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international journal of andrology ISSN 0105-6263 ORIGINAL ARTICLE Vasectomy reversal using a microsurgical three-layer technique: one surgeon's experience over 18 years with 1300 patients J. U. Schwarzer Andrologie-Centrum-Muenchen, Munich, Germany Summary Keywords: The technique and the results of microsurgical vasectomy reversal in a single- azoospermia, infertility, microsurgery, centre study over 18 years are presented. Both vasovasostomy (VV) and epidi- vasectomy reversal dymovasostomy (EV) were carried out in a three-layer technique. With strict adherence to the strategy, end-to-end VV was only performed if spermatozoa Correspondence: J. U. Schwarzer, Andrologie-Centrum- had been demonstrated at the epididymal stump of the vas. In all other cases, Muenchen, Lortzingstr, 26, 81241 Munich, EV was carried out in a preocclusive region of the epididymal tubule. The out- Germany. E-mail: firstname.lastname@example.com patient procedure of refertilization was associated with a very low complication rate, which underlines its minimal-invasive character. The follow-up rate was Received 20 December 2011; revised 31 71%, the overall patency rate was 89% and the pregnancy rate was 59%. Sec- January 2012; accepted 22 February 2012 ondary azoospermia was only observed in 1% of the patients. In relation to the intervals of obstruction, the patency and pregnancy rates were higher after doi:10.1111/j.1365-2605.2012.01270.x short-term obstruction than after long-term obstruction. Correspondingly, higher success rates were found after VV than after EV. This is understandable because the probability for indication of EV increases with longer periods of obstruction. There is a significant discrepancy between patency and pregnancy rates that is likely to be caused by a relevant number of patients with post- operative asthenozoospermia. The duration of obstruction is an important fac- tor concerning epididymal damage, but it only disproportionately affects the results of refertilization if the technology of EV is implemented consistently in case of an epididymal granuloma. Good clinical results are achieved with this strategy, as evidenced by pregnancy rates and semen analyses. Introduction Materials and methods Obstructive azoospermia (OA) is a possible cause of male All microsurgical interventions were carried out on an infertility. OA is mainly caused by vasectomy. The ther- outpatient basis under general anaesthesia. A single shot apy of OA requires microsurgical refertilization (MR) or of Ciprofloxacin 500 mg or Cefuroxim 500 mg was given intracytoplasmic sperm injection (ICSI) with epididymal perioperatively. The use of an operating microscope was or testicular spermatozoa. obligatory in all cases. Through a surgical approach of two In cases of obstructive azoospermia after vasectomy, lateral scrotal incisions (only in a few cases of inguinal MR is performed by end-to-end or side-to-end anastomo- approach because of inguinal vasectomy) both scrotal cav- sis between vas and vas or vas and epididymis. A one- or ities are explored. The tunica vaginalis is only opened two-layer technique is generally used for anastomosis. when epididymal surgery is carried out. The further opera- We consequently applied a microsurgical three-layer tech- tive strategy consists in attempting an end-to-end vasova- nique for the end-to-end and side-to-end anastomoses sostomy (VV) whenever possible (see below). If there is and present this technique and our results over 18 years no sperm outflow from the epididymal stump of the vas in terms of semen analyses and clinical outcomes, such as (which is mainly the case after long obstructive intervals) rates of patency and pregnancy. an end-to-side anastomosis between vas and epididymis is ª 2012 The Authors International Journal of Andrology, 1–8 International Journal of Andrology ª 2012 European Academy of Andrology 1 Vasectomy reversal using a microsurgical three-layer technique J. U. Schwarzer required [epididymovasostomy (EV)]. Both procedures adaptation of the mucosa, however, without any tensile are carried out using a three-layer technique. The wound strength (Figs 1 & 2). is closed with self-dissolving sutures and a pressure dress- The second layer comprises suturing the muscle walls of ing is applied for 1 day. both vasal stumps, which have the same diameter despite different lumina, if both stumps were cut in the straight part of the vas deferens. If the vasectomy site is in the Intraoperative strategy convoluted vas deferens very close to the epididymis, the At first both ligated stumps of the vas deferens are identi- muscular layer of the epididymal duct stump becomes fied, prepared and trimmed. If liquid comes out from the significantly thinner with increasing nearness to the epididymal stump, there is apparently no additional epididymis. About ten 9-0 single stitches are placed with obstruction in the epididymis, caused by the formation of non-absorbable threads. A sharp spatula needle is necessary an epididymal granuloma. The fluid gushing out of the for optimal passage through the compact muscular layer. vas deferens is examined intraoperatively by microscopic The closer the cut is to the epididymis, the thinner is analysis for the presence of spermatozoa and its viscosity. the muscular layer, so that stitches should not be placed If spermatozoa are demonstrated, VV is realizable. Sperm too deeply. The muscularis suture provides tension relief motility and morphology is of minor importance for the to the fragile internal layer (Fig. 3). further surgical strategy according to the authors own The third layer consists of adventitial connective tissue experience and the literature (Belker et al., 1991). surrounding the duct. About ten 8-0 stitches are placed, In addition to the presence of spermatozoa, low viscosity preventing any tensile stress to the internal mucosal layer. of the fluid is a positive prognostic factor for the outcome of the procedure. (Belker et al., 1991; Silber & Grotjan, 2004; Schlegel & Margreiter, 2007; Hinz et al., 2009). If the fluid has a toothpaste like consistence, normally no or only a few fragments of spermatozoa are found. In this case, as in the case of missing epididymal fluid, an anastomosis at the epididymal stump of the vas deferens does not make sense – a view that is largely non-contro- versial (Silber & Grotjan, 2004; Parekattil et al., 2005; Schlegel & Margreiter, 2007; Hinz et al., 2009; Nagler & Jund, 2009). Instead, an EV between pre-occlusive epididymal tubule and abdominal stump of the vas defer- ens should be carried out. If spermatozoa cannot be dem- onstrated only in case of water clear fluid from the epididymal stump, it is indicated to carry out a VV. Patency of the inguinal stump of the vas deferens is checked by injection of 3 mL saline solution. Figure 1 Vasovasostomy: internal layer between the mucosa of both stumps of the vas deferens, typically presenting relevant luminar difference. Operative technique of vasovasostomy The anastomosis is performed with an end-to-end tech- nique. An absolute precondition for a successful anasto- mosis is the possibility of preparing both stumps of the vas deferens without any tension, so that they can be fixed in an approximator. At first the interior (mucosal) layer is sutured with 10–12 non-absorbable single-armed 10-0 stitches with a round needle. So many stitches are necessary to compen- sate for the different lumina of both vasal stumps, to ensure a conical lumen at the point of anastomosis and to avoid a step-like intraluminal formation and any shifting of the mucosal layer. This adaptation of the different lumina is crucial for subsequent patency of the anastomosis. The interior layer is a water tight Figure 2 Vasovasostomy: finished internal layer. International Journal of Andrology, 1–8 ª 2012 The Authors 2 International Journal of Andrology ª 2012 European Academy of Andrology J. U. Schwarzer Vasectomy reversal using a microsurgical three-layer technique When preparing the stump of the epididymal duct it is requires a very subtle operating technique. The outflow of most important to make sure that the connective tissue epididymal fluid indicates the preocclusive location. The layer of the duct is preserved because excessive denuda- outflowing fluid is analysed by the operating surgeon tion involves the risk of secondary hypotrophy (Fig. 4). using a lab microscope, with the aim of demonstrating spermatozoa. If spermatozoa are identified, a side-to-end anastomosis between epididymal tubule and abdominal Operative technique of epididymovasostomy stump of the vas deferens is carried out in a three-layer If there is no outflow or only creamy fluid from the technique. Crucial to the outcome is an operative proce- epididymal stump of the vas deferens, the tunica vaginalis dure without any tissue tension. must be opened for microsurgical exploration of the epi- For the internal layer between the wall of the laterally didymis. The strategy consists in looking for the duct opened epididymal tubule and the mucosa of the vas def- obstruction which in most cases is located in the cauda erens 8–10 non-absorbable single-armed 10-0 stitches are epididymis. placed with a round needle. The pre-occlusive epididymal duct can be identified This internal layer, including the easily tearable struc- under the microscope. Then the dilated pre-occlusive ture of the tubular wall, requires 20–30· magnification tubule is tangentially incised in a selective way, which with the operating microscope as well as extensive micro- surgical experience and utmost concentration of the surgeon (Fig. 5). The second layer is closed between the muscularis of the vas and the epididymal serosa with about ten 9-0 stitches with spatula needle. It provides substantial ten- sion relief to