text:
|Table of Contents
|Vol. 35, No. 1, 2013
Issue release date: February 2013
|Section title: Original Paper
Mortality in Cerebral Venous Thrombosis: Results from the National Inpatient Sample DatabaseNasr D.M.a · Brinjikji W.b · Cloft H.J.b · Saposnik G.c · Rabinstein A.A.a
Departments of aNeurology and bRadiology, Mayo Clinic, Rochester, Minn., USA; cDepartment of Neurology, University of Toronto, Toronto, Ont., Canada Corresponding Author
Alejandro A. Rabinstein, MD
Mayo Clinic, Department of Neurology, W8B
200 First Street SW
Rochester, MN 55905 (USA)
E-Mail email@example.com
Background: Outcomes of cerebral venous thrombosis (CVT) vary from full recovery to death. Few studies have been performed examining epidemiologic and medical risk factors associated with high mortality in CVT. In this study, we examined the National Inpatient Sample (NIS) to determine the epidemiologic and medical risk factors associated with increased mortality from CVT. Materials and Methods: Using the NIS from 2001 to 2008, patients who suffered from CVT were identified using the ICD-9 codes 437.6 (nonpyogenic thrombosis of intracranial venous sinus), 325 (phlebitis and thrombophlebitis of intracranial venous sinuses) and 671.5 (peripartum phlebitis and thrombosis, cerebral venous thrombosis, thrombosis of intracranial venous sinus). We analyzed the associations of demographic factors, risk factors, comorbidities, complications of CVT, and therapeutic interventions with in-hospital mortality. We performed a multivariate logistic regression analysis to determine which variables were independently associated with in-hospital mortality. Results: 11,400 patients were hospitalized with CVT between 2001 and 2008. Two-hundred and thirty-two (2.0%) suffered in-hospital mortality. Patients 15–49 years old had the lowest mortality rate (1.5%) compared with 2.8% for patients aged 50–64 (p < 0.001) and 6.1% for patients ≥65 years old (p < 0.001). The most common condition associated with CVT was pregnancy/puerperium (24.6%), and these women had a low mortality rate (0.4%). On multivariate analysis, the comorbidity most strongly associated with increased risk of mortality was sepsis (mortality rate 15.6%, OR = 7.5, 95% CI = 4.79–11.53, p < 0.001). Malignancy, underlying autoimmune disease and substance abuse were also independently associated with mortality, but with lower mortality rates (<5%). Complications associated with increased risk of mortality included paralysis (8.0%, OR = 3.4, 95% CI = 3.17–6.96, p < 0.001), intracranial hemorrhage (8.7%, OR = 5.4, 95% CI = 4.38–7.96, p < 0.001), and hydrocephalus (15.0%, OR = 3.2, 95% CI = 5.54–15.11, p = 0.004). Demographic variables associated with decreased mortality on multivariate analysis were male gender (2.1%, OR = 0.62, 95% CI = 0.43–0.87, p = 0.006) and Asian/Pacific Islander race (OR = 0.00, 95% CI = 0–0.27, p < 001). Conclusions: CVT is associated with a low in-hospital mortality rate. Amongst patients suffering CVT, male gender and Asian/Pacific Islander race were independently associated with lower odds of in-hospital mortality when compared to their female and white counterparts, respectively. Septic patients with CVT have the greatest risk of in-hospital mortality. Hydrocephalus, intracranial hemorrhage, and motor deficits are also associated with higher risk of death. Our results build on previous evidence that serves to define a group of patients with CVT at high risk of early death.
© 2013 S. Karger AG, Basel
Cerebral venous sinus thrombosis (CVT) is relatively rare, accounting for 0.5–1% of all strokes [1]. It most commonly afflicts young women, but can occur at any age and may be encountered in the hospital in patients with severe infections and malignancies causing hypercoagulability [1,2,3]. Although prognosis is usually favorable and mortality is relatively low, the outcome may vary [4,5,6]. There are limited data on the risk of death among hospitalized patients with CVT [4,5,6]. Factors influencing the chances of mortality in these patients have not been extensively studied.
The goals of this study were (1) to determine the risk of death in hospitalized patients with CVT using the large registry of the National Inpatient Sample (NIS), and (2) to identify the magnitude of effect for different clinical factors associated with a fatal outcome.
We analyzed the NIS hospital discharge database for the period 2001–2008 from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, Rockville, Md., USA. The NIS is a hospital discharge database that represents 20% of all inpatient admissions to nonfederal hospitals in the United States. Diagnoses, comorbidities and procedures for each admission were identified using International Classification of Diseases 9th Revision (ICD-9) codes and Clinical Classification Software (CCS) codes. CCS codes are employed by the NIS database to collect similar diagnoses that span numerous ICD-9 codes into one or several codes in order to ease statistical analysis. Further description is provided at http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccsfactsheet.jsp. Patients who suffered from CVT were identified using the ICD-9 codes 437.6 (nonpyogenic thrombosis of intracranial venous sinus), 325 (phlebitis and thrombophlebitis of intracranial venous sinuses) and 671.5 (peripartum phlebitis and thrombosis, cerebral venous thrombosis, thrombosis of intracranial venous sinus).
Patients were stratified by age group (15–49, 50–64 and ≥65 years old), race/ethnicity (Caucasian, African-American, Hispanic, Asian-American/Pacific Islander), and gender. Comorbidities analyzed included pregnancy/puerperium, thrombophilia (ICD-9 286.9), autoimmune disease (CCS diagnosis code 210–211), sepsis (CCS diagnosis code 2), substance abuse (CCS diagnosis code 660–661), head trauma (CCS diagnosis code 233–235) and malignancy (CCS diagnosis code 11–44). We also analyzed the frequency of a number of complications and clinical sequelae of CVT including seizure (CCS diagnosis code 83), paralysis (CCS diagnosis code 82), intracranial hemorrhage (ICH) (ICD-9 diagnosis code 431) and hydrocephalus (ICD-9 diagnosis code 3313–3314). The frequency of angiography (ICD-9 procedure code 8841), fibrinolytic therapy (ICD-9 procedure code 9910), ventricular drainage (ICD-9 procedure code 231–239), and craniectomy (ICD-9 procedure code 121–201) was also determined.
Our primary outcome was in-hospital mortality. The frequency of in-hospital mortality was determined for the various demographic factors, comorbidities, complications and interventions.
All continuous variables are presented as means ± standard deviations. For univariate analyses, Student's t tests were performed for continuous variables and χ2 analysis was performed for categorical variables. When analyzing the primary outcome of mortality, we calculated the odds ratios and 95% confidence intervals for each demographic factor, comorbidity, complication and intervention. A multivariate logistic regression analysis was performed to discriminate independent associations. Associations with a p value <0.01 were considered statistically significant. Weights were applied to each admission per recommendations from the NIS to make the data nationally representative. All statistical analyses were performed using the SAS-based statistical software package JMP 9.0 (www.jmp.com).
Between 2001 and 2008, a total of 11,400 hospitalized patients age ≥15 had a diagnosis of CVT. The mean age of patients diagnosed with CVT was 38.1 ± 34.8 years (minimum age = 15, maximum age = 94). There was a female predominance (8,938 patients, 78.3%). The racial/ethnic distribution in order of decreasing frequency was Caucasian (5,595 patients, 70.0%), African-American (1,193 patients, 14.9%), Hispanic (977 patients, 12.2%) and Asian-American/Pacific Islander patients (229 patients, 2.9%). In-hospital mortality occurred in 232 (2.0%) cases.
The results of the univariate analyses assessing the associations of demographic factors, comorbidities, complications, and interventions with in-hospital mortality are shown in table 1. Age was directly related to mortality; the mortality rate was 1.5% in patients 15–49 years, 2.8% in patients 50–64 years (p < 0.001), and 6.1% in patients 65 years and older (p < 0.001). There were no significant differences in the risk of mortality related to gender. Asian-American/Pacific Islanders had much lower mortality, but this finding was based on a much smaller number of patients of this racial extraction.
Pregnancy/puerperium was the most common condition associated with the diagnosis of CVT (2,801, 24.6%), but the mortality rate was very low in these cases (0.4%). The most common complications were seizure (14.7%) and ICH (6.4%). The most common intervention performed for CVT patients was angiography (14.2%). The comorbidities associated with significantly higher mortality rates with CVT were sepsis, malignancy, substance abuse, and underlying connective tissue disease. The mortality rate in patients who did not suffer head trauma (2.0%) was significantly lower than the mortality rate in patients suffering head trauma (7.5%, p = 0.01). In a sensitivity analysis, the mortality rate related to sepsis was similarly high (29/161, 17.9%) when the population was restricted to patients with ICD-9 code 437.6 (nonpyogenic thrombosis of intracranial venous sinus). The symptoms/complications associated with a significantly higher mortality rate were hydrocephalus, ICH and paralysis. Patients necessitating ventricular drainage (147, 1.3%) and craniectomy (190, 1.7%) had the highest mortality rates (30.0 and 24.0%, respectively).
The results of the multivariate analysis are displayed in table 2. Male gender, Asian-American/Pacific Islander race and pregnancy/puerperium were associated with decreased mortality. Sepsis, malignancy, substance abuse, autoimmune disease, presence of paralysis, ICH and hydrocephalus were associated with increased mortality. The likelihood of mortality increased with age, but the associations between mortality and age groups did not retain significance on multivariate analysis.
In the present study, we analyzed the NIS registry and identified the largest number of adult patients with CVT reported to date. The overall in-hospital mortality rate was low (2.0%). Our analysis showed known and new variables associated with increased risk of fatal outcome. These variables were sepsis, malignancy, substance abuse, autoimmune disease, motor deficits, ICH and hydrocephalus. The identification of factors associated with higher mortality can be beneficial to select candidates for more aggressive treatment early after diagnosis of CVT.
The mortality rate in our cohort (2%) is comparable to 30-day mortality rates found in previous large – albeit still much smaller – series of CVT patients. In the International Study of Cerebral Vein and Dural Sinus Thrombosis (ISCVT) the 30-day mortality rate was 3.4% (21/624) [4], in a Dutch study 3.3% (3/90) [5], and in a Mexican cohort 3% (2/59) [6]. Several of the factors associated with early mortality in this study are consistent with previous reports. Older age, underlying malignancy, motor deficits and ICH on admission were associated with death or dependency in the ISCVT cohort as they were in our study [4,7,8]. Lower mortality risk was also reported in the analysis of a Mexican registry [6]. Motor deficits and ICH were independent predictors of unfavorable outcome at discharge in a Pakistani series [9]. Coma or altered mental status on admission, thrombosis of the deep venous system, and posterior fossa hemorrhagic lesions were also associated with poor prognosis in the ISCVT cohort [4,7,8,10], but we could not reliably assess for the presence of these factors in our population. Central nervous system infection was a marker of poor outcome in the ISCVT study and sepsis had one of the strongest associations with early mortality in our analysis. A previously published study using the NIS demonstrated that predictors of mortality were age, ICH, hematologic diseases, malignancy and central nervous system infection [11]. Our study provides additional data on comorbidities associated with increased mortality, such as sepsis, substance abuse, autoimmune disease, motor deficits and hydrocephalus. In addition, our study demonstrates that on multivariate analysis, age was not predictive of increased mortality and that male gender and Asian/Pacific Islander race are associated with decreased mortality rates.
The strong association of sepsis with in-hospital mortality in our study deserves to be underscored. Mortality is known to be high in cases of septic thrombosis of the cavernous and superior sagittal sinuses [12]. Using the NIS, Haghighi et al. [11] found the mortality associated with pyogenic CVT was slightly higher than in the nonCVT group (4.55 vs. 3.52%). Outcomes were poorer in a Middle Eastern series with a higher rate of central nervous system infection [9]. In our study, we could not determine how often sepsis was related to central nervous system infection. However, the mortality rate remained high when we restricted our analysis to patients with the diagnostic code for nonpyogenic CVT. Thus, based on our results, septic patients with CVT are at higher risk of death regardless of the source of infection. This frequency and implications of this association deserve attention and further investigation.
