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At Beyond-Search, we understand your needs for clear and honest information concerning ongoing searches. Candidates must have good information to make knowledgeable decisions. The candidate process is divided into four phases:
- Initial Contact
- Presentation to Client
- Interviews
- Post Interview/Placement
1. Initial Contact
All calls to new or existing candidates are based on open positions or potential opportunities. In rare cases, exceptional candidates are selected for "exclusive representation" (see below). The focus on initial candidate conversations is to determine if there is an opportunity for a mutually beneficial relationship – can Beyond-Search help the candidate and vice-versa.
2. Presentation to Client
If both Beyond-Search and the candidate agree that an existing position is a good fit, the process is begun to present the candidate. Specific experience relevant to existing experience will be discussed. This information is included in the initial candidate presentation and is also serves as useful preparation for upcoming interviews.
3. Interviews
The interview is the goal of any candidate presentation. For each interview Beyond-Search will pre-brief and debrief the candidate to increase the chance of a successful interview. An "interview prep" sheet is sent before an initial interview.
4. Post Interview/Placement
Irrespective of outcome, Beyond-Search seeks to provide a positive experience to all candidates.
If the final result is a placement, Beyond-Search will assist the candidate in making the transition to the new employer.
If the candidate is not selected for the position, Beyond-Search will do a final "close-out" discussion to better position the candidates for future opportunities.
Exclusive Representation:
In rare instances, a candidate will be selected for "exclusive representation". Beyond-Search will agree to market this candidate to a few select companies in exchange for a 30 day period of exclusive representation.


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The Drums returned earlier this year with "Abysmal Thoughts" (released via Anti- Records). This time around it was just the last core remaining Drums member Jonny Pierce, more or less operating as his own solo album for the first time under their name.
The album has grown on me tremendously since its release this summer (where they celebrated its release with a show at House Of Vans), finding its way as a major ear worm along the way.
They brought the tour back to us in an official manner on November 15 when they played Brooklyn Steel. Being at the back end of their U.S. tour, the band sounded locked in, handily rocking both new material and old. There some surpirse oldies thrown in there such as "Baby, That's Not the Point," from their "Best Friend" 7″ single.
Find more photos from their performance posted below, along with the setlist.
The Drums Setlist:
1. What You Were
2. Me and the Moon
3. Book of Stories
4. Heart Basel
5. Days
6. Let's Go Surfing
7. Money
8. I Need a Doctor
9. Blood Under My Belt
10. Baby, That's Not the Point
11. Best Friend
12. Rich Kids
13. Head of the Horse
14. Mirror
15. If He Likes It Let Him Do It

subset: commoncrawl


text: This Volvo Passenger Side Headlight Assembly Fits VN, VNL, VNM Models for Years 2004-2016. This is a direct replacement part for a proper fit and matches the vehicles original design. This is a plug and play part, so no programming is necessary. For the driver side headlight assembly see Ace part #BP2506


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HALLANDALE BEACH, FL – Making her graded stakes debut in her first try around two turns, Gary Barber, Baccari Racing Stable, and Chester Prince's Salty swept to the lead on the far turn and powered down the stretch to a dominant 4 1/4-length victory in Saturday's Grade 2, $250,000 Gulfstream Park Oaks at Gulfstream Park.
The 47th running of the 1 1/16-mile GP Oaks for 3-year-old fillies was the fourth of six graded stakes and nine overall stakes worth $2.45 million on a 14-race program that was anchored by the 66th renewal of the Grade 1, $1 million Xpressbet.com Florida Derby.
Salty, bet down to even-money favoritism in a competitive field of eight that included Grade 2 winner Tequilita, Grade 2-placed Jordan's Henny, and previously-undefeated Nonna Bella, completed the distance in 1:42.91 over a fast main track.
Tequilita came with a late run for second, 1 1/2 lengths ahead of Jordan's Henny. It was another neck back to Nonna Bella, followed by Modacious, Conquest Sorcerer, Spring Mist, and Shezaprado.
Nonna Bella was keen early under Hall of Fame jockey John Velazquez and set a demanding pace of 23.26 seconds for the opening quarter-mile, 46.72 for the half, and 1:10.77 for six furlongs. Modacious was her closest pursuer with Jordan's Henny tracking on the outside, while Salty settled in next-to-last with Joel Rosario.
"I thought that there would be some speed, and it was exactly how it happened," Rosario said. "I got her going a little early because of the first wire. She responded very, very nice. The more you ride her, the more she keeps giving it to you. I felt confident in the last turn when she was trying to get up and getting close to the leader."
Racing in the clear on the far outside, Salty gradually began picking up horses down the backstretch to move into contention around the far turn before effortlessly slinging past Nonna Bella and Jordan's Henny as they straightened for home.
"We were back a little farther than I thought we would be," said Salty's trainer Mark Casse. "You're always worried when you think a filly would run two turns when you look at her physique and everything, but Joel (Rosario) got her moving 3/4 of a mile out and that's a long, sustained run — I was a little nervous about it. Even afterward, Joel said, 'Maybe I moved a little early.' He didn't realize how hot the pace was, but they were getting away from him. She's extremely talented, as everyone saw today. We're excited just to have her."
Rosario was also aboard for Salty's previous start, a 2 1/2-length maiden special weight victory on March 5 at Gulfstream in her first start since joining Casse when Barber bought a share of the Quality Road bay filly. She lost by a neck in her debut to Nonna Bella on February 4 before the Casse-trained Grade 1 winner Classic Empire came up short as the favorite in the Grade 2 Lambholm South Holy Bull.
"We were impressed with her first start," Casse said. "She ran the same day that Classic Empire ran, and that evening, I called Gary and said, 'I saw a filly that I really like run today,' and I told him who, and he said, 'I liked her, too.' We started pursuing her, and Gary bought part of her with the current owners and breeder. The first time we breezed her down here, Norman called me and said, 'This is a really good horse.' I said, 'I hope so.'"
Casse indicated that Salty would be pointed to the Grade 1 Kentucky Oaks on May 5 at Churchill Downs.
Salty returned $4, $2.80, and $2.20. Tequilita brought back $3.40 and $2.80, while Jordan's Henny paid $3.20 to show.
Source: Gulfstream Park


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To all of you I wish:
- love
- joy
- happiness
- health
- bliss
Thank you, to all of you, for following my blog this past year. I am looking forward to posting more healthy and vibrant recipes for this new year. I have several recipes that I need to post, but I must somehow dig up the time to do so.
For the New Year, be sure to eat some lucky foods:
- grapes
- cakes (or anything round)
- legumes including lentils
- cooked greens (collards, kale)
and avoid the unlucky ones:
- chicken
- lobster
- winged fowl
Of course, a bit of superstition is a part of a well-rounded New Years isn't it?
For more lucky food ideas, check out last year's Go Ahead Honey It's Gluten Free event that I hosted on foods that bring good fortune!


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Just happened to know CVS this afternoon and it appears I AM suffering CVS already as I do have some symptoms. So, just to share here as it's something important we should all know.
Computer vision syndrome (CVS) is a temporary condition resulting from focusing the eyes on a computer display for protracted, uninterrupted periods of time.
Some symptoms of CVS include headaches, blurred vision, neck pain, fatigue, eye strain, dry, irritated eyes, and difficulty refocusing the eyes. These symptoms can be further aggravated by improper lighting conditions or air moving past the eyes (e.g. overhead vents, direct air from a fan).
Dry eye is a major symptom that is targeted in the therapy of CVS. The use of over-the-counter artificial-tear solutions can reduce the effects of dry eye in CVS. Asthenopic symptoms in the eye are responsible for much of the morbidity in CVS. Proper rest to the eye and its muscles is recommended to relieve the associated eye strain.
A routinely recommended approach is to consciously blink the eyes every now and then (this helps replenish the tear film) and to look out the window to a distant object or to the sky—doing so provides rest to the ciliary muscles.
20-20-20 Rule to Fight computer vision syndrome
Every 20 minutes, focus the eyes on an object 20 feet (6 meters) away for 20 seconds. This basically gives a convenient distance and timeframe for a person to follow the advice from the optometrist and ophthalmologist. Otherwise, the patient is advised to close his/her eyes (which has a similar effect) for 20 seconds, at least every half hour.
Video: What is CVS and what you can do to prevent it?


