text:
"Are you a dog person or a cat person?"
I hate that question. There are days when I don't even consider myself a people person. Why bring pets into it?
Anyway, there is only one acceptable answer. While there are certainly people who prefer cats over dogs, we all know that it's social suicide to admit it.
If you say you're a dog person, people trust you.
Subscribe to Online Edition
Online PDF Print Edition
Copyright 2011 Addison Independent | 58 Maple Street, Middlebury, Vt. 05753 | All Rights Reserved
Site Development by Surf New Media

subset: commoncrawl


text:
Future Gold Coast Information
In the current property market, as a potential purchaser you can be overwhelmed by choice and worry you won't get value for money – that is why smart property developers & caring marketers focus on building relationships, educating and fostering trust with you our buyer first, to help you feel at ease with your investment decision.
Through effective relationship building, we focus on how we can empower you our potential client while still offering a transparent and excellent customer-based service that builds trust between our brand and yourself.
Right now, you the potential purchaser can be overwhelmed by choice and the worry that you won't get value for your money – that is why successful property developers and properT network deliberately focus on building relationships, educating and fostering trust with buyers / investors like yourself first, we help you feel at ease with your informed purchasing decision
Topics like "what to look for in an investment property" or "how to properly navigate the overwhelming information overload" will directly make your lives easier by removing the stress. This is the first step in building a relationship with you our client and positioning our brand/project as transparent and trustworthy so that you are very comfortable in working with us to help you reach your own goals that much more efficiently and astutely.


text:
That's a toss-up. I'd take either. The UK would be a bigger change for me since I'm an American. I've been to Canada a few times, they're used to us.
Would you rather always have Cheeto residue on your fingers, or always have a milk mustache?
The One Ring Messageboard
Return to The Lighter Side: Tom's House
Users browsing this forum: No registered users and 2 guests


text:
You don't need to pay anything for registration. Our service is absolutely free.
* Required Fields
At least 6 characters, no spaces.
To avoid spam and automatic registration we ask you to repeat the code you see in the picture.
Sign up is free of charge. By clicking the "Sign up" button you agree that you have read, understand, and accept our Terms of Service.
Home |
Signup |
Payouts |
Top Users |
FAQs |
Tips |
Advises |
Contact Us |
Login |
Copyright 2019. Dollars Income. All Rights Reserved.


text:
0 Items (Empty)
Recently Viewed Items
You have not viewed any items recently.
Your Shopping Cart
Your shopping cart is currently empty. If you would like to make a purchase today, add items to your shopping cart.
Outdoor Rec Warehouse (ORW) is committed to its customers and will do its best to always ensure high-quality shipping transactions. ORW stands by the quality and craftmanship of all available merchandise and we will work with our customers to the best of our ability regarding any merchandise returns and/or shipping concerns.
Because ORW works with many manufacturers and international sources, delivery time and shipment availability may vary from one product to the next. However, the vast majority of our merchandise is shipped via UPS or FedEx Ground within THREE TO FIVE BUSINESS DAYS of ORDER PLACEMENT.
Shipping costs for UPS or FedEx Ground shipments are calculated on a per-product basis based on weight and the location being shipped to and are retrieved by placing the item in the shopping cart and proceeding to checkout. You do not need to actually place an order during this step. Please make note of the delivery charges associated with each item. The shipping prices are for the 50 United States, including Alaska and Hawaii. For faster shipping, please request as needed at firstname.lastname@example.com and we will provide appropriate quotes prior to any order being placed. NOTE: You may only request faster UPS or FedEx methods, not USPS Priority Mail.
FREE SHIPPING offers are valid only for deliveries inside the 48 contiguous United States. Costs will still apply for deliveries to Alaska and Hawaii. To determine these costs, please send an inquiry to firstname.lastname@example.com
International Shipping Now Available!
We have partnered with Bongo International to service our customers Worldwide!
Bongo International provides our customers with their very own US address. Once you have a US address, you will be able to make purchases with us as well as other US based online retailers. Bongo receives your purchases and logs them into their online system which you can use to view your items and consolidate them with multiple orders.
International customers can save up to 82% off typical international shipping rates by following these four easy steps:
|Register with Bongo and receive a U.S. shipping address.
|Enter the Bongo address as both your billing and shipping address.
|Use the credit card that you have on file with Bongo as the payment method.
|Once the order arrives at Bongo, log into your account to forward to your country.
If you have any questions, please feel free to contact Bongo through live chat or by e-mail. They will be glad to assist you.
Click on the Bongo logo in the corner to get started!
Note: We are unable to ship ghillie gear, ghillie accessories or sports optics / night vision internationally due to laws and regulations.


text:
You have no items in your shopping cart.
There are no products matching the selection.
Ecopac UK Power Ltd are an authorised MEAN WELL UK distributor. MEAN WELL Power Supplies offer a range of AC to DC and DC to DC power supplies & PSU products. These are available in open frame, enclosed or DIN rail format.Ecopac Power Ltd, Unit 4 Ridgeway, Crendon Industrial Estate, Long Crendon, Buckinghamshire, HP18 9BF
01844 20 44 20
Useful Links


text:
This is a follow up to my last week's post about hacked WordPress blogs and poisoned Google Images search results. Cyber-criminals infiltrated 4,000+ self-hosted WP blogs and created doorway pages that would redirect visitors coming from Google Images search to scareware sites. A few days ago I posted a short update to let you know that Google has removed the doorway pages from its index. I also promised to share some new interesting details about that black hat SEO campaign. So here we go!
