text:
Mammography World Markets
- December 2012
- Region: Global
- 211 Pages
- TriMark Publications
- Abviva, Inc.
- Biosound Esaote, Inc
- Dexela
- Hologic, Inc.
- Philips Healthcare
- SenoRx, Inc.
Breast cancer is the most common type of cancer in women, affecting one in eight during their lives. Mammography is the most valuable method for detecting potentially cancerous anomalies in the breast. As such, the mammography segment is poised for a major new phase of growth fueled by the availability of new technologies. This TriMark Publications report examines the leading companies engaged in marketing, manufacturing or developing mammography equipment and supplies in the world. Each company is discussed in extensive depth with a section on its product line, business and marketing analysis, and a subjective commentary of the company's market position. Detailed tables and charts with sales forecasts and market share data are also included.
Mammograms are X-ray images of the breast produced from low radiation X-rays (1-3 milligrays, or mGy).
The three types of mammography systems are:
1) analog systems,
2) computed tomography (CR) systems and
3) full-field digital mammography (FFDM).
The analog systems are the conventional types, and they use X-ray films for capturing the breast images. The CR systems are also film-based, but are retrofitted with digital detectors. In FFDM, the X-ray film is replaced by solid-state detectors that convert X-rays into electrical signals. The electrical signals are used to generate images of the breast that can be viewed on a computer screen or printed on special film similar to conventional mammograms. Additionally, the radiation dose in FFDM is only 1.86 mGy radiation per view.
Scope of This Report
This study gives priority to those companies that are actively developing and marketing clinical laboratory instrumentation, reagents and supplies for performing diagnostic tests specifically related to breast cancer surgery and screening mammograms. This focus is primarily on the hospital market and freestanding-clinic segments and, separately, on a description of the instruments, reagents and supplies marketed by major companies in this segment. Other areas covered in this study include what is generally characterized as digital imaging techniques instruments and reagents, picture archiving communications systems (PACS) or other data storage methods, or other medical imaging technologies. The reader should consult other TriMark reports for a detailed discussion of the important individual market segments related to the mammography market, such as imaging methods, computer tomography, magnetic resonance imaging (MRI) and digital X-ray.
Specialty areas in medical imaging are touched upon in this study, since these segments are frequently a part of the overall analytical focus of companies marketing general mammography equipment. However, no effort is made to quantify the size of this broader market. Companies that market and sell a limited number of instruments and equipment, as an OEM part of a much larger clinical laboratory product line by other companies, are only briefly mentioned. For example, Analytical Devices is discussed in terms of its relationship with Philips and Siemens Corporation. These companies are only reported in passing, since they are not a direct focus of the mammography market. Disposable supplies or imaging materials are not specifically covered here; however, business trends, technology trends and developing areas of clinical mammography are discussed in depth. This study further focuses on mergers and acquisitions in the sector, new product launches, and any important legal issues that are recent and have some bearing on the growth of the mammography testing sector.
This TriMark Publications report thoroughly reviews:
1) existing and emerging mammography technologies,
2) known risk factors for breast cancer,
3) breast cancer treatments and drugs,
4) types of mastectomy procedures,
5) breast reconstruction surgery, and
6) funding for breast cancer research.
The study examines almost all of the companies known to be marketing, manufacturing or developing mammography equipment and breast cancer therapies in the world. Each company is discussed in extensive depth with a section on its history, product lines, business and marketing analysis, and a subjective commentary of the company's market position. Detailed tables and charts with sales forecasts and market share data are also included. SHOW LESS READ MORE >
- Abviva, Inc.
- Biosound Esaote, Inc
- Dexela
- Hologic, Inc.
- Philips Healthcare
- SenoRx, Inc.
1. Overview
1.1 Statement of Report
1.2 Scope of this Report
1.3 Methodology
1.4 Executive Summary
2. Technology Trends in Mammography
2.1 Rationale for Digital Mammography
2.1.1 The Technology
184.108.40.206 Mammography Reading
2.2 Research Studies
2.3 Contrast Injection Mammography
2.4 Digital Breast Tomosynthesis (DBT)
2.5 Dedicated CT of the Breast
3. Mammography Overview
3.1 Early Mammography
3.2 The First Digital Mammography System
3.3 Mammography Technique and Types
3.3.1 Screening Mammogram
126.96.36.199 Cost of Screening Mammogram in the U.S.
18.104.22.168 Interpretation of Mammogram
3.4 Signs and Symptoms of Breast Cancer
3.4.1 Need for MRI
3.5 Most Common Breast Conditions Seen in Screening Mammography
3.5.1 Fibroadenoma
3.5.2 Galactocele
3.5.4 Adenosis
3.5.5 Phyllodes Tumor
3.5.6 Infiltrating Duct Carcinoma
3.5.7 Duct Carcinoma in situ
3.6 Diagnostic Mammography
3.6.1 Views with Diagnostic Mammography
3.6.2 Anomalies Detected by Diagnostic Mammography
3.7 Other exams to Evaluate Breast Anomaly
3.7.1 Computer-Aided Detection in Breast Imaging
3.7.2 Ductal Lavage
3.7.3 Scintimammography
3.7.4 Positron Emission Tomography (PET) in Breast Imaging
3.8 Staging and Survival Rates of Breast Cancer
3.8.1 Numerical Stages of Breast Cancer
3.9 Breast Cancer Stages and Survival Rate
3.9.1 Histologic Grading of Breast Cancer
3.10 Hormone Receptor Status in Breast Cancer
3.11 Metastatic Breast Cancer (MBC)
3.12 Breast Cancer Treatments
3.12.1 Breast Cancer Surgery
126.96.36.199 Breast Conserving Surgery
18.104.22.168 Total Mastectomy
220.127.116.11 Modified Radical Mastectomy
3.12.2 Radiation Therapy
18.104.22.168 External Radiation Therapy
18.104.22.168 Internal Radiation Therapy
3.12.3 Hormone Therapy
3.12.4 Targeted Therapy
3.12.5 Chemotherapy
126.96.36.199 Classes of Breast Cancer Drugs
22.214.171.124.1 Selective Estrogen-Receptor Modulators (SERMs)
220.127.116.11.2 Aromatase Inhibitors
22.214.171.124.3 Biologic Response Modifiers
3.12.6 Profiles of Breast Cancer Drugs
22.214.171.124 Abraxane (paclitaxel protein-bound particles for injectable suspension)
220.127.116.11 Adriamycin (doxorubicin)
126.96.36.199 Aredia (pamidronate disodium)
126.96.36.199 Arimidex (anastrozole)
126.96.36.199 Aromasin (exemestane)
18.104.22.168 Chemotherapy Regimens
126.96.36.199 Cytoxan (cyclophosphamide)
22.214.171.124 Ellence (epirubicin)
126.96.36.199 Evista (raloxifene)
188.8.131.52 Fareston (toremifene)
18.104.22.168 Femara (letrozole)
184.108.40.206 Herceptin (trastuzumab)
220.127.116.11 Megace (megestrol)
22.214.171.124 Tamoxifen
18.104.22.168 Taxol (paclitaxel)
126.96.36.199 Taxotere (docetaxel)
18.104.22.168 Xeloda (capecitabine)
188.8.131.52 Zoladex (goserelin acetate)
18.104.22.168 Zometa (zoledronic acid)
3.13 Breast Reconstruction after Breast Cancer Surgery and Radiation Therapy
3.13.1 Delayed Reconstruction and Radiation
3.13.2 Reconstructing the Irradiated Lumpectomy Breast Deformity
3.13.3 Genetic Testing and Prophylactic Mastectomy
3.14 Types of Mastectomy
3.14.1 Skin-Sparing Mastectomy
3.14.2 Nipple-Sparing Mastectomy
3.14.3 Areola-Sparing Mastectomy
3.14.4 Skin-Reducing Mastectomy
3.14.5 Expander Implant Post Mastectomy Reconstruction
3.14.6 Direct Implant ("One-Step") Breast Reconstruction
3.14.7 Latissimus Dorsi Flap
3.14.8 TRAM Flap Reconstruction
3.14.9 TUG Flap - Inner Thigh Flap Breast Reconstruction
3.14.10 GAP Flap, Other Free Flaps
3.14.11 Implants Used in Breast Reconstruction
126.96.36.199 Types of Breast Implants
3.15 Known Risk Factors for Breast Cancer
3.15.1 Increasing Age
3.15.2 Family History of Breast Cancer and Genetic Predisposition
3.15.3 Hormonal Factors
3.15.4 Clinical Factors
3.15.5 Radiation
3.16 Prevention of Breast Cancer
3.16.1 Obesity
3.16.2 Alcohol Consumption
3.16.3 Tobacco
3.16.4 Menopausal Hormones
4. Breast Cancer and Mammography Data
4.1 Global Breast Cancer Incidence and Mortality
4.2 Characteristics of Breast Cancer Cases
4.3 U.S. Data on Breast Cancer and Mammography
4.3.1 New Breast Cancer Incidence in the U.S.
22.214.171.124 Breast Cancer and Mammography in White Women
18.104.22.168 Breast Cancer and Mammography in Hispanic Women
126.96.36.199 Breast Cancer and Mammography in African-Americans
184.108.40.206 Breast Cancer and Mammography in Asian Pacific Islanders
22.214.171.124 Breast Cancer and Mammography in Native Americans
184.108.40.206 Breast Cancer and Mammography in Ashkenazi Jews
4.3.3 Educational Level and Breast Cancer Incidence in the U.S.
4.3.4 Mammography Percentages by Age in the U.S.
4.3.5 Financial Impact of Breast Reconstruction
220.127.116.11 Payment and Reimbursement Guidelines in 2008 for Intraoperative Electron Radiation Therapy (IOERT)
22.214.171.124 Medicare Inpatient Hospital Payment
184.108.40.206 Rise in Payments for Breast Cancer in the U.S.
4.3.6 Research Funding for Cancer Research in the U.S.
220.127.116.11 NIH Funding Mechanisms
220.127.116.11 Percent Share of Total NCI Dollars
126.96.36.199 Actual Obligations by Mechanism
4.3.7 Funding Trends
126.96.36.199 Research Project Grants
188.8.131.52 Research Career Awards - "K" Program
188.8.131.52 NCI Funding by Cancer Type
18.104.22.168 Funding for Breast Cancer Research
18.104.22.168 Research Areas in Breast Cancer
184.108.40.206 NCI-Designated Cancer Centers
126.96.36.199 NCI's Funding by State
18.104.22.168 2011 Professional Judgment Budget Request
4.4 Breast Cancer Screening in E.U.
4.4.1 Number of People Affected by Screening in E.U.
4.4.2 Program Implementation Status in E.U.
4.4.3 Variation between Member States in E.U.
4.4.4 Breast Cancer Incidence and Mortality in the U.K.
184.108.40.206 Socio-Economic Variations
126.96.36.199 Breast Cancer Trends in U.K.
18.104.22.168 Breast Cancer Incidence in U.K.
126.96.36.199 Mastectomy and Breast Reconstruction Surgery in U.K.
184.108.40.206 Outcomes of Mastectomy and Reconstruction
22.214.171.124 Patient Characteristics and Patterns of Care
220.127.116.11 Types of Primary Breast Reconstruction in U.K.
188.8.131.52 Types of Contralateral and Secondary Reconstructive Procedures
18.104.22.168 National-Level Inpatient Complication Rates
22.214.171.124 Breast Cancer Research in U.K.
126.96.36.199 Breast Screening Programs in England as of 2009
4.4.5 Breast Cancer Screening in Australia
220.127.116.11 Breast Cancer Projections in Australia
22.214.171.124 Trends in Medicare Benefits Schedule (MBS) Funded Mammography
188.8.131.52 Analysis of MBS Funded Mammography by Age
184.108.40.206 MBS Funded Diagnostic Services for Breast Cancer
5. Market Analysis
5.1 Points to be considered Before Buying a Mammography System
5.1.1 Cost Containment in Mammography Systems
5.2 Global Market for Mammography
5.2 Global Market for Film-Based Mammography Systems
5.3 Global Market for Digital Mammography
5.4 Global Breast Cancer Drugs Market
5.5 Global Cancer Biomarkers Market
5.6 Leading Players in Global Cancer Pharmaceuticals
5.7 Global Spending on Cancer Drugs
5.8 Mammogram Procedure Growth in the U.S.
5.8.1 Approved Mammography Facilities in the U.S.
5.8.2 Mammography Quality Standards Act (MQSA) National Statistics
5.8.3 Decline in the Number of Mammography Facilities in the U.S.
5.8.4 Number of Mammography Units in the U.S.
5.8.5 U.S. Mammography Equipment Market
5.8.6 Digital Mammography: Market Penetration in the U.S.
5.9 Business Plan for Digital Mammography
5.10 Breast Cancer and Genetic Testing in the U.S.
5.11 U.S. Market for Brachytherapy Products
5.12 U.S. Market for Breast Irradiation
5.13 Reimbursement for Mammography Procedures
5.14 Global Market for Breast Cancer Drugs
5.14.1 Avastin
5.14.2 Herceptin
5.14.3 Xeloda
5.15 Global Market for Cancer Therapies
5.16 Global Market for Biological Therapies in Cancer
5.16.2 U.S. Market for Biological Therapies in Cancer
5.16.3 European Market for Biological Cancer Therapies
5.16.4 Market for Biological Cancer Therapies in Japan
5.16.6 Market for Biological Cancer Therapies in Rest of the World
5.17 Market for Other Imaging Modalities
5.17.1 Popular Medical Imaging Systems
5.18 Global Market for Medical Imaging
5.18.1 Global Medical Imaging Market by Modality
5.18.2 Global Market for General X-rays
5.18.3 Global Market for Ultrasound (US)
5.18.4 Global Market for Portable Ultrasound
5.18.5 Global Market for Magnetic Resonance Imaging
5.18.6 Global Market for Computed Tomography
5.18.7 Global Market for Nuclear Medicine
5.18.8 Global Market for SPECT/PET
5.18.9 Global Market for PET/CT
5.18.10 Global Medical Displays and Post-Processing Software Market
5.19 North American Market for Medical Imaging
5.19.1 North American Market for Magnetic Resonance Imaging (MRI)
5.19.2 U.S. Market for Computed Tomography
5.19.3 U.S. Market for Multi-Slice CT Scanners
5.19.4 U.S. Market for SPECT and PET Radiopharmaceuticals
