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(Updated April 2015)
This is a branch of medicine that uses radiation to provide information about the functioning of a person's specific organs or to treat disease. In most cases, the information is used by physicians to make a quick, accurate diagnosis of the patient's illness. The thyroid, bones, heart, liver and many other organs can be easily imaged, and disorders in their function revealed. In some cases radiation can be used to treat diseased organs, or tumours. Five Nobel Laureates have been intimately involved with the use of radioactive tracers in medicine.
Over 10,000 hospitals worldwide use radioisotopes in medicine, and about 90% of the procedures are for diagnosis. The most common radioisotope used in diagnosis is technetium-99, with some 40-45 million procedures per year (16.7 million in USA in 2012, 550,000 in Australia), accounting for 80% of all nuclear medicine procedures worldwide.
In developed countries (26% of world population) the frequency of diagnostic nuclear medicine is 1.9% per year, and the frequency of therapy with radioisotopes is about one tenth of this. In the USA there are over 20 million nuclear medicine procedures per year among 311 million people, and in Europe about 10 million among 500 million people. In Australia there are about 560,000 per year among 21 million people, 470,000 of these using reactor isotopes. The use of radiopharmaceuticals in diagnosis is growing at over 10% per year.
The global radioisotope market was valued at $4.8 billion in 2012, with medical radioisotopes accounting for about 80% of this, and is poised to reach about $8 billion by 2017. North America is the dominant market for diagnostic radioisotopes with close to half of the market share, while Europe accounts for about 20%.
Nuclear medicine was developed in the 1950s by physicians with an endocrine emphasis, initially using iodine-131 to diagnose and then treat thyroid disease. In recent years specialists have also come from radiology, as dual CT/PET procedures have become established.
Computed X-ray tomography (CT) scans and nuclear medicine contribute 36% of the total radiation exposure and 75% of the medical exposure to the US population, according to a US National Council on Radiation Protection & Measurements report in 2009. The report showed that Americans' average total yearly radiation exposure had increased from 3.6 millisievert to 6.2 mSv per year since the early 1980s, due to medical-related procedures. (Industrial radiation exposure, including that from nuclear power plants, is less than 0.1% of overall public radiation exposure.)
An important nuclear medicine procedure is Magnetic Resonance Imaging (MRI), which uses powerful magnets and radio waves to create cross-sectional images of organs and internal structures in the body. It does not use radioisotopes or ionizing radiation, but relies on nuclear magnetic resonance of hydrogen.
Diagnostic techniques in nuclear medicine use radioactive tracers which emit gamma rays from within the body. These tracers are generally short-lived isotopes linked to chemical compounds which permit specific physiological processes to be scrutinised. They can be given by injection, inhalation or orally. The first type are where single photons are detected by a gamma camera which can view organs from many different angles. The camera builds up an image from the points from which radiation is emitted; this image is enhanced by a computer and viewed by a physician on a monitor for indications of abnormal conditions.
A more recent development is Positron Emission Tomography (PET) which is a more precise and sophisticated technique using isotopes produced in a cyclotron. A positron-emitting radionuclide is introduced, usually by injection, and accumulates in the target tissue. As it decays it emits a positron, which promptly combines with a nearby electron resulting in the simultaneous emission of two identifiable gamma rays in opposite directions. These are detected by a PET camera and give very precise indication of their origin. PET's most important clinical role is in oncology, with fluorine-18 as the tracer, since it has proven to be the most accurate non-invasive method of detecting and evaluating most cancers. It is also well used in cardiac and brain imaging.
New procedures combine PET with computed X-ray tomography (CT) scans to give co-registration of the two images (PETCT), enabling 30% better diagnosis than with traditional gamma camera alone. It is a very powerful and significant tool which provides unique information on a wide variety of diseases from dementia to cardiovascular disease and cancer (oncology).
Positioning of the radiation source within the body makes the fundamental difference between nuclear medicine imaging and other imaging techniques such as x-rays. Gamma imaging by either method described provides a view of the position and concentration of the radioisotope within the body. Organ malfunction can be indicated if the isotope is either partially taken up in the organ (cold spot), or taken up in excess (hot spot). If a series of images is taken over a period of time, an unusual pattern or rate of isotope movement could indicate malfunction in the organ.
A distinct advantage of nuclear imaging over x-ray techniques is that both bone and soft tissue can be imaged very successfully. This has led to its common use in developed countries where the probability of anyone having such a test is about one in two and rising.
The mean effective dose is 4.6 mSv per diagnostic procedure.
Rapidly dividing cells are particularly sensitive to damage by radiation. For this reason, some cancerous growths can be controlled or eliminated by irradiating the area containing the growth.
External irradiation (sometimes called teletherapy) can be carried out using a gamma beam from a radioactive cobalt-60 source, though in developed countries the much more versatile linear accelerators are now being utilised as a high-energy x-ray source (gamma and X-rays are much the same). An external radiation procedure is known as the gamma knife radiosurgery, and involves focusing gamma radiation from 201 sources of cobalt-60 sources on a precise area of the brain with a cancerous tumour. Worldwide, over 30,000 patients are treated annually, generally as outpatients.
Internal radionuclide therapy is by administering or planting a small radiation source, usually a gamma or beta emitter, in the target area. Short-range radiotherapy is known as brachytherapy, and this is becoming the main means of treatment. Iodine-131 is commonly used to treat thyroid cancer, probably the most successful kind of cancer treatment. It is also used to treat non-malignant thyroid disorders. Iridium-192 implants are used especially in the head and breast. They are produced in wire form and are introduced through a catheter to the target area. After administering the correct dose, the implant wire is removed to shielded storage. This brachytherapy (short-range) procedure gives less overall radiation to the body, is more localised to the target tumour and is cost effective.
Treating leukaemia may involve a bone marrow transplant, in which case the defective bone marrow will first be killed off with a massive (and otherwise lethal) dose of radiation before being replaced with healthy bone marrow from a donor.
Many therapeutic procedures are palliative, usually to relieve pain. For instance, strontium-89 and (increasingly) samarium 153 are used for the relief of cancer-induced bone pain. Rhenium-186 is a newer product for this.
Lutetium-177 dotatate or octreotate is used to treat tumours such as neuroendocrine ones, and is effective where other treatments fail. A series of four treatments delivers 32 GBq. After about four to six hours, the exposure rate of the patient has fallen to less than 25 microsieverts per hour at one metre and the patients can be discharged from hospital. Lu-177 is essentially a low-energy beta-emitter (with some gamma) and the carrier attaches to the surface of the tumour.
A new field is Targeted Alpha Therapy (TAT) or alpha radioimmunotherapy, especially for the control of dispersed cancers. The short range of very energetic alpha emissions in tissue means that a large fraction of that radiative energy goes into the targeted cancer cells, once a carrier such as a monoclonal antibody has taken the alpha-emitting radionuclide such as Bi-213 to exactly the right places. Clinical trials for leukaemia, cystic glioma and melanoma are under way. TAT using lead-212 is said to show promise for treating pancreatic, ovarian and melanoma cancers.
An experimental development of this is Boron Neutron Capture Therapy using boron-10 which concentrates in malignant brain tumours. The patient is then irradiated with thermal neutrons which are strongly absorbed by the boron, producing high-energy alpha particles which kill the cancer. This requires the patient to be brought to a nuclear reactor, rather than the radioisotopes being taken to the patient.
Radionuclide therapy has progressively become successful in treating persistent disease and doing so with low toxic side-effects. With any therapeutic procedure the aim is to confine the radiation to well-defined target volumes of the patient. The doses per therapeutic procedure are typically 20-60 Gy.
Treatment may involve significant radioactivity, e.g. 4.4 GBq is quoted as an average dose of iodine-131 for thyroid ablation, and up to 11 GBq for patients with advanced metastatic disease. According to US regulatory guidelines for I-131, the patient can be released if the activity is below 1.2 GBq, or 0.07 mSv/hr at 1 metre. Meanwhile a lot of I-131 is flushed down the hospital toilet and plumbing needs to be shielded accordingly.
It is very easy to detect the presence or absence of some radioactive materials even when they exist in very low concentrations. Radioisotopes can therefore be used to label molecules of biological samples in vitro (out of the body). Pathologists have devised hundreds of tests to determine the constituents of blood, serum, urine, hormones, antigens and many drugs by means of associated radioisotopes. These procedures are known as radioimmuno-assays and, although the biochemistry is complex, kits manufactured for laboratory use are very easy to use and give accurate results. In Europe some 15 million of these in vitro analyses are undertaken each year.
Gamma irradiation is widely used for sterilising medical products and supplies such as syringes, gloves, clothing and instruments, many of which would be damaged by heat sterilisation. Cobalt-60 is the main isotope used, since it is an energetic gamma emitter. Large-scale irradiation facilities for gamma sterilisation are in many countries. Smaller gamma irradiators, often with Cs-137, are used for treating blood for transfusions and for other medical applications.
Every organ in our bodies acts differently from a chemical point of view. Doctors and chemists have identified a number of chemicals which are absorbed by specific organs. The thyroid, for example, takes up iodine, the brain consumes quantities of glucose, and so on. With this knowledge, radiopharmacists are able to attach various radioisotopes to biologically active substances. Once a radioactive form of one of these substances enters the body, it is incorporated into the normal biological processes and excreted in the usual ways.
Diagnostic radiopharmaceuticals can be used to examine blood flow to the brain, functioning of the liver, lungs, heart or kidneys, to assess bone growth, and to confirm other diagnostic procedures. Another important use is to predict the effects of surgery and assess changes since treatment.
The amount of the radiopharmaceutical given to a patient is just sufficient to obtain the required information before its decay. The radiation dose received is medically insignificant. The patient experiences no discomfort during the test and after a short time there is no trace that the test was ever done. The non-invasive nature of this technology, together with the ability to observe an organ functioning from outside the body, makes this technique a powerful diagnostic tool.
A radioisotope used for diagnosis must emit gamma rays of sufficient energy to escape from the body and it must have a half-life short enough for it to decay away soon after imaging is completed.
The radioisotope most widely used in medicine is technetium-99m, employed in some 80% of all nuclear medicine procedures – hence some 30 million per year, of which 6-7 million are in Europe, 15 million in North America, 6-8 million in Asia/Pacific (particularly Japan), and 0.5 million in other regions. It is an isotope of the artificially-produced element technetium and it has almost ideal characteristics for a nuclear medicine scan. These are:
Its logistics also favour its use. Technetium generators, a lead pot enclosing a glass tube containing the radioisotope, are supplied to hospitals from the nuclear reactor where the isotopes are made. They contain molybdenum-99, with a half-life of 66 hours, which progressively decays to technetium-99. The Tc-99 is washed out of the lead pot by saline solution when it is required. After two weeks or less the generator is returned for recharging.
A similar generator system is used to produce rubidium-82 for PET imaging from strontium-82 - which has a half-life of 25 days.
Myocardial Perfusion Imaging (MPI) uses thallium-201 chloride or technetium-99m and is important for detection and prognosis of coronary artery disease.
Canadian 2006 data shows that 56% of Tc-99 use there is in myocardial ischemia perfusion, 17% in bone scans, 7% in liver/hepatobiliary, 4% respiratory, 3% renal, 3% thyroid.
For PET imaging, the main radiopharmaceutical is Fluoro-deoxy glucose (FDG) incorporating F-18 – with a half-life of just under two hours – as a tracer. The FDG is readily incorporated into the cell without being broken down, and is a good indicator of cell metabolism.
In diagnostic medicine, there is a strong trend to using more cyclotron-produced isotopes such as F-18 as PET and CT/PET become more widely available. However, the procedure needs to be undertaken within two hours reach of a cyclotron, which limits their utility compared with Mo/Tc-99.
For some medical conditions, it is useful to destroy or weaken malfunctioning cells using radiation. The radioisotope that generates the radiation can be localised in the required organ in the same way it is used for diagnosis – through a radioactive element following its usual biological path, or through the element being attached to a suitable biological compound. In most cases, it is beta radiation which causes the destruction of the damaged cells. This is radionuclide therapy (RNT) or radiotherapy. Short-range radiotherapy is known as brachytherapy, and this is becoming the main means of treatment.
Although radiotherapy is less common than diagnostic use of radioactive material in medicine, it is nevertheless widespread, important and growing. An ideal therapeutic radioisotope is a strong beta emitter with just enough gamma to enable imaging, eg lutetium-177. This is prepared from ytterbium-176 which is irradiated to become Yb-177 which decays rapidly to Lu-177. Yttrium-90 is used for treatment of cancer, particularly non-Hodgkin's lymphoma and liver cancer, and it is being used more widely, including for arthritis treatment. Lu-177 and Y-90 are becoming the main RNT agents.
Iodine-131, samarium-153 and phosphorus-32 are also used for therapy. Iodine-131 is used to treat the thyroid for cancers and other abnormal conditions such as hyperthyroidism (over-active thyroid). In a disease called Polycythemia vera, an excess of red blood cells is produced in the bone marrow. Phosphorus-32 is used to control this excess.
A new and still experimental procedure uses boron-10, which concentrates in the tumour. The patient is then irradiated with neutrons which are strongly absorbed by the boron, to produce high-energy alpha particles which kill the cancer.
For targeted alpha therapy (TAT), actinium-225 is readily available, from which the daughter bismuth-213 can be obtained (via 3 alpha decays) to label targeting molecules. The bismuth is obtained by elution from an Ac-225/Bi-213 generator similar to the Mo-99/Tc-99 one. Bi-213 has a 46-minute half-life. The actinium-225 (half-life 10 days) is formed from radioactive decay of radium-225, the decay product of long-lived thorium-229, which is obtained from decay of uranium-233, which is formed from Th-232 by neutron capture in a nuclear reactor.
Another radionuclide recovered from thorium-232 is lead-212, with half-life of 10.6 hours, which can be attached to monoclonal antibodies for cancer treatment by TAT. A Ra-224/Pb-212 generator system similar to the Mo-99/Tc-99 one is used to provide lead-212 from radium-224 (via Rn-220 and Po-216). Pb-212 has a half-life of 10.6 hours, and beta decays to bismuth-212, then most beta decays to polonium-212. The alpha decays of Bi-212 and Po-212 are the active ones destroying cancer cells over a couple of hours. Stable Pb-208 results, via thallium-208 for the bismuth decay.
Considerable medical research is being conducted worldwide into the use of radionuclides attached to highly specific biological chemicals such as immunoglobulin molecules (monoclonal antibodies). The eventual tagging of these cells with a therapeutic dose of radiation may lead to the regression – or even cure – of some diseases.
In 2006 Britain witnessed the apparent murder of one of its newer citizens, a former Russian intelligence official, by poisoning with radioactive polonium. His death was slow and excruciating.
Polonium has about 26 isotopes, all of which are radioactive. Webelements periodic table says that it is 250 billion times more toxic than hydrocyanic acid. It is readily soluble in weak acid. (It was the first element discovered by Marie Curie, in 1898, and named after her native Poland. Her daughter Irene was contaminated with polonium in a laboratory accident and died of leukemia at the age of 59.)
Polonium-210 is the penultimate decay product of U-238, before it alpha decays to become stable lead. It results from the beta decay of Pb-210 (in the U-238 decay series) to Bi-210 which rapidly beta decays to Po-210. This gives rise to its occurrence in nature, where uranium is ubiquitous. However, because of its short (138 day) half life, very little Po-210 would be found in uranium ore or mill tailings (Webelements suggests 0.1 mg/tonne). Po-210 levels in soil would be even less, but it is concentrated in tobacco and traces of it can be found in smokers' urine.
Po-210 can also be made by neutron irradiation of Bi-209, and that is most likely source of any significant quantity. Russia has used Po-210 as a heat source in short-life spacecraft and lunar rovers. It also operates reactors using lead-bismuth cooling, which becomes contaminated with Po-210 due to neutron bombardment.
Because its half-life is so short, a gram of Po-210 is about 5000 times as radioactive as a gram of radium – which sets the standard of activity. But at 138 days its half-life is long enough for it to be manufactured, transported and administered before it loses its potency. It would not put the carrier at much risk, since alpha radiation is only really a hazard inside the body – a layer of skin is protection. About 10 micrograms (2 GBq) was said to have been used, administered in a cup of tea (it would be warm due to the decay).
However, simply dosing someone with polonium might not have much effect if it simply went in one end and out the other in a day or two without being absorbed from the gut. It would probably need to be complexed on to an organic carrier which would enter the bloodstream and take it to vital organs where it would stay. (This is what happens with targeted alpha therapy (TAT) using very low levels of alpha-active radioisotopes: the carriers take them to dispersed cancerous tissues where they are needed.)
In Mr Litvinenko's case the intense alpha radiation was reportedly in vital organs and sufficient to destroy them over three weeks. It was apparently over one hundred times the dose used in TAT for cancer treatment and the Po-210 is much longer-lived than isotopes used for TAT. It could have been attached to something as simple as a sugar.
In 2003 an investigative journalist in Russia, Yuri Shchekochikhin was fatally poisoned, and in 2004 a St Petersburg businessman Romam Tsepov met a similar fate, his symptoms closely resembling those of Livinenko. Both are considered to have been radiologically poisoned.
The main world isotope suppliers are Mallinckrodt Pharmaceuticals (Ireland), MDS Nordion (Canada), IRE (Europe), NTP (South Africa), Isotop-NIIAR (Russia) and ANSTO (Australia).
Most medical radioisotopes made in nuclear reactors are sourced from relatively few research reactors, including:
Of fission radioisotopes, the vast majority of demand is for of Mo-99 (for Tc-99m), and the world market is some US$ 550 million per year. About 40% of it is supplied by MDS Nordion, 25% from Mallinckrodt (formerly Covidien), 17% from IRE and 10% from NTP. Over 90% of the Mo-99 is made in five reactors: NRU in Canada (30-40%), HFR in Netherlands (30%), BR-2 in Belgium (10%), Osiris in France (5%), Maria in Poland (5%), Safari-1 in South Africa (10-15%) and OPAL in Australia (5%). Output from each varies due to maintenance schedules.
Russia is keen to increase its share of world supply, and in 2012 some 66% of its radioisotope production was exported. For I-131, 75% is from IRE, 25% from NTP.
