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Check in from 2:00 PM / Check out prior to 12:00 AM
BEST WESTERN Axis Hotel: Find photos, reviews, information, amenities and compare prices for 3 stars hotels in Kortenberg, Belgium.
Situated close to Erps-Kwerps Train Station, BEST WESTERN Axis Hotel offers guests a convenient base while in Kortenberg. The various amenities this cosy hotel has to offer include meeting rooms, a 24-hour reception and luggage storage.
Hotel description
Rooms at BEST WESTERN Axis Hotel are comfortable and provide a mini bar. All offer a private bathroom, a TV and a telephone.
A satisfying breakfast is prepared every morning at Best Western Axis Hotel Kortenberg, and there are numerous cafés and eateries close by. For those on the move, the hotel offers packed lunches if required.
BEST WESTERN Axis Hotel is a convenient base to explore nearby Royal Palace of Brussels, Mini Europe and Palais de justice de Bruxelles, as well as everything the local area has to offer. Guests looking to discover the region can visit Brussels, which is a 30-minute drive away.
Hotel features
Room Service, Mini Bar, TV, Shower, En suite, Private Bathroom
Business Center, 24 Hour Reception, Dry Cleaning, Conference Room(s), Multilingual Staff, Safe-Deposit Box, Meeting Rooms, Photocopier, Ticket Service, Luggage Storage, Self Laundry
Fitness Room/Gym, Golf Course, Garden, Spa & Wellness Centre
Airport shuttle
Private Toilet, Packed Lunches, Shoe Shine
Availability and Prices
Booking Site
Room Type
Per room
Per night
Per night
Users who viewed BEST WESTERN Axis Hotel also viewed these 3 stars Kortenberg hotels:
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Nearest hotels
- B&B Den Engel
1 miles
- B&B Aline Florentine
1.1 miles
- B&B Bertem Natuur
3 miles


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The sidewall of the Nokian Hakkapeliitta R is labelled with the promising words ultra low rolling resistance. This means that the non-studded winter tyre rolls very efficiently without wasting energy. From the driver's perspective, this translates into economic and environmentally friendly driving with up to half a litre lower fuel consumption per hundred kilometres.
The reduced rolling resistance of the Nokian Hakkapeliitta R does not entail any compromise on grip properties. Notwithstanding the excellent rolling properties, the tyre surpasses its predecessor's braking ability on icy, snowy and especially wet surfaces.
The improved grip properties are the result of a new, Nordic winter compound. Featuring both silica and canola oil, the new-generation rubber compound used in the tread enhances wet and ice grip and improves tear resistance. The patented pump sipe enhances wet and ice grip.
The directional tread pattern is covered by a dense net of sipes, which further improves the grip abilities. Braking grip is enhanced by brake boosters, found to be efficient in the tyre's predecessors.
The Nokian Hakkapeliitta R offers a precise steering response that helps the driver detect changes in the non-studded winter level. The grip range is wide, which helps the driver react to grip changes in time.
The structural and tread pattern solutions of the Nokian Hakkapeliitta R guarantee excellent dodging and steering properties and good stability. The multi-layer tread structure and rubber compound, specially developed for non-studded winter tyres, ensure that the tyre remains stable irrespective of changes in winter conditions.

subset: commoncrawl


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Carly Rae Jepsen
Will Taylor Swift or Rihanna be the big American Music Awards winner?
Posted on Thursday, Nov 15, 2012
Gotye Carly Rae Jepsen One Direction It's a fine list and some of these artists will no doubt find their way into the Grammy best new artist categ ...
Taylor Swift, Nicki Minaj, Adam Levine set to 'Restore the Shore'
Posted on Wednesday, Nov 14, 2012
, Carly Rae Jepsen, Swizz Beats, the Jonas Brothers, Ludacris, All Time Low, Sean Kingston, Christina Aguilera, CeeLo Green, Adam Levine, Blake Shelton and Cars ...
Music Power Rankings: Taylor Swift, Madonna and Carly Rae Jepson top the list
Posted on Sunday, Nov 11, 2012
Carly Rae Jepsen: You know you've arrived when a Ukranian singer accuses you for stealing "Call Me Maybe ...
Does Psy finally knock Maroon 5 out of the top spot on the Billboard Hot 100?
Posted on Wednesday, Oct 24, 2012
1 spot earlier this year when Carly Rae Jepsen's "Call Me Maybe" held "Payphone" at in the No ...
Watch: Carly Rae Jepsen's lyric video for 'This Kiss'
Posted on Thursday, Oct 18, 2012
It's a candy-colored world in Carly Rae Jepsen's lyric video for current single, "This Kiss ...
Maroon 5's 'One More Night' holds one more week on the Billboard Hot 100
Posted on Wednesday, Sep 26, 2012
Owl City and Carly Rae Jepsen's "Good Time" climbs one spot to No ...
Pink is poised to land her first No. 1 on the Billboard 200
Posted on Saturday, Sep 22, 2012
6, and Carly Rae Jepsen's "Kiss" at No ...
Maroon 5 takes 'One More Night' to No. 1 on the Billboard Hot 100
Posted on Wednesday, Sep 19, 2012
Ellie Goulding's "Lights" falls 5-7, Alex Clare's "Too Close" inches 10-8, Carly Rae Jepsen and Owl City's ...
Flo Rida's 'Whistle' blows Taylor Swift out of the top spot on the Billboard Hot 100
Posted on Wednesday, Sep 5, 2012
Carly Rae Jepsen continues to lodge two songs in the Top 10: "Good Time," her duet with Owl City, rises 9-8, while "Call Me Maybe, whic ...
Listen: Justin Bieber and Carly Rae Jepsen on preview of 'Beautiful' single
Posted on Tuesday, Sep 4, 2012
The prince of every pre-teen girls' dreams combines with the pop princess of summer jams: Justin Bieber's Schoolboy Records signee Carly Rae Jepsen will have he ...


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When a teenage girl disappears, a psychic (guest star Martin Short) is brought into the investigation.
Stabler struggles to keep his emotions in check as he interrogates a man (Matthew Modine) suspected in the murder of a teenage girl -- a man he once let get away on similar charges.
A mother who reported the statutory rape of her daughter is found murdered.


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Location :Central
Calle 3 Oriente No 206 Centro Historico
We were lucky to stay in this hotel during our Xmas holidays in Mexico. The atmosphere is cosy, everything was nice, the only thing was lack of windows in our room, and everything else was excellent! I will recommend staying in this hotel to everybody! Merry Xmas!
3/5 Standard of room
3/5 Facilities
0/5 Quality of food
4/5 Service
5/5 Location
4/5 Value for Money


