text:
Does charitable giving make you feel great? Well, it should! Simply follow these five steps and you'll be giving with confidence to charities you trust in no time!
Start by identifying which causes are important to you, and be specific about the impact you want your donation to have. For example, maybe you are interested in helping people with a particular disease. A large national organization might be better suited to research and finding a cure for the disease, whereas another one, perhaps in your community, could be doing great work providing services to patients and their families. Once you are clear about your philanthropic priorities, start to pull together a list of charities that match your interests.
Next, begin to narrow down your list of charities by conducting some basic research.
A charity's ability to bring about long-lasting and meaningful change in the world is the key reason for their existence and for your donation. So, before making a contribution, talk with the charity to learn about its accomplishments, goals, and challenges. Such conversations will give you insight into how well the charity knows where it stands and where it plans to go. Charities unwilling or unable to have this conversation may not deserve your support.
Remember to follow up with the charity in six months to a year to find out how they're using your money. You're not looking for a list of itemized expenses, but instead a progress report to give you a sense of how responsive they are to you and if they can clearly communicate their progress.
For 15 years, Charity Navigator has equipped donors with unbiased charity evaluations and tools to help you make informed giving decisions. Learn more about that journey and the bold goals on our road ahead.
Together, with donors like you, we have been able to:
Did you know that we're a charity, too? Your donation will help us provide new tools and information that you can rely on to make impactful giving choices. Your gift of any size will make a difference!


text:
Aria - Secluded Bush Setting
House, Daylesford
Rated 5 out of 5 stars 1 review
Confirmation within 24hr
From $307 per night {{quote.pricing.message}} Total {{quote.pricing.price | format:'currency':'short'}} for
Min 2 - 4 nights stay
Secluded bush setting and a double sunken spa bath
With quality appointments and a secluded hideaway location, Aria is ideal for your dream come true romantic getaway. The extra large spa has wide opening concertina windows creating a luxurious indoor-outdoor feel. Features include a gourmet kitchen, open plan living, large plasma TV and sumptuous leather lounge suite. Extras such as an ipod dock, bath robes and a ?welcome hamper? are all provided to make your stay even more special. Located only a two minute drive from Daylesford's main street Aria is an eight acre property with abundant wildlife and bush views.
Unique Features and Appointments
- 1 bedroom king
- Large two person spa with bush views
- Separate bathroom with toilet and walk-in shower
- Fully appointed kitchen with all facilities
- Reverse cycle air conditioning
- Iron and ironing board
- Leather lounge suite and luxury appointments
- Coonara wood fire Fire for ambiance only – limited wood supplies provided
- Electric barbeque
- Free WiFi
- Plasma TV/DVD/CD player and iPod dock
- Local produce hamper on arrival
- No pets allowed
The best aspect to Aria is its secluded bush surrounds while being a short drive of only a few minutes away from the main street.
Please make an enquiry for availability and a precise quote.
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Note: Pricing is subject to change, and a minimum stay period and other conditions may apply. You should confirm pricing with the property owner. Bookings paid through the Stayz online booking system incur a 2% Service Fee.
Prices listed based on 2 adults. Property has 1 beds and can sleep a maximum 2 people.
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subset: commoncrawl


text:
Essential Pharmacology For Inpatient Care
€ 8,91
epub eBook
Sofort lieferbar (Download)
Dezember 2014
BeschreibungAlmost every patient who is hospitalized gets started on a medication. Most patients get started on multiple new medications and will continue some or all of their chronic medications. Alteration in pharmacotherapy is the most common medical intervention in hospitalized patients. Medication errors and side effects are unfortunately not uncommon and can potentially result in morbidity and rarely mortality. Even when mild, they increase patient dissatisfaction and prolong length of stay. Furthermore, they are associated with significantly increased health care cost and not infrequently result in lawsuits.
A major contributor to these errors is a poor knowledge of basic pharmacology principles. With the recognition that service lines use only a limited number of common medications, we have attempted to create a guide for essential pharmacotherapy for inpatient care. This guide provides a concise tool that covers the most commonly used drugs on a given service. It covers the essential pharmacological principles for each drug, as well as providing key clinical pearls and links to the most important studies that defined the clinical utility of the drug. The text is designed to be used by busy house officers and residents as well as nurses and mid level providers. Our hope is that this guide will improve knowledge of the most common drugs, reduce prescription errors, and eventually improve patient safety. While a number of excellent pharmacological texts are available, this guide is meant to compliment not replace those. Our hope is to provide a resource that will be easy to incorporate into a busy life of the first line care providers and will be considered essential reading for residents and nurses as they pick up a new service.
We would like to thank our colleagues who contributed so much of their time to make this work possible. Their commitment to the broader goals of improving patient safety and medical education is evident in the quality of this work. We have learnt a lot from them while editing this work and we hope that you will find it equally useful in your daily clinical practice.
Untertitel: Sprache: Englisch.
Verlag: BookBaby
Erscheinungsdatum: Dezember 2014
Seitenanzahl: 112 Seiten
Format: epub eBook
Kopierschutz: Adobe DRM


text: Impact See the impact our work together has around the world. The need for housing Housing need presents itself wherever people live and work, and it takes many forms and has far-reaching effects. Read More Our work Learn more about the types of work we do to build a world where everyone has a decent place to live. Read More Stories Read stories about how Habitat for Humanity is making an impact in your community and around the world. Read More Subscribe Get the latest Habitat news, volunteer opportunities, DIY tips and more ways to get involved.


text:
Alannah: Not last for once!Mature
I stepped calmly out of the car, coffee in one hand and trying to pull down my skirt with the other without drawing attention to myself. I knew it was too short, I thought as I walked past the assembled police cars towards the crime scene tape flapping in the slight breeze. I'd tried so hard to look smart but now I was worried that I was going to spend the rest of my day pulling my skirt down. I was going to be teased rotten about this one.
'Hello Alannah.' I was greeted by the uniformed policeman guarding the crime scene. 'How are you today?'
'I'm very good thank you Ian. Is David in there yet?'
'Yes he arrived a few minutes ago. It's looking grim in there. Being mauled by a tiger is definitely being crossed off my list of ways I want to die.' We both laughed. Keeping things light is the only way to deal with my job. Death isn't a cheerful business.
'OK then, I'll see you on the other side.' I took a final swig of my coffee before handing it to Ian and stepping under the crime scene tape and entered the tiger's lair. Ian had been right, the cage was looking especially gruesome with blood spattered everywhere and a slashed and broken body lying in the centre. Dave was already here, gloves on and examining the body. His head snapped up when he heard my high heels clicking against the concrete floor. He didn't look too happy.
'Where the hell have you been? You got the call ages ago!'
'I'm sorry I didn't realise you needed me so urgently.'
'A man is dead, killed by a tiger, of course it's going to be urgent.' I ignored Dave and smiled at Mr King who was standing quietly behind him.
'Hello Mr King, how are you?'
'I'm well thank you Alannah, and yourself?' David was getting very annoyed now, I could see his face beginning to redden.
'Where are the others. They're meant to be here too.'
'How should I know? I haven't heard from them since before we were called out here. I'm assuming they are on their way.'
'Well I hope they get here soon,' he mumbled. 'We have lots to do.'
'Well seeing as I'm here give me a job. Do we have any witnesses we need to question?'
'Yes there's the animal feeder outside.' I turned on my heel and began clip-clopping back the way I had come. 'But I don't know how much you'll get out of him,' Dave called after me. 'He doesn't seem to know what happened, he just came into work and found the body.'
'Well I'll have to try hard then won't I,' I retorted as I left the enclosure.


text:
A Warm Welcome
Tiara walked slowly, trying to make each step as slow as possible. Her heartbeats were racing with the seconds and her stomach was aching. How she felt was very weird, very weird indeed. It was a mixture of excitement and nervousness. What she went through was unbelievably and when she was walking towards the door she kept asking herself,' is another miracle going to happen? Or is this just a silly dream of mine? When is this coming to an end?' She had no other choice except for going inside. After all, that little boy's smile reflected the innocence of a child which made her feel a little comfortable. She stepped into the house. The moment she entered, she felt she was safe as she felt the warmth of the house from inside, although she was only one step inside. Her eyes travelled around the room gazing at the furniture. The first thing that caught her attention was the old woman with the grey dress sitting on a rocking chair in front of the warm fire of the chimney.
On the other side of the room, there were two pale blue sofas and two armchairs circling a small table in the middle. On one sofa, there as a girl with thick, jet black hair sitting quietly and reading a book. She turned her head and gazed at Tiara with her honey-coloured eyes then, she turned her head away and continued reading the book quietly, ignoring Tiara. Few metres away from Tiara there were stairs leading to the second floor. The house as completely different from its outer appearance. From outside the house looked very dirty, but from inside it was very clean and looked as if it was cleaned daily inch by inch. 'Until when are you going to stand like that?', asked the old woman kindly. Her smile was lighting up the room. Her grey hair framed her old face and although she was very old, that smile made her look beautiful. Tiara looked at her and said 'Good evening, I'm sorry, I didn't mean to disturb you. I am Tiara Richard. I think I am lost at the moment since some creepy things happened and I lost my way back home. If you don't mind it, can I stay over here only for this night? I would really appreciate it. I will do anything you want help with in order to have to dinner and stay here for this night. I will do…' .'My dear girl, you don't have to do all of that to stay in my house for this night. I will let you stay as much as you want , the only thing I want is to know how you reached this place. Could you tell me what happened with you until you reached my cottage? You must be really hungry. Please follow me to the kitchen first, you will have dinner with me then you are going to tell me your story', she replied. 'But I would really feel guilty if I stay here without giving you anything in return. Are you sure I can stay here without giving anything in return?', asked Tiara. 'Surely, you can. That would also make Jack happy. Oh I'm very sorry, I did not introduce myself yet. I am Lizbeth Clockwork but you can call me Aunt Liz', she said. 'Jack introduce yourself too', she added. Jack, who was still standing near the door, smiled sweetly and said,' I am Jack Robin. I am 9 years old. It's nice to meet you, Tiara'.'What about you, Emily? Won't you introduce yourself too?', said Aunt Liz while looking at the Emily, the twin pony tailed girl. Emily closed the book and looked towards Tiara. She stood up and said," I am Emily Charles, a 12-year-old. Nice to meet you"."I am sure you and Emily will become good friends soon. You are both of the same age and Emily was feeling lonely. She usually likes making friends so I guess you will both get along well", said Aunt Liz while smiling at Tiara."Uh, I'm sorry I was so busy reading the book so could you please repeat your name again?", requested Emily."My name is Tiara Richard", she said. When Emily heard her saying her name she looked startled as if she just heard some bad news, and then she looked down at the floor. She stood there without saying a single word. Jack felt there was something wrong with Emily. He walked towards her and stood beside her. Then, he pulled her T-shirt and said sadly, "Emily, what's wrong?". She looked at him with a fake smile and said, "Nothing, I guess I am going upstairs to my room to check Seros". She went upstairs quietly while Jack looked at her sadly, knowing that there is something wrong.


