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Tour Atlantic is an annual bike ride starting in Halfax, Nova Scotia and travelling to Baddeck in Cape Breton, via New Brunswick and P.E.I.
Part of the Cycle Canada Series of events, these tours are affordable cycling expeditions in Canada.
Discover Canada at a human scale, by bicycle. You can contact us at: Cycle Canada
Tour Atlantic travels from Halifax to Baddeck. It is part of the Cycle Canada Series, expeditions designed to explore the diversity of the country and its people.
Tour Atlantic is a supported tour and accommodation is mainly camping. There are indoor stays at the start and end of the tour and on our rest day Charlottetown. Cycling will be on paved roads. We take quiet side roads, bike paths and country roads as much as possible to avoid traffic congestion.
Can't get two weeks off? Ride a portion of Tour Atlantic from Moncton to Baddeck. Includes the Cabot Trail. We have a limited number of spaces for riders who want this shorter segment of Tour Atlantic, so inquire early.
Tour Atlantic is a two week, supported cycling expedition that travels through some of the oldest European settlements in the country. This ride takes you to must-see attractions in the Atlantic Canada provinces of Nova Scotia, New Brunswick and Prince Edward Island.
Riders for Tour Atlantic meet in Halifax, Nova Scotia. We encourage participants to arrive a few days early to explore this historic port city. There will be an afternoon orientation session before the first riding day.
Leaving Halifax we travel along Nova Scotia's south shore through Peggy's Cove and Lunenburg, a World Heritage Site and home port to the Bluenose II. The lighthouse at Peggy's Cove is a Canadian icon and the Bluenose is the famous sailing ship that's the image on Canada's 10-cent coin. From Lunenburg we cross through central Nova Scotia to the Annapolis Valley and a district immortalized by Ernest Buckler in The Mountain and The Valley, a landmark Canadian novel.
Our route goes through Annapolis Royal, once a French garrison town and later a British garrison during the colonial era of European settlements in North America. That naval port atmosphere is still there today in this historic village.
We take the ferry from Digby across the Bay of Fundy to Saint John, where our route crosses a bridge over the reversing falls created by the Fundy Basin's world record tides.
Heading east after a rest day in Saint John, we go through Fundy National Park and visit the Hopewell Rocks, unique formations created by tidal erosion that also are known as the Flowerpot Rocks. We travel through Moncton and go past the Big Lobster in Shediac on the way to to Prince Edward Island.
Our ride leads to the Confederation Bridge to Prince Edward Island, the birthplace of Canadian Confederation. On the ride to Charlottetown there is a side trip to the birthplace of Lucy Maud Montgomery, whose Anne of Green Gables has become an enduring symbol of the Canadian spirit. We have a rest day in Charlottetown and time to visit the place where the Fathers of Confederation gathered to create the Dominion of Canada on July 1, 1867. You could also stop by Cows, perhaps Canada's best known ice cream shop.
We leave P.E.I. by ferry to Nova Scotia and then cross the causeway onto Cape Breton, famous for its Celtic music, its hospitality and its scenery. You will see the scenery at its most spectacular from lookoffs along the Cabot Trail. We do a clockwise loop on the trail to reach Baddeck, where Alexander Graham Bell's summer home is now a museum and where Canada's first airplane, the Silver Dart, had its maiden flight a century ago. We'll have a celebration dinner in Baddeck as new and old friends head their separate ways.
Tour Atlantic will be returning in 2016
Please check availability on our tours before registering.
Fees are per person in Canadian funds
Harmonized Sales Tax (HST) is in addition to above fees.
We recommend you obtain travel, medical and personal insurance.
Please read our policy statement for Cycle Canada events: Policies
You'll find information on other great cycling tours in Canada here: Cycle Canada Events.
Cycle Canada, The Veloforce Corporation is a Canadian company that organizes cycling activities. It is owned by Bud & Margot Jorgensen. Bud is a long-time recreational cyclist and founder of Tour du Canada. Our operations are located in Alliston, Ontario, just north of Toronto.
We have been organizing affordable supported cycling expeditions and vacations throughout Canada since 1987.
We believe that Canada is the best place in the world to go for a bike ride.
Our primary focus is to offer an enjoyable cycling experience. We encourage participants in our events to ride at their own pace and to join us with the goal of completing their tour by bicycle. We believe they will enjoy a cycling trip more in groups where they get to know other riders and share the pleasure of travelling as cycle tourists.
Read more about the management of Cycle Canada here: About Us.
Participants in our events have a right to expect that Cycle Canada, as organizers, and its staff will make all reasonable efforts to ensure that riders complete their ride and are enriched by the cycling experience. We hope that each rider will find companionship in, and be tolerant of other members of the group and help to make the trip a memorable and positive experience for all riders.
It's in Canada and a great day to go for a bike ride!


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Article Summary
The success of MRAP (Mine-Resistant, Ambush-Protected) vehicles in saving lives from IED (Improvised Explosive Device) and ambush attacks has seen the US Marine Corp scrambling to accelerate the rate of production by awarding contracts to multiple companies. Oshkosh Defense has now delivered three production-representative MRAP All Terrain Vehicles (M-ATVs) to the U.S. Army's Aberdeen Proving Ground in Maryland for military evaluation.
Read the full article: Oshkosh delivers MRAP vehicles for testing
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subset: commoncrawl


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Screen Supreme
Work and watch TV at the same time with this new LCD
This story first appeared in the July 2004 issue of Entrepreneur. To receive the magazine, click here to subscribe.
Take multitasking to the next level with Samsung's SyncMaster 192MP. The 19-inch LCD doubles as a computer display and a TV. Its picture-in-picture technology lets you work at home or surf the Web without missing the news or American Idol. SyncMaster 192MP offers 1280 x 1024 native resolution, is HDTV-ready and has analog and digital inputs for a DVD player or any AV source. It's wall-mountable, has integrated speakers, and is viewable from a distance. A remote control is included (street price: $829, www.samsungusa.com/monitor, 800-SAMSUNG).
For reprints and licensing questions, click here.
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TAIPEI, TAIWAN, April 17, 2013 – Even though nothing much about ASRock's next generation Intel 8 Series motherboards can be revealed yet, we simply can't restrain ourselves from spilling out the good news that ASRock's Z87 Extreme4 is the world's first Intel 8 Series motherboard to pass Windows® 8 hardware certification. So, yeah, users may be ensured that ASRock's Z87 Extreme4 will support the latest operating system from Microsoft without any problems, and bear in mind that it's coming to you real soon!
ASRock is always striving for the most advanced hardware designs, as well as the latest software applications. The company is dedicated to offer users only the best cutting edge technology, which of course includes the latest Windows® 8 operating system. Why settle for second place when you can be number one? Be the first to lay your hands on the 8 Series computers with ASRock!
For more product information, please visit : http://www.asrock.com/index.asp
About ASRock
ASRock Inc. was established in 2002, specializing in the field of motherboards. ASRock strives to build up its own brand. With 3C design concepts, "Creativity, Consideration, Cost-effectiveness", the company explores the limit of motherboards manufacturing while paying attention on environmental issues at the same time, developing products with the consideration of being eco-friendly.
ASRock has been growing fast and has become one of the three largest motherboard brands with its headquarters in Taipei, Taiwan and branches in Europe and the USA. The young and vibrant company targets at the entry to mainstream segment of the MB business, owning reputation around the world market with its reliability and proficiency. For further information, please visit: http://www.asrock.com/


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run and hide Martoma- run and hide!
Things Could Be Worse But They Could Also Be Better At SAC Capital Right Now
The good news, if you are Mr. Steve Cohen: you were neither charged nor "mentioned by name" in the criminal complaint against your former employee, Mathew Martoma. The less good news: YOU ARE PORTFOLIO MANAGER A. YOU NEVER WANT TO BE PORTFOLIO MANAGER A!


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Select a region below to explore Resorts & Lodges in that destination.
Plan your trip to Oklahoma
Select a region using the map to your left or pick one from the drop down below.
Book the Honeymoon Suite and make your first getaway as a married couple unforgettable! Your comfortable accommodations feature a two-person Jacuzzi, a fireplace and a private deck with gorgeous views of Grand Lake. Spend your days exploring the natural beauty that surrounds you, or rent a boat for a fun-filled day on the water!
Celebrate the start of your new life together at the luxury Quartz Mountain Resort! You and your new spouse can settle into your own private guestroom or stay in a charming cabin that offers a little more seclusion on your honeymoon. With fireplaces, kitchenettes, and spacious living area, their cabins are perfect for the two of you. The prime...
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Featuring 6,534 acres of fish-filled water, Lake LBJ proves that everything really is bigger in Texas! Speaking of big, the catfish that inhabit these sparkling waters are known to tip the scales. If... more
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Here in Oklahoma, where dense pine forests sprawl out as far as the eye can see, cozy log cabins are the accommodation of choice. But don't mistake "cozy" for "quaint;" with the great... more


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Michael Jackson Scream red by HitomiOsanaiWatch
©2012-2016 HitomiOsanai
I love 'm AWESOME
This is fantastic.
really amazing!
we really like how you use watercolor!
we really like how you use watercolor!
Thank you so much for the faves.
I like your wor art!
I like your wor art!
You capture his spirit so well so lovely
still one of the best MJ fan artworks I´ve seen!
I don't think even David Bowie re-invented himself as totally as did Michael Jackson, a black Peter Pan who actually managed to turn white whilest never really growing up. RIP, Michael.
Absolutely fantastic art
gorgeous! 8D
yo quisiera pintar a si es hermoso
michael jackson por queeeeee waaaaaaaaaaaaaaaaaaaa
michael jackson por queeeeee waaaaaaaaaaaaaaaaaaaa
This is a perfect portrait of the AMAZING MJ! It embodies him perfectly. This is a gorgeous painting! Congratulations
O_O Oh my gosh! Wow...
I am totally spechless, its just so beautiful.
It could easily have won a compitition to make his next album cover, if he had been alive..... RIP MJ<3
It could easily have won a compitition to make his next album cover, if he had been alive..... RIP MJ<3
My goodness, do I ever miss him.
i'm speechless,speechless XD anyway i really love the colours, great work
ahhh this is so lovely hitomisan~
Lovely colors!
Amazing art absolutely Fav
I just need to say that I 'm addicted to your art!
This really caught my eye . Brilliant work great colour . Just love it all really
Your art would make awesome MJ album cover.
It's beautiful
This is so beautiful. I'm speechless
Beautiful! ^^
This is sooo beautiful.... I love how you combined the flower and MJ.... It seems like such a pretty... yet sad picture...
wow. this is so beautiful. great work hitomi.
This is so beautiful, I really don't have words! <3
This is a beautiful painting, instantly caught my eye when i saw it. I love the flower and the leaves. Oh, btw I want to ask you something, Do you use a camera or a scanner?
A wonderful one Hitomi !
just beautiful....
i'm huge fan of your works
assfghjkjhgf This is perfect I'm speechless!!!!!!!!!! *faint*
Beautiful just beautiful
GASP!!! I it.
My God, this is beautiful. I've never seen anything like it. It just takes my breath away!
I felt odd (in a good way) when seeing a mixture of red white and black..
this is amazing! i love the colors
that is amazing!!!
So awesome Hitomi! I love the way you combine flowers and nature into your drawings! Especially your MJ drawings!
Amazing as always.Your work is just PERFECT!!!
Perfectly beautiful Hitomi , you have a precious gift ....
So beautiful, amazing, wonderful, incredible !!! I love it so much! Your work is amazing.