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This promotion is for Rewards members only. To take advantage of exclusive offers like these, join Office Depot® OfficeMax® Rewards now!
- Home /
- Product Details
- NOTE: This product is restricted to qualified educational users only. For current full- and part-time enrolled university and college students, faculty and staff in accredited institutions. Alumni of these institutions are NOT eligible. To use this software, you will be required to verify your eligibility online — through a valid school email address, school sign-in ID, or international student identity card (ISIC).
- Features 7 Office 2013 applications: Word, Excel®, PowerPoint®, Outlook®, OneNote®, Publisher and Access®. Available via 4-year subscription, and includes automatic upgrades. Improved user interface is optimized for a keyboard, pen or touch-screen display. Includes 27GB of online storage, allowing secure access to your documents from anywhere. License allows installation on up to 2 computers and Windows 8 tablets. You simply sign in to your Microsoft account — from practically anywhere — to get to your documents, applications, and settings. (NOTE: Internet connectivity is required.)
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- Publisher 2013 for professional-looking publications that make an impact. Lets you easily and quickly create a brochures, newsletters, calendars, posters, flyers, and more. You can add photos to your documents by a simple drag and drop, and use professional-looking effects, new and improved for 2013, for text, shapes and pictures.
- Access 2013 helps you create custom apps for data. New to the 2013 version, Access web apps are a new type of database that you build in Access, for use by you and others. No app development knowledge needed: Access makes it easy to create apps to solve your specific data-tracking needs, such as customer billing and order tracking. And as with previous versions of Access, you can still create traditional databases, either from scratch or a template.
Product Details
|Item #
|Manufacturer #
|additional requirements
|DirectX 10 graphics card (for hardware-accelerated graphics)
|brand name
|full version/upgrade
|full version
|Language Supported
|License Details
|Microsoft OneNote/Access/Publisher (Windows only)
|License Pricing
|License Quantity
|1 Mobile Device; 20 GB Online Capacity; 2 PC/Mac
|License Type
|Subscription License
|License Validation Period
|4 Year
|Microsoft Corporation
|memory requirements
|1 GB (32-bit); 2 GB (64-bit)
|minimum hard disk space
|minimum processor compatibility
|1 GHz, 32-bit or 64-bit, with SSE2 instruction set
|operating system compatibility
|Windows 7; Windows 8; Windows Server 2008 R2
|Package Type
|Platform Supported
|PC; Mac
|release date
|Service & Support
|New Releases Update - Full-term
|Software Name
|Office 365 University
|software type
|product key (requires download)
Office 365 University
Anytime, anywhere collaboration on up to 2 PCs or Macs, 2 tablets and 2 smartphones
Office 365 University, 4-year subscription
- 4-year subscription
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- Full, installed 2016 versions of Word, Excel, PowerPoint, Outlook and more
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- New upgrades always included Details.
Install on multiple devices
Get the full Office experience on up to 2 PCs or Macs, 2 tablets (including Windows, iPad, and Android) and 2 phones5 - so you can work how you want, when you want and where you want.
Access from anywhere
Office 365 is made for teamwork. 1 TB of OneDrive online storage means you'll have tons of space to save your work to the cloud and share it with colleagues—and even co-author, edit and make comments in real time together, whether you're in the next room or across the globe.
Always up to date
When you purchase an Office 365 subscription, you get the latest software versions and upgrades as soon as they're available, at no extra cost. You control your upgrades, and you decide whether and when to version-up.
Connect with skype
With Office 365, you'll receive 60 minutes of Skype per month. Staying in touch with friends, family and colleagues has never been easier!
Install full Office applications
Always have the latest versions of Word, Excel, PowerPoint, OneNote, Outlook, Publisher, and Access and capture your ideas however you work best--using a keyboard, pen, or touchscreen.
Create, polish, and share beautiful documents. Now sharing and collaborating with the team is a breeze. The new Word allows you to co-author and edit documents with multiple people at the same time-whether you're in the same room or across the globe. And cloud integration makes sharing docs a cinch.
Analyze and visualize your data in new and intuitive ways. Turn numbers into insights with the new Excel. PivotTable Slicers help you discover patterns in large volumes of data, and Recommended Charts gives you the best charts to communicate your data. One-Click Forecasting automatically scans worksheets for data trends and formats them into charts and tables.
Create, collaborate, and effectively present your ideas. Co-author presentations with your team—working simultaneously. Make comments on relevant text and images and compare different versions of a presentation with Conflict Resolution View.
Harness your thoughts in your very own digital notebook. Capture, organize and share your ideas with digital notebooks that you can access on any device. Find things quickly with a powerful search engine that tracks your tags and more.
Publisher is the simple path to professional publications that make an impact. Use Publisher to search your online albums on Facebook, Flickr and other services and add pictures directly to the document, without having to save them first.
Access lets you build a database fast to organize data, accessible anywhere online. Never again get "lost in the data." A standardized app framework makes navigating apps familiar and easy.
Office on more devices
Install Office applications on up to 5 PCs or Macs, and 5 Windows tablets or iPads. Also enjoy easy access to documents with Office Mobile apps for iPhones®, Android phones, and Windows phones.
1 TB OneDrive Online storage
Get 1 TB of OneDrive online storage per user (up to 5 per household). Use it to save your documents, photos, videos and more so you can access them from nearly anywhere. Of course you can save your documents offline to your device as well.
Always up to-date
Always have access to the most-up-to-date versions of your products and services. You decide when to update. We will provide you free access to our latest innovations and refinements on an on-going basis.
Full Office experience on Smartphones
View, create, and edit Word, Excel, and PowerPoint documents from nearly anywhere on your iPhone®, Android phone or Windows phone. Content and formatting stay intact so documents still look great when you're back on your PC or Mac.
Skype world calling minutes
You, and each family member you share your benefits with, get 60 free Skype world calling minutes a month to mobiles or landline phones in 60+ countries. Skype available only in select countries. Calls to select countries.
Microsoft Technical Support
Support via chat or phone at no extra charge for active subscribers.
1. What is Office 365?
Office 365 is a subscription version of Microsoft Office. An Office 365 subscription gives you full, installed versions of familiar Office applications across your devices, and includes 1 Terabyte of online storage (plus additional subscription benefits) so you can access your files and get things done from virtually anywhere and any device. Each Office 365 subscription includes the latest versions of Office applications like Word, Excel, PowerPoint, and Outlook for PC, Mac, tablets (Windows tablets, Android tablets, iPads) and smartphones (iPhones, Android phones). Plus subscription benefits such as Skype minutes and OneDrive online storage. Subscribers will also receive future rights to version upgrades as well as per-use rights across multiple PCs, Macs, tablets, and smartphones. The Office applications you can use across PCs, Macs and tablets vary by platform and device.
2. What is Office 365 University?
Office 365 University is a four-year subscription that includes the latest Office applications, which you can install on 2 PCs, Macs, or tablets. You'll also get extra OneDrive storage, free Skype minutes. Application versions and features vary by platform and device. Currently, Office 2013 for PC and Office 2011 for Mac are available. Publisher, Access and OneNote are available on PC only. Customers with an active subscription will get the newest versions automatically as they become available. Windows 7 or 8, Mac OS 10.6 or later, and an Internet connection are required. When your Office 365 University subscription is in the last year, you can renew your subscription for another 4 years if you still qualify. But you can only renew your subscription once. To activate your subscription, you'll need to accept the Office 365 University EULA.
3. Who is eligible for Office 365 University?
Office 365 University is available to full- and part-time enrolled students, faculty, and staff of qualified, accredited higher education institutions. Alumni of these institutions aren't eligible. Qualified, accredited higher education institutions include Universities, Polytechnic schools, and Institutes of Technology, as well as other tertiary-level institutions, such as colleges and vocational schools that award academic degrees or professional certifications. Restrictions may vary by country.
4. What is the difference between Office 2013 suites and Office 365 plans?
Office 2013 suites include applications such as Word, Excel, PowerPoint, and Outlook; they are available as a one-time purchase for use on a single PC. Office 365 plans also include the applications plus other services that are enabled over the Internet, including online storage with OneDrive and Skype minutes for home use. With Office 365 you get the full, installed Office experience on PCs, Macs, tablets (including iPad and Android tablet) and phones. Office 365 plans are available as a monthly or annual subscription.
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You can install Office on PCs or Windows tablets running Windows 7 or higher, and Macs with Mac OS X 10.6 or higher. Office for iPad can be installed on iPads running iOS 7.0 or higher.
6. Can people with an earlier version of Office open documents I created using Office 365 or Office 2013?
Office 2007, Office 2010, Office 365, or Office 2013 users can open documents created without any additional action. Customers using earlier versions of Office may need to download and install a compatibility pack.
7. Do I keep control of my documents with an Office 365 subscription? What happens if I cancel my subscription?
Yes. Documents that you have created belong fully to you. You can choose to store them online on OneDrive or locally on your PC or Mac. As the expiration date approaches, you will receive notifications in the Office applications and via email, alerting you to the upcoming expiration. If you choose to let your subscription expire, the Office software applications enter read-only mode, which means that you can view or print documents, but you can't create new documents or edit existing documents. To return to full Office functionality, you can purchase a new Office 365 subscription. You could also return to full functionality using an older version of Office, or you can use Office Online for free for basic editing.
8. Is Internet access required for Office?
You do not need to be connected to the Internet to use the Office applications, such as Word, Excel, and PowerPoint, because the applications are fully installed on your computer. Internet access is required to install and activate Office. For Office 365 you will need to go online to manage your subscription account, for example to install Office on other machines, or to change billing options. You will also need to connect to the Internet regularly to keep your version of Office up-to-date and benefit from automatic upgrades. Internet connectivity is also required to access OneDrive.
9. Will Office be identical on a PC, Mac and mobile device?
No. Office applications are tailored to work best on each platform and device. The Office applications available for Mac users and the version numbers may be different from those available for PC users.
10. What are Skype minutes?
With Skype you can makes calls over the Internet through your computer, mobile phone, and other devices. Call, video call, and instant message other people with a Skype account for free, or you can use Skype minutes to call friends or family whether they have a Skype account or not on their mobile phone or landline. You can use Skype minutes from any device where you have Skype installed, whether it's your mobile phone, tablet, TV, or other device, subject to country/region availability. Each active Office 365 subscription is entitled to 60 Skype minutes per month; this allowance resets each month.
11. What is OneDrive?
OneDrive is an online storage service that you can use to store documents, notes, photos, music, videos, or other types of files. With OneDrive you can access your files from nearly any device and you can share them with others. All OneDrive users receive 15 GB of storage with OneDrive for free. An Office 365 subscription gives subscribers an additional 1 Terabyte of OneDrive online storage.
13. Which versions of Office applications are available for Mac? For Windows?
Office applications available for a Mac are Word, Excel, PowerPoint, Outlook, and OneNote. Publisher and Access applications are not available for Mac. Current Office application versions for Office 365 are Office 2013 for Windows and Office 2011 for Mac. Customers with an active subscription will be entitled to the newest versions when available.
|Required Processor
|PC: 1 gigahertz (Ghz) or faster x86 or x64-bit processor with SSE2
Mac: Intel processor
|Required Operating System
|PC: Windows 7 or later, Windows Server 2008 R2, or Windows Server 2012
Mac: OS X 10.10
Windows Tablet: Windows 8 or later
iOS: Office for iPad® requires iOS 7.0 or later, Office for iPhone® can be installed on phones running iOS 6.0 or later
Android: Office for AndroidTM can be installed on tablets and phones that are running Android KitKat 4.4 or later version and have an
ARM-based or Intel x86 processor.
|Required Memory
|PC: 1 GB RAM (32 bit); 2 GB RAM (64 bit)
Mac: 4 GB RAM for Office 2016 for Mac
|Required Hard Disk Space
|PC: 3.0 GB available disk space
Mac: 6 GB HFS + hard disk format for Office 2016 for Mac
|Required Display
|PC: 1024x576 resolution
Mac: 1280 x800 resolution
|Graphics hardware acceleration requires a DirectX 10 graphics card
|A touch-enabled device is required to use any multi-touch functionality. However, all features and functionality are always available
by using a keyboard, mouse, or other standard or accessible input device. Note that the new touch features are optimized for use
with Windows 8 or later.
|Additional System Requirements
|Non-commercial use.
Internet functionality requires Internet connection.
Microsoft account required.
Product functionality and graphics may vary based on your system configuration. Some features may require additional advanced
hardware or server connectivity.
- 1. Publisher and Access are available on PC only. OneNote for Mac is available for download from the Mac App Store. Current Office application versions are Office 2016 for Windows and Office 2016 for Mac. Customers with an active subscription will be entitled to the newest versions when available.
2. Application availability varies by device. For full system requirements, see www.office.com/information.
3. Each additional person you share your subscription gets 1 TB of OneDrive storage.
4. Application availability and features vary by platform device and language. Published and Access are available on PC only.
5. Compatible with Windows 7 or later, OS X 10.10. See Office.com/information for full system requirements, including those for tablets and smartphones. Mac®, Mac OS®, and Mac OS X® are registered trademarks of Apple Inc.
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Percutaneous electrical nerve stimulation (PENS) is an electronic stimulus generator that transmits electrical impulses of various configurations to a needle electrode that is inserted just below the skin for the purpose of pain management.
Needle electrodes are inserted either around or immediately adjacent to the nerves serving the painful area and are then stimulated. PENS is generally reserved for patients who fail to get pain relief from TENS possibly due to physical barriers (e.g., scar tissue, obesity) to the conduction of electrical stimulus. PENS units, which are usually battery operated, have been used to relieve chronic intractable pain, post-surgical pain and pain associated with traumatic injuries unresponsive to other standard pain therapies. The mechanism of action is unknown, but it is purported that the electrical pulses block the transmission of pain to nerve fibers or may stimulate the release of endorphins or serotonin.
Percutaneous neuromodulation therapy (PNT) is a variant of PENS in which fine filament electrodes are temporarily placed at specific anatomic landmarks in the deep tissues near the area of the spine that is causing pain (with or without radiating lower extremity pain). Treatment regimens consist of 30-minute sessions, once or twice a week for 8 to 10 sessions.
Percutaneous electrical neurostimulation or neuromodulation is considered investigational.
See also:
Spinal Cord Stimulation / Peripheral Subcutaneous Field Stimulation for the Treatment of Pain
The literature for percutaneous electrical nerve stimulation (PENS) and percutaneous neuromodulation therapy (PNT) consists primarily of small controlled trials with unclear blinding and short follow-up. The available evidence is insufficient to permit conclusions concerning the effect of this procedure on health outcomes.
American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Academy of Physical Medicine & Rehabilitation. (May, 2011). Evidence-based guideline: treatment of painful diabetic neuropathy. Retrieved March 30, 2016 from the National Guideline Clearinghouse (NGC: 008504).
American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. (2010). Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists task force on chronic pain management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology, 112 (4), 810-833.
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2015). Percutaneous electrical nerve stimulation and percutaneous neuromodulation therapy (7.01.29). Retrieved March 30, 2016 from BlueWeb. (21 articles and/or guidelines reviewed)
Centers for Medicare & Medicaid Services. CMS.gov. NCD for assessing patient's suitability for electrical nerve stimulation therapy (160.7.1). Retrieved March 30, 2016 from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=63&ncdver=2&DocID=160.7.1&from2=search.asp&bc=gAAAAAgAAAAAAA%3d%3d&.
National Institute for Health and Care Excellence. (2012, November). Percutaneous electrical nerve stimulation for refractory neuropathic pain. Retrieved March 30, 2016 from https://www.nice.org.uk/guidance/ipg450/chapter/1-guidance.
National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Diabetic neuropathies: the nerve damage of diabetes. Retrieved March 30, 2016 from http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx.
Rossi, M., DeCarolis, G., Liberatoscioli, G., Iemma, D., Nosella, P., & Nardi, L.F. (2016). A novel mini-invasive approach to the treatment of neuropathic pain: the PENS study. Pain Physician, 19 (1), E121-E128. Abstract retrieved March 30, 2016 from PubMed database.
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.