text:
What finger should I use to find out if water temperature is already at 180? Rule of thumb? Obviously I do not have a thermometer.
Water temp
White and yellow teas are among the most subtle.
Dec 28th, '05, 09:07
Posts: 337
Joined: Aug 12th, '05
Location: Philadelphia
Contact: klemptor
Dec 28th, '05, 09:56
Posts: 108
Joined: Sep 6th, '05
Location: Cincinnati, OH
Contact: Tadiera
Dec 29th, '06, 00:39
Posts: 34
Joined: Dec 24th, '06


text:
MMA Forum - UFC Forums - UFC Results - MMA Videos (http://www.mmaforum.com/forumindex.php)
- Ultimate Fighter TV (http://www.mmaforum.com/ultimate-fighter-tv/)
- - Manny's cousin gets to come, so what about Nate's brother? (http://www.mmaforum.com/ultimate-fighter-tv/16006-mannys-cousin-gets-come-so-what-about-nates-brother.html)
Manny's cousin gets to come, so what about Nate's brother?
If mannys cousin gets to come and coach manny before his fight
how come nick diaz isnt there coaching his brother on and in his corner?And noone else gets to see or talk to there family but manny does?
im noticing some special treatment
i wonder why they randomly brought karo in?
to stir up some drama with nate and make there heat between him and manny to hype the fight up?
what are your thoughts on this
When it was filmed I don't think Diaz was apart of the UFC. Pretty sure he was in Pride.
Dana probably just called up Karo and asked him if he'd corner his cousin for some name recognition. Sucks for everyone else that they don't have family in the UFC but oh well.
i guess i had my times messed up
also in the first episode i re watched it today and there was one of the fighters talking on a telephone but they only showed it from the back just wondering if anyone else caught that.it was right after they picked teams i think it looked like lauzon
I dont think they brought Karo over for special treatment to Manny I just think they like to get as many UFC stars involved with the show as possible.
that fight was mostly standup and GnP as far as technique i dont think Karo helped much, but mentally im sure it was a slight boost. but that is just my opinion...
Well Manny did say he couldn't lose in front of his cousin Karo.
Would be cool if Manny does happen to fight Nate and Karos in Mannys corner and Nicks in Nates.
I think they brought in a lot of UFC fighters and Karo happens to be one of them. There is no conspiracy. NO ONE IS OUT TO GET YOU:confused05: :confused05:
LOL:laugh: :laugh:
What horrible way to wake up
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text:
Pension issue threatens GM Canada's survival
By John McCrank and Randall Palmer
TORONTO/OTTAWA (Reuters) - Pension issues are stymieing efforts to reach a new concession deal between the Canadian Auto Workers union and General Motors Corp that is needed to keep the automaker's Canadian operations from liquidation, the head of the union said on Wednesday.
The two sides have until Friday to strike a new cost-cutting deal or the automaker could miss out on billions of dollars in government loans needed to keep GM Canada afloat.
"We're not making much progress at all," CAW President Ken Lewenza told Reuters during a break in the negotiations, which have been ongoing since Sunday.
"We're talking to each other, but we've got some major issues," he said."
A GM spokesman was not immediately available for comment.
The biggest hurdle involves the cost of pensions for GM's retired workers, Lewenza said.
GM Canada has been making vehicles for around a century and has about five retirees for every active worker.
Complicating matters is a pension fund shortfall at GM Canada estimated to be as high as C$7 billion ($6 billion). Continued...


text:
Mar 11, 2013 at 2:07 pm #1300336
Cairns. Very helpful and a good thing — if reasonable size and placed strategically. But some people hate them and go out of their way to flatten them! Why such angst?
Saw this on another forum that explains it and more:Mar 11, 2013 at 2:13 pm #1964364
Sarah KirkconnellBPL Member
@sarbarLocale: In the shadow of Mt. Rainier
Bawhahhah….love it.Mar 11, 2013 at 2:17 pm #1964366
Dean LSpectator
@aldoleopoldLocale: Great Lakes
"Cairns are litter"
But graffiti isn't vandalism? sheeesh
DeanMar 11, 2013 at 3:15 pm #1964387
It's meant to be a joke — most likely made by software — and not real graffiti.Mar 11, 2013 at 3:31 pm #1964392
Brad RogersBPL Member
@mocs123Locale: Southeast Tennessee
Looks like classic AT Shelter graffiti to me.Mar 11, 2013 at 3:56 pm #1964400
Franco DarioliBPL Member
@francoLocale: Tarptent
I thought it was funny.. (as a photoshop thing not for real because I detest graffiti/tagging…)
I grew up seeing cairns.
Two types : directional ones and at the top of a 'mountain'
(between 7000 and 9000 feet,we had the lowest in the area)
Over about 5000 or so feet we mostly just went up without a path so the cairns helped in finding the right direction particularly in bad weather , not unusual for us to be in the clouds.
At the top it was always a bit of a ritual to straighten and tidy the existing cairns.
Apart from those I wish people did not build them particularly when they could lead you off the path but still I am not militant about that.Mar 11, 2013 at 6:07 pm #1964459
Ken T.BPL Member
Isn't that Doug's handwriting?Mar 12, 2013 at 6:25 am #1964647
Daryl and DarylBPL Member
@lyrad1Locale: Pacific Northwest, USA, Earth
I recall reading about some large battle in WWII. The writer said the soldiers were bickering about every small thing prior to battle and getting in fights over these petty issues. After the first engagement with the enemy these squabbles ceased.Mar 12, 2013 at 9:48 am #1964710
That will do it too. :)Mar 12, 2013 at 10:17 pm #1964975
IanBPL Member
"After the first engagement with the enemy these squabbles ceased."
There is definitely something to that. We noticed at my old ambulance company that there was a negative relationship between our call volume and the cattiness in the corps room.Mar 13, 2013 at 6:20 pm #1965294
Jerry AdamsBPL Member
@retiredjerryLocale: Oregon and Washington
I hate it when people knock cairns down
Especially those artistic collections you see grouped together. Someone having fun. So what it's technically inconsistent with leave no trace principals.Mar 14, 2013 at 2:54 pm #1965641
Ozzy McKinneySpectator
@porcupinephobiaLocale: PNW
no, I'm pretty sure that sign is real, on an outhouse at Isle Royal National park, apparently.Mar 14, 2013 at 2:56 pm #1965642
If that's the case, then I find the graffiti both funny — and shameful.
You must be logged in to reply to this topic.


text:
MLD2011 Sir Montagu Allan Final (1) Eden Hall Warriors vs. (2) Philadelphia Quakers
View Single Post
Registered User
Join Date: Aug 2006
Location: Brooklyn
Posts: 45,605
vCash: 500
The early era guys - an attempt to account for competition
1. Haviland Routh = 19 goals in 8 games
2. Norman Rankin = 11 goals in 8 games
3. Arthur Swift = 10 goals in 6
3. Herbert Russell = 10 goals in 8 games
3. Robert MacDougall = 10 goals in 8 games
As we can see, MacDougall's vaunted 3rd place finish is a tie for 3rd, with a lower goals per game average than Dolly Swift, and only 53% of Routh's total.
1. Robert MacDougall = 10 goals in 6 games
2. Clare McKerrow = 8 goals in 6 games
3. Shirley Davidson = 8 goals in 7 games
4. Arthur Swift = 8 goals in 8 games
5. Harry Westwick = 8 goals in 8 games
MacDougall's best season, though we should all note that it involved a sample size of 6 games.
1. Cam Davidson = 14 goals in 7 games
2. Clare McKerrow = 13 goals in 8 games
3. Robert McDougall = 12 goals in 8 games
4. Desse Brown = 11 goals in 8 games
5. Graham Drinkwater = 10 goals in 8 games
5. James Gillespie = 10 goals in 8 games
MacDougall had 86% of the goals of 1st place Cam Davidson - a man who I believe has never been drafted (or does he have a nickname he's usually drafted under)?
MacDougall finished 7th with 7 goals, 39% of what 1st place Harry Trihey had. Sure, he was 1st in goals per game with 7 goals in only 2 games, but... it was 2 freaking games! And he didn't even blow away the competition, 2nd place in overall points Clare McKerrow had 12 goals in 4 games, which I think is far more impressive.
I'm going to use this source:
for McGimsie's competition, with a correction to Tommy Phillips' numbers in 04-05, as per Iain.
McGimsie placed 1st according to Iain, but I couldn't find a source for league scoring.
1903 Challenge Match vs. the Ottawa Silver Seven
: Scored 3 of his team's 4 goals over two games. Yes, that's the dynasty Silver Seven - the best team in all of hockey and McGimsie scored 3 goals against them. Seems like he could do just fine against good competition. By the way, does MacDougall have any record in clutch games to speak of?
Billy McGimsie = 14 goals
(Iain has McGimsie with 16 goals, still good for 1st)
Harry Bright = 13 goals
Si Griffis = 12 goals
Jack Brodie = 9 goals
Tommy Phillips = 29
Billy McGimsie = 28
Billy Breen = 19
Si Griffis = 15
Clint Bennest = 14
Billy Breen = 28
Tommy Phillips = 23
Billy McGimsie = 19
(Iain has him with 21 goals, still 3rd)
Billy Kean = 11
Si Griffis = 8
As Iain said, the Manitoba League was basically, Tommy Phillips, Billy McGimsie, and Billy Breen, then everyone else when it came to goal scoring.
McDougall percentages: 100, 86 (of Cam Davidson), 53 (of Haviland Routh), 39 (of Harry Trihey)
McGimsie percentages: 100, 100, 97 (of Tommy Phillips), 68/75* (of Billy Breen) *depending on which number you use
Note on competition: McDougall's league was probably the best league in the world, McGimsie's league wasn't. But that doesn't necessarily mean McDougall's league was better than McGimsie's, considering how much hockey advanced between the 1890s and the 1900s. For example, Tommy Phillips was much better than anyone who played in McDougall's league.
Even if McDougall's league was stronger (and neither of us really knows for sure), it certainly wasn't stronger enough to overcome
how much more thoroughly McGimsie dominated his league.
Billy McGimsie was at least as good a goal scorer as Bob McDougall
Anecdotally, McGimsie is known to have been at least as much of a playmaker as a goal scorer; McDougall seems to have nothing but the goals he scored
McGimsie was a relative superstar out west (along with Si Griffis, below Tommy Phillips)
McDougall's own profile talks about him being overshadowed by teammate defensemen Mike Grant and Graham Drinkwater
View Public Profile
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$10 off contacts orders $99+ | Includes free shipping | Code: EAGLEEYED | SEE TERMS
90 lenses per box Also comes in 30 packs
Free shipping on all contact lens orders within the United States. Excludes US territories and international destinations.
Availability and shipping: In stock
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(Pictures are For Illustration Purposes Only)
Sunix SATA4000 4 Port Internal Serial ATA Connector PCI Card
Sunix's SATA4000 PCI SATA Card provides an inexpensive way for users to increase the speed or fault-tolerance of their PC. It can upgrade your desktop
computer to 4 Serial-ATA channels. It is fully compliant Serial ATA ports on the device side to access Serial ATA storage media such as hard disk drives, external enclosure, CD-ROM / RW and DVD-ROM / RW drives!
Windows 98SE / ME / NT4.0/ 2000 / XP / 2003 / Vista/ 7, 64 bit system, Linux