World demand for Mo-99 was 23,000 six-day TBq/yr* in 2012, but has apparently dropped back to about 19,500 since. Mo-99 is mostly produced by fission of U-235 targets in a nuclear research reactor, much of this using high-enriched uranium (HEU) targets. The targets are then processed to separate the Mo-99 and also to recover I-131. OPAL, Safari, and increasingly other reactors such as Maria use low-enriched uranium (LEU) targets, which adds about 20% to production costs. However, in medical imaging, the cost of Mo-99 itself is small relative to hospital costs. Mo-99 can also be made by bombarding Mo-98 with neutrons in a reactor. However, this activation Mo-99 has relatively low specific activity, with a maximum of 74 GBq/g (depending on the neutron flux available in the reactor), compared with 185 TBq/g or more for conventional fission-produced Mo-99.
* 23,000 TBq is on basis of activity at 6 days from production reference point, ie 22% of nearly 100,000 TBq required in production processing (given 66 hour half-life). This is still about two days from the end of irradiation, so some 167,000 TBq/yr must be made in the actual reactors to allow for cooling, processing and decay en route to the users.
A number of incidents in 2008 pointed up shortcomings and unreliability in the supply of medical isotopes, particular technetium. As indicated above, most of the world's supply of Mo-99 for this comes from only five reactors, all of them 43 to 52 years old (in mid 2010). The Canadian and Netherlands reactors required major repairs over 2009-10 and were out of action for some time. Osiris is due to shut down in 2015. NRU at Chalk River has been re-licensed to 2016, and AECL is planning to extend operation to March 2018. A new 20 MW South Korean reactor at Busan is expected to be operating in 2016. An increasing supply shortfall of Tc-99 was forecast from 2010, and the IAEA is encouraging new producers. During the 2009-10 supply crisis, South Africa's (NECSA) Safari was able to supply 25% of the supply of Mo-99. Australia's Opal reactor has the capacity to produce half the world supply of it, and ANSTO is building a much larger Mo-99 production facility to be on line in mid-2016 and ramp up quickly to 130 six-day TBq per week, to meet one-third of world demand, with exports to USA, Japan, China and Korea. Also the processing and distribution of isotopes is complex and constrained, which can be critical when the isotopes concerned are short-lived. A need for increased production capacity and more reliable distribution is evident. The Mo-99 market is about $5 billion per year, according to NECSA.
In 2009 the NEA set up the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) to strengthen the reliability of Mo-99 and Tc-99 supply in the short, medium and long term. It reviewed the Mo-99 supply chain to identify the key areas of vulnerability, the issues that need to be addressed and the mechanisms that could be used to help resolve them. It requested an economic study of the supply chain, and this was published in 2010 by the NEA. The report identifies possible changes needed. The historical development of the market has an impact on the present economic situation, which is unsustainable. The supply chain's economic structure therefore needs to be changed to attract additional investment in production capacity as well as the necessary reserve capacity, and all supply chain participants worldwide need to agree on and implement the changes needed.
The NEA report predicts supply shortages from 2016, not simply from reactors but due to processing limitations. Historically reactor irradiation prices have been too low to attract new investment, and full cost recovery is needed to encourage new infrastructure. This will have little impact on end prices since irradiation only accounts for about 1% of product cost. Transport regulation and denial of shipment impede reliable supply. HEU use needs to be minimised, though conversion to LEU targets will reduce capacity. Outage reserve capacity needs to be sourced, valued and paid for by the supply chain. Fission is the most efficient and reliable means of production, but Canada and Japan are developing better accelerator-based techniques.
This led in December 2014 to a NEA Joint Declaration on the Security of Supply of Medical Radioisotopes, focused on Mo-99, which is so far supported by 13 countries: Australia, Canada, France, Germany, Japan, the Netherlands, Poland, South Korea, Russia, South Africa, Spain, the UK and the USA.
The US Congress has called for all Mo-99 to be supplied by reactors running on low-enriched uranium (LEU), instead of high-enriched uranium (HEU). Also it has called for proposals for an LEU-based supply of Mo-99 for the US market, reaching 111 six-day TBq per week by mid-2013, a quarter of world demand. Tenders for this closed in June 2010, but evidently no immediate progress was made. In December 2012 Congress passed the American Medical Isotope Production Act of 2011 to establish a technology-neutral program to support the production of Mo-99 for medical uses in the USA by non-federal entities.
In mid-2013 Los Alamos National Laboratory announced that had recovered Mo-99 from low-enriched sulphate reactor fuel in solution, raising the prospect of this process becoming associated with commercial reprocessing plants as at La Hague in France.
In January 2009 Babcock & Wilcox (B&W) announced an agreement with international isotope supplier Covidien to produce Mo-99 sufficient for half of US demand, if a new process involving an innovative reactor and separation technology is successful. They planned to use Aqueous Homogeneous Reactor (AHR) technology with low-enriched uranium in small 100-200 kW units units where the fuel is mixed with the moderator and the U-235 forms both the fuel and the irradiation target.* A single production facility could have four such reactors. B&W and Covidien expected a five-year lead time to first production. B&W received $9 million towards this Medical Isotope Production System (MIPS) in 2010 from the US government and completed the R&D and conceptual design phase in 2012. However, in October 2012 Covidien pulled out of the joint venture with B&W "after learning that the time and cost involved with the project would be greater than originally expected." Covidien said that it was "making significant long-term capital investment in a new Tc-99m generator facility at our US plant, and conversion from HEU- to LEU-based Mo-99 production at our processing plant in the Netherlands." B&W appears to have dropped the MIPS.
* LEU is dissolved in acid then brought to criticality in a 200-litre vessel. As fission proceeds the solution is circulated through an extraction facility to remove the fission products with Mo-99 and then back into the reactor vessel, which is at low temperature and pressure.
In the USA, Northstar Medical Technologies founded in 2006 is planning to use the University of Missouri research reactor (MURR) to irradiate Mo-98 targets with neutrons, producing activation Mo-99. Such Mo-99 has relatively low specific activity, and there are complications then in separating the Tc-99. Production was envisaged from mid-2014, rising to meet half of US demand. In November 2013 the company was awarded a $21.8 million cooperative agreement half funded by NNSA to support its "non-uranium based Mo-99 production by neutron capture". A further $5.2 million grant from NNSA was in November 2014. Longer-term Northstar is considering a non-reactor approach – see below.
In 2014 another plan using the US University Reactor Network was announced. Northwest Medical Isotopes LLC (NWMI) plans to produce half of North America's demand for Mo-99 from 2017, using LEU targets. It has licensed the process for small Triga reactors from Oregon State University, which operates one of the 35 in USA, a Triga MkII of 1.1 MW. It is setting up its 44,600 sq metre radioisotope production facility at the University of Missouri's Research Park at Columbia, Missouri. It is not clear whether this involves the University of Missouri research reactor (MURR).
In February 2015 Nordion and its US parent Sterigenics International announced a new arrangement with the University of Missouri research reactor (MURR) and General Atomics to produce Mo-99 from LEU targets from 2017 using the 10 MW pool type reactor. This new medical isotope supply will be produced using General Atomics' innovative Selective Gaseous Extraction (SGE) technology to extract the Mo from the targets.
In the USA Coquí Pharmaceuticals has signed a contract with Argentinian nuclear engineering company INVAP to build an open-pool reactor similar to Australia's Opal, using LEU targets, and a Mo-99 production facility at Alachua county, Florida.
In Russia, the Research Institute of Atomic Reactors (NIIAR or RIAR, with three reactors for isotope production) and Trans-regional Izotop Association (VA Izotop JSC) established a joint venture, Isotop-NIIAR to produce Mo-99 at Dimitrovgrad from 2010. Phase 1 of the Mo-99 production line with capacity of 1700 TBq/yr was commissioned in December 2010, reaching capacity in May 2011, and Phase 2 started in February and commissioned in June 2012 will take capacity to 1480 TBq/yr (evidently 6-day activity). Earlier reports quoted 4800 TBq/yr, and Rosatom aims for 20% of the world Mo-99 market by 2014, supplied internationally through Nordion. Since 2009, VA Izotop has been authorized by Rosatom to control all isotope production and radiological devices in Russia. In September 2010 JSC Izotop signed a framework agreement with MDS Nordion to explore commercial opportunities outside Russia on the basis of this Isotop-NIIAR JV, initially over ten years.
At Russia's Kurchatov Institute the 20 kW ARGUS Aqueous Homogeneous Reactor (AHR) has operated since 1981, and R&D on producing Mo-99 from it is ongoing. (See process description above, re B&W and MIPS).
Technetium-99m or molybdenum-99 can also be produced in small quantities from cyclotrons and accelerators, in a cyclotron by bombarding a Mo-100 target with a proton beam to produce Tc-99m directly, or in a linear accelerator to generate Mo-99 by bombarding a Mo-100 target with high-energy X-rays. It is generally considered that non-reactor methods of producing large quantities of Tc-99 are some years away. At present the cost is at least three times and up to ten times that of the reactor route, and Mo-100 is available only from Russia. If Tc-99 is produced directly in a cyclotron, it needs to be used quickly, and the co-product isotopes are a problem.
In the USA, SHINE Medical Technologies is developing an advanced accelerator technology for the production of Mo-99 as a fission product. It was awarded a $3.2 million grant from NNSA in November 2014, and it has a $125 million debt financing package from healthcare investment firm Deerfield Management. A low-enriched uranium target solution is irradiated with low-energy neutrons in a subcritical assembly – not a nuclear reactor. SHINE is an acronym for Subcritical Hybrid Intense Neutron Emitter. A plant at Janesville, Wisconsin, is planned eventually to supply 50% of the US demand for Mo-99, possibly starting in 2016.
In Canada the government has an Isotope Technology Acceleration Program (ITAP) to promote R&D on non-reactor based isotope production, particularly through the Medical Isotope Program (MIP). Canada Light Source Inc (CLS) in Saskatoon is using a linear accelerator to bombard Mo-100 targets with X-rays, and has produced some Mo-99 for MIP.
Northstar has long-term plans for producing Mo-99 from Mo-100 in an accelerator.
Main Mo-99 Production Reactors
Planned Mo-99 Production Capacity
* Six-day TBq/weekSource: Annex 1, 2 & 3, Supply of Medical Radioisotopes, March 2103, OECD/NEA
Cobalt-60 has mostly come from Candu power reactors by irradiation of Co-59 in special rods, and production is being expanded. Production sites include: Bruce B, Pickering and Gentilly in Canada; Embalse in Argentina; Qinshan Phase III units 1 and 2 in China; Wolsong 1 and 2 in South Korea (all Candu); and Leningrad 1 in Russia (RBMK). These were to be joined by the Clinton and Hope Creek BWRs in USA from 2012.
Areva Med is planning a plant at Caen in France to provide lead-212 from thorium. A radium-224/Pb-212 generator similar to the Mo-99/Tc-99 one enables the Pb-212 to be eluted as required.
The use of radioisotopes for medical diagnosis and treatments results in the generation of mainly low-level waste (LLW). This waste includes paper, rags, tools, clothing and filters, which contain small amounts of mostly short-lived radioactivity. These types of waste often undergo decay storage for periods of months to a few years before being disposed of at urban land-fill sites.
When radiography sources have decayed to a point where they are no longer emitting enough penetrating radiation for use in treatments, they are considered as radioactive waste. Sources such as Co-60 are treated as short-lived intermediate-level wastes (ILW). Other sources such as Radium-226, used in cancer therapy, will however require long-term storage and geological disposal as ILW, as a result of their higher level of long-lived radioactivity.
Australia's ANSTO is developing a co-located Synroc treatment plant for its wastes from Mo-99 production. It will treat legacy acid wastes as well as alkaline ones from ongoing production. The final storage volume with Synroc will be 1% of the same wastes cemented for disposal.
Many radioisotopes are made in nuclear reactors, some in cyclotrons. Generally neutron-rich ones and those resulting from nuclear fission need to be made in reactors, neutron-depleted ones are made in cyclotrons. There are about 40 activation product radioisotopes and five fission product ones made in reactors.
(half-life indicated)
Bismuth-213 (46 min): Used for targeted alpha therapy (TAT), especially cancers, as it has a high energy (8.4 MeV).
Caesium-137 (30 yr): Used for low-intensity sterilisation of blood.
Chromium-51 (28 d): Used to label red blood cells and quantify gastro-intestinal protein loss.
Cobalt-60 (5.27 yr): Formerly used for external beam radiotherapy, now almost universally used for sterilising.
Dysprosium-165 (2 h): Used as an aggregated hydroxide for synovectomy treatment of arthritis.
Erbium-169 (9.4 d): Use for relieving arthritis pain in synovial joints.
Holmium-166 (26 h): Being developed for diagnosis and treatment of liver tumours.
Iodine-125 (60 d): Used in cancer brachytherapy (prostate and brain), also diagnostically to evaluate the filtration rate of kidneys and to diagnose deep vein thrombosis in the leg. It is also widely used in radioimmuno-assays to show the presence of hormones in tiny quantities.
Iodine-131 (8 d)*: Widely used in treating thyroid cancer and in imaging the thyroid; also in diagnosis of abnormal liver function, renal (kidney) blood flow and urinary tract obstruction. A strong gamma emitter, but used for beta therapy.
Iridium-192 (74 d): Supplied in wire form for use as an internal radiotherapy source for cancer treatment (used then removed). Beta emitter.
Iron-59 (46 d): Used in studies of iron metabolism in the spleen.
Lead-212 (10.6 h): Used in TAT for cancers or alpha radioimmunotherapy, with decay products Bi-212 and Po-212 delivering the alpha particles. Used especially for melanoma, breast cancer and ovarian cancer.
Lutetium-177 (6.7 d): Lu-177 is increasingly important as it emits just enough gamma for imaging while the beta radiation does the therapy on small (eg endocrine) tumours. Its half-life is long enough to allow sophisticated preparation for use. It is usually produced by neutron activation of natural or enriched lutetium-176 targets.
Molybdenum-99 (66 h)*: Used as the 'parent' in a generator to produce technetium-99m.
Palladium-103 (17 d): Used to make brachytherapy permanent implant seeds for early stage prostate cancer.
Phosphorus-32 (14 d): Used in the treatment of polycythemia vera (excess red blood cells). Beta emitter.
Potassium-42 (12 h): Used for the determination of exchangeable potassium in coronary blood flow.
Rhenium-186 (3.8 d): Used for pain relief in bone cancer. Beta emitter with weak gamma for imaging.
Rhenium-188 (17 h): Used to beta irradiate coronary arteries from an angioplasty balloon.
Samarium-153 (47 h): Sm-153 is very effective in relieving the pain of secondary cancers lodged in the bone, sold as Quadramet. Also very effective for prostate and breast cancer. Beta emitter.
Selenium-75 (120 d): Used in the form of seleno-methionine to study the production of digestive enzymes.
Sodium-24 (15 h): For studies of electrolytes within the body.
Strontium-89 (50 d)*: Very effective in reducing the pain of prostate and bone cancer. Beta emitter.
Technetium-99m (6 h): Used in to image the skeleton and heart muscle in particular, but also for brain, thyroid, lungs (perfusion and ventilation), liver, spleen, kidney (structure and filtration rate), gall bladder, bone marrow, salivary and lacrimal glands, heart blood pool, infection and numerous specialised medical studies. Produced from Mo-99 in a generator.
Xenon-133 (5 d)*: Used for pulmonary (lung) ventilation studies.
Ytterbium-169 (32 d): Used for cerebrospinal fluid studies in the brain.
Ytterbium-177 (1.9 h): Progenitor of Lu-177.
Yttrium-90 (64 h)*: Used for cancer brachytherapy and as silicate colloid for the relieving the pain of arthritis in larger synovial joints. Pure beta emitter and of growing significance in therapy, especially liver cancer.
Radioisotopes of caesium, gold and ruthenium are also used in brachytherapy.
* fission product
Carbon-11, Nitrogen-13, Oxygen-15, Fluorine-18: These are positron emitters used in PET for studying brain physiology and pathology, in particular for localising epileptic focus, and in dementia, psychiatry and neuropharmacology studies. They also have a significant role in cardiology. F-18 in FDG (fluorodeoxyglucose) has become very important in detection of cancers and the monitoring of progress in their treatment, using PET.
Cobalt-57 (272 d): Used as a marker to estimate organ size and for in-vitro diagnostic kits.
Copper-64 (13 h): Used to study genetic diseases affecting copper metabolism, such as Wilson's and Menke's diseases, and for PET imaging of tumours, and therapy.
Copper-67 (2.6 d): Beta emitter, used in therapy.
Fluorine-18 as FLT (fluorothymidine), F-miso (fluoromisonidazole), 18F-choline: tracer.
Gallium-67 (78 h): Used for tumour imaging and localisation of inflammatory lesions (infections).
Gallium-68 (68 min): Positron emitter used in PET and PET-CT units. Derived from germanium-68 in a generator.
Germanium-68 (271 d): Used as the 'parent' in a generator to produce Ga-68.
Indium-111 (2.8 d): Used for specialist diagnostic studies, eg brain studies, infection and colon transit studies.
Iodine-123 (13 h): Increasingly used for diagnosis of thyroid function, it is a gamma emitter without the beta radiation of I-131.
Iodine-124: tracer.
Krypton-81m (13 sec) from Rubidium-81 (4.6 h): Kr-81m gas can yield functional images of pulmonary ventilation, e.g. in asthmatic patients, and for the early diagnosis of lung diseases and function.
Rubidium-82 (1.26 min): Convenient PET agent in myocardial perfusion imaging.
Strontium-82 (25 d): Used as the 'parent' in a generator to produce Rb-82.
Thallium-201 (73 h): Used for diagnosis of coronary artery disease other heart conditions such as heart muscle death and for location of low-grade lymphomas. It is the most commonly used substitute for technetium-99 in cardiac-stress tests.
OECD/NEA 2012, A Supply & Demand Update of the Mo-99 Market
IAEA 2015, Feasibility of Producing Molybdenum-99 on a Small Scale Using Fission of Low Enriched Uranium or Neutron Activation of Natural Molybdenum, Technical reports series #478
Many of the chemical elements have a number of isotopes. The isotopes of an element have the same number of protons in their atoms (atomic number) but different masses due to different numbers of neutrons. In an atom in the neutral state, the number of external electrons also equals the atomic number. These electrons determine the chemistry of the atom. The atomic mass is the sum of the protons and neutrons. There are 82 stable elements and about 275 stable isotopes of these elements.
When a combination of neutrons and protons, which does not already exist in nature, is produced artificially, the atom will be unstable and is called a radioactive isotope or radioisotope. There are also a number of unstable natural isotopes arising from the decay of primordial uranium and thorium. Overall there are some 1800 radioisotopes.
At present there are up to 200 radioisotopes used on a regular basis, and most must be produced artificially.
Radioisotopes can be manufactured in several ways. The most common is by neutron activation in a nuclear reactor. This involves the capture of a neutron by the nucleus of an atom resulting in an excess of neutrons (neutron rich). Some radioisotopes are manufactured in a cyclotron in which protons are introduced to the nucleus resulting in a deficiency of neutrons (proton rich).
The nucleus of a radioisotope usually becomes stable by emitting an alpha and/or beta particle (or positron). These particles may be accompanied by the emission of energy in the form of electromagnetic radiation known as gamma rays. This process is known as radioactive decay.
Radioactive products which are used in medicine are referred to as radiopharmaceuticals.


