text:
Xirrus Management System
Abbreviated as XMS, the Xirrus Management System is a platform used to provide central management and monitoring of a Xirrus Wi-Fi Array network. XMS uses utilizes a client/server architecture to automatically discover, configure, and monitor an array network. It can also scale from single site to large scale, multi-site deployments. [Source: Adapted from Xirrus.com]
Stay up to date on the latest developments in Internet terminology with a free weekly newsletter from Webopedia. Join to subscribe now.
Webopedia's student apps roundup will help you to better organize your class schedule and stay on top of assignments and homework. Read More »List of Free Shorten URL Services
A URL shortener is a way to make a long Web address shorter. Try this list of free services. Read More »Top 10 Tech Terms of 2015
The most popular Webopedia definitions of 2015. Read More »
Java is a high-level programming language. This guide describes the basics of Java, providing an overview of syntax, variables, data types and... Read More »Java Basics, Part 2
This second Study Guide describes the basics of Java, providing an overview of operators, modifiers and control Structures. Read More »The 7 Layers of the OSI Model
The Open System Interconnection (OSI) model defines a networking framework to implement protocols in seven layers. Use this handy guide to compare... Read More »


text:
- {{matchup.date.fullday}}{{matchup.date.month + ' ' + matchup.date.day}}
Wichita State Defeats Bradley 69-49 - Recap
Wichita State cruised to victory on Tuesday, running Bradley out of the gym and running up a 69-49 score at Carver Arena.
Wichita State was a favorite by 12 points and came through with an ATS victory for bettors.
Wichita State got 15 points from Ron Baker and another 13 points from Tekele Cotton. Tekele Cotton contributed 4 assists, while Tekele Cotton cleaned the glass with 7 rebounds.
Bradley got 18 points from Walt Lemon, Jr. in a losing cause and another 13 points from Tyshon Pickett. Tyshon Pickett contributed 3 assists for them, while Tyshon Pickett had 15 rebounds.
Wichita State led at halftime, 35-25.
Bradley had a 37-36 advantage in the rebounding department as they won the battle in the paint.

subset: commoncrawl


text:
SOOTHE is:
Contains colloidal oatmeal in a base of coconut palm extract and water.
Store in a cool, dry place. Keep out of reach of children.
Cystex Antibacterial And Analgesic Tablets - 100 Ea
Our Price:$11.07
Neutrogena Makeup Remover Cleansing Towelettes Refill Pack - 25 Ea
Our Price:$4.38
Aveeno Active Naturals Smart Essentials Daily Detoxifying Scrub - 5 Oz
Our Price:$4.54
John Frieda Frizz-Ease 3-Day Straight Semi-Permanent Styling Spray - 3.5 Oz
Our Price:$5.92


text:
Results 1 to 2 of 2
- 02-12-2013, 06:39 PM Thread Author #1
- Posts
- 657 Posts
- Global Posts
- 681 Global Posts
- Carrier
- Carbon Rom
Anybody have this bluetooth keyboard case(KHOMO black leather case)?
Hey all, I've been wanting to use my nexus 7 to take notes in school and I am looking into ordering a keyboard CASE, simply for the convenience. So, do any of you have this case and are willing to give a little review on it? it looks really nice, but the only drawback seems to be that the keyboard is small. Thanks!
Amazon.com: KHOMO Black PU Leather 360 Degree Rotating Bluetooth Keyboard Case Cover Stand for Google Nexus 7 tablet (with Automatic Sleep/Wake Function): Computers & Accessories
Similar Threads
Anyone try this bluetooth keyboard/touch pad?By jodyberry in forum Samsung Galaxy Note 2Replies: 6Last Post: 01-07-2013, 12:10 PM
does anybody have this phone lg enlighten?By z71kris in forum LG EnlightenReplies: 2Last Post: 03-09-2012, 02:22 PM
Does anybody have this case?By Horr1bleK1tten in forum Acer Iconia A500Replies: 20Last Post: 12-30-2011, 06:24 PM
Anybody having this issue.By LancerzRalliart in forum Sprint PhotonReplies: 2Last Post: 11-09-2011, 08:16 AM
Anybody have this desktop cradle?By ThomasT626 in forum Thunderbolt AccessoriesReplies: 10Last Post: 04-04-2011, 09:12 AM


text:
Blowin Up
Auteur Explosion that monthly carnival for all things artistic and off-kilter is back in action Saturday night at 9 p.m. for the latest in its series of local, indie gatherings. This time around, local jazz-funk outfit the Seeds of Evolution open up the night with a set of tracks that conjures early era Red Hot Chili Peppers. Later on: The Craven, a synth-driven, new wave project from South Florida stalwart, Timb Krueller; and Astari Night, a spacey quartet that tips its hat to the drone of Sonic Youth. In addition to the good tunes, the tantalizing vixens of Shameless Burlesque will hop on stage sporting some strategically-placed tassels, while art exhibits from Jerry LaVigne Jr., the Art of the Soul, and J. Vinazza will keep folks talking in between sets. At midnight the short films take over, with screenings of Revenge of the B-Girl$, a grindhouse revenge flick that shows some love to the genre, and The Making of Death Print, a someday-DVD-extra chronicling Miami director Aiden Dillards magnum opus. Admission will run you only $5; simply head to Cinema Paradiso at 503 SE Sixth St. in Fort Lauderdale. For more info, visit fliff.com.
Photo by Sonya Revell
Sat., June 20, 9 p.m., 2009
Get the Things to Do Newsletter
Sign up for our weekly guide to events in South Florida, and never be bored again. With suggestions for every day of the week, our recommendations will keep you busy on any budget.
Upcoming Events
Sponsor Content