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i'll never forget the time I was driving home after work around 8:30 at night and I spotted a strange craft at a low altitude, perhaps five hundred feet from the driver's side window. Headed the same direction as my vehicle, it was slowly descending. Astounded with the proximity I rolled down the window to get a clearer look.
The sleek craft was predominantly silver in color, metallic-looking. The street lights reflected off it's futuristic design. The fuselage that served as a compartment for the craft's occupants was roughly cigar-shaped; attached on each side were two long, flat, wing-like structures, and at the rear were smaller wings, one of them in a vertical configuration. Three thin metallic legs extended from the craft's underside, with black, doughnut-shaped objects at their ends. There were two humanoid creatures were plainly visible through the craft's windows; dark lenses concealed their alien eyes, and they wore headgear that looked very much like Red Sox baseball caps.
As I was trying to decipher the odd, blocky markings ("N5447W") on the tail of the craft some sort of tractor beam seized my vehicle, lit up the inside of my car. It nearly forcing me into a ditch. Fortunately, I was able to wrest free of the beam and bring the vehicle to a stop. Pulled over aside the road, still looking through my windshield, I watched the craft slowly disappear in the distance. Then I drove home, badly shaken never to speak of what we saw. I don't think I ever recovered from it all.


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Our most popular technologies
Want to see all the technologies used by pole-emploi.fr?Download our Chrome Extension
Pôle emploi (in English employment centre) is a French governmental agency which registers unemployed people, helps them find jobs and provides them with financial aid. The agency was created in 2009, resulting from the merger between the ANPE and the UNEDIC (or Unédic). The agency employs 45,000 civil servants. The merger had been expected for a very long time, for the two agencies had been created more than forty years before.
For a quick look at additional technographic info on pole-emploi.fr or any domain on the web, download our Chrome Extension. Check out our help article to see how Datanyze Insider can help you.
Private, Public, or Non-Profit
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See how much funding a company has received
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Supreme Science Selective Rabbit
Product details
Supreme Science Selective Rabbit is a tasty, high-fibre blend that provides all the essentials your rabbit needs for a happy, healthy life.
How it works
This food is specially designed to suit the requirements of adult rabbits of all breeds, including dwarf rabbits. High fibre content provides all the nutrition your rabbit needs, promoting healthy digestion and dental strength.
Fibre is generally regarded as the best food source for rabbits, given that a wild animal eats up to 20% fibre when feeding on grass. This recipe is fortified with an even higher level of fibre at 25%, which, together with the natural ingredients, means your rabbit will love the taste. This can prevent your pet from selective feeding, which can lead to a lower intake of important nutrients. Furthermore, a natural fibre diet is beneficial to digestive health as it generally doesn't contain substances which your rabbit might have an intolerance to.
Additionally, this mix is optimised to make sure your pet is satisfied after eating, keeping them fuller for longer to help prevent overeating and maintain a healthy weight. The food is also free from added sugar.
Key benefits
- suitable for adult rabbits of all breeds and size
- high fibre content – exactly what your rabbit needs
- natural ingredients – no added sugar
- optimised to satisfy your pet after every meal
- great flavour discourages selective eating.
When to use it
Wild rabbits have evolved to handle a diet almost exclusively consisting of fibre and the same is true for their domesticated cousins. Finding an all-in-one food for your pet can sometimes be tricky and rabbits are notorious for selective eating. Greens and similar vegetables including broccoli, kale, and herbs are suitable for your pet, as they are high in fibre. Alternatively, specially formulated foods such as Supreme Science Selective Rabbit can also be an excellent choice, as it is designed to meet all the nutritional needs a rabbit requires. If you are planning on changing your rabbit's diet, however, make sure to consult your vet first. Changing a diet too quickly might cause your rabbit to suffer from stomach problems, so it is best to introduce it gradually.
NUTRITIONAL ADDITIVES/Kg:
Vitamin A 15000 IU, Vitamin D3 1500 IU
Crude protein 14.0%, Crude fibre 25.0%, Crude oils and fats 4.0%, Crude ash 8.0%, Calcium 0.6%, Sodium 0.3%, Phosphorus 0.4%.
Customer reviews
Product reviews are filtered by language.
The following reviews are available in English.
12 year old RabbitSelective Rabbit food is the best as our rabbits appear to live much longer than when they were on Supreme or Russell. They appear to lengthen their lifespan from 7/8 years to between 10-12 years. 12 years is our record as most rabbits die between 7 years and 10 years.
Supreme selective rabbit foodExcellent food, rabbit always eats everything, recommended by vets and haven't looked back since
Bunny FoodMy Giant Rabbits love this food and with quick delivery I no longer have to wrestle with large bags of rabbit food to get it home in the car. This is a great ordering and delivery service 5 star.
Good qualityGood quality of food for reasonable price. Rabbit is not selecting and eats everything and I was worrying little bit because my one is really selective. Will buy again.
Love itThis is a high percentage fibre food and my buns love it.


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Long Hot Summer of 2005
Alright! The long hot summer of 2005 has had us locked in the studio with the incredible Jonny Lang. We're putting together a hot record for him, his fifth. Michael Bland (drums) and Jim Anton (bass) came in and held it down with Jonny being Jonny and me and Shannon being me and Shannon. Matt Hyde came in to turn knobs and got great tones on everyone. A truly talented group of individuals was amassed. Look for that one around Feb. 2006.
Still putting the finishing touches on 3 songs for the 3rd India.Arie record. She's singing great these days and has some surprises planned for this one.
Finished one song, "In My Mind", for Heather Headley (RCA) which Serban Ghenea is currently mixing that should have us all over the airwaves.
New collabs are being put together as I write this. We'll update as those are confirmed.
Back to the lab.
Posted by Drew, 8/17/2005 07:54:00 PM
News ArchivesFebruary 2005 August 2005 January 2006 July 2006 February 2010


text: I just started a Facebook page for The Daily Fitness Journal. I hope to figure out how to get the blog to feed directly to the page. In addition, I will use the page to jot down quick notes related to my content and want to see it as a vehicle for questions from you, race inof, anything anyone would like to share to the community. Here is the link:


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Ship Car To Bafoussam
Domestic USA & International Auto Shipping
- Quote Calculator
Wait, before you go...
Get A Free Quote:
Or call: 1-800-518-8708 for an additional 15% off.
Learn more about A-1 AutoTransport.
Get A FREE Quote
And Save an Additional 15%
Or call: 1-800-518-8708 to claim your discount today.
Ship Car To Bafoussam
Bafoussam is the capital of the West Region of the country of Cameroon and one of the three arrondissements in the department of Mifi.
If you intend on importing a vehicle with you in order to travel quickly from one point to another, you might want to trust a reliable shipping agency such as the A-1 Auto Transport. The truth is that handling this task all by yourself could be quite overwhelming.
Cameroon has an estimated population count of about 21.5 million people and it has its location in West Central Africa. Even though the official languages are French and English, not quite a lot of people can actually speak them. The important thing is that the officials do and that's why we have our agents sent there to help you with the communication if something happens. Even though the corruption in the country is relatively high, A1 Auto Transport can ensure that your vehicle gets there safely.
A-1 Auto Transport ships vehicles worldwide. Click here or call 1-800-518-8708 to get a free, no obligation to buy price quote to ship your car.
Recommendations for Import.
Even though English isn't really spoken, the majority of the officials in the Cameroon Customs Department are going to have basic literacy and fluency. The main issue that you should be concerned with if dealing with the process on your own is the high corruption. This along inadequate staffing means that you can expect considerable delays of your shipping.
Having good connections with the officials in Cameroon is particularly important if you don't want to be penalized with unregulated extra fees due to the corruption. And A1 Auto Transport has enough experience to ensure that you wouldn't have to pay any more than the regulated amount. We will work with the local agents and have plenty of experience shipping vehicles to Cameroon.
Shipping Requirements.
There are quite a lot of documents that you would have to provide prior to its arrival. You will have to send it to both the customs in Cameroon and in the USA. These documents include:
- Ownership proof.
- Registration.
- Final destination of the vehicle.
- Insurance Certificate.
- Bill of Sale.
Unless you are shipping the car to a permanent address, you have to pay all of the taxes. The average tax amounts to 19.5333% and there is no excise tax. However, there is an indirect consumer goods tax of about 25% and a VAT of 18.7%.
Shipping Methods.
Though you will have your vehicle with you in Cameroon, before we give you a free quote, we need you to choose between the two common methods of freight shipping. This will help you get the most competitive rates and will fit in with your budget. There are two primary shipping methods that you can choose from:
- RORO shipping requires you to drive the vehicle on its own wheels on a shipping deck. It is then going to be safely strapped on it and transported to Cameroon with the freight carrier. This is the quickest and cheapest sea-freight method but there are a lot of restrictions. You can only ship an empty vehicle with no personal belongings inside it. Additionally, all alarms have to be disabled, air conditioning gas removed and insides of the vehicle cleaned before shipping it out.
- Container shipping allows you to take advantage of an enclosed 20ft or 40ft container and ship as many belongings along with your car as the container can fit. This is why it's slower and more expensive.
To get the latest updates on auto import regulations, contact the Embassy of Cameroon in USA.


