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PCC Alan Hardwick asked to apologise to chief constable
Lincolnshire's police and crime commissioner Alan Hardwick has been asked to apologise for suspending the chief constable.
Temporary police chief Neil Rhodes was suspended by the force's PCC last February over an employment dispute.
But a judicial review found in Mr Rhodes's favour and he has since been given the job permanently.
The police and crime panel, which oversees the work of the PCC, has made the request to Mr Hardwick in writing.
'Toothless tiger'Mr Hardwick said he would respond after he received the letter from the panel, but to do so before would be "inappropriate and discourteous".
Neil Rhodes suspension: Timeline
- 31 March 2012: Neil Rhodes appointed temporary chief constable
- 16 November 2012: Alan Hardwick elected as Lincolnshire's first PCC
- 25 February 2013: Mr Hardwick suspends Mr Rhodes. The matter is referred to the Independent Police Complaints Commission (IPCC) which decides not to investigate
- 14 March 2013: Sir Peter Fahy, chief constable of Greater Manchester, is appointed by Mr Hardwick to investigate
- 28 March 2013: A judicial review into Mr Rhodes' suspension is successful and he is reinstated
- May 2013: The panel that oversees the commissioner appoints a task group to write a report
- August 2013: The Home Affairs Committee chairman Keith Vaz MP brands the saga a "soap opera" and launches an investigation
- 28 January 2014: Task group report published
The move follows a report by a special task group commissioned by the panel, which details a series of recommendations to Mr Hardwick, the Home Office, the Independent Police Complaints Commission, the chief constable and the Association of Chief Police Officers.
Norman Norris, chair of the panel, said: "One of the main reasons for our decision to seek an apology is the feedback received from members of the public who were overwhelmingly critical of the commissioner."
He added: "It is a matter of deep regret that police and crime panels throughout the country do not have the sanctions available to them to censure commissioners.
"All they can do is make reports and recommendations - which is what our task group have done."
He conceded the panel was something of a "toothless tiger", with only limited powers.
A report by Greater Manchester's Chief Constable Sir Peter Fahy concluded there was no evidence Mr Rhodes had acted improperly.


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Findings from the National Faculty Study
A Fast-Moving and Evolving Space
Scratching the Surface of the Microbiome...
Making Molecular Analysis Count in Diagnostics,...
(Page 1 of 1)
Dr. Reddy's has completed Phase I trials for DRF 1042 in India. Under the terms of the agreement, Dr. Reddy's and ClinTec International will conduct Phase II and Phase III trials. Dr. Reddy's retains the commercialization rights for the U.S. and rest of the world, except ClinTec International's territories that include most of Europe.
On commercialization of the product, Dr. Reddy's will receive royalty on sales by ClinTec International in its designated regions and ClinTec International will receive the royalty from U.S. sales from Dr. Reddy's. If either party out-licenses the drug product, the proceeds will be shared by both the parties in a predetermined ratio, excluding Dr. Reddy's territories outside the U.S. Dr. Reddy's will also retain the exclusive rights to supply commercial quantities of the drug product.
Should bans on science education, of the sort imposed on Iranians hoping to study physics and engineering in the United States, encompass other nationals and other fields of study, including biotechnology?
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Poetry (LITR 231)
Selected poems and poetic forms are studied for themes and elements of poetry and for appreciation of poetic technique. Emphasis on reading methods useful for improving comprehension and appreciation. This course meets General Education requirements: Cultural Enrichment. Pre-Requisites: ENGL 150. Typically Offered Fall Only, Even Year Search AgainUse the search to find the course(s) that you are looking for.