text:
Immunoarchitectural Patterns in Nodal Marginal Zone B-Cell LymphomaA Study of 51 Cases
Nodal marginal zone lymphoma (NMZL) represents a rare and heterogeneous group that lacks markers specific for the diagnosis. We evaluated morphologic and immunoarchitectural features of 51 NMZLs, and the following immunostains were performed: CD20, CD21, CD23, CD5, CD3, CD43, CD10, Ki-67, BCL1, BCL2, BCL6, HGAL, and LMO2. Four immunoarchitectural patterns were evident: diffuse (38 [75%]), well-formed nodular/follicular (5 [10%]), interfollicular (7 [14%]), and perifollicular (1 [2%]). Additional features included a monocytoid component (36 [71%]), admixed large cells (20 [39%]), plasma cells (24 [47%]), compartmentalizing stromal sclerosis (13 [25%]), and prominent blood vessel sclerosis (10 [20%]). CD21 highlighted disrupted follicular dendritic cell meshwork in 35 (71%) of 49 cases, and CD43 coexpression was present in 10 (24%) of 42 cases. A panel of germinal center–associated markers was helpful in eliminating cases of diffuse follicle center lymphoma. Our results highlight the histologic and immunoarchitectural spectrum of NMZL and the usefulness of immunohistochemical analysis for CD43, CD23, CD21, BCL6, HGAL, and LMO2 in the diagnosis of NMZL.
- Nodal marginal zone lymphoma
- Monocytoid B cells
- Low-grade B-cell lymphoma
- Immunoarchitecture
- Immunohistochemistry
Nodal marginal zone lymphoma (NMZL) was initially described by Sheibani and colleagues in 19861 as monocytoid B-cell lymphoma because of the similarity of the neoplastic cells to monocytoid B cells that are typically seen in Toxoplasma lymphadenitis. Cousar and colleagues2 used the term parafollicular lymphoma to best illustrate the distribution of the neoplastic cells around hyperplastic follicles. Shortly thereafter, Piris and colleagues3 recognized that lymphomas arising from monocytoid B cells shared similarities with marginal zone cells based on the presence of distinctive nodal architectural and cytologic features, expression of IgM, and electron microscopic observations of short cellular processes and moderately well-developed endoplasmic reticula.
The revised European-American Classification of Lymphoid Neoplasms and the World Health Organization (WHO) classification of hematological malignancies (2001 and 2008) recognized and classified this entity as NMZL.4–6 The term NMZL is used to define marginal zone lymphomas (MZLs) with primary presentation in the lymph node in the absence of clinical evidence of prior or concurrent involvement of extranodal sites (other than the bone marrow) or spleen.7 Although the relationship among nodal, splenic, and extranodal manifestations of MZL remains controversial, multiple studies report differences in disease distribution and clinical outcome among these entities that argue for consideration of NMZL as a distinct entity,8–12 and it is therefore recognized as such in the current WHO classification.6
NMZL is an uncommon form of lymphoma representing 1.5% to 1.8% of lymphoid neoplasms,9,10 with only rare reports in the literature that have attempted morphologic or immunophenotypic characterization. Typically, NMZL has been recognized to exhibit two morphologic patterns, one resembling nodal involvement by extranodal MZL of mucosa-associated lymphoid tissue (MALT) and the other resembling splenic MZL. The resemblance of subsets of primary NMZL to extranodal and splenic MZLs has led to the proposal of subdividing NMZL into MALT-type and splenic-type NMZL.13 In addition, highly variable plasma cell, monocytoid B-cell, and large cell components, as well as follicular colonization, are also described. The lack of definitive immunophenotypic or molecular markers that are specific to this lymphoma offers a continuing challenge for diagnostic accuracy and reproducibility. We undertook this study to better characterize the morphologic and immunoarchitectural features of NMZL to enable separation of typical and variant patterns of NMZL from the other categories of low-grade B-cell lymphomas with which they overlap.
Materials and Methods
Case Selection
We conducted a retrospective review of cases between 1995 and 2004 from the archives of the Department of Pathology, Stanford University Medical Center, Stanford, CA. Institutional review board approval was obtained for these studies. Cases were selected based on the inclusion criteria of MZL with primary presentation in lymph nodes without extranodal or splenic involvement before or at the time of presentation. Extranodal and splenic MZLs were excluded by these clinical features. Although separating NMZL with clonal plasma cells from lymphoplasmacytic lymphoma (LPL) involving lymph nodes is a problem area and there are no unambiguous criteria for this distinction, cases with a significant monoclonal plasma cell component, a high degree of bone marrow involvement by a lymphoplasmacytic component, or clinical findings suggestive of LPL or plasma cell myeloma were excluded from the study.
We identified 53 cases with primary nodal presentation; 2 of these cases were eliminated after additional studies with germinal center–associated markers were performed and found to be positive. These 2 cases represented follicular lymphomas and were excluded on the basis of immunophenotypic criteria. The remaining 51 cases comprise the study population. The patients ranged in age from 19 to 87 years with a male/female ratio of 2:3. The disease in 1 patient had progressed to diffuse large B-cell lymphoma (DLBCL) as shown on a repeated biopsy 14 months after the initial diagnosis. The vast majority of cases were seen in consultation, and further clinical follow-up was not pursued because clinicopathologic correlation was not the main intent of this study.
Morphologic Evaluation
Morphologic evaluation was performed on formalin-fixed, paraffin-embedded tissue sections from the original diagnostic biopsies of each patient. The overall architecture together with the presence or absence of monocytoid and plasmacytoid cells and a large cell component and characteristics of stromal elements, sclerosis, and vasculature were evaluated. Follicular colonization was defined as reactive follicles that are wholly or partially overrun and virtually replaced by the neoplastic infiltrate, resulting in poorly defined follicles within which fragmented residual germinal center cells and small, darkly stained mantle zone cells are dispersed. In some cases, follicles are expanded by the infiltrating cells with loss of the characteristic zoning pattern of reactive follicles.14 Cells were defined as large cells if they demonstrated the following features that are characteristic of transformed B cells: enlarged nuclei (at least 2 to 3 times larger than those of small lymphocytes), open chromatin, 1 or 2 prominent nucleoli, and abundant pale cytoplasm. The presence of a large cell component was assessed by using a semiquantitative scale based on the percentage of large cells in 10 high-power fields and was categorized in the following groups: 0% to 10%, 11% to 20%, 21% to 40%, 41% to 50%, and more than 50%. In the evaluation of large cells, colonized or overrun follicles were carefully avoided with the use of antibody stains.
Immunohistologic Studies
For the study, 4-μm sections from representative paraffin blocks were deparaffinized in xylene and absolute ethanol and then rehydrated by successive immersions in 95% ethanol, 70% ethanol, and distilled water. All immunohistologic staining was performed on a Ventana ES instrument (Ventana Medical Systems, Tucson, AZ) using an indirect biotin-streptavidin method according to manufacturer recommendations with appropriately staining positive and negative control samples. Primary antibodies to lymphocyte markers, including CD20, CD3, CD5, CD43, BCL2, BCL1, CD21, CD23, Ki-67, CD10, BCL6, HGAL,15 LMO2,16 CD138, and κ and λ light chains, were applied, and a detection system using 3,3′-diaminobenzidine was used. Slides were counterstained with hematoxylin. Conditions used for immunohistochemical analysis, dilutions, and sources of all primary antibodies used in this study are shown in Table 1.
Architectural Patterns
Four architectural patterns were apparent on histologic sections and have been designated diffuse, nodular/follicular, interfollicular, and perifollicular Image 1. The frequency of these patterns and associated cytologic features are shown in Table 2.
The diffuse pattern, characterized by sheets of neoplastic cells with effacement of nodal architecture, represented the most common pattern and was evident in 38 of 51 cases. Of the cases with diffuse patterns, 18 also exhibited a vague nodular pattern as a minor component (range, 10%–40% of total area of the node evaluated). The diffuse pattern was intermixed with the nodular pattern in 1 case and the perifollicular pattern in 1 case; both patterns occupied approximately 50% of the node.
The nodular/follicular pattern was noted in 5 cases and was characterized by well-formed nodules that were well demarcated from the uninvolved interfollicular areas and replaced the normal nodal parenchyma. These nodules were crowded, monotonous in size and shape, and composed mostly of small neoplastic cells without evidence of germinal centers or a biphasic pattern (ie, inner darker and outer lighter areas such as seen in the reverse biphasic pattern in splenic MZL).
The neoplastic cells in cases with the interfollicular pattern were limited to the interfollicular areas and spared the normal secondary follicles containing germinal centers. Among the 7 cases with the interfollicular pattern, 4 showed prominent perivascular/perisinusoidal involvement.
The perifollicular pattern was characterized by annular distribution of the neoplastic cells around uninvolved normal secondary follicles and was noted only in 1 case. This pattern was noted in a second case as a minor component intermixed with a diffuse pattern.
Increased numbers of blood vessels were evident in 37 cases (73%), with vascular wall sclerosis in 10 cases (20%). Blood vessel sclerosis (thickening of small vessel walls with sclerotic material) was closely associated with the distribution of the neoplastic cells; this was most evident in cases with a nodular/follicular pattern in which sclerosis was limited to areas with follicular colonization. Interstitial sclerosis, ranging from fine to coarse sclerotic bands, was seen in 13 cases (25%). These sclerotic bands compartmentalized small groups of neoplastic cells and were most evident in cases with a diffuse pattern: 12 cases with the diffuse pattern and 1 with the nodular/follicular pattern showed interstitial sclerotic bands. One case showed associated partial involvement by Castleman lymphadenopathy–like features along the periphery of the lymph node.
Cytologic Features
There was variation in the size of neoplastic cells and in the shape and size of nuclei (cellular pleomorphism). Typically, a range from small to large cells was present within the neoplastic infiltrate. Cellular polymorphism was evident in 38 (75%) of 51 cases, whereas the remaining 13 cases showed predominantly small cells with occasional, scattered, intermediate-sized cells. A large cell component was identified in the following proportion of cases: 43 cases had 0% to 20% large cells, and 8 cases had 21% to 50% large cells. None of the cases showed more than 50% large cells. A higher content of larger cells (40%–50% large cells) was evident in cases with interfollicular (2 cases) and perifollicular (1 case) patterns. In addition, none of the cases with the nodular/follicular pattern showed cellular pleomorphism or a large cell component. A monocytoid B-cell component was present in 36 (71%) of 51 cases, with the following distribution: 27 diffuse, 4 nodular/follicular, and 5 interfollicular patterns. Increased numbers of plasma cells, scattered singly and in small clusters, were present in 24 cases (47%). An overt increase in eosinophils was noted in two cases, and an increase in neutrophils in association with the tumor cells was noted in another case. One case had increased numbers of histiocytes, and its corresponding involvement of the bone marrow also showed an infiltrate with increased histiocytes. Examples of typical cytologic features are shown in Image 2.
Immunohistologic and Immunoarchitectural Features
The immunohistologic characteristics are summarized in Table 3. In all cases, the neoplastic cells were positive for CD20. The stain for CD138 highlighted an increase in plasma cells in 24 (47% of 51 cases), and monoclonality (7 with κ and 9 with λ light chain restriction) was confirmed by immunohistochemistry or in situ hybridization in 16 (31%) of 51 cases. CD43 coexpression was observed in 10 (24%) of 42 cases, and BCL2 was detected in 12 (43%) of 28 cases. The expression of CD43 did not correlate with any particular immunoarchitectural pattern. The stains for CD3, CD5, cyclin D1, and IgD were negative in all cases tested. CD23 was found to highlight neoplastic cells in 1 case in which the staining was diffuse but weakly positive Image 3 (row 1).
The stain for CD21 was performed in 49 cases. This stain highlighted disrupted follicular dendritic cell (FDC) meshwork in 35 cases (71%), while prominent intrafollicular nests of neoplastic cells were highlighted in 13 (27%) cases (Image 3, row 2). The intrafollicular nests of neoplastic cells were found in 7 cases with a diffuse pattern, 4 with the nodular/follicular pattern, and 1 with the perifollicular pattern. Intact or disrupted FDC meshwork associated with residual germinal centers was absent in 8 cases exhibiting a diffuse pattern and in 1 with the nodular/follicular pattern. The stain for CD23 highlighted residual and disrupted FDC meshwork in 8 (40%) of 20 cases, all of which corresponded to the cases that were also highlighted by CD21 staining. The proliferation marker, Ki-67, was evaluated in 13 cases: a high growth fraction was present in residual germinal centers; the neoplastic proliferation showed a range of staining from 5% to 40%, which was primarily localized to scattered transformed large cells (Image 3, row 3).
Separation of the nodular/follicular pattern of NMZL from follicular lymphoma, particularly in cases of follicular lymphoma with a diffuse component, can be problematic. The pattern of staining for CD20, BCL2, and germinal center–associated markers can aid in this separation, as shown in a typical case of NMZL with a nodular/follicular pattern and associated immunohistologic stains Image 4. A panel of 4 germinal center–associated markers, CD10, BCL6, HGAL, and LMO2, was used to eliminate cases of diffuse follicle center lymphoma that show morphologic overlap with NMZL. Initially, 53 cases were retrieved from our files with the diagnosis of NMZL that fulfilled criteria for this study. Staining for CD10 was uniformly absent in all 53 cases; however, 2 cases showed staining for BCL6, HGAL, and LMO2 (both cases showed diffuse staining for BCL6 and LMO2; one case showed weak focal staining for HGAL). This staining was convincingly localized to the neoplastic cells and was not related to residual germinal center cells in colonized or overrun follicles Image 5. Both cases exhibited a diffuse growth pattern and were reclassified as follicle center lymphomas (diffuse pattern, low grade) and not included in the analysis of NMZL immunoarchitectural patterns.
Currently, the WHO guidelines for the diagnosis of lymphoid malignancies require the integration of clinical, morphologic, immunophenotypic, and genetic information for a definitive diagnosis. To date, no immunophenotypic or genetic marker specific to NMZL has been identified. Therefore, the diagnosis of this entity relies on the recognition and development of diagnostic criteria based solely on morphologic and immunoarchitectural patterns and the integration of clinical data at the time of presentation to determine a diagnosis. Because of the rarity of NMZL, large series that thoroughly characterize their pathologic features are limited. In this study, we morphologically and immunophenotypically characterized, to the best of our knowledge, the largest series of primary NMZL cases that meet the current WHO criteria for this entity. We define 4 distinct immunoarchitectural patterns of NMZL that we have designated diffuse, nodular/follicular, interfollicular, and perifollicular and describe their histologic and immunoarchitectural features.
Peripheral lymph node involvement can be seen in extranodal and splenic MZLs.9,17 Thus, in our cohort, we excluded any case with extranodal disease, splenic, or splenic hilar lymph node involvement. The distinction between NMZL with clonal plasma cells and LPL involving lymph nodes is problematic, and currently there are no unequivocal criteria to separate these entities. As such, the morphologic and immunoarchitectural features need to be assessed in the light of clinical manifestations. In the current study, we excluded cases with an increased monoclonal plasma cell component in the lymph node, extensive marrow involvement, and clinical or radiologic features suggestive of LPL or plasma cell myeloma. Although plasma cells were noted in a large proportion of our cases (47%), they represented only a minor component of the neoplastic infiltrate in the lymph node. All cases described in this report met strict diagnostic criteria for NMZL with primary lymph node presentation and absence of extranodal or splenic disease at the time of this study. It is, however, important to consider that some cases of NMZL may manifest as extranodal disease on follow-up and represent secondary involvement of lymph nodes.13
In accord with previous studies, diffuse effacement of architecture (the diffuse pattern) was most commonly encountered with an associated vague nodular pattern in 47% of cases. In cases with both patterns, the diffuse pattern usually represented the major component, and the nodular pattern was a minor component occupying approximately 10% to 40% of the lesion. Traverse-Glehen and colleagues18 made a similar observation that cases with the diffuse pattern are closely associated with a nodular pattern. In contrast with the findings of previous studies,10,18 we identified well-formed follicles in 10% of cases but did not observe any with the so-called inverse follicular pattern. This inverse follicular pattern, which has been described as a follicle with a dark-staining inner zone surrounded by a light-staining outer zone on H&E sections, is typically seen in a subset of splenic MZL and a small number of NMZL (2 of 21) cases in an earlier study.18
A problematic area in the diagnosis of NMZL with a well-defined follicular/nodular or diffuse pattern is its separation from low-grade follicular lymphoma. Germinal center–associated markers that highlight follicular lymphoma cells are typically absent in NMZL. However, subsets of follicular lymphoma may also lack germinal center–associated markers, making the distinction between these entities a diagnostic challenge. We encountered 2 such cases with a diffuse pattern that were originally diagnosed as NMZL based on the lack of CD10 staining. However, with the use of additional germinal center–associated markers, these cases were reclassified as diffuse follicle center lymphomas. In this context, BCL6, HGAL, and LMO2 performed better than did CD10 and showed more sensitivity and specificity for follicular lymphoma cells. In these 2 cases, CD21 immunostaining highlighted disrupted FDC meshwork, a finding that further confounded their separation from NMZL. Overall, CD21 highlighted disrupted FDC meshwork with follicular colonization in the majority of cases in our cohort (71%), regardless of the morphologic pattern, although it was more prominent in cases with a well-defined follicular/nodular pattern (4/5 [80%]). In a recent study of 15 NMZLs with prominent follicular colonization, the difficulty in distinguishing NMZL from other low-grade lymphomas with a follicular pattern is well illustrated.19 Our findings are in agreement with that study and further highlight the need for recognition of the extensive disruption of FDC meshwork and follicular colonization that is often seen in NMZL.
The presence of follicular colonization and disrupted FDCs in some cases and the complete absence of FDCs in other cases suggest a possible evolution of tumor pattern in NMZL. The cases that showed a complete absence of FDCs likely represent more advanced tumors that replace the lymph node architecture. We were unable to verify whether the attrition and eventual absence of FDC meshwork correlate with progression of disease in our cohort of cases because clinical follow-up information was limited. However, this concept warrants further examination on clinically well-characterized cases.
Immunohistologic staining for CD43 and BCL2 can be helpful in the diagnosis of NMZL but shows significant variation among cases and in rates of positivity reported in previously published studies. Staining for CD43 is reported to range from 20% to 75%, whereas the staining for BCL2 has been reported to range from 62% to 100%.12,13,18–22 Lai and colleagues22 showed that CD43 staining was positive in 20% to 40% of nodal and extranodal MZLs, and staining for CD43 in our cohort was in the same range. However, BCL2 positivity was significantly lower in our cohort. A number of factors may be responsible for this difference, including differences in methods and antigen retrieval among cases sent in consultation. In addition, the inclusion criteria used in some studies whereby cases were selected based on their positivity of CD43 and/or BCL2 may also play into the higher number of positive cases reported in published series.12 Nevertheless, it is important to recognize that although immunohistologic stains for CD43 and BCL2 are helpful when present and aid in identifying the neoplastic B-cell infiltrates on which they are coexpressed, their expression is not essential for the diagnosis of NMZL. In addition, other B-cell non-Hodgkin lymphomas such as mantle cell lymphoma (frequently positive for CD43 and BCL2) and follicular lymphoma (particularly, diffuse follicle center lymphoma) should also be carefully eliminated from the differential diagnosis.
Another important morphologic consideration in the diagnosis of NMZL is its relationship to DLBCL, which is particularly problematic in NMZL with increased large transformed B cells. Nathwani and colleagues10 described progression to DLBCL as the cases with more than 20% large cells. In our cohort, however, we found more than 20% large cells in 16% of cases: many of these cases exhibited increased numbers of scattered large cells, and in a minority of cases, up to 50% of large cells were present. These cases showed no significant correlation with a particular morphologic pattern and did not correspond to the 1 case that showed transformation to large cell lymphoma in a subsequent biopsy.
In addition, none of our cases demonstrated sheets of large cells. Similar to the findings of Traverse-Glehen et al,18 our findings suggest that the presence of a large cell component in NMZL is more frequent than previously recognized.3,9,10 This finding of increased scattered large cells should not be confused with sheets of large cells, particularly if the latter is associated with an increase in proliferation (as measured by Ki-67 staining), because sheets of large cells, even if focal, should raise concern for progression to large cell lymphoma. Kojima and colleagues12 recently reported a series of 65 cases of NMZL, of which 20 cases had more than 50% large cells or sheets of large cells and were classified as "DLBCL + MALT-type NMZL"; these cases were associated with a significantly worse outcome.12 Our cohort did not include cases with more than 50% large cells or sheets of large cells and, thus, met the current WHO definition of primary NMZL. Nevertheless, the criteria for the diagnosis of progression to large B-cell lymphoma from NMZL are not well established, and there is no set cutoff for proliferation (as assessed by Ki-67) to aid in this distinction.
B-cell lymphomas arise as a result of deregulation and clonal expansion of B cells at distinct developmental stages, and NMZLs are thought to arise from marginal zone B cells of the lymphoid follicle. Conconi and colleagues23 observed various patterns of immunoglobulin heavy chain variable region (VH) gene mutations in NMZL and identified distinct subsets of B cells, including naive (unmutated V regions) and germinal center and memory B cells (undergone somatic hypermutation) from which NMZLs were derived. These findings suggest that NMZLs originate from different subsets of marginal zone cells and provide a plausible explanation for the immunoarchitectural heterogeneity of this group. Furthermore, although NMZL is thought to arise from marginal zone B cells of lymphoid follicles, aberrant expression of germinal center–associated markers has also been reported in NMZL. From a diagnostic standpoint, the expression of germinal center–associated markers in rare cases of NMZL and their lack in a subset of follicular lymphomas make the separation of NMZL from diffuse follicle center lymphoma particularly challenging. In our experience, the use of additional germinal center–associated markers is helpful in ruling out follicular lymphoma, particularly if staining for CD10, a marker frequently used in immunohistologic panels, is absent. In this study, we found that together with BCL6, HGAL and LMO2, 2 recently characterized germinal center B cell–associated markers, are excellent adjuncts in the immunohistologic workup of low-grade B-cell lymphomas, especially those that exhibit a diffuse small lymphoid proliferation.
We describe a large series of primary NMZLs that highlights the heterogeneity of this disease and exhibits a spectrum of morphologic and immunophenotypic variability. The 4 immunoarchitectural patterns we describe, together with their frequency and potential overlap with other lymphomas in the differential diagnosis, provide a greater understanding of the inherent heterogeneity of this lymphoma. The presence of large cells in a significant proportion of cases and the inclusion of germinal center–associated markers in their workup support and extend previous observations. In addition, we found that CD21 staining was particularly useful in highlighting disrupted FDC meshwork and follicular colonization, a feature that lends support for the diagnosis of MZL. Recent gene expression profiling studies of splenic MZL have pointed to specific abnormalities in that entity,24 which, after further testing and validation, can be used for the diagnosis of splenic MZL. Similarly, genomic and proteomic approaches to interrogate NMZL will be needed and will likely furnish candidate markers specific to the diagnosis. In the interim, awareness of the immunoarchitectural patterns of NMZL is important for making an accurate and reproducible diagnosis and for distinguishing this entity from other lymphomas in the differential diagnosis.
↵* Dr Salama is currently at the Department of Pathology, University of Utah, Salt Lake City.
Supported in part by grants POI CA34233, CA109335, and CA122105 from the National Institutes of Health, Bethesda, MD.
- © American Society for Clinical Pathology


