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Neutropenia Treatment & Management
- Author: Christopher D Braden, DO; Chief Editor: Emmanuel C Besa, MD more...
Approach Considerations
Medical care for patients with neutropenia is mostly supportive and based on the etiology, severity, and duration of the neutropenia. Fever and infections occurring as complications of neutropenia require specific treatment. Surgical care is not usually indicated but may be employed in certain contexts.
Go to Pediatric Autoimmune and Chronic Benign Neutropenia for complete information on this topic.
General Care
General measures to be taken include the following:
Removal of any offending drugs or agents is the most important step in most cases involving drug exposure; if the identity of the causative agent is not known, stop administration of all drugs until the etiology is established
Use careful oral hygiene to prevent infections of the mucosa and teeth; control oral and gingival lesion pain with saline and hydrogen peroxide rinses and local anesthetic gels and gargles
Avoid rectal temperature measurements and rectal examinations
Administer stool softeners for constipation
Use good skin care for wounds and abrasions; skin infections should be managed by someone with experience in the treatment of infection in neutropenic patients
Antibiotic Therapy
Start specific antibiotic therapy to combat infections. This often involves the use of third-generation cephalosporins or equivalents. Fever may be treated as an infection, as follows[5, 6, 5, 7, 3, 8, 9, 10, 11] :
Cefepime, meropenem or imipenem-cilastatin), or piperacillin-tazobactam can be used as a single agent
Agents from other antimicrobial classes (eg, aminoglycosides, fluoroquinolones, vancomycin) may be added for management of complications (eg, hypotension and pneumonia) or antimicrobial resistance (suspected or proven)
With blood culture results suspicious for resistant bacteria, early addition of the following antimicrobials may be considered:
Methicillin-resistant Staphylococcus aureus (MRSA) - Vancomycin, linezolid, or daptomycin
Vancomycin-resistant enterococcus (VRE) - Linezolid or daptomycin
Extended-spectrum β-lactamase (ESBL)–producing gram-negative bacteria - A carbapenem
Carbapenemase-producing organisms, including Klebsiella pneumoniae carbapenemase (KPC) - polymyxin-colistin or tigecycline
If the neutropenic patient's fever does not respond within 4-5 days or if the fever recurs with the administration of broad-spectrum antibiotics after an initial afebrile interval, consider adding empiric antifungal coverage with amphotericin B (preferably lipid formulation), a broad-spectrum azole (eg, voriconazole), or an echinocandin (eg, caspofungin)
Fever in patients with low-risk neutropenia can be treated on an outpatient basis with oral antibiotics. Fluoroquinolones (eg, ciprofloxacin, ofloxacin) are oral antibiotics that are used frequently, either alone or in combination with amoxicillin-clavulanate or clindamycin. In some studies, patients are defined as being at low risk if they have all the following:
Known cause of neutropenia
Hemodynamic stability
Expected duration of neutropenia of less than 7 days
Tumor is under control
No comorbid conditions, nausea, vomiting, or mucositis
Colony-Stimulating Factor Therapy
Myeloid growth factors—specifically, granulocyte colony-stimulating factors (G-CSFs) and granulocyte-macrophage colony-stimulating factor (GM-CSFs)—may shorten the duration of neutropenia in patients who have undergone chemotherapy.
G-CSFs are lineage-specific for the production of functionally active neutrophils and can also be used in patients with severe, chronic neutropenia. GM-CSFs stimulate the production of neutrophils, monocytes, and eosinophils. Filgrastim and pegfilgrastim are examples of G-CSFs; sargramostim is an example of a GM-CSF. These agents are typically administered no sooner than 24 hours after chemotherapy completion. Filgrastim is often the agent of choice if a G-CSF is chosen.
The availability of filgrastim has altered the management of agranulocytosis. It has been shown to shorten the period to recovery and the duration of infection when administered before infection is established. This agent is especially indicated in the management of congenital neutropenia, idiopathic severe chronic neutropenia (SCN), and cyclic neutropenia (CN) when serious infections are involved. If the condition is mild, with only neutropenia without a serious infection, filgrastim may be withheld.
Updated guidelines for use of myeloid growth factors were made available in 2015 by the National Comprehensive Cancer Network (NCCN). Recommendations address the following areas:[48]
Prophylactic use in chemotherapy patients at risk of neutropenia
Therapeutic use for acute febrile neutropenia
Therapeutic use for severe chronic neutropenia
Prophylactic therapy recommendations in the 2015 NCCN guidelines are based on evaluation of the individual's risk of febrile neutropenia associated with chemotherapy. Risk assessment should take place before the initial cycle of chemotherapy and before each subsequent cycle. Disease type, chemotherapy dose regimen, and patient risk factors should be assessed, and the intention of chemotherapy (curative, life-extending, or symptom management) noted.[48]
Prophylactic use of G-CSF is recommended for patients at high risk (>20%) of febrile neutropenia. For patients whose treatment is intended to be curative or life-extending, the recommendation is supported by class 1 evidence. CSF therapy may be considered in patients at intermediate risk (10-20), but the NCCN acknowledges that this is a difficult decision that requires careful discussion with the patient. CSF therapy appears to increase the risk of developing acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), and it is not recommended for patients at low risk (<10%) of neutropenic fever.[48]
The NCCN guidelines state that there is less evidence for therapeutic use than for prophylactic use. If patients with acute neutropenic fever are receiving prophylactic filgrastim or sargramostim, the CSF treatment should be continued. Pegfilgrastim should be discontinued, as it is long-acting and evidence for its therapeutic benefits is lacking. If the patient is not receiving prophylactic CSF, their risk of infection complications or poor outcome should be assessed. CSF should be considered for patients at high risk.[48]
The NCCN guidelines affirm the effectiveness of G-CSF therapy for SCN, CN, and congenital neutropenia. Patients with cyclic or idiopathic neutropenia appear to benefit at lower doses of G-CSF than those with congenital neutropenia. Patients with severe congenital neutropenia, requiring high doses of G-CSF, seem to be at greater risk of AML and MDS.[48]
European guidelines also recommend prophylactic treatment with G-CSFs in patients receiving chemotherapy regimens that pose a high risk of febrile neutropenia.With chemotherapy regimens associated with moderate risk, primary prophylaxis may also be advisable for cases in which patient-related factors increase the overall risk, or to maintain chemotherapy in cases where dose-dense or dose-intense chemotherapy strategies are used because of survival benefits, or reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis.[49]
Primary prophylaxis with biosimilar filgrastim has been shown to be cost-effective.[50] Biosimilar filgrastim has also been recommended for approval in the United States.ref53}
Granulocyte Transfusion
Neutrophil (granulocyte) transfusions have undergone a cycle of popularity followed by disfavor. These transfusions are accompanied by many complications, including severe febrile reactions. Their use is controversial.