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Within the automotive sector, polymers and plastics are often referred to for body panels or interior fixtures and fittings. However, for over 16 years Gajjar Plastics have been providing engineering solutions to the Automotive industry in the form of highly critical components required for steering and safety. Having pioneered a specific material, component and technology, Gajjar Plastics are renowned worldwide for the development of polymer steering components utilised in over 50 million vehicles worldwide, over 60 different platforms.
Dedicated to customer satisfaction through delivery of full engineering solutions. Gajjar Plastics works with all levels of the supply chain and at every stage, from concept design to solution.
Integration with our full R&D laboratory allows development of both engineered designs and engineered polymers bespoke to the application, environment and conditions.
Working in partnership with clients to develop the appropriate solution, with Engineers, Chemists, Designers, and manufacturing, Gajjar Plastics is best placed to offer a full service from advice to components.


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If you recently quit hormonal birth control, you're probably going through a bit of hell right now. I know it's not fair, but you are going through something called Post Birth Control Syndrome.
This withdrawal process from hormonal birth control lasts anywhere from 6-12 months, and it peaks at month 6 (1). It's usually around this time that you might feel like giving up and going back to the pill. But please stay strong and power through this phase, because if you do you will be rewarded.
So why is this happening?!
The reason you are suffering is because your body is detoxing from the strong synthetic estrogen that your hormonal birth control provided. This also usually causes a surge in androgens which can cause acne and other PMS symptoms. Also, since you haven't had a period all these years while taking hormonal birth control (you've really just been having a "withdrawal bleed" or "pill bleed") it might take some time before your body starts ovulating and menstruating again. And it's not until you ovulate on your own that your body can produce progesterone and estradiol, which keeps you from having PMS symptoms.
So what is a "pill bleed"?
Pill bleeds are pharmaceutically induced bleeds that involve no hormone production on your end at all. So all of the "periods" you had while on hormonal birth control were just for show. Let me repeat, these "periods" were completely fake (exception being the Copper IUD and Mirena IUD. Read below for statistics).
Shocking, right?
When a women ovulates without the use of hormonal birth control, she creates progesterone and estradiol. These hormones have a multitude of benefits for your mood, bones, thyroid and metabolism. They're pretty much essential for a women's physiology. This means that women who take a form of hormonal birth control are robbed of these crucial hormones that keep us healthy and happy.
It's one of the largest injustices to women's health today, and it's no wonder many women who take a form of hormonal birth control experience depression.
In October 2016 JAMA psychiatry released a study conducted by researches from the University of Copenhagen. In the study, titled "Association of Hormonal Contraception With Depression" they tracked one million women over the course of 13 years and concluded that women who use hormonal birth control are significantly more likely to be diagnosed with depression (2).
The fact that hormonal birth control is the most widely used form of contraception used today is infuriating. The practice is antiquated, and it's time this harmful trend comes to an end.
Now is the time to take our reproductive system back into our own control. For the sake of our health, and the next generation's.
Common Symptoms of Post-Birth Control Syndrome Include:
- Amenorrhea (loss of menstruation)
- Heavy, painful periods
- Infertility
- Hypothyroidism
- Acne
- Migraines
- Headaches
- Hair loss
- Depression
- Blood sugar dysregulation
- Anxiety
- Gas or bloating
- Changes in bowels
- Inflammation and other immune imbalances
So now the road to recovery begins.
Your 5 Step Plan When Coming Off The Birth Control Pill (or any other form of hormonal birth control):
1. Reestablish your natural hormonal rhythm.
Your hormones fluctuate during different times of your cycle.
There are four cycles:
- Menstruation– days 1-7. Estrogen begins to increase and progesterone is low.
- Follicular Phase- days 8-14. Estrogen peaks, progesterone is low.
- Ovulation– days 14-21. Estrogen begins to fall and progesterone peaks.
- Luteal Phase– days 22-28. Both estrogen and progesterone dip.
Even if you are not yet ovulating on your own, it is important to encourage the production of estrogen and progesterone at the right times of the month. This will help you eventually start to ovulate on your own.
Two methods to reestablish natural hormonal rhythms:
- Seed cycling.
- Vitex– Vitex is an herb that promotes ovulation by protecting your hypothalamus gland from stress and from preventing your pituitary gland from making too much prolactin. Basically, it increases your levels of dopamine, which lowers your levels of prolactin, which makes your luteinizing hormone go up, and then makes you ovulate and make progesterone!
A note of caution about Vitex: Please do not use vitex until you've been off of hormonal birth control for at least three months. I recommend 1,000mg a day taken as a single dose first thing in the morning before breakfast. Stop taking it on days 1-5 of your cycle, and then start again. Discontinue use after six months.
Hormonal birth control causes leaky gut, preventing your body from absorbing all the nutrients from your food. As they say in Ayurveda "you are what you digest.".
This is why women who come off hormonal birth control are deficient in nutrients and minerals such as zinc, B12, magnesium, D3, copper, iodine and selenium-all nutrients necessary for ovarian health. So it's imperative to replenish these levels ASAP.
3. Support detox pathways.
It's important to open your detox pathways, as this is how you will flush out any excess estrogen in the body, as well as all the synthetic hormones you've built up from the use of hormonal birth control . Ways to do this are by going on a cleanse like my 20-Day Hormone Reboot Program in tandem with drinking dandelion root tea, taking Glutothione, chlorella, and/or activated charcoal. NAC is also a great supplement. And of course, drink lots of water and eat plenty of liver supporting foods like broccoli, beets, and cauliflower.
4. Rebuild your gut.
Most women's gut post hormonal birth control is in a state of inflammation due to leaky gut. You must get your microbiome to a healthy state in order to start digesting and absorbing your food properly. Do this by taking probiotics, eating 2-3 servings of fermented foods daily, and drinking gut healing bone broth and collagen.
5. Nourish your thyroid
If you're thyroid is not operating properly, it can prevent you from ovulating and having a healthy period. To support your thyroid, take 150 mcg of iodine daily (nothing more unless advised by a trained practitioner), and replenish your stores of selenium, 1-3 brazil nuts a day will do the trick, or 150 mcg in pill form daily. I encourage you to take a serum ferritin test and if your levels are too low (you want a level of 50-90 ng/ml) then supplement as needed.
Okay, I know this is a lot of information to absorb, and it might be overwhelming at first. But please be reassured that although it might seem like the end of the world, you can and WILL get through this.
And know that you are not alone. Please contact me today for a 30-minute consultation, so we can get you on my 20-Day Hormone Reboot Detox to get your hormones back on track, so you can start feeling the way you're designed to- healthy, happy, and PMS free!
With Gratitude,
Health Coach Jenna
- Briden, L. (n.d.). Period repair manual. p.34.
- Skovlund CW, Morch LS, Kessing LV, Lidegaard O, Association of HOrmonal Contraception With Depression. JAMA Psychiatry. 2016 Nov 1;73(11):1154-1162.PubMed PMID: 27680324.


text: Sodere is Santa Monica, California based Ethiopian media and entertainment company. Sodere transmits and distribute news, movies and other content on website and mobile apps to more than 5 million Ethiopians who live outside Ethiopia. Sodere content are available on Sodere.com, SodereTube.com, Apple Store, Google Play, Apple TV, Amazon Fire TV, Android TV and Roku.


