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The ability of echocardiographic dyssynchrony to predict response to cardiac resynchronization therapy (CRT) has been unclear.
A prospective, longitudinal study was designed with pre-defined dyssynchrony indices and outcome variables to test the hypothesis that baseline dyssynchrony is associated with long term survival following CRT. We studied 229 consecutive Class III–IV heart failure patients, with ejection fraction (EF) ≤35%, and QRS duration ≥120ms for CRT. Dyssynchrony before CRT was defined as: tissue Doppler velocity opposing wall delay ≥ 65 ms, 12-site standard deviation (Yu Index) ≥32ms; speckle tracking radial strain anteroseptal to posterior wall delay ≥130ms; or pulsed Doppler interventricular mechanical delay (IVMD) ≥ 40 ms. Outcome was defined as freedom from death, heart transplant or left ventricular assist device (LVAD). Of 210 patients (89%) with dyssynchrony data available, there were 62 events: 47 deaths, 9 transplants, and 6 LVADs over 4 years. Event-free survival was associated with: Yu Index (p=0.003), speckle tracking radial strain (p=0.003), and IVMD (p=0.019). When adjusted for confounding baseline variables of ischemic etiology and QRS duration, Yu Index and radial strain dyssynchrony remained independently associated with outcome (p<0.05). Lack of radial dyssynchrony was particularly associated with unfavorable outcome in those with QRS duration 120–150 ms (p=0.002).
The absence of echocardiographic dyssynchrony was associated with significantly less favorable event-free survival following CRT. Patients with narrower QRS duration who lacked dyssynchrony had the least favorable long term outcome. These observations support the relationship of dyssynchrony to CRT response.
Cardiac resynchronization therapy (CRT) is an important therapy for patients with symptomatic heart failure, widened electrocardiographic QRS, and reduced ejection fraction (EF).1–3 Despite significant morbidity and mortality benefits from CRT, approximately one-third of patients do not appear to benefit from therapy. The prevailing concept is that correction of mechanical dyssynchrony is the principal mechanism for CRT and that patients who lack significant dyssynchrony despite having QRS widening may not respond. 4–8 Although a large body of literature supports echocardiographic dyssynchrony as a prognostic marker for patient response to CRT, the recent PROSPECT study (Predictors of Responders to Cardiac Resynchronization Therapy) failed at its attempt to define the optimal echocardiographic dyssynchrony approach.9,10 Furthermore, PROSPECT raised concerns about feasibility and reproducibly of echocardiographic methods.11,12 As a result, there is no consensus as to the predictive value of echocardiographic dyssynchrony and current clinical selection criteria for CRT include QRS widening as a surrogate for dyssynchrony. Acknowledged limitations of PROSPECT include confounding variables of different acquisition and analysis approaches, suboptimal end-points, and follow-up limited to 6 months after CRT.11,12 Accordingly, our objective was to test the hypothesis that echocardiographic dyssynchrony is associated with outcome following CRT. We used a prospective longitudinal study design with unified echocardiographic analysis and predefined important end-points of death, cardiac transplant or left ventricular assist device (LVAD) following CRT.
We prospectively studied a series of 229 consecutive heart failure patients referred for routine CRT indications. The protocol was approved by the Institutional Review Board on Biomedical Research and all patients gave informed consent consistent with this protocol. All patients had New York Heart Association functional class III or IV heart failure despite optimal pharmacological therapy, QRS duration ≥ 120ms and LV ejection fraction (EF) ≤ 35%. Optimal pharmacological therapy included angiotensin converting enzyme inhibitors or receptor blockers, β-blockers and spironolactone, as tolerated. A biventricular pacing system was implanted with a standard right ventricular apical lead and left ventricular lead positioned through the coronary sinus in an epicardial vein targeting posterolateral or lateral branches. In the event that a lead could not be placed transvenously because of anatomic constraints, epicardial LV leads were surgically implanted using a mini-thoracotomy in a small subset (<5%) of patients.
All echocardiographic studies and off-line analyses were performed using a standard imaging system and software (VIVID 7, EchoPac BT08 GE-Vingmed, Horton, Norway). Briefly, routine digital 2- dimensional and tissue Doppler imaging (TDI) cine loops were obtained, including mid-LV short axis views at the level of the papillary muscle, apical views and pulsed-Doppler of the right ventricular and LV outflow. Mitral regurgitation was semi-quantitatively assessed by color Doppler jet area and vena contract width. 13 EF was calculated by biplane Simpson's rule. 14 Intraventricular dyssynchrony was determined by TDI and speckle tracking as previously described in detail (Fig. 1). TDI regions of interest (7 × 15 mm) were placed in the basal and mid LV segments for the 3 standard views for 12-sites, adjusted for the most reproducible peak systolic velocities and time-to-peak calculated from the onset of the QRS.6,8,15 Longitudinal dyssynchrony was opposing wall delay (OWD) defined as the maximal difference in peak velocity at basal and mid segments in opposing walls for each view. The Yu index was calculated as the 12-site time-to-peak velocity standard deviation. 8,16 Significant longitudinal dyssynchrony by TDI was pre-defined as the maximal OWD in one view ≥ 65 ms,5,15,17 or Yu Index of ≥ 32 ms.6,8,16
Speckle tracking of routine grayscale mid-LV short-axis images was performed as previously described to assess radial dyssynchrony. An end-diastolic circular region of interest was traced slightly within the endocardial cavity, using a point-and-click approach with special care taken to adjust tracking of all endocardial segments.7 A second larger concentric circle was then generated and manually adjusted near the epicardium. Time-to-peak segmental radial strain was determined from the highest peak positive strain value throughout the cardiac cycle, beginning slightly before the onset of the QRS complex to include very early mechanical activation. Radial dyssynchrony was determine as the time difference between the anteroseptal and posterior wall with ≥ 130ms predefined as significant.7,15
Interventricular dyssynchrony was calculated from routine pulsed-Doppler as previously described.6,18 LV pre-ejection delay was determined as the interval from the onset of the QRS to the onset of LV ejection velocity. Likewise, the right ventricular (RV) pre-ejection delay was determined as the interval from the onset of the QRS to the onset of the RV ejection velocity. Interventricular mechanical delay (IVMD) was determined as the difference between the RV and LV pre-ejection time with ≥ 40ms predefined as significant dyssynchrony. 18
The principal outcome variable was the combined endpoint of mortality, cardiac transplant or ventricular assist device (LVAD) implantation. This combined end-point was pre-determined because only patients with end-stage heart failure with a limited anticipated survival would undergo transplant or LVAD implantation in our institution. The potential impact of dyssynchrony with respect to QRS width was prospectively evaluated using the pre-specified cut-off of QRS 120–150 ms versus QRS > 150 ms, as used in the CARE-HF trial for patient enrollment. 3
Group data were presented as means ± standard deviation and were compared using the student t- test for unpaired data. Proportional differences were evaluated using Fisher's exact test and Chi-square was used for non continuous variables. Kaplan-Meier survival curves were plotted to measure outcome and the log-rank test used to compare survival between patients with or without dyssynchrony. A Cox proportional hazard model was used to assess for any potential influence of covariates. To test the appropriateness of the proportional hazards assumption in the Cox model, we determined that differences in QRS width and incidence of ischemic etiology at baseline were potential confounding covariates. Adjustments were made with the influence of these explanatory variables assumed to be constant over time. We verified the proportional hazards assumption using graphical methods and the log-rank test and observed the proportional hazards assumption to be appropriate. Follow-up duration was truncated at 3 years for smaller sub-group samples. Receiver operator characteristic curve analysis was performed using a nonparametric estimate of the area under curve with its 95% confidence interval based on the method by Hanley et al.19 Data were reported as mean ± standard deviation throughout with a p value of < 0.05 considered as significant.
Of the 229 consecutive patients referred for CRT with attempted echocardiographic studies, 19 (8%) had technically inadequate images for quantitative analysis due to poor windows and were excluded from all further analysis. Of these 210 patients, TDI analysis for the OWD and Yu index was feasible in 205 (90%), speckle tracking radial strain was feasible in 197 (86%). Routine pulsed Doppler for IVMD was added to the protocol after the first 27 patients, and was feasible in 180 of 202 (91%). From 20 randomly selected studies; intraobserver variability for determining routine pulsed Doppler dyssynchrony measures was 3 ± 3 ms (3 ± 4 %) and interobserver variability was 5 ± 5 ms (4 ± 5 %). Intraobserver variability for dyssynchrony by TDI using identical digital cineloops was 6 ± 5 ms (6 ± 7 %) and interobserver variability was 8 ± 7 ms (8 ± 7 %). Intraobserver variability for dyssynchrony by speckle tracking strain from the identical digital cineloops was 17 ± 10 ms (8 ± 7 %) and interobserver variability was 22 ± 14 ms (9 ± 7 %).
The baseline characteristics of the 210 patients with echocardiographic data are shown in Table 1. The prevalence of TDI dyssynchrony by OWD ≥ 65ms and Yu Index ≥ 32ms was 78% and 72%, respectively. The 205 patients with and without dyssynchrony by TDI indices had similar age, proportion of female gender, EF, mitral regurgitation, and QRS duration. However, significant dyssynchrony was observed less often in those with ischemic disease compared with non-ischemic disease as follows: 53% vs. 71% for OWD ≥65ms and 51% vs. 73% for Yu Index ≥32ms (all p< 0.05). The 197 patients with and without significant radial dyssynchrony ≥ 130 ms by speckle tracking radial strain also had similar age, % of females, EF and mitral regurgitation. Patients with ischemic disease had less prevalent radial dyssynchrony than those with non-ischemic disease; 50% vs. 76%, respectively (p<0.05). QRS duration was greater in patients with significant radial dyssynchrony 161 ± 26ms compared with those without radial dyssynchrony 148 ± 23ms (p<0.05). The 180 patients with IVMD data available with and without dyssynchrony had similar age, % females, EF and mitral regurgitation. Once again, patients with ischemic disease had less prevalent dyssynchrony by IVMD ≥ 40 ms compared with those with nonischemic disease; 43% vs. 69%. Similar to radial dyssynchrony, significant IVMD dyssynchrony was associated with wider QRS duration 171 ± 27 ms vs. 147 ± 21 ms in those without significant IVMD (p<0.05).
