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This article appeared in a journal published by Elsevier. The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
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In most cases authors are permitted to post their version of the
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Current Status of
Medical Pleuroscopy
AndrewR.L.Medford, BS,MD,DM,MRCP,Dip(ClinRiskMgt)a,b,*,
Jonathan A. Bennett, BS, MD, DM, FRCPa,
Catherine M. Free, MD, DM, MRCPa,
Sanjay Agrawal, MD, FCCPa
Pleural conditions comprise approximately 25% of
cases presenting to pulmonologists. Hence, there
has been an increasing interest in novel investiga-
tions bypulmonologists
Medical pleuroscopy(MP)—also
medical thoracoscopy, local anesthetic thoraco-
scopy, or video-assisted thoracoscopy—can be
performed by nonsurgeons, as distinct from
video-assisted thoracoscopic surgery (VATS).
Thoracoscopy was first described by Jaco-
baeus using rigid instruments in 1910, although
the first thoracoscopy was actually performed in
1865 in Dublin.1,2
The term, MP, describes
a different procedure that is similar to VATS.3
There are differences, however, in that MP is per-
formed by a pulmonologist on (usually) sponta-
neous breathing patients commonly via a single
port whereas VATS is performed via several ports
by a thoracic surgeon on an intubated patient with
a double-lumen tube. MP is most often a diag-
nostic procedure (especially for pleural effusion),
occasionally for poudrage, whereas VATS is
primarily performed with a therapeutic intent. MP
and VATS should be regarded as invasive
in pleural disease.
referred as
Patient Selection
Patients with unexplained pleural effusion, pleural
infection, and pneumothorax may potentially be
suitable for MP. Contraindications include a World
greater than 2 unless related to the effusion,
uncontrolled coughing, hypoxemia unrelated to
the effusion, pulmonary hypertension, unstable
myocardial status or function, or a bleeding diath-
esis. The only absolute contraindication is lack of
a pleural space due to adhesions, as a partially
collapsed lung is required to safely introduce the
pleuroscope into the pleural cavity.
Organization performancestatus4
Detailed history and physical examination are
prerequisites as is accurate assessment of func-
tional status of patients. Recent chest radiograph,
pleural CT, or pleural ultrasound scan are highly
desirable prior to performing an MP along with
an electrocardiogram,
complete blood count. The international normal-
ized ratio should ideally be below 1.5 for perform-
ing the pleural biopsy and a platelet count greater
than 60,000 per mL of blood. Aspirin prolongs the
bleeding time but is not a contraindication. Clopi-
dogrel, however, can result in significant bleeding
and should be with held 1 week before MP. Efforts
to optimize lung function in those with pre-existing
obstructive lung disease are helpful. Coughing
should also be minimized preprocedure.
MP can be performed in an appropriately sterile
endoscopy suite or an operating room. In many
institutions, decubitus pleural ultrasound is per-
formed on the day of the procedure, which may
clotting profile,and
aDepartment of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester
LE3 9QP, Leicestershire, UK
bNorth Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, Avon, UK
* Corresponding author. North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB,
Avon, United Kingdom.
E-mail address: firstname.lastname@example.com (A.R.L. Medford).
?Medical pleuroscopy?Pleural effusion?Pleural infection
Clin Chest Med 31 (2010) 165–172
0272-5231/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.
Page 3
Author's personal copy
be particularly helpful if loculations are suspected,
to optimize the site of entry and avoid potential
technical challenges.5,6Alternatively, operators
may use a Boutin needle or a similar device to ar-
tificially create a pneumothorax and collapse the
lung, creating a space for trocar insertion. After
placing an intravenous cannula, patients are
usually premedicated with an opiate, atropine
(intramuscular), and intravenous crystalloid infu-
sion. Routine antibiotic prophylaxis is not indi-
cated provided the environment is sterile and an
aseptic technique is used.
Patients lie in the lateral decubitus position with
the abnormal hemithorax uppermost and the arm
raised above the head to allow access to the inser-
tion point along the anterior axillary line and to
maximize the space between the ribs. Essential
monitoring includes respiratory rate, heart rate,
blood pressure, oxygen saturations, and electro-
breathing spontaneously,
under conscious sedation with a combination of
midazolam and fentanyl or propofol infusion and
laryngeal mask airway. Occasionally, assisted
ventilation using a propofol infusion via a single
lumen endotracheal tube is used for better anal-
gesia; an anesthesiologist's input may be needed
in such a scenario. MP thus can avoid the need
for more than one port, general anesthesia, or as-
sisted ventilation via a double-lumen endotracheal
tube, as is required in VATS.
After infiltration of the skin and the chest wall
with a mixture of local anesthetic and adrenaline,
blunt dissection to the pleural space is performed
in the anterior axillary line (or as guided by lateral
decubitus ultrasound) in the same manner as in-
serting an Argyle intercostal chest tube, typically
betweenthe fourthand
spaces. The trocar is inserted with the release
valve open. MP can be performed with one or
two ports typically and using a rigid or a semirigid
scope or a minithoracoscope (discussed later). A
single port is used for diagnostic MP and talc instil-
lation whereas the two-port technique may be
used if need for diathermy is anticipated. The latter
is used to overcome adhesions causing parts of
the hemithorax to be inaccessible via a single
port, to drain complex effusions, or for more
advanced applications, such as lung biopsy.
The effusion is completely drained under direct
visualization and then the pleural surfaces are in-
spected thoracoscopically for optimal biopsy sites
and the presence of any evidence of trapped lung.