text:
|Publication number
|Publication type
|Application number
|Publication date
|Nov 3, 2009
|Filing date
|Jul 22, 2008
|Priority date
|Feb 12, 2004
|Fee status
|Also published as
|Publication number
|Richard K. Spero, Christopher D. Owen, Daniel V. Van Buskirk, Stephen L. Daleo, Russell L. Delonzor
|Original Assignee
|Sanarus Technologies, Llc
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (30), Non-Patent Citations (11), Referenced by (12), Classifications (15), Legal Events (5)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of U.S. application Ser. No. 10/779,520 filed Feb. 12, 2004 now U.S. Pat. No. 7,402,140.
The devices and methods described below relate to the diagnosis and treatment of breast lesions, and more generally, to the diagnosis and treatment of tumors and lesions throughout the body.
Biopsy is an important procedure used for the diagnosis of patients with cancerous tumors, pre-malignant conditions, and other diseases and disorders. Typically, in the case of cancer, when the physician establishes by means of procedures such as palpation, mammography or x-ray, or ultrasound imaging that suspicious circumstances exist, a biopsy is performed. The biopsy will help determine whether the cells are cancerous, the type of cancer, and what treatment should be used to treat the cancer. Biopsy may be done by an open or percutaneous technique. Open biopsy, which is an invasive surgical procedure using a scalpel and involving direct vision of the target area, removes the entire mass (excisional biopsy) or a part of the mass (incisional biopsy). Percutaneous biopsy, on the other hand, is usually done with a needle-like instrument through a relatively small incision, blindly or with the aid of an imaging device, and may be either a fine needle aspiration (FNA) or a core biopsy. In FNA biopsy, individual cells or clusters of cells are obtained for cytologic examination and may be prepared such as in a Papanicolaou smear. In core biopsy, as the term suggests, a core or fragment of tissue is obtained for histologic examination which may be done via a frozen section or paraffin section. One important area where biopsies are performed is the diagnosis of breast tumors.
Traditionally, the biopsy technique for breast tumors involves placing a biopsy device multiple times into the breast and taking several samples of tissue from a mass or tumor which is suspected of being cancerous. Several samples are required to be sure that some tissue from the suspect mass has been captured, and enough tissue has been sampled to ensure that, if disperse cancer cells exist in the suspect mass some of those cancer cells will be captured in the samples. Each time the device is placed the physician must locate and direct the device with ultrasound imaging into the correct position near the suspect mass. Some breast tumors and lesions are very well defined, hard spherical masses which grow within the soft, compliant breast tissue. It is difficult to force a needle into these lesions because they are resistant to puncture and fairly mobile. Forcing the biopsy needle into the lesion is like trying to spear an apple floating in water.
Vacuum assisted biopsy system proposed by Biopsys involves sucking a breast lesion into a cannula and shearing off the captured edge of the lesion to obtain a biopsy sample. The device uses a vacuum to collect tissue into the side of an open tubular device, and then uses a rotating corer to cut the tissue collected. The rotating corer is slidable within the tubular section and can be pulled back to remove the tissue collected in the rotating corer. An additional stylet inside the rotating corer can be used to push the tissue out of the corer. The device can be rotated on its axis to remove a sample, 360 degrees around the central placement of the device. Typically, physicians sample six to eight cores. One advantage of this device is that the physician does not have to remove the device for additional biopsy samples. However, the tumor itself must be re-engaged after every coring operation, which entails substantial effort in relocation and confirmation that the target suspect mass has been engaged by the side aperture. Tumors may be too tough to yield to the suction and deform as necessary to enter the side opening of the cannula. Doctors also currently use the device to take a circular sequence of cores by rotating the device about its long axis or by sideways movement of the suction head to take a line of cores.
After biopsy and analysis, the tumor must be treated with a separate device, as Biopsys teaches that their coring device should not be used for resection. Indeed, the device is not designed to perform resection with assurance that complete resection of a suspect mass has been accomplished. Mechanical cutting and disruption of the tissue structure and cancer cell dispersion (that is, tearing of the tissue around the cancer and movement of the cancer cells amongst normal tissue) will result in unintentional delivery of cancer cells into healthy tissue adjacent the lesion.
The device described below provides for diagnosis of tumors within the breast. The device includes an adhesion probe with structures that permit the surgeon to secure a suspect mass or tumor within the breast during the biopsy procedure. The probe is provided with a rigid tube and a sharp distal tip. To secure the tumor to the probe, the surgeon pierces the tumor with the distal rod. Tubing extending within the rigid tube directs coolant to the distal tip to cool the tip, the tumor then adhering to the cooled probe.
The device also includes a coring apparatus with structures that permit the surgeon to core a sample of the tumor during the biopsy procedure. The coring apparatus is provided with an outer cutting cannula that advances through a tumor to core a sample of the tumor. The coring apparatus is adapted for use with the probe. The adhesion probe is disposed within the cannula with the distal tip of the probe extending beyond the distal tip of the cannula. The device is inserted into the body until the adhesion probe pierces the tumor. Coolant is directed to the distal tip of the probe to lightly cool the distal tip and the tumor. The lightly cooled distal tip adheres to the tumor cells immediately proximate the distal tip. Once the tumor is secured to the probe, the coring apparatus is actuated to excise tumor tissue surrounding the distal tip. The coring apparatus comprises a cutting cannula and means for rotating and translating the cutting cannula. After coring is complete, the device is removed from the body and the cutting cannula is retracted to release the excised tissue. This method of biopsy prevents destruction of the tumor cells and reduces seeding (the dispersion of tumor cells to healthy cell areas).
Small canisters of CO2, (carbon dioxide) or N2O (nitrous oxide), sometimes referred to as whippets, provide the coolant to the device. These small canisters eliminate the need for hoses remotely connected to large coolant canisters and allow the surgeon to freely operate during a procedure without the possibility of severing or tangling coolant supply tubes. The use of liquid CO2 facilitates rapid yet moderate freezing of the target tissue lesion proximate the adhesion probe. The larger heat capacity of the liquid cryogen, vis-�-vis gaseous cryogen such as Argon gas, allows for further miniaturization of the reservoir and cooling probe components, with an overall gain of cooling efficiency and faster cooling operation. The liquid CO2 is also used to drive the rotation and longitudinal translation of the biopsy coring apparatus. The system is controlled with various electromechanical interlocks and a microchip programmed to operate the system in response to operator input and various predetermined parameters.
The biopsy instrument includes a coring mechanism that serves as both a translating mechanism and a rotating mechanism for the cannula. As illustrated, the translating mechanism and a rotating mechanism are provided in the form of a combined translating/coring mechanism which performs the rotating operation as it performs the longitudinal translation of the cannula that is required for coring. The combined translating/coring mechanism is comprised of a hydraulic actuator 12 and the various valves in valve block 13 and mechanical components described in more detail below. A computerized control system is provided on a printed circuit board 14. The control system is powered by a 9 volt battery 15 or other suitable power source. The battery can be removed if needed to facilitate disposal.
As illustrated most clearly in the side views of
The pistons are attached to the cannula 3, and are longitudinally fixed to the cannula, through the actuator 22. The actuator may be integrally formed with the cannula, and may, as illustrated, be formed of the proximal extent of the cutting cannula. The pistons may be rotatably fixed to the cannula, but the cannula may also be longitudinally fixed to the pistons while remaining freely rotatable relative to the pistons. The translation of the pistons distally and proximally through the cylinder is translated to the cannula. The actuator rod or proximal extent of the cannula may extend from the proximal end of the housing, through a bore in the proximal piston and the distal piston, and through the lead screw 22, or it may terminate proximally at the distal piston, or any point in between, so long as it is fixed to the pistons.) In the embodiment shown, the adhesion probe and cannula are coaxially disposed within the pistons, actuator rod and cylinder.
The cannula rotating mechanism is comprised of a lead screw 22 (which also serves as the actuator rod) and a lead screw nut 23. The lead screw is formed of a tube, with screw threads on the outside of the tube and a lumen passing through the tube. The lead screw is longitudinally fixed to the pistons, such that the lumen of the lead screw communicates with the respective piston bores. (The actuator rod or proximal extent of the cannula may pass through the lumen of the lead screw.) The lead screw nut is adapted to receive the lead screw. The lead screw is screwed into and through the lead screw nut. The cannula 3 is rotationally fixed into the lead screw, either directly or indirectly. When the pistons are translated, the lead screw translates under operation of the pistons and rotates via translation of the lead screw through the lead screw nut. The lead screw can have a pitch of 1 inch per revolution, such that for every inch of translation, the lead screw rotates one revolution. Because the lead screw is rotationally fixed to the cannula, the rotation of the lead screw is translated to the cannula.
The cannula translating mechanism has a retracted/proximal position and an extended/distal position.
A manifold 34 is used to distribute liquid cryogen from the main valve to the various points in the system. Main valve outlet tube 58 provides a fluid pathway from the main valve to the manifold, and the fluid is then distributed to the retract valve through retract valve supply tube 62 and to the advance valve through the advance valve supply tube 60. The small wiper contact 35 on the drive nut interacts with a corresponding trace on the printed circuit board which is fixed in predetermined position relative to the valve stem such that the wiper/trace combination may act as a limit switch to provide feedback to the computer control system as to the position of the drive nut and main valve stem. This trace and/or additional traces on the circuit board can be used as described below to provide feedback for control of the motor and drive nut.
During sampling operation (which is initiated when the user depresses the sample button on the input pad shown in
After the dwell time, the motor is reversed. As the main valve stem 42 moves backward, as shown in
Though the electromechanical valve actuators described above in relation to
During retraction (which is initiated when the user depresses the retract button 7 on the input pad shown in
The advance side 61 of the piston cylinder 16 must be evacuated prior to application of high pressure fluid to the retract side, to prevent hydraulic/pneumatic binding of the piston. The advance side of the piston cylinder may be vented in any convenient manner. In the device illustrated in the Figures, the valve bodies comprise cylinders 65 with end caps 66. The threading of end cap on the advance valve is machined so that it is slightly loose (or gas valve threads are used, and the cap is not completely seated) and allows slight leakage of the cryogen from the valve body reservoir. Thus, after the bulk of the cryogen is exhausted into the piston cylinder the advance side exhausts through the end cap. The retract cylinder is vented in the same manner. Vented may be accomplished with small apertures in the end caps or valve bodies in similar fashion.
The amount of time in which coolant is flowing depends on desired temperature of adhesion probe. Final temperature of about −3� to −20� C. is desired for biopsy, while a final temperature below −30� C. is desired for cryo-preservation. Alternatively, a thermocouple may be embedded in the adhesion probe so that the device may be temperature controlled rather than time controlled. This will compensate for differences in device or tissue thermal loading, or the difference between the first shot of liquid CO2 and the last as the device cools down, and for variations in the speed of the valve stem travel which may result from variations in the battery. For a standard biopsy with a fully charged battery, the dwell time after the main valve is fully open is about 0.5 to 2.0 seconds. The valve is open, then, for about 5 seconds, which includes the dwell time and the time in which the valve stem is moving (and the valve is open). CO2 flow of 0.05 and 1.25 grams per 5 second cycle (0.01 to 0.25 grams per second) provides adequate cooling for biopsy, which requires cooling sufficient to adhere the probe to the tissue, and preferable does not result in extensive freezing. This flow is appropriate in embodiments in which the adhesion probe outer tube has an outer diameter of 0.0.43 inches and an inner diameter of 0.029 inches (a 19 gauge hypo tube), and the adhesion probe inner tube has an outer diameter of 0.020 inches and an inner diameter of 0.007 inches (28 gauge). The flow rate may be adjusted as necessary with different constructions of the device.
After moving the jack screw nut back a set distance, the motor is stopped and then driven forward until the jack screw nut is driven to its home position. The control system checks the battery voltage and verifies that the number of cycles used is within the capacity of the CO2 canister. Conveniently sized canisters hold enough liquid CO2 to supply the system for about 7 coring operations. Twelve to sixteen grams of liquid are sufficient in a canister filled to 75% density. If there are any cycles left, the ready light 8 illuminates. If not, the expended light 10 illuminates and the system is software disabled. The system will not operate if it has already counted 7 operating cycles (this limit is somewhat arbitrary, chosen to provide ample cycles for a single patient use, and it may be adjusted as manufacturers and doctors gain experience with the device).
In use, the user screws down the screw cap 26. This drives the CO2 canister 11 down into the pierce pin connector 27. When the canister is fully seated, an electrical connection is completed which "wakes up" the control system on the printed circuit board. A self-check program executes and exercises the gear motor 24 (shown in
valve cycle time=(desired cryogen flow cycle time)+(valve stem travel time to initiate flow);
desired cryogen flow cycle time=valve stem travel time after valve opening+dwell time.
In each case, the valve stem travel time is calculated by dividing the distance the valve must travel (which depends on the construction of the device) by the measured speed of the valve stem (which corresponds to the speed of the drive nut). The speed of the drive nut is determined by measuring the time required to travel past the trace, or to move from one trace to another trace, given that the trace(s) are fixed relative to the drive nut wiper and the length of the trace (or the distance between the traces) is known.
After a successful self-check, the ready light 8 on the button interface 5 illuminates. The user, typically a surgeon or radiologist, inserts the distal tip of the adhesion probe into a tumor or other suspect mass within the body of a patient. When the user is satisfied with the position of the adhesion probe, the user depresses the sample button on the input pad, and the system initiations the cooling and coring operation described above in relation to
The system is provided with safety features to prevent over-pressurization, initiation of sampling with a partially discharged device, etc. The average pressure inside the CO2 canister at room temperature is 850 psi. Extreme ambient heating may result in canister pressure of 3 kpsi. The burst pressure of the canister is 10 kpsi, but there is no need to construct the entire probe to withstand such high pressure. Thus, a burst disk 74 (shown throughout the figures) may be placed in line with the main valve so that it will vent when the pressure is higher than 3 kpsi. Any other suitable pressure relief means may be used. In the event the probe, after having a canister installed, is set aside for an inordinately long time, the canister may self discharge, so that it no longer hold enough gas for a full compliment of sampling procedures, or doctors may inadvertently attempt to use a device on a patient after it has already been used on another patient. Thus, the control system is programmed to exhaust the probe after a predetermined time period, such as by driving the drive nut forward to vent out any remaining gas. Thus, the chance of initiating sampling with a partially charged device that may have been used with another patient is minimized. Additionally, the device is provided as a disposable device, such that it cannot be recharged and re-used. This is accomplished with appropriate programming of the computerized control system within the device. The device could be sent back for re-processing, however, in which case the circuitry, internal components and housing can be recycled into new devices with sterile probe and cutter assemblies, and the control system could be reset to allow another set of operating cycles.
While the preferred embodiments of the methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.
|Cited Patent
|Filing date
|Publication date
|Sep 16, 1985
|Feb 24, 1987
|Concept, Inc.
|Vacuum sleeve for a surgical appliance
|Mar 28, 1990
|Jul 2, 1991
|Cody Michael P
|Vacuum biopsy apparatus
|Nov 22, 1989
|Oct 15, 1991
|Board Of Regents, The University Of Texas System
|Precision breast lesion localizer
|Jul 25, 1989
|Oct 15, 1991
|Medtronic, Inc.
|Esophageal pacing lead
|Mar 7, 1991
|Jul 28, 1992
|Spears Colin P
|Spears retriever
|Sep 25, 1992
|Aug 10, 1993
|Hakky Said I
|Automatic biopsy device housing a plurality of stylets
|Mar 17, 1993
|Oct 11, 1994
|Peb Biopsy Corporation
|Method and device for percutaneous exisional breast biopsy
|Feb 10, 1995
|Jul 22, 1997
|Biopsys Medical, Inc.
|Methods and devices for automated biopsy and collection of soft tissue
|Dec 6, 1995
|Jun 23, 1998
|Biopsys Medical, Inc.
|Control system and method for automated biopsy device
|May 13, 1996
|Jul 7, 1998
|Ethicon Endo-Surgery, Inc.
|Apparatus for automated biopsy and collection of soft tissue
|Aug 29, 1996
|Sep 22, 1998
|Ethicon Endo-Surgery
|Methods and devices for collection of soft tissue
|Sep 15, 1995
|Nov 10, 1998
|Tortal; Proserfina R.
|Cryosurgical technique and devices
|Mar 11, 1997
|Feb 9, 1999
|Sonometrics Corporation
|System for carrying out surgery, biopsy and ablation of a tumor or other physical anomaly
|Jan 21, 1997
|Jun 22, 1999
|Ethicon End0-Surgery, Inc.
|Methods and devices for collection of soft tissue
|Jan 9, 1998
|Jul 27, 1999
|Ethicon Endo-Surgery, Inc.
|Apparatus for automated biopsy and collection of soft tissue
|May 14, 1998
|Aug 31, 1999
|Ethicon Endo-Surgery, Inc.
|Biopsy instrument with multi-port needle
|May 14, 1998
|Oct 12, 1999
|Ethicon Endo-Surgery, Inc.
|Method of use for a multi-port biopsy instrument
|Jun 30, 1998
|Dec 28, 1999
|Ethicon Endo-Surgery, Inc.
|Surgical biopsy device
|Jun 18, 1997
|Jan 25, 2000
|Biopsys Medical
|Vacuum control system and method for automated biopsy device
|Dec 27, 1999
|Aug 21, 2001
|Neothermia Corporation
|Minimally invasive intact recovery of tissue
|Oct 16, 2000
|Apr 1, 2003
|Sanarus Medical, Inc.
|Device for biopsy tumors
|May 3, 2001
|Apr 22, 2003
|Sanarus Medical, Inc.
|Device for biopsy of tumors
|Nov 6, 2000
|Jul 6, 2004
|Suros Surgical Systems, Inc.
|Biopsy apparatus
|Feb 12, 2004
|Jul 22, 2008
|Sanarus Medical, Inc.
|Rotational core biopsy device with liquid cryogen adhesion probe
|Aug 23, 2005
|Mar 8, 2007
|Sanarus Medical, Inc.
|Rotational core biopsy device with liquid cryogen adhesion probe
|Dec 4, 1996
|Jun 12, 1997
|Biopsys Medical, Inc.
|Control system and method for automated biopsy device
|Jul 31, 1997
|Feb 19, 1998
|Biopsys Medical, Inc.
|Apparatus and method for marking tissue
|Aug 27, 1997
|Mar 5, 1998
|Ethicon Endo-Surgery
|Methods and devices for collection of soft tissue
|Mar 2, 1999
|Sep 10, 1999
|Senorx, Inc.
|Breast biopsy system and method
|Aug 24, 1999
|Mar 9, 2000
|Senorx, Inc.
|Securing surgical instruments at target tissue sites
|Bard Product Brochure.
|Biopsy Mammotome Brochure.
|Breast Care Info Web Page: Steps in the Mammotome Procedure.
|Edgar D. Staren, MD et al., Ultrasound-Guided Needle Biopsy of the Breast, Surgery; Oct. 1999, 629-625.
|G.S. Ferzli et al., Advanced Breast Biopsy Instrumentation: A Critique, Journal of American College of Surgeons; 1997; 185:145-151.
|Jackman RJ et al., Needle-Localized Breast Biopsy: Why Do We Fail?, Radiology Sep. 1997, 204(3); 677-84.
|Jackman RJ et al., Percutaneous Removal of Benign Mammographic Lesions: Comparison of Automated Large-Core and Directional Vacuum-Assisted Stereotactic Biopsy Techniques, AJR Am J Roentgenol Nov. 1998; 171(5), 1325-30.
|Open Excisional Surgical Biopsy: Breast Biopsy Website.
|Parker et al., Performing a Breast Biopsy with a Directional, Vacuum-Assisted Biopsy Instrument, Radiographics; 1997 (Sep.-Oct.); 17(5):1233-52.
|Stereotactics in Breast Biopsy: Breast Biopsy Website.
|Tyco Minimally Invasive Breast Biopsy.
|Citing Patent
|Filing date
|Publication date
|Nov 2, 2009
|Jul 31, 2012
|Scion Medical Technologies, Llc
|Rotational core biopsy device with liquid cryogen adhesion probe
|May 1, 2013
|Oct 21, 2014
|Devicor Medical Products, Inc.
|Clutch and valving system for tetherless biopsy device
|Aug 28, 2014
|Oct 18, 2016
|Devicor Medical Products, Inc.
|Cutter drive assembly for biopsy device
|Nov 18, 2002
|Sep 7, 2006
|Erik Hermans
|Instrument for cryogenic treatments in the medical, paramedical and cosmetic field
|Nov 2, 2009
|Feb 25, 2010
|Sanarus Technologies, Llc
|Rotational Core Biopsy Device with Liquid Cryogen Adhesion Probe
|Mar 6, 2013
|Jul 28, 2015
|C. R. Bard, Inc.
|Biopsy device
|Jun 26, 2013
|Jul 28, 2015
|C. R. Bard, Inc.
|Biopsy device
|Apr 7, 2014
|Aug 18, 2015
|C. R. Bard, Inc.
|Biopsy device
|Mar 7, 2013
|Aug 25, 2015
|C. R. Bard, Inc.
|Biopsy device
|Jun 15, 2015
|Mar 8, 2016
|C. R. Bard, Inc.
|Biopsy device
|Jul 15, 2015
|Mar 29, 2016
|C. R. Bard, Inc.
|Biopsy device
|Aug 5, 2015
|Jun 14, 2016
|C. R. Bard, Inc.
|Biopsy device
|U.S. Classification
|600/568, 606/20, 600/562, 606/167, 606/23, 600/567
|International Classification
|Cooperative Classification
|European Classification
|Jul 22, 2008
Owner name: SANARUS MEDICAL, INC., CALIFORNIA
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Owner name: SANARUS TECHNOLOGIES, LLC, CALIFORNIA
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|Nov 7, 2011
Owner name: SCION MEDICAL TECHNOLOGIES, LLC, MASSACHUSETTS
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|Feb 20, 2013
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|Property type
Only 20 metres from the sea and the nearest beach, Rosic Apartments is just a 10-minute walk away from Tivat's town centre. Each room has a well equipped kitchen, balcony and air conditioning.
All rooms have soundproofed windows. The kitchens come with utensils, glasses, cutlery and dishes. The balconies are fitted with garden furniture and some offer views of the Bay of Kotor and Porto Montenegro.
In the living area, guests can find a comfortable sofa, flat-screen cable TV and coffee table. Ironing facilities are also provided in each apartment. Bed preferences: One large double, two large double, two large double and one single bed.
Wi-Fi and private parking are free of charge at Apartments Rosic. There are also a shop and a pizzeria in the immediate vicinity. The luxurious yacht marina Porto Montenegro is a 5-minute walk away.
Tivat airport is located 6 km from apartments. Airport shuttle costs 10 euros per apartment.
Additional fees to be charged upon arrival
Cleaning Fee: 10€
Reservation Detail:
After you successfully submit your reservation request, you will receive an e-mail response from the home owner or property manager, within the next 24 hours. At this point, the full details of your confirmed reservation including the address of the property and the contact details of your local host will be shared with you through e-mail.
We hope you have a pleasant stay!
Cozy apartment with fascinating location!
*Plus compulsory or optional charges based on actual occupancy or consumption. The payment has to be made in the currency offered by the property manager, before use of conversion tool. Payments in other currencies have to be negotiated beforehand with the property manager. The currency conversion tool is provided for your convenience only and is non-binding.