text:
I love me a good pointless song and there is no doubt that the hit song of the summer is "Call Me Maybe" by Carly Rae Jepsen — a fellow Canadian which is another bonus. This song plays all.the.time on the radio and is catchy enough for me to randomly find myself singing it in my head <<dang catchy song!>>
Of course with anything popular another thing I love is a good pointless meme to go along with the catchy tune. I think that's when I knew this song was a sure thing — when the memes started up like crazy — and they are funny too.
Of course, our beloved pets can't be left out of the fun! There are some totally funny spoof memes from this song sprinkling the internet with it's awesome & I've rounded up the best.
Click through to see the 5 most popular "Call me Maybe" memes for animals:
I'm a Dingo 1 of 5Classic line! This is the first animal call me meme I saw and it still gives me a bit of a smile.
Photo hosted on ICHC Network
Yes, This is Dog 2 of 5Oh dog you're so popular even Maybe is calling.
Photo hosted on ICHC Network
I Just Bit You 3 of 5This one is my favorite out of the bunch. It's just too funny.
Photo hosted on ICHC Network
I'm Your Kitten 4 of 5Can you beat a sweet kitten face and a funny rhyme telling is to do it's will?
Photo hosted on ICHC Network
Squirrel 5 of 5I love this movie and Doug is one of the best characters. He is just so ... squirrel !
Photo hosted on ICHC Network
Photo credit: modified image hosted on ICHC Network