If there are thin adhesions obscuring view, they
seventh intercostal
can be carefully severed but with vigilance for
bleeding (very thick fibrous adhesions may often
require surgical decortication). Targeted parietal
pleural biopsies are taken under direct vision,
avoidingthe visceral
vessels, and over a rib if possible. A long sweeping
motion is used to obtain the pleura rather than
a snap-and-grasp technique. If there is no
evidence of a trapped lung with no obvious
visceral pleural thickening or adhesions, then
a talc poudrage is performed, especially if there
is clear evidence of pleural malignancy. At the
end of the procedure, a 24-gauge (or larger, espe-
cially in cases of pleural infection) chest drain is in-
serted and removed within a few hours to 3 days,
depending on re-expansion of the lung and
drainage of the pleural fluid. If the lung is trapped,
options are to try a normal chest drain with or
without suction or to place a tunneled chest drain
for outpatient management. If no talc has been
instilled and the lung has re-expanded with the
patient stable, the patient could be discharged
the same day.
pleura and intercostal
Rigid MP uses a light source, endoscopic camera,
video monitor, and image capture device with
a trocar of between 5 and 10 mm diameter and
5-mm rigid forceps (Figs. 1 and 2). Direct or obliqe
rigid 7-mm pleuroscopes are available, which
Fig. 1. Rigid pleuroscopy stack system: monitor (top
level), light source (top second level), pleuroscope
power supply (lower second level), image capture
device (bottom level left).
Medford et al
Page 4
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provide more panoramic view of the pleural space
(Fig. 3). Other essentials include sterile drapes and
gowns, standard instruments for chest tube inser-
tion, a talc atomizer system, a chest tube (usually
24F–32F),anda negative
Variants of rigid MP exist. A minirigid MP
3.3-mm telescope with 3-mm biopsy forceps has
been used for small loculated effusions inacces-
sible to the standard size rigid MP scope and
larger nonloculated effusions. The diagnostic yield
is still favorable at more than 93%.7Some opera-
tors prefer to use a semirigid thoracoscope in pref-
erence to the rigid scope on the basis that
pulmonologists find this system easier to learn as
it is close to a flexible bronchoscope in its maneu-
verability.8,9The outer diameter of this instrument
is 7 mm and it has a 2.8-mm working channel
that can accommodate conventional
biopsy forceps. It is also compatible with existing
processors and light sources used for flexible
bronchoscopy, reducing costs. Despite concerns
that semirigid thoracoscopy may lead to inferior
biopsies that are significantly smaller in size
compared with the rigid system, available data
suggest that good yields (93%) can be obtained.10
Comparative studies are awaited. Semirigid MP is
probably best reserved for assessment of indeter-
minate pleural effusions, where the suspicion of
malignant mesothelioma is lower, until further
data are available. In all other cases, rigid MP is
the procedure of choice. Finally, a flexible
bronchoscope has been used as a flexible MP
but experience has found the rigid MP superior
with bigger samples and better yield.11,12
MP is a safe procedure when performed by
a trained operator. Mortality rates with rigid MP
are 0.8% or less in published series, including
centerswhereit has been
lished.13–15Complications are few, with reported
rates of between 2% and 6%.16These include
postoperative fever, subcutaneous emphysema,
persistent air leak (>7 days), re-expansion pulmo-
nary edema, cardiac
ischemia, bleeding, empyema, wound infection,
and seeding of the chest wall by the neoplastic
cells.17,18With the semirigid MP scope, complica-
tions are expectedly rarer with no reported
mortality in published studies to date.8–10
recently estab-
Pleural Malignancy—Undiagnosed Pleural
The main benefits of MP in malignancy are diag-
nosing pleural metastasis by guided biopsy under
direct vision (Fig. 4) and providing large amounts
of tissue to allow histologic confirmation,14histo-
logic differentiation(especially
from adenocarcinoma), hormone receptor anal-
ysis, and assessment of lung expandability. MP
also allows for complete drainage of the effusion,
removal of adhesions, and talc pleurodesis, if
appropriate, during one procedure in a controlled
environment andoptimizing
MP is often needed because of the limitations of
less invasive diagnostic techniques. Thoracocent-
esis is the first investigation into unexplained
pleural effusions but pleural cytology is diagnostic
Fig. 4. Metastatic lung adenocarcinoma on parietal
pleura viewed at MP.
Fig. 2. Rigid biopsy forceps (upper), rigid pleuroscope
(middle) and trocar (lower).
Fig. 3. Direct (upper) and oblique (lower) rigid
Medical Pleuroscopy
Page 5
Author's personal copy
only in approximately 62% of cases for malig-
nancy, with a much lower yield in mesothelioma
and in early cancers, as positive cytology requires
malignant cell exfoliation from the pleura into the
pleural fluid and adequate cytologic characteris-
tics.19Even after further sampling with larger
volumes, at least 25% of suspected malignant
effusions remain undiagnosed. If there is a high
pretest probability of pleural malignancy, then
MP is normally indicated at this stage, unless there
is an ipsilateral shifting or midline mediastinum in
the presence of an effusion, which would suggest
main bronchus obstruction, which may require
bronchoscopy as an initial diagnostic test.
Closed (ie, not image-guided, using an Abrams
needle) pleural biopsy only increases the yield for
malignancy over cytology by 7% to 27%.19Pleural
malignant deposits tend to predominate near the
midline and the diaphragm, accounting for the
lower yield of closed pleural biopsy compared
with CT-guided pleural biopsy or MP.20CT-guided
pleural biopsy can achieve yields of 87% to 88%
for malignancy and 86% for mesothelioma.20–22
The yield of MP is superior at 90% to 95%.23,24
MP offers a superior diagnostic option to closed
pleural biopsy and advantages (described previ-
ously), resulting in a short duration of hospital
stay.14Although CT-guided pleural biopsy gives
a better yield than closed pleural biopsy (87% vs
44%),20MP is superior as it allows combined diag-
nostic and therapeutic options (drainage and pleu-
rodesis) in a single visit, if indicated, with a larger
tissue sample for analysis.