text:
Gift Premium Subscription To Scotty_g
Join Date:03-27-2007
Last Activity:09-11-2016 6:04 AM
13 Likes on 12 Posts
- De Pere, WI
- The N20 crew brews at my house because of a lack of proper supervision here. Plus, Angry Pot wouldn't be the same over a decent stove.
- Beer,anime,fire,waterskiing,D&D
- Engineer
- Scott Gigot
- Rush
- Moyashimon - the yeasts are so cute!
- International Association of Pedants--Motto: accuracy before tact
First batch: 12/30/06
First time anyone asked us to make beer for them: 4/24/07
First recipe screwed up: 5/26/07
First batch kegged: 6/07
First lager: 3/8/08
First beer road trip to meet someone from HBT: 2/22/08
Kegerator construction completed: 3/25/08
First hop rhizome planted: 4/17/08
First time welcomed to another state with a homebrew: 5/3/08
First homebrew served at a family reunion: 6/08
First hop harvest: 9/08
First homebrew using home-grown hops: 10/25/08
First attempt at mashing: 2/28/09 (45% efficiency--woo!)
First serious brewing injury ignored because they don't let you finish brewing in the ER waiting room: 2/4/09
- We're getting the hang of AG, but it still involves a lot of lifting. We need a solution that requires lifting nothing heavier than a pint glass.
- Two batches of AG pilsner. Gotta love that Saaz...
- Raspberry melomel, more Centennial Blonde.
- Of note, only the 2007 strawberry melomel.
- Black lager, EdWort's Haus pale ale, Black Tentacles (red ale made from leftovers), Remove Fear (ale made from leftovers), Biermuncher's Centennial blonde.
- Male
- Single
Posted in thread: More to it than I thought. on 04-19-2016 at 04:19 AM
@Altraz I believe the legal limit for homebrew is 200 gallons per year for a household with 2
or more adults. They've got to *catch* you over the limit. As long as you're rotating the stock
like you s...
Posted in thread: Spike Brewing Giveaway - New v3 Kettle - You Pick The Size!! on 02-06-2016 at 07:15 AM
I'd love to get my paws on a 30-gal kettle for those days when I just *have* to fill 4 corny
Posted in thread: What I did for beer today on 06-21-2015 at 06:01 AM
We ported another keggle, replumbed the propane manifold to handle two burners with modern
fittings, and made our first 20-gallon batch (lautered into three vessels, then combined to
equalize volumes ...
Posted in thread: Broke my first carboy on 06-09-2015 at 03:46 AM
The carnage thread is enough to scare a guy, that's for sure. Any time a story includes the
phrase, "and the doctors say I'll make an almost complete recovery" I get spooked. I have a few
glass carboy...
Posted in thread: Uh oh frost on the way on 05-22-2015 at 02:25 AM
We had a little light frost here the last couple of days and it isn't slowing my hops down a
bit. Tallest ones are up to 7'. You pretty much can't kill 'em. A few years ago the weed guy
came by and ho...
Posted in thread: Kolsch help on 04-26-2015 at 06:26 AM
Extract or all-grain? Mashing schedule, if all-grain? Yeast type? Did you make a
starter?Questions aside, you can often kickstart a stalled fermentation (regardless of yeast
type) with some agitation ...
Posted in thread: All grain learners permit suggestions on 04-26-2015 at 06:23 AM
Is the Victory malt providing all the enzymes for the starch conversion in the mash? I was not
aware it had that much diastatic power. I thought wheat needed help converting. I have only
ever used a s...
Posted in thread: The HomeBrewTalk 2015 Big Giveaway! on 03-17-2015 at 04:20 AM
This is truly the mother lode of giveaways. Here's to hoping!
Posted in thread: First time brewer: cider smells and tastes like soft pretzels? on 03-17-2015 at 04:19 AM
No, it was very, very sweet. It had three pounds of pure sugar in less than a gallon of liquid.
The alcohol must have killed the yeast.Yes, this is your problem. 3 lbs of sugar in 1 gallon
puts the OG...
Posted in thread: First time brewer: cider smells and tastes like soft pretzels? on 03-02-2015 at 02:58 AM
I didn't add any priming sugar because it was already very sweet.This is your problem. At the
end of fermentation (when the gravity stopped dropping...you did confirm this, right?) the
yeast have eate...


