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ULTRASOUND CLINICS Ultrasound Clin 2 (2007) 297–309
Ultrasound of Pelvic Inflammatory Disease Mindy M. Horrow, MD, FACR, FAIUMa,b, Shuchi K. Rodgers, MDa,*, Shabbir Naqvi, -
Clinical findings Ultrasound findings Acute pelvic inflammatory disease Chronic pelvic inflammatory disease Related findings and differential diagnosis
Pelvic inflammatory disease (PID) is an infection of the upper genital tract caused by sexually transmitted disease (STD). In addition to the care required during an acute infection, the sequelae of infertility, ectopic pregnancy, and chronic pelvic pain significantly impact the health care system. Data from 1990 show an estimated cost for care of patients with PID at $4.24 billion annually, with 200,000 hospitalized cases and 1,277,700 outpatient cases. From 1984 to 1990, hospitalizations for PID decreased 25%, with only a slight rise in outpatient visits [1]. More recent estimates from the Centers for Disease Control and Prevention approximate 780,000 new cases of acute PID annually [2]. Although it is unclear if this is a true decrease, or just a result of more outpatient care for patients who have PID, most researchers estimate that there is a significant cohort with unrecognized PID. A study in 2004 found the prevalence of chlamydial infection in young adults in the United States was 4.19%. Women, and in particular black women, had higher rates of 4.74 and 13.95%, respectively [3]. The cost of PID to the
Other imaging: CT Other imaging: MRI Summary References
health care system stems more from the major chronic complications than the cost of treating the acute infection. Chronic complications include infertility, ectopic pregnancy, and chronic pelvic pain. A recent study found the average per-person lifetime cost of PID ranges from $1060 to $3180 [4]. Risk factors for PID are related to exposure to STDs and include earlier age at first sexual intercourse, multiple partners, history of prior STD, and use of vaginal douche [5]. There is also increased risk from an intra-uterine device (IUD), but this is limited to the first few weeks after insertion1 [6].
Clinical findings Most cases of PID are caused by Chlamydia trachomatis or Neisseria gonorrhoeae. Co-infections of these organisms and other bacteria, including: Streptococcus species, Escherichia coli, Haemophilus influenza, Bacteroides species, Peptostreptococcus and Peptococcus are common. Normally, the major barrier to the assent of both normal vaginal flora and pathogens
a Department of Radiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA b Jefferson Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA * Corresponding author. Department of Radiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098. E-mail address: email@example.com (S.K. Rodgers). 1 The text of this article is adapted from Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission.
1556-858X/07/$ – see front matter ª 2007 Elsevier Inc. All rights reserved.
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is the endocervical canal and its mucus plug. The infectious bacteria damage the endocervical canal, permitting organisms to ascend into the uterus. Other factors may facilitate the spread of disease. Cervical ectopy (extension of endocervical columnar epithelium outward beyond the cervix) produces a larger area that is susceptible to infection. Cervical ectopy occurs more commonly in teenagers, who also represent the age group with the highest incidence of PID. Cervical mucus changes normally during the menstrual cycle, making the cervix more vulnerable to infection at midcycle, when estrogen levels are high and progesterone is relatively low. After ovulation, the mucus becomes more viscous and less penetrable by both sperm and bacteria. Bacteria also may gain easier access to the uterus when the mucus plug is expelled at menstruation [7]. Less frequently, PID occurs as a secondary infection from adjacent processes (ie, appendiceal, diverticular, postsurgical abscesses, or puerperal, and postdilatation and curettage [D & C] complications). Hematogenous spread is rare, but can occur from tuberculosis. Primary prevention of PID consists of avoiding exposure to STDs. Secondary prevention involves keeping the lower genital infection from ascending into the uterus. This combines disease detection, treatment, and partner notification. Tertiary prevention, which involves preventing an upper genital tract infection from leading to tubal dysfunction and/or obstruction, has been generally disappointing [8]. The initial diagnosis of PID, which is based upon a combination of symptoms, pelvic examination, and laboratory studies, is often incorrect. Molander and colleagues [9] confirmed PID by laparoscopy in only 67% of women who had clinically suspected PID. Laparoscopy, however, is not suitable for
a screening procedure. Initially, transabdominal sonography, and now transvaginal sonography with Doppler have been used in the diagnosis of PID.
Ultrasound findings Despite the widespread use of sonography in the diagnosis and management of patients with pelvic inflammatory disease, there are no large studies evaluating its sensitivity and specificity or overall usefulness [10–12]. Nonetheless, it is a frequently ordered study in patients who have unexplained, acute pelvic pain or in patients with classic symptoms of PID in whom an adequate clinical examination cannot be performed. If demonstration of a pyosalpinx or tubo–ovarian abscess will result in hospitalization, surgery, or follow-up imaging to evaluate nonoperative management, then initial sonography is indicated. In addition, many patients are examined initially by generalists who may feel more confident relying on imaging studies. CT is ordered with increasing frequency to rule out alternative diagnoses such as appendicitis and diverticulitis. Thus, there are more patients in whom CT is the first study to suggest the diagnosis of PID. Though CT is very sensitive for the detection of pelvic abnormalities, it may not be as specific, particularly in differentiating an ovarian from a tubal process, and ultrasound often is obtained after an abnormal CT study to clarify the pathological process and guide management. As one reviews the imaging literature of the last 20 years, it is clear that the sensitivity and specificity of sonography for PID depends upon the findings one considers to be indicators of PID and the quality of the equipment and the sonographer. Transabdominal imaging is suitable for determining overall
Fig. 1. (A) Longitudinal, transabdominal image of the uterus at the time of presentation demonstrates an anteverted, anteflexed uterus with an indistinct endometrial stripe and indistinct margins. (B) Re-examination 3 days later after treatment shows a distinct endometrial stripe and uterine margins. (From Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission.)
Ultrasound of Pelvic Inflammatory Disease
Fig. 2. Sagittal, transvaginal view of the uterus demonstrates prominent echogenic fat (arrows) adjacent to the anterior, superior aspect of the uterine fundus.
extent of disease. Transvaginal sonography with color or power Doppler, however, has significantly improved the ability to detect subtle abnormalities such as slightly swollen fallopian tubes and to distinguish whether the ovary is involved in an abscess [13]. In addition, many patients who have acute PID cannot tolerate an adequately filled urinary bladder; therefore transabdominal sonography is suboptimal [14]. Papers describing the findings of PID in the pretransvaginal era are therefore of limited use. In medical imaging, the ability to make the correct diagnosis depends upon knowledge of the possible manifestations of the disease and correlation with the clinical findings. Transvaginal imaging is suited uniquely in both these regards for diagnosing PID. The higher frequency transvaginal probes allow one to observe the more subtle changes of salpingitis and oophoritis. Furthermore, the act of transvaginal imaging itself permits the
Fig. 3. Sagittal, transvaginal view demonstrates fluid in the endometrial canal consistent with but not specific for endometritis in this patient with pelvic inflammatory disease.
Fig. 4. Transverse, transvaginal view demonstrating complex fluid with low level echoes within the cul de sac from a ruptured hemorrhagic ovarian cyst. The fimbriated portion of a normal fallopian tube (T) is visualized also.
sonographer to correlate the patient's symptoms with the imaging findings, by eliciting focal tenderness upon examination of the affected fallopian tubes and ovaries. This is particularly valuable when the imaging findings are subtle.
Acute pelvic inflammatory disease In a patient without an abscess or pyosalpinx, the manifestations of PID are often subtle and sometimes nonspecific. Mild enlargement or indistinctness of the uterus can be very difficult to appreciate and often only confirmed if a follow-up examination is performed (Fig. 1). If the patient has some fat in the pelvis, inflammatory changes will be manifest as increased echogenicity and prominence of this fat (Fig. 2). It is the authors' experience that subtle changes in uterine size and of the adjacent fat are
Fig. 5. Transverse, transvaginal view of the right adnexa in a patient with pelvic inflammatory disease demonstrates an enlarged right ovary (volume 23 cc) with multiple tiny peripheral cysts. There is also an adjacent thickened fallopian tube (arrows).
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Fig. 6. Transverse, transvaginal image demonstrates a normal fallopian tube outlined by fluid from a ruptured hemorrhagic cyst.
Fig. 8. Transverse, transvaginal view of a fallopian tube (arrows) with a thick, echogenic wall, containing complex fluid, representing a pyosalpinx.
appreciated better transabdominally because of the wider field of view. Both fluid in the endometrium and fluid in the cul de sac, common findings in PID, can be found in normal patients and those with alternative diagnoses (Figs. 3 and 4). In addition, some patients who have PID may have little or no free fluid [11]. Nonetheless, the presence of even small amounts of complex pelvic fluid is worrisome for free pus. Careful attention to gain control settings is necessary to visualize internal echoes. Two groups have reported the finding of enlarged ovaries with increased numbers of small cysts, a socalled polycystic ovary appearance, to correlate with PID (Fig. 5). Cacciatore and colleagues [12] and Golden and colleagues [15] both found largerthan-normal ovarian volumes in their patients who had PID proven by endometrial biopsy or laparoscopy. These authors have found increased ovarian volume to be a useful sign of PID, having documented decreasing volumes on follow-up examinations. A reasonable explanation for this reactive polycystic change is that the inflammation increases ovarian volume by thickening the stroma
and increasing the number and size of cysts. The margins of the ovaries also may become indistinct in PID. Sonographic findings of the fallopian tubes are the most striking and specific landmarks of PID. Normal fallopian tubes are difficult to visualize on routine transvaginal sonography, unless outlined by fluid (Fig. 6). The normal fallopian tube is approximately 10 cm long and runs along the superior margin of the broad ligament. It can be divided into four segments from the proximal uterine end to the distal fimbriated end as follows: interstitial, isthmic, ampullary, and infundibular. The fimbriated portion of the infundibular segment attaches to the ovary and is open to the peritoneal cavity [16]. The diameter of the tube typically varies between 1 and 4 mm, and in the authors' experience is thickest in the infundibular segment. When inflamed, the fallopian tube swells, and the walls and endosalpingeal folds thicken, allowing visualization with ultrasound (Fig. 7). This initial stage corresponds to salpingitis, a thickened fallopian tube without intraluminal pus. On ultrasound, it can appear as an indistinct, elongated, noncystic mass in close proximity to the
Fig. 7. Transverse view of the pelvis with thickened left fallopian tube (arrow), not filled with fluid. (From Horrow MM. Ultrasound of Pelvic Inflammatory Disease. Ultrasound Quarterly 2004;20:171–9; with permission.)
Fig. 9. Transverse, transvaginal view of a slightly dilated, fluid-filled fallopian tube with thickened endosalpingeal folds demonstrating the cog wheel sign.
Ultrasound of Pelvic Inflammatory Disease
Fig. 10. (A) Cross section of significantly dilated tube (arrows) containing echogenic fluid that outlines thickened endosalpingeal folds, demonstrating the cog wheel sign. (B) Photomicrograph of same tube in cross section with thickened folds projecting into a dilated lumen. (From Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission.)
ovary, but separated from it. The endosalpingeal folds are difficult to discern given the lack of intraluminal fluid as a contrast. The pus may flow freely from the tube into the peritoneum, preventing distention and detection of a thickened tubal wall. As the lumen occludes distally, the fallopian tube distends and fills with complex fluid, resulting in a pyosalpinx. Various appearances result, as described by Timor-Tritsh and colleagues [17]. The tube becomes ovoid or pear-shaped, filling with fluid that may be anechoic or echogenic, with layers. The wall becomes thickened, greater than or equal to 5 mm (Fig. 8), and incomplete septi are common as the tube folds back upon itself. If the distended tube is viewed in cross section, it may demonstrate the cog wheel sign (Figs. 9 and 10A), because of the thickened endosalpingeal folds (Fig. 10B) [17]. Typically the swollen fallopian tubes extend posteriorly into the cul de sac, rather than extending superiorly and anterior to the uterus as large ovarian tumors tend to do. Fluid debris levels often are visualized in the dilated tubes (Fig. 11), and very rarely gas/fluid levels or bubbles of gas (Fig. 12). As the disease progresses, the ovary can become involved. Theoretically, a defect in the ovary at the time of ovulation allows bacteria to enter, spreading the infection. When the ovary adheres to the tube, but remains visualized, this indicates a tubo– ovarian complex (Fig. 13). A tubo–ovarian abscess is the result of a complete breakdown of ovarian and tubal architecture such that separate structures no longer are identified (Fig. 14). Without treatment, a tubo–ovarian abscess can rupture, resulting in peritonitis and multiple intra-abdominal abscesses (Fig. 15). If the contralateral side was
not affected initially, the disease may spread there secondarily. When both tubes are inflamed and occluded, the entire complex typically takes on a U shape as it fills the cul de sac, extending from one adnexal region to the other. The lateral and posterior borders of the uterus become obscured, and individual tubes and ovaries cannot be distinguished. Color and power Doppler may show increased flow (hyperemia) in the walls and incomplete septi of the inflamed tubes (Fig. 16). In the acute phase of the infection, the mean resistive and pulsatility indices may be low, measuring 0.5 (standard deviation [SD] 5 0.05) and 0.79 (SD 5 0.12). With treatment, these values increased to 0.63 and 1.17, respectively [18]. Some authors have shown that
Fig. 11. Oblique, transvaginal view of a dilated right fallopian tube containing a fluid–pus level.
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Fig. 12. (A) Dilated left fallopian tube filled with fluid and multiple bright echogenic foci representing bubbles of gas. (B) CT image through the pelvis in the same patient shows dilated tubes (arrows) filling the cul de sac. The left tube contains a gas/fluid level. (From Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission.)
Chronic PID typically results in a hydrosalpinx from accumulation of fluid caused by occlusion of the tube distally or at both ends. Other causes of hydrosalpinx, however, include tubal ligation,