Although disappearing from clinical practice, granulocyte transfusions have some clinical usefulness in treating neonatal sepsis. Their usefulness in adults with neutropenia, in whom adequate increments of WBC counts are difficult to achieve, has not been demonstrated in randomized clinical trials.[51] Granulocyte transfusion could be considered in cases of gram-negative sepsis with no improvement in 24-48 hours.
Other Medical Measures
Other measures that may be taken in the care of the patient with neutropenia include the following:
Corticosteroid therapy (potentially effective in immune-mediated neutropenia)
Correction of nutritional (eg, cobalamin or folic acid) deficiency if detected
In cases caused by heavy metals such as gold, chelation with British anti-Lewisite (dimercaprol)
Careful handwashing before and after direct contact with patients with neutropenia
Meticulous care of indwelling venous catheters and avoidance of urinary catheters and other invasive maneuvers that violate natural infection barriers
Splenectomy and Other Surgical Procedures
In individuals with neutropenia and Felty syndrome who have recurrent life-threatening bacterial infections, splenectomy is the treatment of choice, though the response is often short lived. Systemic lupus associated with autoimmune agranulocytosis may also respond to splenectomy or to immunosuppressive therapy. Idiopathic autoimmune neutropenia may also respond to immune therapy.[14]
Indwelling central venous catheters should be removed in febrile neutropenic patients if septic thromboembolism is suspected. Other indications for catheter removal include the following:
Corynebacterium jeikeium infection
Infection with Candida species
Polymicrobial infection
Persistent fevers
Pocket-space abscess
Tunnel infections
In general, surgery should be avoided in a patient with neutropenia; however, surgical drainage of abscesses that have pus or watery exudate under pressure may occasionally be lifesaving. Perirectal abscesses and cholecystitis with cholangitis are examples of infections that, if left undrained, lead to polymicrobial sepsis, despite antibiotic therapy.
Dietary Measures
Neutropenic patients should follow the following dietary restrictions:
Avoid raw and undercooked meat or well water
Commercial fruit juices, beer, milk, and milk products should be pasteurized
Aged cheese and cheese-based dressings should not be used
Avoid unwashed raw fruits and vegetables; these may contain large numbers of bacteria. All food should be cooked. Fresh flowers should be avoided as well
Outdated products and all moldy products should not be consumed
In patients with periodontitis and stomatitis, a soft or full liquid diet is indicated. Spicy and acidic foods should be avoided until recovery is complete.
Request a hematology consultation for review of the bone-marrow slides and peripheral blood smears to confirm the diagnosis and to assist in G-CSF dosing and evaluation.
Request an infectious disease consultation for advice and assistance in the selection of appropriate antibiotics, especially in patients with complicated infections or prolonged neutropenic fever that is not responding to standard therapy.
Long-Term Monitoring
Obtain daily CBC counts with manual differential to monitor the neutropenic patient's recovery from an etiologic agent or to monitor the neutropenia's response to G-CSF or GM-CSF.
If septic shock occurs, the patient should be transferred to the ICU. Intubation may be required.
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|Clinical Features
|Cyclic neutropenia
|Autosomal dominant
|Alternate 21-day cycling of neutrophils and monocytes
|Kostmann syndrome
|Autosomal recessive
|Stable neutropenia, no MDS or AML
|Severe congenital neutropenia
|Autosomal dominant
|Stable neutropenia, MDS or AML
|Autosomal dominant
|Stable neutropenia, circulating myeloid progenitors, lymphopenia
|Sex linked
|Neutropenic variant of Wiskott-Aldrich syndrome
|Autosomal dominant
|G-CSF–refractory neutropenia, no AML or MDS
|Hermansky-Pudlak syndrome type 2
|Autosomal recessive
|Severe congenital neutropenia, platelet dense-body defect, oculocutaneous albinism
|Chediak-Higashi syndrome
|Autosomal recessive
|Neutropenia, oculocutaneous albinism, giant lysosomes, impaired platelet function
|Barth syndrome
|Sex linked
|Neutropenia, often cyclic; cardiomyopathy, methylglutaconic aciduria
|Cohen syndrome
|Autosomal recessive
|Neutropenia, mental retardation, dysmorphism
|Source: Modified from Berliner et al, 2004.[24]
AML = acute myeloid leukemia; G-CSF = granulocyte colony-stimulating factor; MDS = myelodysplastic syndrome.


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Bank lending to remain tepid in UAE
The UAE is expected to experience a continued credit squeeze although the local banks, particularly those Abu Dhabi-based, have reported a significant reduction in the non-performing loan (NPL) ratios, Moody's said yesterday.
"In the UAE, the NPLs are likely to remain a problem for some more time, especially for the Dubai-based banks as many of them are faced with the burden of large corporate restructurings," Khalid F. Howladar, Vice-President and Senior Credit Officer, Financial Institutions Group, Moody's Investors Services, said.
"Private sector credit growth in the UAE stood at just 2.1 per cent year-on-year at the end of 2011, up from 0.6 per cent at the end of 2010, but lower than our 3.5 per cent forecast. The latest data from the Central Bank also shows that public sector credit growth accelerated to 36.8 per cent in December 2011, up from 13.3 per cent at end-2010."
UAE banks have materially improved their liquidity position since 2008. With a loan-to-deposit (LTD) ratio of 100 per cent as of September 2011 — and liquid assets representing 23 per cent of total assets — UAE banks are better placed to meet short-term cash demands from foreign banks if necessary.