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Masochism by namesjamesWatch
©2012-2017 namesjames
For Poxnora
The look on her face is so evil, demented and wicked... I love it! :3
Stunning expression!!
Dark & beautiful.
Wow!she is looking so vicious and sexy...Nice work!
Flagged as Spam
OH MY GOD! this is a SEXY art!
Love ~
is a nightelf right? hawt!!
Wow very hot!
Brilliant work!
bela arte!!
Love the bg too
Love the bg too
Powerful piece. Is it sick if I say it's...sexy in a disturbing way?
Powerful piece. Is it sick if I say it's sexy in a very disturbing way?
It's already been said, but I love how you made her feel more...real. Not that barbie style of anime elf. Very well done. Kicking all kinds of ass with these new deviations.
I love how the light hits the curves on her stomach, hip, and thigh! AWESOME!
This is the first dev I've commented on in a while dude. Bravo! I love how you added a nice amount weight to her. Makes her look more natural than the average comic body. I envy guys that can pull that off well.
i was about to say the exact same thing, i love that he made a natural girl instead of a stick with boobs!
That's Hawt!
only critique is she looks freakin old
Old?! What the...
So good!!! Great face rendering!
Nothing quenches one's thirst like.... oh, nevermind.
very nice job she looks nasty
Wow. Very nicely done. Great colours too.
nicely done with the scratches and blood work. her non anorexic frame is refreshing to see hah.