The increased risk of CVT with pregnancy and puerperium is well known [1,2,3,4,6,13]. In our multivariate analysis, odds of mortality were higher in female patients; however, the risk of mortality in the setting of pregnancy and puerperium was low. Racial/ethnic differences in CVT outcome have not been previously investigated. Higher rates of poor outcome have been reported in Middle Eastern series [9,14], but the significance of these findings is unclear in the absence of comparative studies across racial groups. In our cohort, Asian-Americans/Pacific Islanders had much lower mortality than Caucasians; however, the number of cases of CVT was much smaller in the former racial group rendering the findings difficult to interpret.
The main strength of our study lies in the size of the population analyzed, which was much larger than all cohorts previously reported. This allowed us to investigate for independent associations in multivariate analysis. However, this study also has several limitations. It is based on an administrative database and therefore it is susceptible to coding errors. Case ascertainment is also a serious limitation. Even with advanced imaging techniques, the diagnosis of CVT can still be difficult to make due to factors such as anatomic variations and radiologist experience. While our study demonstrated a mortality rate similar to other, larger studies of CVT, we also demonstrated markedly lower ICH and seizure rates when compared to some studies [4,6,9]. While the reasons behind this are unclear, explanations include the possibility that cases included in this database were less severe than those included in larger studies, underreporting or undercoding of seizures and ICH and the possibility that patients included in this database may not have been routinely screened for ICH and seizure as they often are in these studies. Various variables of interest were not available for our analysis, including the severity of clinical presentation (e.g. presence of altered level of consciousness), deep-venous system involvement, and causes of death (i.e. neurological versus nonneurological). We also lacked data on death after discharge and the functional outcome of survivors. Yet, we do not think that these limitations negate the validity of the associations reported.
Our results build on previous evidence that serves to define a group of patients with CVT at high risk of early death. Current guidelines favor the prompt initiation of anticoagulation upon diagnosis of CVT and also antibiotics in cases of septic sinus thrombosis [2,15]. However, they also advise to consider more aggressive interventions in patients with unfavorable prognostic indicators who fail to improve rapidly with the initial medical treatment. Endovascular thrombectomy and thrombolysis [16,17] and decompressive craniectomy [17] can be effective options in selected patients with severe complications resulting from CVT although the value of these interventions needs to be further studied.
Alejandro A. Rabinstein, MD
Mayo Clinic, Department of Neurology, W8B
200 First Street SW
Rochester, MN 55905 (USA)
E-Mail email@example.com
Received: 6/25/2012 4:20:10 PM
Accepted: 9/14/2012
Published online: 2/14/2013
Issue release date: February 2013
Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 2
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: http://www.karger.com/CED
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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Brick Squad Monopoly rapper Frenchie is hard at work in the studio preparing his next mixtape entitled F*kk Fame. Today he unveiled the cover art. Check it out up top. He also posted a photo of himself in the lab with PeeWee Longway.
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Article Summary
Having released OS X Mountain Lion (10.8) to developers earlier this year, Apple had already let much of the new features of its Mac operating system out of the bag. At WWDC, Apple has revealed the ninth version of OS X will be available for download from next month.
Read the full article: OS X Mountain Lion to pitter-patter into Mac App Store next month
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Sponsorship opportunities
Doncaster Rovers Belles Mean Business.
To view our current sponsorship packages, click here.
Doncaster Rovers Belles LFC will play all of their home games in the all new FA Women's Super League in the magnificent 15,000 all seater Keepmoat Stadium.
The Keepmoat Stadium is a multi-activity venue, which plays host to Doncaster Rovers and the Doncaster Rovers Belles Football Club, as well as Doncaster Rugby League Football Club.
We will be making all efforts to build on the Belles reputation as one of the UK's most successful women's football clubs by achieving every success possible in the WSL.
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The Doncaster Rovers Belles LFC was formed in 1969 and has enjoyed a prestigious history as one of the UK's highest ranking professional women's football teams. It has become a beacon club for the community of South Yorkshire by becoming a founding member of the FA Women's Super League that commenced in April 2011.
Did you know that women's football is the fastest growing sport in the UK?
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Currently the DRBLFC receives several thousand website visitors per month and we expect this to increase dramatically, now that traffic is being driven to the site from the FA's Super League website. The DRBLFC are offering corporate companies the opportunity to benefit by forming mutually beneficial sponsorship partnerships with the Belles. In return, sponsors will be promoted by every means possible on both a local and national platform through traditional and new media mechanisms.
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Logo on front of shirt. Clear brand visibility on website & matchday programme. Social media presence. Availability of players for press activities. Pitch side and perimeter advertising. Matchday box for up to 10 guests. Meet players.
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Logo on shirt. Clear brand visibility on website. In matchday programme. Availability of players for press activities. Pitch side and perimeter advertising. Matchday box for up to 10 guests. Photo opportunities with the Belles in full kit.
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Logo clearly displayed on shorts. Clear brand visibility on website. In match day programme. Pitch side and perimeter advertising. Agreed press related activity on ongoing communications. Photo opportunities with the Belles in full kit.
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We will reference your company on the player's profile and in the matchday programme. You will receive a signed photo of your chosen player plus have a Business to Business link on the website.
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4 Match Tickets. Signed presented programme. Photo with player of the match. Logo on our website and match day programme.
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We supply the board for you, YOU decide what design. The bigger the board, the cheaper per metre. A mention in the programme. A Business to Business links from our website to your website. A picture of your board with a player.
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We aim to provide the facility for more and more local companies to advertise on the website and further support the club at all levels. This includes Business to Business links.
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Thread: Jackson Ready for Bengals ...
-12-08-2007 #1
Jackson Ready for Bengals ...
Jackson Ready for Bengals
Friday, December 7, 2007
By Nick Wagoner
Senior Writer
In the days leading up to the 2004 NFL Draft, there was no doubt among most teams who the first running back chosen in the draft would be. Steven Jackson was a 62, 230 pound battering ram with the speed to run past any defender and the power to run over them.
Clearly, Jackson had the complete package, at least to most teams. Unfortunately for Jackson , nary a team identified a running back as its top need in the draft. No running backs were taken in the first 23 picks, but the Bengals who earlier swapped first rounders with Denver to acquire cornerback Deltha ONeal had made it clear that finding a backup for Rudi Johnson was a top priority.
Cincinnati not only wanted a backup, but also a third down back with the ability to catch the ball out of the backfield. Jackson seemed the perfect fit. Sure enough, Jackson was the 24th pick in the draft to the Rams.
I do remember that day, Jackson said. We knew the Bengals were in the market for a running back. They had a chance, but they decided to trade down.
Indeed, Cincinnati shipped the 24th pick to the Rams in exchange for their 26th selection and a fourth-round choice. The Rams, even with future Hall of Famer Marshall Faulk in the fold, saw that the future was coming sooner than later.
With that in mind, St. Louis grabbed Jackson and began working him into the mix in the backfield. The Bengals, meanwhile, still opted for a running back in Michigan s Chris Perry.
After the draft, Cincinnati claimed it had Perry rated as the best runner on the board. The Bengals had downgraded Jackson because of concerns about a lingering knee injury and believed Perry was a better receiver.
Jackson believes it didnt hurt Perrys cause that he was playing his college ball so close to the Queen City .
Theyre right there (near Michigan), Jackson said. They get a lot of Michigan games. Theyre accustomed to knowing what he can do. Theyre probably familiar with seeing a lot of him live compared to me on the west coast (at Oregon State).
By now, as the Rams and Bengals prepare to play for the first time since that fateful day, its clear which side got the better end of the deal. In fact, Cincinnati has gotten more from tackle Stacey Andrews (the player it used the fourth-rounder on) than Perry.
In four seasons, Jackson has rushed for 3,875 yards and 29 touchdowns. Perry has played in just 22 games with 337 yards and no touchdowns.
As for the receiving comparison, Perry caught 63 passes for 403 yards with a pair of scores. Jackson proved his receiving skills last year and has 178 catches for 1,511 yards and five touchdowns.
For Jackson , this weeks game wont have any added meaning except for the chance to visit with his friends and fellow Oregon State alums Chad Johnson and T.J. Houshmandzadeh.
I dont hold anything against them, Jackson said. It worked out for the best. Who knows, I might not be playing. Rudi Johnson is playing lights out ball. Its just another game.
Of course, theres no need for Jackson to make a statement to prove the Bengals wrong for passing on him. The numbers speak for themselves.
CHILL IN?: Lost in the ever-expanding love and respect for middle linebacker Will Witherspoon (who has earned all of the accolades hes getting), is the fact that Witherspoon isnt the only linebacker enjoying his best NFL season.
Brandon Chillar has long been overlooked in his role as the strong side linebacker. Chillar isnt as flashy or athletic as a Witherspoon or Pisa Tinoisamoa and his quiet nature makes him one of the more unassuming players on the defense.
In this, the final year of his contract, Chillars play is doing all of his talking. Chillar is fifth on the team in tackles with 67 and has a pair of sacks. In fact, with Tinoisamoa out for the season, Chillar has proved his versatility, sliding in on nickel situations and working as a pass rusher in others on his way to seven quarterback pressures, a forced fumble and a fumble recovery.
Considering his youth and flexibility, Chillar has become a priority for the Rams to bring back into the fold on a long term basis.
Hes really our only true unrestricted free agent, coach Scott Linehan said. There are some guys that are on one year deals, but hes a young player whose contract is coming up. We havent had any discussions that way, but I would love to have Brandon back. Its easier said than done; I understand that. Hes really having a real strong season for us. Weve asked him to do a number of things. Now hes playing a little bit more on third down. Im always hopeful to keep guys around. I think thats the best way to go.
INJURY REPORT: The final injury report for the Rams comes with little in the way of surprises.
Cornerback Eric Bassey (knee) and tackle Rob Petitti (concussion) are out. Brandon Gorin will start in place of Petitti at right tackle.
Quarterback Gus Frerotte (shoulder) is doubtful and wont be active for Sundays game.
Quarterback Marc Bulger (concussion) is questionable after limited participation on Friday (see related story for more).
Receiver Brandon Williams (ankle) is questionable and did not participate Friday. He isnt likely to play and Marques Hagans would handle return duties in his place.
Linebacker Will Witherspoon (groin) was limited, but is probable. Defensive end James Hall (ankle), running back Brian Leonard (knee) and center Brett Romberg (ankle) are all probable and likely to play.
RAM BITS: The Bengals will be without tackle Willie Anderson because of a knee injury. Safety Madieu Williams (back) is questionable Darius Vinnett was officially promoted from the practice squad to take the place of Tye Hill, who was placed on injured reserve earlier in the week. Quarterback Todd Bouman is replacing Dante Hall on the roster after Hall was also placed on I.R.
-12-08-2007 #2Registered User
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Re: Jackson Ready for Bengals ...
wasn't STEVEN JACKSON predicted to go with the DALLAS Cowboys
-12-08-2007 #3
Re: Jackson Ready for Bengals ...
-12-09-2007 #4
Re: Jackson Ready for Bengals ...
Jackson bettter be ready. I think we'll see a large dose of him tomorrow.
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American English: /riˈpeɪmənt/ British English: /riːˈpeɪm(ə)nt/, /rɪˈpeɪm(ə)nt/
Translation of repayment in Spanish:
- 1 uncountable (act of repaying)(before noun) (plan/terms)
de pagoExample sentences
- They are intended to provide consistency in approach toward loan repayments.
- They follow a very narrow work objective: secure repayment of loans at any cost.
- Remarkably, there is a 98 percent repayment rate on the loans.
- 2 countable (installment)Example sentences
- There is nothing in the case law, says Aldridge, which says there is not value in the repayment of trust monies.
- Thus the claim by Guinness for repayment is unanswerable.
- I have a small mortgage with just six years' repayments outstanding.
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DEFINITION of 'Trade Hill Exchange '
A Bitcoin exchange launched in June of 2011. Trade Hill Exchange offers Bitcoin trade support for a number of currencies including the Australian and Canadian dollars, the euro, Chilean peso and Indian rupee. The exchange allows for both limit and market orders, and charges commission fees for all trades placed through the exchange.
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BREAKING DOWN 'Trade Hill Exchange '
Bitcoins are a digital currency created in 2009 which allow users of bitcoin exchanges to make payments and trades at a very low cost. Bitcoin circulation and expansion is governed by Bitcoin software and is programmed to expand as a geometric series, thus limiting the effects of monetary inflation on the virtual currency. Bitcoins are one of many virtual currencies that can be traded online by users.
BitcoinA digital or virtual currency that uses peer-to-peer technology ...
BritcoinA U.K.-based Bitcoin exchange. Britcoin was the first Bitcoin ...
Authorized Forex DealerAny type of financial institution that has received authorization ...
Currency PairThe quotation and pricing structure of the currencies traded ...
Interbank MarketThe financial system and trading of currencies among banks and ...
Quote CurrencyThe second currency quoted in a currency pair in forex. In a ...
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Schumacher Racing 3mm Aluminum Nyloc Nut Set (Purple) (8)
This is a replacement Schumacher 3mm Aluminum Nyloc Nut Set, and is intended for use with the Schumacher Mi4, as well as any application that requires a 3mm lock nut.
This product was added to our catalog on October 19, 2010.
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Shopping Assistance
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Part Number: PA5105U-1PRPA
The Toshiba Portégé Z10t Series Dock is a lightweight docking solution custom-designed for the Portégé Z10t and Z15t series Ultrabook portables. It provides the convenient way to view, store, charge, and access to your desktop environment. The Dock's small footprint and unique stowaway design make it perfect for anywhere and can be carried around as a portable dock and mobile stand for your Ultrabook.
A simple one-touch connection for one Gigabit LAN port, one HDMI port, two USB 2.0 ports, and an audio output port, it also included is a 45W AC adapter, eliminating the need to unplug the AC adapter whenever you undock your laptop. Docking and undocking is a breeze with the easy access top-load proprietary connector. Just drop it in and let the fun begin!
In the box:
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Board of Directors
Lois E. Silverman
Founding Chair
The Commonwealth Institute
Mrs. Silverman's professional career has spanned over 30 years in business where she is most well recognized as one of the first women in Massachusetts to take a company public. In 1988, she founded CRA Managed Care (now Concentra Managed Care), a provider of services to reduce the costs of workers' compensation, automobile, disability and health insurance claims.
Pamela Reeve
The Commonwealth Institute
Pamela Reeve is Chair of The Commonwealth Institute, working with women CEOs, entrepreneurs and business leaders to help them grow their businesses and their careers. She is the former CEO of Lightbridge, Inc. a company she headed from start up in 1989, took public in 1996, and ran for 15 years. Prior to joining Lightbridge, Reeve spent eleven years at the Boston Consulting Group, one of the world's leading management consulting firms. Her prior experience includes National Project Manager for a program funded by National Endowment for the Humanities, and real estate finance and development.
Jennifer Potter-Brotman
Vice Chair, The Commonwealth Institute
Managing Director, Russell Reynolds Associates
Jennifer Potter-Brotman is the Area Manager for the Boston office, a senior leader in the Human Resources practice and Corporate Officers sector and a member of the Diversity practice at Russell Reynolds Associates. She focuses on assessing and recruiting CHROs and other senior HR leaders. She has client relationships across a broad spectrum of industries, including financial services, healthcare, technology, industrial, professional services, and not for profit. Her clients include both public and private organizations.
Kirk Arnold
Data Intensity
Kirk Arnold brings deep experience in technology and services leadership to her role as CEO. Prior to joining Data Intensity, she was COO of Avid, a technology provider to the media industry. Before joining Avid, Kirk was the CEO and President of Keane, Inc., then a publicly-traded billion dollar global services provider. Before Keane, she held senior leadership roles at Computer Sciences Corp, where Kirk was President of the Consulting and Systems Integration Division, Fidelity Investments and IBM. She was also a founder and CEO of Nervewire, a technology and consulting service provider.
Deb Besemer
Deborah Besemer was most recently the CEO of Gemvara, an e-commerce designer jewelry company. Previously she was the President and CEO of BrassRing, a leading provider of talent management solutions. Under her leadership, revenues grew consistently, from $1 million in revenue to $40 million until she oversaw the sale of the company to Kenexa Corp. for $115 million.
Wendy Cebula
Wendy Cebula is currently serving as a business adviser to multiple organizations including Boston-based Gemvara. Previously she served as Chief Operating Officer at Vistaprint where she was responsible for overseeing Vistaprint's North American, European and JANZ business units as well as global capabilities development and manufacturing strategy. Prior to Vistaprint Wendy led retention marketing and analytics for MotherNature.com and worked in various database marketing capacities at financial services company, Partners First.
Andrea Cohen
HouseWorks co-founder and CEO Andrea Cohen is a social entrepreneur dedicated to transforming the way that care is delivered to seniors at home. Her vision for the business crystallized over 20 years ago when she took care of both her parents and became committed to making what she went through easier for families. In Boston over the last decade, Andrea and her team built the largest single site private home care company in the country.
Barbara Nobles Crawford, Ph.D.
Nobles Crawford & Partners
Barbara has extensive global corporate, entrepreneurial, and not-for-profit leadership experience in P&L management, strategic business consulting, organizational transformation, leadership/management development, executive coaching, and integrated talent management, as consultant and business executive in domestic and multinational companies. She is currently Assistant Secretary of Human Resources in the Massachusetts Executive Office of Energy & Environmental Affairs.
Diane Davis
Merrill Lynch Wealth Management
Diane Davis is a Vice President with Merrill Lynch and one of an elite group of financial advisors with a Certified Financial Planner (CFP) designation, a Certified Investment Manager Analyst (CIMA) designation, and the additional Merrill Lynch certification of Wealth Management Advisor.
Fay Donohue
Fay Donohue has been a leader in health and health care delivery and financing since 1975. She has brought her expertise in the dental benefits market and a deep commitment to improving oral health care delivery to her role as President and Chief Executive Officer of DentaQuest over the past 8 years. She retired in June 2015 and now focuses on board work, public policy and education.
Annie Drapeau
Bain Capital
Annie Drapeau joined Bain Capital in 2015 as Operating Partner. Previously, she was EVP of Corporate Strategy and Talent at Iron Mountain, where she also led their portfolio of emerging businesses.
Deborah Ellinger
Ellinger Enterprises
Ms. Ellinger is the President of Ellinger Enterprises, a private investment and consulting firm. She has led three private-equity backed companies, as Chairman and CEO of The Princeton Review, President of Restoration Hardware, and CEO of Wellness Pet Food.
Carol Goldberg
The AVCAR Group. Ltd.
Carol R. Goldberg is President of The AVCAR Group, Ltd., a private investment and consulting firm, which she founded in 1990 with her husband, Avram, after a thirty year career with The Stop & Shop Companies. Prior to founding AVCAR, she was the President and COO of Stop & Shop.
Lauren Jennings
Posternak Blankstein & Lund, LLP
Lauren is the firm's Immediate-Past Managing Partner and a member of the Corporate Practice Group. She is engaged in a general business practice, with particular focus on structuring of strategic relationships, mergers and acquisitions, entity formation and planning, and contracts, including both transactional and ongoing company representation.
Karen Kupferberg
Millwood Management Solutions, Inc.
Karen Kupferberg joined Axeda in December 2004 and was responsible for all of the company's financial, accounting, and legal functions in addition to managing investor relations, information systems and procurement activities. Prior to joining Axeda, Ms. Kupferberg served as President of Millwood Management Solutions, an independent professional services practice consulting to top management of small/mid-size companies, with a focus on the assessment and improvement of business operations.
Irma Fisher Mann
IRMA, Inc.
Irma Fisher Mann, recognized as a leading marketing expert in the travel and hospitality industry, is the founder of IRMA, Inc., a marketing communication and consulting firm specializing on both hospitality and education. She previously formed ISM Strategic Marketing, which she developed into the largest woman-owned marketing agency in New England, before selling the firm in 1999.
Barbara Marx
Barbara Marx is Principal in Marx+, a marketing consultancy that specializes in positioning, branding and messaging. Over the course of her career she has been engaged by emerging growth companies as well as industry leaders such as AT&T, Digital Equipment and Lotus Development/IBM.
Evelyn Murphy
The WAGE Project, Inc.
Evelyn Murphy is President of The WAGE Project, Inc., a national organization to end wage discrimination against working women, and author of Getting Even: Why Women Don't Get Paid Like Men and What To Do About It, published by Simon & Schuster in October 2005. She is Chair of the Board of Directors of SBLI USA Mutual Life Insurance Company and a Director of Citizens Energy Corporation.
June Rokoff
June Rokoff is a Founding Member and Vice Chair of the Board of Directors of The Commonwealth Institute, an organization dedicated to helping women CEO's, entrepreneurs and senior corporate executives build successful companies. Rokoff has recently been a consultant specializing in coaching high technology management.
Aviva Sapers
Sapers & Wallack
Aviva E. Sapers is the CEO of Sapers & Wallack, a third-generation insurance, benefits and investment management firm. Integrity is at the root of the family business, which was founded by Aviva's grandfather, Abraham Sapers, in 1932.
Shirley Singleton
Shirley Singleton is the Chairman, President and Chief Executive Officer of Edgewater. She co-founded the company in 1992 with her partner, David Clancey.
Helene Solomon
Solomon McCown & Company
Helene is the founder & CEO of Solomon McCown and is widely recognized for bringing an entrepreneurial spirit and keen sense of strategic thinking to the definition, recognition and protection of mission-focused organizations and businesses.
Susan Lewis Solomont
The Philanthropic Initiative
Ms. Solomont is a Senior Advisor at The Philanthropic Initiative (TPI) in Boston, Massachusetts. She works with private family foundations, to create entrepreneurial and strategic approaches to private philanthropy. Prior to joining TPI, Susan had an independent consulting company that worked with not-for-profit organizations, helping them with governance, board relations, capacity building and sustainability strategies. In June 2013 Susan Lewis Solomont moved back to the United States after living in Madrid, Spain with her husband Alan D. Solomont, the United States Ambassador to Spain and Andorra (2009-2013).
Phyllis S. Swersky
The MelTech Group
Phyllis Swersky is President of The MelTech Group, which provides a broad range of business advisory services to the CEOs and executive management teams of growing companies. Phyllis draws on two decades of hands-on executive management and financial experience in computer software and service companies, including a pioneering role in the meteoric growth of Cullinet software.


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I am developing a windows 8 phone application with c# and I have to use facebook to login, currently I am use a service to connect to the database. I have the AppID and App secret key. but It failing to execute my facebook login code. My code is available through the link: http://www.developer.nokia.com/Community/Wiki/Integrate_Facebook_to_Your_Windows_Phone_Application. This codes execute successfully but I am unable to see the login page. Could someone please help me?
please check once app-Id and app secret the same is working for me.


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The proprietors here at BiOmega3, LLC are Bill and Kim O'Connell. Descended from Montana Hi-Line homesteader stock, we're carrying on the tradition of pioneering new agricultural opportunities.
We used to farm up on the Hi-Line, not too far east of Glacier Park. Although we were semi-nomadic, and wintered here in the "Valley of the Flowers", running a wild game processing operation which later morphed into a bison skinning/robe/skull emporium, amongst booking agencies, web design, and sundry other ventures. Old habits die hard though, and against all odds, we now find ourselves farming again in the Bozone.
Oddly enough, in both cases we're farming ground that doesn't particularly lend itself to the mass-production industrial ag model. So we've always explored alternatives.
A few years back, when we started raising golden flax and camelina, and regularly consuming these high Omega-3 products, as well as healthy, locally produced foods (as much as possible, from our fellow Farmer's Market vendors!), not exactly quite "all of a sudden" we found our tastes had changed.
It's true, once you get used to eating healthy, there's no going back. Before long you can tell, almost instantly whether food has nutrition in it, or whether it's just "empty" calories.
Far beyond that, your body starts to demand this newfound healthy diet! And it's not just humans... Some of our steadiest customers give these Omega-3 supplements to their pets, and one interesting story lately was from a gal whose Jack Russell terrier now refuses to eat dog food without camelina oil on it!
I don't eat dog food, far from it, but otherwise I'm about there myself...
Times are changing in agriculture. The locally produced, healthy food model is taking hold in a big way. Not only is this of immense benefit to consumers, but for a change it holds promise for producers also.
Direct marketing to consumers, and wholesaling to health-oriented retailers, eliminating giant agribusiness conglomerates in the process... What's not to like?!


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Is there a minimum square metre/footage requirement for BTL mortgage?(1 Post)
flatstress Sat 22-Jun-13 08:16:17
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corps of cadets
"Corps Values"
This was the headline for a story I wrote about the battle over changes that were taking place at Texas A&M, in the heyday of the Gates presidency ("Corps Values," May 2004). Current A&M students have no historical memory of this period. So that readers may understand the entire background of the controversy involving General […]


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WASHINGTON – The University of Maryland determined more than two decades ago that it had no legal responsibility to report to police that its former head swimming coach had a sexual relationship with an underage swimmer.
The university released documents and handwritten notes regarding the allegations against and resignation of Rick Curl to The Washington Post Wednesday, and the documents were obtained by WTOP. The university is standing by its 1988 decision to not take further action against Curl.
Curl was sentenced to serve seven years in prison last week after pleading guilty to abusing that young swimmer, Kelley Davies Currin, over four years starting when she was 13. Davies Currin is now 43.
The Post reported that the university's in-house counsel at the time Curl resigned in 1988, Susan Bayly, determined the university had no duty to report Curl to the police because the victim was no longer a juvenile.
Last week, The Baltimore Sun reported that the university came to the decision not to report the abuse after conferring with the state's attorney general's office.
The notes from Bayly state she had an "informational briefing" with Jim Mingle, who worked for the Maryland attorney general's office at the time. Mingle told both the Sun and the Post that he did not remember the briefing or the case.
"We discussed UMD's duty to report. Concluded no duty b/c statute only applys (sic) to "child." Kelley is now 19," Bayly wrote in her notes.
The documents include a handwritten statement from Curl admitting that he had sexual intercourse with Davies Currin and that he knew she was 15 at the time. He wrote that the sexual activity continued for two years. The letter is signed by Curl, Davies Currin and her parents.
The Davies family later agreed to a $150,000 out-of-court settlement and did not pursue criminal charges.
Curl resigned two years after signing that letter of admission. "I regret the circumstances necessitating this resignation, but do so voluntarily and without coercion, recognizing it is in the best interests of the team, the University and myself," he wrote.
The university attached Curl's statement admitting to the sexual relationship to his notice of resignation, according to another letter the university sent to Montgomery County investigators in 2012.
"These documents show that the university confronted Mr. Curl, demanded his resignation, notified the Attorney General's office, and was advised by the Attorney General's office that no further reporting was required," university spokesman Brian Ullmann said in a statement released to the Post. "This is truly an unfortunate and regrettable situation, but we continue to believe that the university's actions were both reasonable and appropriate at the time."
The documents also included additional Bayly notes that detail options for handling Curl including a civil suit, criminal prosecution, which she noted would be a "nasty approach," or to "write him a letter (sic) get out of swimming."
After leaving the university's swim program, Curl continued to coach until he was banned from USA Swimming in 2012.
Here is an example of the notes:
U.Md. notes on whether to report Rick Curl by wtopweb
Related Stories:
WTOP's Amanda Iacone contributed to this report. Follow @WTOP on Twitter.
A look at winter weather news from around the D.C. area.
From Rhett & Scarlett to Harry & Sally, who are the most romantic movie couples?


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I'd settle for 8 - 4 this year. The comment about Leach having to have escorts with him all of the time because he was so drunk is...
Jerry Moore won the Division I-AA Championship at Appalachian State three years in a row.
Hance has essentially killed the honors program at Tech and has entered into an agreement with the builders of a parking garage that is...
Team Leach and Coach Leach were proud to present this scholarship to such a deserving young man. And of course Coach Leach didn't hold...
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Conventional wisdom suggests that public opinion has moved decisively- perhaps irrevocably - to the left, but recent polls actually express confusion and contradictions in the national mood.
Far from the "sea change," "tectonic shift" and "political revolution" that heavy-breathing pundits impute to the glorious dawn of the Age of Obama, major surveys show a glaring contrast between personal admiration for the President and widespread skepticism about the effectiveness of his policies. For instance, a CNN/Opinion Research survey showed that a huge majority of Americans (67%) don't expect the increased spending in the stimulus package and the budget to improve their financial positions. A Fox News/Opinion Dynamics poll indicated only 24% believed the "economic recovery plan" would help their personal situation, while 19% expected it would "hurt" them and the majority (54%) thought that the new government initiatives (costing at least $15,000 per tax filer) would make no difference at all.
Turning from their own situations to the nation, there is still no majority that believes that Obama's programs will produce their promised impact; only 49% agreed that "the recovery plan would help the economy." By a big margin, Americans believe that the recent recovery legislation is "better described as a spending bill, rather than a stimulus bill" (52% to 31%).
Nevertheless, the public overwhelmingly approves of the job Barack Obama is doing as president (60% to 26%) and views him in highly favorable terms (68% to 25%). Nonetheless, many of the same folks who like the president and appreciate his leadership so far wish for "more Republicans in Congress to provide a check on Obama's power." (46%)
Looking deeply into any major poll, such contradictions turn up again and again. Big majorities say it is "the responsibility of the federal government" to "make sure all Americans have food," "make sure all Americans have health care" and "provide housing to those who cannot afford it," but in the same survey (Fox News/Opinion Dynamics again) three fourths of all respondents worry that "Americans are starting to rely too much on the government and not enough on themselves."
Amazingly, 76% of independents and a startling 63% of Democrats agree that Americans "rely too much on government" – at the very same time that more than two-thirds of these same Democrats want government to start providing food, housing and health care.
Bush mocks Rubio and his fans: Stop whining that it's "unfair" that you're being attacked by another candidate's Super PAC | Allahpundit


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St Angelo Fort, Kannur
Nikon D600
Nikkor 16mm Fisheye
Nikon D600
Nikkor 16mm Fisheye
wow, this must have been a nice view!
The colors fit together perfectly.
The colors fit together perfectly.
You have been featured in #SkyAndNatureClub's Best of January 2013-Feature!
Please consider giving a to spread the word, so more people can see the feature.
Have a nice day
This is incredible, I love fisheye lens'!
Very nice. I love the colors, and how the hues vary from bright to dull.
Excellent photo!
Excellent photo!
Wow,Thats awesome


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Grand Central Terminal
Grand Central Terminal and the Chrysler Building
The Grand Central Oyster Bar
The New York Public Library
The New York Public Library
The New York Public Library: The Rose Main Reading Room
The Metropolitan Museum of Art
Washington Square
The USS Maine Monument at the Southwest Corner of Central Park
The Richard Morris Hunt Memorial on Fifth Avenue
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Get the latest Flash player
Date: 2 years ago
Runtime: 36:52
Views: 34,538
Top Comment
All Comments
I enjoy their naked patience and true enjoyment in the presence of each other. They enjoy being naked loving each other. This a great change
So fucking hot when he came!!!
I would love to be in a vid with you, feel you spasm around my penis when you cum!
He's hot. How did he taste? I would have loved to fuck him after.
You are hot!
Love all the moaning when you take a load in your mouth! And seeing that ass shake
what a wonderful, long video! i came when he was fongering you and giving you a strong orgasm.... and i'll cum more and more soon, for sure


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University of Redlands > Prospective Students >
High School Students & Guidance Counselors >
Redlands In Your Area
We want to get the word out about how great Redlands is. Our admissions counselors frequently travel throughout the United States and internationally, participating in college fairs and giving presentations at high schools and other locations.
We encourage you to attend a presentation at your school or to come visit us at a college fair. It's a great way to get information and to get to know your admissions counselor.
Can't make the scheduled visit? Counselors may also be available to meet one-on-one for interviews while they're in your area. Feel free to contact your counselor for more information.
Can't make a visit? Check out our Virtual Tour.
More than 47 percent of Redlands undergraduates participate in study abroad programs.
© 2015 University of Redlands. All Rights Reserved.


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Activity from earth day
Twitter Tuesday Phrase That Pays Goes Green
Posted by Team Swagbucks on Tue, April 22nd, 2014 at 6:00 am
Hey Swaggernauts!
It's Tuesday, which means it's time for the Twitter Tuesday Phrase That Pays (a.k.a. TTPTP), the contest where your creativity is rewarded with Swag Bucks (in addition to that warm, fuzzy feeling). Instead of all the bells and whistles, we're going to keep it really simple.
If you want a chance to win the #TTPTP, just do the following:
Today's TTPTP Challenge is: In honor of Earth Day, what do you think the 3 R's of Swagbucks should be and why?
On Wednesday, 3 Runners Up will win 50 Swag Bucks and one lucky winner will be awarded with 500 Swag Bucks!
Don't forget to include your Swag Name!
Be creative! Good Luck!
This week's runners-up (winning 50 Swag Bucks each) are:
"Refer, Research (Search & Win), Redeem, because you can't win if you don't get with it and do all 3!" – phimat37, from Citrus Heights, CA
"The 3 "R"s of Swagbucks? Read, Refer and Research to earn swagbucks :)" – kapo0005, from Canada
"Respect the swag, Rule the web and Reward yourself!" – marcotke, from Cincinnati, OH
This week's winner (getting 500 Swag Bucks) is:
"3 Rs of @Swagbucks should be Resourceful, Rockin', and Rollin'–because Swagbucks keeps improving, and it is always fun!" – beachy111, from Rancho Palos Verdes, CA
Congratulations to our winners and everyone who submitted an entry! See you next week for another exciting installment of #TTPTP!
-Team Swagbucks
Swagbucks Tips and Tricks: Celebrate Earth Day!
Posted by Team Swagbucks on Mon, April 21st, 2014 at 6:00 am
Tomorrow, April 22nd, is Earth Day – how will you be celebrating? Many of us take our planet for granted – we never stop to think, to appreciate, the beautiful world in which we live. Earth Day is an important reminder of where we come from and how lucky we are to be here. It's […]
Week in Review – April 28, 2013
Posted by Team Swagbucks on Sun, April 28th, 2013 at 11:00 am
It's time for another Week in Review where we discuss the events and fun things that we do Monday was Earth Day and we celebrated our land from the trees to the clouds from the oceans to the sand Tuesday we announced our Jewelry Sale 10% off everything click here for details In Wednesday's Game […]
Music Monday – Earth Day
Posted by Team Swagbucks on Mon, April 22nd, 2013 at 9:00 am
How are you celebrating Earth Day today? Whether you're planting a garden, going camping in the woods, cleaning up the local beach, or bringing in your cans to recycle, make sure you take a few minutes today to sit back and truly appreciate the beautiful Earth we live on. It's important not to take our […]
Earth Day Tips
Posted by Team Swagbucks on Sat, April 20th, 2013 at 11:00 am
We are two days away from Earth Day – how will you be celebrating? I think many of us take our planet for granted – we never stop to think, to appreciate, the beautiful world in which we live. Earth Day is an important reminder of where we come from and how lucky we are […]
Retail Therapy
Posted by Team Swagbucks on Thu, April 18th, 2013 at 6:00 am
Happy Thursday, Swaggernauts! Hang in there, it's almost Friday! Monday is Earth Day – the day for the world to come together and celebrate the planet in which we live. With all that goes on in the world every day, the good and the bad, it's important to remember our roots and how lucky we […]
How To Make Earth Day Cupcakes
Posted by Team Swagbucks on Wed, April 17th, 2013 at 3:00 pm
Monday is Earth Day, and there are plenty of things we can do to celebrate the planet in which we live. We can plant trees, clean up the beach, recycle old electronics, take a hike to appreciate our nature, and much more. If you're looking for a more delicious way to celebrate Earth Day, check […]
Happy Earth Day
Posted by Team Swagbucks on Sun, April 22nd, 2012 at 11:00 am
On behalf of everyone here at Swagbucks we wish you all a very happy Earth Day. Whether you spend the day cleaning up your local beach, planting flowers in your garden, changing your light bulbs to cut back on energy consumption, walking to the market instead of driving there, or just breathing in the fresh […]
Celebrate our Earth
Posted by Team Swagbucks on Fri, April 22nd, 2011 at 3:30 pm
Happy Earth Day! I've spelled out "Earth" for you in my interpretation of what each letter represents: Everybody can contribute Appreciate our planet Reduce, reuse, recycle Take the lead and let others follow Help protect the world we live in Here are some excerpts of songs that I felt were appropriate for today, showing appreciation […]
Help the Earth, Help Japan
Posted by Team Swagbucks on Fri, April 22nd, 2011 at 2:00 pm
Are you looking for a good way to celebrate and contribute to Earth Day? Well, we are still accepting donations for our Japan Earthquake and Tsunami Relief Fund. Unfortunately, the natural disasters that Japan has faced recently have left thousands in turmoil – some without homes and some without family members. You can help piece […]
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The Think You Know Everything?, All Around Modern Culture Test Test
Their result for The Think You Know Everything?, All Around Modern Culture Test Test ...
Their Analysis (Vertical line = Average)
They scored 80% on intelligence, higher than 61% of your peers.
All possible test results
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In my opinion, being adventurous is one of the best things you can do for yourself. If you try new things every now and then, sure you could run into...
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Hi! And welcome to my runescape Test. I'll be using advanced logic and knowledge to determine your true nature.
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What is your knowledge of Famous Movie Quotes?
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The U.S. Presidents' and U.S. History Test!
How much U.S. History do you really know? Do you remember the things your teachers taught you? Do you pay attention when reading newspapers or watching the news?
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Find out witch of Divergent faction you belong.
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West Virginia -- fiction
LibraryPoint Blog, Magical Realism, My Librarian, Southern gothic, Virginia Johnson, West Virginia -- fiction, World War I -- fiction, wounded veterans -- fiction, Shelf Life Blog, Fantasy, Historical Fiction, Literary Fiction
07/22/2015 - 12:38pm
There are all kinds of angels. There are the sort that make grand pronouncements from God—bright, shining beings that are meant to be obeyed. They usually say their piece, and then they're gone, leaving humans to make the best they can of the situation. That wasn't the kind of angel that followed Henry Bright home from the Great War. No. This was the kind of angel who hung around and made suggestions, pretty much constantly.
1900-1909 -- fiction, African American children's literature, families -- fiction, Family secrets, Historical Fiction, West Virginia -- fiction, Sixth Grade: Good Reading
06/11/2012 - 12:49pm
Alternate history, Military science fiction, Time Travel, West Virginia -- fiction, What If? Alternative History
11/23/2010 - 2:09pm


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Meeting will generate ideas for future trails and greenways
The Southwestern Commission will be hosting a two hour public workshop on Wednesday, September 19 as part of a Regional Trails Plan underway for seven counties in Western North Carolina. The workshop begins at 5:30 at the Franklin Town Hall.
The workshop will focus on generating ideas for future trails in Macon County, including a discussion on potential future greenways, existing greenways, mountain bike trails and hiking trails.


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This content has been marked as final. Show 4 replies
Re: Log in failureJRobinson-esristaff Jan 9, 2012 2:58 PM (in response to lpranger)
I am looking for easy to use census 2010 and ACS data. I thought I'd give Community Analyst a try and have downloaded the 30 trial add in. The icon shows up in ArcMap 10, but when I try to log in (and I have an account and have verified with ESRI that I have an account) I get the attached error. Anyone have any idea what this is and how to resolve? Thanks[ATTACH=CONFIG]11024[/ATTACH]
Can you let me know what your username is and I'll check to see if your trial subscription is correctly setup.
Jason R.
Re: Log in failureJRobinson-esristaff Jan 10, 2012 7:59 AM (in response to lpranger)Linda,
I was able to verify your CA Add-In Trial is active. Let me know if you are still encountering difficulties attempting to login. I might also suggest deleting your temporary internet files or alternatively try a different internet browser if one is available.
Jason R.
Re: Log in failurelpranger Jan 11, 2012 2:34 AM (in response to lpranger)thanks. I've already tried deleting all the temp/cached files. Not sure I know how to try another browser. I don't know what the background is searching for when I click on the community analyst icon. It opens and I enter the info so don't know how it's searching for a browser or which one it's searching for?
Re: Log in failureJRobinson-esristaff Jan 12, 2012 2:07 PM (in response to lpranger)Linda,
I'd suggest contacting Esri Technical support on this. There might be a proxy issue but definitely needs to be explored. There are a number of ways at the below link to log an incident.
Jason R.


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Five Favourite Films with James Marsters
James Marsters is perhaps best known to audiences as the blonde-haired Sid Vicious-alike Spike on the TV series Buffy the Vampire Slayer. The vampire who earned his nickname by impaling his victims on railway spikes, he went from Big Bad to Buffy's boyfriend when a shadowy government cell called The Initiative fitted a chip in his brain that prevented him from doing harm. He stars this week in Dragonball: Evolution, based on the Japanese Manga comic, as Lord Piccolo, the megalomaniacal villain out to destroy the world by uniting the seven Dragonballs. Continue on as he shares his five favourite films with RT.Back to Article


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American English: /ˈmɪkəlməs/ British English: /ˈmɪk(ə)lməs/
Translation of Michaelmas in Spanish:
- fiesta (feminine) de San MiguelExample sentences
- In Michaelmas and Hilary terms of last year, the national and international press covered the Union Presidential election.
- At Michaelmas he must pay ten pence tax, and at Martinmas twenty-three sesters of barley and two hens; at Easter one young sheep or twopence.
- St Michael next means the next feast of St Michael or Michaelmas, which is the 29th September.
Definition of Michaelmas in:
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So That Happened
How to fail spectacularly at taking your own picture.
Jul 22, 2011 @ 12:01pm
This lady's attempt at a photograph went incredibly awry, unless her intention was to get a candid shot of the men in front of her staring up at her breasts. This humiliatingly public technological misfire isn't exactly progress toward tearing down blonde stereotypes, but at least she gave a couple of baseball announcers a brief respite from talking about baseball.
A darker moment in female baseball fan history >>
[ Via 9GAG]


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Comment guidelines: Please be respectful to other people when making comments on this page. Bullying and abuse will not be tolerated and may result in your account being banned. Due to feedback from our user community, comments are now only available to registered users.
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Celeste Beryl Braun (née Bonin; born October 7, 1986) is an American body builder, model, and retired professional wrestler. She is best known for her time in WWE under the ring name Kaitlyn.
List of links to Celeste Bonin fansites:


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Our mattress was getting a little lumpy. More precisely, we had 2 people shaped dips in our mattress despite turning and flipping it over the years. So we finally decided to buy a new one. A CA King memory foam mattress (Yay! for Costco sales). Woot!
Chris made our new bed frame since we needed a platform bed. Hopefully he'll do his own post on the making of the bed cause I think it's pretty cool. I like my furniture plain Jane. Fancy shmancy isn't really my style. Chris did a great job.
Makua "helping" build the frame.


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Opening hours:
Mon to Fri 9am - 9pm, Sat 9am - 7pm, Sun 9am - 1pm
This section of the page features an image gallery, so if you're using a screen reader you may wish to jump to the main content.
This converted barn offers first floor open plan accommodation with bags of character, including exposed beams. There is nothing better than waking to the view across the fields to the sea, especially when a steam train crosses the horizon on the famous Poppy Line. Sea views of the north Norfolk coast can be seen from all of the bedrooms so no one will be disappointed.
It is the ideal setting for a family holiday; you can park your car on arrival and forget about it. As well as the sandy beach just a twenty minute walk away, the 770 acres of woodland and gardens that make up Sheringham Park are practically your back garden so den building and hide and seek will never have been so much fun. There are miles of marked trails to follow across the estate on foot or on bikes and a café for treats along the way.
You have the pretty seaside town of Sheringham on your doorstep but if you decide to go further afield you have the entire Norfolk coast with its excellent beaches, seal trips from Blakeney Quay and coastal Towns such as Cromer to explore. If you are looking for other ways to entertain your family during your stay, we run events and activities at this and many of our Norfolk Properties throughout the year. For some inspiration click on the 'Nearby' tab above.
Heating: Oil central heating included.
Parking: Available for several cars below the barn.
Garden: There is a small grassed area for sitting outside.
Utilities/Electricals: The washing machine and tumble dryer are in a communal laundry that is located on the ground floor of the barns.
Please note: Located on a working farm, noise may be heard.
Storage: Cycle storage provided.
Offers: Holiday Cottage guests have free entry to a selection of local National Trust properties during their stay (listings in cottage welcome folder).
Guests will benefit from a Late Sunday Checkout of 12pm.
The ancient kingdom of East Anglia has preserved much of its unspoilt character, rural landscape, architecture and traditions with attractions ranging from the University city of Cambridge and the Cathedral city of Ely, to glorious, often deserted, sandy beaches, lots of seaside fun, outdoor pursuits and the unspoilt waterways of The Broads. National Trust places in East Anglia are equally varied, ranging from the magnificent Blickling Hall in Norfolk, the impressive rotunda at Ickworth, near Bury St. Edmunds, the elegant Anglesey Abbey, to the dramatic coastline at Dunwich Heath, with its neighbouring RSPB sanctuary and the Anglo-Saxon royal burial site at Sutton Hoo.
Peace, Quiet, Rural setting, view of the sea.
Location and standard of facilities. Excellent location, view from bedrooms beautiful.
Right location and price. Most telephone contact was handled by polite and enthusiastic staff.
We welcome your views on 4 Cart Lodge Barn and these can be provided via our online survey.
Prices include:


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Posted December 12, 2001 and updated on March 16, 2009
Not Another Teen Movie
Poking fun at the teen movie genre, this film spoofs scenes from many popular films.
|MPAA Rating
|R for strong crude sexual content and humor, language and drug content.
|Theatrical Release
|December 13, 2001
No Review
We do not have a full review for Not Another Teen Movie because it is rated R in the US and we usually only review G, PG, and PG-13 movies.
Content Details
Our apologies, but we do not have specific content details for Not Another Teen Movie. We are always updating our database, so please check back soon.
Latest News
Unfortunately we have no news to report on this title at this time.
Check back later for discussion ideas on this title.
Home Video
Not Another Teen Movie is available on home video. Check this page for full information, along with alternative video titles.
Trailers & Clips
At this time we don't have any clips or trailers for Not Another Teen Movie.


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realmagick.com The shrine of knowledge.
Superior Oblique
A selection of articles related to superior oblique.
Original articles from our library related to the Superior Oblique. See Table of Contents for further available material (downloadable resources) on Superior Oblique.
- Story of the Celts: The Ancient Celts
- The Ancient Celts [ 8 ] What is surprising to most modern readers is just how widespread across Europe the Celts once were. The Celts have been called the "Fathers of Europe," that is north of the Greco-Roman Mediterranean. Long before the Germanic...
History & Anthropology >> Celtic & Irish
- The Tarot Queens and the Kama Sutra
- '"Being the source of virtue, woman is the best means of reaching heaven. Man's efforts to be virtuous are impossible outside of conjugal virtue... There is no doubt that women are a source of happiness."' Vatsyayana An ancient principle of Indian...
Tarot Cards >> The Minor Arcana
- Description of the Bach Remedies
- Bach Flower Remedies 1. AGRIMONY (Agrimonia eupatoria) - problems hidden behind light-heartedness - This is the "Keep-smiling!" - remedy: it is for people who hide their fears, grief and worries under a mask of cheerfulness, friendliness and humor....
Homeopathy >> Bach Flower Remedies
- Software of the Mind #2: Adopting Natural Software
- Connection with Nature faded away as humanity removed itself physically and mentally from natural living. Thought replaced direct knowledge, (intuition) and ego replaced the mode of the natural mind. This is becoming increasingly the case not only at the...
Mystic Sciences >> Mind
- Survivalists' Guide for the New Millennium: Chapter 2
- WORKING TO LIVE RATHER THAN LIVING TO WORK Before the dawn of recorded history, a major period of transition occurred. Nomadic hunter-gatherer clans transformed themselves into larger communities who farmed the land. This they did by planting their own...
Philosophy >> Survivalists Guide for the New Millennium
- God The Mother
- IN THE WESTERN WORLD, we are all familiar with the concept of a male god, whether the idea comes from Christianity, Judaism or Mohammedanism. When we think of a male god, at the back of our minds is a picture of an old man in the sky, who has a certain set of...
Religion & Philosophy >> Religions
- Survivalists' Guide for the New Millennium: Chapter 4
- THE TRANSFORMATION OF CATERPILLAR TO BUTTERFLY It is not difficult to see that the whole Agenda behind owning a bigger home, a newer car and more land is one of ego. This is an orientation toward the building of an empire of material wealth, in a vain...
Philosophy >> Survivalists Guide for the New Millennium
Superior Oblique is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Superior Oblique books and related discussion.
Suggested Pdf Resources
- Results of Superior Oblique Tenectomy
- Results of Superior Oblique Tenectomy in Inferior Oblique Paresis. Patrick Olivier , MD, Gunter K. von Noorden, MD.
- archopht.ama-assn.org
- Primary and secondary overacting inferior oblique
- www.ncbi.nlm.nih.gov
- Clinical Features, and Nucleotide Changes in Three Families with
- Three Families with Congenital Superior Oblique Muscle Palsy.
- www.lib.okayama-u.ac.jp
- Nasal Myectomy of the Inferior Oblique Muscles for Recurrent
- www.privateeyeclinic.com
- Treatment of Knapp Class V superior oblique palsy with
- Both the ipsilateral superior oblique and inferior rectus muscles were underactive .
- www.eyesite.ca
Suggested News Resources
- Increased Levator Muscle Function by Supramaximal Resection in Patients With
- The medial and lateral levator horns were cut at a 45° angle to avoid the superior oblique tendon and the lacrimal gland and ductules, respectively.
Suggested Web Resources
- Superior oblique muscle - Wikipedia, the free encyclopedia
- For the abdominal muscle see: External oblique muscle.
- en.wikipedia.org
- Extraocular Muscles
- That is, the lateral rectus (LR) is innervated by C.N.
- www.tedmontgomery.com
- Superior Oblique Tendon Tuck - YouTube
- Sep 15, 2008 Superior Oblique Tendon Tuck- By Dr Ramesh Murthy.
- www.youtube.com
- Ocular Intorsion/Superior Oblique Muscle - YouTube
- www.youtube.com
- Eye Theory
- Four muscles (superior rectus, inferior rectus, superior oblique and inferior oblique) control the vertical motion.
- cim.ucdavis.edu
Great care has been taken to prepare the information on this page. Elements of the content come from factual and lexical knowledge databases, realmagick.com library and third-party sources. We appreciate your suggestions and comments on further improvements of the site.
Superior Oblique Topics
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Graco Alano Classic Connect Travel System
At a glance
A lightweight and easy-to-use travel system with great features at a bargain price.
Children can ride in the stroller until they weigh 50 pounds. The car seat holds babies 5 to 22 pounds and up to 29 inches tall.
Includes the top-rated Graco SnugRide® Classic Connect™ infant car seat
Stroller holds children up to 50 pounds for years of use
Product weight: Stroller: 19.6 pounds; car seat: 12.7 pounds; car seat without base: 7.5 pounds
Product dimensions: Stroller: 30 x 23.5 x 41 inches
Car seat with base: 26.7 x 17.5 x 24.2 inches
BabyCenter Editors' review*
What it is
For the price, it's hard to find an easier-to-use travel system than this stroller and car seat combo. The SnugRide is one of the best-rated car seats on the market; it's comfortable and easy to install. The seat releases easily from the base and then clicks securely into the stroller, which smoothly traverses bumpy sidewalks or uneven dirt paths.
Other thoughtful touches: The child's tray swivels up so you can easily strap in your little one; the stroller harness converts from a five-point to a three-point, which adds to its useful life; cup holders for both parent and child are deep and will hold a latte or a sippy cup without tumbling over – even when the stroller hops over curbs. The storage basket is spacious and can be folded up and down for easy loading. The stroller folds up into a compact shape and stands by itself when folded.
What to watch out for
While the SnugRide seat is cushy, the padding on the stroller seat is a bit skimpy. You'll need two hands to fold the stroller, and some parents complain about the wheels locking up over time.