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37 year old man | New York, NY, USA | Seeking women 25-38 within 5000 miles
CafeConLeche I describe myself as down to earth, Passionate, Confident, Respectful, Ambitious, Insatiable, Sexy. Fun, Happy mature man.
Who Am I? How would you describe yourself?: I describe myself as down to earth, Passionate, Confident, Respectful, Ambitious, Insatiable, Sexy. Fun, Adventurous, Resilient, Strong, 10 , A REAL man who sticks up for his girl. Well educated, Enjoys cooking and having sex but not at the same time:) What Am I Looking For? I am looking for: A fun, outgoing, energetic great lady, "who is of this world not just in this world". (Read between the lines). If your not sure just ask. A woman who respects herself and other's around her. Who loves to travel and do new and exciting things. Sexy and sensual. Must have a positive outlook on life and love to laugh, even at yourself. SERIOUS INQUIRIES ONLY... MUAHHH!
Music and concerts
Cycling, Dancing, Running, Soccer, Swimming, Walking / Hiking, Weights / Machines
I exercise 3-4 times per week.
Don't display my sign
I like Horses
New York Art Museum, Boxing, Slat8 Pool Hall, Chelsea Pier Indoor Sports, Jet Ski Hamptons NY.
I compose music, I love to entertain, I love sex and cooking but not at the same time...lol
Sports, Concerts, Traveling, Female Companion...wink
Quincy Jones My Journey and Passions
Him | What he is looking for | |
Appearance | ||
Height: | 5'11" (180cms) | 5'0" (152cms) to 5'7" (170cms) |
Body type: | I'll tell you later | No preference |
Eyes: | Brown | No preference |
Hair: | Black | No preference |
Lifestyle | ||
Smoke: | No Way | No Way |
Drink: | Social Drinker | Social Drinker |
Occupation: | Technical / Science / Computers / Engineering | No preference |
Income: | I'll tell you later | No preference |
Relationship: | Never Married | No preference |
Have kids: | No | No preference |
Wants kids: | No, but it's OK if my partner has kids | No preference |
Background | ||
Ethnicity: | I'll tell you later | White / Caucasian |
Faith: | Christian / Catholic | No preference |
Languages: | English, Italian, Spanish | English |
Education: | Bachelors degree | Some college |