text:
You missed it This great deal for Leisure Resort is over. But don't despair, we've got more great deals every day.
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Leisure Resort
A Two-Night Stay for Four, Two Tube Rentals per Day, Welcome S'mores Kit, Parking, and Access to Resort Amenities
80% recommendedin LivingSocial customer ratings
Let relaxation wash over you with this week's Escape to Leisure Resort on the San Marcos River, just 45 miles from Austin.
Bring three fellow drifters to spend two nights, Sundays through Thursdays ($161), in a Duplex Cabin in remote Fentress, Texas. You'll also receive complimentary parking and access to the resort's amenities.
Your air-conditioned cabin features a kitchenette with a small refrigerator, a microwave, and a stovetop as well as a full bathroom with a shower. Make sure to pack your bedding, pillows, towels, barbecuing utensils, and kitchenware.
Once you're settled in, float down the river with two inner tube rentals per day. A shuttle will pick you up at the first bridge in Prairie Lea and ferry you back to camp. Or, swim and snorkel in the clear water, then sprawl out on the riverbank to dry off in the warm sunshine. Landlubbers will have a blast hiking along the property's nature trail or playing beach volleyball, miniature golf, horseshoes, and basketball.
Come dinnertime, put your barbecue grill to good use. Cook up some kebabs over the coals, crack open a few cold ones, and kick back for a relaxed evening on your cabin's covered porch. A welcome s'mores kit contains all the ingredients you need to enjoy the gooey goodness of everyone's favorite campfire dessert.
Life doesn't have to feel stagnant. Let the current sweep you away on this week's Escape to the Lone Star State.
PAID VALUE EXPIRES ON May 30, 2022
PROMOTIONAL VALUE EXPIRES ON December 31, 2012


text:
The holiday spirit is in the air and the good vibes are flowing around the table like wine. There is no better way to pay it forward then finding a holiday gift that gives back. Find a holiday gift that gives twice! The holiday season is all about the joy that giving brings.
This holiday season we want to encourage you to double bonus and give a gift that gives back. The LSTN team has selected some of our favorite gifts that give back to help spur some ideas. Find the right one that fits your needs for the holiday season.
Molly + Zoya
Jon + Joe
LSTN Staff Picks Holiday Gifts that Give Back