Continue »»


text:
- Guaranteed to Fit
- Free Same Day Shipping
- Thousands of How-to Videos
Fuel Filter at 1A Auto
What is a fuel filter and where is it located?
The fuel filter is the last line of defense for blocking particles in the fuel from reaching the engine and causing damage. No matter what type of fuel system is found in a particular vehicle, whether it be a high pressure fuel injected or a direct injected gas or diesel fuel system found in the more modern vehicles of today, or a carbureted system of yesteryear, it will have some sort of fuel filter. They are usually found along the fuel line, mounted underneath the vehicle or to the firewall—these are known as in-line fuel filters. Some vehicles may have non-serviceable fuel filters mounted inside the fuel tank, and these are known as in-tank fuel filters and are often referred to as a "strainer" or "sock." Fuel filters have a mesh screen or pleated paper inside them to filter debris out of the fuel. Some diesel engines use a bowl-shaped fuel filter that is able to collect water at the bottom, separating water from the diesel fuel. The water can be released through a valve at the bottom of the filter.
Dirt or grime can enter the fuel during refilling, while flakes of rust and sediment from the inside of the fuel tank can enter the fuel if the tank is corroding. These impurities will contaminate the fuel if allowed to flow freely. So, as you can imagine, it is important to filter out these types of particles regardless of the fuel system as bad fuel can damage fuel injector assemblies, fuel pumps, and carburetors equally due to the abrasive action these harmful contaminants have on these parts. Fuel filters also play a role in improving performance, due to the simple fact that the fewer contaminants there are in the gas or diesel fuel, the better it will flow, and the more efficiently it can be burnt.
How do I know if my fuel filter needs to be replaced?
Since the fuel filter's job is to catch debris before it can reach the fuel pump, it naturally fills up with that material and can eventually become clogged. Deterioration or gelling of the fuel can also clog the fuel filter. Many mechanics recommend that you change the fuel filter any time a tune-up is done on the car or truck—usually every 3 to 5 years—or any time a fuel pump has been changed. The fuel filter has a limited lifespan and requires regular maintenance. Serviceable in-line fuel filters have predetermined service intervals recommended by the auto manufacturer, so be sure to consult your owners' manual.
If this maintenance is not kept up, and the filter becomes clogged, it can cause a restriction in fuel flow, making it hard for the engine to draw precious fuel. This can make the car hesitate or jerk during acceleration or can make it stall out. If the problem gets worse you might not be able to start your car at all. A clogged fuel filter can also cause harm to the fuel pump.
Can I replace a fuel filter myself?
The process for replacing the fuel filter will vary from one model to another, but overall, it can be within the grasp of the do-it-yourselfer. For some models, specialty tools may be required, so consult a repair manual or a knowledgeable mechanic. Disconnect the battery to avoid any sparking occurring as you work on your fuel lines.
You should be able to access the fuel filter either in the engine compartment or underneath the vehicle near the fuel tank. Before you disconnect the fuel lines that run into and out of the fuel filter, you'll want to relieve the pressure in the fuel lines. Otherwise you'll have fuel spraying everywhere, which would be unpleasant and potentially dangerous. You can do this by removing the fuel pump fuse and running the engine until it runs out of fuel and stops.
With that done, you'll have to disconnect the fuel filter from the fuel lines, dismount it, and attach the new one. While the old fuel filter is off, you may want to inspect the fuel lines. If they are hardened or cracked, they should be replaced. Depending on the application, a special fuel line disconnect tool may be required. Other applications may use threaded fittings that will require a flare nut wrench to remove without damaging the line or rounding the fitting.
Need a fuel filter replacement?
Take fuel, add in dirt and contaminants, and you've got a recipe for potentially disastrous results. That's why a properly functioning fuel filter is extremely important, as it filters debris out of the gas or diesel fuel before it is able to cause any fuel efficiency problems, or damage to parts like the fuel injectors. At 1A Auto, we carry a large selection of fuel filters for carbureted and high pressure fuel injected engines, for many makes and models, all designed to meet the demands of your car or truck's engine for proper fuel flow and filtration.
At 1A Auto, we make shopping for a replacement fuel filter for your gas or diesel fuel powered car, truck, SUV or van easy—we're here to help you select the right part for your vehicle! Call our customer service toll free at 888-844-3393 if you have any questions about our products, warranty, compatibility or to purchase, or you can buy online. Order your replacement fuel filter today and keep your carburetor or fuel injection system flowing freely!


text:
House Committee on Ways and Means, Subcommittee on Social Security: The Subcommittee Held A Hearing On SSA's Processing Of Attorneys' Fees. William C. Taylor, SSA's Deputy Associate Commissioner, Office of Hearings and Appeals, testified.
May 17, 2001
Mr. Chairman, Mr. Matsui, and Members of the Subcommittee:
Thank you for giving me the opportunity today to discuss the improvements the Social Security Administration (SSA) has made in the past year in approving and paying attorney fees. As I testified before you last June, we recognize the importance of timely payment to attorneys who represent Social Security clients, and last year SSA issued about 222,000 fee payments to attorneys (an increase of about 10 percent over 1999) totaling over $500 million.