subset: commoncrawl


text:
Recipe Categories Appetizers Beverages Breads Breakfast Desserts Entrees For Baby Holiday Recipes Espresso Recipes Newlyweds Pasta Sauces and Dressings Sides Soups Spice Mixes Special Features KitchenSync App Get Cooking! Recipe Contest Entries Submit your Recipe Finalists & Winners Recipe Photo Contest! Entries Contest Winners My Pantry Recipe Swap How-To and Recipe Videos Recipe Videos
Blender Salsa
User Submitted Recipe
Medium to spicy chunky salsa."
3 fresh medium tomatoes
1 14 oz can diced tomatoes
1/2 C chopped onion
1/2 C chopped cilantro
3 jalapeno peppers chopped
2 teaspoons fresh lime juice
1 teaspoon salt
Combine all ingredients in blender, and pulse on grate or blend until desired consistency.
Serve with favorite chips or tortilla chips.
2 pound containerNutritional Information
Per Serving
no nutrition information available
Version 3.5 now available for iOS, Android, and Kindle Fire!
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text:
Another (Late) Autohotkey Script That Hides the Taskbar
I made an ahk script that (watches) for the taskbar and that little white-line indicator, and then makes them not there. I did it for a couple of reasons. I want the screen clean, but I don't want to be the one doing it, so this:


text:
Freud's psychoanalysis studies was one of the major key points in history of psychology. He explained three basic components of the human personality and those three parts exists together form our personalities plus our conscious mind and unconscious mind.
Often times experts describe this analysis as an iceberg. And here is why. Conscious portion of our characteristics interact with the world daily. On the other hand, our unconscious parts is not part of our known selves and stays well below the surface of awareness. These two together are components of our personalities. Discussed quite often, the id, ego, and superego, Freudians claim, compose the personality
Basic instincts like our sexual drive (libido) or aggressiveness is what freudians call the id. The id is like our most primitive impulses, which Freud thinks is the biggest factor of human behavior. According to Freud, pleasure principle is what drives the id and it seeks for constant gratification.
Second portion of the personality is the ego. Not to be confused with the term 'ego,' which is used moderately often in this society, Freud's definition of the term ego describes it as a principal decision maker in our system which we tend to show the world (conscious part). Unlike the id, ego is driven by the reality principle which does not emphasize gratification as much as the id but seeks for an appropriate outlet to solving conflicts.
Last comes is the superego; in easy terms it is just our morality. The thing that we all have and stops us from doing ungraceful deeds! The term superego literally means 'above ego.' I believe Freud's interpretation was that superego is something superior to the ego and it overrides the force ego holds and make us do what believe is to be good and moral deeds.
tackx008: November 2011 Archives
2 Years after coming to the US, I got to have an experience living with a family with 10-month-old Eva. I basically observed her while playing with her for almost 2 full years during her age of 1 through 3. I was astounded by how fast she was growing and when I visit her every now and then, I still am utterly surprised at her. Infant abilities are amazing and it is especially amazing to see how fast babies can learn the minimalist things. Physically, babies grow incredibly fast. Their large heads gets bigger but as their bodies grow faster than the rate of head, it starts getting smaller and smaller. Babies begin learn how to mobilize and develop motor skills: from crawling to walking and running, EVERYWHERE. Their leg muscles enlarge at a rapid rate and it does not take long for them to begin running after they start walking. Not only running, they begin to do more miscellaneous activities like drawing, opening doors, climbing, and such. As years go by, the biggest change in babies is their ability to talk. Eva started learning words such as ball, dog, and names. These words begin contain meanings rather than simple words. Phrases and sentences are learned quickly after acquiring of words begins. At age 4-5, casual, light-hearted conversations can be held.
As known, infant stage is when acquiring is the easiest for us. They suck information up like sponges and hardly forget things that have already become their long-term memory.


text:
Chelsea sink Middlesbrough to set up United quarter-final
Published on Feb 28, 2013 6:03 AM
MIDDLESBROUGH, United Kingdom (AFP) - Holders Chelsea ground out a 2-0 win at second-tier Middlesbrough on Wednesday to set up an FA Cup quarter-final glamour tie at Manchester United.
Second-half goals from Ramires and Victor Moses secured victory at the Riverside Stadium as Chelsea bounced back from Sunday's 2-0 loss at Manchester City, which had seen them slip to fourth place in the Premier League.
Victory in the fifth-round tie means Chelsea remain on course for what would be a fifth FA Cup title in seven seasons.
Interim manager Rafael Benitez has complained about fixture congestion in recent weeks, but with his side also still in contention in the Europa League, the European champions look set for a busy few weeks.
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MSNBC anchor Thomas Roberts and his new husband Patrick Abner are among those making gay glossy Out's Out 100 list.
Roberts, 39, and Abner, of Merck Pharmaceuticals' HIV/AIDS division, tied the knot in a Manhattan rooftop wedding after being together 12 years. The couple announced their engagement via Twitter on June 25, 2011, one day after gay marriage was legalized in New York.
The handsome couple holds hands while suited up in tuxes in their Out photo.
"I never imagined in a million years that I would be on a stage kissing my male partner, spouse – husband, Thomas is saying – in front of my father," Abner said during the ceremony. "And to be able to do that and have not just my father but my whole family be proud of me? That's something special."
The wedding also appeared to have an affect on Good Morning America weather anchor Sam Champion, who announced his own upcoming wedding to photographer Rubem Robierb at the party, marking the first time he has publicly addressed his sexual orientation.
(Related: Sam Champion says he's lucky to have Rubem Robierb.)
Boy George, Jane Lynch, Sharon Needles and Andrew Rannells grace the covers of Out's December/January double issue which includes its annual roundup of out notables.


text:
Heinrich Isaac: Missa Paschalis1 CD / Christophorus / 2012-03-01 Works: Heinrich Isaac: Resurrexi et adhuc/Tecum sum, introit for 6 voices; Missa Paschalis, mass for 6 voices; Mass Proper for Easter, for 4 voices (Choralis Constantinus no 54); Credo, for 4 voices (Jena, ...Conductors: Rombach, Wilfried Recording information: Church of Sts. Peter & Paul, Mössingen, Germany (04/24/2003-04/26/2003)....continue... read more
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Choral Classics: O Magnum Myseterium / Finck, Ockeghem, Gombert, Brumel5 CD / Brilliant Classics / 2011-11-15 Works: Guillaume Dufay: Missa Ecce ancilla Domini, for 4 voices; Johannes Ockeghem: Missa pro defunctis; Missa prolationum, for 4 voices; Gloria from Cuiusvis toni a 4; Josquin Des Prez: Missa da pacem, for...Conductors: Gottwald, Clytus Ensemble: ; Schola Cantorum Stuttgart, Music in 14th century Europe was dominated by composers working in the Netherlands, Belgium and Northern France. Dufay of Cambrai went to Italy in the...continue... Recording information: Villa Berg, Stuttgart, Germany....continue... read more
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Got a tip for us? Let us know
Nov 23, 2009, 12:44 PM | #1 |
iPhone app for configurable email notification
Hi guys,
I need to be able to react when I receive email. This has to work during the night while I am asleep. So the scenario is: I go to sleep, I receive email in the middle of the night - I have to wake up and take action. Unfortunately iPhone email alert is not that good, nor loud. (I read somewhere that I can jailbreak it and change some file for the notification that I want, but this won't give me configurability) Is there any iPhone application that allows for configuring 'Email Received' alerts? Like to change the sound notification, to play the sound notification repetitively, filter on specific Subject field, From, etc.? |
0 |
Nov 24, 2009, 08:17 AM | #2 | |
0 |
Nov 24, 2009, 08:32 AM | #3 |
MailTones is another option... I downloaded it but won't use it till they add some louder businesslike tones in there. Currently their business tones are not loud enough to be heard in a noisier environment, but if you just need that for mail when your sleeping, they have a loud alarm and some other crazy tones that just might wake you up.
It can configure a default and a tone for mail recieved from a certain person. Last edited by Gokunama; Nov 24, 2009 at 08:42 AM. |
0 |
Nov 24, 2009, 10:41 PM | #4 |
iPhone app for configurable email notifications
Hi guys,
Thanks guys for the suggestions. MailTones won't work, the Exchange server does not allow automatic forwarding outside of the realm. Mail Notifier sounds promising, but I did not find any configurability specs. Will have to try it and see if it works. I can't believe that nobody has written such application until now. Email is one of the worst sides of iPhone and such app will be very useful to a lot of people (translated: "a lot of people will buy it" ). |
0 |
Dec 8, 2009, 08:43 AM | #5 |
Will the Mail Notifier App work with my Comcast email?
Does any know? Thank You.
"i wear a mask for the masks that i meet" |
0 |
Dec 8, 2009, 08:59 AM | #6 |
PushMail lets you select your tone when mail arrives, but it doesn't allow repetitive alerts. You do have to set your main mailer to forward a copy of incoming mail; their server then sends push notification to you. Nothing is stored by the server. The developer is responsive to suggestions in my experience.
0 |
Dec 11, 2009, 11:11 PM | #7 | |
0 |
Dec 27, 2009, 07:17 PM | #8 |
Ultimate Notifier
If you want fast, loud iPhone email notification for POP, IMAP, etc. -- WITHOUT having to copy or forward your existing email accounts -- the Ultimate Notifier app is it!!! You can checkout their website at www.ultimatenotifier.com or just search the AppStore for "notifier". This tool is the perfect solution. You can choose a variety of different sounds for different accounts, and they will alert you to new messages from up to 3 different accounts for just the cost of the app download itself (currently $1.99) and extra accounts for $0.99 each. If you put your iPhone on silent/vibrate mode, Ultimate Notifier (UN) will just make your phone vibrate to notify you of new messages (in addition to its regular visual popup window). I have a Yahoo! bizmail account, which only works with webmail and POP, and this app was the answer to my prayers! Very impressive.
0 |
Nov 1, 2012, 05:13 AM | #9 |
have you looked at the altamail app?
i have been using it for a while, but its now been updated to include push notifications and this is a free feature! you can do stuff like customize email alert notifications and set different sounds for the type of message or for a particular person etc loads of good features with this, more than i thought! try here: https://itunes.apple.com/us/app/alta...328890658?mt=8 |
0 |
Dec 12, 2012, 10:02 AM | #10 |
Im also looking for an app that makes different sounds but my priority is to get the alert within a few seconds that I receive the email...does anyone know which apps are the fastest to alert you...im currently using a gmail account but am willing to change if something else would be faster/easier or more compatible with an app... |
0 |
Dec 11, 2013, 01:49 PM | #11 |
Notify for specific word in subject line
Need to know if I can set-up iPhone 5c to beep or vibrate if email subject line has the word "page".
Thanks |
0 |
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text: American Legion Auxiliary scholarships $500 award for high school seniors (B-C student), Auxiliary Unit 16 scholarship, deadline is April 1. American Legion Western District, $1,000, for seniors who may not be able to get a scholarship and are ready to make a commitment to post-secondary education, Feb. 28 deadline. National President's Scholarship, $1,500 to high school seniors who are daughters, sons, greats and step-great children of veterans who served in the Armed Forces during eligibility dates for membership in The American Legion; no Legion membership is required; March 1 deadline. Western District Auxiliary Scholarship, $500-$1,000 for continuing students who are members of the Legion family; due last day of March. Non-Traditional Auxiliary Scholarship, $1,000 for continuing students who are members of the Legion, Auxiliary, or S.A.L. legion family, March 1 deadline. Auxiliary Spirit of Youth Scholarship, $1,000. Must be a Junior Auxiliary member for past three years and hold a membership card for 2013. Deadline is March 1. For applications, see school counselors; for more information, call 235-6789 or 235-8864.