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Undergraduate Program in Chemistry
Many Chemistry students are drawn to ESF because of the department's focus on using our varied specialties to find ways to improve our world:
- Finding better ways to generate energy.
- Discovering new, useful natural and synthetic materials.
- Making better use of our natural resources.
- Finding new medications and ways to deliver medicines.
- Understanding natural processes and the impacts of human activities on our environment.
ESF Chemistry graduates find outstanding employment opportunities all over the country and right here in Central New York. Many go on to earn advanced degrees in chemistry and related fields, medicine and law. Some continue study at ESF, while others are accepted at top graduate and medical schools such as MIT, Yale, Cal Tech, and Cornell.
ESF Chemistry graduates go on to leadership roles in industry, government, and academia, in roles as varied as biotechnology, forensic chemistry, new process development, etc.
Bachelor of Science in Chemistry
In pursuing a bachelor of science in chemistry, students first receive a strong foundation in analytical, physical, organic and inorganic chemistry before selecting one of three options leading to the degree: biochemistry and natural products, environmental chemistry, and natural and synthetic polymer chemistry. Each option offers an advanced course of studies beyond the basic courses of the classical undergraduate chemistry curriculum. All options are excellent grounding for professional work at the B.S. level or for advanced graduate study.
Learn more about the options:
- Biochemistry and Organic Chemistry of Natural Products
- Environmental Chemistry
- Natural and Synthetic Polymer Chemistry
Students may enter the Bachelor of Science program as first-year students or as transfer students. Students who are preparing to transfer to ESF as juniors must have earned at least 60 credits of college coursework in courses comparable to the lower-division course requirements.
Why ESF for Chemistry?
A Rigorous Education
Chemistry faculty bring their expertise in cutting edge research to the classroom, providing an education that is grounded in the latest knowledge and real-world examples. Also, in addition to the usual chemistry courses, undergraduates take three introductory graduate level classes, which looks very attractive to employers. Opportunites exist to participate in research projects leading to co-authorship of papers in major scientific journals.
Employers value the education our students receiveESF Chemistry undergrads have been highly successful in gaining employment or acceptance into graduate or medical schools soon after earning their degrees.
Personal Attention
Upper-level courses for chemistry majors usually have enrollments of only 5-15 students, so chemistry majors get personal attention from the professors. All courses are taught by professors, not graduate students.
Jahn Laboratory
The department's home is the 71,000 square foot, Edwin C. Jahn Laboratory, which was completed in October, 1997. In addition to normal classroom and laboratory instruction, students perform cutting-edge research. Students at all levels are encouraged to become involved with research, and two out of three students do so before their senior year. All seniors must perform an independent research project. Students commonly present their research results at local and even national scientific meetings.
Undergraduate Resources
- Undergraduate Chemistry Courses at SUNY-ESF
This link takes you to ESF Chemistry courses that have their own web pages and as well as brief descriptions of the other ESF Chemistry courses.
- List of professional electives for chemistry students (PDF)
- The Alchemist Society
This organization of chemistry students travels to local schools to show off the magic of chemistry to young people.
SUNY-ESF and SU Class Schedules
Some Additional Choices/Possibilities for Undergraduates
- Chemistry Minor
Open to students who have taken one year of both general chemistry (with lab) and organic chemistry (with lab)
- The ESF Honors Program
Open to juniors who have completed at least 60 credit hours with a cumulative GPA of 3.5.
- Advising for Preprofessional Programs
Interested in professional careers in medicine, dentistry, veterinary science and law?
- Summer opportunities in chemistry and biochemistry
Numerous research opportunities are available on campus at ESF. Contact individual professors to see what's available.
- Summer research opportunities with the US DOE Global Change Education Program
- Jobs
- Internships at government research laboratories
- Internships in Chemistry
Contact us
For more information, contact:
Department of Chemistry
Jahn Laboratory
1 Forestry Drive
Syracuse, NY 13210
315-470-6856 (fax)
Ivan Gitsov, Chair
David J. Kieber, Associate Chair for Undergraduate Laboratories
Theodore S. Dibble, Associate Chair for Graduate and Undergraduate Programs
Mark Teece, Undergraduate Curriculum Coordinator
Chemistry Undergrad in Antarctica
Chemistry Professor David Kieber researched chemical and biological transformations in Antarctica, along with grad students George Westby and Jordan Brinkley, and undergrad John Bisgrove. Read more!
"I have been meaning to write to Dr. Hassett to tell him how grateful I am to the chemistry department at ESF. There have been so many times in the last two semesters that I have silently thanked one professor or another for some specific skill I learned there. I had a really good experience there; it is a very, very good place to learn!"
Graduate student in physical chemistry
University of Colorado at Boulder


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Originally posted by Saucerat
They all look like stereotypical flying saucers.
what do you guys think of this audio recording of a plaedian space ship apparently made by infamous billy meier i know most if not all of his stuff is fake but the thing that intrigued me was that nobody could duplicate the audio using hi-tech equipment how the heck do you think he done it?
*** Advanced technologies described
I do not know enough about the scientific technology of aliens to comment on this part.
Originally posted by zerotime
***Hundreds of photographs of the spacecraft (most of them in daylight)
I thought there were 1200+ photos?
Originally posted by zerotime
Taken from the Billy Meier Website point for point... I have some answers and I have some questions. Hoping I will get some answers to these questions and keep the thread on track. And actually I want to send out an apology to Aurelius. Even though I think you are wrong about your views on this case I can tell you are sincere in what you believe. Since you seem to have background in this case maybe you can answer some of my questions.


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I run all JBL pieces except for my sub, which is an 8" Assassin by Ascendant.
If you want to go for sheer SQ, be prepared to open up your wallet. My audio components are a total of about $550
Printable View
I run all JBL pieces except for my sub, which is an 8" Assassin by Ascendant.
If you want to go for sheer SQ, be prepared to open up your wallet. My audio components are a total of about $550
Understand that while I like the audio quality of my system, it is far from award-winning.
The people that I know that compete in SQ competition have invested many times what I have invested in audio hardware....
I'm not using that audio card right now...;) For me to implement it is going to require a bit of fabrication and time down for the car...we cannot do that to our sponsors right now. We're installing a PC in the truck and I hope to be able to set it up in there eventially before i move it into the car. I need to test it 100% first before it goes in the GTi. It's still something I VERY much want to implement....it's just going to take a LOT of time. The other thing holding me back is the ease of use...I'm struggling with the point of having all this tuning on the PC if I still have to use a laptop to remote in just to be able to see everything to control it...lol
btw - that's 4 titles in USACi...see sig for more...:D
Anywho, it's no different between a car PC and a head unit...it's all about how it's set-up. If you spend the time to really research the CarPC and how the audio is handled you'll learn that a CarPC can sound better than a head unit. Now the short fall is the transport...a 'high end' computer CD player is practically non-existant. Afterall, it's just 1s and 0s...right!? HA!
Sorry bout that Red, It is 4 titles, i forgott about the Trifecta.
I had a Jensen VM9410 flipout DVD player which powered, via RCAs, 3 amps. I used none of the onboard PS. I went from that to a carputer (see sig) and used the onboard 5.1 audio. It's a HUGE difference in sound quality, with the carputer winning bigtime! I was also worried about noise in my system and still have zero. It's only been installed for a week now, but I need to spend some time tweeking it. My sound system is as follows:
SoundStream Van Gogh 320.4 = front componets
SoundStream Van Gogh 320.4 = center channel & 2 mids
US Acoustics USX-1000D = subs (1250w RMS)
MB Quart RCE Components (front)
2 JL Audio 8W3V2
3 JL Audio 10W3V2
ALL Stinger wiring throughout
The 4 titles are as follows:
2 in Intermediate Consumer (2 years in a row)
1 in Advanced Pro
1 in Advanced Q (same year as Advanced Pro - just different class - sound only, no install)
A few threads that might interest you:
And the MOTHER of all threads on this topic:


text:
Best Newsstand (2001)
Globe News
Mega-stands may come and go, but Globe is forever. In business since 1961, Globe News is not only the best, it's also the oldest. And it has the musty smell that a newsstand should have. Its selection covers the waterfront of publishing from newsweeklies and monthlies to sports to photography to music to food. Daily newspapers from around the country in front; porn from around the world in back.
More Shopping & Services Awards
Best Auto RepairMontrose Tire & Automotive Center
Best NewsstandGlobe News
Best Used CDsCD Warehouse
Best Tattoo ParlorMiss Fortune Tattoo