the tearable internal layer (Fig. 6). Complete tension relief is then achieved by suture of the third layer, which is performed between the adventitia of the vas and the epididymal serosa with about ten 8-0 single stitches (Fig. 7). For completion of the third layer it is most important that the connective tissue around the vas deferens is well- preserved; excessive denudation should therefore be avoided (see operative technique of VV). Patients Figure 3 Vasovasostomy: middle layer between the muscular layer of From 10 ⁄ 93 to 06 ⁄ 11, 1429 patients underwent MR by both stumps of the vas deferens. one surgeon in a single centre for genital microsurgery. Between 1987 and 1993 the author used a two-layer Figure 4 Vasovasostomy: outer layer between the adventitia of both Figure 5 Epididymovasostomy: internal layer between mucosa of the stumps of the vas deferens. vas deferens and wall of the epididymal tubule. ª 2012 The Authors International Journal of Andrology, 1–8 International Journal of Andrology ª 2012 European Academy of Andrology 3 Vasectomy reversal using a microsurgical three-layer technique J. U. Schwarzer thus comprises 1303 patients who underwent vasectomy reversal. Of these, 172 (13.2%) required repeat interven- tion after a previous attempt of refertilization. All patients were physically examined with palpation of the scrotum, especially for identification of the vasal stump, and a scrotal sonography. The age of the patients ranged from 24 to 67 years, with an average of 41 years. The age of the female part- ners ranged from 21 to 45 years, with an average of 34.6 years. The periods of obstruction ranged between 18 h and 32 years (average 8.2 years). One patient with 18-h obstructive interval needed immediate reversal because of a non-accepted vasectomy ('agreement error'). The study followed ethical guidelines that are established for human Figure 6 Epididymovasostomy: middle layer between muscular layer subjects by the Department of Urology of the Technische of vas deferens and serosal layer of epididymis. ¨ ¨ Universitat Munchen. Results Perioperative course Nine-hundred and fifty-eight patients underwent bilateral VV, 214 patients unilateral VV in combination with con- tralateral EV. Another 36 patients underwent unilateral VV, 84 patients EV bilaterally and 11 patients EV unilat- erally (Table 1). So in 24% of the patients EV had to be carried out at least at one side according to our strategy as mentioned above. The operation time ranged from 90 to 150 min, 110 min on average. The complication rate was 0.3% (n = 4) for scrotal haematoma, only one patient had to be reoperated for evacuation of haematoma. Ten (0.8%) had a superficial Figure 7 Epididymovasostomy: outer layer between adventitia of vas wound infection, no case of epididymitis was seen. Apart deferens and serosal layer of epididymis. from two cases of allergic reaction to antibiotics, no side effects or complications were ever seen. technique in several hundred patients, who are not con- sidered in the database and therefore are not included in Post-operative course this article. Also excluded are 126 patients with seminal tract obstruction caused by infection or iatrogenic factors The follow-up was characterized by special problems, e.g. who were operated during the study period. The study that many patients changed their place of residence and Table 1 Vasectomy reversal by microsurgical technique: type of anastomosis in relation to the period of obstruction (total number of patients n = 1303): epididymovasostomy at least on one side in 24% of patients Group Obstruction Patients Bilateral Vasovasostomy + Bilateral Unilateral Unilateral no. period (years) (n) vasovasostomy epididymovasostomy epididymovasostomy vasovasostomy epididymovasostomy 1 <5 312 n = 268 (86%) n = 31 (10%) n = 6 (2%) n = 7 (2%) n = 0 2 5–9 527 n = 399 (76%) n = 85 (16%) n = 22 (4%) n = 16 (3%) n = 5 (1%) 3 10–15 340 n = 217 (64%) n = 76 (22%) n = 33 (10%) n = 11 (3%) n = 3 (1%) 4 >15 124 n = 74 (59%) n = 22 (18%) n = 23 (18%) n = 2 (2%) n = 3 (3%) Total 1303 n = 958 (75%) n = 214 (16%) n = 84 (5%) n = 36 (3%) n = 11 (1%) International Journal of Andrology, 1–8 ª 2012 The Authors 4 International Journal of Andrology ª 2012 European Academy of Andrology J. U. Schwarzer Vasectomy reversal using a microsurgical three-layer technique Table 2 Vasectomy reversal by microsurgical technique: patency and pregnancy rates in relation to the period of obstruction in a follow-up of n = 924 out of 1303 patients (71% follow-up rate) Group Obstruction Patients Average age of the no. period (years) (n) Patency rate (%) Pregnancy rate (%) partner (years) 1 <5 204 97 (n = 197) 66 (n = 134) 33.2 2 5–9 361 91 (n = 328) 64 (n = 231) 34.5 3 10–15 251 84 (n = 211) 51 (n = 128) 33.8 4 >15 108 81 (n = 87) 48 (n = 52) 35.1 Total 924 89 (n = 823) 59 (n = 545) 34.6 Statistical significance p = 0.0103 (1 ⁄ 2) p = 0.7147 (1 ⁄ 2) p < 0.05 between between group (no ⁄ no) p = 0.0155 (2 ⁄ 3) p = 0.0015 (2 ⁄ 3) all groups p = 0.4449 (3 ⁄ 4) p = 0.4645 (3 ⁄ 4) Table 3 Ejaculate quality after vasectomy reversal in relation to the period of obstruction. Follow-up includes 788 patients with semen analyses according to World Health Organization 2010 (Oligozoospermia: <40 Mio ⁄ ejac., Asthenozoospermia: progressive motility <32%). Of 924 patients followed up, 136 reported a pregnancy without having had semen analyses Obstruction Patients Normozoo- Oligozoo- Asthenozoo- Oligoasthenozoo- Group period (years) (n) spermia (%) spermia (%) spermia (%) spermia (%) Azoospermia (%) 1 <5 138 70 (n = 97) 5 (n = 7) 7 (n = 9) 13 (n = 18) 5 (n = 7) 2 5–9 317 67 (n = 212) 6 (n = 20) 9 (n = 27) 8 (n = 26) 10 (n = 32) 3 10–15 240 55 (n = 133) 6 (n = 14) 17 (n = 42) 5 (n = 11) 17 (n = 40) 4 >15 93 52 (n = 48) 5 (n = 5) 14 (n = 13) 6 (n = 6) 23 (n = 21) Total 788 62 (n = 490) 6 (n = 46) 12 (n = 91) 8 (n = 61) 12(n = 100) Statistical significance p = 0.0016 (1 ⁄ 2) p = 0.1003 (1 ⁄ 2) between groups (no ⁄ no) p = 0.0063 (2 ⁄ 3) p = 0.0296 (2 ⁄ 3) p = 0.5422 (3 ⁄ 4) p = 0.2109 (3 ⁄ 4) were not detectable. Nevertheless, great importance was Patency was demonstrated by semen analyses according attached to the follow-up using an individualized data- to World Health Organization (2010), performed by the base (based on filemaker). Statistical analysis was per- referring urologists or in our andrological centre. In 136 formed by use of Fisher's exact test. patientes who reported a pregnancy without having had Patients were urgently asked to have a sperm analysis semen analyses, patency was assumed. performed after 3 month and to report the occurrence of Among 788 patients who had follow-up semen analy- a pregnancy. This request was explicitly documented in ses, 490 (62%) were found to be normozoospermic, 198 the medical report to the urologists responsible for (26%) had oligo- and ⁄ or asthenozoospermia of different further treatment. Unless a response had been received markedness, 100 (12%) were azoospermic (Table 3). Of concerning sperm analysis and ⁄ or pregnancy, active 823 patients with initially demonstrated patency, 8 (1%) follow-up consisted of telephone inquiries with patients experienced repeated occlusion after 3–13 month (late or urologists 1 year after the operation, strongly recom- failure); in six cases, refertilization was successfully per- mending a semen analysis. formed again. Forty-eight patients (4%) had actually no desire to The patency and pregnancy rates include 136 pregnan- have children or wished to have the operation for other cies that occurred without follow-up semen analyses. This reasons, such as chronic pain syndrome or psychic or mainly concerns couples who achieved pregnancy within religious motives. This group of patients was not consid- the first 3–4 month after refertilization so they saw no ered in the follow-up. need (and could not be persuaded) to have a sperm The follow-up period comprised at least 3 month, in analysis performed. one case 14 years where the patient presented for repeat vasectomy after having fathered four children. Discussion Altogether, 924 of 1303 cases were followed up, show- ing an overall patency rate of 89% and a pregnancy rate In cases of obstructive azoospermia methods of MR can of 59% without any use of IVF (Table 2). be used to achieve natural fertility, whereas the alternative ª 2012 The Authors International Journal of Andrology, 1–8 International Journal of Andrology ª 2012 European Academy of Andrology 5 Vasectomy reversal using a microsurgical three-layer technique J. U. Schwarzer procedure of ICSI is a means of artificial reproduction with studies reporting rates up to 12% for VV and up to with a relevant burden to the female partner and higher 21% for EV (Belker et al., 1991; Matthews et al., 1995; costs (Lee et al., 2008). Silber & Grotjan, 2004; Kolettis et al., 2005). In our expe- The follow-up rate in our study is higher after long rience, the secondary azoospermia rate is not relevantly periods of obstruction (>10 years) compared with those underestimated, because patients with an initial positive <5 years, presumably because the results after short-time result in semen analysis whose female partner doesn't occlusion are better anyway and patients did not report become pregnant, will come to reevaluate the ejaculate the treatment success. This is supported by the fact that quality in most cases. the majority of patients who reported pregnancies with- We can present a large single-centre study with a fol- out having had sperm analyses belong to this group (85 low-up rate of 71% relating to semen analyses or reported of 136 patients). pregnancies. A comparison of our results and those of others should primarily consider a study by Silber & Grotjan (2004) Operation technique who published their findings with two-layer VV and EV Different techniques are used