Moreover, I am pleased to be able to report that SSA has made significant improvements in the timeliness with which payments to attorneys are made. To illustrate, since April 2000, over 50 percent of payments to attorneys were made in less than two months from the date a decision was made on the claim. In comparison, only a small fraction of payments to attorneys were issued in that timeframe in 1999.
Today, I will begin by briefly describing the process and its history and then, in more detail, our progress in improving that process. In addition, I will discuss the activities of a workgroup that has been meeting this past year to develop plans to improve the attorney payment process, and the question of issuing checks jointly to attorneys and beneficiaries.
History of Attorney Representation and Fee Approval
Since I described the complete history of the attorney fee process in my testimony last year, I would like to just briefly summarize that history for you today. The Social Security Act has recognized the important role for attorneys as claimants' representatives beginning with the enactment of the Social Security Amendments of 1939. Pursuant to statutory authority, the Social Security Board's Administrator promulgated rules and regulations governing representatives of claimants and set the maximum fee attorneys could charge which was $10 unless a petition was filed and a higher amount was authorized.
Amendments to the Social Security Act enacted in 1965 provided that a court making a favorable judgment could award the claimant's attorney a reasonable fee not in excess of 25 percent of past-due benefits and that SSA could certify payment of the fee directly to the attorney in court cases. The purpose of the provision was to ensure that in court cases claimants would have access to effective legal representation at a fair rate of compensation.
The Social Security Amendments of 1967 required the Secretary to approve a reasonable fee for a representative's services rendered in administrative proceedings, and extended to such administrative proceedings the Secretary's authority to certify payment, not to exceed 25 percent of past-due benefits, directly to an attorney from a claimant's past-due OASDI benefits.
The Omnibus Budget Reconciliation Act of 1990 established the fee agreement process to streamline authorization of representatives' fees by permitting SSA to approve a fee if the representative and client both agreed in writing to the amount of the fee. The fee agreement is generally approved if, among other things, the fee specified in the agreement is limited to no more than the lesser of $4,000 or 25 percent of past-due benefits.
The Ticket to Work and Work Incentives Improvement Act of 1999 required SSA to charge an assessment, not to exceed 6.3 percent of the fee amount that SSA pays to an attorney, to recover the full costs incurred by the Agency for determining and certifying fees to attorneys. SSA began charging the assessment on cases in which decisions were made on or after February 1, 2000. This same legislation eliminated a mandatory 15-day waiting period that was part of the original fee agreement process. The waiting period was intended to give all parties to the agreement an opportunity to review and protest the agreed-upon amount of the fee, before the fee had been paid, if they wished to do so. SSA's experience was that few protests were received. Under the new provision, the parties may request review of the fee within 15 days while the payment is being processed.
The legislation set the assessment for calendar year 2000 at 6.3 percent of the amount that SSA pays to the attorney. For subsequent years, the legislation requires the Commissioner of Social Security to determine the assessment required to recover all of the costs associated with determining and certifying fees to attorneys. However, the provision limited the assessment to no more than 6.3 percent. On January 19, 2001, SSA published a notice in the Federal Register that established an assessment rate of 6.3 percent for 2001. We based our decision to continue the 6.3 percent assessment rate on the same cost accounting system that SSA uses to justify to the Congress its annual appropriation requests for administrative expenses and to apportion those expenses among the various trust funds that have been established for the programs SSA administers.
A representative's fee must be authorized by SSA before the representative can seek payment from his or her client, or before SSA will make any direct payment to an attorney. The approved fee represents the maximum amount the representative can charge for services provided. Representatives can obtain SSA's authorization of a fee through either a fee petition or a fee agreement process. I will discuss the two processes next.
Representative Fee Processes
The first process I will describe is the fee petition process, which is used less frequently than the fee agreement process. Of all the fees authorized by SSA, about 12 percent are paid through the fee petition process.
Under this process, the representative (attorney or non-attorney) must request the Commissioner's approval of fees after completing his or her services for the client. In a fee petition, the representative must provide SSA with a detailed description of the services provided in representing the client as well as any expenses incurred by the representative in providing those services. The Agency official who authorizes the fee, usually an ALJ, then evaluates the information in the petition and sets a reasonable fee for the services that were provided. In making these determinations, the fee authorizer considers factors such as the extent and nature of the services performed, the complexity of the case, and the amount of time the representative spent on the case.
After SSA authorizes a fee, we notify the claimant and their representative of the authorized fee and their right to administrative review. Because of the complexity of the issues that must be evaluated in this process, fee petitions usually require a longer period of time for resolution than those approved through the fee agreement process.
Under the fee agreement process, if the representative and claimant sign and submit a written agreement, SSA will generally approve the agreement if the fee specified does not exceed a statutory cap, which is the lesser of 25 percent of the claimant's past due benefits or $4,000. Upon approval of the agreement, the Commissioner notifies the respective parties of the maximum fee based on past-due benefits and of the right to request administrative review. In 2000, the fees of about 88 percent of all cases involving representation were approved using the fee agreement process.
One important difference in the attorney fee authorization process between the Social Security and SSI programs is that,while both fee petition and fee agreement processes can be used to approve fees in SSI cases, SSA does not currently have authority to withhold and certify payment to the attorney from past-due SSI benefits. The attorney must be paid directly by the beneficiary.