following hysterectomy if the fallopian tubes are left in to protect the vascular supply to the ovary, and primary or secondary tumors of the fallopian tubes [16]. Several specific ultrasound findings can help distinguish a hydrosalpinx from other cystic adnexal lesions. A hydrosalpinx tends to be anechoic, more tubular, and often demonstrates the incomplete septa sign (Fig. 17). The tubal wall is thin, less than 5 mm, and in cross section demonstrates the beads-on-a-string sign (Fig. 18) [17]. These beads are 2 to 3 mm hyperechoic nodules projecting from the wall, representing remnants of the endosalpingeal folds. If color flow is detected in a hydrosalpinx, it tends to be less exuberant than in acute PID. Molander and colleagues [9] found a higher pulsatility index in patients who had a chronic hydrosalpinx (1.5 .1) than with
Fig. 13. Tubo–ovarian complex. Sagittal, transvaginal image of the left adnexa demonstrates an ovary (O) with ill-defined borders, surrounded by a thickened fallopian tube (T) containing fluid (F) and pus (P).
Fig. 14. Transverse, transvaginal image of the pelvis demonstrates a right tubo–ovarian abscess (TOA) and a left tubo–ovarian complex consisting of a pyosalpinx (T) and the adjacent left ovary (OV).
patients who responded to conservative, medical treatment tended to have a higher resistive index (.6 .15) than those who required surgery (.52 .08), although there was significant overlap between the two groups [19]. It is the authors' experience that color Doppler imaging can be useful to differentiate PID from tumors or masses, but specific resistive and pulsatility indices are not helpful. Decreased flow on follow-up imaging may be useful to assess for response to therapy.
Chronic pelvic inflammatory disease
Ultrasound of Pelvic Inflammatory Disease
Fig. 17. Sagittal, transvaginal image of a hydrosalpinx, demonstrating an incomplete septum (arrow).
Fig. 15. Coronal enhanced CT scan in a different patient demonstrating peritoneal inflammation (white arrows) and multiple abscesses (black arrows) from a ruptured tubo–ovarian abscess.
acute PID (.84 .04). Occasional patients with prior PID may demonstrate a peritoneal inclusion cyst. This diagnosis is made when the ovary is surrounded by a loculated fluid collection with thin septations [20]. A peritoneal inclusion cyst forms
when fluid from a ruptured ovarian cyst is trapped around the ovary by adhesions (Fig. 19). Sonographic changes can occur fairly rapidly after treatment of PID. Minor findings such as complex fluid and inflammation in the surrounding fat can resolve in a few days. A pyosalpinx can change to a hydrosalpinx and possibly resolve over a few weeks to several months. Interestingly, Taipale and colleagues [21] found that 9 of 55 patients who had clinical PID and an initial, normal sonogram developed a hydrosalpinx with time. If a pyosalpinx does not resolve or develops into
Fig. 16. Color and pulsed Doppler image of a left pyosalpinx demonstrates low resistance arterial flow (RI 5 .49).
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Fig. 18. (A) Hydrosalpinx. Lengthwise, transvaginal view of a dilated, fluid-filled fallopian tube demonstrating residual endosalpingeal folds (arrows). (B) Cross section of the same tube shows the beads on a string sign.
Patients who have severe PID can develop a reactive ileus (Fig. 20), which can be visualized during sonographic evaluation of the pelvis. Perihepatitis associated with PID is known as Fitz-Hugh-Curtis Syndrome, which occurs in 3% to 10% of patients who have PID [22]. The acute right upper quadrant pain often overshadows the pelvic pain because of acute salpingitis. Inflammatory exudates in the pouch of Douglas spread along the peritoneal surface to the anterior surface of the liver by means of the paracolic gutter (Fig. 21). Often alternative diagnoses such as cholecystitis are considered first, and imaging of the right upper quadrant may be requested. Shoenfeld and colleagues [23] found thickening of the right anterior extrarenal fascia
on ultrasound in nine patients. Scattered cases of Fitz-Hugh-Curtis syndrome on CT have demonstrated increased enhancement of the peritoneal surface of the anterior aspect of the liver, gallbladder wall thickening, and a transient hepatic attenuation difference [24,25]. Though the combination of sonographic and clinical findings is often quite specific for PID, there are several other common diagnoses in the differential diagnosis. The most common alternative diagnoses with findings which simulate PID by the presence of an indistinct uterus and complex pelvic fluid, are ruptured hemorrhagic cyst and endometrioma. Perforated appendicitis and ruptured tubo-ovarian abscess may present with indistinguishable findings of peritonitis and intra-abdominal abscesses. Other tubular structures in the pelvis which bear a resemblance to dilated fallopian tubes but should be distinguishable from them include
Fig. 19. Sagittal image of the right adnexa demonstrating loculated fluid with thin septations, surrounding the right ovary compatible with a peritoneal inclusion cyst. The patient has a history of pelvic inflammatory disease.
Fig. 20. Transabdominal image of the right pelvis in a patient with pelvic inflammatory disease demonstrates dilated loops of small bowel without peristalsis, compatible with a reactive ileus.
a hydrosalpinx, it probably signifies an incompletely treated infection.
Related findings and differential diagnosis
Ultrasound of Pelvic Inflammatory Disease
Fig. 21. Fitz-Hugh-Curtis syndrome in a patient with pelvic inflammatory disease. Coronal unenhanced CT image demonstrates peritoneal inflammation (white arrows) extending to the inferior liver capsule (black arrow). The patient presented with right upper quadrant pain.
an inflamed appendix (Fig. 22), a hydroureter, prominent pelvic veins (Fig. 23), and varices. Septic ovarian vein or pelvic vein thrombophlebitis may present with a similar clinical picture as PID. However, it most commonly occurs postpartum, but can be associated with pelvic trauma, PID, or recent pelvic surgery. In the majority of cases, it occurs on the right side, and during the first week postpartum. On sonography, a tubular anechoic or hypoechoic structure is identified, extending superiorly from the adnexa, with absence of flow on Doppler imaging (Fig. 24) [26].
A hydrosalpinx can mimic a cystic ovarian mass. This occurs when a significantly scarred hydrosalpinx has multiple septa without connecting compartments. Conversely, cystic ovarian tumors seldom have incomplete septa. Large para-tubal or para-ovarian cysts can also appear similar to a hydrosalpinx. For example, a hydatid of Morgagni is a benign cystic structure arising from a mu¨llerian duct vestige adjacent to the fimbrial end of the fallopian tube (Fig. 25). Identification of the ovary separate from the hydrosalpinx allows differentiation from an ovarian mass. MRI or CT may aid in difficult cases. Torsion of the fallopian tube is a rare condition that can occur with PID or other pre-disposing conditions. These include hydrosalpinx, tubal tortuosity, tubal ligation, tumor, or extrinsic causes such as a paratubal mass, adjacent adhesions, or enlargement of the uterus compressing the tube. The clinical presentation is similar to ovarian torsion. Sonography typically shows a thick-walled distended fallopian tube, which may contain hemorrhage. Differentiation of acute PID with tubal pus from tubal torsion with hematosalpinx may be difficult. Since tubal blood supply is from both ovarian and uterine vessels, the presence of flow on color Doppler does not exclude the diagnosis. Ultimately, the prospective diagnosis of tubal torsion is very difficult and is most often made pathologically [16,27].
Other imaging: CT When significant sonographic findings are detected in the pelvis, sonography should be extended into the abdomen. Complex pelvic fluid may ascend into the flanks and Morison's pouch. Hydroureteronephrosis is not uncommon. Patients with nausea
Fig. 22. (A) Transabdominal view of the right adnexa demonstrates a tubular, blind ending structure with lowlevel internal echoes. Patient had surgically proven appendicitis. (B) Transverse view of the same dilated appendix with surrounding echogenic fat consistent with inflammation.
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Fig. 23. (A) Sagittal, transvaginal view of the right adnexa demonstrates a tubular structure adjacent to the right ovary (O). (B) Corresponding color Doppler image demonstrates that the tubular structure represents a prominent iliac vein.
and vomiting often demonstrate dilated loops of small bowel with minimal peristalsis, indicative of an ileus. While ultrasound remains the imaging modality of choice in cases of suspected PID, if the symptoms are more generalized and non-specific, CT is often ordered first. CT should be performed with both oral and intravenous contrast. While many of the classic sonographic findings including enlarged ovaries, dilated tubes and free-fluid are equally well seen on CT, the mild inflammatory changes of PID may be better appreciated on CT than ultrasound. Mild pelvic edema causes thickening of the utero–sacral ligaments and haziness of pelvic fat [28]. Periovarian stranding and enhancement of the peritoneum, endometrium and endocervical canal are well visualized with CT (Figs. 26 and 27).
CT is also beneficial in detecting involvement of adjacent structures such as: small and/or large bowel ileus or obstruction, ureteral obstruction, secondary inflammation of the appendix and inflammation of the greater omentum. The extent of a ruptured tubo-ovarian abscess is better appreciated with CT. In contrast to ultrasound however, it is more difficult to differentiate a pyosalpinx from a tubo-ovarian complex or abscess by CT. Similarly mildly dilated tubes may go unrecognized on CT. A subgroup of patients with an intra-uterine contraceptive device in place may develop a particular type of subacute or indolent form of PID. They are prone to infection with Actinomyces israelii, leading to a more chronic, suppurative infection which may simulate a neoplasm with carcinomatosis on CT [29].
Fig. 24. (A) Axial enhanced CT of the pelvis in 13-year-old recently postpartum patient shows bilateral tubular low density structures with enhancing walls, compatible with thrombosed, septic pelvic veins. (B) Corresponding transverse color Doppler image shows hypoechoic thrombus in a left pelvic vein.
Ultrasound of Pelvic Inflammatory Disease
Fig. 25. Transverse, transvaginal view of the left adnexa demonstrates a paratubal cyst (Hydatid of Morgagni) arising from the fimbriated portion of the left fallopian tube.
Fig. 27. CT scan through superior aspect of pelvis shows distended bladder (B) and inflammation of peritoneal fat (arrow). The anterior peritoneum is thickened and enhancing, and small collections of fluid are present (F). (From Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission.)
Other imaging: MRI Scattered reports of MR imaging for PID show findings similar to CT. Pelvic inflammation appears as ill-defined hyperintense areas on fat-suppressed T2 weighted images and marked enhancement on gadolinium-enhanced fat-suppressed T1-weighted images. Contents of a pyosalpinx or abscess are slightly hyperintense on T1-weighted images and slightly hypointense on T2-weighted images relative to urine due to hemorrhage or debris. The superior tissue contrast and multiplanar capability of MRI is occasionally useful in problem solving difficult
ultrasound cases (Fig. 28). For example, MRI can distinguish hematosalpinx from pyosalpinx, both of which can look similar on ultrasound. In a study comparing ultrasound and MRI in a group of 21 patients with PID proven at laparoscopy, sensitivity and specificity for PID was 95% and 89% by MRI and 81% and 78% for ultrasound [30]. The authors felt that MRI was better than ultrasound for distinguishing other causes of cystic adnexal masses when a dilated tube was not present. Also, MRI was more sensitive for small amounts of fluid throughout the pelvis. Nonetheless, the significantly lower cost and easier availability of ultrasound makes it the initial imaging study of choice, with MRI used selectively for problem solving in complex or equivocal cases.
Fig. 26. CT scan through pelvis shows thickening of the broad ligaments (thin arrows) and thickening and enhancement of the peritoneum in the cul de sac (thick arrows). The cul de sac contains fluid and dilated fallopian tubes. (From Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission.)
Though the true sensitivity and specificity of ultrasound for PID are unknown, this study is frequently ordered. Awareness of the subtle findings of PID, particularly those that distinguish a dilated fallopian tube from other cystic adnexal masses (''incomplete septa,'' ''cog wheel,'' and ''beads-ona-string'' signs) will allow the interpreter to be more accurate. Transvaginal scanning allows one to correlate imaging findings with symptoms. As CT is used with increasing frequency, imagers must be able to appreciate the findings of PID on this modality and when to correlate with sonography.
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Fig. 28. (A) Transverse, transvaginal image demonstrating a cystic right adnexal mass with fine, uniform lowlevel echoes and peripheral echogenic mural nodule, highly suggestive of an endometrioma. (B) Coronal T2weighted MR image shows lumen of the same cystic mass continuous with the adjacent fallopian tube (arrow), indicating that it is tubal in origin. Surgical pathology proved this structure to be a pyosalpinx.
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[12] Cacciatore B, Leminen A, Ingman-Friberg S, et al. Transvaginal sonographic findings in ambulatory patients with suspected pelvic inflammatory disease. Obstet Gynecol 1992;80:912–6. [13] Bulas DI, Ahlstrom PA, Sivit CJ, et al. Pelvic inflammatory disease in the adolescent: comparison of transabdominal and transvaginal sonographic evaluation. Radiology 1992; 183:435–9. [14] Bellah RD, Rosenberg HK. Transvaginal ultrasound in a children's hospital: is it worthwhile? Pediatr Radiol 1991;21:570–4. [15] Golden N, Cohen H, Gennari G, et al. The use of pelvic ultrasonography in the evaluation of adolescents with pelvic inflammatory disease. Am J Dis Child 1987;141:1235–8. [16] Benjaminov O, Atri M. Sonography of the abnormal fallopian tube. AJR Am J Roentgenol 2004; 183:737–42. [17] Timor-Tritsch IE, Lerner JP, Monteagudo A, et al. Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol 1998;12:56–66. [18] Tinkanen H, Kujansuu E. Doppler ultrasound findings in tubo–ovarian infectious complex. J Clin Ultrasound 1993;21:175–7. [19] Tepper R, Aviram R, Cohen N, et al. Doppler flow characteristics in patients with pelvic inflammatory disease: responders versus nonresponders to therapy. J Clin Ultrasound 1998; 26:247–9. [20] Horrow MM, Brown KJ. Femscan: multiloculated pelvic cyst. Journal of Women's Imaging 2002;4: 89–90. [21] Taipale P, Tarjanne H, Ylostalo P. Transvaginal sonography in suspected pelvic inflammatory disease. Ultrasound Obstet Gynecol 1995;6:430–4. [22] Ignacio E, Hill M. Ultrasound of the acute female pelvis. Ultrasound Q 2003;19:86–98.
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[23] Schoenfeld A, Fisch B, Cohen M, et al. Ultrasound findings in perihepatitis associated with pelvic inflammatory disease. J Clin Ultrasound 1992;20:339–42. [24] Tsubuku M, Hayashi S, Terahara A, et al. FitzHugh-Curtis syndrome: linear contrast enhancement of the surface of the liver on CT. J Comput Assist Tomogr 2002;26:456–8. [25] Pickhardt PJ, Fleishman MJ, Fisher AJ. FitzHugh-Curtis syndrome: multidetector CT findings of transient hepatic attenuation difference and gallbladder wall thickening. AJR Am J Roentgenol 2003;180:1605–6. [26] Quane LK, Kidney DD, Cohen AJ. Unusual causes of ovarian vein thrombosis as revealed
by CT and Sonography. AJR Am J Roentgenol 1998;171:487–90. Gross M, Blumstein SL, Chow LC. Isolated fallopian tube torsion: a rare twist on a common theme. AJR Am J Roentgenol 2005;185:1590–2. Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. RadioGraphics 2002;22:1327–34. Lee I-J, Ha HK, Park CM, et al. Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features. Radiology 2001;220:76–80. Tukeva TA, Aronen HJ, Karjalainen PT, et al. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 1999; 210:209–16.


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Re: Deleting expressions containing a certain head, and a plea for Esc-fn-Esc
In support of my tireless campaign for the Esc-fn-Esc notation for pure functions, I submit
Cases[{2^(Complex[ 2, 3 ]) + 3 , 2 , 3 x }, _?(s \[Function] FreeQ[ s, Complex ]) ].
I have never been comfortable with the fact that
(#^3 &)[x]
(#^3) &[x]
give the same result.
Admittedly, in the above case, your
Cases[{2^(Complex [2, 3] ) + 3 , 2 , 3 x }, _?(FreeQ[ #, Complex ] &)]
works whereas
Cases [{2^(Complex [ 2, 3 ]) + 3 , 2 , 3 x }, _?(FreeQ [#, Complex ]) & ]
doesn't, which I think adds weight to my point. Sometimes (&) and ()& are equivalent, sometimes not. Avoiding the question as to where the "&" goes, inside the "()" or outside, is in the spirit of no ambiguity in Mathematica code, IMHO.
I just noted that the online help entry "tutorial/PureFunctions" mostly does not use parentheses, except for an example involving Fold, thus avoiding my dilemma. Hmm. It also says:
"When you use the ampersand notation for pure functions, you must be careful about the grouping of pieces in your input. As shown in "Operator Input Forms" the ampersand notation has fairly low precedence, which means that you can type expressions like #1+#2& without parentheses. On the other hand, if you want, for example, to set an option to be a pure function, you need to use parentheses, as in option->(fun&). "
I like to avoid @, #, and * because - especially in groups - they still remind me of swearing in a comic.
>>> On 12/04/2012 at 4:36 pm, in message <201204120636.CAA05485 at smc.vnet.net>, Ray
Koopman <koopman at sfu.ca> wrote:
> On Apr 11, 3:26 pm, Brentt <brenttnew... at gmail.com> wrote:
>> Hello, I have a list of expressions, and I am trying to use DeleteCases to
>> delete expressions in the list which contain a certain head *anywhere* in
>> the expression. Setting the levelspec for DeleteCases to Infinity almost
>> works, except I want to delete the entire expression containing the head
>> from the list as opposed to just the head itself while leaving the rest of
>> the expression in the list.
>> e.g.
>> I want this
>> DeleteCases[{2^(Complex[2,3])+3 , 2 ,3x }, Complex[_,_], Infinity ]
>> to output this
>> {2,3x}
>> Getting rid of any expression that has a complex number in it.
>> How does one go about this?
> Cases[{2^(Complex[2,3])+3 , 2 , 3x }, _?(FreeQ[#,Complex]&)]
> {2, 3 x}

subset: commoncrawl


text:
Hi all from sunny Cape Town, South Africa
First off, I think this site is great and you all have a lot of great info to offer..thanks! :danceban:
My question: I recently bought a Crucible FX II with a tccs carry system but to wear it IWB is a problem for me. It seems to ride too high when attached to my belt making it stick outwards and print too much. Have you any suggestions for other types of sheaths to use? Thanks all.
ps: Damn I'm envious that you guys can go out and pretty much buy any firearm or as many as you want! I can only get one and that's after rigorous procedures plus a 1-2 year wait!! :aargh4:


text:
Justin Theroux: I dress for winter
Justin Theroux has come to realise that appropriate men's attire should always be "winter from the waist down".
The actor is known for rocking his signature style of dark jeans and combat boots, whatever the weather.
Justin questioned the logic behind his fashion rule in a column he penned for Esquire magazine.
"A friend once shared with me an idiotic maxim: regardless of the season, a guy's attire 'should always be winter from the waist down: jeans and boots'. Chuckling, I dismissed the quote until it dawned on me that he had just described a hips-down uniform I've slavishly adhered to ever since I stopped wearing training pants," Justin joked.
"I'm the first to admit that jeans and combat boots might not always be the practical choice. Depending on whom you ask, denim was invented for either prospectors or cowboys, and seeing as I gave up wanting to be either of those things when I was six, why do I still leave my apartment ready to be dragged behind a horse? Especially when it means dragging myself through a New York summer with a clambake happening in my boots and my body maintaining the same core temperature as fondue."
Justin is often photographed walking around New York City dressed in his motorcycle leathers. He uses his method of transport as an explanation for why he always wears the same thing.
"When I was a teenager, jeans and boots were a style choice that somehow made sense, but nowadays, like toenails or knuckle hair, they seem like some masculine evolutionary remnant that I could probably stand to lose. Sure, they're useful in winter, but they become harder to justify at a pool party on the Fourth [of July, US holiday]," he pondered. "I'll frequently point to the fact that it's safer to wear jeans when I take my motorcycle for a spin, but what's my excuse the rest of the time?"
The fiancé of glamorous Hollywood star Jennifer Aniston moaned about the lack of clothing options available for men. Justin would rather be known for adopting a "winter from the waist down" style mantra than be seen in sweatpants or flip-flops.
"In fairness to me, maybe my loyalty to these jeans and boots isn't so much an endorsement of them as it is an expression of my distaste for anything else. Other options seem almost too grim to contemplate. Sweatpants? Cargo shorts? Light slacks?! Just the word slacks makes me anxious. And my boots might be functionally useless, but Teva sandals with Velcro fasteners? What's the thing with guys who wear those? I may not be panning for gold anytime soon, but are they going on a hike under a waterfall?" Justin teased.
"I guess it goes without saying that we all make sacrifices when we choose what we wear, but the 'winter from the waist down' mantra is not without merit."
© Cover Media


text:
Anesthesia and Postoperative Pain
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
The purpose of this study is to compare post-operative pain after anesthesia with either isoflurane or propofol. Each group will be further randomized to recieve intranasal nicotine or placebo inorder to detect potetial pronociceptive action of isoflurane.
The study is a randomized, prospective, double-blinded controlled trial. Eighty adult women undergoing uterine surgery will be recruited for this study. Enrollment in this study is limited to women, because our animal studies suggest that females have a greater hyperalgesic response to volatile anesthetics than do males.
The patient will be given one of two standard anesthetics for their surgery: isoflurane or propofol. We are interested in these two anesthetics because we seek to see if there exists a difference in their effects on a patient's perception of pain, as has been shown to be the case in animal studies but has not yet been studied in humans.
The primary outcome variable will be postoperative pain, as measured by a numerical analog pain score (VAS) at 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 120, and 1440 minutes postoperatively. Secondary outcome measures will include morphine utilization via PCA and hemodynamics variables including heart rate, systolic BP, and diastolic BP, all of which will be measured at the same time points as the VAS score.
|Postoperative Pain
|Drug: Nicotine (drug)
|Phase 4
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:
|Intranasal Nicotine for Postoperative Pain Treatment: A Comparison of Its Effects in the Context of Isoflurane-induced Anesthesia Versus Propofol Anesthesia
- - Score on a pain rating scale (numerical analog score) at 5, 10, 15, 20, 25, 30, 35, 40, 45, 60, 120, and 1440 minutes post-op [ Time Frame: 24 hours ]
- - Cumulative morphine usage at 5, 10, 15, 20, 25, 30, 35, 40, 45, 60, 120, and 1440 minutes post-op [ Time Frame: 24 hours ]
- - Heart rate and blood pressure at 5, 10, 15, 20, 25, 30, 35, 40, 45, 60, 120, and 1440 minutes post-op [ Time Frame: 24 hours ]
|Study Start Date:
|July 2003
|Study Completion Date:
|March 2006
|Primary Completion Date:
|July 2005 (Final data collection date for primary outcome measure)
|Assigned Interventions
Experimental: 1
Propofol anesthetic with and without nicotine
Drug: Nicotine (drug)
nicotine nasal spray (3mg) before surgery
Experimental: 2
isoflurane anesthetic with and without nicotine
Drug: Nicotine (drug)
nicotine nasal spray (3mg) before surgery
Show Detailed Description
|Ages Eligible for Study:
|18 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- greater than or equal to 18 years of age
- female sex
- present to New York Presbyterian Hospital for open pelvic surgery
Exclusion Criteria:
- smoking
- uncontrolled hypertension
- myocardial disease
- history of stroke
Please refer to this study by its ClinicalTrials.gov identifier: NCT00232817
|United States, New York
|New York Presbyterian Hospital
|New York, New York, United States, 10032
|Principal Investigator:
|Pamela D Flood, M.D.
|Columbia University
|Responsible Party:
|Pamela Flood, Principal Investigator, Columbia University Medical Center
|ClinicalTrials.gov Identifier:
|NCT00232817 History of Changes
|Other Study ID Numbers:
|Study First Received:
|October 3, 2005
|Last Updated:
|January 12, 2011
Keywords provided by Columbia University:
Postoperative pain
Additional relevant MeSH terms:
Pain, Postoperative
Neurologic Manifestations
Nervous System Diseases
Postoperative Complications
Pathologic Processes
Signs and Symptoms
Ganglionic Stimulants
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Nicotinic Agonists
Cholinergic Agonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Anesthetics, Inhalation
Anesthetics, General
Central Nervous System Depressants
ClinicalTrials.gov processed this record on June 22, 2017


text:
Every Knife You'll Ever Need In One Deluxe Set
And You Won't Believe The Price!
The Right Knife For Every Kitchen Job!
For Less Than $40 !
Sharp, Perfectly Balanced... The Ultimate In Performance
Professional chefs will tell you that one of their top secrets is a great set of knives. Sometimes they'll spend thousands of dollars to outfit their kitchen. Now a home cook can't afford that, but you still want quality knives without spending a fortune. This amazing 12-piece knife set is just what you need.
They are stainless steel and triple-riveted for durability! I could write paragraphs about it, but why don't I just show you these beauties. A picture is worth a thousand words and these photos will show you why these are the knives you've been waiting for.
First, we've got your most important knives - a sturdy small and large chef's knife with a perfectly balanced handle for comfort. You have to hold them in your hand to feel the difference. Chopping vegetables becomes a breeze. There's also a handy cheese knife. Look at them, they are gorgeous.
But what about meat & fish? This professional quality carving knife is why those slices in restaurants look so nice and the ones you make at home can look ragged. And the filet knife makes boning fish or butterflying meat a breeze. These first 5 knives would make an amazing set, but there's still more!
Next, check out this neat little cleaver. How easy will it be to chop with that? The super-sharp bread knife means an end to crumbs and squished baked goods.
The bonus Showtime knife will cut absolutely everything with its lifetime sharp edge. It does an especially amazing job on roast chicken or turkey. You can even use the special tip to serve meat!
All of this for only $39.97 ! And we aren't even finished yet! Because you also get two perfect paring knives, a tough pair of kitchen shears and a knife sharpener.
Kitchen shears are the best thing since sliced bread. You can use them to bone chickens, de-vein shrimp or snip up herbs! You'll never run out of uses for these sturdy helpers!
And maybe the most important tool in this set - this deluxe knife sharpener. Super-sharp knives are the secret to quick chopping and slicing and also the #1 way to stay safe in the kitchen. DULL knives are what cause accidents.
This amazing tool allows you keep your knives ready to go. It sharpens two ways First you pull your knife through the sharpener, then you hone it to perfection on the stone! Just like a professional - for a fraction of the cost!
Thanks to a special buy, we can offer you this deluxe 12-piece set of amazingly sharp, durable professional-quality knives for only $39.97 !
You get all of this:
- Chef Knife
- Small Chef Knife
- Cheese Knife
- Chop and Serve
- Showtime Knife
- Bread and Bagel Knife
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- Small Paring Knife
- Large Fillet Knife
- Professional Carving Knife
- Kitchen and Poultry Shears
- Knife Sharpener
And that includes free U.S. shipping! It's time to toss out all of those dull knives that turn cooking into a chore and get this fabulous set that makes cooking a breeze!
Click the store link below to add this outstanding professional-quality set to your shopping cart for the special price of $39.97!
Product Description
Always be prepared for every cooking situation with the Ronco Showtime Six Star+ 12-Piece Knife Set. In this set, you'll find everything you need to slice, chop, dice, trim, and more! Included are nine different knives ranging from a Chef's Knife to a Fillet Knife and even a Bread and Bagel Knife, so you'll always have to\he right tool for the job. Plus, you'll get Kitchen and Poultry Shears, and a Knife Sharpener to make jobs even easier. Each knife is made with stainless steel and triple riveted to provide plenty of durability and strength. And, because each is perfectly balanced, they'll feel just like an extension of your arm with each meal you prepare.
Key Features
- Set includes everything you need to slice, chop, dice, trim, and more
- Each knife is perfectly balanced for fine control during any job in the kitchen
- Made with a full stainless steel tang for added durability
- Impact-resistant black handles provide a gorgeous look that matches any kitchen decor
- Knives are triple riveted for added strength
- Knives and shears are dishwasher safe for easy clean-up
- The sharpener is perfect for sharpening knives and kitchen tools by hand
- Sharpener is for use with straight edge knives only
- Sharpener's unique white and red design stands out so you can find it easily when you need it
- Ronco Chef Knife
- Ronco Small Chef Knife
- Ronco Cheese Knife
- Ronco Chop and Serve
- Ronco Showtime Knife
- Ronco Bread and Bagel Knife
- Ronco Utility Paring Knife
- Ronco Small Paring Knife
- Ronco Large Fillet Knife
- Ronco Professional Carving Knife
- Ronco Kitchen and Poultry Shears
- Ronco Knife Sharpener
- Knives and Shears Color: Black/Silver
- Sharpener Color: White/Red
- Chef Knife Use: Preparing food
- Chef Knife Length: 13"
- Small Chef Knife Use: Preparing food
- Small Chef Knife Length: 11.25" (Approx)
- Showtime Knife Use: All-purpose (slice, chop, dice, and more)
- Showtime Knife Length: 14 3/8"
- Fillet Knife Use: Fillet meat off the bone
- Fillet Knife Length: 14 3/4"
- Carving Knife Use: Slicing cooked meats like turkey, chicken, and roast
- Carving Knife Length: 15 5/8"
- Bread and Bagel Knife Use: Slicing both hard and soft bread
- Bread and Bagel Knife Length: 13 1/4"
- Cheese Knife Use: Slicing cheese
- Cheese Knife Length: 11"
- Utility Paring Knife Use: Cut up vegetables, use with smaller pieces of meat, or trim and peel skins
- Utility Paring Knife Length: 9 1/4"
- Small Paring Knife Use: Trimming, peeling, coring, and other small jobs
- Small Paring Knife Length: 7 5/8"
- Shears Use: Cutting food into pieces, snipping fat, or even snipping from herbs and vegetables from the garden
- Shears Length: 8 3/8"
- Chop and Serve Knife Use: Chopping and then scooping/serving ingredients
- Chop and Serve Knife Length: 9.25"
- Sharpener Use: Sharpening straight edge knives only
- Sharpener Dimensions: 8.75" x 2.25" x 1.6" (L x H x W, Approx)
- Material: Stainless steel


text:
Notre Dame, Indiana, USA < change city >
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text:
My Problem
Optical disk couldn't be repaired. Dealer promised to make me an offer for the repair. After several weeks, when no offer came, I decided to check iFixit to see whether I could possibly do it myself.
My Fix
iFixit instructions are excellent. Repair was a little bit delicate because of the small screws, but . . .


text:
150-358.505 [Renumbered to 150-358-0500]
Determining Value of Historic Property Qualified for Special Assessment
(1) For purposes of this rule,
(a) "Assessed Value" (AV) is defined in ORS 308.146.
(b) "Maximum Assessed Value" (MAV) is defined in ORS 308.146 without application of ORS 308.146(4).
(c) "Changed Property Ratio" (CPR) is the ratio described in OAR 150-308-0170.
(d) "Internal ratio" (IR) is the quotient of MAV/RMV for an individual property, as if the property is not specially assessed. The ratio cannot be more than 1.0.
(e) "Maximum Specially Assessed Value" (MSAV) means maximum assessed value for property subject to special assessment.
(f) "Real Market Value" (RMV) is defined in ORS 308.205(1).
(2) This rule applies to initial and second qualifying periods beginning on or after July 1, 2010, with application being made on or after September 28, 2009.
(3) When a property is subject to historic property special assessment, the county assessor must:
(a) Include a "Historic property — potential additional tax" notation on the tax roll.
(b) Maintain the RMV and a MAV as if the property were not specially assessed. The RMV and MAV as if the property were not specially assessed must be adjusted to include any changes in value as addressed in ORS 308.146, 308.149, 308.153, 308.156, and 308.159 (commonly referred to as exception value).
(c) Calculate MSAV of the property annually while the property remains in the program.
(4) Calculate first period values for SAV, MSAV and AV.
(a) Step 1: Calculate the property's SAV to be used throughout the entire first 10 year period of historic property special assessment.
(A) The SAV equals the AV of the property on the tax roll at the time the application is submitted pursuant to ORS 358.487.
(B) If the property is specially assessed or exempt in the tax year during which an application is made, SAV equals the RMV on the tax roll at the time the application is submitted pursuant to ORS 358.487 multiplied by the CPR for that tax year.
(b) Step 2: Calculate MSAV for the first year of special assessment by multiplying the SAV by the IR. The MSAV is recalculated in the second and subsequent years and equals the greater of:
(A) The AV for the prior year multiplied by 103 percent; or
(B) The MSAV for the prior year
(c) Step 3: Calculate the AV, which is the lesser of the:
(A) SAV calculated in step 1;
(B) MSAV calculated in step 2; or
(C) The RMV.
Example 1: The State Historic Preservation Officer (SHPO), in January 2010, notifies the assessor that the owner of an old warehouse applied for historic property special assessment in October 2009 and qualified for that special assessment. The value of the warehouse as reflected on the 2009-10 tax roll is: RMV $400,000; MAV $302,380; AV $302,380. The first year of special assessment is 2010-11. The RMV for 2010-11 is $416,000.
(a) Step 1: Calculate the SAV. SAV = AV in the tax year the application is submitted = $302,380
(b) Step 2: Calculate MSAV for first year of special assessment.
(A) 2010-11 MAV = AV x 1.03, $302.380 x 1.03 = $311,451
(c) Step 3: Calculate the AV for the current year. It is the lesser of SAV ($302,380), MSAV ($226,482) or RMV ($416,000). AV = $226,482.
Example 2: SHPO, in January 2010, notifies the assessor that the owner of an old mansion no longer used by the Elks as a clubhouse that will be first disqualified from exemption for 2010-11 applied for historic property special assessment in October 2009 and that the property is qualified for special assessment for 2010-11. The CPR for this classification of property, had it been taxable in 2009-10, was 0.656, and the property's RMV for 2009-10 was $300,000. The first year of special assessment is 2010-11. The RMV for 2010-11 is calculated at $295,000 and the countywide CPR for this property classification for 2010-11 is 0.650. Other than the disqualification from exemption and the qualification for historic special assessment, there have been no changes to the property for 2010-11.
(a) Step 1: Calculate MAV for 2010-11 pursuant to ORS 308.156 as a result of disqualification from exemption.
(A) MAV = RMV x CPR, $295,000 x 0.650 = $191,750
(b) Step 2: Calculate SAV
(A) SAV = RMV x CPR from the tax year of application, $300,000 x 0.656 = $196,800
(c) Step 3: Calculate MSAV for first year of special assessment
(A) MSAV = SAV x IR, $196,800 x ($191,750 / $295,000) = $127,920
(d) Step 4: Calculate AV
(A) AV = lesser of SAV (step 2) or MSAV (step 3) or RMV. AV = $127,920.
(5) Calculate Second period values for SAV, MSAV and AV.
(a) Step 1: Calculate SAV for the first year of a second qualifying period.
(A) The SAV equals the RMV of the property for the assessment year in which the application is made.
(B) The SAV will remain constant throughout the second ten-year period of special assessment.
(b) Step 2: Calculate the MSAV for the first year of the second qualifying period of special assessment by multiplying the SAV by the internal ratio. The MSAV is recalculated in the second and subsequent years and equals the greater of:
(A) The AV for the prior year multiplied by 103 percent; or
(B) The MSAV for the prior year
(c) Step 3: Calculate the AV, which is the lesser of the:
(A) SAV calculated in step 1;
(B) MSAV calculated in step 2; or
(C) The RMV.
Example 3: SHPO approves an application filed in March 2020 and qualifies a renovated chateau for a second 10 year period of special assessment beginning with the 2020-21 tax year. The first historic property special assessment period ended in the 2018-19 tax year. For 2020-21, the RMV is $825,000, and MAV without special assessment would be $509,850.
(a) Step 1: Calculate SAV. SAV = RMV for assessment year in which application made. SAV = $825,000
(b) Step 2: Calculate MSAV for the first year of special assessment. MSAV = SAV x IR, $825,000 x ($509,850 / $825,000) = $509,850
(c) AV = lesser of SAV (step 1), MSAV (step 2), or RMV. AV = $509,850.
(6) When a building that is certified for historic property special assessment is divided into condominium units:
(a) The original account is deleted and each condominium becomes a new account.
(b) Each new account is appraised to establish a new RMV and calculate a new MAV.
(c) SAV and MSAV of the original account are apportioned between the new accounts but the total SAV and MSAV does not change as a result of the conversion to condominiums.
(d) The initial sale of each condominium unit by the developer disqualifies that unit from special assessment.
(e) Upon disqualification, the condominium unit is immediately requalified without further application for the remaining term of the original building's current 10 year period of historic property special assessment.
(f) Upon requalification, the SAV of the condominium unit equals its RMV for the tax year in which the sale of the unit occurred multiplied by the CPR for that tax year.
(g) The MSAV for the condominium unit for the first year after initial sale are calculated as described in step 3, using the MAV and RMV of the unit to determine the IR.
(h) The AV for the condominium unit for the first year after initial sale is calculated based on the lower of the SAV, MSAV, or RMV of the unit for that year.
Example 4: An account with an old warehouse building is qualified by SHPO for historic property special assessment. Its RMV, MAV, MSAV, SAV, and AV have been calculated as described in previous examples. The building is then converted to condominium units. When the condominium conversion is complete and all approvals are in place, each condominium unit becomes a separate account. New RMV and MAV are calculated for each account. Existing SAV and MSAV of the original warehouse account are apportioned between the new accounts. Total SAV and MSAV do not change as a result of the condominium conversion.
Account (tax lot) 00100, old warehouse building, is in its fourth year of its historic property special assessment. Its most recent tax roll values are as follows: RMV = $400,000; MAV if not specially assessed = $300,000, SAV = $225,000; MSAV = $179,020; AV = $179,020. CPR for this class of property is 0.750. The warehouse has now met all requirements for condominium and the 25 units worth $1,000,000 each are certified for sale. Account 00100 is deleted and replaced with account (tax lot) 90001 through account (tax lot) 90025. All units are identical in this building and each account has an RMV of $1,000,000. Total RMV of the building is now $25,000,000 and MAV is $18,750,000. Each account has a SAV of $9,000 and a MSAV of $7,160.
Total value of the building and site as condominiums (account 00100 deleted):
RMV = unit value * number of units, $1,000,000 x 25 = $25,000,000
MAV = RMV x CPR, $25,000,000 x 0.750 = $18,750,000
Value of each unit (each new account, 90001 through 90025):
MAV = RMV x CPR, $1,000,000 x 0.750 = $750,000
SAV = total building SAV apportioned by unit value, $225,000 / ($25,000,000 / $1,000,000) = $9,000
MSAV = total building MSAV apportioned by unit value, $179,020 / ($25,000,000 / $1,000,000) = $7,160
Example 5: A condominium unit in the building described in example 4 is sold by the developer for $1,000,000 on July 20, 2015. The unit is disqualified from the historic property special assessment due to the sale and then immediately requalified for the remaining term. Upon requalification, the SAV, MSAV, and AV are calculated for this unit. As of January 1, 2015 the individual unit had an RMV of $1,000,000 and an MAV of $750,000. Historic property special assessed values are reflected in an SAV of $750,000 and an MSAV of $562,500. The SAV calculated for the 2015-16 tax year will remain the same, frozen, throughout the remaining years of the building's 10 year term.
Unit values:
The building was in its 4th year of its 10 year historic property special assessment term; the new SAV for the condominium unit will remain the same, $750,000, for the remaining years of the building special assessment or until the building is otherwise disqualified.
The remaining accounts in the building are not affected by this sale.
(7) This rule is effective January 1, 2016.
Stat. Auth.: ORS 305.100, 358.505
Stats. Implemented: ORS 358.505
Hist.: REV 11-2009, f. 12-21-09, cert. ef. 1-1-10; REV 4-2015, f. 12-23-15, cert. ef. 1-1-16; Renumbered from 150-358.505, REV 37-2016, f. 8-12-16, cert. ef. 9-1-16
State Archives • 800 Summer St. NE • Salem, OR 97310


text:
a place for zinesters - writers and readers
Happy International Zine Month! I have a great way for you to celebrate and help out the Portland Zine Symposium!
The Portland Zine Symposium is hosting a 24 Hour Zine Challenge at the Independent Publishing Resource Center (IPRC) on July 16-17. This is benefit for the Portland Zine Symposium. If you sponsor a zinester to complete the 24 Hour Zine Challenge and pledge $10 or more you will receive the zine they finish!
If you go here and sponsor me in the 24 Hour Zine Challenge and donate $10 to the Portland Zine Symposium you will get whatever creation I come up with. Last year it was a zine full of storeis about all the post boxes I .... If you sponsor me for $25 I'll send some extra special goodies like stickers and buttons. In the words of my mother "It's a pretty good bet that you'll finish"
There will all be a Ustream channel so wherever you are in the world you can watch of caffeine induced scribbling and creating. More info on that soon. Stay tuned by keeping and eye on my blog.
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Photo: Looking north (upstream) at the four spans near the mouth of the river, from near to far: Amtrak, US Route 40, freight rail, I-95. Credit: Ben Longstaff, IAN, UMCES
The 2,900-mile East Coast Greenway connects 15 states and more than two dozen major cities throughout the Eastern seaboard. There are many challenges to completing the trail (now 29% off-road on greenways), but one rises high above the rest: crossing the Susquehanna River. Did you know that in the state of Maryland there is no safe way to cross the Susquehanna on foot or by bike? The closest safe crossing is in Pennsylvania, over 23 miles upstream from Havre de Grace, Maryland. With your help, we can change that!
New Amtrak Bridge Planned
There are presently four crossings in the river's southernmost stretch, two for autos and two for rail, and none permit bikes or pedestrians. One of these (Amtrak's Susquehanna River Bridge) was completed in 1906, and is one of the most significant bottlenecks in Amtrak's Northeast Corridor. The Maryland Department of Transportation (MDOT) has been awarded $22 million to design this bridge's replacement. This is a great first step, but it doesn't guarantee that bicycle and pedestrian infrastructure will be built; we all know that when cost projections start rising, bike and ped features are often the first to be cut.
The 2035 Maryland Transportation Plan and the Draft Maryland Twenty-Year Bicycle & Pedestrian Master Plan set strong goals for enhancing non-motorized transportation in Maryland. This bridge, if properly designed and built with accommodation for walkers and cyclists, will be proof positive that MDOT walks the talk.
Please join the East Coast Greenway Alliance as we urge MDOT to build a bridge that will serve multiple modes, connecting communities by rail, bike, and foot, for the next 100 years. Together we can make our voices heard as we call for healthy and sustainable transportation infrastructure for the 21st century.
How Can YOU Help?
Many separate voices have much less strength than a single, strong, focused voice. Together we can make a difference. Join in this effort, have your voice heard: sign this petition to support bicyclist and pedestrian access to the new bridge, and forward it to your friends! Please also contact our Mid-Atlantic Coordinator, Andy Hamilton (email@example.com) for more ways to get involved.
We'll provide updates as the new Amtrak bridge project progresses. Together, we can provide safe pedestrian and cyclist access across the Susquehanna River in Maryland, so that people using all modes can enjoy this beautiful and important waterway.
Wilmington Area Planning Council Transportation Improvements Plan (TIP)
Right now WILMAPCO, the Wilmington, DE, Area Planning Council is accepting comments on their 2015 – 2018 Transportation Improvement Plan (TIP). This includes the Susquehanna Bridge Replacement project – the public may review and comment, so make your voice heard, and send comments about the project in before March 4th. (Anyone may comment, not only Delaware residents.)
Information from WILMAPCO: The WILMAPCO Transportation Improvement Program (TIP) is the regionally agreed upon 4-year list of priority transportation projects, as required by federal law (MAP-21). The TIP must list all projects that intend to use federal funds, along with all non-federally funded projects that are regionally significant, and includes bicycle, pedestrian, ITS, and freight related projects, as well as the more traditional highway and public transit projects. The draft TIP is available for public comment from January 13 – March 4, 2014.
Contact WILMAPCO for more information or to comment on the project: email (send to email@example.com), mail comments to WILMAPCO, 850 Library Ave., Suite 100, Newark, DE, 19711, or call (302) 737-6205, toll free from Cecil County, (888) 808-7088. Learn more at www.wilmapco.org/tip.


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From Squeaker/ My Angel's Catster Photos[ View profile page ]
|"Handsome ME!!"
Leave A Comment | 8 people already have
Wow! You are a handsome guy. I might be biased though, we look similar MoL
You truly are a Good Lookin' Boy! :)
Yes, you are! But like Nuk Anuk I am also biased. You do remind me of me :)
Don't forget me!! MOL
Wishin' you a furry Birthday Squeaker : )
Happy Birthday to you!
Happy Gotcha Day! Hope you had a pawsome day.
Happy belated BD!
Our computer was busted for a week, so we just heard now.
Our computer was busted for a week, so we just heard now.


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Why Wild Hogs Are Worrisome
Fortunately, the most I have to worry about wildlife is usually limited to deer attempting to cross the road in front of my truck. A few clients who have livestock such as alpacas and sheep that live up on a small mountain ridge in my area sometimes worry about the occasional black bear roaming through their place, trying to steal a meal, but that's about the extent of the wild animal excitement here in Maryland. Out west, however, there are bigger problems.
Feral hogs are a huge agricultural threat in some states, particularly Texas. A recent count estimates the number at 2.6 million wild hogs in this state, a number which has continued to grow almost exponentially over the past few decades despite allowances for all-year hunting of these animals.
Considered an invasive species, these hogs are incredibly destructive. Able (and willing) to eat almost anything, they destroy acres of crops at a time and have even been known to root up freshly planted seeds. Their rooting behavior also damages the land, so not only farmers but recreational parks are also having problems with these roaming animals. Non-invasive wildlife is also threatened, since hogs have been known to eat eggs out of the nests of local birds, reptiles, and amphibians.
In my eyes, the greatest threat of the feral hog is their capability to easily and uncontrollably spread disease. Not only do these animals have the potential to bring back a resurgence of reportable diseases such as pseudorabies, brucellosis, and influenza, they can also make the containment of an outbreak almost impossible. For example, if foot and mouth disease were to break in Texas, these feral hogs would carry the disease far and wide. And this is a scary thought.
Although there are no restrictions on hunting these animals — and hunters do their share not only to help population control but also because feral hog can be tasty on the table — people cannot beat the sheer fecundity of this species. Female hogs reach sexual maturity at six to eight months of age and can produce three litters of piglets (with sizes ranging from six to twelve piglets) every two years. Add to this the fact that hogs are incredibly smart and can learn to avoid traps and snares, and it's no wonder these animals are a cause for concern.
What about poison? Currently, federal laws do not permit the use of toxins to control feral hog populations. A toxin's effect can go way beyond just the targeted victim. For animal control, a toxin can also potentially affect the environment as it sits in baits, potentially polluting run-off, or being picked up by scavenger animals that dine on the carcasses of the victims. And then there's the question of the fate of unintended species that eat the poisoned bait.
Recently, researchers started looking into the use of sodium nitrite, which is a compound used in Australia — a country with its own feral hog problems. This compound shows some promise, since swine seem to be particularly sensitive to it, but it's not ready for use yet. Until something comes along, be it an effective and highly specific toxin, a foolproof hog trap, or a Pied Piper comes to Texas with a penchant for wild bacon, agriculture in certain areas of the U.S. is going to continue dealing with a multi-faceted threat.
Dr. Anna O'Brien
Image: Volodymyr Burdiak / Shutterstock


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Web Extras
Guest Picks: Patrick McEnroe
What is Patrick McEnroe's favorite novel? Patrick told all during his recent appearance on The Leonard Lopate Show.
What have you read or seen lately (book, play, film, etc.) that moved or surprised you?
Kids' book and parenting how-tos.
What are you listening to right now?
Melissa Errico, Lullabies and Wildflowers and LeGrand record
What's the last great book you read?
George Friedman, The Next 100 Years. Geopolitical.
What's one thing you're a fan of that people might not expect?
Steven Sondheim
If you only had one day left, how would you spend it in New York City?
With my girls in Central Park


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Tensions come to a head in the eighth epic volume of the BONE series.
The Bone cousins, Gran'ma Ben, and Thorn finally reach the city of Atheia, where they reunite with old friends and plan to thwart The Lord of the Locusts. The Pawan army has joined forces with Briar and the rat creatures, and danger increases as Thorn's visions get stronger. Meanwhile, Phoney Bone is convinced Atheia is a city rich in gold, and he is determined to find it!
Series: Bone Reissue Graphic Novels (Paperback)
Audience: Children
For Ages: 8+ years old
For Grades: 3 - 7
Format: Paperback
Language: English
Number Of Pages: 136
Published: 1st August 2008
Country of Publication: US
Dimensions (cm): 23.19 x 14.99 x 0.91
Weight (kg): 0.34


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I have pretty nice skin for a 45-y.o. - no real issues, just some fine lines and a lack of fullness. I had been doing at-home fruit acid peels with great results and considering a heavier-duty commercial one to plump up a bit, reclaim my rosy glow, and get rid of some minor sun damage, when my favorite aesthetician mentioned that she was now offering glycolic peels. I made the decision to do it on the spur of the moment to take advantage of the "sale."
Um, just FYI, don't do this impulsively like I did! Bad, bad idea! I was prepared for a little burning, a little redness and then a few days later some flaking. Instead: searing pain, immediate blistering and giant swelling. The spa manager went into a panic - she felt so bad she didn't charge me. For 3 days I had weeping brown patches all over my face, horrible swelling. Luckily I'd already planned for the time off, but instead of taking our Christmas roadtrip I spent my time under the covers in bed, crying my eyes out and googling to see if I should be taking care of it differently and whether I was going to be okay.
Then on day 5, like Christmas magic, all the scabs fell off to reveal beautiful, glowing skin. I looked healthy and 5-7 years younger, with less pronounced nasolabial folds and slightly plumper cheekbones. 10 days out now, I'm not quite as breathtaking as day 5 but I'm still pretty pleased.
Here are my caveats: 1) I would never, ever do this on the fly - I'd consult, test, shop around, and plan for a week of downtime. 2) Also I'd have a medical person do it, not an aesthetician, ESPECIALLY not a relatively inexperienced aesthetician like mine. 3) I would def. be sure to have a test patch ON THE CHEEK, not just the forehead. My forehead barely reacted at all to the 35% so the aesthetician amped it up to 70% for 3 minutes. My cheeks got fried and completely blistered over, while my forehead only got a little pink and never even flaked noticeably (pin sized brown dots falling off four days later).
If my whole face had reacted like my forehead did, there would have been no freakout or change of plans. I took an "after" picture just now, but because this was a spur-of-the-moment thing I don't have a good "before" for contrast. I can tell a difference in real life, but I can't see any difference between the photo of me just now vs. the blurry closeup from a month ago. So I like the result, but I feel like it was way more invasive than I needed or wanted, so I don't think I'll be doing it again.


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Welcome back, students! It's nice to have the vibrancy and energy back on campus that you always bring with you. Go check out what we've done with your coffee shop. It's cool, but it doesn't have a name yet.
Now, For Your First Assignment!
Tags: coffee shop, contest, jca, student center, Students


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They have a few more weeks to reach their goal, and they're still lacking donations. Geneva Salvation Army Lt. Raul Rivera tells us there have been some setbacks that have resulted in lower funds during the Red Kettle Campaign.
They've raised between 12,000 and 15,000 dollars, which is about 16% of their 90,000 dollar campaign goal.
He also admits that the Angel Tags are lacking as well, but they're available.
Bell ringers will be out through Christmas Eve.


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La Spinetta
Winery lot located in Piedmont, in small, high-quality wine producers around the world high reputation.
"La Spinetta" refers to the top of the hills in the Piedmont. Giancarlo, Bruno, Giorgio rivetti three brothers took over from his grandfather's dream, committed to making wine. Their brewing philosophy is the pursuit of high-quality wines. Vineyard cultivation work from maturation in the bottle in the final stage, won't compromise at all stages. Home ground and they deeply love and respect nature, while sticking to the indigenous grape varieties, and to challenge new wines won numerous prestigious awards.
Also, as a new initiative, buy a field mask village of the town of テッリチョーラ near Pisa, Cantina 'mask della Spinetta"was completed in 2008. Wines are made from native grapes of Tuscany represent the land of Tuscany in its best form here, and think rivetti said, Sangiovese and colorino.
Harvest vineyard grapes grown from the BREW, maturation in the bottle for the final stage ranging, perfect in the La Spinetta Inc. delivers quality pursuit, gem. Feel passion for winemaking from the 80's, in the Piemonte main traditional conservative was going to at that time, progressive and innovative work that the Green harvest, also without compromise.
About the design of the etiquette]
Rhinoceros coloring la Spinetta's wine etiquette was born from the works of great painters in Germany Renaissance, Mr. Albrecht Durer (1471-1528). Drew called the founder established the technique of copperplate Dürer's Rhinoceros in 1515;
In Europe at the time, referred to as depicting the Rhino lived to see the opportunity is very rare, he also heard through the grapevine, and saw the draft several points of the design. This Web site over hundreds of years later, dictionary of animals was introduced as a fantasy figure, original is now housed in the British Museum.
| In Piedmont, many small, high-quality production of highly acclaimed Winery!
Moscato D'Asti was released in the late 80's reputation from the around the world restaurant and wine critics, La Spinetta's fame has spread. Always perfect in the pursue quality, we continue to challenge. Produces excellent wines such as Barbera passion for winemaking Georges rivetti said without compromise to the Center, then released and Barbaresco, Barolo.
Single vineyard of 3 species build la Spinetta Barbaresco in even most masculine and strong taste [Valeirano (ヴァレイラーノ)].
Farm 3 ha located in Treiso. The elevation is about 450 m. Cliff South opened in a field. In calcareous soils and rocky. Average age 35-45 years.
From early October to the middle of harvest. 7-8 Days in Rotary fermentation tank the alcoholic fermentation. After the malolactic fermentation, medium toast French oak new barrels to the aged 20-22 months. 3 Months before bottling in stainless steel tanks, bottle aged 12 months. Not clarifying filtration.
All three species of Barbaresco are Barrick (Otaru) fermentation and ripening. Characteristics of the three Cru single vineyard direct feel. Is the La Spinetta with a familiar "rhinoceros" label to the first wine. With white truffle and herb aromas, spicy complexity, the firm structure and texture delicate tannin is felt. Lingering feel Mint and thyme. Three types of Barbaresco in most masculine and strong taste. It goes well with dishes such as grilled or roasted meat, matured cheese, etc..
Piedmont dialect as written on the label at the bottom see VURSU ( ヴルス )"" strongly desired, coveted "that means.
* product images are helpful. Vintage brand name will deliver.
[* note *]
● This product is [Purchase orders] We are getting into.
-We order this item from inventory to make the arrangements to import
We will.
-If you order for Fri, sat, Sun will make arrangements early next week.
-Also if the sale because the inventory is changing daily.
You must contact here.
-Stock notation is standard.
-Typically arrive 3-4 business days we.
On weekends and holidays, if you interrupt, temporarily closed by orders, delivery to
Please note that this may take about one week.
-For by order time and day of the week will receive in the shortest possible after 2 days.
-[Purchase orders], so the base is to accept returns after purchase
Can not.
-Usually shipped with products is not possible. Will occur if you shipped separately.
»» Thinking about * shop vintage
[Red full body] [Italy Red] [Piedmont Red] [DOCG Piedmont] [Piedmont full-body] [Italy] [Piedmont] [Italy dry red] [Piedmont dry red] [Barolo boys] [Winery of the year] [La Spinetta] [La Spinetta Barbaresco ヴァレイラーノ] [La Spinetta ヴァレイラーノ Barbaresco] [DOCG Barbaresco] [La Spinetta] [Giorgio rivetti] [Barolo boys rivetti brothers] [Donguriano Wine] [ドングリアーノ wine] 【】
This product cannot be shipped to United States from the store.
Please contact the store for further information.


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Branding begins in your building. Your brand managers have spent countless hours and resources crafting a strategic message to target internal and external clients. Shouldn't your building do the same? The Holt Group will collaborate with your marketing and facility personnel to bring a communicative identity to your corporate spaces that aligns with your product and service offerings.
The Holt Group works with hospitals, universities, colleges, and faith-based institutions to design, build, and install branded and interpretive elements within their spaces. Whether you are looking for custom wayfinding or mission-driven audio-visual interactives, we can help you to develop a design idea to fit your current fiscal budgets or to create an earmark for future fundraising purposes.
Whether your mission is to teach children about the intricacies of an ocean ecosystem or to relay the history of an historical home to visitors of all ages, we understand how to listen to your needs. We are able to collaborate with you to design, build, and install your vision for new, permanent, and traveling interpretive elements, A/V kiosks, and electro-mechanical interactives.