Metastatic pleural disease in non–small cell lung
cancer precludes surgery and has recently been
reclassified from T4 to M1 disease, taking into
account the abysmal prognosis for patients with
malignant pleural effusion.25MP can assess accu-
rately whether or not the effusion is paramalignant
or due to metastases, although in clinical practice,
VATS may often be performed in this setting by
a thoracic surgeonto
Changes in practice and an increased drive to
reduce inpatient hospital stay have resulted in
increasing use of MP by the pulmonologists. A
recent United Kingdom survey demonstrated that
37 centers now offer an MP service; 15 (41%) of
these perform fewer than 20 procedures per year
(Dr N. Downer, personal communication, 2009).
There have been 218% and 336% increases since
2004 and 1999, respectively.27
Although low pleural pH due to large tumor burden
predicts failure of pleurodesis,28MP talc poudrage
can be 88% effective even when the pleural pH is
less than 7.3.29MP talc poudrage (Fig. 5) has been
shown superior to talc slurry (relative risk of nonre-
currence 1.19) via a normal chest drain in a recent
Cochrane systematic review.30Although a recent
randomized trial did not show an overall superi-
ority for thoracoscopic talc poudrage over talc
slurry via chest drain, a subgroup of patients with
lung and breast cancer had greater success with
talc poudrage (82% vs 67% success at 30
days).31In the same study, the proportion of
patients with talc-related acute respiratory failure
was slightly higher in the poudrage group than
the slurry group (8% vs 4%, respectively).
Pleural Tuberculous
For tuberculous (TB) pleural effusion, closed
pleural biopsy has a much higher yield than in
pleural malignancy due to the more diffuse nature
of the pleuritis with combined yield of histology,
tissue culture, pleural fluid smear, and culture
varying between 80% and 90%.19MP remains
superior to closed pleural biopsy (100% vs 80%
yield), however, in areas with a high TB preva-
lence.32If MP is not locally available, however,
closed pleural biopsy is a reasonable first-line
investigation in this situation. CT-guided pleural
biopsy may be performed yet requires interven-
tional radiologic expertise and a pleural CT.
MP has the advantage over closed and CT-
guided pleural biopsy of obtaining a greater
amount of tissue, which may be relevant when
the diagnosis is in doubt or when there is a need
to obtain anti-TB drug sensitivity profiling for sus-
pected drug-resistant cases. MP also allows the
simultaneous opportunity to break down adhe-
sions and drain the effusion in a safe, sterile, and
controlled fashion, which may be necessary for
larger effusions while waiting for response to
anti-TB treatment.
Fig. 5. Standard rigid forceps for MP after talc
Medford et al
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Pleural Infection and Empyema
In pleural infection, loculations may impede
drainage via a conventional chest tube and intra-
pleural fibrinolysis is not recommended in this
context.33The exact timing and role ofMP remains
an area of ongoing debate. Guidelines from the
American College of Chest Physicians and the
British Thoracic Society do not refer to MP but
focus onthe roleof
MP can be useful early in the course of
empyema where thin fibrinous adhesions can be
broken down and the fluid and the infected mate-
rial can be removed to allow lung expansion,
providing an opportunity to take targeted biopsies
to exclude occult undiagnosed infection or malig-
nancy.34,36Further research is ongoing to assess
the potential of pleural lavage in pleural infection,
which is also possible at MP.
In the later phase of empyema, when there are
thick fibrous adhesions (Fig. 6),37trapped lung,
or a pleural peel, early VATS decortication may
be required using classic multiport intervention
under general anesthesia with double-lumen intu-
bation.38,39Expert medical pleuroscopists can
also perform MP in empyema in the fibrinopurulent
stage, however, and this may be a preferred option
in frail or elderly patients, where conventional
chest drainage has not been successful and
patients are at a high risk for VATS.40,41Existing
data on MP in pleural infection are sparse but
a 93% primary success rate in avoiding surgical
intervention has been achieved in early-stage
pleural infection.42
VATS undersuch
MP can visualize blebs and bullae in patients with
spontaneous pneumothorax. Pleural abrasion or
talc pleurodesis can be performed or even coagu-
lation of such blebs. MP with talc poudrage may
be particularly helpful in the setting of patients
with significant comorbidity and advanced lung
disease that may not be suitable for VATS43and
is superior to standard pleurodesis via a chest
tube.44For suitable patients, VATS or thoracotomy
detects blebs or bullae better than MP. VATS bul-
lectomy, pleural abrasion, or pleurectomy is supe-
rior to MP for recurrent pneumothoraces.45
Autofluorescence MP has been used recently to
detect areas of potential air leak, which are macro-
scopically normal on white light MP using inhaled
Other Benign Pleural Disease
If thoracocentesis is unhelpful, MP can also help
diagnose other benign pleural disorders in certain
settings. The parietal pleura can have a gritty
appearancein rheumatoid
asbestos pleural plaques have a characteristic
smooth, white, but hard consistency that is difficult
to biopsy as a result.
Advanced applications of MP include visceral
pleural and lung biopsy and sympathectomy.
Other potential applications for the future are
being researched.
Visceral Pleural and Lung Biopsy
Visceral pleural biopsy and peripheral lung biopsy
can be undertaken at the same time as parietal
pleural biopsy at MP, especially when there is
coexistence of a pleural effusion with lung disease.
This maybe important for detecting asynchronous
tumor or altering prognosis of a known tumor.
Often coagulating forceps may be used via
a two-port technique, although a single-port tech-
nique is possible with optical forceps without
coagulation or using minithoracoscopy.7
Lung biopsy via MP for diffuse or localized lung
disease is less commonly performed with the
advent of VATS wedge lung biopsy and improve-
ment of high-resolution CT.48International guide-
lines from several continents on interstitial lung
disease have recommended the use of VATS
lung biopsy in particular when indicated.49,50
VATS wedge biopsies contain more vascular
structures than forceps biopsies, with less crush
artifact and greater size.51Therefore, for pulmo-
nary disorders where vascular integrity is impor-
tant, forceps biopsy via MP is not recommended.
