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Fri.Apr 06, 2012
Use Buyer-Based Selling To Engage The New SMB Buyer
Tony Zambito
©All Rights Reserve by PhotoSteve 101. This is part 5 and final article of a series on the challenge of targeting SMB markets and how the use of buyer-based modeling and buyer-based marketing help organizations to grow their SMB customer base. Prognosticators today abound on the demise of sales. Not so fast. Where are we today? The phone now is only one of several. Follow @tonyzambito.
Savvy Week in Review April 6th
Savvy B2B Marketing
Friday, again? And - APRIL? Really? When did that happen? And, how did we escape April Fool's Day intact?). Well, the Easter Bunny may be hopping down the bunny trail, but all our marketing buddies have been busily hopping down the blogging trail - dishing up lots of fabulous posts to inspire and educate. Here are our favorite picks of the week. the right way. No Pictures Allowed by @mitchjoel.
4 Key Components for Hosting a Branded Charity Event
Branded charity events are an excellent way to give back to your local community, bring your firm's employees together and even improve your business by raising brand awareness. In a previous post we discussed the many benefits of hosting a branded charity event, but you may be wondering what's involved. Here's some of her advice on the key components to consider: 1. Make it Fun.
B2B Blogger – Are You Being Tricky or Transparent?
B2B Marketing Traction
If you ask me, visitors who land on a blog post have the right to know when it was written. So, why do B2B marketers hide their blog post dates? guess they want to fool us. "Hey! This blog post could have been written yesterday… …or, 3 years ago!" " They don't want us to look at the post date and immediately leave for more current information. Why do I care?
150 Content Marketing Tips
Drive traffic—and leads—with these tips for SEO, social media, content optimization, email marketing, and more.
More Trending
Gartner cuts 2012 IT spending forecast by 1/3rd
The ROI Guy
Are you ready to grab your share of the dwindling 2012 IT Budget? The predictions for solid growth might have gotten ahead of themselves once again, as Gartner cuts their IT spending growth predictions by 1/3rd for the remainder of 2012. Going into this New Year, Gartner analysts predicted that IT spending would expand worldwide by 3.7%. But in their most recent estimates in April, Gartner has downgraded the 2012 forecast by a substantial amount, now predicting only a 2.5% expansion for the year. growth, with strong growth in computer hardware and telecom equipment as well.
Employers Be Cautious Using Social Media To Screen Job Applicants
WindMill Networking
Recently, there has been "much ado" over some employers seeking Facebook password and login information from job applicants. While this practice just recently caught the media's attention, the reality is employers have been using social media to investigate job applicants for years. Employers, however, should be cautious when using information obtained from social media to make hiring decisions.
The Sorry State of Internet News
Image credit: Getty Images via @daylife. I am likely to step on a few toes here. Don't worry, though, because whatever seems like an accusation of the Internet and social media marketing "news" industry applies to me as well. In other words, I ain't perfect. What I am, however, is a little frustrated. have been "reporting" on the Internet and social media marketing space for the better part of four years now. That doesn't make me a wily Internet veteran, although I was working in the space during the first bubble burst all those years ago.
11 Essential Elements of a Well-Designed Marketing Ebook
How many ebooks does your marketing team have in its content arsenal? With the rise of tablet and e-reader popularity, ebooks are only growing in popularity. According to a newly released report by Pew Internet , in mid-December 2011, 17% of American adults had reported they read an ebook in the previous year; by February, 2012, the share increased to 21%. So today, let's focus on design.
Content Marketing 2016: Staffing, Measurement, and Effectiveness
We surveyed 2016's content marketing leaders on their biggest issues, hurdles, and goals.
Can You Solve this Digital Marketing Puzzle? – #1950
Puzzle Marketer
For a fun Friday brain teaser, PuzzleMarketer.com brings you a puzzle using terms out of our digital marketing glossary. See how quickly you can guess what the images below are identifying. Check back every Friday for a new advertising puzzle to solve. Are you stumped? Click here to go to our marketing puzzles answers page.
8 Ways to Boost Ecommerce Shopping Cart Conversions
The Internet superhighway can be particularly cruel to ecommerce marketers, what with more than 50% of all shopping carts abandoned prior to purchase according to Marketing Experiments. It's no accident that the most successful ecommerce companies take a strategic, calculated approach to their product pages and shopping cart usability. Simple, oft-overlooked tweaks can yield dramatic results. Consider a product page's load time, for example. Amazon calculated that one additional second of load time on their product pages would cost them $1.6 billion in annual sales. Yikes.
Harness the power of Newsjacking to Grow Your Business
Fearless Competitor
Use the News to Capture Free Publicity for your Company. David Meerman Scott ( @dmscott ), who was interviewed by Jeff Ogden, President of the lead generation company Find New Customers via Skype at Social Media Camp NYC , has a new book, Newsjacking. just purchased it on my iPad and read it. We're also using this in our new client engagement.). " to his associate. He said "Wow!
Networking Or Schmoozing Business Relationships
Business Growth Development
The idea that you're doing something for money horrifies many people. Yet we ALL do it in some shape or form, and then justify in whatever manner we see as "right". Depending on how you perceive the process of networking it could be seen as just a necessarily evil to avoid at all costs or social way of developing your business and getting out of the office. If it wasn't money though we'd find something else to focus on, just like the emotional needs of certain artists to be adored, laughed with and to leave their fans amazed no matter the genres or media. Networking is no different.
Study: How Much of Your Content Marketing Is Effective?
745 marketers told us how effective their content marketing is. Between November 5 and November 17, we surveyed 601 marketers with an 18-question online survey. A few weeks later, Adweek sent the questionnaire to 144 additional marketers. As the survey was answered by nearly our entire population target, the calculated margin of error was approximately 1 percent. Here's what we learned.
Welcoming Find New Customers newest client
Fearless Competitor
We're delighted to announce the newest client of the lead generation company and global marketing firm Find New Customers – Protegrity. Welcome! We look forward to a long and mutually rewarding relationship with this valued client. We'll be helping them in many aspects of b2b marketing, including buyer personas, content marketing, roadmap for a new target market, creating a content calendar, company collateral, blogs, marketing dashboard, sales presentations, business partner development, advertising campaigns and customer case studies. About Protegrity.
