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solid waste Companies serving Puerto Rico
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Burns & McDonnell
based in Kansas City, MISSOURI (USA)
Burns & McDonnell, headquartered in Kansas City, Mo., is a full-service engineering, architecture, construction, environmental and consulting solutions firm. Our multidisciplined staff of more than 4,300 employee-owners includes engineers, architects, construction experts, planners, estimators, economists, technicians and scientists, representing virtually all design ...
CH2M Hill Companies, Ltd.
based in Englewood, COLORADO (USA)
CH2M HILL offers a full range of environmental engineering, consulting, and construction services including site remediation, contaminated sediment services, ecosystems management, waste management, and munitions response programs. Applying innovative, creative, and value-based approaches is integral to every project we work on—CH2M HILL saves you money and time by ...
Bergmann, Heinz, e.Kfm.- Machines for Waste Management
based in Lathen/Ems, GERMANY
Mobile Compactors, Roll-Packers and Roto Compactors. BERGMANN Waste Disposal Equipment offers his customers in trade and industry waste disposal solutions which help to significantly lower disposal costs. BERGMANN´s success in this industry is based on its 3 decades of experience and on the large amount of worldwide patents for it space-setting developments. Bergmann, the ...
SIMPEC S.r.l.
based in Nova Milanese (MB), ITALY
Simpec works in the design, construction, installation and service of industrial water and wastewater treatment plants. Main sector of the company is metal and plastic surface finishing treatments. Simpec works for all the industries that use and consume water in their different production processes. Simpec realizes also plants for landfills (leachate treatment), plants ...
Immacutec Systems Technologies Inc.
based in Toronto, ONTARIO (CANADA)
Immacutec delivers the complete portrait of an organization's solid waste stream. We design and perform third party waste generation studies of varying size and complexity. This involves characterizing, quantifying, reporting and monitoring the contents, generation trends and disposal activities of all operations. Our measured and audited resource management data ...
based in Warszawa, POLAND
SYMBIONA is technology provider with offices in London, Warsaw and Kuala Lumpur.We specialize in wastewater treatment and reuse and anaerobic wastewater/waste treatment. We provide Clients with unique approach linking technologies with a short ROI. Our offer includes:- anaerobic MBR's for high strength wastewaters and organic waste fermentation (AnoxyMem®);- high rate ...
Morbark, LLC
based in Winn, MICHIGAN (USA)
Morbark is a major manufacturer of grinding, shredding, and chipping equipment for reduction, disposal and recycling of wood waste. Solid waste management, land clearing and site development, pulp and paper, forestry and logging, sawmills, these are the principal industries served by Morbark. We are the world's leading designer and manufacturer of wood grinding, chipping ...
PBS Velká Bíteš, a.s.
based in Velká Bíteš, CZECH REPUBLIC
PBS Velká Bíteš develops and manufactures except other equipments also decanter centrifuges for continuous separation of solid and suspended particles from liquids. The decanters by PBS may be used for a wide range of applications: from separation of municipal and industrial sludge in waste water treatment plants, through food and chemical industries up to agriculture. We ...
Anaergia Inc.
based in Burlington, ONTARIO (CANADA)
Anaergia Inc. is a global leader in offering sustainable solutions for the generation of renewable energy and the conversion of waste to resources. Through a proven portfolio of proprietary technological solutions, Anaergia maximizes the generation of renewable energy, diversion of waste from landfill and reduction of greenhouse gases for customers across the municipal, ...
OTI Greentech AG
based in Berlin, SWITZERLAND
OTI Greentech, is a leading international cleantech engineering group based in Switzerland. OTI Greentech provides sustainable solutions in cleaning, recovery and waste management of oil in a variety of applications. These include: cleaning products for tanks, ships, and industrial machinery; oil based sludge treatment; land remediation; processing and enhanced recovery ...
Tech Oil Products
based in New Iberia, LOUISIANA (USA)
Founded in 1980, Tech Oil Products, Inc. is known for the Enviro-Pak® line of compactors, balers, galley grinders, and other waste management solutions for the offshore and maritime industries. The company is also known for SafeSub®, an innovative solution for the handling and transporting of drilling subs, and its Recycle The Gulf® program for the Gulf of Mexico, a ...
BioBag Americas, Inc.
based in Palm Harbor, FLORIDA (USA)
BioBag is a world leader in providing bags and films for the collection of organic waste for the purpose of composting. Unlike regular plastic, BioBags are made from a resin derived from plant starches, vegetable oils & compostable polymers and can be consumed by micro-organisms that live in our soils. Because of this, our bags can also be readily composted along with ...
EnGlobe Corp.
based in Quebec, QUEBEC (CANADA)
EnGlobe Corp. is a worldwide leader when it comes to integrated environmental services. We have developed a unique expertise in the management of organic waste materials and in reusing or recovering decontaminated soils as well as in the precision testing and calibration of bulk tanks and storage systems. Our clients are in public administration, in business and industry ...
Husmann Umwelt-Technik GmbH
based in Dörpen, GERMANY
Manufacturers of equipment for waste disposal / environmental technology in Europe. Since more than 50 years the brand Hussman stands in the disposal branch for liability, quality and competence. We use our experience for finding solutions that fit exactly our customers' requirements. This as well as our innovative technology and our wide range of products for the ...
Balance Consulting Inc
based in Mandeville, LOUISIANA (USA)
Founded in 1996, BCI's services include small to mid-size industry, Fortune 500 companies, utilities, financial institutions, transportation agencies, municipalities, developers, contractors, and various other clients in the public and private sector. Our staff of engineers, planners, and environmental scientists possess a keen understanding of environmental conditions, ...
Applied Spectra, Inc.
based in Fremont, CALIFORNIA (USA)
Applied Spectra, Inc. was founded in 2004 by Dr. Richard E. Russo. As a pioneer in the study and development of laser ablation and LIBS at the Lawrence Berkeley National Laboratory for almost 30 years. Applied Spectra, Inc. (ASI) is a leading supplier of analytical instruments. We stand at the forefront of laser ablation (LA) based elemental analysis techniques, with our ...
Maren Engineering Corporation
based in South Holland, ILLINOIS (USA)
Maren Engineering Corporation has evolved into a North American leader for designing and manufacturing a full line of Horizontal Balers and Shredders. Additionally Maren markets a variety of conveyors, metering systems, cart tippers and material handling products, making us the "One Source" for innovation for your Waste Management System needs. The company has been the ...
based in Livingston, UNITED KINGDOM
Empteezy is the home of quality engineered spill containment and spill control products. Our overriding aim is to help you comply with legislation and implement best practice in connection with your oil and chemical storage needs, spill response programs, including spill kits & spill kit training, emergency safety shower and tank shower applications and waste handling ...
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 ...
Prozone International
based in Huntsville, ALABAMA (USA)
Prozone Water Products is a manufacturer of ozone generators for air and water purification systems for residential, commercial and industrial use. Prozone is a world leader in ozone generator manufacturing and ozone applications engineering. Ozone`s patented germicidal UV combined with ozone creates Advanced Oxidation processing, a purification technology that is ...


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Villacrusis Wins Food & Wine Fest Throwdown
In the first annual Grand Chef Throwdown at the Palm Beach Food & Wine Festival last night, Roy Villacrusis's cuisine reigned supreme.
Villacrusis, chef-owner of the new (and terrific) Kubo Asiatic Cuisine in North Palm Beach, smacked down former Top Chef contestant Howie "Bulldog" Kleinberg and local private chef Jeremy Hanlon in Battle Flank Steak.