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Confocal Laser Endomicroscopy |
Medical Policy | ||
Section Medicine |
Original Policy Date 01/2013 |
Last Review Status/Date Created with literature search/1:2013 |
Issue 1:2013 |
Return to Medical Policy Index |
Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
Confocal laser endomicroscopy (CLE), also known as confocal fluorescent endomicroscopy and optical endomicroscopy, allows in vivo microscopic imaging of cells during endoscopy. CLE is proposed for a variety of purposes, especially as a real-time alternative to histology during colonoscopy and for targeting areas to undergo biopsy in patients with inflammatory bowel disease and Barrett's esophagus.
Confocal laser endomicroscopy (CLE), also known as confocal fluorescent endomicroscopy and optical endomicroscopy, allows in vivo microscopic imaging of the mucosal epithelium during endoscopy. According to the American Society for Gastrointestinal Endoscopy (ASGE), (1) with CLE, light from a low-power laser illuminates tissue and, subsequently, the same lens detects light reflected from the tissue through a pinhole. The term confocal refers to having both illumination and collection systems in the same focal plane. Light reflected and scattered at other geometric angles that is not reflected through the pinhole is excluded from detection which dramatically increases the special resolution of CLE images.
To date, 2 types of CLE systems have been cleared by the U.S. Food and Drug Administration (FDA). One is an endoscope-based system in which a confocal probe is incorporated onto the tip of a conventional endoscope. The other is a probe-based system; the probe is placed through the biopsy channel of a conventional endoscope. The depth of view is up to 250 um with the endoscopic system and about 120 um with the probe-based system. A limited area can be examined; no more than 700 um in the endoscopic-based system and less with the probe-based system. As pointed out in review articles, the limited viewing area emphasizes the need for careful conventional endoscopy to target the areas for evaluation. Both CLE systems are optimized using a contrast agent. The most widely used agent is intravenous fluorescein, which is FDA-approved for ophthalmologic imaging of blood vessels when used with a laser scanning ophthalmoscope.
Unlike techniques such as chromoendoscopy (see policy 2.01.84), which are primarily intended to improve the sensitivity of colonoscopy, CLE is unique in that it is designed to immediately characterize the cellular structure of lesions. CLE can thus potentially be used to make a diagnosis of polyp histology, particularly in association with screening or surveillance colonoscopy, which could allow for small hyperplastic lesions to be left in place rather than removed and sent for histological evaluation. This would reduce risks associated with biopsy and reduce the number of biopsies and histological evaluations. Another key potential application of CLE technology is targeting areas for biopsy in patients with Barrett's esophagus undergoing surveillance endoscopy. This is an alternative to conducting random biopsies during surveillance and has the potential to reduce the number of biopsies and/or improve the detection of dysplasia. Other potential uses of CLE under investigation include better diagnosis and differentiation of conditions such as gastric metaplasia, lung cancer and bladder cancer.
As noted previously, limitations of CLE systems include a limited viewing area and depth of view. Another issue is standardization of systems for classifying lesions viewed with CLE devices. Although there is not currently an internationally accepted classification system for colorectal lesions, 2 systems have been developed that have been used in a number of studies conducted in different countries. These are the Mainz criteria for endoscopy-based CLE devices and the Miami classification system for probe-based CLE devices. (2) Lesion classification systems are less developed for non-gastrointestinal lesions viewed by CLE devices e.g., those in the lung or bladder. Another potential issue is the learning curve for obtaining high-quality images and classifying lesions. Several recent studies, however, have found that the ability to acquire high-quality images and interpret them accurately can be learned relatively quickly; these studies were limited to colorectal applications of CLE. (3, 4)
Regulatory Status
Two confocal laser endomicroscopy devices have been cleared for marketing by the FDA. These include:
Cellvizio (Mauna Kea Technologies; Paris, France): This is a confocal microscopy with a fiber optic probe (i.e., a probe-based CLE system). The device consists of a laser scanning unit, proprietary software, a flat-panel display and miniaturized fiber optic probes. The F-600 system, cleared by the FDA in 2006, can be used with any standard endoscope with a working channel of at least 2.8 mm. According to FDA documents, the device is intended for confocal laser imaging of the internal microstructure of tissues in the anatomical tract (gastrointestinal or respiratory) that are accessed by an endoscope.
Confocal Video Colonoscope (Pentax Medical Company: Montvale, NJ): This is an endoscopy-based CLE system. The EC-3S7OCILK system, cleared by the FDA in 2004, is used with a Pentax Video Processor and with a Pentax Confocal Laser System. According to FDA materials, the intended use of the device is to provide optical and microscopic visualization of and therapeutic access to the lower gastrointestinal tract.
Use of confocal laser endomicroscopy is considered investigational.
Policy Guidelines
Beginning in 2013, there are specific CPT codes for the use of this technology:
43206 Esophagoscopy, rigid or flexible; with optical endomicroscopy
43252 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy.
The interpretation and report of optical endomicroscopic image(s) would be reported with the following code:
88375: Optical endomicroscopic image(s), interpretation and report, real-time or referred, each endoscopic session.
Code 88375 cannot be reported in conjunction codes 43206 and 43252.
Benefit Application
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all U.S. Food and Drug Administration (FDA)-approved devices, drugs, or biologics may not be considered investigational, and thus these devices may be assessed only on the basis of their medical necessity.
Literature Review
This policy was created in with a search of the MEDLINE database through November 2012.
Following is a summary of the key literature.
Colorectal lesions
What is the accuracy of confocal laser endomicroscopy (CLE) compared to biopsy with histology for analysis of colorectal lesions?
The ideal study to answer this question would include an unselected clinical population presenting for screening colonoscopy, use biopsy and histology as the reference standard, include blinded analysis of CLE findings and use an accepted standardized method of CLE analysis.
Individuals at increased risk of colorectal cancer
In 2012, a systematic review and meta-analysis of studies evaluating the efficacy of CLE for discriminating colorectal neoplasms from non-neoplasms was accepted for publication. (5) The review, by Su and colleagues, included studies that used histological biopsy as the reference standard and in which the pathologist and endoscopist were blinded to each other's findings. Included studies also used a standardized CLE classification system. Patient populations in included studies were individuals at increased risk of colorectal cancer due to personal or family history, patients with previously identified polyps, and/or patients with inflammatory bowel disease (IBD). Two reviewers independently assessed the quality of individual studies using the modified quality assessment of diagnostic accuracy studies (QUADAS) tool, and studies considered to be at high-risk of bias were excluded from further consideration.
A total of 15 studies with 719 adult patients were found to be eligible for the systematic review. All were single-center trials and 2 were available only as abstracts. In all the studies, suspicious lesions were first identified by conventional white-light endoscopy with or without chromoendoscopy and then further examined by CLE. A pooled analysis of the 15 studies found an overall sensitivity of CLE of 94% (95% confidence interval [CI]: 0.88 to 0.97) and specificity of 95% (95% CI: 0.89 to 0.97), compared to histology.
Six of the studies included patients at increased risk of colorectal cancer (CRC) who were undergoing surveillance endoscopy, 5 studies included patients with colorectal polyps and 4 studies included patients with IBD. In a pre-defined subgroup analysis by indication for screening, the pooled sensitivity and specificity for surveillance studies was 94% (95% CI: 90 to 97%) and 98% (95% CI: 97 to 99%) respectively. For patients presenting with colorectal polyps, the pooled sensitivity of CLE was 91% (95% CI:: 87 to 94%) and specificity was 85% (95% CI: 78 to 90%). For patients with IBD, the pooled sensitivity was 83% (95% CI: 70 to 92%) and specificity was 90% (95% CI: 87 to 93%). In other pre-defined subgroup analyses, the summary sensitivity and specificity was significantly higher (p<0.001) in studies of endoscopy-based CLE (97% and 99%, respectively) than studies of probe-based CLE (87% and 82%, respectively). In addition, the summary sensitivity and specificity was significantly higher (p<0.01) with real-time CLE in which the macroscopic endoscopy findings were known (96% and 97%, respectively) than with blinded CLE in which recorded confocal images were subsequently analyzed without knowledge of macroscopic endoscopy findings (85% and 82%, respectively).
Representative studies are described below:
A 2011 study by Xie and colleagues in China included 116 consecutive patients who had polyps found during CLE; 1 patient was excluded from the analysis. All patients had an indication for colonoscopy (19 were undergoing surveillance post-polypectomy, 2 had a family history of colorectal cancer, 3 had IBD and 91 were seeking a diagnosis). All patients first underwent white-light colonoscopy. Endoscopy-based CLE was used on the first polyp identified during withdrawal of the endoscope (i.e., one polyp per patient was analyzed). Intravenous fluorescein sodium was used. Real-time diagnosis of the polyp was performed based on criteria used at the study center (which is adapted from the Mainz classification system). The polyps were then underwent biopsy or were removed and histopathological diagnosis was determined. Real-time CLE diagnosis correctly identified 109 of 115 (95%) adenomas or hyperplastic polyps. Four adenomas were misdiagnosed by CLE as hyperplastic polyps (2 were tubulous adenomas and 2 were tubulovillous adenomas) and 2 hyperplastic polyps were misdiagnosed as adenomas. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CLE diagnosis was 93.9% (95% CI: 85.4 to 97.6%), 95.9% (95% CI: 86.2 to 98.9%), 96.9% (95% CI: 89 to 99%), and 94.8% (95% CI: 89.1 to 97.6%), respectively. For polyps less than 10 mm, the CLE diagnosis had a sensitivity of 90.3% and specificity of 95.7% and for polyps 10 mm and larger, sensitivity was 97.1% and specificity was 100%. (6)
In 2010, Buchner and colleagues at Mayo Clinic published findings on 75 patients who had a total of 119 polyps. (7) Patients were eligible for study participation if they were undergoing surveillance or screening colonoscopy or undergoing evaluation of known or suspected polyps identified by other imaging modalities or endoscopic resection of larger flat colorectal neoplasia. White-light colonoscopy was used as the primary screening method. When a suspicious lesion was identified, it was evaluated by virtual chromoendoscopy system and a probe-based CLE system. Intravenous fluorescein sodium was administered after the first polyp was identified. Following the imaging techniques, the appropriate intervention, i.e., polypectomy, biopsy, or endoscopic mucosal resection, of lesions were performed and all resected specimens underwent histopathological analysis by a pathologist blinded to CLE information. Confocal images of the 119 polyps were evaluated after all procedures were completed; the evaluator was blinded to histology diagnosis and endoscopic appearance of the lesion. Diagnosis of confocal images used modified Mainz criteria; polyps were classified as benign or neoplastic. According to histopathological analysis, there were 38 hyperplastic polyps and 81 neoplastic lesions (58 tubular adenomas, 15 tubulovillous adenomas and 4 adenocarcinomas). CLE correctly identified 74 of 81 neoplastic polyps (sensitivity: 91%, 95% CI: 83 to 96%). In addition, CLE correctly identified 29 of 38 hyperplastic polyps (specificity: 76%, 95% CI: 60 to 89%). In contrast, virtual chromoendoscopy correctly identified 62 neoplastic polyps (sensitivity: 77%, 95% CI: 66 to 85%) and 27 hyperplastic polyps (specificity: 71%, 95% CI: 54 to 85% ).
Another Mayo Clinic study was published in 2012 by Shadid and colleagues. (8) The focus of the study was to compare 2 methods of analyzing CLE images: real-time diagnosis and blinded review of video images after endoscopy (known as "offline" diagnosis).The study included 74 patients with a total of 154 colorectal lesions. Eligibility criteria were similar to the Buchner et al. study (see above); the included patients undergoing surveillance or screening colonoscopy for evaluation of known or suspected polyps.
Patients underwent white-light colonoscopy and identified polyps were also evaluated with virtual chromoendoscopy and probe-based CLE. Intravenous fluorescein sodium was administered after the first polyp was identified. At the time of examination, an endoscopist made a real-time diagnosis based on CLE images. Based on that diagnosis, the patient underwent polypectomy, biopsy or endoscopic mucosal resection, and histopathological analysis was done on the specimens. The CLE images were then de-identified and then reviewed off-line by the same endoscopist at least one month later. At the second review, the endoscopist was blinded to the endoscopic and histopathological diagnosis. Of the 154 polyps, 74 were found by histopathological analysis to be non-neoplastic and 80 were neoplastic (63 tubular adenomas, 12 tubulovillous adenomas, 3 mixed hyperplastic-adenoma polyps and 2 adenocarcinomas). Overall, there was not a statistically significant difference in the diagnostic accuracy of real-time CLE diagnosis and blinded offline CLE diagnosis (i.e., confidence intervals overlapped). The sensitivity, specificity, PPV and NPV for real-time CLE diagnosis was 81%, 76%, 87% and 79%, respectively. For offline diagnosis, these numbers were 88%, 77%, 81% and 85%, respectively. However, in the subgroup of 107 smaller polyps less than 10 mm in size, the accuracy of real-time CLE was significantly lower than offline CLE. For the smaller polyps, sensitivity, specificity, PPV and NPV of real-time CLE was 71%, 83%, 78% and 78% and for offline CLE was 86%, 78%, 76% and 87%, all respectively. For larger polyps, in contrast, there was a non-significant trend in favor of better diagnostic accuracy with real-time compared to offline CLE.
A 2011 study by Hlavaty and colleagues in Slovakia included patients with ulcerative colitis or Crohn's disease. (9) Thirty patients were examined with standard white-light colonoscopy, chromoendoscopy and an endoscopy-based CLE system. An additional 15 patients were examined only with standard colonoscopy. All lesions identified by white-light colonoscopy or chromoendoscopy were examined using CLE to identify neoplasia using the Mainz classification system. Suspicious lesions underwent biopsy and, additionally, random biopsies were taken from 4 quadrants every 10 cm per the standard surveillance colonoscopy protocol. All specimens underwent histological analysis by a gastrointestinal pathologist who was blinded to the CLE diagnosis. Diagnostic accuracy of CLE was calculated for examinable lesions only. Compared to histological diagnosis, the sensitivity of CLE for diagnosing low-grade and high-grade intraepithelial neoplasia was 100%, the specificity was 98.4%, the PPV was 66.7%, and the NPV was 100%. However, whereas CLE was able to examine 28 of 30 (93%) flat lesions, it could examine only 40 of 70 (57%) protruding polyps. Moreover, 6 of 10 (60%) dysplastic lesions, including 3 of 5 low-grade and high-grade intraepithelial neoplasms were not evaluable by CLE. It is also worth noting that the diagnostic accuracy of chromoendoscopy (considered investigational, see in policy 2.01.84) was similar to that of CLE. The sensitivity, specificity, PPV and NPV of chromoendoscopy was 100%, 97.9%, 75% and 100%, respectively.
Conclusions: Multiple studies have evaluated the diagnostic accuracy of confocal laser endoscopy compared to histopathology for patients at increased risk of colorectal cancer. A meta-analysis of diagnostic accuracy studies found a pooled sensitivity of 94% (95% CI: 0.88 to 0.97) and a pooled specificity of 95% (95% CI: 0.89 to 0.97). Although the reported diagnostic accuracy is high, it is not clear whether the accuracy is high enough to replace biopsy/polypectomy and histological analysis.
Barrett's esophagus (BE)
What is the evidence that CLE with targeted biopsy can:
- distinguish BE without dysplasia from BE with low- and high-grade dysplasia,
- lead to fewer biopsies of benign tissue compared to surveillance with random biopsies?
The American Gastroenterological Association (AGA) recommends that patients with Barrett's esophagus who do not have dysplasia undergo endoscopic surveillance every 3 to 5 years. (10) They further recommend that random 4-quadrant biopsies every 2 cm be taken with white-light endoscopy in patients without known dysplasia.
The ideal study to answer the above question would include an unselected clinical population of patients with Barrett's esophagus presenting for surveillance and would randomly assign patients to CLE with targeted biopsy or a standard biopsy protocol without CLE. Relevant outcomes include diagnostic accuracy for detecting dysplasia, the detection rate for dysplasia, and the number of biopsies. Several studies with most or all of these elements of study design were identified, including randomized controlled trials. A description of representative randomized studies is included below.
In 2011, Sharma and colleagues published an international, multicenter RCT with sites in several European countries and the United States. (11) The study included 122 consecutive patients presenting for surveillance of Barrett's esophagus or endoscopic treatment of high-grade dysplasia or early carcinoma. Patients were randomly assigned to receive, in random order, both standard white-light endoscopy and narrow-band imaging. Following these 2 examinations which were done in a blinded fashion, the location of lesions was unblinded and, subsequently, all patients underwent probe-based CLE. All examinations involved presumptive diagnosis of suspicious lesions. Also, in both groups, after all evaluations were performed, there were biopsies of all suspicious lesions, as well as biopsies of random locations (4 quadrants every 2 cm). The authors did not mention the criteria that were used to diagnose a lesion as dysplastic or non-dysplastic. Histopathological analysis was the reference standard. Twenty-one patients were excluded from the analysis. Of the remaining 101 patients, 66 (65%) were found on histopathological analysis to have no dysplasia, 4 (4%) had low-grade dysplasia, 6 (6%) had high-grade dysplasia and 25 (25%) had early carcinoma. The sensitivity of CLE with white-light endoscopy for detecting high-grade dysplasia or early carcinoma was 68.3% (95% CI: 60.0 to 76.7%), which was significantly higher than white-light endoscopy alone; 34.2% (95% CI: 25.7 to 42.7%, p=0.002). However, the specificity of CLE and white-light endoscopy was significantly lower than white-light endoscopy alone : 92.7% (95% CI: 90.8 to 94.6%) versus 87.8% (95% CI: 85.5 to 90.1%, p<0.001). For white-light endoscopy alone, the PPV was 42.7% (32.8 to 52.6%) and the NPV was 89.8% (95% CI: 87.7 to 92.0%). For white-light endoscopy with probe-based CLE, the PPV was 47.1% (95% CI: 39.7 to 54.5%) and the NPV was 94.6% (95% CI: 92.9 to 96.2%). White-light endoscopy alone missed 79 of 120 (66%) areas with high-grade dysplasia or early carcinoma and white-light endoscopy with CLE missed 38 (32%) areas. On a per patient basis, 31 patients were diagnosed with high-grade dysplasia or early carcinoma. White-light endoscopy alone failed to identify 4 of these patients (sensitivity: 87%) whereas white-light endoscopy and CLE failed to identify 2 patients (sensitivity: 93.5%).
Another RCT was published in 2012 by Bertani and colleagues in Italy; this was a single-center study. (12) The study compared the dysplasia detection rate of biopsies obtained by standard white-light endoscopy only to the detection rate with standard endoscopy followed by probe-based CLE in patients with Barrett's esophagus who were enrolled in a surveillance program. One hundred consecutive patients were included and 50 were randomly assigned to each group. In both groups, targeted biopsies of suspicious lesions and random 4-quadrant biopsies (1 biopsy every 1 cm) were taken. The authors described the criteria they used for classifying CLE images as dysplastic or neoplastic. According to histopathological analysis, the reference standard, high-grade dysplasia was diagnosed in 3 patients and low-grade dysplasia was diagnosed in 16 patients, for an overall detection rate of 19 in 100 (19%) cases. Five cases were in the standard endoscopy group (1 case of high-grade dysplasia and 4 cases of low-grade dysplasia) and 14 were in the CLE group (2 cases of high-grade dysplasia and 12 cases of low-grade dysplasia). No suspicious lesions were identified in the standard endoscopy group and thus only random biopsies were performed. In the CLE group, no suspicious lesions were identified when patients were initially evaluated with standard endoscopy but CLE detected areas suspicious for neoplasia in 21 of 50 (42%) of patients. All the cases of dysplasia were in patients with areas suspicious for neoplasia at CLE but not standard endoscopy. The sensitivity, specificity, PPV and NPV of probe-based CLE for detecting dysplasia were 100%, 83%, 67% and 100%, respectively. Overall, the mean number of biopsies did not differ between groups (mean of 6.6 per patient in the standard endoscopy group and 6.1 in the CLE group, p=0.77) so the increased detection rate in the CLE group cannot be explained by a larger number of biopsies.
A single-center cross-over randomized controlled trial (RCT) was published in 2009 by Dunbar and colleagues. (13) This study was able to evaluate whether CLE can reduce the biopsy rate. Forty-six patients with Barrett's esophagus (BE) were enrolled and 39 (95%) completed the study protocol. Of these, 23 were undergoing BE surveillance and 16 had BE with suspected neoplasia. All patients received endoscopy-based CLE and standard endoscopy, in random order. One endoscopist performed all CLE procedures and another endoscopist performed all standard endoscopy procedures; endoscopists were blinded to the finding of the other procedure. During the standard endoscopy procedure, biopsies were taken of any discrete lesions followed by 4-quadrant random biopsy (every 1 cm for suspected neoplasia and every 2 cm for BE surveillance). During the CLE procedure, only lesions suspicious of neoplasia were biopsied. Endoscopists interpreted CLE images using the "Confocal Barrett's Classification" system, developed in a previous research study. Histopathological analysis was the reference standard. Among the 16 study completers with suspected high-risk dysplasia, there were significantly fewer biopsies per patient with CLE compared to standard endoscopy (mean of 9.8 biopsies versus 23.9 biopsies per patient, p=0.002). Although there were fewer biopsies, the mean number of biopsy specimens showing high-grade dysplasia or cancer was similar in the 2 groups: 3.1 during CLE and 3.7 during standard endoscopy, respectively. The diagnostic yield for neoplasia was 33.7% with CLE and 17.2% with standard endoscopy. None of the 23 patients undergoing BE for surveillance were found to have high-grade dysplasia or cancer. The mean number of mucosal specimens obtained for patients in this group was 12.6 with white-light endoscopy and 1.7 with CLE (p<0.001).
Conclusions: Several RCTs suggest that CLE has high accuracy for identifying dysplasia in patients with BE. The sensitivity of CLE in these studies was higher than for white-light endoscopy alone, but the specificity was not consistently higher. There are limited data comparing standard protocols using random biopsies to protocols using CLE and targeted biopsies, so data are inconclusive regarding the potential for CLE to reduce the number of biopsies in patients with BE undergoing surveillance without compromising diagnostic accuracy. Moreover, studies do not appear to use a consistent approach to classifying lesions viewed using CLE as dysplastic.
Other potential applications of CLE
Preliminary studies have been published evaluating CLE for diagnosing a variety of conditions including lung cancer, (14) bladder cancer, (15, 16) gastric cancer (17, 18) and bile duct malignancies. (19) There are insufficient studies to determine the accuracy of CLE for these applications and their potential role in clinical care in the United States.
Ongoing Clinical Trials
Confocal Laser Endomicroscopy for the Diagnosis of Gastric Intestinal Metaplasia, Intraepithelial Neoplasia, and Carcinoma (NCT01642797) (20): This double-blind randomized trial will include approximately 242 patients with Helicobacter pylori infection, gastric intestinal metaplasia, low-grade intraepithelial neoplasia or atrophic gastritis. Patients will receive either confocal laser endomicroscopy with targeted biopsy or standard white-light endoscopy with standard biopsy. The primary outcome measure is the diagnostic yield for identifying gastric intestinal metaplasia, intraepithelial neoplasia and carcinoma.
Comparison Between Probe-based Confocal Laser Endomicroscopy, White-light Endoscopy and Virtual Chromoendoscopy (pCLE-GCEP) (NCT01398579) (21): This is a single-blind randomized trial including an estimated 20 patients at increased risk of gastric cancer. All patients will be examined using 4 different endoscopy methods (CLE, white-light endoscopy, magnifying narrow-band imaging and autofluorescence imaging. Randomization will determine the order of the tests. The primary outcome is accuracy for diagnosing gastric pre-neoplastic and neoplastic lesions, using histopathology as the reference standard.
Confocal laser endomicroscopy (CLE) is a device that allows in vivo microscopic imaging of cells during endoscopy. For patients undergoing screening or surveillance colonoscopy, multiple studies have evaluated the diagnostic accuracy of CLE. While the reported sensitivity and specificity in these studies is high, it may not be sufficiently high to replace biopsy/polypectomy and histolopathologic analysis. Therefore, this evidence is not sufficient to conclude that CLE improves outcomes when used as an adjunct to colonoscopy.
Several studies have evaluated CLE for identifying areas of dysplasia and targeting biopsies in patients undergoing surveillance for Barrett's esophagus. Evidence from RCTs supports that CLE is more sensitive than white-light endoscopy for identifying areas of dysplasia. However, this evidence is insufficient to determine the impact of this technology on health outcomes in this population, particularly outside of the research setting. National guidelines continue to recommend 4-quadrant random biopsies for patients with Barrett's esophagus undergoing surveillance. There are less data on the use of CLE in non-gastrointestinal conditions such as lung or bladder cancer. Thus, use of CLE with endoscopy is considered investigational for all indications.
Practice Guidelines and Position Statements
In 2009, the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee published a report on confocal laser endomicroscopy. (1) The document concluded, "In recent years, confocal laser endomicroscopy rapidly moved from the bench to the bedside. It is being analyzed as a potentially valuable addition to conventional endoscopy as a means of in vivo optical biopsy enabling real-time histological examination of the superficial layer of the GI tract. How this will affect the practice of screening, surveillance, and early diagnosis of benign, premalignant, and malignant lesions of the GI tract requires further study."
In 2006 (reaffirmed as current in 2011), ASGE published a guideline on the role of endoscopy in the surveillance of premalignant conditions of the upper gastrointestinal (GI) tract. (22) The guideline included the following statements on surveillance of patients with Barrett's esophagus:
- "The cost effectiveness of surveillance in patients without dysplasia is controversial. Surveillance endoscopy is appropriate for patients fit to undergo therapy, should endoscopic/histologic findings dictate. For patients with established Barrett's esophagus of any length and with no dysplasia, after 2 consecutive examinations within 1 year, an acceptable interval for additional surveillance is every 3 years."
- "Patients with high-grade dysplasia are at significant risk for prevalent or incident cancer. Patients who are surgical candidates may elect to have definitive therapy. Patients who elect surveillance endoscopy should undergo follow-up every 3 months for at least 1 year, with multiple large capacity biopsy specimens obtained at 1 cm intervals. After 1 year of no cancer detection, the interval of surveillance may be lengthened if there are no dysplastic changes on 2 subsequent endoscopies performed at 3-month intervals. High-grade dysplasia should be confirmed by an expert GI pathologist."
- "Surveillance in patients with low-grade dysplasia is recommended. The significance of low-grade dysplasia as a risk factor for cancer remains poorly defined; therefore, the optimal interval and biopsy protocol has not been established. A follow-up EGD (screening esophagogastroduodenoscopy) (i.e., at 6 months) should be performed with concentrated biopsies in the area of dysplasia. If low-grade dysplasia is confirmed, then one possible management scheme would be surveillance at 12 months and yearly thereafter as long as dysplasia persists."
In 2011, the American Gastroenterological Association (AGA) published a position statement on the management of Barrett's esophagus. (10) The statement included the following recommendations regarding endoscopic surveillance of Barrett's esophagus:
The guideline developers suggest that endoscopic surveillance be performed in patients with Barrett's esophagus (weak recommendation, moderate-quality evidence).
The guideline developers suggest the following surveillance intervals (weak recommendation, low-quality evidence):
- No dysplasia: 3–5 years
- Low-grade dysplasia: 6–12 months
- High-grade dysplasia in the absence of eradication therapy: 3 months
For patients with Barrett's esophagus who are undergoing surveillance, the guideline developers recommend:
- Endoscopic evaluation be performed using white light endoscopy (strong recommendation, moderate-quality evidence).
- 4-quadrant biopsy specimens be taken every 2 cm (strong recommendation, moderate-quality evidence).
- Specific biopsy specimens of any mucosal irregularities be submitted separately to the pathologist (strong recommendation, moderate-quality evidence).
- 4-quadrant biopsy specimens be obtained every 1 cm in patients with known or suspected dysplasia (strong recommendation, moderate-quality evidence).
The guideline developers suggest against requiring chromoendoscopy or advanced imaging techniques for the routine surveillance of patients with Barrett's esophagus at this time (weak recommendation, low-quality evidence).
Medicare National Coverage
No national coverage determination.
- American Society for Gastrointestinal Endoscopy Technology Committee. Confocal laser endomicroscopy. Available online at: http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/confocal.pdf. Last accessed December, 2012.
- Salvatori F, Siciliano S, Maione F et al. Confocal Laser Endomicroscopy in the Study of Colonic Mucosa in IBD Patients: A Review. Gastroenterol Res Pract 2012; 2012:525098.
- Neumann H, Vieth M, Atreya R et al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26(7):867-72.
- Buchner AM, Gomez V, Heckman MG et al. The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia. Gastrointest Endosc 2011; 73(3):556-60.
- Su P, Liu Y, Lin S et al. Efficacy of confocal laser endomicroscopy for discriminating colorectal neoplasms from non-neoplasms: a systematic review and meta-analysis. Colorectal Dis 2012 [Epub ahead of print].
- Xie XJ, Li CQ, Zuo XL et al. Differentiation of colonic polyps by confocal laser endomicroscopy. Endoscopy 2011; 43(2):87-93.
- Buchner AM, Shahid MW, Heckman MG et al. Comparison of probe-based confocal laser endomicroscopy with virtual chromoendoscopy for classification of colon polyps. Gastroenterology 2010; 138(3):834-42.
- Shahid MW, Buchner AM, Raimondo M et al. Accuracy of real-time vs. blinded offline diagnosis of neoplastic colorectal polyps using probe-based confocal laser endomicroscopy: a pilot study. Endoscopy 2012; 44(4):343-8.
- Hlavaty T, Huorka M, Koller T et al. Colorectal cancer screening in patients with ulcerative and Crohn's colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy. Eur J Gastroenterol Hepatol 2011; 23(8):680-9.
- Spechler SJ, Sharma P, Souza RF et al. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. 2011. Available online at: www.guideline.gov. Last accessed December, 2012.
- Sharma P, Meining AR, Coron E et al. Real-time increased detection of neoplastic tissue in Barrett's esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011; 74(3):465-72.
- Bertani H, Frazzoni M, Dabizzi E et al. Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Dig Dis Sci 2012 [Epub ahead of print].
- Dunbar KB, Okolo P, 3rd, Montgomery E et al. Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. Gastrointest Endosc 2009; 70(4):645-54.
- Fuchs FS, Zirlik S, Hildner K et al. Confocal laser endomicroscopy for diagnosing lung cancer in vivo. Eur Resp J 2012 [Epub ahead of print].
- Sonn GA, Jones SN, Tarin TV et al. Optical biopsy of human bladder neoplasia with in vivo confocal laser endomicroscopy. J Urol 2009; 182(4):1299-305.
- Liu JJ, Droller MJ, Liao JC. New optical imaging technologies for bladder cancer: considerations and perspectives. J Urol 2012; 188(2):361-8.
- Wang SF, Yang YS, Wei LX et al. Diagnosis of gastric intraepithelial neoplasia by narrow-band imaging and confocal laser endomicroscopy. World J Gastroenterol 2012; 18(34):4771-80.
- Li WB, Zuo XL, Li CQ et al. Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions. Gut 2011; 60(3):299-306.
- Smith I, Kline PE, Gaidhane M et al. A review on the use of confocal laser endomicroscopy in the bile duct. Gastroenterol Res Pract 2012; 2012:454717.
- Sponsored by Shandong University. Confocal Laser Endomicroscopy for the Diagnosis of Gastric Intestinal Metaplasia, Intraepithelial Neoplasia, and Carcinoma (NCT01642797). Available online at: www.clinicaltrials.gov. Last accessed December, 2012.
- Sponsored by National University Hospital (Singapore). Comparison Between Probe-based Confocal Laser Endomicroscopy, White-light Endoscopy and Virtual Chromoendoscopy (pCLE-GCEP) (NCT01398579). Available online at: www.clinicaltrials.gov. Last accessed December, 2012.
- Hirota WK, Zuckerman MJ, Adler DG et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. 2006. Available online at: www.guideline.gov. Last accessed December, 2012.
Codes |
Number |
Description |
43206 |
Esophagoscopy, rigid or flexible; with optical endomicroscopy |
43252 | Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy | |
88375 | Optical endomicroscopic image(s), interpretation and report, real-time or referred, each endoscopic session. | |
ICD-9-CM Diagnosis |
Investigational for all relevant diagnoses |
ICD-10-CM (effective 10/1/14) | Investigational for all relevant diagnoses | |
Barrett's esophagus code range |
Z13.810 | Encounter for screening for upper gastrointestinal disorder | |
Z13.811 | Encounter for screening for lower gastrointestinal disorder | |
Z13.83 | Encounter for screening for respiratory disorder NEC | |
ICD-10-PCS (effective 10/1/14) | ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the use of this technology. |
Confocal fluorescent endomicroscopy
Optical endomicroscopy
Pentax Confocal Laser System
Policy History
Date | Action | Reason |
01/10/13 | Add to Medicine section | Policy created with literature search through November 2012; considered investigational. |
3/14/13 | Replace policy-correction only | Correction of typographical error in the Rationale discussion of Buchner 201 (reference 7) |