Follow-up for the 210 patients with available echocardiographic dyssynchrony data was for a period of 4 years. CRT implants occurred throughout this period in this single center experience, and the numbers reflect the variable follow-up duration, ranging from a minimum of 1 year to 4 years. During this period, 62 outcome events occurred including 47 deaths, 9 transplants and 6 LVAD implantations. Notably, one of these unfavorable clinical events occurred < 6 months after CRT implant in 30 patients. Patients with IVMD ≥ 40ms had a significantly more favorable outcome following CRT than those with IVMD < 40 ms (p=0.019) (Fig 2). OWD by TDI using our pre-defined cut-off of ≥ 65 ms had a trend for a better outcome, but this only came close to statistical significance (p= 0.075) (Fig. 3A) We then performed post hoc analysis with a OWD cut-off of ≥ 80 ms, which was associated with a statistically significant more favorable event-free survival after CRT (p=0.011) (Fig. 3B). Yu index as prospectively defined ≥ 32 ms was predictive of survival free from transplant or LVAD (p=0.003) (Fig 4). Radial dyssynchrony ≥ 130 ms by speckle tracking was highly associated with event-free survival following CRT (p=0.003) (Fig. 5). Importantly, when adjusted for the covariates of ischemic etiology and QRS duration using a Cox proportional hazard model, the Yu Index and radial strain remained independently predictive of event-free survival (p<0.05). The hazard ratio of radial dyssynchrony for predicting survival was 2.21, with a 95% confidence interval (CI) of 1.35 – 4.79, p = 0.003. When adjusted for QRS, the instantaneous relative risk was 0.55 with 95% CI of 0.32 – 0.944, p = 0.03. When adjusted for ischemic disease, the instantaneous relative risk was 0.53, with a 95% CI of 0.31 – 0.92, p = 0.03. The hazard ratio of the Yu Index for predicting survival was 2.13 with a 95% CI of 1.38 – 4.46, p = 0.003. When adjusted for QRS, the instantaneous relative risk was 0.51 with 95% CI of 0.30 – 0.85, p = 0.01 and when adjusted for ischemic disease, the instantaneous relative risk was 0.53 with a 95% CI of 0.31 – 0.90, p = 0.02. In contrast, IVMD and OWD were too closely associated with ischemic etiology to be independently predictive.
Using receiver operator characteristic curve analysis, the Yu Index with a cut-off of 32 ms was highly specific at 78%, but less sensitive at 40% for predicting death, transplant or LVAD. (Figure 6). Radial strain with a cut-off of 130 ms was similarly specific at 79% and less sensitive at 39% for predicting clinical outcome. Accordingly, excluding dyssynchrony by Yu Index or radial strain was specifically associated with death, transplant or LVAD following CRT. For comparison, the area under the curve for radial strain at 0.65 was greater than the Yu Index at 0.55.
Subgroup analysis was performed to examine the potential relationship of QRS width and dyssynchrony to survival following CRT using a pre-defined QRS cut-off. Patients with narrower QRS width 120–150 ms (n = 122) were compared to those with QRS > 150 ms (n=136). Dyssynchrony by the Yu Index was associated with a more favorable outcome in either QRS duration group, with wider QRS patients with dyssynchrony having the best outcome, and narrower QRS patients without dyssynchrony having the poorest outcome. (Fig 7). With regard to radial dyssynchrony, patients with QRS width > 150 ms similarly favorable outcome, however, those with QRS width 120–150 ms who lacked radial dyssynchrony had a particularly poor prognosis (p=0.003 vs. all other groups). (Fig. 8).
This study demonstrated the relationship between several echocardiographic dyssynchrony markers and the important outcome variable of long term survival following CRT. A large series of consecutive patients were included using a prospective longitudinal study design with pre-specified end-points. The echocardiographic approach revealed a relatively high yield (89%) in consecutive patients referred for CRT. Baseline clinical variables were balanced overall in those patients with and without dyssynchrony, however the lack of dyssynchrony was significantly more prevalent in those with ischemic disease. Radial dyssynchrony and IVMD were also related to baseline QRS width. As expected from this severely ill group of heart failure patients, there were a large number of the unfavorable events of death, heart transplant or LVAD. Using pre-defined cut-offs, baseline dyssynchrony before CRT by the Yu Index, speckle tracking radial strain anterioseptal to posterior wall delay, and IVMD were all associated with more favorable survival free from transplant or LVAD. The TDI OWD with the pre-defined cut-off of ≥ 65 ms had a trend for association with event-free survival (p=0.075), however, an OWD cut-off of ≥ 80 ms by post hoc analysis became significantly associated (p=0.011). Of note, the Kaplan-Meier curves for each of these TDI indices did not diverge until after the first 6 months after CRT, which was the follow-up interval of PROSPECT. Of the 191 patients with both Yu index and radial dyssynchrony data available, 128 (67%) were concordant for dyssynchrony using pre-specified cut-off values. When considering 8 additional patients with borderline dyssynchrony values ± 5 ms for Yu index and ± 10 ms for radial dyssynchrony, concordance increased to 71%. The exact reason for discordance is unknown. Perhaps TDI longitudinal velocity and speckle tracking radial strain assess different aspects of dyssynchrony and provide additional information. 15 When adjusted for covariates of ischemic etiology and QRS width, the Yu Index and radial strain remained independently predictive of outcome. Subgroup analysis demonstrated that patients with narrower QRS width 120–150 ms who lacked radial dyssynchrony had a particularly poor survival. These observations strongly support the association of echocardiographic dyssynchrony with long-term patient outcome after CRT.
Several previous studies have also shown the ability of echocardiographic mechanical dyssynchrony to predict response to CRT.4,5,7,8,15–17,20–25 Baseline dyssynchrony has been related to improvement in heart failure class, 6-minute walk distance, quality of life score, EF and reductions in end-systolic volumes. However, the multicenter PROSPECT study of predictors of response to cardiac resynchronization therapy failed to show conclusively that a single echocardiographic dyssynchrony measure was highly predictive. 9 Although there have been over a hundred published articles supporting the utility of echocardiographic dyssynchrony to predict CRT response, PROSPECT has had a particularly high impact on clinical opinion because of its prospective multicenter design. CRT guidelines continue to use QRS width as a surrogate for mechanical dyssynchrony. 26 Several acknowledged limitations of PROSPECT included a low yield of feasibility, high variability using three different echocardiographic systems and software, and three different echo core labs. 11,12 For example, the overall yield for routine measures in PROSPECT such as end-systolic volumes was approximately 67%, indicating poor image quality in a third of patients. Furthermore, TDI Yu Index was feasible in only 50% of attempted studies, in contrast to the present study with a yield of 89% of consecutive CRT patients. Importantly, the follow-up was limited to 6 months in PROSPECT which may likely have been too short a duration to demonstrate the relationship of dyssynchrony with patient outcome.
Specific echocardiographic measures of dyssynchrony predictive of outcome following CRT have been reported by several authors. Bax et al. demonstrated that a TDI OWD of ≥ 65 ms was associated with a lower incidence of heart failure hospitalizations and death in the first year following CRT. 5 This OWD cut off of 65 ms in our present study had a strong trend to significantly predicting survival free from transplant or LVAD, however, we did not include heart failure hospitalizations as and end-point. Pitzalis et al. used M-mode to show that an anteroseptal to posterior wall delay of ≥ 130 ms successfully predicted outcome. 23 We and others have had more success with speckle tracking radial strain to assess anteroseptal to posterior wall delay, with a favorable predictive value using the same 130 ms cut-off value. 7 Bank et al. showed that radial strain by speckle tracking was also predictive of response to CRT in a multicenter study. 27 Analyses from the CARE HF trial used a cut-off of 49 ms for IVMD to demonstrate its value to predict outcome following CRT. 28 We selected a pre-defined IVMD cut-off of ≥ 40 ms as originally described and also used in the PROSPECT trial. 9,18 More recently, Chailil et al. used cardiac magnetic resonance imaging to assess dyssynchrony and predict mortality following CRT. 29 Others have shown that mechanical dyssynchrony either independently or when combined with clinical markers is associated with a more favorable survival following CRT. 30 Furthermore, echocardiographic dyssynchrony has been shown to be a marker for mortality in heart failure patients with narrow QRS duration using TDI or after myocardial infarction using velocity vector imaging. 31 We observed that the absence of radial dyssynchrony in patients with QRS 120–150 ms to be associated with a particularly high probability of death, transplant or LVAD. Radial dyssynchrony was not associated with outcome in patients with QRS > 150 ms. However, we observed that the Yu Index was particularly associated with outcome in patients with QRS >150 ms. The exact reason for these results is unclear, but suggests that the TDI Yu index and speckle tracking radial strain may be assessing different aspects of LV dyssynchrony. 15 More recently, radial and transverse strain by speckle tracking was shown to be associated with ejection fraction response and survival after CRT in a separate multicenter study using different echocardiographic equipment and software.31 In summary, this present study demonstrates that baseline echocardiographic dyssynchrony is associated with a more favorable outcome following CRT, and that patients who lack dyssynchrony may be identified as being at comparatively higher risk for death, transplant or LVAD following CRT.
