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Frequency by Decades of Unicuspid, Bicuspid, and Tricuspid Aortic Valves in Adults Having Isolated Aortic Valve Replacement for Aortic Stenosis, With or Without Associated Aortic Regurgitation
Background— Aortic valve stenosis (with or without aortic regurgitation and without associated mitral stenosis) in adults in the Western world has been considered in recent years to most commonly be the result of degenerative or atherosclerotic disease.
Methods and Results— We examined operatively excised, stenotic aortic valves from 932 patients aged 26 to 91 years (mean±SD, 70±12), and none had associated mitral valve replacement or evidence of mitral stenosis: A total of 504 (54%) had congenitally malformed valves (unicuspid in 46 [unicommissural in 42; acommissural in 4] and bicuspid in 458); 417 (45%) had tricuspid valves (either absent or minimal commissural fusion); and 11 (1%) had valves of undetermined type. It is likely that the latter 11 valves also had been congenitally malformed. Of the 584 men, 343 (59%) had either a unicuspid or a bicuspid valve; of the 348 women, 161 (46%) had either a unicuspid or a bicuspid aortic valve.
Conclusions— The data from this large study of adults having isolated aortic valve replacement for aortic stenosis (with or without associated aortic regurgitation) and without associated mitral stenosis or mitral valve replacement strongly suggest that an underlying congenitally malformed valve, at least in men, is more common than a tricuspid aortic valve.
Received August 27, 2004; revision received November 22, 2004; accepted December 13, 2004.
The most common cardiac operation today, of course, is coronary artery bypass grafting. The second most common is aortic valve replacement for aortic valve stenosis. During the past 11 years, we have examined 932 operatively excised, stenotic aortic valves from adults. This study describes the frequency of the various aortic valve structures (unicuspid, bicuspid, and tricuspid) in each of 8 decades of life in a group of patients who had isolated aortic valve replacement. This study differs from previously reported similar analyses in that children and patients with concomitant mitral valve replacement or associated mitral stenosis were excluded. The hypothesis was that if cases of rheumatic heart disease could be excluded, then the frequency of an underlying congenital heart disease of those undergoing aortic valve replacement would be higher than previously realized.
See p 832
From January 1993 through June 2004, every cardiac valve operatively excised at Baylor University Medical Center and submitted to the surgical pathology department of the same medical center has been examined by one of us (W.C.R.). Among the valves examined during this >11-year period were 932 aortic valves that had some degree of stenosis (a peak left ventricular to aortic systolic pressure gradient ≥10 mm Hg or clear anatomic evidence of aortic valve stenosis) with or without some degree of aortic regurgitation. Excluded from this study were patients having combined aortic and mitral valve replacement, patients with mitral stenosis whether or not the mitral valve was excised or the patient had a mitral valvuloplasty, patients ≤20 years of age at the time of aortic valve replacement, patients who had had a previous aortic valvulotomy, and patients who also had hypertrophic cardiomyopathy. Thus, patients included herein were those in whom only the aortic valve was excised and the aortic valve had some degree of stenosis.
Each stenotic aortic valve was received in the surgical pathology department in a container of formaldehyde. The valve structure in all cases was determined by one of us (W.C.R.). In recent years, the operatively excised stenotic valve was weighed. The age and sex of each patient was recorded from the surgical slip accompanying the operatively excised aortic valve. The preoperative cardiac catheterization and echocardiographic reports were obtained from either the respective laboratory or the patient's medical chart or, in more recent years, from the Apollo cardiovascular database of Baylor University Medical Center.
Hemodynamic data from cardiac catheterization was available for 689 (74%) patients, 43 of whom had transvalvular peak pressure gradients between 10 and 20 mm Hg. Nearly all of the remaining 243 patients also had undergone cardiac catheterization, but those studies were performed before the patient was referred to Baylor University Medical Center, and the data were not available to us. Another 111 patients had echocardiographic data available but no cardiac catheterization data available. Thus, for 800 (86%) of the 932 patients, either cardiac catheterization data or echocardiographic data before aortic valve replacement were available. The transvalvular peak systolic pressure gradients ranged from 10 to 141 mm Hg (mean±SD, 53±25); in the patients not having simultaneous coronary bypass surgery, the peak gradients ranged from 10 to 141 mm Hg (mean±SD, 57±26), and in those patients having coronary bypass surgery at the time of aortic valve replacement, from 10 to 133 mm Hg (mean±SD, 49±24; P<0.001). Aortic valve areas (637 patients) ranged from 0.18 to 1.90 cm2 (mean±SD, 0.74±0.25) and were significantly different in those having versus those not having simultaneous coronary bypass surgery (mean±SD, 0.72±0.25 versus 0.76±0.25; P=0.037). All 932 patients had structurally abnormal aortic valves including calcific deposits, including those patients with peak transvalvular pressure gradients as low as 10 mm Hg.
Statistical analysis was performed with SigmaStat version 2.0 software (SPSS Inc). To compare the percentages in 2 different groups, the z test was used. To compare the mean transvalvular peak systolic pressure gradients and the mean aortic valve areas in patients with and without simultaneous coronary bypass surgery, the nonparametric Mann-Whitney rank-sum test was used instead of a parametric test because the data to be analyzed did not pass the normality and equal-variance assumption tests. To compare the mean ages among patient groups with unicuspid, bicuspid, and tricuspid valves, the nonparametric Kruskal-Wallis 1-way ANOVA on ranks test was used. A probability value <0.05 was considered statistically significant. The institutional review board of Baylor University Medical Center approved the study protocol.