text: Oh My Aching Hand! A look at Carpal Tunnel SyndromeMay 14, 2004 The Bottom Line Numbness? Tingling? Pain?? It may be Carpal Tunnel Syndrome. A lot of people come up to me and complain about their aching hand/arm. They tell me it hurts because they must have Carpal Tunnel Syndrome. Sometimes their doctor may diagnose them for CTS and they are afraid of what it means: possible surgery. As a hand therapist, I treat hundreds of people a year with this thing called Carpal Tunnel Syndrome. Sometimes it turns out to be CTS and sometimes it isn't. How can you tell? Most times the average person does not know what CTS is except for the symptoms: pain, numbness and tingling. There are thousands of pages on the web about CTS so I will condense everything down for the layman and explain it in easy-to-understand English, in very simplistic terms. DISCLAIMER: I am not responsible for anything I write here. You are reading at your own risk and you should always check with a medical doctor. BASIC NERVE ANATOMY OF THE HAND: The hand is a very complex part of your body. I won't even try to go into the details of the structure of the hand. It took me over ten years to learn the hand and I am still learning! Just for the sake of simplicity, let's talk about the nerve. The nerves in the human body (including the hand) is responsible for sensation (hot, cold, pain, pressure, light touch, etc) and powering the muscles for movement. If you put pressure on the nerve, guess what happens? Its like kinking a water hose...the water just barely trickles out. Same with the nerve. If you smash it and kink it up, it won't be able to function properly. Nerves do not contain liquid like a water hose, but it does carry signals from the muscles to the brain and vice versa. Kink the "wire" and you have a lot of problems. In CTS, the nerve gets smashed up inside the wrist, in the carpal tunnel, hence the name. It gets its name because the area that the nerve travels in is very narrow, like a tunnel. The floor of the tunnel are the carpal (hand) bones and the roof of the tunnel is a thick band of ligament called the transverse carpal ligament. Now, with such a narrow space, you can see how easily it is to smash this nerve, or, if you want to picture it, kink a water hose. HOW THE NERVE GETS SMASHED UP: This nerve inside your wrist that is traveling through the narrow tunnel is called the Median nerve. It goes to your thumb, index finger, middle and half of the ring finger. When this nerve gets smashed, you will know it! For the sake of simplicity, let's assume that your nerve is smashed in the wrist (the most common location). Sometimes it is not smashed in the wrist, but rather in the forearm, in your elbow or in your spine. But just for this discussion, let's say it is a pure CTS. You have been diagnosed by your doctor and he/she tells you that it is your wrist that is the problem. How did this happen? There are many, many factors! But again, for the sake of being a simple primer, let's just list the most common causes of nerve compression: 1) your work = do you use the keyboard a lot? Do you use a lot of repetitive motions for your job like working on an assembly line? Does your job require you to grab items and hold them for long periods of time? Bend your wrist constantly? Are you in an awkward position and working in tight spaces (auto mechanic, dentist, plumber, etc)? Do you use a lot of force (construction)? Do you use vibrating tools? Are you in a cold environment (meat cutters, factory workers, etc)? As you can see, your work can be the primary source of nerve irritation and/or compression. 2) your hobbies = are you on the computer a LOT? Do you knit? Crochet? Sew? Windsurf? Bowl? What kinds of hobbies do you like to participate in? Hobbies usually are not solely to blame for causes of CTS (unless you are a computer addict like me ;-) but can aggravate existing problems. 3) your current health = the risks for CTS include pregnancy, swelling of hand or arm via chemotherapy or IV drugs, diabetes, obesity, arthritis, fractures (old or new) of the wrist or hand, hypothyroidism, trigger fingers among others. The ones I have listed are the most common causes. Women who are pregnant or have delivered usually have relief of the symptoms when the swelling goes down. SYMPTOMS: Numbness and tingling, especially in the thumb, index, middle and sometimes ring finger are the first signs of CTS. Usually, but not always will a patient exhibit numbness and tingling. Patients complain of the "hand falling asleep" and the need to shake out the hand. Sleep is sometimes disrupted, with patients waking up frequently throughout the night. Pain in thumb area, wrist or forearm. Pain can be characterized as "burning", "aching", "tiredness" or "throbbing" may be reported. Impaired circulation can cause the patient to complain of symptoms like the hand feeling "cold" or "frozen". HOW IS A DIAGNOSIS MADE? Your doctor will make the diagnosis of CTS. There are a variety of tests that the doctor can do on your hand besides just listening to your symptoms. Tinel's Sign - your doctor may tap your wrist to see if you get the "zinging" sensation that is tell-tale of nerve compression. Phalen's Test - your doctor may have you bend your wrists to purposely smash the nerve in the tunnel to see if you have an increase in symptoms. EMG - the doctor may do an electromyogram on your hand/arm to see where the nerve is smashed. He/she uses electrodes/needles to shock your hand or arm to see how fast your muscles react to the currents. Most likely though, the diagnosis is made solely by patient complaint. TREATMENTS: Some doctors will order therapy (physical or occupational therapy PT/OT) or nothing. They may issue a wrist support brace and tell you take some anti-inflammatory medications and see if you get better. Sometimes you may get a cortisone shot. In the cases of severe nerve compression, you will need to have surgery. If you are sent to a PT or OT, they will do a complete exam of your hand by testing your grip and pinch strength, your wrist bending measurements, take a look at your muscles, your arm and in some cases your neck or spine. If you are lucky enough to be seen by a therapist who is also an ergonomist, this therapist will do a complete analysis of your work demands, your workstation set up, your hobbies, etc. The therapist may do postural training, splinting, massages, ultrasound and iontophoresis drug treatments, stretches, and sometimes actually come out to your work to look at your computer set up (if that is the kind of work you do). If nothing helps and your nerve compression is moderate to severe, you may need to have surgery. The doctor may do the surgery herself, or refer you out to a surgeon. It is usually an outpatient surgery where you are still awake in the doctor's office. Your arm is numbed and then operated on. Most doctors will not let you watch. Some doctors will ask you if you are interested. It takes about 30 minutes and the roof of the carpal tunnel is snipped in half to relieve the pressure on the nerve. The incision is then sewed up and you may be placed in a splint to rest the hand for about 2 weeks. RECOVERY: Recovery is usually within 6-8 weeks. You may be sent to therapy to do hand exercises, desensitization of the scar tissue and scar management. If not, your doctor may just follow up with you to make sure you are healing OK without complications. RELATED HAND/ARM PROBLEMS: Besides CTS, the other more common diagnoses are DeQuervain's Tenosynovitis (pain along the thumb side and making thumb/wrist motions toward the thumb), Cubital Tunnel Syndrome (smashed ulnar nerve in elbow), ulnar nerve smashed up in hand on pinkie side (pinkie and ring fingers go numb), trigger finger (finger snaps or "catches" and "locks up"). I will write more articles in the future regarding how to choose a good doctor and how to work with your therapist. Thanks for reading! I must get off the computer now. my hand is swelling up from all this typing and the salty food I ate. |