Exemplifying the risk-taking that's his signature at Kubo, Villacrusis served a cold dish on an evening that was already colder than a witch's rack, plating thin strips of simply seasoned seared-raw beef with a salad of shredded romaine hearts, basil, scallions and mushrooms lightly smoked with a nifty hand-held smoke-shooting device called the Smoking Gun, all dressed at the table with a salty-tangy blend of soy sauce and yuzu juice.
For his efforts, Villacrusis took home $5,000 cash and another $5,000 donated in his name to the Peggy Adams Animal Rescue League.
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Brit M. is the author of several erotic romance novels, including Three in Love and Two Men and a Lady.
Teaching Him a Lessonby Brit M.
- LendMe LendMe™ Learn More
Alex Gilman is excited about his upcoming teaching assistant position for the university's new professor. Matt Klein is looking forward to a better job and the opportunity to make a difference teaching. Neither man expects the powerful attraction they feel toward each other. Despite the potential trouble, they become lovers, hoping to keep their relationship a secret for the semester until their working relationship comes to an end. Without the intrusion of Alex's ex-boyfriend Kay James, that might have been easy. Alex must work around Kay's suspicions and stay one step ahead or risk losing his job - and Matt's in the process. He's also unsure of his feelings about Matt and the sudden start of their relationship. Can their desperate passion for each other help them overcome their obstacles?
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Welcome to Rotherfield
As the District Commissioner for Rotherfield Scout District I would like to welcome you to our web site. Rotherfield covers a large area stemming from Bentley, Alton all the way to Alresford and Cherition, including the Bordon area too. The district offers unlimited opportunities for young people aged between 6 to 18, and not to forget adults as well who can participate in helping run a section, going on camps or even just helping occasionally. I hope that this site will provide you with all the information that you need.
Good Scouting
Mark Hughes
District Commissioner
Gold all the way
Team GB weren't the only group going for Gold over the Summer. A group of 5 Explorers from Shaws (Four Marks) ESU, took on the challenge of completing their Gold DofE Expedition over the Summer. Back in July the group went to the Black mountains in South Wales to carry out their practice exped. Travelling for 8 hours a day the group visited locations such as Sugar Loaf, and Lord Hereford's Knob (Yes many a joke was had)!! The purpose of the practice was to ensure that their navigation skills and lightweight expedition skills were up to scratch. It also provided and opportunity for them to learn some of the pitfalls of backpacking.
The main expedition took place in the Lake District, the mamoth 4 day self supported walk saw the group walk over 60km in 4 days.
- Day 1 started from the campsite at Eskdale to the top of Wasdale.
- Day 2 comprised of taking the Blacksail pass down into Ennerdale and staying overnight at the Scout Centre on the edge of Ennerdale.
- Day 3, possibly the hardest day of the trip took the team over some very rugged terrain into the Buttermere valley to stay at the campsite in Buttermere, mutch to the delight of the group who were provided with a cheeky pint (all the group were over 18)
- Day 4, a very early start for the group as they were keen on getting to Keswick in plenty of time to travel the 18 miles to Penrith ready to catch their train home. All the motivation for the day was there when they knew that they could have a pint or two at the end.
Well done to all the group and we look forward to seeing your presentation in a couple of weeks time. Thanks also goes to Steve & Rachel, for orgainsing the whole trip, Matt for supervision of the Exped and also Ian who was the assessor.
Beavers Fun Day
Over 100 beavers representing ALL of the Groups within the District attended the District Beaver Native American Activity Day and Beaver 30 Year Birthday Party held at Four Marks Primary School on Saturday 25th June.
Despite the occasional light morning shower the Beavers visited the 9 activity stations in rotation – tomahawk making, headdress making, lasso throwing, rain sticks, target throwing, dream catcher making, archery, hand painting & model wigwam making, completing the tasks with enthusiasm.
After a B-B-Q hot dog lunch, cooked by SAS members the Beavers were set the task of making and decorating/painting a wigwam using 5 canes and a dust sheet and making totem poles out of plastic bottles or large cardboard tubes, producing some very good items.
Whilst the Beavers moved into the school hall to celebrate the 30th Birthday of Beavers with party food and individual cupcakes each with an edible 30year Badge on the top, the camp fire was lit. Unfortunately, the rain became steady which prevented the Beavers assembling around the camp fire. However, with Lee Robinson leading, the Beavers enjoyed a sing a long in the school hall before leaving for home each with a 30 year celebratory woggle, tired but happy. A great day only possible due to the support of leaders, helpers, scouts, explorers, young leaders the SAS and of course the Beavers. My thanks to them all.
Rowan – ADC Beavers
St George's Day Parade
With members from all sections and groups attending it was another busy parade last weekend to celebrate St Georges Day. Starting from market square and parading down Market Street via a saluting DC, the prosession filed in to the centre ready for another service. This year being the last for Howard who has being running the service for the last 5/6 years, as he is moving on to pastures new, we wish him and his family all the best.
We were very privileged to have no less than 3 new Queen Scouts from the district this year, each carried the colour party flags at the front of the procession. Congratulations to Lizzie, Chris & Luke on your hard work and dedication. In addition to the new Queens Scouts, there were numerous awards to both young people and also Leaders. It was great to see so many young people gaining awards for the effort that they put into their Scouting.
Monopoly Run 2016
Firstly well done to all teams who competed in this years Monopoly Run, it was our largest Run so far with 920 Scouts, Explorers, Guides, Senior Section and Leaders/Parents from all around the UK taking part. Dispite some technical issues with the internet at the start of the day (it dropped 3 times for us over a 2 hour period), we hope that everybody enjoyed themselves and had a great afternoon.
The photos that were posted via Twitter (https://twitter.com/monopolyrun) & Facebook (https://www.facebook.com/MonopolyRun/) show some very happy Scouts & Guides. We hope that we will see everybody again next year for what will be our 10th Monopoly Run. We have lots of exciting additions to the Run for next year so watch this space.


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Recent advances in the imaging assessment of infiltrative cardiomyopathies
- Correspondence to Professor Joseph B Selvanayagam, Department of Medicine, Flinders University, Flinders Medical Centre, Adelaide 5042, Australia; joseph.selvanayagam{at}flinders.edu.au
Infiltrative cardiomyopathy can result from a wide spectrum of both inherited and acquired conditions with varying systemic manifestations. They usually portend an adverse prognosis, although in rare instances (eg, Fabry disease) early diagnosis can result in potentially curative treatment. Cardiac amyloid remains the archetypal infiltrative cardiomyopathy and is discussed in most detail in this article. Non-invasive imaging—principally echocardiogram and cardiovascular MRI—plays a pivotal role in the early diagnosis and follow-up of all types of infiltrative cardiomyopathy. This article focuses on the use of these modalities in infiltrative cardiomyopathy, with special emphasis on the most recent advances in imaging assessment.
Amyloidosis is a clinical disorder caused by extracellular deposition of insoluble abnormal fibrils, derived from aggregation of misfolded, normally soluble, protein.1 ,2 About 20 different unrelated proteins are known to form amyloid fibrils in vivo, which share a pathognomonic ultrastructure. Systemic amyloidosis, in which amyloid deposits are present in the viscera, blood vessel walls and connective tissues, is usually fatal and is the cause of about 1/1000 deaths in developed countries. There are also various localised forms of amyloidosis in which the deposits are confined to specific foci or to a particular organ or tissue. 'Cardiac amyloidosis' describes involvement of the heart by amyloid deposition, whether as part of systemic amyloidosis (as is most commonly the case) or as a localised phenomenon.