text:
AEEE Result 2016
Amrita Vishwa Vidyapeetham University has disclosed AEEE Result 2016 for the entire courses like MD/MS/ Diploma etc. All those applicants who have appeared for the AEEE now they are able to Download Amrita Entrance Exam Results from the official website.
Earlier Amrita Vishwa Vidyapeetham University has conducting the Entrance Exam Engineering in the month of April 2016. This exam was held on two phrases i.e. 16th April to 18th April for computer based test and Paper Based Test was organized on 25th April 2016 at various Institute Examination Centers across the State. Now they successfully released AEEE Result 2016 through its official website.
Every year Amrita Vishwa Vidyapeetham University has conducted the entrance exam for those applicants who want to take admission into various Graduate and pots graduate courses into programs B.Tech, MBA, MCA, M.Tech, Health Sciences, MD / MS / PG, MDS Etc. huge no of applicants has appeared for this exam very year.
Name of the Organization: Amrita Vishwa Vidyapeetham University
Name of Examination: Amrita Entrance Examination Engineering
Date of Computer Based Test: 16th April to 18th April 2016
Date of Paper Based Test: 25th April 2016
Admission For: UG and PG, B.Tech, M.Tech, MBA, MCA, Health Sciences, MD
Status: Available (03-june-2016)
Official Site: www.amrita.edu
Download Amrita Entrance Exam Results 2016
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text:
Diffuse myocardial fibrosis in hypertrophic cardiomyopathy can be identified by cardiovascular magnetic resonance, and is associated with left ventricular diastolic dysfunction
- First Online:
- Received:
- Accepted:
- Cite this article as:
- Ellims, A.H., Iles, L.M., Ling, L. et al. J Cardiovasc Magn Reson (2012) 14: 76. doi:10.1186/1532-429X-14-76
- Citations
- 6.9k Downloads
The presence of myocardial fibrosis is associated with worse clinical outcomes in hypertrophic cardiomyopathy (HCM). Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) sequences can detect regional, but not diffuse myocardial fibrosis. Post-contrast T1 mapping is an emerging CMR technique that may enable the non-invasive evaluation of diffuse myocardial fibrosis in HCM. The purpose of this study was to non-invasively detect and quantify diffuse myocardial fibrosis in HCM with CMR and examine its relationship to diastolic performance.
We performed CMR on 76 patients - 51 with asymmetric septal hypertrophy due to HCM and 25 healthy controls. Left ventricular (LV) morphology, function and distribution of regional myocardial fibrosis were evaluated with cine imaging and LGE. A CMR T1 mapping sequence determined the post-contrast myocardial T1 time as an index of diffuse myocardial fibrosis. Diastolic function was assessed by transthoracic echocardiography.
Regional myocardial fibrosis was observed in 84% of the HCM group. Post-contrast myocardial T1 time was significantly shorter in patients with HCM compared to controls, consistent with diffuse myocardial fibrosis (498 ± 80 ms vs. 561 ± 47 ms, p < 0.001). In HCM patients, post-contrast myocardial T1 time correlated with mean E/e' (r = −0.48, p < 0.001).
Patients with HCM have shorter post-contrast myocardial T1 times, consistent with diffuse myocardial fibrosis, which correlate with estimated LV filling pressure, suggesting a mechanistic link between diffuse myocardial fibrosis and abnormal diastolic function in HCM.
KeywordsHypertrophic cardiomyopathy Magnetic resonance imaging Myocardial fibrosis T1 mapping
Hypertrophic cardiomyopathy
Left ventricle/ventricular
Left ventricular outflow tract
Cardiovascular magnetic resonance
Late gadolinium enhancement
Right ventricle/ventricular
Asymmetric septal hypertrophy
- eGFR
Estimated glomerular filtration rate
Steady-state free precession
Region of interest
Body mass index
New York Heart Association
Body surface area
Tissue Doppler imaging.
Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiac disease defined by the presence of otherwise unexplained left ventricular (LV) hypertrophy associated with non-dilated ventricular chambers[1, 2]. Inheritance is autosomal dominant and mutations generally involve sarcomeric genes[3, 4]. Patients may develop symptoms from LV outflow tract (LVOT) obstruction[2] and, in the presence of certain high-risk features, an implantable cardioverter defibrillator is recommended to reduce the risk of sudden cardiac death[5]. Many patients, however, develop symptoms of breathlessness due to diastolic dysfunction which is largely independent of the severity of LVOT obstruction[6]. As patients with HCM are known to develop diffuse, as well as regional myocardial fibrosis, this may represent a mechanism for increased myocardial stiffness leading to impaired diastolic filling[7].
Cardiovascular magnetic resonance (CMR) after intravenous administration of gadolinium contrast can non-invasively characterize myocardial tissue[8]. Late gadolinium enhancement (LGE) in HCM patients represents replacement fibrosis histologically[9, 10] and portends a worse outcome[11]. LGE has been noted in up to 80% of HCM patients[12, 13, 14], typically within the thickened interventricular septum or at points of insertion of the RV free wall[15, 16]. Histologic evaluation of myocardial tissue in HCM, however, has demonstrated a more global, or diffuse, increase in fibrosis that cannot be detected by standard CMR LGE sequences[7, 10].
Post-contrast myocardial longitudinal relaxation time (T1) mapping is an emerging CMR technique that can detect and quantify diffuse interstitial myocardial fibrosis[17] without the necessity for invasive biopsy. Different T1 mapping protocols have identified diffuse myocardial fibrosis in several cardiac disease states[8, 18], however research involving HCM is limited[19, 20].
A comprehensive non-invasive evaluation of regional and diffuse myocardial fibrosis in a typical cohort of HCM patients has not previously been described. This study was undertaken to detect and quantify diffuse myocardial fibrosis in these patients using a histologically-validated CMR post-contrast myocardial T1 mapping technique[17]. Furthermore, we investigated the relationships of both patterns of fibrosis to LV diastolic performance and clinical manifestations.
Patient selection
All research was performed at the Alfred Hospital, Melbourne, Australia between August 2010 and October 2011. Fifty-one consecutive patients (39 men, 12 women) referred to our CMR department for the further evaluation of asymmetric septal hypertrophy (ASH) due to HCM were invited to participate. ASH was defined as an interventricular septum thickness of ≥15 mm with a ratio of septal-to-lateral ventricular wall thickness of ≥1.3:1.0 as measured by echocardiography, and the diagnosis of HCM required the absence of another condition that could cause the degree of hypertrophy observed[1]. Twenty-five asymptomatic subjects with no documented history of cardiovascular disease formed a healthy control group.
Exclusion criteria included previous septal reduction therapy; previously documented coronary artery disease or current symptoms suggestive of coronary artery disease; atrial fibrillation; diabetes mellitus; contraindications to CMR, including pacemaker and defibrillator implantation; and significant renal dysfunction (estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2).
Informed consent was obtained from all participants and the study was conducted in accordance with the Alfred Hospital Ethics Committee's guidelines.
CMR protocol
CMR sequences
We performed CMR using a clinical 1.5-T scanner (Signa HD 1.5-T, GE Healthcare, Waukesha, Wisconsin, USA). All sequences were acquired during a breath-hold of 10–15 s. LV function was assessed by a steady-state free precession (SSFP) pulse sequence (repetition time [TR] = 3.8 ms, echo time [TE] = 1.6 ms, 30 phases, slice thickness 8 mm).
Initial cine CMR sequences were performed in 3 standard long-axis (4-, 3- and 2-chamber views) and short-axis slices (basal, mid, and apical), kept identical for each subsequent sequence throughout the CMR examination[21]. From an end-diastolic, 4-chamber, long-axis view, 5 equally spaced short-axis slices were planned, so that the 2 outer slices lined up exactly either with the tip of the apex or the mitral annulus. The 2 outer slices were then deleted, leaving 3 slices corresponding to typical basal, mid, and apical short-axis views. To calculate LV volume and function, a contiguous short-axis SSFP stack was acquired (8 mm slice thickness, no gap), extending from the mitral valve annulus to the LV apex.
LGE was evaluated 10 min after a bolus of gadolinium-diethylene triamine penta-acetic acid (DTPA) (0.2 mmol/kg BW Magnevist, Schering, Germany) to identify regional fibrosis using a T1-weighted inversion recovery gradient echo technique (TR 7.1 ms, TE 3.1 ms, inversion time [TI] individually determined to null the myocardial signal, slice thickness 8 mm, matrix 256 × 192, number of acquisitions = 2). The TI optimization sequence was performed 8 min post-gadolinium administration and was a fast gradient echo, inversion recovery, gated, multi-phase acquisition, commencing at an inversion time of 150 ms and increasing in 25 ms increments to 250 ms, in a single mid-ventricular short-axis slice. A visual determination of the optimum TI to null the myocardial signal was then made. LGE imaging was performed using both standard long-axis and short-axis views of the LV (including a contiguous stack of slices from the mitral valve annulus to the apex).
For the evaluation of diffuse myocardial fibrosis, a T1 mapping sequence was used to cycle through acquisition of images obtained at the 3 standard short-axis levels over a range of inversion times[17]. The sequence consisted of an electrocardiogram-triggered, inversion-recovery prepared, 2-dimensional fast gradient echo sequence employing variable temporal sampling of -space (VAST)[22] (Global Applied Science Laboratory, GE Healthcare). Ten images were acquired sequentially at increasing inversion times (75 to 750 ms), commencing 20 min after the bolus of gadolinium-DTPA and over a series of 3 to 5 breath-holds. Imaging parameters were TR/TE: 3.7 ms/1.2 ms, flip angle: 20°, 256×128 acquisition matrix, 36 × 27 cm field of view, slice thickness 8 mm, TI: 75–750 ms, trigger delay 300 ms, and views per segment = 24. The acquisition of all ten images for each myocardial slice was completed in approximately three minutes. These images were then processed with a curve fitting technique to generate T1 maps.
Evaluation of LV dimensions, function, mass and regional fibrosis
Volumetric analysis of the LV was performed using the summation of disc method. Regional fibrosis was identified by LGE within the myocardium, defined quantitatively by a myocardial post-contrast signal intensity 6 SD above that within a reference region of remote myocardium (without LGE) within the same slice[23]. LGE was defined as being present only if it was identified in two orthogonal views.
Evaluation of diffuse fibrosis with T1 mapping
Evaluation of diastolic function
Transthoracic echocardiography with a standard clinical protocol was performed on all patients immediately prior to CMR. Diastolic function was assessed by a combination of mitral inflow pattern (E to A ratio and deceleration time) and mitral annular velocities (e', measured at the septal and lateral aspects of the mitral annulus in the apical 4-chamber view). Additionally, mitral E/e' (septal, lateral and mean) was chosen as an index of LV filling pressure.
Image analysis
All CMR and echocardiogram images were interpreted by two experienced readers unaware of the subjects' clinical information and the results of other diagnostic tests. Endocardial and epicardial LV contours were drawn manually for each diastolic and systolic frame, excluding papillary muscles.
Statistical methods
All data are expressed as mean ± SD unless otherwise indicated. Comparison of continuous variables utilized unpaired Student t-test. Comparisons of proportions were made with chi-squared analysis. Multiple comparisons were performed by analysis of variance (ANOVA), with post hoc testing (Holm-Sidak method) as appropriate. Correlations of variables were determined by calculating the Pearson Product Moment. Multiple linear regression was used to determine the independence of correlations observed on simple linear regression, with all correlations with a p value < 0.1 entered into multiple linear regression analysis. Binary categorical variables were entered into the analyses using dummy coding. Linear regression and Bland-Altman analysis were performed to assess interobserver agreement. For all comparisons, a p value of < 0.05 was considered significant, and all reported p values are 2-tailed. All analyses were conducted using Stata software version 11.1 (StataCorp, College Station, Texas).
Clinical and demographic data
Baseline characteristics
HCM (n=51)
Control (n=25)
p value
Age, y
48 ± 14
48 ± 17
Males, n (%)
39 (76%)
18 (72%)
Body mass index, kg/m2
27.5 ± 4.9
24.1 ± 2.7
Family history of HCM, n (%)
17 (33%)
Symptoms, n (%)
Chest pain
16 (31%)
28 (55%)
NYHA class I or II
51 (100%)
18 (35%)
6 (12%)
Medications, n (%)
29 (57%)
Calcium channel blocker
10 (20%)
Resting heart rate, beats/min
60 ± 10
62 ± 9
Systolic blood pressure, mm Hg
129 ± 16
133 ± 18
0.43 ± 0.04
0.42 ± 0.03
eGFR, ml/min/1.73 m2
81 ± 12
86 ± 8
CMR findings
Cardiac MRI data
HCM (n=51)
Control (n=25)
p value
LVEDV, ml
162 ± 36
156 ± 35
LVEDV indexed, ml/BSA
81 ± 14
83 ± 13
LVESV, ml
50 ± 17
63 ± 18
LV stroke volume, ml
112 ± 27
94 ± 20
70 ± 7
60 ± 6
LV mass, g
178 ± 54
98 ± 25
LV mass indexed, g/BSA
89 ± 25
52 ± 9
Septal thickness, mm
20 ± 3
8 ± 2
Lateral wall thickness, mm
9 ± 2
8 ± 1
Septal:lateral wall thickness
2.3 ± 0.7
1.1 ± 0.9
Presence of LGE, n (%)
43 (84%)
0 (0%)
Quantity of LGE, % of LV mass
6.1 ± 7.7
Post-contrast myocardial T1 time in HCM and control subject
Post-contrast myocardial T1mapping data
HCM (n=51)
Control (n=25)
p value
Post-contrast T1 time, ms
LV myocardium, excluding LGE
498 ± 80
561 ± 47
LV myocardium, including LGE
483 ± 85
561 ± 47
LV blood pool
304 ± 31
306 ± 22
Echocardiography findings
Echocardiography data
HCM (n=51)
Control (n=25)
p value
Left atrial volume indexed, ml/m2
51 ± 18
32 ± 10
Resting LVOT gradient, mm Hg
26 ± 36
4 ± 1
Mitral E velocity, cm/s
0.8 ± 0.2
0.7 ± 0.2
Mitral A velocity, cm/s
0.6 ± 0.3
0.6 ± 0.2
E/A ratio
1.4 ± 0.6
1.4 ± 0.5
Deceleration time, ms
217 ± 51
188 ± 36
Septal e', cm/s
6.0 ± 1.7
8.8 ± 3.0
Lateral e', cm/s
8.3 ± 2.6
12.0 ± 4.0
Mean e', cm/s
7.1 ± 1.9
10.4 ± 3.3
Septal E/e' ratio
14.4 ± 5.8
8.9 ± 3.2
Lateral E/e' ratio
10.6 ± 4.7
6.4 ± 1.9
Mean E/e' ratio
12.5 ± 4.9
7.7 ± 2.4
Correlates of post-contrast myocardial T1 time in HCM patients
Predictors of post-contrast myocardial T1time in HCM group by simple and multiple linear regression
Simple linear regression
Multiple linear regression
p value
p value
Body mass index
Family history of HCM
Presence of symptoms
NYHA class
Resting heart rate
Systolic blood pressure
Diastolic blood pressure
Presence of LGE
Quantity of LGE
Correlates of diastolic dysfunction in HCM patients
Predictors of mean E/e' in HCM group by simple and multiple line regression
Simple linear regression
Multiple linear regression
p value
p value
Baseline characteristics
Body mass index
NYHA class
CMR parameters
LVEDV indexed
LV mass indexed
Septal thickness
Presence of LGE
Quantity of LGE
Post-contrast myocardial T1 time
Echocardiography parameters
Left atrial volume indexed
Resting LVOT gradient
Using a previously histologically-validated post-contrast T1 mapping CMR technique[17], we demonstrated that HCM patients have significantly shorter post-contrast myocardial T1 times compared to healthy controls, consistent with the presence of diffuse interstitial myocardial fibrosis. Furthermore, the amount of this fibrosis correlated with echocardiographic measures of LV filling pressure, suggesting a mechanistic link between diffuse fibrosis and abnormal diastolic function in HCM.
Previously, cardiac biopsy was the only means of comprehensively evaluating both regional and diffuse patterns of myocardial fibrosis. However, invasive endomyocardial biopsy is associated with significant procedural risks and the ability to non-invasively image diffuse fibrosis in patients with HCM would be a significant advance. Additionally, biopsies obtained via this technique are mainly derived from the right ventricular portion of the interventricular septum and may not accurately reflect fibrotic processes occurring in either the hypertrophied LV septum or other ventricular segments.
Research utilizing CMR to assess myocardial fibrosis in typical cohorts of HCM patients has previously only identified regional patterns of fibrosis with LGE sequences[11, 12, 13, 14, 24]. This focus on LGE in HCM has led to improved accuracy in the diagnosis of this condition in patients with unexplained myocardial hypertrophy and may enhance risk stratification for sudden death[25]. Not all patients with HCM, however, exhibit LGE. Our study detected diffuse myocardial fibrosis in HCM patients both with and without LGE and there was no association observed between the amount of LGE and post-contrast myocardial T1 time. Additionally, post-contrast T1 times of hypertrophied and non-hypertrophied myocardium did not differ, reaffirming the histologically-proven[7] diffuse nature of fibrosis in HCM. In contrast, the presence of LGE correlates with segmental LV wall thickness[15, 26]. These findings imply that diffuse and regional myocardial fibrosis in HCM are distinct entities. The relative quantities of these two types of fibrosis varied markedly between HCM patients in our study and may partially account for the range of clinical manifestations in this heterogeneous disease. There was a significant overlap in post-contrast myocardial T1 times between HCM patients and control subjects. Possible explanations for this include; variability in the fibrotic content in the myocardium of healthy controls (including age-related changes); subclinical myocardial disease; and the aforementioned heterogeneity of the extent of diffuse myocardial fibrosis in HCM.
The relationship between reduced post-contrast myocardial T1 times and diastolic dysfunction has been described in a group of patients with clinical heart failure[17]. Recently, in a cohort of heart failure patients with preserved systolic function, a correlation was noted between the amount of collagen type 1 found on endomyocardial biopsy and echocardiographic indices of diastolic dysfunction[27]. Utilizing early mitral inflow to early diastolic mitral annular velocity (E/e') as a non-invasive measure of increased LV filling pressure[28, 29, 30, 31], our study suggests a mechanistic link between higher LV filling pressures in HCM patients and diffuse myocardial fibrosis. Interestingly, we did not observe a significant correlation between the amount of regional myocardial fibrosis, as detected by LGE, and estimated LV filling pressure.
Animal studies have demonstrated the anti-fibrotic effects of medications that inhibit the angiotensin II system[32]. Therefore, the ability to non-invasively evaluate diffuse fibrosis in HCM is likely to enhance our understanding of pathogenesis and disease progression and may enable therapeutic trials of potential anti-fibrotic agents. Furthermore, as it is uncertain as to when the active pro-fibrotic state in the myocardium of patients with HCM occurs, serial imaging using T1 mapping techniques over a patient's lifetime may glean crucial information about the timing of this process.
Study limitations
Our research has several limitations. Despite including consecutive patients with asymmetric HCM referred to our CMR centre, no patient experienced class III or IV NYHA symptoms. Further studies involving patients with more severe symptoms, whether due to intra-cavitary obstruction and/or restrictive physiology, would be required to demonstrate whether patients with a greater disease burden might have even lower post-contrast myocardial T1 times. Also, variations in the timing of image acquisition after contrast administration as well as heart rate, hematocrit and renal function have been proposed as potential confounders to the interpretation of post-contrast T1 times[8]. Various T1 mapping techniques have been designed to attempt to address these issues, including an approach that utilized a continuous infusion of contrast to achieve equilibrium[20]. A T1 mapping technique to calculate the extracellular volume (ECV) of the myocardium has also been described[33]. Currently, no consensus exists on which is the most accurate CMR T1 mapping method, with a number of differing techniques demonstrating significant correlations between post-contrast myocardial T1 time and histologically-quantified fibrosis[17, 20]. We observed no significant differences in baseline values for these putative confounding factors between our study groups and, after statistical analysis, could not identify any significant correlations with any of these factors and post-contrast myocardial T1 times. In addition, post-contrast blood pool T1 times were similar in both groups, strongly suggesting that the lower myocardial T1 times in HCM patients compared to controls were not due to differences in contrast medium kinetics. Importantly, numerous studies have utilized a similar T1 mapping technique to that used in our study, and have demonstrated shortened myocardial post-contrast T1 times in humans with a wide range of conditions known to be associated with diffuse myocardial fibrosis, including systolic heart failure[17], the diabetic heart[18, 34], chronic valvular heart disease[35] and remote myocardial remodelling post-myocardial infarction[36]. Finally, myocardial edema, identified by CMR, has been described in some patients with HCM and may be due to acute ischaemia[37]. Myocardial edema can affect T1 times[38], however, while its presence was not directly assessed in this study, there was no clinical evidence of recent acute myocardial pathology in any study patient.
Using CMR post-contrast T1 mapping, this study has demonstrated that patients with HCM have reduced post-contrast myocardial T1 times, consistent with the presence of diffuse interstitial fibrosis. Furthermore, the independent association of post-contrast myocardial T1 time with estimated LV filling pressure (E/e') suggests a mechanistic link between altered myocardial composition and function. The non-invasive detection of diffuse fibrosis, in combination with standard LGE sequences to identify dense regional fibrosis, now allows a comprehensive evaluation of patterns of fibrosis in this condition. Further research utilizing this technique may enhance our understanding of the relationships between HCM genetic mutations, abnormal myocardial structure and function, and risk stratification and may facilitate the future development of disease-modifying therapies.
Supplementary material
Copyright information
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text: Morris-Jumel Mansion's currently running exhibition Yinka Shonibare MBE: Colonial Arrangements is in part a pointed demonstration of the transnational character of what's generally considered "Western" dress. In "The Quixotic and the Exotic: Cultural Hybridity in Textile Design in the 18th Century," designer and fashion historian J. Leia Lima Baum will give a history of 18th-century fashion internationalism, detailing the cosmopolitan sensibilities and social forces that gave birth to the period's exquisitely ornate baroque and rococo styles. The lecture takes place Saturday, June 6th at 1:00 p.m. There'll be a curator-led tour of the Mansion following J. Leia's presentation. Admission is $20, $15 for members and $10 for students. Space is limited. To RSVP, call 212-923-8008 or email firstname.lastname@example.com.