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Google should be banned, had early epu scan yesterday am 5 weeks could see sac and baba they could see heart beat I couldn't!
Doc says my progesterone level is low @ 17 so put me on vaginal gel to build it up, she says 30 is what they like to see and under 10 is a non viable pregnancy I'm up the walls! Repeat scan and bloods next week !
Please someone put my mind at rest!
Post Deleted Because: The OP deleted this post
Been through ivf and those vaginal gels pessaries are very efficient so once you take it they will boost your levels no problem.
Wors of warning they they can irritate you and give you a funny colour discharge sometimes. Good luck.
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text:
Crosstown Pub begins Trivia Tuesdays in Naperville
By 08/09/2013 09:29:00
Every week on Tuesday, teams converge at the Crosstown Pub in Naperville to put their reputation on the line by showing their knowledge of places, people, history and events at a trivia event produced by Whaddyaknow Trivia.
If you haven't been to a trivia event before, the rounds are evenly paced and will challenge a different section of your general knowledge with picture and question segments. With your best friends by your side, you'll need to come up with a whimsical, naughty or pop culture laden team name and submit answers to brain stumping questions to score points. The team with the most points when the dust settles wins money and the runner-up wins a gift card. How often can you say you made money at a bar?
Sign up for news, deals and doings


text:
Ideal Shield is the manufacturer of the Original Bumper Post Sleeve, the strongest guardrail on the market, the portable sign base, and a wide variety of handrail systems. Our patented line of products save time, money, and maintenance by eliminating the need to paint. We continue to be the industry leader in facility maintenance solutions with a long list of acclaimed products which also includes bollard covers, sign bases, handrail, both standard and custom guardrail systems, dock door protection goal posts, column wraps, clearance bars, and more. With hundreds of styles available in a variety of sizes and colors, we continually meet the needs of any facility or company.
Shield products are designed to be a cost-effective way to improve safety in and around your facility, protecting your most valuable assets – your personnel and machinery – as well as enhancing the overall appearance of your structure.
Since the beginning, our mission has been to provide innovative solutions, superior quality, and excellent customer service.
Located in Southwest Detroit, with five manufacturing plants and a vast distribution network throughout the United States, Ideal Shield's product line is proudly made in America and readily available for quick shipping.
Take a look at our YouTube channel to keep up with latest innovations at Ideal Shield!
We are Ideal, a customer-focused company delivering innovative solutions, providing maximum value in construction services, protection products, and indirect material management.
Copyright © 2019 Ideal Shield. All Rights Reserved.


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Precise Guide to fitness plan in 2019
With the New Year, comes an evergreen resolution of many, about getting fitter and healthier this year. Now many fail to keep the hard work going in the Gym due to lack of dedication and many archives their ultimate goals. To succeed in your fitness plan you need a precise guide to be prepared. Let's […]Read More →
Smart guide for gym equipment – Beginners Aid!
Starting up with the idea of building up a gym is quite risky. Navigating your way through the heavy and various types of gym equipment available in the market makes it difficult to make correct choices. You need to look for the machines which can help you in gaining strength in the most effortless and […]Read More →
Medicine ball exercises – A comprehensive guide
Using medicine balls have always served as a great alternative to gain a curvy and perfect body type. The movements associated with the medicine balls play an impactful role in the improvement of the overall athletic ability of a person. In ancient days, animal skin pouches were filled with sand and used for the patients […]Read More →
Important Tips For Plus Size Workout
Undertaking a plus size workout is quite difficult. The beginning sometimes turns up to be a very daunting task. However, you need to own a very song will and work dexterously for attaining your target. You need to work really hard to bring out the inner athlete and gain a healthier and fit body. In […]Read More →
Winter exercise motivation tips
With winter around the corner, everyone wants to snuggle up in front of the television set with a cup of coffee and watch the favorite show instead of going out for a walk. You should keep in mind that the seasons would come and go but once you decide to stay in your shell like […]Read More →
How to develop abs and core strength?
Core Strength is an important thing to gain as it looks after the body as a person starts to age. So, it is very important to get into exercises which would help in strengthening of the body. You need to start with a proper abs routine which would directly target at your abdominal muscles. It […]Read More →
Eating rules before and after a workout
Just undergoing hardcore exercise is not enough. The nutrient which you provide your body plays a major role in the growth of the muscles and increment of the core strength. Majority people ignore the importance of nutrition and hydration which they need to take before starting with their daily workout. The eating habits which a […]Read More →
How to stimulate muscle growth?
It is often seen that no matter how strong you are training and workout you undergo, sometimes the muscle growth slows and results in a halt. All your efforts and hard work seem to gain no successful results. There could be problems related to your exercise routine and which results in such a situation. So, […]Read More →
How to plan a workout if you have less time in hand?
Planning workouts is a very tough job. You need to have enough information about the type of exercises which requires lesser time but is comparatively more efficient. Once you can get hold of all the necessary exercises, you can insert them in your workout plan. To help you out with your workout plan, here are […]Read More →
Break these bad gym habits immediately
Bad habits are something which is really very hard to break. Often we forget to understand that we are in a continuous manner repeating our regular behaviour and the same set of mistakes. It even takes a lot of self-awareness and a genuine effort to actually change it. Here the most common bad gym habits […]Read More →


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Role: Tank
Type: Sound
Big Brother
The Circle Community Manager
After a brief career in politics, Peter Goodworth was recruited by the US Navy to be their figurehead. His job was to keep the Navy's image in check, to defuse any political or social friction, and to make sure everyone followed the guidelines to the letter.
The Circle saw his talent for making people do what they were supposed to, and offered him a substantial raise to come work for them.
Now, he is their elite team's "Big Brother", keeping an eye on their every move. His job is to make sure missions go precisely according to plan, and he does anything necessary to make sure they do.


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As noun
a surface forming or suggesting the top of a table
a photograph of an arrangement of objects on top of a table
As adjective
intended for use on the top of a table or the like
noting or relating to an arrangement of objects, especially miniatures or models, as would be appropriate to the top of a table
noting or relating to a type of game that requires the physical presence of players and the manipulation of game pieces, as board games and some card games or role-playing games but not video games
As noun
any of various apparatus for heating, especially for heating water or the air in a room
the element of a vacuum tube that carries the current for heating a cathode
a pistol, revolver, or other firearm
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Imagine coming home to a resort-like setting with generous living spaces and abundant natural light abound.
The property at 725 Baywood is a perfect combination of function, style and ease of living. Built in 1979, this Harbor Bay townhouse is located in a coveted location adjacent to a salt-water lagoon and close to endless paved trails, offering peaceful park-like surroundings.
The four-bedroom, two-and-a-half-bathroom home boasts an open design on the main level — a living room with gas fireplace, high ceilings and large windows. The dining area, kitchen and adjoining family room space are perfect for entertaining. The lower level also features a half bathroom and access to the spacious two-car garage. Upstairs are four generous bedrooms and two bathrooms — the master suite is highlighted by a private wraparound deck shaded by mature trees and an oversize en-suite bathroom complete with spa shower and luxurious walk-in closet.
Harbor Bay Isle is a jewel of a community along the East Bay shoreline. Conveniently located and ideal for commuters due to its close proximity to the San Francisco ferry, Google shuttle bus, BART and bus.
Price: $980,000
Listing agent: Ringo Liu, Realtor, DRE# 01106012, Berkshire Hathaway HomeServices Drysdale Properties, 510-913-1600, email@example.com.
Source: East Bay Sponsored: A serene sanctuary in Alameda


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Hi Em,Great pic of the Heron and nest. Being completely ignorant of the natural world I had no idea they were so big. Its great that you got so close. Whenever I get within shot of a bird it flies off or I end up with something out of focus.All the bestNechtan
Wow! The picture of the heron on it's nest just made my day. Thanks Em! :)
Post a Comment


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Book Tee Times
Tee Times
Input Score
Below you will find great discount tee times for the Cedar Crest Golf Club in Murfreesboro, Tennessee. You may also view online tee times at other golf courses in the area of Tennessee or other locations by using the search box. At Cedar Crest Golf Club, golfers tee off from the Blue, White Or Gold tees at a maximum distance of 6,729 yards from the Blue tees.


