to a water feature for adding ambiance and a touch of elegance. We carry many types from lotus flowers, peonies, orchids to floating roses. Surprise your guests at you next event with some of our artificial floating flowers and they'll be amazed that they're not real. Browse our unique selection of floating artificial flowers and make sure to contact us if you have any questions.
At QualitySilkPlants.com we want you to be ecstatic about your purchase and offer a 100% Guarantee. Click here to read more...
Featured on:
ABC's Extreme Makeover: Home Edition
We supplied the Rainford family with artificial trees and plants for their new home. Check it out...
24" Poinsettia & Pine Wreath
Price: $185.00
Sale Price: $86.00
Set of 2 - 3' Cedar Artificial Topiary Trees - Indoor / Outdoor
Price: $189.99
Sale Price: $89.99
Merry Christmas Rose Hydrangea Arrangement
Price: $99.99
Sale Price: $49.00
Poinsettia w/Fluted Vase Silk Flower Arrangement
Price: $94.00
Sale Price: $44.00
6' Double Ball Ficus Silk Tree
Price: $294.00
Sale Price: $137.00
6' Robellini Palm Silk Tree
Price: $315.00
Sale Price: $147.00
Copyright 2014 QualitySilkPlants.com All Rights Reserved.
*Free shipping is for the lower 48 U.S. states only.
Floating Silk Flowers


text:
Dancing Half-Moon
The Dancing Half-Moon targets shoulders, obliques, hips, glutes, and thighs.
-The Dancing Half-Moon tones your shoulders, obliques, hips, glutes, and thighs. Be sure to keep your knees aligned above your ankles. Let your neck relax and press your shoulders away from your ears. Do 5 to 10 repetitions on each side. For added relaxation, hold each position for 3 breaths.
This Week's Top Videos Natural Fall Wreath for Your Front Door Getting A New Baby To Sleep Through The Night Sleep Secret Found in the Nursery Getting Baby #3 To Sleep 3 Tips for Your Fall Front Door Display On a Diet? 3 Healthier Breakfast Foods 3 Healthy Low-Cal Lunch Ideas How to Freeze Hearty Slow Cooker Chili Soup


text:
Kathryn Bernardo and Daniel Padilla to pair anew in 'Got To Believe'— May 8, 2013
This time, you Got To Believe in Kathryn Bernardo and Daniel Padilla's magic once more.
You first saw their magic worked on the TV series, "Princess and I", then again you saw it worked in the movie, "Must Be Love".
Wanting more of their magic? You 'Got To Believe.'
So cheezy, eh? Uhm, that might be a statement from from a KathNiel fan out there.
This phenomenal loveteam is set to hit the prime time with "Got To Believe" and the teaser could be found below.
But before you hit that play button (or you might have played it already before reading this… K fine!), let me tell you this… the sound track of the series, 'Got to Believe in Magic,' originally sang by David Pomeranz and was revived by band Side A just made me miss my favorite Rico Yan so much!
Plus, in this series' trailer, they showed Rico Yan who starred in the Got 2 Believe movie with Claudine Baretto, his last film before his March 2002 death. In case you don't know, Got 2 Believe movie is one Filipino film teenagers during the time of his death (this author included) loved and will forever cherish. *Teary Eyed Now*
It was a box-office success.
We could only hope that this generation's Rico and Claudine, in the persons of Kathryn and Daniel, could give us of what we expect of them.
Got To Believe (2013), is an upcoming romantic comedy prime time series that ABS-CBN presented during the network's Trade Launch at the NBC Tent on March 7. It's one of the Kapamilya shows the network offers in celebration of its 60th Anniversary.
Details of the story is yet to be announced but as of press time, the KathNiel supporters are shouting out on Twitter how excited they are for the TV show.
We will keep our eyes on this series so better bookmark this link and tag @elysplanet on Twitter whenever you feel like wanting to see some magic. Uhm, that's a bit exaggerated. Ok, you just Got To Believe.