Amyloid subtype classification
Systemic AA amyloidosis, formerly known as secondary amyloidosis, rarely involves the heart (table 1). Systemic AL amyloidosis, previously known as primary amyloidosis, is the most commonly diagnosed form of clinical amyloid disease in developed countries. AL fibrils are derived from monoclonal immunoglobulin light chains and consist of the whole or part of the variable (VL) domain. The heart is affected pathologically in up to 90% of AL patients, in 50% of whom diastolic heart failure with physical signs of right heart failure is a presenting feature. Conversely, <5% of patients with AL amyloidosis involving the heart have clinically isolated cardiac disease. Death in more than half of these patients is due to either heart failure or arrhythmia.
Rapezzi et al conducted a longitudinal study on 233 patients with cardiac amyloidosis in two large tertiary Italian centres.3 They found significant differences in pathophysiology and courses in the three types of amyloidosis that affect the heart. AL cardiomyopathy seems to be associated with only slightly increased wall thickness, but shows the highest frequency of haemodynamic derangement and low QRS voltage on ECG, and its clinical course is aggressive. The transthyretin (TTR) related cardiomyopathies, especially senile systemic amyloidosis (SSA), are associated with notably increased left ventricular (LV) wall thickness but less frequently with haemodynamic alterations. Their clinical course is less aggressive than in the AL type patients, despite the patients' average higher age and greater morphological abnormalities. It has been postulated that the circulating free light chains in AL amyloid have direct toxic effects on the myocardium and the TTR related amyloid is predominantly an infiltrative cardiomyopathy.w1
Echocardiography can show several features that are suggestive of cardiac amyloidosis, although the classical features are commonly only present in the later stages of disease, and there is a wide spectrum of echocardiographic findings. It cannot confirm diagnosis in isolation and the images should be interpreted in the context of the clinical picture and other investigations. AA amyloid very rarely affects the heart, and the common types that do—that is, AL and variant/wild-type TTR types—cannot be distinguished by echo. Although extremely rare, hereditary apolipoprotein A-I amyloidosis can involve the heart, again producing similar echocardiographic abnormalities.
The most common echocardiographic feature is increased thickness of the LV wall, particularly in the absence of hypertension (figure 1A), referred to incorrectly as 'hypertrophy' as the pathological process is infiltration, not myocyte hypertrophy. This feature has poor specificity for amyloidosis due to its occurrence in other conditions (eg, hypertensive heart disease, hypertrophic cardiomyopathy and other infiltrative cardiac diseases such as glycogen storage diseases, sarcoidosis and haemochromatosis) (figure 2). The combination of increased LV mass in the absence of high ECG voltages may be more specific for infiltrative diseases, of which amyloid is the most common. High sensitivity (72–79%) and specificity (91–100%) have been reported for this combination,w2 though some study sizes are small and may be influenced by referral bias.
Increased echogenicity of the myocardium, particularly with a granular or 'sparkling' appearance, has been reported in several studies4 (figure 1A). This can occur in other causes of LV hypertrophy (LVH) and, although high specificity rates are quoted (71–81%),w2 the populations studied were those referred with suspected amyloid, and this specificity may not be reflective of 'real life' practice. Moreover, sensitivity tends to be low, with this pattern seen in 26–36% of cardiac amyloid (CA) cases, apart from a single study suggesting a sensitivity of 87%. It should be noted that this granular pattern only applies to standard echocardiographic imaging, without tissue harmonics being applied, as this increases myocardial echogenicity in general. Newer echocardiographic image processing techniques may also reduce the granular appearance. Thus, although increased echogenicity is common in amyloid, its usefulness as a discriminating factor is limited.
LV systolic function is usually normal until the late stages of the disease process. Systolic function can in some cases be hyperdynamic (hence can be mistaken for hypertrophic or hypertensive cardiomyopathy) in initial stages, but in advanced stages systolic function can be depressed without cavity dilation, resulting in a pronounced reduction in stroke volume and cardiac output.
Diastolic dysfunction, however, is the fundamental abnormality in cardiac amyloidosis and is abnormal before systolic dysfunction, which is often normal even with advanced symptoms. Early in the disease process, there may be an abnormal relaxation pattern with progression to a restrictive pattern in advanced and symptomatic disease (figure 3). Not only do diastolic parameters correlate with severity of symptoms but they are prognostic with a restrictive filling pattern (deceleration time (DT)<150 ms) associated with a mortality of 50% at 1 year. Atrial enlargement is a common finding in amyloid heart disease and reflects the abnormal diastolic function (figure 1B).
Tissue Doppler imaging measures regional myocardial motion and velocity and can detect changes in systolic and diastolic function before more conventional measurements of cardiac dysfunction. However, tissue Doppler velocity imaging suffers from the confounding effects of tethering and translation and hence newer techniques which assess regional longitudinal myocardial deformation, such as strain and strain rate, may be more sensitive. These tissue myocardial changes may be present before increased LV wall thickness and symptoms, and hence may have a role in preclinical detection. In a study of 97 biopsy proven AL amyloid patients, Koyama and colleagues demonstrated that, in contrast to standard echocardiography, strain and strain rate imaging were more sensitive in the detection of a subtle impairment in longitudinal contraction early in the clinical course of cardiac amyloidosis.5 The same authors have subsequently shown that systolic basal strain is a predictor of clinical outcome in patients with AL amyloidosis, more so in the presence of heart failure.6
With two dimensional (2D) speckle tracking echocardiography it is possible to assess the LV torsional deformation around its longitudinal axis which is described as twisting (torsion) and untwisting. Twisting/untwisting motion involves both systolic and diastolic function and therefore would be altered in thickened ventricle as in cardiac amyloidosis. This was assessed in a study by Porciani and colleagues in 45 patients with AL amyloid and 26 control subjects.7 The AL patients were subgrouped into CA if LV wall thickness was ≥12 mm and non-CA (NCA) if LV thickness was ≤12 mm. Both AL patients and controls had standard echocardiograms, and 2D speckle tracking, LV rotation in basal and apical planes, twisting, twisting rate and longitudinal strain were measured. The LV twist and untwisting rate was increased in the NCA group compared to the CA and the control groups. The increase is a compensatory mechanism to impaired relaxation seen early in the disease and fails as the disease progresses. Similar findings were noted by the same group in patients with hypertension without any LVH.8
Therefore, newer 2D echocardiography techniques of strain, strain rate and 2D speckle tracking imaging are promising in the preclinical detection of cardiac amyloidosis.
Other echocardiographic features are the result of diffuse infiltration with resultant increased wall thickness of the right ventricle, cardiac valves and interatrial septum. Although cardiac valves may be focally or diffusely thickened, significant dysfunction is not common. Interatrial septal thickening along with speckling is a distinctive sign of amyloid with high specificity. The atria are enlarged and often immobile, giving an 'owl's eyes' appearance. Abnormal atrial function can be demonstrable using strain echocardiography and may be contributory to cardiac symptoms in primary amyloidosis. Right ventricular (RV) abnormalities are common and may manifest as systolic or more commonly diastolic dysfunction. RV dilatation, if present, may reflect a more advanced disease process and is associated with a more adverse prognosis. Small to moderate sized pericardial effusion due to pericardial involvement is also common, particularly in end stage disease (figure 1B). A high frequency of intracardiac thrombosis has been noted in patients with cardiac amyloidosis, especially those with the AL type, despite the presence of sinus rhythm and preserved LV ejection fraction.9
Despite the number of echocardiographic features found in amyloid heart disease, none, taken individually, are diagnostic and they can be seen in other cardiac diseases. The diagnosis is still based on the combination of various echocardiographic findings with the integration of clinical findings and (where available) further imaging with cardiovascular magnetic resonance (CMR) (see below). However, pronounced myocardial hypertrophy along with valvular thickening, abnormality of diastolic function (particularly restrictive physiology), and the presence of pericardial effusion in combination with characteristic ECG findings makes amyloid disease an important diagnostic consideration.