The present study was not part of a randomized trial, and the relationship of echocardiographic dyssynchrony to survival in those who do not undergo CRT remains unknown. Although the absence of echocardiographic dyssynchrony appears to be a marker for a worse prognosis in patients following CRT, the potential influence of CRT on outcome in patients without dyssynchrony remains unknown. However, it is presently difficult to withhold CRT from patients who meet current CRT implantation criteria to elucidate this point. Another limitation was that echocardiographic dyssynchrony analysis could not be successfully performed on all consecutive CRT patients, and 10–11% of patients did not have adequate image quality for quantification. Furthermore, high quality images appear to especially important for speckle tracking analysis. 7,15,32 It is acknowledged that these echocardiographic methods are operator dependent, and require user experience. In particular, technical difficulties with speckle tracking strain occurred in regions of myocardial scar, and appeared to be more robust in patients with nonischemic cardiomyopathies. However, reproducible results may be achieved with a systematic core-lab approach, detailed in the methods. A limitation of the study design may be considered that all survival free from heart transplantation or LVAD was used as the primary end-point, rather than all cause mortality. However, heart transplantation and LVAD implantation in our institution are utilized only in heart failure patients with a very limited life span anticipated without these interventions. Another limitation was that markers of CRT response used in other clinical trials, such as heart failure hospitalizations, 6-minute walk distance, peak myocardial oxygen consumption, LV reverse remodeling or EF improvement were not part of the present study. It may be considered a limitation that ischemic etiology may influence response to CRT from scar burden or lead positioning and have confounding effects. 33,34 Analysis of scar burden and lead positioning was not part of the current study. We demonstrated that when adjusting specifically for ischemic etiology, the Yu index and speckle tracking radial strain remained independently associated with survival. Our subgroup analysis on heart failure etiology and QRS width provided additive information which may be of clinical impact. Recent data support the potential utility of echocardiographic dyssynchrony in patients with less wide QRS duration as an adjunct to clinical decision making. 22 It remains uncertain how these data will directly influence clinical practice, and ongoing further study is warranted.
This study demonstrated the association of echocardiographic dyssynchrony with long term survival following cardiac resynchronization therapy (CRT). We studied 229 consecutive patients with routine CRT indications (symptomatic heart failure, reduced ejection fraction and widened QRS ≥ 120 ms) of which 210 (89%) had baseline echocardiographic dyssynchrony data available. Dyssynchrony was pre-specified as tissue Doppler longitudinal velocity opposing wall delay ≥ 65 ms, 12-site standard deviation (Yu Index) ≥ 32 ms, speckle tracking radial strain anteroseptal to posterior wall delay ≥130 ms, or pulsed Doppler interventricular mechanical delay ≥ 40 ms. Of 210 patients, there were 62 unfavorable events over 4 years after CRT: 47 deaths, 9 transplants, and 6 left ventricular assist device implantations. All echo dyssynchrony indices were significantly associated with a more favorable long term prognosis than patients without dyssynchrony, except tissue Doppler velocity opposing wall delay became significant at ≥ 80 ms. When adjusted for covariates of ischemic etiology and QRS width, the Yu Index and speckle tracking radial strain remained independently predictive of outcome. Subgroup analysis demonstrated that patients with narrower QRS width 120–150 ms who lacked radial dyssynchrony had a particularly poor survival. Although this study has identified the absence of echocardiographic dyssynchrony as a marker for a less favorable prognosis in patients who undergo CRT for routine indications, the potential influence of CRT on outcome in patients without dyssynchrony remains unknown. These observations strongly support the association of echocardiographic dyssynchrony with long-term patient outcome after CRT.
The authors are grateful to the entire University of Pittsburgh Medical Center Electrophysiology Laboratory faculty and staff for their continued support and cooperation.
Funding Sources: Dr. Gorcsan was supported in part by N.I.H. award K24 HL04503-01.
Disclosure: GE Medical Systems donated the software and technical support for this study.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Spending for online ads delivered via fixed broadband service in the United States will reach $58 billion in five years, or 40 percent of the $143 billion projected to be spent worldwide on online ads, according to a new report from Digital TV Research.
The report, "Online Advertising Forecasts," released Nov. 14, 2012, also projects the U.K. will see fixed broadband online ad spending grow to $11.7 billion in 2017, and China will see an increase to $10.8 billion in 2017. In 2014, China will overtake Japan as third in overall online ad spending.
In the United States, the 2017 projection is more than twice the $26 billion spent on online ads in 2010. U.S. online advertising spending will continue to top the list of spending in all territories throughout the period measured.
The 2017 forecast for worldwide online ad spending is more than double the $66 billion posted in 2012 and significantly higher than the $92 billion projected for 2012. Driving this growth is the increasing adoption of broadband service by households around the world, the report says.
By 2017, 745 million homes in 40 countries will subscribe to fixed broadband, up from 473 million in 2010, it says. The 2017 total represents 49.2 percent of total households, up from 33.5 percent at the end of 2010.
Online advertising per fixed-broadband household will increase from $139 in 2010, to $165 in 2012 and $197 by 2017, the report said. Digital TV Research did not include mobile advertising in the projections.
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subset: commoncrawl


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Third time lucky for Kanye West? Singer set to revive his failed fashion line after APC success - and this time it will be unisex
Third time lucky: After the success of his APC collaboration last week, Kanye West may revive his own fashion label
After the success of his APC collaboration last week, Kanye West may revive his own fashion label.
The rapper released his debut womenswear collection, DW by Kanye West, in 2011 to scathing reviews, but he now looks set to make a fashion comeback with a unisex spring/summer 2014 line.
The 36-year-old reportedly spent a week in Milan working on a new collection with the help of Diesel's artistic director, Nicola Formichetti.
According to Vogue, the collection will comprise of 100 unisex pieces to be unveiled during the September shows.
The revival could be third time lucky for Mr West - who closed his fashion label in March 2012 - after showing at Paris Fashion Week for two seasons.
His fashion debut was been slated by industry insiders, who gave the musician less than tepid reviews.
Mr West, who moved to Rome to work as an intern for Fendi as part of his research, was accused of 'lack[ing in] creative marksmanship,' and his efforts were called 'stupendously vacuous'.
The Wall Street Journal wrote at the time: 'Good thing Kanye has a day job... The only thing
more painful than witnessing the dresses was watching the model pitch down
the runway in shoes so ill-fitting that her spike heels were bending at
Reminiscing about his fashion endeavours, the singer recently said: 'The first collection was way better than the second, it was more artful. It was 30 collections in one.
Slash and burn: Slashed bandage dresses,
colour block trousers and oddly bulbous shoes did nothing to charm
critics, with some saying the fit was poor
'It just takes time for me to slow down and think like a normal person. I have to somehow put out something that says, "I look sensible!"'
The musician recently collaborated with French label APC on a capsule menswear collection, which sold out within hours of being made available online - and the heavy stream
of traffic even caused the site to crash.
collaboration - which features T-shirts, sweatshirts and jeans priced
between $120 and $280 - was available for pre-order, and it is not known
when a second drop of products will be expected.
One for the boys: Mr West's sold out APC menswear collaboration features T-shirts, sweatshirts and jeans priced between $120 and $280
Two years to make: APC creative director Jean Touitou said the pieces are 'precious' to both he and Mr West 'because it took time and thoughts to get there'
APC creative director Jean Touitou, who worked with Kanye West on the new collection, told W Magazine that because of Mr West's 'strong obsessions,' it took two years to create just three items.
A spokesperson for the singer declined to comment on the new collection, however his move into unisex apparel could be attributed to his sudden success with APC.
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Five Must Have Business Utilities In 2013
As we all know, it is tough to start your own business, especially with the drastic ups and downs of this modern economic climate. With the right tools you will be able to tackle any task that you put your mind to; however if you are not prepared, your business will be eaten alive by the competition. Here are some of the utilities that you will need to help your business grow, even in the face of these obstacles.
1. Google Analytics
We all know how important it is to drive traffic to a new website. Without traffic a business simply will not succeed. If your business does get traffic, you obviously want to know where it is coming from. The traffic can come from a variety of sources, such as referrals and direct visits, and it is important to know where the traffic is coming from so you can maximize the money that you spend on internet advertising and marketing campaigns.
With Google analytics you can see where your traffic is coming from, as well as more advanced metrics. You can also see the time a visitor stayed, the pages they searched, the bounce rate of your website, the keywords they typed into a search engine to get to your website, and much more. You can maximize your traffic, enabling you to monetize your traffic more effectively.
2. Odesk
When you start a business, you most likely will not have the budget to purchase a brick and mortar building right away, but there are some support services that you will need. You will likely need some help building a website, marketing your business, and even building special software for your company.
With Odesk you can easily find qualified professionals that are willing to work at very competitive rates. You can post the specifics of the job that you need done, and then have freelance experts bid on the services that you need. The best part about Odesk, is that it is very safe to use. Most of the time, with the right contract, you will not have to pay for the work until the work is done. The rating system at Odesk allows you to see the feedback about the freelancers that you are considering hiring, so that you will be able to find the most qualified person to do the job that you need.
3. DropBox
While working with freelancers, it can get very overwhelming checking emails and logging into Odesk to check the work you outsourced. You need a tool that will make gathering and sorting the information much easier.
With DropBox you can install an extension to your computer that works off of a cloud server where you can share documents and information with the people that you have doing work for you, without the hassle of sending and receiving the information through email. It is very easy to use: all you have to do is right click an icon on your task bar and it will open up files on your cloud server, enabling you to simply drag and drop the documents you need without sifting through countless emails and other communication.
When you start to get traffic and increase the number of customers that you are dealing with at one time you will need a system to help you keep your sales focused. Customer relationship management, or CRM, is the solution that your business will need to keep your customer information organized.
SugarCRM offers incredible CRM software that will help you manage your clients with ease. You can upload contracts, enter in leads, add phone numbers, sync your social accounts, and much more. The largest advantage to SugarCRM is that they provide open source code that allows you to add modules and other custom pieces that will let you customize SugarCRM to handle the tasks that you need it to do. SugarCRM is by far the best tool to keep your customer information organized and help you convert more potential customers into paying customers.