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Wednesday, March 21, 2007
SpaceX Gets Successful Test Launch
El Segundo-based SpaceX, the commercial space startup developing orbital launch vehicles, has successfully launched its Falcon 1 vehicle Tuesday afternoon. The launch, which took place yesterday at 6:10pm PST, reached 200 miles into space, and was the first successful launch for the company. SpaceX is preparing for a commercial satellite launch later in the year. The successful launch comes after a number of earlier scrubbed launches and issues. SpaceX is headed by PayPal's Elon Musk.


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How to Buy
Solutions Overview
This script is Copyright (C) 2012-2016 Tenable Network Security, Inc.
Synopsis :
The remote database server is affected by multiple vulnerabilities.
Description :
The version of MySQL installed on the remote host is earlier than
5.0.51a / 5.1.23 / 6.0.4 and thus reportedly affected by the following
two vulnerabilities :
- An attacker may be able to cause the federated handler
and daemon to crash when the federated engine issues a
SHOW TABLE STATUS LIKE query by having a malicious
server return a response with less than 14 columns.
(MySQL bug #29801 / CVE-2007-6304)
- It fails to update the DEFINER value of a view when that
is altered, which could allow an authenticated user to
gain additional access through the ALTER VIEW. (MySQL
bug #29908 / CVE-2007-6303)
See also :
Solution :
Upgrade to MySQL version 5.0.51a / 5.1.23 / 6.0.4 or later.
Risk factor :
Medium / CVSS Base Score : 5.0
CVSS Temporal Score : 4.3
Public Exploit Available : true
Family: Databases
Nessus Plugin ID: 17813 ()
Bugtraq ID: 26832
Get Nessus Professional to scan unlimited IPs, run compliance checks & more
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Gareth Bale believes he has similar qualities to Cristiano Ronaldo and hopes to emulate the Real Madrid superstar.
Tottenham's left-sided ace grabbed his 12th goal of the season in Wednesday's 1-1 draw with Norwich.
His stunning late leveller stretches Andre Villas-Boas' side's unbeaten League run to eight matches and keeps Spurs fourth.
Bale's lightning run and blistering finish was reminiscent of former Manchester United star Ronaldo.
Since Ronaldo quit for Spain, Bale has succeeded him as the top-flight's most exciting talent.
And the
Bale said: "The way he plays I think he is the best all-round player in the world. People have said things in the past and the stuff he does is similar in a way to what I do.
"He is right up there and a benchmark for every player who wants to be as good as him.
"The free-kick technique works for him and he scores a lot of goals and big goals. He is obviously doing something right and it's good to look at other players, how they do things and take my game to another level.
He is on a different planet... apart from Messi. He is one of those players that everyone aspires to and I'd love to be half as good as him - you set your sights."
Bale had a quiet first half at Carrow Road when Spurs trailed 1-0 to Wes Hoolahan's opener. But Tottenham were much-improved after the break as Bale came into the game more.
And the talented left-footer,who has been linked with a move to join Ronaldo, admits he felt a responsibility to get Spurs back into the contest.
Bale added: "If we are struggling then some people have to stand up. It's not always me, the team always pulls through most times. We all work together.
"But it was great to get the goal, get us back on track and we were very unlucky not to win in the end.
"The important thing was it got us back into the game near the end and we were unlucky not to get three points.
"In the first half we were nowhere near good enough and the manager told us at half-time we weren't good enough. We came out in the second half and we played some great stuff and turned up a few gears, showed what we're capable of and we were unlucky not to win. We had to turn it up a few notches."
Bale is now anxious Villas-Boas' side continue their unbeaten league form when they travel to West Brom on Sunday.
"You have your blips in the season but the main thing is we're not losing these games. We've got West Brom at the weekend and we're going to have to step up a level now.
"In a way, I think these two games in a week might help us, rather than having long weeks and not getting that rhythm of games.
"Time will tell, but we're all confident we'll be able to push on from here."


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Petition filed to increase Florida bar fees
TALLAHASSEE, Fla. (AP) - Some 500 attorneys are asking the Florida Supreme Court to increase Florida bar membership fees to pay for legal services for the poor.
Former Supreme Court Justice Raoul Cantero is leading the group, which filed a petition Monday seeking to increase the fees from $265 annually to $365. The Florida Bar Foundation funds legal aid for the poor through its interest on trust accounts revenue, which decreased by $38 million from 2007 to 2012.
The Florida Bar and President Eugene Pettis oppose the increase.
Pettis agrees with the need of additional funding and the ability to provide more services to those struggling financially. He says the extra fee from nearly 99,000 members isn't enough to solve the problem and that other agencies besides the Florida Bar need to be involved.


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For the fourth consecutive year, InkHead Promotional Products continues its support for the Leukemia & Lymphoma Society and the organization's mission to raise funds for blood cancer research. This year, InkHead sponsors Kelly Napier, niece of InkHead's Vice President of Sales & Marketing Jim Franklyn, for the LLS's 2013 Atlanta "Woman of the Year."
Atlanta, GA — Not only is InkHead Promotional Products one of the nation's premier distributors of custom promotional products, it's also one of Georgia's most philanthropic companies–supporting worthwhile organizations and spearheading the exploration of issues that impact Georgians and beyond. For the fourth consecutive year, InkHead is teaming up with the Leukemia & Lymphoma Society to help raise funds for the organization through the LLS's Atlanta Man and Woman of the Year campaign–a spirited 10-week fundraising competition in which dynamic and passionate candidates in communities across the country compete to raise funds for life-changing blood cancer research.
This year, InkHead is proud to sponsor Georgian Kelly Napier for the title of LLS 2013 'Woman of the Year". Kelly lives in Marietta and is the niece of Jim Franklyn, InkHead's Vice President of Sales & Marketing and himself a 2011 candidate for the LLS 'Man of the Year' honor. Kelly is passionate about this cause–her grandmother, an aunt, and an uncle all were diagnosed and eventually succumbed to this debilitating disease. As you might imagine, Kelly embraces the campaign, not only in remembrance of her own family members that passed, but also in hopes of giving support for those millions of families affected by blood cancer all across the country and around the world.
InkHead has followed Kelly's campaign to raise funds very closely, dedicating blog posts and articles on the InkHead.com web site that share Kelly's story and her efforts with InkHead clients and customers. With a goal of raising $75,000, Kelly has organized local events at such On the Border restaurant, Belk's retailer, Andretti's Speed Lab entertainment complex, and an old-fashioned garage sale in her Lee's Crossing Marietta neighborhood.
Jim Franklyn explains InkHead's enthusiasm when it comes to this worthwhile endeavor. "When we went to our first Gala in 2010 we were hooked! Every 60 seconds, someone passes away from cancer–it is a deadly disease. Since cancer touches the lives of almost everyone in some capacity, InkHead felt compelled to give back to a cause that has no friends. The gifts we provide for the Gala to sponsor Kelly Napier's campaign is a no-brainer. There will be 660 people in attendance, many cancer survivors, and a Boy and Girl of the Year who would not have had a chance for a cure if it were not for events like Man & Woman of the Year competition to help raise funds. InkHead is grateful to do our part to help LLS of Georgia."
The Leukemia & Lymphoma Society is the world's largest voluntary health organization dedicated to blood cancer research and support for victims of the various diseases caused by blood cancers. The outcome of the organization's research brings LLS close to a cure for leukemia, lymphoma, Hodgkin's disease and myeloma, as well as helps the organization improve the quality of life of patients and their families in the form of free information and support services.
The 5th annual Atlanta campaign will kick off on Thursday, March 28th at The Buckhead Theatre and will culminate with a celebration of everyone's efforts at the now sold out Grand Finale Gala on Saturday, June 8th at the Loews Atlanta Hotel in Midtown. InkHead will be donating an entire range of branded promotional products for giveaway at the gala event.
About InkHead Promotional Products
Atlanta-based InkHead Promotional Products is an online distributor of custom promotional products, logo apparel, and corporate gifts. InkHead.com's customers include Fortune 500 firms, single-owner businesses, private-event organizers, government agencies, churches and other religious groups, non-profit organizations and charities, the military, educational institutions and other citizen groups.


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Pay up • Being the chief executive in Utah may carry prestige and power, but compensation from the state is nothing to crow about. It is time to raise the governor's pay. We agree with the Elected Official and Judicial Compensation Commission that the office of the executive should pay $150,000 a year, a 36 percent raise over the current $109,900. The commission noted in its recommendation that raises for top elected officials have been delayed for nearly 10 years. The governor earns much less in salary than many top state employees at the University Medical Center and Medical School, for example, where competition for high-level doctors and researchers is fierce. While elected leaders should consider their jobs public service, we can expect only those who are independently wealthy to take an interest in running if the pay isn't at least somewhat attractive.
Speak up • Gov. Gary Herbert spoke with President Barack Obama at the White House this week along with two other Republican governors and three Democratic governors from the National Governors Association. Herbert is a member of the group's executive committee. The visitors spent an hour with the president and 30 minutes each with House Speaker John Boehner, R-Ohio, and Senate Majority Leader Harry Reid, D-Nev. They urged quick action by Congress to avoid drastic budget cuts and tax increases commonly called the fiscal cliff. States would lose millions in federal grants under the budget-deficit package set to go into effect in January. The group offered suggestions and asked for flexibility in imposing cuts but took no official position on proposals that have been made so far in negotiations. Herbert is right that Washington should bring governors into the loop on important issues.
Look up • Urban light pollution means a lot of Americans can't see many stars in our night skies. But whether we can see them or not, they're still up there, not only in our galaxy, the Milky Way, but in our neighboring galaxy, Andromeda. So many, in fact, that astronomers are asking for help in identifying star clusters in Andromeda. And you don't have to travel to some remote spot to do it. The Andromeda Project lets ordinary people no astronomical experience necessary study images of Andromeda taken by the Hubble Space Telescope. There are about 10,000 images, and astronomers hope to get each analyzed about 20 times. Just go to the website www.andromedaproject.org and follow a tutorial that explains how you yes, you can put your mark on space.