CMR imaging
A strength of CMR using the late gadolinium enhancement (LGE) technique is the ability to 'phenotype' various forms of cardiomyopathy with high spatial resolution and reproducibility. Maceira et al studied 29 patients with systemic amyloidosis and 16 hypertensive controls using gadolinium enhanced CMR.10 Amyloidosis was associated with qualitative global and subendocardial gadolinium enhancement of the myocardium (figure 4B). Subendocardial longitudinal relaxation time (T1) in amyloid patients was shorter than in controls, and was correlated with markers of increased myocardial amyloid load, such as LV mass, wall thickness, interatrial septal thickness, and diastolic function. Global subendocardial LGE was found in approximately two thirds of patients. Based on pathological correlates in a patient from this study, the CMR hyper-enhancement probably represents interstitial expansion from amyloid infiltration.
Perugini et al studied an Italian population of patients with histologically proven systemic amyloidosis and echocardiographic diagnosis of cardiac involvement.11 Gadolinium enhancement by CMR was detected in 16 of 21 (76%) patients. In contrast to the study of Maciera et al, where the pattern of late enhancement was global and subendocardial, Perugini et al reported a much more variable pattern of late enhancement, that could be localised or diffuse, and subendocardial or transmural. Transmural extension of hyperenhancement (ie, how much of the LV wall thickness was enhanced) within each patient significantly correlated with LV end systolic volume. The number of enhanced segments correlated with LV end diastolic volume, end systolic volume, and left atrial size. An especially unique feature of LGE appearances in this population is the blood pool appearing atypically dark. This reflects the similar myocardial and blood T1 values due to high myocardial uptake and fast blood pool washout of the contrast agent.
Syed et al performed LGE CMR in 120 patients referred to a tertiary centre with confirmed amyloidosis; 97% of the histologically confirmed cardiac amyloidosis (35/120) had abnormal LGE and 91% had increased LV wall thickness on echocardiography.12 The pattern of LGE was global (transmural and subendocardial) in 83%. Of the patients without cardiac histology and a normal echocardiogram, 30% had LGE (patchy focal or global), and the LGE presence was strongly associated with clinical, morphological, functional, and biochemical markers of prognosis. The absence of endomyocardial biopsy data in patients with a normal echocardiogram, however, is a weakness of the study and leaves the findings in this study subset as speculative rather than confirmatory.
Although yet to be proven, imaging with a highly reproducible and quantifiable technique such as CMR may help to estimate the prevalence of cardiac involvement in systemic amyloidosis when cardiac morphological changes are not apparent by echocardiography. Screening of subclinical early cardiac involvement may become possible if delayed enhancement proves to have adequate sensitivity in detecting early amyloid infiltration. Improved non-invasive surveillance may also potentially aid in the evaluation of new chemotherapeutic agents. Figures 4A and B illustrates the typical CMR features of amyloid heart disease.
Gadolinium kinetics on CMR could be a potential prognostic marker in cardiac amyloidosis. Maceira et al prospectively followed the 29 patients from their earlier study for a period of 2 years.13 All patients underwent biopsy, 2D echocardiography and Doppler studies, 123I-serum amyloid P (SAP) scintigraphy, serum N terminal pro B-type natriuretic peptide (NT-proBNP) assay, and CMR with T1 mapping method and LGE. Their results show that the 2 min post-gadolinium intramyocardial T1 difference between the subepicardium and subendocardium predicted mortality with 85% accuracy at a threshold value of 23 ms. The intramyocardial T1 gradient as measured post-gadolinium imaging is a reflection of the burden of amyloid deposition in the myocardium. Lower T1 indicates increased subepicardial involvement. The intramyocardial T1 gradient was a better predictor of survival than free light chain response to chemotherapy or diastolic function.
Radiolabelled SAP component scintigraphy
SAP is a highly conserved, invariant plasma glycoprotein of the pentraxin family that becomes specifically and highly concentrated in amyloid deposits of all types as a result of its calcium dependent binding to all types of amyloid fibril. Following intravenous injection, radiolabelled SAP distributes between the circulating and the amyloid bound SAP pools in proportion to their size and can then be imaged and quantified.w3 This safe, non-invasive method provides unique information on the diagnosis, distribution and extent of amyloid deposits throughout the body, and serial scans monitor progress and response to therapy. Serial SAP scans have unequivocally demonstrated that amyloid deposits of all types regress in a proportion of patients when the supply of the respective amyloid fibril precursor protein is sufficiently reduced. Unfortunately, planar SAP scintigraphy is unable to image amyloid in the moving heart.
Sarcoidosis is a systemic disorder of unknown aetiology involving granulomatous infiltration of various organs, including the heart. The pathophysiology is thought to be related to an excessive cell mediated immune response to an unknown antigen with accumulation of mononuclear inflammatory cells, mostly CD4+ lymphocytes.w4 The resultant inflammatory response produces tissue injury and fibrosis which may be focal or diffuse.
There is a striking variance in prevalence, with the disease more common in blacks and Scandinavians.w5 Cardiac involvement occurs in up to 30–40% of cases in postmortem studies14 and is associated with poorer prognosis, particularly if patients exhibit cardiac symptoms. Clinically, cardiac involvement occurs in 5% of patients and its presentation may include rhythm disturbance (particularly heart block), cardiac failure, cor pulmonale, and even sudden death.w6 However, diagnosis of cardiac involvement is difficult due to the numerous different manifestations of the disease process and the lack of sensitivity or specificity of various cardiac imaging tests. The Japanese Ministry of Health and Welfare guidelines (JMHW) for diagnosis of cardiac sarcoid, which incorporates the use of ECG, cardiac imaging and histopathology, is the most well known and is currently the reference standard.15 Mehta et al found that including advanced cardiac imaging with positron emission tomography (PET) scanning or CMR increased sensitivity above the previously established criteria.16
Sarcoid involvement of the heart is a great masquerader and may present with a variety of echocardiographic abnormalities, including wall motion abnormalities (particularly regional thinning and aneurysms),w7 systolic and diastolic dysfunction, pulmonary hypertension, and pericardial effusions. Case reports have sarcoidosis mimicking coronary artery disease, takotsubo cardiomyopathy, right ventricular cardiomyopathy,w8 hypertrophic cardiomyopathy, and valvular dysfunction. However, in most cases of systemic sarcoidosis there are no distinctive morphological or functional abnormalities of the heart. Tissue Doppler17 and ultrasonic tissue characterisation by myocardial integrated backscatter have demonstrated abnormalities in the absence of other 2D echocardiographic features, and hence may have the ability to diagnose early cardiac involvement.
Nuclear imaging
Thallium-201 scintigraphy in sarcoidosis can be distinctive with a pattern of reverse redistribution in which a resting perfusion defect improves with stress imaging. This can be helpful in differentiating sarcoid heart disease from an ischaemic cause. However, these findings are non-specific, particularly in the absence of cardiac symptoms, and hence are of limited value as a screening test. Gallium-67 scintigraphy has also been used to diagnose cardiac sarcoid as it accumulates in the presence of active inflammation. Hence the absence of uptake may not exclude sarcoid involvement but suggests lack of active disease and has been shown to predict response to corticosteroid therapy.18
(18)F-fluoro-2-deoxyglucose PET (FDG PET) has high diagnostic accuracy in the assessment of cardiac sarcoidosis. A retrospective study by Langah et al, using FDG PET in 30 patients with systemic sarcoidosis and suspected cardiac sarcoidosis, showed a specificity of 90% and sensitivity of 85%.19 The sensitivity and specificity of diagnostic accuracy of FDG-PET against the JMHW in 164 patients in a recent meta-analysis was 89% and 78%, respectively.20 Restricted availability of this modality is a limitation in its wider uptake in the routine assessment of infiltrative cardiomyopathy.