text:
Schools in North Salem, IN
About North Salem Schools
- There is 1 K-12 school in North Salem, IN. North Salem public schools belong to one district, North West Hendricks Schools School District.
- There is 1 North Salem elementary school.
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Contact Education.com with questions or feedback about SchoolFinder.
Please note, if you wish to speak to someone at the school, you must contact the school directly.


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FDA Approves Simponi to Treat Ulcerative Colitis »
"The U.S. Food and Drug Administration today approved a new use for Simponi (golimumab) injection to treat adults with moderate to severe ulcerative colitis.
Simponi works by blocking tumor necrosis factor (TNF), which plays an important"...
Read the FDA Approves Simponi to Treat Ulcerative Colitis article »
Dipentum Side Effects Center
Medical Editor: John P. Cunha, DO, FACOEP
Dipentum (olsalazine sodium) is used to treat ulcerative colitis. It is a salicylate anti-inflammatory drug. Common side effects include headache, nausea, vomiting, or loss of appetite.
The usual dosage of Dipentum in adults for maintenance of remission is 1.0 g/day in two divided doses. Dipentum may interact with blood thinners, thioguanine, or mercaptopurine. Tell your doctor all medications and supplements you use. During pregnancy, Dipentum should be used only when prescribed. This drug may pass into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breastfeeding.
Our Dipentum (olsalazine sodium) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is Patient Information in Detail?
Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.
Dipentum in Detail - Patient Information: Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using olsalazine and call your doctor at once if you have any of these serious side effects:
- worsening colitis (fever, stomach pain, cramping, or bloody diarrhea);
- chest pain, shortness of breath, fast or pounding heartbeats; or
- nausea, stomach pain, loss of appetite, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
- mild stomach discomfort;
- nausea, heartburn;
- skin rash, itching;
- headache;
- muscle or joint pain; or
- urinating more often than usual.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Dipentum (Olsalazine Sodium Capsules)
What is Patient Information Overview?
A concise overview of the drug for the patient or caregiver from First DataBank.
Dipentum Overview - Patient Information: Side Effects
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor immediately if diarrhea occurs. Your doctor may need to lower your dose or prescribe another medication to treat the diarrhea.
Tell your doctor immediately if any of these rare but very serious side effects occur: severe stomach/abdominal pain, pale stools, unusual tiredness, persistent nausea/vomiting, change in the amount of urine, dark urine, yellowing eyes/skin, signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding.
A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Dipentum (Olsalazine Sodium Capsules)
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Dipentum FDA Prescribing Information: Side Effects
(Adverse Reactions)
Olsalazine has been evaluated in ulcerative colitis patients in remission, as well as those with acute disease. Both sulfasalazine-tolerant and intolerant patients have been studied in controlled clinical trials. Overall, 10.4% of patients discontinued olsalazine because of an adverse experience compared with 6.7% of placebo patients. The most commonly reported adverse reactions leading to treatment withdrawal were diarrhea or loose stools (olsalazine 5.9%; placebo 4.8%), abdominal pain, and rash or itching (slightly more than 1% of patients receiving olsalazine). Other adverse reactions to olsalazine leading to withdrawal occurred in fewer than 1% of patients (Table 1).
Table1: Adverse Reactions Resulting In Withdrawal From Controlled
Studies Total
Olsalazine (N = 441) |
Placebo (N = 208) |
Diarrhea/Loose Stools | 26 (5.9%) | 10 (4.8%) |
Nausea | 3 | 2 |
Abdominal Pain | 5 (1.1%) | 0 |
Rash/Itching | 5 (1.1%) | 0 |
Headache | 3 | 0 |
Heartburn | 2 | 0 |
Rectal Bleeding | 1 | 0 |
Insomnia | 1 | 0 |
Dizziness | 1 | 0 |
Anorexia | 1 | 0 |
Light Headedness | 1 | 0 |
Depression | 1 | 0 |
Miscellaneous | 4 (0.9%) | 3 (1.4%) |
Total Number of Patients Withdrawn | 46 (10.4%) | 14 (6.7%) |
For those controlled studies, the comparative incidences of adverse reactions reported in 1% or more patients treated with olsalazine or placebo are provided in Table 2.
Table2: Comparative Incidence (%) of Adverse Effects Reported
By One Percent Or More of Ulcerative Colitis Patients Treated With Olsalazine
Or Placebo in Double Blind Controlled Studies
Adverse Event | Olsalazine (N=441) % |
Placebo (N=208) % |
Gastrointestinal Disorders | ||
Diarrhea | 11.1 | 6.7 |
Abdominal Pain/Cramps | 10.1 | 7.2 |
Nausea | 5.0 | 3.9 |
Dyspepsia | 4.0 | 4.3 |
Bloating | 1.5 | 1.4 |
Vomiting | 1.0 | - |
Stomatitis | 1.0 | - |
Increased Blood in Stool | - | 3.4 |
Metabolism and Nutrition Disorders | ||
Anorexia | 1.3 | 1.9 |
Nervous System Disorders | ||
Headache | 5.0 | 4.8 |
Insomnia | - | 2.4 |
General Disorders and Administration Site Conditions | ||
Fatigue/Drowsiness/Lethargy | 1.8 | 2.9 |
Psychiatric Disorders | ||
Depression | 1.5 | - |
Ear and Labyrinth Disorders | ||
Vertigo/Dizziness | 1.0 | - |
Skin and Subcutaneous Tissue Disorders | ||
Rash | 2.3 | 1.4 |
Itching | 1.3 | - |
Musculoskeletal and Connective Tissue Disorders | ||
Arthralgia/Joint Pain | 4.0 | 2.9 |
Infections and Infestations | ||
Upper Respiratory Infection | 1.5 | - |
Over 2,500 patients have been treated with olsalazine in various controlled and uncontrolled clinical studies. In these as well as in post-marketing experience, olsalazine was administered mainly to patients intolerant to sulfasalazine. There have been rare reports of the following adverse effects in patients receiving olsalazine. These were often difficult to distinguish from possible symptoms of the underlying disease or from the effects of prior and/or concomitant therapy. A causal relationship to the drug has not been demonstrated for some of these reactions.
Blood and Lymphatic System Disorders
Anemia, Eosinophilia, Hemolytic anemia, Interstitial pulmonary disease, Leukopenia, Lymphopenia, Neutropenia, Reticulocytosis, Thrombocytopenia
Cardiac Disorders
Chest pains, Heart block second degree, Myocarditis, Palpitations, Pericarditis, Peripheral edema, Shortness of breath, Tachycardia
A patient who developed thyroid disease 9 days after starting DIPENTUM (olsalazine sodium capsules) was given propranolol and radioactive iodine and subsequently developed shortness of breath and nausea. The patient died 5 days later with signs and symptoms of acute diffuse myocarditis.
Ear and Labyrinth Disorders
Eye Disorders
Dry eyes, Vision blurred, Watery eyes
Gastrointestinal Disorders
Abdominal pain (upper), Diarrhea with dehydration, Dry mouth, Epigastric discomfort, Flare in symptoms, Flatulence, Increased blood in stool, Pancreatitis, Rectal bleeding, Rectal discomfort
In a double-blind, placebo-controlled study, increased frequency and severity of diarrhea were reported in patients randomized to olsalazine 500 mg B.I.D. with concomitant pelvic radiation.
Rare cases of granulomatous hepatitis and nonspecific, reactive hepatitis have been reported in patients receiving olsalazine. Additionally, a patient developed mild cholestatic hepatitis during treatment with sulfasalazine and experienced the same symptoms two weeks later after the treatment was changed to olsalazine. Withdrawal of olsalazine led to complete recovery in these cases.
General Disorders and Administration Site Conditions
Fever chills, Hot flashes, Irritability, Rigors
Immune System Disorders
Bronchospasm, Erythema nodosum
ALT (SGPT) or AST (SGOT) elevated beyond the normal range.
Musculoskeletal and Connective Tissue Disorders
Muscle cramps
Nervous System Disorders
Insomnia, Paraesthesia, Tremors
Psychiatric Disorders
Mood swings
Renal and Urinary Disorders
Dysuria, Hematuria, Interstitial nephritis, Nephrotic syndrome, Proteinuria, Urinary frequency
Reproductive System and Breast Disorders
Skin and Subcutaneous Tissue Disorders
Alopecia, Erythema, Photosensitivity reaction
Vascular Disorders
Hypertension, Orthostatic hypotension
The following events have been identified during post-approval use of products that contain (or are metabolized to) mesalamine in clinical practice. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to a combination of seriousness, frequency of reporting, or potential causal connection to mesalamine:
Blood and Lymphatic System Disorders
General Disorders and Administration Site Conditions
Hepatobiliary Disorders
Hepatic enzyme increased, Hepatitis, Increased bilirubin
Reports of hepatotoxicity, including elevated liver function tests (SGOT/AST, SGPT/ALT, GGT, LDH, alkaline phosphatase, bilirubin), jaundice, cholestatic jaundice, cirrhosis, and possible hepatocellular damage including liver necrosis and liver failure. Some of these cases were fatal. One case of Kawasaki-like syndrome, which included hepatic function changes, was also reported.
Musculoskeletal and Connective Tissue Disorders
Respiratory, Thoracic and Mediastinal Disorders
Dyspnoea, Interstitial lung disease
Skin and Subcutaneous Tissue Disorders
Angioneurotic oedema
Nervous System Disorders
Paraesthesia, Peripheral neuropathy
Renal and Urinary Disorders
Interstitial nephritis
Drug Abuse And Dependency
None reported.
Drug dependence has not been reported with chronic administration of olsalazine.
Read the entire FDA prescribing information for Dipentum (Olsalazine Sodium Capsules)
Dipentum FDA Prescribing Information
Additional Dipentum Information
Dipentum - User Reviews
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Women's Health
Find out what women really need.