About author
Ely Valendez is an award-winning blogger-journalist based in the Philippines. He handles several social media marketing projects for various brands in his home country as well as for a US-based IT/e-commerce company, PCM where he works full time. He uses his spare time doing financial consultancy for a UK-based company. He also sits as member of the Board of Directors of the Philippines Communication Society and serves as a web manager and resource person of the Philippine Press Institute.
Related Articles
'Got To Believe' second trailer releasedAugust 12, 2013
'Got To Believe' to push throughJuly 12, 2013
Follow Us On Instagram
Recent Posts
- Aj Ramos speaks up amidst video scandal October 6, 2014
- The Aj Ramos Scandal: Why Is Everyone Happy About It? October 6, 2014
- Donate Your Broken Phones, Help Build Classrooms in Aklan October 5, 2014
- Edward Benosa to conquer showbiz with original, soulful songs October 5, 2014
- #GEN3NextACT: The Artistically Designed Globe Stores October 5, 2014
- Globe brings back Free Facebook for postpaid, prepaid, TM subscribers October 4, 2014
- Cinemalaya 2014's award-winning 'The Janitor' to open in regular theaters October 8 October 4, 2014
- Hey Joe Show: New Humor Vlog Features Bisaya-Speaking Americans October 3, 2014
- Healthy Is Hot: The Ellen Adarna Banned TVC Hits The Web September 25, 2014
- Bench' The Naked Truth Postponed September 19, 2014


text:
Product Showcase
Whitepapers archive
Video Library
Partner Sites
About Us
Advertising Info
Contact Us
Click for LinkXpress
Reader Inquiry Service
Enter code to receive information:
Where I can find code?
Register Free
Sign In
Password reminder
Latest Issue
Nuclear medicine
General/Advanced Imaging
Imaging IT
Industry News
Computer Model Improves Ultrasound Image
By Medimaging International staff writers
Posted on 02 Dec 2008
A Dutch researcher has developed a computer model that can predict the sound transmission of improved designs for ultrasound instruments. The computer model is capable of processing large quantities of data and can be run on both a personal computer (PC) and a parallel supercomputer.
Clinicians utilize diagnostic ultrasound to visualize organs and other internal structures of the human body. Investigators from Erasmus University Medical Center (Rotterdam, The Netherlands) and Oldelft Ultrasound (Röntgenweg, The Netherlands) are now using this program to design a new sonographic transducer. Dr. Koos Huijssen, from Delft University of Technology (The Netherlands), has been searching for a computer model that could predict the behavior of ultrasonic waves. Over the past 10 years, the images produced by ultrasound have been vastly improved by making partial use of the nonlinear nature of acoustic waves. Due to these developments, ultrasound can now be used for a larger group of patients.
Additional improvements could be realized by refining the ultrasound equipment, the transducer that generates the ultrasound, and the imaging method. However, this requires a computer model that can accurately predict the transmission of ultrasound. Dr. Huijssen is in the process of developing a model that makes calculations over a three-dimensional area that is larger than existing computer models can handle.
The major challenges in producing such a model are the enormous complexity of the problem and dealing with the required storage capacity and processing power. The model was developed in cooperation with the company VORtech Computing (Delft, The Netherlands), and it has demonstrated to have an excellent performance level.
Related Links:
Erasmus University Medical Center
Oldelft Ultrasound
Delft University of Technology
VORtech Computing
Latest Ultrasound News
Streamlined Ultrasound System with All-Touch Control Panel Designed to Enhance Productivity
Low-Resolution Ultrasound Used to Measure Muscle Health
Intravascular Photoacoustic Imaging Technology Designed for Diagnosing Heart Disease
Ultrasound Used to Help Children with Speech Problems
Ultrasound System Developed for Emergency Medicine Applications
Point-of-Care Ultrasound System Is Versatile, Compact, and Supports Enhanced Patient Care
Ultrasound Provides Insights into Abdominal Aortic Aneurysms
Tablet-Based Ultrasound Technology Shows Lifesaving Potential in Emergency Service Study
Point-of-Care Ultrasound Training Program Established for Regional Anesthesiologists
"Virtual Breast" Designed to Enhance Ultrasound Elastography Cancer Detection
Ultrasound System Visualizes Complete Blood Flow during Interventional Heart Valve Procedures
CT Scans Are No More Effective Than Ultrasound Detecting Kidney Stones
Ultrasound Scanner Offers Enhanced View of Fetus
Ultrasound System Designed for Ob/Gyn Applications
Ultrasound System Designed to Reduce High Patient Volume Pressures in Hospitals and Clinics
Ultrasound System Developed for the Emergency Room
view channel
Low-Dose CT Offers Cost-Effective Lung Screening
Quality Assurance Meter Provides Streamlined X-Ray Constancy Checks
Coronary CT Angiography Reveals Link between Coronary Artery Plaque and Liver Di...
