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MR Angiography (MRA)
MR angiography (MRA) uses a powerful magnetic field, radio waves and a computer to evaluate blood vessels and help identify abnormalities. This exam does not use radiation and may require an injection of contrast material. The contrast material used for MRA is less likely to cause an allergic reaction than the contrast material used for computed tomography (CT).
Tell your doctor about any health problems, recent surgeries, allergies and whether you are pregnant. The magnetic field is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no risk, but you should always tell the technologist if you have any devices or metal in your body. Sometimes, your doctor will give you a card with information about your implant. Give this to the technologist. Guidelines about eating and drinking before your exam vary between facilities. Unless your doctor tells you otherwise, take your regular medications as usual. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you have a fear of close spaces or anxiety, consider asking your doctor for a mild sedative prior to the exam.
- What is MR Angiography?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of MR Angiography?
- Which test, procedure or treatment is best for me?
What is MR Angiography?
Doctors use angiography to diagnose and treat blood vessel-related diseases. Angiography exams produce pictures of major blood vessels throughout the body. In some cases, contrast material is used.
Doctors perform angiography using:
- fluoroscopy (x-rays) to help place catheters into blood vessels and inject contrast to help visualize them
- computed tomography (CT)
- magnetic resonance imaging (MRI)
In magnetic resonance angiography (MRA), a powerful magnetic field, radio frequency waves and a computer are used to evaluate blood vessels and help identify abnormalities. This exam, like all MR-based exams, does not use radiation.
An MRA exam may or may not use contrast material. If needed, an injection of a gadolinium-based contrast material may be used. Gadolinium is less likely to cause an allergic reaction than the iodinated contrast material used in CT angiography. The doctor or the technologist will usually administer the contrast material by placing a small intravenous (IV) catheter in a vein in your arm.
What are some common uses of the procedure?
Doctors use MRA to examine blood vessels in key areas, including the:
- brain
- neck
- heart
- chest
- abdomen (such as the kidneys and liver)
- pelvis
- legs and feet
- arms and hands
Doctors use MRA to:
- identify abnormalities, such as aneurysms, in the aorta, both in the chest and abdomen, or in other arteries.
- detect atherosclerotic (plaque) disease in the carotid artery of the neck, which may limit blood flow to the brain and cause a stroke.
- identify a small aneurysm or arteriovenous malformation (abnormal communications between blood vessels) inside the brain or other parts of the body.
- detect atherosclerotic disease that has narrowed the arteries to the legs and help prepare for endovascular intervention or surgery.
- detect disease in the arteries to the kidneys or visualize blood flow to help prepare for a kidney transplant or stent placement.
- guide interventional radiologists and surgeons making repairs to diseased blood vessels, such as implanting stents or evaluating a stent after implantation.
- detect injury to one or more arteries in the neck, chest, abdomen, pelvis or extremities in patients after trauma.
- evaluate arteries feeding a tumor prior to surgery or other procedures such as chemoembolization or selective internal radiation therapy.
- identify dissection or splitting in the aorta in the chest or abdomen or its major branches.
- show the extent and severity of the effects of coronary artery disease and plan for a surgical operation, such as a coronary bypass and stenting.
- examine pulmonary arteries in the lungs to detect pulmonary embolism (blood clots, such as those traveling from leg veins) or pulmonary arteriovenous malformations.
- look at congenital abnormalities in blood vessels, especially arteries in children (e.g., malformations in the heart or other blood vessels due to congenital heart disease).
- evaluate obstructions of vessels.
- screen individuals for arterial disease, especially patients with a family history of arterial disease or disorders.
MRA is also used as a substitute for CT angiography when iodinated contrast material cannot be used.
How should I prepare?
You may wear a gown during the exam or allowed to wear your own clothing if it is loose-fitting and has no metal fasteners.
Guidelines about eating and drinking before an MRI exam vary at different facilities. Unless your doctor says otherwise, follow your regular daily routine and take medications as usual.
MRA may require an injection of contrast into a vein in your arm. The radiologist or technologist may ask if you have asthma or allergies to certain drugs, foods or the environment. Doctors may use gadolinium-based contrast material for MRI exams. It does not contain iodine, and it is less likely to cause an allergic reaction than CT and X-ray iodine based contrast.
Tell the radiologist and technologist about any serious health problems and what surgeries you have had. Some patients with severe kidney or liver disease may not be able to receive contrast material during an MRI exam.
Women should always inform their physician or technologist if there is any possibility that they are pregnant. MRI has been used for scanning patients since the 1980s with no reports of any ill effects on pregnant women or their unborn babies. However, because the unborn baby will be in a strong magnetic field, pregnant women should not have this exam in the first three to four months of pregnancy unless the potential benefit from the MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of gadolinium contrast material except when absolutely necessary for medical treatment. See the MRI Safety page for more information about pregnancy and MRI.
If you are breastfeeding at the time of the exam, you should ask your doctor how to proceed. It may help to pump breast milk ahead of time and keep it on hand for use after contrast material has cleared from your body, about 24 hours after the test.
If you have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician for a prescription for a mild sedative prior to your scheduled examination.
Infants and young children usually require sedation or anesthesia to complete an MRI exam without moving. Whether a child requires sedation depends on the child's age, intellectual development and the type of exam. Moderate and conscious sedation can be provided at many facilities. A physician or nurse specializing in sedation or anesthesia for children should be available during the exam for your child's safety. You will be given special instructions for how to prepare your child for the sedation or anesthesia.
Alternatively, certain pediatric facilities have child life personnel who can work with younger children to help avoid the need for sedation or anesthesia. They prepare the children for MRI by showing them a dummy scanner, play the noises that the child might hear during the MRI exam, answer any questions and explain the procedure to relieve their anxiety. Some pediatric facilities also provide goggles or headsets so that the child can watch a movie while the scan is being performed. Thus, the child remains motionless allowing for good quality images.
Jewelry and other accessories should be left at home, if possible, or removed prior to the MRI scan. Because they can interfere with the magnetic field of the MRI unit, metal and electronic items are not allowed in the exam room. In addition to affecting the MRI images, these objects can become projectiles within the MRI scanner room and may cause you and/or others nearby harm. These items include:
- jewelry, watches, credit cards and hearing aids, all of which can be damaged
- pins, hairpins, metal zippers and similar metallic items, which can distort MRI images
- removable dental work
- pens, pocket knives and eyeglasses
- body piercings
In most cases, an MRI exam is safe for patients with metal implants, except for a few types. People with the following implants cannot be scanned and should not enter the MRI scanning area:
- cochlear (ear) implant
- some types of clips used for brain aneurysms
- some types of metal coils placed within blood vessels
- nearly all cardiac defibrillators and pacemakers
You should tell the technologist if you have medical or electronic devices in your body. These objects may interfere with the exam or potentially pose a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will have a pamphlet explaining the MRI risks for that particular device. If you have the pamphlet, it is useful to bring that to the attention of the scheduler before the exam and bring it to your exam in case the radiologist or technologist has any questions. Some implanted devices require a short period of time after placement (usually six weeks) before being safe for MRI examinations. Examples include but are not limited to:
- artificial heart valves
- implanted drug infusion ports
- artificial limbs or metallic joint prostheses
- implanted nerve stimulators
- metal pins, screws, plates, stents or surgical staples
If there is any question of their presence, an x-ray may be taken to detect and identify any metal objects. In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure.
Patients who might have metal objects in certain parts of their bodies may also require an x-ray prior to an MRI. You should notify the technologist or radiologist of any shrapnel, bullets, or other pieces of metal that may be present in your body due to prior accidents. Foreign bodies near and especially lodged in the eyes are particularly important because they may move during the scan, possibly causing blindness. Dyes used in tattoos may contain iron and could heat up during an MRI scan, but this is rare. Tooth fillings and braces usually are not affected by the magnetic field, but they may distort images of the facial area or brain, so you should let the radiologist know about them.
What does the equipment look like?
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a moveable examination table that slides into the center of the magnet.
Some MRI units, called short-bore systems, are designed so that the magnet does not completely surround you. Some newer MRI machines have a larger diameter bore which can be more comfortable for larger size patients or patients with claustrophobia. Other MRI machines are open on the sides (open MRI). Open units are especially helpful for examining larger patients or those with claustrophobia. Newer open MRI units provide very high quality images for many types of exams. Older open MRI units may not provide this same image quality. Certain types of exams cannot be performed using open MRI. For more information, consult your radiologist.
The computer workstation that processes the imaging information is located in a separate room from the scanner.
How does the procedure work?
Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not utilize ionizing radiation. Instead, radiofrequency pulses re-align hydrogen atoms that naturally exist within the body. This does not cause any chemical changes in the tissues. As the hydrogen atoms return to their usual alignment, they emit different amounts of energy depending on the type of body tissue they are in. The MR scanner captures this energy and creates a picture of the tissues scanned based on this information.
The magnetic field is produced by passing an electric current through wire coils in most MRI units. Other coils, located in the machine and in some cases, placed around the part of the body being imaged, send and receive radio waves, producing signals that are detected by the coils. The electric current does not come in contact with the patient.
A computer then processes the signals and generates a series of images, each of which shows a thin slice of the body. The images can then be studied from different angles by the interpreting radiologist.
Frequently, the differentiation of abnormal (diseased) tissue from normal tissues is better with MRI than with other imaging modalities such as x-ray, CT and ultrasound.
When a contrast material is introduced to the bloodstream during the procedure, it clearly defines the blood vessels being examined by making them appear bright white.
How is it performed?
This examination is usually done on an outpatient basis.
You will be positioned on the moveable examination table. Straps and bolsters may be used to help you stay still and maintain the correct position during imaging.
Devices that contain coils capable of sending and receiving radio waves may be placed around or adjacent to the area of the body being studied.
If a contrast material will be used in the MRI exam, a physician, nurse or technologist will insert an intravenous (IV) catheter, also known as an IV line, into a vein in your hand or arm. A saline solution may be used to inject the contrast material. The solution will drip through the IV to prevent blockage of the IV catheter until the contrast material is injected.
You will be placed into the magnet of the MRI unit and the radiologist and technologist will perform the examination while working at a computer outside of the room.
If a contrast material is used during the examination, it will be injected into the intravenous line (IV) after an initial series of scans. Additional series of images will be taken during or following the injection.
When the examination is complete, you may be asked to wait until the technologist or radiologist checks the images in case additional images are needed.
Your intravenous line will be removed.
MRI exams generally include multiple runs (sequences), some of which may last several minutes.
The entire examination is usually completed in approximately 60 minutes once imaging has started.
What will I experience during and after the procedure?
Most MRI exams are painless. However, some patients find it uncomfortable to remain still during MR imaging. Others experience a sense of being closed-in (claustrophobia) while in the MRI scanner. Therefore, sedation can be arranged for those patients who anticipate anxiety, but fewer than one in 20 require medication.
It is normal for the area of your body being imaged to feel slightly warm, but if it bothers you, notify the radiologist or technologist. It is important that you remain perfectly still while the images are being obtained, which is typically only a few seconds to a few minutes at a time. You will know when images are being recorded because you will hear and feel loud tapping or thumping sounds when the coils that generate the radiofrequency pulses are activated. Some centers provide earplugs, while others use headphones to reduce the intensity of the sounds made by the MRI machine. You may be able to relax between imaging sequences, but will be asked to maintain your position without movement as much as possible.
You will usually be alone in the exam room during the MRI procedure. However, the technologist will be able to see, hear and speak with you at all times using a two-way intercom. Many MRI centers allow a friend or parent to stay in the room as long as they are also screened for safety in the magnetic environment.
Children will be given appropriately sized earplugs or headphones during the exam. MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help you pass the time.
In some cases, intravenous injection of contrast material may be administered before the images are obtained. The intravenous needle may cause you some discomfort when it is inserted and you may experience some bruising. There is also a very small chance of irritation of your skin at the site of the IV tube insertion. Some patients may sense a temporary metallic taste in their mouth after the contrast injection.
If you do not require sedation, no recovery period is necessary. You may resume your usual activities and normal diet immediately after the exam. On very rare occasions, a few patients experience side effects from the contrast material, including nausea, headache and pain at the site of injection. Similarly, patients are very rarely allergic to the contrast material and experience hives, itchy eyes or other reactions. If you experience allergic symptoms, notify the technologist. A radiologist or other physician will be available for immediate assistance.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.
Follow-up examinations may be necessary. Your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if a finding is stable or changed over time.
What are the benefits vs. risks?
- MRI is a noninvasive imaging technique that does not involve exposure to ionizing radiation.
- Detailed images of many blood vessels and blood flow can be obtained without having to insert an IV catheter into the blood vessels. When needed, a small IV catheter is inserted into a small vein in the arm so that there is no risk of damaging a major blood vessel.
- An MRA scan may take less time than traditional catheter angiography and requires no recovery period, unless sedation was provided. If no sedation was used, you may return to your normal daily activities immediately following the MRA exam.
- MR angiography is less costly than catheter angiography.
- Even without using contrast material, MRA can provide useful high-quality images of many blood vessels. This makes it very valuable for patients prone to allergic reactions or with reduced kidney or liver function.
- The contrast material used in MRI exams is less likely to produce an allergic reaction than the iodine-based contrast materials used for conventional x-rays and CT scanning.
- The MRI examination poses almost no risk to the average patient when appropriate safety guidelines are followed.
- If sedation is used, there are risks of excessive sedation. However, the technologist or nurse will monitor your vital signs to minimize this risk.
- Although the strong magnetic field is not harmful in itself, implanted medical devices that contain metal may malfunction or cause problems during an MRI exam.
- Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of MRI believed to be caused by the injection of high doses of gadolinium-based contrast material in patients with very poor kidney function. Careful assessment of kidney function before considering a contrast injection minimizes the risk of this very rare complication.
- There is a very slight risk of an allergic reaction if contrast material is injected. Such reactions are usually mild and easily controlled by medication. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance.
- Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 hours after contrast medium is given. However, both the American College of Radiology (ACR) and the European Society of Urogenital Radiology note that the available data suggest that it is safe to continue breastfeeding after receiving intravenous contrast. For further information please consult the ACR Manual on Contrast Media and its references.
What are the limitations of MR Angiography?
Unlike CT angiography, MRA is not able to see and capture images of calcium deposits within the blood vessels.
MRA images of some arteries may not be as clear as catheter angiography images. MRA evaluation of small vessels, in particular, may be difficult. Sometimes it may be difficult to create separate images of arteries and veins with MRA.
Patients who cannot lay still or on their backs may have poor quality MRA images. Some tests involve monitoring the heartbeat or require patients to hold their breath for 15 to 25 seconds at a time in order to get high quality pictures. Any type of motion, such as patient movement, breathing motion, cardiac motion, or other involuntary movements can decrease the image quality and potentially limit diagnosis.
High-quality images are assured only if you are able to remain perfectly still and follow breath-holding instructions while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging.
A person who is very large may not fit into the opening of certain types of MRI machines.
The presence of an implant or other metallic object sometimes makes it difficult to obtain clear images due to streak artifacts from the metallic objects. Patient movement can have the same effect.
A very irregular heartbeat may affect the quality of images obtained using techniques that time the imaging based on the electrical activity of the heart, such as electrocardiography (EKG).
Although there is no reason to believe that magnetic resonance imaging harms the fetus, pregnant women usually are advised not to have an MRI exam during the first trimester unless medically necessary.
Doctors usually avoid contrast injections during pregnancy unless they are absolutely necessary for medical treatment.
Which test, procedure or treatment is best for me?
Additional Information and Resources
Society of Interventional Radiology (SIR) - Patient Center
This page was reviewed on June 04, 2019


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The man in black fled across the desert, and the gunslinger followed. The Dark Tower I: The Gunslinger by Stephen King
Is there any better first line to start a novel?
The beginning hook when I'm writing is usually "Okay, there was this guy running around the desert. And then there's this other guy who's being chased by that one guy."
I'm headed for the best-seller's list, aren't I? Look for the sequel That Girl in the Orange Shirt Standing by That Tree.
Stephen King's Dark Tower series was actually inspired by Robert Browning's poem "Childe Roland to the Dark Tower Came". The Dark Tower novels (starting with The Gunslinger and ending (?) with The Wind Through the Keyhole out April 24th) are among his most popular works. He gets batches of mail from people asking how and when he's going to finish the series. One woman in her 80s wrote to him and said she didn't have much time left because she has cancer so could he please tell her how the books are going to end? She then added "I won't tell anyone."
In Dark Tower I: Gunslinger, Roland Deschain is the last of his kind: a gunslinger. Gunslingers were boys raised to fight and protect their world, the old ways and old traditions. But his home has been destroyed by the man in black who some call the devil and others call a dark magician. For years Roland has been on a quest to kill the dark man, traveling in a world that is parallel to ours (except Roland's world doesn't have Wal-Marts or McDonald's but has some hold-overs like "Hey Jude" and "Beans, Beans, the Magical Fruit"). Cities have been decimated, migrations patterns all askew, and mutated humans roam in the dark places.
I've read the book 3 times and, honestly, I have no idea why Roland needs to get to the Dark Tower. When I ask other people who've read the book about it, instead of enlightenment I get a blank stare. Hey at least I know I'm not alone. But in the end it doesn't matter. All you neeed to know is that the Tower is the gravitational pull for both good and evil.
In addition to Roland's obsession with destroying the man in black and getting to the Tower, there is the story of Jake a boy from our world who was hit by a car in the 70's and ended up in Midworld. Roland finds himself torn between caring for the boy and continuing his chase for the man in black. He and Jake meet up with the Muties who are horribly deformed humans that live underground. Did I mention the spiders the size of a monster truck wheel? That alone had me checking the corners of my ceiling and tucking my biggest spider smashing pair of shoes under my bed. Just in case.
The Dark Tower I: The Gunslinger is a fast paced novel that barely skims the surface of what's to come for Roland and the people who fall into his life. This book is followed by The Drawing of the Three, The Waste Lands, Wizard and Glass, Wolves of the Calla, Song of Susannah, The Dark Tower and the soon to be released The Wind Through the Keyhole.
So if you want a book about good versus evil (and maybe a little gray area mixed in between) this one will be absolutely perfect.
But make sure to check for those spiders.

subset: commoncrawl


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Discussion topics can be whatever interests you - effective meetings, board recruitment, library policies, the possibilities are endless. Participants agree to abide by a few simple guidelines:
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Joey Chestnut Wins Again at the 2009 Nathan's International Hot Dog Eating Contest
Yesterday morning in Coney Island, thousands of cheering people crowded the corner of Surf and Stillwell Avenue. But these cheers were not for independence—no, they were for something greater. Something meatier. Something log-shaped.
Hot dogs—more specifically, lots of hot dogs being shoveled down many gullets at the same time within a ten-minute period. This is the scene of Nathan's International Hot Dog Eating Contest, the oldest (since 1916) and most famous eating competition in America.
Joey Chestnut garnered first place for the third year in a row, at the same time breaking the world record by eating 68 hot dogs, or HDBs (shorthand for hot dog and buns in the competitive eating world), in ten minutes. Takeru Kobayashi came in second with a still-nauseatingly-high 64 and a half hot dogs. In third place was Patrick Bertoletti, who ate a mere 55 hot dogs. And let's not forget about the female champion Sonya Thomas, who set a new women's world record by chowing down 41 hot dogs. (For the full results, visit nathansfamous.com.)
I just summed up the whole contest for you. Somewhat. If you don't think you'll ever make it to the big day, here a more detailed look at the contest with lots of photos, after the jump.
If you want a decent view, you have to get there earlier than around 10:30 when the above photo was taken. The contest doesn't start until 12:30—die-hard fans are ready to endure hours of standing to see their heroes in action. Some of them came wearing hot dog-related costumes or wielding homemade posters. My favorite poster said, "Pandas for KOBAYASHI."
There's pre-competition entertainment in case pure anticipation of watching mass hot-dog-face-stuffing isn't enough to keep your attention. One of my friends said the entertainment was better this year than last. There was live music, world-class trampoline jumpers, performers from Ringling Bros. Circus (including some dachshunds; of course, that's what I took a photo of), a kid's Hot Dog Eating Contest where the contestants tried to eat as neatly as possible, cheerleaders who shot T-shirts into the audience, the Coney Island Strongman who lay on a bed of nails while holding an anvil and getting hit with sledgehammers, and more.
The two women of the contest, Juliet Lee and Sonya Thomas, were brought out to a cheering crowd. Rock on, slim Asian women!
A special award for gas guzzling (not the real name; that may have been the "Carbon Footprint Award") was giving to the man who drove the most in the past year to attend hot dog eating contests.
Judges and contestants finally took to the stage minutes before the contest was to begin, with Chestnut and Kobayashi in the center. A few minutes before, a giant screen to the side of the stage showed Chestnut and Kobayashi sitting next to each other backstage looking about as excited as they would be if they were waiting at the DMV. There didn't seem to be any pre-contest jitters; it was just another year of eating an inhumanly large amount of hot dogs.
And they're off!
In the first 40 seconds, Chestnut and Kobayashi down seven hot dogs. About a minute later, Chestnut eats another nine hot dogs, Kobayashi another eight. (This is about the time when any desire I had to eat a hot dog has disappeared.) Four minutes in, they're in the 30s. Seven minutes in, Chestnut is in the lead with 53 hot dogs, with Kobayashi at 50. Chestnut hits the 60 mark with one and a half minutes left.
With two seconds left, Chestnut and his belly of 68 hot dogs gives a fist pump of victory, subsequently followed by the slump over of, "Oh god, there are 68 hot dogs in my belly."
Chestnut, draped in an American flag, raises his first place trophy to the cheering crowd.
Kobayashi may have finished second place with his 64 and a half hot dogs, but it's still his personal best. Here he shows off his distended belly to his fans.
In an interview with ESPN right after his win, Chestnut says he had the capacity to eat more than 70 hot dogs. Maybe next year. And what was for dinner that night? "Probably a Cobb salad. Something with ranch on it."
USA Wins! Joey Chestnut Defeats Kobayashi at Nathan's Hot Dog Eating Contest!
Nathan's Hot Dog Eating Contest Shortened to Ten Minutes
Bar-Graphing Nathan's Hot Dog Eating Champs
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Ducks rookie Fasth shuts out Avs to improve to 4-0
DENVER -- Viktor Fasth is making the Anaheim Ducks look good and the rest of the NHL look bad.
Fasth stopped 31 shots for his first shutout in just his fourth NHL start, and Anaheim beat the Colorado Avalanche 3-0 Wednesday night.
Sheldon Souray and Saku Koivu had a goal and an assist each, and Francois Beauchemin added a goal for the Ducks, who have won four straight.
Fasth, who has won each of his starts, is quickly making a name for himself as a 30-year-old rookie. Anaheim (7-1-1) signed him as a free agent out of Sweden last summer and called him up two weeks ago. In his four appearances, he has a 0.98 goals-against average and a .962 save percentage.
He is the first goalie in NHL history age 30 or older to win his first four games.
"It feels great," he said. "The guys battling in front of me, they make it easier for me to play back there."
Semyon Varlamov made 17 saves for Colorado, which has lost two straight.
The Avalanche (4-6-0) continue to struggle on offense. They have yet to get a goal from a defenseman.
"We've been shut out three times in 10 games. ... It's a joke," center Matt Duchene said. "We've got to figure it out. We've got to bear down in practice and try to make a few more plays every now and then. We're knifing the puck in all the time instead of trying to get inside and score a goal. Give them credit, their goalie played outstanding."
Souray gave Fasth the only goal he would need when he beat Varlamov with a slap shot from the point at the 6:20 mark of the first period. Koivu made it 2-0 when he scored on a 5-on-3 power play with 4:21 left in the frame.
The Avalanche pressed to get one back and nearly did when defenseman Matt Hunwick pinched in and had a shot at an open net late in the first. Anaheim defense Bryan Allen got his stick in the way to block the shot.
"I can't fault our effort," Avalanche coach Joe Sacco said. "They're goalie played well when we did have some opportunities, and he made some good saves at key times."
Fasth made a strong save on David Jones in the second to keep it a two-goal game before his team gave him a cushion on Beauchemin's goal halfway through the game.
"We've been playing a really strong team game, and our goaltending has been really good," Souray said.
Colorado had its chances in the third, but Fasth came up big several times. He stopped a shot from Chuck Kobasew and a rebound attempt from Mark Olver on a breakaway, stoned Paul Stastny on a 3-on-1 and made a save on Duchene on another odd-man rush.
"A lot of us are streaky scorers, and it's just a matter of getting one in and hopefully the floodgates open," Jones said. "I know that's the case with me. As long as I'm getting chances, it's going to come. Unfortunately games like today, we need them."
Colorado had 11 shots in the third but never solved the former Swedish Elite star.
He gave his team a boost to start a season-long, six-game road trip.
"It's nothing you think about, you just try to do your best and help the team as much as you can," Fasth said of the shutout. "It's a little bonus, but the important thing is we got the win and started the road trip really well."
The Ducks finished 1-for-4 on the power play, and they killed off the Avalanche's lone man-advantage, which came in the first period.
NOTES: Beauchemin played in his 500th career game. ... Ducks forward Teemu Selanne notched his 750th career assist. ... Anaheim recalled defenseman Jordan Hendry from Norfolk of the AHL to take the roster spot of defenseman Toni Lydman, who is out with the flu. Hendry was in the lineup Wednesday night. ... Jones returned to the lineup after missing two games with a knee injury. ... Ducks defenseman Cam Fowler was scratched for the second straight game with an upper-body injury. ... Anaheim's first-period, power-play goal was the first the Avalanche have allowed at home this season. They had killed off 20 straight before Souray scored. ... The Ducks are off to their best start since 2006-07, the year they won their only Stanley Cup. ... Colorado forward Aaron Palushaj, claimed off waivers Tuesday, was a healthy scratch.


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Bryce Reed, an Emergency Medical Services worker in West, Texas, was arrested early Friday on a charge of possession of a destructive device.
A reporter at news station WFAA in Texas tweeted that Reed is accused of possessing bomb-making materials.
Reed was a first responder in last month's fertilizer plant explosion in the small town about 80 miles south of Dallas.
The cause of the fire and resulting blast is still under investigation, and local news station KWTX says there is so far no indication that Reed's arrest is connected to the explosion that killed 14 people and injured about 200 others. Many of those who died in the blast were first responders.
The AP is reporting that authorities have no evidence connecting Reed to the explosion. The news outlet cites a criminal complaint that says police were called to a home near West, Texas earlier this week and they found a pipe, chemicals and fuses that belonged to Reed.
A "destructive device" commonly refers to a bomb or grenade, but can also refer to other types of devices. Reed's neighbor told a local news station that he reported Reed to the Bureau of Alcohol, Tobacco and Firearms after Reed said he made a pipe bomb.
Reed was close to a man, Cyrus Reed, who died in the explosion. Some media outlets report that Cyrus is Bryce's brother and others say he's Bryce's close friend.
Reed talked to multiple media oulets — including the Los Angeles Times and CNN— after the explosion. He spoke extensively with The Dallas Morning News about his experience with the tragedy and his difficulty coping afterward.


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News broadcasts for people who don't want to park themselves in front of a television are being brought to you by Watchup, an app that plans to sit in front of your face through Google Glass.
Already critically acclaimed on Apple and Android smartphones and tablets, Watchup pulls videos and summaries from several news websites and creates a personalized playlist based on user-set preferences. Videos and news come from the websites of the Wall Street Journal, the Washington Post, CNN and several others. For now, most playlists are ad-less.
Launched in beta this week, the version for Google's smart glasses only features PBS Newshour in the United States. The overwhelming majority of the population that ignores public television's nightly news show will have to wait for the 20 or so additional options expected by the end of the year.
Adriano Farano founded Watchup about three years ago while on a Knight fellowship at Stanford University. He previously worked at news websites in Europe. Now based in Menlo Park, Calif., Farano has said he's used the Glass version of his app while making coffee in the morning. Other users, he said, have turned on Watchup on Glass while doing dishes, taking the pet out for a walk or cleaning around the house.
"I was at first skeptical about Glass -- would it be too close?" Farano said. "Then, I found myself using it while doing things for which I really needed my hands. And as an Italian, I always need my hands for something."
Watchup, which has raised $1.5 million from Microsoft, Turner Broadcasting and others, started developing for Glass even before starting to port its iPad version to iPhone. Both took two months of separate developers' time to create.
"What we really like about Glass for video is when you are watching a video on Glass, it's very intimate," Farano said. "It's the closest we can get to your eyes, and it's the mobile experience by definition because it can really move with you."
The staff of six at Watchup have positioned their app as the go-to for news videos, similar to Hulu for television shows and Netflix for films.
Farano, speaking from the Turner/Warner Bros. MediaCamp in Atlanta, said a version of Watchup for "bigger" screens will be unveiled in a few weeks with 10 more news partners.
So even though the Glass app will park videos in front of your eyes, Watchup still plans to have a version for couch potatoes.
Chat with me on Twitter @peard33


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U.S. Equal Employment
Opportunity Commission
Telecommunications Provider Harassed Jewish Employees, Federal Agency Said
PHILADELPHIA — One Communications Corp., the largest privately held regional provider of telecommunications services in the United States, has agreed to pay $66,000 and provide other equitable relief to settle a religious harassment lawsuit, the U.S. Equal Employment Opportunity Commission (EEOC) announced today.
The EEOC charged in its lawsuit that the vice president of sales regularly subjected account executives Collin Buten, Alan Gordon and Marc Reinstein to harassment because of their religion, Judaism, at the company's facility in Conshohocken, Pa. Even though the employees complained to management about the harassment, which included anti-Semitic remarks, the company failed to take effective remedial measures to stop the offensive conduct. The religious harassment was so intolerable that Gordon was forced to quit, the EEOC said in its lawsuit, filed in U.S. District Court for the Eastern District of Pennsylvania, Civil Action No. 09-04448.
Title VII of the Civil Rights Act of 1964 prohibits religious harassment at the workplace. The EEOC filed suit after first attempting to reach a voluntary settlement.
In addition to the monetary relief to the claimants, the five-year consent decree resolving the lawsuit enjoins the telecommunications company from engaging in religious harassment or retaliation. The settlement requires the company to provide training to all managers and employees at the Conshohocken facility and to post a remedial notice.
"Unfortunately, the number of religious discrimination charges filed with the EEOC has increased dramatically over the last decade," said District Director Spencer H. Lewis, Jr. of the EEOC's Philadelphia District Office, which oversees Pennsylvania, Delaware, West Virginia, Maryland and parts of New Jersey and Ohio. "This lawsuit should remind all employers that religious harassment is not just reprehensible, it is also illegal."
EEOC Regional Attorney Debra Lawrence added, "We believe that this settlement, including the injunctive relief and training requirements, will protect all company employees from unlawful harassment by addressing the problems that led to the lawsuit."
According to its web site, www.onecommunications.com, One Communications Corp. has over 2,000 employees and $800 million in annual revenue.
The EEOC enforces federal laws prohibiting employment discrimination. Further information about the Commission is available on its web site at www.eeoc.gov.


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ASHEVILLE NC – With so many exciting basketball teams in North Carolina, fans everywhere will be glued to the TV to watch the games. All that sitting can lead to snacking and weight gain, but with a little creativity you can still move without missing a second of the big game! Here are some ideas:
- Watch the game while at the gym or on the treadmill. Kick up the intensity while the opposing team has the ball and hustle right along with your team.
- During time outs and commercial breaks do sit-ups, lunges, pushups and jumping jacks to keep the energy going.
- Hold a half-time challenge of your own and challenge fellow basketball fans to see how many baskets you can make in one minute.
Tags: asheville, march madness


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Stackable Brick Mugs
Build a tower of mugs!
- Mugs stack up for easy access
- Cube keeps mugs clean and dust free
- Microwave and dishwasher safe
Open shelving is very on-trend in the world of home decor these days. People are eliminating their upper cabinets in favor of easy access shelving that displays some of their most-used or most-beloved kitchen items.
Stackable Cube Mugs make mugs one of those easy-to-store and easy-to-access kitchen items. Each cube-shaped mug comes with a interlocking, stackable "container," like a little house for your mug. Not only do these cubes give you easy storage, but they also keep your mugs clean and dust free when they are not in use.
Product Specifications
- Stackable Cube Mugs
- Mugs come with containers that are interlocking and stackable
- Great space saver at home or in the office
- Capacity: 8.5 oz.
- Materials: Ceramic Mug with Acrylonitrile Butediene Styrene box
- Dimensions: Mug is about 2.7"; cube is about 3.6"
- Microwave and dishwasher safe


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The North Park ballfield where a plane crashed earlier this week should be repaired and ready for play this spring.
The plane belonged to LabCorp. David Gamble, 57, was the pilot and sole occupant. He died, the only person injured.
The site is adjacent to the Mayco Bigelow Community Center and serves as a ballfield for teams playing youth baseball and softball in leagues sponsored by the Burlington Recreation and Parks Department.
Employees of Atlanta Air Recovery were retrieving the wreckage Friday � loading it onto a flatbed trailer. A spokesman for the National Transportation Safety Board said it�s not unusual to take a year or more to determine the cause of such crashes.
Tony Laws, director of the Recreation and Parks Department, said because of the volume of fuel spilled at the site, a good portion of soil will have to be excavated and removed. Emergency personnel said as much as 400 gallons of aviation fuel were on the plane at the time of the crash.
The aircraft had taken off minutes earlier from Burlington-Alamance Regional Airport. It was en route to New Jersey.
Laws said that once the extent of the contamination is determined, the appropriate amount of soil will be excavated. It�ll be replaced with fresh dirt, Laws said, and the infield redone. The outfield will be resodded and damaged fencing replaced.
�I feel pretty confident it will be ready by the start of the season,� Laws said. He said that will be either late April or early May.
Laws said it has yet to be determined who�ll pay for the repairs, though he said he hopes it�ll be covered by insurance. He said this is his 44th year with the Recreation and Parks Department and the first time a plane has crashed on a ball field or in a park belonging to the city.
�It�s very unusual and certainly a tragedy,� Laws said. �In my opinion, if the pilot had to put a plane down in that area, he picked the best possible site. I give a lot of credit to him. He saved lives.�
Numerous residents of the area surrounding the field agreed, noting they heard the plane in distress prior to the crash, the pilot seeming to be searching for a vacant field in which to land. Many hailed Gamble as a hero.
Alamance County Emergency Management Director David Leonard was in his office on Martin Street � near the old Western Electric plant � early Wednesday at the time of the crash. The office isn�t far from North Park and Leonard was among the first emergency responders to arrive.
He said he called Zack Smith, Burlington�s emergency management coordinator, on the drive over. Smith arrived just minutes after Leonard.
Leonard said debris from the wreck was on fire when he arrived, though firefighters with the Burlington Fire Department quickly extinguished the flames. He said there were numerous residents of the community at the site � all searching frantically for survivors.
Leonard said he was told by NTSB officials the wreckage will be carried to Atlanta where it will be sheltered until an investigation is complete. He said volunteers with the Red Cross were a great help to emergency responders and investigators, as were volunteers from a number of other organizations.
�So many people stepped up from within the community,� Leonard said.
A spokesman for LabCorp said the plane that crashed Wednesday was one of three belonging to the company that fly out of Burlington-Alamance Regional Airport. He said the planes are principally used for the transportation of medical specimens between LabCorp facilities and collection sites.


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Stream/download "Getcha Roll On", the new single from T-Pain ft. Tory Lanez: https://tpain.ffm.to/gyro.oyd
NAV - Tap ft. Meek Mill
Odell Beckham Jr. Gets Tattooed By Bang Bang | INKED
DaniLeigh - Easy (Remix) ft. Chris Brown
Ink Geeks was established in 2013, for the purpose of connecting artists to potential clients. The inspiration for the creation of this site comes from personal experiences.
Read more...
Consumers: Inkgeeks is not responsible for the artist that you choose to do your tattoo nor is inkgeeks responsible for the tattoo that you choose.Inkgeeks simply provides a sample portfolio and contact information for the artists.
Artists: All artists that inkgeeks present are subject to portfolio approval. Inkgeeks strives to promote professionally skilled artists.
© 2019 InkGeeks Tattoos


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BLiS Smoked Steelhead Roe Caviar is deep orange-red with medium sized "berries" & a delectable buttery flavor which is enhanced by the subtle application of smoke. BLiS is the leading producer of wild domestic roe. Carefully hand selected and prepared by Chef Steven Stallard, BLiS Wild Domestic Steelhead roe caviar is a staple in the top restaurants across the country.
Product of Michigan
One 250 gram tin
Find delicious recipes, visit the Earthy Delights Blog!
2871 Jolly Road
Okemos MI 48864
tel 855.328.8732
fax 517.253.7366
Contact Us
My Account
More Recipes
Wild Harvest Calendar
Buy Wholesale
Careers at Earthy


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Kevinwaldo necesitaba un nuevo diseño de logotipo y lanzó un concurso de diseño en 99designs.
Un ganador ha sido elegido entre 52 diseños de 20 diseñadores freelance.
Leading urban celebrity blog
TheGlamourousLife.com reaches over 200,000 monthly unique visitors. We are completely redesigning the site, starting with your logo!
So don't be held back by any of the current colors or fonts.
The site features top urban celebrities from the world of music and film. Top search queries include Nicki Minaj, Chris Brown, Taylor Swift and Paula Patton.
We are revamping the site and content, but would like to start with a new logo. The primary use of the logo will be on the site - viewed by hundreds of thousands of North Americans monthly.
Your logo should be hip and a little edgy, and appeal to an urban audience but not alienate a more mainstream audience.
The name MUST be used in the logo - just use "The Glamourous Life" (you don't have to include .com).
NOTE THE SPELLING - "glamourous" not "glamorous".
Other sites in our competitive space include NecoleBitchie.com, BET.com, DatPiff.com, and KillerHipHop.com. Basically hip-hop (rap) sites, but our site skews a bit more female than typical rap sites. Our readers are interested in hip-hop celebrities, but more about their hair, tattoos, and other style elements.
Your logo will also be modified to include a .ico version (the small box to the left of the site name in a browser window) and a watermark for pictures used on the site (presumably a transparent version or something similar). Ideally these changes will be done by you for a small additional fee after you are chosen the winner for this main logo contest.
Descubre cómo funciona un concurso de diseño u obtén más información sobre nuestros servicios de diseño de logo.


text: This handbook is designed for Faculty Department/Program Assistants and Administrators as a convenient and informal resource of information about processes, policies and procedures at Barnard College. Faculty Department Assistants and Administrators work closely with many offices throughout the campus and this guide strives to bring together, in one place, resources for the many different responsibilities of the position. Whenever possible, the handbook links directly to the source, with the expectation that it is the location for the most accurate and up-to-date information. If you have any questions or need clarification of any information on a website, please call the department directly.


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These deeds were reported as recorded by the office of Marion County Register of Deeds.
Randal B. and Carol D. Vogel to Carol D. and Randal B. Vogel, co-trustees, warranty deed; Tract 1: SW/4 S3-T19-R4 except right-of-way; Tract 2: S/24 S4-T19-R4; Tract 3: S/2 SE/4 S17-T19-R4; Tract 4: NW/4 S7-T19-R5.
Randal B. and Carol D. Vogel to Randal B. and Carol D. Vogel, co-trustees, warranty deed; Tract 1: N/2 NE/4 S33-T18-R4 with exeptions; Tract 2: NE/4 S9-T19-R4; Tract 3: NW/4 S9-T19-R4; Tract 4: N/2 SE/4 S9- T19-R4 with exeptions.; Tract 4A: All minerals in and under N/2 SE/4 S9-T19-R4; Tract 5: N/2 SW/4 S9-T19-R4; Tract 6: All our interest in an undivided 25% of SE/4 S11-T19-R4 with exeptions; Tract 7: NE/4 S7-T19-R5; Tract 8: NW/4 S8-T19-R5.
Patrick E. and Jandee K. Moore to Lane D. and Amber N. Smith, warranty deed; Part of S/2 S8-T20-R4.
Cheryl M. and John Brandsted to Erick J. and Cheryl K. Brandsted, quitclaim deed; South 15 feet of Lot 9 and all of Lot 10, Block 1, Eastmoor development, Marion.
Doe Ann Hague to Chen, warranty deed; Part of Lots 7 and 8, All of Lot 9, Block 63, North Peabody, Peabody.
Keith Harder, trustee, and Judy Harder to Betty D. Fruechting, trustee, trustee's deed; S/2 NE/4 S12-T19-R5 with exeptions; E/2 SW/4 and SE/4 S12-T19-R5.
William M. Kroupa to William M. Kroupa and Linda J. Kroupa, quitclaim deed; NE/4 and NW/4 and N/2 SW/4 S26-T18-R4.
Erna Mae Yeagley, by POA, to James Van Goethem and Lori Van Goethem, trustees, warranty deed; E/2 SE/4 S25-T19-R3.
Harold and Joyce Unruh to Harold W. Unruh and Joyce M. Unruh, co-trustees, warranty deed; SE/4 NE/4 S32-T20-R1.
William R. and Peggy J. Falen to William R. and Peggy J. Falen, trustees, warranty deed; Tract 1: W/2 E/2 S36-T17-R4; Tract 2: S/2 SW/4 S-25-T17-R4; Tract 3: W/2 SW/4 S35-T17-R4 Lying West of RR; Tract 4: W/2 SE/4 S35-T17-R4 with exeptions; Tract 5: Part of SW/4 S2-T18-R4 Lying West of RR.
Renessa D. Krause to Keith E. and Nancy M. Just, warranty deed; Lot 6, Lakeside Addition, Marion County Park and Lake.
Allen L. and Norma J. Bartel to Kenneth J. and Velma M. Decker, warranty deed; Lots 11, 12, 13, 14, 15, 16, 17 and 18, Block 3, Weber's Addition, Lehigh.
City of Marion to Cardie Oil, Inc., warranty deed; Lot 3, Block 3, Batt Industrial Park Addition, Marion.
Gregory C. and Zeola A. Langenegger to Safe Harbour Eat IX, LLC, warranty deed; SE/4 S23-T22-R4.
Rural Excursions, LLC to Barbara J. Anderson, quitclaim deed; Lot 13 and N/2 of Lot 14, Block 2, Strotkamp and Werry's Addition, St. Francis City, Burns.


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In a time when consumption of television shows is gravitating to instant gratification, when you can just marathon through an entire series on Netflix or YouTube, less time between episode watching ensues. So every time a new episode starts, you have to choose: zip through the opening title sequence, or watch it again because it's actually quite enjoyable? Even though you just saw it like 50 minutes ago? What is it about this feature that is basically a title card with What This Is, Who's In It, and Who Made It? The well-crafted ones use a distinctive piece of music, and an original, engaging visual narrative.
The following twenty are by no means an authoritative list, just another opinion by Johnny Cat, some guy on the Internet.
20. The Outer Limits
This was clever for its time, because in the 60s, TV sets would always be "going on the fritz" or otherwise losing picture quality. So when people first saw the intro to the show, they were creepily informed that the horizontal and vertical controls of their prized living room television were in the hands of some weird television show.
Filmed in the mountains of California, the famous intro to M*A*S*H describes a typical day for our friends at the 4077th. The helicopters glide over the "Korean" landscape, seeming to dance gently to the sweet music… um, yeah the song's titled "Suicide is Painless" and had lyrics in the original movie version. But anyway, then the doctors run and whisk the injured away to go to work on them. Always fun to watch, never a chore.
18. 30 Rock
One aspect of an awesome intro is getting the information out to the viewer efficiently; entertainingly, as well. There are a few very short entries on this list, and third shortest is the zippy punch that is the intro to 30 Rock.
17. Buck Rogers in the 25th Century
Although I watched every episode of this dreadful show, and have previously named Dr. Theopolis as the most worthless droid, the best part of those otherwise wasted viewings was the opening sequence.
16. The Fresh Prince of Bel Air
Go on, sing along to the original, extended version and see how you do on that middle part.
15. The Simpsons
The show hit the airwaves running, and never looked back. Throughout the hundreds of episodes, the iconic opening sequence remains generally the same, of course with a different blackboard phrase, and a different couch scene. Here's one with an oddly serious ending, and here's every couch scene in a row.
The shortest one on the list, and included for its sheer simplicity. The show's structure was one with an opening scene, which would usually end with some WTF moment or discovery, then – cut to this intro. It's interactive, because the audience is simultaneous feeling what the word is saying. It's effective.
13. Weeds
The Malvina Reynolds song "Little Boxes" is one of the best choices for a show like Weeds. Nancy Botwin and her family feel so out of place in a gated community, and its ticky-tacky people. As the series went on, the theme song would be covered by various artists. This is the original.
12. The Twilight Zone
Rod Serling was a fan of anthology pulp fiction stories as a little boy. As an adult, he wished to write on social commentary themes such as racism, government, war, society and human nature in general. He decided to combine the two so he could not only indulge both of these passions, but also to get away with talking about these on television at a time when television wasn't allowed to address such things.
Perfectly sums up one of the most loved TV shows, with one of the most unforgettable intros.
11. The Sopranos
In this intro, we simply sit shotgun and look around as Tony Soprano makes a drive from the city to Jersey, and finally to his nice home in the hills. With an edgy song as backdrop, the journey is a beautiful one of neighborhoods, people, and T smoking a cigar.
10. The Walking Dead
Riveting music, broken picture frames, the modern wasteland. It's explanatory and beautiful in its depiction of the show's premise. And I love how it always blends in with the opening scene.
9. Breaking Bad
Short, sweet, and to the point. Yo! Bounce!
8. Star Trek
Have you seen this? I mean, have you seen it? The ship flies from one end of the universe to the other, right in your face! Epic narrator, sweeping sci-fi-ish music, and The Enterprise swishing speedily across your face. It's so… fascinating.
7. Rescue Me
Ostensibly filmed using actual FDNY guys. The song fits the mood of the show, and the cinematography is brilliant.
6. The Six Million Dollar Man
My friends and I were such geeks about this show, and would be upset if we somehow accidentally missed the intro. I love the high tech stuff, and the music, and the drama. Shucks, embedding disabled. Check out the HD version.
5. The Dukes of Hazzard
Sure, most of the beauty of this one comes from the car, but there's also the kooky song, Daisy kicking some dude with her high heels, explosive arrows, breakfast… But yeah, it's mostly about the General. Odd footnote: to my knowledge, Waylon Jennings never did appear in character as The Balladeer, he just sung the same damn song every week.
4. The Muppet Show
Gonzo's finale was always different, so you pretty much had to watch each intro just to see that, and whatever else they sometimes threw in there.
3. Freaks and Geeks
This masterpiece of an intro never gets old. The setting of the thing takes place during school pictures, and we meet our characters as they attempt to pose for the camera while Joan Jett hammers out the angst musically. The song alone is probably the best on this list, but the editing is what really makes this one rock.
2. Dexter
I know if you're a fan of good modern TV shows, you knew this one would be on this list, probably near number 1. The tableau of our title character waking up and getting ready for work has all the right elements to describe the mood of the show, as well as the creepy undertones to everything Dexter does, no matter how mundane. The song is also perfect in those regards, and I'll never have ham for breakfast again.
1. The Prisoner
If you were a fan of British scifi/spy shows from the 60s, you no doubt knew this one would be here, by hook or by crook, and especially had to live in the number one spot. Its epic scale exceeds all expectations of what a watchable (over and over) intro should be. It's the Anti-LOST intro, in that it's three and a half minutes long, but it's sooo watchable (over and over).
There are many more good, re-watchable intros out there, old and new. I know it; it's why I pinned a still from the Gilligan's Island intro up top. So remind me, what'd I leave off this list?


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The cost of private ambulance service in county New Jersey
Approximately 3.6 million Americans miss or delay medical care because they lack appropriate transportation to their appointments. Many low-income Americans lack the disposable income necessary to have access to adequate transportation, and may lack public transit options to get a ride to medical appointments. Some government health benefit programs provides patient transport services benefit that pays for the least costly and appropriate way of getting people to their appointments whether by taxi, van, public transit or mileage reimbursement.
This brief provides an overview of the different ways local governments are dealing with the increase in people who need non emergency patient transport because of age, chronic conditions or income
The Increasing Need for Non-Emergency Medical Transportation Services
Medicaid funds are the single largest transfer of federal money to states, representing an average of 44 percent of all federal revenue received. The transportation component is about $3 billion of that yearly fund transfer, making up less than 1 percent of total Medicaid expenditures. Though a small percentage of Medicaid overall, consistent transportation access to healthcare helps enhance the medical outcomes of Medicaid recipients and leads to cost-savings.
With more medical care provided on an outpatient basis, and an increasing number of people with serious conditions,trips to medical appointments are the lifeblood of a sustainable healthcare system. Non-emergency medical transportation (NEMT) provides trips for scheduled doctors appointments, return trips from medical facilities and transfers between hospitals for people without access to transportation. By providing consistent and efficient access to healthcare management appointments, states can save money by helping these individuals avoid costly medically necessary trips or emergency room visits.
Medicaid Expansion
Under the Affordable Care Act, the population of people eligible for Medicaid is expanding. Based on projections from the 25 states where coverage expansion is underway, it is estimated that 9 million people will be added to the Medicaid program; Medicaid and the Children's Health Insurance Program (CHIP) have more than 6 million new enrollees as of April 30, 2014. Because the expansion includes people who are 133 percent of the federal poverty rate, they are expected to have relatively fewer NEMT transportation needs. A study from the Transportation Research Board estimates that only 270,000 new enrollees will require NEMT, which still could potentially strain systems in some states.
Providing Health Care Access
Non-emergency assisted transportation is essential for disadvantaged Medicaid recipients, those who are older, or have disabilities or low incomes who have no transportation to access healthcare services.
Medicaid recipients who own a car or can provide their own transportation may receive travel service reimbursement for costs related to getting to their care, including gasoline, car maintenance or repair, cost of vehicle modifications for adaptive technologies and other financial stipends to support ongoing transportation needs. For those who are unable to provide their own transportation, because of income, age or disability, other methods of NEMT service delivery are necessary.
Growth of Chronic Conditions
Many people with chronic conditions, which include arthritis, asthma, cancer, cardiovascular disease, chronic obstructive pulmonary disease and diabetes, need medical services often. Treatment of chronic conditions account for most of all U.S. healthcare spending. As of 2009, the Centers for Disease Control estimate that over 3/4ths of the adult population above the age of 55 has at least one of these chronic conditions. Additionally, estimates are that states will add more than a half million adults who have serious mental health issues that impair their everyday functioning to the Medicaid population. These people will need NEMT to access life saving treatments and health maintenance services.
For the nearly 20 million adults with long term kidney disease who are undergoing dialysis three times a week, NEMT is a great service to get to appointments and avoid going to the emergency room if appointments are missed. Sixty-six percent of dialysis patients rely on others for rides to their treatments, only 8 percent used public transportation or taxi services, and 25.3 percent drove or walked to the clinic themselves. A recent study examining Florida's NEMT costs found that if 1 percent of total medical trips resulted in avoiding an emergency room visit, the state could save up to $11 for each dollar spent in non-emergency medical transportation.


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NEW YORK (TheStreet) -- Apple (AAPL - Get Report) has been upgraded to "outperform" from "sector perform" with a $635 price target, said Pacific Crest Securities on Tuesday. The firm noted business stagnation has been priced into the stock.
Must Read: Warren Buffett's 10 Favorite Stocks
STOCKS TO BUY: TheStreet Quant Ratings has identified a handful of stocks that can potentially TRIPLE in the next 12 months. Learn more.
Separately, TheStreet Ratings team rates APPLE INC as a Buy with a ratings score of A-. The team has this to say about their recommendation:
"We rate APPLE INC (AAPL) a BUY. This is based on the convergence of positive investment measures, which should help this stock outperform the majority of stocks that we rate. The company's strengths can be seen in multiple areas, such as its revenue growth, largely solid financial position with reasonable debt levels by most measures, solid stock price performance, expanding profit margins and growth in earnings per share. We feel these strengths outweigh the fact that the company has had sub par growth in net income."
Highlights from the analysis by TheStreet Ratings Team goes as follows:
- AAPL's revenue growth has slightly outpaced the industry average of 4.7%. Since the same quarter one year prior, revenues slightly increased by 5.7%. Growth in the company's revenue appears to have helped boost the earnings per share.
- Although AAPL's debt-to-equity ratio of 0.13 is very low, it is currently higher than that of the industry average. Along with the favorable debt-to-equity ratio, the company maintains an adequate quick ratio of 1.23, which illustrates the ability to avoid short-term cash problems.
- The stock has risen over the past year as investors have generally rewarded the company for its earnings growth and other positive factors like the ones we have cited in this report. Turning our attention to the future direction of the stock, it goes without saying that even the best stocks can fall in an overall down market. However, in any other environment, this stock still has good upside potential despite the fact that it has already risen in the past year.
- 41.65% is the gross profit margin for APPLE INC which we consider to be strong. It has increased from the same quarter the previous year. Along with this, the net profit margin of 22.69% is above that of the industry average.
- APPLE INC's earnings per share improvement from the most recent quarter was slightly positive. This company has reported somewhat volatile earnings recently. But, we feel it is poised for EPS growth in the coming year. During the past fiscal year, APPLE INC reported lower earnings of $39.63 versus $44.16 in the prior year. This year, the market expects an improvement in earnings ($42.73 versus $39.63).
- You can view the full analysis from the report here: AAPL Ratings Report
STOCKS TO BUY: TheStreet Quant Ratings has identified a handful of stocks that can potentially TRIPLE in the next 12 months. Learn more.


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North-East Asian youth adopt powerful post-2015 development visionJan 9, 2013
Seoul, Republic of Korea – Job opportunities, rising inequalities, the environment, gender equality and peace and security in North-East Asia are key priorities the region's youth want to see addressed in the world's future development agenda.
Fifty-one youth representatives from China, Japan, Korea and Mongolia have today adopted a bold declaration on the future of global development entitled 'The World We Want: A North-East Asian Youth Vision' (pdf).
Their vision was finalized in Seoul at a major youth forum convened as part of worldwide United Nations-led consultations to prepare a new universal development framework ahead of the 2015 target date for the Millennium Development Goals (MDGs).
"The young people from all four countries talked openly, honestly and as equals. As young people, I think we tackled some of the more sensitive issues more logically than adults often do. There is a real desire to work together for development and peace in future," said Clara Suh, 24, a participant from Seoul.
The declaration demands decision-makers also ensure access to quality education, calls for a world free from discrimination and stresses the need for greater peace, security, economic and cultural cooperation and open communication in North-East Asia.
"I realize that right here, right now I have the chance to fight for the people I have never met and for children I will never know. We have worked so hard to picture a beautiful future for the next generations," said Qingling Kong, 23, a participant from Beijing.
Prepared as formal input for the UN Secretary-General's High-level Panel on the Post-2015 Development Agenda, the declaration was presented to Korea's Minister of Foreign Affairs and Trade and High-level Panel member, Mr Kim Sung-hwan today on behalf of North-East Asian youth.
Purvedorj Erkhembulgan, Head of the International Cooperation Division in Mongolia's Ministry of Education, Science and Culture, and Hirojima Soma, Economic Counselor in the Embassy of Japan to Korea were also presented with copies of the vision during the public closing ceremony at Korea University.
Participants included graduate students from major universities in the four countries, as well as youths from diverse backgrounds including ethnic minorities, refugees, orphans, rural youths, domestic migrant workers, sexual minorities and disabled persons.
The three-day forum was hosted by the UN Development Programme (UNDP) Seoul Policy Centre, the UN Economic and Social Commission for Asia Pacific's Sub-regional Office for East and North-East Asia, the Global Compact Korea Network and Korea University.
Whilst looking forward, participants also looked back at the progress and lessons from the Millennium Development Goals and the challenges ahead. They committed to continue the discussions in their own countries after the event.
In his keynote address to the conference's closing ceremony, Minister Kim highlighted his aims to bring an Asian perspective to the work of the High Level Panel and shared his views on the key pillars required for a new framework's success.
"To achieve sustainable economic growth and environmental management, a future global development framework should prioritize inclusive economic growth and green growth. Given these considerations, I will contribute two concept papers to the Panel: one on Green Growth and the other on a Post-2015 implementation mechanism," he said.
Minister Kim also spoke of the need for a wide-ranging global partnership for development.
"These young people have stated clearly that the Millennium Development Goals have made a huge impact in the lives of billions in Asia and worldwide. They also recognize much more must be done to address extreme poverty, disease, and economic and environmental crises to deliver a better and more equitable world for all," said Anne-Isabelle Degryse-Blateau, Director of the UNDP Seoul Policy Centre.
Kilaparti Ramakrishna, Director of UNESCAP's Sub regional Office for East and North-East Asia, highlighted the need to ensure a representative mix of young people in securing youth inclusion in the post-2015 consultation process.
"Given the widening inequalities among and within countries in North-East Asia, it is critical that for a such as this youth conference reach out to various social groups, so that voices from diverse life experiences join the dialogue," Mr Ramakrishna said.
A global consultation portal has been set up to gather public priorities to be tackled in a post-2015 global development framework as part of the unprecedented UN-led consultations.
The portal was officially launched in Korean language at the closing ceremony today and can be found at www.myworld2015.org.Contact information
Matthew Taylor; firstname.lastname@example.com; Tel: +82 (0)102754 2814


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An American Eagle flight out of Kennedy Airport was delayed nearly four hours after two flight attendants got into a verbal altercation on the plane, forcing the cockpit crew to turn the plane around and head back to the gate, passengers tell NBC 4 New York.
American Eagle Flight 3823 to Washington, D.C. was scheduled to leave New York City at 3:10 p.m. The plane started to roll away from the gate when two female flight attendants began to argue, witnesses said.
It got so heated the cockpit crew was alerted, and they ultimately made the decision to turn the plane around and head back to the gate.
"We were informed we were going back to the gate because the flight attendants couldn't work with each other," said Dan Alexander, a passenger.
"I find it hard to believe the flight attendants couldn't work with each other for an hour," he added, noting the approximate flight time from New York to Washington.
Passengers had to wait approximately four hours while the airline searched for a replacement flight crew. When they finally landed in D.C., passengers were still annoyed.
"It was incredible, totally unbelievable that there was such little professionalism between these women," said Marge Lopez.
Karen Grantham said it was "ridiculous" that the flight attendants became upset.
"Doesn't anyone teach good customer service anymore?" she asked. "You have to be thick-skinned to be in customer service. It just happens, you can't let this get the best of you."
American Airlines told NBC News that the two flight attendants would be meeting with their manager on Thursday to determine what will happen next.
A statement from the company, sent to NBC News, said: "There was a disagreement between two flight attendants Wednesday afternoon prior to the departure of American Eagle flight 3823 from New York JFK to Washington Reagan. The aircraft returned to the gate to switch flight attendant crews, and the flight departed a short while later. We're looking into the matter."
The airline has already been dealing with scheduling problems and delays. It said it was forced to cancel 300 flights this week because a high number of pilots were calling out sick and crews were filing more maintenance reports.
AMR Corp., which owns American Airlines and American Eagle, said Wednesday that it canceled the flights in advance to avoid inconveniencing passengers.
Earlier this week, American said it would cut its schedule through the end of October by up to 2 percent.
The Wall Street Journal's veteran travel reporter, Scott McCartney, on Tuesday told travelers to avoid the carrier because "American's operation is in shambles."
McCartney said American Airlines is too unreliable because of trouble with the pilots union.
Denny Kelly, an aviation expert and former pilot, told NBC DFW he agreed that travelers should avoid the Fort Worth-based airline.
"If you're going to fly a trip from Dallas to someplace and you have a choice, and you have to be there on time or within a reasonable amount of time ... why take a chance on American?" he said. "Why take a chance on [if] a flight's going to be delayed or canceled? Go on somebody else that doesn't have that problem."


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