Content Marketing Showcase Series # 3 The Eloqua Blog Tree
Connect the Docs
Name: Eloqua. Normal. sap. 1. 1. 2012-04-05T16:18:00Z. 2012-04-05T16:19:00Z. 1. personal. 2. 1. 10.2625. Clean. Clean. MicrosoftInternetExplorer4. Name : Eloqua. Eloqua helps clients accelerate revenue growth with powerful insight to inform marketing and sales decisions today that drive revenue tomorrow. Type of Content: Infographic. Normal. sap. 1. 0. 2012-04-05T16:21:00Z. 2012-04-05T16:21:00Z. 1.
Hunger Games and Sales - How to Make the Odds Ever in Your Favor
Sales Prospecting Perspectives
In the hungry and cut throat world of sales, you have to be smart about how you play the game. Being a successful inside sales rep is not only based on your phone skills, but also reflects your ability to utilize the tools, training, and support of your mentors and peers. The keys to success are the tools and support you must employ to find your opportunities. &rdquo
Friday Wrap-up: This Week in B2B Marketing Tips
B2B Lead Blog
Each week we present a collection of some of the best marketing tips, guides, and best practices from thought leaders around the blogosphere to help you stay informed, hone your craft, and improve your marketing efforts. Enjoy! 1. Link Building Tip: How to Do It the Smart Way SEO and keywords
Content Methodology: A Best Practices Report
If you're concerned that your organization's content marketing isn't as effective as it could be, this report is for you.
INFOGRAPHIC: The Inbound Marketing Multiplier
Client Bridge
From Marketo, here's an infographic that explains the benefits of combining inbound marketing with a traditional, outbound marketing campaign. View Original Article
Networking Or Schmoozing Business Relationships
Business Growth Development
High Speed Business Networking Event (Photo credit: Wikipedia) The idea that you're doing something for money horrifies many people. Yet we ALL do it in some shape or form, and then justify in whatever manner we see as "right". No one approach, is a greater or lesser moral than the other. Networking is no different. Networking is no different. Sales business help networking relationships
E-Quip Blog: Thinking Rightly About Time
Your time is your most valuable personal--and corporate--asset. You can't do anything without expending some of it. There's only a limited, finite amount of it. You can't replace it. You can't create more of it. You can't stop its
Networking Or Schmoozing Business Relationships
Business Growth Development
High Speed Business Networking Event (Photo credit: Wikipedia). The idea that you're doing something for money horrifies many people. Yet we ALL do it in some shape or form, and then justify in whatever manner we see as "right". Depending on how you perceive the process of networking it could be seen as just a necessarily evil to avoid at all costs or social way of developing your business and getting out of the office. No one approach, is a greater or lesser moral than the other. Networking is no different. Networking is no different. Social vs Market Norms at Reddit (technologyreview.com).
Staffing and Launching Your Content Marketing Program
Brand voice? Editorial calendar? Approval workflow? Learn how to craft the crucial parts of a content marketing program. In the third installment of our five-part playbook series, discover the necessary steps to execute a content marketing program.


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Principles of Contract Law, 3d (Concise Hornbook Series)This overview of contract law explains concepts clearly and concisely, in an informal, humorous style. For ease of reading and understanding, the book refrains from including complex textual footnotes. Instead, the footnotes cite cases, with most including short quotations to substantiate assertions made in the text. The book also contains numerous examples and illustrations. Cross references
Shining: The Story of a Lucky ManA remarkably warm-hearted, uplifting and inspiring story of one boy's survival against the odds. Abdi's world fell apart when he was only fifteen and Somalia's vicious civil war hit Mogadishu. Unable to find his family and effectively an orphan, he fled with some sixty others,heading to Kenya. On the way, death squads hunted them and they daily faced violence, danger and starvation. After almost
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$7.99'My revenge on Hitler is a lifetime in which delight has reached me from a hundred sources, and been welcomed.'—Vera Wasowski A story of courage, unconventionality and lust for life. Vera Wasowski was just seven years old when German soldiers marched her family into the Lvov Jewish ghetto in Poland. She watched her father take his own life and her mother accede to sexual blackmail in order to
$13.59Joyful is a remarkable, razor-sharp comedy of grief from one of Australia's most dynamic writers. Leon Joyce's years with Tess Wachowicz began with an Emanuel Ungaro taffeta ballgown, part of his collection of women's attire kept in three wardrobes at the South Yarra house. The collection took in Givenchy, Jacques Fath, Schiaparelli, Madae Gres, Helmut Lang, Claire McCardell, Mainbocher, Miyake,
$10.99This unique Indigenous man is one of the most inspiring music stories of our generation. From concert halls to recording studios and into Aboriginal heartlands, this is the story of Australia's Geoffrey Gurrumul Yunupingu. This unique Indigenous man is one of the most inspiring music stories of our generation. Part road trip, part biography, Robert Hillman's account of Gurrumul's life and music
Hematology in Clinical Practice, Fifth EditionThe most practical and efficient guide to the diagnosis and management of blood disorders – now in full color 200 full-color illustrations! Hematology in Clinical Practice is a succinct, cutting-edge guide to the diagnosis and treatment of disorders of red blood cells, white blood cells, and hemostasis, and the use of blood components for transfusion. Each disease state is discussed in detail,
The Rugmaker of Mazar-e-SharifThis book traces an Afghan refugee's extraordinary journey-from his early life as a shepherd boy in the mountains of Northern Afghanistan to his forced exile after being captured and tortured by the Taliban, to incarceration in an Australian detention centre...and finally to freedom. A poignant and powerful, often humorous, story of suffering, injustice and survival that explores the resilience of
$8.99From the authors of the bestseller The Rugmaker of Mazar-e-Sharif comes their latest book, The Honey Thief. A superb collection of spellbinding tales from Afghanistan that portray a vivid landscape of hardship and brotherhood, catastrophes and miracles. These tales of peasants, poisoners and kings leap into life to reveal the rich storytelling traditions of Afghanistan. The beekeeper said to the
Principles of Payment Systems (Concise Hornbook Series)Provides law students with an in-depth introduction to the UCC without burdening them with unnecessary detail. Citations have been used to enable the reader to understand the kinds of cases that might be presented under particular provisions of the Code. The chapters on Article 9 have been completely rewritten to deal only with revised Article 9 (1999). Similar revisions have been made to the

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Crafter's Workshop Butterfly Collage Template 6''x6''
Product Actions
BUY ONLINE PICK-UP IN-STORE now available in a store near you.
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Add a variety of colorful details to your card making or scrapbooking projects using the Crafter's Workshop Template 6'' x 6''. This pack comes with one decorative template featuring a lovely design that measures 6 x 6 inches. Use this decorative template for spray painting, sponging, stenciling and to create other wonderful effects on your craft creations. Available in a variety of designs, each sold separately.