SSA does not routinely track data on the use of fee agreements and fee petitions. However, we know from special studies that the percentage of payments to attorneys that were paid using the fee petition process has declined from 30 percent in 1995 to just 12 percent in 2000. The number of fee agreement cases increased from 70 percent of fee payments processed in 1995 to almost 88 percent in 2000. Obviously, more and more attorneys prefer to use the more streamlined process. In 2000, the average payment under the fee agreement process was $2,458.86; fee petitions averaged $2,437.73.
SSA Actions to Improve Process
As I mentioned earlier, Mr. Chairman, SSA has made significant improvements in the service it provides to attorneys. However, we believe there is still much that can be done to improve the service we provide to this important constituency. I will now discuss our plans for achieving this improvement.
As I stated in previous testimony before this Committee, SSA has undertaken a comprehensive review of the attorney fee approval and payment process. To lead this review, the Agency convened a multi-component workgroup to study the attorney fee process and to recommend ways that the Agency can improve our service in this area. The team brings to bear a broad array of knowledge and experience in working with all facets of the attorney fee process. We expect that the work of the team will lead to improvements in service in both the near and the longer term.
During the past 11 months, the workgroup sponsored a multi-tiered effort to review as many aspects of the attorney fee process as possible. These reviews included the current level of automation, data collection and the management information available on attorney fees, processing times, availability of public information to representatives, the feasibility of raising the $4,000 limit in fee agreement cases, and ways to simplify the process. As part of this effort, the workgroup undertook special studies, including a review of all cases involving attorney fees that were paid on a day in August 2000, to obtain new and current data about the attorney fee process. We also have in progress a special study being performed by SSA's Office of Quality Assessment, to be completed later this year, that will assess the accuracy of attorney fee payments. We will of course share the results of this study when it has been completed.
The workgroup was required to confront immediately a lack of comprehensive data and management information about what is largely a manual process. To obtain basic information about processing times for hearings cases, the workgroup performed special studies to collect this data. As I have already mentioned, the data from those reports showed marked improvement in processing times for attorney fee, payments. However, obtaining statistical information in this manner is not an efficient use of resources, and makes developing a full and reliable picture of the Agency's performance laborious and costly.
Automating the Attorney Fee Payment Process
Part of the workgroup's analysis is how to improve the payment process through systems enhancements. As I mentioned, the current attorney fee payment process is essentially a manual one. The result is a process that relies primarily on human resources and that fails to achieve the efficiencies that SSA has introduced into its other business processes. We think we can do better and, under the leadership of the workgroup, we have already begun the analysis needed to develop an automation plan for the process. We believe that this work will identify areas in which we can make improvements. While this analysis will focus broadly on all aspects of the fee approval and payment process, there are some automation activities that SSA already has undertaken that will improve the existing attorney fee payment process, and I would now like to describe them briefly.
The first change I will describe has already been implemented. This change involves cases in which the claimant has filed for Social Security and SSI benefits and has an attorney. In these cases, we reduce the amount of any retroactive Social Security benefits by the amount owed to the attorney, as well as by the amount the individual has already received from SSI. In the past, the amount of the reduction for SSI was often initially calculated without consideration of the amount already paid to the attorney from retroactive Social Security benefits. In many of these cases, the program service center had to request the field office to recalculate the amount owed the beneficiary to take that information into account. The field office would then tell the program service center the new amount of retroactive benefits. With the new change in place, the SSI system will make the computation, including the attorney fee, in about 70 percent of concurrent SSI and Social Security cases involving fee agreements. This enables the field office to notify the attorney more quickly of the amount of the fee he or she will be authorized for the SSI portion of a concurrent claim.
A more significant systems improvement, the first phase of which we plan to implement in the summer or fall of 2002, will be a national system that automates payments to some non-beneficiaries, including attorneys. These payments are currently made outside of our automated systems. The first release of the system will begin automation of attorney fee payments. In addition, the release will automate certain other payments made outside the current automated system. These include underpayments made on the records of deceased beneficiaries to individuals who are not otherwise entitled, such as the estate of the beneficiary. Later releases will increase the automation capabilities to include the release of excess benefits withheld and other recurring payments which are currently outside the range of SSA's automated capabilities.
Here is how this new improvement will work. Currently, for award actions processed in the field offices, a technician inputs the necessary information to award the claimant benefits and withhold 25 percent to pay the attorney. An electronic message is then sent to the program service center to advise them to prepare a form for the attorney payments and release the excess benefits withheld. The form is then sent to another technician to enter the information into the payment system.
For those award actions processed in the program service center, which are the majority of cases, a technician inputs the necessary information to award the claimant benefits and withhold 25 percent to pay the attorney. The case is then handed off to a second technician to prepare the form for the attorney payment and release the excess benefits withheld. The form is sent to a third technician to enter the information into a payment system.
In both instances, copies of the input forms as well as the corresponding systems output must then be filed.
The new process will significantly reduce the number of handoffs involved and the number of people needed to process a case. The new process will, for most fee agreement cases, receive the attorney information through the same action that authorizes the award to the beneficiary, release the payment to the attorney, and send an alert to the processing center to release any excess withholding. In fee petition cases, it will automatically generate the attorney information to another database where it will be held until fee authorization is received. Once that authorization is received, payment of the attorney fee will require only minimal manual actions.
For actions that cannot be processed through the system I have described, the technician will be able to enter payment information directly, without handoffs and forms.