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Back pain after having an epidural
I recently had my third child and chose to have an epidural instead of doing it natural like in my past birthing experiences, has anyone had an epidural and experienced back pain several weeks to months later?
Posted: 09/13/2007 by cdbthompson02
Mom Answers
Sort by: best answers | most recent answers
71 - 80 of 182 answers
Yes, I had an epidural when i had my daughter and she is now 7 months it only worked on the right side of my body and they had to push extra meds too relieve SOME pain. I have problems sleeping and i am a cosmetologist and stand all day, and it hurts at the exact spot that the needle went in it even FEELS like its still there.posted 05/14/2013 by Lolarabbit143
I have four children and had an epidural with all four. My last child I had in August 2009 and my epidural only took on the right side, so I felt the labor & delivery. Needless to say that after having four epidurals my back hurts everyday. I never gained more than 27 lbs. with any of my pregnancies and dropped back down to my pre-pregnancy weight of 120 lbs. within a few months after delivery. I knew the other risks of having an epidural but didn't know that lower back pain everyday for the rest of my life would be one of the side effects. On a good day my pain is about a 6 but I'm lucky to have 2 good days a week. Going to the dr. next week to see what can help. It's hard trying to do all the things you want to do with your children when you're constantly in pain.posted 04/26/2013 by mistyshortt
It's been 3 weeks and my pain from the epidural has just started and it is mostly when I bend down, but very painful. I had a little pain right after but it seemed to be from the bruise I had gotten. I wish I had never had the epidural... it helped with the contractions but was worn off by the time I actually delivered my baby so didn't help all that much. It was nice to relax and not feel contractions for a couple of hours though.posted 03/04/2013 by a BabyCenter Member
I had epidural during c-section 6 1/2 months ago and am experiencing severe back pains. My pains started the day after the c-section with a severe spinal headache which lasted for three weeks. The pain ran from where i got the epidural straight up to the top of my head with it being more severe at the back of the neck. I could do nothing, not even breastfeed the baby. I had to lock my self in a dark room just to get relief from the headache, but that didnt help much. I got a relief after 3 weeks and that lasted for 2 months. However by the time my baby reached 3 months, the pains resurfaced and has the same pattern of moving from the back up to the head. Its unbearable as regular pain killers dont work. Sometimes I cant even lift my baby due to the pains and trying to relax is difficult. Am registered to start pain management today with a different anethesiologist today so am praying that i will get some help. This pain is freakin me out as its even slowing me down at work.posted 01/29/2013 by valcy
Update: I experienced so much pain that I couldn't lay flat on my back or pick up my baby without wincing for more than 4 months, and I am very fit. Finally I took my husband's advice and went to his chiropractor and it was immediately relieved. Immediately. That was mostly low back pain. The insertion sit of the epidural still bothers me when I extend my arms over my head to reach high for something... It's just not right!posted 12/18/2012 by MegStein77
I recently gave birth in March of this year to a healthy baby boy........my angel baby. However, this was my fourth and last birth and let me inform you all four births were c-sections, yes four and i'm still alive......only because of the grace of GOD. This was my first time having a spinal epidural and 8 months later I feel pain not only in my back but also my right leg. The pains not just horrible right now but it does become uncomfortable and nagging. But to hold my little man makes it all worth it and I would do it all over again. Note: I have 3 girls 12, 6, and 4. And God blessed me with my son. I hope this helps. Be Blessed!posted 12/18/2012 by venessam4
I had my daughter 3 years ago and had to get up this morning and inquire about this epidural and my back pain. I have 3 children the first two I had natural but with my daughter I was in labor for over 16 hours and gave into the epidural when it got too painful. Every since that day my back pain has got worse. At first it would just come and go now its constant at least 4 times out the week. I really wished I never had got that epidural and am thinking I'm going to be taking back pain relief Medicine for the rest of my life.posted 12/08/2012 by peachzandcream
Still in pain after five years never again will I get that epidural ...I feel like my life is over cause I can't do much I can barely walk , it's best not to get that done..posted 11/15/2012 by felicialundy
Yes I had my child in 06 I chose to have the epidural done and my back ain't been right since. I'm in pain now as I type this up I can barely walk I wish I had never got epidural smh...posted 11/15/2012 by felicialundy
November 20th, 2010 - Had an epidural for the birth of my son when I was at 8cm dilated. 2 Months later, I still feel pain in the injection site. It's a strange kind of pain. The best way for me to describe it is that I feel like my spine is going to collapse backwards... Like I don't have enough strength to keep my back straight. It is the same feeling I had when I was in recovery right after having my son - just not as intense. I feel the sensation every day throughout the entire day, though tolerable. However in the morning when I first get out of bed is when I feel it the most and its then, that it tends to be very painful. I can't believe I am only 24 and I already have pain that, from what I've read, I will have the rest of my life. The anesthesiologist didn't mention this in the speech of possible side effects...posted 01/21/2011 by Luv2bsingn
Answer this question


text: eminusx May 02, 2011 7:53 AM @monstergreat point, totally agree. If Jorge had let Dani past earlier it might have been a different story, maybe he would have rattled dani's cage a little, maybe not.I'm glad Dani won, so great to see his operation went well as he's a fantastic rider and the championship is far better with him riding to his ability like yesterday. Finally seems to be coming together, he looks mentally tougher and more wiley than in previous years. Could be a big year for him if he continues to ride smart! Reply Report abuse 1 agree 0 disagree


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Not so beatiful as on the pictures, although pictures are not fake - only well chosen. Owner is very nice and friendly, wi-fi does not work in some of the rooms. I have two complaints - some of the dishes were dirty and no protection against mosquitoes- room was full of them all the time. But all in all -... More
We are searching for
the best rooms at the best prices,
so you don't have to.


text: A potter's wheel is a stone disk 90 cmin diameter with a mass of 120 kg. If the potter's foot pushes atthe outer edge of the initially stationary wheel with a76 N force for one-eighth of arevolution, what will be the final speed? Use the work-energytheorem. answer = ______ rad/s


text:
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This flea pill works
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9-1-1 working again after overnight outage
Peninsula Daily News
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CenturyLink spokeswoman Kerry Zimmer said technicians don't know if the problem was caused by computer hacking or an equipment problem.
Zimmer said the outage began about 1:30 a.m. at Sheridan, Ore., and service in Oregon was also affected for a time.
All service was restored just after 7 a.m.
Last modified: April 10. 2014 8:31AM


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Picture from stock
Charlotte Ikonen, Chief Reporter - Watford and St Albans / / News
Two men have been arrested on suspicion of burglary in St Albans city centre.
Hertfordshire Constabulary were called by a concerned member of the public at 11.30pm last night.
The men were seen acting suspiciously outside Cex in French row.
After a search of the shop and a police chase, a 34-year-old and a 32-year-old, both from London, were arrested and remain in police custody.
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Get A Jump on
Our list of clients includes The Lost Colony, The Pennsylvania Renaissance Faire, Off-Broadway productions and many others...
We make black ruffs too! Perfect for Villains, Goth Elizabethans, and Evil Clowns ...
That's ok. We offer a mail order form and accept money orders, cashier checks and personal checks with a ten-day holding period.
Our gallery provides snapshots of the various unique commissions we've made over the years as well as our experiments. Take a look at what we've done over the past five years!Go to the Gallery
Have a question? Don't hesitate to contact us!
Don't want to use PayPal? That's ok! Download our Mail Order Form.
The Renaissance Tailor has been in business and online since February 2004. In that time, we've made hundreds of ruffs, cuffs, and collars.
We're proud of our products and stand behind them 100%. If, for any reason, you are not satisfied with your item, let us know and we'll work to make it right.
Copyright © 2010 - 2011 The Renaissance Tailor


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We offer discount to nonprofits, government agencies, and federal contractors
In December 2015, DHS conducted nationwide raids to deport Central American families. AILA has condemned these inhumane tactics.
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AILA Doc No. 12012448 | Dated May 8, 2012 | File Size: 560 KDownload the Document
USCIS executive summary from 1/31/12 teleconference discussing processing changes for "grandfathering" certain orphan adoption cases when the U.S. and another country become Hague partners, specifically focusing on China and Guatemala. Original invitation included.
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Cite as AILA Doc. No. 12012448.Open the Document
American Immigration Lawyers Association
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Copyright © 1993-2016
American Immigration Lawyers Association.


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About Me
I am a young women who lives in Lusaka, Zambia. I am co-founder of an organisation called Asikana Network. We aim to teach women ICT skills for better job placement as well as increase the number of women in the IT field.
I have a background in Information systems management, computing and am currently pursuing another Bsc in Business Computing. I have a passion to learn IT, as well as find ways to use technology to improve quality of lives as i believe it is our future and there is no need to run away from what is eminent. I also have a passion for teaching my skills to other women such as myself in order to keep the chain of 'Pay-it-forward' going. Coding, karaoke I can be an introvert and seem to always take a back seat Website development
My Vision for the Future
To have an equal number of women and men in ICT careers


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Originally posted by AnonATI
My favorite has got to be the N64. So many good times and hours wasted lol. Favorite game would probably be either Mario 64 or Zelda: Majora's Mask.
This content community relies on user-generated content from our member contributors. The opinions of our members are not those of site ownership who maintains strict editorial agnosticism and simply provides a collaborative venue for free expression.
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Caibre Netheryn by dwinbotpWatch
©2007-2016 dwinbotp
Warlord CCG character, an elvish rogue done again using painter7, hope you all like it
He's certainly a roguish figure
I've featured this creation in my May 2007 Visual Art Feature.
Check it here : [link]
This feature is also in the news so more views for you!!!
(fave the news article if you like it! [link] ).
Please check it to view other's art!
You can see the previous features here :
April 2007
March 2007
Februar 2007
January 2007
Enter the PEACE Contest!
View the news article here : [link]
This cause deserves and needs support!
Skilfull. Wonderful color.
galing naman ng coloring mo..by the way are you a Filipino?...i wonder you know tagalog much..hehe..idol naman ng mga arts mo..
astig talaga ung gawa mo.
Nice stuff, now if only you uploaded the rest of your warlord art.... lol
He looks wicked. Nice job on the digital paints. That dagger he is holding looks poisonous...
card size ba original nito? galing!
what is CCG?
and you're on a roll two in a row?
love the work you did with that dagger.
and you're on a roll two in a row?
love the work you did with that dagger.
Brilliant... Amazing... Georgeus...
Scary lookin!!! :Fear:
likey ... !!!
nice work! but litle small to appreciate!