text:
MoMA MULTIMEDIA
MoMA Multimedia
(American, born 1955)
Steve Wolfe. Untitled (Cubism and Abstract Art). 1997
(American, born 1955)
Oil, lithography ink, and modeling paste on paper mounted on wood and canvasboard, 10 1/4 x 8 x 7/8" (26.0 x 20.3 x 2.2 cm). Given anonymously. © 2009 Steve Wolfe
Audio courtesy of Acoustiguide
Special Exhibitions Audio: Open Ends (9)
Steven Holl Architects. Bridge of Houses Project, Melbourne, Australia, Scale model 1/16" = 1'0". 1979-82
Joel Shapiro. Fingerprint Drawing. (1969)
James Rosenquist. Campaign. 1965
Karin Sander. Wallpiece 24 x 18". 1994
Glenn Ligon. White #19. 1994
Andy Warhol. Hammer and Sickle. 1976
Willie Cole. Domestic I.D. IV. 1992
Steve Wolfe. Untitled (Cubism and Abstract Art). 1997
Andy Warhol. Campbell's Soup Cans. 1962
MoMA Channels
Select <
- Featured Content
- Most Recent
- Audio
- Videos
- Interactive
If you are interested in reproducing images from The Museum of Modern Art web site, please visit the Image Permissions page (www.moma.org/permissions). For additional information about using content from MoMA.org, please visit About this Site (www.moma.org/site).
© Copyright 2016 The Museum of Modern Art
Welcome to MoMA.org. To take full advantage of all the site's features, including the option to save works in the collection, please upgrade your browser to Firefox, Google Chrome, Safari, or Internet Explorer 9. See our help page for more information.
To take full advantage of all of the features on MoMA.org, please upgrade your browser to Firefox, Google Chrome, Safari, or Internet Explorer 9.


text:
An anti-Semitism claim against an Anglican vicar by the Board of Deputies of British Jews was resolved through mediation.
Justin Welby, the Archbishop of Canterbury, leads the Church of England and the Anglican church worldwide. He also happens to be half-Jewish on his father's side.
The Jewish umbrella body in Britain lodged a complaint with church officials about an Anglican vicar whom they accuse of anti-Semitic speech.


text:
View: All | by Category
Sort by: Date | Title
Descriptions: Show | Hide
|Gun-Free Schools Act Implementation Report for 2001-2002 ( MS Word) (Nov 23, 2004)
|This document is a report on the implementation of the Gun-Free Schools Act in the States and outlying areas for School Year 2001-2002
|Partnering To Prevent Truancy Conference (Oct 28, 2004)
|Joint Justice and Education conference offers attendees practical approaches to reduce truancy in their schools and communities.
|Safe Lanes on Campus: A Guide for Preventing Impaired Driving and Underage Drinking (Mar 10, 2004)
|This publication helps senior administrators, faculty, staff, students, community leaders, enforcement agencies, and campus and community coalitions in choosing prevention strategies appropriate to their campus and their community.
|Portable Document Format (PDF) (1MB)
|Student-led Crime Prevention: A Real Resource with Powerful Promise (PDF) (May 20, 2003)
|This guide will provide principals, other school administrators, teachers, school resource officers, and interested community members with the basis to articulate how students can help make the school safer and the steps for considering and establishing student-led initiatives.
|Practical Information on Crisis Planning: A Guide for Schools and Communities (PDF) (May 14, 2003)
|The U.S. Department of Education has developed a guide to provide schools and communities with basic guidelines and useful ideas on how to develop emergency response and crisis management plans.
|The Final Report and Findings of the Safe School Initiative: Implications for the Prevention of School Attacks in the United States (MSWORD) (May 31, 2002)
|The Safe School Initiative drew from the Secret Service's experience in studying and preventing assassination and other types of targeted violence and the Department of Education's expertise in helping schools facilitate learning through the creation of safe environments for students, faculty, and staff. This document, the Safe School Initiative's final report, details how our two agencies studied school-based attacks and what we found.
|Safeguarding Our Children: An Action Guide (Apr 28, 2000)
|On April 28, 2000, the U.S. Department of Education and Department of Justice released a new jointly developed Action Guide to help schools and communities prevent school violence.


text:
Hampton Inn - Warner Robins
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this hotel rated in the past?
- Free High-Speed Internet
- Continental Breakfast
- Swimming pool
- Business Services
- Fitness/Health center
- Wheelchair accessibility
Travelers also recommend:
- More recommendations
- Swimming pool
- Fitness/Health center
- Free High-Speed Internet
- Wheelchair accessibility
- Free parking
- Continental Breakfast
- Business Services
TripAdvisor Reviews Hampton Inn - Warner Robins
Travel Blogs from Warner Robins
The Lake in Georgia and Fried Green Tomatoes
... to storms and there was a weather warning on the radio that the whole of Georgia had storm warnings and to stay indoors (great) So we carried on through battling with the rain on the highway till we saw white sky ahead, we thought yes it's over.... But no it wasn't. It turned out to be the eye of the storm and I thought we were going to die. So I pulled over on the hard shoulder and put my hazards on. The rain was so hard you couldn't see out your windscreen. Worse than any other ...
Big traffic jams and high humidity
A quick blog today. I will add to when I have more time. At this stage all I will say is that we are late in due to horrendous traffic on various interstates. It has been very hot and humid so need a drink and some food. I will catch up with you ...
On the road again...
... while we talked to John. The 2 of us ate the whole pizza! And then, suddenly, it seemed, it was time to hit the road.
I'm writing this post as Jeff drives through north Florida (I drove from Simpsonville to Warner Robbins). We are listening to the East Village Opera Company LOUD on the car stereo (piped in from Jeff's iPhone).
Holy mackerel!!! A semi just cut us off - good reflexes on Jeff's part, but I'd better stop writing and "help" him drive!
Deep Cultural Southern Roots
... and General Joseph E. Johnston of the Confederacy. Kennesaw Mountain was a key point, as it was within sight of Atlanta and the much sought-after industrial base for the Confederacy. To this point, General Sherman had used a series of right-flanking moves in trying to get around General Johnston, but decided at Kennesaw to use a frontal assault. It was an ill-fated decision that cost him dearly in casualties. The main assaults actually took ...
A Thankful Thanksgiving
... thrown into the fray of crazy people trying to grab insignificant items for a few dollars. Just the combination of the people and intense atmosphere made me want to punch the nearest person in the face for almost no reason. I have been assured by Ible that our shopping experience should not be like that. So, I am looking forward to tomorrow morning and whatever it may bring.
On the 29th, after the ...


text:
Stumbled across this awesome girl - Fuyuri - on Dropsnap. How amazing does she look?! Then I clicked around on various links (as you do) and found her again through her Sister blog (Sister). Ha, she just gets better and better. Had to share the awesomeness! I'm loving all these patterned stockings and chic Jackets.
Thursday, December 3, 2009
Posted by Suri May at 10:50 PM
Labels: Drop Snap, Street Fashion
4 comments:
- yiqin; said...
Very well put together <3
- December 4, 2009 at 2:07 AM
- Rebecca, The Clothes Horse said...
She's fantastic, so edgy. Love the tights.
- December 4, 2009 at 2:34 PM
- Harry McKinley said...
Wow, she is fierce!
- December 5, 2009 at 1:22 AM
that white coat is AMAZING
- December 5, 2009 at 5:42 PM
Subscribe to: Post Comments (Atom)