After you have the tools to drive traffic, analyze traffic, monetize your traffic, and input your data, you will need something to make the transaction official.
With EchoSign you can send your contracts quickly to your client's email, where they can open it and digitally sign their signature. After they sign it you will have a legally recognized copy in your EchoSign account, which drastically reduces the amount of time that it takes to get contracts signed, sealed and delivered, so that you can get to work fulfilling your customers' orders.
About the Author: My name is Matthew Boley, and I run many successful small businesses that range from local construction to a large marketing company. I could not have done it without the small business tools that I have already discussed. I wrote this article because I feel it is important to tell others about what helped me along my way to success.
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Sunday, July 24, 2016
Suggested Readings on Kurdish History?
Since I will be living and working in Kurdistan come the end of August I have been trying to educate myself on the region and its people. So far this has largely consisted of keeping up with news stories on the region, watching a few documentaries and interviews on Youtube, and listening to a lot of Kurdish music on Youtube. Granted these are rather superficial sources. But, one has to start somewhere. So I am asking for suggested readings on Kurdish history here. Currently I am in Kyrgyzstan so unfortunately I do not have access to JSTOR and other academic databases right now. Please bear that in mind regarding accessibility.
Posted by J. Otto Pohl at 1:10 AM No comments:
Saturday, July 23, 2016
A Sunny Saturday in Bishkek
Posted by J. Otto Pohl at 2:43 AM 1 comment:
Thursday, July 21, 2016
Bishkek in July
This summer Bishkek has had an usually large number of rainy and cool days. Usually it is hot all the time. But, this summer has been anything other than usual.
I have been having extensive dental work done here prompted by the need for an emergency root canal. Since dental work here is very cheap and relatively good in quality I suppose it is a good thing in the long run. But, I really don't like people sticking sharp instruments in my mouth.
I have been having extensive dental work done here prompted by the need for an emergency root canal. Since dental work here is very cheap and relatively good in quality I suppose it is a good thing in the long run. But, I really don't like people sticking sharp instruments in my mouth.
Posted by J. Otto Pohl at 10:17 AM No comments:
Tuesday, July 19, 2016
Next Month is the 75th Anniversary of the Deportation of the Volga Germans
Posted by J. Otto Pohl at 3:32 AM 2 comments:
Sunday, July 17, 2016
I just got back from two days in Almaty Kazakhstan. Due to the collapse of oil prices Kazakhstan is now cheaper than Kyrgyzstan despite the fact that Almaty has a level of development comparable to most European cities. Indeed going from Bishkek to Almaty is a lot like going from Mexico to the US in terms of architectural modernity. The cityscape of Almaty thus is in many ways much closer to that of cities in the EU and North America than it is to Bishkek. Even the old Soviet apartment blocks in Almaty look a lot newer and better maintained than those in Bishkek. The huge Megacenter mall has a lot of US franchises that I have not seen in many years including Burger King, Costas, Gloria Jean's, and Hardees. In addition to Central Asian food it has restaurants serving Japanese, Chinese, Vietnamese, Georgian, Italian, and Croatian dishes among others. The tiny Ramstor at Vefa Center left Bishkek after 2010. But, the Megacenter has a huge and fully stocked Ramstor. Besides the Megacenter we also took the cable car ride above the city. It is like a ski lift but you take it down from the mountain and back. You get up the mountain in the first place on a minibus. I am not sure of all the reasons for the much greater development in Almaty than Bishkek. One clear reason is of course Kazakhstan's natural resources most notably oil and gas and the recent long run of high prices for these commodities. Another is undoubtedly political stability. Kazakhstan has been under the rule of the same man for its entire existence as an independent state. He was head of the Kazakh SSR for two years before that. In contrast Kyrgyzstan has had two major revolutions in recent years. They had one in 2005 and another in 2010. These two factors are undoubtedly major contributors to the much higher foreign investment Kazakhstan has received compared to Kyrgyzstan in the last decade. Finally, Almaty is a welcome relief from Bishkek and Accra in being free of NGO parasites from the EU and North America. For instance there is no Peace Corp in Kazakhstan. The absence of such organizations and their extremely corrupting influence on society undoubtedly has also played a significant role in Kazakhstan's recent social and economic development.
Posted by J. Otto Pohl at 1:35 AM 5 comments:
Monday, July 11, 2016
On the Move Again (Kurdistan)
Posted by J. Otto Pohl at 1:06 AM 4 comments:
Monday, July 04, 2016
Happy Independence Day to all my American Readers
Happy Independence Day to all my American readers both in the US and abroad.
Posted by J. Otto Pohl at 8:46 AM 1 comment:
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text:
Trisomy 18 Treatment & Management
- Author: Harold Chen, MD, MS, FAAP, FACMG; Chief Editor: Luis O Rohena, MD more...
Medical Care
See the list below:
- Medical care in trisomy 18 is not directed, or it is supportive if that is the family's wish.
- There are confirmed 20+-year-old patients with this disorder; at least 5-10% of these patients survive, and parents are not typically prepared to care for them long term. In general, cardiac management is the most intense decision parents have to make.
- Treat infections as appropriate. These are usually secondary to otitis media, upper respiratory tract infections (eg, bronchitis, pneumonia), and urinary tract infection.
- Sepsis is a continuous concern.
- Provide nasogastric and gastrostomy supplementation for feeding problems.
- Orthopedic management of scoliosis may be needed secondary to hemivertebrae.
- Cardiac management is primarily medical. Most of these children require a diuretic and digoxin for congestive heart failure. Optional treatment for cardiac lesions includes the following:
- Intensive cardiac management with pharmacological intervention for ductal patency (indomethacin and/or mefenamic acid for closure, and prostaglandin E1 for maintenance) and palliative and corrective cardiac surgery was demonstrated to improve survival in patients with trisomy 18.[30]
- In a study of patients with trisomy 18 who had cardiac lesions, 82% of patients undergoing heart surgery were discharged home with alleviated cardiac symptoms; congenital heart defect–related death occurred in only one patient, suggesting that cardiac surgery is effective in preventing congenital heart defect–related death; and initial palliative surgery was associated with longer survival than intracardiac repair.[31]
- Neonatal intensive care (NICU) management
- Management of neonates with trisomy 18 is controversial, purportedly because of the prognosis and the lack of precise clinical information concerning the efficacy of treatment.[32]
- Improved survival (in one study,[32] survival rates at age 1 wk, 1 mo, and 1 y, respectively, were 88%, 83%, and 25%; median survival time, 152.5 d) through NICU treatment (eg, cesarean delivery, resuscitation, respiratory support, and surgical procedures) are helpful for clinicians to offer the best information on treatment options to families of patients with trisomy 18.
- A survey of US neonatologists regarding newborn care of trisomy 18 infants reported that 44% would provide medical intervention (including resuscitation), primarily because of parental wishes to support the baby.[33]
- For an excellent recent review of survival rates and the evolving natural history of trisomy 18, please see Cereda A, Carey JC. The trisomy 18 syndrome. Orphanet J Rare Dis. 2012;7:81.[19]
- Genetic counseling
- Recurrence risk is 1% or less for full trisomy 18. If a parent is a balanced carrier of a structural rearrangement, the risk is substantially high.
- The risk should be assessed based on the type of structural rearrangement and its segregation pattern.
- The wide phenotypic variation and lack of correlation with the percentage of trisomic cells in mosaic trisomy 18 makes informative prediction of natural history and genetic counseling challenging.[13]
- Patients with large 18q duplications (which may arise from parental translocations/inversions) or "partial trisomy 18" could benefit from the same routine ultrasonographic screening for Wilms tumor as those with full trisomy 18, because early detection is essential to optimizing survival.[34]
- Psychosocial management
- During the neonatal period, issues of diagnosis and survival are paramount. Parents need information about the syndrome, including its cause, implications, and possible outcomes.
- Support services within the hospital and in the community should be made available to the family.
- The presence of a disabled child in any family is a source of stress and anxiety.
- Families also undergo a complex grieving process that combines both the reactive grief predominant in chronic illness and the preparatory grief associated with impending death.
Surgical Care
Because of the extremely poor prognosis, surgical repair of severe congenital anomalies such as esophageal atresia or congenital heart defects should be discussed with families.
A retrospective study by Nakai et al indicated that cardiac surgery can prolong survival in trisomy-18 patients who have high pulmonary blood flow. The study involved 20 patients, including 10 who underwent cardiac surgery with pulmonary artery banding and 10 who were treated conservatively; the surgical patients survived for a significantly longer period (495 days) than did the conservative management group (93.1 days).[35]
See the list below:
- Clinical geneticist
- Developmental pediatrician
- Cardiologist
- Ophthalmologist
- Orthopedist
- Psychologist
- Speech language pathologist
- Audiologist
- Early childhood educational programs
- Consider involving the institution's ethics committee if surgical intervention is recommended.
See the list below:
- No special diet is required.
See the list below:
- Activities are limited because of profound mental retardation and physical handicaps.
Edwards JH, Harnden DG, Cameron AH, et al. A new trisomic syndrome. Lancet. 1960 Apr 9. 1:787-90. [Medline].
Smith DW, Patau K, Therman E, Inhorn SL. A new autosomal trisomy syndrome: multiple congenital anomalies caused by anextra chromosome. J Pediatr. 1960 Sep. 57:338-45. [Medline].
Cereda A, Carey JC. The trisomy 18 syndrome. Orphanet J Rare Dis. 2012 Oct 23. 7:81. [Medline]. [Full Text].
Rasmussen SA, Wong LY, Yang Q, May KM, Friedman JM. Population-based analyses of mortality in trisomy 13 and trisomy 18. Pediatrics. 2003 Apr. 111(4 Pt 1):777-84. [Medline].
Meyer RE, Liu G, Gilboa SM, et al. Survival of children with trisomy 13 and trisomy 18: A multi-state population-based study. Am J Med Genet A. 2015 Dec 10. [Medline].
Kelly M, Robinson BW, Moore JW. Trisomy 18 in a 20-year-old woman. Am J Med Genet. 2002 Nov 1. 112(4):397-9. [Medline].
Lebel RR, Roberson J, Van Dyke DL. Regarding trisomy 18. Am J Med Genet A. 2006 May 1. 140(9):964-5. [Medline].
Shanske AL. Trisomy 18 in a second 20-year-old woman. Am J Med Genet A. 2006 May 1. 140(9):966-7. [Medline].
Embleton ND, Wyllie JP, Wright MJ, et al. Natural history of trisomy 18. Arch Dis Child Fetal Neonatal Ed. 1996 Jul. 75(1):F38-41. [Medline].
Nicolaidis P, Petersen MB. Origin and mechanisms of non-disjunction in human autosomal trisomies. Hum Reprod. 1998 Feb. 13(2):313-9. [Medline]. [Full Text].
Crider KS, Olney RS, Cragan JD. Trisomies 13 and 18: population prevalences, characteristics, and prenatal diagnosis, metropolitan Atlanta, 1994-2003. Am J Med Genet A. 2008 Apr 1. 146(7):820-6. [Medline].
Morris JK, Savva GM. The risk of fetal loss following a prenatal diagnosis of trisomy 13 or trisomy 18. Am J Med Genet A. 2008 Apr 1. 146(7):827-32. [Medline].
Tucker ME, Garringer HJ, Weaver DD. Phenotypic spectrum of mosaic trisomy 18: two new patients, a literature review, and counseling issues. Am J Med Genet A. 2007 Mar 1. 143(5):505-17. [Medline].
Carey JC. Trsiomy 18 and trisomy 13 syndromes. Cassidy SB, Allanson JE. Management of Genetic Syndromes. 2nd. New York, NY: Wiley-Liss; 2005. 555-68.
Bettio D, Levi Setti P, Bianchi P, Grazioli V. Trisomy 18 mosaicism in a woman with normal intelligence. Am J Med Genet A. 2003 Jul 15. 120(2):303-4. [Medline].
Staples AJ, Robertson EF, Ranieri E, Ryall RG, Haan EA. A maternal serum screen for trisomy 18: an extension of maternal serum screening for Down syndrome. Am J Hum Genet. 1991 Nov. 49(5):1025-33. [Medline]. [Full Text].
Perni SC, Predanic M, Kalish RB, Chervenak FA, Chasen ST. Clinical use of first-trimester aneuploidy screening in a United States population can replicate data from clinical trials. Am J Obstet Gynecol. 2006 Jan. 194(1):127-30. [Medline].
Breathnach FM, Malone FD, Lambert-Messerlian G, et al, for the First and Second Trimester Evaluation of Risk (FASTER) Research Consortium. First- and second-trimester screening: detection of aneuploidies other than Down syndrome. Obstet Gynecol. 2007 Sep. 110(3):651-7. [Medline].
Cereda A, Carey JC. The trisomy 18 syndrome. Orphanet J Rare Dis. 2012 Oct 23. 7:81. [Medline]. [Full Text].
Wei S, Siu VM, Decker A, Quigg MH, Roberson J, Xu J. False-positive prenatal diagnosis of trisomy 18 by interphase FISH: hybridization of chromosome 18 alpha-satellite DNA probe (D18Z1) to the heterochromatic region of chromosome 9. Prenat Diagn. 2007 Nov. 27(11):1064-6. [Medline].
Caughey AB, Hopkins LM, Norton ME. Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstet Gynecol. 2006 Sep. 108(3 Pt 1):612-6. [Medline].
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 88, December 2007. Invasive prenatal testing for aneuploidy. Obstet Gynecol. 2007 Dec. 110(6):1459-67. [Medline].
ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 2007 Jan. 109(1):217-27. [Medline].
Lo YM, Corbetta N, Chamberlain PF, et al. Presence of fetal DNA in maternal plasma and serum. Lancet. 1997 Aug 16. 350(9076):485-7. [Medline].
Ashoor G, Syngelaki A, Wagner M, Birdir C, Nicolaides KH. Chromosome-selective sequencing of maternal plasma cell-free DNA for first-trimester detection of trisomy 21 and trisomy 18. Am J Obstet Gynecol. 2012 Apr. 206(4):322.e1-5. [Medline].
Wiedmeier SE, Henry E, Christensen RD. Hematological abnormalities during the first week of life among neonates with trisomy 18 and trisomy 13: data from a multi-hospital healthcare system. Am J Med Genet A. 2008 Feb 1. 146(3):312-20. [Medline].
Sepulveda W, Wong AE, Dezerega V. First-trimester sonographic findings in trisomy 18: a review of 53 cases. Prenat Diagn. 2010 Mar. 30(3):256-9. [Medline].
Zheng Y, Zhou XD, Zhu YL, Wang XL, Qian YQ, Lei XY. Three- and 4-dimensional ultrasonography in the prenatal evaluation of fetal anomalies associated with trisomy 18. J Ultrasound Med. 2008 Jul. 27(7):1041-51. [Medline].
Lin HY, Lin SP, Chen YJ, et al. Clinical characteristics and survival of trisomy 18 in a medical center in Taipei, 1988-2004. Am J Med Genet A. 2006 May 1. 140(9):945-51. [Medline].
Kaneko Y, Kobayashi J, Yamamoto Y, Yoda H, Kanetaka Y, Nakajima Y. Intensive cardiac management in patients with trisomy 13 or trisomy 18. Am J Med Genet A. 2008 Jun 1. 146A(11):1372-80. [Medline].
Kaneko Y, Kobayashi J, Achiwa I, Yoda H, Tsuchiya K, Nakajima Y. Cardiac Surgery in Patients with Trisomy 18. Pediatr Cardiol. 2009 Apr 2. [Medline].
Kosho T, Nakamura T, Kawame H, Baba A, Tamura M, Fukushima Y. Neonatal management of trisomy 18: clinical details of 24 patients receiving intensive treatment. Am J Med Genet A. 2006 May 1. 140(9):937-44. [Medline].
McGraw MP, Perlman JM. Attitudes of neonatologists toward delivery room management of confirmed trisomy 18: potential factors influencing a changing dynamic. Pediatrics. 2008 Jun. 121(6):1106-10. [Medline].
Starr LJ, Sanmann JN, Olney AH, Wandoloski M, Sanger WG, Coulter DW. Occurrence of nephroblastomatosis with dup(18)(q11.2-q23) implicates trisomy 18 tumor screening protocol in select patients with 18q duplication. Am J Med Genet A. 2014 Apr. 164A(4):1079-82. [Medline].
Nakai Y, Asano M, Nomura N, Matsumae H, Mishima A. Effectiveness of cardiac surgery in patients with trisomy 18: a single-institutional experience. Cardiol Young. 2016 Jan 28. 1-6. [Medline].
[Guideline] Cunniff C. Prenatal screening and diagnosis for pediatricians. Pediatrics. 2004 Sep. 114(3):889-94. [Medline].
Bronsteen R, Lee W, Vettraino IM, et al. Second-trimester sonography and trisomy 18. J Ultrasound Med. 2004 Feb. 23(2):233-40. [Medline].
Carey JC. Introductory comments - special section: Prader-Willi syndrome. Am J Med Genet A. 2007 Mar 1. 143(5):413-4. [Medline].
Chen CP. Aplasia and duplication of the thumb and facial clefts associated with fetal trisomy 18. Am J Med Genet A. 2006 May 1. 140(9):960-3. [Medline].
Chen H. Trisomy 18 syndrome. Atlas of Genetic Diagnosis and Counseling. 2nd ed. New York Dordrecht Heidelberg London:Springer: Humana Press; 2012. 3: 2069-2080.
Moyano D, Huggon IC, Allan LD. Fetal echocardiography in trisomy 18. Arch Dis Child Fetal Neonatal Ed. 2005 Nov. 90(6):F520-2. [Medline].
Niedrist D, Riegel M, Achermann J, Schinzel A. Survival with trisomy 18--data from Switzerland. Am J Med Genet A. 2006 May 1. 140(9):952-9. [Medline].


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Add your site here! Send an email to links @ kwintessential.co.uk
Translation service providers in or near Anderson, Indiana include:
|Mendi+Keith Obadike -If theHeavensDon't Hear(A Roller Skating Jam for Marian Anderson)Voidwell Remix
MENDI + KEITH OBADIKE | Document: If the Heavens Don't Hear, the Earth Will Hearfree downloadhttp://www.mediafire.com/ObadikeStudio· Side A: "If the Heavens ...
|Lili Marlene (Lale Andersen - English translation)
Lili Marlene, Lale Andersen's English translation
|Lost In Translation
simply the life.....Lost In Translation Streets Of Philadelphia Bruce Springste David Grimm fuck Suicide Hardcore tv japan treff
|Dança do Ouro by Jon Anderson
Dança do Ouro was on Jon's Deseo CD. Sung in Portuguese accompanied by the Brazilian band Boca Livre, the song is hauntingly beautiful. I have redone the vid...
|Anni-Frid Lyngstad & Agnetha Faltskog reunion (22 January 2009) + Translation
Benny Andersson and Björn Ulvaeus cant come tonight.But we are proud, we are happy to honour the winners of the Rockbjörn Lifetime achievement.Ladies and gen...


text:
PCI-e x1 to PCI-e x4
Last response: in Components
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[ Field of View ≈ 175° x 65° ] [ 4 x 14 x 7 HDR brackets(1ev) = 392 photographs ] [ Camera: Panasonic GH4 Lens: Lumix G VARIO 35-100mm, f/2.8, @35mm(ff eq 70mm), f/11.0, ss(1/1600 – 1/25), iso100 ] [ ]
Panorama of the backside or Southside of the Kop van Zuid in Rotterdam
Re-render of gigapan.com/gigapans/187987 which I didn't process properly. The light was all over the place when I took this as a storm was approaching, so I had to readjust light balances for for many of the images individually. This panorama was taken from an olive grove below the village of Perinaldo just ove...
It was raining when I got here for lunch but after a pint or so it brightened up for 15 minutes so I quickly captured this panorama hand held. This is a lovely place to eat, drink and explore. Please see www.visitmaldon.co.uk/heybridge-basin / for more info. Nikon 810 - 72 images @ 80mm, f9, ISO 200, 1/400 sec
Beach huts as far as you can see in front of the Sea-view Holiday Park. This is only half of them. Unfortunately the weather was terrible so I just took this test shot hand held. Nikon D810, 87 images @ 80mm, f9, ISO 200, 1/400
180 ° - Panorama von der Römnitz über die Domhalbinsel zur Jugendherberge, zum Barlachblick und zur Fischerei. Blick vom Steg der Seebadeanstalt.
Dairy Bush GigaPan - 357 – July 27 2016 Year 7 - Week 47 - 360° Another hot hot week and weekend. The forecast high today is around 36. The forest floor is still tinder dry. 23°C, 73 % humidity, and essentially no wind (from the W at 9 km/hr). The bloodroot is gone. This is the earliest it has happened since ...


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The story of four friends who tried running a studio and succeeded beyond their wildest dreams.
Album Reviews
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Featuring LCD Soundsystem, John Carpenter, Explosions in the Sky, Dinosaur Jr., Destroyer, and many more.
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Missing FaceTime icon on iPod touch
Ask iLounge offers readers the opportunity to get answers to their iPod-, iPhone-, iPad-, iTunes-, or Apple TV-related questions from a member of the iLounge editorial team. We'll answer several questions here each week, and of course, you can always get help with more immediate concerns from the iLounge Discussion Forums. Submit your questions for consideration using our Ask iLounge Submit Form. We reserve the right to edit questions for grammar, spelling, and length.
Q: I bought a new fourth-generation iPod touch a few days ago, but I don't see a FaceTime icon. How can I get it and download the software?
- Pablo
A: iPod touch models sold in certain Middle East countries actually have FaceTime disabled. The exact reasons for this are unknown, but it seems to apply to models MC547AB, MC540AB and MC544AB. If your iPod touch is one of these models, regardless of where you actually bought it from or which country you're now in, it will not be possible to activate FaceTime on your device without jailbreaking it. You can check the model number of your current iPod touch by going into your Settings app and choosing the About option.
You can also use the built-in Spotlight search found by swiping the left of the first home screen to try and find the FaceTime app in the event that it's been inadvertently moved to another screen or folder.
If your iPod touch is not one of the restricted models and you're still not seeing the FaceTime icon show up even in a search, check your Settings app to ensure FaceTime is not disabled in the General, Restrictions section. Also if the "FaceTime" option appears in the Settings app, try going in there and toggling FaceTime "on" to see if that makes the icon re-appear. Normally, the FaceTime icon should be present on the Home Screen by default, although in some rare cases it may be hidden as a result of restoring a prior iPod touch backup or having a restriction previously set.
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I have the ipod that contains this model, MC540AB but still I cant find facetime anywhere.
Posted by Basil in Toronto on July 7, 2013 at 2:00 PM (CDT)
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text:
The Young's modulus (see Problem P2.40) of muscle fiber is approximately 2.80 × 107 Pa. A muscle fiber 3.25 cm in length and 0.125 cm in diameter is suspended with a mass M hanging at its end. Calculate the mass required to extend the length of the fiber by 10%.
Reference problem 40
The formalism of the Young's modulus is sometimes used to calculate the reversible work involved in extending or compressing an elastic material. Assume a force F is applied to an elastic rod of cross-sectional area A0 and length L0. As a result of this force the rod changes in length by L. The Young's modulus E is defined as
a. Relate k in Hooke's Law to the Young's modulus expression just given.
b. Using your result in part (a) show that the magnitude of the reversible work involved in changing the length L0 of an elastic cylinder of cross-sectional area A0 by is


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Jumanji (Blu-ray + DVD)
Robin Williams
Joe Johnston
Starring: Robin Williams Director: Joe Johnston Rated:
Roll the dice and unleash the excitement!
LOW STOCK: Only 3 copies left
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|$16.54 Limited Time Only
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Available: Usually ships in 1-3 business days
Format: Blu-ray (2 Discs)
sku: XSDC
Brand New
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Blu-ray Details
- Number of Discs: 2
- Rated: PG
- Run Time: 1 hours, 44 minutes
- Released: June 28, 2011
- Originally Released: 1995
- Label: Sony Pictures
Performers, Cast and Crew:
|Robin Williams
|Bonnie Hunt, Kirsten Dunst, Bradley Pierce, Jonathan Hyde, David Alan Grier, Bebe Neuwirth & Patricia Clarkson
|Directed by
|Joe Johnston
|Edited by
|Robert Dalva
|Screenplay by
|Jonathan Hensleigh, Greg Taylor & Jim Strain
|Composition by
|James Horner
|Produced by
|Scott Kroopf & William Teitler
|Director of Photography:
|Thomas E. Ackerman
|Executive Production by
|Robert W. Cort, Ted Field & Larry J. Franco
Product Description:
Robin Williams, Kirsten Dunst and Bonnie Hunt star in this phenomenal adaptation of the award-winning children's book. When young Alan Parrish discovers a mysterious board game, he doesn't realize its unimaginable powers, until he is magically transported before the startled eyes of his friend, Sarah, into the untamed jungles of Jumanji! There he remains for 26 years until he is freed from the game's spell by two unsuspecting children. Now a grown man, Alan (Williams) reunites with Sarah (Hunt) and together with Judy (Kirsten Dunst) and Peter (Bradley Pierce) tries to outwit the game's powerful forces in this imaginative adventure that combines breathtaking special effects with an enchanting mixture of comedy, magic and thrills.
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Seriously, is there no one else out there? Just the mere fact that he mentions that he feels that he is now more mature, tells me that this is an issue.
Thirty-six would be young for a congressman, he is 26. I am sure he is a nice young man, and probably has a great future ahead of him, but we don't need someone who is still eligible to be on his parent's insurance plan making important decisions for the third district while in Washington.
But on the other hand, if he did nothing at all, that could possibly be an improvement over our current representative. Is this just a matter of his father pushing him to do this because he misses being in office and wants to now live vicariously through his son?
Weston, please come back in 10 years. Someone, anyone, please step forward.
John Fricke
* * *
I don't think it would be fair to exclude Weston Wamp or any other young person based solely on one's age. Youthful thinking may be the only hope of changing a political process that has become stale and gridlocked.
Though I didn't always agree with his father on every issue, he was an independent thinker and accomplished much for the Tennessee Valley. I really think such leadership has been lacking since his dad's departure and almost nothing has been accomplished since.
Welcome Weston's courage and consider most folks continue to learn and mature throughout their lifetime.
David Little
* * *
N.D. Kennedy Sr.
The Third District needs to give Weston a chance.
Will he legislate like his father? Like father like son? Of course! Because we all end up thinking just like our parents, right? Weston is his own person, and to make the assumption he will be anything but represent his constituents is absurd.
Weston Wamp's age has only one purpose, to clear the minimum age to become a Representative. His youth is a better representation of Chattanooga's forward thinking, progressive, 'dream big or go home' culture, and the open-mindedness, reach across the aisle attitude which is far overdue in Washington.
If Weston is so inexperienced, so naive, and unfit for public service, then why would he have the position Director Of Communications for one of the most successful, fastest growing companies in Chattanooga called Lamp Post Group? You want to see the future of business and economics in this city, look up what the parent company of Lamp Post Group and it's subsidiaries. They are bringing vitality to Downtown Chattanooga, Warehouse Row and are an active job creator within our city.
The people of the Third District are so unhappy with the current status of Washington, that I have no doubt the derelict barge across from the waterfront would poll better than our current Congress.
Go get em' Weston.
Justin Strickland
Weston isn't ready for Congress because he isn't mature enough? Please tell me it's a joke, because the combined maturity level of the current 535 voting members of Congress couldn't compete with the average teeny bopper, and that's on a good day.
Not wanting Weston Wamp in Congress because of concerns of his maturity is like not wanting "John Smith" to be sheriff because he "might" have an outstanding parking ticket on his record, when the current sheriff has multiple felony convictions.
Even if the concerns about Weston's maturity level are proven valid (which I sincerely doubt they will be), he will still be several steps up from what we have now. Literally every single day, I see/hear people complaining about Congress in general, and specifically that they don't care about the people for whom they work. Reelecting our current representatives will be a mistake that we have already repeated far too many times as it is.
Dallas Cole
My goodness folks, how silly can we be to think Weston Wamp's age would preclude him from being the best public servant our district can send to D.C. to represent "we the people"? Let me remind you Thomas Jefferson was 33 years old when he wrote the Declaration of Independence. George Washington was 42 when he lead our newly formed rag-tag, ill-equipped army, under most pitiful conditions, to victory and our independence and freedom from the King.
J. Pat Williams
I voted for Weston two years ago, so very happy that he will be our next representative. I won't waste time on our current situation as it should be apparent, but fresh ideas and someone who will represent our area and not a party would be a vast improvement. The whole country would be better off, if we would replace the gray hairs who are fighting for their retirements and bank accounts with new blood who will fight for real change.
Just imagine..Lots of news faces and Hillary in command?
Double rainbows every day...
Sally, if you support both Weston and Hillary, you are painfully ill-informed on at least one of the candidates' platforms, and possibly both. If double rainbows means Hillary is the CIC, I pray to never again see another double rainbow. Thank God Weston will be fighting to minimize the further harm Hillary will inflict upon our country, should both be elected.
Jim Dothard
July 26, 2016
July 25, 2016
The Democrats and liberals would have us to believe that Putin and Trump conspired on the emails. Quote: Sanders supporter, former head of the NAACP, jealous argued Monday that ... (click for more)
My wife and I have had four children who have attended and graduated from Hamilton County schools. During their time in school we volunteered at the schools and worked extensively on the PTA ... (click for more)
With the influx of money from Lookout and Signal Mountains as well as the teacher's union, one of my opponents has already been able to send out 3-4 mailers, two letters and a postcard. One should ... (click for more)
The Democrats and liberals would have us to believe that Putin and Trump conspired on the emails. Quote: Sanders supporter, former head of the NAACP, jealous argued Monday that the Russians couldn't be blamed for the content of the emails. "What I know for sure is that the Russians didn't write the emails. That is the most important thing, what was in the ... (click for more)
My wife and I have had four children who have attended and graduated from Hamilton County schools. During their time in school we volunteered at the schools and worked extensively on the PTA boards. We believe we have some first hand knowledge of the workings in the school system. For some time now, the entire school board has lost sight of what is going on in the schools and ... (click for more)
The customer who shot and killed a robber at an East Ridge convenience store on June 30 said the robber threw a cigarette rack at him and also threatened to kill a female clerk. Charles Russell also said that he fired when Anthony Edmonds reached for something. He said he thought he was going for a gun. East Ridge Police said Edmonds was armed with a meat cleaver that he wielded ... (click for more)
The District Attorney's Office defended a controversial suspended sentence in a rape case involving a substitute county school bus driver. Prosecutor Jason Demastus said the victim, who was 15 years old at the time of the March 2015 incident, was in agreement on the plea and refused to testify against Alexander Rodriquez. Rodriguez, 34, last Thursday pleaded guilty to ... (click for more)
J.D. Dunbar had been promoted to head wrestling coach at Ooltewah High School. Dunbar, an assistant with the Owls' mat program since 2012, becomes a head coach for the first time at the high school level. He replaces Bryant Blackmon, who recently resigned. The 36-year-old Dunbar is also the school's strength and conditioning coach and assistant head football coach on ... (click for more)
More than 10,000 fans gathered at Finley Stadium last Saturday to see a 5-3 penalty kick win over Miami United. CFC keeper Gregga Hartley made a save and scored the winning penalty kick, helping his team to advance to the national semifinals on Saturday. They will host Sonoma County Sol at 7:30 in the comfy confines of "Fort Finley" Chattanooga is the top ... (click for more)


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Phoenix Suns
Phoenix Suns' Eric Bledsoe makes big jump in ESPN's yearly player rankings
Two Phoenix Suns have landed in ESPN's list of top 100 players in the NBA heading into the 2013-14 season.
The list, which is put out annually by ESPN.com and its partner network of NBA blogs, places guard Eric Bledsoe at No. 63 and center Marcin Gortat at No. 87.
The jump is significant for Bledsoe; he came in at No. 122 a year earlier. Of course, no longer having to play behind Chris Paul in Los Angeles could do that to you. Bledsoe is expected to have a breakout season with his new team. He has a chance to become the team's star player, as evidenced by already being ranked higher than any other Sun.
Gortat fell 30 spots from where he was ranked a year earlier. He saw a dip in points after no longer having Steve Nash to run the pick-and-roll with him; he also missed the last two months of the season. Combine those factors with the fact he could be the subject of trade rumors and have the No. 5 pick of the draft, Alex Len, vying for playing time this season, and the Polish Hammer's standing in the league isn't as esteemed as it once was. Ironically, Gortat came in one spot ahead of Nash in this year's rankings.
Suns guard Goran Dragic fell out of the top 100 this year, coming in at No. 107; he was No. 83 heading into the 2012-13 season. Although he was one of the team's only bright spots in a year that saw them go 25-57, he seems to have fallen in the rankings largely due to the Suns' acquisition of Bledsoe, who may share point guard duties with him this season.
Most Popular
Suns Audio
7-29-16 The Sports Kabob with Jarrett Carlen
Friday July 29
Topics include the DNC, Chris Sale, and Ama're Stoudemire. It's sports news skewered
Vinny Joe Trivia - Amar'e Stoudemire
Thursday July 28
Vince takes on AZCentral Suns reporter Paul Coro in an Amar'e quiz full of controversy
Paul Coro, AZCentral Suns reporter
Thursday July 28
Coro talks Amar'e retiring a Knick and previews the upcoming Suns season.
Alan Hahn, ESPN New York Radio Host
Wednesday July 27
Alan Hahn discusses why Amare Stoudemire retired as a Knick rather than a Sun?
Yay or Nay?
Wednesday July 27
Amar'e should be in the Suns Ring of Honor, Dave Coulier was funniest on Full House + more


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How I Met Your Mother 2005 | TV Show Watchlist
Season 4, Episode 23 As Fast as She Can
First Aired: May 11, 2009
An acquaintance of Ted's feels guilty about a previous wrong and tries to atone for it by helping Ted get a job. Meanwhile, Barney thinks he can talk his way out of a speeding ticket.
Guest Cast
Ezra Buzzington Ezra Buzzington Highway Cop #1
Joe Thornton Jr. Joe Thornton Jr. Highway Cop #3
Renee Taylor Mrs. Matsen
Amir Talai Amir Talai Richard Greenleaf
Next On TVSee all »
Thu Jul 28 11:00am
Shelter IslandSeason 4, Episode 5 LIFEI'll Watch111 Watching
Cast & Details See all »
- Premiered: September 19, 2005
- Rating: TV-14
- Premise: A man named Ted tells his kids how he met the love of his life, through flashbacks, years in the future. The bored kids sit on the couch and listen as dad regales them with tales of his pursuit of romance. The sitcom's secondary character, Ted's smarmy fri… (more)
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By 20th Century FoxBuy New: $12.77
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Popular Shows
- 1. Orange Is the New Black
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Popular Movies
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- 1. Rami Malek
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text:
forecast for tonight- shitshow with a chance of tbell
my version of bright and sunny.
Wipe that smile off your face.
I actually had to roll up my long sleeves to masturbate. I hate the winter
The drunk teletubby stumbling out of the place tipped me off..
You going to have to be more specific than the night we blew an 8ball off the toilet..
Some chick is drunk waving down a taxi with a slice of pizza.
He literally sends me dick pictures, EVERY DAY. SEVERAL DIFFERENT ANGLES ..it's like I GET THE POINT.
just gonna show up naked this time. that way i dont have to worry about finding my clothes tomorrow
In times of desperation, never...NEVER put green apple scented hand sanitizer on your vagina.
We had him convinced Visine is flammable. He was genuinely freaked out that everyone would know when he was stoned.
That is cause you are some weird type of mutant that lives off of Alcohol.
Currently watching Zombie Sharks while high. This is why I love Shark Week.
You told him about your cats? I told his friend to put his dick in my mouth, and you talked about cats!?
I still can't believe that dog licked my nipple.
My roommate is fucking his gf in the shower and i really have to pee do i just bust in or pee on his bed


text:
Relevant offers
In the South
School bands used to be popular and Southland had its share of pipe, brass, and fife and drum bands.
This picture, courtesy of Graeme Mulligan, shows the SBHS marching band on Anzac Day 1941 on its way from the town hall to the cenotaph. It is led by bandmaster Lieutenant Napier, who was ex-British Army. The previous year the band attended the 1940 centennial celebrations in Wellington.
The first feature film to include footage of Southland was the 1935 J J W Pollard film The Wagon and the Star which showed Eglinton Valley, Te Anau and Invercargill.
The first known results from a New Zealand sawing and wood chopping competition come from a Woodlands contest on Christmas Day, 1888.
The Southland Times said: "A form of competition, viz, chopping and cross-cutting trees, which has not been often introduced in this district, proved very interesting and close. Cross-cutting competition - James O'Neil and D. Hannah, 1 min. 13 secs and 1 min. 41 secs first; G. Anderson and John O'Neil, 1 min. 13 secs and 1 min. 47 secs second.
Chopping Competition - James O'Neil, (scratch) 6 mins. 10 secs. first; John Fisher (45 secs handicap), 7 mins. 21 secs, second."
Southland's best rugby point scorer is Simon Culhane with 976 points in 104 games played for Southland from 1988 to 1998. Playing for Otago in 1999, he scored a further 48 points in six games.
Southland's largest eggs were laid by giant moas and measured 24cm x 18cm although no intact ones have been found in Southland. The egg of the elephant bird of Madagascar was 34cm long but the bird was shorter than the moa. The largest eggs from living Southland birds come from the brown kiwi - 12.5cm - and the black swan and buller's mollymawk - both 10.4cm.
About The South
Lloyd Esler
15 Mahuri Rd,
Otatara, RD 9,
Phone-fax (03) 213 0404
email: firstname.lastname@example.com
- The Southland Times
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Southland man who was once homeless finds beauty in creating music
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Tucker and Hall: like-minded stalwarts of the theatre
Southland musician's album comes to life more than 30 years after it was first invisaged
Southlanders gain spots in Children's Music Awards
Creative NZ Southland arts pilot begins to take form
Jody Direen, Kaylee Bell to carry country music torch at Lake Hawea
Dunedin: The small city with the big wow factor
Southland restaurants absent from Cuisine's 2016 Good Food Guide
Thousands of spectators expected for Southland Polyfest 2016
Queenstown's Steve Fortune leads New Zealand Alpine Team to success at Taulliraju in Peru
Elisabeth Moss and Top of the Lake crew 'busy' filming in Queenstown
Ghost towns haunt the southern region
Bannockburn vineyards unite to produce 'evolutionary' map
Three month old baby murder accused appears in court
Women tried to smuggle $7m of meth among household goods
Invercargill social housing forum - it's time for change
Southlander Damon Duncan making waves in NZ film industry
Homeless shelter to open in Invercargill
Invercargill teen on star-studded flag panel
Meat company mergers could mean more dollars
Cue TV turns off transmissions
Southland Sharks coach Paul Henare wants to go out with a bang
Exciting Formula One into gear for raceday debut
Last remaining coastwatcher base to be restored
Online early childhood survey released
Severe gales, downpours, thunder, snow and big swells for the weekend
Rural brigades struggle to get volunteers, fire engines – and even water
Super Rugby: Highlanders assistant coach Clarke Dermody ready for more scrum pressure
Snow in the south, tropical storms in the north - what's up with the weather?
Club Rugby: Barbarians win Galbraith Shield with victory over Woodlands
Super Rugby: Highlanders 2016 title hopes remain alive
Club Rugby: Barbarians coach Bretton Taylor proud of remarkable 2016 season
Southland football players involved as the Otago U17 stuns Burnley in Super Cup warm up


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C++ Jobs in South Yorkshire
Jobs 1 to 7 of 7
PHP Developer - Graduate Opportunity, Top Web Agency
PHP Developer - Graduate - Sheffield. PHP / Java / C++ / C# PHP Developer (Junior or Graduate) sought by major Web Development house in Sheffield... Experience with PHP would be great, but they will also cross-train from Java, C / C++ / C# as long as you have a really strong knowledge of coding principles.....
Sheffield -
Applause IT Ltd
Salary: £18000 - £22000 per annumPosted: 17 days ago
Embedded software Engineer
You will be joining the software team to drive the new Linux based product development involving full life cycle development of both existing and next generation systems utilising mobile technology... Extensive embedded Linux development inc... C++ and embedded C. Experience with Linux Kernel and filing system configuration and build. Degree...
Barnsley -
Progressive Recruitment
Salary: competitivePosted: 22 days ago
Software Developer - C# / C++
As an organisation they are moving away from much of their C++ legacy code to C# .NET - mostly focusing on WPF Desktop Applications... Key Technologies: As mentioned in this role, you'll be mainly focussing on C# WPF Desktop Applications as the company move away from the C++ legacy code.....
Sheffield -
Cathcart Associates
Salary: £22000 - £40000 per annum + Excellent BenefitsPosted: 22 days ago
Senior Software Engineer - Sheffield
Due to continued growth we are now looking for an additional Embedded Software Engineer to join the engineering team. You will need to be a confident Embedded Software Engineer able to work on projects which are either team related or a solo effort. Embedded Software Engineer - Role & Responsibilities... - Ability to...
Sheffield -
Computer Futures
Salary: £32000 - £41000 per annum + competitivePosted: 21 days ago
Senior Embedded Software Engineer - Sheffield
They currently seek an enthusiastic Senior Software Engineer with a get up and get on with it mentality to come in and join their high performing team. You will be programming in Embedded C on RTOS for a variety of projects including in the safety critical arena... Embedded C... C++...
Sheffield -
Computer Futures
Salary: £35000 - £42000 per annum + competitivePosted: 16 days ago
Software Engineer / Developer (PHP, Java, C#, Javascript, ASP.Net, C++, Python, Ruby)- Tech+
Along with your strong analytical skills and logical reasoning, you'll also need to have a thorough understanding of the complete software lifecycle and plenty of programming experience (PHP, Java, C#, Javascript, ASP.Net, C, C++, Python, Ruby, Perl, Visual Basic, Delphi, R, Groovy, PL/SQL, COBOL, Fortran, Clojure, Scala,...
Sheffield -
Salary: £32,000 - £45,000 pa (dep. on experience) + benefitsPosted: 17 days ago
Software Engineer C/C++ Embedded Linux - Barnsley
Software Engineer, Software Developer, Embedded Software, Embedded Linux, BSP, Linux Kernel, Embedded C, C/C++, Qt... Due to an expanding market and product range we are looking for an experienced Embedded C/C++ Software Engineer to join the current Software team and drive new LINUX based product development forward... Essential...
Barnsley, South Yorkshire -
Saxon Recruitment Solutions
Salary: £40000 - £50000 per annumPosted: 4 days ago
C++ Jobs in South Yorkshire


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72" D-top supported with post leg and T-Base. 60" return that includes box/box/file pedestal. (item #31033)
8x4 maple laminate table, oval shape,middle grommet and square matching base. (item #35142)
-24x34½x30 -2 drawer -American Dark Cherry Laminate (item #37274)
72x24 white laminate top with black T-style bases. These are in fantastic condition. (item #36240)
60x60 custom designed wood veneer table surfaces with wood bases and Anigre pattern. (item #31012)
Maple veneer, 2 piece, round table with matching base. Base does contain minor damage. (item #35135)
Blue vinyl stack chairs with black arms and gray frame (item #35187)
This 17 ft used conference table in the Boston is as beautiful as unique. Comes with pop up audio/data jacks. Boat Shape 4x7x17 in a light cherry Veneer. Also has compartmental bases. The picture don't do justice to how pretty it is in person. (item #29622)
Beautiful as a pair or even stand alone, these chairs fit any lobby area. Blue fabric and mahogany finish legs. (item #36398)
Mahogany laminate finish with (3) matching bases, middle base includes trap door for media wire management. 2 piece table with center media grommet attachment. (item #37130)
Used Conference chairs in Boston - Black fabric seating with black frame and fixed black loop arms. (item #24636)
A beautiful custom made light cherry veneer 4x 18 ft used conference room table with grommets and a stunning gold inlay border. Also, matching 24x72 credenza and (12) Norstar high back black leather chairs. New Hampshire & Massachusetts, we can assist you with your used office furniture needs. (item #24158)
84"x 36" gray rectangular top with the option of various bases. (item #37186)
This one of a kind custom table is guaranteed to give you the most unique conference room in the building. It's V-shaped design of gorgeous woodworking and it's incorporation of marble make it like nothing on the market. Complete built in media with individual microphones for each meeting participant make sure your conference room has the tools you need to meet the needs of your clients. Act fast before it's gone! (item #36243)
-Cherry laminate -matching laminate x-base -36" round--29½ tall (item #37300)
Blue fabric task with black base and fixed arms. (item #23367)
-full solid marble top that can accompany any base of your choosing (item #37328)
36x20 fixed storage unit with 3 shelves (item #36100)
72x36 desk with box/box/file and 72x24 return with file/file. Our inventory has (2) desks, (1) with right return and (1) with left return. (item #35033)
54x23 veneer coffee table (item #36582)


text:
Chapel Hill Lion Club Overview
This profile for Chapel Hill Lion Club is located in Indianapolis, IN.Chapel Hill Lion Club industry is listed as Religious Organization. There are no officers listed for this company.
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Chapel Hill Club II, LLC
San Diego, CA
San Diego, CA
Officers: Leonard Ryder Member , Ryder Member Michael and 1 other Michael Ryder Member
Chapel Hill Highlighter Booster Club
Tyler, TX
Tyler, TX
Pine Hill Chapel Christian Sick Relief Club, Inc
Green Cove Sprg, FL
Green Cove Sprg, FL
Officers: Melvin Presha , Fred Hampshire and 4 others Allen Hall , Herbert Knight , Ethel L. Wrights , Raymond Pender
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The Joint Commission has approved a new National Patient Safety Goal for 2012 related to catheter-associated urinary tract infection (CAUTI) prevention in hospitals. The goal requires implementation of evidence-based practices to prevent CAUTIs, which account for up to 80 percent of all healthcare acquired infections (HAIs).
McKnight's Senior Living magazine shared some counter-intuitive but important research recently. The article is available here. The researchers found that individuals had more adverse events from medic
Focusing on Both Deaths and Harm from Medical Errors In his latest post to the "Line of Sight" blog, IHI President and CEO, Derek Feeley, reflects on the controversy and criticism surrounding a recent
A study completed at The Ohio State University, and published in the American Journal of Medical Quality, shows a patient safety cultural transformation after implementation of Crew Resource Management.
The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.


text:
Watch Featured Movies
The Voice: Four famous musicians search for the best voices in America and will mentor these singers to become artists. America will decide which singer will be worthy of the grand prize.
|The Battles (3)
|Air Date:
|March 19, 2012
|60 mins
|Family Music Reality-TV
|Carson Daly Christina Aguilera
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The Voice ( S2 E8 ) Comments
|Posted by waddupbidgez 3 years, 9 months ago
I didn't really like the one from North Dakota when I first heard her, because I felt like her being like, "Oh, I gave up having a family." she was just like searching for some sort of sob story to make her more appealing. And tbh, she's like in her twenties, she has like at least twenty more years to have kids. But, after how gracious she was even when she lost, she redeemed herself in my eyes. I also love how honest she was when she said, "I am sad for myself, because I wanted to go on, but I couldn't have lost to a better person." That made me respect her. And I just want to say, I started bawling when her father died, I wasn't ready for it, and I wasn't expecting them to say he died so soon, I thought he had longer.
|Posted by missstatefan 2 years, 10 months ago
Erin Martin can not sing! The Shields Brothers are clearly better than her!
|Posted by chalvintapris 4 years, 4 months ago
thank you so much mlerose! :D
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Pisces_ : good family film for Halloween
SoleExecutioner : I mostly skimmed through this movie for fun, and its a rainy day sort of movie. ...
LunarKing : This episode reminded me of Initial D. And was that random bluejay a ref to Regu ...
cuttingup : RALPH BAKSHI ! cool world, american pop, fire and ice, fritz the cat...
currymel : This one episode made up for that horrible last season! Can't stop laughing over ...