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September 2016 News
Yehuda Amichai's 'Language of Love'
September 21, 2016
Chana Kronfeld, author of "The Full Severity of Compassion: The Poetry of Yehuda Amichai" (Stanford, 2016) will speak on Thursday, October 13 at 4:00 pm in the SML Lecture Hall about Yehuda Amichai (1924–2000) – one of the most important and well-known Hebrew poets of the twentieth century, and an...
The Book As Stage: Performance and Theater in the Book Arts
September 21, 2016
The book format has long been used as a vehicle for artistic expression. This exhibition opening on September 26 in the Haas Family Arts Library, focuses on the presentation of theatrical texts and documentation of performance in the book arts. The objects on display showcase the space of the page...
Student Research at Yale University Library
September 21, 2016
This annual exhibit opening Monday, October 3 in the Sterling Memorial Library Exhibits Corridor, highlights four Yale students' exceptional research at the Yale University Library. The subjects represented are as diverse as the Yale Library collections and convey a combination of both complete and...
Institution for Social and Policy Studies at Yale: Research, Policy, Leadership
September 21, 2016
Since 1968, the Institution for Social and Policy Studies (ISPS) at Yale has advanced interdisciplinary research, shaped public policy, and informed democratic deliberation. Through its study centers, fellowships, support for research and publication, and other major initiatives, ISPS brings...
Character Mongers, or, Trading in People on Paper in the Long 18th Century
September 21, 2016
In the course of the long eighteenth century—the Age of Caricature, and of The Rise of the Novel—the British reading public perfected the pastime of savoring characters. In a flourishing print culture, buying and selling likenesses of people and types became a business—and arguably an art. Real and...
Quicksearch for Music
September 19, 2016
Quicksearch became the featured search box on the Music Library's website this summer. Quicksearch is a search interface that allows researchers to search across a variety of library resources, presenting results from three groups: Books+, which searches across the two library catalogs (Orbis and...
The Book As Stage: Performance and Theater in the Book Arts
September 19, 2016
The Book As Stage: Performance and Theater in the Book Arts September 26 – December 18, 2016 The book format has long been used as a vehicle for artistic expression. This exhibition focuses on the presentation of theatrical texts and documentation of performance in the book arts. The objects on...
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10 Signs He Loves You (Even If He Hasn't Said It Yet).
#6. Does he make you feel like you are the most important thing in life?
Does he make sure that the free time he has is spent either with you or on you? Those few spare minutes that come up during the day... are those yours?
#7. Does he talk about the future with you?
Do you have discussions about the future? Are those discussions about a future together?
#8. Do you want to grow old with him?
Do you picture yourself like this down the road? Is this a future picture of the two of you?
#9. Does he make you feel like a princess in a fairy tale?
The main question is does he make you feel like nobody else has or can? We all know that fairy tales aren't real, but he can certainly make it feel close to it. Does he do that?
#10. If all of the above are true, it might be time to turn 'I' and 'you' into 'us.'
If you answered yes to all of the above then you just might have found the man that will love you forever. If you said no to most of the questions it might be time to go out and find that man that is waiting for you.
Next, quotes about love from celebrities.
Page 2 of 2Next ›


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Saturday, 15 February 2014
Posted by Unknown at 13:50
4 comments:
- Andrea said...
Hi Mele
I like your writing about swimming. I really like the choice of words you chose. What made you come up with these ideas?
- 21 February 2014 at 11:25
- Yazmin Aung said...
malo e lelei Mele , Great comic keep up your hard work till you go college . "Do you like to swim " .
- 21 February 2014 at 11:27
- camill said...
Malo Lelei Mele
You have done a very good job on your comic. I really wish I could do one just like you. Do you go swimming?
- 21 February 2014 at 11:28
- Tupou Rose said...
Hi mele i read your comic. It was fantastic. I like how you used the 4 photos it is nice good work. When is the next time you a going to make this?
- 25 February 2014 at 10:59
Subscribe to: Post Comments (Atom)


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Still buzzing off of a brief European promo tour, Alabama native Miztuh Chazs releases his 5th studio album titled 500MICS. It has been 5 years since his critically acclaimed indie album A.W.O.L. surfaced and now he's back to once again push the boundaries of his craft. The mix of lyrical wordplay and signature AMP instrumentals creates a unique sound that only Miztuh Chazs has mastered. No other project has proven this more than his current project 500MICS which released on December 18, 2015.
As a Midwest ambassador, Miztuh Chazs continues to bend the curve of the definition of hip hop. With high energy beats, his album gives an exquisite blending of jazz, soul, and rock with a perfect hybrid of 1940's piano style music, southern hip hop rhythm mixed with an amped club vibe and a fresh touch of satire about life. Both an artist, songwriter, beat producer, and entertainer, he has spanned various states in the U.S. from California to Tennessee and overseas to Germany and France.
Even with other projects in the works for Miztuh Chazs, he took a long step back to fully focus on his album. One can almost say he meditated until his resolve became clear. Any listener or fan, new and old, can find a piece of themselves in this record. Because of this he created an entity that could stand up to most hip hop classics that are around today. 500MICS is the pinnacle of underground, indie, and hip hop music. Want to experience the rising legend that is Miztuh Chazs? Check him out at these social media sites.
Reverbnation: @mrchazs
Periscope: @miztuhchazs
Instagram: @miztuhchaz
Myspace: @streetmarinemusic
Twitter: @wearesamg
Vine: @TheOfficialMiztuhChazs
Snapchat: @wearesamg


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Lizards, Turtles, and Snakes… OH MY!
On Sunday, June 28th, the New Mexico Herpetological society joined us at Coronado Historic Site to share some native reptiles and amphibians. Their president Scott told us about many common species, and he brought his pets as well, which included a bull snake, many types of lizards, turtles, and frogs! Scott was joined by other helpers who brought dozens of creatures including a Gila Monster. A representative from a pharmaceutical company explained to us how the Gila Monster venom was being used to treat certain types of diabetes and Alzheimer's' disease. All of the visitors that were on site had the opportunity to hold the snakes and lizards, some people were more excited than the others! They also brought a very friendly parrot named Toby, who particularly liked to sit on peoples heads. The Herpetological Society did a fantastic job, and hopefully we can make this an annual event!


text: Up for sale is a retrax truck bed cover. I want to install a camper, so the truck bed cover is going to have to go. I'm not shipping this, you're going to have to come pick it up in Fairfield, Ca. However, depending on location, I am willing to come drop it off or even meet half ways. I'm selling it for $450. Any questions, please let me know. Cheers!