text:
Science Based Cuisine
Cook something new. Eat something. Feed someone. Learn. Share. Enjoy. http://sciencebasedcuisine.com
Thursday, May 12, 2016
Oliver Twisting
Multiple friends and acquaintances promptly sent this pretty good piece John Oliver did "exposing" the media exploitation of scientific studies. Whilst entertaining, the irony is that to do this piece, Oliver's team had to cherry pick the data itself. For example, how frequently did media outlets report the studies accurately as opposed to exploit it for the benefit of the story?
And let's not forget Oliver's own fast and loose interpretation of science (and "scientists") to forward the requisite controversy in a story.
Posted by Dr. Ricky at 5/12/2016 12:40:00 PM
No comments:
Labels: commentary, entertainment, journalism, science, television
Wednesday, May 11, 2016
Softer, whiter, more predictable
|Selection of delicious doughnuts from Morningstar
An interesting parenthetical clause. After all, much handwringing and high value is given to using "unbleached" and "unbromated" flour already exists, but what is the basis for mentioning potassium bromate directly?
Before we go into the chemistry of flour bleaching, I tried to find out just how often potassium bromate is added to flour. By law, it has to be listed among the ingredients, and it's quite difficult to source specifically bromated flour. In fact, I get the impression that using bromate in flour has fallen out of favor given the concern that less that fully cooked bread can retain trace amounts of it - and there are multiple alternative oxidizing agents available. I'd welcome comments as to the commonality of bromated flour in restaurant and home applications.
So why is bread bromated and or bleached? Freshly milled flour actually doesn't bake very well, and usually has a yellowish cast. Aging the flour while exposed to air results in oxidation of the proteins and carotenoids, resulting in a paler color, and better baking performance. However, aging is notoriously poorly reproducible, and slow. But we do know that what we are looking for is oxidation - so we can add oxidizing agents in trace amounts to not only speed the process but also make it more reproducible. So, bleaching agents (i.e., benzoyl peroxide) serve to whiten the flour, while maturing agents help develop the gluten. Potassium bromate is a maturing agent - so it doesn't serve to create "whiter dough". Note, however, that there are multiple possible bleaching and maturing agents. In most small batch situations, there really is negligible difference between using unbleached and bleached flour - arguably when scaled up to industrial levels, the differences in reproducibility can be dramatic. But at least in the case of cake flour, bleached (matured) flour is definitely superior in angel food cake.
Search results for potassium bromate on Google will be dominated by multiple articles calling it out as a carcinogen - notably the IARC classification of carcinogen Category 2B. However, this classification is so broad, it includes things like coffee, pickled vegetables, and talcum powder. Being a powerful oxidizing agent, doses of potassium bromate is undoubtedly toxic, but I don't see any concern about it with regards to flour. Adding an emotionally charged and factually dubious clause to the report tends to fuel the misunderstandings about flour processing. I do think preference for unbleached flour is certainly any cook's prerogative, but scientifically, that declaration does not add significant value.
Hat tip to Stella Parks of bravetart.com for her article in Serious Eats. And to Sam Vance (@samvance on Twitter) for vigilant reading of food science, and for sending Stella's article my way.
Posted by Dr. Ricky at 5/11/2016 03:33:00 PM
No comments:
Labels: baking, chemophobia, cooking, doughnuts, gluten
Tuesday, November 3, 2015
Ghost of Gluten-free
|Torta de chile relleno. Oaxaca, Mexico.
Or "How modern journalism works".
Keeping up with the scientific reports, I came across this link suggested by a popular science communication site. Dated 2 November 2015, it's a snarky blog post titled Millennials Seek New Ailment After Gluten Sensitivity Turns Out Not To Be Real - the gist of which is summarized in the first paragraph:
A new scientific study by the people who proved that gluten sensitivity is a definitely a thing has proved that gluten sensitivity is definitely not a thing.Note the use of "new". Following the link, it leads to a ScieceAlert page dated 19 August 2015, which details a familiar shift of the issue from gluten to FODMAPs. Reaching the end of the article, we note that this was actually originally published in Business Insider on 16 May 2014. Which means that the journal article being cited as being published "last year" was relative to that date - indeed, it actually refers to the Gastroenterology paper published in Aug 2013.
So, like what was old is new again, thanks to the remix nature of internet reporting. Back then, the iPhone 5 was the hottest thing around.
Posted by Dr. Ricky at 11/03/2015 03:49:00 PM
1 comment:
Labels: internet., journalism, reporting, science communication
Thursday, October 29, 2015
The physics of frugal fluffiness
|Hokkaido cupcake, Kamalan Bakery, Houston, TX
In a sense, a chiffon cake is basically a stabilized soufflé.
Due to the delicate nature of the foam, it needs to cling to the edges of the pan to promote rising, thus, chiffon cake containers cannot be lubricated for ease in unmolding, and the cake must be cooled upside down to avoid collapsing. When baked in a flute pan with a central chimney, this is possible, but as a cupcake, cooling upside down is impractical. But the ever frugal inventors came up with a clever solution: reinflate the cake with filling:
Note also the use of square cardboard cupcake liners. These are quite clever - the traditional fluted liner is there to facilitate removal from the pan due to the no-grease requirement, but still requires a traditional cupcake pan mold. The cardboard cups provide sufficient strength on their own to be used without the pan mold, and the square shape allow for more efficient use of oven space. However, they seem to be rather difficult to find in American groceries.
Posted by Dr. Ricky at 10/29/2015 02:02:00 PM
No comments:
Tuesday, October 20, 2015
The Science Behind Cooking Videos
Video is a powerful medium. I've noticed that when presented as a "documentary" format, people rarely question something presented as a video. Maybe because it can be compellingly presented with music and editing that can be emotionally engaging, or perhaps because in video, the presenter is in control. The viewer seldom can backtrack, and slow down the pace to digest the facts. Which is why quite often, something like the "Science of Macarons" video presented above, despite the appearance of precision, actually presents very little actual science. In fact, the baker exhorts the baking rules as if they were religious commandments rather than explaining what happens, for example, if the sugar to almond ratio were changed, or that the whipping speed order for egg whites were changed.
Some call this "science-y" rather than actual science.
In contrast, watch below for a well presented video on the effects of salting on food before and after cooking. Unfortunately, the title "Secrets of Salting" appeals to the quasi-mysterious nature of cooking, when in fact, science serves to illuminate.
Posted by Dr. Ricky at 10/20/2015 11:15:00 AM
No comments:
Labels: baking, commentary, cooking, science, video
Subscribe to: Posts (Atom)


text:
Sign Up
Log In
Size:  (micro)
Cache Issues:
Time for some more Bus Stops. Easy to find, direct and straight to the point or cache.
Bus route service hours: Monday - Friday 6:15 AM - 10:30 PM and Saturday 8:15 AM - 10:30 PM. Just watch out for muggles waiting for a bus. If muggles are there, leave and take a break and come back later. This might be better to do during off hour or weekends when there are less muggles.
Please place the cache exactlly as it was found so others can enjoy finding it.
Congrats goes to suzisumac for the FTF at 11:33 am on 2/19/2012
Additional Hints
Decryption Key
(letter above equals below, and vice versa)
What are Attributes?
Advertising with Us
There are no Trackables in this cache.
View past Trackables
What are Trackable Items?
106 9 1 1 1 3
View Logbook | View the Image Gallery of 2 images
**Warning! Spoilers may be included in the descriptions or links.
Current Time: 10/24/2016 18:25:19 Pacific Daylight Time (01:25 GMT)Last Updated: 2016-10-19T16:59:44Z on 10/19/2016 09:59:44 Pacific Daylight Time (16:59 GMT) Rendered From:UnknownCoordinates are in the WGS84 datum


text:
- Services
- We strive to provide complete care for our patients. Learn more about all the services we provide.
Welcome to Asia Chiropractic Health Services!
Are you interested in living a more active lifestyle? Do you want to regain more energy and vitality?
Welcome to Asia Chiropractic, you have come to the right place. At Asia Chiropractic, healthy living for you and your family is our first priority. Start exploring your health here - you'll discover that Asia Chiropractic provides a wealth of options. You can begin today by booking for a spinal assessment. We provide various treatment methods for; pain relief, managing a chronic condition, enhancing overall health and improving sport performance.
Chiropractic adjustments improve areas of joint restriction, adhesion in spinal tissues, and increasedmuscle tightness or spasm. Tell me more ...
MyofascialRelease Techniques
Our professionals utilize various state of the art soft-tissue techniques. Tell me more ...
Functional Rehabilitation
Rehabilitation assists in restoring health, function and strength to the body. Tell me more ...


text:
J Pharmacokinet Biopharm viagra vs cialis which more effective 1996. Reactivity of diflunisal acyl glucuronide in human and rat plasma and albumin solutions. 24:399–415. Stereoselective binding properties of naproxen glucuronide diastereomers to proteins.
Dickinson RG, watt J.
Contains alkaloids viagra vs cialis which more effective and potassium. Could possibly reduce the absorption and therapeutic effect of potassium and sodium iodides, sodium bicarbonate, aluminum hydroxide, magnesium sulfate. 9-40g AH. Could possibly cause hyperkalemia when used with potassium-sparing diuretics.
Use with MAO-inhibitors may cause headaches, tremors, and manias. Huang Qi, Bei Qi (Radix Astragali Membranacei, astragalus) Standard daily dosage. Safe when used appropriately C&C.
Ménétrier disease typically produces a viagra vs cialis which more effective thickened mucosal layer. Lymphoma and simple rugal hyperplasia typically involve the mucosal and submucosal layers. Full-thickness mucosal biopsy samples show the characteristic massive foveolar hyperplasia. Low acid secretion, loss of parietal cells, and protein-losing gastropathy are typical of this viagra vs cialis which more effective disease. This technique defines five alternating hyperechoic and hypoechoic layers of the gastric wall, corresponding to mucosa, muscularis mucosa, submucosa, muscularis propria, and adventitia.
Endoscopic ultrasound plays an important diagnostic role in patients with large gastric folds. On endoscopy, large gastric folds are seen that do not flatten with maximal insufflation and the diagnosis is made by biopsy.
E., Balfour, D viagra vs cialis which more effective. Journal of Neurochemistry 20, 1263–1267. Benwell, M.
J., and Anderson, J. (1985). Evidence that tobacco smoking increases the density of (-)-[2H]nicotine binding sites in human brain.
Goldman-Rakic, P viagra vs cialis which more effective. Functional connectivity during working memory maintenance. (2001).
Cortex. Cognitive Affective, and Behavioral Neuroscience, 3, 580–589. Gazzaley, A., Rissman, J., & D'Esposito, M.
In E viagra vs cialis which more effective. (1982). Simon, H., viagra vs cialis which more effective & Le Moal, M. Mesencephalic dopaminergic neurons.


text:
CLEVELAND, Ohio – Here are four girls basketball players up for Game Balls based on their performances during the last week.
Read the descriptions of the performances below and vote in the poll to the right. Voting is open until noon Friday.
Last week: On Monday, the senior finished the night with 30 points, 11 rebounds, nine steals three assists in a 59-41 win against Brookside.
Anne Bloomfield, North Olmsted
Last week: The sophomore guard scored a career high 19 points and added seven rebounds and four assists in a win over Brookside.
Last week: The senior finished with 15 points, five rebounds, and four assists in a 50-33 win against Charlotte Christian at the Carolina Invitational. Then in the 56-45 win against Charleston Northwood, she finished with 24 points, five rebounds and three assists. She ended up being named to the all-tournament team.
Last week: The center led the Patriots to a victory on Wednesday against Lincoln West by a score of 83-37. She had a season and team high 32 points, along with 19 rebounds, three steals, one assist and one block.
Follow girls basketball all season
Bookmark the girls basketball webpage at cleveland.com to see every post and video pertaining to the sport.
Follow our high school sports Twitter account @neovarsity and tag your high school sports tweets and score updates with the #NEOVarsity hashtag.
Missed something or have a story idea you would like to submit for consideration? Please leave them in the comments section below.
For more high school sports news, like us on Facebook and follow us on Twitter. Contact Nathaniel Cline on Twitter (@nathanielcline), by email (email@example.com) or log in and leave a message in the comments section below.