New Radiosurgery Technology Used to Treat Tumors Encroaching on Patient's Spinal...
Low-Dose CT Offers Cost-Effective Lung Screening
A new statistical analysis of from a US lung screening trial concluded that performing low-dose computed tomography (CT) screening can be cost-effective compared to doing no screening for lung cancer in aging smokers. "This provides evidence, given the assumptions we used, that it is cost-effective," said Ilana Gareen,...
Read more
Quality Assurance Meter Provides Streamlined X-Ray Constancy Checks
A quality assurance (QA) meter provides an effective and convenient way to make the regular constancy checks of X-ray equipment as fast and as accurate as possible. Cobia Sense, developed by RTI Electronics...
Read more
Coronary CT Angiography Reveals Link between Coronary Artery Plaque and Liver Disease
Researchers using coronary computed tomography angiography (CCTA) imaging have found a close correlation between high-risk coronary artery plaque and a common liver disease. The research revealed that...
Read more
New Radiosurgery Technology Used to Treat Tumors Encroaching on Patient's Spinal Cord
A 71-year-old man with a tumor encroaching on his spinal cord was among the first individuals to receive treatment using a new radiosurgery system. The radiosurgery platform provides clinicians with a...
Read more
view channel
MRI Shows Brain Anatomy Differences Between Autistic and Typically Developing In...
Diffusion-Tensor MRI Shows Brain Abnormalities in Patients with Chronic Fatigue
Ultrahigh-Field fMRI Reveals Language Hubs in the Brain in Great Detail
Pacemakers Receive CE Mark with Options for MRI
MRI Shows Brain Anatomy Differences Between Autistic and Typically Developing Individuals to Be Mostly Indistinguishable
In the largest magnetic resonance imaging (MRI) study of patients with autism to date, Israeli and American researchers have shown that the brain anatomy in MRI scans of autistic individuals older than...
Read more
Diffusion-Tensor MRI Shows Brain Abnormalities in Patients with Chronic Fatigue
Radiology researchers have discovered that the brains of patients with chronic fatigue syndrome (CFS) have reduced white matter and white matter abnormalities in the right hemisphere of the brain....
Read more
Ultrahigh-Field fMRI Reveals Language Hubs in the Brain in Great Detail
For the first time, new research has demonstrate that the areas of the brain that are important for understanding language can be targeted much more effectively using ultrahigh-field, 7 Tesla magnetic...
Read more
Pacemakers Receive CE Mark with Options for MRI
A range of pacemakers have received CE marking approval, and they are the first to enable patients to undergo full-body magnetic resonance imaging (MRI) scans in both 1.5 Tesla and 3.0 Tesla systems. When implanted with the Ingevity leads, Accolade pacemakers enable patients to receive full-body MRI scans....
Read more
Nuclear medicine
view channel
World's First Clinical MRI-Guided Radiation Therapy System Awarded CE Marking
Combining PET and MRI to Visualize Development of Alzheimer's Disease
Hypofractionated Prostate Radiotherapy Electromagnetic Positioning Tool Tracks T...
PET Scans Reveal How Psychodynamic Therapy for Depressed Patients May Alter Brain...
World's First Clinical MRI-Guided Radiation Therapy System Awarded CE Marking
The world's first magnetic resonance imaging (MRI)-guided radiation therapy system has received CE marking approval, which will allow the developer of the technology to deliver the systems throughout Europe...