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About The Camp
Ambassador Camp exists for the purpose of bringing children to the saving knowledge of Jesus Christ through the use of a program-based week-long summer camp. Though camp is certainly a blast, the main focus of the week is spiritual renewal and growth.
What does the camp believe?
Ambassador Camp is not affiliated with any particular denomination, but we do consider ourselves an evangelical Christian camp. Doctrinally, we are committed to:
- The full and final authority of the Bible
- The trinity of the Godhead, externally existing as Father, Son, and Holy Spirit
- The full deity and humanity of Jesus Christ, His virgin birth, sinless life, substitutionary death, and bodily resurrection.
- The absolute need of all people for salvation, available only through the grace of Jesus Christ and His merits, and received by faith in him alone.
- The personality of the Holy Spirit, who imparts spiritual life at conversion and sustains that life for spiritual growth and development according to God's plan.
- The personal and actual return of Jesus Christ to earth at the end of the act to set up His kingdom and judge the world.
You can become a Camp promoter by requesting a "Sender's Kit," by email, phone, or by mail. The "Sender's Kit" includes Camp brochures, staff applications, etc. There is also a promotional video that is available. If returned to Ambassador Camp, there is no charge; otherwise there is a reasonable charge.
Also, schedule permitting, our Camp Director, Ms. Rebecca Wray, can come and do a 30 minute presentation to parents and children.
Ambassador Camp is a non-profit organization: At this point, you can donate money by making a check payable to Ambassador Camp, Inc. and send it to our address. You can donate online through our Nehemiah Project Page or by gifting stocks or bonds. Contact the camp for more information. Your gift is tax-deductible and much appreciated.Donate
Ambassador Camp Leadership
- Ms. Rebecca Wray – Whiteville, NC
Board of Directors
- Mr. James Arnemann – Sumter, SC
- Mr. D.F. Barber Jr. -Sumter, SC
- Mr. Randy Hardee – Sunset Beach, NC
- Rev. John Mower – Colombia, SC
- Mrs. Susan Perrou – Florence, SC
- Mr. Ron Walton – Matthews, NC
- Ms. Rebecca Wray – Whiteville, NC
- Rev. Ray Yow – Whiteville, NC
Office/Kitchen Manager
- Carol Yow – Whiteville, NC


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Communicating with your cats can be made easy with the aid of their favorite treats. You can even train them almost every trick imaginable with the help of cat treats they love.
Here we will show you how you can communicate effectively with your feline pals using cat treats.
Training your cat is possible based on a feeding schedule and discovering what makes your cat think: "Jackpot!!" Learn how to find that special treat, and how to use it, in this week's episode.
Please use the "Next Page" button below to watch how to communicate with cats using treats!
Pages: 1 2


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Hi everyone! This month Creative Embellishments are guests at CSI and this is my creation for Case File No. 161. I love the colors on this one…such a different combo to play with! I really enjoy CSI case file…they force me to journal a bit and I need that little push! I have used Maja Design Nyhavn Collection from the Flying Unicorn store.
For my evidence I used some: wet medium, stripes, triangles and metal. I tucked in pieces from the Distressed Chicken Wire Border and I LOVE using the Distressed Text Stamp!
The title chippy is covered with some Dazzlerz from Shimmerz…lots of texture on that chippy. Add some journaling...case solved!
That is it for me for today! Don't forget to check out the new April challenge and play along with us! Make sure to share all of your creations on our Facebook page…please share your CSI entries with us too!! Take care and happy Scrapping!
Creative Embellishments Products:


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Guild Wars 2: Skills Tool builder
The folks over at LunaAtra have published their Guild Wars 2: Skills Tool for those interested in setting up their Guild Wars 2 character abilities. The tool also allows you to save your setup via URL for later adjustments, or for sharing your builds with friends.
The Skills Tool also supports multiple languages. (thanks goes out to Ohad, one of our readers, for sending us a heads up)
via LunaAtra


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Attachments give construction equipments thier versatility. Now a days, Hydraulic breakers, shears, crushers, pulverizers and processors are absolutely imperative for demolition contractors.
OKADA AIYON CORPORATION offers a variety of attachments providing a broad range of sophisticated demolition equipment as MASTER OF DEMOLITION. We can provide variety of attachments for demolition you need, like a "Demolition Coordinator".
Intelligent Technology
> Anti Blank Fire System
> Anti-abrasion box style bracket design
> Blow Speed control adjuster
> Auto Lubrication system (option)
> Under water application (option)


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Connectivity Technology
Our technology-neutral philosophy provides you the broadest range of network services and coverage options, while lowering total cost of network ownership.
Help Me To
Managed Network Services
To ensure network efficiency, availability and ROI, more and more companies have discovered that outsourcing network operations simply makes sense. SageNet brings clarity to managed network services.
Technology Solutions
SageNet helps you connect, manage and protect your organization's vital information and network resources. SageNet associates bring you in-depth technological expertise bolstered by years of hands-on experience within a variety of vertical markets.
Your network is our passion. Delivering the highest possible quality of customer service and support is our mission. For immediate SageNet support call 800.400.8999. For Spacenet Satellite Services support call 800.325.9202.
Author: IV DIckson, Director, Digital Signage /Tuesday, May 01, 2018/Categories: Professional Services for your Network
Digital signage has become increasingly common as organizations employ the technology to deliver dynamic and highly targeted messaging to a variety of audiences. Analysts say rising demand for these compelling solutions will make digital signage a $33 billion market by 2023.
Technological advances in outdoor digital signage will contribute to a good portion of that growth.
Until recently, digital signage initiatives have been almost exclusively focused on reaching indoor audiences. There were simply too many challenges involved with supporting outdoor displays — bright sunlight can make them practically unreadable, extreme weather conditions can disable them, and there is always the threat of vandalism.
Engineering advances have neutralized many of these challenges. So-called "high-bright" displays that generate more than 2,500 nits (a unit of visible-light intensity) deliver the color contrast and brightness to make signage readable even in direct sunlight. Powder-coated aluminum housings resist moisture, humidity, dust, extreme temperatures and even insects. For additional peace of mind, extremely durable signage enclosures protect against theft or tampering.
Retail, financial services and public transportation are seen as very strong vertical markets for outdoor digital signage. However, analysts are nearly unanimous in identifying quick service restaurants (QSRs) as the sector with the most obvious use case for high-bright outdoor signage.
Consider first that the vast majority of QSR customers don't come inside the building. Various market studies find that up to 70 percent of QSR sales come at the drive-thru window — and that figure is likely to increase as time-pressed customers place a premium on speed and convenience. Whether picking up dinner for the whole family or simply grabbing a late-night snack after the dining room is closed, customers value the ability to be served without leaving the car.
Outdoor digital menu boards aren't entirely for the customer's convenience, either. The restaurants benefit from eliminating the cost and resources involved with posting and updating traditional printed menu signs in the drive-thru. They have the flexibility to change menu items, prices and promotions based on sales, customer and contextual data. For example, digital signage makes it simple to implement on-the-spot discounts on slow-moving items, as well as remove information or promotions on items that are out of stock.
According to a Forrester Research study, outdoor digital menus allow QSRs to reduce their operating costs, increase sales, streamline operations and deliver a better customer experience through more relevant and targeted digital content. Based on in-depth interviews with customers and a survey of 150 QSR operators, the study concluded that a 10-store QSR organization would achieve a 196 percent return on investment, with payback in 11 months.
While the benefits are well-established, this is not a do-it-yourself technology. Expert installation and maintenance are critical to ensure high levels of performance and reliability in harsh outdoor environments. These systems also have significant network bandwidth requirements and can disrupt or slow the performance of other business applications if your network isn't up to the task. In addition, you'll need a content management system to create and customize messaging in a thoughtful and professional way.
SageNet understands that QSRs may not have the time, expertise or internal resources to design, implement and manage outdoor digital signage. We can help. With our end-to-end approach, we can design, deploy, monitor and support multisite digital signage solutions. We can work with you to identify objectives and your usage requirements, and develop a solution that meets those targets.
Number of views (841)/Comments (0)


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1. Your seven-year-old son's socks are crusted to his feet.
2. Your dish towel has spaghetti sauce spots on it and you haven't had spaghetti since last week.
3. You don a surgical mask when you open the hamper.
4. The laundry pile topples over and smothers the dog.
5. You don't have any underwear left in your drawer.
6. Your toddler's shirt retains his shape when he takes it off.
7. Your closet echoes.
Disclaimer: Some of the points listed may or may not contain references to actual events. While this blog makes every effort to provide accurate and complete information, this data may not apply to every person or every situation. Please note that this blog does not control and cannot guarantee the relevance, timeliness, or accuracy of these seven warning signs in each individual situation.
How do you know it's time to do laundry?