CMR imaging
The superior spatial resolution of CMR is particularly useful in identifying even small areas of myocardial oedema and fibrosis leading to post-inflammatory scarring that is typically seen in cardiac sarcoidosis. Both global and regional contractile dysfunction has been described, although, similar to cardiac amyloidosis, the LGE technique has been most widely evaluated in clinical studies using CMR. Smedma and colleagues evaluated the utility of LGE in 58 patients with biopsy proven pulmonary sarcoidosis, 25% of whom also had symptoms suggestive of cardiac involvement.21 All patients underwent clinical assessment, 12 lead ECG, ambulatory ECG monitoring, transthoracic echocardiography, 201thallium single photon emission CT (SPECT), and CMR (cine and LGE). The modified JMHW criteria were used as the gold standard. CMR revealed LGE, mostly involving the epicardium of the basal and lateral segments, in 73% of patients diagnosed with cardiac involvement by the Japanese criteria (figure 5). In about half of these patients scintigraphy was normal, while patchy LGE was present, underlining the differences in spatial resolution. This study is limited in that only a minority of patients had correlation between LGE-CMR results and endomyocardial biopsy. Other studies have confirmed the predilection of LGE for the basal–lateral segments, although subendocardial or transmural hyperenhancement has been also observed, mimicking the ischaemic pattern.
More recently, Patel and colleagues prospectively studied 81 patients with biopsy proven extracardiac sarcoidosis for a parallel and masked comparison of cardiac involvement between LGE CMR and standard clinical evaluation, with the use of consensus criteria based on JMHW guidelines.22 Obstructive coronary disease was excluded by x-ray angiography in the LGE CMR positive patients. They found that LGE CMR identified myocardial abnormalities in significantly more patients than a standard clinical evaluation based on JMHW guidelines (26% vs 12%). LGE CMR positive patients had a higher rate of adverse events, including cardiac death, during a 21 month follow-up, compared to LGE CMR negative patients. Myocardial damage detected by LGE CMR appears to be associated with future adverse events including cardiac death, but there were few events in this small cohort and therefore a large scale study is required.
Apart from LGE, both functional and anatomical ('white blood' and 'black blood') CMR sequences can help in detecting cardiac sarcoid by demonstrating some of its characteristic features—septal thinning, LV/RV dilatation and systolic dysfunction, and pericardial effusion.w9 w10 T2 weighted sequences may also help in identifying myocardial oedema.23 CMR also identifies pulmonary features of sarcoid, such as enlarged hilar lymph nodes and lung fibrosis.
Anderson-Fabry disease
Fabry disease is an X-linked condition with systemic and cardiac manifestations. It is an enzyme deficiency of ∝-galactosidase,w11 which results in accumulation of glycosphingoplipids in the lysosomes of various cells and organs including the heart. Cardiac involvement is frequent24 and results in myocyte vacuolation, hypertrophy, and regional fibrosis.25 ,26 This can result in heart failure and conduction abnormalities and is an important cause of death in these patients.w12 Currently, the diagnosis is based on one or more of biochemical testing, genetic mapping and endomyocardial biopsy. However, imaging of the myocardium has been explored as a non-invasive way of early screening and diagnosing patients. Correct diagnosis is of vital importance as, unlike many other forms of infiltrative cardiomyopathy, the condition is potentially reversible with treatment by enzyme replacement therapy.27 Fabry cardiomyopathy is not as rare as initially thought and can be difficult to distinguish from other forms of infiltrative or hypertrophic cardiomyopathies. A recent study discovered that 6% of male patients diagnosed with hypertrophic cardiomyopathy in fact have Fabry disease on biochemical and genetic testing.w13 Another study found that Fabry disease was present in 10% of patients referred to their cardiac unit with unexplained hypertrophy.w14
The principal echocardiographic finding is concentric LVH with often initially preserved systolic function and without cavity dilatation. The main functional abnormality, like in other infiltrative cardiomyopathies, is abnormal diastology, though restrictive physiology is also possible, but not as common. Cardiac valves may be thickened, but severe valve dysfunction is rare. There is also increased incidence of aortic root dilatation.w15
Recent studies using tissue Doppler imaging have shown a reduction in both relaxation and contraction tissue Doppler velocities in patients. These findings are detectable before the onset of LVH and other morphological changes.28 Strain and strain rate imaging reflect regional myocardial function and contractility, respectively. They are also reduced early in the disease process and can be reversed with treatment.27 Strain imaging has the advantage over tissue Doppler velocity in that it can detect regional heterogeneity in myocardial function, which is characteristic of Fabry disease with strain abnormalities being most pronounced in the inferolateral wall.w16 Interestingly, this is also the area where LGE CMR abnormalities are most pronounced.
More recently, Pieroni et al29 have described the so-called binary sign, which is an abnormal appearance of the LV endocardial border thought to be related to glycosphingolipid compartmentalisation. They found this to be both a specific and sensitive marker for Fabry disease. However, other authors have disputed this finding and suggested this binary appearance is non-specific and affected by instrumental settings.w17
As with other infiltrative and storage cardiomyopathies, the progression and spectrum of disease are not static. In the initial stages, standard morphological and functional changes may not be apparent and hence these newer tissue imaging techniques could provide earlier diagnosis with prompt consideration for enzyme replacement. Regardless, the higher than expected incidence of Fabry disease should alert the imaging clinician to this diagnosis in anyone with unexplained LVH.
CMR imaging
Systematic reporting of CMR features in this disease is sparse. Moon et al have reported LGE patterns in a unique distribution involving the basal inferolateral wall, sparing the endocardium, in 50% of affected patients.30 LGE in this respect probably represents interstitial expansion secondary to replacement fibrosis, although why this region of the myocardium is favoured is unclear. The extent of fibrosis on LGE CMR determines the response to enzyme replacement therapy (ERT). Weidemann and colleagues studied 32 Fabry patients over 3 years regarding disease progression and clinical outcome under ERT.31 LGE CMR was used to assess myocardial fibrosis. They found that in patients without myocardial fibrosis, ERT resulted in significant reduction in LV mass, an improvement in myocardial function, and higher exercise capacity. Those with mild or severe fibrosis showed a minor reduction in LVH and no improvement in myocardial function or exercise capacity.
Prolongation of myocardial T2 relaxation time has also been shown in studies of patients with genotype positive Fabry disease, probably related to the pronounced deposition of glycolipid in the myocardium. This has been suggested by some as a useful marker of this disease. However, there is a wide overlap in myocardial T2 values of Fabry disease patients when compared with patients with LVH from other causes, such that T2 times alone are unlikely to be useful in confirming the diagnosis.32
Cardiac siderosis
CMR myocardial T2* assessment has proven to be an important diagnostic tool and prognostic indicator in cardiomyopathy secondary to iron overload.33 Non-invasive determination of the cardiac iron load is possible using CMR by measuring myocardial relaxation time T2*. T2* is a measure of magnetic relaxation and is shortened when particulate hemosiderin storage iron disturbs the magnetic microenvironment. Myocardial T2* correlates well with cardiac iron concentration measured from biopsy specimens in contrast to liver iron concentration and serum ferritin. This direct assessment allows early detection of patients at risk of cardiomyopathy secondary to iron overload, directs chelation therapy effectively, and prevents deaths from a potentially reversible cardiomyopathy. Declining myocardial T2* is associated with increasing risk of LV dysfunction34 ,35 and increased likelihood of cardiac events in transfusion dependent thalassaemia.36 Significantly, Modell et al observed a 60% reduction in mortality in thalassaemia major patients after the introduction CMR T2* guided chelation therapy.37 This is one of the few examples where systemic use of non-invasive imaging modality has led to an improvement in patient outcome.