Read more
Combining PET and MRI to Visualize Development of Alzheimer's Disease
Neuroscientists are seeking new strategies for developing better treatments for Alzheimer's disease (AD). However, it is just as important to find useful procedures to evaluate the probability of new treatments...
Read more
Hypofractionated Prostate Radiotherapy Electromagnetic Positioning Tool Tracks Tumors in Real Time During Treatment
A new add-on tool to existing radiotherapy equipment has been designed to track a tumor at any time during the treatment. The system could enable the clinic to enhance precision in their cancer treatment,...
Read more
PET Scans Reveal How Psychodynamic Therapy for Depressed Patients May Alter Brain Function
New imaging findings show that metabolic differences in a major brain region could predict which patients are most likely to respond to psychodynamic therapy. A study from Massachusetts General Hospital (MGH; Boston, MA, USA) has identified for the first time changes in the metabolic activity of a key brain region in...
Read more
General/Advanced Imaging
view channel
Photoacoustic Imaging Optimizes Visualization of Cancerous Tissues Using Time Re...
Handheld Probe Generates Precise Images Without Bulky, Costly Instruments
Collaboration to Make Diagnostic Medical Imaging Less Hazardous Using Hyperpolar...
Radiologists in Europe Launch Call for Action on Radiation Protection Measures
Photoacoustic Imaging Optimizes Visualization of Cancerous Tissues Using Time Reversal Technology
Unique time-reversal technology is being used to better focus light in tissue, such as muscles and organs. Current high-resolution optical imaging technology allows researchers to see about 1-mm-deep into the body. In an effort to enhance this imaging technology, the investigators are employing photoacoustic imaging, which...
Read more
Handheld Probe Generates Precise Images Without Bulky, Costly Instruments
A new handheld probe developed by university and industry researchers in the Netherlands and France could give clinicians useful new imaging capabilities that fit in the palms of their hands....
Read more
Collaboration to Make Diagnostic Medical Imaging Less Hazardous Using Hyperpolarization Agents
A collaborative effort by scientists has led to the development of an innovative strategy that can considerably improve the capabilities of medical imaging with safer procedures for the patient....
Read more
Radiologists in Europe Launch Call for Action on Radiation Protection Measures
A Europe-wide Call for Action campaign has been launched comprising 12 points, which include encouraging appropriateness in imaging, keeping radiation doses within diagnostic reference levels, using the as low as reasonably achievable (ALARA) principle, emphasizing the need for up-to-date equipment, empowering patients,...
Read more
Imaging IT
view channel
Enterprise Image Viewer Provides Rapid Access to Images from Any Mobile or Web D...
Imaging Data, Tools Developed for Heart Disease Research
Faster Treatment Choices for Bowel-Cancer Patients Using Tumor-Imaging Analysis ...
Software Designed to Automatically Outline Bones in X-Rays
Enterprise Image Viewer Provides Rapid Access to Images from Any Mobile or Web Device
New enhancements to an enterprise image viewer enable new ways of working for physicians, even when they are not working inside a caregiving facility. The solution provides rapid access to diagnostic images...
Read more
Imaging Data, Tools Developed for Heart Disease Research
A virtual machine is being developed to optimize reproducibility and data availability to assess and enhance analyses of magnetic resonance imaging (MRI) myocardial perfusion data. The project was described November 11, 2014, in the open access, open data journal GigaScience. The study's researchers, from the Universidad...
Read more
Faster Treatment Choices for Bowel-Cancer Patients Using Tumor-Imaging Analysis Technology
New imaging analysis technology helps hospitals make earlier and more accurate treatment decisions and survival assessments for patients with bowel cancer. An innovative new medical imaging technology, TexRAD (Cambridge, UK), is an imaging risk stratification tool that analyses the texture of clinical diagnostic images...
Read more
Software Designed to Automatically Outline Bones in X-Rays
Research into such as arthritis and other disorders will soon get a helping hand from new software that automatically outlines bones, saving thousands of hours of manual work. There is a shortage of...