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I am nothing but a corpse now, a body at the bottom of a well. Though I drew my last breath long ago and my heart has stopped beating, no one, apart from that vile murderer, knows what's happened to me. As for that wretch, he felt for my pulse and listened for my breath to be sure I was dead, then kicked me in the midriff, carried me to the edge of the well, raised me up and dropped me below. As I fell, my head, which he'd smashed with a stone, broke apart; my face, my forehead and cheeks, were crushed; my bones shattered, and my mouth filled with blood.
Lust awakens the desire to possess. And that awakens the intent to murder.
55.854373 -4.233935


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G-Worldwide Entertainment's frontline act Kiss Daniel kicked off his first ever official Europe tour recently with performances in Germany's capital, Berlin as well as Cyprus. The singer whose latest single "Sofa" is making the rounds treated fans to thrilling performances of songs from his debut album "New Era".
See photos and a video from his tour below:
Watch the video below:
Photo Credit: Instagram – @iamkissdaniel


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소아 일측성 감각신경성 난청에서 전산화 단층 촬영과 자기공명영상의 영상학적 평가
Computed Tomography and Magnetic Resonance Imaging Evaluation in Pediatric Unilateral Sensorineural Hearing Loss
Article information
Trans Abstract
Background and Objectives
Children with unilateral sensorineural hearing loss (USNHL) are not actively evaluated by physicians. The diagnostic tool for evaluation of USNHL is also controversial, and no strategy for diagnosing USNHL through imaging studies has been established. We examined the results of temporal bone computed tomography (TBCT) imaging and magnetic resonance imaging (MRI) studies on children with USNHL.
Subjects and Method
Eighty-nine patients with USNHL were reviewed. Of these patients, 21 underwent both TBCT and MRI, 51 underwent temporal MRI only, and 17 underwent TBCT only.
The etiology of USNHL were determined through imaging studies in 20 patients. The most common abnormal finding (65%) was a narrow internal auditory canal identified on TBCT and cochlear nerve aplasia on temporal MRI. Incomplete partition (20%), common cavity (10%), and labyrinthitis ossificans (5%) were also observed in imaging studies. The hearing threshold was lower in USNHL patients with normal findings (76.1±28.7 dB) than in USNHL patients with abnormal findings on TBCT or temporal MRI (100.1±22.3 dB).
Cochlear and cochlear nerve abnormalities can be detected through imaging studies in approximately 25% of patients with USNHL. Therefore, we suggest that children should undergo TBCT when USNHL is confirmed through audiologic evaluation.
Congenital sensorineural hearing loss is one of the most common health concerns, and affects 11% of children [1]. Unilateral sensorineural hearing loss (USNHL) is commonly not recognized until early grade school and affects approximately 0.1-3% of children [2,3]. USNHL is underestimated because patients with USNHL show normal development in speech and language [4]. As a result, they are not evaluated using imaging studies to determine causes of hearing loss and no active intervention occurs.
Recent studies have suggested that children with USNHL have scholastic or behavioral problems in school [5]. Lieu reported that school-aged children with USNHL demonstrated worse oral language scores than did their siblings with normal hearing [6]. A meta-analysis of children with unilateral hearing loss revealed them to have lower full-scale and performance intelligence quotient scores than children with normal hearing [7]. Thus far, the importance of USNHL has remained uncertain, and the management of patients with USNHL is controversial [8]. Children with USNHL are not actively evaluated by physicians, and therefore little is known about the potential of imaging studies in determining the etiology of USNHL in children. The diagnostic tool for evaluation of USNHL is also controversial, and no strategy for diagnosing USNHL through imaging studies has been established. Therefore, in this study, we investigated the results of temporal bone computed tomography (TBCT) imaging and magnetic resonance imaging (MRI) studies and the usefulness of imaging studies in assessing children with USNHL.
Subjects and Method
We retrospectively reviewed the medical records of children under the age of 18 years who visited our tertiary referral otolaryngology department for unilateral hearing loss during the period of August 2007 to October 2015. Inclusion criteria were as follows: 1) Patients aged 18 years or younger with USNHL, 2) unilateral hearing thresholds worse than 25 dB with no air-bone gap (<10 dB), 3) contralateral normal hearing threshold better than 20 dB, 4) having undergone TBCT or temporal MRI. A total of 89 patients (52 boys and 37 girls, mean age 10.9±4.5 years) with USNHL were included in this study. The demographics of the patients are shown in Table 1. This study was approved by the Institutional Review Board (IRB No. 2017-04-004) of Soonchunhyang University.
Measurement of hearing threshold
In the three children who were younger than 3 years, the auditory brainstem response (ABR) was measured using a GSI Audera (MKS Medic, Madison, WI, USA). For ABR testing, a click stimulus was presented at alternate polarities, using earphones. The lowest intensity at which wave V was recorded was marked as the patient's hearing threshold (nHL). In the 86 children who were older than 3 years, the hearing level was measured using pure tone audiometry to determine the average hearing thresholds. Hearing loss was evaluated based on the average of pure tone audiogram results at 500, 1000, 2000, and 4000 Hz.
Imaging studies
The imaging studies were selected according to the doctor's opinion. High-resolution TBCT imaging with a slice thickness of <1 mm was used. Temporal bone scanning was performed using the LightSpeed VCT 64-slice scanner (GE Medical Systems, Milwaukee, WI, USA) with the following settings: detector configuration, 2×0.625 mm; slice thickness, 0.625 mm; field of view, 160×160 mm; resolution, 150 mA (60 mAs), 120 kVp; reconstruction matrix, 512×512. Coronal images were reconstructed with a slice thickness of 1.0 mm. The width of the bony cochlear nerve canal (BCNC) was measured at its midportion using calipers. BCNC stenosis was defined as a BCNC diameter of 1.5 mm or less in TBCT [9].
MRI scans were performed on a 3.0T or 1.5T MRI system (Intera Achieva; Philips Medical Systems, Best, Netherlands) using a six-channel sensitivity-encoding head coil. All images were evaluated with a parasagittal 3D-driven equilibrium sequence perpendicular to the internal auditory canal (IAC). A targeted parasagittal scan perpendicular to the long axis of the IAC was obtained with a T2-weighted 3D turbo spin-echo sequence with a driven equilibrium radio frequency reset pulse following routine MRI sequences with spin-echo T1- and T2-weighted images. The imaging parameters for the 3D-driven equilibrium sequence were as follows: repetition time/echo time=1500/200 ms; 256 acquisition/256 reconstruction; 15-cm field of view; 1.5-mm section thickness; 0.75-mm overlap; number of acquisitions =2; and acquisition time <5 min. The presence of the cochlear nerve was observed on the parasagittal image of the middle of the IAC, using an automatic window-level setting. Cochlear nerve deficiency was considered if the cochlear nerve was not visualized in temporal MRI. All TBCT and temporal MRI results were reviewed by two otorhinolaryngologists, who were blinded to the subjects' information for consistency.
Statistical analysis
For statistical analysis, we used Origin software (OriginLab, Northampton, MA, USA). Differences of hearing thresholds between two groups (diagnosed etiology and unknown etiology) were evaluated using t-test. Age and hearing thresholds between groups were evaluated using 1-way analysis of variance. Gender and the number of patients with abnormality in imaging studies between groups were evaluated using Chi-square test. To find the optimal cutoff value of hearing threshold for abnormal findings in imaging studies, receiver operating characteristic (ROC) curve analysis was performed. The optimal cutoff was calculated by Youden's index. A p-value of <0.05 was considered statistically significant.
Among the 89 children with USNHL, 21 underwent both TBCT and MRI, 51 underwent temporal MRI only, and 17 underwent TBCT only. The characteristics of the patients are shown in Table 1. The hearing threshold of a normal ear was 10.0±6.9 dB in patients with TBCT only, 6.6±3.4 dB in patients with temporal MRI only, and 11.5±8.9 dB in patients with TBCT and temporal MRI. The hearing threshold of a diseased ear was 92.9±31.4 dB in patients with TBCT only, 78.2±28.8 dB in patients with temporal MRI only, and 81.5±26.7 dB in patients with TBCT and temporal MRI.
Table 2 lists all of the significant abnormalities identified on CT and MRI studies on patients with USNHL, according to imaging findings. Of the 89 patients, 20 (5 in TBCT only, 9 in TBCT and temporal MRI, 6 in temporal MRI only) showed abnormal findings identified on TBCT or temporal MRI. The most common abnormal finding (13 of 20 patients, 65%) was a narrow IAC, compared to a normal ear, identified on TBCT, or cochlear nerve aplasia on temporal MRI. Incomplete partition (20%), common cavity (10%), and labyrinthitis ossificans (5%) were observed.
Among 21 patients who underwent both TBCT and temporal MRI, 9 showed abnormal findings in TBCT or temporal MRI. One patient exhibited an IAC of normal width, identified on TBCT, but the cochlear nerve was not identified on temporal MRI. Re-review of TBCT images indicated a narrow BCNC (Fig. 1). The other patients with cochlear nerve deficiency identified on temporal MRI had abnormal findings without visualization of the BCNC on TBCT. The number of patients who underwent both TBCT and temporal MRI showed high detection rate of abnormality which was statistically significant among three groups (p=0.012).
The number of patients with etiology confirmed using TBCT or temporal MRI was twenty patients. The hearing thresholds between the patients with abnormality and without abnormality were compared. The hearing threshold was 76.1±28.7 dB in the USNHL patients with normal findings on TBCT or temporal MRI, and 100.1±22.3 dB in the USNHL patients with abnormal findings on TBCT or temporal MRI (Fig. 2). Statistically significant correlation was observed between confirmation of abnormal findings on imaging and the severity of hearing loss based on pure-tone average (p<0.001). The area under the curve of proposed nomogram was 0.729 by ROC curve analysis, indicating a fair power to identify Hearing threshold. The optimal cut-off value of hearing threshold by the Youden's Index was 101.7 (Table 3).
The present study showed that the overall prevalence of abnormal imaging findings in TBCT or temporal MRI was 22.5% (20 of 89 patients) in children with USNHL. The prevalence of abnormalities identified by using TBCT was 36.8% (14 of 38 patients), and the prevalence of abnormalities identified by using MRI was 20.8% (15 of 72 patients) in children with USNHL. Studies have reported the prevalence of abnormal TBCT findings at 7 to 66.7% [2,10-12]. Simons et al. [11] reported that the prevalence of TBCT abnormalities was 35% (29 of 83 patients), and the prevalence of temporal MRI abnormalities was 25% (10 of 40 patients) in children with USNHL, which is comparable to the results of our study. Song et al. [12] reported that 93 of 322 (28.9%) children with USNHL were identified as abnormal in TBCT. Masuda reported a relatively high prevalence of inner ear or IAC malformations identified by TBCT in children with USNHL [10].
The most common etiology of USNHL in children evaluated through imaging studies was abnormality of the cochlear nerve. Of the 20 patients with abnormal image findings, 13 (65%) exhibited a narrow IAC in the diseased ear, compared to a normal ear, identified on TBCT, or cochlear nerve deficiency on temporal MRI. Other studies have reported the prevalence of cochlear nerve deficiency at 18 to 73% [13-16]. One patient showed discrepancy between normal IAC findings on TBCT and cochlear nerve deficiency on temporal MRI; however, despite the normal IAC finding, TBCT revealed a narrow BCNC. In addition, all the patients who exhibited cochlear nerve deficiency on temporal MRI showed a narrow BCNC on TBCT. Simons et al. [11] reported that among 33 patients with USNHL, in 2 cases abnormalities were seen only on MRI, not on TBCT. One of the cases was a hypoplastic eighth nerve, and the other was a brain tumor only identified on MRI. This study has the limitation of not considering the BCNC.
The BCNC is the bone-covered route that passes from the fundus of the IAC to the base of the modiolus. Several studies have investigated the correlation of hearing level and dimensions of BCNC in bilateral/unilateral SNHL. Fatterpekar et al. [17] first reported that the length and width of the BCNC were significantly smaller in patients with congenital SNHL than in the control group. Jang et al. [18] also reported that the length and width of BCNC in the affected inner ears in USNHL patients were significantly smaller than contralateral inner ears in USNHL patients. In the present study, the patients with cochlear nerve deficiency identified on temporal MRI all exhibited a narrow BCNC on TBCT. This is consistent with recent studies reporting that BCNC stenosis with a diameter of 1.5 mm or less, as assessed using CT, suggests cochlear nerve deficiency or hypoplasia, as assessed using MRI [15-19]. Our study suggests that if temporal MRI is not performed, a narrow BCNC finding identified through high resolution TBCT can indicate cochlear nerve deficiency. Adunka et al. [20] also suggested that a narrow cochlear aperture can indicate hypoplasia or aplasia of the cochlear nerve.
The present study showed that the children with etiology confirmed by imaging studies had significantly worse hearing levels in the diseased ear. And the cut-off value of hearing threshold for predictive probability for abnormal imaging studies is 101.7 dB in USNHL. Of the 20 patients with etiology confirmed by imaging studies, 13 exhibited cochlear nerve deficiency, including a narrow BCNC. Definite cochlear nerve deficiency might affect the severity of hearing loss. Wilkins et al. [21] showed a significant correlation between the degree of BCNC stenosis and the degree of hearing loss.
The present study showed the high detection rate of abnormality in patients when using temporal bone CT combined with temporal MRI. It's ideal when two imaging studies performed, but high cost and sedation problem cannot be ignored in reality. We suggest that high-resolution TBCT should be performed in patients with USNHL as the initial study. During TBCT, the presence of a narrow BCNC as well as IAC should be checked for cochlear nerve deficiency. The algorithm for patients with USNHL is not established. The central nervous system disorder which is rare can be identified only on temporal MRI. If any neurological symptoms co-occur, MRI should be performed to rule out diseases of the central nervous system. Further investigation should be performed to identify the ideal imaging algorithm (the most effective imaging modality) in these children. Despite the sedation and rehabilitation problems with children, imaging studies in USNHL can yield information that is helpful in counseling patients and parents. Physicians can provide useful information about the etiology of USNHL for almost 26% of patients, and reassure the parents that USNHL is caused by an inner ear abnormality and determine whether it might affect the contralateral ear. Patients with anatomic abnormalities of the inner ear identified through imaging studies were associated with a higher degree of hearing loss than the patients with unconfirmed etiology.
In conclusion, abnormalities of the cochlea and cochlear nerve can be detected using imaging studies in approximately 25% of patients with USNHL. TBCT is likely to be adequate as the first imaging modality in all children with USNHL. And BCNC should be checked in TBCT. Therefore, we suggest that children should undergo TBCT after USNHL is confirmed through audiologic evaluation.
This work was supported by the Soonchunhyang University Research Fund.