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Find a Degree
Find a Degree
Marriage and Family Therapy, MMFT
Department: Family, Consumer, and Human Development Department
College: Emma Eccles Jones College of Education & Human Services
About This Degree
The MMFT is designed to prepare students for clinical careers in marriage and family therapy. As they study human development and marital and family relations, students are provided with basic academic and initial clinical practice requirements for Utah state licensure as marriage and family therapists and for clinical membership in the American Association for Marriage and Family Therapy. This program is accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) and qualifies students for intern-level licensure as marriage and family therapists in the state of Utah.
The Department of Family, Consumer, and Human Development is housed in the College of Education and Human Services, which is in the top 2% of all graduate colleges of education in the nation and is ranked third in total research dollars received.
- MMFT - Logan Campus
Recent graduates have found employment as counselors in the following areas:
- Public schools
- Academic departments at colleges and universities
- Research centers
- Hospitals
- Head Start
- Child care programs
- Social services agencies
- Mental health agencies
- Private and clinical practice settings
- Extension services
- Financial institutions and agencies
- Any related agencies that teach about, study, or serve individuals and families
Admissions Requirements
It is preferred that applicants have the equivalent of at least a minor in family, consumer, or child studies. However, competent students have been admitted from a variety of backgrounds. If a student does not have a family, consumer, or child studies background, they may be required to take prerequisite courses depending on their experience.
Application Requirements:
- Complete the online application
- Pay the $55 application fee
- Score at or above the 40th percentile on the GRE or MAT
- Have a 3.0 or higher GPA on your last 60 semester or 90 quarter credits
- Provide transcripts of all college/university credits
- Provide three contacts for letters of recommendation
International students have additional admissions requirements.
Admissions Deadlines
The department has the following deadline:
Fall semester – December 20th
Master's Degree Plan Option(s)
Students can receive the MMFT by pursuing the following option:
- The Plan B option requires the production of a paper or creative work of art and is expected to reflect equivalent scholarship standards as a thesis.
Financial Assistance
The department has a variety of scholarships, fellowships, and assistantships available for students. The department tries to arrange funding for all first-year students. After the student's first year, they must find their own funding, but various funding opportunities are still available.
A variety of additional funding opportunities are available, including tuition awards and travel support. Additionally, students may be eligible for subsidized health insurance through qualifying assistantships.
Program Requirements
Click here to see course requirements for the Master of Marriage and Family Therapy.
Dave Robinson
MFT Graduate Advisor
Office: FL104
Phone: 435-797-7431
Email: firstname.lastname@example.com
David Robinson, PhD 1999, Brigham Young University
Associate Professor, Director-Marriage and Family Therapy Program
Area: Community-based participatory research, rural mental health, medical family therapy, distance deliverer of mental health services.
Office: FLC 104
Phone: 435-797-7431
Email: email@example.com
Ryan Seedall, PhD 2011, Michigan State University
Assistant Professor
Area: Attachment and Emotional Experience during Couple Interaction; The Provision of Social Support during Couple Interaction; The Relationship Checkup; Attachment, Depression and Emotionally Focused Therapy; Family and Disability.
Office: FLC 207
Phone: 435-797-7433
Email: email@example.com
Professional Organizations, Honor Societies, and Clubs
American Association for Marriage and Family Therapy: AAMFT is the professional association for the field of marriage and family therapy. The association leads the way to increasing understanding, research, and education in the field of marriage and family therapy, and ensuring that the public's needs are met by trained practitioners. The AAMFT provides individuals with the tools and resources they need to succeed as marriage and family therapists.
National Council on Family Relations: NCFR is the oldest, multi-disciplinary, non-partisan professional organization focused solely on family research, practice, and education. It is an association of professionals dedicated to understanding and strengthening families.
Labs, Centers, Research
Marriage and Family Therapy Clinic: The Marriage and Family Therapy Clinic is sponsored by the Department of Family, Consumer, and Human Development in the Emma Eccles Jones College of Education and Human Services. The clinic's dual mission is to provide high-quality, low-cost marital and family therapy services to the public and to provide a training environment for master's degree students majoring in marriage and family therapy. While conducting therapy, the therapists-in-training are under the direct supervision of clinical faculty members who are all licensed marriage and family therapists.


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Differences between a population and a sample
Determine whether the group is a sample or a population.
a. The participants in a study of a new cholesterol drug
b. The drivers who received a speeding ticket in Kansas city last month
c. Number of people on welfare in Cook County (Chicago) Illionis
d. The 30 stocks reported as part of the Dow Jones industrial average.
Solution Summary
This question deals with the differences between a population and a sample. 4 examples are provided. Answers and explanations are given for each of the 4 examples.


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For more information about this meeting, contact Becky Halpenny.
Title: | "Coexistence of Hyperbolic and Non-hyperbolic Behavior in Smooth Dynamical Systems" |
Seminar: | Ph.D. Thesis Defense |
Speaker: | Jianyu Chen, Adviser: Yakov Pesin, Penn State |
Abstract Link: | http:// |
Abstract: | |
We investigate the essential coexistence of hyperbolic and non-hyperbolic behavior in dynamical systems, which was numerically observed in classical mechanics but theoretically remains an important open problem. We present some recent devel- opments of such coexistence phenomenon in the category of smooth conservative systems in both discrete and continuous-time cases. In the discrete-time case, we show that there is a smooth volume preserving dieomorphism of a 4-dimensional compact smooth manifold, which is close to the identity map and has nonzero Lyapunov exponents on an open and dense subset of positive but not full volume while having zero Lyapunov exponents on its com- plement. Moreover, this subset consists of countably many connected components, on each of which the dieomorphism is isomorphic to a Bernoulli automorphism. We demonstrate an essential coexistence phenomenon in the continuous-time case by constructing a smooth volume preserving ow on a 5-dimensional compact smooth manifold that has nonzero Lyapunov exponents almost everywhere on an open and dense subset of positive but not full volume and is ergodic on this subset while having zero Lyapunov exponents on its complement. The latter is a union of 3-dimensional invariant submanifolds and on each of these submanifolds the ow is linear with Diophantine frequency vector. Thus the ow exhibits a KAM-type phenomenon. |
Room Reservation Information
Room Number: | MB106 |
Date: | 04 / 23 / 2012 |
Time: | 01:00pm - 03:00pm |


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I love how the blues go together so well in the Hip 2b Square's May kit!
Friday, June 25, 2010
1 comment:
- Melanie said...
Fun monochromatic LO :) The flowers are a great addition. And that bow above the cut PP is so cute!
- June 25, 2010 at 11:49 AM
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If you're an official fan, then the MLB Tampa Bay Rays Men's Synthetic Polo T-Shirt in Blue is a homerun. This handsome polo features a front collar button up and short sleeves. The Rays logo and light blue and navy colors are on full display on the soft shirt. Wear with your favorite slacks or other MLB gear for your best look. The polo t-shirt is easy to wash by tossing it in the washing machine as needed.
Sizing: Men
Material: 100 % Polyester
Neckline Style: Collared, Polo collar
Sleeve Style: Short, Raglan sleeve, Basic sleeve
Closure Style: Front collar button
Garment Length: At hip
Hem Type: Plain hem
Care and Cleaning: Machine wash, normal, Do not bleach, Tumble dry, normal, low heat, Iron, low, on reverse side
other Info.
- Item can be gift wrapped.
- Imported


text:
By The Assocated Press
PENSACOLA, Fla. — A federal judge in Florida says he wants to set a fast schedule for a lawsuit by at least 18 states aimed at overturning President Barack Obama's health care overhaul.
But Senior U.S. District Judge Roger Vinson said Wednesday the case still could take months to make its way through his court. Hearings and filing deadlines in the case are slated into November.
Wednesday's scheduling hearing was the first court date in the case brought by Florida Attorney General Bill McCollum and attorneys general or governors to stop the health care plan.
The states claim the federal government cannot force citizens to buy health insurance or force a mandate on states without providing money to pay for it.