Customer deposits rise
Despite strong growth in customer deposits and sustained improvement in the LTD ratio, Howladar said lending is likely to remain muted in the UAE as banks are likely to keep large liquidity buffers to meet any contingencies.
With a huge dependence on external funding exacerbated by $50 billion (Dh183.66 billion) of refinancing due in 2012-13, the UAE banks, particularly those Dubai-based, are likely to go slow on lending.
As of September 2011, total foreign deposits in UAE banks amounted to $86 billion. The balance of the financing consists of longer maturities and is lent directly to both public and private sector borrowers, bypassing the local banks. While not yet visible, the expected reduction in some of this foreign lending will likely exacerbate local funding pressures, given the significant refinancing needs of around $50 billion over the next two years.
The net foreign position of UAE banks is negative and, as such, they would have to sell local assets and convert the proceeds into hard currency to meet cash demands from foreign counterparts.
"Given the large amounts of foreign reserves held by the Central Bank (amounting to $40 billion as of September 2011) and substantial liquid assets held by the sovereign wealth fund, we do not consider such large-scale foreign-exchange conversions to be problematic in the short term," Moody's analysts said.
Reliance on foreign funds
The UAE economy, particularly Dubai, has a significant reliance on foreign funding. The withdrawal of European banks would leave a significant funding gap in the local economy and new financing strategies and funding sources would need to be found, Moody's said yesterday.
Top Headlines
- Tunisian, Moroccan Chambers of Commerce meet to discuss economic partnership
- Winter wonderland: Dubai debuts Aspen Chalets with view of Ski Dubai
- Egyptian economic experts predict inflation rate will continue to climb
- Shoura Council: Expats cannot buy property in Mecca, Medina, Riyadh
- Tensions increase between Egypt, Italy over renewable energy projects


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This summer, as you kick your feet up and sip from an ice-cold drink, the last thing you want to worry about is storage. It can drive many people crazy to rely on a semi-mysterious device to keep all of the precious memories and photographs of their most recent excursion safe, especially as they go about their travels. Hopefully, this portable hard drive guide can demystify the selection process and help you truly relax during your well-earned vacation.
You know what I hate? That's right, Facebook status updates that begin with "I believe…" I also hate waiting in line, tight shoes, and people who respond to a question with a question. But what really grinds my millet is dropping money on an electronic item, something on which I am going to be viewing and listening to large amounts of data, only to discover that it is limited by stingy onboard storage.
Card readers? Really? It might come as a surprise that these are worthy of an article, but we'd ask you to keep an open mind. You can transfer data quickly from SD, CompactFlash (CF) or XQD cards with USB-equipped memory card readers. Some even help you speed up your photography workflow by enabling simultaneous transfers from multiple cards.
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text: Feline practice management Your clinic cat's no scaredy cat FIRSTLINE: Aug 03, 2015 By CC the Clinic Cat While you're busy fighting fright with Fear-Free tactics, CC, your veterinary clinic cat, frets over your fearless veterinary practice approach. Cat care game-changer: The feline care toolkit dvm360.com: Jul 29, 2015 By dvm360.com staff Change the way you and your team understand feline medicine, change your life. Well, more like finally start seeing more cats. Use these tools to find your way (with and educational grant provided by Zoetis). Spooky the cat's Fear-Free veterinary visit FIRSTLINE: Jun 04, 2015 By dvm360.com staff Here's a cat's-eye-view of a feline fine exam where the cat gets the power to choose how he experiences a visit to the veterinarian. I don't care about this data ... maybe you shouldn't either DVM360 MAGAZINE: Apr 01, 2015 By Mike Paul, DVM Two surveys of national veterinary fees and charges may contradict each other. Here's what you should really focus on. 10 revenue-boosting tactics to pay staff more VETERINARY ECONOMICS: Feb 01, 2015 By Ernest E. Ward Jr., DVM If your team members deserve better compensation—and if you want to keep the best of the best, they do—you need to boost your revenue. Here's how to make it happen. Plus, data from 2015 Firstline Career Path Study. Fear Free veterinary tip: Teach fraidy cats to love their carriers FIRSTLINE: Jan 07, 2015 By dvm360.com staff No animal should live their life in fear—especially when it comes to normal life events, such as going to the veterinarian. Vetcetera: The business case for seeing more cats dvm360.com: Dec 19, 2014 By dvm360.com staff Veterinarians' dirty little secret, making more money through feline visits, and commentary from Dr. Elizabeth Colleran. 10 simple ways to let clients know you care DVM360 MAGAZINE: Dec 01, 2014 By Mike Paul, DVM Do you care about clients outside the exam room? Show it. CATalyst gets shelter pets into veterinary clinics DVM360 MAGAZINE: Nov 01, 2014 By Sarah A. Moser One year in, an innovative program sees some success at connecting new pet adopters with local veterinarians. Why all the fuss about low-cost veterinary clinics? DVM360 MAGAZINE: Nov 01, 2014 By Joan Freesh, MS, DVM Veterinarians agree that spaying and neutering pets is a good thing. Stop being so concerned about who provides the service. « First « Previous ... 2 3 4 5 6 ... 12 Next » Last » Hot topics on dvm360Michigan appeals court finds in favor of Dr. Pol Dear top dog specialist: Stop looking down on your colleagues Not One More Vet: Veterinary peers discuss suicide, offer safe place for dialogue Is the gold standard the old standard? 3 killer career moves


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2009 Proven All Around Show Gelding. Shown and competitive at AQHA level. Greenlee is a gorgeous bodied 16.2 h by Hot Diggity Joe (Blazing Hot). Halter…$18,000 CAD
Kit and Caboodle is the real deal. Only 7 years old, AQHA registered, ROM in racing and Western Dressage. She has been shown in Dressage and Western…$10,000
Stars video https://youtu.be/wZtNOEg01tc Star is a beautiful, personable, and kind all-around gelding that is able to be maintained at home. He is suitable…$37,500