- Brand: Crafter's Workshop
- Theme: Butterfly Collage
- Includes one template
- Available in a wide variety of designs, each sold separately
- Dimensions: 6 x 6 inches
- Content: Plastic
- Made in USA
- Handling Code:
Items shipping from our warehouse ship within 3 business days (Mon-Fri) for standard shipping. If an order is placed on Friday, Saturday or Sunday, it will ship out within 3 business days the following week. Items shipping direct from the manufacturer will take additional processing time and ship separate from the remainder of your order. See our Full Shipping Policy >
|In-Home Arrival Estimate
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text:
until hell freezes over
Definition from Wiktionary, the free dictionary
Alternative forms[edit]
- (idiomatic) forever; One will never in their life get the results that they want, no matter what they're doing involving the situation.
- He can continue to be hard on himself until hell freezes over, because he's so self-centeredly pessimistic that there's nothing I can ever do to lighten him up and get a life.
- They can be bellyaching to me about their life's problems until hell freezes over, but it doesn't mean that they'll ever get my sympathy.
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text:
Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization?
Aims To evaluate the diagnostic accuracy of a combined non-invasive assessment of coronary artery disease with coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) for the detection of flow-limiting coronary stenoses and its potential as a gatekeeper for invasive examination and treatment.
Methods and results In 78 patients (mean age 65 ± 9 years) referred for coronary angiography (CA), additional CTA and MPI (using single-photon emission-computed tomography) were performed and the findings not communicated. Detection of flow-limiting stenoses (justifying revascularization) by the combination of CTA and MPI (CTA/MPI) was compared with the combination of quantitative coronary angiography (QCA) plus MPI (QCA/MPI), which served as standard of reference. The findings of both combinations were related to the treatment strategy (revascularization vs. medical treatment) chosen in the catheterization laboratory based on the CA findings. Sensitivity, specificity, positive and negative predictive value, and accuracy of CTA/MPI for the detection of flow-limiting coronary stenoses were 100% each. More than half of revascularization procedures (21/40, 53%) was performed in patients without flow-limiting stenoses and 76% (47/62) of revascularized vessels were not associated with ischaemia on MPI.
Conclusion The combined non-invasive approach CTA/MPI has an excellent accuracy to detect flow-limiting coronary stenoses compared with QCA/MPI and its use as a gatekeeper appears to make a substantial part of revascularization procedures redundant.
- Coronary CT angiography
- Myocardial perfusion imaging
- Conventional coronary angiography
- Coronary artery disease
Over the past decades, many advances in imaging techniques have enhanced our pathophysiologic understanding of coronary artery disease (CAD). A comprehensive assessment of CAD should include both information on coronary artery anatomy and functional information about the haemodynamic relevance of coronary artery lesions in order to guide revascularization procedures.1–3 In stable CAD, the debate on the role of elective percutaneous coronary intervention (PCI) is highly controversial.4,5 Guidelines recommend proof of ischaemia prior to elective revascularization of coronary stenoses,2,4,6 and several reports have demonstrated that PCI fails to improve prognosis in patients with stable CAD compared with conservative treatment.5,7 Nonetheless, in clinical practice, the decision to revascularize is often based solely upon visual angiographic criteria rather than objective proof of ischaemia. Similarly, while quantitative coronary angiography (QCA) is commonly used as gold standard in clinical trials,8 its clinical role is limited as accurate analysis is generally not readily available during the procedure.
Coronary multislice CT angiography (CTA) has evolved rapidly during the past decade allowing now visualization of coronary artery morphology and lesions with a temporal and spatial resolution that approaches conventional coronary angiography (CA).9,10 Combination of CTA and myocardial perfusion imaging (MPI) is non-invasive, and thus, allow non-invasive integrative assessment of CAD.11 Hence, it seems conceivable that an early non-invasive assessment of CAD with CTA and SPECT may act as a gatekeeper for conventional coronary angiography and thus avoid unnecessary invasive diagnostic and revascularization procedures.
Therefore, the aim of the present study was to evaluate the diagnostic accuracy of the combination CTA/MPI vs. QCA/MPI as a gatekeeper for invasive coronary examination and treatment.
Study population and study design
We prospectively enrolled consecutive patients with known or suspected CAD referred to our institution for elective CA. The clinical decision to perform CA was based on the history and/or symptoms of the patient and/or on the results from exercise stress testing. Patients were eligible if they were in a stable clinical condition i.e. if they were in Canadian Cardiac Society class I to III, and in New York Heart Association functional class I to III. Exclusion criteria were severe obstructive lung disease, high-grade atrioventricular conduction disturbances, atrial fibrillation, and known intolerance of iodinated contrast agents. Patients who agreed to participate underwent CTA and myocardial perfusion SPECT prior to the invasive procedure and the results from non-invasive testing were withheld from the interventional cardiologist. The study protocol was approved by the local institutional review board and all patients gave written informed consent before enrolment. All patients were made aware of the additional radiation dose from MPI and CTA prior to consent. The study population is shared with a prior publication by our group.12
CT angiography image acquisition
All scans were performed on a 64-slice CT scanner (Somatom Sensation 64; Siemens Medical Solutions, Forchheim, Germany). Patients with pre-scan heart rates above 70 b.p.m. received intravenous beta-blocker therapy (5–15 mg metoprolol) immediately prior to the CT scan. Low-dose calcium score, helical CTA scanning, and image reconstruction parameters were used as previously reported.12,13
CT angiography image interpretation
CT angiography image interpretation was performed on axial source images, multiplanar and curved reformations, and thin-slab maximum intensity projections. First, image quality for each data set was rated by one reader on a scale ranging from score 1 (excellent image quality), 2 (good image quality), 3 (moderate image quality), 4 (poor, but still diagnostic image quality), to score 5 (very poor image quality, non-evaluable data set defined as having at least one non-evaluable segment). Coronary arteries were subdivided according to a 15-segment model proposed by the American Heart Association.14
Then, each segment was visually evaluated on at least two planes, one parallel and one perpendicular to the course of the vessel with regard to coronary artery delineation. On these images, the degree of diameter stenosis was qualitatively graded by two independent readers (who were both blinded to the clinical history and to the findings from MPI and CA) on a decimal scale in 10% steps from 0 to 100%. The ultimate diameter stenosis was calculated as the mean of both measurements. A significant stenosis was defined as narrowing of the coronary lumen ≥50%, and all vessels with a diameter down to 1.5 mm were included in the analysis.