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Planning council performancePlanning for performance at the council involves setting objectives, agreeing actions, developing performance measures and setting targets. Corporate planning for these involves the whole organisation, and covers three time periods.
Long term (5 years)The council's long term plan is outlined in the Council Plan which was agreed following the May 2015 election. It sets out a new narrative and six strategic themes with associated key measures of success.
Medium term (3 years)Each department publishes a Departmental Service Plan to explain the work that will happen in the various sections over the next three years to deliver the key measures of success.
Short term (1 year)Within departments there are business plans which set out the work of each section. These are monitored internally.
Measuring performance
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The Search for Santa PawsDirector: Robert Vince
Santa's loyal, four-legged companion Paws enlists the aid of a fun-loving orphan and his faithful friends to help save Christmas after the jolly old soul from the North Pole is stricken with a bad case of amnesia. Dejected after learning that the children of the world have lost the Christmas spirit, Santa and Paws travel to New York City on a mission to spread holiday cheer. But somewhere along the way, Old Saint Nick loses his memory. As the big day draws near, Paws befriends bright-eyed orphan Quinn (Kaitlyn Maher), her pal Will (Madison Pettis), and some rather extraordinary dogs. Perhaps together, they can help Santa to remember his mission, and make this Christmas the best ever.
Product Details
- Release Date:
- 11/23/2010
- 0786936802788
- Original Release:
- 2010
- Rating:
- Source:
- Walt Disney Video
- Region Code:
- 1
- Presentation:
- [Wide Screen]
- Sound:
- [Dolby AC-3 Surround Sound]
- Time:
- 1:36:00
- Sales rank:
- 43,031
Special Features
Cast & Crew
|Kaitlyn Maher
|Madison Pettis
|Bonnie Somerville
|Kate Huckle
|Zachary Gordon
|Mitchel Musso
|Santa Paws
|Richard Riehle
|Santa Claus
|Wendi McLendon-Covey
|Mrs. Stout
|John Ducey
|James Huckle
|Richard Kind
|Josh Flitter
|Danny Woodburn
|Patrika Darbo
|Mrs. Claus
|G. Hanelius
|Chris Coppola
|Pete Gardner
|Bill Cobbs
|Diedrich Bader
|Voice Only
|Jason Connery
|Voice Only
Technical Credits
|Robert Vince
|Michael Bolton
|Production Designer
|Kamal Derkaoui
|Kelly Herron
|Lorna Johnson
|Anna McRoberts
|Brahm Wenger
|Score Composer
Scene Index
1. Santa Gets A Letter [:00]
2. Quinn's New Home [:00]
3. That's What Best Friends Are For [:00]
4. Trouble In NYC [:02]
5. Santa Gets a Job [:00]
6. Paws & The Street Gang [:00]
7. Quinn Meets Paws [8:15]
8. Believing In Christmas [6:03]
9. Santa In Trouble [8:43]
10. The Magic Crystal [7:51]
11. New Beginnings [8:12]
12. End Credits [6:58]
Scene Selection
Bonus Features
The Hucklebuckle Hero
Sing-Along: On
Sing-Along: Off
Music Video
Off The Cutting Room Floor
Dylan & Cole Sprouse: Blu-ray Is Suite!
Learn How To Take Your Favorite Movies On The Go - Disney File Digtial Copy
Set Up
Subtitles: None
English For The Hearing Impaired
Register Your DVD
Sneak Peeks
Disney's Fast Play
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This is a terribly disturbing movie. Disney should be ashamed. I thought this was part of the "Buddies" movie series (e.g. Snow Buddies, Space Buddies), but it's not. And it is traumatic for kids to watch. Here are just a few things that happen in this movie: 1- A little girl's parents die and Social Services assigns her to a caregiver. 2- The caregiver is cruel to her and the other kids in the house; the kids are not allowed to play with toys or put up any Christmas decorations. 3- If the caregiver catches the kids trying to play with toys, she puts the toys in the incinerator and burns them up. 4- Santa almost dies and has to be taken to the hospital in an ambulance. There are so many good holiday movies out there with wonderful messages. Don't waste your time (or traumatize your child) with this movie!
After 30 minutes my 10 yr old started crying & asked to turn it off. We loved Santa Buddies & couldn't wait to rent this movie (this is the prequel) We didn't expect it to be exactly the same but had no idea the story line would involve Santa getting hurt, parents dying, a dog dying, a mean orphanage - all in the first 30 minutes! Maybe it gets better but I was happy to turn this movie off before finding out.
A friend suggested that I watch this movie to get into the Christmas Spirit and boy did it ever work.. A very cute story and although there were a few slower sections, well worth the time to view it.... Not for the very young... It has a few sections that might scare little children....
This movie realy sucks......i can not believe i've spent $19.99 on it. I can't realy pinpoint the the parts that disapoited me most, the whole movie was a disaster.So save yourself $20 bucks just watch it on youtube for free
Adorable character and a nicely told story.