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Smart Zone Book Archive 2017 | All Rights Reserved


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Christmas Angels completed Dec 2007
These were created Dec 2008 just in time to adorn the tree.
Hope your Christmas have been filled with a lot of joy and happiness...thanks for the visit at my blog...couldnt reply you since you were on no reeply...and I wanted to wish you a Happy New Year ...filled with a lot of creative happines...and maybe some more quilting!! :o)
Great projects! I hope you had a wonderful holiday!
hey thanks for visiting my blog! I love your blog, it is so colorful. I love how you have it decorated in the margins. I need to learn how to do that. Although you didn't win scraps from me this week, try again on Saturday, I'm going to have another give away. Happy Holidays!
Lovely projects, but I am coming to expect that from you!! Happy New Year to you and yours!
Hope your Christmas and New Year were happy and fulfilling. Looking forward to more inspiration in 2009!


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Selecting a company to work on your roof is very important. Unfortunately there are roofing companies out there that are trying to scam you.
Like this roofing scam, according to WFLA, where a Tampa man scammed more than 100 people.
"He was a despicable low life scum," said Pamela Beynon, whose roof still has serious damage to it more than three years after Carlton Dewayne Dunko scammed her.
Dunko pleaded guilty to a massive roof and insurance fraud scam that was first discovered by an investigation nearly two years ago.
"I couldn't be happier," Beynon added, "other than getting a new roof."
Dunko's fraudelent company, NBRC Construction LLC, scammed more than 100 homeowners across the Tampa Bay area promising to fix their roofs and storm drains along with their insurance costs.