for MR, and since the last in 4010 patients, reporting a high follow-up rate of 86.5% 30 years many papers have been published about these and patency rates of 95% for bilateral VV and 78% for techniques and their results (Fischer & Grantmyre, 2000; bilateral EV. The problem of low follow-up rates is to be Holman et al., 2000; Marmar, 2000; Paick et al., 2000; found in many studies on refertilization, reflecting insecu- Dohle & Smit, 2005; Ho et al., 2005; Parekattil et al., rity about whether the patients who were not followed up 2006; Patel & Sigman, 2008; Lipshultz et al., 2009; Jee & are statistically equal to those who underwent long-term Hong, 2010). We introduced and consequently used a follow-up. three-layer technique for VV and EV, resulting in single- surgeon experience over 18 years. Importance of epididymovasostomy In our opinion, the three-layer technique is insignifi- cantly more time-consuming than both the previous one- We suggest that the most important prerequisite for or two-layer techniques (Fischer & Grantmyre, 2000; achieving good results even after a long period of Marmar, 2000; Paick et al., 2000; Ho et al., 2005; Jee & obstruction is the consistent implementation of the strat- Hong, 2010) and the robotic techniques currently pub- egy to perform epididymovasostomy if no spermatozoa is lished (Fleming, 2004; Kuang et al., 2004; Parekattil et al., detectable at the epididymal stump of the vas deferens 2010). One reason for our preference of the three-layer (Sheynkin et al., 2000; Sigman, 2004). technique over the one- or two-layer technique is the In 24% of our patients, predominantly in those with possibility of exact adaptation of the interior layer which longer periods of obstruction, we encountered the situa- typically shows luminal disparity. tion that a bypass anastomosis had to be performed at Secondly, the third layer of the anastomosis, i.e. the least on one side. So clearly the indication for epididym- connective tissue coat (adventitia), provides tension relief ovasostomy is statistically correlated with the period of to the internal layer to a greater extent than does the sec- obstruction (see Table 1). This is in accordance with the ond layer alone. Furthermore, the third layer ensures vas- experiences of many other authors (Goldstein & Girardi, cularization of the duct. According to the author's 1997; Eguchi et al., 1999; Matsuda, 2000; Boorjian et al., experience, preservation of the connective tissue layer is 2004; Chawla et al., 2004; Silber & Grotjan, 2004; Schiff of essential importance for a successful operation because et al., 2005; Schlegel & Margreiter, 2007; Hinz et al., it prevents hypotrophy of the duct and ensures complete 2008; Magheli et al., 2010). tension relief to the internal layer – an issue that has so far not been considered in the literature. When the Epididymal damage stumps of the epididymal duct are prepared, the third layer of connective tissue should be preserved by all Similar to other studies (Belker et al., 1991; Kolettis et al. means. Excessive or prolonged denudation and loss of the 2006; Silber & Grotjan, 2004; Bolduc et al., 2007) we third layer involve a high risk of secondary hypotrophy found a significant discrepancy between the patency and and fibrotic occlusion of the anastomosis. the pregnancy rates, independently of the interval of Apart from the operative strategy, the aforementioned obstruction. In most cases this discrepancy was explained technical peculiarities of three-layer anastomosis may by the demonstration of asthenozoospermia or oligoas- explain our favourable results. Although these are not thenozoospermia in the post-operative semen analyses. better than many others published before, the 1% rate of This pathologic finding could be caused by epididymal secondary reocclusions is significantly lower compared damage because of a long period of obstruction or International Journal of Andrology, 1–8 ª 2012 The Authors 6 International Journal of Andrology ª 2012 European Academy of Andrology J. U. Schwarzer Vasectomy reversal using a microsurgical three-layer technique antisperm antibodies (McDonald, 1996; Marconi et al., Importance of the three-layer technique ´ ´ 2008; Legare et al., 2010). In Tables 2 and 3 it is shown that with increasing time The advantage of the three-layer technique with a high of obstruction the sperm quality and pregnancy rates are number of stitches is a perfect seal of the internal layer, decreasing. However, the patency rates did not differ sig- preventing leakage with the possible consequence of gran- nificantly with the obstruction period. uloma. In addition, the third layer with about ten 8-0 In our opinion it can be concluded that the main rea- stitches is sufficient to prevent any tension to the internal son for the decreasing pregnancy rates lies in the decreas- layer of the anastomosis which secures the liquid-tight ing sperm quality. Directly correlating individual seal. The third layer is important for vascularization of the pregnancies to individual semen analysis is limited, deferent duct, so that consequent preservation of this con- because for a relevant group of pregnant females (136) nective tissue coat prevents scarring at the anastomotic no semen analysis of the male partners was available. In site and secondary occlusion. In the present study, this is our study the distribution of the female age was similar supported by the low rate of 1% of secondary azoospermia in all the groups independent from the obstructive per- (late failure) and a very low complication rate. iod. Besides the female factor no other important factor Although excellent results with the two-layer technique was obvious for us. So we conclude that the sperm qual- are published in the literature we feel that the three-layer ity is the most relevant factor influencing the pregnancy offers a promising addition the established surgical tech- rates. niques. Spermatogenesis is not altered by the obstruction for at In our opinion, the three-layer anastomosis is no more least 20–25 years, which was shown by histological studies time-consuming than a two-layer technique and the in patients with obstructive azoospermia. Only insignifi- patient benefit justifies the higher amount of time com- cant alterations of spermatogenesis are described, such as pared with the single-layer technique. According to our interstitial fibrosis (Shiraishi et al., 2002) and increased experience, this sophisticated reconstruction of the semi- sperm DNA fragmentation (Smit et al., 2010). However, nal tract using at least two-layer-, better three-layer tech- the epididymis suffers from obstruction in that it nique, in the framework of a minimally invasive decreases with time (Srivastava et al., 2000; Lavers et al., procedure should be the standard of refertilization 2006; Yang et al., 2007). Statistically, this deteriorating surgery against which all other techniques, such as the effect to the epididymis is related to the interval of robotic technology, must be measured. obstruction, which finds expression in the necessity of EV (Table 1). However, individual differences in the resis- Acknowledgements tance to time-related epididymal damage must be pre- sumed because in single cases of normozoospermia I would like to thank Gudrun Scharfe and Heiko Steinfatt for complete recovery of the epididymis after refertilization their friendly support in drafting the english version of the text. may occur. I would particularly like to thank Prof. Wolfgang Weidner from Giessen for his generous encouragement of the andrological microsurgery over many years. I also owe gratitude to my urolo- Female fertility factor gical mentor Prof. Rudolf Hartung from Munich who had the vision to promote my microsurgical passion from the beginning. Another relevant factor for the difference between patency External sources of support in the form of financial aid, grants and pregnancy rates may be the relatively high average or equipment were not used. age of 34.6 years of the female partners, affecting their fertility. However the age of the female partner at the time of operation was not significantly related to the per- References iod of obstruction among the male patients. Belker AM, Thomas AJ, Fuchs EF, Konnak JW & Sharlip IR. (1991) Table 2 suggests that the female age being the most Results of 1469 microsurgical vasectomy reversals by the vasovasos- important female fertility factor can be considered as an tomy group. J Urol 145, 505–522. Bolduc S, Fischer MA, Deceuninck G & Thabet M. (2007) Factors pre- independent variable (Fuchs & Burt, 2002; Gerrard et al., dicting overall success: a review of 747 microsurgical vasovasosto- 2007). mies. Can Urol Assoc J 1, 388–394. 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Urol Clin North Am mircorsurgical vasoepididymstomy and vasovasostomy: temporal 31, 769–772. considerations. J Urol 154, 2070–2073. Fuchs EF & Burt RA. (2002) Vasectomy reversal performed 15 years or McDonald SW. (1996) Vasectomy review: sequelae in the human epi- more after vasectomy: correlation of pregnancy outcome with part- didymis and ductus deferens. Clin Anat 9, 337–342. ner age and with pregnancy results of in vitro fertilization with Nagler HM & Jund H. (2009) Factors predicting successful microsurgi- intracytoplasmic sperm injection. Fertil Steril 77, 516–519. cal vasectomy reversal. Urol Clin North Am 36, 383–390. Gerrard ER Jr, Sandlow JI, Oster RA, Burns JR, Box LC & Kolettis PN. Paick JS, Hong SK, Yun JM & Kim SW. (2000) Microsurgical single (2007) Effect of female partner age on pregnancy rates after vasec- tubular epididymovasostomy: assessment in the era of intracytoplas- tomy reversal. Fertil Steril 87, 1340–1344. mic sperm injection. Fertil Steril 74, 920–924. 