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I had to dig deep into my archives for this image, which I want to enter in a butterfly challenge. It was taken back in 2007 at The Butterfly Place in my home town of Westford, Mass. with my D80 and 60mm macro lens. Even though it's just a few miles from my house, I haven't been back to the Butterfly Place in years. I had a problem with lenses fogging up due to the higher humidity inside, so I haven't wanted to risk that problem again.
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butterfly, macro, nature, insects, anita pollak, featured in explore
I am a photographer living in Massachusetts and my passion is flowers. I take the time to reveal the special beauty of each flower and I hope that comes through as you look at my work.
View Full ProfileThanks Ray!
– Anita Pollak
Absolutely breathtaking! Wonderful editing and presentation! Wow!
What a wonderful comment, Angie! Thank you so much for the comment and the fave!
– Anita Pollak
Beautiful Anita. Stunning capture
Thank you so much for your kind comments, Maxwell!
– Anita Pollak
Beautiful image Anita :-)
Thank you so much for your kind comments, Thomas!
– Anita Pollak
Thank you so much, Poete100!
– Anita Pollak
Thank you so much, ienemien!
– Anita Pollak
What a beauty this butterfly is, and perfectly set off against the soft background!
Thank you so much for your kind comments, Celeste!
– Anita Pollak
Congratulations Anita,
For being in the Spotlight & Featured Member in International Showcase!
Enjoy, Jo ;)
Thank you so much, Jo!
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beautiful picture!
Thank you so much for the feature and your kind words, Manon!
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Thank you, Larry!