Myocardial perfusion imaging image acquisition
SPECT image acquisition was performed using a 1 day electrocardiographically (ECG) gated stress/rest protocol with adenosine stress (140 µg/kg/min) and 99mTc-tetrofosmin (250–350 MBq at peak stress and three times the stress dose at rest according to standard protocol).15 Scanning parameters and image reconstruction algorithms were applied as previously reported.12 Patients were told to refrain from caffeine-containing beverages for at least 12 h, nitrates and calcium channel blockers 24 h, and beta-blockers 48 h before the MPI study.
Myocardial perfusion imaging image interpretation
SPECT image interpretation was visually performed by consensus of two experienced nuclear cardiologists on short axis, horizontal long axis, and vertical long-axis slices, and semiquantitative polar maps of perfusion using previously validated automated software.16 Anterior and septal wall perfusion defects were allocated to the left anterior descending (LAD) coronary artery, lateral defects to the left circumflex (LCX) coronary artery, and inferior defects to the right coronary artery (RCA). Reversible perfusion defects were considered to represent myocardial ischaemia. Fixed perfusion defects with concomitant regional wall motion abnormalities were considered to be myocardial scars.17
Quantitative coronary angiography
Biplane conventional CA was performed according to standard techniques and evaluated by an experienced observer who was blinded to the results from CTA and MPI. Quantitative coronary angiography measurements were performed on two different image planes using an automated edge-detection system (Xcelera 1.2, Philips Medical Systems, Best, The Netherlands) as previously described.12 A significant stenosis was defined as a diameter reduction of ≥50%.
Comparison of CT angiography and quantitative coronary angiography
The diagnostic accuracy of CTA was assessed by comparison with the results from QCA, which was considered to be the gold standard for coronary stenosis evaluation. Comparison was performed on an intention-to-diagnose basis and therefore, non-evaluable segments on CTA were considered as positives.
Assessment of flow-limiting coronary stenoses
A flow-limiting coronary stenosis was defined as a lesion with a diameter narrowing exceeding 50% (on CTA or on QCA) inducing a reversible perfusion defect in its subtending myocardial territory on MPI (myocardial ischaemia) (Figure 1). A coronary stenosis of ≥50% without any associated myocardial ischaemia was considered to be non-flow-limiting. Conversely, a reversible perfusion defect in a territory subtended by a non-stenotic coronary artery was considered to represent a false-positive MPI result. As shown in Figure 1, the presence or absence of flow-limiting coronary stenosis was assessed independently for the combination of CTA plus MPI (CTA/MPI) and for the combination of QCA plus MPI (QCA/MPI), the latter being considered the gold standard for a combined assessment of coronary morphology and haemodynamic lesion severity.
Coronary revascularizations
Coronary revascularization procedures included PCI with or without stent implantation and coronary artery bypass grafting (CABG). According to guidelines, a stenosis was considered as an indication for revascularization only if it was associated with a reversible perfusion defect on MPI (flow-limiting stenosis). Finally, the patients' actual treatment strategy (revascularization vs. medical treatment) was compared with the imaging-derived treatment recommendations, on patient- and vessel-based analysis.
Statistical analysis
Statistical analysis was performed using the SPSS software package (SPSS 12.0.1 for Windows, SPSS Corp.). Quantitative data are expressed as mean ± SD (unless otherwise stated) and categorical data given in proportions and percentages. Statistical comparison of quantitative data was performed using an unpaired two-tailed Student's t-test or Mann–Whitey U test where appropriate and comparison of categorical data using a chi-squared test with Yates' correction or McNemar's test for comparison of paired proportions. A P-value <0.05 was considered statistically significant for all tests. Pre-test CAD likelihood was calculated according to Diamond and Forrester.18 Sensitivity, specificity, positive (PPV), and negative predictive value (NPV), and accuracy were obtained from 2×2 contingency tables and their respective 95% confidence intervals (CIs) calculated from binomial expression. Accuracy was determined as the percentage of correct diagnoses in the entire sample. Univariate logistic regression was used to identify predictors for revascularization and the regression results are presented as odds ratios and their respective 95% CIs. Additionally, multivariate logistic regression was applied to identify independent predictors by including all factors with P < 0.05 and correction for the baseline characteristics with P < 0.1 on univariate analysis.
Ninety-six patients were enrolled in the study, of which 18 (19%) had to be excluded: no CTA (n = 7) due to atrial fibrillation or technical reasons, no CA (n = 11) due to rescheduling, consent withdrawal, clinical deterioration, and logistic reasons. The final analysis included 78 patients with a mean age of 65 ± 9 years (range, 40–87 years) [35 (45%) female] (Table 1). The median time interval between CTA and MPI was 0 days (range, 0 to 26 days), between CTA and CA 1 day (range, 0 to 22 days), and between MPI and CA 1 day (range, 0 to 26 days). A delay of more than 2 weeks between CTA and MPI was found in only one patient, and between CTA/MPI and CA in five patients.
|All patients (n = 78)
|Revasc group (n = 40)
|Medical group (n = 38)
|Age (years)
|65 ± 9
|66 ± 8
|63 ± 10
|Female gender, n (%)
|35 (45)
|13 (33)
|22 (58)
|Body mass index (kg/m2)
|26 ± 4
|27 ± 4
|26 ± 4
|Systolic blood pressure (mmHg)
|134 ± 19
|135 ± 19
|132 ± 19
|Diastolic blood pressure (mmHg)
|78 ± 12
|77 ± 11
|80 ± 12
|Total serum cholesterol (mmol/L)
|4.8 ± 1.0
|4.7 ± 0.9
|4.9 ± 1.1
|Cardiovascular history, n (%)
|Known CAD
|19 (24)
|14 (35)
|5 (13)
|Single-vessel CAD
|5 (6)
|3 (8)
|2 (5)
|Two-vessel CAD
|5 (6)
|4 (10)
|1 (3)
|Three-vessel CAD
|9 (12)
|7 (18)
|2 (5)
|Previous MI/ACS
|16 (21)
|11 (28)
|5 (13)
|Previous PCI
|19 (24)
|14 (35)
|5 (13)
|Previous CABG
|0 (0)
|0 (0)
|0 (0)
|Missing exercise test
|34 (44)
|19 (48)
|15 (39)
|Pathological exercise test
|35 (45)
|16 (40)
|19 (50)
|59 ± 15
|60 ± 11
|59 ± 18
|Symptoms, n (%)
|Angina pectoris CCS I-III
|30 (38)
|21 (53)
|9 (24)
|Atypical chest pain
|16 (20)
|5 (13)
|11 (29)
|Dyspnoea NYHA I–III
|19 (24)
|7 (18)
|12 (32)
|13 (17)
|7 (18)
|6 (16)
|Cardiovascular risk factors, n (%)
|Diabetes mellitus
|13 (17)
|11 (28)
|2 (5)
|61 (78)
|34 (85)
|27 (71)
|40 (51)
|24 (60)
|16 (42)
|Current or former smokers
|40 (51)
|25 (63)
|15 (39)
|Unknown CAD
|59 (76)
|26 (65)
|33 (87)
|CAD pre-test likelihood (%)a
|75 ± 26
|86 ± 16
|66 ± 30
|Framingham risk score
|12 ± 9
|15 ± 9
|10 ± 7
Data not given in n (%) is shown as mean ± SD.