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World J Urol 27, 781–785. human robot-assisted microsurgical vasovasostomy. J Endourol 24, Ho KL, Witte MN, Bird ET & Hakim S. (2005) Fibrin glue assisted 511–514. 3-suture vasovasostomy. J Urol 174, 1360–1363. Patel SR & Sigman M. (2008) Comparison of outcomes of vasovasos- Holman CD, Wisniewski ZS, Semmens JB, Rouse IL & Bass AJ. (2000) tomy performed in the convoluted and straight vas deferens. J Urol Population-based outcomes after 28.246 in-hospital vasectomies and 179, 256–259. 1.902 vasovasostomies in Western Australia. BJU Int 86, 1043–1049. Schiff J, Chan P, Li PS, Finkelberg S & Goldstein M. (2005) Outcome Jee SH & Hong YK. (2010) One-layer vasovasostomy: microsurgical and late failures compared in 4 techniques of microsurgical vasoepi- versus loupe-assisted. Fertil Steril 94, 2308–2311. didymostomy in 153 consecutive men. J Urol 174, 651–654. Kolettis PN, Burns JR, Nangia AK & Sandlow JI. (2006) Outcomes for Schlegel PN & Margreiter M. (2007) Surgery for male infertility. Eur vasovasostomy performed when only sperm parts are present in the Urol Update Series 5, 105–112. vasal fluid. J Androl 27, 565–567. Sheynkin YR, Chen ME & Goldstein M. (2000) Intravasal azoospermia: ´ Kolettis PN, Fretz P, Burns JR, Damico AM, Box LC & Sandlow JI. (2005) a dilemma. BJU International 85, 1089–1092. Secondary azoospermia after vasovasostomy. Urology 65, 968–971. Shiraishi K, Takihara H & Naito K. (2002) Influence of interstitial Kuang W, Shin PR, Matin S & Thomas AJ Jr. (2004) Initial evaluation fibrosis on spermatogenesis after vasectomy and vasovasostomy. of robotic technology for microsurgical vasovasostomy. J Urol 171, Contraception 65, 245–249. 300–303. Sigman M. (2004) The relationship between intravasal sperm quality Lavers AE, Swanlund DJ, Hunter BA, Tran ML, Pryor JL & Roberts and patency rates after vasovasostomy. J Urol 171, 307–309. KP. (2006) Acute effect of vasectomy on the function of the rat epi- Silber SJ & Grotjan HE. (2004) Microscopic vasectomy reversal 30 didymal epithelium and vas deferens. J Androl 27, 826–836. years later: a summary of 4010 cases by the same surgeon. J Androl Lee R, Li PS, Goldstein M, Tanrikut C, Schattmann G & Schlegel PN. 25, 845–859. (2008) A decision analysis of treatments for obstructive azoosper- Smit M, Wissenburg OG, Romijn JC & Dohle GR. (2010) Increased mia. Hum Reprod 23, 2043–2049. sperm DNA fragmentation in patients with vasectomy reversal has ´ ´ Legare C, Boudreau L, Thimon V, Thabet M & Sullivan R. (2010) no prognostic value for pregnancy rate. J Urol 183, 662–665. Vasectomy affects cysteine-rich secretory protein expression along Srivastava S, Ansari AS & Lohiya NK. (2000) Ultrastructure of langur the human epididymis and its association with ejaculated spermato- monkey epididymidis prior to and following vasectomy and vasova- zoa following vasectomy surgical reversal. J Androl 31, 573–583. sostomy. Eur J Morphol 38, 24–33. Lipshultz LI, Rumohr JA & Bennet RC. (2009) Techniques for vasec- World Health Organization (2010) Laboratory Manual for the Examina- tomy reversal. Urol Clin North Am 36, 375–382. tion and Processing of Human Semen, 5th edn. WHO Press, Geneva. Magheli A, Rais-Bahrami S, Kempkensteffen C, Weiske WH, Miller K Yang G, Walsh TJ, Shefi S & Turek PJ. (2007) The kinetics of the & Hinz S. (2010) Impact of obstructive interval and sperm granu- return of motile sperm to the ejaculate after vasectomy reversal. loma on patency and pregnancy after vasectomy reversal. Int J J Urol 177, 2272–2276. Androl 33, 730–735. International Journal of Andrology, 1–8 ª 2012 The Authors 8 International Journal of Andrology ª 2012 European Academy of Andrology
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How well do you know "Harry Potter and the Half-Blood Prince?"
Most diehard Harry Potter fans will swear that they know everything there is to know about each of J.K. Rowling's books. But how well do you really remember the sixth book in the series, "Harry Potter and the Half-Blood Prince?" As we all prepare for the July 15, 2011, release of the movie version of "Harry Potter and the Deathly Hallows, Part 2" – the eighth and final "Harry Potter" film – take our quiz and find out!
Question 1 of 10
1. In book 6, who owns 12 Grimmauld Place, head quarters of the Order of the Phoenix?
Who owns 12 Grimmauld Place?
Remus Lupin.
Harry Potter.
Bellatrix Lestrange.
Question 1 of 10

subset: commoncrawl


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Yukon Fitness Cable Cross Over Home Gym Attachment
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OUR SKU # YKF1061Cable Cross Over Home Gym Attachment is also sometimes listed under the following manufacturer numbers: CCO-177


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A martini just tastes better when you are over-looking an amazing view. In fact, that goes for all drinks. Even tap water.
So if our mathematics are correct, along with our theory, the tap water you drink at Marrakech's Kosybar might taste like it was delivered by a unicorn skipping over a rainbow. The bar's terrace overlooks the gorgeous Place de Ferblantiers across to the Badii Palace.
Kosybar has the reputation as being one of Marrakech's very best bars, and while it's not the cheapest, the votes are that it's still worth it. It's lavishly decorated, with lush fabrics and subtle lighting. And as well as just about every drink under the sun, Kosybar offers meals ranging from light lunches to decadent dinners.
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Very Underrated
Visually, Hydrophobia is gorgeous. The water physics are unlike nothing I've ever seen in a game before and are obviously the highlight of the game. The atmosphere is very well done also, you really feel immersed in this gigantic boat that is sinking as you progress in the story, giving you a claustrophobic feeling.
There was a lot of complaints about the controls back when the game released but now the new control scheme is very intuitive and works very well.
The only downside I think would be the length of the game. It will last about 4-6 hours depending on if you rush through it or try to explore everything. Once you finish it, you can play the Challenge Room or go back to the story to find all the collectibles.
Overall a great downloadable title that lives up to its promises.


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'The Love of God in China' by John S. Peale is Released
CHARLOTTESVILLE, Va., July 15, 2014 /PRNewswire/ The Chinese people, especially those who are both Christian and patriotic, are in a deeply and almost thoroughly problematic situation. They are caught up in dilemmas both within the Christian perspective and within general Chinese cultural beliefs and practices. Given this situation, author John S. Peale, sheds light on what's going on and what's happening in the Christian churches in China in his book, The Love of God in China.
Many of the books written on Christianity in China or of churches in China focus on or promote one of the points of view on Christianity represented by one of the church bodies in China: the Chinese Christian Church (Protestant), the Independent House Church or home meeting points movement, and the Catholic Church in China. On both the Protestant and the Catholic sides, there are the open or official churches and the "underground" or house churches or meeting points.
By coming to understand this situation and by focusing clearly on the problems in it, readers will come to learn more about China and more about the Christian faith. People can know more about what it means to live the Christian life in one's own culture by understanding the situation of the Christian in a very different cultural setting. There are important lessons for any Christian anywhere which emanate from the Chinese Christian experience.
In this book, he raises the question as to whether a person really can be both Chinese and Christian, which, in the end, he answers with a resounding "yes".
This book is available online and can be purchased at www.iuniverse.com, www.amazon.com and www.barnesandnoble.com.
About the Author
John Peale's passion for China goes back twenty years, and that for Christianity all his life. He is a Professor of Philosophy and a Christian minister, the son of Dr. Norman Vincent Peale. John Peale has immersed himself in research work in Chinese studies, in Christianity and in native Chinese religions.
The Love of God in China
by John S. Peale
Publication Date: April 5, 2005
Paperback: $21.95; 302 pages; ISBN 9780595336197
To request a complimentary paperback review copy, you may contact Mary Clark at BookWhirl.com by phone at (877) 207-1679 or by Email.
SOURCE BookWhirl.com
About Author
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Israeli model's name mentioned as possible star of upcoming blockbuster, alongside models Miranda Kerr and Brooklyn Decker and actresses Gemma Arterton and Ashley Greene.
Moments after American actress Megan Fox announced that she would not take part in the third installment of the hugely successful 'Transformers' blockbusters, names of possible replacement female leads began popping up.
Among the names circulating on the internet, Israeli model Bar Refaeli has been mentioned, alongside British actress Gemma Arterton, Australian model Miranda Kerr, and Sports Illustrated cover girl Brooklyn Decker.
The popular website TheWrap reports that a source close to the production of the new Transformers film said that Arterton has already met with the director, while Refaeli and Kerr have auditioned with the film's casting director.
However, the website AICN offers a different list of possible candidates, including actress Zoe Saldana, who portrayed the female lead in the immensely popular film Avatar, Hayden Panettiere of the television series Heroes, and Ashley Greene who starred in the Twilight film series.