Read more
Industry News
view channel
Partnership to Integrate Image Workflow Server into Image Viewer
Partnership to Provide 3-D Holographic Imaging to Medical Professionals
Infraredx Agreement with HealthTrust to Offer Intravascular Imaging Technology
Global Partnership Provides Treatment Planning Support for Modulated Arc Radioth...
Partnership to Integrate Image Workflow Server into Image Viewer
Intelerad Medical Systems (Montreal, Canada), a developer of medical imaging picture archiving and communication systems (PACS), radiology information systems (RIS), and workflow solutions, reported that...
Read more
Partnership to Provide 3-D Holographic Imaging to Medical Professionals
Zebra Imaging, Inc. (Austin, TX, USA), a provider of three-dimensional (3-D) holographic visualization technologies, reported on a partnership with the Zygote Media Group, Inc. (American Fork, UT, USA),...
Read more
Infraredx Agreement with HealthTrust to Offer Intravascular Imaging Technology
Infraredx, Inc. (Burlington, MA, USA), a medical device company focused on the diagnosis and management of coronary artery disease, has entered into an agreement with HealthTrust (San Jose, CA, USA), a...
Read more
Global Partnership Provides Treatment Planning Support for Modulated Arc Radiotherapy
Varian Medical Systems (Palo Alto, CA, USA) Eclipse treatment planning software can now be used to plan modulated arc radiotherapy (mARC) treatments at sites using Siemens Healthcare (Erlangen, Germany) medical linear accelerators. Varian Medical Systems and Siemens Healthcare presented their range of solutions that...
Read more
Featured Products
more products
Ultrasound System
LCD Retrofit Kit
DR System
Universal Stand
Radiographic System
Proton Beam Therapy System
Featured Whitepaper
more whitepapers
Unfors RaySafe:
A holistic approach to radiation safety
Download Whitepaper
Video Library
more videos
Partnership to Integrate Image Workflow Server into Image Viewer
Prone Radiotherapy Board Used for Breast Cancer Patients Cuts the Amount of Radiation to Lung, Heart Tissue by 90%
Digital Breast Tomsynthesis System Receives Approval
more events
30 Nov 2014 - 05 Dec 2014
RSNA 2014 - Radiology Society of North Ameruca Annual Meeting
01 Dec 2014 - 05 Dec 2014
Zdravookhraneniye 2014
11 Jan 2015 - 14 Jan 2015
Breast Imaging in the Caribbean
Featured Links
Ultrasound Equipment
Trademed.com is our new marketplace where you will find ultrasound devices and equipment for hospitals and clinics.
About Us
Advertising Info
Client Login
Privacy Policy
Journal Info
Contact Us
Nuclear Medicine
General Imaging
Imaging IT
Industry News
Product Showcase
Whitepapers archive
Video Library
Partner Sites
Client Login
Copyright © 2000-2014 Globetech Media. All rights reserved.


text:
Buick Q&AAsk Your Question
All 1994 Buick LeSabre questions
Will a 1994 buick lesabre motor work in a 1993 buick lesabre?
How do you reset the brain?
my air in not running
when i turn it on it blows from the defrosters, after I push auto many times it would blow correc...
My dome, dash, brake, and parking lights stay on. What is the problem?
why wont my buick start?
my buick started stalling on me a few days ago I changed battery now It wont start at all what ca...
No signal from test plug to the computers.cuts out start up the sometimes races
cuts out while driving but restarts on its own.
Thumping Sound & Buzzing coming from Trunk of 1994 Buick LeSabre...Serious Prob?
This has been a great car for me with very little issues for the past two years since I purchased...
i changed plugs & wires then eng would turn but not start.
then changed plugs again it started right up . drove it ran good then it sat over nite & woul...
My car keeps stalling when slowing down or coming to a complete stop????????????
This car was idoling high, I fixed that problem in the beggining it was idoling high and stalling...
My car keeps stalling and idoling high
The battery light comes on and goes off, the service engine light comes on and goes off the car i...
A couple of times my car will spit and sputter randomly and shut off?