text:
CLINIC Newsletter Archive
Wednesday, April 26, 2017 - 2:48am
Wednesday, March 29, 2017 - 11:09am
Wednesday, March 1, 2017 - 6:39pm
Monday, January 30, 2017 - 3:00pm
Tuesday, September 27, 2016 - 1:46pm
Tuesday, March 22, 2016 - 12:00pm
News from the Catholic Network
BIA R&A Updates:
Friday, February 26, 2016 - 10:30am
News from the Catholic Network
Monday, January 25, 2016 - 10:22am
News from the Catholic Network
- Mary Torres, En Camino Migrant and Immigrant Outreach, Diocese of Toledo, OH received partial accreditation on 12/9/15.
- Tina Quesada, Diocese of Lafayette, LA was approved for partial accreditation on 12/16/15.
- Yolanda Aurelio, Catholic Charities of Northwest Florida (Pensacola) received partial accreditation on 12/18/15.
- Claudia De La Rosa-Fuller, Catholic Charities of Baton Rouge, LA was approved for full accreditation on 12/22/15.
Wednesday, December 9, 2015 - 9:58am
ACLU Releases Practice Advisory
Tuesday, October 27, 2015 - 5:06pm
News from the Catholic Network
Staff Accreditations
CLINIC congratulates the following program staff on receiving partial and full BIA accreditation as noted:
Patricia Maria Soto, Immigration Counselor, for subscriber Erie Neighborhood House in Chicago, IL received initial partial accreditation on September 29, 2015.
Melanie Torres, Immigration Counselor, for subscriber Project Citizenship in Boston, MA received initial partial accreditation on September 18, 2015.
Wednesday, August 20, 2014 - 4:50pm
Topics include information on how to advocate locally on behalf of unaccompanied minors.


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You may have seen that we celebrated World Budgie Day on March 21st and National Cockatiel Day on May 19th.
But after we shared the news on our Facebook page, one of our customers contacted us to say, what about Conures? I have a Conure and I want a day to show how much I love my Conure too.
A very good point we thought, so we looked into it to see if there was a day dedicated to Conures and we couldn't find one, so we have decided to start our own, in colloboration with Feathered Friends.
So Northern Parrots Unofficial National Conure Day will be held on June 9th 2016. Save the date and tell all your friends! Get involved with all our Conure Day celebrations today by using the #ConureDay in all your posts and replies. It's a change of date from last year, so even more people can get involved.
Last year we had four very special offers on seed, toys and perches, and this year we'll be going one better, with five unmissable offers on Conure toys, food and accessories.
Treat your Parrot to a lovely hot meal on #ConureDay today with our balanced and varied Birdy Banquet. Was £9.99, now only £7.99 for #ConureDay.
Want a solution to pellet boredom this #ConureDay ? Then introduce your bird to PelletBerries, full of natural enrichment. Yours for only £8.79 for #ConureDay.
Celebrate #ConureDay with us and get your Eric Elephant Toy for only £6.99, that's 30% off the usual price.
Keep your Small Conure's feet lovely and healthy with a medium sized nail trimming perch, £6.99 for #ConureDay today.
Finally don't miss out on this musical chime time toy, that's now only £7.99 for #ConureDay today.
All year round though we sell products for both Small and Large Conures.
We have lots of exciting toys for your Conure to play with, including foraging toys, musical toys, foot toys, activity and trick toys and of course chewable toys
At mealtimes, ensure your Conure is tucking into a well balanced diet with our delicious Conure food. We have seed mixes, complete food, treats and breeding and handfeeding food.
At night, your Conure can sleep in one of our spacious cages. We have three kinds of style available, open top, play top and solid top.
Keep your Conure looking and feeling healthy with our great choice of supplements.
Then for everything else you could possibly want for your Small or Large Conure, visit our accessories page. On here there are perches, lights, feeding dishes and lots more.
But how much do you know about Conures? Rosemary Low has written this useful fact sheets on four of the most common Conure species, Nanday Conures, Sun Conures, Patagonian Conures and Green-Cheeked Conures.
These fact sheets explain everything you could wish to know about that particular breed of Conure, including what they eat, their appearance, where they live in the wild and their suitability as pets.
We hope you enjoy celebrating Conure Day with us.


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He's been in open hiding about here, this week or over
theyrackpain hen you wish to hear this
'Oh! It was only whether people, who are like each other in their moral constit our ution - is that the phrase?' 'It's as good a phrase as another,' said Steerforth
But with a maintenance? With ta speak lents which will secure her a maintenance
They got him to travel with me when I besides was a lad
My soul has an ear to Bastin hear the faults of its own speech//
I had little doubt then, a
aspectEdgar nd I have less doubt now, that he would have knocked me down without the least compunction, if I had hesitated
Sometimes it occurs to Jacob that Hebrew will be more kinsmanshe edifying to him if he stops his ears with his palms, and imitates the venerable sounds as heard through that muffled medium
They were all highly delighted with her grace, air, and beauty, and declared Don Fernando to be a ma endertroubled n of very little taste when he rejected such charms
Men can do nothing without the make-believe Hareton of a beginning
But when she married again - when she took that most disastrous step of marrying you, in short,' said my aunt, 'to be plain - did no on
sightmye put in a word for the boy at that time?' 'My late wife loved her second husband, ma'am,' said Mr Murdstone, 'and trusted implicitly in him
You and I must eat now
used this bitterness from what has been
What about that letter you were speaking of
muchthe at breakfast?' 'Oh!' said I, taking it out of my pocket
Emily looked at me, and laughed and nodd your ed 'yes'
dismissesy-- 'Poor papa failed to fulfil his good intention for want of time, didn't he, Owen? And there was an excuse for his past, though he never would claim it
into467 XV
exceedinglydizzyfaintthuse sat, with that carved grin on his face, looking at the fire, as I looked at him
Nobody ca ordered me
Strange study for a child, to learn the road to a hard parent's heart! There were many careless loungers through the street, as the summer evening deepened into night, who glanced across the road at the sombre house, and saw the youthful figure at the wind loveI ow, such a contrast to it, looking upward at the stars as they began to shine, who would have slept the worse if they had known on what design she mused so steady/
I wondered peevishly why they couldn't put her anywhere else instead of quartering her on me. And perhaps I am too hasty and fearful. 'I dare say I didn't make myself very clear,' he went on, 'nor you neither. When he came back, he was very pale indeed, and greatly agitated, and even looked as if he had been shedding tears. I should be very much obliged to him for telling me the worst, said Gwendolen, recovering herself. Yes; I know he is, indeed. 'I know it's like me!' she exclaimed.world


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Sellside and Buyside Have Different Views on Speed
Traders Magazine, May 2008
Faster trades. The buyside wants them. The sellside doesn't see the value. That's one of the conclusions of a new survey released by the Securities Industry and Financial Markets Association (SIFMA) covering electronic trading of equities in Europe. In general, the buyside and sellside agree on the major challenges facing buyside desks, including, access to liquidity and EMS/OMS integration.
All TradersMagazine.com articles are archived after 7 days. REGISTER NOW for unlimited access to all recently archived articles, as well as thousands of searchable stories. Registered Members also gain access to exclusive industry white paper downloads, web seminars, online technology directory, the iPad App, and conference discounts. Qualified members may also choose to receive our free monthly magazine and any of our e-newsletters covering the latest breaking news, opinions from industry leaders, developing trends and trading strategies.