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- Location: Minnesota
- Join Date: 10/8/08 at 7:59pm
COOLER MASTER Hyper 212 EVO
Product Overview
Cooler Master Hyper 212 EVO CPU Cooler (RR-212E-20PK-R1)Read Reviews (20) | Write a Review
Rated #2 in CPU Fans & Heatsinks
Cooler Master, an industry leading chassis, thermal solution, peripheral, and accessory manufacturer, signals the rebirth of a household name in computing, the Hyper 212 EVO CPU Cooler. It comes packed with an improved tower fin design, heat pipe layout, and upgraded fans and fan brackets that provide an even more extreme value for end-users of all types.
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Kerry Rego Consulting offers Social Media & Technology education, implementation, training, consulting and support for individuals, organizations, businesses, and teams. Kerry is also available for private classes and keynote speaking engagements.
You can purchase her book "What You Don't Know About Social Media CAN Hurt You: Take Control of Your Online Reputation" on her website. Available in paperback or Kindle.


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9 posts tagged with awesome and slyt.
Displaying 1 through 9 of 9. Subscribe:
They called you exotic. Which is just people talk for awesome.
Coyote Peterson, host of wildlife TV show Brave Wilderness, was hunting for spiders at night on a trail through Costa Rica's Osa Peninsula when he encountered a very different kind of creature.
"I'll apologize but I won't take off my glasses, because they're famous"
When his parents went out of town, 16 year old Corey Worthington threw a party. When 500 people showed up, things got out of hand. Eventually the police were called, who mobilized units including their air wing & canine teams to quell the disturbance (for which Corey is being billed $20,000). And in the aftermath, Corey gave this awesome interview.
Replacing a trampoline with a see-saw...
Goats Yelling Like Humans
Goats Yelling Like Humans. Does what it says on the tin. [SLYT]
Relax, it's Saturday
El Internet (sNSFW). [more inside]
Only 6 grams of fat, HALLELUJAH!
Food Court Flash Mob sings the "Hallelujah" chorus.
It never DOESN'T work!
Once in a generation, there comes along a piece of aural majesty able to improve any piece of video made by man or beast. From movies to British game shows to video games to even Scooby-Doo. Prepare for your life to be changed forever.
Bike Parkour
Bike Parkour. Exactly what it says on the tin.
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text: ODOT Deal nearly set to fund MLK/71 interchange project By Tana Weingartner • Nov 13, 2013 Tana Weingartner / WVXU UPDATE: The OKI board unanimously approved the funding plan at its meeting Thursday morning. The OKI Regional Council of Governments board will vote Thursday on a first-of-its kind financing plan to rebuild the Interstate 71/Martin Luther King interchange. OKI Director Mark Policinski says the plan calls for a loan from the state infrastructure bank. Find out where you can drive 70 mph in July By Tana Weingartner • May 21, 2013 ODOT / Provided Beginning July 1, the speed limit on some Ohio interstates increases to 70 mph. The Ohio Department of Transportation (ODOT) is making some new signs and updating others with the new limit. The cost is $8,287.19. ODOT outlines the new speed zones below. You can also click here for a large map. Interstate 70 ODOT launches one of the 'largest construction season to date' By Tana Weingartner • Apr 10, 2013 Tana Weingartner / WVXU The Ohio Department of Transportation (ODOT) is officially making it every driver's favorite time of year by kicking off construction season Wednesday. The state is working on nearly a thousand projects totaling an estimated $2.3 billion. Camp Washington Business Association Executive Director Joe Gorman says his community is excited about plans to upgrade the Hopple Street - I-75 interchange. Lytle Tunnel rehab being planned By Jay Hanselman • Apr 8, 2013 The Ohio Department of Transportation is planning a major renovation for the Lytle Tunnel. Some of the work will begin later this year.The project includes sealing tunnel joints, replacing tiling, and upgrading obsolete lighting and electric systems.A second phase of the project consists of replacing and expanding the tunnel's ventilation system. That will require modifications to Lytle Park above the tunnel.City Transportation and Engineering Director Michael Moore updated Council's Budget and Finance Committee Monday about the project. Cleaning up near Cincinnati interstates By Jay Hanselman • Apr 5, 2013 Mark Heyne Keep Cincinnati Beautiful is teaming up with the Ohio Department of Transportation for a clean-up project Saturday focusing on the city's dirtiest entrance and exit ramps on Interstates 71 and 75.Volunteers are asked to report to the ODOT location at 1400 Seymour Avenue in Cincinnati by 10:30 a.m. ODOT launches traffic website By Karen Kasler (Ohio Public Radio) • Jan 15, 2013 Karen Kasler / Ohio Public Radio With all the construction that's likely to start up on Ohio roads this spring and summer, this may be some good news for drivers from ODOT. The transportation department is launching ohgo.com, where ODOT director Jerry Wray says travelers can customize their trips within six major Ohio cities and between different regions of the state. Ohio bid rigging investigation underway By Ann Thompson • Dec 18, 2012 Mark Heyne There are questions regarding whether Ohio Department of Transportation employees followed the proper bidding procedures and allowed conspiracies between suppliers. A Hamilton County company is the first to plead guilty. Timeline moved up for Eastgate interchange By Tana Weingartner • Oct 4, 2012 ODOT Drivers don't often get excited about road construction but some in the Eastgate area may like this project. Pages« first ‹ previous 1 2