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Congratulations BOMGAR for winning the 6th Annual HTM Classic!
February 27, 2012
Dubbed "Golf With A Higher Purpose," this highly anticipated annual fundraiser pairs sponsors with an Atlanta technology celebrity for a round of best ball golf on the immaculate and challenging links of The Standard Club.
Congratulations to BOMGAR for winning the 6th annual HTM Classic!
Special thanks to Miriam McClemore, CIO of Global Functions at Coca-Cola, for joining us as our Technology Celebrity Chair, as well as the rest of our Technology Celebrities for playing!
HTM Classic Champions: (left to right) Josh Nelson, Scott Braynard, Greg Morrison, Jim Norton


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Students who wish to be listed on this page should contact Amanda Porterfield, email@example.com
Jaclyn Cwick
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Curriculum Vitae: PDF
Dissertation Title: "Expanding Coercive Mobility Theory: Women's Social Capital and Neighborhood Social Control"
Dissertation Committee: Elaine Doherty (chair), Robert Bursik, Stephanie DiPietro, Beth Huebner, and James Lynch (University of Maryland)
Areas of Interest: Communities and crime; social disorganization; crime and the life course; consequences of incarceration; race and gender inequality; quantitative methods.
Mike Deckard
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Curriculum Vitae: PDF
Dissertation Title: "The Efficacy of Police Patrol in Chronic and Episodic Hot Spots of Firearm Violence"
Dissertation Committee: Richard Rosenfeld (chair), Beth Huebner, Dan Isom, Lee Ann Slocum, and David Weisburd (George Mason University/Hebrew University)
Areas of Interest: Evidence-based crime policy; hot spots policing; Geographic Information Systems (GIS); mixed-methods research designs; experimental criminology; environmental criminology.
Shytierra Gaston
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Curriculum Vitae: PDF
Dissertation title: Race, Neighborhood Context, and Drug Enforcement: A Mixed-Method Analysis of Racial Disparities in Drug Arrests
Dissertation committee: Richard Rosenfeld (chair), Janet Lauritsen, Michael Campbell, and Rod Brunson (Rutgers University)
Areas of interest: Race, crime, and criminal justice; corrections; prisoner reentry; collateral consequences of criminal justice contact; families and communities of offenders; quantitative, qualitative, and mixed-methods research.
Jordan Pickering
Email: email@example.com
Curriculum Vitae: PDF
Dissertation title: To Shoot or Not to Shoot: An Analysis of Police Officers' Deadly Force Decision-Making Processes
Dissertation committee: David Klinger (chair), Kristin Carbone-Lopez, Finn-Aage Esbensen, and Geoffrey Alpert (University of South Carolina)
Areas of interest: Police use of deadly force; officer decision-making; law enforcement training; police-community relations; organizational theory; qualitative methods.


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LIVE! Tivoli Storage Manager FastBack Demo - 2011 Schedule
Richard Vining firstname.lastname@example.com Tags: bmr instant-restore tivoli cdp storage-blog backup disaster-recovery storage-management replication fastback 2,463 Visits
Tivoli will be performing a live demonstration of Tivoli Storage Manager FastBack and Tivoli Storage Manager FastBack for Exchange data protection products. These welcome additions to the Tivoli Storage Manager product family provide the ability to meet...
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IBM will be providing a series of live web-based demonstrations dedicated to showing you the value of IBM Tivoli Storage FlashCopy Manager. It will also show you how the product works. These will be DEMOS of live code. Organizations seeking to improve...
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The Power of Independent Thinking
Independent Institute President David J. Theroux Discusses C.S. Lewis on Ave Maria Radio
Recorded: Saturday, August 1, 2015
Founder and President of the Independent Institute, David Theroux is interviewed by Ave Maria Radio President Al Kresta at the Napa Institute Annual Conference. Also President of the C.S. Lewis Society of California, David Theroux talks about C.S. Lewiss writings on liberty and Christianity and how Lewis became one of the best-read and most influential writers of the 20th and 21st centuries.
Experts: David J. TherouxType: RadioIssues: Civil Liberties/ Human Rights, Culture/ Society, Freedom, Government Power, Political Ideology and Philosophy, Privacy, Religion
Full Video of The Independent Institutes 25th Anniversary Gala for Liberty
Recorded: Tuesday, November 15, 2011
Part 1 |
Part 2
Part 3
Part 4
Part 5
Full Video of The Independent Institutes 2011 25th Anniversary Gala for Liberty held November 15, 2011.
Part 1: Introductory Remarks and Tribute to Robert Higgs
Part 2: Tribute to Mario Vargas Llosa
Part 3: History of The Independent Institute and Fund for the Future
Part 4: Tribute to Lech Walesa
Part 5: Special Tributes, Sponsors, and Credits
Experts: Leszek Balcerowicz, Price V. Fishback, Robert Higgs, Ron Paul, Jorge Quiroga, David J. Theroux, Archbishop Desmond M. Tutu, Mario Vargas Llosa, Lech Wałęsa, Yuri Yarim-AgaevType: Independent Institute EventIssues: Bureaucracy and Government, Business, Civil Liberties/ Human Rights, Constitutional Law, Defense and Foreign Policy, Democracy, Economic History and Development (U.S.), Economic Policy, Government Power, History (International), History (U.S), Latin America, Nationalism, Political Ideology and Philosophy, Politics, Privatization, Property Rights, Terrorism and National Crises
Why Are Politicians Always Trying to Scare Us?
Recorded: Thursday, December 6, 2007
Part 1 |
Part 2
Part 3
Part 4
Experts: Robert Higgs, David J. TherouxType: Independent Institute EventIssues: Civil Liberties/ Human Rights, Government Power, Politics, Terrorism and National Crises


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Pretty sure you have to be standing on a roof and looking out into the water. Zoom in and you'll see Arkham Island in the distance.
beyondbidj posted...How come I got this from the GCPD building.. or is that the general direction? Oh well.---U.I.O.G.D.
Well, you were probably standing on the GCPD building when you scanned the area. If you just scan the general area of the water - as long as you get a good chunk of the Asylum in the shot - you should get the credit anyway.
You are not allowed to request a sticky.


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Lexington, KY (WVLT) - New details have been released about the investigation into the crash of Delta Connection Comair Flight 5191.
The NTSB says that toxicology reports indicate that no illegal drugs or alcohol were found in either the pilot or co-pilot.
Meanwhile, the family of the co-pilot James Polehinke says he still does not remember the accident.
Polehinke was at the controls when the jet turned down the wrong runway at the Lexington Airport and crashed while trying to take off on August 27th, killing all 49 other people on board.
Polehinke has been at the University of Kentucky Hospital since the crash, where he's undergone several surgeries, including the amputation of one of his legs.


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Mon., January 27, 2014 1:12pm
Expansion of Savannah Port Expected To Begin In June
Georgia ports officials are edging closer to beginning work on the long-planned expansion of the Port of Savannah. Dredging to deepen the port should begin by June, according to the chairman of the Georgia Ports Authority Board. Robert Jepson says he's confident work will be underway when he completes his term as chairman this summer.
Full Story
©Copyright 2015, Georgia Public Broadcasting. All Rights Reserved
Georgia Public Radio®


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I'm starting to feel abit left out! i am 10 weeks, I have had my first appt with nurse, but don't see Dr. until 12 weeks. I'm starting to feel very anxious!! I havn't heard a heartbeat or anything, my Dr wont see patients until 12 weeks. I also don't feel preggo at all, except for sore breasts. Anyone else not seen Dr, heard a heartbeat or had an ultrasound!?
Anyone else no ultrasound yet?
I"m in the same boat, except for different reasons i have no insurance
i know it sucks, but good news from other ladies makes me feel real positive.
I don't know if it matters, but my only symtoms have been tender breasts, exhaustion, and bloating. I wouldn't "feel" pregnant unless I saw the ultrasound. I'm sorry you couldn't get in earlier.
Nicole (28)
i ssaw my dr for the first time at 12 weeks and we heard the heartbeat and it was nice and strong. most doctors dont like to do an over abundance of ultrasounds. if all is well, why do the extra poking and proding? i wasnt thrilled at first but now that i think about it, im comfortable in knowing the heartbeat is there and dandy, and if i would have done a million things earlier, then i probably would be a more of worry wart than i am now =]
Ashton & Taylor est. 2009
NRW 2/12 MC 5/15 MC 6/15 Rainbow Boy Due 06/16!
Married to my wonderful husband 1/23/11
Evelyn Bradleigh expected to be arriving around 2/25/12
I havent had an u/s or even my first appt yet and im almost 13 weeks...its actually tomorrow though and im really excited cause ive had preg symptoms but it still doesnt feel real yet. I havent been to this OB before so im not really sure what all she is going to do, I do hope for an u/s cause id love to see the baby :)
Who's having a girl?! I make pretty bows for baby girls!! Check out my Facebook Shop :)
Keelie Bowtique
Ryan and Merideth married May 19th, 2012 (after dating for 7 1/2 years)
Raegan Leigh born June 7th, 2012 at 36 weeks!!!
i have my first appointment on wednesday.....i'm hoping my dr will give me an ultrasound then.....i wanna see my baby!
I know it's not what you want to hear in that position, beause with my first it was the same way as that- 12 weeks before anything. But I CAN tell you that with the exception of some doctors who do one ultrasound to date the pregnancy, that's normal. Be thankful that so far things are ok. And I only say that because this time I had 6 ultrasounds before 7 weeks, due to complications with bleeding, and then they couldn't find the embryo, and then they thought the embryo wasn't developing. I was told there was only a 20% chance the pregnancy was developing, and spent the first 3 weeks petrified and depressed because every ultrasound was bad news and they told me expect a miscarriage. And only got to hear the heartbeat because I was told there wasn't one, and to confirm it. No ultrasounds or tests before 12 weeks is a good thing- it means you're right one track so far. More ultrasounds and tests means there are most likely problems.
In Norway I have to wait to get an ultrasound between weeks 18-21. I also just found out it is my only ultrasound during the whole pregnancy.