Very nice N/N 2015 colt out of an own daughter of Ima Cool Skip and a Impressed By Eighty son, who is out of an own daughter of Mr Conclusion. Sire is…$6,500
Boom N Smoke is a 2005 AQHA mare who has a superior in reining and ranch pleasure events. She has had 2 babies by Mr Sunolena Letters. Her oldest is…$6,500
Amazing Gelding! "Junior" has 400 plus points in Paint and Pinto association, wins at world shows, APHA Superiors in Hunter under Saddle - Open and Amateur…$8,000
Locally owned and managed, Blackwater Horse Training offers basic-advanced training for all stages including colt starting, tune-ups/attitude adjustments…$400
WF Angelina is registered with the Half Arabian Horse Registry and the American Warmblood Society$15,000


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GrandStay Hotel & Suites Chaska, Minneapolis - St. Paul (and vicinity)
- Free continental breakfast, free WiFi, and free parking
Main amenities
- 81 smoke-free guestrooms
- Restaurant
- Indoor pool
- 24-hour fitness center
- Business center
- Childcare
- Air conditioning
- Daily housekeeping
- Garden
- Arcade/game room
- Front desk safe
- Self-serve laundry
What's around
- Hazeltine National Golf Club (4.1 mi / 6.7 km)
- Chaska Town Course (4.9 mi / 8 km)
- Saint Francis Regional Medical Center (6.3 mi / 10.1 km)
- Minnesota Landscape Arboretum (6.5 mi / 10.4 km)
- Deer Run Golf Club (6.6 mi / 10.7 km)
GrandStay Hotel & Suites Chaska, Minneapolis - St. Paul (and vicinity)
Hotel Info: 866-539-8117from $110
- Studio suite
- Standard Room, 1 Queen Bed
- Standard Room, 2 Queen Beds
- Deluxe Suite
- Standard King
- One Bedroom
- Two double beds
- Deluxe suite
- Parlor
- Two Queen Suite
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 81 rooms
- This hotel is arranged over 3 floors
- Check-in time starts at 3 PM
- Check-out time is 11 AM
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Pets not allowed
Extra people
- Roll-away beds available, charges may apply*
- Free wired Internet access in public areas
- Free WiFi in rooms
- Free self parking
Other information
- Smoke-free property
Nearby Two Star Minneapolis - St. Paul (and vicinity) hotels
In the hotel
- Supervised childcare/activities
- Free continental breakfast daily
- Restaurant
- Indoor pool
- 24-hour fitness facilities
- Spa tub
- Golfing nearby
- Hiking/biking trails nearby
- Arcade/game room
- Business center
- Number of meeting rooms - 3
- Conference space
- Meeting rooms
- Tours/ticket assistance
- Laundry facilities
- Free newspapers in lobby
- Safe-deposit box at front desk
- Garden
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Minibar
- Coffee/tea maker
- Iron/ironing board
- Blackout drapes/curtains
- Separate dining area
- Separate living room
- Private bathroom
- Shower/tub combination
- Designer toiletries
- Hair dryer
- 37-inch flat-screen TV
- Satellite TV channels
- Desk
- Free WiFi
- Free local calls
- Refrigerator
- Microwave
- Daily housekeeping
- Connecting/adjoining rooms available
Top Minneapolis - St. Paul (and vicinity) hotels
Recently reviewed hotels in Minneapolis - St. Paul (and vicinity)
- SpringHill Suites Minneapolis-St Paul Airpt/Mall of AmericaFrom
"The staff was GREAT and offered good knowledge of activities and "things to do" GREAT customer service. Check-in and Check-out was fast and easy. Continental breakfast was…"Jul 25, 2016
- Hilton Garden Inn Minneapolis DowntownFrom
"In addition to the convenient location of the hotel in downtown Minneapolis, I enjoyed courtesy from staff members. Prices of the products at the pantry were quite reasonable.…"Jul 25, 2016
- Radisson Blu Mall of AmericaFrom
"This was my second time staying at Radisson Blu Mall of America. Hotel is very clean, always staff at the front door/desks to help you in/out, and the place is in the BEST…"Jul 25, 2016
- Hyatt Regency MinneapolisFrom
"The staff and accommodations were great. The price was affordable and the location is excellent with the highway and beach nearby. We even extended our stay. "Jul 25, 2016
Nearby hotels
GrandStay Hotel & Suites Chaska, Minneapolis - St. Paul (and vicinity)'s small print
Also known as
- Best Western Chaska
- Best Western Chaska River Inn
- Best Western Plus Chaska
- Best Western Plus Chaska River
- Best Western Plus Chaska River Inn
- Chaska Best Western
- GrandStay Hotel Chaska
- GrandStay Chaska
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
Recent reviews
Good 3.2 /5 from 47 reviews
The room was so so. Not the cleanest. The toilet in the pool area looked like it hadn't been cleaned in a week. Outside lounging area very dirty. Plate on a table Saturday was still there Sunday.
Rooms need upgrading, our room did not get cleaned the second day.They offered me sheets to change my own bedding. They did give a discount on my second night but still charged my credit card the whole total plus more than my hotels.Com quote. The pool area was ok but the bathroom was dirty and not clean towels to use at the pool.
presently being remodeled
Worn down hotel
Is the description of this hotel not correct? Tell us


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Published on
"This presentation will walk you through how to optimize and measure your app's performance in the Android market, and how to make your app generate (more) revenue. With over 300,000 apps in the market, even a great app needs to be promoted to reach its audience.
Various methods of generating attention for your app will be discussed and the importance of measuring your app's performance in the market will be highlighted with code snippets and case studies where possible.
The last part of the talk will discuss the different options for monetizing your app, how to have a minimal impact on the user experience, and how to make the best choice between the different options."
Mathijs Vogelzang co-founded AppTornado, which develops the popular Android app discovery platform AppBrain.com and 30 other Android apps under the name "Swiss Codemonkeys" with a combined total download count of over 20 million. Mathijs has been building software for over 20 years. After competing in many programming contests Google hired him in 2007 to work on the YouTube team in Zürich, Switzerland. He and Uwe Maurer, one of his colleagues at Google, started to build fun Android apps together in their free time, and this lead to them leaving Google to found AppTornado near the end of 2008. Since February 2011 Mathijs is leading the Dutch branch of AppTornado based in Utrecht.