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Article ID: 266371 - View products that this article applies to. This article was previously published under Q266371 This article has been archived. It is offered "as is" and will no longer be updated. SYMPTOMS
When a user's mailbox is located on an Exchange Server 5.5 computer and is a member of a distribution list (DL) that is based on a computer that is running Microsoft Exchange 2000 Server, the Exchange Server 5.5 user may receive duplicate e-mail messages if a message is sent to the DL and the user is carbon copied (cc) on the e-mail message.
RESOLUTIONTo resolve this problem, obtain the latest service pack for Exchange Server 5.5. For additional information, click the following article number to view the article in the
Microsoft Knowledge Base:
191914 The following files are available for download from the Microsoft
Download Center:
XGEN: How to Obtain the Latest Exchange Server 5.5 Service Pack
For additional information about how to download Microsoft Support files, click the following article number to view the article in the Microsoft Knowledge Base:
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Alpha: Collapse this image
Microsoft scanned this file for viruses. Microsoft used the most current virus-detection software that was available on the date that the file was posted. The file is stored on security-enhanced servers that help to prevent any unauthorized changes to the file.
How to Obtain Microsoft Support Files from Online Services
STATUSMicrosoft has confirmed that this is a problem in Microsoft Exchange Server version 5.5. This problem was first corrected in Exchange Server 5.5 Service Pack 4. PropertiesArticle ID: 266371 - Last Review: October 20, 2013 - Revision: 4.2


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Go to m.barnard.edu for the Mobile Barnard web app or download it from the App Store or Google Play.
Go to m.barnard.edu for the Mobile Barnard web app or download it from the App Store or Google Play.
A team of women led by Barnard Zine Librarian Jenna Freedman and Barnard Archivist Shannon O'Neill formed a "zine-mob" on the F train.
Planned Parenthood President Cecile Richards urges graduates to be activists, troublemakers, and agitators.
Similar event to take place in Shanghai in conjunction with Barnard's Sixth Annual Global Symposium
Exhibit features work from Anna Hyatt Huntington, a trailblazing sculptor
Sophomore wrote an anti-bullying play that has been performed at several schools in Florida
Meet some of Barnard's exceptional young women and hear about their academics, aspirations, and lives in New York City.
Playing Liesl Von Trapp, Barnard junior performs in the Macy's Thanksgiving Day Parade
Copyright © 2015 Barnard College | Columbia University | 3009 Broadway, New York, NY 10027 | 212.854.5262


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In Stock
Ships Within 24 Hours Sellout Risk: Extremely High
These slim fit Patagonia Slim Snowshot Ski Pants have the warmth and style everyone craves. The slim fit allows the wearer a snug fit that stays in place while trapping in the body heat and keeping out as much cold air as possible. The waterproof and breathable material is another great addition to these pants. They keep them feeling fresh and clean while being able to breathe and move around without hassle. The Slim Snowshot Ski Pants are ideal for skiers looking to stay dry and warm this winter.
Slim Snowshot