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Play any type of Game at Y8.com. The biggest Game Collection to play free online. Flash, Unity 3D, Html5, Android, Java and Shockwave.
If the game freezes, just click inside it (games can get unresponsive if you click elsewhere on the page).
This is the city of gangsters. Or, let's just say it was the city of gangsters, until you came here to clean the mess and set the people free. Use guns and other weapons to shoot the bad guys. Skills required. Move fast and do not make mistakes or you can loose your life. Play cool in this free online shooting game!
This game is played with mouse only.


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May 31, 2010
You must read this if you want to make your own photo album using an online book printing service. I am not joking. This guy (who has such a lovely Canadian accent in his videos) spent over a year working on photobooks. He created a baby album, had it printed, and hated it, so he spent 6 months (after the initial 9 months of creating the perfect baby book) testing out the top photobook contenders. There is a video for every book with all the pros and cons along with a description of the process for each service. A huge thank-you to Jason Dunn and his hard work.


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Whether you own or operate a business or a nonprofit, the Greater Warrenton Chamber of Commerce gives you opportunities to grow and learn, find new resources, and contribute to our community in numerous ways. This website will provide a thorough overview of these opportunities, but we whole-heartedly encourage you to reach out to us with any questions you may have. After all, many do refer to us as the "huggable" chamber!
You'll find a variety of ways in which you can be involved, and your level of involvement is totally up to you. Network to make new connections, volunteer to give back to the community, attend seminars to learn better business practices, sponsor events to put yourself in front of new potential customers, or serve on our board or one of our committees to strengthen the voice of our local businesses.
Let us know how you would like to benefit from your membership, and we'll point you in the right direction! Thanks so much for visiting – we look forward to seeing you soon!
Membership DirectorySearch for a Member
Learn more about our chamber members.
Business AssistanceBusiness Assistance Team
Learn more about the BAT.
Networking EventsAttend or Arrange an Event
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Chamber News
Latest news, updates and event information from the GWCC.Read More
Member Spotlight
Member feature and news spotlight written by George Rowand.Read More
Member Blog
Learn more about happenings from our Chamber Member blog.Read More
Our Champion Members
We apologize if you have trouble viewing our Champion Members gallery; this portion of our site is currently undergoing redevelopment. Please visit our Champion Members:


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Setting up my blog was quite simple. I initially encountered some problems due to the inevitable 'red tape' of the
journalism industry. Getting quotes from the right people is proving difficult as I do not have the right contacts or at least not anyone high up in the festival industry. To combat this I have carried out more thorough research and located press releases that allow me to gather more information from various sources and put them all together, sometimes only for a 200 word news story.
I believe an issue of professional practice and a factor that has become very common and useful over recent years is the use of links. Jeff Jarvis (2007) wrote about linking on his blog Buzz Machine, he said "Cover what you do best. Link to the rest." I have tried to adopt this notion in my own blog and also used it as a refencing technique.
So far I have only used Rex Features for my images but due to personal interest and contacts I do have access to other images which I am planning to use at a later stage in the website and some within the magazine issues. This will help eliminate any copyright concerns.
I hope to incorporate video and perhaps slide shows into my website as these are trends within journalism I would like to embrace. I think the use of multimedia will enhance my website and allow me to showcase other skills. The website itself will also benefit as it will appear more interesting and have more of a realistic edge.


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Data Warehouse Managers receive generous compensation in the United States — earning an average of $108K per year, their standard salaries shoot well into the six-figure range. With some bonuses and profit sharing proceeds approaching $25K each, total incomes of Data Warehouse Managers generally range from $73K to $146K depending on individual performance. Career length and the particular city each impact pay for this group, with the former having the largest influence. Male Data Warehouse Managers who responded to the survey are more common than women; more than half (68 percent) are men. Medical benefits are awarded to almost all, and a large number earn dental coverage. Job satisfaction is high and work is enjoyable for most Data Warehouse Managers. This snapshot results from replies to PayScale's salary survey.
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Data warehouse managers oversee the storage of data in facilities, analyzing this data as needed for departments within their organization. They are primarily responsible for evaluating data using metrics related to performance and usage, as well as analyzing data load and monitoring job usage of data. The data warehouse manager is given various data warehouse tasks by upper management, department chairs and other parties within their organization; they must ensure data systems are fully functional to ensure they can provide these stakeholders with necessary data.Read More...
Data warehouse managers also conduct process automation, monitor operations, and develop stable data solutions. They may be in charge of identifying potential risks relating to data storage and transfer, as well as working to mitigate these risks as needed. The data warehouse manager should work to develop standard policies and systems surrounding the data warehouse. Additionally, data warehouse managers must keep up to date with the latest data warehouse developments in order to continuously improve their organization's systems.
This is a management position that generally requires previous supervisory experience in addition to experience in a relevant role. At least a bachelor's degree in engineering or another relevant field is needed as well.
Data Warehouse Managers seem to require a number of specific skills. Most notably, skills in PL/SQL, Microsoft SQL Server, Business Intelligence, and Database Management & Reporting are correlated to pay that is above average, with boosts between 6 percent and 11 percent. Most people who know Business Intelligence also know Microsoft SQL Server. Skill sets containing Database Management & Reporting also tend to include Project Management and SQL.
Median of all compensation (including tips, bonus, and overtime) by years of experience.
Although employees with less than five years' experience earn around $78K on average, the five-to-10 year group has a much higher, six-figure median of $108K. Data Warehouse Managers who work for 10 to 20 years in their occupation tend to earn about $117K. Individuals who report more than two decades of experience seem to make about the same as folks in the 10-to-20 year range.
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exactly as advertised
By One of many helping our community
from Huntington Beach, CA
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Comments about Baudville Lapel Pin - Milestone - Shining Star:
We are a 100% volunteer nonprofit organization. These pins are used to help us give recognition and say thank you to members.
Bottom Line Yes, I would recommend this to a friend
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Very Cute!
By Daphne
from Houston, TX
About Me Education Industry
These are so much better than they look on the website. For the price, you can't beat it as recognition for employees, students, etc. Everyone loves them!


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Viktoria Palace4
Price FromView Rooms
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About the hotel
The hotel is situated only a short distance from the car ferry stop and 900 m from the public vaporetto to the St. Mark's Square stop. The connection is guaranteed by a public bus that leaves from the vaporetto stop every 10 minutes and stops directly in front of the hotel.
Guests will find the nearest bars, restaurants and shopping around 15 minutes' walk from the hotel. The beach is some 10 minutes' walk away. The centre of Venice can be reached in around 20 minutes' walk. Venice Marco Polo Airport is around 21 km away and Treviso Airport is some 70 km away. The hotel was completely renovated in 2010. This hotel is decorated in a classical Venetian style and offers a total of 29 rooms. There is wireless Internet access available to guests through the building. Situated in the Lido of Venice near San Nicolo, on a quiet island, the hotel is surrounded by a large wooded park overlooked by almost half of the rooms. Many rooms have a charming view on the Venetian lagoon or of the garden surrounding the hotel. Facilities at this charming, family-friendly hotel include air conditioning, a lobby with 24-hour reception and check-out service, lift access to the rooms, a bar and a breakfast room. Room service and a laundry service are offered, and guests may also make use of the car park. All rooms are furnished in a typical Venetian style with old headboards in wrought iron that create an elegant, warm and welcoming atmosphere. All rooms are equipped with all comforts, including air conditioning, central heating, a telephone, minibar, safety box, satellite TV, wireless Internet access, a radio, double or king-size bed, a balcony (on request) and a hairdryer. The nearby beach is sandy. Golfers will find the nearest golf course around 11 km away. Guests can enjoy breakfast served in the garden overlooking Venice lagoon.
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Natalie O'Neill / / News
Pensioners, low earners and disabled people in Barnet can get advice on heating their homes for less during Big Energy Saving Week.
Energy Best Deal project will provide face to face advice on how to reduce energy costs during 14 sessions across the borough.
The sessions will cover a range of topics including how to understand bills, tariffs and payment methods, as well as advice on energy costs and energy efficiency.
For information about a session, email Tope Teniola at Barnet Citizens Advice Bureau at email@example.com
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Denver Radio Club, WØTX
Denver Radio Club Hamfest - The BIG ONE!
Thanks for supporting our 2014 Hamfest!
Please join us for the 2015 D.R.C. Hamfest:
Sunday, August 16th, 2015, 8:30 am to 1:00 pm
Admission: Only $6.00 (Children under 13 are free with a paid adult).
Click Here for the Sellers' Table Reservation Form and Site Location Map
Click here for the proposed Table Layout Plan.
Get your first F.C.C. Amateur Radio License, or upgrade your existing license:
Technical Forums:
We are presenting a couple of technical forums during the 2015 Hamfest.
9:30 AM – How and Why Do Antennas Radiate?
The Technical Forums and VE Testing sessions will be held in the conference rooms on the north lower level.
For more information contact:
Bryan Steinberg, KBØA 303-987-9596


text: I Will Answer Any Question You Dare Ask Ask Away...this Could Be Fun! I'm new to EP but would love to find some friends here! Ask away...I'll answer any questions with complete honesty! dawinla 56-60, M 1 Response 1 Sep 14, 2012 Me Too Your Response Please respond with authenticity, support, and respect Cancel You can join Experience Project now! Username: Password Email Birthday Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Gender Select Male Female Trans* Already a member? Sign In By clicking "Sign Up", you confirm that you agree to the Terms of Service of Experience Project, Inc. Login Login to respond Username: Password: Keep me logged in Not a member? Sign Up Sign Up Favorite book? Zarifa 18-21, F Mar 22, 2013 1 Reply Cancel