5.19.5 U.S. Market for SPECT
5.19.6 U.S. Market for Positron Emission Tomography (PET)
5.19.7 Medical Imaging in Canada
5.20 Medical Imaging Market in Europe
5.20.1 Medical Imaging Market in Central Europe
5.20.2 European Market for Digital Radiography (DR)
5.20.3 European Market for Computed Radiography
5.20.4 European Market for MRI
5.20.5 European Market for Digital Radiography (DR)
5.20.6 European Market for Computed Radiography (CR)
5.21 Emerging Markets in Medical Imaging
5.21.1 Medical Imaging in China and India
5.21.2 Medical Imaging Market in China
5.21.3 Market for Ultrasound in China
5.21.4 Medical Imaging Market in India
6. Company Profiles
6.1 Abviva, Inc.
6.1.1 Mammastatin Serum Assay (MSA)
6.2 Agendia B.V.
6.2.1 MammaPrint
6.2.2 BluePrint
6.2.3 TargetPrint
6.3 Agfa Healthcare
6.4 Amgen, Inc.
6.4.1 Amgen's Cancer Drugs
220.127.116.11 Aranesp (darbepoetin alfa)
22.214.171.124 Xgeva (denosumab)
22.214.171.124 Vectibix (panitumumab)
22.214.171.124 Neulasta (pegfilgrastim)
6.5 Analogic Corporation
6.5.1 Analogic's CT Systems and Subsystems
6.5.2 Analogic's MRI Power Solutions
6.5.3 Analogic's Specialized Ultrasound Solutions
6.5.4 Analogic's Digital Radiography Subsystems
6.5.5 Analogic's Radiation Therapy Solutions
6.6 Ardent Sound, Inc
6.7 AstraZeneca
6.7.1 Arimidex
6.7.2 Faslodex
6.7.3 Casodex
6.7.4 Zoladex
6.7.5 Iressa
6.8 Aurora Imaging Technology, Inc.
6.8.1 Aurora 1.5T Dedicated Breast MRI System
6.9 C.R. Bard, Inc.
6.10 Biosound Esaote, Inc
6.11 Bristol-Myers Squibb
6.11.1 Ixempra (ixabepilone)
6.11.2 Erbitux (cetuximab)
6.11.3 Sprycel (dasatinib)
6.12 Canon U.S.A., Inc
6.13 Chison Medical Imaging, Co., Ltd
6.14 Clarient, Inc.
6.15 Dako
6.15.1 Dako's Products
6.16 deCODE Genetics
6.16.1 deCODE BreastCancer
6.17 Dilon Technologies, Inc.
6.17.1 Dilon 6800 Gamma Camera
6.17.2 The GammaLoc System
6.17.3 PenRad Mammography Information System
6.18 Dexela
6.18.1 Dexela Digital Mammography Workstation
6.19 Eli Lilly
6.19.1 Eli Lilly's Oncology Products
6.20 Encapsule Medical Devices, LLC.
6.21 Fonar Corporation
6.21.1 Fonar's Upright MRI
6.21.2 Fonar 3600
6.22 Fujifilm Medical Systems USA, Inc.
6.23 Fukuda Denshi Co., Ltd.
6.24 GE Healthcare
6.25 Genentech, Inc.
6.25.1 Genentech's Oncology Products
22.214.171.124 Avastin (bevacizumab)
126.96.36.199 Herceptin (Trastuzumab)
22.214.171.124 Rituxan
126.96.36.199 Tarceva (erlotinib)
22.214.171.124 Xeloda (capecitabine)
6.26 Hitachi Medical Corporation
6.27 Hologic, Inc.
6.27.1 Hologic's Breast Health Products
184.108.40.206 Selenia Full Field Digital Mammography System
188.8.131.52 Breast Tomosynthesis
18.104.22.168 Screen-Film Mammography Systems
126.96.36.199 SecurView Workstation
18.104.22.168 CAD Systems
22.214.171.124 Stereotactic Breast Biopsy Systems
126.96.36.199 Breast Biopsy Products
220.127.116.11 Breast Brachytherapy Products
18.104.22.168 MammoPad Breast Cushion
18.104.22.168 Photoconductor Coatings
188.8.131.52 Sentinelle Medical MRI Breast Coils and Workstation
6.28 Imaging Diagnostic Systems, Inc.
6.28.1 Computed Tomography Laser Mammography (CTLM)
6.29 Konica Minolta Medical Imaging USA, Inc.
6.29.1 Xpress CR
6.29.2 REGIUS PureView System
6.30 MacKay LifeSciences
6.30.1 Breast Cancer Diagnostic System (BDS)
6.31 Lantheus Medical Imaging, Inc.
6.32 Medis Medical Imaging Systems BV
6.33 Medical Tactile, Inc
6.33.1 SureTouch System
6.34 Medison America, Inc.
6.35 Medtronic Navigation and Imaging
6.35.1 PoleStar Surgical MRI system
6.35.2 StealthStation i7
6.35.3 O-arm Surgical Imaging System
6.35.4 StealthViz Advanced Visualization and Planning
6.36 MeVis Medical Solutions AG
6.36.1 MeVis Software for Digital Mammography
6.36.2 Syngo MammoReport
6.36.3 SecurView DX
6.36.4 DynaCAD
6.37 Naviscan PET Systems, Inc.
6.37.1 Naviscan PEM Scanner
6.38 NeoMatrix LLC
6.38.1 HALO Breast Pap Test
6.39 Novartis AG
6.39.1 Femara
126.96.36.199 The Action of Femara
6.40 Philips Healthcare
6.40.1 Philips PCR Eleva CosimaX system
6.40.2 Integral Breast Workspace solution from Philips Healthcare
6.40.3 Breast Ultrasound from Philips Healthcare
6.40.4 MammoDiagnost
6.40.5 MammoDiagnost DR
6.40.6 MammoDiagnost with PCR Eleva
6.41 Pfizer, Inc.
6.41.1 Pfizer's Pipeline of Therapeutics
6.42 Roche Holdings, Ltd.
6.42.1 Roche's Cancer Pharmaceuticals
6.42.2 Avastin
6.42.3 MabThera/Rituxan
6.42.4 Herceptin (trastuzumab)
6.42.5 Xeloda (capecitabine)
6.42.6 Tarceva (erlotinib)
6.42.7 Regulatory Approvals for Roche's Cancer Drugs
6.43 Sanarus Technologies, LLC
6.43.1 Sanarus Visica cryoablation treatment system
6.44 Sanofi-Aventis
6.44.1 Taxotere
6.44.2 Eloxatine (oxaliplatin)
6.44.3 Sanofi's Oncology Pipeline
6.45 Sectra Medical Systems
6.45.1 Sectra MicroDose Mammography
6.45.2 Sectra Breast Imaging RIS/PACS
6.46 Planmed
6.47 Scanis, Inc.
6.47.1 Mammex MammoCAD System
6.48 Siemens Healthcare
6.48.1 Digital Mammography from Siemens
6.48.2 3D Breast Tomosynthesis
6.48.3 Mammomat Novation
6.49 SenoRx, Inc.
6.49.1 EnCor Breast Biopsy System
6.49.2 SenoRx Family of Markers
6.49.3 Contura Multi-Lumen Balloon (MLB)
6.49.4 Gamma Finder
6.50 Shimadzu Medical Systems
6.51 SonoCine, Inc.
6.51.1 SonoCine
6.52 TechniScan Medical Systems
6.52.1 Svara Warm Bath Ultrasound (WBU)
6.53 Toshiba America Medical Systems, Inc.
6.53.1 Infinix-i systems
6.53.2 Aquilion ONE CT System
6.53.3 Vantage Titan
6.53.4 Viamo
6.53.5 Radrex-i
6.54 U-Systems, Inc.
6.54.1 SomoV Automated 3D Breast Ultrasound System
6.55 Varian Medical Systems
6.55.1 Varian's Oncology Business
6.55.2 Varian's X-Ray Business
6.56 VuCOMP, Inc.
6.56.1 M-Vu CAD system
6.56.2 M-Vu Digital CAD system
6.56.3 M-Vu Viewer Station
6.56.4 M-Vu Digitize + Archive
Appendix 1: Breast Cancer Nutrition
Appendix 1.1: Vegetables and Fruits
Appendix 1.2: Grains
Appendix 1.3: Meat and Fish
Appendix 1.4: Alcohol and Beverages
Appendix 2: Breast Cancer Statistics
Appendix 3: Integration of Digital Mammography on PACS
Appendix 3.1: Considerations in Deploying Digital Mammography
Appendix 4: CAD for Digital Mammography Using Syngo MammoCAD
Appendix 5: BRIDGE Metastatic Breast Survey
Appendix 5.1: BRIDGE Metastatic Breast Cancer (MBC) Survey
Appendix 5.2: Psychological Impact of Breast Cancer
Appendix 5.3: Preast Cancer Patients' Outlook on Life
Appendix 5.4: Role of Information in Helping Women to Cope with MBC
Appendix 5.5: Clinical Trial Awareness and Experience in MBC
Appendix 5.6: Reasons for Not Participating in Clinical Trial
Appendix 5.7: The Role of Information and "Inforemation Seeking Women"
Appendix 6: Clinical Trials in Mammography as of December 2010
Appendix 7: Advances against Cancer in the Past 150 years
Appendix 8: Emerging Technologies in Breast Cancer Detection
Appendix 8.1: Digital Mammography
Appendix 8.2: Indirect-Conversion Digital Detectors
Appendix 8.3: Direct-Conversion Digital Detectors
Appendix 8.4: Contrast-Enhanced Mammography
Appendix 8.5: Breast Tomosynthesis
Appendix 8.6: Digital Mammography/Ultrasound Fusion
Appendix 8.7: Computer-Aided Detection
Appendix 8.8: Magnetic Resonance Imaging (MRI)
Appendix 8.9: Breast Ultrasound
Appendix 8.10: Breast Thermography
Appendix 8.11: Positron Emission Tomography (PET)
Appendix 8.12: Scintimammography
Appendix 8.13: Near Infrared Optical Imaging
Appendix 8.14: Bioelectric Imaging
Appendix 9: Medical Imaging Technologies
Appendix 9.1: Ultrasound Systems
Appendix 9.2: Computed Tomography (CT)
Appendix 9.3: Magnetic Resonance Imaging (MRI)
Appendix 9.4: Digital X-Ray
Appendix 9.5: Positron Emission Tomography (PET)
Appendix 10: The Supply of Medical Radioisotopes
Appendix 10.1: Potential for New Reactors
Appendix 10.2: Processing Capacities and Restraints
Appendix 11: Opportunities in the Middle East for Healthcare and Medical Imaging
Appendix 11.1: The largest U.S. Customers in the Middle East Region
Appendix 11.2: U.S. Exports of Medical Imaging Products to the Middle East, 2009
Appendix 12: Value of Radiation Therapy and Medical Imaging
Appendix 12.1: Effective Use of Medical Radiation
Appendix 12.2: Innovations to Reduce Radiation Dose
Appendix 12.3: Innovation in CT Imaging
Appendix 12.4: Effectiveness of Radiation Therapy
Appendix 12.5: Efforts to Minimize Radiation Dose
Appendix 12.6: New Dose-Check Features
Appendix 13: Health and Medical Imaging Expenditures in OECD Countries
Appendix 13.1: Medical Imaging Equipment and Utilization Statistics
Appendix 13.2: CT Scanners per Million
Appendix 13.3: Gamma Cameras per Million of Population in OECD Countries
Appendix 13.4: Mammography Units per Million of Population in OECD Countries
Appendix 13.5: MRI Scanners per Million Population in OECD Countries
Appendix 13.6: PET Scanners per Million of Population in OECD Countries
Appendix 13.7: Utilization of Medical Imaging Modalities in OECD Countries
Appendix 13.8: CT Exams per 1,000 of Population in OECD Countries
Appendix 13.9: MRI Exams per Scanner in OECD Countries
Appendix 13.10: MRI Exams per 1,000 of Population in OECD Countries
Figure 1.1: Growth of Digital Mammography in the U.S., 2003-2008
Figure 1.2: Digital Mammography System that Uses a Direct Conversion Flat-Panel Detector
Figure 1.3: Digital Mammography Plate Reading Station
Figure 1.4: A Digital Mammography Workstation
Figure 1.5: Tomosynthesis Scanner from GE
Figure 1.6: Standard 2D and Tomosynthesis Slice Breast Images
Figure 3.1: Attention Given to MBC Compared with EBC in Different Countries, 2008
Figure 3.2: Patients' Emotions When Given a Diagnosis of Metastatic Breast Cancer (MBC)
Figure 3.3: Patients' Concerns when Given a Diagnosis of Metastatic Breast cancer (MBC)
Figure 4.1: Percent Incidence of Sporadic and Familial Breast Cancer
Figure 4.2: Global Breast Cancer Incidence and Mortality in Select Regions as of 2008
Figure 4.3: Number of Women Diagnosed with Breast Cancer by Age and Type of Disease, 1996-2008
Figure 4.4: Number of Women Diagnosed with Breast Cancer by Year and Type of Disease, 1996-2008
Figure 4.5: Distribution of Number of Screening Mammograms per Woman for 1996-2008
Figure 4.6: Distribution of U.S. Women in 2008 by Race/Ethnicity
Figure 4.7: New Breast Cancer Incidence in North America, 2009-2017
Figure 4.8: Percent of White Women in the U.S. Opted for Mammogram, 2000-2008
Figure 4.9: Percent Hispanic or Latina Women in the U.S. Opted for mammogram, 2000-2008
Figure 4.10: Percent of African-American Women in the U.S. Opted for Mammograms, 2000-2008
Figure 4.11: Percent of Asian Women in the U.S. Opted for Mammograms, 2000-2008
Figure 4.12: Percent of Native American Women Opted for Mammograms, 2000-2008
Figure 4.13: Percentage of U.S. Women Aged 40 Years and Older Who Have Had a Mammogram by Race and Ethnicity, 2000-2008
Figure 4.14: Percentage of U.S. Women Aged 40 Years and Older Who Have Had a Mammogram by Education Level, 2000-2008
Figure 4.15: Percentage of U.S. Women Aged 40 Years and Older Who Have Had a Mammogram by Age, 2000-2008
Figure 4.16: Physician Reimbursement for Unilateral Breast Reconstruction by Operating Room Time Utilization
Figure 4.17: Blue Cross/Blue Shield Physician Reimbursement for Unilateral Breast Reconstruction
Figure 4.18: Total Cost per Episode in the U.S., 2003-2007
Figure 4.19: National Cancer Institute 2009 Actual Obligations by Mechanism ($4.967 Millions)
Figure 4.20: National Cancer Institute % Share of Total RPG Funds, 2009
Figure 4.21: Research Dollars Allocated by NCI for Breast Cancer, 2005-2009
Figure 4.22: NCI Breast Cancer Research Portfolio: Percentage of Total Dollars by Scientific Area, 2008
Figure 4.23: Type and Status of Breast Cancer Screening Programs in E.U. Member States in 2007
Figure 4.24: Type and Status of Breast Cancer Screening Programs in Women aged 50 to 69 in the E.U. Member States in 2007
Figure 4.25: Incidence and Mortality Rates in Six of the E.U. 27 Countries, 2008
Figure 4.26: Breast Cancer Incidence and Mortality Rates in U.K., 1975-2007
Figure 4.27: Age Specific Breast Cancer Incidence Rates in the U.K., 1975-2007
Figure 4.28: Age-Specific Incidence Rate of Breast Cancer in U.K., 2007
Figure 4.29: Percentage coverage for women aged 53-70, 53-64 and 65-70, England 2006-2009
Figure 4.30: Incidence of Breast Cancer in Australia: Projections from 2007 to 2015
Figure 4.31: Annual Numbers of Mammograms, Both Breasts and One Breast, Women 50-69 years, 1987-2007
Figure 4.32: Age-Specific Rate of Mammograms, Both Breasts, by Age Group, 2006 and 2007
Figure 4.33: Age-Specific Rate of Mammograms, Both Breasts by Age Group, 2007
Figure 4.34: Age-Specific Rate of mammograms, one breast (MBS item 59303) by age group, 2007
Figure 5.1: Global Market for Mammography, 2010-2016
Figure 5.2: Global Market for Film-Based Mammography Systems, 2010-2016
Figure 5.3: Global Market for Digital Mammography Equipment, 2010-2016
Figure 5.4: Global Market for Breast Cancer Drugs, 2010-2016
Figure 5.5: Global Market for Biomarkers, 2010-2016
Figure 5.6: Biomarker Patent Filings by Type of Cancer, 2010
Figure 5.7: Top Ten Companies in Global Cancer Therapeutics Market, 2009
Figure 5.8: Projected Sales of Avastin, 2008-2015
Figure 5.9: Top Ten Therapies in Global Cancer Therapeutics Market, 2008
Figure 5.10: Oncology Drug Spending in Major European Countries, 2009
Figure 5.11: U.S. Mammogram Procedure Growth, 2010-2016
Figure 5.12: Number of Certified Mammography Facilities, 2000-2010
Figure 5.13: Number of Mammography Units in the U.S., 2000-2010
Figure 5.14: U.S. Mammography Equipment market, 2009-2016