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Seven months without any major work stoppages
July 09, 2009
For a seven-month period from November 2008 through May 2009 there have been no major work stoppages initiated in the United States.
Since 1981, aside from the current seven-month period with no major work stoppages, the longest such period was the three months from November 2003 to January 2004.
Since 1947 (the earliest data available), the smallest number of major work stoppages in a calendar year was 14, in 2003. During the 1947-1980 period there were many years with over 200 work stoppages. The year with the fewest work stoppages was 1963, with 181; the year with the most was 1952, with 470.
Major work stoppages are defined as strikes or lockouts involving more than 1,000 employees. Annual work stoppages data are available for 1947 forward; monthly data on major work stoppages have been published since 1981, additional details concerning work stoppages are available for 1993 forward.
These data are from the BLS Work Stoppages program. Data for the most recent month are preliminary. An annual major work stoppages news release is published each year in mid-February. The most recent annual work stoppages release is "Major Work Stoppages in 2008" (HTML) (PDF), USDL 09-0150. Work stoppages data can be obtained from the Work Stoppages Most Requested Statistics webpage.
Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Seven months without any major work stoppages on the Internet at http://www.bls.gov/opub/ted/2009/jul/wk1/art04.htm (visited March 04, 2015).
Three recent editions of Spotlight on Statistics
Housing: before, during, and after the Great Recession
looks at consumer expenditures on household items, employment in residential construction, prices for household items, and injuries in occupations involved in building and maintaining our homes. -
Women veterans in the labor force examines the demographic, employment, and unemployment characteristics of women veterans.
BLS Statistics by Occupation provides an overview of occupational employment and wages with an emphasis on STEM jobs and occupational data by typical entry-level education required.


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Minneapolis »
By neighborhood:
St. Paul »
Whether it's relationship-building or a campaign tactic, storytelling is key to community organizing. Intentional and strategic storytelling is an incredibly effective way to develop the power of a community. This workshop-style class will help you harness that power. Discover how storytelling can serve as a tool to support base-building, bridging the gaps between community and ally. Learn how your stories can help you do outreach through media, and boost relationship-development with the press. Gain practice shaping and becoming comfortable sharing your stories. Find out how to draw out the stories of communities, community leaders, and community members. During our time together, you will have the opportunity to share a story and begin writing that story down.
Cirien Saadeh is an organizer and communications professional with statewide non-profit La Asamblea de Derechos Civiles. In the past, she has worked for E-Democracy, in communications, and with The UpTake, as a journalist. She also served as the executive producer for AM950's "Food Freedom Radio." A graduate of the Organizing Apprenticeship Project in Minneapolis, Cirien has been active in campaigns around transit equity, food justice, digital access and inclusion, and immigrant justice. She is a writer by trade and a perpetual student. Cirien believes that storytelling is the most powerful tool that community organizers and leaders can develop and leverage to build equity in disenfranchised communities.


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Columbia Plateau Ridge Parka
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The Columbia Plateau Ridge Parka for men showcases a wind and water-repellent construction of nylon Bergundtal Cloth with abrasion-resistant Moraine Grid trimming. The polyester fleece insulation is lightweight yet warm, and the Hydro-Pel Plus lining offers additional resistance to rain and wind.
- FogDog Sports
Columbia Plateau Ridge Parka
previously retailed for:
$99.97 - $109.97
$99.97 - $109.97
The Columbia Plateau Ridge Parka is not available from the stores we monitor. It was last seen sometime before 2006 at FogDog Sports.
If you're looking for a new snowsport jacket, check out the best reviewed current models.


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Shop our collection of girls sale clothing and find a deal girls of every age, size and style will love! Top designer brands like Lipstik and Bonnie Jean are always available at unbelieveable prices. We have sale clothing for all seasons, from girls discount swimwear to girl's discount outerwear and every temperature in between! Shop girls sale clothing today and get a lot of look for a little price.
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Property Information Recently Viewed Listings « Back
Harbor Club Villas - The Reserve Pawleys Island Real Estate
MLS# 1301922 - 193 Harbor Club Drive Pawleys Island, SC 29585
Property Summary
Subdivision Harbor Club Villas - The Reserve
Area 42a Pawleys Island Area-litchfie
Sales Price $497,500
Beds 3
Baths 3 Full / 1 Half
Est. Heated SqFt 2851-2900
Floor / Unit# 1st / 19-B
Parking Private Grg
Furnished No
Style Low-Rise 2-3 Stories
Exterior Finish Brick Veneer
Living Room 15'10x16'1
Dining Room 13 x 12
Master Bedroom 14'11x13'5
Listing Agent Jamie Beard
Listing Office The Litchfield Company Re
Stipulation of Sale None
Remarks Brand new Harbor Club Villa in The Reserve! This is a must see. 3 bedroom. 3.5 bath villa loaded with upgrades. Tile and carpeted floors, kitchen with custom cabinets, large master bedroom and bath with walk in closet, Carolina Room, loft area, tiled showers, 2 car garage and more. These villas live like a single family home with the luxury of a condominium. The property management handles all yard maintenance and upkeep of the exterior of the building. Just a short stroll to the Waccamaw River and Harbor Club Marina. Nothing stops short of superior for Harbor Club Villas II owners including amenities. The Reserve Harbor Club Marina and Marina Club featuring dry stack storage and wet slips, is adjacent to the property. Residents enjoy access to Litchfield by the Sea amenities including private beach access, miles of private walking and biking trails, tennis, private beach club, onsite restaurant and more. The Reserve Club also features the private Greg Norman designed Reserve Golf Club, which owners have the opportunity to join. 2880 heated square feet with 3549 under roof.
- Living Room
- Ceiling Fan, Vaulted/Cathedral Ceiling
- Dining Room
- Kit/DR Combo
- Master Bedroom
- 1st Flr Level, Sitting Area, Walk-in Closet
- Master Bath
- Double Sink, Shower, Tub
- Kitchen
- Range, Dishwasher, Garbage Disposal, Microwave, Pantry, Breakfast Nook, Range Hood, Stainless Steel Apps., Granite Countertops, Oven
- Interior Features
- Garage Door Opener, Smoke Detector, Wshr/Dryer Connection, Split Bedroom Plan, Fireplace
- Levels
- Two-Story
- Foundation
- Slab
- Water Heater
- Electric
- Other Rooms
- Carolina Room, First Floor Bedrooms, First Floor Bathrooms, Foyer, Laundry/Utility
- Exterior Features
- Insulated Doors/Windows
- Utilities
- Electricity, Water Public, Sewer, Cable TV, Underground Utilities, Telephone
- Building Location
- In Golf Course Community


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Monthly Archive for September, 2009
Future Rats likely to get NHL chance Friday or Monday
RALEIGH, N.C. — Training camp is under way for the Carolina Hurricanes, and it is a quick one. The 'Canes open the regular season Friday, Oct. 2, which is just 17 days away, so their exhibition schedule consists of only four games. Maurice said today at practice that Carolina's prospects — those mostly likely to […]
[Read More]
Engineers vs. sledders
The RPI men's and women's hockey team has probably never faced a team like this. Members will scrimmage STRIDE's Capital District Sled Warriors in sled hockey at 7 p.m. Friday at RPI's Houston Field House. In sled hockey, players with disabilities are seated, and use shortened custom hockey sticks to propel themselves. "We are very […]
[Read More]
Hurricanes announce training camp roster
Believe it or not, hockey begins next week as coaches and players in the the Carolina Hurricanes organizations report to training camp Sunday in Raleigh, N.C. (We'll have blog posts from there beginning Tuesday and stories in in the print edition of the Times Union starting Wednesday.) We'll let you try to figure out which […]
[Read More]
Paiement, Olson, Herauf back with Rats
The Albany River Rats today announced the signing of four players, including defensemen Jonathan Paiement and Benn Olson, to American Hockey League contracts. Paiement, Olson and forward Brad Herauf, who signed a one-year, two-way AHL/ECHL contract, played with the Rats last season. Albany also signed Jacob Micflikier, a 5-foot-8, 180-pound forward who had four goals and […]
[Read More]
Weller traded by Senators to Ducks
South Glens Falls native Shawn Weller was traded today by the Ottawa Senators to the Anaheim Ducks for right wing Jason Bailey. Weller, a left wing, had nine points in 70 games for the Binghamton Senators last season. The Ducks' primary AHL affiliate this season will be the San Antonio Rampage.
[Read More]
Former River Rat retires after 14-year NHL career
Defenseman Jason Smith, whose pro hockey career began with parts of two seasons with the Albany River Rats, announced his retirement today after 14 NHL seasons. Smith, 35, scored six goals and five assists in 27 games in the 1993-94 and 1994-95 seasons. His NHL career took him through New Jersey, Toronto, Edmonton, Philadelphia and […]
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Stole it from ThePetiteShop Loved the idea and already found a way to be an elf for someone else :3
Step 1.
Make a post in your dA journal (the manual INCLUDED - I wont grant any wishes, if I see no manual). The post should contain your list of 10 holiday wishes. The wishes can be anything at all, from simple and fandom-related ("I'd love a Snape/Hermione icon that's just for me") to medium ("I wish for _____ on DVD") to really big ("All I want for Christmas is a new car/computer/house/TV.") The important thing is, make sure these wishes are things you really, truly want.
If you wish for real-life things (not fics or icons), make sure you include some sort of contact info in your post, whether it's your address or just your email address where Santa (or one of his elves) could get in touch with you.
Step 2.
Surf around your friends list (or friends friends, or just random journals) to see who has posted their list. And now here's the important part:
If you see a wish you can grant, and it's in your heart to do so, make someone's wish come true. Sometimes someone's trash is another's treasure, and if you have a leather jacket you don't want or a gift certificate you won't use--or even know where you could get someone's dream purebred Basset Hound for free--do it.
You needn't spend money on these wishes unless you want to. The point isn't to put people out, it's to provide everyone a chance to be someone else's holiday elf--to spread the joy. Gifts can be made anonymously or not--it's your call.
There are no rules with this project, no guarantees, and no strings attached. Just...wish, and it might come true. Give, and you might receive. And you'll have the joy of knowing you made someone's holiday special.
Step 3.
The list:
1) Handmade creations (anything!) from anyone!
2) Tell me something you think i should try to do
3) Show me a Gallery here on dA that makes you day dream!
4) Llama Badges
4) Tell me what is my best and worst work Be honest!
5) A custom icon related with my username
7) Anything related to Tolkien, Harry Potter, Star Wars or others like that
8) Show me a website you love!
9) More free time so spend with my boyfriend
10) Wish me a Merry Christmas ^^
Thank you all for reading! and if you have a list, please share so I can take a look! Maybe i can be your elf!
Byebye everyone!