text:
Dear Delegates and Faculty Advisors,
It is my pleasure to welcome you to the 19th Annual Washington Area Model United Nations Conference, hosted by The George Washington University's International Affairs Society. WAMUNC XIX will be held from Thursday, March 2nd to Sunday, March 5th, 2017 at the Marriott Wardman Park in the heart of Washington D.C. The Secretariat is thrilled to welcome you to out nation's capital this spring.
At WAMUNC, you will find an expertly crafted combination of high-quality debate and delegate experience and second-to-none access to D.C.'s finest institutions, landmarks, and organizations. At WAMUNC, we combine top-notch committee experiences with hands-on, practical learning from experts and decision-makers in international politics.
WAMUNC prides itself on its committees. We combine a comprehensive list of traditional and innovative committees alike; everything from General Assembly committees like DISEC and Legal to creative committees like GM Board of Directors, 2009 and The New York Times Editorial Board. With 24 committees, we have something for every delegate.
With knowledgeable and professional committee Chairs and Crisis Directors and highly detailed background materials, we give the delegates the tools they need to have a game-changing weekend here at WAMUNC. With active and enthusiastic participation, each delegate can take ownership of his or her country representative or character, learn a great deal, and apply that knowledge using real-world skills in the committee room.
My experiences with Model United Nations have made me a better learner, public speaker, communicator, team member, and global citizen. Model UN does not directly change the world, but it helps prepare the future leaders of our country, society, and world. At WAMUNC, we strive to unearth the confidence, creativity, and passion of each delegate, helping them realize their true leadership potential.
I hope you will apply for WAMUNC. Pay close attention to our registration deadlines and financial policy to put your delegates in the best position. We have a committed team here, eager to help with any questions or concerns so do not be afraid to reach out.
This will be a truly unforgettable experience and I hope you can join us this spring. I wish you the best of luck with your preparations and I cannot wait to welcome you to WAMUNC in March.
Best regards,
Supriya Mazumdar
Secretary-General of WAMUNC XIX


text:
If you are in Australia and interested in purchasing tiles, there are three tile firms in that supply the ideal offers on tiles for modest-end to best-finish consumers.Mercure Marseille Beauvau Vieux Port is a first class hotel. Each and every area has air conditioning, a safe, television, phone, Net entry, mini bar and a balcony or terrace. The hotel functions a 24 hour reception, parking, babysitting or kid care, laundry service and so much far more.If you see an image of EMS delivery, then this shop is runed by men and women from China. That is because EMS is express mail services in China. It is unique in the planet. As we know, the bags you will buy from this seller are normally not genuine.If you enjoy JCPenney in addition to like conserving funds, you have to try to find jcpenney coupon printable prior to leaving the house. You will finish up astonished at how much funds you'll be capable to and definately will support conserve. You can use these sort of coupons up for grabs and web-based mostly. When you go to world wide web website you will note some excellent value cost savings. For instance,, you save $10 in the occasion you expend $50, or even $15 ought to you devote $75. Surely not by utilizing these coupons for economic financial savings is compared to throwing money absent as well as who are in a position to manage to achieve that? There are numerous goods to select from, home products, clothes, video games, and footwear. Just about what you can would like are going to be discovered in the shop.cheap longchamp
Of program, what guy doesn't love Gucci? They do have an on-line retailer and they fairly considerably have almost everything in it that's in the correct division keep as well. Now, keep in mind that Gucci is not cheap. This is higher class merchandise so your going to pay a fairly penny here but, also preserve this considered--Gucci is some of the very best you can get. Everybody has needed to have some of this designer in their closet at one time or yet another. The major essential stage, this keep is for special events only. Even so, for the holidays--nicely that is specific now isn't it?Overall the key to transitioning among cooler to warmer seasons is to layer appropriately and to smartly accessorize. If you preserve in thoughts these 6 crucial wardrobe pieces you will maintain a practical and fashionable transition from those dreary winter days into these unpredictable nevertheless mood boosting spring days. Those unprepared are these that endure.Are you at the moment preparing on taking a journey to Paris, France sometime this Autumn? If so, I would hugely recommend that you check out the Prix de l'Arc de Triomphe although you are there. It is typically held in the course of the initial Sunday in October. The Prix de l'Arc de Triomphe is 1 of the most effectively known horse races in the whole globe, and it is a very entertaining and fascinating event to view!Longchamp has a background about 64 years. More and a lot more individuals will purchase it as the first selection contains me. Per 12 months I only acquire one particular bag for myself. Do these can conserve a lot money? longchamp outlet is my ideal favourite. Standing now, I give you some suggestion. Dears go to purchase it for a consider.
Zebra is 1 of the identifications of Kate Moss for longchamp. Every single bag has particular zebra lining, matching with zebra scarf. The logo - Kate Moss For longchamp was exquisitely sewn within. These variations are all constrained edition. There are 3 sub-collections: the Gloucester cylinder luggage bags, Gloucester travel bag, and Sohoclutch. They are not only with the ideal accessories, but also Kate Moss' summary of travelling knowledge.The characters longchamp bag ought to be near to the very same age, as the character, and need to resemble the character's seems, or temporarily be produced to seem like the character they are enjoying.The size of your handbag also is an important consideration. You need to recognize that the tiny dimension of the handbag will make you carry ample things you want. But you also do not need a massive handbag to place your every thing in it. You want pay attention to the also large handbags for they often are placed at the bottom of the cabinet.Buy reduced Promote higher- Get products from its original manufacturing country and promote it for an increased price in your home port or in yet another city. For illustration, you can promote a longchamp bag in the States with a 30-forty% mark-up when you get it from Paris and even now be at an aggressive value. Apple merchandise in the States price way more affordable than retail cost in Asia as well. Consider benefit of your travel possibility, and post your products on eBay, Craigslist, or produce your very very own on-line purchasing internet site.
Never effectively duplicated despite the fact that often imitated, coach longchamp bag are famous internationally for their major-edge style, style, and top quality. When one particular thinks of prime-good quality leather bags, Coach is what comes in mind.Myself, I commit most of my time poring by way of data, seeking at patterns and trends that repeat a lot more than the common. And I hardly ever bet. But that's my secret, I hardly ever bet - only when I do, I'm a lot more informed than the bookmaker.
And leather bags on sale are of different types which differed as an outcome of designers' conception. Nearly, a dazzling array of options is obtainable. Be it present day, exquisite, gorgeous, or grand, your demand will just be pleased as you want it. As a matter of fact, bag designers are continuing to incorporate all vogue aspects like exclusive metallic accessories or embroidery paint into the design of leather bags. This ensures that the boom of leather bags won't be a quick-lived one particular.longchamp weekender
Zebra is one particular of the identifications of Kate Moss for longchamp. Every bag has specific zebra lining, matching with zebra scarf. The emblem - Kate Moss For longchamp was exquisitely sewn within. These variations are all constrained edition. There are 3 sub-collections: the Gloucester cylinder luggage bags, Gloucester travel bag, and Sohoclutch. They are not only with the perfect accessories, but also Kate Moss' summary of travelling knowledge.The Bois de Boulogne will not disappoint any man or woman who paid money to travel to France. Inspired by London's Hyde Park and Regent Park, Bois de Boulogne is the preferred of Parisian walkers and vacationers. Inside, France travelers can also discover the Auteuil and longchamp race programs. One more sight that any individual who travels in France should go seem for is the renowned clay tennis court, Roland Garros, where the French Open is held. The court is all housed inside of the Bois de Boulogne.
longchamp darshan
There is no require for you to waste time and funds for a journey, since you can check out coach online outlet for your comfort. If you do not wish to go out on a weekend and you need to continue to be at property, then the greatest thing for you to do is to open your personal computer and surf coach site. There is a huge percentage of money that goes to the gasoline once you pick to travel and look for the greatest coach outlet near you. Even if you have one bag and coach purse, you can use it anytime you want in any social perform. When you establish to buy or buy in coach purse longchamp outlet, you just have to wait for a doorbell inside your house and you will get all the trendy products that you have bought from coach on-line store.Maybe some of the difficulties whether or not it is fashion, since in enough winter, we not only want the degree of warmth and trend. There is no doubt. The reply longchamp outlet is yes. Look at those Fashionistas! In winter, they are the 1st selection moncler jackets uk. Brilliant colors and trendy design and style is extremely basic, not only make a more relaxed and more trendy. Moncler are well-known all more than the world.You don't be concerned about the cold winter any much more, Moncler Coats really can maintain you warm outside your residence, our moncler jackets all are picked with higher quality and fashion designs. Moncler is the renowned large-end outerwear brand which designed a quilted jacket trend in the fashion world.Prev page:large longchamp bag


text:
realmagick.com The shrine of knowledge.
Puritan Theology
A selection of articles related to puritan theology.
Original articles from our library related to the Puritan Theology. See Table of Contents for further available material (downloadable resources) on Puritan Theology.
- Divinity: Thought We are Many, Are We One?
- Dear Questioner, You asked if there was such a thing as Christian Wicca. The simple answer is, of course there is! The tradition of communing with all the lovely fellow spirits in this cosmos goes way back beyond apostolic times. Didn't the Magi (plural for...
Religions >> Christianity & Paganism
- Path/Peteh
- Ptah, Peteh, 'South of His Wall', 'The Ancient One', worshipped in Mennefer (Gr: Memphis) already in the early dynastic period, probably at first as the local patron of craftsmanship, his High Priest in Mennefer was titled 'Greatest of the controllers of...
Deities & Heros >> Egyptian
- Elhaz
- Elhaz is the seventh Rune of the second aett (group of eight). Its name means "elk," in the European sense of the word. The European elk is essentially the same animal as the North American "moose." The North American elk (wapiti) is a...
Divination >> Rune Stones
- History of the Egyptian Religion, part II: The Old Kingdom
- II - The Old Kingdom ca 2686-2181 BC During the Old Kingdom the Egyptian society moved from tribal communities to a fully developed theocratic system, where the power of the king was absolute. The great pyramids of Dynasty 4 was made possible by technological...
Religions >> Egyptian
- Egyptian Temples, part VI: The House of Life
- Library - Archive 'The House of Life' could well be called a library. It was that part of the temple where all records and texts were kept and stored. These papyrii encompassed many different fields of learning as well as the accountings on the daily and...
Religions >> Egyptian
- Jesus Christ! You're acting like one of those Christians
- "He drew a circle that shut me out— Heretic, rebel, a thing to flout. But Love and I had the wit to win; We drew a circle that took him in!" – Edwin Markham The room was filled with Pagans, Witches and a few Asatru. The discussion had flowed from &qu...
Paganism & Wicca >> Daily Life
Puritan Theology is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Puritan Theology books and related discussion.
Suggested News Resources
- The Witch review – an eerie campfire tale that gets under your skin
- Played like a campfire tale (the film is loosely "inspired by folklore"), the plot follows a family in 17th-century New England who are excommunicated from a Puritan community.
- What really happened in Salem?
- Eggers' movie is inspired in its approach: to understand the Puritans we really do have to understand their theology.
- American Protestantism and Madness
- Vacek artfully constructs her narratives on five individuals: the turn-of-the-seventeenth-century Puritan theologian and minister Cotton Mather, the Revolutionary-era Presbyterian physician Benjamin Rush, Dix, the early twentieth-century Presbyterian ...
- How Director Robert Eggers and DP Jarin Blaschke Created the Look of 'The Witch'
- It's about saying every single shot in this film has to be articulating a memory of our own Puritan childhood, and what did our dad's smell like that day in the corn field, and what was the mist like on the corn.
Great care has been taken to prepare the information on this page. Elements of the content come from factual and lexical knowledge databases, realmagick.com library and third-party sources. We appreciate your suggestions and comments on further improvements of the site.
Puritan Theology Topics
Related searchesottawa senators third jersey
pagan traditions
igor stravinsky stylistic periods
james james
first aid survey the scene
john prescott bibliography
About - Contact - Advertising
© 2000 - 2016 Realmagick.com, All Rights Reserved.
© 2000 - 2016 Realmagick.com, All Rights Reserved.