MP is still occasionally used for diffuse lung
disease by some interventional pulmonologists
Fig. 6. Chronic sterile empyema at MP with thick
fibrous septations and pleural peel.
Medical Pleuroscopy
Page 7
Author's personal copy
when bronchoalveolar lavage and transbronchial
biopsy have not yielded a diagnosis with good
rates of high quality biopsies.52For localized lung
disease, yields with MP forceps lung biopsy are
lower, at less than 50%53and this method is no
longer used.
Complications with MP lung biopsy are low, the
most common are air leaks, but are at similar rates
to VATS lung biopsy.54,55Bleeding or tissue coag-
ulation is minimal and mortality is extremely low.
Sympathectomy has been used for the treatment
of hyperhidrosis or chronic pancreatic pain in
particular but percutaneous methods are not
very effective with high complication rates.56
Although generallyperformed
surgeons at VATS,57advanced pleuroscopists
have described a single-port technique via a single
lumen endotrachealtube
tery.58,59Complications of MP for this indication
are rare (usually <1%) but include Horner's
syndrome, pneumothorax, and hemorrhage.
by thoracic
using electrocau-
Future Research Areas
The applications of MP are evolving. Pleuroscopic
lavage is under evaluation in the treatment of
pleural infection. Autofluorescence pleuroscopy
may potentially have an application in detection
of early pleural malignancy as autofluorescence
bronchoscopy has been utilized for early detection
of malignant lesions in the bronchial tree.60
Cost Analysis
There are no published cost analyses of MP. A
recent United Kingdom tertiary center theoretic
cost analysis, however, which compared Abrams
or CT-guided pleural biopsies to MP, calculated
cost savings of $2198 (£1527) per patient.14The
cost savings over Abrams needle biopsy, CT-
guided pleural biopsy, and VATS are likely to be
dure, shorter hospital stay, avoidance of thoracic
operating room costs, and allowing increased
patient flow through interventional radiology and
thoracic surgery services. In health care systems
is essential to allow correct remuneration. Coding
errors occur for a variety of reasons and are well
described in MP and other specialties.61,62
The American Thoracic Society and European
Respiratory Society guidelines on interventional
pulmonology do not address MP,63although the
procedure is regarded as easier to learn than flex-
ible bronchoscopy.40The American College of
Chest Physicians interventional
guidelines recommend 20 supervised MP proce-
dures for training and a minimum of 10 per year
to maintain skills.64The British Thoracic Society
is currently revising training guidelines for MP but
many centers suggest at least 25 to 30 supervised
MP procedures to achieve competency pending
the development of formal guidelines. To deliver
a robust training program, there needs to be an
appropriate service demand in terms of proce-
dures performed per year, which suggests this
would not be a procedure for all pulmonologists.
Significant demand can occur in tertiary centers
despite having thoracic surgery on site.14
MP offers pulmonologists an opportunity to take
multiple pleural biopsies to diagnose malignant
and nonmalignant pleural diseases. In addition,
operators may drain large pleural effusions, break
down adhesions, and perform an effective pleu-
rodesis with talc poudrage under direct vision,
using conscious sedation. Advanced operators
may treat pneumothorax and take lung paren-
chymal or visceral pleural biopsies.
Close collaboration between the pleuroscopist,
thoracic surgeon, and thoracic radiologist is key,
as MP remains an invasive procedure requiring
training and careful patient selection.
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|Discussed the Moving Ahead for Progress in the 21st Century Act (MAP-21) and recently released related guidance. Transcript:
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|In this session, you will learn the following: Identify the customer. Analyze the current and future needs. Determine how to choose the right tools. Discuss solution oriented proposals. Understand marketing pitfalls.


text:
|A to Z | Popular | Random | Origins
TaisRate Tais: Do you like this name?
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Meaning and name origin
Tais \tais\ as a girl's name is of Greek origin. Tais is a variant of Thais (Greek): Thaïs is an ancient name of unknown meaning.
Tais is not a popular first name for females and an equally uncommon surname or last name for all people (2000 U.S. Census).
Displayed below is the baby name popularity of the name Tais for girls (2015 statistics).
Similar Names
Tais is also pronounced similarly to Ta-, Taya, Tia and Toia. Other suggested similar baby names are Tace, Tacia, Tacie, Tacy, Taija, Taisa, Taisha, Taisia, Taisie, Taisse, Tait, Taja, Taji, Tajia, Tanis, Tasa, Tash, Tasia, Tassa, Tazia, Tess, Thaisa, Tisa, Tish, Toos and Tris. These names tend to be more commonly used than Tais.
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Robert Olson-Dates:Death date: February 14, 2013.
Al Hayat Media/CNN
ISIS forces have extended their control around the ancient Syrian city of Palmyra. The capture of Syria's ancient city, about 150 miles northeast of Damascus, threatens a UNESCO World Heritage Site described as having "stood at the crossroads of several civilizations," Learn more about the group.
Test your knowledge of Memorial Day facts and see how well you know the holiday in this slideshow.
With beach season upon us, Dr. Beach lists his top picks for sandy stretches in 2015.
Michelle Li, Susan Siman and Charlotte Deleste anchors will be the 2015 Race for the Cure chairs.
Join WISC-TV3 and Channel3000.com on May 30 and walk or run for the cure.
An award-winning nonprofit that helps consumers solve problems is looking for volunteers in the Madison area.