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oil spills Companies in New Jersey
Osprey Spill Control
based in Virginia Beach, VIRGINIA (USA)
Osprey Spill Control offers a Sorbent LifeCycle Management Solution to aid in the recovery and remediation of oil and other hydrocarbon based liquid products.
Spill Doctor (SA)
based in Cape Town, SOUTH AFRICA
The Jesbra Group, now trading as Spill Doctor in Africa, represents some of the worlds industry leading providers of environmental, safety and health products. With over a decade of international experience and 25 years operating in Africa, Spill Doctor has consolidated a range of internationaly recognised products that both our regional and international clients regard ...
West Coast Spill Supplies Ltd.
based in Saanichton, BRITISH COLUMBIA (CANADA)
West Coast Spill Supplies specializes in spill response absorbent products as well as custom spill response kits. West Coast also distributes secondary containment products to prevent hazardous materials spills from occurring.
Moleculoc, LLC
based in Groveton, NEW HAMPSHIRE (USA)
Moleculoc, LLC providing global green technologies for 21st century, rapid response land, marine and bio-hazard spill control. Moleculoc, LLC will work diligently to find a sensible solution to mitigation problems worldwide. We are of the philosophy that there is a manageable, cost effective plan available for every spill contamination event. Sometimes the obvious is the ...
CL Solutions, LLC
based in Cincinnati, OHIO (USA)
CL Solutions provides products for control and removal of environmental spills of oil, fuel and industrial chemicals. CL Solutions' absorbents, microbial cultures, and surfactants are safe for human health and the environment. When used under appropriate conditions, as guided by our field test kits, our microbial blends remove oil from surface spills, soil, surface water ...
based in Oklahoma City, OKLAHOMA (USA)
RTASCo manufactures proprietary innovative remediation solutions for hydrocarbon, acid and brine spills. Our products remediate a broad range of contaminates, are quick, simple and safe to use before, during and after application. In quickly transforming spills into non-hazardous residues at the accident site, liability risk and cost is reduced significantly. RTASCo ...
EXCAL Visual LLP
based in Boulder, COLORADO (USA)
Produces EH&S training audio-visual aids. Excal Visual creates effective EH&S employee training videos for industry, business and government. EV training is aimed at the `hands-on` people -- the operators, technicians, laborers, drivers and others who need to know and follow the best practices for safety, security and environmental protection in the course of their jobs. ...
Rapid Response USA, LLC
based in Mcleansville, NORTH CAROLINA (USA)
Rapid Response USA, LLC is a full service environmental company specializing in clean up of hazardous and non-hazardous waste with an average response time of less than 2 hours. Headquartered in Mcleansville, NC, Rapid Response USA has the ability to dispatch response teams in all 50 states as well as the Caribbean and Canada. Rapid Response USA is a veteran owned - ...
Spill Control Association of America (SCAA)
based in Alexandria, DISTRICT OF COLUMBIA (USA)
SCAA was founded in 1973 to actively promote the interests of all groups within the spill response community. Our organization represents spill response contractors, manufacturers, distributors, consultants, instructors, government & training institutions and corporations working in the industry. The strength of our organization can be found in our membership directory. ...
Moosewood Communications
based in Rumney, NEW HAMPSHIRE (USA)
Moosewood Communications is a company with Social Responsibility and Social Entrepreneurship at its core. Since 1988 Moosewood has been providing a unique set of communications services to a broad range of clients from local mom and pop operations to International Foundations and Corporations.


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Welcome to REDD News – a centre for the latest news on REDD+, aggregated from partner sites, list servers, conferences and news services. Each link below provides a direct link to a news article on a partner site.
Filter by topic
Displaying 121 - 130 of 639
Community forestry and community-based forest landscape management for safeguard information systems


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What does LCV mean in Airport Codes?
This page is about the meanings of the acronym/abbreviation/shorthand LCV in the Regional field in general and in the Airport Codes terminology in particular.
Find a translation for LCV in other languages:
Select another language:
Discuss this LCV abbreviation with the community:
Use the citation below to add this abbreviation to your bibliography:
"LCV." Abbreviations.com. STANDS4 LLC, 2015. Web. 5 Mar. 2015. <http://www.abbreviations.com/term/268456>.
LCV also stands for:
- LüTfen Cevap Veriniz
- Laboratoire Central Vétérinaire
- Landing Craft Vehicle
- large cell variant
- Las Cajas de Veracruz (Banks Veracruz)
... and 13 more »
Nearby & related abbreviations:
Alternative search:
- Search Lucca, Italy on Amazon
- Search Lucca, Italy on Google


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I wrote a while back about a man named Dave who wrote me 4 times on an online dating site with the same message. It was so sad that it became funny, and after I wrote back to a couple of his emails telling him I appreciated the interest but did not feel we were a match, I gave up... read on
Rest in Peace Wade Belak
August 31, 2011 | 10:33 pm
Wade Belak, one of my favorite hockey players, died today in Toronto. He was married with two young daughters, and only 35 years old. The cause of death is unknown at this time, and while... read on


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-The revenge of the Rakazel-
Behold the roguish crow.
We named our captain in its image. Some believe that mortal hands cannot take the life of such a beast, for it is far too shrewd to return to the hell it once called home.
Captain Balbaris mocks at our admirations, saying that he himself is able to kill these demons. We remain silent, no one daring to laugh.
The quiet is what finally caught his attention. Only the crackling flames that licked sluggish at the remains of the battle could be heard. The gentle sound might never again be comforting during a campfire.
Balbaris tried to open his burning, soot-filled eyes. For a frightening moment he believed himself blinded, but after a few searing blinks he began to recognize, bit by bit, the contours of the battlefield.
The silhouettes of his fallen companions were flickering dark spots against the garish red of the fire. Balbaris weighed the possibilities of his men escaping the flame roller. No. The bitter truth sank in. Whether now a blessing or a curse, one had survived.
"Crows cannot be killed."
Nevertheless, the ridiculous nickname his crew had bestowed him and made him famous proved accurate. He had never been able to make friends with it. He resisted the desire to laugh and instead lay in his hiding place. His long hair hung lank in his face. The stinking cake of soot, sweat and blood, equal parts his opponents and his own, clung to his skin. Working more out of instinct than actual higher thought, he had found a burning shelter and miraculously escaped the watchful eyes of the knight's guard. He felt like a coward, but at least he was alive. But had he not fought well? With his sword in hand he had proven himself as a daring opponent. No pompous knight of the fop's army was an enemy for him, but with this one attack they had surprised him. Even he had to admit that he had entered the trap like a fool, for while the shrewdness of Balbaris was well known, he was powerless when the magician came into play. One single flame roller and the fight was decided.
They called this high-raking swine Jelester. The mage had slaughtered his crew, but his spongey, fat face expressed neither joy nor disgust. He had been grim, virtually motionless. Could it be that he drew no elation from the burning of so many men? Balbaris would show him soon how to glory condingly in the defeat of his enemies.
The crackle quieted until the flames almost faded, finally. He rose. The burnt walls of his shelter crumbled around him. He knocked off the dust from his clothes and swayed a few steps over the soot-blackened ground. Once more the wind whirled stinging cinders into his face. His eyes flared in pain anew, but an internal power prevented him from turning away. Still he felt no fury, only bewilderment. Fury would come later, brought upon by the desire for justice, for vengeance. Those who were responsible would have to atone.
There was no mistake that even one of the corpses charred unrecognizable was still alive So Balbaris wasted no time in verifying the dead bodies like a fool. For a short, melancholic moment Balbaris considered taking leave to a nearby field and building a small memorial to his men. He rejected the sentiment - he would be putting himself on display. No one should know that one of the Razakel had survived.
He had to keep going. His revenge had to restore the honor of his fallen companions. In that moment he filed a silent oath to the souls of his men. Balbaris, captain of the Razakel, would fall into oblivion but not disappear. The crow withdrew his broken wings into the kingdom of the dead to repair and to awake, finally, again, anew.
Read next: Chapter 1 "Lourde"