If Refaeli scores the role, it will be her Hollywood debut. She has one previous film in her repertoire, Israeli director Haim Bozaglo's "Session," and a leading role in the Israeli telenovella "Pick Up".


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Written on: 09/06/2010 by Freeky (41 reviews written)
I`ve had freeview from sky & the geniun freesat service as well as a concurrent freeview recorder, freeview from sky is very much the poorer service, you don't get all the same channels as you get on freeview (as the previous reviewer mistakenly stated) You can't get 5 unless you have a card or use the v awkward manual scan. Dave, Yesterday, Virgin, Fiver & FIVE USA are missing to name a few.
Other issues are the card only lasts so long, then you have to buy a new one, or put up with extra missing channels (so not exactly freeview!)
You also have to put up with skipping past loads of channels you can't view, compare that with the freesat service that only lists all the channels that are viewable.
Picture quality wise its clear that sky SD is poorer than the same on freeview, I do note that there is no difference between the picture on my sky box compared to my freesat box.
In conclusion I feel the freeview from sky service is only there to respond to the genuine freeview/freesat services & is deliberatly degraded to persuade you to buy a sky package.
As rated by our community of reviewers
" Customer and broadband service " Read More
" Calling it garbage would be a compliment " Read More
Written by deadparrots
" Awful " Read More
" Virgin media " Read More
" Not "live" " Read More


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EZ Clean – resists stains; is kid and pet friendly.
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An incredibly dense and ultra-thick synthetic construction has been transformed into the classic "old world" Persian designs. The true colorations of ancient Persia have been updated to give the look and feel of a true handmade collector's rug with today's hottest fashion colors. The styles chosen represent a cross-section of "the best of the best" in traditional styling.
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Jahlil Beats »
Fred The Godson hops back on the scene with a remix to the popular Jahlil Beats produced track 'Hot Nigga'. Maybe we can expect more in the near futureRead More »
Lee Mazin – Phat (Prod by Jahlil Beats) (Official Video)
Dreamchasers own Lee Mazin releases the official video for "Phat" produced by Jahlil Beats. This video was shot by Inferno ProductionsRead More »
Jahlil Beats & CRMC Preview 'Legend Dynasty' Mixtape (Video)
Our cameras recently caught up with Jahlil Beats and CRMC the duo of Barzy King & Fats who Jahlil has hand picked to lead Hip-Hop from his hometown of Chester, PA into the future.Read More »
Jahlil Beats & CRMC – Legend Dynasty (Mixtape)
Back in June, Jahlil Beats introduced us his CRMC (Crush Records Movie Crew) on our HHS1987 cameras. Two duo talked about a few of their Legend Dynaty tracks, the success of their popular singleRead More »
Jahlil Beats Talks Bobby Shmurda "Hot Nigga" Beat (Video)
Jahlil Beats pulls the camera out to explain how the Bobby Shmurda "Hot Nigga" record came about. He The beat was originally for Lloyd Banks who used it for "Jackpot" but since he didntRead More »
SiAngie Twins – Butterflies (Prod. by Jahlil Beats) (Video)
Philly's own SiAngie Twins have linked with producer Jahlil Beats for their latest single. Check out the visual for the SiAngie Twins' latest single "Butterflies" produced by Jahlil Beats above.  Read More »
Lee Mazin – Phat
Lee Mazin does her thing over a beat by Jahlil Beats. This is definitely a track that would ring off well in the club. Listen belowRead More »


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- Home
- Prospective Students
- Interdepartmental Modules
- Departments & Centres
- People
- Postdoctoral Research
- Research
- News & Events
- Contact Us
- UCL Modern Languages League Table Information
- Public Engagement in SELCS
- Made In Italy Evening Classes
ContactsAdmissions Officer
Mr Joe Tilley
Email: firstname.lastname@example.com
Tel: +44 (0)20 7679 3096
Fees and funding
UK & EU fee
£9,000 (2014/15)
Overseas fee
£15,200 (2014/15)
General funding notes
Details about financial support are available at: www.ucl.ac.uk/study/ug-finance
French and an Asian or African Language BA
UCAS code: RT19
The French components of this four-year programme are taught and taken at UCL, and the Asian or African language components at the School of Oriental and African Studies (SOAS), our near neighbour. There is strong emphasis on spoken and written language work and the opportunity to undertake interdisciplinary study.
Degree benefits
- A strong focus on spoken and written language work. Oral presentations, comprehension work and translation exercises will be a feature of your learning. Native speakers of French form an integral part of our teaching team.
- Emphasis on film and literature studies, with resources including a notable French section in the UCL Library. We offer courses covering all periods of French and francophone literature and thought.
- You will have access to the facilities of the UCL Centre for Languages & International Education. The French Society organises cultural and social events, for example, theatre visits, drama productions and trips to France.
The structure of the programme allows you to study core courses in French language (written and oral), literature, culture, history, politics and society. You will have some flexibility throughout your degree to focus on areas you find particularly interesting, and these opportunities increase as you progress.
You may also take School of European Languages, Culture and Society (ELCS) courses, which allow you to study literature, film, art and culture from outside your subject area(s), focusing on broad cultural movements, issues and approaches from an interdisciplinary perspective and drawing on the full range of specialisms within the school.
The other half will be taught by the School of Oriental and African Studies.
You will spend half of your third year in France or a French-speaking part of the world (for example, Switzerland, Quebec or Martinique). You can choose whether to spend the term as a language assistant in a French school, as a student at a French-speaking university, or to undertake a work placement abroad.
You will spend the other half of the year in a country where the other language studied is spoken.
Your learning
Throughout the degree your teaching will be conducted mainly through small seminar groups, together with some lectures. Seminars are characterised by a 'hands-on' textual and analytical approach, whereas lectures are used for discussing general intellectual contexts.
Most courses are examined either by end-of-year examination papers or by assessed essay work completed during the year. You will also undertake oral examinations in French.
Structure 1 (Near or Middle Eastern Language)
Students take 4.0 cu each year. Below are the requirements for the French side of your degree. Please consult your department at SOAS for the SOAS side of your degree.
Year One
Compulsory Modules (1.0 course unit)
- FREN1001 Use of French (0.5cu)
- FREN1102 Reading French Texts (0.5cu)
It is recommended that students take FREN1002 French Oral on a voluntary non-assessed basis.
Year Two
Compulsory Modules (1.0 course unit)
- FREN2001 Use of French (0.5cu)
- FREN2002 French Oral (0.5cu)
Francophone students take a FREN2*** module (0.5cu) instead of FREN2002.
Optional Modules (2.0 course units)
A total of 1.5cu from FREN2*** modules
One 0.5cu ELCS6*** intermediate-level module
Year Three
- ELCS3001 - Year Abroad Assessment A (1.5cu)
- ELCS3002 - Year Abroad Assessment B (1.5cu)
- ELCS3004 - Third Year Project B (0.5cu)
Final Year
Compulsory Modules (1.0 course unit)
- FREN4001 Use of French (0.5cu)
- FREN4002 French Oral (0.5cu)
Francophone students can choose to take FREN4003 French Essay (0.5cu) or FREN4004 Advanced Translation (0.5cu) instead of FREN4002.
Optional Modules (1.0 course unit)
Choose two advanced European Language, Culture and Society (ELCS) courses (0.5 course units each):A total of 1.0cu from FREN41**/FREN42**/FREN43** modules
One FREN41**/FREN42**/FREN43** module (0.5cu) and one ELCS4*** advanced-level module (0.5cu).
Structure 2 (Non Near or Middle Eastern Language)
Students take 4.0 cu each year. Below are the requirements for the French side of your degree. Please consult your department at SOAS for the SOAS side of your degree.
Year One
Compulsory Modules (1.5 course units)
- FREN1001 Use of French (0.5cu)
- FREN1002 French Oral (0.5cu)
- FREN1102 Reading French Texts (0.5cu)
Francophone students take a FREN1*** module (0.5 cu) instead of FREN1002
Optional Modules (0.5 course units)
FREN1101 The Making of Modern France (0.5cu)
One ELCS6*** intermediate-level module (0.5cu)
*Students must choose one 0.5cu intermediate-level ELCS module either in year 1 or in year 2.
Year Two
Compulsory Modules (1.0 course unit)
- FREN2001 Use of French (0.5cu)
- FREN2002 French Oral (0.5cu)
Francophone students take a FREN2*** module (0.5 cu) instead of FREN2002
Optional Modules (1.0 course unit)
A total of 1.0cu from FREN2*** modules
Or, if students did not take an ELCS6*** module in year 1:
One 0.5cu FREN2*** module and one 0.5cu ELCS6*** module
*Students must choose one 0.5cu intermediate-level ELCS module either in year 1 or in year 2.
Year Three
- ELCS3001 - Year Abroad Assessment A (1.5cu)
- ELCS3002 - Year Abroad Assessment B (1.5cu)
- ELCS3005 - Third Year Project C (1.0cu)
- ELCS3006 - Progress Portfolio A (0cu)
- ELCS3007 - Progress Portfolio B (0cu)
Final Year
Compulsory Modules (1.0 course unit)
- FREN4001 Use of French (0.5cu)
- FREN4002 French Oral (0.5cu)
Francophone students can choose to take FREN4003 French Essay (0.5cu) or FREN4004 Advanced Translation (0.5cu) instead of FREN4002.