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Check in from 14h / Check out prior to 11h
Sithonia Village: Find photos, reviews, information, amenities and compare prices for 3 stars hotels in Gerakini, Greece.
Sithonia Village is ideally positioned in a peaceful setting in Gerakini, a short drive from Nikiti and Nea Potidea. It has a fitness centre, as well as a garden, a safe and parking.
Hotel description
The rooms are air conditioned and offer a private bathroom and a refrigerator. A hair dryer and cable/satellite channels are also provided.
Those staying at the resort are served breakfast every morning.
Thessaloniki International Airport is a 55-minute drive from Sithonia Village. It is also minutes from Wine Route of Halkidiki.
Hotel features
Air Conditioned, Refrigerator, Cable / Satellite TV, Hair Dryer, TV, En suite, Private Bathroom
Safe-Deposit Box
Fitness Room/Gym, Garden
Availability and Prices
Booking Site
Room Type
Per room
Per night
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Nearest hotels
- Possidona Beach Hotel
75 m
- Paschalia Studios
89 m
- Akti Liakada Hotel
835 m


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Beefy Macaroni and Cheese With Tomatoes
Total Time
Prep 15 mins
Cook 20 mins
This is a great time saver and who doesn't like mac and cheese with a little surprise?
Ingredients Nutrition
- 1 (5 ounce) box macaroni and cheese mix (don't use the cheap mix)
- 1⁄4 cup milk
- 1⁄4 cup butter (not spread or tub product) or 1⁄4 cup margarine (not spread or tub product)
- 1⁄2 cup of diced onion
- 1 lb ground beef
- 1 (14 ounce) can diced tomatoes
- salt
- pepper
- garlic
- Prepare your mac and cheese per instructions on the box. Set aside.
- Fry your ground beef the with onion added and add whatever spice you like.
- Garlic, Salt and Pepper are my favorites.
- After you drain your hamburger you can add the mac and cheese to it.
- Add your can of diced tomatoes, mix well and heat thru.
- If you want you can throw some veggies in the mix as well.
- Enjoy!
Most Helpful
Great easy recipe when the pantry is getting bare. I wanted to add veggies, but was vetoed by my husband, who was cooking this. He decided to add a bunch of cayenne, so now he's the only one eating it, but before he did that it was really good! I'll do the cooking next time we make this one. Thanks for sharing a quick recipe idea!
This was a huge hit with my family! Added a bag of mixed veggies to it.
This is a fantastic budget meal. I used ground turkey and added 2 cloves of minced garlic. I did toss in some finely chopped mushrooms. The recipe makes lots. It was served with a side salad for a quick weeknight meal. Made for *PAC Spring 2008*


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Is this a pizza restaurant?
Is this restaurant good for dinner?
Is this restaurant good for lunch?
Does this restaurant have private dining rooms?
Is this primarily a bakery?
Is this a dessert shop?
Is this primarily a coffee shop?
Thanks for helping!
3 Days in Venice
Museum Guide for Venice
Venice Off the Beaten Path
Well worth a visit. €2 slice of pizza and €1.50 can of beer. Excellent and actually pretty welcome respite from the 'seriousness' of Venetian food. Great bar just up the road too....
Prices are surprisingly low. I almost feel ashamed for grabbing a big slice of pizza for just two euro. For this price the quality is more than amazing. The pizza dough is perfectly Italian and quite crunchy. Ingredients could be fresher but the final taste is yummy. Great for lunch or quick dinner.
My wife and I got a very very very large Prosciutto è Fungi take away pizza which was excellent. All for a terrific $12 Euro, excellent value
Such good and big slice of pizza for so little money! Really enjoyed it! Such friendly staff and ready straight away!
This place is not crowdy, I guess, people just don't know that pizza here is very tasty!! Furthermore, it is cheap!! We bought a prosciutto one and it was just perfect for only 5,50€!! Totally recommend it to everyone!!!
We stopped for an early dinner and had amazing take away pizza for ash incredibly price. Shockingly there was no line, probably because it was still early.
We usually eat baguettes to save money when we're travelling but Venice is so expensive that we decided to give this place a try. And I'm glad we did.
The staff was very friendly and made our pizzas in front of us. For 4 € we got each a huge and delicious pizza - we were full after 3 pieces....
Cheap, tasty, no tourist pizza. Place is popular among venetian students, not tourist. Really long lines is a proof of it. The best way to save your money and to eat good is to take pizza away and to enjoy Venice from one of its beautiful bridge with a great piece of pizza. The best is with a seafood (!)
Campo Santa Margherita is the place to go in Dorsodro for a coffee or a light meal. Lots of choices in and around the square but the best pizza, unquestionably, is to be had at this unassuming takeaway.
Simple and very reasonable. This place was such a temptation, even after lunching elsewhere in the city, as they freshly cook huge, delicious pizzas for next to nothing. There's no seating, but that gives you the chance to soak up the square on one of the nearby benches. Gorgeous.
Own or manage this property? Claim your listing for free to respond to reviews, update your profile and much more.


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Budget Host Hutchinson
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?
- Swimming pool
- Continental Breakfast
- Wheelchair accessibility
- Pets allowed
Travelers also recommend:
- Swimming pool
- Wheelchair accessibility
- Pets allowed
- Continental Breakfast
TripAdvisor Reviews Budget Host Hutchinson
Travel Blogs from Hutchinson
Visited my mom's hometown today!
... I sent them a congratulations card and Mamie actually sent me a thank you letter on White House stationery.....which I still have! We then drove the Eisenhower memorial Road 15 to two of my family's hometowns....Newton and Sedgwick. Loved Gavin's navigation as he drove me by the farm home of my biological father and then to the cemetery where he and his wife are buried. Loved it when he said, "that's my ...
Day sometime between 0-52
... br>
So as arrived early had another milkshake at my current favourite place-Braums I think it is. Then had a dip in the pool and was quickly befriended by Felicity aged 5. Her dad is 38 and her mum 35. Good to know. Dinner all done, over eaten as per usual and now off to bed. Another short day tomorrow of 65 miles but there look like storms coming and I fear we may have used up all our luck on tail wind....
Hot Hot Hot!!
... becoming road kill. It was close enough that the team were white after the truck had gone. I've since bought a bright flashing rear light, bright enough to be seen during the day. I hope this helps. Yesterday, one of the team, Andrea, headed back to Perth for 10 days. She'll be back in 10 days, but the numbers are now down to six. We'll miss her while she's away. Some small items: We've now had 9 flat tyres, all on rear ...
Laying low in Lyons
... for most of us. We continued through Ellinwood noting the swelling streams and channels in the fields filled with the earlier rains. Quivira, the mythical Lost city of gold that Coronado sought in the 16th century was in this area. History has taught that he came this far before turning back to ...
Bullinger Homestead
... it. The last stop was the church we went to. They still attend there. It is a rural church out in the middle of the farm land, not in the town. My Great Grandfather Rev. W.F. Bullinger was pastor there from 1902-1910 and his picture was on the wall. There is a cemetery out back of the church where a lot of my relatives are buried. It was very moving to see the grave sites. When we got back to the farm, Irma got busy with supper. I think that's what they call the evening ...


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October 2016
This was a great tour for the whole family. They had something for all ages and abilities. Great crew and good food.
September 2016
Wonderful, everything was on schedule a nice experience under the sea!
September 2016
Wonderful on schedule great experience under the sea!
September 2016
Awesome day out. We all had the best time ever. We were able to see lots of fish and have a good look around. The staff were very helpful and lots of fun. The lunch was basic but good. Would have been nice to have lettuce with the hamburger but not a biggy. The boat trip was good and the fruit was nice on the way there.
We all had a good time and would definitely recommend doing this tour. Lots of fun and very relaxing.
August 2016
Super fun and staff was stellar!
August 2016
Something for every age. Very good.
July 2016
Boat was full, but didn and #39;t seem like it at all! Plenty of seating available! My kids loved the slides and snorkeling! Great service, food was decent, and this is totally worth the money!
July 2016
Wonderful! Perfect amount of cruising and snorkeling time. Beautiful location. Very nice and helpful staff. And the food was great!
April 2016
Really enjoyed the trip. The crew was wonderful and the boat was fantastic to snorkel from. Can't wait to do it again.
August 2015
Had a brilliant time -- great snorkeling, lovely crew, good food.
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The performance of gold in recent weeks has been surprisingly lackluster. After ramping higher from mid-August to mid-September in anticipation of more balance sheet expanding quantitative easing (QE) from the U.S. Federal Reserve, the rally effectively stalled once the Fed officially announced the launch of QE3 on September 13. Overall, the price of gold is down -2.3% in the weeks since.
Balance sheet expanding monetary stimulus programs like QE3 are particularly supportive of gold. This is due to the fact that such programs result in the Fed printing money, which serves to devalue the U.S. dollar and induces investors to seek a store of value in hard assets such as gold (NYSEARCA:GLD). And gold has performed exceptionally well in recent years when the Fed is actively engaged in QE. In short, when the Fed is expanding its balance sheet during QE, gold rises along with it. And when the Fed steps away from a QE program, the increase in gold ebbs unless concerns over a potential crisis take over.
So why has gold not responded thus far under the latest QE3 program launched in September? This is because the Fed's balance sheet has yet to start expanding under the current stimulus program.
Unlike past QE programs that included the purchase of U.S. Treasuries, the Fed is focused only on purchasing Mortgage Backed Securities (MBS). Although the Fed is pledging to purchase $40 billion in MBS each month, the final settlement for these Fed purchases is not immediate. Instead, it can take up to 180 days for the Fed to complete the transaction on these purchases. As a result, the initial phases of the current QE program have been marked by a slow and uneven expansion of the Fed's balance sheet that has also been offset by accelerated prepayment of existing MBS in the Fed's portfolio. Over time as this program builds momentum, the Fed's balance sheet is likely to smooth into a more consistent expansion. A recent article in The Wall Street Journal provides more details on this point.
Looking ahead, if the Fed seeks to expand its current QE program by opting to buy U.S. Treasuries outright once its current Operation Twist program concludes at the end of the year, the expansion of the Fed's balance sheet could pick up pace in an even more meaningful way.
All of this bodes well for gold in the months ahead. As the expansion of the Fed's balance sheet picks up pace, the tailwind behind gold should increase accordingly. Moreover, gold has the potential to receive additional upside support if the European Central Bank and/or the People's Bank of China end up resuming balance sheet expanding monetary stimulus programs of their own in the coming months. Lastly, the financial risks and potential crisis points facing the global economy remain as pronounced as ever, which would also support the appeal for gold as a hard asset safe haven investment.
In maintaining exposures to gold, the Central GoldTrust (NYSEMKT:GTU) provides an ideal choice. And for those seeking exposure to both gold and silver (NYSEARCA:SLV), which offers a higher-octane exposure to these same themes, the Central Fund of Canada (NYSEMKT:CEF) is also a suitable alternative.
This post is for information purposes only. There are risks involved with investing, including loss of principal. Gerring Wealth Management (GWM) makes no explicit or implicit guarantee with respect to performance or the outcome of any investment or projections made by GWM. There is no guarantee that the goals of the strategies discussed by GWM will be met.
Disclosure: I am long GTU, CEF. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.