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A curve in a speed track has a radius of 200 m and a rated speed 0f 180km/h. (See Sample Prob. 12.6 for the definition of rated speed.) Knowing that a racing car starts skidding on the curve when traveling at a speed 0f 320 km/h, determine (a) the banking angle θ (b) the coefficient of static friction between the tires and the track under the prevailing conditions, (c)the minimum speed at which the same car could negotiate that curve.
Fig. P12.53


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Are you Sietske Rozie?Claim your profile
Publications (24)49.93 Total impact
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ABSTRACT: The distensibility of a blood vessel is a marker of atherosclerotic disease. In this paper we investigate the feasibility of measuring carotid artery distensibility on 4D CTA, both manually and using a new automatic method. On 4D CTA datasets manual (n=38) and automatic (n=76) measurements of the carotid distensibility were performed. A subset (n=10) of the manual annotations were repeated by a second observer. The interobserver variability was assessed using a Bland-Altman analysis and appeared to be too large to reliably measure the distensibility using manual annotation. We compared two versions of the automatic method: one using 3D registration and one using a 4D registration method. The latter resulted in a more smooth deformation over time. The automatic method was evaluated using a synthetic deformation and by investigating whether known relations with cardiovascular risk factors could be reproduced. The relation between distensibility and cardiovascular risk factors was tested with a Mann-Whitney U test. Automatic measurements revealed an association with hypertension whereas the manual measurements did not. This relation has been found by other studies too. We conclude that carotid artery distensibility measurements should be performed automatically and that the method described in this paper is suitable for that. All CTA datasets and related clinical data used in this study can be downloaded from our website (http://ctadist.bigr.nl).
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ABSTRACT: This paper describes an evaluation framework that allows a standardized and objective quantitative comparison of carotid artery lumen segmentation and stenosis grading algorithms. We describe the data repository comprising 56 multi-center, multi-vendor CTA datasets, their acquisition, the creation of the reference standard and the evaluation measures. This framework has been introduced at the MICCAI 2009 workshop 3D Segmentation in the Clinic: A Grand Challenge III, and we compare the results of eight teams that participated. These results show that automated segmentation of the vessel lumen is possible with a precision that is comparable to manual annotation. The framework is open for new submissions through the website http://cls2009.bigr.nl.
Article: Automated versus manual segmentation of atherosclerotic carotid plaque volume and components in CTA: Associations with cardiovascular risk factors[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study was to validate automated atherosclerotic plaque measurements in carotid arteries from CT angiography (CTA). We present an automated method (three initialization points are required) to measure plaque components within the carotid vessel wall in CTA. Plaque components (calcifications, fibrous tissue, lipids) are determined by different ranges of Hounsfield Unit values within the vessel wall. On CTA scans of 40 symptomatic patients with atherosclerotic plaque in the carotid artery automatically segmented plaque volume, calcified, fibrous and lipid percentages were 0.97 ± 0.51 cm(3), 10 ± 11%, 63 ± 10% and 25 ± 5%; while manual measurements by first observer were 0.95 ± 0.60 cm(3), 14 ± 16%, 63 ± 13% and 21 ± 9%, respectively and manual measurement by second observer were 1.05 ± 0.75 cm(3), 11 ± 12%, 61 ± 11% and 27 ± 10%. In 90 datasets, significant associations were found between age, gender, hypercholesterolemia, diabetes, smoking and previous cerebrovascular disease and plaque features. For both automated and manual measurements, significant associations were found between: age and calcium and fibrous tissue percentage; gender and plaque volume and lipid percentage; diabetes and calcium, smoking and plaque volume; previous cerebrovascular disease and plaque volume. Significant associations found only by the automated method were between age and plaque volume, hypercholesterolemia and plaque volume and diabetes and fibrous tissue percentage. Significant association found only by the manual method was between previous cerebrovascular disease and percentage of fibrous tissue. Automated analysis of plaque composition in the carotid arteries is comparable with the manual analysis and has the potential to replace it.
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ABSTRACT: This paper presents a level set based method for segmenting the outer vessel wall and plaque components of the carotid artery in CTA. The method employs a GentleBoost classification framework that classifies pixels as calcified region or not, and inside or outside the vessel wall. The combined result of both classifications is used to construct a speed function for level set based segmentation of the outer vessel wall; the segmented lumen is used to initialize the level set. The method has been optimized on 20 datasets and evaluated on 80 datasets for which manually annotated data was available as reference. The average Dice similarity of the outer vessel wall segmentation was 92%, which compares favorably to previous methods.
Article: Prevalence and Calcification of Intracranial Arterial Stenotic Lesions as Assessed With Multidetector Computed Tomography Angiography[Show abstract] [Hide abstract]
ABSTRACT: Intracranial arterial stenosis (ICAS) in patients with recent ischemic stroke is associated with a high risk of recurrent stroke. More insight into the pathophysiology of ICAS could help identify patients at high risk requiring more aggressive secondary prevention. We evaluated the prevalence, distribution, calcification, and the risk factors predisposing ICAS in a European stroke population. Consecutive patients with a transient ischemic attack or ischemic stroke (n=786) were evaluated for the presence and distribution of ICAS (≥30% luminal narrowing) by CT angiography. ICAS were categorized as symptomatic or asymptomatic, and the presence of calcification was assessed. The association of traditional cerebrovascular risk factors and the erythrocyte sedimentation rate with ICAS was analyzed. In 178 of 786 patients (23%), 288 ICAS were observed. Most stenoses (n=194/288; 67%) were located in the posterior circulation arteries. In 59 of 786 patients (8%), ICAS were considered symptomatic. ICAS in the basilar artery and arteries beyond the circle of Willis were mainly noncalcified. In addition to age, gender, and several traditional cerebrovascular risk factors, erythrocyte sedimentation rate was independently associated with the presence of ICAS (OR, 1.20; 95% CI, 1.06-1.36) and with the presence of noncalcified ICAS in particular (OR, 1.20; 95% CI, 1.05-1.37). ICAS was observed in a noteworthy number of European stroke patients. Particularly, the majority of ICAS was observed in the posterior circulation, possibly conferring worse prognosis. ICAS in distal arteries were mainly noncalcified. Association of noncalcified ICAS and erythrocyte sedimentation rate may indicate a prominent role for inflammatory factors in intracranial atherosclerotic disease.
Article: Association Between Carotid Artery Plaque Ulceration and Plaque Composition Evaluated With Multidetector CT Angiography[Show abstract] [Hide abstract]
ABSTRACT: Symptomatic carotid artery plaque ulceration is associated with distinct plaque components such as a large lipid-rich necrotic core (LR-NC) in ischemic stroke patients with a ≥50% carotid stenosis. We evaluated the associations between carotid artery plaque ulceration and plaque characteristics in ischemic stroke patients with ≥50% stenosis, as well as in those with a low degree of stenosis (0% to 49%). Consecutive patients (n=346) with symptoms in the anterior circulation were evaluated with multidetector CT angiography (MDCTA) for the presence of atherosclerotic plaque, degree of stenosis, and plaque ulceration in the symptomatic carotid artery. Plaque volume and plaque component proportions of LR-NC, fibrous tissue, and calcification were measured. The associations between plaque ulceration and plaque characteristics were analyzed using logistic regression. Atherosclerotic plaque was present in 185 patients. Plaque ulcerations were present in 38 (21%) patients, of which half had a low degree stenosis (0% to 49%). Plaque volume was significantly larger in ulcerated plaques. After adjustment for age, sex, and degree of stenosis, LR-NC proportion was strongly associated with plaque ulceration (odds ratio, 2.21; 95% CI, 1.49 to 3.27), whereas calcification proportion was inversely associated with plaque ulceration (odds ratio, 0.60; 95% CI, 0.40 to 0.89). These associations remained significant in patients with a low degree stenosis (0% to 49%). Plaque volume, degree of stenosis, and LR-NC proportion evaluated noninvasively with MDCTA are associated with carotid artery plaque ulceration, even in patients with a low degree stenosis (0% to 49%). Plaque volume and composition analysis with MDCTA may identify rupture prone plaques and improve risk stratification in ischemic stroke patients.
Article: Evolution of Atherosclerotic Carotid Plaque Morphology: Do Ulcerated Plaques Heal A Serial Multidetector CT Angiography Study[Show abstract] [Hide abstract]
ABSTRACT: Atherosclerotic carotid plaque rupture may lead to thromboembolization, causing transient ischemic attack or ischemic stroke. Carotid plaque ulceration on angiography is associated with plaque rupture. Although healing of ruptured plaques has been described in coronary arteries, little is known about the natural development of plaque ulcerations in carotid arteries. We therefore explored the evolution of carotid plaque surface morphology with serial multidetector CT angiography (MDCTA). From a registry of patients with transient ischemic attack or minor ischemic stroke, we selected 83 patients who had undergone serial MDCTA of the carotid arteries. Arteries subjected to revascularization procedures between the two scans were excluded (n = 11). Plaque surface morphology was classified as smooth, irregular or ulcerated on both baseline and follow-up MDCTA. Progression (i.e. development of irregularities or ulceration) and regression (i.e. disappearance of irregularities or ulceration) in morphology were evaluated. The mean time interval between the MDCTA scans was 21 ± 13 months. At baseline, 28 (18%) arteries were normal, 124 (80%) contained atherosclerotic plaque and 3 (2%) were occluded. Plaque surface morphology was smooth in 86 arteries (55%), irregular in 23 (15%) and ulcerated in 15 (10%). At follow-up, surface morphology was unchanged in 88% of arteries, had progressed in 8% and regressed in 4%. Most importantly, plaque morphology remained unchanged in most ulcerated plaques (10/15; 67%). One ulcerated plaque had progressed, whereas 4 had regressed. New ulcerations had developed in 2 nonulcerated plaques. MDCTA allows evaluation of temporal changes in atherosclerotic carotid plaque morphology. Plaque surface morphology remained unchanged in most arteries. Carotid ulcerations persist for a long time, and may remain a potential source of thromboembolism.