Optional Modules (1.0 course unit)
A total of 1.0cu from FREN41**/FREN42**/FREN43** modules
One FREN41**/FREN42**/FREN43** module (0.5cu) and one ELCS4*** advanced-level module (0.5cu).
Interdepartmental Modules
Entry requirements
A Levels
|French required.
|AS Levels
|For UK-based students a pass in a further subject at AS level or equivalent is required.
|English Language at grade B, plus Mathematics at grade C. For UK-based students, a grade C or equivalent in a foreign language (other than Ancient Greek, Biblical Hebrew or Latin) is required. UCL provides opportunities to meet the foreign language requirement following enrolment, further details at: www.ucl.ac.uk/ug-reqs
IB Diploma
|A total of 18 points in three higher level subjects including French grade 6, with no score lower than 5.
Other qualifications
For entry requirements with other UK qualifications accepted by UCL, choose your qualification from the list below:
Selected entry requirements will appear here
International applicants
International qualifications
In addition to A level and International Baccalaureate, UCL considers a wide range of international qualifications for entry to its undergraduate degree programmes.
Select country above, equivalent grades appear here.
Undergraduate Preparatory Certificates
UCL offers intensive one-year foundation courses to prepare international students for a variety of degree programmes at UCL.
The Undergraduate Preparatory Certificates (UPCs) are for international students of high academic potential who are aiming to gain access to undergraduate degree programmes at UCL and other top UK universities.
For more information see our website: www.ucl.ac.uk/upc
English language requirements
If your education has not been conducted in the English language, you will be expected to demonstrate evidence of an adequate level of English proficiency. Information about the evidence required, acceptable qualifications and test providers can be found on our English language requirements page. A variety of English language programmes are offered at the UCL Centre for Languages & International Education.
Your application
We aim to ascertain the depth and extent of your intellectual interest in French culture. Evidence of this may include reading in French beyond the examination syllabus, in particular of literary works, and experience of watching French-language films. We may also employ other selection methods, which we shall inform you about in advance.
How to apply
Application for admission should be made through UCAS (the Universities and Colleges Admissions Service). Applicants currently at school or college will be provided with advice on the process; however, applicants who have left school or who are based outside the United Kingdom may obtain information directly from UCAS.
If your application demonstrates that you are suitable and you receive an offer, then we shall invite you to a post-offer Open Day, where you can experience the sort of teaching which we offer and life in SELCS.
Video: applying to UCL through UCAS
In addition to linguistic and cultural understanding, the programme aims to develop skills in critical reasoning, independent thinking and application of theoretical concepts. You will learn how to conduct research and to communicate effectively both orally and in writing.
Graduates of the department have entered a wide range of professions including finance, commerce, journalism, education, the media, public relations, translation and interpreting, and the police.
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Bucks County and Globalization Senior Seminar Barbara L. Cook April 13, 2004 List of Tables Figure 1. PA state map, showing the boundaries of each county Figure 2. Bucks county map, showing the boundaries of each township Figure 3. Bucks county industry listing, showing the various sectors, number of employees, and payroll amounts Bucks County is located in the SouthEast corner of Pennsylvania, and was formed in 1682 (Figure 1). As one of the first counties, Bucks is named for Penn's England home- Buckinghamshire. It encompasses 608 square miles of land and 15.8 square miles of water. The Parks and Recreation department consists of 23 parks, totaling about eight thousand acres and 43 hundred acres of gameland. The entire county consists of 31 townships and 23 boroughs (Figure 2). Bucks might be a small county, but is quite diverse in several aspects and has made significant contributions in education, health care, and economic growth (Freepages). In the year 2000, the total population of Bucks county was 597,635 people. With a 51% female and 49% male population, the county is slightly even in terms of gender. Several communities within Bucks, such as Morrisville, Hulmeville, and Levittown are known as suburban areas. Many of their residents are married (61%) and a relatively small group consists of senior citizens over 65 years old (12%). Much of the population is well over 18 years old and is either enrolled in higher education or are out in the work force (Demographics). When examining the county by race, differences are very visible. A 2000 census divides Bucks into the following racial groups: White (93%), Black (3%), Asian (2%), and American Indian or Alaska native (1%). The ancestry of Bucks county residents presents a strong representation of European culture. Despite the fact that 8% doesn't speak English as their native tongue, these immigrants were able to have children and establish a home in a predominantly agricultural state. Today, about 93% of PA residents were born in the United States, with 70% born within the borders of the keystone state (Demographics). A large percentage of the county's population is married and have children enrolled in school. About 46% of those children are enrolled in elementary grades one through eight. Another 33% are high school graduates, but higher education is one of the options that many don't pursue. In 2000, 89% of county residents were at least high school graduates, but only 38% were able to earn a post-graduate degree (Demographics). More and more companies require their employees to have a degree or a certification of some kind. In order to compete in high-tech companies for better paying jobs, higher education is necessary. Bucks County has a few institutions that specialize in higher learning, but none of them are adequate enough to service the demands of its residents. Among those who continue their education, 27% receive either a two or four year degree and 11% earn graduate or professional degrees (Demographics). The county maintains thirteen public schools, three technical schools, and many more that are private, parochial, or otherwise classified (Freepages). But, are those schools getting the manpower and funding that they need to keep their programs going effectively? In 2000, the county spent $136,227 on its educational services and hired 6,202 workers. About 58% of the educators in this county work in either an elementary or secondary environment. Is it possible that more than enough effort is invested in young children, but not enough is given to teenagers and young adults (Business Patterns, 2000). County technical and trade schools claimed about $5,000 of education's annual budget and only 179 employees. Fine arts programs were only able to receive $6,100 and 192 county workers. The area's colleges and universities are able to wrestle away a pitiful $23,000 and 1,200 workers, but these numbers are grim compared to those of the elementary and secondary education sectors. This means that the county isn't focusing enough attention on the needs of its residents after they graduate from High school (Business Patterns, 2000). After viewing these numbers, it is safe to assume that the county has very little concern for children once they reach a certain time in their education. It would appear obvious that Bucks county is specifically focused on education that is considered mandatory by the state education board. After that point, it is everyone for themselves and if you don't make the right choice, you have only yourself to blame. There is no real emphasis on the importance of a college education. As a resident of Bucks county, I personally can't remember anyone telling me that the choice of going or not going to college would affect my entire life. I made the decision to continue my education beyond high school. Also, to receive a quality education, I would have to leave my hometown and venture out into the unknown. This probably means that other children were forced to make the same choice and had to travel to other cities for a proper college or technical education. There are 83,500 acres of land that comprise the state of Pennsylvania. But, as described in Fig. 3, only .02% of employees in Bucks are involved in Fishing, Agriculture and other related industries. There are several industries that comprise the majority of the county's labor force. So, most of the county's commerce is centered in boroughs and many major transportation routes (Freepages). Manufacturing, employs 15.27% of county residents, comprises 20% of the annual payroll, and is the center of county business and revenue. This includes the production of fabrics, textiles, apparel, foods, plastics, hardware, electronics, etc. This sector is supplemented by other provided employment services, including by health care and social assistance (11.32%), wholesale trade (7.03%), retail trade (15.78%), construction (6.68%), and professional services (5.83%) (Business Patterns, 2000). Bristol Township Bristol Township is located in Bucks County and founded in 1692 as Buckingham Township. But, the time the name was changed to Bristol in 1702. By 1701, Bristol Mills and Mill Pond (now Silver Lake) became industrial areas. It was the attraction of wealthy Philadelphians to invest in fledgling businesses and perhaps seek new residence away from the city that caused the suburban boom to begin (Wilson). After the WWII, several industries developed, including when U.S. Steel's Fairless Works was constructed in Falls Township in the 1950's. To meet the housing demand for returning GIs and the steelworkers, plans for a suburban development were conceived by William Levitt. That once developing community, now called Levittown, comprises parts of Bristol Township, Falls, and Middletown Townships, as well as part of Tullytown Borough (Wilson). Over the years, industries including Thiokol, 3M, and Rohm and Haas used the highway and rail network to build prosperous industries throughout the township. By the 1980's, most of the township was developed and Levittown was experiencing a second generation of homeowners. The redevelopment, attraction of new industry, and a rebuilding of the infrastructure are on the agenda for the future. But, in an attempt to improve the plight of a small town, a classic landmark has been destroyed (Wilson). Today, some industries including 3M, have moved their operations to other cities or closed their doors due to lack of business. One these industries began to falter, other businesses followed in their footsteps. The once prominent Levittown Shopping Center, rich in commerce and glutton with trade, now sits as a pile of concrete. This progression was caused by the importance of increasing profits and eliminating cash draining locations. This center was no longer seen as a sound investment, so