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SA Journal of Radiology
versión On-line ISSN 2078-6778
versión impresa ISSN 1027-202X
S. Afr. J. radiol. (Online) vol.18 no.1 Johannesburg oct. 2014
An approach for performing a successful computed tomography colonography examination
Joel H. Bortz
LSG Imaging, Santa Monica, United States of America
Computed tomography colonography (CTC) is a minimally invasive, fast, safe and accurate screening examination for colorectal cancer. It also allows evaluation of structures outside the colon. A successful CTC examination requires good bowel preparation, adequate patient hydration, tagging agents, the use of automated carbon dioxide insufflation, and correct positioning for two view and additional view scans. Knowledge of polyp morphology and measurement of polyps are important when interpreting 2D or 3D scans.
Colorectal carcinoma (CRC) is the third most common cancer in the United States of America (USA), and the second most common cause of death from cancer. The latest CRC statistics for new cases in the USA is expected to decrease to 136 830 from the previous estimate of more than 143 000 cases in 2012.1,2,3 The number of deaths in 2014 is expected to decrease to 50 310 from the previous figure of more than 52 000 deaths per year.1,2,3 Most colon cancers, apart from inherited genetic disorders, such as hereditary non-polyposis colorectal cancer, arise from a pre-existing polyp which develops over a period of 10-15 years into a cancer.4 Colon cancer screening is recommended every five years from the age of 50,2 but colorectal examinations are a contested terrain of diagnostic imaging versus optical colonoscopy (OC). This contested terrain has shifted since the introduction of newer imaging technologies, such as computed tomography colonography (CTC),2,5,6 which is widely recognised as a highly sensitive and specific test for identifying polyps and cancer in the colon.2,5 To the best of the author's knowledge, no article on how to perform a CTC has been published to date in South Africa. CTC was not included as a screening test for CRC in a 2011 survey of a privately insured population for a single insurer across all nine South African provinces.7 CRC was the fourth leading cancer in South Africa in 2004;8 more recent CRC statistics are not available.
Although double-contrast barium enema (DCBE) is not as effective as CTC, and is rapidly becoming an obsolete technique,9 it remains widely practised in South Africa and elsewhere in the world. Fairly recent studies show the sensitivity of DCBE at approximately 50% for polyps >10 mm10 whereas for CTC it is 97% for polyps >10 mm.11
An important advantage of CTC over OC is the former's ability to visualise the intra-abdominal and pelvic organs. The majority of findings will ultimately prove to be of little or no clinical significance.12,13 However, in approximately 10% of cases, significant pathology may be identified, such as early cancers of the kidney and ovary as well as abdominal or pelvic lymphadenopathy in underlying lymphoma. Abdominal aortic aneurysms >5 cm in transverse diameter may be detected incidentally.12,13 Visualisation of such pathology is not possible with OC or DCBE. CTC is less invasive, with minimal complications.14
OC holds inherent risks related to sedation and potential bowel perforation.15 CTC is a much safer form of study than OC as no sedation is required and the risk of perforation is significantly less, with only sporadic cases of perforation recorded.16 Perforation is higher in diagnostic studies than with screening procedures, particularly when stenosing lesions are present. Certain precautions are recommended to maintain a low perforation rate, namely (1) the use of a soft rubber catheter as opposed to the large plastic barium enema tube; (2) constant infusion of carbon dioxide (CO2) under monitored pressure; and (3) not performing the study after a recent full thickness biopsy.16
The aim of the present paper is to present an approach for a successful CTC examination, ensuring the performance of a high-quality study that allows accurate interpretation by a general diagnostic radiologist.17 The author has performed more than 5200 CTCs in the USA over the past 10 years. Bowel cleansing in CTC for screening patients is highlighted. In addition, CTC following an incomplete OC is discussed. Interpretation of images is also briefly discussed.
CTC protocol
There are two critical components to achieving a successful CTC: an adequately cleansed bowel and good distension of the colon with CO2. There are many ways to perform CTC, but it is advisable to choose a method from an institution that has published evidence of consistently producing outstanding results, and to then follow the published recommendations. The author has adopted the technique used by Drs Pickhardt and Kim from the University of Wisconsin (USA),18 who have shown the importance of: bowel preparation; the use of CO2 instead of room air; 3D visualisation using approved software; and a multiple detector computed tomography (MDCT) scanner. A deficiency in any of these factors can cause a poor CTC result.
The following points are embedded in the CT protocol used by the author: adherence to CTC indications (Table 1); informed consent; adequate patient hydration; cathartic and tagging agents; and the use of CO2 (Table 2).
Colonic preparation
Bowel preparation is controversial in terms of patients' compliance.19,20 There are a variety of bowel preparations available, including magnesium citrate, a cathartic bowel preparation. In addition, tagging agents, such as 250 ml of 2.1% w/v Readi-Cat and 60 ml diatrizoate (gastrografin), are used. The barium tags the stool and the gastrografin tags the residual fluid (Table 3).
For a successful examination, bowel preparation should comprise a well-established CTC standard protocol.6 Bowel preparation commences the day before the scheduled examination; a 24-hour liquid diet is required (Table 3 presents a list of permitted liquids), with nil per mouth from midnight. If the patient has had breakfast in error, another CTC appointment must be arranged. It is important for the patient to be fully briefed on all requirements when a CTC is booked. An appropriately trained person must carefully explain to the patient the importance of adhering to a liquid diet and taking the bowel preparation medication at the correct times (steps 1 and 2 in Table 3). The times to take the medication in these steps, and the tagging agents, must be included on the labels on the bottles.
The patient must be informed that onset of bowel action is variable: it may occur after 30 minutes or for up to 4 hours. Tagging is an integral part of the colonic preparation (steps 3 and 4 in Table 3). The patient should be warned of the unpleasant taste of gastrografin; dilution in a flavoured drink lessens the unpleasant taste.
Notably, barium does not adhere to the colonic wall, but rather coats the surface of polyps, making them more conspicuous and easier to diagnose.6,17 This effect may reduce the false-positive rate on CTC. Gastrografin has a dual action: (1) it stains the residual fluid white, aiding in 2D evaluation of submerged polyps; and (2) it emulsifies the stool adherent to the bowel wall, causing a secondary catharsis.6
It is sensible to shift to polyethylene glycol solution (PEG: Klean-Prep) for the extremely small percentage of patients who are in poor health owing to cardiac or renal disease, or hypertensive patients taking angiotensin-converting-enzyme (ACE) inhibitors to avoid fluid or electrolyte shift. Klean-Prep has an unpleasant taste, and consumption of a large volume is necessary; consequently, patients do not usually adhere strictly to its correct use.
Positioning and introduction of CO2
Before commencing a CTC examination, the patient is sent to the restroom as the rectum must be emptied of any residual fluid. Figure 1 is a synopsis of the CTC technique described below. The patient is positioned feet first in a left lateral position in the scanner. A disposable soft rubber rectal catheter is then gently inserted into the rectum and the balloon is insufflated with 20 cc of air employing a 3-way connection (Figure 2). The hard plastic tube previously used for DCBE is employed only in rare cases. Use of a soft rubber catheter reduces risk of perforation.
It is essential to check that there is sufficient CO2 in the cylinder before commencing a CTC. The CO2 insufflator (PROTOCO2L - Bracco) is switched on and the pressure set to 15 mmHg to enable the CO2 to gently flow at low pressure into the descending colon until one litre of CO2 has been introduced (Figure 3). At this point, turn the patient onto the right side to fill the proximal transverse and ascending colon. The pressure at this stage may be increased to 20 mmHg to distend the colon. When the volume reaches two litres, return the patient to the supine position and commence scanning. For all scans, instruct the patient to inhale, then exhale, and suspend breathing during scanning. Scanning is performed in exhalation as this elevates the diaphragm and allows the colon and flexures to expand. The first breath hold (5 seconds) allows acquisition of the scout film. Once this film is reviewed, inform the patient that the full supine scan of the abdomen will commence.
Next, the CO2 insufflator is switched off whilst the patient is turned prone. This is done because elderly and obese patients may have trouble turning prone and the intracolonic pressure rises rapidly, often above 60 mmHg, thereby triggering the machine alarm. Some radiologists use the deflation manoeuvre after completion of the supine scan by emptying the rectum of air and then re-inflating for the prone scan; this reduces the incidence of pain.21 From time to time, it may not be possible for some patients to turn into the prone position, and a decubitus view will be required instead. Ensure that, when scanning in the prone position, a pillow placed under the patient's chest does not impinge on the abdomen.
With the patient in the prone position, (1) the balloon is deflated to visualise internal haemorrhoids, if present (Figure 4); and (2) the CO2 insufflator is switched on and the patient positioned for scanning. A scout film is taken on exhalation and breath hold. The scan usually takes 12 seconds. When the prone scan is completed, the insufflator is switched off and the clip of the rectal bag is opened to empty the rectum. This manoeuvre gives immense relief to the patient, who is turned into the right lateral decubitus (RLD) position while the images are examined by the radiologist. On average, the acquisition and assessment of a two-view CTC study takes no more than five minutes. CTC requires on average between 15 to 20 minutes' room time.
Should areas of poor distension be identified, in particular the sigmoid colon in cases of diverticular disease, the patient is ready to be scanned in the RLD position. The insufflator is switched on again, introducing a litre of CO2, as the rectum was previously emptied when the bag was unclamped. After the CO2 has been introduced, scanning on breath hold can recommence. Whilst waiting for the images to be processed, the CO2 is switched off. In the rare case where the RLD is unable to distend the appropriate area, the patient is turned into the left lateral decubitus (LLD) position. The CO2 isswitched on and the patient re-scanned.
It is important to appreciate the benefits of using an insufflator. The intracolonic pressure is constantly monitored, as indicated on the second dial on the CO2 insufflator. The maximum pressure is 25 mmHg, which prevents the risk of perforation. By comparison, a standard handheld air-bulb insufflator cannot determine the intracolonic pressure or the volume of gas introduced. According to Sosna and colleagues,22 each puff of the handheld device will introduce approximately 40 cc of air; at least 50 puffs will be required to introduce two litres of air. Of importance is that the pressure at which the air is introduced is unknown. The danger of perforating the bowel under these circumstances far exceeds that of the gentle measured pressure and volume attained with a CO2 insufflator.
Carbon dioxide is rapidly resorbed compared with room air, which results in reduced abdominal distension and pain.23,24 It may, however, cause bloating for a short period. If a patient does complain of pain early on in the procedure, it is important to immediately check the inguinal regions for possible bowel herniation (Figure 5a and Figure 5b). If this is negative, the most likely cause is underlying diverticular disease.
Adequate distension does not imply complete distension of all segments in all cases. Cases of established diverticulosis tend to cause areas of non-distension. Additional views are frequently required to open the sigmoid area satisfactorily.
Do spasmolytics have a role in CTC?
Glucagon is rarely used as a spasmolytic in the USA because of cost and the side-effects of nausea and vomiting. Buscopan (hyoscine butylbromide) is not available because it has not been approved by the USA's FDA (Food and Drug Administration).6 In Europe and South Africa, Buscopan is often used to relax the bowel for good distension. However, it may relax the ileo-caecal valve and result in the small bowel filling with air. Occasionally the valve may be incompetent without the use of a spasmolytic. Carbon dioxide refluxes into the small bowel and it may rapidly reach the stomach (Figure 6). When this occurs, the patient complains of nausea and usually breaks into a sweat. It is essential to instruct the patient to burp, causing immediate relief.
Role of tagging
Apart from tagging stool, barium also lightly covers a polyp, thereby making it more conspicuous on 2D viewing. A useful tip is to scroll carefully through the polyp to assess whether there is soft-tissue thickening underlying the barium. A recent paper6 underscores that contrast coating of a flat polyp can act as a marker for detection (Figure 7).
There are clues that allow differentiation between a polypoidal lesion and stool: 2D and 3D views are complementary. The former is the most useful method for making the distinction. Stool may be covered by barium and frequently contains small bubbles of air, giving it a heterogeneous appearance (Figure 8). Air within stool is not identified on 3D viewing. Most typically, stool will move to the opposing wall when the patient is turned from the supine to the prone position (Figure 9). A sessile polyp does not move with postural change. However, beware of the pedunculated polyp on a long stalk which may move with postural change (Figure 10).
Should 40% w/v barium be used in CTC?
Use of the relatively high-density barium has several disadvantages and is therefore not recommended for use in CTC examinations. If 40% w/v barium is used for a CTC study, this does not include a cathartic bowel cleansing so it is not possible to perform a same-day OC.17 Electronic cleansing is not routinely performed because it may cause a large number of artifacts that could make interpretation difficult. Part of the surface mucosa may be electronically removed and could result in missed lesions.
CTC protocol: Radiation dose considerations
It is feasible to perform CTC using a 4-slice and above scanners.25 Currently, 16-slice scanners and above are recommended. Such scanners allow for a short breath hold during scanning but image quality is not improved. Sub-millimetre collimation is neither recommended nor used. Slice collimation is set at 1.25 mm with a 1 mm reconstruction interval. Tube potential is set for 120 kVp which is raised to 140 kVp for large patients. Reducing tube current (mA) reduces dose to the patient, in keeping with ALARA (as low as [is] reasonably achievable) principles.26 CT manufacturers have taken heed of increasing concerns about radiation dose, and have developed radiation reduction tools such as automated tube current modulation, automated tube potential and iterative reconstruction, in the latest generation scanners.27 With the introduction of tube current modulation, protocols can now concentrate on setting an appropriate noise level to minimise dose. A tube current modulation system is used (Smart mA, GE Healthcare) whereby the noise level is set at 30 for the supine study and 50 for the prone study, and the tube current range at 30 mA-300 mA. This has yielded a 40% reduction of dose in the prone position with minimal degradation of 3D and 2D images. For MDCT scanners not equipped with a tube current modulation system, a technique with a tube current-time product in the range of 50 mAs-75 mAs usually suffices.28 A tube current-time is set between 50 mAs-75 mAs for those machines not equipped with a tube current modulation system. These protocols result in a median effective dose of 4.5 mSv for both supine and prone studies: CTC is a low-dose examination.29
Diagnostic CTC following incomplete OC
Reasons for a failed OC might include older patients, female gender, colon length, number of acute angle bends and flexures, advanced diverticular disease, prior abdominal surgery, occlusive cancers, benign strictures, colon containing hernias, intestinal malrotation and poor bowel preparation. From a CTC perspective, this latter group of patients is the most challenging. They have predominantly been prepared for an OC using a 'wet' preparation, such as PEG, and not a 'dry' one as is favoured for CTC. In addition, these patients were not given preprocedural contrast or fluid tagging, making it more challenging to exclude false-positives, such as stool adherent to the wall.
It is imperative to first exclude the possibility of an OC-caused colonic perforation before commencing with CTC. There have been rare reports of colonic perforation at CTC, especially in patients with obstructive lesions.16 Approximately 50% of patients with colonic perforations do not have symptoms. To avoid possible medico-legal implications, a pre-procedure low-dose CT scan should be done prior to rectal catheter insertion. The technique used by the author comprises a 10 mm slice thickness at 10 mm intervals.30 The subsequent images are viewed by the radiologist and, if extra-luminal air is present, a CTC is not performed. The referring clinician is informed of this CT finding.
Hough et al.30 reported a total effective dose of 0.9 mSv for men and 1.2 mSv for women in low-dose abdomino-pelvic CT to exclude perforation. Alternative techniques may be used, such as a slice through the upper, middle and lower abdomen. These increased gaps may be a trade-off for sensitivity. Professor P. Pickhardt (personal communication, May 2014) stated that low-dose CT is preferred to erect plain-film radiographs. According to Professor Pickhardt, the latter only excludes free air whereas most perforations have contained extra-luminal gas, retroperitoneally or intramural.
Before proceeding with a CTC, the radiologist must know whether a recent polypectomy or biopsy (superficial or deep) has been performed. Occasionally, with superficial biopsies, the CO2 may track sub-mucosally and result in pneumatosis coli. If a deep biopsy or polypectomy has recently been performed, it is advisable to wait at least four weeks before proceeding with the CTC to allow the mucosa to heal (see Table 1).
Patients would prefer a same-day CTC after a failed OC to eliminate the need for two separate bowel preparations. From a CTC standpoint, the examination tends to be sub-optimal as tagging has not been performed. To overcome this limitation, 30 ml of gastrografin is administered when the patient is fully awake and able to swallow. The patient is then turned onto the right side and kept in this position for two hours to empty the stomach. Gastrografin usually takes a minimum of two hours to travel through the colon. The patient is then scanned. This CTC technique results in moderate success because there is excess luminal fluid or streak artifacts from the dense residual contrast in the stomach, which degrades the quality of the study. Unfortunately, 30 ml of gastrografin does not effectively tag residual faecal matter.
An option that is seldom adopted is to keep the patient on a liquid diet for a second day. Then 250 ml of 2.1% w/v Readi-Cat is taken at approximately 17h00, followed by 60 ml gastrografin three hours later (at 20h00). No further laxatives are required, and the patient is scanned the following morning.
In view of CTC's efficacy, barium enema following incomplete OC should no longer be performed.31
Extracolonic findings
CTC screening is usually performed in healthy asymptomatic individuals. The protocol also includes performing non-contrast scans of the pelvis and abdomen. An automatic retrospective reconstruction of the supine series of all patients is performed for evaluation of extracolonic findings. This consists of 5 mm sections at 3 mm intervals. It is important to remember that, when performing the prone series, there is often more coverage and certain lesions, such as those from lung cancer, may only be detected on prone imaging.
A classification of extracolonic findings has been devised (Table 4).18,32,33 The overall detection rate of unsuspected cancer is approximately one per 200 asymptomatic adults undergoing routine screening CTC, including about one invasive CRC per 500 cases, and one extracolonic cancer per 300 cases.34
A successful CTC is not difficult to perform if the bowel is clean and the colon is well distended. There are two methods available to read the scans: 2D and 3D. Some proponents prefer using 2D as a primary approach with 3D reserved for problem-solving, whereas others prefer 3D as the primary methaod.2,35 There is consensus that readers need to be skilled in both interpretation methods. For 2D polyp detection, the window setting should be at a window width of 1500 and centred at 0 to -200.18 Sessile polyps have a round or ovoid morphology and are of soft-tissue density. These should be visualised in both prone and supine scans as their position is not affected by postural change. Stool, on the other hand, does move as previously discussed. Air is often visible in the stool, giving it a heterogeneous appearance (Figure 8). As stated previously, one must beware the pedunculated polyp on a long stalk in terms of postural change (see Figure 10).
Pickhardt et al. maintain that primary 3D evaluation is preferable; they advocate the use of 2D for evaluation of polyp/stool differentiation.35 They maintain that this approach is easy, quick and extremely accurate. They conducted research on the accuracy of readers when using 2D compared with 3D.35 According to these authors, primary 2D CTC is less sensitive than primary 3D CTC for polyp detection in low-prevalence screening cohorts.
All current systems allow improved 3D fly-through. The author's preference is a primary 3D system, such as the Viatronix 3D system, but there are other options. The author's standard protocol is to perform supine and prone scans; additional views in the RLD and LLD may be required (Figure 1). Changing a patient's position by 180⁰ allows shifting of pooled liquid as well as movement of stool from one wall to the opposite wall. The field of view (FOV) is set at 120⁰ to provide good visualisation of the mucosa and folds. The folds in the left colon (anal verge to splenic flexure) are usually circular; in the right colon (caecum to splenic flexure) they become triangular (Figure 11 and Figure 12).
A centreline is automatically generated and continues in a retrograde fashion to the caecum and ileo-caecal valve. An icon is then clicked which reverses the fly-through from the caecum to the rectum. It takes less than two minutes to perform this bidirectional flight. The same is done in the prone study. The software used by the author allows exceptional visualisation of the bowel lumen for every case by clicking on the 'paint' icon to spray the bowel green. Areas that may not have been visualised (i.e. missed regions) are visualised as pink. To remedy this requires clicking the icon area by area until 100% visualisation has been achieved. Note that unidirectional fly-through results in only about 90% coverage of the colon.
A colour-density map is used to assess the density of any protrusions suggestive of polyps or stool that are encountered on the way. Polyps appear as red, barium appears white, and lipomas display as green colouration. The anterior surface of a colon fold faces the rectum and anus; the posterior surface of the fold faces the caecum and ileo-caecal valve (Figure 13). The anterior folds are seen on a retrograde fly-through from the rectum; the posterior ones are seen on the reverse fly-through from the caecum. A 'bookmark' or red dot can be placed on the colon outline to indicate the site of a polyp or carcinoma. The bookmark is useful if a subsequent OC needs to be done. The red dot indicates the site of the lesion as well as the distance from the anal verge (Figure 14). The green line indicates the automated centerline.
How to manage polyps is important. Radiologists need to have a working knowledge of polyp morphology and how to measure polyps,36 as well as recommendations to make when polyps are present. It is advisable to include the following disclaimer in all CTC reports: 'CTC is not intended for detection of diminutive polyps (≤5 mm), the presence or absence of which will not change the clinical management of the patient'.
The head of a pedunculated polyp is measured; the length of its stalk is not measured. Polyps of 6 mm-9 mm are termed small. A study is considered positive when a lesion ≥6 mm is detected. If there are more than 3 polyps in the 6mm-9mm range, OC is recommended. If the polyp burden is lower, an option is OC on the same day (Table 3); this will require the study to be read soon after completion of the CTC. A further option is for the patient to be put in a surveillance programme and followed up in three years. If after three years there is an increase in polyp size, the patient can be referred for an OC. Most polyps, however, tend to regress in size. Polyps ≥10 mm are routinely removed. The chance of malignancy is <1% in an asymptomatic low-risk individual.37 A summary of classifications of colonic pathology is presented in Table 5. The characteristics of advanced adenomas should be known by radiologists.18,37 There are three components to this pathology (Table 6).
More recently, computer-aided diagnosis (CAD) systems have become available.38,39 They are of value as either a primary or secondary reader depending on a radiologist's experience. CAD has demonstrated excellent performance for polyp detection in a large screening population undergoing CT colonography with cathartic preparation and oral contrast agent tagging. The combination of high sensitivity for relevant polyps and an acceptable number of false- positive results is very important if CAD is to be implemented clinically.38
Given the ongoing technological advances in imaging, new CTC display techniques are also available, such as the 'filet' view where the colon is opened up to view for polyps, or the band view.40 These new techniques speed up interpretation time but there is distortion of the mucosal folds, making polyp visualisation difficult.
Concluding remarks
In a panel discussion in 2006, it was suggested that, within the subsequent five years, CTC would make OC obsolete as the primary colon cancer screening test.41 Unfortunately, this prediction has not come to fruition. CTC is a minimally invasive, fast, safe and accurate screening examination for colorectal cancer,1 yet 99% of screening colonoscopies are done via the optical route. In this contested terrain, the referral rate for low-cost screening CTC is dismal. When all the benefits of CTC are presented,2,5,21,42,43 patients should be given a choice of deciding to either undergo CTC as the primary screening procedure or therapeutic OC.44 A screening CTC study should be undertaken every five years.1,2
Regardless of OC's predominance, radiologists need to embrace the new technology, and be prepared and fully trained in all aspects of CTC. This will require making a small investment in a CO2 insufflator as the benefits of CO2 are clearly evident.23 What constitutes an adequate number of studies performed before being competent varies and should be contextualised.25,45 In countries where CTC is a developing modality, such as in South Africa, the role-players should collectively agree on the number of studies that should be performed in order to be competent. CTC is a relatively new procedure that has been validated in the literature.2,6,29,33,36,46 It should be part of routine imaging and not a super-specialist examination. There are two aspects to CTC competency: performing the study and interpreting the images. To address both aspects, CME courses could be developed to meet local needs.25,45
Professor Perry Pickhardt and Professor David Kim, of the Department of Radiology, University of Wisconsin Medical School, are thanked for their support and sharing their knowledge with me. I am indebted to both of them for advice and guidance for many years as well as always being available for 'second opinions'.
Competing interests
The author declares that he has no financial or personal relationship(s) that may have inappropriately influenced him in writing this article.
1. American Cancer Society. Cancer facts and figures 2014. [ Links ] [cited 2014 May 20]. Available from: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics.
2. Yee J, Weinstein S, Morgan T, Alore P, Aslam R. Advances in CT colonography for colorectal cancer screening and diagnosis. J Cancer. 2013;4(3):200-209. http://dx.doi.org/10.7150/jca.5858 [ Links ]
3. Siegel R, Naishadbam D, Jemal A. Cancer statistics, 2012. Ca Cancer J Clin. 2012;62(1):10-29. http://dx.doi.org/10.3322/caac.20138 [ Links ]
4. Muto T, Bussey HJR, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36(6):2251-2270. http://dx.doi.org/10.1002/cncr.2820360944 [ Links ]
5. Pickhardt PJ, Choi R, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349(23):2191-2200. http://dx.doi.org/10.1056/NEJMoa031618 [ Links ]
6. Kim DH, Hinshaw L, Lubner MG, Munoz de Rio A, Pooler BD, Pickhardt PJ. Contrast coating for the surface of flat polyps at CT colonography: A marker for detection. Eur Radiol. 2014;24(4):940-946. http://dx.doi.org/10.1007/s00330-014-3095-z [ Links ]
7. Adonis L, An R, Luiz J, et al. Provincial screening rates for chronic diseases of lifestyle, cancers and HIV in a health-insured population. S Afr Med J. 2013;103(5):309-312. http://dx.doi.org/10.7196/SAMJ.6686 [ Links ]
8. The South African National Cancer Registry 2005. [ Links ] [cited 2014 May 20]. Available from: http://www.cansa.org.za/files/2013/08/Fact-Sheet-Colorectal-Cancer-July-2013.pdf
9. Fletcher RH. The end of barium enemas? N Engl J Med. 2000;342(24):1823-1824 (editorial) [ Links ]
10. Ferrucci JT. Double-contrast barium enema: Use in practice and implications for CT colonography. AJR. 2006;187:170-173. http://dx.doi.org/10.2214/ajr.05.0900 [ Links ]
11. Chung DJ, Huh KC, Choi WJ, Kim JK. CT colonography using 16-MDCT in the evaluation of colorectal cancer. AJR. 2005;184(1):98-103. http://dx.doi.org/10.2214/ajr.184.1.01840098 [ Links ]
12. Veerappan GR, Ally MR, Choi JR, Pak JS, Maydonovitch C, Wong RKH. Extracolonic findings on CT colonography increases yield of colorectal cancer screening. AJR. 2010;195(3):677-686. http://dx.doi.org/10.2214/ajr.09.3779 [ Links ]
13. Gluecker TM, Johnson CD, Wilson LA, et al. Extracolonic findings at CT colonography: Evaluation of prevalence and cost in screening population. Gastroenterology. 2003;124(4):911-916. http://dx.doi.org/10.1053/gast.2003.50158 [ Links ]
14. Gluecker TM, Johnson CD, Harmsen WS, et al. Colorectal cancer screening with CT colonography, colonoscopy and double-contrast barium enema examination: Prospective assessment of patient perceptions and preferences. Radiology. 2003;227(2):378-384 http://dx.doi.org/10.1148/radiol.2272020293 [ Links ]
15. Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg. 2008;143(7):701-707. http://dx.doi.org/10.1001/archsurg.143.7.701 [ Links ]
16. Burling D, Halligan S, Slater A, Noakes MJ, Taylor SA. Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology. 2006;239(2):464-471. http://dx/doi.org/10.1148/radiol.2392051101 [ Links ]
17. Pickhardt PJ. Screening CT colonography: How I do it. AJR. 2007;189(2):290-298. http://dx.doi.org/10.2214/ajr.07.2136 [ Links ]
18. Pickhardt PJ, Kim DH. CT colonography: Principles and practice of virtual colonoscopy. Philadelphia: Saunders; 2009. [ Links ]
19. Summers R. The elephant in the room: Bowel preparation for CT colonography. Acad Radiol. 2009;16(7):777-779. http://dx.doi.org/10.1016/j.acra.2009.04.001 [ Links ]
20. Hara AK, Kuo MD, Blevins M, et al. National CT colonography trial (ACRIN 6664): Comparison of three full-laxative bowel preparations in more than 2500 average-risk patients. AJR. 2011;196(5):1076-1082 http://dx.doi.org/10.2214/AJR.10.4334 [ Links ]
21. Dachman AH. Advice for optimising colonic distention and minimizing risk of perforation during CT colonography. Radiology. 2006;239(2):317-321. [ Links ]
22. Sosna J, Bar-Ziv J, Libson E, Eligulashvili M, Blachar A. CT colonography: Positioning order and intracolonic pressure. AJR. 2008;191(4):W175-W180. http://dx.doi.org/10.2214/ajr.07.3303 [ Links ]
23. Burling D, Taylor SA, Halligan S, et al. Automated insufflation of carbon dioxide for MDCT colonography: Distension and patient experience compared with manual insufflation. AJR. 2006;186(1):96-103. http://dx.doi.org/10.2214/ajr.04.1506 [ Links ]
24. Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH. Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR. 2006;186(6):1491-1496. http://dx.doi.org/10.2214/ajr.05.0416 [ Links ]
25. American College of Radiology. ACR practice guideline for the performance of computed tomography (CT) colonography in adults. Revised 2009. [ Links ] [cited 2014 March 01]. Available from: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/CT_Colonography.pdf
26. Talati RK, Dunkin J, Parikh S, Moore WH. Current methods of monitoring radiation exposure from CT. J Am Coll Radiol. 2013;10(9):702-707. http://dx.doi.org/10.1016/j.jacr.2013.03.002 [ Links ]
27. Raman SP, Johnson PT, Deshmukh S, Mahesh M, Grant KL, Fishman EK. CT dose reduction applications: Available tools on the latest generation of CT scanners. J Am Col Radiol. 2013;10(1):37-41. http://dx.doi.org/10.1016/j.jacr.2012.06.025 [ Links ]
28. Brenner DJ, Georgsson MA. Mass screening with CT colonography: Should radiation exposure be of concern? Gastroenterology. 2005;129(1):328-337. http://dx.doi.org/10.1053/j.gastro.2005.05.021 [ Links ]
29. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US multi-society task force on colorectal cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3):130-160. http://dx.doi.org/10.3322/CA.2007.0018 [ Links ]
30. Hough DM, Kuntz MA, Fidler JL, et al. Detection of occult colonic perforation before CT colonography after incomplete colonoscopy: Perforation rate and use of a low-dose diagnostic scan before CO2 insufflation. AJR. 2008;191(4):1077-1081. http://dx.doi.org/10.2214/ajr.07.2746 [ Links ]
31. Copel L, Sosna J, Kruskal JB, Raptopoulos V, Fareell RJ, Morrin MM. CT colonography in 546 patients with incomplete colonoscopy. Radiology. 2007;244(2):471-478. [ Links ]
32. Zalis ME, Barish MA, Choi JR, et al. CT colonography reporting and data system: A consensus proposal. Radiology. 2005;236(1):3-9. http://dx.doi.org/10.1148/radiol.2361041926 [ Links ]
33. Pickhardt PJ, Taylor AJ. Extracolonic findings identified in asymptomatic adults at screening CT colonography. AJR. 2006;186(3):718-728. http://dx.doi.org/10.2214/ajr.04.1748 [ Links ]
34. Pickhardt PJ, Kim DH, Meiners RJ, et al. Colorectal and extracolonic cancers detected at screening CT colonography in 10286 asymptomatic adults. Radiology. 2010;255(1):83-88. http://dx.doi.org/10.1148/radiol.09090939 [ Links ]
35. Pickhardt PJ, Lee AD, Taylor AJ, et al. Primary 2D versus primary 3D polyp detection at screening CT colonography. AJR. 2007;189(6):1451-1456. http://dx.doi.org/10.2214/ajr.07.2291 [ Links ]
36. Pickhardt PJ, Kim DH. Colorectal cancer screening with CT colonography: Key concepts regarding polyp prevalence, size, histology, morphology, and natural history. AJR. 2009;193(1):40-46. http://dx.doi.org/10.2214/ajr.08.1709 [ Links ]
37. Johnson CD, Chen M, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359(12):1207-1217. http://dx.doi.org/NEJMoa0800996 [ Links ]
38. Lawrence EM, Pickhardt PJ, Kim DH, Robbins JB. Colorectal polyps: Stand-alone performance of computer-aided detection in a large asymptomatic screening population. Radiology. 2010;256(3): 791-798. http://dx.doi.org/10.1148/radiol.10092292 [ Links ]
39. Halligan S, Mallett S, Altman DG, et al. Incremental benefit of computer-aided detection when used as a second and concurrent reader of CT colonographic data: Multiobserver study. Radiology. 2011;258(2):469-476. http://dx.doi.org/10.1148/radiol.10100354 [ Links ]
40. Lee SS, Park SH, Kim JK, et al. Panoramic endoluminal display with minimal image distortion using circumferential radial ray-casting for primary three-dimensional interpretation of CT colonography. Eur Radiol. 2009;19(8):1951-1959. http://dx.doi.org/10.1007/s00330-009-1362-1 [ Links ]
41. Yoshida H, Svoboda AC. Within the next five years CT colonography will make conventional colonoscopy obsolete for colon cancer screening. In: Orton CG, Hendee WR, editors. Controversies in medical physics: A compendium of point/counterpoint debates. Maryland: American Association of Physicists in Medicine [cited 2008]. [ Links ] Available from: http://22.214.171.124/pubs/books/PointCounterpointCompedium.pdf#page=245
42. Perisinakis K, Seimenis I, Tzedakis A, Papadakis A, Kourinou K, Damilakis J. Screening computed tomography colonography with 256-slice scanning: Should patient radiation burden and associated cancer risk constitute a major concern? Invest Radiol. 2012;47(8):451-456. http://dx.doi.org/10.1097/RLI.0b013e318250a58c [ Links ]
43. Gonzalez AM, Kim KP, Yee J. CT colonography: Perforation rates and potential radiation risks. Gastrointest Endosc Clin N Am. 2010;20(2):279-291. http://dx.doi.org/10.1016/j.giec.2010.02.003 [ Links ]
44. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007;357(14):1403-1412. http://dx.doi.org/10.1056/NEJMoa070543 [ Links ]
45. Fletcher JG, Chen M, Herman BA, et al. Can radiologist training and testing ensure high performance in CT colonography? Lessons from the national CT colonography trial. AJR. 2010;195(1):117-125. http://dx.doi.org/10.2214/ajr.09.3659 [ Links ]
46. Yee J, Keysor KJ, Kim DH. The time has arrived for national reimbursement of screening CT colonography. AJR. 2013;201(1):73-79. http://dx.doi.org/ajr.13.10656 [ Links ]
Joel Bortz
13031 Villosa Place, Apartment 141
Playa Vista, California 90094
United States of America
Email: firstname.lastname@example.com
Received: 13 Mar. 2014
Accepted: 17 Aug. 2014
Published: 01 Dec. 2014


text:
Moonshine Closing Reception at Gallery Nucleus
A big warm THANK YOU to everyone who came out on Friday for the closing reception and book signing of "Moonshine" at Gallery Nucleus. Nothing could have excited the artists and fans more than seeing all this hard work put together in a perfectly bound arrangement. Not to mention the overwhelming joy of these DreamWorks … Continue reading

subset: commoncrawl


text:
Firmware upgrading has five steps
Insert a blank formatted memory card in the camera.
Turn on your FinePix JX200 / JX205 / JX210 while holding down the [DISP/BACK] button.
The number displayed on the screen is the camera's "CURRENT" firmware version.
Use a fully charged battery.
After checking the firmware version, press the [DISP/BACK] button and then turn off your camera.
You can download the firmware upgrade using the "Downloading the firmware upgrade" link on this page.
|Firmware upgrade
|File name
|Firmware update transfer program for Windows XP users
|File name
|Firmware update transfer program for Windows Vista / 7 users
|File name
|Firmware upgrade
|File name
|Firmware upgrade transfer program
|File name
You can choose either of the following methods.
Before this procedure, the software provided on the CD-ROM bundled with the camera must be installed on the PC.
Both the downloaded firmware upgrade file and transfer program must be placed on the desktop of your PC.
1.Remove all the USB devices connected to the PC except for the mouse.
2.Connect the camera to the PC.
* Refer to the FinePix JX200 / JX205 / JX210 Owner's Manual (p.76) for more information on connecting the camera.
As the software "MyFinePix Studio" is activated automatically after connecting, this software must be stopped before the next procedure.
3.Invocation for the transfer program
Double-click "FPUPDATE.DAT" file on desk top of your PC
Click the [OK] button on the dialog.
Click the [Exit] button on the dialog.
4.Turn off the camera.
5.Disconnect the camera from the PC.
This completes the copying procedure of the firmware update to the memory card.
For the next step, keeps the memory card containing the copied firmware update in the camera.
Check the memory card containing the copied firmware update into the camera.
Always use a fully charged battery when updating the firmware.
*Use a fully charged battery.
Press the [OK] button.
Press the [OK] button.
(The screenshot is an example of firmware upgrade from version 1.00 to version 1.02)
The firmware updating has started.
It takes about 5 seconds for completing the firmware update.
When this screen appears, the firmware update has been successfully completed.
Following the procedure in step 1) "Check the firmware version," confirm the current firmware version.
Cf. Please reformat the media before taking pictures.


text:
Nonna's Italian Kitchen: Delicious Home-Style Vegan Cuisine -- 20% OFF!
Quantity in Basket:
Code: Nonna's Italian Kitchen
Shipping Weight: 0.00 pounds
NONNA'S ITALIAN KITCHEN: DELICIOUS HOME-STYLE VEGAN CUISINE by
Bryanna Clark Grogran -- 20% OFF THE RETAIL PRICE OF
Many regional Italian dishes are traditionally vegetarian, focusing on grains, legumes,
vegetables, and fruits. If you are vegan, lactose-intolerant, or trying to lower your
cholesterol, you can still make delicious Italian fare! Vegan cooking expert Bryanna
Clark Grogan takes you on a tour of tempting possibilities, enriched by her Italian heritage,
and reveals how Italian cooks work their culinary magic. (paperback, 255 pages.)


text:
Friday, June 8, 2012
* Homemade Father's Day Gift - Backrub T-Shirt
I wanted to share a homemade gift idea with you
that is easy to make with your kids and you may even
have all of the supplies you need to make it in the house!
P.S. Your Hubby will love it too!
The girls and I always try to make gifts for Geoff
that are useful as well as creative.
This year, while trolling Pinterest, I came across
an image of a back massage t-shirt and knew it was the perfect
kid-made gift for daddy this Christmas.
It would be a fantastic Father's Day gift too!
You draw a map on the backside of a t-shirt and the kids
drive cars all over daddy's back to give him a "massage."
There was a lot of giggling when he opened it -- from daddy and his girls!
provided templates but we like to do things our own way.
We raided one of Geoff's white t-shirt style, 100% cotton, undershirts.
Then, we folded up some newspaper and put it inside to keep the ink
from bleeding through to the front of the t-shirt.
We thought about using fabric crayons or markers
but decided to use what was in the house
and it's probably not going to be worn or washed that much anyway!
So, we got out our permanent markers.
I marked off some roads and "E" got to work adding the yellow dotted lines.
Then, both girls colored houses, a coffee shop,
parking lots, a football stadium (On Wisconsin!)
a play ground, and traffic lights.
So many fun details.
They named it "Dad-Ville."
After all of the details were in,
we put it in a gift box with some new Matchbox cars.
The idea is that Geoff will wear the shirt and lay down on the floor
while the girls drive cars all over his back! : )
We had fun working on it and their daddy loves it.
Happy Homemade Gift Making!
For more homemade gift ideas,
check out my Pink and Green Mama Crafts
Pink and Green Mama
Posted by pink and green mama MaryLea
Labels: DIY T-Shirt, Father's Day, Homemade Gifts
Blog Archive
- ► 2013 (74)
- * Tiny Tooth Fairy Package and Letter From Leafcut...
- * Summer Wish Flags (Summer To-Do List Modified)
- * Catching Fireflies Review and Giveaway!
- * Happy Birthday Eric Carle! Hungry Caterpillar Co...
- * Mouse Painting With Cotton Balls and Q-Tips insp...
- * Painted Rainbow Doily Bag Tutorial
- * Scissor Practice - Paper Cutting Box
- * I'm A Melissa and Doug Camp Sunny Patch Honor Co...
- * Color Your Own Coloring Book With Ikea Bird Fabr...
- * Artsy Crafty Goodness Around Our House This Past...
- * Organizing Paper In The Art Studio and Craft Roo...
- * Homemade Father's Day Gift - Backrub T-Shirt
- * Ice Cream Theme Sensory Box
- * Wrapping Up Another School Year - Help Your Chil...
- * Celebrating The End Of The School Year!
- ▼ June (15)
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text:
In Memoriam
NCLB Update
Testing Items
Teacher Workshops
Charter Schools Week
Mentoring Program
Helping America's Youth
Upcoming Events
In Memoriam
In response to the horrific attacks on the campus of Virginia Tech University, President Bush and Secretary Spellings issued the following statements:
"Our nation is shocked and saddened by the news of the shootings at Virginia Tech today.... I've spoken with Governor Tim Kaine and Virginia Tech President Charles Steger. I told them that Laura and I and many across our nation are praying for the victims and their families and all the members of the university community who have been devastated by this terrible tragedy. I told them that my administration would do everything possible to assist with the investigation, and I pledged that we would stand ready to help local law enforcement and the local community in any way we can during this time of sorrow.... Schools should be places of safety and sanctuary and learning. When that sanctuary is violated, the impact is felt in every American classroom and every American community."
|President George W. Bush (4/16/07)
"As the mother of a daughter in college, my heart goes out to the parents of the students who lost their lives and to the entire Virginia Tech community on this sad day. My Department is working with the White House and other agencies to identify what resources can be provided to Virginia Tech as they assess their needs."
|Secretary of Education Margaret Spellings (4/16/07)
A presidential proclamation honoring victims of the tragedy is available at http://www.whitehouse.gov/news/releases/2007/04/20070417.html.
NCLB Update
On April 12, the President and Secretary met with a group of education, business, and civil rights leaders at the White House to discuss reauthorization of the No Child Left Behind Act. The attendees recommended some changes but were unified on the need to renew the law. "I believe the No Child Left Behind Act needs to be reauthorized because it's working," the President noted. "It's a piece of legislation which believes in setting high standards and using accountability to make sure that every single child receives a good education." For more information, please go to http://www.whitehouse.gov/news/releases/2007/04/20070412.html.
Then, a day later, the President and Secretary met with parochial school leaders and parents. "We want every school, public or parochial, to meet expectations and to give our children the skill sets necessary to realize the great promise of the country," the President said, praising the Catholic school system for often educating the neediest students and supplying a school choice. "Parental choice is a very important part of educational excellence." For more information, please go to http://www.whitehouse.gov/news/releases/2007/04/20070413-4.html.
This week, the Secretary returned to the Gulf Coast to launch the 2007 Gulf Coast Summer Reading Initiative. The initiative, a public-private partnership between the Department, First Book, and Scholastic, will provide new books to replenish schools, libraries, community organizations, and homes. For more information, please go to http://www.ed.gov/news/pressreleases/2007/04/04182007.html.
Testing Items
Approaching the end of the school year, thoughts turn to testing. Here is some key news from that front.
Nine states (AR, IN, KY, MD, MA, NJ, OH, PA, and RI) have agreed to share an Algebra II end-of-course assessment from Pearson Educational Management. The test should be ready for implementation next spring, although not every state will use it immediately. The only other such test-sharing agreement is among four New England states (ME, NH, RI, and VT), spanning third- through eighth-grade. For more information, please go to http://www.achieve.org/node/836/.
ACT's latest national curriculum survey highlights the persistent gap between what high schools are teaching and what colleges want incoming students to know. Specifically, high schools tend to offer less in-depth instruction of a broader range of skills and topics, while colleges often seek students with a more in-depth understanding of a selected number of fundamental skills. Why the disconnect? According to ACT, the primary problem is state academic content standards, which teachers are required to follow. Therefore, many states are creating P-16/20 councils to coordinate goals and expectations across all the levels of education. For more information, please go to http://www.act.org/path/policy/reports/curriculum.html.
"Beating the Odds," the Council of the Great City School's annual analysis of state-mandated tests in 67 big city school districts in 37 states, reveals urban systems are continuing to improve in reading and math. Indeed, 55% of students scored proficient or above in fourth-grade reading in 2006 (a gain of 12 percentage points from 2002), and 42% were proficient or above in eighth-grade reading (a gain of eight percentage points from 2002). In math, 59% of students scored proficient or above in fourth-grade during 2006 (a gain of 15 percentage points from 2002), while 46% were proficient or above in eighth-grade (a gain of 11 percentage points from 2002). Several urban districts (five in reading and seven in math) had both fourth- and eighth-grade scores equal to or greater than their own states, and the proficiency gap between urban systems and their respective states generally declined. Moreover, within districts, racial proficiency gaps are narrowing. For more information, please go to http://www.cgcs.org/publications/achievement.aspx.
Also, on April 19, the Department released state-by-state data on the Reading First program. Students in Reading First schools largely recorded impressive gains on standardized tests in reading fluency and comprehension from 2004 to 2006. For more information, please go to http://www.ed.gov/news/pressreleases/2007/04/04192007.html.
Teacher Workshops
This summer, the agency is sponsoring 19 Teacher-to-Teacher regional workshops for teachers to learn from fellow educators who have had success in raising student achievement. Each workshop focuses on a specific subject or subjects (math and science, history, art, etc.) Registration is free, and meals/refreshments will be supplied during scheduled activities, but participants are responsible for transportation and lodging. For more information, please go to http://www.t2tweb.us/Workshops/Schedule.asp. (Registration is already underway for several venues. The remaining venues will be posted shortly.)
Charter Schools Week
From April 30 to May 4, charter advocates, students, teachers, and parents will celebrate the important role high-performing charter schools play in the American public education system. This year's theme is "Closing the Gap." The week is also an excellent opportunity to spread the word about the more than 4,000 charter schools serving over a million children in 40 states and the District of Columbia. To help, the National Alliance for Public Charter Schools has developed a detailed toolkit. For more information, please go to http://www.publiccharters.org/content/publication/detail/1866/.
Note: In the week preceding National Charter Schools Week, Secretary Spellings will keynote the seventh-annual National Charter Schools Conference in Albuquerque. For more information, please go to http://www.nationalcharterconference.org/.
Mentoring Program
The Safe and Drug-Free Schools' Mentoring Program promotes mentoring activities for at-risk children that (1) assist such children in receiving support and guidance from a mentor; (2) improve academic performance; (3) improve interpersonal relationships with peers, teachers, family members, and other adults; (4) reduce the dropout rate; and (5) reduce juvenile delinquency and involvement in gangs. To be eligible for funding, projects must be school-based and serve students in one or more grades (4-8) living in high-crime areas, troubled-home environments, or rural areas or who attend campuses with violence problems. The deadline for applications is May 23. For more information, please go to http://www.ed.gov/programs/dvpmentoring/.
Helping America's Youth
On April 11 and 12, First Lady Laura Bush hosted a regional conference on Helping America's Youth at Tennessee State University in Nashville. The first day of the event was dedicated to hands-on training on the Community Guide to Helping America's Youth, a web-based tool to assist communities in coordinating resources and tracking effective programs. On the second day, the First Lady addressed attendees and joined local, regional, and state leaders for panels on challenges facing youth and successful methods for positive development. For more information, please go to http://www.helpingamericasyouth.gov/.
Upcoming Events
The Department's next "Education News Parents Can Use" broadcast, on teacher quality, is scheduled for May 15. For more information, please go to http://www.ed.gov/news/av/video/edtv/.
Over the next two weeks, the Department will be exhibiting at the White House Initiative on Educational Excellence for Hispanic Americans' American Competitiveness Initiative (ACI) conference in El Paso (April 23-25), the Literacy Station Project in Santa Fe (April 29), and the Asian-Pacific American Federal Career Advancement Summit here in Washington, D.C. (May 3). If you are attending any of these events, please stop by the Department's booth.
Credits, Subscribe & Unsubscribe
Please feel free to contact the Office of Communications and Outreach with any questions:
Director, Intergovernmental AffairsRogers Johnson, (202) 401-0026, email@example.com
Deputy DirectorMarcie Ridgway, (202) 401-6359, email@example.com
Program AnalystAdam Honeysett, (202) 401-3003, email@example.com
To be added or removed from distribution, or submit comments (we welcome your feedback!), please contact Adam Honeysett. Or, visit http://www.ed.gov/news/newsletters/edreview/index.html.
This newsletter contains hypertext links to information created and maintained by other public and private organizations. These links are provided for the user's convenience. The U.S. Department of Education does not control or guarantee the accuracy, relevance, timeliness, or completeness of this outside information. Furthermore, the inclusion of links is not intended to reflect their importance, nor is it intended to endorse any views expressed, or products or services offered, on these sites, or the organizations sponsoring the sites.


text:
Arlene Greenfield
Photo courtesy of: Patton College of Education
Oct 18, 2012
By Mary Beth Gillom
"Philanthropy, in a very simple definition, is contributing of one's time, talent or treasure. ... Oftentimes, it's not all three at one time. Sometimes it's way down the line that you give your treasure."
Arlene Greenfield shared these and many other words of wisdom with students and faculty of The Patton College of Education as the first fall semester Violet L. Patton Lecture Series speaker on Oct. 15 in McCracken Hall.
Greenfield's extensive biography boasts several philanthropic organizations, including Women in Philanthropy at Ohio University, as well as multiple senior-level command and staff assignments in the U.S. Army during her 30 years of service. She began her lecture with what she described as "the condensed, 'Cliff's notes' background of women in the army."
According to Greenfield, the story of women in the army begins with the birth of our nation and women such as Margaret Corbin and Molly Pitcher. Her summary continued through the 18th and 19th centuries,
when women "got around the rules by masquerading as men," until her own decision to join the Women's Army Corps during her senior year at Ohio University in 1971.
Field training was much different for women during the '70s, compared to what they experience today.
Greenfield described her first "overnight" - as opposed to the weeks that the army spends outdoors to train now – when, because it rained, the women were sent back indoors.
"Really, when I think about the evolution and the changes since then ... it's been giant leaps, even though, as with many areas, we often think, 'Why isn't this happening fast enough?,'" said Greenfield.
"The military is a microcosm of society."
Greenfield said in her description of the slow transition to accepting women in the military. She also acknowledged that the process is not finished, citing the examples of sexual harassment that we hear about today. She said that she handled the reluctance within the ranks to change by deciding simply to do the job she was assigned to do, while using the resources and individuals that were available to help her through the frustrating times.
Greenfield's lecture concluded with the advice to students that even though many of them won't end up actually working in their fields of study at college, they should continue the process of "learning to
learn," as she did in her seemingly surprising shift from studying Home Economics to becoming a colonel in the U.S. Army.


text:
I love how you keep using YOURSELF as an example of average consumers.
I'm not saying I'm average, but the service I bought is readily available where I live. As more and more people use streaming services like Netflix the popularity of such offerings will go up.
I know lots of people that download all the TV series/movies they watch. Streaming puts higher demands on bandwidth than downloading, particularly if you want to do other things at the same time without interference.
The availability of higher bandwidth will, over time, lead to that bandwidth being utilized by more and more people. I can get 100Mbit for $10 more per month, I didn't bother because I'm not even sure how that would benefit me right now, but it was tempting to bump up to 250mbit as its not that much more expensive and bound to be awesome. Maybe if I had a house full of media consuming teenagers.
Not everyone is going to utilize more than 10, or 20 Mbit internet connections, but you're only justifying your own circumstances if you think people can't, or that only outliers will.
of course outliers exist. I clearly said so in the past. and they actually help drive it for everyone else.
And here is the thing--even you couldn't justify to yourself to get double the bandwidth for only $10 more per month (what is that--25% extra?). And here is the thing--you admit you are nothing like the normal consumer, way higher demands and expectations. So if you couldn't justify it, how would normal consumers?
Difference is, I may not know what to do with that much bandwidth today, but I expect it will all get utilized in the future.
As for the US being a unique snowflake, bull fucking shit, the only thing unique is you allow companies to profiteer, without actually providing service. The US spend huge amounts of taxpayer money to improve Internet speeds via grants and tax breaks and all you got to show for it was companies with higher profit margins and shit broadband speeds. You have private companies challenging the rights of a community to set up their own networks if even a single person in that district could signup for a commercial service. They repeatedly game the system to not provide services and to artificially restrict where, when and how it's used.
I can get better service in the middle of nowhere in Canada than many people in large metropolitan area in the US.
For $120/month I can sign up for 250Mbit in several Canadian cities, I can get 10-20 Mbit well into farm country, and 2-3+Mbit virtually everywhere. (Churchhill is one of the only exceptions, but then there aren't any roads to Churchhill for over half the year either)


text:
Deloitte Insights
Fraud, Waste, and Abuse
Fraud, waste, and abuse are perennial problems for government benefit programs. To make their anti-fraud dollars work harder and smarter, agencies can build platforms that combine predictive analytics, behavioral economics, and collective intelligence into a holistic enterprise system, coordinating data from across the enterprise while remaining agile enough to respond to new vulnerabilities.
Deloitte Insights
Government's cyber challenge: Protecting sensitive data for the public good
For government, cybersecurity isn't only a challenge—it's a big obstacle to long-awaited digital transformation. Plus, the stakes are sky-high: Hacking public-sector information might imperil national security as well as citizens' trust. Is government up to the task?
Deloitte Insights
Employees as customers: Reimagining the employee experience in government
As governments look to build a workforce able to tackle the tough, interconnected challenges of the 21st century, strengthening the government employee experience is particularly critical. By treating employees as customers, agencies have the chance to improve both the employee experience and their own ability to execute their mission.
Deloitte Insights
Comparing economies: How is economic size measured and why does it matter?
How do we compare economies? GDP is generally measured in a country's own currency, but for comparing economies, one must convert to a common measure. The choice of conversion factor can make a huge difference in our understanding of relative size.


text:
Arsenal goalkeeper signs for Sunderland
Sunderland have filled the void left by Simon Mignolet by completing the signing of Arsenal's third choice goalkeeper Vito Mannone.
Mignolet's move to Liverpool had left the Black Cats manager Paolo Di Canio with good amount of money for a complete overhaul for his squad.
He seems to have a plan to replace the entire spine of his squad and the Sunderland scouts were having the busiest days in summer so far.
They were linked to Tottenham Hotspur playmaker Tom Huddlestone among many other stars. Sunderland have already roped in quite a number of free agents to their roster as well.
Signing the talented Gunner is part of the overhaul he is planning and the keeper is expected to provide a battle for the number one spot.
Mannone has just made 23 appearance for Arsenal so far in his career. This includes some fantastic performances in high-profile matches as well.
His outstanding performances came against the likes of Stoke City, Liverpool and Manchester City in Arsenal's Premier League outings.
This seems to have increased his stock and the reason behind Sunderland's acquisition of the Italian custodian. Those performances were analysed thoroughly and their verdict was he is ready for Premier League.
His performances during loan spells at Barnsley and Hull City in npower Championship also helped him to secure a move to the Premier League club.
Mannone joins the Black Cats on a two-year deal for an undisclosed free. He is expected to challenge Kieran Westwood for the goalkeeping spot.
With a complete overhaul in Sunderland set up, one cannot rule out the possibilities of further additions as well.
Write for GiveMeSport! Sign-up to the GMS Writing Academy here: http://bit.ly/12evFlH
DISCLAIMER: This article has been written by a member of the GiveMeSport Writing Academy and does not represent the views of GiveMeSport.com or SportsNewMedia. The views and opinions expressed are solely that of the author credited at the top of this article. GiveMeSport.com and SportsNewMedia do not take any responsibility for the content of its contributors.News Now - Sport News


text:
Recently, launched Ready To Wear on its e-commerce site to add to it's allotment of bags, shoes and accessories. The launch was accompanied by a photo shoot of Rose Gilroy, daughter of Rene Russo, and the team at Ferragamo had exclusive images shot for PurseBlog of the bag with Rose that can only be seen here. The bag is theFerragamo Gancio Clip Top Handle Bag and it's a bag that I really love and covet, especially when thinking about finding a new exquisite black bag.
The photos themselves are stunning, with Rose Gilroy wearing all shoppable trends that are standout pieces from the Fall Winter 2016 Ferragamo runway collection. I've said it many times before, but I'm a Ferragamo girl. I don't have one Ferragamo bag that has fallen apart or not lived up to the standards I'd expect and the shoes are some of the most comfortable compared to all designer shoes on the market.
While this campaign, set in a quintessentially dreamy NYC townhome, featured more stand-out bags and outfits on Rose Gilroy, there's one specific bag that was the focus for us. The Ferragamo Gancio Clip Top Handle Bag fits the category of the perfect black bag for so many reasons. First off, it's stunning. This bag is a standout from the moment you look at it and I always find myself appreciating how Ferragamo rests on the simplicity and beauty of its designs versus over-the-top embellishments. Secondly, this bag is practical and easy to wear and carry, with dimensions of 10.2" x 12.9" x 5.1" and an ample 8" drop shoulder strap (which is also adjustable). You can easily carry this bag on a daily basis and it will stand the test of time with both the quality and style. The interior features a zip pocket and the exterior has easy access back pockets. Price of the bag is $3,200
Ferragamo Gancio Clip Top Handle Bag


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Here are the rules:
- §1 This game is called Nomy, and is a game of Nomic.
- §2 Players may make one motion to change the rules per post.
- §3 Motions are decided by the next player who posts. They can either be accepted or refused.
- §4 If a motion is accepted, the rules have to be updated in that post.
- §5 Double Posting is forbidden.
- §6 The winner shall be the first person to get 3 motions accepted. The winner of Nomy shall get 10 points, and everyone who participates 3 points
The points referred to are in the parent Nomic game.
I make a motion to require that the third motion in this game of Nomy involve ninjas.


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23 Kan. App. 2d 889
No. 75,3281
JOHN L. VAKAS, M.D., Appellant, v. KANSAS STATE BOARD OF HEALING ARTS, Appellee.
1. One of the eight factors to be considered in determining whether to reinstate a medical license is the nature and seriousness of the original misconduct.
2. In considering the nature and seriousness of the original misconduct, the factual conclusions of the revocation order must be accepted as what was proven in the hearing. The question of what misconduct was established cannot be relitigated.
3. The scope of judicial review of an agency action in revoking a medical license is limited by K.S.A. 77-621.
4. The findings of the Kansas State Board of Healing Arts in a medical license revocation proceeding are presumed valid on review.
5. In determining whether substantial evidence supports an agency action, the reviewing court may not set aside an agency order merely because it would have reached a different conclusion if it had been the trier of fact. Instead, the evidence must show that the agency's determination was so wide of the mark as to be outside the realm of fair debate.
6. The burden of proving the Kansas State Board of Healing Arts has erred in denying reinstatement of a license is on the appellant.
7. The person whose medical license has been revoked has the burden of proving by clear and convincing evidence that he or she is sufficiently rehabilitated to justify reinstatement of his or her license.
8. K.S.A. 65-2844 provides that if the Kansas State Board of Healing Arts determines that a person's medical license shall not be reinstated, that person shall not be eligible to reapply for reinstatement for 3 years. The Kansas State Board of Healing Arts may offer applicants relief from the 3-year waiting period through additional requirements. These are not conditions of reinstatement. Applicants are free to wait 3 years and reapply without doing the things recommended by the Board.
Appeal from Shawnee District Court; FRED S. JACKSON, judge. Opinion filed February 28, 1997. Affirmed.
Daniel E. Monnat, of Monnat & Spurrier, Chartered, of Wichita, for the appellant.
Mark W. Stafford, of Topeka, for the appellee.
Before MARQUARDT, P.J., PIERRON, J., and ROGG, S.J.
PIERRON, J.: Appellant John L. Vakas filed an application with the Kansas State Board of Healing Arts (Board) for reinstatement of his license to practice medicine. The Board denied the application, and appellant appeals the district court's order upholding the Board's decision. We affirm.
Appellant was granted a license to practice medicine in 1966. In 1985, the Board issued an emergency order prohibiting him from selling, dispensing, administering, or prescribing controlled substances. In 1988, the Board revoked appellant's license to practice medicine and surgery. He did not appeal the revocation. In 1989, appellant filed an application for reinstatement of his license to practice medicine. The Board's denial of the application was upheld by the district court, and then the Kansas Supreme Court in Vakas v. Kansas Bd. of Healing Arts, 248 Kan. 589, 608, 808 P.2d 1355 (1991).
Appellant filed another application for reinstatement of his license in 1992, which is the subject of this appeal. The hearing officer issued an initial order recommending that appellant's license be reinstated upon his successful completion of the SPEX examination (which tests medical knowledge) and that he not be permitted to prescribe controlled substances upon reinstatement. Appellant petitioned for the Board to review this order. The Board's final order denied the application for reinstatement, and appellant requested judicial review of the final order. The district court affirmed the decision of the Board.
One of the eight factors to be considered in determining whether to reinstate a medical license is "the nature and seriousness of the original misconduct." Vakas, 248 Kan. 589, Syl. ¶ 2. Appellant appears to argue that this allows for an essentially de novo review of the underlying decision.
The final order revoking appellant's license was issued on May 6, 1988, and he did not appeal from the revocation order. Therefore, the Board's findings of fact with respect to the revocation became final and conclusive and must be accepted as true. See Crawford v. Prudential Ins. Co. of America, 245 Kan. 724, 728, 783 P.2d 900 (1989); Palmer v. State, 10 Kan. App. 2d 656, 657, 707 P.2d 1091, rev. denied 238 Kan. 878 (1985).
The actions constituting the original misconduct were determined in the 1988 revocation order. In considering the nature and seriousness of the original misconduct, the factual conclusions of the order must be accepted as what occurred and was proven in the hearing. The question of what misconduct was established cannot be relitigated. It would not be appropriate for any hearing officer or court to review the original transcript and make contrary conclusions or findings.
Appellant emphasizes that this appeal may be his only opportunity to have the revocation hearing transcript reviewed. Any opportunity for complete review of that transcript and subsequent findings has passed. The only opportunity for a thorough review of that transcript would have been in a direct appeal from the revocation order.
The majority of appellant's arguments are attempts to challenge the sufficiency of the evidence in the revocation proceeding. This is improper. The findings of fact made at the time are final and binding. There is no necessity for the original transcript or the testimony of witnesses at that hearing to be reviewed and completely reevaluated in connection with this proceeding.
The next issue we must address is whether the Board acted improperly in refusing to grant appellant's application for reinstatement.
This case involves judicial review of an agency action. The scope of review is limited by K.S.A. 77-621. Appellant does not clearly identify the basis of his claim that the Board improperly refused to reinstate his license, but his brief indicates he is relying on K.S.A. 77-621(c)(7) and (8). These provisions permit the court to reverse an agency action when the action is not supported by substantial evidence when viewed in light of the record as a whole, or when the agency action is otherwise unreasonable, arbitrary, or capricious.
In Vakas, 248 Kan. 589, Syl. ¶ 2, the Kansas Supreme Court listed eight factors to be included when considering whether a license to practice medicine should be reinstated. These are (1) the present moral fitness of the petitioner; (2) the demonstrated consciousness of the wrongful conduct and disrepute which the conduct has brought the profession; (3) the extent of petitioner's rehabilitation; (4) the nature and seriousness of the original misconduct; (5) the conduct subsequent to discipline; (6) the time elapsed since the original discipline; (7) the petitioner's character, maturity, and experience at the time of the original revocation; and (8) the petitioner's present competence in medical skills.
The Vakas opinion also states the applicable standard of review. The agency's findings are presumed valid on review. In determining whether substantial evidence supports the agency action, the reviewing court may not set aside an agency order merely because it would have reached a different conclusion if it had been the trier of fact. Instead, the evidence must show that the agency's determination was so wide of the mark as to be outside of the realm of fair debate. 248 Kan. at 603. In determining whether the action was unreasonable, arbitrary, or capricious, the court must consider whether the agency acted without regard to the benefit or harm to all interested parties, or whether a particular action is justified or was done without foundation in fact. 248 Kan. at 604.
The burden of proving that the Board erred in denying reinstatement is on appellant. See 248 Kan. at 602. He also has the burden of proving by clear and convincing evidence that he is sufficiently rehabilitated to justify reinstatement of his license. See K.S.A. 65-2844.
In his brief, appellant discusses the evidence from the revocation hearing and concludes there was no serious misconduct shown. He then uses his belief that the original revocation was unjustified to argue summarily that most of the other seven factors are not relevant.
Appellant's attitude toward the reinstatement process is evident in a transcript from a Board meeting held on April 21, 1992. His application for reinstatement had just been deemed complete, and there was a discussion on how to proceed. The Board noted that some of the letters provided by appellant's doctors indicated he might not have the physical ability to practice medicine, and some letters stated he had a depressive mood disorder. The question of whether appellant was current in his medical knowledge was also raised.
The Board said it needed to resolve these issues and needed more information before it could evaluate the application. It requested that appellant be evaluated by a doctor designated by the Board, undergo a psychiatric evaluation, take the SPEX test to verify that his medical knowledge was current, and either take a test to determine whether he was physically capable of practicing medicine or get clearance from his treating physician that he was physically able to practice. Appellant refused to consider any of these, stating they were more stumbling blocks from the people who had persecuted and destroyed him.
Appellant appears unwilling to take reasonable steps to affirmatively establish his current knowledge and abilities. He did not meet his burden of showing he was sufficiently rehabilitated to justify reinstatement of his license. The Board's decision to deny his application is supported by substantial evidence and is not unreasonable, arbitrary, or capricious. No basis for reversing the agency action has been shown.
Appellant also contends the Board lacks the authority to impose conditions or restrictions on reinstatement of a medical license. The specific areas addressed by him are whether the Board can restrict his license by prohibiting him from prescribing controlled substances and whether the Board can condition reinstatement on his taking the SPEX examination and testifying before the Board. These issues are not properly before this court.
The Board denied appellant's application for reinstatement. It did not attach conditions or restrictions to the reinstatement of the license. There is no actual controversy regarding these matters before the court, and this court does not render advisory opinions. See Shanks v. Nelson, 258 Kan. 688, 907 P.2d 882 (1995); Carr v. Diamond, 192 Kan. 377, 380, 388 P.2d 591 (1964).
The Board's decision does refer to the SPEX examination, but does not make the taking of the examination mandatory. K.S.A. 65-2844 provides that if the Board determines that a license shall not be reinstated, the person shall not be eligible to reapply for reinstatement for 3 years. In its order, the Board offered appellant relief from this 3-year waiting period. If he obtained a sufficient score on the SPEX examination and was willing to testify before the Board about his rehabilitation and ability to practice medicine, then the Board would consider an application for reinstatement prior to the expiration of 3 years. However, this was not a condition to reinstatement. Appellant is free to wait 3 years and to reapply without doing the things recommended by the Board.
1REPORTER'S NOTE: Previously filed as an unpublished opinion, the Supreme Court granted a motion to publish by an order dated May 5, 1997, pursuant to Rule 7.04 (1996 Kan. Ct. R. Annot. 40).


text: August 14, 2001 - Green Leads Pack Among Likely Dem Voters, Quinnipiac University Poll Finds; Two-Thirds Say They Might Change Their Mind Public Advocate Mark Green holds a strong lead among likely Democratic primary voters, but falls short of the 40 percent needed to avoid a primary runoff election, according to a Quinnipiac University poll released today. Among likely Democratic voters: Green gets 36 percent; Comptroller Alan Hevesi gets 19 percent; City Council Speaker Peter Vallone gets 17 percent; Bronx Borough President Fernando Ferrer gets 14 percent. Among these likely voters, 65 percent say they might change their mind before the September 11 primary election, while 35 percent say their mind is made up. From August 6 - 12, Quinnipiac University surveyed 330 New York City likely Democratic primary voters, with a margin of error of +/- 5.4 percent. "No matter how you measure it, Public Advocate Mark Green is the front- runner. The question is whether he gets to 40 percent or faces one of the other three in a runoff," said Maurice Carroll, director of the Quinnipiac University Polling Institute. "There's four weeks to go, with 14 percent of Democratic likely voters still undecided and 65 percent saying they might change their minds." Among all New York City registered Democrats: Green gets 32 percent; Hevesi gets 18 percent; Vallone gets 15 percent; Ferrer gets 14 percent. The survey includes 713 registered Democrats with a margin of error of +/- 3.7 percent. This compares with a July 25 poll by the independent Quinnipiac University where Green got 30 percent of registered Democrats, followed by 18 percent for Ferrer, 17 percent for Hevesi and 16 percent for Vallone. By a 52 - 15 percent margin, New York City likely Democratic primary voters have a favorable opinion of Green, with 21 percent mixed and 11 percent saying they don't know enough to form an opinion. Favorability ratings among other Democratic candidates are: Favorable Unfavorable Mixed No Opinion Hevesi 36% 13% 30% 20% Vallone 33 15 30 20 Ferrer 35 16 26 22 "When we shift from measuring registered Democrats to likely Democratic primary voters, we see an increase in support for Green, a big jump in his favorability rating and a big drop in the number of those who `haven't know enough,'" Carroll said. "The magic number for Green in the next 28 days is 40." The Quinnipiac University Poll, directed by Douglas Schwartz, conducts public opinion surveys in New York, New Jersey and Connecticut as a public service and for research. For additional data -- www.quinnipiac.edu or call (203) 582-5201 2. Is your opinion of Fernando Ferrer favorable, unfavorable, mixed, or haven't you heard enough about him? Likely Democratic Primary Voters Favorable 35% Unfavorable 16 Mixed 26 Hvn't hrd enough 22 REFUSED 2 3. Is your opinion of Alan Hevesi favorable, unfavorable, mixed, or haven't you heard enough about him? Likely Democratic Primary Voters Favorable 36% Unfavorable 13 Mixed 30 Hvn't hrd enough 20 REFUSED 1 4. Is your opinion of Mark Green favorable, unfavorable, mixed, or haven't you heard enough about him? Likely Democratic Primary Voters Favorable 52% Unfavorable 15 Mixed 21 Hvn't hrd enough 11 REFUSED 1 5. Is your opinion of Peter Vallone favorable, unfavorable, mixed, or haven't you heard enough about him? Likely Democratic Primary Voters Favorable 33% Unfavorable 15 Mixed 30 Hvn't hrd enough 20 REFUSED 2 6. If the Democratic Primary for New York City Mayor were being held today, and the candidates were Fernando Ferrer, Peter Vallone, Mark Green and Alan Hevesi for whom would you vote? Likely Democratic Primary Voters Ferrer 14% Vallone 17 Green 36 Hevesi 19 SMONE ELSE(VOL) - DK/NA 14 8. Is your mind made up, or do you think you might change your mind before the election? Likely Democratic Primary Voters Made up 35% Might change 65 DK/NA 1


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Before there was How I Met Your Mother, there was Friends. Thing is, I never watched Friends as a teen growing up in the 90's. I know, I missed out. After falling in love with How I Met Your Mother and because everyone compared it to Friends (even the producers of HIMYM admit that it pays homage to Friends) I decided to give it a go.
It helped that my roommate owns the complete Friends series on DVD. So, about 2 years back I began my Friends education, starting with Season one. I'm currently on Season 5, and I admit, Friends is awesome stuff and I'm a bit ashamed that I missed out on this piece of pop culture growing up.
So what's the point, you wonder? Well, I found out that there's a Friends fanatic in the lab that I work at. He claims to have seen every episode from season 4 on at least three times. He likes to ask people random Friends Trivia. He has all of season 5 on his iPhone. Anyway, I overheard him asking some Friends trivia the other day, and surprisingly, I knew the answers (at least up to Season 5). I was stoked, and that actually made me want to watch even more episodes of Friends just so that I could come up with a good trivia question for our Friends fanatic.
The one With All The Thanksgivings was a great episode. Incidentally, that's where I'm at now and what's even better is that that episode is breading ground for good Friends trivia. So I came up with a question from that episode that actually stumped him. The question?
What was the name of Chandler's band in college?
He didn't get it! And I was so happy.
By the way, you can pick up the official Way, No Way vintage style T-Shirt from the NBC Store for $25. And in case you're wondering, you can also pick up Friends: The Complete Series Collection from Amazon for $144.99.


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Explore the Possibilities. Create a Spark. Inspire Change. Transform Lives.
Empower an Entire Community
By funding a project you take direct action to enable a struggling community.
How it works:
You choose the project and help to fund the gifts of livestock, training for the community and veterinary care needed to make the project successful.
Your contribution allows Heifer to work with the community to develop farms, businesses and education required for those in need to rise from chronic poverty.


text:
The most effective and economical global security system ever engineered. Over 60 million hacks blocked, thousands of hackers shut down and many active prosecutions. Now you can get this Proven Next Generation patented system for your website or server for an amazing low price of just $9.95 per month per domain. Never worry about your security again!
- Real Time Hacker Prevention
- Robust Alerting & Reporting
- Law Enforcement Interface
- Just Pennies A Day
Web security has fast become a serious issue when it comes to websites, intellectual property and customer data. If you have been looking for a serious and proven security solution for your website, look no further. SecureLive is an advanced security system designed to seamlessly integrate into a variety of platforms including: Joomla security, WordPress security, Drupal security, and E107 security. Coming soon is support and security for Magento, PHPNuke, Xoops, SecureCart, and SecureForm.
With a simple plugin installation and activation, you will immediately begin blocking hackers and seeing reports of the malicious activity on your site. SecureLive goes one step further and reports the hackers to the appropriate authorities.
- Patent pending technology: (CST) Continuous Scan Technology
- Live real-time monitoring
- Tested 98% effective against hacking and online theft
- Endorsed by industry experts in independent testing
- Advanced custom user security controls to fit your site
- Blocks intruders before attack through advanced recognition
- Email alerts and text via mobile devices to client and monitors
- Logs all violations and captures attacker signature
- Forwards attacker profiles to proper authorities
- Reduces attacks through systematic banning of violators


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Project Leader, Bogotá
At BCG, Challengers go against expected thinking and inspire their teams to be truly innovative. Mauricio empowers and inspires others.
All expectations about working in business consulting with BCG have been fulfilled.
After few months as an associate in the New York office, I received the good news that BCG was planning to open an office in Bogotá and I was invited to be part of this new endeavor. I therefore decided to return after 12 years living abroad, and I couldn't have made a better decision
All expectations about working in business consulting with BCG have been fulfilled: dynamism, continuous learning, brilliant and motivated colleagues, and the satisfaction of having a profound impact on major companies and organizations worldwide.
However, the experience of launching the office in Bogotá has been perhaps the most rewarding aspect of my career at BCG thus far. The team and our relationships with clients continue to strengthen at a rate not expected even in the most optimistic projections—all while we shape the office culture to create a great working environment.
Mauricio holds a master's degree in systems engineering from MIT and a BA in computer science, Japanese, and political science from Macalester College. Prior to BCG, he worked as a software engineer at JPMorgan's credit and rates trading desk in Hong Kong.
Q: What international experiences at BCG have been the most interesting for you?
A: One of the main reasons I joined the team launching the Bogotá office was my desire to work with companies seeking to grow in Latin America. The first project I worked on after transferring from New York was aimed at figuring out how to triple revenues for our client in a period of only five years. This involved working across Brazil, Mexico, and Colombia, talking to company leaders and key clients in these three countries in order to define a growth strategy that truly captured the potential in the region.
Q: What is something that has surprised you about working at BCG?
A: Before joining BCG, I was quite skeptical of a model in which recent college graduates could give useful advice to senior executives who had spent their entire lives running companies in specialized industries and functions. My biggest surprise has been to witness how this model is a reality and how I am part of it every day. The leverage that new hires get from the accumulated knowledge and experience built at BCG enables this model and fuels our contributions to clients.
Q: If you could compare what you do with any other job, what would you say?
A: The diversity of work and the level of intellectual challenge that we face on a daily basis is something that is very hard to find in other jobs.


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We are looking for someone who is already excellent and wants a bigger challenge and looking to work on an exciting project. We have already 2 full time web developers working on this project and you will be working with this existing team. You will be working on integration of our project management app with Basecamp, Google apps and Freshbooks. You will be working on the back end as well as a lot of user interface work. This is full time work (minimum 30 hours per week.
Payment methods: Paypal/ preferred local banks


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Manchester City secured a unconvincing 2-0 win over a resolute Hull City Tigers side with two second-half goals at the Etihad Stadium.
Alvaro Negredo ÔÇô who was introduced at the break for Edin Dzeko ÔÇô nodded in Pablo Zabaleta's cross in the 65th minute, before Yaya Toure struck a late free kick to give Manuel Pellegrini's men all three points.
Hull enjoyed the better of the first half, with Sone Aluko and Robert Koren going close, while Danny Graham had an effort ruled out for offside, but City did enough at Etihad Stadium to claim the win.
Pellegrini dropped Javi Garcia and Gael Clichy from the side that lost 3-2 to Cardiff City, replacing the pair with the fit-again Matija Nastasic and Aleksandar Kolarov.
Hull City boss Steve Bruce made 11 changes to the side that scraped through the second round of the League Cup against Leyton Orient, while Republic of Ireland midfielder Stephen Quinn won a place on the bench after recovering from a hamstring injury.
One of the new inclusions, Nigeria international Aluko, almost gave Hull a shock lead in the seventh minute after a loose ball broke to him and he raced through the Manchester City defence.
But with only goalkeeper Joe Hart to beat, Aluko scuffed his effort wide, failing to match his impressive run with a composed finish.
It was a warning sign for the hosts, and one they did not heed, as shortly after Dzeko tested Hull City goalkeeper Allan McGregor at the other end with a near-post header, the visitors went close again.
On this occasion Steve Bruce's men had the ball in the back of the net, but Graham's volley was correctly chalked off for offside.
McGregor reacted well to tip Joleon Lescott's header over the bar soon after, before Koren was next to go close for Hull.
However, the Slovenia international saw his 25-yard effort ÔÇô that had Manchester City goalkeeper Joe Hart beaten ÔÇô sail just wide.
The hosts slowed the tempo of the game down in the immediate aftermath, as the likes of David Silva and Toure helped them enjoy extended periods of possession.
But Hull dealt with every challenge they were presented with and went to the half-time break with their heads held high.
Frustrated by his teamÔÇÖs inability to find a breakthrough, Pellegrini brought on Negredo, and the Spaniard had a good chance just minutes after coming on.
He was unable to direct a header on target though, following an excellent Silva ball, while Graham fired over for Hull at the other end.
Jesus Navas had an acrobatic attempt on goal fly wide soon after, but City finally broke the deadlock in the 65th minute.
Zabaleta was the provider, with his looping cross from the right finding Negredo, who headed the ball into the ground and across McGregor to open the scoring.
Lescott had a late chance to double City's lead before Toure scored an exquisite free kick to seal the result.
The Ivorian curled in a 20-yard effort which Ahmed Elmohamady could not keep out despite his desperate efforts on the line as City celebrated another home victory.


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The Construction and Materials Group provides support to help districts with managing their construction projects. This includes providing construction administrative services to supplement the workforce with temporary technicians, construction administrative services and material testing assistance; conducting independent review of workmanship, materials and documentation; providing training for construction and lab technicians; maintaining instructional guides for construction methods and procedures; providing the services of a registered landscape architect; and processing monthly pay estimates, quantity documentation and subcontractor approvals.
The group also consists of central and regional laboratories. They maintain AASHTO accreditation for the state and provide
materials-related technical support; conduct research into construction materials and methods; develop test methods and specifications; and perform testing of soils and aggregates, asphaltic concrete, asphalt binder, concrete, cement, steel and other structural materials. The regional labs are responsible for monitoring the tests performed by project labs and for conducting independent assurance and correlation testing in an effort to maintain uniform testing procedures statewide.
The ADOT Materials Testing Manual, ADOT Materials Practice and Procedure Directives (PPD) Manual, ADOT Construction Manual, and ADOT Preliminary Engineering and Design Manual are available for download.
This page contains links to requests to review contract modifications, stipulated fee information and AASHTO's "Primer on Contracting for the Twenty-First Century."
Visit these pages for information regarding forms, links and documents of interest to contractors. You will also find a section on frequently asked questions.
This page contains links to all Construction Bulletins dating back to the year 2002.
The responsibility of the Consultant Contracts office is to develop and negotiate all outside service construction contracts. These contracts are developed for projects identified by ADOT districts to be assigned for construction contract administration and construction materials testing assistance.
The Field Reports section processes submittals from the field, including monthly pay estimates, quantity documentation and other project reports. They approve all subcontractors and serve as the Labor Compliance Office. Field Reports personnel can answer questions about contract documentation and record-keeping requirements.
This page contains resources to facilitate the construction inspection.
The Laboratory Inspection Program administers all materials testing laboratories that perform testing activities for the department. Compliance to test procedures and equipment requirements are included in the inspection.
The Quantlist checklists contained in these pages were developed by ADOT for ADOT administered projects using ADOT specifications and standards.
Recording and storing results of concrete cylinder testing performed during road construction is a function of numerous construction offices throughout the state. Through a number of computer applications, these testing results are captured, stored, and regularly utilized internally. This information is provided for the general public as well as current and potential vendors wishing to do business with ADOT.
The purpose of technician certification through ATTI is to ensure that the technician can demonstrate competency in appropriate Arizona and AASHTO test procedures through actual demonstration of test procedures, written examination and required calculations.
Value Engineering is a function-oriented, systematic, team approach to eliminate and prevent unnecessary cost.
This page contains information regarding ADOT's Intermodal Transportation Division Work-Zone Safety and Mobility Policy and Implementation Guidelines.
Go to this page for contact information for different areas of the Construction Group.
Arizona Department of Transportation
Contact Us
Copyright © Arizona Department of Transportation – All rights reserved.


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Taylor Swift and Harry Styles Have a Late NYC Night
Taylor Swift and Harry Styles Head Out After a Busy Night
Taylor Swift and Harry Styles Head Out After a Busy Night
Taylor Swift and Harry Styles made separate exits out of their NYC hotel this morning. She attended last night's Ripple of Hope Gala in the Big Apple, decked out in a ready-for-the-holidays sequined dress. The benefit, which was organized by the Robert F. Kennedy Center For Justice & Human Rights, was also attended many of her new Kennedy pals. Taylor, who performed on stage later in the night, first said hi to Kerry Kennedy and Robert Kennedy Jr. Robert posed on the carpet alongside his girlfriend, Suburgatory star Cheryl Hines. Melanie Griffith and Antonio Banderas also attended, as did emcee Alec Baldwin and his wife, Hilaria Thomas, and Homeland's Mandy Patinkin.
Afterward, Taylor's night wasn't over — she met up with One Direction's Harry Styles! Taylor Swift and Harry Styles have grown close, and were even seen exploring NYC's Central Park Zoo together over the weekend. The two hit the town last night, and later returned to her hotel.