Alpendurada and colleagues have demonstrated that the RV function mirrors the decrease in LV function with worsening myocardial iron overload.w18
Hereditary haemochromatosis (HH) can also be considered an infiltrative cardiomyopathy, as it is a deposition disease in which iron is deposited intracellularly, causing cell damage with associated cardiac dysfunction. Cardiac siderosis in HH is uncommon. In a retrospective analysis of patients presenting for evaluation of myocardial iron overload on CMR, Grasso et al found cardiac siderosis in six (11%) out of 53 patients with HH.w19 Echocardiography demonstrates features of dilated cardiomyopathy, including LV dilatation and global systolic dysfunction in an advanced stage of cardiac involvement. Cardiac involvement is progressive and in the later stages can manifest restrictive physiology that clinically can mimic constrictive disease. As in secondary causes of cardiac siderosis, CMR T2* imaging plays a vital role in the early detection of myocardial iron overload, consequently eliminating the need for endomyocardial biopsy in the assessment of iron deposition in HH.
Other infiltrative cardiomyopathies
In glycogen storage diseases (GSD), deficiencies in enzymes responsible for metabolising muscle glycogen not only cause systemic diseases, but can involve the myocardium. Many types have been described, most of which can involve the heart, although in a number of cases (eg, GSD type 2a, Pompe disease) the disease is invariably fatal in early infancy, and is unlikely to be encountered by the adult cardiologist. Danon disease (GSD type 2b), characterised by an X-linked dominant inheritance pattern, can present in childhood and early adulthood. Among males, the key features are cardiomyopathy, skeletal myopathy, and intellectual disability ranging from mild learning problems to mental retardation. In a recent seminal study, Arad et al showed that cardiac disease can be the initial and predominant manifestation of defects in human glycogen metabolism.w20 It was found that specific glycogen metabolism mutations, LAMP2 and PRKAG2, cause multisystem glycogen storage disease and can also present as primary cardiomyopathy, mimicking hypertrophic or infiltrative cardiomyopathy.
The evaluation and management of patients with infiltrative cardiomyopathy remains clinically challenging (table 2). Cardiac involvement in amyloidosis and sarcoidosis is associated with a more adverse prognosis and hence early identification is warranted. Echocardiography, though able to detect gross morphological and functional abnormalities, lacks specificity and sufficient sensitivity. Newer methods using tissue imaging may prove to have a role in the future by their ability to define focal abnormalities and detect subclinical disease. Nuclear imaging is helpful in differentiating sarcoid from other cardiac diseases when symptoms are present, as well as predicting response to treatment. More recently, cardiac MRI has shown promise for all types of infiltrative cardiomyopathy (figure 6), in not only identifying typical morphological and functional changes, but also in assessing disease activity. However, no imaging technique stands alone, and even the 'gold standard' of endomyocardial biopsy may often not be conclusive, given the focal nature of cardiac infiltration in some cases. The integration of clinical assessment, tissue biopsy and cardiac imaging will still need to form the basis of any future diagnostic framework.
Advances in imaging assessment of infiltrative cardiomyopathies: key points
Infiltrative cardiomyopathy usually portends an adverse prognosis, although in rare instances (eg, Fabry disease) early diagnosis can result in potentially curative treatment.
Echocardiography and CMR are important non-invasive imaging techniques in the assessment of infiltrative cardiomyopathy.
Late gadolinium CMR imaging can distinguish the various types of cardiomyopathies, with excellent spatial resolution and reproducibility.
Sarcoidosis of the heart mimics most other common cardiac diseases.
Cardiac iron overload can be determined by myocardial relaxation time (T2*) on CMR and is a prognostic marker in thalassaemia major.
Diagnosis of infiltrative cardiomyopathy requires integration of clinical assessment, multimodality cardiac imaging and endomyocardial biopsy.
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Provenance and peer review Commissioned; internally peer reviewed.
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- ↵A large review analysing the diagnostic and clinical profiles of the different types of cardiac amyloid.
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- ↵A recent review on the role of LGE in the assessment of severity and the prognosis in cardiac amyloid.
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- ↵A recent study demonstrating the role of LGE CMR in identifying cardiac amyloid and its association between clinical, morphological, functional, and biochemical features.
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- ↵Landmark retrospective study looking at the incidence of antemortem clinical manifestations and postmortem evidence of myocardial lesions in necropsy of patients with cardiac sarcoidosis.
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- ↵This is the first study to show that advanced cardiac imaging with PET scanning or CMR is more sensitive than established Japanese criteria for identification of cardiac sarcoidosis.
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- ↵This is the first prospective study evaluating the utility of delayed enhancement CMR imaging in asymptomatic patients with biopsy proven extracardiac sarcoidosis. The study showed increased adverse cardiac events including sudden cardiac death when there was myocardial involvement.
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- ↵This study demonstrated that enzyme replacement therapy in Fabry disease can decrease LVH and improve regional myocardial function.
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- ↵This study showed the long term benefits of early detection and treatment in Fabry's disease. This is one of the few examples where non-invasive cardiac imaging has a positive impact on long term outcomes.
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- ↵First study to validate the role of T2* CMR in non-invasive assessment of myocardial iron overload.
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- ↵A large study that demonstrated T2* CMR can predict heart failure and arrhythmia in thalassaemia major.


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Smith & Loveless Inc.
based in Lenexa, KANSAS (USA)
For more than 65 years, Smith & Loveless has delivered engineering ingenuity and quality craftsmanship to the water industry by pioneering superior pre-engineered pumping, treatment and headworks systems. Our factory-built concepts pave the way for thousands of municipalities, developments and industry to reap the benefits of complete, single-source solutions and peerless ...
Canamidex International Corp.
based in Richmond Hill, ONTARIO (CANADA)
Canamidex International Corp. was founded in 2007, as a result of our thirty plus years of Engineering and Management experience and expertise in the water and wastewater treatment, transfer industries and industries utilities within North America, Middle East and North Africa (MENA) regions. We started in response to demand within our networks, for advice and guidance ...
The McIlvaine Company
based in Nothfield, ILLINOIS (USA)
We are a market research company with more engineers and scientists than MBA`s, a publishing company which doesn`t accept advertising, a consulting company which doesn`t provide conventional services. But in one sentence: we are a knowledge bridge between supplier and end user. Each of our specialists concentrates on a niche and then uses this knowledge to assist ...
Intereco S.n.c.
based in Candiolo (TO), ITALY
INTERECO was founded in 1978 in Italy (just outside of Turin) by Dott. Ing. Fulvio Boaglio. In the first years of operation INTERECO concentrated on heating and air conditioning for civil and industrial plants, and one some very sophisticated operations for filtering and recovering air in industrial buildings.As the company has progressed, the manufacture of wastewater ...
SRS Crisafulli, Inc.
based in Glendive, MONTANA (USA)
SRS Crisafulli manufactures, sells and services versatile high capacity pumps, dredges, power units, accessories, and spare parts. Crisafulli Products are manufactured in both custom and standard configurations. Dredges, Dredging Services, Flotation Equipment, Irrigation Systems, Lagoon Equipment, Pumps/Centrifugal, Pumps/Lift Station, Pumps/Sludge, Pumps/Submersible, ...