it slowly died (Wilson). Falls Township Falls Township is also located in Bucks County, and was legally established in 1692. It was the largest village in the township, until Levittown was constructed and became a thriving community. Over the years, growth continued, with the construction of homes, an inn, public buildings, various retail stores, and small craftsmen's shops. Township development is directly associated with the county's eclectic transportation system. This system includes the following routes: the Delaware River, the Delaware Canal, the Amtrak and Conrail railroads, and other highway routes: Interstate 95, Route 13, and Business Route 1. The proximity of these major transportation systems influenced much development (Fallstwp). The earliest of these routes was the Delaware River and Falls township is located at the upper end of the navigable portion of the river. Then known as the King's Highway, it runs from Philadelphia to Trenton going through Bristol, Falls, and Morrisville. The King's Highway was frequently used to transport goods, still exists as Route 13. A railroad line from Philadelphia to Trenton via Morrisville was later built to easily transport shipment and goods. These rail lines now accommodate SEPTA, Amtrak, and CONRAIL passenger and freight cars between Philadelphia and Trenton. There is also a deep water port located on the Delaware River and nearby airports that is owned by the township (Fallstwp). Falls Township's economic development has been very influenced by geographic location. Locations along the Delaware River made it a very attractive area for industry. Close proximity to Philadelphia and Trenton have made it very good for local businesses. Falls Township was once a resource supply satellite with a residential population similar to Philadelphia. Approximately 4,000 affordable homes were constructed in Falls Township alone, and the residential population increased from 3,000 to 30,000 people within a decade. Naturally, land values rose rapidly, and farmers were enticed to sell their land to similar developers. The result of selling off farms was that residents were forced to travel to larger cities to find jobs. Falls Township was now considered residential commuter community, a suburb of Philadelphia and Trenton, and an exurb of New York City with a labor force as its most salable resource (Fallstwp). In the past, Falls Township was home to various industries, most notably Fairless Works, a steel industry. It reached its height in 1973, before beginning a downturn like many other regional industries. They were able to utilize workers regardless of their educational backgrounds, which attracted a large "blue collar" labor force to the area. The added bonus of moderately priced housing, the industrial growth attracted many residents that still live in the area today. The "suburbanization of business" in the New York and Philadelphia metropolitan area has Falls township slowly shedding its label as a suburban community and will once again be characterized as self-sufficient (Fallstwp). Middletown Township Middletown Township is in the heart of Lower Bucks, and is the most heavily urbanized portion of the County. It was named Middletown because it lies in the center of five other townships. It is crossed by major traffic routes, including Interstate 95, U.S. route 1, and PA Route 413. These roads are convenient links to locations across the Delaware Valley and lead directly to the interstate highway system (Middletowntwp). This unique and diverse community contains 19.4 square miles and is the third most populous municipalities of Bucks County. The southern portion of the Township houses Levittown's residential development. Central parts contain large retail and other commercial development areas. Western Middletown is also home to residential areas, but they are much older than those in the rest of the township (Middletowntwp). There is also a part of the township that isn't getting the attention that it deserves. Northern Middletown is the only portion of Middletown with substantial undeveloped properties. Particular care is being taken to conserve the natural environment and existing low-density land use patterns in northern Middletown. Striking a balance between the Township's overall growth and preservation needs is a central theme of this comprehensive plan (Middletowntwp). Although formally established as a Township in 1692, Middletown was well established by 1682. Since that time, the area has grown in terms of housing and commercial development. The township is home to various retail shops and recreational sites. The most prominent would be Sesame Place amusement park, located in close proximity to various highway routes (Middletowntwp). So, how does this fit into the idea of globalization? Globalization is defined by some as the tendency of a nation to move toward an environment of world wide investment, including the integration of its national capital markets (Financial glossary). Those areas that want to gain technology and attract capital at the same time must be willing to make certain sacrifices to its way of life. But, Thomas Friedman sees globalization as reality and not as a choice; that "the only way to grow at a good speed is to seek out multinationals that are willing to invest in your interests and sell what you produce in a global market". Unfortunately, this didn't happen in Bucks county. Several areas businesses were forced to moved to larger cities because their products and services weren't ready available to the masses (Waltz). The "golden straitjacket", referred to by Thomas Friedman, offers some simple suggestions to make areas more appealing to foreign investors, including openness to trade and investment, a balanced budget, and economic deregulation. But, for the most part, there is no one in charge of this system. Decisions don't rest on the shoulders of a group of impartial elites; they are made because investors move their money around in a system where movement can shape of shift a market. The markets to Bucks county, at one time or another, experienced a withdraw of economic security that had held up its economy for so long. Whether it was one dissatisfied investor or another, the economic success it had once enjoyed was now gone (Waltz). It is an assumption that globalization will stabilize the economic aspects of all regions (wages, products, wealth, prices, interest rates, and profits). But, before that stabilization occurs, there is first resistance by those whose economic security is threatened. Though, sooner or later, that economy will falter and be forced to surrender itself to globalization and all that accompanies it. The economic future of Bucks County has been toppled; and now it must submit itself to the practices of a succeeding economic plan or face further ruin (Waltz). Works Cited 1) Bucks County Pocket Facts. <Http://freepages.genealogy.rootsweb.com> (February 12, 2004). 2) Business Patterns for Bucks, Pa (2000). <Http://www.census.gov/epcd/cbp/map> (February 17, 2004). 3) Falls Township Online: History. Http://www.fallstwp.com/hist.html (March 10, 2004). 4) "Globalization" Yahoo glossary. <http://biz.yahoo.com/glossary/bfglosg.html> (April 10, 2004). 5) Middletown Township. Http://www.middletowntwpbucks.org/full (March 11, 2004). 6) US Census Bureau, Bucks county, Pa: 2000 Demographic Profiles. <Http://factfinder.census.gov> (March 3, 2004). 7) Waltz, Kenneth N. Globalization and Governance: The state of the state. <http://www.apsanet.org/PS/dec99/waltz.cfm> (April 10, 2004). 8) Wilson, Bill. Bristol Township, a brief history. Http://www.bristol.com/poi.htm (February 12, 2004). Fig. 3 Industries of Bucks County, Pennsylvania Industry Annual Payroll 1) Mining $17,298 2) Utilities $29,025 3) Agriculture/Fishing 0.01% 4) Construction $695,961 5) Manufacturing $1,554,111 6) Wholesale trade $847,058 7) Retail trade $844,008 # of employees % % 385 0.22% 395 0.37% N/A 16,555 8.89% 37,816 19.86% 17,412 10.82% 39,089 10.78% 4,259 6,646 3.34% 10,042 5.30% 3,770 1.5% 14,435 8.79% 3,281 25,334 0.15% 0.15% 0.2% 6.68% 15.27% 7.03% 15.87% 1.72% 2.68% 4.05% 1.52% 5.83% 1.32% 10.23% N/A 8) Transportation/Warehousing $141,577 1.8% 9) Information $262,062 10) Finance/Insurance $415,002 11) Real Estate $120,015 12)Professional services $688,032 13) Company/enterprise management $222,818 2.84% 14) Admin support/waste management $485,178 15) Educational services $136,227 6.20% 6,202 1.74% 28,031 3,228 15,830 2.39% 2,582 1.05% 12,008 0.09% 222 0.08% $9,138 4.85% 1.04% 11.32% 1.30% 6.39% 2.5% 16) Health Care/Social assistance $792,574 N/A 17) Arts/Entertainment/Recreation $49,034 0.6% 18) Food/Accommodation $187,695 19) Auxiliaries $82,598 20) Other services $244,638 21) Unclassified 0.11%
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Microsoft's SNIPP3T app lets you keep track of your favorite celebrities
Microsoft has released a new app for the iPhone called SNIPP3T that lets you keep track of all your favorite celebrities.
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Royal Mail asks government for staff to be given stake in the firm
Royal Mail has formally asked the Department of Trade and Industry to allow staff to be given a stake in the company as part of its proposals seeking the government's financial backing for a £2bn modernisation programme.
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Digital download sales fail to offset CD slide
Global music sales fell 3% last year to $20.8bn (£12bn) at wholesale level as the growth of digital distribution failed to offset the continued decline in compact discs.
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Treat us like the film industry, says SCi boss
SCi Entertainment, owner of the Lara Croft computer game franchise, urged the government yesterday to consider introducing tax breaks for games developers.
Business Post says it is likely to meet forecasts
Royal Mail's rival Business Post warned yesterday that the cost of converting its franchise network would be £1.2m higher than expected, at £2.7m.


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What is the difference between Proof, Brilliant Uncirculated and Bullion coins?
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Family Fun Crafts: 16 Craft Ideas for Kids
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Fun Frisbees
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Have fun making these easy and cheap Frisbees with your child. Then have great summer fun playing with your new toys outside in the sun! Find this craft and 21 other crafts for kids in our FREE Summer Crafts for Kids eBook.
- Two paper plates
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- Place one paper plate on the table as if you were going to put food on it. Place beads on the plate.
- Glue the second paper plate on top so that they now resemble a flying saucer.
- Decorate your new Frisbee with glitter glue and let sit to dry. When finished drying completely, take outside to enjoy with some fun exercise!
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Danko and Volbeat & Duff McKagan
by Jolene
posted Mar 21 2013 5:23PM
Danko and Volbeat & Duff McKagan
The show is sold out at Showbox Market tomorrow night! The feedback on the new Volbeat song "The Hangman's Bodycount" is great thus far. I'll be doing video interviews with Volbeat and Danko Jones.