Revasc group, group of patients undergoing coronary revascularization; Medical group, group of patients treated conservatively; CAD, coronary artery disease; MI, myocardial infarction; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; LVEF, left ventricular ejection fraction as assessed with gated SPECT; CCS, Canadian cardiac society; NYHA, New York Heart Association.
aPre-test likelihood for CAD was calculated according to Diamond and Forrester.18
*P-value for comparison of Revasc vs. Medical group.
CT angiography results
All patients were in stable sinus rhythm and the mean heart rate during the CT scan was 62 ± 9 b.p.m. Ten patients (13%) were pre-treated with intravenous metoprolol.
A total number of 1093 coronary segments in 310 main coronary arteries were analysed. In two patients, the left main coronary artery (LMA) was missing as LAD and LCX had separate origins from the left coronary sinus. The mean image quality score was 2.9 ± 0.9. Image quality scores were 1 in 1 (1%) patient, 2 in 31 (40%) patients, 3 in 26 (33%) patients, 4 in 15 (19%) patients, and 5 in 5 (6%) patients. Eight (1%) coronary segments were not evaluable because of motion artefacts (n = 2), heavy calcifications (n = 1), or both (n = 5). On intention-to-diagnose basis, visual CTA image analysis revealed a stenosis in 137/1093 (13%) segments corresponding to 91/310 (29%) coronary arteries in 46/78 (59%) patients (Figure 2). The details of the CTA results are given in Table 2. Interreader agreement for stenosis detection on CTA was 92% (95% CI, 90–93%) on segment-based analysis.
|All patients (n = 78)
|Revasc group (n = 40)
|Medical group (n = 38)
|CTA results
|Coronary calcium score (ASE)a
|370 (100, 915)
|529 (193, 1432)
|156 (1, 586)
|Patients with CTA stenoses, n (%)
|46 (59)
|39 (98)
|7 (18)
|LMA stenoses
|0 (0)
|0 (0)
|0 (0)
|LAD stenoses
|33 (42)
|30 (75)
|3 (8)
|LCX stenoses
|28 (36)
|25 (63)
|3 (8)
|RCA stenoses
|30 (38)
|26 (65)
|4 (11)
|MPI results
|Fixed perfusion defects
|13 (17)
|9 (23)
|4 (11)
|Reversible and partially reversible perfusion defects
|20 (26)
|20 (50)
|0 (0)
|Normal MPI perfusion
|47 (60)
|13 (33)
|34 (89)
|QCA results
|Patients with QCA stenoses, n (%)
|49 (63)
|40 (100)
|9 (24)
|LMA stenoses
|1 (1)
|1 (3)
|0 (0)
|LAD stenoses
|33 (42)
|27 (68)
|6 (16)
|LCX stenoses
|29 (37)
|28 (70)
|1 (3)
|RCA stenoses
|29 (37)
|26 (65)
|3 (8)
|Combination CTA/MPI: flow-limiting stenoses
|19 (24)
|19 (48)
|0 (0)
|Combination QCA/MPI: flow-limiting stenoses
|19 (24)
|19 (48)
|0 (0)
Revasc group, group of patients undergoing coronary revascularization; Medical group, group of patients treated conservatively; CTA, CT angiography; ASE, Agatston score equivalents; LMA, left main artery; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; MPI, myocardial perfusion imaging; QCA, quantitative coronary angiography.
aData for coronary calcium score are given as median and interquartile range and comparison performed using Mann–Whitney U test.
*P-value for comparison of Revasc vs. Medical group.
Myocardial perfusion imaging results
Image quality of MPI was amenable to visual interpretation in all 78 patients. Visual image analysis revealed 14 reversible, 13 fixed, and 6 partially reversible perfusion defects in 31/78 (40%) patients (Table 2). The distribution of the perfusion defects among the different coronary artery territories was as follows: reversible perfusion defects: LAD (n = 8), LCX (n = 2), RCA (n = 4); fixed perfusion defects: LAD (n = 4), LCX (n = 3), RCA (n = 6); partially reversible perfusion defects: LAD (n = 1), LCX (n = 1), RCA (n = 4).
Coronary angiography results
Quantitative coronary angiography analysis of biplane CA revealed stenoses (of ≥50% diameter stenosis) in 92/310 (30%) coronary arteries corresponding to 49/78 (63%) patients. As with CTA, the LMA was missing in two patients as LAD and LCX had separate origins from the left coronary sinus. The details of the QCA results are given in Table 2.
Comparison of CT angiography vs. quantitative coronary angiography
Sensitivity, specificity, PPV, NPV, and accuracy of CTA for the detection of coronary stenoses on QCA was 88% (95% CI, 80–94%), 95% (92–98%), 89% (81–95%), 95% (91–97%), and 93% (90–96%), respectively, on vessel-based analysis, and 94% (83–99%), 100% (88–100%), 100% (92–100%), 91% (75–98%), and 96% (89–99%), respectively, on patient-based analysis.
Assessment of flow-limiting stenoses
On both combined analyses of CTA/MPI as well as QCA/MPI 19/78 (24%) patients had flow-limiting stenoses. Eight stenoses were localized in the LAD-, 2 in the LCX-, and 9 in the RCA-territory. Sensitivity, specificity, PPV, NPV, and accuracy of the combination CTA/MPI for the detection of flow-limiting coronary stenoses on QCA/MPI was 100% (95% CI, 82–100%), 100% (99–100%), 100% (82–100%), 100% (99–100%), and 100% (99–100%), respectively, on vessel-based analysis, and 100% (82–100%), 100% (94–100%), 100% (82–100%), 100% (94–100%), and 100% (95–100%), respectively, on patient-based analysis. When including fixed perfusion defects into the analysis, the PPV of MPI was 85% with a clear trend towards improvement after addition of CTA (96%) although the difference fell short of statistical significance (P = 0.07).
A revascularization procedure was performed in 40/78 (51%) patients of whom 11/78 (14%) underwent CABG and 29/78 (37%) PCI (with stenting in all but one patients). The median time interval between CA and revascularization procedure was 0 days (range, 0–51 days), all PCI procedures were performed ad hoc. On vessel-based analysis, 62/310 (20%) coronary arteries were revascularized (LMA, n = 2; LAD, n = 23; LCX, n = 21; RCA, n = 16).
Figure 3 shows the study population subcategorized according to the presence or absence of flow-limiting stenoses on CTA/MPI or QCA/MPI and the treatment strategy (revascularization vs. medical treatment) on patient- and vessel-based analysis. Typical angina was present in 21 (53%) and 9 (24%) patients (P = 0.02) in the revascularization and medical group, respectively, and a pathological exercise test in 16 (40%) and 19 (50%) patients, respectively (P = 0.51). However, an exercise test was only performed in 44 (56%) of patients. Among the 21 patients without flow-limiting stenoses undergoing revascularization, the prevalence of symptoms was: typical angina, 25% (10/21); atypical chest pain, 5% (2/21); dyspnoea, 10% (4/21); and no symptoms, 13% (5/21) (P=NS compared with patients without flow-limiting stenoses and medical treatment).
All patients with flow-limiting stenoses were revascularized. However, more than half of revascularization procedures (21/40, 53%) were performed in patients without flow-limiting stenoses and 76% (47/62) of revascularized vessels were not associated with ischaemia on MPI (Figure 4). Nineteen per cent (4/21) of revascularization procedures in patients without flow-limiting stenoses were CABG and 81% (17/21) ad hoc PCIs. The fraction of CABG among patients without flow-limiting stenoses tended to be lower than in patients with flow-limiting stenoses (19 vs. 37%, P=NS). In patients with no flow-limiting stenoses, there were no differences in baseline characteristics between those undergoing revascularization (n = 21) and those treated medically (n = 38) except for a higher prevalence of known CAD in the former group (62 vs. 13%, P < 0.001).
Significant clinical predictors of revascularization by univariate logistic regression were a history of CAD, the presence of typical angina, history of diabetes mellitus, and current or former smoking status (Table 3). Multivariate logistic regression analysis identified a history of diabetes mellitus as the only independent predictor of revascularization.
|Clinical characteristics
|Age (years)
|1.04 (0.98–1.09)
|History of CAD
|3.55 (1.13–11.15)
|Previous MI/ACS
|2.50 (0.78–8.06)
|Pathological exercise test
|0.67 (0.27–1.64)
|1.00 (0.97–1.03)
|Angina pectoris CCS I–III
|3.56 (1.35–9.41)
|Atypical chest pain
|0.35 (0.11–1.13)
|Dyspnoea NYHA I–III
|0.46 (0.16–1.33)
|1.13 (0.34–3.73)
|Cardiovascular risk factors
|Diabetes mellitus
|6.83 (1.40–33.28)
|2.31 (0.76–7.05)
|2.06 (0.84–5.09)
|Current or former smoker
|2.56 (1.03–6.37)
OR, odds ratio; CI, confidence interval; CAD, coronary artery disease; MI, myocardial infarction; ACS, acute coronary syndrome; LVEF, left ventricular ejection fraction.
Our study documents an excellent ability of a combined non-invasive approach with CTA and MPI using SPECT for detecting flow-limiting coronary stenoses compared with the gold standard of QCA combined with MPI. In all patients with flow-limiting coronary stenoses (i.e. stenoses that were associated with myocardial ischaemia as evidenced by MPI), a revascularization procedure was performed. However, half of patients undergoing revascularization lacked any flow-limiting coronary stenoses based on non-invasive imaging and almost three quarters of revascularized vessels were not associated with myocardial ischaemia. These findings underline a potential role of a combined non-invasive assessment with CTA and MPI as a gatekeeper for revascularization procedures in order to avoid its overuse and the associated burden of periprocedural morbidity. By doing so, in our study population in 21/78 (27%) patients, an unnecessary revascularization procedure might have been prevented, while in none of the patients a revascularization procedure would have been falsely withheld.
The role of revascularization procedures in patients with stable CAD is controversial. As with medical therapy, the objectives of coronary revascularization procedures are two-fold, to improve survival free of ischaemic events, and to diminish or eradicate ischaemic symptoms.4 Since the highest risk patients derive the highest benefit from revascularization procedures, both the individual risk of the patient as well as his symptomatic status must be a major determinant in the decision-making process. High risk factors include high risk angiographical configuration (LMA disease, proximal three-vessel disease), impaired left ventricular function, pronounced symptoms (angina CCS III–IV), or the presence of myocardial ischaemia by non-invasive testing.19 Coronary revascularization procedures have convincingly shown to reduce ischaemic symptoms and improve quality of life even in patients at low risk.7 However, periprocedural morbidity and mortality remain important considerations. In fact, in a stable CAD population, coronary revascularization procedures have failed to demonstrate an improvement in prognosis compared with state-of-the-art medical therapy.5,7,19,20 Therefore, guidelines recommend proof of ischaemia prior to revascularization procedures.2,4 If moderate to large ischaemia is present, however, a coronary revascularization may actually improve prognosis compared with medical treatment21 by a more effective reduction in the amount of jeopardized myocardium.22 On the other hand, revascularization of a non-flow-limiting coronary stenosis is not of benefit for the patient, neither from a prognostic nor from a symptomatic point of view.23,24
Therefore, MPI has been suggested as gatekeeper for invasive examination.25 However, combining MPI with CTA has been shown to improve the accuracy of non-invasive assessment,26 as false positive MPI findings may be disproved by negative CTA which may be of particular importance in low CAD prevalence populations. In addition, not every flow-limiting lesion may be suitable for PCI, which may be identified by CTA avoiding futile invasive attempts. Interestingly, only 56% of patients in our non-selected study population had undergone a stress ECG prior to CA, and in less than half of patients the stress ECG was pathologic. However, patients in the revascularization group had a higher prevalence of angina pectoris. This may explain why a considerable amount of presumably non-flow-limiting lesions were nevertheless revascularized, as 87% of these patients had symptoms. This reflects that in clinical reality, a decision to revascularize often also incorporates the overall presentation and symptoms of a patient. Of note, the vast majority of these revascularization procedures were ad hoc PCIs. This observation is in line with previous publications reporting that 66% of PCIs are ad hoc procedures in stable CAD patients.27
Several factors may contribute to the observed discrepancy between guidelines and the use of PCI in real life, among them insufficient use of non-invasive testing, and potential medicolegal considerations (presumably not allowing a detected stenosis untreated). The latter may be driven by the open artery theory, although not supported by the latest results.28 In fact, previous reports have documented a high correlation between catheterization and revascularization rates.29 Our results suggest the use of a combined non-invasive approach with CTA and MPI prior to coronary revascularization as a method to help providers more fully incorporate clinical evidence into their decision-making process. Additionally, a comprehensive non-invasive assessment of CAD with CTA and MPI would allow for careful selection of the optimal revascularization procedure according to the guidelines improving the balance between periprocedural risk and prognostic benefit for each individual patient.