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8-year-old Rachel Huber, 50.5 inch musky on Wisconsin River
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text: You guys are unnecessarily speculating. The onus is on SKI to provide proof for his remarks, before then just consider as lying with a straight face in public. I mean if its a private survey and thus a private matter or whatever is being alluded to don't announce it in public unless you can prove it. Some of these things are really getting to be sickening and disgusting and even alien to over native. I suspect congenital dissonance from the pair.


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Lillian Etta McFayden Sherrill, 90, of Ellerbe, beloved mother and grandmother, passed away Friday, September 20, 2013 at her daughter's home.
Miss Lillian, as she was affectionately known, was born November 19, 1922 in Richmond County, a daughter of the late Colon Alexander and Etta Melinda Freeman McFayden. She was a graduate of Ellerbe High School, Class of 1939. She was an active member of Jackson Springs Presbyterian Church, where she had taught Sunday School and served as an Elder and a Deacon and was a life member of the Presbyterian Women. She had worked at A & P Grocery in Charlotte and Rockingham and retired after 25 years as a teacher's assistant at Ellerbe Primary and Mineral Springs Schools. Following her retirement, she loved working at David's Produce in Ellerbe, which was a part of her family farm.
Miss Lillian loved local history and from 1992 – 1998 she and her husband Woodford were instrumental in the restoration of Bostick School in Ellerbe. She was also the family historian, a member of the Richmond County Historical Society and the Daughters of the American Revolution. She was preceded in death by her husband, Woodford Sherrill, grandson, Alex Sherrill, brothers Colon and Ralph McFayden, sister, Mary Jean McFayden, son in law, Ray Robbins and sister in law, Gladys McFayden.
Surviving are her children, David Sherrill (Jackie) of Ellerbe, Brenda Baucom (Thomas) of Rockingham and Nancy Robbins of Rockingham; grandchildren, Brian Baucom (Genny), Trey Robbins (Emily), Ryan Baucom, Sherri Boyle (Johnathan) and Ashley Cagle (Andy); great grandchildren, Braden Baucom, Carson Boyle, Levi Boyle, Caroline Robbins, Owen Baucom and Maddox Baucom; brother, Harold McFayden (Peggy), Robert McFayden (Marie) and Willard McFayden (Enid), all of Ellerbe and sister in law, Dot McFayden of Ellerbe.
A service to celebrate Miss Lillian's life will be held at 11 am Monday at Jackson Springs Presbyterian Church with Rev. Wyatt Coley and Rev. Jim Ritter officiating. Interment will follow in Ellerbe Cemetery.
The family will see friends from 5 to 7 pm Sunday at Carter Funeral Home in Ellerbe and at other times at the Baucom home, 112 Entwistle Third St. Rockingham.
Memorials may be made to the Alex Sherrill Memorial Scholarship Fund, c/o BB&T, P.O.Box 1028, Rockingham, NC 28380 or to Jackson Springs Presbyterian Church, P.O.Box 7, Jackson Springs, NC 27281.
Condolences may be made online at www.carterfuneral.net.
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Wind Energy Update: India Wind Report Gives Confidence to Market
Following interviews with experts from the Indian wind industry, Wind Energy Update have compiled a "State of the Industry" report which is now available to download as reported by Wind Energy Update.
London, UK (PRWEB) May 21, 2012
The report features interviews with 3 industry experts and highlights where the challenges lie and what the future prospects are for wind energy in the medium to long term.
The Wind energy Update report highlighted that while the dismantling of the accelerated depreciation model is seen to have a negative impact on the industry in the short term, the introduction of GBI´s is widely seen to be a good move for the long term health of the renewable energy industry in India. "There may be temporary drop in capacity additions. But in the long run, the quality of projects will improve, and the investment environment will get better as well", states Sunil Jain, Chief Operating Offer of Green Infra Ltd. "With the new Generation Based Incentive (GBI) introduced just over a year ago, we've seen the addition of 3,200 MW in 2011-12, which is the highest annual addition to date", agrees Mr Krishnakumar, Managing Director of Orient Green Power.
Will Broad of Wind Energy Update explained that readers of the report will get an "an honest and useful appraisal of one of the most dynamic RE environments in Asia".
To receive the complimentary report, visit the website http://www.windenergyupdate.com/india/content3.php or contact Will Broad at will(at)windenergyupdate(dot)com.
For the original version on PRWeb visit: http://www.prweb.com/releases/prweb2012/5/prweb9519367.htm


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Welcome Baazi Mehmaan Nawazi Ki - Teaser 02
Added on 1/19/2013
By : lifeok
Overall Rating :
Rate Me... Rating Saved!
View : 39015 Comments : 80 Video Courtesy : Life OK
|Total Votes : 86
|kheira, sweety3773, dynamos, Walwam, radwan, faisel1980, faisa1980, Shahnaz11, ..Zahra.., huddy, sanaya_pari, oroniArShi, lovelygal_sou, ..SaNaYaHoLiC.., .Ishveer.matsh, anjusr06, spsharmila, SwaNia_1, binimoti, -krrish-, Aliya_hzsn, SIZZZLER, _SilverLining_, hodan1987, gunurlove, IPKKNDfan4ever, sweet-fairy, Alyaa_27, SwaNia_2, monaya4eva, -SanzAngel-, -Spell0fJoy, tiahalder, EtherealSanz.., ..Enchantress.., P.Srinivas, FascinatingSanz, xMidnightStarx, mpat, Sidda8, MadhuO, chandana.s, Naz_nisar, SublimeSanaya, bkamber, amaia, SanayaFlawless, CandYlicious_S, -Marie-, .Saraa., DreamsFlyFree, shillu.arshi, DiyaS, charmee_sammy, Joseph_A, SanzPaRudholic, Arshi.Sugi.IPK, AdorableDevil
sanaya a flawless beauty girl she always rocks
love u Sanaya and if i m not wrong ...
this RED Dress Sanaya already wore in MJHT as
a SaJan very First Officially DATE and the very HOT Song Sequence
*roshni se bhare bhare*here a picx ...[img]http://i802.photobucket.com/albums/yy301/sajan-monaya/Roshni%20Se/127.png[img/]
loved her dress :) good luck Sanaya and i really hope and pray u WIN the Show !!!
love ya ... keep ROCKING Barbie Doll
- S a n a -
Sanaya Irani, you are the reason I will watch this show. Love you.