text:
European Securities Markets, The Investment Services Directive and Beyondby Ferrarini
Pub. Date: 03/01/1998
Publisher: Wolters Kluwer Legal & Regulatory
The European Union is moving towards the full implementation of the Investment Services Directive (ISD). Indeed, in some Member States, further changes to the domestic legal framework to increase competition among financial institutions and markets
Product Details
- 9789041107367
- Publisher:
- Wolters Kluwer Legal & Regulatory
- Publication date:
- 03/01/1998
- Pages:
- 428
- Product dimensions:
- 6.14(w) x 9.21(h) x 0.94(d)
Table of Contents
Preface, List of Contributors, List of Abbreviations PART I GENERAL 1 The Implementation of the ISD and CAD in National Legal Systems Eddy Wymeersch 2 Banking and Investment Services: Implications of the New Financial Landscape Ross Cranston 3 Economics of Securities Markets Regulation: Some Current Issues Francesco Cesarini PART II PRUDENTIAL RULES AND INSOLVENCY 4 Cross-border Compliance: Organisational Duties Imposed on National and International Investment Firms Uwe H. Schneider 5 Practicing Safer Lex: The Proper Domain of Property, Secured Transactions and Insolvency Laws in the Regulation of Intermediaries Charles W. Mooney Jr 6 Segregation of Securities and Insolvency under German Law Dorothee Einsele 7 Segregation of Assets and Insolvency under Italian Law Pier Giusto Jaeger PART III CONDUCT OF BUSINESS 8 Rules of Conduct: Further Harmonisation? Johannes Köndgen 9 Is there a Need to Harmonise Conduct of Business Rules? Cristopher Cruickshank 10 Derivatives Sales: Private Law and the Impact of Regulatory Standards William Blair 11 Conflicts of Interest: An English Problem? Barry A.K. Rider 12 Conflicts of Interest: The Spanish Experience Anibal Sanchez PART IV EXCHANGE COMPETITION 13 The Changing Microstructure of European Equity Markets Marco Pagano 14 Competition between Regulated Markets in London Stephen M. Schaefer 15 Competition among European Exchanges: Recent Developments Ailsa Roell 16 Competition among Exchanges or Financial Systems? Marco Onado PART V EXCHANGE REGULATION 17 Exchange Governance and Regulation: An Overview Guido Ferrarini 18 A European Directive for Regulated Markets? Some Personal Views Andrew Whittaker 19 A European Directive for Regulated Markets? A French Reaction Fabrice Demarigny 20 Regulation of the Relationship between European Union Stock Exchanges: Lessons from the United States Hal S. Scott 21 Derivatives Clearing Houses: The Regulatory Challenge Richard Dale PART VI ENFORCEMENT AND TAXATION 22 The Enforcement of the European Regime for Investment Services in the Member States and its Impact on National Conflict of Laws Sergio M. Carbone and Francesco Munari 23 Cooperation among Supervisory Authorities under the ISD Carlo Biancheri 24 Cooperation between Supervisors Susanne Bergstriisser 25 International Tax Aspects of Portfolio Investment Jaap van Hoorn Jr, Index
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VILNIUS, Lithuania -- Dirk Nowitzki has been carrying Germany on his back at major international tournaments for the past decade. For once on Friday, his teammates came to his aid in crunch time and carried the load when it mattered most.
Beset by foul trouble, the Dallas Mavericks forward still had 19 points, including a number of key free throws in the closing minutes, as the Germans rolled Turkey 73-67 to keep alive their hopes of reaching the quarterfinals of EuroBasket -- and qualifying for the 2012 Olympic Games.
Los Angeles Clippers center Chris Kaman had a game-high 20 points and Phillip Schwethelm delivered 11 points in the fourth quarter as the Germans came from behind to snatch the victory.
They still might need to defeat host Lithuania on Sunday to advance. Having an opportunity, at least, was enough for Nowitzki, who is averaging 20 points and 6.3 rebounds in the tournament.
"We took the first step," the 33-year-old said. "It wasn't pretty but that doesn't matter. There was a lot of pressure on the line. We started off the game very slow. We only had six points after the first quarter, which wasn't really the start we were hoping for. But we kept battling.
"Our defense was solid all night. We hit some big shots down the stretch and took the game to them. It was definitely a big win."
Despite the rigors of a long NBA season that culminated in bringing the NBA championship to Dallas, the 10-time All-Star has been visibly enjoying his time in Lithuania, joking around with a bunch of teammates who grew up watching him on TV as he blazed a trail across the Atlantic.
During his career, there have been plenty of achievements to cherish in a German uniform: a bronze medal at the 2002 FIBA world championships in Indianapolis, plus a silver at the 2005 EuroBasket in Belgrade.
"It's always been great times and great memories," Nowitzki said.
But the country hasn't yet bred a natural successor for when its favorite son finally calls time on his national team career. Preparing the Germans to remain competitive in his absence has been another of his objectives this summer.
"We have some interesting challenges," Nowitzki said. "It's time for the younger players. It's been fun with the new guys. They want to learn. They want to play. They're all nice guys. They're great talents, so it's been fun.
"We've had some tough losses that we have to learn from and we used that today down the stretch."
One more win and there may be more lessons available. One more loss, and the final buzzer may sound on Nowitzki's global tour.
Mark Woods is a freelance writer based in Edinburgh, UK, whose work appears regularly in British publications.


text:
|Item Weight
|2.2 pounds
|Product Dimensions
|6.6 x 3.6 x 3.6 inches
|3.5 Pounds
Other Sellers on Amazon
+ Free Shipping
Restoration Hypoallergenic Powder to Clean Antique and Delicate Linens Safely 32 Ounce Tub- One
|$25.38 & FREE Shipping on orders over $49. Details
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- Revives color and adds freshness to valuable antique linens
- Safe for most fabrics and colors
- Environmentally safe
- Easy to use
- Removes most stains and yellowing
Fulfillment by Amazon (FBA) is a service we offer sellers that lets them store their products in Amazon's fulfillment centers, and we directly pack, ship, and provide customer service for these products. Something we hope you'll especially enjoy: FBA items qualify for FREE Shipping and .