Figure 5.15: U.S. Market for Breast Cancer Genetic Testing, 2010-2016
Figure 5.16: U.S. Market for Brachytherapy Products, 2010-2016
Figure 5.17: U.S. Market for Partial Breast Irradiation, 2008-2016
Figure 5.18: Avastin: HER2-negative metastatic Breast Cancer (mBC) 2010 Population
Figure 5.19: Herceptin: HER2+ Early Breast Cancer (eBC) 2010 Population
Figure 5.20: Herceptin: HER2+ Metastatic Breast Cancer (mBC) 2010 Population
Figure 5.21: Xeloda: Adjuvant Breast Cancer (eBC) 2010 Population
Figure 5.22: Xeloda: Metastatic Breast Cancer (mBC) 2010 Population
Figure 5.23: Global Cancer Market by Therapy Area, 2009
Figure 5.24: Global Market for Biological Therapies in Cancer, 2009-2014
Figure 5.25: U.S. Market for Biological Cancer Therapies, 2009-2014
Figure 5.26: Europe/ROW market for Biological Cancer Therapies, 2009-2014
Figure 5.27: Japanese Market for Biological Cancer Therapies, 2009-2014
Figure 5.28: Market for Biological Cancer Therapies in Rest of the World, 2009-2014
Figure 5.29: Global Medical Imaging Market (%) by Region, 2009
Figure 5.30: Global Medical Imaging Market (%) by Modality, 2009
Figure 5.31: Global Market for General X-rays, 2010-2016
Figure 5.32: Global Market for Ultrasound, 2010-2016
Figure 5.33: Global Market for Portable Ultrasound Equipment, 2009-2014
Figure 5.34: Global Percent MRI Market by Geography, 2010
Figure 5.35: Global Market for MRI, 2010-2016
Figure 5.36: Global Market for CT, 2004-2009
Figure 5.37: Global Market for Computed Tomography, 2010-2016
Figure 5.38: Global Market for Nuclear Medicine, 2010-2016
Figure 5.39: Global Market for SPECT/PET, 2010-2015
Figure 5.40: Global Market for PET/CT, 2010-2015
Figure 5.41: Global Market for Medical Displays and Post-Processing Software, 2009-2014
Figure 5.42: North American Market for Medical Imaging Equipment, 2010-2016
Figure 5.43: North American Market for MRI, 2010-2015
Figure 5.44: U.S. Market for Computed Tomography, 2010-2016
Figure 5.45: Market for Multi-Slice CT Scanners in the U.S., 2010-2016
Figure 5.46: U.S. Market for Radiopharmaceuticals, 2009-2017
Figure 5.47: U.S. Market for SPECT, 2009-2017
Figure 5.48: U.S. Market for PET, 2009-2017
Figure 5.49: Market for Medical Imaging Modalities in Canada, 2009-2014
Figure 5.50: Percent Distribution of Diagnostic Imaging Examinations in Canadian Hospitals
Figure 5.51: Western European Market for Medical Imaging, 2009-2016
Figure 5.52: Imaging Diagnostics Market in Central Europe, 2009-2012
Figure 5.53: European Market for Digital Radiography, 2009-2016
Figure 5.54: European Market for Computed Radiography, 2009-2016
Figure 5.55: European Market for MRI, 2010-2015
Figure 5.56: European Market for Digital Radiography (DR), 2009-2016
Figure 5.57: European Market for Computed Radiography, 2009-2016
Figure 5.58: Medical Imaging in Emerging Markets, 2010-2016
Figure 5.59: Market for Medical Imaging Equipment in Greater China, 2010-2016
Figure 5.60: Market for Ultrasound Equipment in China, 2009-2014
Figure 5.61: Medical Imaging Market in India, 2010-2016
Figure 6.1: Performance of Eli Lilly's Cancer Drugs by Geography, 2009
Figure 6.2: Eleva User Interface
Figure 6.3: Roche's Performance in Pharmaceuticals in the first Six Months of 2010
Figure 6.4: Volume Growth in Net Orders for Varian's Oncology Systems, 2007-2009
Figure 6.5: Volume Growth in Net Orders for Varian's X-Ray Products, 2007-2009
Figure App. 3.1: Workflow using Philips' iSite Radiology for mammography SCR
Figure App. 3.2: Workflow using third party workstation for mammography SCR
Figure App. 4.1: Digital Workflow with CAD
Figure App. 5.1: Public Attention Given to MBC
Figure App. 5.2: Women Afraid to Talk Openly About their Experiences with MBC
Figure App. 5.3: MBC Patient's Outlook on life
Figure App. 5.4: Women with MBC Who Have Participated in a Clinical Trial
Figure App. 5.5: Reasons for Not Participating in a Clinical Trial
Figure App. 5.6: Respondents who have looked for Information on Clinical Trials
Figure App. 9.1: Block Diagram of Imaging Ultrasound Equipment
Figure App. 9.2: Block Diagram of Medical CT System
Figure App. 9.3: Block Diagram of Medical MRI
Figure App. 9.4: Block Diagram of Digital X-Ray
Figure App. 9.5: Block Diagram of PET
Figure App. 10.1: Current Supply and Demand for Medical Radioisotopes, 2010-2024
Figure App. 10.2: Percent Market Share of Medical Radioisotopes by Reactor, 2010
Figure App. 11.1: U.S. Exports of Medical Products to the Middle East, 1996-2009
Figure App. 11.2: U.S. Exports of Medical Products to Israel, Saudi Arabia and Turkey, 2009
Figure App. 11.3: U.S. Exports of Medical Imaging Products to Israel, Saudi Arabia and Turkey, 1996-2009
Figure App. 13.1: Public and Private Expenditure on Health % of GDP in Select OECD Countries
Figure App. 13.2: Angiography Units per Million of Population in OECD Countries
Figure App. 13.3: CT Scanners per Million of Population in OECD Countries
Figure App. 13.4: Gamma Cameras per Million of Population in OECD Countries
Figure App. 13.5: Mammography Units per Million of Population in OECD Countries
Figure App. 13.6: MRI Scanners per Million of Population in OECD Countries
Figure App. 13.7: PET Scanners per Million of Population in OECD Countries
Figure App. 13.8: CT Exams per Scanner in OECD Countries
Figure App. 13.9: CT Exams per 1,000 of Population in OECD Countries
Figure App. 13.10: MRI Exams per Scanner in OECD Countries
Figure App. 13.11: MRI Exams per 1,000 of Population in OECD Countries
Table 3.1: Percent of American Women Who Had Mammograms in the Past Two years
Table 3.2: Size of Tumors Found by Mammography and Breast Self-Examination
Table 3.3: BI-RADS Assessment Categories
Table 3.4: Screening Guidelines for the Early Detection of Breast Cancer in Average-risk, Asymptomatic Women Aged 20 Years and Older
Table 3.5: Pros and Cons of Ultrasound and MRI in Breast Imaging
Table 3.6: Staging of Breast Cancer
Table 3.7: Breast Cancer Survival Rate by Stage
Table 3.8: Histologic Grade System for Breast Cancer
Table 3.9: Breast Cancer Grades and Description
Table 3.10: Activities and Materials Women with MBC value
Table 3.11: Classes of Tests Used to Treat Breast Cancer
Table 3.12: Silicone vs. Silicone Implants
Table 3.13: Factors That Increase the Relative Risk for Breast Cancer in Women
Table 3.14: Age-specific Probabilities of Developing Invasive Female Breast Cancer
Table 4.1: Global Breast Cancer Incidence Rate as of 2008
Table 4.2: Female Breast Cancer Risk Factors
Table 4.3: Female Breast Cancer Risk Factors: Relative Risk Range 2.1-4.0
Table 4.4: Female Breast Cancer Risk Factors: Relative Risk Range >4.0
Table 4.5: Probability of U.S. Women for being diagnosed With Breast Cancer
Table 4.6: Reconstructive Breast Procedures in the U.S., 2009
Table 4.7: Physician Coding and Payment
Table 4.8: Medicare Inpatient Hospital Payment
Table 4.9: Hospital Outpatient Services
Table 4.10: NCI Dollars Spent by Mechanism, 2008-2009
Table 4.11: Percent Share of Total NCI Dollars, 2005-2009
Table 4.12: NCI and its Historical Funding Trends, 2005-2009
Table 4.13: Percent Growth by Mechanism, 2005-2009
Table 4.14: NCI Research Project Grants, 2008-2009
Table 4.15: National Cancer Institute Extramural vs. In-house Funding
Table 4.16: NCI's Research Career Awards, 2008-2009
Table 4.17: Research Dollars by Various Cancers, 2005-2009
Table 4.17: Cancer Centers by State (P30 Core Grants), 2009
Table 4.18: Grant and Contract Awards by State, 2009
Table 4.19: National Cancer Institute New Investments, 2011
Table 4.20: Breast Cancer Screening Programs in the E.U. Member States in 2007
Table 4.21: Number of New Cases and Rates of Breast Cancer in U.K., 2007
Table 4.22: Number of New Cases and Rates of Breast Cancer in U.K., 2007
Table 4.23: Women Opting for Three Types of Procedures in U.K.
Table 4.24: Tumor Characteristics and Prognostic Factors, by type of Tumor
Table 4.25: Types of Primary Breast Reconstruction in U.K.
Table 4.26: Symmetrization Surgery and its Timing
Table 4.27: Postoperative Complications
Table 4.28: Complication Rates by Type of Surgery
Table 4.29: Some Breast Cancer Research Programs in U.K. as of January 2011
Table 4.30: Rates of Mammograms, Both Breasts and One Breast of All Ages 1996 to 2007
Table 4.31: Annual Numbers for Both Breasts for ages 20-85+ years, 1987- 2007
Table 4.32: Annual Number of Ultrasound Diagnostic Services for Breast Cancer (20 to 85+), 1993-2007
Table 4.33: Annual Number of Fine-Needle Aspiration Services for Breast Cancer (20 to 85+), 1993-2007
Table 4.34: Annual Number of Core Biopsy Services for Breast Cancer (20 to 85+), 1993-2007
Table 4.35: Annual Number of Ductogram Services for Breast Cancer (20 to 85+), 1995-2007
Table 5.1: Top Mammography System Companies, 2011
Table 5.2: Biomarkers Used in Cancer Diagnosis
Table 5.3: MQSA Certified Facilities and Accredited Mammography Units in the U.S., 2000-2010
Table 5.4: Number of Hospitals in the U.S.
Table 5.5: MQSA National Statistics on Number of Mammography Facilities and Procedures, 2011
Table 5.6: Digital Mammography Market Penetration in the U.S.
Table 5.7: U.S. Digital Mammography Market Model
Table 5.8: Business Plan for Digital Mammography
Table 5.9: Reimbursement Rate for Mammography Procedures in the U.S.
Table 5.10: MRI Biopsy Reimbursement: Facility Billing, 2010
Table 5.11: MRI Biopsy Reimbursement: Physician Billing, 2010
Table 5.12: Ultrasound Biopsy Reimbursement: Facility Billing, 2010
Table 5.13: Ultrasound Biopsy Reimbursement: Physician Billing, 2010
Table 5.14: Breast-Specific Gamma Imaging Reimbursement: Hospital Outpatient Department (Medicare Billing), 2010
Table 5.16: Radiologist and/or Surgeon Global Billing, 2010
Table 5.17: Top Ten Imaging Systems Purchased, 2006-2009
Table 5.18: Medical Imaging Equipment Installations in China and India, 2000-2009
Table 5.19: Availability of Medical Imaging Equipment per Million Populations in China and India, 2009
Table 5.20: Affordability for Medical Imaging in Emerging Economies
Table 6.1: Agfa's Medical Imaging Products
Table 6.2: Amgen's Cancer Product Pipeline as of 2010
Table 6.3: Ardent's Product Portfolio
Table 6.4: AstraZeneca's Marketed Products in Oncology, 2009-2010
Table 6.5: AstraZeneca's Performance in Oncology, 2007-2009
Table 6.6: Bard's Breast Products
Table 6.7: Biosound Esaote's Ultrasound Systems
Table 6.8: Performance of Bristol's Oncology Products, 2007-2009
Table 6.9: Canon's Imaging Products
Table 6.10: Chison's Ultrasound Product Portfolio
Table 6.11: Selected Clarient's Cancer Tests
Table 6.12: Encapsule's Products
Table 6.13: Fujifilm's Product Portfolio
Table 6.14: Fukuda's Ultrasound Products
Table 6.15: GE Healthcare's Medical Imaging Equipment and Contrast Media
Table 6.16: Genentech's Oncology/Hematology Pipeline
Table 6.17: Hitachi's Medical Imaging Product Portfolio
Table 6.18: Lantheus' Contrast Agent Products
Table 6.19: Medis' Software for Various Medical Imaging Modalities
Table 6.20: Medison's Medical Imaging Products
Table 6.21: Features of PCR Eleva CosimaX image plate reader
Table 6.22: Eleva workspot
Table 6.23: Application and Pixel Matrix of Eleva
Table 6.24: Pfizer's Oncology Pipeline as of 2010
Table 6.25: Pfizer's Clinical Trial Programs in Breast Cancer as of 2010
Table 6.26: Roche's Cancer Drugs, 2010
Table 6.27: Roche's Regulatory Filings for Cancer Drugs in the First Half of 2010
Table 6.28: Sanofi's Performance in Cancer Drugs
Table 6.29: Planmed's Mammography Systems
Table 6.30: Shimadzu's Product Portfolio
Table App. 4.1: Hardware Specifications
Table App. 5.1: Bridge Survey at a Glance
Table App. 5.2: Types of Information Women with MBC Find Important
Table App. 6.1: Clinical Trials in Mammography as of December 2010
Table App. 8.1: New and Near-Term Technologies for Breast Cancer Detection
Table App. 10.1: The Major Medical Radioisotope Producing Reactors, 2010
Table App. 10.1: Potential Reactor-Based Projects for 99MO Production, 2010-2024
Table App. 10.2: Processing Capacity of Major Reactors, 2010
Table App. 10.3: Demand Scenarios for 99Mo, 2010-2025
- Abviva, Inc.
- Agendia B.V.
- Agfa Healthcare
- Amgen, Inc.
- Analogic Corporation
- Ardent Sound, Inc
- AstraZeneca
- Aurora Imaging Technology, Inc.
- Aurora . T Dedicated Breast MRI System
- C.R. Bard, Inc.
- Biosound Esaote, Inc
- Bristol-Myers Squibb
- Canon U.S.A., Inc
- Chison Medical Imaging, Co., Ltd
- Clarient, Inc.
- Dako
- deCODE Genetics
- Dilon Technologies, Inc.
- Dexela
- Dexela Digital Mammography Workstation
- Eli Lilly
- Encapsule Medical Devices, LLC.
- Fonar Corporation
- Fujifilm Medical Systems USA, Inc.
- Fukuda Denshi Co., Ltd.
- GE Healthcare
- Genentech, Inc.
- Hitachi Medical Corporation
- Hologic, Inc.
- Computed Tomography Laser Mammography (CTLM)
- Konica Minolta Medical Imaging USA, Inc.
- MacKay LifeSciences
- Lantheus Medical Imaging, Inc.
- Medis Medical Imaging Systems BV
- Medical Tactile, Inc
- Medison America, Inc.
- Medtronic Navigation and Imaging
- MeVis Medical Solutions AG
- Naviscan PET Systems, Inc.
- NeoMatrix LLC
- Novartis AG
- Philips Healthcare
- Pfizer, Inc.
- Roche Holdings, Ltd.
- Sanarus Technologies, LLC
- Sanofi-Aventis
- Sectra Medical Systems
- Planmed
- Scanis, Inc.
- Siemens Healthcare
- SenoRx, Inc.
- Shimadzu Medical Systems
- SonoCine, Inc.
- TechniScan Medical Systems
- Toshiba America Medical Systems, Inc.
- U-Systems, Inc.
- Varian Medical Systems
- VuCOMP, Inc.


text:
Three cheers for Miss Montana, Alexis Wineman for winning the People's choice award at the Miss America Competition! Alexis, a former cheerleader living with autism, inspired thousands of people across the country during her journey to the Miss America contest. We are so proud that the cheerleading community has such a great role model for young people across the country! Alexis took time out of her busy schedule to share her cheerleading memories.
How did being a cheerleader help you prepare for the Miss Montana/Miss America pageant? Being a cheerleader really helped me get comfortable in front of crowds and to have fun while doing it.
What was your favorite part of cheerleading? I absolutely loved stunting with my team. It was so much fun laughing with the girls over the small successes. It made all the practices worthwhile. I must admit, I loved being in the Macy's Thanksgiving Day Parade with 650 other cheerleaders! That was an awesome experience.
What would you tell someone wanting to try out for cheerleading but can't find the courage to do it? I would tell them that if a girl like me, who has autism and was an outcast her whole life, then they can too. You will amaze yourself at what you can do when you are willing to step out of your comfort zone and just try. Even if you don't make it, you are still successful by overcoming your fears and trying.
If you could relieve your cheerleading career over again, would you change anything? I wish I would have been a part of it during my sophomore year, but I think in hindsight I needed that time to see if cheerleading was something that I wanted to be part of my life. The first year, I cheered because I was pushed into it by my mom and sisters. It was their way of helping me build confidence making friends. When I went back my junior year, it was because I wanted to do it.
Why does America need Cheerleaders? Cheerleaders are just that-leaders. Cheerleading helps young men and women develop confidence and leadership that this generation needs.
We'd like to thank Alexis for taking time to speak with us, and would like to congratulate her on all of her success. To follow along with her journey, be sure to check out Miss Montana on Facebook.
-Tayler Easton