The new process will also allow us to capture name, address, and payment information on more than one attorney over the life of the beneficiary's record. In addition, this information will be captured on a new database, assuming we have a means to collect unique identifiers for each attorney. Currently our payment history information is limited to just the name of the most recent representative of record, which overlays any payment record of prior representation.
We expect to begin the first phase of implementing the new process sometime next year. When implemented, we believe that process will increase the efficiency of the payment process. This change will mean quicker payments and notices to the attorneys.
Fee Agreement Cap
Another issue the workgroup has reviewed is the $4,000 limit for fee agreements. The Social Security Act provides that the Commissioner may increase this limit from time to time as long as the rate of increase does not exceed aggregate cost-of-living adjustments to beneficiaries.
The fee cap has been $4,000 since the fee agreement process became effective in July 1991. The Agency is now reviewing the analysis of the workgroup.
Later this year we will announce our determination. Before we decide on the amount of the fee cap, we will consult with interested parties.
Public Information
SSA is also taking steps to improve the accessibility and range of information available to the public on our website about representation by attorneys or nonattorneys, as well as information for representatives to help them get a better understanding of their rights and responsibilities.
The information that will be available from the perspective of the claimant will include general information about the right to obtain representation and advice on how to choose a representative. We will also provide information about the fee agreement process and the fee petition process.
We will also provide information about the two processes tailored specifically for representatives. In addition, the website will display a model fee agreement to be used if the representative and claimant so wish. We hope that by providing a sample agreement, we can reduce the number of fee agreements we receive that contain technical deficiencies that invalidate them. Currently, if we receive an agreement with such defects, the attorney's fee agreement must be disapproved and the attorney must file a petition, causing additional delay. We will also explain any situations for which the fee agreement cannot be honored, such as in certain court cases or cases involving multiple representatives who do not sign a single fee agreement.
We expect to post on the website information that will help a representative understand the type of claim development information that representatives can submit. We particularly hope that the availability of this information will speed the processing of these cases; for instance, workers' compensation information which can delay the processing of payments to the attorney.
Finally, the website will provide links to forms used to appoint representatives and to obtain approval of fees. These forms can be simply printed out by the website visitor without calling or visiting an SSA office.
Two-Party Check Payments
Finally, Mr. Chairman, you asked that I discuss replacing the current attorney fee payment process with one that would issue the first check jointly to both the beneficiary and the attorney.
Issuing a joint check, also known as a two-party check, is an idea that the Congress has considered in the past. However, there were concerns that such a system might be vulnerable to misappropriation and require a new and ongoing supervisory role for SSA to ensure that funds were correctly disbursed. Congress did not institute the two-party check system, and instead enacted the fee agreement process in the Omnibus Budget Reconciliation Act of 1990.
SSA is also concerned that two-party checks would result in the claimants not having access to any past-due benefits until the attorney released the funds. Under the current process, we can in some cases using guidelines that we have found to be reliable pay the beneficiary based on evidence in file while we develop payment factors completely. However, the attorney fee is delayed in the fee agreement process until all those factors are resolved. Under a two party check system, the beneficiary's payment would necessarily have to be delayed, and, indeed, the claimant would not receive payment until after the attorney had been paid.
Implementation of the changes needed for a two-party check system would require a large systems effort and delay a considerable number of already planned changes. Because several of SSA's master computer files, such as those used to pay claims and record the payment information, would be involved to change to a two-party process, implementation would be lengthy and difficult.
In conclusion, Mr. Chairman, we appreciate the concerns of Congress and the legal community regarding the service they receive from our Agency. The Social Security Administration has made significant improvements in processing attorney fees. Many attorney fee payments that used to take 60 to 90 days to process now take under 45 days.
We look forward to working with you and the other members of the Subcommittee as we move forward to automate the system and find other ways to improve our service to representatives. I will be happy to answer any questions you may have.


text:
Our Ann All commented extensively on the Burson-Marsteller's Global Social Media Check-up earlier this month, so we wanted to bring you the highlights of the study (which you can download in its entirety here in PDF format).
Burson-Marsteller found a somewhat different twist to this strategy problem of exactly how many folks at your company to get involved in social media. Rather than not including enough folks in their social efforts, as other sources had described to Ann, many companies include too many -- and don't provide a unifying strategy to guide them.
Specifically, Burson-Marsteller found 65 percent of Global 100 companies have active Twitter accounts, 54 percent have Facebook fan pages, 50 percent have YouTube video channels and 33 percent have corporate blogs. Seventy-nine percent of the companies use at least one of these social media platforms, but just 20 percent utilize all four channels, suggesting they are missing opportunities for deeper interactions with customers. While just about a third of the companies blog, Burson-Marsteller says blogs are "ideal venue[s] for a more in-depth interactive discussion." (You can only say so much in 140 characters, right?)
Related Topics : Unisys, Stimulus Package, Security Breaches, Symantec, Electronic Surveillance
To protect the company from those insiders who abuse their privileged access and from hackers with stolen credentials, many companies are turning to a privileged access management (PAM) solution. ... More >>
Is fake news a security issue? Some say yes, as it can be used as a social engineering tool to spread disinformation and conceivably to get unsuspecting users to click on malicious links. ... More >>
Blockchain comes with many costs and is surrounded by confusion. Here, we examine realistic use cases, drawbacks and the potential of blockchain. ... More >>


text:
Magnetic Resonance Imaging (MRI) - Breast
Magnetic resonance imaging (MRI) of the breast uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within the breast. It is primarily used as a supplemental tool to breast screening with mammography or ultrasound. It may be used to screen women at high risk for breast cancer, evaluate the extent of cancer following diagnosis, or further evaluate abnormalities seen on mammography. Breast MRI does not use ionizing radiation, and it is the best method for determining whether silicone breast implants have ruptured.