Article: Robust CTA lumen segmentation of the atherosclerotic carotid artery bifurcation in a large patient population[Show abstract] [Hide abstract]
ABSTRACT: We propose and validate a semi-automatic method for lumen segmentation of the carotid bifurcation in computed tomography angiography (CTA). First, the central vessel axis is obtained using path tracking between three user-defined points. Second, starting from this path, the segmentation is automatically obtained using a level set. The cost and speed functions for path tracking and segmentation make use of intensity and homogeneity slice-based image features. The method is validated on a large data set of 234 carotid bifurcations of 129 ischemic stroke patients with atherosclerotic disease. The results are compared to manually obtained lumen segmentations. Parameter optimization is carried out on a subset of 30 representative carotid bifurcations. With the optimized parameter settings the method successfully tracked the central vessel paths in 201 of the remaining 204 bifurcations (99%) which were not part of the training set. Comparison with manually drawn segmentations shows that the average overlap between the method and observers is similar (for the inter-observer set the results were 92% vs. 87% and for the intra-observer set 94% vs. 94%). Therefore the method has potential to replace the manual procedure of lumen segmentation of the atherosclerotic bifurcation in CTA.
Article: Three-dimensional registration of histology of human atherosclerotic carotid plaques to in-vivo imaging[Show abstract] [Hide abstract]
ABSTRACT: An accurate spatial relationship between 3D in-vivo carotid plaque and lumen imaging and histological cross sections is required to study the relationship between biomechanical parameters and atherosclerotic plaque components. We present and evaluate a fully three-dimensional approach for this registration problem, which accounts for deformations that occur during the processing of the specimens. By using additional imaging steps during tissue processing and semi-automated non-linear registration techniques, a 3D-reconstruction of the histology is obtained. The methodology was evaluated on five specimens obtained from patients, operated for severe atherosclerosis in the carotid bifurcation. In more than 80% of the histology slices, the quality of the semi-automated registration with computed tomography angiography (CTA) was equal to or better than the manual registration. The inter-observer variability was between one and two in-vivo CT voxels and was equal to the manual inter-observer variability. Our technique showed that the angles between the normals of the registered histology slices and the in-vivo CTA scan direction ranged 6-56 degrees , indicating that proper 3D-registration is crucial for establishing a correct spatial relation with in-vivo imaging modalities. This new 3D-reconstruction technique of atherosclerotic plaque tissue opens new avenues in the field of biomechanics as well as in the field of image processing, where it can be used for validation purposes of segmentation algorithms.
Article: Atherosclerotic Plaque Ulceration in the Symptomatic Internal Carotid Artery Is Associated With Nonlacunar Ischemic Stroke[Show abstract] [Hide abstract]
ABSTRACT: Atherosclerotic carotid plaque ulceration is considered a marker of previous plaque rupture and subsequent thromboembolism. It can be accurately detected with multidetector CTA. We hypothesized that atherosclerotic plaque ulceration is associated with nonlacunar ischemic stroke rather than lacunar stroke. Prospectively, 750 consecutive patients with transient ischemic attack or ischemic stroke symptoms in the anterior cerebral circulation were evaluated for the presence of atherosclerotic plaque ulceration in the symptomatic carotid artery with multidetector CTA. Patients with stroke attributable to cardiac embolism or other specific etiologies and patients with amaurosis fugax were excluded. Ischemic strokes in the remaining 534 patients were classified as nonlacunar (n=236) or lacunar (n=298) based on clinical symptoms and multidetector CT of the brain. Ulceration was defined as extension of contrast material beyond the vascular lumen into the surrounding plaque. Plaque ulceration in the symptomatic carotid artery was more common in nonlacunar strokes (n=47; 20%) as compared to lacunar strokes (n=20; 7%; P<0.001). After adjustment for age, gender, cardiovascular risk factors, and degree of stenosis, ulcerations were independently associated with nonlacunar stroke compared to lacunar stroke (odds ratio, 2.70; 95% confidence interval, 1.43-5.09). Atherosclerotic carotid plaque ulceration is associated with nonlacunar ischemic stroke, independent of the degree of carotid stenosis. These results suggest that nonlacunar stroke and lacunar stroke are caused by different pathophysiological mechanisms.
Conference Paper: Automated carotid artery distensibility measurements from CTA using nonrigid registration[Show abstract] [Hide abstract]
ABSTRACT: The distensibility of a blood vessel is a marker of atherosclerotic disease. Manual measurement of the distensibility on CTA images is a difficult task. In this paper we describe a method to automatically determine the distensibility of the carotid artery by locally analyzing the deformation field of a nonrigid registration of a series of ECG-gated CTA images. We evaluate two variants of the method, and compare the results with manually measured distensibilities.
Conference Paper: Atherosclerotic Carotid Plaque Composition in a Healthy Elderly Population: The Rotterdam Study[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE Plaque vulnerability to rupture is related to the composition and morphology of the atherosclerotic plaque. With multiple contrasts, MRI can provide an effective mean to identify and quantify different components of atherosclerotic plaque in the carotid arteries. METHOD AND MATERIALS The present study is performed within the framework of the Rotterdam study, a large ongoing population-based study performed in healthy subjects aged 45 years and older. Participants with asymptomatic carotid atherosclerosis (defined by ultrasound) were studied. We acquired MRI scans with multiple contrast weightings (PDW-FSE, PDW-EPI, T2W-EPI, 3D-T1W-GRE, 3D-PC-MRA) using a 1.5Tesla MRI scanner and a bilateral surface coil. All images were linear registered. Presence of plaque, presence of different plaque components (calcification, intraplaque hemorrhage, lipid rich necrotic core (LR/NC), fibrous tissue), predominant plaque component and maximal plaque thickness was determined using previously defined MR imaging criteria (figure). RESULTS Five hundred subjects (age range 48,3-98.3 years; 57% men) were studied. Thirty-two studies (6%) were excluded due to low image quality. Hundred-ten carotid arteries were normal. In 826 carotid arteries (88%) a plaque was present with a plaque thickness of 3.3±1.0 mm. Calcifications, intraplaque hemorrhage and LR/NC were respectively seen in 62%, 21% and 22% of the plaques. . Intraplaque hemorrhage and LR/NC were present in respectively 12% and 13% of carotid plaques with a plaque thickness below the median plaque thickness (3.1mm). In plaques with a thickness > 3.1mm these components were present in 30% and 31% of the plaques. The predominant plaque component was fibrous tissue in 55%, calcification in 28%, intraplaque hemorrhage in 9% and LR/NC in 8% of the plaques. CONCLUSION Carotid plaque evaluation in the healthy population is feasible. Different components of the plaque can be identified. Intraplaque hemorrhage and LR/NC, which are considered constituents of the vulnerable plaque, are present predominantly in 26% of asymptomatic participants. CLINICAL RELEVANCE/APPLICATION This study will enhance the understanding of the natural history of carotid atherosclerosis and the relationship between atherosclerosis and cerebrovascular events.
Conference Paper: Atherosclerotic Carotid Plaque Volume and Composition in Relation with Plaque Ulceration: An Analysis with MDCT Angiography[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE Atherosclerotic plaque ulceration is a marker for previous plaque rupture, which is related to the composition of the atherosclerotic plaque (which may lead to thromboembolism). We studied the relationship of ulcerated plaques with plaque volume and plaque composition. METHOD AND MATERIALS We included 351 patients (60% male, mean age 61.70 ± 13.78 years) with ischemic cerebrovascular symptoms in the anterior circulation who underwent MDCT Angiography of the carotid bifurcation. In 210 patients (165 with bilateral plaque, 45 with unilateral plaque) plaque was present an analyzed. Plaque volume and plaque components (lipid, fibrous, calcium) were measured using a custom-made software tool (PV en PC). Plaque ulceration was assessed with MPRs. Two observers performed the volume measurements and scored the presence of ulcerated plaques. RESULTS Atherosclerotic plaque was present in 375 arteries. Plaque ulceration was present in 66 out these atherosclerotic arteries. The mean PV of the 66 ulcerated plaques was 1320 ± 822 mm3 and the mean PV of the 309 non-ulcerated plaques was 775 ± 557 mm3, which was significantly different (p<0.001).The ulcerated plaques had a significantly larger contribution (%) of lipid than the non-ulcerated plaques (26 ± 11 % vs 18 ± 10 %; p<0.001). The contribution of calcium was not significantly different between the ulcerated and the non-ulcerated plaques. (12 ± 11 % vs 15 ± 14 % ; p<0.001). CONCLUSION Plaque ulceration is more frequently present in larger plaques and plaque with a lipid core. CLINICAL RELEVANCE/APPLICATION Multidetector CT angiography allows classification of atherosclerotic carotid plaque surface and plaque volume and plaque composition and plaque rupture can be predicted based on plaque composition.
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ABSTRACT: PURPOSE Whereas lacunar strokes are associated with local occlusive disease of the deep perforating arteries, cortical strokes are supposed to be caused by thromboembolism from the heart, and stenotic atherosclerotic disease in the extracranial and intracranial arteries. The current study aimed to explore the prevalence of symptomatic intracranial arterial stenosis in patients with ischemic strokes of different etiological mechanisms. METHOD AND MATERIALS Prospectively, 408 consecutive patients (55% male, mean age 62±14 years) with hemispherical ischemic cerebrovascular symptoms in the anterior circulation were included. Based on clinical symptoms and brain imaging, strokes were classified into cortical and lacunar strokes. Patients with cardiac embolism (N=52) and other stroke etiology (N=9) were excluded. Cardiovascular risk factors were registered. Presence of intracranial stenosis was assessed using MDCT Angiography, in the intracranial internal carotid artery, the anterior cerebral artery up to the A2 segment and the medial cerebral artery until segment M3. In addition, degree of stenosis and the presence of atherosclerotic plaque ulceration were evaluated in the symptomatic extracranial carotid artery. The association between cortical strokes and intracranial stenosis was studied in a logistic regression model with lacunar strokes as a control group. RESULTS Symptomatic intracranial arterial stenoses were present in 21 out of 144 patients with cortical stroke (15%) and 24 out of 203 patients with lacunar stroke (12%) (p=0.75). After correction for cardiovascular risk factors and race in a multivariate model, no association between cortical stroke and intracranial stenosis was found. However, independent associations between cortical stroke and degree of extracranial carotid stenosis (OR = 1.0; 95%CI 1.0 -1.02) and plaque ulceration (OR = 2.4; 95%CI 1.2-5.0) were confirmed. CONCLUSION In contrast to atherosclerotic plaque ulceration and degree of stenosis in the extracranial carotid artery, intracranial stenoses are not independently associated with ischemic cortical strokes. CLINICAL RELEVANCE/APPLICATION Evidence of an etiological relationship between intracranial stenoses in the symptomatic territory and cortical stroke remains uncertain.