subset: commoncrawl


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Wow. Our experiment is off to a great start—let's see if we can finish it off sooner than expected.
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'Homeland,' Season 2, Episode 2, 'Beirut Is Back': TV Recap
On this week's episode of "Homeland," we're back in Beirut, where Carrie meets her asset, Fatima, the wife of a Hezbollah commander whom she recruited eight years ago. In exchange for $5 million and a flight to the U.S., Fatima tells Carrie that her husband is meeting, in person the next day, none other than Abu Nazir.
At a party in Washington, Congressman Brody hears from Vice President Walden that Israeli airstrikes against Iran's nuclear facilities have been partially successful: One site is too deep and requires a bigger bomb. The party's host has the right type of bunker-buster but the president is blocking the export license. "It falls on me," Walden says, and he asks for Brody's help in convincing the Secretary of Defense of the weapon's necessity. "Brody, you with me?" he asks. Things are getting very chummy between the VP and Brody, even though Walden is the official who ordered the drone strike that killed Issa.
Jessica is being courted by Mrs. Walden to co-host a fundraiser. Jessica, who has visions of becoming Mrs. Vice President herself, agrees to come by the Walden home the next day. When she and Dana arrive, Dana and the Waldens' son, Finn, strike up a conversation and friendship.
In Beirut, Carrie meets Saul at the safe house. He's annoyed that she met Fatima on her own – no one's able to trust Carrie 100% these days – but there's no time to arrange another meeting. Abu Nazir's on his way, Carrie says. They set up a Skype connection with David Estes back at the ranch, because VOIP is apparently safe enough for discussions of covert capture-and-kill missions. At least Fatima's husband discussed Abu Nazir's arrival over satellite phone.
Saul expresses doubts about Fatima's reliability, but Carrie remains steadfast. She trusts her asset. Estes says it could all be a trap to lure in American ground troops and kill them in Hezbollah territory. He tells Saul to make the call.
Carrie struggles to maintain her equilibrium because she doesn't trust her own mind anymore. She still believes she was way off on Brody. "I have never been so sure, and so wrong," she tells Saul on the roof, in a heartbreaking scene. We know, even if she doesn't, that she was in fact dead on with Brody, and that she successfully averted the assassination by planting doubt in Dana's mind. "Every time I think I see something clearly now, it just disappears," Carrie says. But she does trust the old, assured Carrie who recruited Fatima. And Saul does too. The operation's a go.
Mike visits Brody and asks him to investigate Tom Walker's death. Why did the best sniper in their group miss a shot at the vice president, three times? The guys in the platoon are suspicious.
As the capture and kill operation gets under way, Saul and Carrie wait at the safe house. She asks her old friend and mentor why he stopped calling. He said he was following doctor's orders, since he would only remind Carrie of work. But she's clearly ready to come back now. "I know. Don't get used to it," she says. At the Pentagon, Walden brings Brody in to watch the special operation as it goes down. It's not clear why Brody would be invited to sit with the Joint Chiefs of Staff, other than Walden's telling him, "I thought you'd be interested." Once again, Brody finds himself in a windowless room full of the most powerful defense chiefs in the country, but at least this time he's not planning to blow himself up. He carries just one weapon: His BlackBerry.
In Beirut, the convoys arrive, and at first appear to know of the U.S. operation. Has the informant struck again? As if on cue, Carrie appeals for an explanation: "Saul?" Turns out the vehicles are just there to clear the street, but their men outnumber the U.S.'s so Estes changes the mission to a "Kill."
In the room, Brody discreetly sends a text message, "May 1," out into the ether as the others watch the live feed. In Beirut, Abu Nazir exits a vehicle. Estes and Saul stare in disbelief. Carrie is vindicated – her asset was telling the truth. Just as a sniper prepares to strike, Abu Nazir checks his phone and sees the message, backing away just in time.
Carrie and Saul are rushed into a van so they can pick up Fatima and get out. As the van waits outside Fatima's building, men who are presumably her husband's affiliates come out to study these strange visitors. As Fatima comes down, Carrie asks for her keys and runs into the building so she can collect whatever she can. The men circle the van and begin attacking it. The van must drive off.
Carrie finds some papers and disks and shoves it all into a canvas bag. The men go after her inside the apartment, and she leads them on a dangerous chase. She attacks a man with a rock and narrowly escapes down the stairs and back into the van.
After arriving back home, Carrie is driven back to sister Maggie's, to the beautiful house and life that's not hers.
Brody and Roya meet at night in an abandoned parking lot. "I'm a Congressman," he reminds her. And then he says one of "Homeland's" constant refrains: "You get that, right?" Roya gets it. Brody wants to back out of the whole "Kill An Idea" operation and just, you know, sit back and be vice president. But Roya tells him he's needed now more than ever.
Brody then meets the platoon guys and lies about Walker, saying there's no information about his death. When he gets resistance from Lauder, Brody says Walker was a traitor who gave them all up. "He's not who you think he is," Brody says.
Brody sure can lie his way out of a hole with the platoon guys, but he's now entrenched between Vice President Walden and Abu Nazir. And it's about to come out.
Saul, still in Beirut, goes through the files that Carrie stole with his assistant, but they can't find anything. While he packs up, Saul feels something hidden inside the cloth of the canvas bag: An SD card. He plays it on his laptop and it's Brody's videotaped message just before he planned to carry out the attack on the vice president.
Saul is shocked. Once again, Carrie was right.
What did you think of this episode of "Homeland"? Leave your thoughts in the comments.


text:
Tobacco Training for Health Professionals
Tobacco Training Materials
Tobacco Training CME - Online
The TOEP provides online, continuing medical education (CME) credits in ethics/professional responsibility to Texas physicians. TOEP online training materials are also available to other health care professionals not seeking CME credit. The online curriculum consists of two courses designed to complement one another. The didactic Tobacco Cessation Course 1 presents two lectures delivered by international experts in evidence-based tobacco cessation interventions who provide a comprehensive overview of the most up-to-date knowledge of the nature of tobacco dependence and effective behavioral and pharmacological treatments. The interactive Tobacco Cessation Course 2 offers behavior-modeling video vignettes which demonstrate counseling patients with common or special tobacco-related concerns. Next, the learner moves to the virtual office where he or she can make his/her own clinical decisions and practice tobacco counseling with virtual patients. While learners can take the courses in either order, it is recommended that they first view the Tobacco Cessation Course 1. The knowledge provided in the didactic Course 1 will facilitate a better understanding of the counseling scenarios presented in the interactive Tobacco Cessation Course 2.
Both courses include a pre-test to be filled out before viewing the content and a post-test available after viewing the content to assess the knowledge obtained from the course. The pre- and post-tests are required for healthcare providers seeking CME credit. For individuals not seeking CME credit, the pre- and post-tests provide an opportunity to assess knowledge and skills after completing the course.
To access the tobacco training online, please proceed to the Tobacco Cessation Series page.
Tobacco Training CME - DVD
Individuals can choose to receive a DVD of the Tobacco Cessation Course 1 training lectures along with a paper version of the course evaluation. Physicians and health care professionals seeking CME credit are required to mail back a paper survey to the University of Texas MD Anderson Cancer Center at the address provided in the DVD mailing.
To request a DVD copy of the training materials, please complete a request form. Include an address denoting where course materials should be shipped. Those fields denoted with an asterisk (*) are required. Contact information (phone number or email address) is required to confirm DVD orders.
Tobacco Training CME - Print/Electronic Materials
While providers may receive the DVD within a kit containing the course evaluation form, posters, brochures, and Clinical Practice Guidelines, they can also order those print materials individually by filling out the form above. Illustrative storybooks (i.e. fotonovelas) about secondhand smoking are also available for downloading from the main TOEP page.


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In this Feb. 9, 2013 file photo, thousands of Indian Hindu devotees walk across a pontoon bridge at Sangam, before bathing at the confluence of the Ganges, Yamuna and mythical Saraswati River, during the Maha Kumbh festival, in Allahabad, India. Millions of Hindu pilgrims are attending the Maha Kumbh festival, which is one of the world's largest religious gatherings that lasts 55 days and falls every 12 years. During the festival pilgrims bathe in the holy Ganges River in a ritual they believe c


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Like months in a year another new Curren$y drop is always inevitable. This time, Da Hot Spitta files under the moniker "Priest Andretti" and releases a mixtape in that name. Curren$y also recently dropped the trailer for his most recent release. Hear Spitta's latest project below.
Mixtape: Curren$y "Priest Andretti"
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Breast cancer survivor stories
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Game of Thrones is a site for the HBO-series based on George R.R. Martin's A Song of Ice and Fire.
New to the series? Read our spoiler-free review of A Game of Thrones.
Read our Privacy Policy.
An article in the Brazilian magazine Epoca Sao Paulo feaures young actor Lino Facioli, and mentions his role in Game of Thrones. Chiefly, it notes that he's due to start filming his scenes—as Robin Arryn, the sickly young Lord of the Eyrie—this month. The article also covers his concern about having to wear removable braces and his role in the Russel Brand film Get Him to the Greek.
For those keeping score, Lino's scenes would fit into Catelyn's sixth and seventh chapters.
Thanks to MouthTheOne for bringing the article to light, and WiCnet for the RT. Also, a translation of the article can be found here, provided by Vasco Cardoso.
The Westeros network consists of several different sites, including a forum and a wiki, for all your A Song of Ice and Fire needs.