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LEDYARD-PAWCATUCK AMERICAN LEGION BASEBALL: Welcome
Centerfield (Let's Go!)
Ledyard - Pawcatuck
Season News
The 2015 LP Season is just around the corner if you could believe it. We want to welcome all returning eligible players as well as new players desiring to play American Legion Baseball in 2015 with the Ledyard-Pawcatuck program.
The 2015 Senior and Junior Team tryouts will be held on Saturday May 30th and Sunday May 31st at Ledyard High School from 10:00-12:30pm. More information as we get closer to the tryout dates will be provided so stay tune.
The 2014 Award Winners
Most Valuable Player: Troy Stefanski - OF / SS / P
Rookie of the Year: Bryce Bedard - P / 3B / DH
Unsung Hero: Michael Dellaporta - 2B / P
Most Valuable Player: Michael Bruce - P / SS
Unsung Hero: Sam Foster - CF / P
Monday, November 17
2015 Age Eligibility:
As of Jan 1st-Dec 31st 2015:
Players born in the years of 1996 (age 19) and 1997 (age 18) must play at the senior level.
Monday, November 17
2015 Age Eligibility:
As of Jan 1st-Dec 31st 2015
Player born from the years of 1998 (age 17) through 2002 (age 13) are eligible for Juniors.
Monday, August 4
Congratulations to Troy Stefanski and Jordan Kowalski for being selected to the Zone 6 All Star team. Troy was also selected as the Most Valuable Player in Zone 6. You can see their complete stats in the handout section on the left. Congratulations to both!
Monday, July 21
The final stats are shown in the handouts section. Click on the handout tab in the menu on the left.
For information about Ledyard-Pawcatuck Legion Baseball contact:
Dave Cruz
209 Iron Street, Ledyard, CT 06339
860-235-5849 or 860-694-2873


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Aussie Farmers Direct
Customer Reviews for Aussie Farmers Direct, 91 reviews
I've found the meat to be reasonable quality. I tried the fruit and veg a few times but was disappointed in the quality of produce (also no option to list likes/dislikes that some other services offer).
I like the idea of supporting farmers rather than the supermarket chains so have continued ordering milk + a few other items eg tasty cheese that I have been happy with."
They also offer our school a small percentage of the profit from the people who nominate their school."
By feigyg -
100% Trust
5th April 2013 11:51 pm
"Glad to hear you enjoy this service I hve been considering using this myself at some point. Good to know they are a good company"
I have noticed however with my credit card currently being replaced due to (not connected) suspect activity, they have been calling every second day for payment even though they are fully aware of the issue. Slow in paying? they are fully on top of that one, just the food, yeah, not so important ugh."
I'm certainly not going to be out there at 3:30am bringing the bag in, so on warm nights, or even just mild nights, I put several ice bricks in the bag, to ensure the contents are kept cold. I've never had a problem with the food spoiling or animals getting to it.
I tried setting up a regular order for a while, but my needs were too variable, so these days I just submit a one-off order once a week or so. Despite this variability, the milkman has never failed to deliver exactly what I've ordered, except on one occasion a few weeks ago when he didn't turn up at all. I was straight on the phone the next morning to Aussie Farmers, who apologised and promptly refunded the money back into my account while I was still on the phone. They didn't know why the delivery didn't arrive, but their best guess was that the regular driver was sick and his replacement made a mistake.
Regarding the quality of the produce: the milk, butter and free-range eggs are all fine. No complaints whatsoever. It would be nice if the Greek-style plain yoghurt came in a size smaller than 500g, as the flavoured yoghurts do, but that's a minor quibble. It would be even nicer if the cream and yoghurt had longer use-by dates on them - they can vary quite a bit, and sometimes they are shorter than I had hoped for. And I occasionally order marinated prawns, which are fine, if a bit pricey.
Some of the other products I'm not so crazy about, although your mileage may vary. I've tried several breads, including the "gourmet" ones, and they're just ordinary. I can get far better ones at my local bakery. The sweet bagels don't taste like authentic boiled bagels to me, despite the fact that they're made by Glicks; they lack the chewiness that a bagel is supposed to have, and are more like a soft sweet bun with a hole in the middle.
And the meat pies I ordered were seriously awful, with big lumps of fat and gristle. Yuk. Never ordering those again. (The apple pie is fine, though.) I see that Aussie Farmers have added lasagnes to their range of products, and I'm interested, but after experiencing the horrible meat pies, I'm wary. I'd be interested to know what other customers think of the lasagnes.
I can't comment on their fruit and veg as I've never tried them.
Overall, I can highly recommend this service for convenience, for reliability (although perhaps that depends on which suburb you live in), for the helpfulness of the people on the other end of the phone, and for the quality of its milk, butter, and eggs. I've marked the Quality score down a little because some of the other products were disappointing. But if you want the convenience of home-delivered produce, and you'd like to help farmers and to make a dent in the profits of the Big Two supermarkets at the same time, I can recommend this service."
By janeb9 -
100% Trust
1st November 2011 11:06 pm
"Yes i am in total agreeance with this feedback, where Aussie Farmers deliver in the wee early hours of the morning, I ordered some milk, cheese and apple pies and my order arrived at 2.30am which is a ridicoulus time to be delivering it more like very late at night for delivery rather than early morning. Only unlike the other comment where there items werent eaten. I wasnt so lucky, so creature ate half of the apple pie with the gladwrap also. I rang Farmers Direct and they refunded my money. I have returned once since, but im not in any rush to return to them."
By Bonnie2 -
100% Trust
2nd November 2011 12:28 am
"@janeb9, I don't consider 2:30am a necessarily ridiculous delivery time, unless you live in the tropical north, nor is the scavenging animal problem guaranteed to be prevented by a later delivery time. Would it not be possible to use an animal-proof container rather than the Aussie Farmers bag - say an esky with the lid locked into place - with a note on top to let the milkman know to put the delivery inside it? When I wrote my review above, I didn't mean to imply I was unhappy with Aussie Farmers' early delivery. It doesn't bother me at all. Ice bricks keep the contents cold, and if I ever had a problem with scavenging animals, I'd simply switch to an esky. I mentioned the early delivery time only because it was such a contrast to @Ruthie's delivery time, and she lives very near me."
By tomboy64 -
50% Trust
27th January 2012 2:03 pm
"no - have to agree completely. tried them once and the bread and stuff were delivered somewhere near 3am waking everyone in the house. have not gone back to them. prefer to wake up early (but not that early) and walk down to the bakers"


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What does CCAC mean in Veterinary?
This page is about the meanings of the acronym/abbreviation/shorthand CCAC in the Medical field in general and in the Veterinary terminology in particular.
Canadian Council on Animal Care
Find a translation for CCAC in other languages:
Select another language:
Discuss this CCAC abbreviation with the community:
Use the citation below to add this abbreviation to your bibliography:
"CCAC." Abbreviations.com. STANDS4 LLC, 2015. Web. 4 Mar. 2015. <http://www.abbreviations.com/term/220311>.
CCAC also stands for:
- California College of Arts and Crafts
- Carolina Computer Access Center
- Cash Check And Charge
- Catholic Charities for the Archdiocese of Chicago
- Centre City Advisory Committee
... and 4 more »
Nearby & related abbreviations:
Alternative search:
- Search Canadian Council on Animal Care on Amazon
- Search Canadian Council on Animal Care on Google


text:
Nike+ Fuelband SE Unveiled by Brendan Dunne 1 Comments
January 28, 2013 BY John Kim / 0
How are your 2013 resolutions coming along? Yeah, we thought so. If you need some more encouragement to get off your tush and reach that personal best, beat your opponent, and get rid of excuses for good, check out this new great video of the Nike Fuel community and its goal to create the best "you" ever. Monitor your daily activity while competing with yourself and/or your fellow athlete now by joining the Nike+ community with the FuelBand in its various colorways – you'll definitely feel the urge after watching the jolting video below.
Tags: Nike+ FuelBand
Nike+ Fuelband SE Unveiled by Brendan Dunne 1 Comments
Nike+ Fuel "Fuelie" Figurine by John Kim 3 Comments
Nike Presents The NikeFuel+ Zine by John Kim 0 Comments
Nike Hyperdunk+ Premium Console by Aaron Hope 2 Comments
Nike House Of Innovation at Selfridges by John Kim 0 Comments


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Residents of Domlur were flummoxed when plainclothesmen claiming to be police officials arrived on their doorstep earlier this month and asked them to fill a form containing personal questions on their daily routine.
"What time do you go for a walk?"; "How many members are there in your family?"; and "Who will be at home when you are away?"; were some of the questions posed to the residents.
Homemaker Lakshmi Mani was obviously uncomfortable sharing such personal details with apparent strangers.
However, she soon learnt that the probing questions on her family were part of the City Police Department's Crime Prevention Month activities held in December each year.
Though the purpose of the exercise is to step up security in the area as part of the Crime Prevention Programme, the residents confessed that they were uneasy about revealing personal information.
Another resident in the area, businessman Santhosh Hegde, said a couple of people in civil dress, introducing themselves as policemen from Ulsoor police station, handed over similar forms to the residents.
"However, they said they would collect the forms the next day. If they had immediately demanded the submission of the forms, then I too would have been concerned," he added.
Mr. Hegde found certain questions rather intrusive. "They asked us basic details and also whether we knew which police station numbers to contact in case of an emergency in our area. But, they also wanted to know what time I moved out of the house and who are the family members at home when I am away. These were perhaps not necessary," he said.
Official's view
When The Hindu contacted Ulsoor police station, the officials said the plainclothesmen sent to the houses of residents were indeed police officials. "They had been sent to talk to the residents and get an idea about the level of security in their respective areas," a police officer said.
A senior police official said the city police observes Crime Prevention Month every year in December, which also includes holding awareness programmes and competitions throughout the month.
Personal questions
However, he said personal questions need not be entertained by the public.
"The month is observed mainly to reduce crime and create awareness about it. There is no need for questions that are personal in nature to be asked."
City Police Commissioner B.G. Jyothi Prakash Mirji had attended a crime prevention programme held on CMR College premises in HRBR Layout on Thursday.