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Things Are Changing!
The migration of TuDiabetes has begun
Content created between now and the launch of our new site on April 20th will NOT be moved to that new home, but our community values and Terms of Service still apply during this time.We are not accepting new members during this transition period. If you want to join the TuDiabetes community please send an e-mail to email@example.com. We will send you an invitation to join after the migration is completed.
Has anyone ever noticed a post site change high, even with the .3 prime? If so, do you prime more than that or what do you do? I saw some posts about it happening with Omnipod users. It doesn't happen all the time but seems like fairly often.
This is VERY common. It has to do with slow insulin absorption with the new site. I actually get incredibly high post site change without lots of planning. My endo says some people have different rates of absorption with a site change and I must be one of the people that has very resistant tissue at first!
So this is what I have to do:
Temp basal rate of 140% for 1 hour before changing site.
Change site, .5 fixed prime. Immediately set a 2 hour temp basal for 200%. That usually does it. I'll check 1-1.5 hours in and reduce or cancel the temp basal if I notice numbers in range that early.
I also never bolus immediately after changing the site--for me that's a recipe for a disastrous high. I try to wait 2 hours. So I'll bolus on the old site, eat breakfast, then change the site, so by lunch I'll be able bolus on the new site.
For me it's really quite a production!
David has always used a prime that is slightly higher than the recommended prime. He uses an MM pump and after reading about post site change highs on tudiabetes and how a number of users have dealt with that by increasing the set change fixed prime, he increased his fixed prime, and has kept it increased the past couple years.
I have inconsistent post change highs, so I have not been able to give a set formula. I try never to change at night so I can test frequently. I use a .5 prime not a .3. I try to do it prior to a meal, but also to be sure that the site is "good" before eating and bolusing. After having diabetes over 30 years, some sites just don't work well, and I have been known to struggle with multiple site changes,manual injections, and high sugars. I just do my best each time. I test within 30 minutes of inserting, to see which way I am trending. if high, I treat, then check again in 30 minutes. I know that is not much time, but I can see if I am at least going up or down. If I am still high or going higher, I will usually wait about one more house, then start again. It wastes a lot of time, and I am grateful on the changes that do take, are not uncomfortable, and last a few days.
iddm-1979 pumping 10 years, all systems go with a few small exceptions :-)
Yep, I fought this for the first few months I was on the pump. After consulting with my CDE (who has been pumping for years) and finding out she uses a much larger prime to combat this, I have ended up with a prime of 2.2. I had pretty consistent highs, so my adjustment was fairly easy - I knew the standard .3 prime was leaving me at about 160 mg/dl 4 hours later, so I increased it to 2.0 for a couple changes, then fined tuned it to 2.2. I'm still a bit high sometimes (120 - 130) but not consistently enough to change at this point.
Which set do you use? With the silohuette sites the prime is 0.7 and never really noticed an unusual high. I'll need to pay more attention.
Wow! What a revelation...I thought that I was having problems because the old site was causing me to run high (not work as well). I wouldn't have even thought to ask my D-team about it. I should look back because I do not always have problems but it might depend on timing with meal and/or needing a correction...hmm
What sort of infusion set do you use? the .3 prime is fine for Mios, but Silhouettes need a .7 prime.
I usually need a higher basal rate for 24 hours. When this first began to happen I would sometimes pull out my new set thinking it was bad!! Now, I set the basal higher and supplement with shots.
I do get highs after a site change but never took a prime. I might be dumb asking this but how do you calucalate prime. Is it a fixed amount or should be calculated. My DE never discussed about this.
Melissa Lee
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Product prices and availability are accurate as of the date/time indicated and are subject to change. Any price and availability information displayed on Musician\'s Friend at the time of purchase will apply to the purchase of this product.
For use with all Bb, Eb, C and bass clef instruments, the Jazz Play-Along Series is the ultiimate learning tool for all jazz musicians. With musician-friendly lead sheets, melody cues and other split-track choices on the included CD, this first-of-its-kind package makes learning to play jazz easier than ever before. FOR STUDY, each tune includes a split track with: Melody cue with proper style and inflection Professional rhythm tracks Choruses for soloing Removable bass part Removable piano part. FOR PERFORMANCE, each tune also has: An additional full stereo accompaniment track (no melody) Additional choruses for soloing. 10 songs: Auld Lang Syne Deck the Hall The First Noel Good King Wenceslas Jingle Bells O Christmas Tree Toyland Up on the Housetop We Three Kings of Orient Are We Wish You a Merry Christmas. Softcover with CD72 pagesSize: 12" x 9"Composer: VariousISBN: 1423482530. Price: $15.99
© Copyright 2015 - Christmas.com. All rights reserved and protected by Christmas Spirit


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"Beautiful day" mum said as I walked up to grab my lunch off the counter. Even though I couldn't care less I have to admit, it was one the nicest days we have seen all year. And the exact count down is on, with only 3 months until graduation. June 25 is when we can officially leave that hell hole. Prom and grad itself, I couldn't care less for. I mean really, nobody to take, no money to spend.
I'm what you call the 'tag along friend'. Of course there is somebody that I would love to take to prom. Her name is Mikayla Mayman and we have been best friends since 6th grade. She has long beautiful dark brown hair that has a cute but subtle natural wave. She has bright blue eyes that no matter what will catch your attention from across the room.
But all of this day dreaming over her comes to an end when reality seems to hit like a wall every time. She has a boyfriend. His name is Trent Denby. He sure isn't anything special and I don't know what she sees in him. Yes he has money, but only because he works with his uncle washing windows on the weekend. He gets paid pretty well and has no trouble telling the world. Since I got shafted into the friend zone and Trent is obviously more than just a friend like myself, we have actually gotten to know him pretty well because unfortunately he sits at our table every lunch.
When I say "we" I mean Kelly Heller. She's a permanent exchange student from Canada and has been at Mikayla's right hand since practically the beginning of the year. I don't mind her nearly as much as Trent. She's very polite but loud in the sense of always laughing and shouting. Seems to be obsessed with her strawberry red hair and makeup she claims to only be able to get from Canada. Canada is the only thing she seems to know about, other than that she's a little stupid to be brutally honest.
"You're going to miss the bus" Mum shouted from the top of the stairs. As I quickly scramble to get my stuff together I know in the back of my mind there is no way I can run these 4 blocks in 2 minutes. I also know that if I don't even try my mum will make me walk the 18 or so blocks to school. As I leave I slam the door shut and start running as fast my little feet can take it. I hear the bus approaching and feeling of eyes drilling the back of my head as I run to beat it the next half a block. My face is red and I'm out of breath, but thankfully I make it.
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Last updated: 4/21/2015 2:29:46 AM
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Multiple unspecified vulnerabilities in HP Performance Insight 5.3 allow remote attackers to have an unknown impact, related to (1) a "Remote exploit" on Windows platforms, and (2) a "Remote preauthentication exploit" on the Windows Server 2003 SP2 platform, as demonstrated by certain modules in VulnDisco Pack Professional 8.11. NOTE: as of 20090903, this disclosure has no actionable information. However, because the VulnDisco Pack author is a reliable researcher, the issue is being assigned a CVE identifier for tracking purposes.
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Time Management Sites
Assignment Calculator
Having trouble getting long term assignments done? Try this out:Choose your subject. Put in today's date. Then put in the date the assignment is due. CLICK and voila. All the interim pieces, what you have to do each week to get it done on time, are laid out for you. No more excuses! http://assignmentcalculator.library.ubc.ca/
Time Management for Right Brained People
PDF file
Subtitled: Or-What to do if to-do lists are not your style Not everyone is a list maker. Here are some alternative approaches. What about a "not to do list"? http://lsc.cornell.edu/Sidebars/Study_Skills_Resources/Study%20Skills%20PDFs%20for%20LSC%20Website/Time%20Managment%20for%20Right-Brained%20People.pdf
A Guide for Time Management
Extensive site from Planning Your Time to Staying on Track! Under Planning Your Time, check out Coping with Info-Heavy Courses and Coping with Multiple Deadlines. http://www.learningcommons.uoguelph.ca/guides/time_management/
Anticipating and Planning for Courses
Only you will know what is required of you during the semester, BUT you will only know this is you look at all of your courses together. Use the matrix provided here to get the full picture. http://www.smu.edu/~/media/Site/ALEC/Time%20Management/Anticipating%20%20planning.ashx
Evaluating Your Schedule
How many hours is your week? Get a weekly schedule form here! http://www.bucks.edu/%7especpop/sched.htm
If to do lists are not working for you, try this.
If you want a creative way to remember and handle your to do lists, try mind mapping. See how here. http://www.usingmindmaps.com/mind-map-time-management.html
Priority Management: Are you Doing the Right Things or Are You Just Doing Stuff?
In this video Professor Piscitelli from Florida State College, Jacksonville says that you can't manage time. You can only manage priorities. Check out the fun 8 minute demo of this concept. http://youtu.be/QmMUy2t0ZvQ
PDF file
How to use this tool and strategies for the different quadrants. Don't miss this one. It's important AND urgent! Print this PDF and post it in your study area for reference and constant review! http://www.ucop.edu/center-operations-excellence/_files/The%20Urgent-Important%20Matrix.pdf
Time Management
Designed specifically for college students. "The Big Picture: Planning the Semester." http://well.wvu.edu/articles/time_management
Time Management Video
Got 15 minutes? Check out this video about time management in college. http://www.dartmouth.edu/~acskills/videos/video_tm.html
Time Management Workshop
What college students are required to do and the challenges of managing time. Don't let college manage you. Take charge of your own time. http://appl003.lsu.edu/cas/learningjourney.nsf/LiveSlide/2EFE7067F15C15718625709200594ACC?OpenDocument
What will my first semester classes look like?
Here is a color coded schedule, not only of classes, but of study time and work! Fills up the time slots really quickly. Scroll down to see several examples of how the college schedule fills up fast! http://www.uiowa.edu/web/advisingcenter/academiclifeatiowa.htm#schedule
Find out about 4 planning tools and the thinking strategies that go with each. http://lss.info.yorku.ca/resources/university-time-management/#Planning
Time Management Quiz
Lots of resources here, but start with the Time Management Quiz. Depending upon your results, you will be able to choose what to do next! http://www.ucc.vt.edu/academic_support_students/online_study_skills_workshops/time_management_strategies/index.html
Steve Covey's Time Management Matrix as a MindMap
This is a graphic visualization of the 4 quadrants of managing your time effectively. Worth putting up on your bulletin board! http://mappio.com/mindmap/cbrown/steven-covey-s-time-management-matrix-as-a-mindmap-map-2-of-2
Making a Task List
First find out what it is and then the steps needed. Under planning time, click on Making a Task List. Then use the side bar to follow steps 1 through 3. http://www.learningcommons.uoguelph.ca/guides/time_management/