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Monday marks six months since Bardstown police officer Jason Ellis was shot and killed in Nelson County.
No arrests have been made in his murder.
The reward in the case has topped $200,000.
Ellis was shot and killed in May along the bluegrass Parkway as he stopped to remove debris from an exit ramp.
Police say he was ambushed.
Anyone with information in the case is asked to contact Kentucky State Police.


text:
Bournemouth are close to completing the signing of striker Frank Demouge pending international clearance.
The 30-year-old Dutchman passed a medical at Dean Court earlier this week and has agreed a two-year deal.
"It was my dream to play in England. Now I'm 30-years-old and it's the right moment," he told the club's official website.
"I've played in the Premier League in Holland for almost 11 years and I know that league, and I'm looking forward to playing here and I hope I can help the club.
"Everyone watches English football and there are a lot of Dutch players in the Premier League. I spoke to a couple of them and they said it was great to play here.
"I know this is a lower level, but I hope to find my way here as soon as possible."


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Weak cold front is moving through the area and will cool us down a bit in the morning.
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Nicholls president search narrows
Published: Monday, August 19, 2013 at 11:10 a.m.
Last Modified: Monday, August 19, 2013 at 11:10 a.m.
The search for the next president of Nicholls State University will take another step today.
The search committee was scheduled to meet today in Baton Rouge to review the applications of 17 candidates and narrow that list to a group of semifinalists. Those semifinalists will interview on campus the week of Aug.26.
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


text:
How Shell Made It Big on Facebook
AMSTERDAM — How does an oil company — not exactly a category of enterprise popular with young activists — clock up just shy of one million Facebook fans in under two months? It's an impressive achievement by anyone's measure.
Royal Dutch Shell, the Anglo-Dutch oil major, has achieved just that. At the Next Web Conference here, the company's executive vice president for communications — and the man charged with masterminding its social media strategy –revealed the secret to the company's success in social media.
The appointment of a new chief executive, Peter Voser, marked the sea change in the company's approach to communications, according to Herbert Heitmann. "He said he wanted the company to engage, to open up," he said.
Given the size and scope of Shell, which has some 50,000 employees world-wide, it took some time. It wasn't until May 2011 that Shell had its first Facebook page. "Nothing happened. It was a dead place. We had a few fans, but that was it," he explains. The company faced a serious issue: Send the social media idea off into the sunset or revise its strategy and go for it in a big way.
"We wanted one million fans," Mr. Heitmann said. "That is a huge number, but it had to be big because we had to make it clear that it would not happen by itself." Coincidentally, Greenpeace has around one million fans, too. By contrast, companies such as IBM has around 113,000 and GE has around 300,000.
Mr. Heitmann approached Facebook and brought in social-media experts. "With the help of Facebook and other partners, we designed an approach that was designed to engage and open up," he said.
The company actively sought out people. "Somebody who has indicated they are interested in energy, in motor sports, is much more likely to engage with us," he said. Three areas with the highest level of engagement were the future of energy, working at shell and Shell's work in the community.
Rather than attempting to hide controversial topics, such as Antarctic oil exploration, the company was open about it. "When you have a good reason to do what you are doing, you just need to explain yourself. You get more buy-in than if you hide behind walls, and don't share, don't give insight, don't explain what you are doing," said Mr. Heitmann.
While Mr. Heitmann is delighted with the figures, he is less happy with the geographical breakdown. The company has 224,000 fans in Malaysia, but it fares much worse in Western Europe. "One disappointment is that we only have 1,000 fans here in the Netherlands, given that 10,000 people work for Shell here," he said.
His main advice to others looking to copy Shell's success: "If you decide to go social — don't try to do it with amateur approaches. Be willing to invest, and above all put the right people in, surround yourself with experienced partners."
"[Social Media] is like the wind, so the least you can do is to build a windmill," he said.


text: [Budget of the United States Government, Fiscal Year 1999] [Page 239-243] [DOCID: f:1999_bud.bud27.wais] From the Budget of the U.S., FY 1999 Online via GPO Access [wais.access.gpo.gov] [[Page 239]] 27. ADMINISTRATION OF JUSTICE ---------------------------------------------------------------------- Table 27-1. FEDERAL RESOURCES IN SUPPORT OF ADMINISTRATION OF JUSTICE (In millions of dollars) ---------------------------------------------------------------------------------------------------------------- Estimate Function 750 1997 ----------------------------------------------------------- Actual 1998 1999 2000 2001 2002 2003 ---------------------------------------------------------------------------------------------------------------- Spending: Discretionary Budget Authority.......... 22,942 24,229 25,728 24,554 24,381 24,551 25,075 Mandatory Outlays: Existing law.......................... 78 1,359 640 287 149 174 160 Proposed legislation.................. ........ 10 51 55 49 42 35 ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- While States and localities bear most of the responsibility for fighting crime, the Federal Government also plays a critical role. Along with supporting State and local activities, the Federal Government investigates and prosecutes criminal acts that require a national response. In 1998, anti-crime expenditures will consume 4.6 percent of all Federal discretionary spending, compared with about two percent in 1988. Total Federal, State, and local resources devoted to the administration of justice--including law enforcement, litigation, judicial, and correctional activities--grew from $71.8 billion in 1989 to an estimated $141.7 billion in 1998--by 97 percent or, as Chart 27-1 shows, by 46 percent in constant 1992 dollars. During this period, the Federal law enforcement component, including transfer payments to State and local law enforcement activities, more than doubled, from $10.1 billion in 1989 to $25.3 billion in 1998. Nevertheless, Federal resources account for only 18 percent of total governmental spending for administration of justice. The number of criminal offenses that law enforcement agencies reported fell by three percent from 1995 to 1996--marking the fifth straight year that the crime rate has fallen. The number reported in the first six months of 1997, the most recent period for which figures are available, was four percent lower than in the same period in 1996. The drop in crime, when compared with increases in anti-crime spending during the same period, appears to suggest a general relationship, although crime is affected by varying factors. The budget builds upon this record of success by continuing to provide substantial funding for proven anti- crime programs. Federal Activities Federal funding for the Administration of Justice function includes: (1) Federal law enforcement activities; (2) litigative and judicial activities; (3) correctional activities; and (4) financial assistance to State and local entities (see Chart 27-2). In 1998, 70 percent of these funds went to the Justice Department (DOJ), while most of the rest went to the Treasury Department and the Judicial Branch. Law Enforcement: The budget proposes in 1999 to enforce a wide range of laws, reflecting the unique Federal role in law enforcement. Some responsibilities--such as customs enforcement--date from the beginning of the country. DOJ's FBI and Drug Enforcement Administration (DEA) enforce diverse Federal laws dealing with violent crime, terrorism, white collar crime, drug smuggling, and many other criminal acts. The Immigration and Naturalization Service (INS) protects the U.S. border from illegal migration while providing [[Page 240]] <GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT> services to legal aliens. These agencies, and the ones discussed below, also work with State and local law enforcement agencies, often through joint task forces, to address drug, gang, and other violent crime problems. Within the Treasury Department, the U.S. Customs Service, Bureau of Alcohol, Tobacco and Firearms (ATF), United States Secret Service, and other bureaus enforce laws related to drug and contraband smuggling across our borders; firearms trafficking; arson and explosives crime; financial crime and fraud, including money laundering, counterfeiting, and credit card fraud; and the regulation of the alcohol, tobacco, and firearms industries. The Secret Service protects the President, Vice President, and foreign dignitaries. The Federal Law Enforcement Training Center (FLETC) trains Federal law enforcement personnel. Federal responsibility to enforce civil rights laws in employment and housing arises from Titles VII and VIII of the Civil Rights Act of 1964, as well as more recent legislation, including the Age Discrimination in Employment Act and the Americans with Disabilities Act. The Department of Housing and Urban Development enforces laws that prohibit discrimination on the basis of race, color, sex, religion, disability, familial status, or national origin in the sale or rental, provision of brokerage services, or financing of housing. The Equal Employment Opportunity Commission enforces laws that prohibit employment discrimination on the basis of race, color, sex, religion, disability, age, and national origin. DOJ enforces the criminal civil rights laws. Litigation and Judicial Activities: After law enforcement agencies such as the FBI, DEA, and ATF have investigated and apprehended perpetrators of Federal crimes, the United States must prosecute them-- and the budget proposes $7.5 billion for this purpose. This task falls primarily to the 93 United States Attorneys and the 4,450 Assistant United States Attorneys. Along with prosecuting cases referred by Federal law enforcement [[Page 241]] <GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT> agencies, the U.S. Attorneys work with State and local police and prosecutors in their efforts to bring to justice those who have violated Federal laws--whether international drug traffickers, organized crime ringleaders, or perpetrators of white collar fraud. The U.S. Marshals Service protects the Federal courts and their officers; apprehends fugitives; and maintains custody of prisoners involved in judicial proceedings. In addition, DOJ contains several legal divisions specializing in specific areas of criminal and civil law. These divisions--including the Civil, Criminal, Civil Rights, Environment and Natural Resources, Tax, and Antitrust Divisions--work with the U.S. Attorneys to ensure that violators of Federal laws are brought to justice. The Federal Government, through the Legal Services Corporation, also promotes equal access to the Nation's legal system by funding local organizations that provide legal assistance to the poor in civil cases. The Judiciary's growth in recent years arises from increased Federal enforcement efforts and Congress' continued expansion of the Judiciary's jurisdiction. Accounting for 13 percent of total law enforcement spending, the Judiciary comprises the Supreme Court and 12 circuit courts of appeals, 90 bankruptcy courts, and 94 district courts, 94 federal probation offices, the Court of Appeals for the Federal Circuit and the Court of International Trade. The Federal Judiciary is overseen by 2,096 Federal judges and nine Supreme Court justices. Correctional Activities: The budget proposes $3.5 billion for corrections activities. Due to higher spending on law enforcement and tougher sentencing, the number of Federal Prison System inmates has risen to 114,000, more than double the number in 1988. The Federal inmate population--less than a tenth of the total U.S. inmate population--will continue to grow due to the abolition of parole, minimum mandatory sentences, and sentencing guidelines. State inmate populations will [[Page 242]] grow, in part, due to sentencing requirements tied to Federal prison grant funds. In the Federal system, about 62 percent of inmates serving time were convicted on drug-related charges. Criminal Justice Assistance: The budget proposes $4.6 billion to help State and local governments fight crime. The Administration is encouraging the adoption of community policing practices through the Community Oriented Policing Services (COPS) program. The Truth-in- Sentencing/Violent Offender Incarceration grant program seeks to ensure that convicted violent offenders are incarcerated and serve at least 85 percent of their sentences. Similar changes in law from 1984 for Federal prisoners increased the time served by 60 percent. To combat the significant problem of violence against women, the budget proposes $271 million to enhance the States' abilities to respond, and to further expand access to previously under-served rural, Indian, and other minority populations. To promote increased drug testing and treatment for individuals under the supervision of the criminal justice system, the budget proposes a $94 million increase over the 1998 level for drug testing and treatment and Drug Courts. In addition, the budget continues to provide $553 million in law enforcement assistance grants under the Edward Byrne Memorial State and Local Law Enforcement Assistance Program. To prevent young people from becoming involved in the juvenile justice system, the budget continues juvenile justice programs, including those that provide supervised afternoon and evening activities for youth. The budget also provides additional assistance to State and local prosecutors' offices to address gang violence and other juvenile crime, and to courts and court-related entities to expedite the handling of violent juvenile cases. Finally, the budget provides a $6 million increase for ``Weed and Seed,'' which helps communities develop and implement comprehensive strategies to ``weed'' out violent crime, illegal drugs, and gang activity, and to ``seed'' their communities with programs that prevent crime. Performance Goals Federal agencies, as cited below, will work to achieve the following performance goals with the proposed budget funds: With regard to violent crime: <bullet> The Justice Department will maintain the Federal Government's commitment to reducing the incidence of violent crime below the 1996 level of 634 offenses per 100,000 population. <bullet> The Justice Department will provide funding for communities to hire and deploy 16,000 more officers in 1999. <bullet> The Treasury Department will help solve violent crimes and reduce firearms trafficking by tracing up to 275,000 firearms used in criminal activities, compared to 116,674 in 1996. <bullet> The Justice Department will reduce specific areas of organized crime and its influence on unions and industries from the 1997 level, while intensifying its efforts to prevent emerging organized crime enterprises from gaining a permanent foothold in particular areas. <bullet> The Treasury Department will ensure the physical protection of the President, Vice President, visiting foreign dignitaries, and others protected by the Secret Service. <bullet> The Justice Department will ensure that no judge, witness, or other court participant is the victim of an assault stemming from his or her involvement in a Federal court proceeding. <bullet> The U.S. Marshals Service will apprehend 80 percent of violent offenders within one year of a warrant's issuance, and will reduce the fugitive backlog from 1998 by five percent. <bullet> The Interior and Justice Departments will work to increase the number of law enforcement officers for Indian Tribes from the current level of 1.3 officers per 1,000 citizens to 2.9 officers per 1,000 citizens. [[Page 243]] With regard to drug abuse: <bullet> Federal and non-Federal entities will work together to reduce the availability and abuse of illegal drugs. Separately, the Office of National Drug Control Policy will present a comprehensive set of societal performance measures for anti-drug programs, recognizing that achieving national drug control objectives depends critically on the actions of not only the Federal Government, but of State, local, and foreign governments and on the behavior of individuals. With regard to immigration and border control: <bullet> The Justice Department will reduce the average time between application and naturalization of qualified candidates from an estimated 24 months in 1997 to six to 10 months in 1999. <bullet> The Treasury, Justice and Agriculture Departments will increase the percent of legitimate air passengers cleared through primary inspection in 30 minutes or less from an estimated 31 percent in 1997 to 39 percent in 1999; and will work to process legitimate land border travelers through the primary inspection process on the Mexico border in 30 minutes or less in 1999. <bullet> The Justice Department will increase the number of removals of aliens who are illegally in the United States from 111,794 in 1997 to about 134,900 in 1999. <bullet> The Justice Department will identify over 38,500 unauthorized workers, thereby opening up potential jobs for U.S. citizens and other legally authorized workers. <bullet> The Treasury Department will increase trade revenue from duties collected and enhance the accuracy of trade data by improving importers' compliance with trade laws (e.g., quotas, trademarks, and copyrights) from 83 percent in 1997 to 85 percent in 1999. With regard to civil rights and other matters: <bullet> The Equal Employment Opportunity Commission will reduce the average time to process private sector equal employment complaints by doubling the number of complaints eligible for the mediation-based alternative dispute resolution program. <bullet> The Department of Housing and Urban Development (HUD) will ensure that HUD grantees in 20 communities undertake fair housing audit-based enforcement, using a HUD-developed standardized methodology, to develop local indices of discrimination, to identify and pursue violations of fair housing laws, and to promote new fair housing enforcement initiatives at the local level. <bullet> The Treasury Department will step up its efforts to disrupt and dismantle the illegal activities of major violators of Federal financial crimes laws (e.g., counterfeiting, forgery, money laundering, and credit card fraud).