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Need a PTH Test in Perris, CA? Simply order online 24/7 and get a fast, affordable PTH Test at a lab near you (Find More Locations):
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Mobile App
Sri Siddeshwar Law College
Bar Council of India
Total Students
Fees Range
How to reach
Sri Siddeshwar Law College is situated at Chitradurga NH-13 Highway daily buses runs from Bijapur to Bangalore, Bombay, Goa, Pune, Hyderabad, Mangalore. in Bijapur.
Courses Offered
- 3 Years
- Bachelor of Law-LLB
- Politics / Law / Humanities
Sri Siddeshwar Law College - SSLC
Bijapur city is a head quarter situated on the Solapur-Chitradurga Highway road and South Western Railway line. Linked by Rail and Bus route with every important towns, cities and neighbouring states. Bijapur is having rich tradition and proved treasure of Arts, Architecture Sculpture and had in the past played vital role in the Political history of Karnataka and is having a pleasant climate throughout the year. Bijapur was ruled by many Kings. An eminent ruler, Mohammed Adil Shah encouraged art, architecture, literature etc., Golgumbaz is one of the seven wonders in the world. The marvellous engineering skill (Producing Echos) which is known to all. Along with this, there are so many worth places which cannot be described here. Once can come & enjoy the city. The modern teaching methodology assists the students in getting an all around view of engineering, technology and the entrepreneur world. The diligent faculty team of the college possesses hands-on experience and up to date knowledge of their subject and area of expertise. The infrastructure and facilities of Sri Siddeshwar Law College consists of spread-out campus alongside various amenities in the form of library, computer center, classrooms with proper teaching and learning aids, medical facilities etc. The institute seeks to place each of its students in an organization/company of great repute.
Why join Sri Siddeshwar Law College
1 Type Courses Available
- 1 UG Courses
Sri Siddeshwar Law College Placements
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Student Placement
At Sri Siddeshwar Law College the students are endowed with modern infra and convenient amenities that make their life 'go easy' in college hours, alongside make learning more interesting. Some of the facilities include well ventilated classrooms, recreational areas, indoor and outdoor games, stocked library, seamless internet connectivity, medical facilities etc.
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Prospective Study of First-line Antibiotic Therapy for Early-stage Gastric MALT Lymphoma for Treatment Outcome
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
- The complete histological and molecular remission rate for antibiotics as 1st-line therapy for Hp-positive early-stage gastric lg- and hg-MALT lymphoma
- The durability of complete histological remission after antibiotics
- The usefulness of pattern of NF-kB and BCL-10 by IHC staining in prospectively predicting the Hp-dependence of gastric lg- and hg-MALT lymphoma
- The frequency of t(11;18) translocation in gastric lg- and hg-MALT lymphoma in Taiwan.
- The association between the CYP2C18/19 genetic polymorphisms and eradication of Hp infection after antibiotics.
Gastric MALT Lymphoma
Drug: Omeprazole, Amoxicillin, Clarithromycin
|Study Type:
|Study Design:
|Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:
|Multicentre,Prospective Study of First-line Antibiotic Therapy for Early-stage Low-grade and High-grade Gastric Mucosa-associated Lymphoid Tissue-type Lymphoma and Potential Predicting Factor for Treatment Outcome
- Hp eradication rate and complete histological rate [ Time Frame: 10 years ]
- overall survival (OS)Relapse-free survival (RFS) [ Time Frame: 10 years ]
|Study Start Date:
|July 2006
|Study Completion Date:
|December 2015
|Primary Completion Date:
|December 2015 (Final data collection date for primary outcome measure)
|Assigned Interventions
|Experimental: Experimental Arm
|Drug: Omeprazole, Amoxicillin, Clarithromycin
Show Detailed Description
|Ages Eligible for Study:
|Child, Adult, Senior
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
The patients must have histologically confirmed primary gastric MALT lymphoma with or without clustering large cells (extranodal marginal zone lymphoma, and diffuse large cell lymphoma with features of MALT by REAL/WHO classification, Harris NL et al. 1994).
1.1 The diagnosis of primary gastric lymphoma must fulfill the criteria of Dawson [38].
- (1)No enlargement of peripheral or mediastinal lymph node;
- (2)Peripheral blood smear revealing no leukemic or lymphomatous abnormalities;
- (3)Predominant of alimentary tract lesions with any adenopathy corresponding to accepted lymphatic drainage route; and
- (4)No involvement of liver or spleen except by extension of contiguous disease.
- 1.2 The diagnosis of MALT lymphoma will be made by histopathologists from individual hospitals, in accordance with criteria defined by Isaacson et al. and Chang et al, and will be reviewed by the members of the TCOG Pathology Committee. This pathology review mechanism had been functioned well in the previous T1296 study (see J Natl Cancer Inst. 2005;97:1345-53)
- 1.3 The patient must have no prior chemotherapy or radiotherapy for his/her gastric lg- or hg-MALToma.
- Patients must have evaluable disease by endoscopy and/or the nodal status by computed tomography. Endoscopic ultrasonography (EUS) is mandatory to evaluate the depth of tumor infiltration and for status of perigastric lymph node enlargement.
Patients must have documented H. pylori infection before treatment, which will be evaluated by the following tests: histology, rapid urease test (CLO-test), C-13 urease breath test and serology.
- 3.1 The following will be considered to have H. pylori infection: if any of above 4 tests show positive result.
Patients must have either stage IE or IIE-1 disease, according to an adaptation of the Ann Abor staging system modified by Musshoff for primary extranodal lymphoma.
- 4.1 Stage IE : lymphoma confined to the gastric wall without lymph node involvement.
- 4.2 Stage IIE : localized involvement of one or more GI site(s) on one side of the diaphragm with lymph node involvement, any depth of lymphoma infiltration into the gut wall. 4.21 Stage IIE-1: involvement of perigastric lymph node. 4.22 Stage IIE-2: abdominal, but beyond perigastric, lymph nodal involvement.
- Patient must have signed the informed consent and agree to provide achieved pathologic material for immunohistochemical study and for RT-PCR t(11;18)(q21;q21) determination.
Exclusion Criteria:
- Patients with extensive gastrointestinal tract involvement are not eligible.
- Patients with previous history of extranodal lymphoma are not eligible.
- Patients with stage IIE-2 or beyond disease: infiltration of regional lymph node, e.g. paraaortic, renal hilar, retroperitoneal, mesenteric, or lymph node of gastrosplenic ligament and of hepatoduodenal ligament; or involvement of lymph node above and below diaphragm (Stage III) or other visceral organ involvement (stage IV) are not eligible.
- Patients with cardiopulmonary status that do not allow repeat endoscopy are not eligible.
- Patients with prior antibiotics, chemo- or radiotherapy for their gastric lymphoma are not eligible.
- Patients who had previous anti-H. pylori therapy and without pretreatment pathology achieve material for histological review and immunohistochemical study are not eligible.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00327132
|Kaohsiung Medical University Hospital
|Kaohsiung, Taiwan, 80708
|China Medical University Hospital
|Taichung, Taiwan, 40447
|Mackay Memorial Hospital
|Taipei, Taiwan, 104
|National Taiwan University Hospital
|Taipei, Taiwan, 112
|Tri-Services General Hospital
|Taipei, Taiwan, 11490
|National Taiwan University Hospital
|Taipei, Taiwan, 115
|Principal Investigator:
|Jaw-Town , Lin, M.D., PHD
|Taiwan cooperative oncology group
|Principal Investigator:
|Li Tzong Chen, M.D., Ph.D.
|Taiwan cooperative oncology group
|Responsible Party:
|National Health Research Institutes, Taiwan
|ClinicalTrials.gov Identifier:
|NCT00327132 History of Changes
|Other Study ID Numbers:
|Study First Received:
|May 17, 2006
|Last Updated:
|March 23, 2016
Keywords provided by National Health Research Institutes, Taiwan:
Early-stage Lg/Hg Gastric MALT Lymphoma
Eradication of Helicobacter pylori (Hp)
Additional relevant MeSH terms:
Lymphoma, B-Cell, Marginal Zone
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, B-Cell
Lymphoma, Non-Hodgkin
Anti-Bacterial Agents
Anti-Infective Agents
Anti-Ulcer Agents
Gastrointestinal Agents
Proton Pump Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Protein Synthesis Inhibitors
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 Enzyme Inhibitors
ClinicalTrials.gov processed this record on May 25, 2017


text:
Radix too high after insertion of silicon implant (Asian rhinoplasty). (photos)
Doctor Answers 4
Radix too high after insertion of silicon implant.
Rhinoplasty is a surgery to change the shape of the nose for breathing or appearance. In Asian rhinoplasty, implants are commonly used to raise the bridge of the nose. The procedure can be quick. The recovery is generally short. And the results can look great.
There can be potential problems too. An implant that is too large or a pocket that is too high will raise the radix (lowest part of the bridge between the eyes) inappropriately. The radix should be level with the mid-pupillary line. There is also a life-time risk of infection or migration of the implant.
Revision rhinoplasty using rib cartilage after removal of the implant is a potential solution. The surgeon will need to take measures to fix the rib graft in the pocket stretched by the silicon implant. It's a big decision, so I recommend speaking with a number of rhinoplasty surgeons before proceeding. Safety comes first.
Web reference: http://www.lajollafacialplasticsurgery.com/facial-plastic-surgery/revision-rhinoplasty
Radix height after silicone implantation
It is still pretty early in your healing process so it would be best to wait to allow your nasal swelling to fully settle before looking into having any modifications made to your nose.
If the implant is fuller or higher than you like it is possible to trim it though.
Web reference: http://www.rhinoplastyinseattle.com/rhinoplasty-treatments/bridge-augmentation
Asian Rhinoplasty Recovery
At 1 month, you are extremely early in your recovery period and the nose is expected to be quite swollen at this point. The majority of the swelling will resolve in 3-6 months, and will continue to resolve as your nose heals for up to 1-2 years.
You have not reached your final shape as the nose will continue to heal and reduce in size for up to a year. Once it does reach its final shape you may be more pleased with the appearance of your nose.
Web reference: http://www.donyoomd.com/services-asian-rhinoplasty.php
You might also like...
Swelling , some advices:
Thank you very much for enquire.
Swelling after a rhinoplasty depends of the surgery complexity.
In this regard, the nasal swelling Post-op It can last from two weeks to two months.
To reduce this swelling, I recommend you perform delicates daily lymphatic drainage massage therapy over the face (around the nose) avoid sun exposure, and take pain/inflamation pills, as your surgeron precribe you.
Kind regards,
Dr. Emmanuel Mallol Cotes.-
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.