text:
The problem, of course, is that organizations seeking the ultimate network are probably already dependent on a network that is decidedly un-ultimate. Building the best is a whole lot easier when you start from scratch, and it's easier to build a house from blueprints when there is nothing already there, but only start-ups have the benefit of a technology greenfield. On the other hand, Levy says, you can only pin your problems on legacy technology for so long.
"At some point, you have to stop blaming legacy technology," he says. "You have to integrate the good and the bad in you plans and move forward. No one can divine the future, but you can prepare for it by planning from where you are and building with open standards. If you have a clean, modular network, even if it's old, you can upgrade."
Standards, in fact, are a key component of any network that claims the title "ultimate." With the growth in server virtualization and storage networking, for example, many organizations have found themselves running up against compatibility and performance issues that can bring core processes to their knees. EMC director of technology and analysis Ken Steinhardt says "The new thing, and 'first to market' aren't necessarily good things if the standards aren't finalized. Standards that provide interoperability are key."
With that all in mind, the first step is to assess what you've got in terms of hardware, cabling -- even the physical plant where your network assets are installed. "If nothing else, you should do an inventory," Levy says. "Then you can identify your points of pain -- where are you constrained, performance-wise, and how can you change that?"
Ultimately, the quest for the ultimate network should lead up to a short list of business impacts fro insufficiently or inefficiently deployed technologies and processes. Make no mistake, a bigger network pipe and faster hardware could well be in your future but, Steinhardt says, "the key is to have the full chain; you're never going to be better than the weakest link in the chain."
Indeed, the mistake that most organizations make, according to Levy, is that they go shopping too soon. "All the technology in the world isn't going to help you -- and it'll probably hurt you by wasting money -- if you don't know what you need and how you're going to deploy it," Levy says. "Again with the architectural metaphor, you don't build your house if you don't know what kind of land you're on. You need to know your topology and re-arrange it if necessary; if you need to segment then segment properly."
Building the ultimate network, then, is about planning the ultimate network. It is, above all, about doing your homework, knowing what you have, what you need, and what you can afford to spend. "Then you go shopping," Levy says. "Bring in the vendors that you need to get things done, and show them the plan."


text:
Welcome to DBSTalk
Like most online communities you must register to view or post in our community. Sign-up is a free and simple process that requires minimal information. Be a part of our community by signing in or creating an account. The Digital Bit Stream starts here!
- Reply to existing topics or start a discussion of your own
- Subscribe to topics and forums and get email updates
- Send private personal messages (PM) to other forum members
- Customize your profile page and make new friends
Guest Message by DevFuse
NEWS STORY: DBS Combo Tackles Regulatory, Rural Questions
Started by Guest , Oct 30 2001 06:24 AM
No replies to this topic
#1 Guest__*
Posted 30 October 2001 - 06:24 AM
Executives with EchoStar, Hughes and its DirecTV unit insisted Monday that their unified DBS platform would become a stronger competitor to cable TV.
As for dominating rural areas, where cable has a lacking presence, both companies suggested that the National Rural Telecommunications Cooperative, which sells DirecTV in rural areas, may surface as an additional satellite TV competitor to their joint platform.
EchoStar CEO Charlie Ergen, who will lead the new DBS company, said once regulators see the positives a combined platform would create for rural TV viewers, they may warm up to the deal. "This is good for consumers, particularly in rural America," he said.
How that second competitor takes shape, and whether it will sell a competing DirecTV product next to the DirecTV/EchoStar combination, will be determined sometime in the future.
Both EchoStar and Hughes made the DBS/cable distinction immediately following the merger announcement. Even before the deal was made, EchoStar was promoting the proposed combination as a multichannel marketplace play rather than a satellite TV industry move.
As soon as the agreement was unveiled, the companies attempted to divert attention from the 16.7 million customers that would be covered under a joined EchoStar/DirecTV entity. Instead, the companies took out 1.8 million subscribers controlled by NRTC and its affiliates, leaving 14.9 million subscribers owned-and-operated by the combined company.
That makes the unified DBS platform the second biggest multichannel provider in the country, just short of AT&T Broadband's 15 million cable customers.
According to reports, executives behind the merger will present it to Billy Tauzin, Louisiana Republican and chairman of the House Energy and Commerce Committee, sometime today.
From SkyReport (Used with permission)