Sanny u r looking so beautiful !!!
sanaya irani you are one of a kind..proud to be your fan..
Sanaya Irani looks the most calm and well presented in order of behaviour and appearnace in this teaser... Truly stands out from the rest and stays true to her nature and personality...love you for that Sanaya Irani!!
Love you Sanaya Irani
Mwwwaahhh xxx
Sanaya Irani as beautiful as ever. Waiting for monday to see you back onscreen. Love you.
sanaya is looking gorgeous!
waiting to see u back!
Sanaya Irani - sweet and beautiful - and you are back!
Love you Sanaya Irani...excited to watch u back onsceen...:)
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Forbes Reveals 2015 List of Most Powerful Women
Only on "CBS This Morning," Forbes reveals its annual list of "World's 100 Most Powerful Women." It includes 24 CEOs, 15 billionaires and eight heads of state. The power women control $1 trillion in annual revenues.
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This restaurant and bar is an excellent place to sit outside and watch the main street in Ouagadougou. They have nice white linen tablecloths, excellent waitresses, a good menu and cold beers. They even have take-away pizzas you can phone ahead for. I just stopped by for a drink, but had a nice beer and watched the city go by slowly. That's Ouagadougou for you. If you are bar hopping or just want to people watch - this is a great place for a drink.
Food runs along the pizza and burger route, but they offer a few meals, lots of desert, wines and some wild sounding cocktails.
Open 6pm-Midnight 7 days a week.
Zaka: Live music and food
Zaka is in the middle of the lively citycentre with marketstalls and mopeds, but when you enter the courtyard built in traditional Mossi style you are in another world.
Zaka is a nice place to enjoy life music while having dinner. It seemed to be already a favourite place for travellers in the past. When we visited Zaka at our first evening in Ouagadougou in 2013 we were introduced to traditional music at balafon and djembé. We took our dinner (chicken and salad) and hung around for some time with some drinks.
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text:
Pirates stomp Mavericks with balanced attack
Sinton runs for 4 touchdowns, passes for 3 more
FLORESVILLE - Sinton's offense didn't look like it belonged in the Class 3A football playoffs Friday night. Not even close.
It looked like something out of the Big 12.
The Pirates blistered Pearsall's defense in the Division II area-round contest. It took only 31 offensive plays for Sinton to rack up seven touchdowns en route to a 49-14 rout of the Mavericks.
"They gave us some fits early, and we made a couple of adjustments," Pirates coach Tom Allen said. "We've got a bunch of seniors who just don't want it to end."
It will continue for at least another week. Sinton (11-0) will meet the winner of tonight's Bellville-La Vernia game in next week's regional round.
Pearsall (7-4) had a 7-point lead early when the Pirates began to get rolling. By the time the Pirates starters were pulled less than two minutes into the fourth quarter, the score was 49-7 and Sinton had ripped the Mavs for 502 yards on 31 plays.
Fourteen of those first 31 plays went for 10 yards or more, and it was evenly divided between rush and pass.
"We just took what they gave us," said Ram Sanchez, who caught two touchdown passes and ran for another score. "Sometimes it was the pass. Sometimes it was the run. Whatever we took, we accomplished it."
But it all turned on a defensive play. With the game tied at 7, Pearsall's Rene Gonzales was headed into the end zone at the beginning of the second quarter. But the ball was stripped at the Pirates 10. Sinton recovered and returned it to the 26.
Richard Orta broke off a long scoring run on the next play.
"We are not blessed with a bunch of D-I kids, but they will fight, fight, fight," Allen said. "They're going in for the score and we get a strip. We score on the next play. That was the turning point."
The Mavs moved the ball but could not get it into the end zone. After scoring on the opening drive of the game, they made it into Pirates territory on five of the next six possessions.
But Pearsall came away empty each time. The Mavs fumbled on the Sinton 10, failed on a fourth down and quarterback Nathan Valle was picked off on a fourth down to end the first half. In the second half, there was another interception and a blocked quick kick.
Again, that miscue had a quick response, as Reno Rendon took the handoff on the next play after the blocked kick and sprinted 44 yards for a score. It showed the efficiency of the Pirates' offense.
Pearsall's Valle threw 50 times and rolled up 327 yards, but could only score in the first quarter and when the game was out of hand in the fourth quarter.
The Pirates, conversely, seemed like they could choose their route to the end zone, with quarterback Josh Harrison passing for three touchdowns and Sinton rushing four times for scores, including one by Harrison.
And Orta, who rushed for 119 yards on five carries, thinks it will just get better.
"We're not playing near as well as we can," he said. "But we'll get there."
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Letters to the Editor: 02.04.12
John Carona, Texas state senator
Response to windstorm editorial
I read the Caller-Times editorial, "Coastal unity is a wise approach," with interest, and there are a few things I don't quite understand in it. First, your ability to describe the commonality of interest that the rest of the state shares with the coast (which I agree with) and in the same breath encouragement of an us-versus-them attitude appears at best counterproductive. The coast has always been well represented in Austin, and its concerns are our concerns. I know, because in addition to chairing the Senate committee of jurisdiction and co-chairing two joint committees on the subject, I spent my earliest years in Texas City and have constituents with coastal property.