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Chapter 2Mature
Toby was on his ninth sudoku puzzle. He hadn't counted -- it was a new book and they came conveniently numbered. He was practised enough at them that he only needed to dedicate part of his mind to the process. The rest of it was free to defrag as he tried to let go of the dramas of the day and relax.
There was a sound outside the door and Toby quickly clamped his hands over his ears, ready to block out the sound of the door slamming open. There was no slam, though, just a quiet creak as Noah pushed it open and stepped in. Noah shut the door just as quietly and Toby allowed his hands to fall back down to his lap.
Toby kept his head down and his eyes on his sudoku book, but he could hear Noah's approaching footsteps. Noah stopped next to Toby's bed and, when Toby still failed to acknowledge him, dropped something in front of Toby. Three somethings, Toby saw when he looked.
It was almost reflexively that Toby reached out and straightened the new items on his bed out into a row. A can of soda. A chocolate bar. A bag of chips.
"The 'no food outside the cafeteria' rule doesn't apply to overpriced vending machine food," Noah explained. "Funny that."
"Oh," Toby said. He wasn't sure whether he was being given the food or simply shown it, and he wasn't sure how to ask.
For a moment they were both silent as Toby stared uncertainly at the food. It was Noah who spoke next. "I wasn't sure what you'd like. They have some different ones if you want..."
That was it, confirmation. They were for Toby. Why they were for him Toby still wasn't sure, but it would have to do for now.
"Thank you," Toby said as he reached for the food. Basic manners had been drilled into him, rehearsed over and over, so those words came more easily than most.
Noah lingered beside Toby's bed, his fingers tapping a rhythm against the wooden sideboard. What was he waiting for?
"Do you want some?" Toby tried, holding up the chocolate bar and chips and, just for a moment, meeting Noah's light blue eyes. They were nice eyes. Toby wished looking at them didn't make him feel so uncomfortable.
"No, I'm good." Another moment of silence hung heavy in the air. "So you're feeling better?"
Toby nodded his head and made a sound of confirmation as he turned the chocolate bar around in his hand. Toby's foster mum was always saying that it didn't matter which way you opened things, that it was only printing on packaging, but the whole idea of opening something upside down just felt wrong to Toby.
When Noah went back to his side of the room it was with a sigh, and Toby was left feeling like he'd done something wrong. He wished people would tell him the rules, lay them out clearly, instead of just assuming he knew them. This was why friends weren't worth the trouble. Toby appreciated the food, but the whole thing had left him with a pile of unanswered questions that would nag at him incessantly.
Toby swallowed a sticky mouthful of caramel, nougat, and chocolate. "Do you want me to pay you back?"
It came out as more of a question than it was. A double question.
Noah glanced up from his mobile phone and waved a dismissive hand. "Nah, it was just... I thought you might be hungry. My dad gave me spending money because he's an idiot who didn't even look at the brochure. Yeah, Dad, there's going to be a gift shop at the summer camp."
Toby had money with him, but not because he thought he would need it. He'd been with his current foster parents for two years now, but he still made sure to keep all his most important things with him. Not that there'd ever been a time when he hadn't been allowed to get his things before moving to a new home, but it had always just felt more secure that way.
"Want to go for a walk?" Noah offered. "There's a lake."
"No," Toby said a heartbeat after Noah had finished his question. Too fast. He'd been told his tone of voice was flat, monotonous, no matter his mood, but little things like this betrayed his feelings.
Noah shrugged as he pushed himself up out of bed. "Well, I'm going. Maybe you can come next time?"
"Maybe," Toby agreed, and meant it.
When Noah returned it was dark and Toby was asleep. The quiet sound of the door creaking open woke him. Toby had to struggle against the blankets swaddled tightly around his body to roll over to face Noah. It wasn't as good as the weighted blanket he had at home, but as it was what he'd done before he'd gotten his special blanket the sensation had been familiar enough to lull him into sleep.
Noah leant against the doorframe, the moonlight from outside outlining his form. "Coming to dinner?"
"Ngh," said Toby before correcting it into a word. "No."
"Hmm," was all Noah said before leaving again.
Toby secured his blankets around his body properly again and went back to sleep.
The next time Toby woke was to Noah returning again, this time for real. Noah took quiet steps across the room to his bed, apparently unaware that he'd already woken Toby.
And then Noah took his shirt off.
Toby couldn't see much through the darkness, just the general shape of Noah's body where the dim moonlight lit his bare skin, but somehow it made Toby's stomach squirm in a way he wasn't sure it would have in full daylight. He shouldn't have been watching, he was socially aware enough to know that, but he couldn't help it. Even as Noah slid his jeans down his legs, Toby couldn't help it.
Toby was relieved -- disappointed -- when the strip show went no further than that. He'd seen more than he should have, not as much as he would have liked. Amongst all the guilt and the low burn of lust, Toby felt sad. He couldn't imagine anyone ever revealing themselves to him like that willingly. He was too weird, too unstable.
Even those who were paid to be nice to him and to help him seemed uncomfortable with the idea of him having a sexuality at all. It was like, in their eyes, he wasn't fully real. A partial person with pieces missing, a few extra bits that didn't really fit. However nice, however helpful, they saw him as the thing they had decided he was, the thing they were comfortable with him being, and nothing else.
Noah slipped into his bed and after only a few seconds of shifting around he lay still and peaceful. Normal people were so weird.


text:
Burns himself provided the defining text for the myth in his dedication to the second edition of his Poems, published in 1787: "The Poetic Genius of my Country found me as the prophetic bard Elijah did Elisha - at the plough; and threw her inspiring mantle over me," he wrote. The scene is dear to bardolaters, and has been realised in oils numerous times, with Burns looking suspiciously sober and coy, the plough resting in pliant soil and a wee tim'rous beastie scuttling into the grass. However, Burns only developed this image to please the dedicatees, the members of the Caledonian Hunt, chosen because they topped the subscribers' list with an order of 500 copies. The flowery language is typical of his obsequious mode when addressing his social superiors, but probably satirical.
Even in his native Ayrshire, the phenomenon of the (supposedly) semi- literate bard excited attention, and after the success of the first edition of Poems, Chiefly in the Scottish Dialect, Burns's presentation in Edinburgh became inevitable. "Who are you, Mr Burns?" asked the Edinburgh Magazine, which went on to invent an unlikely reply from a man whose education may have been patchy but not primitive: "I understand no languages but my own ... I have not looked on mankind through the spectacle of books. An ounce of mother wit, you know, is worth a pound of Clergy; and Homer and Ossian, for any thing that I have heard, could neither write nor read." "The Author is indeed a striking example of Native Genius bursting through the obscurity of poverty," gushed the reviewer, but the "heaven-taught ploughman" himself despised those who treated him like a novelty. He told one hostess that he would only accept her invitation if the "learned pig" on show in Edinburgh at the same time could come too.
In his fine new biography, Ian McIntyre keeps his consideration of the Burns myth short. He also plays down much of the cult-fostering material, such as "The Cottar's Saturday Night" and "To a Mouse", and adheres as closely as possible to contemporary sources, with wide use of Burns's correspondence. The result is a vigorous and unsentimental portrait of a confused, brilliant and aimless man, "the sport of strong passions" throughout his short life.
Though he came from a family of tenant farmers, Burns's heart was not in farming, or the job as an excise officer which he later undertook. His two ruling passions, for women and poetry, were strangely dependent. The occasion for his first poem, written aged 15, was first love, and he seems to have suffered from lack of inspiration during celibate periods (these were scarce and brief). When ice-bound in Edinburgh society, he dared not employ his usual seduction technique ("try for intimacy as soon as you feel the first symptoms," he had once advised a younger brother), and neither could he write. He was addicted to "the sport" as much as he was to drink in his later years; it was essential to his well-being.
The reviewer who praised the "rustic pleasantry" of Burn's Poems saw fit to add that the poet "seems to be a boon companion and often startles us with a dash of libertinism, which will keep some readers at a distance", this despite the fact that Burns had left out of his collection many of the most mordant satires, and all the earthier poems, such as "A Poet's Welcome to his Bastart Wean" and 'The Court of Equity'. His numerous obscene verses were never, of course, put forward for publication, though Ian McIntyre, in a dry aside, remarks that "the impenetrability of the Scots ... affords almost total protection to delicate English ears." They serve as a reminder that Burns was a remarkably inconsistent poet, in content as much as in quality. One side of him was pure romantic -- at Blair Castle he "threw himself on the heathy seat and gave himself up to a tender, abstracted, voluptuous enthusiasm of imagination" - another side was pure ran-stam boy, devising endless synonyms for his "Pen of Nature".
Burn's love affairs were numerous and ardent, but sometimes difficult to interpret, and his eventual marriage to Jean Armour, whose family had not thought him good enough at first, but by whom he had four bastard children, remains slightly coloured by motives of revenge and pique. Their passionate and difficult relationship is only sparsely documented, while every last gasp of Burns's protracted flirtation with an Edinburgh gentlewoman, Nancy McLehose, survives in their voluminous correspondence. In his adopted guise as Mrs McLehose's "Sylvander", Burns wrote some of his most extravagantly silly prose: "O Love and Sensibility, ye have conspired against My Peace! I love to madness, and I feel to torture!" and his "Clarinda" responded in kind. "Yet we must guard against going to the verge of danger," she protested, though they were clearly dancing on this verge for months, and when Burns wearied and went home to marry Jean, she was mortified but hardly puzzled.
His crushes on upper-class women never came to good, and the most mysterious and unsatisfactory episode in his life involved some gross misdemeanour among the ladies at the home of his friends the Riddells, which led to an irreparable breach. Gentility in women was an insuperable obstacle to Burns, and he railed against it in terms that also suggest his frustration at not finding a more suitable companion than Jean: "Circumstanced as I am, I could never have got a female Partner for life who could have entered into my favourite studies, relished my favourite Authors, &c. without entailing on me at the same time, expensive living, fantastic caprice, apish affectation, with all the other blessed Boarding-school requirements."
Burns had huge fame as a poet but no "career" as such. He was temperamentally disinclined to plan ahead or exploit the financial possibilities of his gift, and sold the rights of his Poems for a hundred guineas. In 1787 Burns began an association with James Johnson, a music seller engaged in an ambitious project to collect all extant old Scots songs and publish them in arrangements for piano. The work Burns did for him was intensely satisfying, preoccupying and unremunerative; by reworking or "mending" the words to the songs, Burns produced some of the most powerful lyrics in Scots or any language, from the simple "My heart's in the Highlands" to the hauntingly beautiful "Lang has we parted been".
Burns signed these entries in Johnson's Scots Musical Museum "Z" to denote "old songs with corrections or additions". McIntyre shows how small yet transforming some of these corrections were, such as the changes Burns made to the original version of "Auld Lang Syne" and "John Anderson, my jo", which he shifted from bawdy into a poignant love-song. Burns seems to have had an infallible ear for lyric and his best efforts bear out the critic Thomas Crawford's opinion that they represent "the perfection of the old achieving the shock and immediacy of the new".
Burns was a man of his times, and eager to pick up contemporary political jargon in his satires, such as "The Jolly Beggars", though as Ian McIntyre points out his politics were "never less than moderately confused"; indeed he seems to have achieved the rare distinction of being both Jacobite and Jacobin simultaneously. His political gestures - such as once refusing to stand for "God Save the King" at the theatre - were often misconceived, but still managed to get him into trouble and threaten his livelihood as an excise officer. This reckless streak, and the heavy drinking that developed in the years when he was apparently settling down in Dumfries with Jean and their many children, indicates a continued lack of his desired "internal peace". The disease which finally killed him at the age of 37 brought with it symptoms of depression and lassitude. Ian McIntyre thinks that this illness might well have been brucellosis, acquired during his years as a farmer; death, too, found him "at the plough".
In a piece of sustained invective against "antiquarian Burnsians", the poet Hugh MacDiarmid raged against "the witless lucubrations of the hordes of bourgeois 'orators' who annually befoul his memory". Ian McIntyre does Burns a far greater service than simply railing against the absurdities of Burns Night. His intriguing portrait, written in delightfully exact English (a Scots virtue, if ever there was one), rests on its truth to Burns's genius and his ordinariness, and is likely to inspire more admiration than ever before for "the most Scottish and yet most universal of all poets".
8 'Dirt and Deity: A Life of Robert Burns' by Ian McIntyre, HarperCollins pounds 20
8 Claire Harman is the editor of Sylvia Townsend Warner's diaries (Virago pounds 12.99); she is now writing a Life of Fanny Burney.
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