If you're a seller, Fulfillment by Amazon can help you increase your sales. We invite you to learn more about Fulfillment by Amazon .
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Customer Reviews
Top Customer Reviews
As I was using it, I was struck by how similar it was to the original Oxi Clean (which I have used for years). I thought to myself, "It really can't be the same, can it?" Curious, I went and got my tub of Oxi Clean and compared the ingredients of both products and was shocked that the ingredients were indeed the same. Since Oxi Clean is less than half the price for more than twice the product ($9.47 for 5lbs) Oxiclean Versatile Stain Remover, 5 Pounds, and contains identical ingredients, I won't be buying the overpriced Restoration again ($15.95 for 2lbs).
Gently rinse items & then make up another solution (can be done in washer) & soak items for 6-8 hours. Everything comes out fresh & clean.
Since then we have used Restoration on table linens, pillowcases, cross-stitch samplers and more. Only thing we noticed with the powder was that in high humidity it dissolves; so keep it in a sealed plastic bag.
Also, I should point out that the recipe below worked extremely well for me but I tested it thoroughly on a corner of one of my less valuable pieces. You may wish to do the same. Thanks!
Original Review ----------
I recently restored over 60 vintage napkins and tablecloths. They were in horrible shape after years and years of neglect. I didn't think anything would work to get the stains and yellowing out. Some were so bad I actually thought they were supposed to be beige (when it turns out they were white)! After I began using the Restoration I noted that, even after five or more treatments (and a lot of money spent), some dinginess remained. I honestly thought this was the best I could hope for and almost gave up. The Restoration is good but I found something even better from a linen-restoration expert on the Internet:
1 scoop Biz
1 scoop OxiClean (I love OxiClean "White Revive")
3/4 cup Ammonia
1 gallon *hot* water (as hot as the fabric will allow. I heated water on the stove)
Mix all the ingredients in a large tub, sink, or plastic bucket.Read more ›
Customer Images
Most Recent Customer Reviews
Great product! It worked wonders on some white and embroidered early-twentieth century linens. Stars deducted for the price. Read morePublished 10 days ago by lmedford
This is absolutely amazing and so much better than bleach. For old yellowed linens or for stains on any cloth. Dissolve into small amount of water and paint onto stain. Read morePublished 28 days ago by Karla E
It was simple to use and did the job nicely. I didn't expect to have to soak the vintage quilt for 6 hours and it may have compromised the fabric as it did tear a bit , but it... Read morePublished 1 month ago by Marilyn Q.
Works extremely well! I restored a baptism gown that's been in my family for generations, and it had become quite yellowed. Read morePublished 2 months ago by Ryan C.
I used it twice so far. First on a light blue vintage 1950s dress. This dress was awful; not wearable. Read morePublished 2 months ago by B. Smith
This product cleaned linens, crochet & old linens beautifully.
I have been recommending it to all my friends & family!
Extremely satisfied with this product!
Restored some yellowed table cloths. Worked great with more than one application. I was very pleased with the outcome.Published 3 months ago by Ruth Seither


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Man charged over alleged online child procurement | Photos, VideoDetectives from State Crime Command's Sex Crimes Squad have charged a man from the Lithgow area Detectives from State Crime Command's Sex Crimes Squad have charged a man after a covert online investigation into child exploitation. Earlier this ... Lithgow Mercury, 2 weeks ago
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Investigators said they found "very violent" pictures of corpses on his computer. (Photo: AP) Aquaintances had described him as someone who 'didnot practising Muslim, ate pork, took drugs and had an unbridled sex life'.. Nice, France: Mohamed Lahouaiej ...Asian Age, 1 week ago 84 People Killed After a Truck Driver Rammed into Them in Nice, France ForNaija.com, 2 weeks ago Terrorist used truck to attack in Nice, France Videos, Photos [LIVE] News EasyBranches.com, 2 weeks ago Germany Tightens Border Controls After Nice Attack ForNaija.com, 1 week ago
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With Game of Thrones on break, John Turturro's new HBO series, The Night of , has some massive shoes to fill both in ratings and nudity. "Are there any dragons in this one? Do you get naked in this?" Stephen Colbert asked the actor on Tuesday's The ...Rolling Stone, 2 weeks ago VIDEO: John Turturro Explains How to Direct a Sex Scene on LATE SHOW Broadway World, 2 weeks ago
Parramatta Eels star Corey Norman in centre of sex tape extortion bid (Yahoo7 News)
, 6:06 pm Video NRL star at centre of extortion attempt Parramatta Eels star Corey Norman has become the centre of an extraordinary extortion bid, after a sex tape was leaked and put up for sale to the highest bidder. 7 News broke the ...Yahoo! News Australia, 2 weeks ago 'No reason to drag his name through the mud': Eels furious over sex tape scandal ONE News, 2 weeks ago 'Sex tape' of NRL Parramatta Eels' Corey Norman offered to media for $150,000 NewsGrio, 2 weeks ago Parramatta Eels captain Tim Mannah angry at Corey Norman 'sex tape' seller Stuff.co.nz, 2 weeks ago
Huntingdon man Craig Stewart jailed for filming girls committing...
Comments(0) A PAEDOPHILE who stored hundreds of images and videos of teenage girls committing sex acts has been jailed for two and a half years. Peterborough Crown Court heard that Craig Stewart, 23, secretly recorded conversations he had ...Ely News, 2 weeks ago
Norman sent video via Snapchat
| The Corey Norman sex tape saga has taken another twist after revelations the Parramatta five-eighth allegedly sent footage of an elderly man snorting a white substance to Eels teammates via Snapchat. A separate video of Norman involved in a sex ...Sydney Morning Herald, 2 weeks ago Corey Norman sent video to Parramatta Eels teammates via Snapchat NewsFlow24, 2 weeks ago
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Eels rally around Norman amid sex tape row
Eels captain Tim Mannah has taken a swipe at the people trying to sell lewd videos of under-fire team mate Corey Norman. 'I think it's a shame when people see the benefit of attacking and using people's private lives for the benefit for ...Sky News Australia, 2 weeks ago Eels anger at lewd video seller Special Broadcasting Service, 2 weeks ago Eels anger at lewd video seller (AAP) Yahoo! News Australia, 2 weeks ago
More from: , GWN7 - Yahoo7...and 4 other sources
The 1975's Matt Healy on 'surreal' new video
"Having sex with myself is quite interesting," declares Matt Healy, lead singer of The 1975. Speaking backstage at T in The Park, he is to the point about the video for the band's latest single Somebody Else. In one scene, he sports a wig and a ...BBC, 2 weeks ago
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Click for supplies used in this project: ... In this step-by-step sewing tutorial I show you how to make a pair of baby/toddler pants out of a t-shirt. This tutorial can be used to make shorts or pants.This is a great beginner project
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My dream house is for sale….
If someone could please buy it for me, that would be lovely :)
My dream house is for sale….
If someone could please buy it for me, that would be lovely :)
Another year, another opportunity to get glammed up and enjoy a fantastic day out at Glyndebourne Opera House, thanks to my Sister's generosity.
It was a bit same old, same old, this year, in terms of my outfit. 195 more words
I wrote my last post in March. MARCH!!! Honestly, I just don't know where the time is going. Days blur into each other and I'm clearly struggling to keep up, and finding time to blog just hasn't seemed like a high priority; at the same time, it's a really important way for me to keep in touch with my online friends, and to promote my sewing (when I have things other than curtains and blinds to show) so I shall be making a firm and proper effort to get back into the rhythm. 368 more words
So my husband hit target last week so we celebrated with a bacon double cheese burger, chips and coleslaw at the hungry horse. I was quite surprised I couldn't actually eat it all. 236 more words
While listening to some of my favourite gaming podcasts and playing Doom this weekend I found there was a moment where I had to pause the game and stop the podcast I was listening to. 424 more words
So I ended my relationship with slimming world for a week or so as I was sick of my husband and son commenting on everything I put in my mouth. 64 more words
A little bit about me, I am 34, married, have 1 son, 1 temporarily adopted dog and 1 cat.
I have wanted to lose weight since I was 22 and every attempt has left me heavier than the last. 117 more words


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New Blue Characters T Shirts, Tanks And Hoodies
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Character t-shirts, tank tops, sweatshirts, phone cases and art prints include all the funniest comics, monsters, and imaginative creatures.
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Jukebox manufacturer TouchTunes has announced its newest smartphone app, which the company says is more intuitive than previous versions and will also sync with your Spotify library.
At CES 2016, Harman unveiled its Summit, a new audio platform for high-end cars that not only replicates the acoustic qualities of famous music venues, but also creates a deep immersion experience far beyond surround.
The refined build quality and slick performance of the Dell Venue 10 7000 make it one of the finest Android tablet-hybrids around.
The music service will also set up reminders to alert you to buy tickets and will send you a weekly personalized digest with upcoming shows.
The second installment of Woz's wildly popular "Age of Geek" event will be even bigger this year, expanding into three additional venues.
Officials from the Japanese city worry the search for Pikachu could disrupt an annual ceremony remembering victims of the first atomic bomb.
Whether you're in Philly or following the Democratic National Convention from home, here are seven apps every DNC-watcher should have on their phone.
Political junkies can stay on top of next week's DNC with a new app that includes a 360-degree video stream and real-time access to speeches and photos.
The X-Games medalist will test her driving skills this weekend in a 650-horsepower beast that is made to fly.
Technically Incorrect: The face-painted rock star is pained by people using phones to film concerts.


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No cages, or only one or two, only the sounds of the peacocks and the flamingos. A quiet place where you might see animals hopping, running, stopping and staring at you... read more
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Looking for a new heatsink for HD 6870
Last response: in Overclocking
Related resources
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Read discussions in other Overclocking categories


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- Anónimo
- Alemanha, Mulher, 18-24
- Nómada principiante
- 1 comentário
Absolutely nice staff and totally ok for the price. The metro station was right there and shops where you can buy food and drinks. I would always book this hostel again. If you don't have high expectations it's the perfect hostel for you. For those who like partying: the hostel is in Clarke Quay, the party district in Singapore.
- Anónimo
- Tailândia, Grupo misto, 18-24
- Nómada principiante
- 3 Comentários
why i dont like this hostel 1) it was musty room 2) black stains on all bed sheets 3) all toilets are very very very dirty omg! i never stay hostel where like this staying at this hostel was a nightmare for me GOOD BYE ALL HOSTEL IN SG
APP Hostelworld para telemóvel
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6 Female IOEBA reg. Olde English Bulldoggees-$1,200 Lodi … Read more
Kim Gantiser pours Michael Kirwan a glass of Boneshaker Zinfandel from Cycles Winery during Vine Dawgz Rock! for LOEL Senior Center at the home of Steve and Bo Diede on Saturday, Nov. 10, 2012.Buy this photo
6 Female IOEBA reg. Olde English Bulldoggees-$1,200 Lodi … Read more
2005 Honda CR-V EX, 93K miles, exc. cond., new tires/brak… Read more
4401 W. Sargent Rd. Dining table/chairs, Treadmill, Recli… Read more
Waste Management hiring a Driver (Area Relief) in Lodi, C… Read more
Trustee Sale No. : 00000005938501 Title Order No. 1600829… Read more
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The following person(s) is/are doing business as: LINA'S … Read more
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Green Dragon Spring is located in the Back Basin at Norris Geyser Basin. Some of the photos and comments are confusing this Spring with Dragon's Mouth Spring in the Mud Volcano... read more
A hot spring located in Yellowstone National Park.
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1,230 vehicles matched;
Now showing page 10 of 123. 10 results per page.
Listed by Back in the Day Classics
When the Flathead V8 was introduced in 1932, the coachbuilder that would be best remembered for its contributions to the
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With a combination of modern engineering advancements and sleek new styling by Harley Earl, Chevrolet sales passed the million-car mark
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Listed by B & S Enterprises
The owner says this one is going to be his flower car when he dies ! He has owned it
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Dark Metallic Blue Exterior Black Leather Bucket Seats 307 ci/ 305 HP VORTEC V8 Automatic Transmission Cold A/C Power Disc Brakes Power Steering Full wood bed Beautifully restored
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1940 Ford Deluxe 4 Door Sedan nicely restored with a small block Chevy engine that has less than 2,000 miles
Listed by Classic Car Marketing, Inc.
Classic Car Marketing, Inc. Southern California's premier marketing company is pleased to introduce this new listing offered for sale by
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1946 Chevy Fleetmaster 2dr sedan, great body of frame restoration, new paint, beautiful redone leather interior, engine 8 cyl 350
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1949 Nash Airflyte Super 600 Two-door Fastback, 50,000 miles, totally 100% rust free, the all new aerodynamic design- with its
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by Joel S. Hirschhorn
With a kind of religious fervor, American conservatives love to talk about their love of capitalism, as if it has a singular definition and can always be counted on to serve public and national interests. The intelligent way to think about capitalism is that it can be of two kinds. The good kind is patriotic and stakeholder oriented, the bad kind is selfish and shareholder obsessed. The global economic downturn is strong evidence of the dominant second form of capitalism that has caused so much human suffering while it has served the rich and powerful.
When those with power take actions purely to serve corporate financial interests even though it greatly harms employees, the middle class and the national economy then the bad kind of capitalism is being pursued. Think of the mass export of good jobs, especially in manufacturing, the preference for imported goods, and the investment of capital to build new manufacturing and research facilities in other countries. Maximizing financial returns to reward corporate bigwigs and stockholders even though the actions greatly harm the US economy and society results from US companies practicing bad, immoral capitalism. Think of this development as the conquest of Wall Street over Main Street, of those who make money over those who create and make products, of those who promote economic inequality over those who value the middle class.
The power elites that have succeeded in perverting capitalism have also succeeded in making much of the American public so dumb and distracted that they no longer function as informed and effective citizens, which has allowed the government to be hijacked by the rich and powerful through a two-party plutocracy.
Selfish capitalism was exemplified by the role of Fannie Mae in creating the economic disaster by perverting the housing market, as conservative David Brooks correctly concluded; he noted the "leadership class is fundamentally self-dealing;" it practiced "shameless self-enrichment" which produced disastrous results.
To be clear, the conflict is not between capitalism and socialism, the way right wing ideologues talk, but between the good and bad kinds of capitalism, which those on the left need to learn how to talk about. Bad, greed-driven, too-big-to-fail capitalism has ruined the US for all but the rich which have sucked off much of the nation's wealth.
A fine analysis by Harold Meyerson on the difference between the highly successful German economy and the dismal US one drives home the crucial differences between the two forms of capitalism. The need is for the US to learn from the more successful German, good form of capitalism and develop policy reforms that could rejuvenate the US economy by curbing the bad form of capitalism. The ideas that Republicans keep advocating are all wrong because all they want to do is promote bad capitalism, which only serves the interests of the rich and powerful, not ordinary Americans, not the middle class, and not workers. Peter Coy has also assembled great information on what can be learned from other nations.
The German economy makes the US one look like it is on its deathbed. The German tripartite system has business, labor and government working together. Faced with the same competition from low wage developing countries and the entire globalization condition, Germany has a booming manufacturing sector that constitutes almost twice the share of the economy than that in the US. And even in the current global economic recession German unemployment is 7 percent. The tripartite system has kept German labor unions strong and, therefore, protects the middle class whose pay has risen at roughly the same rate as top incomes. This is in stark contrast to the rich-getting-richer and union–busting situation in the US. Indeed, the top 1 percent in the US are seeing their proportion of total income rise dramatically, even as their German counterparts are seeing their share of total income shrink. German corporate boards are required by law to have an equal number of management and employee representatives. By law!
Germany's stakeholder capitalism benefits the many unlike the US where selfish capitalism benefits the upper class and brutalizes everyone else. Corporate power has not captured the German government the way it has hijacked the US government.
One powerful and highly successful public policy used by several democracies with strong capitalistic systems in the current economic downturn is providing companies with funds to keep workers on the payroll until demand improves. This directly fights unemployment and puts government dollars directly in the pockets of workers, in stark contrast to the many billions of dollars the US has spent which have not helped fight unemployment nor helped ordinary Americans, because the billions have flowed to corporate and financial interests. This more sensible approach that boosts consumer demand and spending has been used by Singapore, Germany and Japan, for example.
Steven Pearlstein recently examined the history of IBM and noted its "outmoded ethos – namely that the company exists not simply to maximize profit for shareholders but to maximize the benefits it can offer to customers, employees and the society as a whole." Exactly right.
If President Obama was as smart as he and so many others think he is, and if he was a genuine leader and seeker of deep reforms, he would learn, respect and work like a dog to apply the best practices other nations are using to get better and fairer economic results. But as the Center for Public Integrity found, Obama has showered benefits on big time funders of his presidential campaign. Will he be a forceful advocate for capitalism with a human face?
Don't hold your breath.
If Republican presidential hopefuls and crony capitalists cared as much about serving the public interest as serving corporate desires, than they would stop their nonsensical free market claptrap embracing selfish capitalism and seek a more patriotic form that puts the nation first. Time to stop talking about cutting taxes. Pursue new and better ideas. Face reality, a free market that provides freedom for corporate and financial interests to victimize the public must be changed. Admit that!
Don't hold your breath.
[Contact Joel S. Hirschhorn through delusionaldemocracy.com.]
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January 2 - January 8, 2012
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QuickBooks ProAdvisor is now charged monthly and I'm just doing my VAT return and I am rethinking about how to categorise the expenses:
It entitles me to a free upgrade of the software, technical support and an entry on their ProAdvisor website.
What category of expense do you suggest? Should I split it? It doesn't effect my tax return but I am interested in views.
Should it be:
Support contract
Something else
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By Chris Smail
07th Feb 2013 13:47
Dear me Peter
I think you must have too much time on your hands, take a long weekend.