The actions taken by the 82nd Legislature improved the actuarial soundness of the system. Without that, there is no rate that will provide a level of protection. We also improved the oversight and governance of the Texas Windstorm Insurance Agency. We know that the availability of windstorm insurance under circumstances presented along the vulnerable Gulf Coast is an issue that generates intense interest from a wide spectrum of public and private stakeholders, and our work here is far from done. The Legislature will continue to look for better ways to ensure that coastal property owners have an avenue to obtain windstorm insurance coverage and that legitimate claims are handled in a timely and satisfactory fashion.
I welcome anyone's suggestions for improvement. Feel free to send an email with comments to email@example.com and follow the discussion on these and other important issues on the Texas Senate Business & Commerce Committee blog at http://bandc.posterous.com.
Mario H. Marroquin, Alice
Address streets, water lines first
You had an article about the sales tax increase for the city of Alice ("Sales tax revenue boosts Alice budget," Jan. 19). Too bad you didn't look deeper into the problems of Alice.
True, we are a booming town at the moment. But we have gone through this before. The $15 million or so in sales tax receipts was an unexpected windfall for the city.
Alice has Third World streets on the south and west of town. At least 80 percent or more of Hispanics live in this area. I live on the west side of town and we also experience multiple water leaks every week in my area of town. You would think that our city council and mayor would think of upgrading the streets and water lines first. No, they already decided to build a city convention center and a fancy swimming area for the city.
Too bad the citizens of Alice haven't complained about being cheated out of their money.
Andrea Dobson
The military model is un-American?
Conservatives must be getting desperate in their opposition to the president.
We Americans have used military analogies to fight everything from football games to cancer to the Great Depression — but when Obama uses one, as Jonah Goldberg pointed out in his Jan. 30 column, it could only be a Socialist plot to take away our freedom!
Carlos H. Valdez Sr.
State parks and Perry
I'm an avid reader of David Sikes' columns. On Jan. 19 he wrote an article about our state parks and the tough time they are having making ends meet. He encouraged us to visit the parks. Basically Texas Parks and Wildlife is passing the hat. The fires and the hot weather have not helped. The Legislature also cut their funding.
Where is Gov. Rick Perry? This is the time if he was a leader he would be leading the charge. While he was chasing the nomination for president, the state was spending $400,000 a month for his security. I thought the state was broke? Gov. Rick Perry presided over a $27 billion deficit the last legislative session. The budget was balanced by cutting crucial programs and services. This was done with a super Republican majority.
Dave McNeely writes in his column that for every month Perry was pursuing the presidency we could have hired 10 teachers. Or helped the parks. What has Perry done for the greater good of the residents of Texas?
This is conservatism at its best. Have you every heard a conservative say his budget is too big or he will take a cut? Don't hold your breath
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What's in the "Wilier" name! - Wilier Triestina style, the result of a refined balance between tradition and innovation, today also means safety and reliability at the highest levels. The victories of professionals equipped with Wilier provide for us.
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- Price: $139.00
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Store Fashion osCommerce Template 19220
osCommerce 2.2 RC2a Template that was composed by our webmaster artist Lovely.
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Description, Sources, Software & Requirements
This OSCommerce clothing store template has a white background, an over-all light theme, and uses mostly white, shades of gray, red, blue, and black. The header has a white background, a red "@" logo beside black "Style Store" text on the left, and to the right a shopping cart status area with gray text and a set of language selection flag icons. The logo can easily be customised or replaced with your own logo. Under there there is a glossy gradient light gray navigation bar with black links pointing to Home Page, New Products, Specials, My Account, and Contact Us. Next there is a light gray gradient tool bar with a red and white search box and buttons on the left, a white and gray currency exchange drop-down in the center, and a gray and white manufacturers drop-down on the right. Following that there is a tall leader-board banner image with a black and dark gray background, black swirl decorations, a girl in a white shirt posing on the right, and blue/white text on the left. The banner can easily be customised or replaced with your own banner. Under the banner there is a light gray sale section that spans the width of the content area, on top there is a title sale which says "Hurry free shipping", and below it in three blocks there are sets of black and blue links for sale categories. The sale section items can easily be customised or replaced with your own sale section items. Next there is a short satin red banner image with white "Special Offer" sparkle text on the left and white details text on the right. The banner can easily be customised or replaced with your own banner. The content section of the template is split into two main columns, a thin sidebar on the left and a wider featured products column on the right. The first sidebar block is a category listing with a white background, bold black title, and black category links. Next there is a special item block with a white title bar that bas a black title, and a dark gray content area with a small white thumbnail image on the left, and to the right has white and blue text and price links. The title bar on the right column is blue with white title text. There are three columns in the featured products grid. Each of the tall thin product cells has a large thumbnail image on top, followed by black description text, red price text, a blue rounded corner add to cart button, and a grey boxy details button. Some of the items this template might be used to display include shirts, jackets, hoodies, sweaters, pants, suits, hand bags, shoes, boxers, underwear, hats, and various other clothing related items. The footer has a black background with Paypal, Visa, and Mastercard logos on the left and white text and links on the right. Store Fashion osCommerce Template 19220 is available in the following sources: .PSD, and .PHP. Software required includes Winzip 9+ (Windows) or Stuffit Expander 10+ (Mac) for uncompressing .zip files, Adobe Photoshop CS+, Adobe Dreamweaver 8+ (or any php-editor), Apache Only (on Unix/Freebsd/Linux/Windows), and Hosting with PHP5x and MySQL5x. It has had a total of total of 2 downloads since it first appeared.


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Nate Logston
50 - 100 downloadsAdd this app to your listsTweets por @Appszoom
The brand new official Nate Logston Mobile App is now available! Stream my music, see pictures, check out my bio, and share it all with your friends. Stay connected for the latest updates from Nate Logston on your mobile device with my free Mobile App.
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1. In a small bowl, mix tamarind paste and jaggery.