Genesis Water Technologies, Inc
based in Maitland, FLORIDA (USA)
Genesis Water Technologies, Inc. is a USA based manufacturer of advanced, innovative and sustainable treatment solutions for applications in process water, drinking water, water reuse and waste water to our valued clients and collaboration partners worldwide.
Hach Company - a subsidiary of Danaher Corporation
based in Loveland, COLORADO (USA)
Hach Company provides advanced analytical systems and technical support for water quality testing, with solutions for lab, process, and field. Hach Company manufactures and distributes analytical instruments and reagents used to test the quality of water and other aqueous solutions. Our systems are designed to simplify analysis, and include: complete, easy-to-follow ...
Superior Tank Co., Inc.
based in Rancho Cucamonga, CALIFORNIA (USA)
Superior Tank Co., Inc. has been manufacturing and installing a complete line of bolted steel storage tanks for the potable water, wastewater, fire protection, and crude oil industries since 1984. Being an innovator in the steel tank industry, Superior Tank introduced Powder Coating to Bolted Steel Tanks in the early 1990's. Quality products and outstanding customer ...
Voltrex UV LTD.
based in West Vancouver, BRITISH COLUMBIA (CANADA)
Voltrex UV Ltd is a manufacturer and supplier of potable water, wastewater and saltwater disinfection systems, using the medium of ultraviolet light to provide safe reliable disinfection equipment for the Municipal, Industrial, Commercial and Aquaculture industries throughout the world. Our "Ultraviolet Disinfection Systems" provide safe reliable effective non-chemical ...
World Water Works, Inc.
based in Oklahoma City, OKLAHOMA (USA)
World Water Works is a manufacturer of specialized advanced water treatment solutions focused on performance, flexibility and longevity designed to yield clean water, recover energy and resource recovery. World Water Works` innovative products are transforming wastewater treatment to water reuse and resource recovery facilities. World Water Works has successfully ...
Encotech, Inc. / Carbon Service and Equipment Company a Division of Encotech, Inc.
based in Eighty Four, PENNSYLVANIA (USA)
Encotech is a leading provider of environmental products, systems, and services. With over 35 years of experience, we offer the best products and support to our customers. With offices in PA, FL, SC and LA, we currently service sites from Maine to Florida and throughout the Central US. We are also involved in project work throughout the world. We design and ...
based in Indianola, IOWA (USA)
Alka Tech is an industry leader in providing alkaline stabilization systems for the treatment of wastewater biosolids. Alka Tech`s systems receive, store, deliver, proportion and mix alkaline and mineral materials with organic byproducts to manufacture Class A or Class B biosolids. With processing rates from 1-80 tons per hour, our systems can meet the needs of any size ...
BIO-SYSTEMS International
based in Beloit, WISCONSIN (USA)
BIO-SYSTEMS International is an ISO certified manufacturing company producing various strains of bacteria for use in the hydrocarbon (grease, fats) treatment industry. Our products are used in tertiary treatments, municipalities, septic systems, grease traps, and drain cleaners.
Related Terms for wastewater treatment
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text:
SynProcProject reference: 203427
Funded under :
Synchronous Linguistic and Visual Processing
Project details
Total cost:EUR 1 126 000
EU contribution:EUR 1 126 000
Coordinated in:United Kingdom
Call for proposal:ERC-2007-StGSee other projects for this call
Funding scheme:ERC-SG - ERC Starting Grant
When humans process language, they rarely do so in isolation. Linguistic input often occurs synchronously with visual input, e.g., in everyday activities such as attending a lecture or following directions on a map. The visual context constrains the interpretation of the linguistic input, and vice versa, making processing more efficient and less ambiguous. Given the ubiquity of synchronous linguistic and visual processing, it is surprising that there is only a sparse experimental literature that deals with this topic, while virtually no computational models exist that capture the synchronous interpretation process. We propose an experimental research program that will investigate key features of synchronous processing by tracking participants' eye movements when they view a naturalistic scene and listen to a speech stimulus at the same time. The aim is to understand synchronous processing better by studying the interaction of saliency and ambiguity, and the role of incrementality, object context, and task factors. These experimental results will feed into a series of computational models that predict the eye-movement patterns that humans exhibit when they view a scene and listen to speech at the same time. The key modeling idea is to treat synchronous processing as an alignment problem, for which a rich literature exists in computational linguistics. Building on this literature, we will develop models that incrementally construct aligned linguistic and visual representations, and that can be evaluated against eye-tracking data.
Related information
Principal Investigator
Tel.: +44-131-650-4407
Fax: +44-131-650-4587
Host Institution
United Kingdom
Tel.: +44 131 650 9024
Fax: +44 131 650 9023
United Kingdom
Tel.: +44 131 650 9024
Fax: +44 131 650 9023


text:
Jon 'maddog' Hall writes about the community
Finally, this is your column, too. If you have something you would like me to discuss, send me email at email@example.com and I will try to address your request. Also, you can read my Linux Magazine blog at: http://www.linux-magazine.com/pawprints. If you see me at a conference or event, feel free to talk to me – although I bark a lot, I hardly ever bite.
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- Jornadas Regionales de Software Libre 2008: http://jornadas.cafelug.org.ar/8/es/home.php
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Nextcloud Announces Raspberry Pi-Powered Home Cloud Box
Innovative system adds a hard drive and Ubuntu Core to the RPi for an IoT hub.
Linus Torvalds Confirms the Date of the First Linux Release
Linux is two weeks younger than we thought!
End of OpenOffice?
The Apache Software Foundation considers retiring OpenOffice
Adobe Gives New Life to NPAPI Plugin for Linux
Adobe won't kill the plugin in 2017
LinuxCon North America Convenes in Toronto, Canada
Linux Foundation's big event celebrates the 25th anniversary of Linux
Linux Turns 25
Linux has evolved from "won't be a professional" project to one of the most professional software projects in the history of computers.
Mirantis Joins Hands with SUSE To Offer RHEL Support; Red Hat Not Happy
Competitors get in the game with RHEL without Red Hat
Linux on Windows 10 Poses a Security Risk
Security researchers have already notified Microsoft; some fixes are available
Mirantis to Refactor OpenStack Fuel for Kubernetes
The company is collaborating with Google and Intel to use Kubernetes as an engine for Fuel
Canonical Joins Document Foundation Advisory Board
The upcoming release of LibreOffice will be available as a snap package


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The Alcohol and Tobacco Tax and Trade Bureau Permitting Process
Employment Law This Week®: Non-Solicitation Violation, SOX 304 Clawback, NLRB's Joint-Employer Standard, OSHA's "Walk Around" Rule
Compliance into the Weeds-Episode 14-Wells Fargo and the Fraud Triangle
The Science of PTAB Pharma Litigation
Navigating Patent Litigation at the PTAB
Tax Considerations for BDC Consolidation Transactions
How Can We Develop Anti-Bribery Ambassadors?
Meritas Capability Webinar - Corporate Governance Essentials
Government Investigations - How to Respond to a Search Warrant: 10 Practical Steps
Ten Hallmarks of an Effective Compliance Program-Hallmark 7
This Week in FCPA-Epiode 19, the International Edition
Five Things a Business Owner Must Do Before Selling a Company
Ten Hallmarks of an Effective Compliance Program-Hallmark 2
Ten Hallmarks of an Effective Compliance Program-Hallmark 1
Can Emerging Markets Counter the Corrupt Narrative?