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Hostelling International Tripbook for
8 Entries
Liseberg Funpark
Being one of Europe's leading amusement parks, Liseberg offers a lot of rides. Try everything from flying teacups, bumper cars, the Ferris wheel, circular rollercoaster, and just about everything in between.
AttractionAdd to favourites
Älvsborg Fortress excursion
In medieval times, Älvsborg fortress served to protect Sweden's only access to the North Sea and Atlantic Ocean.
ActivityAdd to favourites
The Göteborg Culture Festival
This festival is one giant street party attracting some 700,000 festival-goers to its downtown party area – and it's all free. Expect live music, dance, fashion design, film, street artists, handicraft, history, comedy, poetry and theatre....
EventAdd to favourites
The West Coast islands
Visit islands including Styrsö, Vrångö and Donsö for a bit of West Coast island life culture, beauty and bathing spots, and walks.
AttractionAdd to favourites
Midsummer in Göteborg
Midsummer marks the summer solstice and the longest day of the year. It's the largest holiday celebration in Sweden, apart from Christmas, and is strongly associated with summer and the traditional dance around the maypole.
EventAdd to favourites
Göteborg city card
Do yourself a favour and buy a Göteborg City Card when you visit. It gets you free travel on public transport, free admission to attractions, free guided tours and sightseeing, discounts in shops, and free parking in the city.
HostelAdd to favourites
Swedish Tourist Association
Contact details for the Swedish Tourist Association


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Nim's Island (2008) Trailer B
2nd feature trailer for Nim's Island features more footage from the island and a better introduction to Nim.
On a secret island a girl named Nim lives with her dad... And her amazing friends. But an unexpected visitor will discover their island, and when Nim's dad gets in trouble there search for him will be the adventure of a lifetime.
Film Info
1 min 35 sec Duration
11,716 views
- Posted: March 20, 2008
- Director: Jennifer Flackett
- Writer: Mark Levin
- Studio: 20th Century Fox
- Release: April 4, 2008
- Cast: Jodie Foster, Abigail Breslin, Gerard Butler
Trailer Tracks
No music available


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Moderators: SecondTalon, Prelates, Moderators General
Microscopic cog wrote:True you'll probably enjoy them a lot more. I saw them in a huge Arena, when the whole crowd was waiting for Rammstein to show up, so we weren't too excited about Combichrist.
(he/him/his)Shishichi wrote:Applies a sexward force to counter the sexpression effect that Forward Advection can apply to fluid density, particularly along sextainer boundaries. In this way, the sextribute attempts to conserve the overall fluid volume ensuring no density loss.
Canadian_F_H wrote:last month i saw Black Label Society, and Clutch in Houston Texas. also saw 2 concerts with CROWBAR! (played 3 times in one month in their home state of Louisiana) can't recall the order, i'm fuzzy on this time stuff...
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And during his four-year military career in the Navy Reserves, he was cited at least eight times for "misconduct," including multiple unexcused absences and the rather serious offenses of insubordination and disorderly conduct.
Why the "honorable" discharge?
Did he get a pass from a military not willing to take the trouble to get him discharged under less-than-honorable conditions?
How does someone with three arrests, two of which are gun-related, become a military contractor's employee? How does someone with a military record that includes several citations for "misconduct" pass security background checks, obtain a "secret"-level security clearance, and get hired by a military contractor?
Were disqualifying factors overlooked or minimized for fear that Alexis, a black man, would accuse the military of racism?
Recall the case of Army Major Nidal Hasan, the Muslim psychiatrist who murdered 13 on Nov. 4, 2009, at the military base in Fort Hood. Colleagues reportedly feared him, thought he had anger issues, and some even heard him express pro-jihadist sentiments. In the months before the murders, intelligence agencies intercepted at least 18 emails between Hasan and al-Qaida recruiter Anwar al-Awlaki, several discussing jihad. Authorities took no action.
Did Hasan benefit from a fear an investigation would provoke a charge of bias against Islam?
In Los Angeles, ex-LAPD cop Christopher Dorner, a black man, went on a killing spree that resulted in the deaths of five, including Dorner. He wrote and posted on his website an angry "manifesto" that accused the LAPD of racism. Since the LAPD's stated hiring goal is for a force that "represents the diversity of the city," the best and most qualified do not necessarily get hired. In Dorner's case, he became a cop despite run-ins during training at the police academy, including an accusation of an accidental discharge of the police-issued firearm.
Did Dorner benefit from the LAPD's quest for "diversity''? Did political correctness and fear of being accused of "profiling" allow Alexis, Hassan and Dorner to skate through?
Finally, the Navy Yard, like Fort Hood, has a no-gun rule. A 1993 military policy change under President Bill Clinton effectively prohibited guns on military bases. Only military police posted at entry or other security points are armed.
Rather than a poster child for more gun control, Alexis looks like a case study of how political correctness -- in a gun-free zone -- can get people killed.
Rush Limbaugh defends Rubio's debate answer: He's absolutely right that Obama knows what he's doing | Allahpundit
Time for Team Hillary to break out the gender card for young liberal women who prefer Sanders | Allahpundit


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WRITING COACH: Judith Lesley Marshall
Stuart Laundy, Reporter (Barnard Castle & Teesdale) / / News
A WRITING Retreat Day being staged in Teesdale will help people put pen to paper.
The event, at The Morritt, Greta Bridge, near Barnard Castle, is being organised by Durham Creatives and led by creative writing coach Judith Lesley Marshall.
Writers of all genres, from beginners to advanced, published or not, are welcome to attend.
Ms Marshall said: "The aim of the day is to write in the company of other creative people, to swap writing tips, books and ideas in surroundings which inspired writers and artists such as Dickens and Turner.
"It is hoped that writers will end the day equipped with pages of words that they would not otherwise have written and renewed enthusiasm for continuing with personal writing projects."
A selection of resources and exercises will offer inspiration should writers run out of steam on their own project.
The event takes place on Wednesday, May 8, from 9.30am to 3.30pm.
Places can be booked online at www.durhamcreatives.co.uk.
Promoted Stories
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Estate and letting agents in East London
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Welcome to ARQ Homes. At ARQ, we insist on the highest level of customer service, being at the ... more
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Ashley King is a dynamic independent Estate & Lettings agent in Canary Wharf. We pride ourselves ... more
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For most of us, our homes are the most valuable asset we've got. It's hardly surprising then, ... more
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For most of us, our homes are the most valuable asset we've got. It's hardly surprising then, ... more
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Bairstow Eves - Leytonstone Lettings
658 High Road Leytonstone, Leytonstone, London, E11 3AA
Bairstow Eves Countrywide Lettings has a network of branches extending across the UK delivering ... more
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142 The Grove, Stratford, E15 1NS - We also cover E13, E16 and E7
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68 High Street Wanstead, London, E11 2RJ