text:
What is PQRS?
Developed by the Centers for Medicare and Medicaid Services (CMS), the Physician Quality Reporting System (PQRS) is designed to improve the quality of reporting and patient data throughout the entire healthcare industry, thus reducing fraud and optimizing the payment process.
PQRS requires that all eligible Medicare providers—including physical therapists, occupational therapists, and qualified speech therapists—meet criteria for the satisfactory reporting of certain outcome measures. Although PQRS is not technically mandatory, eligible professionals (EPs) who do not meet the reporting requirements are subject to financial penalties.
In 2016, that penalty is a 2% downward payment adjustment on all Medicare Part B payments in 2018. To comply with PQRS and avoid the penalty, rehab therapists who participate in the program as individuals must report on nine measures across three NQS domains for at least 50% of their Medicare Part B fee-for-service (FFS) patients. (Click here to learn more about reporting requirements, including group reporting.)
Is PQRS ending?
All in all, the 2016 PQRS requirements—and penalties—are nearly the same as they were last year. However, there are hints that this year might be the last reporting year for PQRS. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 confirms that the negative payment adjustment associated with PQRS will indeed be in effect through 2018. But, the wording suggests that PQRS penalties may not impact any subsequent years—and, because the 2018 penalty is based on 2016 data, it would stand to reason that there may not be a PQRS in 2017.
Before you start celebrating, though, remember that this next Final Rule could sing a completely differently tune, so it's possible that PQRS could remain in effect. Furthermore, while PQRS may not be relevant next year, Medicare's focus on quality data reporting will only intensify—as will its financial penalties for noncompliance. In 2017, Medicare plans to launch the Merit-based Incentive Payment System (MIPS), which is a conglomeration of PQRS, Meaningful Use, and Value-Based Payment Modifier (these last two programs never applied to rehab therapists).
MIPS will use the same measures and data analysis mechanisms as the old systems did, but it will apply them in a new way. Fortunately, CMS is planning a slow launch, which means rehab therapists most likely won't have to begin adhering to MIPS regulations until 2019.
But back to PQRS in 2016.
Who are Eligible Professionals?
Any professional who provides services paid under or based on the Medicare Physician Fee Schedule is subject to PQRS regulations. This means that if you bill under Medicare Part B for outpatient therapy services—including physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), and chiropractic services (DC)—in a private practice setting, you're subject to a financial penalty if you do not satisfactorily complete PQRS. You can find the complete list of EPs here.
However, some professionals who are subject to PQRS regulations based on their specialty are exempt because of their billing method. The following are examples of providers who are exempt, according to CMS:
- Professionals who provide Medicare Part B services, but bill under Part A (i.e., at a facility or institution)
- "Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider's individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services"
- Professionals who provide services payable under fee schedules or methodologies other than the Medicare Physician Fee Schedule (e.g., services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals, rural health clinics, ambulance providers, and ambulatory surgery center facilities)
Can PTAs report PQRS?
Physical therapist assistants (PTAs) do not qualify as EPs, which means they cannot report PQRS data. They can assist in gathering PQRS data as long as the PT supervises and signs off on all quality actions performed.
What are the Differences Between Registry-Based, Claims-Based, and GPRO PQRS Reporting?
If you're an individual provider, you can choose to report via claims or a registry, like WebPT. If you're reporting as a group, you can use the Group Practice Reporting Option (GPRO). Here's a breakdown of each:
Claims-Based (Manual Individual Submission)
If you decide to go the claims-based reporting route, you must manually enter your PQRS data on your claim forms before submitting them to Medicare. WebPT's claims-based reporting option allows you to use your WebPT documentation to assist you with completing PQRS. (Our system will help you select the appropriate codes, so you'll submit accurate data.) However, it's still your responsibility to make sure the quality data codes (QDCs) are properly submitted with your Medicare claims (just like any other code, but with a $0.00 charge).
Registry-Based (Automatic Individual Submission)
When you report PQRS measures electronically via a registry, the registry handles most of the legwork for you. For example, as a certified PQRS registry, WebPT merges PQRS reporting requirements with standard documentation, so we'll prompt you to report your measures within the patient record. We then compile that data and submit it to CMS on your behalf.
Basically, once you select your PQRS measures, you simply document within the patient record, and we manage the rest. You never have to worry about remembering to complete PQRS on an eligible patient, because we remember for you.
Registry-based reporting is the easiest reporting method for EMR users.
Group Practice Reporting Option (GPRO) (Automatic Group Submission via a Registry)
Clinics with two or more therapists who operate under the same tax ID, or TIN, may use the automatic group submission (GPRO) reporting method to meet the satisfactory reporting requirements together. For example, if a practice has two eligible therapists and one therapist reports on 60% of his or her patients, the other therapists only needs to report on 40% of his or hers.
This method is not available to those submitting PQRS data via claims. Additionally, practices wishing to participate in GPRO must sign up (self-nominate) for GPRO directly through CMS. (Note: 2016 registration should open on April 1, 2016.)
What are the Advantages of Registry-Based Reporting Over Claims-Based?
When you go the registry-based reporting route, all you need to do is choose your measures and document within the patient record. Your registry (i.e., WebPT) will manage the rest, including collecting your reporting data and submitting it directly to CMS on your behalf. This means you won't ever have to fill out a lengthy paper PQRS form for every applicable note you complete. Plus, you'll always know which measures are available each year, because we update the system based on the annual CMS Final Rule. Furthermore, we narrow down the options based on specialty, so you'll have an easier time selecting the measures on which you'd like to report.
In other words, a registry makes it nearly impossible not to stay compliant, which is why we highly recommend registry-based reporting.
With claims-based reporting, on the other hand, the burden of compliance is mostly on you. You're responsible for remembering what to report, for whom, and how frequently. You're also responsible for correctly documenting and submitting the data to Medicare. While this method can work well if Medicare makes up only a small percentage of your payer mix, there are no automated checks and balances to ensure you're compliant.
What are the Reporting Requirements?
First, it's important to understand that PQRS is not technically mandatory. Even if you are eligible for PQRS, you can choose not to participate. However, in 2013 Medicare introduced a financial penalty for those EPs who do not successfully complete the requirements for satisfactory reporting. In 2016, that penalty is a 2% downward payment adjustment in 2018.
Individual Reporting
In 2016, each EP must report on nine measures across three NQS domains for at least 50% of Medicare Part B FFS patients. If fewer than nine measures apply, the EP must report on all applicable measures available for at least 50% of Medicare Part B FFS patients. In this case, the EP will be subject to Medicare's Measures Applicability Validation (MAV) process, which allows Medicare to determine whether the EP should have reported on additional measures. Furthermore, an EP who sees at least one Medicare patient in a billed visit during 2016 must report on at least one cross-cutting measure, even if fewer than nine measures apply. CMS will not count any measures with a 0% performance rate.
Group Reporting
There are three ways to report using GPRO:
- Report nine measures for at least 50% of Medicare Part B FFS patients. These measures must cover at least three NQS domains, and at least one measure must qualify as a cross-cutting measure. (WebPT's registry-based PQRS service supports this reporting option.)
- Report six measures across two NQS domains for at least 50% of Medicare Part B FFS patients—and conduct a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey using a CMS-certified vendor. (Note: This survey is required for clinics with 100 or more EPs participating in GPRO.)
- Report using CMS's GPRO Web Interface, which requires groups to report on all measures included in the interface for their first 248 Medicare Part B patients. If your practice doesn't see that many patients, you must report on at least one measure for 100% of your Medicare Part B patients. (Note: This option is for practices with 25–99 EPs.)
For 2016, Medicare added a review of cross-cutting measure applicability to the Measures Applicability Validation (MAV) process for the GPRO.
Still trying to make sense of PQRS 2016?
Watch the below webinar and become a PQRS pro. We cover everything PTs, OTs, and SLPs need to know about satisfactory reporting.
What Does it Mean to Actually Satisfy PQRS Requirements?
The purpose of PQRS is to measure quality, which is based on four factors:
- Measure eligibility
- Performance criteria or quality action
- Reporting rate
- Performance rate
Measure Eligibility
EPs use a set of measure specifications to determine whether they can perform that measure on a particular patient. These typically include:
- Time period for a particular condition
- Age range
- Procedure (CPT) code
- Diagnosis (ICD-10) code
- Place of service
- Factors related to condition
Performance Criteria
This is the number of eligible patients who meet the specifications for a particular measure, meaning an EP can perform a "quality action" for those patients. When completing a measure for an eligible patient, an EP must mark that the measure was:
- Met (i.e., a quality action was performed);
- Not Met (i.e., a quality action was not performed); or
- Excluded (i.e., there is a documented reason for not meeting the performance criteria). Note: Not all measures allow for exclusions.
Reporting Rate
The reporting rate is the number of patients an EP reported (met, not met, and excluded) divided by the EP's total number of eligible patients. To avoid the penalty, professionals must have a reporting rate of at least 50%.
Performance Rate
There's some confusion over how performance rate is calculated. However, the major takeaway regarding performance rate is this: Medicare will not count any measures that have a 0% performance rate. That means EPs cannot simply mark all eligible patients as "not met" or "excluded" for any particular measure. Rather, EPs must select a satisfactory answer (i.e., a quality action) for at least 1% of the patients who are eligible for each measure. So, for example, if an EP sees 500 Medicare patients in 2016, he or she would need to report a satisfactory response on at least five of those patients for each qualifying measure.
When Do I Report?
The reporting intervals vary from measure to measure. To find out when you need to report on a particular measure, check the measures specifications guide, which you can download here.
What is the MAV Process?
When EPs report fewer than nine measures covering three NQS domains, they are subject to Medicare's Measures Applicability Validation (MAV) process, which allows Medicare to identify whether an EP should've reported quality data codes for additional measures.
Because there are a limited number of measures available for PTs and SLPs, EPs of both specialities will automatically go through the MAV process, regardless of which reporting option they choose. OTs have enough measures available to them that this may not be the case.
Looking for detailed information on the MAV process? Click here if you're reporting via claims and here for if you're completing registry-based reporting.
Note: Do not resubmit a claim for an evaluation you've already billed in order to add PQRS data. This is an audit red flag to Medicare, and they'll reject the claim anyway.
What Measures are Available to Me?
There are a total of 281 PQRS measures for 2016 (up from 225 in 2015). However, only a small number of them apply to rehab therapists. Here they are broken out by specialty:
Physical Therapy
- #126 Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation
- #127 Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear
- #128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
- #130 Documentation of Current Medications in the Medical Record
- #131 Pain Assessment and Follow-Up
- #154 Falls: Risk Assessment
- #155 Falls: Plan of Care
- #182 Functional Outcome Assessment
Occupational Therapy
- #128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
- #130 Documentation of Current Medications in the Medical Record
- #131 Pain Assessment and Follow-Up
- #134 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
- #154 Falls: Risk Assessment
- #155 Falls: Plan of Care
- #181 Elder Maltreatment Screen and Follow-Up
- #182 Functional Outcome Assessment
- #226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
- #431 Preventive Care and Screening: Unhealthy Alcohol Use - Screening and Brief Counseling (Note that this measure is not available within WebPT)
Speech-Language Pathology
- #130 Documentation of Current Medications in the Medical Record
- #131 Pain Assessment and Follow-Up
- #226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Download Your 2016 PQRS Measures Chart Now
Curious as to which measures are available for registry-based reporting, claims-based reporting, or both? Want to know which ones are cross-cutting measures? Wondering about NQS domains for each measure? Enter your email address below, and we'll email you all this information, broken up by measure and specialty, in a PDF chart.
How Do I Report on Measures 154 and 155?
Measure 154 (Falls Risk Assessment) and 155 (Falls Risk Assessment & Plan of Care) are linked, so if you report on 154, you also must report on 155. Both require reporting at least once per reporting period, and patients must be at least 65 years of age and have a history of falls.
As of 2016, these measures are now associated with CPT codes 92541 and 92542. These codes are typically used by chiropractors, but not frequently.
How Do I Report on Measures 126 and 127?
If you're a PT using a registry-based reporting system, you may use measures 126 (Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation) and 127 (Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear) as long as you report both at least once per reporting period at either initial evaluation or re-evaluation. The ICD-10 diagnosis codes that trigger both measures fall into the E10, E11, and E13 code families.
Measure 126
Measure 126 applies to patients who are 18 years or older with a diagnosis of diabetes mellitus and neurological exams of their lower extremities within the last year.
Measure 127
The denominator that applies to 126 also applies to this measure. Eligible patients also must have been evaluated for proper footwear and sizing within the last year.
How Does ICD-10 Affect PQRS?
Certain ICD-10 codes trigger certain PQRS codes, just as certain ICD-9 codes used to do. If you use WebPT to report PQRS, the system will prompt you to report when one of those triggers exists.
What are Cross-Cutting Measures?
Cross-cutting measures are broadly applicable measures that convey a more complete picture of the overall quality of care that EPs are providing. To meet PQRS requirements, all EPs who have had at least one in-person meeting with a Medicare patient must report one cross-cutting measure.
Please note that there are multiple cross-cutting measures availables to PTs and OTs and at least one available to SLPs. Therefore, PTs, OTs, and SLPs should be able to meet this requirement.
What Measures Groups are Available This Year?
CMS defines a measures group as "a subset of four or more PQRS measures that have a particular clinical condition or focus in common." Other EPs have numerous measures groups on which they can report. However, there are no measures groups available to PTs, OTs, or SLPs. (For those who remember the back pain group available to physical therapists, that measures group hasn't been available since 2014.)
Simplify PQRS reporting—and avoid penalties—with WebPT.
Schedule a free online tour of WebPT today, and discover how our certified registry + EMR take the pain out of Medicare compliance.


text:
News & Events
Weekend Getaway in Sonoma County1/15/2014
"I owe it to myself" is what you should be saying right about now this time of year. With the crunch of kids going back to school, the relaxation of the holidays being over and the winter solstice in full swing, now is the time for a weekend getaway. By leaving it all behind and getting away at Sonoma Coast Villa and Spa you can gain the benefits that only a weekend retreat can provide.
Taking the time for you, allows you to slow down and allow life's ever changing pace to take a backseat to your health and comfort. Reconnecting with what's important and what matters most in our life is what we're all about. A weekend getaway can provide you with the psychological release your life requires from time to time.
Allow Sonoma Coast Villa and Spa to ease your stress and provide you with a weekend getaway that will leave you refreshed. Contact us today!
Here is a brief list of our rooms and rates,for a full list of rooms and rates, please click here and for a full comprehensive list of all our packages/services and amentities, please download the PDF here.
The Honeymoon Suite $225-$325
Junior Suite $175-$325
Country Rooms $155-$265
Deluxe Villa Rooms $195-325
Also offered is the "Family Getaway Package", as well as the "Sonoma Coast Wine Food and Wine Experience For Two"