Compliance into the Weeds-Episode 12-risk in a decentralized business model
This Week in FCPA-Episode 17
Richard Hsu Interviews Mike Hintze, Chief Privacy Counsel, Microsoft
Richard Hsu Interviews Jack Yang, Chief Privacy Officer at Visa
The Internal Revenue Service (the "IRS") has announced plans to update Revenue Ruling 67-390, which requires an organization to "re-apply" for tax-exemption if it changes its corporate structure, including in situations...more
For just the second time in the Foreign Corrupt Practices Act's (FCPA) history, a company was charged with FCPA offenses based solely on a charitable contribution that was intended to buy the influence of a foreign...more
The Non-Profit Organizations/Public Charities Division of the Office of the Attorney General (the "Division") recently released helpful guidance regarding (i) good governance of charitable organization and (ii) the rules that...more
Section 501(c)(4) of the Internal Revenue Code ("IRC") exempts from the federal income tax certain nonprofit corporations that are operated exclusively for the promotion of social welfare (commonly referred to as "Social...more
Tax-exempt and governmental employers do not pay Federal income tax and therefore, unlike for-profit entities, are not affected by the timing of tax deductions relating to the payment of compensation. Tax authorities are...more
As I continue to reflect this week on nine years of blogging, it's hard to recall that I started this before the Great Recession hit. Since that time, all businesses have become more cost-conscious and creative in how they...more
On August 24, 2016, it was widely reported in the business media that Duke University had filed a claim against the estate of Aubrey McLendon, the former CEO of Chesapeake Energy Corp., who died in March 2016. The claim was...more
Those responsible for managing a private foundation's investment assets may not always understand the unique fiduciary and tax constraints imposed on private foundations and their managers by both state and federal law....more
The following developments from the past month offer guidance on corporate law and governance law as they may be applied to nonprofit health care organizations:
In an...more
We've all heard about India's rape crisis, but not everyone knows that it's the result of the larger problem of gender inequality. According to UNICEF, India is the worst place to be born a girl. The birth of a baby girl is...more
The Internal Revenue Service (IRS) recently released General Counsel Memorandum 201634021 ("Memorandum") concluding that the employees of a disregarded single member limited liability company (SMLLC) (1) must be allowed to...more
Nonprofit entities that intend to operate as tax-exempt organizations described in section 501(c)(4) of the Internal Revenue Code (Code) are subject to new reporting requirements with the IRS. Specifically, newly-enacted...more
We're back with the second installment in our series on the IRS's Section 457 proposed rules. The first alert covered Section 457(f) basics and discussed the meaning of "deferred" compensation....more
As I suspected, law firms are churning out memoranda on the SEC's recent enforcement actions involving alleged impediments to whistleblowers. While accurately, summarizing these actions, I'm not sure that some of the authors...more
Many sports figures have created nonprofit organizations to raise funds for a cause close to their hearts. But the reality is that athletes' foundations aren't always successful in raising money for charity.
This article...more
On July 8, 2016, the Internal Revenue Service (IRS) issued Revenue Procedure 2016-41 implementing a provision of the Protecting Americans from Tax Hikes Act of 2015 (the "PATH Act"). The provision, Section 405 of the PATH...more
The Protecting Americans from Tax Hikes Act of 2015, or the PATH Act, made several changes to tax law applicable to section 501(c)(4) organizations operating this election year. In addition, two relatively recent IRS denials...more
Our client, Linchpins of Liberty, is a non-profit organization that, along with roughly 37 other clients, applied for non-profit status under IRC Sections 501(c)(3) or 501(c)(4). Because of their names, the IRS failed to...more
No matter who wins the White House in November, the new president's agenda will include tax reform. But changes to our tax laws need not wait until after inauguration day, as we learned four years ago when the "fiscal cliff"...more
Special rules apply to compensation arrangements of tax-exempt entities. If the arrangement does not comply with the rules, then the amount of compensation subject to the arrangement is taxed to the employee as soon as it is...more
Earlier this month, the US Internal Revenue Service (IRS) released its long-awaited temporary regulatory framework implementing the new statutory notification requirements placed on 501(c)(4) nonprofit organizations by the...more
On June 21, 2016, concurrent with its issuance of proposed regulations under Code section 409A, the IRS also issued proposed regulations under Code section 457, which address deferred compensation arrangements covering...more
In a recent ruling, PLR 201615022, the IRS denied tax exemption to an accountable care organization on the basis that the organization was conferring private benefit on its participating physicians by negotiating shared...more
The Internal Revenue Service recently issued proposed regulations under Section 457 of the Internal Revenue Code (the "Code") that prescribe rules regarding deferred compensation plans sponsored by state and local governments...more
In an open letter to their newborn daughter last December, Facebook CEO Mark Zuckerberg and wife Priscilla Chan announced they will eventually give 99 percent of their Facebook shares during their lives to a variety of...more
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ECU has been rated 5 stars for teaching quality for the 8th year in a row, a record now unmatched by all but a few universities in Australia.Read more
Want to join ECU as a research professor?
Kelly Watson hasn't even graduated yet, but she's already been named the best new professional in the Human Resources industry's annual awards.
Practice is the way we improve our skills. But as Professor Craig Speelman will explain in a free public lecture, it also shapes the way we perceive the world.
ECU researchers involved in the science of cycling at the highest levels are gearing up to share their knowledge with Perth cyclists as part of ECU's Research Week.
Career support, networking, events and more for our global community of graduatesSee more
ECU welcomes philanthropic support from individuals, alumni, businesses and the communitySee more
ECU is committed to developing and engaging with Aboriginal and Torres Strait Islander peoples and communitiesSee more
Realise your ambitions by applying for an ECU scholarshipSee more


text:
38 years of experience
Accepting new patients
Video profile
University of Washington Medical Center
1959 NE Pacific St
Seattle, WA 98195 Phone number & directions
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. John Krieger:
View the full profile to get information on:
- Qualifications
- What's important to you
View full profile
Patient Reviews
The overall average patient rating of Dr. John Krieger is Excellent.
Prepare before visiting Dr. Krieger
Urge Incontinence Patient Education Urinary incontinence patient education guide covers all aspects concerning overactive bladder diagnosis and treatment options.Before Visiting Dr. Krieger Learn More
|More Patient Guides & Topics
Erectile Dysfunction
Implant Contraception
Overactive Bladder
Prostate Cancer
Urinary Incontinence
Specialties & Research
Dr. John Krieger, MD is board certified in Urology.
- He has special expertise in 30 areas:
- AIDS/HIV (Acquired Immunodeficiency Syndrome)
- Bacteriuria
- Chlamydia Infections
- Cystoscopy
- Cytomegalovirus Infections
- Endoscopy (Endoscopic Surgery)
- Enlarged Prostate (Prostatic Hyperplasia)
- Epididymitis
- Erectile Dysfunction (ED)
- Gonorrhea
- Gynecologic disorders
- HIV Infections
- Kidney Cancer
- Kidney Disease
- Kidney Inflammation (Pyelonephritis)
- Kidney Stones (Kidney Calculi)
- Kidney Transplant (Renal Transplant)
- Male Genital Disesases
- Male Urogenital Diseases
- Overactive Urinary Bladder
- > Show all expertise
Education & Awards
Dr. Krieger graduated from Cornell University, New York. He has 5 awards.
Dr. Krieger has 6 hospital affiliations:
- Northwest Hospital & Medical Center
- University Of Washington Medical Ctr
- French
- Spanish
- English
Similar doctors nearby
Dr. Jane Miller
Dr. George Brannen
Dr. George Schade
Dr. Richard Berger
Dr. Paul Lange
Dr. Daniel Avery
- Additional Information
- Dr. John N Krieger MD is a male Urologist, has 38 years of experience and practices in Urology.
- Where does Dr. John N. Krieger practice?
- Dr. John Krieger has 1 office location.
Dr. John Krieger practices Urology near Seattle, WA.
See Seattle Urologists.