I've been a huge Danko fan for quite some time now. We each have those bands that we love and wonder why they're not bigger. That's the case for me and Danko. At least here in the states. I can't wait to hear what I know will be good things about them tomorrow night. Our good buddy Duff McKagan is a fan as well. He wrote a great piece on the band this week for Seattle Weekly.
Please check it out!!
I unfortunately won't be at the show due to well, my airshift. So have fun and hopefully we can gain some new Danko fans here in the pacific northwest!
The new album is called Rock And Roll is Black And Blue. Dig it!
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text: Five years ago, chef Roy Choi and a partner launched Kogi and ushered in a food truck "new wave" in Los Angeles. He tells his story in his new book, L.A.Son: My Life, My City, My Food. Courtesy of Harper Collins hide caption itoggle caption Courtesy of Harper Collins The Salt LA Food Truck King Tells His Story, One Recipe At A Time November 5, 2013 Roy Choi changed the food truck fad forever when he and his friend started selling Korean barbecue tacos outside clubs in Los Angeles. He talks about his life and his food truck foundations in his new book, L.A. Son: My Life, My City, My Food. Listen Loading… 7:50 Playlist Download Embed Embed Close embed modal <iframe src="http://www.npr.org/player/embed/243016353/243168234" width="100%" height="290" frameborder="0" scrolling="no">


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During the month of October, Hotel Galvez concierge Jackie Hasan will guide participants on a tour through the historic hotel's ghostly past while using popular ghost hunting tools to conduct a paranormal investigation. The one-hour ghost tour, which begins at 6 p.m., is followed by a three-course dinner at Bernardo's Restaurant at Hotel Galvez at 7 p.m.
"The ghost tour and dinner package at Hotel Galvez allows our guests to explore the ghost history of the hotel while providing participants with an interesting and uniquely entertaining experience,"
Hotel staff has often reported odd occurrences throughout the hotel, such as candles blowing out on their own, dishes breaking with no one around and unexplained breathing or children's laughter in some public areas. Similarly, guests have reported seeing or sensing the occasional spirit in their rooms or unexplained orbs in their photos. The hotel's "Ghost Bride," has reportedly been seen in Room 501 and throughout the fifth floor. Hotel Galvez and its ghosts have been featured on the Travel Channel's Ghost Stories and on Discovery Channel's Ghost Lab.
About Hotel Galvez & Spa
Hotel Galvez & Spa, A Wyndham Grand® Hotel and National Trust Historic Hotel of America, is the only historic beachfront hotel on the Texas Gulf Coast. This 224-room, century-old hotel offers 13,000 square feet of meeting space, a 9,763-square-
About Wyndham Hotels and Resorts
Wyndham Hotels and Resorts, LLC, a subsidiary of Wyndham Worldwide Corporation (NYSE: WYN), offers upscale hotel and resort accommodations throughout the United States, Europe, Canada, Mexico, China and the Caribbean. All Wyndham® hotels are either franchised by the company or managed by Wyndham Hotel Management, Inc., one of its affiliates or through a joint-venture partner. Additional information and reservations for all Wyndham hotels are available by calling (800) WYNDHAM – (800) 996-3426 – or visiting www.wyndham.com.
About Galveston Island
Galveston Island is a historic beach town located on the Gulf of Mexico just 50 miles from Houston. The island is best known as a vacation destination, offering 32 miles of beaches, a variety of family attractions, Texas' premier cruise port and one of the largest and well-preserved concentrations of Victorian architecture in the country, including several National Historic Landmarks. Galveston Island is home to popular amusements such as Moody Gardens and Schlitterbahn Galveston Island Waterpark, as well as a variety of museums and recreational activities from surfing to birding. For more information on Galveston Island visit www.galveston.com or call (888) GAL-ISLE.


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This is the very adorable Vann, who slept like a champion for his photo session. He was the first to wear the new little knitted overalls from the MILK collection and I have since ordered some more. Everytime I think I have enough props I do a session like this and then order some more. Boys are harder than girls too, so I love lots of greys and blues and chunky texture.
Thursday, April 16, 2015
vann { ten days new }
Posted by Skye Rocket Studio at 9:26 AM 0 comments
Wednesday, April 15, 2015
the mountain session
There were many more taken on the day but these are some of my favourites from my session at Sugar Pine Walk up new Batlow. I had a ute full of props, a very helpful assistant and nine amazing models and even saw a brumby, which I didn't realise had been on my bucket list till it happened, so I have since added "Photograph brumbies" to my bucket list. It was a long but wonderful day full of sunshine and beautiful moments and wildflowers.
Posted by Skye Rocket Studio at 1:25 PM 0 comments
Thursday, March 12, 2015
annalise { a newborn session }
Posted by Skye Rocket Studio at 1:20 PM 0 comments
Wednesday, December 17, 2014
charlie { a newborn session }
Posted by Skye Rocket Studio at 8:30 AM 0 comments
Labels: baby portraits, newborn, wagga baby photography
Monday, December 15, 2014
alfie { a location session }
Posted by Skye Rocket Studio at 8:30 AM 0 comments
Saturday, December 13, 2014
emily { a newborn session }
I have been using my new timber backdrop for lots of newborns session lately, loving the dark tones it brings to the background. Goes beautifully with the timber drawer. I would love about five more of these drawers but they arent that easy to find!
Posted by Skye Rocket Studio at 3:38 PM 0 comments
Labels: newborn, studio shoot
Friday, August 29, 2014
darcy { seven months old }
Darcy and his big brother Jasper came to visit my studio and I think Darcy had the most smiles ever in one photo sessoin. He is such a happy little boy and this is such a wonderful age to photograph as well. They give me lots of great expressions, they can sit up by themselves but they cant crawl away from me yet. You really get a sense of their personality from a photo session at this age. And Darcy is such a happy little man.
Posted by Skye Rocket Studio at 3:24 PM 0 comments
Labels: baby portraits, studio shoot
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Is Your Man Sagging A Little Up Top? Funkybod Is Ready To Give Him That Boost
Funkybod Muscle top or Wundershirt....think I just found someone's Christmas present!
skinny people go home! haha funniness. I actually look to see what these people are doing so I can do it too (it's obviously working)
We LOVE Arrested Development - and this captures a lot of great moments/ongoing jokes from the show. I think this would be an excellent gift for my hubby!


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Ratings based on 121 Verified Reviews
They paid and stayed. We double-checked.
4.6 Room cleanliness
4.5 Service & staff
4.5 Room comfort
4.5 Hotel condition
They paid and stayed.
We double-checked.
We double-checked.
for Everyoneby A verified traveler from Sanford, FL
Nice Stay, Good ValuePosted Jun 25, 2015
Pros: Comfortable bed. Clean. Convenient
Cons: Remodel lobby, hallway and elevator flooring.
We will stay here again if we are in the North Houston Area. It is a good value. Clean. The lobby and hallways need upgrading. The road areas are under construction which makes it tricky getting in and out of the place. Friendly staff.
by A verified traveler
Posted May 8, 2015
Staff is nice, he recommended us to take 3rd floor room which is more quiet since the sound proofing is pretty bad. Breakfast is so so only. There's some weird smell from the carpet.
for Everyoneby A verified traveler from Illinois
Nice hotelPosted Apr 4, 2015
Pros: The breakfast
Cons: Had some broken tiles in the room
Location: The location was great, but there was a lot of freeway construction
Hotel was clean, staff was very nice. Breakfast was very filling and hot.
for Couplesby Samuel from Sonora
good hotel for the pricePosted Apr 1, 2015 on Hotels
access is a bit difficult at the moment due to construction at freeway. friendly staff, clean rooms, decent breakfast.
for Couplesby Dennis
Posted Mar 31, 2015 on Hotels
for Familiesby Ragika from Memphis
Fantastic!!Posted Mar 22, 2015 on Hotels
The hotel was very nice. The staff was very friendly and professional. The room was very clean and the bed was comfortable. The only complaint I have was the refrigerator didn't work. I would definitely stay at this hotel in the future.
for Familiesby Michael from Corpus Christi
Friendly StaffPosted Mar 16, 2015 on Hotels
The front desk personnel was very friendly. Parking was very convenient and free. The hotel is surrounded by construction zones. We did not hear any noise, but it was a little tricky to find our way at first.
for Familiesby Jeremy from Spartanburg, SC
Good place to stay a couple of days.Posted Mar 14, 2015 on Hotels
Location was terrible, lots of stuff in the hotel wasn't working, even though the hotel was brand new. I would tally it all up to shake-down issues. The rooms were clean, and I always felt safe.
for Personal Eventby shambrecca from lufkin,tx
GREAT STAY!!!Posted Mar 3, 2015 on Hotels
excellent stay!!!!
for Business Travelersby A verified traveler
Cordial staff.Posted Feb 13, 2015
Pros: cleanliness
Cons: parking
Location: don't know. just passing thru.
Hotel access is awkward at present due to road construction. Parking is limited.