Tell your doctor about any health problems, recent surgeries or allergies and whether there's a possibility you are pregnant. The magnetic field is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no risk, but you should always tell the technologist if you have any devices or metal in your body. Guidelines about eating and drinking before your exam vary between facilities. Unless you are told otherwise, take your regular medications as usual. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you have claustrophobia or anxiety, you may want to ask your doctor for a mild sedative prior to the exam.
- What is MRI of the Breast?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of MRI of the Breast?
- Which test, procedure or treatment is best for me?
What is MRI of the Breast?
Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose medical conditions.
MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI does not use ionizing radiation (x-rays).
Detailed MR images allow physicians to evaluate various parts of the body and determine the presence of certain diseases. The images can then be examined on a computer monitor, transmitted electronically, printed or copied to a CD or uploaded to a digital cloud server.
MRI of the breast offers valuable information about many breast conditions that cannot be obtained by other imaging modalities, such as mammography or ultrasound.
What are some common uses of the procedure?
MRI of the breast is not a replacement for mammography or ultrasound imaging but rather a supplemental tool that has many important uses, including:
- Screening in women at high risk for breast cancer
For women at high risk for breast cancer, typically because of a strong family history, MRI may be an appropriate tool to screen for breast cancer. A strong family history is usually a mother or sister who has had breast cancer before age 50. It can also be aunts or cousins, including those on your father's side. Relatives who have had ovarian cancer also increase your risk. Your radiologist or primary care doctor can look at your family history and determine if screening MRI may be appropriate for you. Depending on your family history, genetic counseling may also be recommended.
- Determining the extent of cancer after a new diagnosis of breast cancer
After being diagnosed with breast cancer, a breast MRI may be performed to determine:
- how large the cancer is and whether it involves the underlying muscle.
- if there are other cancers in the same breast and whether there is an unsuspected cancer in the opposite breast.
- if there are any abnormally large lymph nodes in the armpit, which can be a sign the cancer has spread to that site.
- Further evaluating hard-to-assess abnormalities seen on mammography
Sometimes an abnormality seen on a mammogram cannot be adequately evaluated by additional mammography and ultrasound alone. In these rare cases, MRI can be used to definitively determine if the abnormality needs biopsy or can safely be left alone.
- Evaluating lumpectomy sites in the years following breast cancer treatment
Scarring and recurrent cancer can look identical on mammography and ultrasound. If a change in a lumpectomy scar is detected by either mammography or a physical exam, MRI can help determine whether the change is normal maturation of the scar or a recurrence of the cancer.
- Following chemotherapy treatment in patients receiving neoadjuvant chemotherapy
In some cases, breast cancer will be treated with chemotherapy before it has been removed by surgery. This is called neoadjuvant chemotherapy. In these cases, MRI is often used to monitor how well the chemotherapy is working and to reevaluate the amount of tumor still present before the surgery is performed.
- Evaluating breast implants
MRI is the best test for determining whether silicone implants have ruptured.
How should I prepare?
You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners.
Guidelines about eating and drinking before an MRI exam vary with the specific exam and with the imaging facility. Unless you are told otherwise, you may follow your regular daily routine and take food and medications as usual.
Some MRI examinations may require you to receive an injection of contrast material into the bloodstream. The radiologist, technologist or a nurse may ask if you have allergies of any kind, such as an allergy to iodine or x-ray contrast material, drugs, food, or the environment, or if you have asthma. The contrast material most commonly used for an MRI exam contains a metal called gadolinium. Gadolinium can be used in patients with iodine contrast allergy. It is far less common for a patient to have an allergy to a gadolinium-based contrast agent used for MRI than the iodine-containing contrast for CT. However, even if it is known that the patient has an allergy to the gadolinium contrast, it may still be possible to use it after appropriate pre-medication. Patient consent will be requested in this instance. For more information on adverse reactions to gadolinium-based contrast agents, please consult the ACR Manual on Contrast Media.
You should also let the radiologist know if you have any serious health problems, or if you have had any recent surgeries. Some conditions, such as severe kidney disease, may prevent you from being given gadolinium contrast for an MRI. If you have a history of kidney disease or liver transplant, it will be necessary to perform a blood test to determine whether the kidneys are functioning adequately.
Women should always inform their physician or technologist if there is any possibility that they are pregnant. MRI has been used for scanning patients since the 1980s with no reports of any ill effects on pregnant women or their unborn babies. However, because the unborn baby will be in a strong magnetic field, pregnant women should not have this exam in the first three to four months of pregnancy unless the potential benefit from the MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of gadolinium contrast material except when absolutely necessary for medical treatment. See the MRI Safety page for more information about pregnancy and MRI.
If you have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician for a prescription for a mild sedative prior to your scheduled examination.
Jewelry and other accessories should be left at home, if possible, or removed prior to the MRI scan. Because they can interfere with the magnetic field of the MRI unit, metal and electronic items are not allowed in the exam room. In addition to affecting the MRI images, these objects can become projectiles within the MRI scanner room and may cause you and/or others nearby harm. These items include:
- jewelry, watches, credit cards and hearing aids, all of which can be damaged
- pins, hairpins, metal zippers and similar metallic items, which can distort MRI images
- removable dental work
- pens, pocket knives and eyeglasses
- body piercings
In most cases, an MRI exam is safe for patients with metal implants, except for a few types. People with the following implants cannot be scanned and should not enter the MRI scanning area:
- cochlear (ear) implant
- some types of clips used for brain aneurysms
- some types of metal coils placed within blood vessels
- nearly all cardiac defibrillators and pacemakers
You should tell the technologist if you have medical or electronic devices in your body. These objects may interfere with the exam or potentially pose a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will have a pamphlet explaining the MRI risks for that particular device. If you have the pamphlet, it is useful to bring that to the attention of the scheduler before the exam and bring it to your exam in case the radiologist or technologist has any questions. Some implanted devices require a short period of time after placement (usually six weeks) before being safe for MRI examinations. Examples include but are not limited to:
- artificial heart valves
- implanted drug infusion ports
- artificial limbs or metallic joint prostheses
- implanted nerve stimulators
- metal pins, screws, plates, stents or surgical staples
If there is any question of their presence, an x-ray may be taken to detect and identify any metal objects. In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure.
Patients who might have metal objects in certain parts of their bodies may also require an x-ray prior to an MRI. You should notify the technologist or radiologist of any shrapnel, bullets, or other pieces of metal that may be present in your body due to prior accidents. Foreign bodies near and especially lodged in the eyes are particularly important because they may move during the scan, possibly causing blindness. Dyes used in tattoos may contain iron and could heat up during an MRI scan, but this is rare. Tooth fillings and braces usually are not affected by the magnetic field, but they may distort images of the facial area or brain, so you should let the radiologist know about them.
What does the equipment look like?
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a moveable examination table that slides into the center of the magnet.
Some MRI units, called short-bore systems, are designed so that the magnet does not completely surround you. Some newer MRI machines have a larger diameter bore which can be more comfortable for larger size patients or patients with claustrophobia. Other MRI machines are open on the sides (open MRI). Open units are especially helpful for examining larger patients or those with claustrophobia. Newer open MRI units provide very high quality images for many types of exams. Older open MRI units may not provide this same image quality. Certain types of exams cannot be performed using open MRI. For more information, consult your radiologist.
The computer workstation that processes the imaging information is located in a separate room from the scanner.
How does the procedure work?
Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not utilize ionizing radiation. Instead, radiofrequency pulses re-align hydrogen atoms that naturally exist within the body. This does not cause any chemical changes in the tissues. As the hydrogen atoms return to their usual alignment, they emit different amounts of energy depending on the type of body tissue they are in. The MR scanner captures this energy and creates a picture of the tissues scanned based on this information.
The magnetic field is produced by passing an electric current through wire coils in most MRI units. Other coils, located in the machine and in some cases, placed around the part of the body being imaged, send and receive radio waves, producing signals that are detected by the coils. The electric current does not come in contact with the patient.
A computer then processes the signals and generates a series of images, each of which shows a thin slice of the body. The images can then be studied from different angles by the interpreting radiologist.
Frequently, the differentiation of abnormal (diseased) tissue from normal tissues is better with MRI than with other imaging modalities such as x-ray, CT and ultrasound.
How is the procedure performed?
MRI examinations may be performed on outpatients or inpatients.
You will be positioned on the moveable examination table. Straps and bolsters may be used to help you stay still and maintain the correct position during imaging.
For an MRI of the breast, you will lie face down on a platform specially designed for the procedure. The platform has openings to accommodate your breasts and allow them to be imaged without compression. The electronics needed to capture the MRI image are actually built into the platform. It is important to remain very still throughout the exam. This is best accomplished by making sure you are comfortable and can relax rather than trying to actively hold still tensing your muscles. Be sure to let the technologist know if something is uncomfortable, since discomfort increases the chance that you will feel the need to move during the exam.
If MRI of the breast is being performed for the sole purpose of determining if you have a ruptured breast implant, you will not be given contrast material. If the exam is being performed for any other reason, you will need to have a contrast material injected intravenously. MRI of the breast without contrast material is inadequate for identifying breast cancers.
If a contrast material will be used in the MRI exam, a physician, nurse or technologist will insert an intravenous (IV) catheter, also known as an IV line, into a vein in your hand or arm. A saline solution may be used to inject the contrast material. The solution will drip through the IV to prevent blockage of the IV catheter until the contrast material is injected.
You will be placed into the magnet of the MRI unit and the radiologist and technologist will perform the examination while working at a computer outside of the room.
If a contrast material is used during the examination, it will be injected into the intravenous line (IV) after an initial series of scans. Additional series of images will be taken during or following the injection.
When the examination is complete, you may be asked to wait until the technologist or radiologist checks the images in case additional images are needed.
Your intravenous line will be removed.
MRI exams generally include multiple runs (sequences), some of which may last several minutes.
The imaging session lasts between 30 minutes and one hour and the total examination is usually completed within an hour and a half.
MR spectroscopy, which provides additional information on the chemicals present in the body's cells, may also be performed during the MRI exam and may add approximately 15 minutes to the total exam time.
What will I experience during and after the procedure?
Most MRI exams are painless. However, some patients find it uncomfortable to remain still during MR imaging. Others experience a sense of being closed-in (claustrophobia) while in the MRI scanner. Therefore, sedation can be arranged for those patients who anticipate anxiety, but fewer than one in 20 require medication.
It is normal for the area of your body being imaged to feel slightly warm, but if it bothers you, notify the radiologist or technologist. It is important that you remain perfectly still while the images are being recorded, which is typically only a few seconds to a few minutes at a time. For some types of exams, you may be asked to hold your breath. You will know when images are being recorded because you will hear tapping or thumping sounds when the coils that generate the radiofrequency pulses are activated. You will be able to relax between imaging sequences, but will be asked to maintain your position as much as possible.
You will usually be alone in the exam room during the MRI procedure. However, the technologist will be able to see, hear and speak with you at all times using a two-way intercom. Many MRI centers allow a friend or parent to stay in the room as long as they are also screened for safety in the magnetic environment.
You may be offered or you may request earplugs to reduce the noise of the MRI scanner, which produces loud thumping and humming noises during imaging. MRI scanners are air-conditioned and well-lit. Some scanners have music to help you pass the time.
When the contrast material is injected, it is normal to feel coolness and a flushing sensation for a minute or two. The intravenous needle may cause you some discomfort when it is inserted and once it is removed, you may experience some bruising. There is also a very small chance of irritation of your skin at the site of the IV tube insertion.
If you have not been sedated, no recovery period is necessary. You may resume your usual activities and normal diet immediately after the exam. A few patients experience side effects from the contrast material, including nausea and local pain. Very rarely, patients are allergic to the contrast material and experience hives, itchy eyes or other reactions. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.
Follow-up examinations may be necessary. Your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if a finding is stable or changed over time.
What are the benefits vs. risks?
- MRI is a noninvasive imaging technique that does not involve exposure to ionizing radiation.
- MRI has proven valuable in detecting and staging breast cancer, particularly when other imaging studies (mammography, ultrasound, etc.) fail to provide adequate information.
- MRI as an addition to mammography has been shown to be useful in evaluating women at high risk for breast cancer.
- MRI can successfully image the dense breast tissue common in younger women, and it can successfully image breast implants. Both of these are difficult to image using traditional mammography.
- If a suspicious lesion is seen with MRI only, MRI can provide guidance for biopsy.
- The contrast material used in MRI exams is less likely to produce an allergic reaction than the iodine-based contrast materials used for conventional x-rays and CT scanning.
- The MRI examination poses almost no risk to the average patient when appropriate safety guidelines are followed.
- If sedation is used, there are risks of excessive sedation. However, the technologist or nurse will monitor your vital signs to minimize this risk.
- Although the strong magnetic field is not harmful in itself, implanted medical devices that contain metal may malfunction or cause problems during an MRI exam.
- Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of MRI believed to be caused by the injection of high doses of gadolinium-based contrast material in patients with very poor kidney function. Careful assessment of kidney function before considering a contrast injection minimizes the risk of this very rare complication.
- There is a very slight risk of an allergic reaction if contrast material is injected. Such reactions are usually mild and easily controlled by medication. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance.
- Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 hours after contrast medium is given. However, both the American College of Radiology (ACR) and the European Society of Urogenital Radiology note that the available data suggest that it is safe to continue breastfeeding after receiving intravenous contrast. For further information please consult the ACR Manual on Contrast Media and its references.
What are the limitations of MRI of the Breast?
High-quality images are assured only if you are able to remain perfectly still and follow breath-holding instructions while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging.
A person who is very large may not fit into the opening of certain types of MRI machines.
The presence of an implant or other metallic object sometimes makes it difficult to obtain clear images due to streak artifacts from the metallic objects. Patient movement can have the same effect.
A very irregular heartbeat may affect the quality of images obtained using techniques that time the imaging based on the electrical activity of the heart, such as electrocardiography (EKG).
Although there is no reason to believe that magnetic resonance imaging harms the fetus, pregnant women usually are advised not to have an MRI exam during the first trimester unless medically necessary.
MRI may not always distinguish between cancer tissue and fluid, known as edema.
MRI typically costs more and may take more time to perform than other imaging modalities.
Sometimes a benign (non-cancerous) piece of tissue in the breast can take up the contrast material and show up as a bright spot on the image. Often, the radiologist can tell by the appearance of the tissue whether it is cancer or not. When it is not possible, other testing such as ultrasound of that specific spot or a biopsy may be needed. If additional testing or biopsy shows no cancer, it is called a false-positive test result.
Which test, procedure or treatment is best for me?
Additional Information and Resources
This page was reviewed on February 15, 2018


text:
Many, many terrific photos from the Moot that happened last night. None taken by me, alas, as my phone camera lacked a flash, but here's a few examples and links to the galleries where they've been posted:
Wyvernwoodhas some of the best shots I've seen so far. Here's one with myself and George chatting with Finn Jones, and Mark Addy's in the shot:
DrNickVC has posted several terrific pictures. I particularly like this one, featuring (from left to right) Gethin Anthony (Lord Renly), Eugene Simon (Lancel), Joseph Altin (Pypar), DrNick himself, Luke McEwan (Rast), Mark Addy (King Robert), and Finn Jones (Ser Loras):
DocFourFour (aka Rimshot) has a great series of photos he took through the night, including many of the raffle drawings.
I'm sure there are more out there, but these are a great start. Hope to have my own Moot report, with some details I picked up from the actors, later in the evening. Still recovering from the whirlwind trip!