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Dr. Yan Zhao
Research Molecular Biologist
New knowledge derived from genome information is critical for developing novel strategies to combat plant diseases caused by spiroplasmas and phytoplasmas.
One of our research objectives is, through genome annotation and cross-genomic comparison, to understand the molecular basis of spiroplasma/phytoplasma pathogenesis and to identify genes involved in pathogen-host interactions.
Our research is also devoted to development and use of Agrobacterium-mediated stable transformation and viral vector-mediated transient expression technologies for genetic engineering of disease-resistant plants.
Click on image to visit virtual gel website
ATP-binding cassette proteins and their predicted functions in Spiroplasma kunkelii (Zhao et al. Mol Genet Genomics 2004 271, 325-338)


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Samsonite Dives on Debut
From Dow Jones Newswires and Market Talk:
Samsonite International SA opened 10.3% lower Thursday on its first day of trade following a US$1.25 billion initial public offering in Hong Kong.
The shares opened at HK$13.00, compared with their IPO price of HK$14.50.
The benchmark Hang Seng Index opened 1.6% lower, tracking Wall Street's loss overnight amid concerns over the Greek debt crisis.
Samsonite is the most heavily traded stock in Hong Kong. Buy orders far outweigh asks, suggesting bargain-hunters are eyeing the debut weakness as a chance to accumulate the stock.


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If there were any other reasons to stay in Carlsbad besides Legoland (or for shoppers, the outlets), I'm trying to think of an excuse to stay here again! A perfect little surprise amidst our family festivity filled holiday, we were welcomed to free parking, complimentary wireless, 'real' breakfast, & crib! Did I mention two KING beds!?! When you got two little kiddos that squirm in their sleep that is definitely an A in my book. Clean, modern, they even have that cinnamon-oh-man-it-smells-so-cozy in their holidays. Perfect stay for families w/children w/cookie & milk hour, board games & books in the "family" room aka off of the lobby area: leather sofas, flat screen & faux fireplace included.
Off to find out if they're a chain... =)
- Official Description (provided by the hotel):
- Next to the pristine beaches of Carlsbad, minutes from attractions such as LEGOLAND, the Museum of Making Music, Lagoons and Outlet Shopping, our boutique style hotel offers 86 rooms including 36 suites. All rooms include one or two king sized beds, free wireless HSIA, 37" flatscreen tv's, refrigerator stocked with two complimentary welcome waters upon arrival, microwave, hairdryer, iron / ironing board, and complimentary full breakfast. For relaxation enjoy our water wall around a sparkling pool/whirlpool. Adults take part in our Seasonal Pour while our smaller guests enjoy cookies and milk at bedtime. Let our shuttle service (within 5 miles of the hotel)take your mind off gathering directions while our Concierge team plan your next move. The property features two dining on-site dining options Bistro West (Contemporary Farm to Table faire) and West Steak and Seafood (Fine Dining). ... more less
- Reservation Options:
- TripAdvisor is proud to partner with TravelClick, Agoda, Expedia, Travelocity and Hotwire so you can book your West Inn & Suites Carlsbad reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- West Inn & Suites Carlsbad Hotel Carlsbad
- West Inn And Suites Carlsbad
- West Hotel Carlsbad
- Carlsbad West Hotel


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Top Definition
Oh god, oh god, we're all gonna die
"This is the captain, we have a little problem with our entry sequence, so we may experience some slight turbulence and then... explode." -Mal Reynolds
viết bởi Badass Magee 14 Tháng năm, 2010
Trending Now
Can you define these popular missing words?
Usually, something you will experience on a aircraft when up in the air due to the plane flying through clouds or a area of unstable air. It consists of light jolts or jerks. That's why you are always asked to keep your seatbelt fastened even when the sign is off as it is sometimes unexpected. It can also be called "Rough Air."
"Ladies and Gentlemen this is your captain speaking, we seem to be experiencing some turbulence, please return to your seat and fasten your seatbelt, Thank You.
viết bởi snoozedimmer 16 Tháng tám, 2010
when a guy has a bad experience on the flight to boston. ie girl uses teeth or does not finish.
no way man there was crazy turbulence on my flight to boston
viết bởi C QUAD 23 Tháng chín, 2010
when your tossin someones salad and they fart in your face.
Man, Todd sure experienced Turbulence when he was eating out Samantha.
viết bởi urmom69dme2 14 Tháng mười một, 2011
Where your tossing somebodies salad and they shit Diarrhea in your face
Honey I just blew turbulence on your face.
viết bởi Dick Tucker 24 Tháng năm, 2004
An attractive female, or group of females.
Hey chief, check out the turbulence on the slopes today.
viết bởi hordan40 09 Tháng ba, 2009
When two or more overweight men have sex on an airplane and cause it to move around because of the weight shifts and thrusting.
Justin and Brian made turbulence when they decided it was GO TIME.
viết bởi Paul Henry Junior 01 Tháng tư, 2008


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Sat 23rd Feb at 7:15pm
Exeter Symphony Orchestra
@ Exeter Cathedral, Exeter
Also appearing: Exeter Philharmonic Choir, Tamsin Waley-Cohen
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Never miss another 'Exeter Symphony Orchestra' show
Exeter Symphony Orchestra, Exeter Philharmonic Choir, Tamsin Waley-Cohen
A concert to celebrate our soldiers with music including:
Bruch: Violin Concerto No 1 in G minor
Parry: I was glad
Brahms: How lovely are thy dwellings
Jeremiah Clarke: Trumpet Voluntary
Leaving Port Askaig featuring Pipe Major William Ross
With Myles Taylor (trumpet) and David Davies (organ) and the City of Exeter Pipe Band.
Rreadings by Martin Bell and Crawford Logan
Exeter Symphony Orchestra
The Exeter Symphony Orchestra has its origins in the late 1930s in association with the cathedral-based Exeter Musical Society; becoming an independent enterprise in January 1989.
Exeter Symphony Orchestra tour dates
Exeter Philharmonic Choir
The Exeter Philharmonic Choir was founded in 1846, early in the reign of Queen Victoria. First known as the 'Exeter Oratorio Society', it has an unbroken history to the present day, making it one of the oldest musical organisations in the country.
Exeter Philharmonic Choir tour dates
Tamsin Waley-Cohen
Tamsin Waley-Cohen performs as a soloist with orchestras including the Royal Philharmonic Orchestra, Orchestra of St John's, London Concert Orchestra and London Chamber Orchestra, Orchestra of the Swan and Brighton Philharmonic, and under conductors including Andrew Litton, Jose Serebrier, Shlomo Mintz, Nicolae Moldoveanu, and Achim Holub.
Tamsin has played at Cadogan Hall, Symphony Hall, Birmingham, Bridgewater Hall, Manchester, Queen Elizabeth Hall, Barbican, Liszt Academy Hall, Budapest and in venues across the UK and Europe.
Tamsin Waley-Cohen tour dates
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Venue Facts
Venue: Exeter Cathedral
Website: exeter-cathedral.org.uk
Enquiries: 01392 255573
→ Exeter Central 7 min walk


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Ruby recommends that everyone stop focusing on squeezing into skinny jeans, and work toward making their bodies healthy instead.Flag this Video
Ruby just keep up the good work,
I've lost weight and gained it back
plus, this time I've lost 80 lbs the
last time 5 years ago it was 106 which
for me was to much loss, BUT which
is a bad word, I have issues with the
keeping it off part. I'm 65 you think I'd
have it figured out by now but I'm praying
this time I will. Ruby your doing great.
I love this show and I love Ruby! She has such a wonderful personality and is loved by my two young daughters and myself. I have been overweight all my life and have lost over 100lbs. I am at my goal weight but everyday is a struggle. It will always be that way for the rest of my life. I have faith in you Ruby and I know you will do it..... Keep up the good work and you will be in my prayers.
I'm nobody important but I hope me telling you that I am sooooo proud of you does make a difference in your strength.Please don't give up!
I'll be keeping up with your wonderful life story. Thanks for a great show. Char
Hello Ruby,
What a wonderful inspiration you are to me! I was 289 #'s, now I am 235. My goal is 150, I want to be healthy and look good in my clothes. I have Many health issues, so it has been slow going. But , I saw your story and you have jump started my heart with inspiration! And girl, we are winners! We will reach our goals in Jesus name! Amen!.Thank You for sharing your life with us. I am so proud of you! I will continue to follow your story.You are my hero! Us Southern Bells have to stick together! God bless you!
Hi Ruby - Happy New Year to you! I agree I want this to be the best year ever. Taking the pressure of ourselves to squeeze into our "skinny jeans" is fabulous. Getting healthy - feeling better - being able to move around - gaining confidence in ourselves - that is what I want for all of us - that share this struggle. Stay strong. There are a lot of people praying and pulling for you. Hang in there. Thanks for being so open.


text:
Want to give Hermione a run for her money in the know-it-all field? Simply play the quiz by commenting on this post with your answers at any time over the weekend. All comments with answers will be screened until the answer sheet is posted on Monday morning EDT. On Monday, all quizzlings with the correct answers will receive a pretty banner to prove their quiz prowess. Ready? Set? Play!
Match the quotes to the story titles without picking the red herring titles:
Stud-muffin by debjunk
Chocolate Enchantment by Vivian B
Making Love by teddyradiator
A Mutually Beneficial Arrangement by melusin_79
When Only the Best Will Do by fizzabella1110
Delicious by of_anoesis
A Chocolate Frog Card for Professor Snape by selinabln
Like Taking Candy From a Professor by I M Sterling
Strange Taste by wingless
Short and Sweet by Corazon
The Blues by Toblass
Pearl Button by savvyshka
1. A small, black, oval box on the coffee table caught her attention.
'What on earth...?'
That hadn't been there this morning. Wherever had it come from? Noticing a scrap of parchment tucked under the silver bow on the lid, she carefully removed it and turned it over. In a familiar, spiky hand, it read:
Please accept this small gift with my compliments.
Start with the white one—I trust you will be able to work out the correct sequence after that.
Endeavour to savour each one for as long as possible.
P.S I await your instructions for Friday.
A present? From Snape? Hermione stared at the box wondering whether it was some kind of practical joke. What on earth could it be? Unable to contain her curiosity, Hermione undid the bow and removed the lid.
Five chocolates. And handmade too, by the looks of it.
They were arranged in the shape of a cross: a white one in the centre, flanked with milk chocolates on either side, and a dark one above and below it.
Hermione was already salivating, her hand reaching for the centre chocolate as instructed, when she came to her senses. Had she gone mad?
2. Her breath came fast and her chest rose and fell swiftly within the confines of her impractical dress. "You are utterly infuriating!"
Severus watched in silent dismay as one of the few colleagues he had thought to be something like a friend began to turn from him, like all the rest before.
"I tried being nice to you, and you're nothing but snippy and short in return. I show an interest in your work and you're sarcastic and . . . snarky in response."
Was that even a word?
"You're a bad as Ron!" she continued, her cheeks flushed and her eyes bright
Now, that was a little unfair, surely.
"Honestly, if you like me, all you have to do is tell me."
Like her? What was she going on about? Well, of course he liked her. He had been willing to but up with this conversation
for far longer than he was comfortable with – surely that ought to count for something?
"Why is it all men think that the way to gain a girl's attention is to insult her?" She continued. "I put hours into looking like this and you tell me that I look like some mint confection."
"I like mint." He interjected. "I like chocolate.
3. Hermione strategically placed the candy bar on her table. In a few minutes, Severus would be stopping by to go over plans for the next Hogsmeade weekend. They were to chaperone together, and he was insistent that they work out everything ahead of the upcoming weekend. She'd jumped at the chance to have him stop by. He'd been acting funny for a few weeks and late one evening, instead of sleeping, she'd spent the whole night analyzing his behavior.
He looks away when I smile at him. He runs the other way when I'm coming down the hall. He makes excuses that he has meetings with fictional people to avoid me. Who on earth is The Incredible Arse, anyway? Maybe he was talking about Dumbledore, he's been grumpy lately.
Realization hit her like a ton of bricks. Severus Snape was attracted to her. The rest of the night was spent in deliberating just what she was going to do about it.
Now she looked down at the results of her planning. That candy bar should loosen Severus up so he could tell her how he felt. She crossed her fingers as there was a light rap on her door. Hopefully it would work.
4. "Finally, the last sample. As you know, I am not terribly fond of chocolate, so I am not sorry to see the end of this," he waved his hand over his desk, "the end of this twaddle. Here we go, sample number twelve."
As he had with the other samples, he sniffed this one as he opened the box, and a brief, fleeting smile crossed his face.
"Sample number twelve is a dark chocolate with a strong cacao scent; just a hint of what I judge to be genuine vanilla bean, rather than a pre-prepared extract; the chocolate smells sweet but not overpoweringly so."
Mrs. Webley thought this sounded hopeful; his comments were, far and away, the most positive of all the chocolates he'd sampled. She watched with interest as he bit into the sample.
"Mmmmm." In the several years she'd worked for him, Mrs. Webley had never head Director Snape make a sound like that, but his eyes were closed in chocolate-induced bliss and he smiled as he finished the sample piece.
"Sample twelve must have the highest cacao content of any samples submitted; the texture is very smooth, the taste perfectly balanced between the bitter cacao and the sweetness of the vanilla and sugar. The sample snapped cleanly, and has obviously been properly stored."
5. Headmaster Snape eased back in his chair, propping his booted feet upon the desk. Carefully, he held the opened purple foiled box up to his prodigious nose and inhaled deeply, allowing the heady aroma to waft through his olfactory receptors. With a contented sigh, he peered inside at the delicately embossed dark chocolates and silently thanked Hermione. Unable to wait a moment longer, he reached in, plucked out one of the lovely brown domes and popped it into his mouth. He rolled the chocolate on his tongue, gently sucking at the liquid slowly oozing out with a hum of satisfaction.
The combined symphony of flavours—bitter, dark chocolate and tart raspberry—exploded on his tongue and he was awash with euphoric bliss. Oh, sweet Merlin, but this is good! When the last bit melted away, he eagerly popped yet another delectable confection into his mouth. At that moment, his wife came through the Floo.
"Hello, Severus, what are you—no!" Hermione shrieked, aghast at the scene before her.
6. An appetizing smell of chocolate and vanilla caught Severus' attention and drew him to the window of the candy shop, at which point the daring idea was born in the Potions master's mind. For a minute, he looked at the bright display in indecision. His hesitation was almost palpable. Then he huffed, jerked his enormous nose up and bravely stepped inside.
The bell on the shop's door announced Severus' entrance, inevitably arousing the attention of inhabitants of the shop. Here he stood – the dark, evil outcast, dressed completely black – in the middle of this absurdly neon paradise filled with sugar, chocolate and confectionaries. For mere seconds, the only thought flashing through the Professor's mind was – run, now!
"Shit," growled Severus under his breath. However, he wasn't ready to give up just yet. A year spent in the proximity of Gryffindor had rubbed off on him. He straightened his shoulders and courageously walked to the counter, almost scaring the unsuspecting shop assistant to death in the process. Apparently they weren't used to such stormy clouds of black looming over their counters.
"What would you like, sir?" asked the assistant, his voice trembling.
"Some chocolate truffles, perhaps. What would you recommend?" asked Severus in his most civil possible voice. Miraculously, it worked. After this question, the boy at the counter visibly relaxed and obviously got a second wind.
"Ah, sir, we have absolutely the best chocolate truffles in England." He began to fuss around Severus. "Maybe you will find these two interesting," said the boy as he excitedly pushed two identical chocolate truffles to Severus. "This one is the darkest chocolate we have, filled with black cherry flavoured chocolate mousse," he pointed at one of them, "and this one is the same dark chocolate, sir, but with black currant flavoured mousse inside." The shop assistant continued to chatter, especially emphasizing the words 'darkest', 'dark' and 'black' while describing each truffle.
"You have to try them sir, they are truly exquisite."
7. Ron, being stubborn or persistent, take your choice, decided he was going to find out who "he' was. He owled his brothers, George and Fred, and asked for some recommendations on how to approach the situation. They immediately owled him back and sent along a package with a letter.
These are Aphrodite's Chocolates. Whoever eats them will have the overwhelming urge to kiss the person they are most infatuated with. Be careful Ron! Only one piece is needed.
Fred and George
Ron smiled. He knew exactly when he was going to use them.
8. She returned her attention to her book, absently stuffing sweets in her mouth. All three men watched her yap quietly after every bite she took.
"What in the blazes are you eating?" Snape finally asked what everyone was thinking.
She looked up, startled. "Cherry and Chilli Gummy Sweets," she explained, not understanding his need to know. He wasn't usually interested in anything she did.
"You're yapping like a pug in the throws of an orga… asthma attack," he informed her dryly, pretending not to have almost uttered the word orgasm in front of his ex-student.
She grinned sheepishly, pretending to overhear the sexual reference that had him blushing a little. "Sorry," she said and proceeded to offer the sweets to the other men.
Remus demurred, but Albus was quick to try the new sweet. He was already affected by the chilli when she turned the bag to Snape.
"Are you sure they are fit for human consumption?" he drawled.
Hermione only rolled her eyes and thrust the bag under his formidable nose.
After a moment's hesitation, he took one of the gummy things that even optically resembled both a cherry and a chilly.
She watched him chew, and he stared back at her with a frown, not quite liking her scrutiny.
The cherry flavour came first, and he quite liked it; then after a few chews the chilli flavour made its presence known, and he had to breathe through his mouth to relieve the hot feeling in his mouth.
"Merlin's balls," he wheezed a little after he managed to swallow the thing. His eyes stung a little and surely looked watery, but he'd be damned before he'd wipe his eyes in front of the chit.
9. Hermione was grading papers in her office. A box of chocolate sat at her elbow. She needed to put the box away, they were absolutely delicious, and she'd eat the whole thing if she didn't pace herself. That thought didn't keep her from taking another bite and letting out a small moan.
A light knock on the door made her look up, mid-bite.
Severus Snape looked down at her with his lips twitching in an almost-smile.
"That good, are they?"
She swallowed and smiled up at him. "A gift from Minerva for Christmas, and yes, they're every bit of that good. Try one." She offered the gold foil box without hesitation.
He raised a brow, but didn't argue. He popped the chocolate in his mouth. The flavors were delicate but well balanced...hints of pomegranate from the center and something unusual...violets mixed into the chocolate? He was not a true chocolate aficiando, but these were the most complex sweets he'd ever bitten into, but he'd be damned if he moaned over chocolate...
10. He turned to Hermione, and with every ounce of seduction he could dial into his voice, he purred, "A gift this special is really too lovely not to share." An elegant eyebrow accompanied his invitation. "You will join me, won't you, Hermione?"
She bit her lip in a way that made his mouth water, and meeting his eyes with a coy little smile, she looked down in the box and chose a large, pyramid-shaped piece.
In return, he chose a rounded chocolate with a tiny piece of candied ginger on top. It was obviously fashioned to resemble an erect nipple; the imagery was not lost on either of them. To cover his embarrassment, Severus saluted Hermione with the chocolate, and placed the entire piece in his mouth. As it melted on his tongue, Hermione watched him carefully, unable to tear her eyes away from his gaze. Almost imperceptibly, something changed. A hint of surprise flashed in his eyes, and he chewed the chocolate slowly, as if savouring it to its fullest. She watched, fascinated, as he swallowed, and licked his lips.
He took a deep breath, and seemed to grow more relaxed. "I must put in my order now," he drawled. "This is without a doubt the most delicious chocolate I've ever tasted." He turned to Hermione, his large eyes warm and inviting. She looked surprised as he plucked the chocolate she still held in her fingers, and lifted it toward her mouth. With the slightest hint of a smile, he purred intimately, "I want you to enjoy this as much as I did."
Almost shyly, Hermione leaned forward and nibbled the chocolate from his fingers. He knew he was breathing hard, but he could not stop himself from gasping as her soft tongue darted out and brushed against his fingertips.
She closed her eyes and chewed slowly, a soft moan of pleasure sounding in her throat. Severus sat back against the sofa and watched her swallow.
Still hungry? Try out the stories on our first Sweetest Day Quiz, How Sweet It Is!