The numbers and percentages of patients in each of the 8 decades subdivided by aortic valve structure and sex are shown in Table 1. Among the 932 patients, 46 (5%) had unicuspid unicommissural valves, 458 (49%) had bicuspid valves, 417 (45%) had 3-cuspid aortic valves, and 11 (1%) had valves excised in several pieces, such that the underlying valve structure was not clearly discernible. (We believe that these 11 valves with uncertain structure were also congenitally malformed because they all contained a very large amount of calcific deposits.) More men than women had congenitally malformed valves (59% versus 46%, P=0.008; Table 1), and fewer men than women had tricuspid aortic valves (40% versus 53%, P=0.011; Table 1).
The unicuspid aortic valves were all heavily calcified, and their cusps were rigid. Of these 46 valves, 42 had a single, unfused commissure, and the valve orifice was linear (similar to an exclamation point), eccentrically triangular, or oval (Figure 1); the other 4 had triangular, more central orifices, and 3 "undeveloped commissures" (Figure 2).
The bicuspid aortic valves were of 2 types (Figure 3). All had been excised in 2 pieces. In 432, the free margins of both cusps were relatively linear in appearance, or the margins of one of the 2 cusps had a V-shaped configuration, with the apex of the V pointing toward a raphe (false commissure). In the latter situation, the free margins of the raphe cusp were concave, and the free margins of the nonraphe cusp were convex, such that the valvular orifices were nevertheless usually competent. The ventricular aspect of the valve beneath the raphe in all instances was flat or nearly so. Furthermore, on the aortic aspect at the site of the raphe, the V-shaped cuspal margins were not visible in the raphe. The cephalad extension of the raphe was always less than that of the 2 true commissures. In the remaining 26 valves classified as bicuspid, the cusps were fused at one commissure, and the length of the fusion was ≥4 mm and usually ≈10 mm. In these circumstances, the free margins were visible cephalad to the cuspal fusion, which was located caudal to the margins. The fused cusps beneath the visible free margins (which extended to the aortic wall) were either flat or not. Additionally, the cephalad extension of the fused commissure appeared to be on the same horizontal plane as the other 2 commissures.
The tricuspid aortic valves were of 2 types (Figure 4). None of the 3 commissures were fused, such that each cusp was excised separately (340 cases), or there was slight (≤3 mm) fusion of one or more commissures (77 cases); in nearly all cases, the fusion extended for only 1 or 2 mm.
The fewer the number of aortic valve cusps, the younger was the patient. Patients with 3-cuspid aortic valves had higher mean ages than did patients with fewer cusps. The ages of the 46 patients with unicuspid valves ranged from 26 to 75 years (mean±SD, 51±14); that of the 458 patients with bicuspid valves, from 27 to 91 years (mean±SD, 67±11); and that of the 417 patients with 3-cuspid valves, from 45 to 91 years (mean±SD, 74±8; P<0.001). Of the 932 patients, 176 (19%) were in the 4 younger decades (21 to 60 years), and 756 (81%) were in the 4 older decades (61 to 100 years). Nearly two thirds (66%) of the 932 patients were aged 61 to 80 years at the time of aortic valve replacement. Of the 46 patients with unicuspid valves, 33 (72%) were in the 4 younger decades, and the other 13 were in the next 2 older decades (61 to 80 years). Of the 458 patients with bicuspid valves, 115 (25%) were in the 4 younger decades (21 to 60 years), and 343 (75%) were in the 4 older decades (61 to 100 years). Of the 417 patients with tricuspid aortic valves, 27 (6%) were in the 4 younger decades (21 to 60 years; 25 of the 27 in the sixth decade); the other 390 (94%) were in the 4 older decades (61 to 100 years). Of the 176 patients in the 4 younger decades, the aortic valves in 33 (19%) were unicuspid; in 115 (65%), bicuspid; and in 27 (15%), tricuspid. In contrast, of the 756 patients in the 4 older decades (61 to 100 years), the aortic valves were unicuspid in 13 (2%); bicuspid in 343 (45%); and tricuspid in 390 (52%).
The age range of the 932 patients was 26 to 91 years (mean±SD, 70±12). The 584 men ranged in age from 26 to 91 years (mean±SD, 69±11), and the 348 women, from 27 to 91 years (mean±SD, 71±11). Of the 584 men, 119 (20%) were in the 4 younger decades (21 to 60 years), and 465 (80%) were in the 4 older decades (61 to 100 years); of the 348 women, 57 (16%) were in the 4 younger decades, and 291 (84%) were in the 4 older decades.
Of the 932 patients, 490 (53%) also had coronary artery bypass grafting at the time of aortic valve replacement (Table 2). Coronary artery bypass grafting was performed in 7 (15%) of the 46 patients with unicuspid valves, in 211 (46%) of the 458 patients with bicuspid valves, in 268 (64%) of the 417 patients with tricuspid aortic valves, and in 4 (36%) of the 11 with undetermined valve structure. Of the 176 patients in the 4 younger decades (21 to 60 years), 59 (34%) had concomitant coronary bypass surgery; of the 756 patients in the 4 older decades, 431 (57%) had concomitant coronary bypass surgery.
The present study of 932 stenotic aortic valves operatively excised from 1993 to 2004 in patients >20 years of age has demonstrated that slightly more patients had congenitally malformed aortic valves (either unicuspid or bicuspid) than tricuspid aortic valves (54% versus 45%; indeterminate structure=1%). Among the 46 patients with unicuspid aortic valves, 42 (91%) had valves with 2 rudimentary commissures and 1 true commissure (Figure 1): Four had valves with 3 rudimentary commissures and no true commissures (Figure 2). We classify these latter 4 cases as unicuspid acommissural aortic valves. These 4 cases in the past would have been classified by most investigators, we suspect, as rheumatic in origin. We, however, searched the medical records thoroughly for evidence of mitral valve disease in these 4 cases and found none. It is possible, of course, in rheumatic heart disease for aortic valve disease to be clinically apparent before the appearance of clinical evidence of mitral disease, and that could be the situation in these 4 cases. It is also possible that the cuspal fusion at each of the 3 rudimentary commissures was present at the time of birth, and therefore, this multifusion represents congenital heart disease. Lack of separation of each of 3 cusps before birth appears to us a more reasonable explanation of the valve disease in these 4 cases than rheumatic heart disease manifesting itself clinically as isolated aortic valve disease.
Although the patients with unicuspid or bicuspid aortic valves clearly had congenital heart disease underlying their aortic stenosis, the cause of the aortic stenosis in the patients with 3-cuspid aortic valves is almost certainly acquired in origin. Although stenosis involving a 3-cuspid aortic valve unassociated with mitral valve disease has in the past most commonly been called "degenerative" in origin—a consequence of aging—we prefer to call these stenotic, 3-cuspid aortic valves (unassociated with mitral disease) "atherosclerotic" in origin. The evidence for attributing the calcific and other deposits on the aortic aspects of the 3 cusps in these patients to atherosclerosis is the following: (1) Patients with homozygous familial hypercholesterolemia (individuals with serum total cholesterol levels >800 mg/dL from the time of birth) develop aortic stenosis by the teenage years (without lipid-lowering therapy)1; (2) patients >65 years of age with aortic stenosis involving a 3-cuspid aortic valve (unassociated with mitral valve disease) usually have extensive atherosclerosis involving the major epicardial coronary arteries and usually other arterial systems2,3; (3) serum total cholesterol levels tend to be higher in patients with aortic stenosis involving a 3-cuspid aortic valve than in patients of similar age and sex without aortic stenosis4; (4) the use of lipid-lowering therapy (statins) has been demonstrated to slow the progression of aortic valve stenosis5; and (5) histological study of 3-cuspid, stenotic aortic valves has demonstrated that these valves have features similar to those in arterial atherosclerotic plaques. It has been demonstrated that the cusps of congenitally bicuspid, stenotic valves are usually of unequal size; ie, that they differ in weight.6 Likewise, the cusps of 3-cuspid, stenotic aortic valves also often differ in weight. Roberts and Ko7 weighed 260 operatively excised, stenotic 3-cuspid aortic valves from patients having no evidence of mitral valve disease and found that all 3 cusps differed (by >0.1 g) in weight in 69 patients (26%), that one cusp differed in weight from the other 2 in 158 patients (61%), and that in only 33 patients (13%) were all 3 cusps of similar weight.
The first institution where a large number of operatively excised stenotic aortic valves were examined was the Mayo Clinic. Subramanian and colleagues8 in 1984 described 374 valves with "pure aortic stenosis" (no associated aortic regurgitation or only mild regurgitation); Passik and colleagues9 in 1987 examined another 646 operatively excised valves with "pure aortic stenosis"; and Subramanian et al10 in 1985 examined another group of operatively excised valves with "combined aortic stenosis and insufficiency." The difficulty in comparing their findings with those in the present study is that the former also included patients with coexistent mitral disease and children. Combining the findings of the 3 studies from the Mayo Clinic together indicated that 44 (4%) of their 1219 patients with operatively excised, stenotic aortic valves had unicuspid valves, 459 (38%) had bicuspid valves, 431 (35%) had "postinflammatory" valves, 257 (21%) had "degenerative" valves, and 28 (2%) had valves of indeterminate structure. Their inclusion of children appeared to increase the likelihood of congenitally malformed valves. These authors also intermixed etiology with structure, a process that prevented us from being entirely clear about valve structure in their cases. Their patients as a group were younger than those included in the present study because the earlier studies included both children and patients with unambiguous rheumatic heart disease. The present study, in contrast, made every reasonable attempt to exclude patients whose valve disease was of rheumatic etiology.
Turri and colleagues11 in 1990 described operatively excised aortic valves from 602 patients having valve replacement, but these authors combined data from patients with pure regurgitation and those with some degree of aortic stenosis. That study also included patients who had concomitant mitral valve disease, and indeed, the most common cause of aortic stenosis (≈348 patients) in their patients was rheumatic heart disease (undefined; in 172 [49%]). Only 17 (5%) of their patients had congenitally bicuspid aortic valves, and only 44 (13%) had the "senile" type of stenotic valve, presumably 3-cuspid ones. Although it was not possible to separate the ages of their patients with stenotic valves from those with purely regurgitant valves, the mean ages of their stenotic cases were clearly much younger than patients included in the present study (mean age, ≈50 versus 70 years).
Agozzino and associates12 in 1992 described operatively excised aortic valves from 912 patients having valve replacement in the 1980s: A total of 787 valves had some degree of stenosis, but there was no attempt to describe valve structure. These authors also included patients with associated mitral valve disease, and indeed, rheumatic heart disease was the most common etiology of the aortic valve stenosis (573 of 787 [73%]). "Degenerative calcification" was the explanation for the stenosis in the other 214 patients (27%). These authors also included children in their study. The mean ages of their patients with aortic stenosis was 47 years.
Several features of the present study make it different from previous studies on operatively excised, stenotic aortic valves. First, the study was limited to adults >20 years of age and excluded those patients who had had a previous aortic valvulotomy. Second, it excluded patients with associated mitral stenosis, which in adults is virtually always of rheumatic origin, and it also excluded patients having mitral valve replacement for any reason. Third, it included only patients whose stenotic aortic valve was excised in the last decade of the 20th century or the first decade of the 21st century. Fourth, the structure of the operatively excised stenotic aortic valve was determined by a single physician (W.C.R.), who has studied the aortic valve for >40 years. Fifth, it made no attempt to separate stenotic valves into those that were purely stenotic versus those that were both stenotic and regurgitant, a division that is fraught with error unless an aortogram or echocardiogram has been used for this determination.
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- Frequency by Decades of Unicuspid, Bicuspid, and Tricuspid Aortic Valves in Adults Having Isolated Aortic Valve Replacement for Aortic Stenosis, With or Without Associated Aortic RegurgitationWilliam C. Roberts and Jong M. KoCirculation. 2005;111:920-925, published online before print February 21, 2005http://dx.doi.org/10.1161/01.CIR.0000155623.48408.C5
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- Frequency by Decades of Unicuspid, Bicuspid, and Tricuspid Aortic Valves in Adults Having Isolated Aortic Valve Replacement for Aortic Stenosis, With or Without Associated Aortic RegurgitationWilliam C. Roberts and Jong M. KoCirculation. 2005;111:920-925, published online before print February 21, 2005http://dx.doi.org/10.1161/01.CIR.0000155623.48408.C5
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With an AO Aftercare Protection Plan, you can relax in the knowledge that there's help at hand should your product break down.
We like to do things differently at AO and that's why we've teamed up with Domestic & General, the leading provider of appliance breakdown and warranty protection in the UK, to offer you a bespoke AO Aftercare Protection Plan with amazing features and benefits:
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Top StoriesCalendarVideosSocial MediaMore StoriesWebCasts
Cross Country Continues To Improve at Codfish Bowl Beacons record strong finishes at Franklin Park Full Story
Cross Country Returns To Action at UMass Dartmouth Invitational Beacons runners compete against the top teams in New England Full Story
Beacons 360 and Summer Spotlight Series Make Their Debuts UMass Boston athletics presents the first-ever episode of their studio show Beacons 360 Full Story
Cross Country Opens 2016 at Jim Sheehan Memorial Invitational Both teams record 5th place finishes in their first meet of the year Full Story
2015-16 UMass Boston Cross Country and Track & Field Highlights Hulerie McGuffie won the Beacons' first two national championships since 1998
Men's Cross Country
Men's Cross Country
General News
Men's Cross Country
General News
UpcomingView Full Schedule
Oct 01
Men's Cross Country 10:00 AM
Tri-County Cross Country Invitational
Hosted by CCRI - Lincoln, R.I.
Oct 08
Men's Cross Country 12:00 PM
NEICAAA Championship Meet
Franklin Park - Dorchester, Mass.
Oct 14
Men's Cross Country 2:00 PM
Emmanuel College Saint's Invitational
Franklin Park - Dorchester, Mass.
Oct 29
Men's Cross Country 11:00 AM
Little East Conference/New England Alliance Championship Meet
Hosted by UMass Dartmouth - Dartmouth, Mass.
Nov 12
Men's Cross Country TBA
NCAA Division III New England Regional Championship Meet
Site To Be Determined
June 15, 2016 Cross Country Announces 2016 Schedule Cross Country will compete in eight meets this fall
April 4, 2016 UMass Boston Athletics "It's On Us" Video Members of all 18 UMass Boston athletic teams took the "It's On Us" pledge to help end sexual assault on college campuses
February 29, 2016 UMass Boston Athletics Hosts Second Annual Special Olympics Basketball Tournament UMass Boston hosted over 75 Olympians on February 21, 2016
February 5, 2016 UMass Boston to Offer Student Housing in 2018 Innovative public-private partnership will provide on-campus housing; housing closely linked to academic success
January 7, 2016 Beacons Athletics Launches Go Beacons App Fans can follow your favorite Beacons team with the official Go Beacons app for Android and IPhone
November 14, 2015 Cross Country Closes Out 2015 at NCAA Regional Championship Three Beacons represent the men's and women's team in their final meet of the 2015 season
October 31, 2015 Cross Country Competes at Conference Championship Meet Beacons post 6th and 7th place finishes respectively at LEC Championship Meet
October 19, 2015 Cross Country Highlights from Emmanuel College Saints Invite The women's team finished 12th and the men's side ended the day 15th
Beacon Social
Twitter Tweets by @UMassBeacons


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News Ring 0's Meimu Draws Manga for Gundam MS IGLOO 2 Anime
posted on 2008-08-26 14:42 EDT
The October issue (released on August 26) of Kadokawa Shoten's Gundam Ace magazine has announced that the artist Meimu will launch a manga based on the computer-animated Mobile Suit Gundam MS IGLOO 2: Jūryoku Sensen series in the next issue. The anime recounts the first war in the Gundam robot franchise from the perspective of the regular rank-and-file soldiers of the Earth Federation forces. Meimu previously drew the manga for another Sunrise robot anime work, Gasaraki, as well several horror manga adaptations such as Ring 0: Birthday, Juon 2, and Dark Water. The next issue of Gundam Ace will be released on September 26. The anime's first volume (pictured at right) will ship in Japan on October 24.
Source: Muhyojo
Image © Sotsū, Sunrise
The Fall 2016 Anime Preview Guide
Available Now: Bloodivores - DREAM FESTIVAL ― Welcome to Anime News Network's Fall 2016 Preview Guide! Here's how it goes: our team of critics write up their impressions instantly and they get posted as they go along. Each critic will cover as many shows as they can handle, resulting in al...


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Writing and translation
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Handy excuse, the old polo injury.
The Prince of Wales had just managed to miss the wicket by a good 30 centimetres and he had it at the ready.
More Life and Style Videos
To royal or not to royal?
Clementine Ford goes through her 'Dicktionary'
Supermodel Gigi Hadid assaulted
Chelsea Handler doesn't hold back on Brangelina split
A brief history of Brad and Angelina
How to find a good tradie
The first openly gay Miss America contestant
Body image challenge accepted!
To royal or not to royal?
We ask the common people at Flemington what they think of the visiting royal couple Charles and Camilla.
"You've got to remember I've broken my arm in two places," he cried. "I can't do it."
Prince Charles had stopped by the MCG on his way to that other of Melbourne's sacred grounds, Flemington.
He was met by officials from Cricket Victoria, players from Victoria's Bushrangers and a multicultural giggle of enthusiastic youngsters from Cricket Victoria's Harmony program. As the young players shied a tennis ball at a single wicket - with considerable success - the Prince was invited to try his arm.
"I knew it," he chuckled.
And missed. By a margin that would have him sacked from a D grade team.
It was time to roll out the old injury.
Royal prerogative, clearly.


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hi all
just made this profile to get more access to the various stuff on 1up.com. I have my own blog that isn't really gamer-related but I enjoy writing on.
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look up pmarus78 on their site to get my twitter
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How Frannie and Five Other Incorrigible Cats Seized Control of Our House and Made It Their HomeBob Tarte had his first encounter with a cat when he was two and a half years old. He should have learned his lesson then, from Fluffy. But as he says, "I listened to my heart instead, and that always leads to trouble." In this tell-all of how the Tarte household grew from one recalcitrant cat to six—including a hard-to-manage stray named Frannie—Tarte confesses to allowing these interlopers to
$12.99In this long-awaited sequel to the "unforgettable" (Boston Herald) bestseller Mrs. Mike, Benedict and Nancy Freedman paint a portrait of the World War II era—as seen through the eyes of a young Cree woman on her own for the very first time… When her dear friend O Be Joyful died in a flu epidemic, Mrs. Mike Flanigan opened her home—and heart—to her orphaned child, Kathy Forquet. Over the years,
How the New Feline Science Can Make You a Better Friend to Your PetCats have been popular household pets for thousands of years, and their numbers only continue to rise. Today there are three cats for every dog on the planet, and yet cats remain more mysterious, even to their most adoring owners. In Cat Sense, renowned anthrozoologist John Bradshaw takes us further into the mind of the domestic cat than ever before, using cutting-edge scientific research to
A Fearless Feline Tale, or How I Learned About Love and Life with a Blind Wonder CatBONUS: This edition contains a new afterword and an excerpt from Gwen Cooper's Love Saves the Day.ONCE IN NINE LIVES, SOMETHING EXTRAORDINARY HAPPENS. The last thing Gwen Cooper wanted was another cat. She already had two, not to mention a phenomenally underpaying job and a recently broken heart. Then Gwen's veterinarian called with a story about a three-week-old eyeless kitten who'd been
$9.99The Instant New York Times Bestseller!James is a street musician struggling to make ends meet.Bob is a stray cat looking for somewhere warm to sleep. When James and Bob meet, they forge a never-to-be-forgotten friendship that has been charming readers from Thailand to Turkey.A Street Cat Named Bob is an international sensation, landing on the bestseller list in England for 52 consecutive weeks and
$2.99Theda Krakow is in a funk. Her sometime boyfriend's gone for good. The death of her beloved cat opened a bigger void. And the career leap she's made from copy editor to freelance writer has left her financesand her spiritflat. She desperately needs a headline to get her life back on track. One day, out for a stroll in her Cambridge neighborhood, Theda spies an adorable stray kitten. This charmer
Chicken Soup for the Soul: My Cat's Life
101 Stories about All the Ages and Stages of Our Feline Family MembersChicken Soup for the Soul: My Cat's Life captures the entire arch of life with our feline friends. Readers will be moved and uplifted by these heartwarming, humorous, and inspiring stories.From kittenhood through the twilight years, our feline companions bring joy, love, and laughter to their "staff." Chicken Soup for the Soul: My Cat's Life captures the experience of living through the natural
$8.69Internet sensation Grumpy Cat's epic feline frown has inspired legions of devoted fans. Celebrating the grouch in everyone, the Grumpy Cat book teaches the fine art of grumpiness and includes enough bad attitude to cast a dark cloud over the whole world. Featuring brand new as well as classic photos, and including grump-inspiring activities and games, Grumpy Cat delivers unmatched, hilarious
What the World's Most Incorrigible Cat Taught Me About Life, Love, and Coming Cl eanCat behaviorist and star of Animal Planet's hit television show My Cat from Hell, Jackson Galaxy, a.k.a. "Cat Daddy," isn't what you might expect for a cat expert (as The New York Times noted, with his goatee and tattoos, he "looks like a Hells Angel"). Yet Galaxy's ability to connect with even the most troubled felines -- not to mention the stressed-out humans living in their wake -- is awe
The Craggy Hole in My Heart and the Cat Who Fixed It
Over the Edge and Back with My Dad, My Cat, and MeGeneen Roth's legions of fans have always responded to her humor and honesty, her warmth and savvy. Those qualities, so present in The Craggy Hole in My Heart and The Cat Who Fixed It, take us deep into the story of a remarkable twenty-pound cat, Mister Blanche, and Geneen's beloved father, Bernard, and the ways in which each taught her to love without reservation and to accept the fact that she
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Pianist's Postponement
Published: April 28, 1992
The pianist Santiago Rodriguez has postponed the final two performances in his all-Rachmaninoff series, tomorrow and on May 20 at 8 P.M. at the 92d Street Y. He cited health problems. Tickets should be kept until new dates and refund options are announced. Information: (212) 415-5440.


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A while ago reviewed an app called Llama, which I mainly reviewed for the purpose of changing profiles such as switching a phone to silent when you get to work. Another great feature is the ability to adjust other setting based on location. Things such as leaving wifi on can drain your battery quick, with Llama you can set things like wifi to turn on when you get home or only when phone is charging. So if you didn't already download it for the profile reason, here's another reason to download Llama
ClipSync – copy paste from desktop to android
ClipSync lets you share your clipboard between an android and your computer, basically you can copy paste from your android to your desktop and visa versa. It's pretty simple first you need to install the desktop software here and then the android software here. You make sure the server side software is running on your computer and that your phone and computer are on same network, then run the software on phone and it will find computer. Once setup its automatic, just hit copy on your phone or computer and paste on the other device. I used to copy then paste to email, email it to myself and then copy paste again, this saves so much time.
Alarm Clock Plus
As you know by know my favorite part of Android over iPhone is the ability to replace system apps. A while ago I reviewed Alarm Clock Xtreme, and recently for some reason it has been given me problems. I decided to try a different alarm and my search got me Alarm Clock Plus. It has many of the same features such as deciding if you want auto snooze and shutoff. Also has a feature to decide if each alarm should be based on system volume or independent. I find this convenient as my morning alarm I always want beeping but I have some in the afternoon that I don't want sounding if I'm in a meeting. So check it out and let me know which you prefer.
Continue reading
SwiftKey Flow
A while ago I reviewed a great keybaord app, SwiftKey. I was torn between the predictability of Swiftkey, which learns your style and dictionary but its ability to read your texts, email and even facebook, and Swype which allows you to type by swyping your finger. Swiftkey just took the lead but adding a new feature called SwiftKey Flow which gives you Swype features. So check out my new favorite keybaord at http://www.swiftkey.net.
Lookout – security and lost phone finder
Lookout is a great all in one security app, it provides Android with a lot of the features iPhones have through iCloud primarily mobile wipe and find lost phone. There are two versions of this app the free and paid. The free version offers antiviurs, backup and tools for missing device. Missing device tools includes gps tracking, remote wipe and making the device scream or ring really loud which is great for finding the phone when it falls under the couch. The app can be downloaded here
Bump – send files from Android phone to computer and visa versa
Very often I want to quickly send a file from my computer to my phone or from my phone to computer. There are ways to do this by using usb cable, bluetooth or email. Sometimes you just want to quickly send a small file without the hassle of the mentioned methods, that's where bump comes in. It allows you to send files back and forth between the computer and your phone just by hitting your spacebar with your phone. It's really simple, almost didn't believe it. But so fart it works great, so check it out. This is a must have for anyone. And of course it lets you share files between two phones by bumping. Check out their website or find the app at Google Play.
This is one of the many keyboard available for the Android. Most new Androids are coming with a version of the Swype keyboard. For those who want an alternative check out SwiftKey. It is a new way of predictive text, basically you start typing a word and it finished it for you. Instead of guessing the word based on the current word you are typing, like old dumb could do, it recognizes common phrases you type. With this method it usually guessing the complete word one you start typing one, sometimes even no characters.
Link: https://play.google.com/store/apps/details?id=com.touchtype.swiftkey
Tunein Radio
Tunein radio is a pretty simple easy to use app that allows you to listen to radio stations from all over. The interface is pretty straight forward and you can browse by station type or by location. Great way to listen to your favorite stations no matter where you are. It sometimes works for sports but some games seem to be blacked out.
Link: https://play.google.com/store/apps/details?id=tunein.player&hl=en
Unified Remote
The app is really great if you watch movies on your TV through your computer. This app connects to your computer wirelessly via bluetooth or wifi network and acts as a remote allowing the user to control their computer by your phone. It has several different remotes to control different function, my favorite is the media remote but also can control keyboard, mouse and files. I think the best feature is the media remote. I strongly recommend this app for anyone who has their computer plugged into a TV. Instead of paying for a usb remote you can get this app for free and use your phone and the setup is really easy just install the desktop software in addition to the app.
Link: https://play.google.com/store/apps/details?id=com.Relmtech.Remote&hl=en
So the Fitocracy is new to the Android but has been on the iPhone for a bit. It's an interesting app the integrates social networking and working out. The basic idea is that it gives you workout to do and then gets rewards which you can brag about. This is motivation but definitely built on the honor system and we know no one would ever lie on Facebook. While it's an interesting idea I really don't like it as a pure working out app. Continue reading


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Federal Lands:
Views on H.R. 2941--A Bill to Improve Housing for Employees of Land Management Agencies
T-RCED-96-110: Published: Mar 26, 1996. Publicly Released: Mar 26, 1996.
Additional Materials:
- Full Report:
(202) 512-4800
GAO discussed employee housing at federal land management agencies and proposed legislation that would improve the housing situation for these agencies' employees, focusing on the National Park Service (NPS). GAO noted that: (1) about 11 percent of NPS employee housing either needs major repairs or is obsolete; (2) NPS has not adequately justified about 12 percent of its employee housing inventory; (3) NPS has a large housing repair and maintenance backlog, but it could not verify the NPS estimate of a $546-million backlog; (4) insufficient rental rates and competition for operating funds that supplement rental income are the underlying reasons for the backlog; (5) NPS is implementing some GAO recommendations to improve the housing situation; (6) the proposed legislation would address some key issues that GAO has identified; (7) it is concerned that the legislation would allow the use of employee housing as a recruitment and retention incentive; and (8) the legislation would raise budget scorekeeping issues, expose land management agencies to liability by allowing them to rent temporarily unneeded housing to nongovernment employees, and cause funding priorities problems for NPS by requiring it to set aside funds from operating funds to supplement rental income.
Aug 15, 2016
Grants Management:EPA Could Improve Certain Monitoring PracticesGAO-16-530: Published: Jul 14, 2016. Publicly Released: Aug 15, 2016.
Jul 26, 2016
Army Corps of Engineers:Additional Steps Needed for Review and Revision of Water Control ManualsGAO-16-685: Published: Jul 26, 2016. Publicly Released: Jul 26, 2016.
Levee Safety:Army Corps and FEMA Have Made Little Progress in Carrying Out Required ActivitiesGAO-16-709: Published: Jul 26, 2016. Publicly Released: Jul 26, 2016.
Jul 21, 2016
Oil and Gas:Interior Could Do More to Account for and Manage Natural Gas EmissionsGAO-16-607: Published: Jul 7, 2016. Publicly Released: Jul 21, 2016.
Jul 14, 2016
Environmental Protection Agency:Status of Efforts to Address Nonpoint Source Water Pollution through the Section 319 ProgramGAO-16-697R: Published: Jul 14, 2016. Publicly Released: Jul 14, 2016.
Jul 7, 2016
Polar Satellites:NOAA Faces Challenges and Uncertainties that Could Affect the Availability of Critical Weather DataGAO-16-773T: Published: Jul 7, 2016. Publicly Released: Jul 7, 2016.
Unauthorized Grazing:Actions Needed to Improve Tracking and Deterrence EffortsGAO-16-559: Published: Jul 7, 2016. Publicly Released: Jul 7, 2016.
Jun 14, 2016
Environmental Protection:Status of GAO Recommendations to EPAGAO-16-722T: Published: Jun 14, 2016. Publicly Released: Jun 14, 2016.
Indian Energy Development:Interior Could Do More to Improve Its Process for Approving Revenue-Sharing AgreementsGAO-16-553: Published: Jun 13, 2016. Publicly Released: Jun 14, 2016.
Jun 13, 2016
Climate Change:Selected Governments Have Approached Adaptation through Laws and Long-Term PlansGAO-16-454: Published: May 12, 2016. Publicly Released: Jun 13, 2016.
Looking for more? Browse all our products here


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Chess 4 Change
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Becoming Bald As The Result Of Aging Isn't Inescapable
Many individuals, particularly men, accept thinning hair as just a natural element involving growing older, however as necessary as hair is towards a man's general individuality, sense of self-worth and sometimes, social not to mention career, it's actually not a sad loss which will is required to be accepted as certain. The majority of people who are plagued with thinning hair are familiar with the medications that are offered to fight baldness through quelling DHT generation (which it is believed is in charge of the degeneration involving the hair follicles).
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hair growth treatments
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There happen to be a couple of different kinds of hair transplants. One is called a FUE hair transplant, and the other a FUT transplant. They may be similar, yet they are not exactly the same. Fundamentally, both entail shifting hair roots from regions of the person's scalp via where heavy hair growth remains, and also putting it on the places that happen to be missing hair. It is essential to realize that its not all people are fantastic contenders regarding hair transplants. A lot of people come to discover that their probability of being a prospective applicant are bigger the earlier into their very own hair thinning they select this choice.
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Carbon Management Companies serving Benin
Current filtering criteriaYou can remove a filter by clicking on the x
Category: Air & Climate ×
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Industry: Energy - Bioenergy ×
Serving: Africa ×
Serving: Benin ×
based in Fuengirola, SPAIN
Geotranslations delivers document translation and proofreading services to companies, organizations, institutions and professionals involved in the fields of Geoscience, Environment, Health & Safety, Renewable Energy, Carbon Markets and Greenhouse Gas (GHG) Reduction Projects and Climate Change.We translate and proofread a wide variety of materials of varying nature and ...
Clean Development Projects Limited
based in Hertford, UNITED KINGDOM
Clean Development Projects Limited is part of the Global Precious Commodities PLC Group. The Group focuses on investing in the private equity of enterprises that in turn operate in the precious commodities sector - where property, energy, water, food and precious minerals are the driving force for LOHAS consumer products (`LOHAS` is the acronym for Lifestyles of Health ...
CEMS Experts - a division of GK Associates, Inc.
based in Simi Valley, CALIFORNIA (USA)
For over 20 years, CEMS Experts has been providing turn-key CEMS solutions, consulting, and technical support services for the emissions compliance and process monitoring needs of our clients. Our customer base spans many industries including power generation, petro-chemical, cement, glass, forest products, landfills, municipal utilities, waste-energy, and many others. We ...
ifu Hamburg GmbH
based in Hamburg, GERMANY
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Events Manager
- Recruiter
- New Frontiers
- Location
- Buckinghamshire
- Salary
- Market related
- Posted
- 14 Sep 2016
- Closes
- 12 Oct 2016
- Ref
- Contact
- Caroline Wakil
- Sector
- Business Travel
- Job function
- Customer Service
- Hours
- Full Time
- Contract Type
- Permanent
Events Manager
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KENWOOD Recognizes Top Reps, Rep Firms With Sales Excellence Awards
Trent Partners celebrates fourth award since taking on KENWOOD in 2003
Mobile Solutions
Mobile Solutions Grows Capacity, Capability and Curriculum With More Space, Behemoth CNC
Additional 1,800 square feet makes room for more production and dedicated training rooms
JVC Mobile Entertainment
JVC Works to Strengthen Specialist Retail Relationships With DrivePoints, Apple CarPlay™
In-store staff to win prizes for selling qualifying JVC products through June 30
Latest Press Releases
Audiofrog Gives Driver and Passengers an Audiophile Experience with New Multichannel Platform
Audiofrog announced it will debut the first multichannel audio processing platform developed and optimized specifically for the automotive aftermarket.
Mobile Solutions to Hold Its First Spanish-Language Training
Mobile Solutions announced it will be holding its first Spanish language MasterTech Boot Camp, September 12-14, 2016, at its Tempe, Ariz., facility.
Audiofrog Relocates Office, Warehouse Facilities
Audiofrog, high-end loudspeaker brand designed for audiophiles, announced the relocation of its facility in Monrovia, Calif., to Sun Valley, Calif.
Brandmotion Strengthens Marketing, Technical Support With New Hires
Brandmotion, leading supplier of OEM-grade safety and driver assistance solutions for the automotive aftermarket, has welcomed four additional members to its Southfield, Mich., staff.
JVC Ships Flagship Multimedia Receiver With Apple CarPlay™
JVC Mobile Entertainment announced it is shipping the KW-V820BT, its 2016 flagship multimedia receiver introduced at CES earlier this year.
KENWOOD Delivers Collision Avoidance, Lane Assistance With New DVR Camera
– KENWOOD USA is introducing its first advanced safety product for the North American aftermarket.
Design Engineering Brings Full-Line Boom Mat Brand to the Mobile Electronics Industry
Design Engineering, Inc. (DEI), foremost developer of thermal tuning and sound control solutions for the automotive aftermarket, announced that it has begun a campaign to better engage with and support specialist retailers in the mobile electronics industry.
KENWOOD to Support Specialists in 2016 With X Rewards Promotion
Kenwood USA announced the kickoff of the eXcelon X Rewards promotion for 2016.
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Platero y yo / Platero and Iby Myra Cohn Livingston Juan Ramón Jiménez Joseph F. Domínguez
In English and Spanish, this book presents a picture of life in the town of Moguer, in Andalusia, Spain, as seen through the eyes of a wandering poet and his faithful donkey.
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Malfatti (Spinach and Ricotta Dumplings)
Malfatti — delicious little spinach and cheese dumplings are similar to gnocchi. Be sure to cook most of the moisture out of the spinach so the balls hold together. Test by cooking a couple of dumplings. If the mixture is loose, add another tablespoonful of flour.
Yield: 6 servings
- 1/4 cup (1/2 stick, or 4 tablespoons) butter
- 1/2 cup minced onion
- 2 10-ounce packages frozen chopped spinach, defrosted and squeezed dry
- 3/4 cup ricotta
- 2 eggs, beaten
- 3/4 cups grated Parmesan cheese
- 1 teaspoon salt
- 1/2 teaspoon fresh black pepper
- 1/2 teaspoon nutmeg
- 8 tablespoons flour, plus more for coating hands
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