Study limitations
An important drawback of non-invasive cardiac imaging is the high radiation exposure associated with CTA and MPI. In fact, studies with 64-slice CTA reported an estimated radiation burden of up to 21.4 mSv without the use of ECG-pulsing30 and MPI-SPECT studies with 99mTc-based radiotracers are associated with radiation doses in the range of 9–11 mSv.31 However, with the implementation of prospective ECG-gating protocols for CTA, radiation exposure can be reduced down to 2.1 mSv32,33 and alternative MPI techniques such as positron emission tomography with 13N-ammonia or 15O-water may reduce radiation placing the resulting radiation exposure well within the range of conventional CA. Additionally, hybrid imaging combining CTA using prospective ECG gating with stress-only SPECT has been suggested as an attractive alternative to standard stress/rest SPECT for the detection of CAD reducing radiation exposure to 5.4 mSv.34
In the present study, we have defined flow-limiting stenoses as angiographically determined coronary narrowings associated with a reversible perfusion defect in the subtended myocardial territory. The perfusion defect was assessed by SPECT MPI, a method which may be limited to accurately localize ischaemia-producing lesions in patients with multivessel CAD.35 Thus, in these patients, determining which lesions warrant stenting can be difficult. This may potentially be overcome by invasively assessed fractional flow reserve.24 Whether alternative measures such as, for instance, cardiac magnetic resonance imaging with an in-plane resolution superior to SPECT may help solving this issue, remains to be determined.
Another shortcoming of our study was the limited number of study participants. As a result, no significant increments in diagnostic accuracy with CTA/MPI compared with MPI alone were observed. Furthermore, it was not possible to perform subgroup analysis across different patient strata such as patients with multivessel vs. patients with single vessel disease. In addition, the study was not designed to assess the clinical follow up. Therefore, a potential improvement in clinical symptomatology justifying the revascularization was possibly missed.
The combined non-invasive approach with CTA and MPI in patients with known or suspected CAD has an excellent accuracy to detect flow-limiting coronary stenoses compared with the gold standard of QCA combined with MPI and may be used as a gatekeeper for CA and revascularization procedures.
This study was supported by a European Society of Cardiology (ESC) research grant (O.G.), and by a grant from the Swiss National Science Foundation (P.A.K.).
Conflict of interest: none declared.
This paper was guest edited by Prof. Van de Werf, Department of Cardiology, University Hospitals Leuven, Belgium
- Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: firstname.lastname@example.com


text:
"Imagin8 Mission is a competition that encourages you to be creative and have fun with the Nokia Imaging SDK. Whether you are an app developer or not, make use of your imagination, stand out from the crowd and you could win great prizes."
This meetup listing is for informational purposes only. This is a WEB Event although it would be great if some meetup members coordinated to work together in person. The following URL has the detailed information for entry:
NOTE: deadline is May 5th.
From the website:
App development awards
How to enter:
Submit a new or updated Windows Phone 8 app created using the Nokia Imaging SDK to one of these Challenges in DVLUP, our developer rewards program.
All the valid app submissions will be rewarded with DVLUP Points and Experience Points (XPs). Only the 3 best, most imaginative and stand-out app submissions will win the Imagin8 Mission prizes.
An expenses paid trip for 2 people to experience zero gravity. We will take you to Cape Canaveral, Florida, where you will enjoy the experience on July 19, 2014.
2 Nokia Lumia devices of the winner's choice.
10,000 Points and XPs in DVLUP.
Promos for the winning imaging app in Windows Phone Store, App Social and other Nokia and Nokia Developer channels.
2 Runners-up:
A Nokia Lumia 1520.
5,000 Points and XPs in DVLUP
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text:
This stock has found strong support at $31 following the strong sell off for the past 3 weeks. The next support is 200-day Average. The volume is drying up, making it easy for the market makers and hedge funds to manipulate this.
YEA !! support is anything above 31.50-------going to 40. PLUS !!!!
Sentiment: Strong Buy
200 day m.a. is $30. down almost $2.
what's your play from here? ;-)


text:
"Keeping Yourself Safe" is a prevention presentation that will be provided to our students in Grades 9, 10, and 11 by the staff of Personal Development Center (PDC)
The grant awards school districts up to $1,000 for each pupil earning an approved industry-recognized certification.
In light of a recent news article, the District is clarifying information regarding an internal staff communication survey and the results.
Watch as Dr. Wells sits down with Hub City Times to discuss current topics in our school system
The Public Listening Session Dates have been set regarding the upcoming referendum
The Board of Education took action and approved the Personalized Learning Handbooks
The Board of Education took action and approved the motion to go to referendum to exceed the revenue limit for non-recurring purposes.
The purpose of this page is to provide assistance in determining what is factual from information that is inaccurate or speculative.
Here is a list of the upcoming Homecoming Activities
Washington Elementary School PTO, along with the support of the Leadership Marshfield Class of 2016 are excited to present Washington's Outdoor Learning Center
Marshfield School District Student Earns Prestigious Academic Talent Search Honors at Northwestern University
Students at Nasonville School celebrated Constitution Day by having a flag raising ceremony
Six Marshfield High School seniors attended the Badger Boys or Badger Girls State Leadership Program this past summer.
Thursday, August 25th, a group of community members and Career and Technical Education teachers met
4:30 PM - 5:00 PM Homecoming Parade - time TBA
7:00 PM - 9:30 PM Homecoming Football vs Oshkosh N - Senior Night - Band Halftime
8:00 PM - 11:55 PM Homecoming Dance
7:30 PM - 9:30 PM Regular Board of Education Meeting
7:30 PM - 9:00 PM Barrage Concert - MHS Orchestra - Auditorium 7:30 p.m.


text: Lon Morris College, a private, two-year institution in Texas that has been facing severe financial difficulties, has announced that it will not hold a fall semester. A statement from the college said that it is working with Jacksonville College and Tyler Junior College to find places for students admitted to the college. The statement said that the college is looking for a "purchaser" or "financial partner."


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Argus takes compliance with antitrust law seriously. The purpose of the Argus Americas Crude Summit is to provide a high-level update on changes taking place in the crude markets including supply/demand fundamentals, North American infrastructure dynamics as well as understanding the complexities of global trade flows. The conference sessions will follow the agenda as circulated.
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Pronounced (L-ay-ss-j-ah-b) - the sexual act of performing a handjob with your hands tied together by shoelaces.
Nic traded me shoes for my Yugioh cards, so I used those shoelaces to give Robbie a lacejob.
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Llŷr Williams, piano
Welsh pianist Llŷr Williams is widely admired for his profound musical intelligence, and for the expressive and communicative nature of his interpretations. Williams is an acclaimed performer of Beethoven with one complete piano sonata cycle under his belt and another under way. The first one in the form of an epic two-week marathon during the Edinburgh International Festival won him the prestigious South Bank Show award. At the Old Divinity School he'll perform:
Beethoven: Piano Sonata No.30 in E major, Op.109
Beethoven: Piano Sonata No.31 in A flat major, Op.110
Beethoven: Piano Sonata No.32 in C minor, Op.111
Doors open 7.30pm, concert begins at 8pm
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Abnormal fear of singer/songwriter Paul Williams after seeing him on "The Muppet Show" as a young child. Symptoms may include extreme anxiety when viewing the movie "Smokey and the Bandit" and the inability to watch "Bugsy Malone" even though you love Scott Baio. Some liken it another childhood trauma that caused "Shields and Yarnell Syndrome."
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The Polish God of pork.
Let all who worship the Magical Animal kneel before Zew!
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Our Poetry of Place fall weekends here at 26 Split Rock Cove are now an institution! Barbara Helfgott Hyett has created an inspiring blend of generative writing, free writing, observation and experiential writing exercises, all leading to our goal of finished poems. We read poems of other Maine poets, past and...
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Israel arrests four diamond dealers in HSBC Swiss tax evasion case
JERUSALEM (Reuters) - Israeli authorities made their first arrests in a tax evasion investigation focussed on the Swiss arm of HSBC <HSBA.L>, taking into custody four diamond dealers who allegedly held undeclared accounts at the bank, the tax authority said on Thursday.
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UFC Fight Night 93 draws 11,763 fans for live gate of $913,428 in Hamburg, Germany
HAMBURG, Germany – Saturday's UFC Fight Night 93 event drew an announced attendance of 11,763 for a live gate of $913,428 U.S. dollars.
RFA 42 results: Christos Giagos beats Arthur Estrazulas, calls for title shot or UFC return
Christos Giagos pleaded for an opportunity to return to the UFC after beating Arthur Estrazulas in the RFA 42 main event. However, his performance was on the less than thrilling side, so he might have some more work to do.
UFC contender Tony Ferguson has Ray Elizalde ready, relaxed for tonight's RFA 42
Ray Elizalde enters the cage at RFA 42 with a sparkling unbeaten record. However, he said the pressure is on the man standing across the cage from him tonight.
RFA 42 headliner Christos Giagos predicts second-round TKO win, UFC return
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Today's UFC Fight Night 87 event drew an announced attendance of 10,421 fans and a live gate of $1,523,320. James Elliott, the vice president and general manager of UFC Europe, Middle East and Africa, announced the figures at the night's post-event news conference, (…)
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LAS VEGAS – Saturday's UFC Fight Night 82 event drew an announced attendance of 7,422 and a live gate of $1.435 million.
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Hi there, this is the creative practice of
I am a serial initiator of creative collaborations - bringing ideas to life as projects. I love hatching plans, galvanising groups, and sharing the results. I write poems, sketch and create events. Based in London, I wander far and wide.
All's Well Wall
A re-expression of the 1901 Camberwell coat of arms in the heart of Camberwell - mural with Istanbul starlet Göksu Gül and Shanghai creative director Ben Weldon, Summer 2016
Being Bodies
A creative exploration of our physicality - each month of 2015 a diverse set of creatives will reflect on a different part of the body - project initiated with Sarah Lowe.
Most Things Move
Most Things Move is an illustrated book of short poems exploring things that move and things that move us. Illustrations by the embarrassingly talented Gretchen Jacobsen and published by Simply This in 2013. The wonderful Katie Bonna said "Each page is bejewelled with lines which catch you unawares, cutting to the quick of our desire to understand human experience."
Into Pieces
Acclaimed composer Hannah Kendall used six of my poems as inspiration for a new work in six movements.
Into Pieces was premiered as part of the CoMA national festival of contemporary music on 4th March 2016 at Kings Place – performed by London Sinfonietta & Contemporary Music for All, and conducted by Gregory Rose.
The poems are read aloud as part of the piece.
I have been part of the London poetry scene since 2009 and try to deliver interesting ideas with straightforward words. I've also performed on my travels in New York, San Fran, Shanghai, and Melbourne. Special shout to Kid I Wrote Back, Sage & Time and Bus Drivers' Prayer.
Take It & Run
A 40-person cross-genre creative collaboration in response to the Pen Paper Pause sketches. I invited people with a creative appetite to take one of my sketches, and run with it, using their own individual style and whatever medium they wanted. We had a project showcase in January 2011 for all the wonderful work – from ilustration to upholstery, from sculpture to song - which you can now enjoy online.
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Pass It On
Pass It On was a 2008 project where I made 100 books by hand and gave them to 100 people; the idea was that if you were given the book you were not allowed to keep it but had to pass it on - a perpetual system of sharing.
Reflections On Darkness
I'm a contributor to this annual project exploring darkness.
The Borough Common
Part of starting and nurturing The Borough Common, a self-organising collaborative community exploring spiritual growth and doing good in the world - an experimental model for religious community.
Let's Go
I have a creative consulting practise called Let's Go where i help organisations of all sorts get going with new things. That normally means a new product/service, a new brand, or a new strategic direction.
Literal Idioms
When we use figurative phrases, we can lose track of the literal meanings of words and we are left with abstract concepts. This project was an attempt to bring back the literal; you can see it all here.


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The Federal Energy Regulatory Commission (FERC) generally has denied rehearing of its comprehensive September 29 rate order concerning Southern Natural Gas Co. (SNG). The order settled 23 rate cases, resolved the company's costs associated with the transition to Order 636, and refunded about $150 million to customers. Last September, FERC chair Elizabeth A.
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