Conference Paper: Serial Imaging of Carotid Atherosclerotic Plaque Morphology with MDCTA in Patients with Ischemic Cerebrovascular Disease[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE Atherosclerotic carotid plaque rupture is thought to lead to thrombus formation with subsequent embolisation of plaque material and/or thrombus and consequently an acute ischemic cerebrovascular event. The purpose of this study was to get insight into the natural history of ulcerated plaques with serial MDCT angiography. METHOD AND MATERIALS In this retrospective study we selected patients with more than one MDCTA of the carotid arteries from our database with patients with ischemic cerebrovascular disease and CTA evaluation. MDCTA images (slice thickness ≤ 1.0 mm, increment 0.6 mm) were evaluated by two blinded observers with multiplanar reformatting software. Plaque surface morphology in the carotid bifurcation was classified as smooth, irregular or ulcerated. Change in surface morphology over time was evaluated. Arteries which were treated in between the two MDCTA scans were excluded. RESULTS We selected 84 patients (63% men, aged 61,8 ± 12,4 years) who had more than one MDCTA of the carotid arteries. The mean time period between the two MDCTA scans was 21 ± 13 months. During the first MDCTA 82% of the patients had symptoms in the carotid circulation and 18% in the vertebrobasilar circulation. Of the 155 arteries available for analysis, 3 (1.9%) were occluded at the first MDCTA and 114 (73,6%), 23 (14,8%) and 15 (9,7%) arteries had smooth, irregular and ulcerated luminal surfaces respectively. On the second MDCTA the surface morphology was unchanged in 91% of the arteries, whereas 5,2% showed progression and 3,9% regression of plaque morphology. Remarkably, the majority (10 out of 15) of the ulcerated plaques showed no changed morphology over a time period of 20 ± 15 months. One ulcerated plaque showed progression (in 21 months), 4 showed regression (in 20 ± 17 months), whereas in two non-ulcerated plaques an ulceration developed (34 ± 9 months). CONCLUSION MDCTA is useful for the evaluation of temporal changes in plaque morphology. On serial MDCTA, atherosclerotic carotid plaque morphology did not change in most cases and healing of ulcerated plaques is not a common phenomenon. CLINICAL RELEVANCE/APPLICATION Atherosclerotic carotid plaque ulceration on MDCTA should be evaluated with clinical and brain imaging data in order to distinguish old, asymptomatic ulcerations from active, symptomatic ulcerations.
Conference Paper: Evaluation of Pulsatile Waveforms and Mechanical Properties in Carotid Arteries with ECG-gated Dual-Source CT Angiography[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE Arterial distensibility is a functional and early marker for atherosclerotic disease.The purpose of this study was to evaluate the feasibility of ECG-gated multidetector CTA (MDCTA) in the assessment of the mechanical properties of the vessel wall in the carotid bifurcation. METHOD AND MATERIALS Patients (n=41; mean ages 63.0 ± 8.7 years, 26 male) with cerebrovascular symptoms were prospectively included. They underwent ECG-gated MDCTA of the carotid artery on a 64-slice DSCT scanner. On the reconstructed 4D datasets we measured lumen area in the common carotid artery (CCA) and in the internal carotid artery (ICA) on images which were reconstructed at every 8% of the RR-interval of the cardiac cycle. Luminal area versus time curves were analysed to illustrate the carotid pulsatile waveforms. Using the change in lumen area (ΔA=Amax - Amin), the relative distension was calculated as [∆A /Amin] * 100. The pulse pressure (ΔP) was used to calculate the distensibility (D) as: ΔA / (Amin x ΔP) (10-3kPa-1). RESULTS Most segments (61%) showed an evident biphasic waveform. The distensibility in the carotid artery was 24.1 ± 12.4 (kPa-1) and was not significantly different for the CCA's and ICA's. The distensibility in normal and atherosclerotic carotid arteries was not significantly different. CONCLUSION ECG-gated DSCTA allows the evaluation of distensibility in the carotid arteries. It is feasible to analyze the cross-sectional lumen area changes during a cardiac cycle in different locations along the carotid artery by using an ECG-gated Dual-Source MDCT angiographic protocol. CLINICAL RELEVANCE/APPLICATION Arterial distensibility of the carotid artery can now be evaluated with MDCTA to improve our understanding of the relation between plaque accumulation, plaque composition and morphology.
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ABSTRACT: A novel method is presented for carotid artery vessel wall segmentation in computed tomography angiography (CTA) data. First the carotid lumen is semi-automatically segmented using a level set approach initialized with three seed points. Subsequently, calcium regions located within the vessel wall are automatically detected and classified using multiple features in a GentleBoost framework. Calcium regions segmentation is used to improve localization of the outer vessel wall because it is an easier task than direct outer vessel wall segmentation. In a third step, pixels outside the lumen area are classified as vessel wall or background, using the same GentleBoost framework with a different set of image features. Finally, a 2-D ellipse shape deformable model is fitted to a cost image derived from both the calcium and vessel wall classifications. The method has been validated on a dataset of 60 CTA images. The experimental results show that the accuracy of the method is comparable to the interobserver variability.
Conference Paper: Carotid Artery Segmentation and Plaque Quantification in CTA.[Show abstract] [Hide abstract]
ABSTRACT: A novel, slice-based, semi-automatic method for plaque segmentation and quantification in CTA of carotid arteries is introduced. The method starts with semi-automatic, levelset based, lumen segmentation initialized with three points. Pixel based GentleBoost classification is used to segment the inner and outer vessel wall region using distance from the lumen, intensity and Gaussian derivatives as features. 3D calcified regions located within the vessel wall are segmented using a similar set of features and the same classification method. Subsequently, an ellipse-shaped deformable model is fitted using the inner-outer vessel wall and calcium classification, and plaque components within the wall are characterized using HU ranges. The method is quantitatively evaluated on 5 carotid arteries. Vessel and plaque segmentation are compared to the interobserver variability. Furthermore, correlation of slice-based plaque component quantification with the ground truth values is determined. The accuracy of our method is comparable to the interobserver variability.
Article: Atherosclerotic plaque volume and composition in symptomatic carotid arteries assessed with multidetector CT angiography; relationship with severity of stenosis and cardiovascular risk factors[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study was to examine the volume and the composition of atherosclerotic plaque in symptomatic carotid arteries and to investigate the relationship between these plaque features and the severity of stenosis and the presence of cardiovascular risk factors. One hundred patients with cerebrovascular symptoms underwent CT angiography. We measured plaque volume (PV) and the relative contribution of plaque components (calcifications, fibrous tissue, and lipid) in the symptomatic artery. The contribution of different components was measured as the number of voxels within defined ranges of HU values (calcification >130 HU, fibrous tissue 60-130 HU, lipid core <60 HU). Fifty-seven patients had atherosclerotic plaque in the symptomatic carotid artery. The severity of stenosis and PV were moderately correlated. Age and smoking were independently related to PV. Patients with hypercholesterolemia had significantly less lipid and more calcium in their plaques than patients without hypercholesterolemia. Other cardiovascular risk factors were not significantly related to PV or plaque composition. Luminal stenosis of the carotid artery partly reflects the amount of atherosclerotic carotid disease. Plaque volume and plaque composition are associated with cardiovascular risk factors.
Conference Paper: The Relationship between Calcifications of the Intracranial Segment of the Symptomatic Internal Carotid Artery and Infarcts in the Symptomatic Hemisphere Assessed with Multidetector CT[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE Calcification of the intracranial segment of the internal carotid artery can be assessed by and quantified with multidetector computed tomography angiography (MDCTA). Intracranial calcification is a marker of intracranial atherosclerosis. We hypothesize that presence of intracranial calcification in the symptomatic artery is related to the presence of infarct on CT in the symptomatic hemisphere. METHOD AND MATERIALS We studied 351 consecutive patients (59.5 male; mean age 62.4 ± 13.1 years), who had cerebrovascular symptoms in the carotid artery territory with MDCTA. Patients with a likely cardioembolic stroke etiology (n=30) or occluded internal carotid artery (n=20) were excluded. CT brain images were reviewed for the presence of recent and old infarcts. We quantified intracranial calcification by manually drawing contours on axial images with a custom-made software tool. The Mann-Whitney U test and Logistic Regression were applied for statistical analysis. RESULTS Intracranial calcification was present in 58% of the symptomatic carotid arteries. Infarcts were present in 43% of the symptomatic hemispheres. The quantity of intracranial calcification was significantly higher in the symptomatic carotid artery of patients with infarcts in the symptomatic hemisphere (36 mm3 ± 78 mm3) than in patients without infarcts in the symptomatic hemisphere (21 mm3 ± 47 mm3) p<0.001). In multivariate analysis after adjustment for age and sex, no independent relationship was found between the quantity of intracranial calcification in the symptomatic artery and infarcts in the symptomatic hemisphere. CONCLUSION The quantity of intracranial calcification was significantly higher in the symptomatic carotid artery of patients with infarcts in the symptomatic hemisphere than in patients without infarcts in the symptomatic hemisphere. However, after adjustment for age and sex, intracranial calcification in the symptomatic artery was not independently associated with infarcts in the symptomatic hemisphere. CLINICAL RELEVANCE/APPLICATION The quantity of intracranial calcification is not an independent predictor of stroke.
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Erasmus MC
Rotterdam, South Holland, Netherlands
- Department of Radiology
Delft University of Technology
Delft, South Holland, Netherlands
- Faculty of Applied Sciences (AS)
Erasmus Universiteit Rotterdam
Rotterdam, South Holland, Netherlands
- Department of Radiology