When it shuts down its like the battery has been disconnected and resets my radio and makes the c...
Where is the proportioner valves on this vehicle?
I am having diagonal right front and left rear brake failure. I was told that it could be a prop...
dual climate control is blowing hot air out of driver side a/c vents and cold
air out of passager a/c vents rear vent also blows same as front drivers side can this be repaire...
sticky steering
have noticed my power steering has been stiff or sticky what may cause this
Why does my car shake and have a loss of power and stall out?
A little background...my Buick ran fine until I had a new air compressor installed. The old one h...
This week's top 10
|1 CharlesAutomotive
|6 csubak30
|2 pushrod
|7 ross1974
|3 ziptie12
|8 Randico
|4 globalhelper
|9 acc
|5 Hal...
|10 goodguy


text:
Peter Ramsey: The 'Rise of the Guardians' Interview
- Details
- Published: Friday, 07 December 2012 07:15
- Written by Kam Williams Special to The Skanner News
Rise of the Guardians is Peter Ramsey's first feature film after directing the hit DreamWorks Animation Halloween special, "Monsters vs. Aliens: Mutant Pumpkins from Outer Space." This project followed the feature film, "Monsters vs. Aliens" on which Ramsey served as Head of Story. While at DreamWorks Animation, Ramsey also served as a story artist on "Shrek the Third," and as a story board artist on "Shark Tale."
Read more: Peter Ramsey: The 'Rise of the Guardians' Interview


text:
Posted April 25, 2012 on AP on Fox
Billy Butler hit two of Kansas City's four home runs to help the Royals snap a 12-game losing streak by beating the Cleveland Indians 8-2 Wednesday night. Butler's two-run blast off Ubaldo Jimenez (2-1) put the Royals ahead in the first. He added a solo shot in the ninth off reliever Jairo Asencio, following Alex Gordon's three-run homer against the reliever. Eric Hosmer's two-run shot in the fifth made it 4-0 - the Royals' largest lead since April 8, when they beat the Los Angeles Angels 7-3. Luke Hochevar (2-1) allowed four hits and two runs over 6 1-3 innings, recovering from a horrendous home opener start April 13 when he gave up seven runs in the first inning of an 8-3 loss to Cleveland. The Royals went 0-10 on the homestand. Their 12-game loss streak tied for the third longest in team history, seven short of the record worst in 2005. Gordon had three hits, raising his average 30 points to .197. In the first, Chris Getz drew a leadoff walk and Butler ...
Original Story: http://msn.foxsports.com/mlb/story/Ro...
PLAYERS: Billy Butler, Ubaldo Jimenez, Jairo Asencio, Alex Gordon, Eric Hosmer, Luke Hochevar, Chris Getz, Asdrubal Cabrera, Jason Kipnis, Mike Moustakas, Mitch Maier, Jack Hannahan, Michael Brantley, Carlos Santana, Travis Hafner, Shelley Duncan, Tommy Hottovy, Casey Kotchman, Aaron Cunningham, Aaron Crow, Shin-Soo Choo, Manny Acta, Jeremy Jeffress, Ned Yost, Johnny Damon, Grady Sizemore
TEAMS: Kansas City Royals, Cleveland Indians, Los Angeles Angels
TEAMS: Kansas City Royals, Cleveland Indians, Los Angeles Angels
Comments are closed.
What do you think?To leave a comment, you can:
MLB News
Delivered to your inbox
You'll also receive Yardbarker's daily Top 10, featuring the best sports stories from around the web. Customize your newsletter to get articles on your favorite sports and teams. And the best part? It's free!
Follow us on Twitter
|Latest Rumors
|Best of Yardbarker
Youth Football Referee Wins $275K Settlement After Being Attacked By Irate Coaches And Parents During Game
Today's Best Stuff
For Bloggers
Join the Yardbarker Network for more promotion, traffic, and money.
Company Info
What is Yardbarker?
Yardbarker is the largest network of sports blogs and pro athlete blogs on the web. This site is the hub of the Yardbarker Network, where our editors and algorithms curate the best sports content from our network and beyond.