2. Slit the chilies lengthwise and stuff with the mixture.
3. In a mixing bowl, place gram flour, add enough water to make a thick batter, add salt and mix.
3. In a wok, heat oil, dip the chilies into the gram flour batter one at a time, slide into the oil, fry until it turns light golden brown.
4. Serve hot with chutney of your choice.
Select straight chilies. It should not be very hot. While frying keep the slit park face the bottom.


text:
PhatWare Corporation is a leading provider of easy to use powerful software products and professional services for the mobile and desktop computing marketplace. PhatWare specializes in handwriting recognition, digital ink, note taking and database, and network management software development. PhatWare's products include such popular titles as CalliGrapher, PenOffice, PhatNotes, PhatPad, WritePad, and others.
WritePad lets you take notes in your own handwriting with an iPad stylus (such as AluPen by just|mobile) or even your finger. The state-of-the-art handwriting recognition software will adapt and learn your style of writing. You can use simple gestures to select text, cut, copy, paste, and insert special characters.
WritePad has a spell checker with its own custom dictionary, a context analyzer, auto-corrector, and a Shorthand feature that fills-in words and phrases you frequently use...
More than another note-taking app, PhatPad turns your iPad into an advanced brainstorming tool. Draw, write, and type your ideas then instantly share them via email, WiFi sync, Dropbox, or presentation mode. PhatPad's digital ink technology and handwriting recognition engine allows you to scribble handwritten notes and drawings and convert them into digital text, or perfect geometrical shapes.
PhatPad offers everything you need to express your...
PhatNotes is an award-winning notes organizer for Desktop PC, iPhone and iPod Touch. You can create notes providing them with category, subject, color, priority, creation, authoring, and modification date, which helps to find required information quickly and easily. With PhatNotes you can search for specific text in a specific field and sort notes by category, date, priority, color, or subject. You can protect notes from unauthorized access with a password and send e-mail messages directly...
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News from WTOP
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Shows & Panels
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- Cybersecurity Game Changer: Real-Time Event Processing in Government
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- Federal Executive Forum
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2014 budget takes center stage on Capitol Hill
Monday - 4/15/2013, 8:25pm EDT
With the release of the White House's 2014 budget proposal last week, budget season on Capitol Hill is in full swing.
But things are a little different this year.
Coinciding with the release of the budget and the flurry of congressional hearings about various agencies' top-line requests for next fiscal year were confirmation hearings for Sylvia Burwell, President Barack Obama's pick to head the Office of Management and Budget.
"This is a critical nomination, as we know," said Sen. Tom Carper (D-Del.), chairman of the Senate Homeland Security and Governmental Affairs Committee, which held one of two confirmation hearings for Burwell last week.
The OMB director role has been vacant since January 2012, when then-director Jack Lew left to become White House chief of staff. (Lew has since been nominated and confirmed to serve as Treasury secretary).
The HSGAC committee is set to vote on Burwell's nomination Wednesday. The Senate Budget Committee is also expected to vote this week. The full Senate must also approve Burwell's nomination.
Burwell, a former OMB deputy director who most recently served as the head of the Walmart Foundation, told the Senate HSGAC committee last week her first priority is "regular order and relationship," at OMB. That includes timeliness and responsiveness from the Executive Branch in supporting the congressional budget and appropriations process.
Congressional Republicans have criticized the White House for submitting its 2014 budget request two months late and for being uncommunicative at times about the implementation of the across-the-board budget cuts known as sequestration.
"If I am confirmed, my primary focus will be to contribute to achieving balanced deficit reduction, increased efficiency and effectiveness in how government works, and targeted investments that grow the economy and create jobs," Burwell told the Senate Budget Committee.
"Although OMB is most well-known for its work on the federal budget, the management side of OMB is also critical," she added.
Despite the high-profile nature of the job and the often heated rhetoric surrounding the budget, Burwell's nomination has not been a controversial choice, and she faced a mostly friendly reception at her two confirmation hearings last week.
Slate of budget hearings set to kick off
Along with the vote on Burwell's nomination this week, both the House and Senate will host a number of budget hearings.
The House Appropriations Committee will hear testimony Tuesday from no fewer than three Cabinet secretaries on their 2014 budget requests.
Defense Secretary Chuck Hagel will defend the Pentagon's $536.6 billion base budget, about 7 percent more than the department is slated to receive this year because of sequestration. DoD's budget also calls for a 1 percent pay raise for uniformed and civilian workers, increased TRICARE fees and another round of base realignment and closure (BRAC) in 2015.
Transportation Secretary Ray LaHood will appear before the Appropriations Committee to detail the $76.6 billion proposed budget for DoT, including spending nearly $1 billion for further development of the Next Generation Air Transportation System, known as NextGen.
Agriculture Secretary Tom Vilsack will appear before the Appropriations Committee to elaborate on the department's $22.6 billion budget request. That includes a $4 billion investment in renewable energy improvements. The budget also calls for the creation of a chief evaluation officer at USDA to "support evidence-based policy-making." The new position will work with component agencies and program offices "to develop and implement evaluation agendas and priorities set by policy officials."
Acting Labor Secretary Seth Harris will also appear before the committee to detail the department's $12.1 billion request.
Later in the week, Homeland Security Secretary Janet Napolitano is slated to appear before the Senate Homeland Security and Governmental Affairs Committee to defend the department's $39 billion budget request. That actually represents a decrease of 1.5 percent from 2012 levels. DHS said its 2014 request also reflects savings of $1.3 billion from reduced administrative costs.
The DHS budget also includes $44 million to fund an expansion of the department's Comprehensive National Cybersecurity Initiative. In addition, the budget seeks to eliminate stand-alone grants for the Federal Emergency Management Agency and fold them into a new departmentwide grants program.
Kathleen Sebelius, secretary of the Health and Human Services Department, is slated to appear before the Senate Finance Committee Wednesday to defend the $80.1 billion HHS budget.
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