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The biotech group as represented by the NYSE ARCA Biotech Index ($BTK) has been weak this year, now down over 30% from the highs it hit earlier in the year in May. In this article, we discuss the investing activities of the world's largest fund managers, managing between $100 billion and over a trillion dollars, in small-cap biotech stocks, based on the latest available Q3 institutional 13-F filings. Taken together these mega funds are bearish on the group, cutting a net $103 million in Q3 from their $6.64 billion prior quarter position, and they are also equal-weight in the group (for more general information on these guru funds, please look at the end of the article). We have broken the biotech group by capitalization due to the sheer size of the group, and the fact that larger biotech companies with commercial product portfolios attract a more risk-averse and conservative investors who look for revenues and sustained profitability in constructing their value thesis. Small-cap and micro-cap biotech companies in contrast generally have no commercial products, but rather a pipeline of product candidates being tested in early- to sometimes mid- or late-stage clinical trials for a variety of disease conditions, and hence they generally attract a more speculative investor due to the uncertainty associated with the cash flow from their product portfolios.
The following are the small-cap biotech companies that mega fund managers are bullish about (see Table):
Optimer Pharmaceuticals (OPTR): OPTR focuses on discovery, development and commercialization of hospital specialty products such as products that treat gastrointestinal infections and related diseases. Its commercialized product portfolio includes only DIFICID that was launched in July for the treatment of Clostridium difficile-associated diarrhea (CDAD) in patients 18 years of age and older, and its lead product candidate includes Pruvel for the treatment of infectious diarrhea that is currently in phase 3 trials. Mega funds added a net $3 million in Q3 to their $164 million position in the company. The largest mega fund buyer of OPTR in Q3 was Fidelity Investments ($26 million), which was also the largest holder at the end of Q3 ($44 million). OPTR currently generates losses and is projected to continue to do so for a while, however, its revenues are on a strong upward trajectory, driven mostly by the recent launch of DIFICID on July 19th. The shares traded lower recently after the company missed its projected loss estimates for Q3.
Vical Inc. (VICL): VICL develops DNA-based vaccines and therapeutics to prevent and treat cancer and cardiovascular and infectious diseases. Mega funds added a net $8 million in Q3 to their $66 million prior quarter position, and together they now hold an outsized 40.6% of the outstanding shares. The largest mega fund buyer in Q3 was Fidelity Investments ($16 million), which was also the largest holder with $23 million. VICL shares have been among the best performers in the group this year, up almost 120% YTD, buoyed on positive developments in its pipeline, particularly on its lead product Allovectin being tested in phase 3 trials for metastatic melanoma.
Endocyte Inc. (ECYT): ECYT develops targeted therapies using small molecule drug conjugates for the treatment of cancer and inflammatory diseases. Mega funds added $10 million in Q3 to their prior $20 million position, and together they now hold an outsized 48.3% of the outstanding shares. The largest buyer in Q3 was Fidelity Investments ($4 million), who is also the largest holder with $19 million. ECYT shares are among this week's strongest movers to the downside, down 72% this week so far, after the company announced on Tuesday the results of supplemental analyses of its phase 2b PRECEDENT trial that failed to show a survival advantage.
The following are select small-cap biotech companies that these mega fund managers are most bearish about (see Table):
Arena Pharmaceuticals (ARNA): ARNA is a biotech developer of oral drugs for cardiovascular, central nervous system, inflammatory, and metabolic diseases. Mega funds cut a net $7 million in Q3 from their $77 million prior quarter position in the company. Wellington Capital Management was the largest seller by far, selling $8 million in Q3 from its $31 million prior quarter position. Wellington has been aggressively reducing its position in ARNA, and in fact, just last week we reported that Wellington filed SEC Form SC 13G/A indicating that it now holds 9.1 million or 6.3% of outstanding shares of ARNA, a decrease of 2.1 million shares from the 11.2 million shares that it reported holding in the 13-F filing for Q3. Even after this sell, Wellington is still the largest institutional holder in ARNA, with Vanguard Group being the next largest with 4.7% of the outstanding shares. ARNA shares have rallied strongly recently, up more than a double since the last week of November when the stock started rallying on positive comments from Piper Jaffray regarding its upcoming NDA re-submission to the FDA for lorcaserin.
Spectrum Pharmaceuticals (SPPI): SPPI develops innovative therapies with a focus in the areas of hematology and oncology. Mega funds cut a net $16 million in Q3 from their $234 million prior quarter position in the company. The largest mega fund seller in Q3 was State Street Corp., selling $10 million from its $44 million prior quarter position. SPPI stock has been among the best performers in the biotech group lately, having more than doubled since the beginning of October, mostly on the basis of strong operational data for its Q3 in which revenues ($51 million versus $40 million) and earnings (34c versus 10c) topped estimates. SPPI trades at 18 forward P/E and 4.8 P/B compared to averages of 31.8 and 6.2 respectively for its peers in the drug manufacturers group; however, earnings after staging a turnaround in 2011 are expected to drop from 97c in 2011 to 82c in 2012.
Antares Pharma Inc. (AIS): AIS is a developer of trans-dermal and intra-dermal therapeutic delivery systems, including needle-free and mini-needle injector systems and gel technologies. Mega funds cut a net $1 million in Q3 from their $28 million prior quarter position. The bottom fell out from under AIS shares today after its partner Biosante Pharmaceuticals (BPAX) announced that Libigel for female sexual dysfunction had failed to show a statistically significant difference in two pivotal trials versus those on placebo. AIS had planned to develop the delivery system for the drug, and so it fell along with the steep 80% plus drop in BAPX shares last week.
Avanir Pharmaceuticals (AVNR): AVNR develops therapeutic products for the treatment of chronic diseases, including central nervous system and inflammatory diseases. It currently markets FazaClo for severely ill schizophrenic patients who fail to respond adequately to standard drug treatments for schizophrenia, and it has an ongoing program with Novartis (NVS) for the treatment of inflammatory disease. Mega funds cut a net $5 million in Q3 from their $112 million position in the company. The top seller in Q3 was Deutsche Bank ($2 million). AVNR shares have been among the weakest performers in the group this year, down 55% YTD.
PDL Biopharma Inc. (PDLI): PDLI develops treatments for cancer and immune disorders based on proprietary antibody humanization technology. Mega funds cut a net $22 million in Q3 from their $350 million prior quarter position, and the biggest sellers were Goldman Sachs Group ($6 million), Invesco Ltd. ($5 million) and Credit Suisse ($4 million). PDLI trades at 4-5 forward P/E compared to the average 31.2 for its peers in the genetics biotech group.
General Methodology and Background Information: The latest available institutional 13-F filings of over 30+ mega hedge fund and mutual fund managers were analyzed to determine their capital allocation among different industry groupings, and to determine their favorite picks and pans in each group. These mega fund managers number less than one percent of all funds and yet they control almost half of the U.S. equity discretionary fund assets. The argument is that mega institutional investors have the resources and the access to information, knowledge and expertise to conduct extensive due diligence in informing their investment decisions. When mega Institutional Investors invest and maybe even converge on a specific investment idea, the idea deserves consideration for further investigation. The savvy investor may then leverage this information either as a starting point to conduct his own due diligence.
Credit: Fundamental data in this article were based on SEC filings, I-Metrix® by Edgar Online®, Zacks Investment Research, Thomson Reuters and Briefing.com. The information and data is believed to be accurate, but no guarantees or representations are made.
Disclaimer: Material presented here is for informational purposes only. Nothing in this article should be taken as a solicitation to purchase or sell securities. Before buying or selling any stock you should do your own research and reach your own conclusion. Further, these are our 'opinions' and we may be wrong. We may have positions in securities mentioned in this article. You should take this into consideration before acting on any advice given in this article. If this makes you uncomfortable, then do not listen to our thoughts and opinions. The contents of this article do not take into consideration your individual investment objectives so consult with your own financial adviser before making an investment decision. Investing includes certain risks including loss of principal.
Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours.